bluuebunny/crossref_metadata_2025 huggingface dataset:
External metallic circle in hepaticojejunostomy
Authors: Göçmen Erdal , Keskek Mehmet , Tez Mesut , Karamürsel Sebat , Koç Mahmut , Kılıç Mehmet
Published: October 2004

Background

Biliary-enteric anastomosis especially Roux-en Y hepaticojejunostomy is frequently used for biliary diversion in benign biliary strictures. In this study, we present the results of hepaticojejunostomy with external metallic circle.

Methods

Hepaticojejunostomy with external metallic circle were performed in eight male Sprague-Dawley rats. At the end of the third month, anastomoses were analysed for patency and stability of external circles.

Results

Relaparotomy revealed that all the anastomoses were patent and circles were in original places.

Conclusion

To provide the patency of narrow hepaticojejunostomy anastomoses, external metallic circle can be a good alternative to use of internal stents in suitable cases.
Community nursing needs more silver surfers: a questionnaire survey of primary care nurses' use of information technology
Authors: Chan Tom , Brew Sarah , de Lusignan Simon
Published: October 2004

Background

In the UK the health service is investing more than ever before in information technology (IT) and primary care nurses will have to work with computers. Information about patients will be almost exclusively held in electronic patient records; and much of the information about best practice is most readily accessible via computer terminals.

Objective

To examine the influence of age and nursing profession on the level of computer use.

Methods

A questionnaire was developed to examine: access, training received, confidence and use of IT. The survey was carried out in a Sussex Primary Care Trust, in the UK.

Results

The questionnaire was sent to 109 nurses with a 64% response rate. Most primary care nurses (89%) use their computer regularly at work: 100% of practice nurses daily, compared with 60% of district nurses and 59% of health visitors (p < 0.01). Access to IT was not significantly different between different age groups; but 91% of practice nurses had their own computer while many district nurses and health visitors had to share (p < 0.01). Nurses over 50 had received more training that their younger colleagues (p < 0.01); yet despite this, they lacked confidence and used computers less (p < 0.001). 96% of practice nurses were confident at in using computerised medical records, compared with 53% of district nurses and 44% of health visitors (p < 0.01.) One-to-one training and workshops were the preferred formats for training, with Internet based learning and printed manuals the least popular (p < 0.001).

Conclusions

Using computers in the surgery has become the norm for primary care nurses. However, nurses over 50, working out in the community, lack the confidence and skill of their younger and practice based colleagues.
Health, human rights and mobilization of resources for health
Authors: Lie Reidar K
Published: October 2004

Background

There has been an increased interest in the role of a human rights framework to mobilize resources for health.

Discussion

This paper argues that the human rights framework does provide us with an appropriate understanding of what values should guide a nation's health policy, and a potentially powerful means of moving the health agenda forward. It also, however, argues that appeals to human rights may not necessarily be effective at mobilizing resources for specific health problems one might want to do something about. Specifically, it is not possible to argue that a particular allocation of scarce health care resources should be changed to a different allocation, benefiting other groups. Lack of access to health care services by some people only shows that something has to be done, but not what should be done.

The somewhat weak claim identified above together with the obligation to realize progressively a right to health can be used to mobilize resources for health.
Tracking of physical activity, fitness, body composition and diet from adolescence to young adulthood: The Young Hearts Project, Northern Ireland
Authors: Boreham Colin , Robson Paula J , Gallagher Alison M , Cran Gordon W , Savage J Maurice , Murray Liam J
Published: October 2004

Background

The assumption that lifestyles formed early in life track into adulthood has been used to justify the targeting of health promotion programmes towards children and adolescents. The aim of the current study was to use data from the Northern Ireland Young Hearts Project to ascertain the extent of tracking, between adolescence and young adulthood, of physical activity, aerobic fitness, selected anthropometric variables, and diet.

Methods

Males (n 245) and females (n 231) were assessed at age 15 y, and again in young adulthood [mean (SD) age 22 (1.6) y]. At both timepoints, height, weight and skinfold thicknesses were measured, and physical activity and diet were assessed by questionnaire and diet history method respectively. At 15y, fitness was assessed using the 20 metre shuttle run, while at young adulthood, the PWC170 cycle ergometer test was used. For each measurement made at 15y, subjects were ranked into 'low' (L1; lowest 25%), 'medium' (M1; middle 50%) or 'high' (H1; highest 25%) categories. At young adulthood, similar categories (L2, M2, H2) were created. The extent of tracking of each variable over time was calculated using 3 × 3 matrices constructed using these two sets of categories, and summarised using kappa (κ) statistics.

