bluuebunny/crossref_metadata_2025 huggingface dataset:
STRICTURE AFTER ENDOSCOPIC SUBMUCOSAL DISSECTION FOR EARLY GASTRIC CANCERS AND ADENOMAS
Authors: Iizuka Haruhisa , Kakizaki Satoru , Sohara Naondo , Onozato Yasuhiro , Ishihara Hiroshi , Okamura Shinichi , Itoh Hideaki , Mori Masatomo
Published: July 2010

Background and Aim:  Stricture is a complication that may occur after endoscopic submucosal dissection (ESD) of gastric neoplasms. The goal of the present study was to investigate the incidence, risk factors and management of gastric stricture after ESD.

Methods:  The medical records of 308 patients who underwent ESD for gastric neoplasms were reviewed. Stricture is defined as having symptoms caused by an obstruction through which a 1‐cm diameter endoscopic fiber cannot be passed.

Results:  Stricture was identified in six of 308 patients (1.9%). Three of the six lesions were located in the prepylorus, two cases in the antrum and one in the cardia. The mean longitudinal distance and the mean area of the resected specimens in the six cases with stricture (7.8 ± 2.0 cm, 34.0 ± 15.8 cm2, respectively) was significantly larger than in those without stricture (4.5 ± 1.4 cm, 12.7 ± 8.3 cm2, respectively, P < 0.01). The ratio of the resected circumference/whole circumference was 83.3 ± 7.5% in those with stricture in comparison to 25.4 ± 16.3% in those without stricture (P < 0.01). All six patients underwent endoscopic balloon dilations, and obtained relief from stricture. However, one patient experienced a gastric perforation and recovered following conservative therapy.

Conclusion:  Sub‐circumferential resection over 75% of the circumference by ESD in the prepylorus, antrum and cardia is a risk factor for the occurrence of stricture. Early intervention might be considered for this high‐risk group to avoid a perforation during balloon dilation.
Vascular aging: From molecular mechanism to clinical significance
Authors: Sawabe Motoji
Published: July 2010

The large and medium‐sized arteries in elderly people show varying degrees of intimal and medial change. The medial change is known as age‐related medial degeneration and sclerosis (ARMDS). The ARMDS results in systolic hypertension and left ventricular hypertrophy of the heart as a result of loss of arterial elasticity. It also causes aortic dilatation, or even aortic aneurysm. The ARMDS and atherosclerosis are distinct entities, but are often overlapped and confused with each other. The present review mainly focuses on ARMDS and briefly addresses atherosclerosis, and aging of arterioles, capillaries and veins. The smooth muscle cells in the inner half of the aortic media of elderly people degenerate and undergo apoptosis. This causes degradation of elastin fibers and the accumulation of collagen fibers in the media, but the inflammatory infiltrates are scarce. Biochemical studies showed an age‐related decrease of elastin and its crosslinks, and an increase of collagen and its crosslink. Because the turnover of elastin is very long, it likely suffers from glycation (Maillard reaction) and glyco‐oxidative reaction. The advanced glycation end‐products accumulate in the aortic media with increasing age. Alcian‐blue positive mucin accumulates in aortic media in elderly people. The major component of the increase of aortic mucin is chondroitin‐6‐sulfate. Microcalcification is frequent in the inner acellular portion of the aortic media in elderly people. Calcium contents increase with age. In conclusion, the ARMDS is a distinct pathological entity with clinical significance. The pathogenesis of ARMDS is unclear; the mechanical stress of elastin, endothelial dysfunction, and glycation of elastin are proposed. Geriatr Gerontol Int 2010; 10 (Suppl. 1): S213–S220.
Muscle weakness and neuromuscular junctions in aging and disease
Authors: Shigemoto Kazuhiro , Kubo Sachiho , Mori Syuuichi , Yamada Shigeru , Akiyoshi Takuyu , Miyazaki Tsuyoshi
Published: July 2010

A critical issue in today's super‐aging society is the need to reduce the burden of family care while continuing to make our medical institutions supportive. A rapidly emerging, major health concern is the debilitating effect of muscle weakness and atrophy from aging, termed sarcopenia; however, the molecular basis of this condition is not well understood. Our research aim is to elucidate the molecular mechanisms of age‐related muscle atrophy and to devise new measures for preventing and treating this disability. A promising treatment for muscle atrophy is the promotion of muscle regeneration by recruiting stem cells into the targeted region. The first requirement is to understand how the motor system, which consists of muscles and motoneurons, is maintained to accomplish that goal. Recent studies in the field of neuroscience have focused on neuromuscular junctions (NMJ), which play important roles in the maintenance of both motor nerves and muscle fibers. Signaling between muscles and motoneurons at NMJ supports interactions within the motor system. To understand the mechanisms involved, we focus our research on the pathogenic processes underlying neuromuscular diseases. The well‐known autoimmune disease, myasthenia gravis (MG), serves as a model not only for tracking the pathogenesis and treatment outcomes of all autoimmune diseases, but also for understanding synaptic functions in maintaining the motor system. Here, we describe recent insights into the molecular mechanisms required for the maintenance of NMJ and the related causes of muscle atrophy. Geriatr Gerontol Int 2010; 10 (Suppl. 1): S137–S147.
New attempt using ablative curettage technique for managing benign premenopausal uterine bleeding
Authors: Thabet Saeed Mohamed Ahmad
Published: July 2010

Aim:  To assess the efficacy of a newly suggested ablative curettage technique in managing premenopausal dysfunctional uterine bleeding.

