bluuebunny/crossref_metadata_2025 huggingface dataset:
Ecological Correlates of Roost Fidelity in the Tent‐Making Bat Artibeus watsoni
Authors: Chaverri Gloriana , Quirós Oscar E. , Gamba‐Rios Melquisedec , Kunz Thomas H.
Published: May 2007

Roost switching is a common occurrence in bats, yet the causes and consequences of such behavior are poorly understood. In this study we explore the ecological correlates of roost fidelity in the tent‐making bat Artibeus watsoni, particularly focusing on the effect of sex, reproductive status, and roost availability using a three‐factor general linear model (GLM). We estimated roost fidelity of radio‐tracked individuals and found that the GLM was significant (R2 = 0.72, F10,34 = 8.91, p < 0.001). Significant interaction terms were observed for relative roost availability and sex (F4,34 = 16.96, p < 0.001), and relative roost availability and reproductive status (F6,34 = 7.62, p < 0.001), indicating that variation in roost fidelity among males and females, and among individuals under different breeding conditions, depended on relative roost availability at the site where they were radio‐tracked. Individuals in areas of high roost availability exhibited lower roost fidelity than those sampled in areas of lower roost availability. Females exhibited less roost fidelity than males for all roost availability categories, but the difference between males and females was only significant at high roost availability. The general pattern of decreased roost fidelity as roost availability increased was also prevalent among individuals in different breeding conditions. Additionally, satellite males exhibited higher roost fidelity than resident males in areas of low roost availability, and lactating females had higher roost fidelity than non‐breeding females in areas of medium roost availability. Our study thus demonstrates that sex, reproductive status, and roost availability all affect roost fidelity in the tent‐making bat A. watsoni, and also suggests that roost availability is the most important factor influencing roost fidelity in this bat, providing the first quantitative evidence that roost fidelity is correlated with roost abundance in a single species.
How do we improve outcomes for gastric cancer?
Authors: Yeoh Khay‐Guan
Published: May 2007

Although the incidence of gastric cancer is decreasing globally, it remains the second leading cause of cancer death, accounting for 600 000 deaths annually worldwide. It is particularly common in Asia and especially in China, Japan and Korea. In Singapore, it is the fourth commonest cancer in men, who have a 1:50 lifetime risk of developing gastric cancer. Gastric cancer traditionally carries a poor prognosis because of late presentation at an advanced stage of disease. If diagnosed at an early stage, it is a curable disease. Four strategies will systematically help to improve outcomes for gastric cancer: (i) early detection by screening of high‐risk groups; (ii) clarification of the hypothesis that Helicobacter pylori eradication in endemic areas with a high incidence of gastric cancer is an effective primary prevention strategy; (iii) improvement of treatment by well‐designed clinical trials, coupled with molecular characterization of tumors; and (iv) improving our biological understanding of gastric carcinogenesis.
Parent‐initiated oral corticosteroid therapy for acute asthma: A survey of current practice
Authors: Vuillermin Peter J , South Mike , Carlin John B , Biscan Maree I , Brennan Sharon L , Robertson Colin F
Published: May 2007

Aim:  To determine (i) the proportion of doctors who recommend parent‐initiated oral corticosteroids (PIOCS) for acute asthma; and (ii) the proportion of parents who have received this advice.

Methods:  (i) An internet‐based survey of doctors involved in the care of children with asthma; and (ii) a questionnaire‐based survey of parents of children aged 4–13 years who were identified from a random sample of primary schools within the Barwon region of Victoria.

Results:  Eight‐five per cent (95% confidence interval 80.0–89.1%) of responding doctors reported recommending PIOCS to parents of children with asthma. However, only 16.5% (95% confidence interval 14.2–18.7%) of parents of children with recent asthma symptoms report that they have received such advice.

Conclusion:  The majority of responding doctors involved in the care of children with asthma report recommending PIOCS to parents. By contrast, a minority of parents of children with asthma report that they have received such advice.
Diverging trends for lower respiratory infections in non‐Aboriginal and Aboriginal children
Authors: Moore Hannah , Burgner David , Carville Kylie , Jacoby Peter , Richmond Peter , Lehmann Deborah
Published: May 2007

Aim:  To investigate temporal trends in admission rates for acute lower respiratory infections (ALRI) in a total population birth cohort of non‐Aboriginal and Aboriginal children.

Methods:  Retrospective analysis of linked population‐based data using the Western Australian Data Linkage System. All singleton live births in Western Australia between 1990 and 2000 were included. Hospital admission rates per 1000 live births for ALRI before age 2 years and linear time trends for ALRI admission rates were investigated.

Results:  ALRI admission rates were 7.5 (95% confidence interval (CI) 7.2–7.7) times higher in Aboriginal than non‐Aboriginal children (337 vs. 45 per 1000 live births); pneumonia rates were 13.5 (95% CI 12.8–14.4) times higher and bronchiolitis rates were 5.8 (95% CI 5.3–6.0) times higher. ALRI admission rates rose in non‐Aboriginal children (<12 months, 6%/year, P < 0.002; 12–23 months, 11%/year, P < 0.001) but declined in Aboriginal children aged 12–23 months (4%/year, P = 0.003). Bronchiolitis rates rose in all children, especially non‐Aboriginal infants aged <12 months (13%/year, P < 0.001), while pneumonia rates rose in non‐Aboriginal children but declined in Aboriginal children. Declines in bronchitis and asthma were also noted.