Results

Tracking of diet and fitness was poor (κ ≤ 0.20) in both sexes, indicating substantial drift of subjects between the low, medium and high categories over time. The tracking of physical activity in males was fair (κ 0.202), but was poor in females (κ 0.021). In contrast, anthropometric variables such as weight, body mass index and sum of skinfolds tracked more strongly in females (κ 0.540, κ 0.307, κ 0.357 respectively) than in males (κ 0.337, κ 0.199, κ 0.216 respectively).

Conclusions

The poor tracking of fitness and diet in both sexes, and physical activity in females, suggests that these aspects of adolescent lifestyle are unlikely to be predictive of behaviours in young adulthood. In contrast, the fair to moderate tracking of anthropometric variables, particularly in females, suggests that attempts to reduce the ever increasing incidence of overweight and obesity in adults, should probably begin in earlier life.
Risk Adjustment and Outcome Measures for Out‐of‐hospital Respiratory Distress
Authors: Keim Samuel M. , Spaite Daniel W. , Maio Ronald F. , Garrison Herbert G. , Desmond Jeffrey S. , Gregor Mary Ann , O'Malley Patricia J. , Stiell Ian G. , Cayten C. Gene , Chew John L. , MacKenzie Ellen J. , Miller David R.
Published: October 2004

The purpose of the Emergency Medical Services Outcomes Project (EMSOP) is to develop a foundation and framework for out‐of‐hospital outcomes research. In prior work, this group delineated the priority conditions, described conceptual models, suggested core and risk adjustment measures potentially useful to emergency medical services research, and summarized out‐of‐hospital pain measurement. In this fifth article in the EMSOP series, the authors recommend specific risk‐adjustment measures and outcome measures for use in out‐of‐hospital research on patients presenting with respiratory distress. The methodology included systematic literature searches and a structured review by an expert panel. The EMSOP group recommends use of pulse oximetry, peak expiratory flow rate, and the visual analog dyspnea scale as potential risk‐adjustment measures and outcome measures for out‐of‐hospital research in patients with respiratory distress. Furthermore, using mortality as an outcome measure is also recommended. Future research is needed to alleviate the paucity of validated tools for out‐of‐hospital outcomes research.
Cause‐and‐effect Analysis of Risk Management Files to Assess Patient Care in the Emergency Department
Authors: White Andrew A. , Wright Seth W. , Blanco Roberto , Lemonds Brent , Sisco Janice , Bledsoe Sandy , Irwin Cindy , Isenhour Jennifer , Pichert James W.
Published: October 2004

Objectives: Identifying the etiologies of adverse outcomes is an important first step in improving patient safety and reducing malpractice risks. However, relatively little is known about the causes of emergency department–related adverse outcomes. The objective was to describe a method for identification of common causes of adverse outcomes in an emergency department. This methodology potentially can suggest ways to improve care and might provide a model for identification of factors associated with adverse outcomes. Methods: This was a retrospective analysis of 74 consecutive files opened by a malpractice insurer between 1995 and 2000. Each risk‐management file was analyzed to identify potential causes of adverse outcomes. The main outcomes were rater‐assigned codes for alleged problems with care (e.g., failures of communication or problems related to diagnosis). Results: About 50% of cases were related to injuries or abdominal complaints. A contributing cause was found in 92% of cases, and most had more than one contributing cause. The most frequent contributing categories included failure to diagnose (45%), supervision problems (31%), communication problems (30%), patient behavior (24%), administrative problems (20%), and documentation (20%). Specific relating factors within these categories, such as lack of timely resident supervision and failure to follow policies and procedures, were identified. Conclusions: This project documented that an aggregate analysis of risk‐management files has the potential to identify shared causes related to real or perceived adverse outcomes. Several potentially correctable systems problems were identified using this methodology. These simple, descriptive management tools may be useful in identifying issues for problem solving and can be easily learned by physicians and managers.
Teaching Techniques in the Clinical Setting: the Emergency Medicine Perspective
Authors: Wald David A.
Published: October 2004