Methods:  A prospective controlled operative study and clinical trial was carried out at the Department of Obstetrics and Gynecology, Kasr El‐Aini Hospital, Cairo University, Egypt. One hundred cases of premenopausal bleeding were divided into 50 controls and 50 studied cases. Routine diagnostic and follow‐up techniques for managing premenopausal bleeding were carried out. Two operative techniques were compared: overcurettage, using Sims sharp curette, and the newly suggested dilatation and ablative curettage, using a Thabet double‐bladed sharp curette. Histopathology of curetted material and the endomyometrium after ablation in the failed cases that needed hysterectomy was also included.

Results:  Successful endometrial ablation and control of the premenopausal bleeding were recorded in 66% of overcurettage cases and in 90% of cases treated with ablative curettage. The latter had significantly fewer operative and postoperative complications. These advantages were also significantly reduced in both techniques compared with other ablative techniques and hysterectomy. Complete ablation could be confirmed histopathologically in the ablated endometrium and in the endomyometrium of the hysterectomy specimens.

Conclusion:  Ablative curettage is an efficient technique in managing premenopausal dysfunctional uterine bleeding, especially in developing countries where there are limited financial resources.
Group A streptococcal toxic shock syndrome with extremely aggressive course in the third trimester
Authors: Sugiyama Takashi , Kobayashi Takumi , Nagao Kenji , Hatada Tsuyoshi , Wada Hideo , Sagawa Norimasa
Published: July 2010

Group‐A‐streptococcus‐(GAS)‐induced toxic shock syndrome (TSS) is uncommon, but carries a high risk of maternal mortality during pregnancy. The onset of gravidic GAS‐TSS has been reported mostly during the puerperium.

A 16‐year‐old woman, who was at 37 weeks of gestation, and without obstetrical care during the last 30 weeks, was referred to our hospital. She complained of fever for one day with headache and abdominal pain after the fever developed. On admission, her consciousness was drowsy, intrauterine fetal death was recognized, and she rapidly developed shock status with coma and hypotension, hemolysis, disseminated intravascular coagulation (DIC), and multi‐organ failure. Although we had not obtained the results of a bacterial culture, we suspected sepsis with DIC with homolysis and multi‐organ failure resulting from an infection. The patient was treated with antibiotics and intubation because of respiratory insufficiency. Twelve hours after admission to the intensive care unit in our hospital, she died. Cultures from blood, subcutaneous tissue, vaginal discharge, and pharynx all revealed GAS bacteria, and therefore she was diagnosed as having GAS‐TSS.

GAS‐TSS in pregnancy is rare. However, once the infection occurs in a pregnant woman, it rapidly develops into sepsis with multi‐organ failure. Therefore, early recognition and intensive treatment for GAS during pregnancy is recommended in women with high fever, muscular pain, hemolysis and DIC during pregnancy.
Broca’s region: linking human brain functional connectivity data and non‐human primate tracing anatomy studies
Authors: Kelly Clare , Uddin Lucina Q. , Shehzad Zarrar , Margulies Daniel S. , Castellanos F. Xavier , Milham Michael P. , Petrides Michael
Published: July 2010

Brodmann areas 6, 44 and 45 in the ventrolateral frontal cortex of the left hemisphere of the human brain constitute the anterior language production zone. The anatomical connectivity of these areas with parietal and temporal cortical regions was recently examined in an autoradiographic tract‐tracing study in the macaque monkey. Studies suggest strong correspondence between human resting state functional connectivity (RSFC) based on functional magnetic resonance imaging data and experimentally demonstrated anatomical connections in non‐human primates. Accordingly, we hypothesized that areas 6, 44 and 45 of the human brain would exhibit patterns of RSFC consistent with patterns of anatomical connectivity observed in the macaque. In a primary analysis, we examined the RSFC associated with regions‐of‐interest placed in ventrolateral frontal areas 6, 44 and 45, on the basis of local sulcal and gyral anatomy. We validated the results of the primary hypothesis‐driven analysis with a data‐driven partitioning of ventrolateral frontal cortex into regions exhibiting distinct RSFC patterns, using a spectral clustering algorithm. The RSFC of ventrolateral frontal areas 6, 44 and 45 was consistent with patterns of anatomical connectivity shown in the macaque. We observed a striking dissociation between RSFC for the ventral part of area 6 that is involved in orofacial motor control and RSFC associated with Broca’s region (areas 44 and 45). These findings indicate rich and differential RSFC patterns for the ventrolateral frontal areas controlling language production, consistent with known anatomical connectivity in the macaque brain, and suggest conservation of connectivity during the evolution of the primate brain.
Genomic analysis of oceanic cyanobacterial myoviruses compared with T4‐like myoviruses from diverse hosts and environments
Authors: Sullivan Matthew B. , Huang Katherine H. , Ignacio‐Espinoza Julio C. , Berlin Aaron M. , Kelly Libusha , Weigele Peter R. , DeFrancesco Alicia S. , Kern Suzanne E. , Thompson Luke R. , Young Sarah , Yandava Chandri , Fu Ross , Krastins Bryan , Chase Michael , Sarracino David , Osburne Marcia S. , Henn Matthew R. , Chisholm Sallie W.
Published: July 2010