Conclusion:  There has been an increase in incidence of bronchiolitis before age 12 months. For children aged 12–23 months a diagnostic shift from asthma and bronchitis to bronchiolitis and changes in health service utilisation are likely explanations for diverging temporal trends. The continuing disparity between Aboriginal and non‐Aboriginal children needs to be addressed and appropriate preventative measures for ALRI, and in particular bronchiolitis, are urgently needed.
Consensus statement on perinatal care
Authors: French Noel
Published: May 2007

Abstract:  While there is general agreement with the framework of the consensus statements, it is at the margins of the ‘grey zone’, particularly at 23 weeks of gestation, that practice in other states appears to differ from practice in New South Wales (NSW)/Australian Capital Territory (ACT). This is evidenced by the lower regional survival in NSW/ACT at 23 weeks compared with other contemporaneous regional Australian cohorts, reflecting the discouragement of active intervention in NSW/ACT at this gestation. At the other end of the ‘grey zone’, surely active intervention, including prenatal transfer to a tertiary obstetric centre, should always be given to an otherwise uncomplicated 25‐week infant? At any of these gestations, where infants survive, the majority are not severely disabled, leading us in this state to support initiation of intensive care to infants of marginal gestations where informed parents wish us to do so. The consensus conference questions and response rates by professional group should be published in full.
Botulinum neurotoxin A: An unusual systemic effect
Authors: Howell Katherine , Selber Paulo , Graham H Kerr , Reddihough Dinah
Published: May 2007

Abstract:  Systemic effects from Botulinum neurotoxin A are uncommon but can have serious consequences. We report the case of a boy with severe cerebral palsy who developed deterioration in respiratory and oromotor function following repeated injections of Botulinum neurotoxin A. Caution is needed in using this treatment in children with severe cerebral palsy and pseudobulbar palsy.
Erythropoiesis‐stimulating agent hyporesponsiveness (Review Article)
Authors: JOHNSON DAVID W , POLLOCK CAROL A , MACDOUGALL IAIN C
Published: May 2007

SUMMARY:  Approximately 5–10% of patients with chronic kidney disease demonstrate hyporesponsiveness to erythropoiesis‐stimulating agents (ESA), defined as a continued need for greater than 300 IU/kg per week erythropoietin or 1.5 μg/kg per week darbepoetin administered by the subcutaneous route. Such hyporesponsiveness contributes significantly to morbidity, mortality and health‐care economic burden in chronic kidney disease and represents an important diagnostic and management challenge. The commonest causes of ESA resistance are non‐compliance, absolute or functional iron deficiency and inflammation. It is widely accepted that maintaining adequate iron stores, ideally by administering iron parenterally, is the most important strategy for reducing the requirements for, and enhancing the efficacy of ESA. There have been recent epidemiologic studies linking parenteral iron therapy to an increased risk of infection and atherosclerosis, although other investigations have refuted this. Inflammatory ESA hyporesponsiveness has been reported to be improved by a number of interventions, including the use of biocompatible membranes, ultrapure dialysate, transplant nephrectomy, ascorbic acid therapy, vitamin E supplementation, statins and oxpentifylline administration. Other variably well‐established causes of ESA hyporesponsiveness include inadequate dialysis, hyperparathyroidism, nutrient deficiencies (vitamin B12, folate, vitamin C, carnitine), angiotensin‐converting enzyme inhibitors, angiotensin receptor blockers, aluminium overload, antibody‐mediated pure red cell aplasia, primary bone marrow disorders, myelosuppressive agents, haemoglobinopathies, haemolysis and hypersplenism. This paper reviews the causes of ESA hyporesponsiveness and the clinical evidence for proposed therapeutic interventions. A practical algorithm for approaching the investigation and management of patients with ESA hyporesponsiveness is also provided.
Non‐invasive computed tomography angiography in the assessment of coronary stent patency: an Australian experience
Authors: Soon K. H. , Cox N. , Chaitowitz I. , Selvanayagam J. B. , Farouque O. , MacGregor L. , Bell K. W. , Lim Y. L.
Published: May 2007

Background: This study aimed to evaluate the feasibility and accuracy of 16‐slice computed tomography (CT) in the assessment of coronary stent patency. CT coronary angiography (CA) has a high degree of accuracy in the assessment of coronary artery disease compared with invasive selective CA. However, its accuracy in the evaluation of stent patency is not well investigated.

Methods: We conducted a retrospective observational study of paired CT coronary angiography (CT–CA) and invasive fluoroscopic coronary angiography (FCA) in 37 patients with 47 coronary stents. CT–CA was carried out with an electrocardiogram‐gated 16‐slice CT (LightSpeed‐16, General Electric (GE), WI, USA). Two CT reporters, blinded to the FCA findings, assessed CT images for stent patency. A cardiologist blinded to CT findings reported FCA. FCA was regarded as the reference standard.

Results: A CT–CA could assess 45 of 47 coronary stents (96%). Non‐assessable stents on CT–CA were due to motion artefacts and stent‐blooming effects. Of those 45 assessable stents, CT–CA correctly identified five out of seven stents with binary in‐stent restenosis (ISR) and 37 of 38 stents without binary ISR. The sensitivity and specificity of 16‐slice CT in the evaluation of coronary stents for binary ISR were 71% (95% confidence interval (CI) (29%, 96%)) and 97% (95%CI (86%, 100%)), respectively, exclusive of non‐assessable stents. The positive and negative predictive values of 16‐slice CT were 83% (95%CI (36%, 100%)) and 95% (95%CI (83%, 99%)), respectively.