The emergency department (ED) provides a unique educational experience that is distinct from both inpatient and ambulatory care settings. Because of the high acuity, interesting pathology, and rapid patient turnover, the ED is an ideal location to train medical students. Numerous teaching opportunities exist within the domain of the ED. In the preclinical years, the ED setting provides medical students with an introduction to clinical medicine and may serve as a venue for teaching basic history and physical examination skills. In the clinical years, medical students are exposed to a wide range of undifferentiated patients. Besides common medical and surgical complaints, many medical students will encounter clinical scenarios that they otherwise would have little direct contact with. Encounters such as the acutely poisoned or intoxicated patient, environmental emergencies, interaction with out‐of‐hospital providers, and patients requiring emergency procedures are just a few situations that make emergency medicine a distinct clinical specialty. These and other student–patient encounters can provide the teaching physician an opportunity to focus case‐based teaching on a number of elements including complaint‐directed medical interviewing and physical examination skills, development of case‐specific differential diagnosis, diagnostic evaluation, implementation of patient management plans, and patient disposition. In this review article, the authors discuss various ways to approach and improve clinical teaching of medical students, including: opportunities for teaching in the ED, teaching procedural skills, student case presentations, clinical teaching styles, qualities of an effective clinical teacher, and barriers to effective clinical teaching.
Regulation of p27 by S-Phase Kinase-Associated Protein 2 Is Associated With Aggressiveness in Non–Small-Cell Lung Cancer
Authors: Osoegawa Atsushi , Yoshino Ichiro , Tanaka Shinji , Sugio Kenji , Kameyama Toshifumi , Yamaguchi Masafumi , Maehara Yoshihiko
Published: October 2004

Purpose

The F-box protein S-phase kinase-associated protein 2 (Skp2) is one of the positive regulators of the cell cycle that promote ubiquitin-mediated proteolysis of the cyclin-dependent kinase inhibitor p27. In this study, we investigated the significance of Skp2 expression in human non–small-cell lung cancer (NSCLC).

Patients and Methods

Clinicopathologic features and immunohistochemical expression of Skp2 and p27 proteins were studied in 138 patients with NSCLC. Survival analyses were performed using the Kaplan-Meier method and the Cox regression model. To analyze the role of Skp2 in vitro, NSCLC cells were transfected with an Skp2-expressing vector or small interfering RNA.

Results

Skp2 was overexpressed in males, smokers, patients with squamous cell carcinomas, and patients with poorly differentiated cancers (P = .034, < .0001, < .0001, and .002, respectively). The multivariant analysis revealed that Skp2 expression is an independent prognostic factor for survival in NSCLC. An inverse relationship of Skp2 with p27 expression was observed (P = .012), and patients with both a higher expression of Skp2 and a lower expression of p27 showed a significantly unfavorable prognosis (P = .0002). In vitro ectopic expression of Skp2 in NSCLC cells reduced the protein level of p27. Conversely, induction of Skp2 siRNA increased the protein level of p27, leading to growth inhibition in NSCLC cells.

Conclusion

Skp2 overexpression is closely associated with the suppression of p27 and the aggressiveness in NSCLC. It also could be a therapeutic target in NSCLC.
Web-Based Survey of Fertility Issues in Young Women With Breast Cancer
Authors: Partridge Ann H. , Gelber Shari , Peppercorn Jeffrey , Sampson Ebonie , Knudsen Katherine , Laufer Marc , Rosenberg Randi , Przypyszny Michele , Rein Alison , Winer Eric P.
Published: October 2004

Purpose

Young women with breast cancer often seek advice about whether treatment will affect their fertility. We sought to gain a better understanding of women’s attitudes about fertility and how these concerns affect decision making.

Patients and Methods

We developed a survey about fertility issues for young women with a history of early-stage breast cancer. The survey was e-mailed to all registered Young Survival Coalition survivor members (N = 1,702). E-mail reminders were used.

Results

Six hundred fifty-seven eligible respondents completed the survey. Mean age at breast cancer diagnosis was 32.9 years; mean current age was 35.8 years. Ninety percent of women were white; 62% were married; 76% were college graduates. Stages at diagnosis were as follows: 0, 10%; I, 27%; II, 47%; III, 13%. Sixty-two percent of women were within 2 years of diagnosis. Fifty-seven percent recalled substantial concern at diagnosis about becoming infertile with treatment. In multivariate logistic regression, greater concern about infertility was associated with wish for children/more children (odds ratio [OR], 120; P < .0001), number of prior pregnancies (OR, 0.78; P = .01), and prior difficulty conceiving (OR, 1.86; P = .08). Twenty-nine percent of women reported that infertility concerns influenced treatment decisions. Seventy-two percent of women reported discussing fertility concerns with their doctors; 51% felt their concerns were addressed adequately. Women seemed to overestimate their risk of becoming postmenopausal with treatment.

Conclusion

Fertility after treatment is a major concern for young women with breast cancer. There is a need to communicate with and educate young patients regarding fertility issues at diagnosis and a need for future research directed at preserving fertility for young breast cancer survivors.
Long-Term Follow-Up for Locally Advanced and Inflammatory Breast Cancer Patients Treated With Multimodality Therapy
Authors: Low Jennifer A. , Berman Arlene W. , Steinberg Seth M. , Danforth David N. , Lippman Marc E. , Swain Sandra M.
Published: October 2004

Purpose

To determine long-term event-free (EFS) and overall survival (OS) for patients with stage III breast cancer treated with combined-modality therapy.