T4‐like myoviruses are ubiquitous, and their genes are among the most abundant documented in ocean systems. Here we compare 26 T4‐like genomes, including 10 from non‐cyanobacterial myoviruses, and 16 from marine cyanobacterial myoviruses (cyanophages) isolated on diverseProchlorococcusorSynechococcushosts. A core genome of 38 virion construction and DNA replication genes was observed in all 26 genomes, with 32 and 25 additional genes shared among the non‐cyanophage and cyanophage subsets, respectively. These hierarchical cores are highly syntenic across the genomes, and sampled to saturation. The 25 cyanophage core genes include six previously described genes with putative functions (psbA,mazG,phoH,hsp20,hli03,cobS), a hypothetical protein with a potential phytanoyl‐CoA dioxygenase domain, two virion structural genes, and 16 hypothetical genes. Beyond previously described cyanophage‐encoded photosynthesis and phosphate stress genes, we observed core genes that may play a role in nitrogen metabolism during infection through modulation of 2‐oxoglutarate. Patterns among non‐core genes that may drive niche diversification revealed that phosphorus‐related gene content reflects source waters rather than host strain used for isolation, and that carbon metabolism genes appear associated with putative mobile elements. As well, phages isolated onSynechococcushad higher genome‐wide %G+C and often contained different gene subsets (e.g.petE,zwf,gnd,prnA,cpeT) than those isolated onProchlorococcus. However, no clear diagnostic genes emerged to distinguish these phage groups, suggesting blurred boundaries possibly due to cross‐infection. Finally, genome‐wide comparisons of both diverse and closely related, co‐isolated genomes provide a locus‐to‐locus variability metric that will prove valuable for interpreting metagenomic data sets.
The effects of rosiglitazone on atherosclerotic progression in patients with Type 2 diabetes at high cardiovascular risk
Authors: Yee M. S. , Pavitt D. V. , Dhanjil S. , Godsland I. F. , Richmond W. , Johnston D. G.
Published: July 2010

Diabet. Med. 27, 1392–1400 (2010)

Aims  Cardiovascular mortality remains high despite intensive treatment of people with Type 2 diabetes mellitus. Meta‐analyses on rosiglitazone have raised concerns regarding its cardiovascular safety. We studied the effects of rosiglitazone on ultrasonic indices of carotid arterial disease and inflammatory markers in a group of Type 2 diabetic patients at high cardiovascular risk.

Methods  A trial of rosiglitazone in Type 2 diabetic patients with high cardiovascular risk and internal carotid artery plaque compared changes in carotid ultrasound intima–media thickness (IMT), plaque thickness, arterial stiffness and compliance, and inflammatory markers at baseline, 26 and 52 weeks.

Results  In the rosiglitazone group (n = 28), carotid artery plaque thickness was reduced by 0.08 mm, compared with an increase of 0.19 mm (P = 0.075) in the placebo group (n = 29). There were no significant differences in changes of IMT, carotid wall compliance and stiffness between the two groups. Glycated haemoglobin reduced by −0.9 vs. 0.1% (−7 vs. 2 mmol/mol), (P < 0.001); insulin resistance (HOMA‐IR) reduced by −37.6 vs. −1.1% (P = 0.016); and B cell function (HOMA‐B) increased by 36.8 vs. 0.7% (P = 0.009). Non‐esterified fatty acids reduced by −23.5 vs. 7.9% (P = 0.005); tissue plasminogen activator reduced by −25.0 vs. 0.6% (P = 0.001); and plasminogen activator inhibitor activity reduced by −57.4 vs. −34.6% (P = 0.052).

Conclusions  Rosiglitazone reduced carotid artery plaque thickness, though not significantly, and there was no significant change in intima media thickness or other ultrasonic indices of carotid arterial disease. There were significant improvements in glycaemic control, insulin sensitivity and fibrinolytic, but not inflammatory, markers. There was no evidence in this study of any adverse effects on progression of carotid arterial disease.
The effect of increased ambulatory activity on markers of chronic low‐grade inflammation: evidence from the PREPARE programme randomized controlled trial
Authors: Yates T. , Davies M. J. , Gorely T. , Talbot D. , Bull F. , Sattar N. , Khunti K.
Published: July 2010

Diabet. Med. 27, 1256–1263 (2010)

Aims  To investigate whether an exercise intervention programme, with or without pedometer use, is effective at reducing chronic low‐grade inflammation in those with impaired glucose tolerance.

Methods  Using baseline and 12 month data from the Pre‐diabetes Risk Education and Physical Activity Recommendation and Encouragement (PREPARE) programme randomized controlled trial, we investigated whether the pedometer or the standard version of the PREPARE programme is associated with reduced chronic low‐grade inflammation. Outcomes included interleukin‐6, C‐reactive protein, fasting and 2 h post‐challenge glucose values and objectively measured ambulatory activity.

Results  Sevety‐four participants (31% female; mean age, 65 years; body mass index, 29.3 ± 4.8 kg/m2) were included, of which 26 were in the control group and 24 were in each intervention group. At 12 months there was an increase in ambulatory activity of 1351 and 1849 steps/day in the standard and pedometer group, respectively, compared with control conditions; however, there was no significant change in markers of chronic low‐grade inflammation. Across the pooled study sample, change in ambulatory activity was significantly correlated with change in interleukin‐6 (r = –0.32, P = 0.01) after adjustment for group, age, sex, ethnicity, aspirin and statin medication, baseline body mass index and change in body mass index. Change in interleukin‐6 was also significantly correlated with change in 2 h glucose after adjustment for the same variables (r = 0.26, P = 0.03).

Conclusions  This study failed to show reductions in markers of chronic low‐grade inflammation following an intervention that promoted modest increases in ambulatory activity; however, across the study sample, increased ambulatory activity was associated with reduced interleukin‐6, independent of obesity.
Investigation of ACE, ACE2 and AGTR1 genes for association with nephropathy in Type 1 diabetes mellitus
Authors: Currie D. , McKnight A. J. , Patterson C. C. , Sadlier D. M. , Maxwell A. P. ,   The UK Warren 3/GoKinD Study Group
Published: July 2010

Diabet. Med. 27, 1188–1194 (2010)

Background  Polymorphisms in ACE and AGTR1 genes have been assessed in multiple studies for association with diabetic nephropathy; however, results are conflicting. The ACE2 gene has not been studied extensively for association with diabetic nephropathy.