Conclusion: Sixteen‐slice CT has a low sensitivity, but very a high specificity when compared with FCA in the evaluation of coronary stents for ISR.
Sarcoidosis in Australia
Authors: Gillman A. , Steinfort C.
Published: May 2007

Background:The incidence of sarcoidosis in Australia is unknown. The clinical features, diagnostic strategy and treatment of sarcoidosis in Australia have been poorly documented.

Methods:We analysed the medical records of 122 patients with sarcoidosis presenting to a respiratory service, between 1995 and 2005, which serves a regional southeastern Australian population of approximately 200 000.

Results:The incidence of sarcoidosis from 2000 to 2005 remained static and ranged from 4.4 to 6.3 patients per 100 000 population. The data showed that 55% were women and 28% were current smokers. Systems involved included lung parenchyma (66%), thoracic adenopathy (58%), skin (22%), ocular (18%), joint (11%), gastrointestinal tract (5%), central nervous system (3%) and hypercalcaemia (3%). Fifty‐one per cent of patients had an increased serum angiotensin‐converting enzyme level. The diagnosis was secured based on histological confirmation in 69%. Forty‐three per cent of the patients were treated with oral corticosteroids and 10% with inhaled steroids.

Conclusion:Sarcoidosis in Australia is a multi‐system disease of unknown aetiology. This is the first reported incidence of sarcoidosis in Australia. The incidence is similar to another US‐based epidemiological study of a predominately white population. The development of a larger multicentre database would assist in the identification, clinical description and treatment of sarcoidosis.
Use of a functional assay to diagnose protein S deficiency; inappropriate testing yields equivocal results
Authors: Johnston A. M. , Aboud M. , Morel‐Kopp M.‐C. , Coyle L. , Ward C. M.
Published: May 2007

Inherited deficiency of protein S (PS) is a rare but accepted risk factor for venous thromboembolism. There is accumulating evidence that inherited PS deficiency may be associated with a variety of adverse obstetric events. Acquired PS deficiency may be caused by a variety of clinical states including normal pregnancy. We conducted a retrospective audit of the results of screening for PS deficiency through our reference laboratory. The majority of patients in this audit with significantly reduced (<50%) free functional PS levels had a major confounding factor likely to cause acquired PS deficiency, most frequently pregnancy. Recommendations for PS testing for the diagnosis of hereditary PS deficiency include deferring testing until at least 40 days post‐partum. It appears that these recommendations are not being adhered to leading to difficulty in the interpretation of results.
The change in renal function in the supranormal hydronephrotic kidney after pyeloplasty
Authors: Song Cheryn , Park Hongjoo , Park Sungchan , Moon Kyung Hyun , Kim Kun Suk
Published: May 2007

OBJECTIVE

To investigate changes in the differential renal function (DRF) before and after pyeloplasty in renal units with unilateral pelvi‐ureteric junction obstruction (PUJO) with supranormal function, and to evaluate the clinical significance.

PATIENTS AND METHODS

We reviewed the medical and radiographic records of 29 children (26 boys and three girls) with unilateral PUJO with a DRF (estimated by 99mTc‐mercaptoacetyltriglycine renal scintigraphy) of ≥ 50% in the affected renal unit, who had pyeloplasty and were followed for >1 year after surgery. Patients were divided into two groups according to the degree of change in their DRF to compare the clinical variables, anteroposterior pelvic diameter and parenchymal thickness measured by renal ultrasonography. The mean (range) follow‐up after pyeloplasty was 35 (12–89) months.

RESULTS

After pyeloplasty, although the mean DRF reduced from 53.8% to 51.4%, in seven (24%) patients the DRF decreased significantly (>5%) while most (76%) showed a change of ≤ 5% of the preoperative function, or further improvement. In the seven patients with a DRF of ≥ 55% before surgery, the DRF afterward was >55% in four and 50–55% in one. Between those with and with no significant reduction in DRF, only the preoperative renal parenchymal thickness differed significantly (2.78 vs 5.00 mm, P = 0.006).

CONCLUSION

Supranormal DRF exists and represents the true split function of the affected renal unit in patients with adequate renal parenchyma; these units maintained the supranormal function after pyeloplasty. Parenchymal thickness might be useful to differentiate between the true and false estimates and predict surgical outcome before surgery.
Production of glucocerebrosidase with terminal mannose glycans for enzyme replacement therapy of Gaucher's disease using a plant cell system
Authors: Shaaltiel Yoseph , Bartfeld Daniel , Hashmueli Sharon , Baum Gideon , Brill‐Almon Einat , Galili Gad , Dym Orly , Boldin‐Adamsky Swetlana A. , Silman Israel , Sussman Joel L. , Futerman Anthony H. , Aviezer David
Published: May 2007