Patients and Methods

Between 1980 and 1988, 107 patients with stage III breast cancer were prospectively enrolled for study at the National Cancer Institute and stratified by whether or not they had features of inflammatory breast cancer (IBC). Patients were treated to best response with cyclophosphamide, doxorubicin, methotrexate, fluorouracil, leucovorin, and hormonal synchronization with conjugated estrogens and tamoxifen. Patients with pathologic complete response received definitive radiotherapy to the breast and axilla, whereas patients with residual disease underwent mastectomy, lymph node dissection, and radiotherapy. All patients underwent six additional cycles of adjuvant chemotherapy.

Results

OS and EFS were obtained with a median live patient follow-up time of 16.8 years. The 46 IBC patients had a median OS of 3.8 years and EFS of 2.3 years, compared with 12.2 and 9.0 years, respectively, in stage IIIA breast cancer patients. Fifteen-year OS survival was 20% for IBC versus 50% for stage IIIA patients and 23% for stage IIIB non-IBC. Pathologic response was not associated with improved survival for stage IIIA or IBC patients. Presence of dermal lymphatic invasion did not change the probability of survival in clinical IBC patients.

Conclusion

Fifteen-year follow-up of stage IIIA and inflammatory breast cancer is rarely reported; IBC patients have a poor long-term outlook.
Response to Paclitaxel, Topotecan, and Topotecan-Cyclophosphamide in Children With Untreated Disseminated Neuroblastoma Treated in an Upfront Phase II Investigational Window: A Pediatric Oncology Group Study
Authors: Kretschmar Cynthia S. , Kletzel Morris , Murray Kevin , Thorner Paul , Joshi Vijay , Marcus Robert , Smith E. Ide , London Wendy B. , Castleberry Robert
Published: October 2004

Purpose

Most children older than 1 year of age with metastatic neuroblastoma (NB) die despite intensive chemotherapy and bone marrow transplantation. The Pediatric Oncology Group conducted a study of paclitaxel, topotecan, and topotecan-cyclophosphamide (topo-cyclo) in newly diagnosed children with stage IV NB.

Patients and Methods

There were 102 patients enrolled between September 1993 and October 1995; two of them were later shown to be ineligible. Of the remaining 100 patients, the first cohort of 33 patients received paclitaxel 350 mg/m2 intravenously (IV) over 24 hours every 14 to 21 days; the next 33 patients received topotecan 2 mg/m2/d for 5 days IV every 21 days; a third cohort of 34 patients were treated with IV cyclophosphamide 250 mg/m2 followed by topotecan 0.75 mg/m2 each day for 5 days every 21 days. Patients were re-evaluated after two courses and then treated with intensive induction therapy and bone marrow transplantation.

Results

Objective responses (complete response + partial response + mixed response) were documented in 67% of children who received topotecan, 76% after topo-cyclo, and 25% after paclitaxel. Four patients had grade 3 to 4 allergic reactions to paclitaxel; most patients developed grade 3 to 4 marrow suppression after topotecan or topo-cyclo. Neither disease-free survival nor overall survival differed significantly between children who received a phase II agent and those who did not. The 6-year disease-free survival and overall survival rates for all 100 children were 18% ± 5% and 26% ± 5%, respectively.

Conclusion

Topotecan and topo-cyclo are active in children with NB, are well tolerated, and should be evaluated further in combination regimens.
Racial/Ethnic Differences in Functional Outcomes in the 5 Years After Diagnosis of Localized Prostate Cancer
Authors: Johnson Terri Kang , Gilliland Frank D. , Hoffman Richard M. , Deapen Dennis , Penson David F. , Stanford Janet L. , Albertsen Peter C. , Hamilton Ann S.
Published: October 2004

Purpose

We investigated racial/ethnic differences in functional outcomes up to 5 years after diagnosis among men with aggressively treated localized prostate cancer.

Patients and Methods

Patients were from the Prostate Cancer Outcomes Study, a population-based cohort study that surveyed patients at 6, 12, 24, and 60 months after diagnosis. Analyses were stratified by primary treatment. Racial/ethnic differences at each time point were assessed using Generalized Estimating Equations, adjusting for pretreatment function, age at diagnosis, secondary treatment, and other confounders. An adjusted summary score for each functional domain was calculated for each time period.