Methods  We investigated variants in ACE, ACE2 and AGTR1 for association with nephropathy in a case–control group (1467 participants with Type 1 diabetes, case subjects n = 718; control subjects n = 749) of white descent with grandparents born in the British Isles. All recruited individuals were carefully phenotyped and genotyping was performed using Sequenom, Taqman and gel electrophoresis methods. The χ2‐test for contingency tables was used to compare genotype and allele frequencies in case and control groups.

Results  No departure from Hardy–Weinberg equilibrium was observed in cases or controls. Two variants within the ACE gene (rs4293, Pallelic = 0.02, Pgenotypic = 0.008; rs4309, Pallelic = 0.02, Pgenotypic = 0.01) were significantly associated with nephropathy at the 5% level. No variant remained statistically significant following adjustment for multiple comparisons. No single nucleotide polymorphisms in the ACE2 or AGTR1 genes were significantly associated with nephropathy when analysed either by genotype or allele frequencies.

Conclusions  Our independent case–control study provides no evidence that common variants in ACE, ACE2 and AGTR1 play a major role in genetic susceptibility to diabetic nephropathy in a white population with Type 1 diabetes.
Essentialist theory of ‘hybrids’: From animal kinds to ethnic categories and race
Authors: Wagner Wolfgang , Kronberger Nicole , Nagata Motohiko , Sen Ragini , Holtz Peter , Palacios Fátima Flores
Published: July 2010

This article presents a theory of the perception of hybrids, resulting from cross‐breeding natural animals that pertain to different species and of children parented by couples with a mixed ethnic or racial background. The theory states that natural living beings, including humans, are perceived as possessing a deeply ingrained characteristic that is called ‘essence’ or ‘blood’ or ‘genes’ in everyday discourse and that uniquely determines their category membership. If, by whatever means, the genes or essences of two animals of different species are combined in a hybrid, the two incompatible essences collapse, leaving the hybrid in a state of non‐identity and non‐belonging. People despise this state and reject the hybrid (Study 1). This devaluation effect holds with cross‐kind hybrids and with hybrids that arise from genetically combining animals from incompatible habitats across three cultures: Austria, India and Japan (Study 2). In the social world, groups and ethnic or racial categories frequently are essentialized in an analogue way. When people with an essentialist mindset judge ethnically or racially mixed offspring, they perceive a collapse of ethnic or racial essence and, consequently, denigrate these children, as compared to children from ‘pure’ in‐group or out‐group parents (Study 3). The findings are discussed in terms of the widespread ‘yuck factor’ against genetically modified animals, in terms of the cultural concepts of monstrosity and of racism and prejudice.
AGAINST CARTESIAN MISTRUST: CAVELL, HUSSERL AND THE OTHER MIND SCEPTIC
Authors: Alweiss Lilian
Published: July 2010

This paper asks whether we should still be haunted by scepticism about other minds. It draws on the writings of Cavell and Husserl to show that there is some truth in the Cartesian premise that has given rise to scepticism about other minds, namely, that our self‐awareness is of a fundamentally different type from our awareness of objects and other subjects. While this leads Cavell to argue that there is a truth to scepticism, it proves the opposite to Husserl, viz. that other minds scepticism is necessarily non‐sensical. The paper shows why Husserl's position is more convincing than Cavell's.1
WHAT ARE SEEMINGS?
Authors: Cullison Andrew
Published: July 2010

We are all familiar with the phenomenon of a proposition seeming true. Many think that these seeming states can yield justified beliefs. Very few have seriously explored what these seeming states are. I argue that seeming states are not plausibly analyzed in terms of beliefs, partial beliefs, attractions to believe, or inclinations to believe. Given that the main candidates for analyzing seeming states are unsatisfactory, I argue for a brute view of seemings that treats seeming states as irreducible propositional attitudes.
IS THERE A CONSERVATIVE SOLUTION TO THE MANY THINKERS PROBLEM?
Authors: Kovacs David Mark
Published: July 2010

On a widely shared assumption, our mental states supervene on our microphysical properties – that is, microphysical supervenience is true. When this thesis is combined with the apparent truism that human persons have proper parts, a grave difficulty arises: what prevents some of these proper parts from being themselves thinkers as well? How can I know that I am a human person and not a smaller thinker enclosed in a human person? Most solutions to this puzzle make radical, if not absurd, claims. Recently, however, Michael Burke and Howard Robinson proposed conservative solutions that, according to them, do not have such undesired consequences. This paper argues that the conservative solutions tacitly assume at least one of the radical ones, and therefore they provide no alternative to the extreme solutions.
MORAL PERCEPTION AND THE CAUSAL OBJECTION
Authors: McBrayer Justin P.
Published: July 2010

One of the primary motivations behind moral anti‐realism is a deep‐rooted scepticism about moral knowledge. Moral realists attempt counter this worry by sketching a plausible moral epistemology. One of the most radical proposals in the recent literature is that we know moral facts by perception – we can literally see that an action is wrong, etc. A serious objection to moral perception is the causal objection. It is widely conceded that perception requires a causal connection between the perceived and the perceiver. But, the objection continues, we are not in appropriate causal contact with moral properties. Therefore, we cannot perceive moral properties. This papers demonstrates that the causal objection is unsound whether moral properties turn out to be secondary, natural properties; non‐secondary, natural properties; or non‐natural properties.1
DIVISIONALIZATION AND HORIZONTAL MERGERS IN A VERTICAL RELATIONSHIP*
Authors: MIZUNO TOMOMICHI
Published: July 2010