Gaucher's disease, a lysosomal storage disorder caused by mutations in the gene encoding glucocerebrosidase (GCD), is currently treated by enzyme replacement therapy using recombinant GCD (Cerezyme®) expressed in Chinese hamster ovary (CHO) cells. As complex glycans in mammalian cells do not terminate in mannose residues, which are essential for the biological uptake of GCD via macrophage mannose receptors in human patients with Gaucher's disease, an in vitro glycan modification is required in order to expose the mannose residues on the glycans of Cerezyme®. In this report, the production of a recombinant human GCD in a carrot cell suspension culture is described. The recombinant plant‐derived GCD (prGCD) is targeted to the storage vacuoles, using a plant‐specific C‐terminal sorting signal. Notably, the recombinant human GCD expressed in the carrot cells naturally contains terminal mannose residues on its complex glycans, apparently as a result of the activity of a special vacuolar enzyme that modifies complex glycans. Hence, the plant‐produced recombinant human GCD does not require exposure of mannose residues in vitro, which is a requirement for the production of Cerezyme®. prGCD also displays a level of biological activity similar to that of Cerezyme® produced in CHO cells, as well as a highly homologous high‐resolution three‐dimensional structure, determined by X‐ray crystallography. A single‐dose toxicity study with prGCD in mice demonstrated the absence of treatment‐related adverse reactions or clinical findings, indicating the potential safety of prGCD. prGCD is currently undergoing clinical studies, and may offer a new and alternative therapeutic option for Gaucher's disease.
The Effectiveness of Jobs Reservation: Caste, Religion and Economic Status in India
Authors: Borooah Vani K. , Dubey Amaresh , Iyer Sriya
Published: May 2007

This article investigates the effect of jobs reservation on improving the economic opportunities of persons belonging to India's Scheduled Castes (SC) and Scheduled Tribes (ST). Using employment data from the 55th NSS round, the authors estimate the probabilities of different social groups in India being in one of three categories of economic status: own account workers; regular salaried or wage workers; casual wage labourers. These probabilities are then used to decompose the difference between a group X and forward caste Hindus in the proportions of their members in regular salaried or wage employment. This decomposition allows us to distinguish between two forms of difference between group X and forward caste Hindus: ‘attribute’ differences and ‘coefficient’ differences. The authors measure the effects of positive discrimination in raising the proportions of ST/SC persons in regular salaried employment, and the discriminatory bias against Muslims who do not benefit from such policies. They conclude that the boost provided by jobs reservation policies was around 5 percentage points. They also conclude that an alternative and more effective way of raising the proportion of men from the SC/ST groups in regular salaried or wage employment would be to improve their employment‐related attributes.
SOCIALLY RESPONSIBLE INVESTMENTS AMONG SAVINGS BANKS AND CREDIT UNIONS: EMPIRICAL FINDINGS IN THE SPANISH CONTEXT
Authors: VALOR Carmen , PALOMO Ricardo , ITURRIOZ Javier , MATEU José Luis
Published: May 2007

ABSTRACT**:  This article examines the socially responsible offer of savings banks and credit unions in Spain. In particular, it has been analysed their perceived commitment with socially responsible investments, their product portfolio, their marketing strategy, and their reported forecasts of future growth. The findings lead us to conclude that a socially responsible market in Spain is at an introductory stage among credit unions, and at a growth stage among savings banks. The paper outlines managerial implications for marketing managers so as to reap the potential benefits derived from this approach to investment.
FONDEMENTS ET IMPLICATIONS DE LA DIVERSITÉ ORGANISATIONNELLE AU SEIN DU COMMERCE ÉQUITABLE
Authors: HUYBRECHTS Benjamin
Published: May 2007

RÉSUMÉ**:  Cet article a pour but d'étudier le paysage organisationnel d'un secteur en pleine expansion: celui du commerce équitable. Plus particulièrement, nous cherchons à comprendre les raisons qui expliquent la diversité des formes organisationnelles des acteurs qui s'investissent dans cette filière. A cette fin, nous commençons par décomposer le concept de commerce équitable en quatre grands types de biens. Ensuite, en lien avec ces quatre types de biens, nous tentons de comprendre les facteurs d'émergence des différents acteurs de la filière. Enfin, nous étudions la répartition des rôles entre ces différents acteurs et évoquons quelques pistes quant à l'évolution de ce secteur. Nous ciblons notre analyse sur les organisations des pays « du Nord », en illustrant notre propos par des exemples d'organisations belges.
INTERNAL REGULATION BY MIXED ENTERPRISES: THE CASE OF THE ITALIAN WATER SECTOR
Authors: MARRA Alessandro
Published: May 2007

ABSTRACT**: This paper aims at proposing an economic analysis of mixed enterprises in local utilities. We suggest that the public service concession to mixed enterprises could embody a noteworthy substitute to the traditional public provision and the concession to totally private enterprises. The starting point of the entire analysis is that ownership allows the (public) owner to gather more information about the actual management of the firm, according to property rights theory. Following it, we conclude that under certain conditions mixed enterprises could significantly reduce asymmetric information between regulators and regulated firms by implementing a sort of ‘internal’ regulation. With more information, the public authority can stimulate the private operator to be more efficient and can monitor it more effectively with respect to the fulfilment of contractual obligations. Moreover, concerning the latter function, the board of directors of these enterprises can be the suitable place where public and private representatives can meet to solve all disputes arising from incomplete contracts.
A New Approach to Predicting Recessions
Authors: Nyholm Ken
Published: May 2007

This paper presents a new approach to recession prediction. The methodology relies on the shape of the yield curve alone and does not incorporate macroeconomic information or other explanatory variables. This makes the modelling framework less data intensive and more intuitive than other models that have the same goal. The workhorses of the approach are (i) data transformation of observed yields with the purpose of normalizing the yield spread, and (ii) a three‐state regime‐switching version of the Nelson–Siegel parametric model of the yield curves' shape and location. In an out‐of‐sample exercise the model predicts all US NBER recessions from 1973 to 2004 at least eight months in advance of their occurrences.
Prevalence and correlates of partner violence among South African adolescents
Authors: Flisher Alan J. , Myer Landon , Mèrais Adele , Lombard Carl , Reddy Priscilla
Published: May 2007

Background:  Little is known about the prevalence of partner violence among adolescents, nor of the factors with which it is associated. The objectives of this study were to document prevalence rates for partner violence among high school students in Cape Town, and to explore factors that are associated with such violence.