Results

Patients included 1,475 non-Hispanic white, 321 African-American, and 279 Hispanic prostate cancer patients. After 60 months, among prostatectomy patients, African-Americans had significantly higher sexual function scores than non-Hispanic whites (43.9 v 36.1; P = .02), but were more likely to have a moderate to big problem with sexual function (50.6% v 44.4%; P = .04). African-Americans also had higher urinary function scores at 5 years than non-Hispanic whites (78.5 v 72.4; P = .04) and were less likely to have problems with incontinence. Changes in sexual and bowel function after radiotherapy showed no significant racial/ethnic differences.

Conclusion

This long-term cohort study found that, among prostatectomy patients, African-Americans had better recovery of sexual and urinary function at 60 months after diagnosis that was likely to be of mild clinical significance, despite reporting more problems with sexual function than non-Hispanic whites. More study is necessary to understand reasons for these differences. In contrast, no racial/ethnic differences in recovery from radiotherapy were found.
Circulating Deoxyribonucleic Acid As Prognostic Marker in Non–Small-Cell Lung Cancer Patients Undergoing Chemotherapy
Authors: Gautschi Oliver , Bigosch Colette , Huegli Barbara , Jermann Monika , Marx Arthur , Chassé Eveline , Ratschiller Daniel , Weder Walter , Joerger Markus , Betticher Daniel C. , Stahel Rolf A. , Ziegler Annemarie
Published: October 2004

Purpose

Circulating cell-free DNA is present in increased amounts in the blood of cancer patients, but the clinical relevance of this phenomenon remains unclear. We conducted a clinical study to assess the value of circulating DNA as a prognostic marker in patients with non–small-cell lung cancer (NSCLC).

Patients and Methods

A standard protocol for the quantification of circulating DNA by real-time polymerase chain reaction was set up and validated at two oncology units. One hundred eighty-five informed patients with NSCLC and 46 healthy controls were included in the study. DNA concentrations were determined in paired plasma and serum samples and analyzed for a relationship with leukocyte counts and lactate dehydrogenase (LDH) levels. DNA concentrations in healthy controls and in patients were compared, and cutoff levels for plasma and serum DNA were determined. Patient survival was analyzed relative to baseline DNA concentrations, and the relationship between tumor responses and changes in DNA concentrations was assessed in patients receiving chemotherapy.

Results

We found a significant correlation between increased plasma DNA concentrations and elevated LDH levels (P = .009), advanced tumor stage (P < .003), and poor survival (P < .001). Tumor progression after chemotherapy was significantly (P = .006) associated with increasing plasma DNA concentrations. Serum DNA concentrations strongly correlated (P < .001) with leukocyte counts.

Conclusion

Our data demonstrate that quantification of plasma DNA is an accurate technique amenable to standardization, which might complement current methods for the prediction of patient survival. This approach might be considered for evaluation in large prospective studies.
Immediate Versus Deferred Hormonal Treatment for Patients With Prostate Cancer Who Are Not Suitable for Curative Local Treatment: Results of the Randomized Trial SAKK 08/88
Authors: Studer Urs E. , Hauri Dieter , Hanselmann Silvia , Chollet Dominique , Leisinger Hans-Jürg , Gasser Thomas , Senn Edgar , Trinkler Felix B. , Tscholl Reto M. , Thalmann George N. , Dietrich Daniel
Published: October 2004

Purpose

To determine if immediate hormonal therapy is advantageous compared with deferred treatment in newly diagnosed asymptomatic prostate cancer patients who, for any reason, were not candidates for curative local treatment.

Patients and Methods

Between February 1988 and February 1992, 197 patients with a median age of 76 years (range, 56 to 86 years) were randomly assigned to receive either immediate or deferred orchiectomy on symptomatic progression. The two groups did not differ significantly in clinical or laboratory parameters; 67% had T3-4 tumors and 20% had lymph node metastases. Patient accrual was stopped prematurely because of a similar competing trial. Therefore, observation time was prolonged to achieve the desired number of events and statistical power.

Results

Deferred orchiectomy was necessary in 58% of the patients. Median time to disease progression was 2.8 years less than for patients with immediate orchiectomy. However, overall pain-free time from random assignment to symptomatic progression after immediate or deferred orchiectomy, and performance status, were identical in both groups. Cancer-specific survival tended to be longer in the immediate group (P = .09) but there was no difference in overall survival between the two groups (P = .96). The median hemoglobin value decreased significantly after immediate orchiectomy (P < .001).