In this paper we evaluate the effects of horizontal mergers in a vertical relationship. Each downstream firm can create autonomous divisions. We show that an infinitesimal merger of downstream firms may exhibit a positive welfare effect if the upstream and downstream sectors are sufficiently unconcentrated. However, any merger of upstream firms reduces social welfare. Moreover, a decrease in the concentration in the upstream stage (respectively downstream stage or non‐merging stage) makes the welfare effects of the merger in the upstream stage (respectively downstream stage or non‐merging stage) less negative (respectively ambiguous or ambiguous).
How many hours do you have to work to be integrated? Full‐time and part‐time employment of native and ethnic minority women in the Netherlands
Authors: Bevelander Pieter , Groeneveld Sandra
Published: July 2010

Labour market integration of ethnic minority women is central for economic integration, as they may experience a double disadvantage: both as a woman and as a migrant. This presumed double disadvantage has recently become the focus of both Dutch integration and emancipation policy. To test several assumptions underlying this, we analyse to what extent labour market participation of different groups of women and the hours they work are influenced by human capital and household characteristics.

Our results show some remarkable differences in employment patterns. Controlling for educational level, partnership and the presence of children, it was found that native women more often work in part‐time jobs than ethnic minority women. For native Dutch women, the number of children influences both the employment decision and the number of hours worked, whereas for ethnic minority women, this only effects full‐time employment.
Psoriasis in children: a retrospective analysis
Authors: Stefanaki C , Lagogianni E , Kontochristopoulos G , Verra P , Barkas G , Katsambas A , Katsarou A
Published: July 2010

Background  Few epidemiological studies are available on childhood psoriasis.

Methods  Between 2005 and 2008, information was collected about all children diagnosed with psoriasis in the Pediatric Dermatology Unit of Andreas Sygros Skin Hospital, in Athens, Greece.

Results  A total of 125 children with psoriasis were examined, the male to female ratio was 1.4 : 1 and the peak age of onset was in the 9‐ to 10‐year‐old age group. Only 16% of the patients had a positive family history. Plaque type psoriasis was the most prevalent type at presentation with 56.8% of the children affected, followed by scalp involvement (33.6%). The limbs were the most prevalent site of involvement (70 children, 56%), followed by the body (59 children, 47.2%) and scalp (60 children, 48%) equally affected. Most of the children had <5% of their skin affected by psoriasis (53.2%). Age of onset had no influence on the severity of the disease (P = 0.107), whereas a positive correlation was found with sex and severity of the disease, with male patients being more severely affected (P = 0.008). Family history did not influence the age at presentation (P = 0.68). Topical steroids were used in most commonly followed by keratolytics, calcipotriol, topical tacrolimus and topical pimecrolimus.

Conclusion  Our study reflects the patterns of presentation of childhood psoriasis in sunny countries like Greece.
Impact of physical activity and body composition on heart function and morphology in middle‐aged, abdominally obese women
Authors: Eriksson Michael , Uddén Joanna , Hemmingsson Erik , Agewall Stefan
Published: July 2010

Several studies have shown training induced morphological changes in the heart. Our aim was to assess how frequent, low‐intensity exercise (walking and cycling) influences heart function and morphology in abdominally obese women. Fifty women with abdominal obesity (mean age 47·0 ± 7·5 years, waist circumference (WC) 103·2 ± 7·8 cm), free of cardiovascular problems were recruited. They were equipped with a bicycle and pedometers and instructed to start commuting in a physically active way for 6 months. Evaluation of cardiac function and morphology was performed using echocardiography (ECHO) before and after 6 months of training. The subjects increased significantly their daily physical activity. After 6 months, there was a significant decrease in WC (from 103·3 ± 7·9 to 100·8 ± 8·4 cm, P = 0·0003), in systolic and diastolic blood pressure (126·8 ± 15·2 to 120·4 ± 14·5 mmHg, P = 0·0001, and 79·8 ± 7·8 to 77·8 ± 8·4 mmHg, P = 0·0006, respectively). ECHO showed an increase in the right ventricular (RV) systolic longitudinal function expressed as tricuspid annular motion from 22·00 ± 3·30 to 23·05 ± 3·59 mm, P = 0·015; and a similar trend in left ventricular (LV) mitral annular motion, which increased from 13·09 ± 1·53 to 13·39 ± 1·47 mm, P = 0·070. Cycling was associated with reductions in LV systolic and RV diastolic dimensions, whereas walking was not associated with any changes in the ECHO‐variables. A reduction in WC by frequent, low‐intensity exercise in abdominally obese women is associated with decrease in blood pressure and improved longitudinal RV systolic function.
Dapsone hydroxylamine induces premature removal of human erythrocytes by membrane reorganization and antibody binding
Authors: Bordin Luciana , Fiore Cristina , Zen Francesco , Coleman Michael D , Ragazzi Eugenio , Clari Giulio
Published: July 2010

BACKGROUND AND PURPOSEN‐hydroxylation of dapsone leads to the formation of the toxic hydroxylamines responsible for the clinical methaemoglobinaemia associated with dapsone therapy. Dapsone has been associated with decreased lifespan of erythrocytes, with consequences such as anaemia and morbidity in patients treated with dapsone for malaria. Here, we investigated how dapsone and/or its hydroxylamine derivative (DDS‐NHOH) induced erythrocyte membrane alterations that could lead to premature cell removal.