Method:  The sample consisted of 596 Grade 8 and 11 students attending public high schools in Cape Town, who were selected using a multistage cluster design. They completed an anonymous and confidential questionnaire. The dependent variable was whether they had ever perpetrated partner violence, or intended to do so. The independent variables, which were derived from a modified version of the Theory of Planned Behaviour (TPB), included attitudes, subjective norms (general and peer social influence and outcome expectancy) and self‐efficacy. Separate multiple logistic regression models were developed of partner violence intentions or behaviours on the scales derived from the TPB and demographic variables. Regression coefficients from adjusted models were used to examine the potential mediating role of partner violence intentions in the association between each scale and partner violence behaviours using the Sobel test.

Results:  Among participants who reported being in a relationship, 20.7% reported perpetrating partner violence, and 16.4% reported intending to do so. After adjusting for demographic characteristics and other predictor scales, perpetration of partner violence was significantly associated with attitudes and outcome expectancy, while intention to perpetrate partner violence was significantly associated with attitudes and general social influence. The influence of attitude and general social influence on violent behaviours were each partially mediated by partner violence intentions.

Conclusions:  There are high levels of partner violence among high school students in Cape Town. Interventions to address this problem should focus on violence‐related attitudes and outcome expectancy.
Characterization of expressed sequence tag‐derived microsatellites from the kuruma prawn, Marsupenaeus japonicus
Authors: ZHAO YUMING , LI QI
Published: May 2007

The kuruma prawn, Marsupenaeus japonicus, is a commercially important benthic marine crustacean in East Asia. Understanding the species’ population structures will be very important for its proper stock assessment and management strategy. Herein, 13 polymorphic microsatellite loci originating from expressed sequence tag libraries of M. japonicus were isolated and characterized. Number of alleles per locus ranged from two to 15, observed and expected heterozygosities ranged from 0.250 to 0.906 and from 0.310 to 0.932, respectively. The adequate level of variability within the population renders these microsatellite loci ideal markers for population genetic analysis of M. japonicus.
Factors influencing the outcome of lower‐extremity diabetic ulcers treated with hyperbaric oxygen therapy
Authors: Fife Caroline E. , Buyukcakir Cem , Otto Gordon , Sheffield Paul , Love Tommy , Warriner Robert
Published: May 2007

The objectives of this study were to report outcomes of a large number of patients receiving hyperbaric oxygen therapy (HBO2T) for diabetic lower‐extremity ulcers, and to identify likely outcome predictors. Five hyperbaric facilities supplied data on 1,006 patients. A sixth clinic served as a validation sample for the regression‐based prediction model, and later additional data from Memorial Hermann Hospital were added. The severity of lower‐extremity lesions was assessed upon initiation of HBO2T using the Modified Wagner scale, and the outcome described as healed, partially healed, not improved, amputated, or died. Overall, 73.8% of patients improved (granulated or healed). Factors significantly related to outcome included renal failure, pack‐year smoking history, transcutaneous oximetry, number of HBO2T treatments, and interruption of treatment regimen. Number of treatments per week and treatment pressure (2.0 vs. 2.4 atmospheres absolute) were not significant factors in outcome. Concomitant administration of autologous growth factor gel did not improve outcome. A multiple regression model was fitted to the data that can be used to predict the outcome of diabetic patients undergoing HBO2T. Given the high cost of amputation and rehabilitation, these data suggest that hyperbaric oxygen treatment should be an important adjunctive therapy to heal lower‐extremity lesions, especially those with a Wagner grade of 3 or higher.
Clinical utilization of near‐infrared spectroscopy devices for burn depth assessment
Authors: Cross K. M. , Leonardi L. , Payette J. R. , Gomez M. , Levasseur M. A. , Schattka B. J. , Sowa M. G. , Fish J. S.
Published: May 2007

The diagnosis of burn depth is based on a visual assessment and can be subjective. Near‐infrared (NIR) spectroscopic devices were used preclinically with positive results. The purpose of this study was to test the devices in a clinical setting using easily identifiable burn wounds. Adult patients with acute superficial and full‐thickness burns were enrolled. NIR point spectroscopy and imaging devices were used to collect hemodynamic data from the burn site and an adjacent unburned control site. Oxy‐hemoglobin and deoxy‐hemoglobin concentrations were extracted from spectroscopic data and reported as oxygen saturation and total hemoglobin. Sixteen patients (n=16) were included in the study with equal numbers in both burn wound groups. Point spectroscopy data showed an increase in oxygen saturation (p<0.0095) and total hemoglobin (<0.0001) in comparison with the respective control areas for superficial burn wounds. The opposite was true for full‐thickness burns, which showed a decrease in oxygenation (p<0.0001) and total hemoglobin (p<0.0147) in comparison with control areas. NIR imaging technology provides an estimate of hemodynamic parameters and could easily distinguish superficial and full‐thickness burn wounds. These results confirm that NIR devices can successfully distinguish superficial and full‐thickness burn injuries.
Efficacy of gaseous nitric oxide in the treatment of skin and soft tissue infections
Authors: Ghaffari Abdi , Jalili Reza , Ghaffari Mazyar , Miller Chris , Ghahary Aziz
Published: May 2007