Conclusion

For elderly, asymptomatic patients not undergoing curative local treatment, we were unable to show any major advantage of immediate compared with deferred hormonal treatment regarding quality of life or overall survival in our limited number of patients. Disabling complications were prevented in the deferred-treatment arm by careful follow-up; 42% of these patients never required any tumor-specific treatment.
The C-terminal domain LLKIL motif of CXCR2 is required for ligand-mediated polarization of early signals during chemotaxis
Authors: Sai Jiqing , Fan Guo-Huang , Wang Dingzhi , Richmond Ann
Published: October 2004

HEK293 cells expressing wild-type CXCR2 recruit PH-Akt-GFP to the leading edge of the cell in response to chemokine. However, in cells expressing mutant CXCR2 defective in AP-2 and HIP binding, i.e. with a mutation in the LLKIL motif, PH-Akt-GFP does not localize to the leading edge in response to ligand. Inhibition of Akt/PKB by transfection of HEK 293 cells with a dominant negative (kinase defective) Akt/PKB inhibits CXCR2 mediated chemotaxis. FRET analysis reveals that membrane-bound activated Cdc42 and Rac1 localize to the leading edge of cells expressing wild-type CXCR2 receptor, but not in cells expressing mutant CXCR2. By contrast, when the activation of Cdc42 and Rac1 are monitored by affinity precipitation assay, cells expressing either wild-type or LLKIL mutant receptors show equivalent ligand induction. Altogether, these data suggest that restricted localized activation of Akt/PKB, Rac1 and Cdc42 is crucial for chemotactic responses and that events mediated by the LLKIL motif are crucial for chemotaxis.
Elongation of centriolar microtubule triplets contributes to the formation of the mitotic spindle in γ-tubulin-depleted cells
Authors: Raynaud-Messina Brigitte , Mazzolini Laurent , Moisand André , Cirinesi Anne-Marie , Wright Michel
Published: October 2004

The assembly of the mitotic spindle after depletion of the major γ-tubulin isotype by RNA-mediated interference was assessed in the Drosophila S2 cell line. Depletion of γ-tubulin had no significant effect on the cytoskeletal microtubules during interphase. However, it promoted an increase in the mitotic index, resulting mainly in monopolar and, to a lesser extent, asymmetrical bipolar prometaphases lacking astral microtubules. This mitotic accumulation coincided with the activation of the mitotic checkpoint. Immunostaining with an anti-Asp antibody revealed that the spindle poles, which were always devoid of γ-tubulin, were unfocused and organized into sub-spindles. Despite the marked depletion of γ-tubulin, the pericentriolar proteins CP190 and centrosomin were recruited to the spindle pole(s), where they formed three or four dots, suggesting the presence of several centrioles. Electron microscopic reconstructions demonstrated that most of the monopolar spindles exhibited three or four centrioles, indicating centriole duplication with a failure in the separation process. Most of the centrioles were shortened, suggesting a role for γ-tubulin in centriole morphogenesis. Moreover, in contrast to metaphases observed in control cells, in which the spindle microtubules radiated from the pericentriolar material, in γ-tubulin-depleted cells, microtubule assembly still occurred at the poles but involved the elongation of centriolar microtubule triplets. Our results demonstrate that, after depletion of γ-tubulin, the pericentriolar material is unable to promote efficient microtubule nucleation. They point to an alternative mechanism of centrosomal microtubule assembly that contributes to the formation of abnormal, albeit partially functional, mitotic spindles.
Jump Bidding Strategies in Internet Auctions
Authors: Easley Robert F. , Tenorio Rafael
Published: October 2004

Abidding strategy commonly observed in Internet auctions is that of “jump bidding,” or entering a bid larger than what is necessary to be a currently winning bidder. In this paper, we argue that the cost associated with entering online bids and the uncertainty about future entry—both of which distinguish Internet from live auctions—can explain this behavior. We present a simple theoretical model that includes the preceding characteristics, and derive the conditions under which jump bidding arises in a format commonly used for online trading, the ascending-price auction. We also present evidence, recorded from hundreds of Internet auctions, that is consistent with some of the basic predictions from our model. We find that jump bidding is more likely earlier in an auction, when jumping has a larger strategic value, and that the incentives to jump bid increase as competition increases. Our results also indicate that jump bidding is effective: Jump bidders place fewer bids overall, and increased early jump bidding deters entry later in the auction. We also discuss possible means of reducing bidding costs and evidence that Internet auctioneers are pursuing this goal.
Single High-Dose Rectal Acetaminophen in Children
Authors: Varela Marie L , Howland Mary Ann
Published: October 2004

OBJECTIVE

To determine whether there is sufficient evidence to support the use of one-time high-dose (>30 mg/kg) rectally administered acetaminophen to control postoperative pain in children.

DATA SOURCES

Literature was accessed through MEDLINE (1966–May 2004) and bibliographic searches.

STUDY SELECTION AND DATA EXTRACTION

All articles identified from the data sources were evaluated and all studies regarding the use of greater than 30 mg/kg of acetaminophen in children were included for this review.