EXPERIMENTAL APPROACHErythrocytes from healthy donors were subjected to incubation with dapsone and DDS‐NHOH for varying times and the band 3 protein tyrosine‐phosphorylation process, band 3 aggregation, membrane alteration and IgG binding were all examined and compared with erythrocytes from two patients receiving dapsone therapy.

KEY RESULTSThe hydroxylamine derivative, but not dapsone (the parent sulphone) altered membrane protein interactions, leading both to aggregation of band 3 protein and to circulating autologous antibody binding, shown in erythrocytes from patients receiving dapsone therapy. The band 3 tyrosine‐phosphorylation process can be used as a diagnostic system to monitor membrane alterations bothin vitro, assessing concentration and time‐dependent effects of DDS‐NHOH treatment, andin vivo, evaluating erythrocytes from dapsone‐treated patients, in resting or oxidatively stimulated conditions.

CONCLUSIONS AND IMPLICATIONSDDS‐NHOH‐induced alterations of human erythrocytes can be directly monitoredin vitroby tyrosine‐phosphorylation level and formation of band 3 protein aggregates. The latter, together with antibody‐mediated labelling of erythrocytes, also observed after clinical use of dapsone, may lead to shortening of erythrocyte lifespan.
Spasticity therapy reacts to astrocyte GluA1 receptor upregulation following spinal cord injury
Authors: Gómez‐Soriano Julio , Goiriena Eider , Taylor Julian
Published: July 2010

For almost three decades intrathecal baclofen therapy has been the standard treatment for spinal cord injury spasticity when oral medication is ineffective or produces serious side effects. Although intrathecal baclofen therapy has a good clinical benefit‐risk ratio for spinal spasticity, tolerance and the life‐threatening withdrawal syndrome present serious problems for its management. Now, in an experimental model of spinal cord injury spasticity, AMPA receptor blockade with NGX424 (Tezampanel) has been shown to reduce stretch reflex activity alone and during tolerance to intrathecal baclofen therapy. These results stem from the observation that GluA1 receptors are overexpressed on reactive astrocytes following experimental ischaemic spinal cord injury. Although further validation is required, the appropriate choice of AMPA receptor antagonists for treatment of stretch hyperreflexia based on our recent understanding of reactive astrocyte neurobiology following spinal cord injury may lead to the development of a better adjunct clinical therapy for spasticity without the side effects of intrathecal baclofen therapy.

LINKED ARTICLEThis article is a commentary on Oshiroet al., pp. 976–985 of this issue. To view this paper visithttp://dx.doi.org/10.1111/j.1476‐5381.2010.00954.x
Viral hepatocarcinogenesis: from infection to cancer
Authors: Tan Alexander , Yeh Shiou‐Hwie , Liu Chun‐Jen , Cheung Claudia , Chen Pei‐Jer
Published: July 2010

Hepatocellular carcinoma (HCC) is a worldwide health issue that has started receiving attention but is still poorly understood. However, the hepatitis B virus (HBV) and the hepatitis C virus (HCV) are known to be two major causative agents of HCC. They differ in their modes of infection, their treatment options, their genomes and their carcinogenic abilities. However, both share a link with HCC through alterations of the host genome. In order to continue in our search for the mechanisms behind viral hepatocarcinogenesis, the individual entities (HBV, HCV, HCC and host), their natural history, treatment options and genomic properties must be further understood. Additionally, an understanding of the genomics, the link between the entities, is crucial for the success of the ongoing search for therapeutic options for HCC. Similar to most types of cancer, hepatocarcinogenesis is a multistep process involving different genetic alterations that ultimately lead to malignant transformation of the hepatocyte. As technology advances and research continues, the genetic changes and influences among these entities will prove essential to improved diagnostic and therapeutic options. It remains a challenge to provide a clear picture of the connection between virus and cancer. We review (i) the epidemiological link between HBV/HCV infection to HCC; (ii) prevention and control of chronic hepatitis B or C in reducing HCC risk; and (iii) genetic characters of viruses and hosts and the mechanisms associated with HCC susceptibilities, with the intention of providing a direction for future research and treatment.
Artificial Liver: The Effect of ACAC Microencapsulated Charcoal Hemoperfusion on Fulminant Hepatic Failure
Authors: Chirito E. , Reiter B. , Lister C. , Chang T. M. S.
Published: July 2010

Control trials and statistical analysis were carried out to assess the effects of albumin‐collodion microencapsulated activated charcoal (ACAC) hemoperfusion on fulminant hepatic coma. A rat model of galactosamine induced fulminant hepatic coma was used. Rats which did not recover died at 3.0 0.6 days after galactosamine injection. Those which survived this period recovered. Forty‐eight hours after galactosamine injection, a test group of 21 rats were treated with 1 hour hemoperfusion and compared with an untreated group of 23 rats. 71.4% of the treated group survived as compared to 30.4% of the untreated rats. Statistical analysis (t test) shows a significant increase in recovery for the treated group (<0.01). Biochemical and histological results will be discussed.
The Development of Polymeric Cardiovascular Collagen Prostheses
Authors: Sawyer P. N. , Stanczewski B. , Kirschenbaum D.
Published: July 2010

In an attempt to develop a long‐lasting, non‐thrombogenic, collagen cardiovascular prosthesis this laboratory has sequentially evaluated a series of modified collagen structures treated as polymers. Bovine arteries and human umbilical cords have been subjected to various chemical modifications and grouped as follows: 1.) fresh, untreated vessels, 2.) commercially available dialdehyde starch tanned grafts, 3.) ficin digested (muscle and elastin removed) vessels, 4.) ficin digested negatively charged, untanned grafts, 5.) ficin digested, negatively charged, dialdehyde starch tanned grafts, 6.) ficin digested, oxidized carboxymethylcellulose tanned grafts, 7.) ficin digested, glutaraldehyde tanned, protein cross‐linked, negatively charged grafts. The aim in each case was to create a specific recurrent stereo specific electrochemical charge at the blood‐tissue interface. These tubular grafts were then evaluated in several positions following canine implantation. The results confirmed that the single most important factor in assuring long‐term patency and function was provision of a uniform, highly covalently bonded, glutaraldehyde tanned, negative surface charge. Unmodified grafts thrombosed and then became calcified or dissolved within a short period of time.