Bacterial burden significantly interferes with the healing process in chronic ulcers. Nitric oxide (NO) plays a key role in regulating skin's response to infection and wound healing. In previous studies, we demonstrated that exogenous NO gas (gNO) at 200  parts per million (ppm) exhibits potent antimicrobial effects against a representative range of pathogens. The aim of the present study is to explore the antimicrobial properties of gNO in vivo and to determine skin cells' sensitivity to the cytotoxic effects of gNO. To test gNO's antimicrobial effects, full‐thickness wounds were infected with Staphylococcus aureus on the dorsal skin surface of New Zealand White rabbit and treated with 200 ppm gNO for 8 hours/day for 3 consecutive days. Significant reduction in wound bacterial content was observed in the presence of gNO. In a separate experiment, primary cultures of human fibroblasts, keratinocytes, and endothelial cells were established to test gNO's cytotoxicity in the skin. Methyl thiazolyl tetrazolium proliferation assays demonstrated that human skin cells, unlike bacterial cells, exhibited significant resistance toward gNO cytotoxicity. In vitro migration studies on keratinocytes and endothelial cells revealed that gNO treatment does not seem to interfere with reepithelialization and angiogenesis during the process of wound healing. Following 24 hours of gNO treatment, fibroblasts expressed significantly higher levels of procollagen and, to a lesser degree, a decrease in matrix metalloproteinase ‐1 mRNA. In conclusion, the present study provides evidence for the potential application of high doses of gNO as an antimicrobial agent for the treatment of infection in chronic nonhealing ulcers or burn patients, without compromising the viability, and function of skin cells.
Adult rat hepatic bipotent progenitor cells remain dormant even after extensive hepatectomy
Authors: Yamamoto Harumi , Togo Shinji , Zheng Yun‐wen , Kubota Toru , Taniguchi Hideki , Shimada Hiroshi
Published: May 2007

ABSTRACTS

It remains unknown whether the normal adult liver contains bipotent stem/progenitor cells, and if it does, then what are the circumstances under which they proliferate. The aim of this study was to clarify whether the normal adult liver contains hepatic stem/progenitor cells, and if it does, will they be activated by extensive hepatectomy? Adult rat liver cells were isolated and cultured at a low‐density, and the colony‐forming assay was performed to evaluate the cell proliferative capacity. Immunocytochemistry and reverse transcription‐polymerase chain reaction were used to investigate the multilineage differentiation capability. The rate of colony formation by cells from the normal liver and those from the regenerating liver after partial hepatectomy (PH) were compared to determine whether progenitor cell proliferation might be activated by PH. Only a few epithelial colonies (0.043±0.009% of nonparenchymal cells) continued to proliferate for more than 1 month. Reverse transcription‐polymerase chain reaction and immnocytochemistry showed that these progenitor colonies expressed both hepatocyte and cholangiocyte markers. The proportion of progenitor cells that formed bipotential colonies did not differ significantly between the cells obtained from the normal and PH livers. Adult normal liver contains bipotent hepatic progenitor cells, but they are scarcely activated even after extensive hepatectomy.
An Assessment of Racial Differences in Clinical Practices for Hypertension at Primary Care Sites for Medically Underserved Patients
Authors: Lackland Daniel T. , Lin Yan , Tilley Barbara C. , Egan Brent M.
Published: May 2007

Ethnic disparities in hypertension‐related outcomes may relate to differences in medical care. This study assessed primary care sites serving low‐income patients to determine if differences in process and treatment indicators might contribute to disparities in outcomes. Eight sites were enrolled with 100,000 patients, collectively. Trained nurses abstracted a random sample of medical records for diagnoses, laboratory data, medications, and demographic variables. Data were obtained on 1250 white and 2786 African‐American adults. African Americans were more likely (p<0.01) to be hypertensive (44% vs. 23%) and diabetic (16% vs. 8%) than whites. African Americans were more likely to have serum creatinine, potassium, lipid, and glycosylated hemoglobin values recorded in the medical record than whites (p<0.01). African‐American hypertensives were more likely (p<0.05) than white hypertensives to receive calcium channel blockers, angiotensin‐converting enzyme inhibitors, diuretics, and combination therapy. Thus, there appeared to be little difference in the level of care between the two groups. Based on the sites examined, ethnic variations in important process and treatment indicators do not explain racial differences in cardiovascular and renal outcomes.
Comprehensive Lifestyle Modification and Blood Pressure Control: A Review of the PREMIER Trial
Authors: McGuire Heather L. , Svetkey Laura P. , Harsha David W. , Elmer Patrick J. , Appel Lawrence J. , Ard Jamy D
Published: May 2007