DATA SYNTHESIS

A single high dose of rectally administered acetaminophen has been used in children to control postoperative pain. Ten randomized controlled trials and pharmacokinetic studies evaluating the use of greater than 30 mg/kg of rectally administered acetaminophen in children were identified and reviewed. Each study had a unique objective. The studies also differed substantially in regard to design, study population, dosing, rectal formulation used, and monitoring.

CONCLUSIONS

Due to limited study data, wide study variability, and lack of standardization in terms of design, objectives, study population, dosing, rectal formulation, and monitoring, compounded by the fact that children often require additional doses of acetaminophen to control postoperative pain, the practice of using one-time, high-dose, rectally administered acetaminophen in children cannot be recommended at this time.
Patient and Physician Attitudes to Using Medications with Religiously Forbidden Ingredients
Authors: Sattar S Pirzada , Ahmed Mohammed Shakeel , Madison James , Olsen Denise R , Bhatia Subhash C , Ellahi Shahid , Majeed Farhan , Ramaswamy Sriram , Petty Frederick , Wilson Daniel R
Published: October 2004

BACKGROUND

Over 1000 medications contain pork- and/or beef-derived gelatin and stearic acid as inert ingredients. Use of these medications in patients with religious beliefs against consumption of these ingredients might constitute an ethical conflict.

OBJECTIVE

To assess patients’ and physicians’ attitudes about using medications with religiously prohibited ingredients derived from pork and/or beef.

METHODS

In this pilot study, 100 patients and 100 physicians completed a survey designed to assess their knowledge and opinion on using medications that might contain inert ingredients derived from animals whose consumption offends followers of certain religions.

RESULTS

Of the 100 patients surveyed, most (84%) reported that they were not aware that several medications contained ingredients derived from pork and/or beef. About 63% of the patients wanted their physicians, and 35% of the patients wanted their non-physician healthcare providers (pharmacists, nurses), to inform them when using such medications. Thirteen percent of the patients shared religious reasons for not consuming pork and/or beef products. Approximately 70% of physicians were unaware that several medications contain ingredients that might be against their patients’ religion, and most (70%) thought that it was important to inform their patients if such drugs were prescribed.

CONCLUSIONS

This pilot study suggests that both patients and physicians think that patients should be informed whenever medications that contain pork- and/or beef-derived products are prescribed. The use of medications with these ingredients is an ethical issue. Informing patients about this issue promotes respect for their religious beliefs and may promote therapeutic alliance; therefore, this might have public health implications and needs further research.
Development, Implementation, and Evaluation of a Community Pharmacy–Based Asthma Care Model
Authors: Saini Bandana , Krass Ines , Armour Carol
Published: October 2004

BACKGROUND

Pharmacists are uniquely placed in the healthcare system to address critical issues in asthma management in the community. Various programs have shown the benefits of a pharmacist-led asthma care program; however, no such programs have previously been evaluated in Australia.

OBJECTIVE

To measure the impact of a specialized asthma service provided through community pharmacies in terms of objective patient clinical, humanistic, and economic outcomes.

METHODS

A parallel controlled design, where 52 intervention patients and 50 control patients with asthma were recruited in 2 distinct locations, was used. In the intervention area, pharmacists were trained and delivered an asthma care model, with 3 follow-up visits over 6 months. This model was evaluated based on clinical, humanistic, and economic outcomes compared between and within groups.

RESULTS

There was a significant reduction in asthma severity in the intervention group, 2.6 ± 0.5 to 1.6 ± 0.7 (mean ± SD; p < 0.001) versus the control group, 2.3 ± 0.7 to 2.4 ± 0.5. In the intervention group, peak flow indices improved from 82.7% ± 8.2% at baseline to 87.4% ± 8.9% (p < 0.001) at the final visit, and there was a significant reduction in the defined daily dose of albuterol used by patients, from 374.8 ± 314.8 μg at baseline to 198.4 ± 196.9 μg at the final visit (p < 0.015). There was also a statistically significant improvement in perceived control of asthma and asthma-related knowledge scores in the intervention group compared with the control group between baseline and the final visit. Annual savings of $132.84(AU) in medication costs per patient and $100,801.20 for the whole group, based on overall severity reduction, were demonstrated.