Techniques for evaluation included resistance to thrombosis and observed characteristics of the grafts at periodic intervals of 1 second, 2 hours, 2 weeks, 1 month, 3 months, 6 months, 9 months, 12 months and longer. Upon removal, each of these grafts was inspected, photographed, tested for tensile strength, and observed by light and scanning electron microscopy. In summary, the most satisfactory graft was the ficin digested, glutaraldehyde tanned, negatively charged prosthesis.

Subsequently, these grafts were prepared for implantation in humans. At this time approximately 69 segments have been implanted in 35 patients. The majority (36) have been implanted in the femoral‐popliteal position. Axillofemoral, femorofemoral, aortorenal, peripheral arteriovenous, coronary, iliopopliteal and femoroperoneal bypasses were also performed. These results have been compared with gas endarterectomy, saphenous vein bypass (conventional), and bovine heterograft prostheses in similar implantation sites. Follow‐up of this group to two years reveals patency approaching that of autogenous saphenous vein grafts and surpassing that of conventional bovine heterografts. These data suggest that collagen with chemical and surface charge modification may lead to a new generation of biological cardiovascular prostheses exhibiting improved performance characteristics and freedom from thrombosis.
Intraocular Lens Implantation: A Review
Authors: Langston Roger H. S.
Published: July 2010

Intraocular lens implantation has been developing over the past 15 years in Europe and is now becoming popular in the United States. Lens materials and designs as well as surgical techniques are still being evaluated. The overall results are excellent, with a small increase in complications being the price paid for a dramatic increase in visual rehabilitation.
A 1978 Perspective of Hemoperfusion
Authors: Chang Thomas M. S.
Published: July 2010

The present status of adsorbent hemoperfusion is introduced with emphasis on available systems and their roles in uremia, acute intoxication, fulminant hepatic failure and chronic schizophrenia.
Sorbent Membranes Used in a Conventional Dialyzer Format
Authors: Gurland Hans J. , Fernandez Jose C. , Samtleben Walter , Castro Louis A.
Published: July 2010

The possibility of installing sorbent membranes into proven dialyzer configurations could result in certain advantages over dialyzers with conventional membranes. A sorbent membrane dialyzer might prove superior in that it allows a higher clearance in the middle molecule molecular weight range, thereby shortening dialysis time and possibly allowing a reduction in the amount of dialysate fluid required. Finally, this device could be used without dialysate if the technician's goal is to eliminate a single substance readily adsorbed by charcoal. For example, this would apply to the treatment of certain intoxications.

In vitro data were established for six substances in the molecular weight range of 60 to 5200 daltons and compared to corresponding results for conventional Cuprophan dialyzers. Clinical evaluation of sorbent membrane dialyzers for patients with uremia and intoxication, both with and without use of dialysate, has proven effective with no adverse reactions.
Chronic Hemofiltration
Authors: Schaefer Klaus , Herrath Dietrich v. , Gullberg Claes A. , Asmus Gemot , Hüfler Michael , Offermann Gerd , Cremer Heinz , Heuck Claus C. , Ritz Eberhard
Published: July 2010

The experiences which have been compiled in more than 2400 hemofiltrations confirm that this method represents an alternative way of treating uremic patients. The main advantages of chronic hemofiltration are the comfort of the patient and the ease in handling excess overhydration without extending treatment time, which is less than 3 × 3 hours/week if adequate hemofilters are used. With regard to the improvement of such typical uremic complications as severe hypertension, hypertriglyceridemia or neuropathy, hemofiltration does not seem to be superior to hemodialysis. However, since most hemofiltration patients do not require phosphate binders and, additionally, remarkable amounts of parathyroid hormone are removed during one hemofiltration, it appears possible that hemofiltration might be an important therapeutic alternative for those renal patients who suffer from severe hyperphosphatemia and secondary hyperparathyroidism.
Clearance of Meprobamate by Hemoperfusion Over Columns of Charcoal and Amberlite Resin
Authors: Hoy Wendy , Schwab Gary , Freeman Richard B.
Published: July 2010

Perfusion of the blood of a patient with toxic levels of meprobamate through an activated charcoal cartridge resulted in efficient early clearance of the drug, then a decline in extraction. Perfusion through a resin column resulted in total drug extraction without a decline in clearance over four hours. Both procedures were stable with minimal disturbance in hematological values or blood chemistries. This is the first report of in vivo hemoperfusion over resin for meprobamate poisoning. The efficacy and safety of the procedure need emphasis.
Partial Artificial Heart (ALVAD) Use with Subsequent Cardiac and Renal Allografting in a Patient with Stone Heart Syndrome
Authors: Norman John C. , Dacso Clifford C. , Reul George J. , Massin Edward K. , Klima Tomas , Kahan Barry D. , Reiser John T. , Cooley Denton A.
Published: July 2010