The PREMIER trial assessed the aggregate effect on blood pressure (BP) of nationally recommended lifestyle modifications in free‐living adults with high‐normal (stage 1) hypertension. Participants (N=810) were randomized to the advice‐only group; the established group (consisting of weight loss, increased physical activity, and reduced sodium and alcohol intake); or the established plus Dietary Approaches to Stop Hypertension (DASH) diet group (consisting of the established interventions in addition to the DASH dietary pattern). The primary outcome was change in systolic BP at 6 months. Net of advice only, mean systolic BP declined by 3.7 mm Hg for members of the established group (p<0.001) and 4.3 mm Hg for the established plus DASH group (p<0.001). The prevalence of hypertension decreased from a baseline of 38% to 17% in the established group (p=0.01) and to 12% in the established plus DASH group (p<0.001) compared with a decrease to 26% in the advice‐only group. The PREMIER trial demonstrated that persons with above‐optimal BP and stage 1 hypertension can make multiple lifestyle changes leading to better control of BP.
Mortality in Patients With Microvascular Disease
Authors: Marks David Scott , Gudapati Surrendra , Prisant L. Michael , Weir Brooke , DiDonato‐Gonzalez Caroline , Waller Jennifer L. , Houghton Jan L.
Published: May 2007

Patients with chest pain/ischemic cardiac disease and normal coronary arteriography are thought to have a benign prognosis despite diminished quality of life. Many patients with hypertension fall into this group, at least in the early stage of their disease. Whether abnormalities in coronary flow reserve in these patients are associated with increased morbidity and mortality is unknown. One hundred sixty‐eight patients with chest pain/ischemic cardiac disease and normal coronary angiograms who underwent invasive measures of coronary flow reserve were followed longitudinally. Mortality and quality of life were ascertained by query of the national death index and telephone administration of standardized questionnaires. Patient follow‐up occurred at a mean of 8.5 years. In the abnormal coronary flow reserve group, 12 deaths (20%) were documented in 60 patients compared with eight out of 108 patients (7%; p=0.016) with normal coronary flow reserve. Coronary flow reserve did not predict impairment in functional health status in long‐term follow‐up. Thus, invasive measures of coronary flow reserve in patients with chest pain/ischemic cardiac disease and normal coronary angiograms predicted increased mortality. Surviving patients with chest pain/ischemic cardiac disease and normal coronary angiograms have significant morbidity.
Angiotensin‐Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in African‐American Patients With Hypertension
Authors: Papademetriou Vasilios , Narayan Puneet , Kokkinos Peter
Published: May 2007

African‐American patients with hypertension are less responsive to blockers of the renin‐angiotensin system than white patients. The relative efficacy of angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers and the extent of cross‐resistance to these agents has not been studied. Fifty‐one African‐American patients with stage 1–2 hypertension were randomly assigned to enalapril or candesartan cilexetil for 8 weeks and then crossed over to the other treatment. Nonresponders to enalapril and candesartan used a combination of the two. Of the 51 patients randomized (average age 61.2±9 years, blood pressure 148/100 mm Hg, heart rate 74 bpm, and body weight 92.8 kg), 44 completed the study. At Week 8, systolic blood pressure (SBP) was reduced by 4.8 mm Hg with enalapril and by 4.7 mm Hg with candesartan (p=NS), and diastolic blood pressure (DBP) was reduced by 4.4 mm Hg and 5.6 mm Hg, respectively (p<0.04). Of these 44 patients, 11 (25%) responded to enalapril by SBP criteria and 19 (43%) by DBP criteria. Seven patients (16%) responded by both SBP and DBP criteria, and 21 patients (48%) were nonresponders. With candesartan, 13 patients (29%) responded by SBP criteria, 20 (45%) by DBP criteria and 12 (27%) by both SBP and DBP criteria (p<0.04, compared with enalapril). Only six patients (14%) responded to both enalapril and candesartan by both SBP and DBP criteria. Of the 18 nonresponders to either enalapril or candesartan, the combination of the two had minimal additional effect. Significant changes in plasma‐renin activity and angiotensin II levels were noted only with the high dose of each drug. In this small group of patients, treatment with candesartan resulted in slightly higher response and control rates than enalapril, more than 40% of patients who responded to enalapril did not respond to candesartan and vice versa, and in nonresponders, a combination of candesartan and enalapril offered little additional antihypertensive effect.
Interview With Louis Tobian, MD
Authors: Moser Marvin
Published: May 2007

Dr. Tobian has been involved in hypertension research and treatment for more than 50 years. His work on the sodium and water content in blood vessel walls and the protective effects of potassium has been widely accepted and incorporated into everyday practice decisions. Those of us who have interacted with this researcher and clinician marvel at his ability to translate basic science findings into practice. He has enlivened dozens of meetings with his to‐the‐point questions and cogent arguments. Dr. Tobian is one of the few investigators and clinicians who have been there, done that, and participated in the exciting ongoing saga of hypertension from the time when physicians believed a little high blood pressure was a good thing and couldn't be treated, to the present when we recognize risks of hypertension and reduce it with effective treatment. We asked Dr. Tobian to give us his thoughts about his research and where he believes hypertension treatment may be headed.
Systolic Hypertension in the Elderly: Pushing the Frontiers of Therapy—A Suggested New Approach
Authors: Stokes Gordon S.
Published: May 2007