The abdominal left ventricular assist device (ALVAD) is an order of magnitude more effective than conventional intra‐aortic balloon pumping (IABP) in unloading and providing circulatory support to the failing left ventricle. This is a report of a unique case which demonstrates that in the absence of pulmonary vascular obstruction or constriction, the ALVAD can substitute for both left and right heart function. A 21‐year‐old patient with a congenital bicuspid aortic valve developed acute valvular endocarditis which rapidly progressed to congestive heart failure. An operation was undertaken, the mitral and aortic valves were excised and replaced by porcine heterografts, and a fistula from the right sinus of Valsalva to the right ventricle was closed. When coronary circulation was restored, irreversible ischemic contracture of the left ventricle, or “stone heart” syndrome, developed and emergency ALVAD or partial artificial heart implantation was effected. This device functioned as a total artificial heart for nearly six days, while a donor heart was sought. The patient then underwent removal of the ALVAD and cardiac and renal allografting. The transplanted heart functioned well, but the patient expired fifteen days later from gram‐negative sepsis.
Mannitol and Maintenance Hernodialysis
Authors: Swamy Alagiri P. , Cestero Rafael V. M.
Published: July 2010

The extensive use of mannitol during maintenance hemodialysis prompted a study of mannitol kinetics. In 17 patients receiving empirical mannitol therapy, residual levels range from 19 to 100 mg%.

In vitro mannitol clearance exceeds 125 ml/min for the CDAK 5 and PF 1.6 dialyzers, while in vivo clearance ranges from 98 to 140 ml/min in the Triex 1, PF 1.6 and CDAK 5. Despite an apparently adequate clearance rate, mannitol administered during dialysis is incompletely removed. Repeated use of mannitol during dialysis leads to mannitol accumulation. Clinical significance of the residual mannitol levels needs further evaluation.
Ultrastructural Characteristics of Dog and Human Platelets Adherent to Native and Collagen‐Coupled Cuprophan
Authors: Lewis Jon C. , Didisheim Paul , Grabowski Eric F. , Mann Kenneth G.
Published: July 2010

Adhesion of human and dog platelets to native and collagen‐coupled Cuprophan under defined flow conditions was studied by scanning and transmission electron microscopy. Dog platelets, singly adherent to and uniformly distributed on both native and collagen‐coupled Cuprophan, extend slender pseudopods across the surface without evidence of degranulation. Human platelets, while not adhering to native Cuprophan, formed irregularly shaped, semi‐confluent cytoplasmic sheets on the collagen‐coupled surface. Extensive cytoplasmic reorganization and degranulation suggests a post‐release state of the human platelets. Aspirin had no apparent effect on either human or dog platelet adhesion or upon the apparent release state of the human platelets.
Initial Experiences with Continuous Ambulatory Peritoneal Dialysis
Authors: Fenton Stanley S. A. , Cattran Daniel C. , Allen Ann‐Frances , Rutledge Paul , Ampil Mercedes , Dadson Joseph , Locking Heather , Smith Susan D. , Wilson Douglas R.
Published: July 2010

Continuous ambulatory peritoneal dialysis (CAPD) has been initiated on 51 patients: 27 females (mean age — 43.9 years) and 24 males (mean age — 46.4 years). This group has been observed for a total of 1420 patient weeks of treatment (27.3 patient years).

Thirty‐six episodes of peritonitis have been noted among 19 patients. The overall incidence was one episode per 39.4 patient weeks. Recurrent episodes of peritonitis resulted in discontinuation of CAPD in five (9.8%) of the patients. Three (5.9%) of the patients were unable to continue with CAPD because of its inability to control extracellular fluid balance.

In the patients who transferred from intermittent peritoneal dialysis to CAPD, there was a 4.5 mg/dl drop in serum creatinine and a 34 mg/dl drop in mean BUN values. There was a rise of approximately 2 gm in the hemoglobin levels of this group of patients. If the problem of peritonitis can be solved, CAPD will become the dialytic treatment of choice for the majority of patients with end‐stage renal disease.
Subcutaneous Peritoneal Catheter: 2½Years Experience
Authors: Kablitz Carl , Kessler Thomas , Dew Pamela A. , Stephen Robert L. , Kolff Willem J.
Published: July 2010

A subcutaneous peritoneal catheter (SCPC) developed at the University of Utah has been used for chronic peritoneal dialysis in this center during the last 2% years. Fifty‐six SCPC's were implanted in 48 patients for a total of 11, 260 days (30.8 patient years). The SCPC's were used for peritoneal dialysis for 7831 days (21.4 patient years) for 3356 peritoneal dialyses, the longest for 778 days (2.1 years). The SCPC remained functioning in ten patients during periods of nonuse, e. g., successful renal transplant, for 1908 days (5.2 patient years). The functional status of the SCPC was unknown in five patients lost to follow‐up for 809 days. Functional outflow obstruction episodes occurred 39 times during peritoneal dialysis (1 per 6.6 patient months); 29 of these episodes were corrected by either bedside maneuvers or minor surgical procedures. Five out of ten SCPC's removed for obstruction were successfully replaced. Twenty‐nine infections occurred (0.80% of peritoneal dialyses), resulting in nine SCPC removals (three successfully replaced). In spite of the necessary insertion of a 14‐g needle for each peritoneal dialysis, the SCPC was well accepted by the patients, mostly because of the reduced care required and the increased personal freedom gained during the interdialytic interval. The long periods of patency during nonuse (up to 397 days) further indicated the possible usefulness of the SCPC as a back‐up device for hemodialysis patients. This could greatly reduce the problems associated with temporary loss of blood access in patients on hemodialysis.