In elderly patients with systolic hypertension resistant to treatment with conventional therapy, increased aortic pulse wave reflection and a high augmentation index are often present. These findings are indicative of endothelial dysfunction and deficient generation of nitric oxide, a potent vasodilator in the arterial tree. In such patients, treatment with the nitric oxide donor extended‐release isosorbide mononitrate characteristically produces prompt and sustained falls in both pulse wave reflection and systolic blood pressure. The adjunct use of this nitrate produces useful additional decreases in systolic blood pressure ranging from 10 to 45 mm Hg, often achieving target blood pressure goals in isolated systolic hypertension. By combining this endothelium‐independent nitric oxide donor with angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers, the potential exists to address both the nitric oxide deficiency and endothelial dysfunction of the vascular endothelium in these patients. Other possibilities for synergism with this combination include complementary hemodynamic, circadian, and metabolic actions together with prevention of nitrate tolerance. Isosorbide mononitrate may also be used successfully with calcium channel blockers, β blockers, and diuretics.
Managing High‐Risk Patients With Hypertension: Focus on the Renin‐Angiotensin System
Authors: Gradman Alan H.
Published: May 2007

The goal of treating hypertension has evolved from merely lowering blood pressure to an emphasis on the more important objective of decreasing morbidity and mortality. Recent trials have emphasized, however, that the major benefit in outcome relates to the level of blood pressure achieved. Hypertension associated with other risk factors, such as age, diabetes, nephropathy, and left ventricular hypertrophy, places patients at high risk of myocardial infarction, stroke, renal failure, and cardiovascular death. In numerous studies, reductions in end points were usually achieved with combination therapy. The Antihypertensive and Lipid‐Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) reaffirmed the value of diuretics in treating high‐risk hypertension and reducing morbidity, but it also confirmed the necessity of combination drug therapy. Agents that block the effects of angiotensin II are an important component of antihypertensive therapy because of their proven ability to lower the incidence of cardiovascular and renal events in high‐risk hypertensive patients.
Recruitment of African Americans With Chronic Renal Insufficiency Into a Multicenter Clinical Trial: The African American Study of Kidney Disease and Hypertension
Authors: Phillips Robert A. , Faulkner Marquetta , Gassman Jennifer , Jaen Luzmaria , Kusek John W. , Norris Keith , Ojo Akinlolu ,   African American Study of Kidney Disease and Hypertension Study Group
Published: May 2007

In patients with hypertensive nephrosclerosis, the African American Study of Kidney Disease and Hypertension (AASK) demonstrated the superiority of angiotensin‐converting enzyme inhibitor therapy in blunting progression of renal disease compared with a β blocker and a dihydropyridine calcium channel blocker. In addition, the study found that a blood pressure treatment strategy that resulted in an achieved blood pressure of 128/78 mm Hg (low blood pressure goal) was no more effective in slowing the progression of renal disease than a strategy that resulted in a blood pressure of 141/85 mm Hg (usual blood pressure goal). AASK, which enrolled only African Americans with mild to moderate chronic renal insufficiency, also provided an opportunity to evaluate recruitment methods in minority populations. Eighty‐three percent of patients were recruited through screening in clinical practice. To randomize 635 patients, 558,295 charts were reviewed (approximately 879 charts per randomized patient). More than half of the randomized patients (n=635 or 58%) were found by chart review. Sixty percent of women with creatinine levels considered within the normal range had at least mild chronic renal insufficiency. Screening in clinical practice was the most effective strategy to recruit participants with mild to moderate chronic renal insufficiency and hypertension into the clinical trial. This technique may also be an effective approach in trials of other essentially asymptomatic conditions.
Metabolic Properties of Vasodilating β Blockers: Management Considerations for Hypertensive Diabetic Patients and Patients With the Metabolic Syndrome
Authors: Jacob Stephan , Henriksen Erik J.
Published: May 2007

Type 2 diabetes and hypertension are both insulin‐resistant states that impose an excessive risk burden for future major cardiovascular events, including coronary heart disease, stroke, and heart failure. β‐adrenergic receptor antagonists are effective for the treatment of hypertension, but they are underused in diabetic patients because of possible adverse effects on carbohydrate and lipid metabolism, including insulin resistance, glucose intolerance, and dyslipidemia. Traditional β blockers, both nonselective and selective, are vasoconstrictive due to unopposed α1 activity; however, vasodilating β blockers are not associated with these negative metabolic effects. This review discusses the background of insulin resistance and its link to diabetes and hypertension, emphasizing the role of vascular control by the renin‐angiotensin and sympathetic nervous systems on insulin sensitivity and glucose utilization. Clinical evidence is reviewed for the use of vasodilating β blockers in the treatment of hypertension and in reducing cardiovascular risk in the diabetic population.
Diuretic‐Related Side Effects: Development and Treatment
Authors: Sica Domenic A.
Published: May 2007

Diuretics are important therapeutic tools. First, they effectively reduce blood pressure and have been shown in numerous hypertension clinical trials to reduce both cardiovascular and cerebrovascular morbidity and mortality. In addition, their use has been equally effective in controlling cardiovascular events as angiotensin‐converting enzyme inhibitors or calcium channel blockers. Diuretics are currently recommended by the Seventh Report of the Joint National Commission on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure report as first‐line therapy for the treatment of hypertension. In addition, they remain an important aspect of congestive heart failure treatment in that they improve the congestive symptomatology, which typifies the more advanced stages of congestive heart failure. This article reviews the commonly encountered side effects with the various diuretic classes. Where indicated, the mechanistic basis and treatment of such side effects is further discussed.