CONCLUSIONS

Based on the results of this study, it appears that a specialized asthma care model offers community pharmacists an opportunity to contribute toward improving asthma management in the Australian community.
Serum Amyloid A (SAA): a Concise Review of Biology, Assay Methods and Clinical Usefulness
Authors: Yamada Toshiyuki
Published: October 2004

Serum amyloid A (SAA) is a family of proteins encoded in a multigene complex. Acute phase isotypes SAA1 and SAA2 are synthesized in response to inflammatory cytokines. SAA and C-reactive protein (CRP) are now the most sensitive indicators for assessing inflammatory activity. In viral infection and kidney allograft rejection, SAA proved more useful than CRP. Development of convenient assay methods for SAA will facilitate its use in clinical laboratories.
Serum Cystatin C as an Endogenous Marker of the Renal Function – a Review
Authors: Randers Else , Erlandsen Erland J.
Published: October 2004

Since 1985, cystatin C has been suggested to be a marker of the renal function. Cystatin C is a proteinase inhibitor with a low molecular weight (Mr= 13359) . It is produced at a constant rate in all nucleated cells investigated to date, freely filtered in the renal glomeruli and reabsorbed and catabolised in the proximal tubules. The concentration of serum cystatin C is mainly determined by glomerular filtration, which makes cystatin C an endogenous marker of glomerular filtration rate (GFR). There are few data describing the influence of various factors on the production and elimination of cystatin C. Fully automated assays using particle-enhanced turbidimetry or particle-enhanced nephelometry are available and the assays are precise, rapid and usable in clinical routine practice. Reference intervals have been determined for cystatin C in adults and in children older than one year. It has been suggested that the same reference interval can be used in children older than one year and in adults without gender differences, on the assumption that the same method with the same standardisation is used. Several studies including adults and children with different renal diseases with various kidney function have suggested serum cystatin C to be a better marker of GFR than serum creatinine.
The Influence of Radiation and Chemotherapy-Related DNA Strand Breaks on Carcinogenesis: An Evaluation
Authors: Froelich Jens J. , Schneller Folker R. G. , Zahn Rudolf K.
Published: October 2004

Purpose: DNA strand breaks are believed to induce carcinogenesis. This study was conducted to analyze induction and repair of irradiation- and chemotherapy-related strand breaks in vitro.

Methods: Friend Leukemia cells were exposed to irradiation and various chemotherapeutic agents at different doses and concentrations. Occurence of strand breaks was determined fluorometrically, measuring the rate of DNA unwinding immediatly after exposure and 24 hours later.

Results: The amount of double-stranded DNA decreased significantly for irradiation, doxorubicin, dactinomycin and etoposide (p ≤ 0.05, t-test). After 24 hours free of exposure, the persistent damage was detectable for all of these agents but not for irradiated cells, with DNA strand breaks being decreased for etoposide, unchanged for doxorubicin and increased for methotrexate as well as for dactinomycin.

Conclusions: Severe DNA damage is induced by various chemotherapeutic agents and by irradiation. While repair of chemotherapy-related strand breaks may remain incomplete or prolonged for some chemotherapeutic agents, repair of radiation induced strand breaks is faster and more complete. Therefore chemotherapy-related carcinogenesis may partially be explained by prolonged persistence of DNA strand breaks.
Endothelin-1- and Endothelin-Receptors in Lung Biopsies of Patients with Pulmonary Hypertension due to Congenital Heart Disease
Authors: Lutz Jens , Gorenflo Matthias , Habighorst Matthias , Vogel Martin , Lange Peter E. , Hocher Berthold
Published: October 2004

Endothelin-1 (ET-1), with its vasoconstrictive and proliferation-stimulating effects, could play a role in the pathogenesis of primary pulmonary hypertension. We investigated the relationship between the ET-1 like immunoreactivity and the ET-receptor density, the grade of the pulmonary vasculopathy, and properties of the pulmonary circulation in patients with pulmonary hypertension due to congenital heart disease.

Twenty-six patients with a median age of 1 year and 1 month (6 weeks–17 years–9 months) were assigned to group I (n = 15) with a pulmonary to systemic flow ratio (Qp/Qs) ≥ 1.5 and a pulmonary to systemic resistance ratio (Rp/Rs) ≤ 0.3 (“high flow–low resistance group”) and to group II (n = 11) with a Qp/Qs < 1.5 and an Rp/Rs > 0.3 (“low flow–high resistance group”).

Patients belonging to group II showed a higher ETA-receptor density in lung arteries (p < 0.05) and parenchyma (p < 0.01) than patients in group I. Patients with the highest ET-1 like immunoreactivity in lung artery walls also showed a trend towards a higher ETA-receptor density. The ETB-receptor expression was low and not related to any of the above factors.

Our results suggest that the paracrine lung ET-1 system is up-regulated in pediatric patients with secondary pulmonary hypertension associated with congenital heart disease.
Biomarkers of Bone Turnover and Bone Mineral Density in Hyperprolactinemic Amenorrheic Women
Authors: Shaarawy Mohamed , El-Dawakhly Abdel-Salam , Mosaad Medhat , El-Sadek Mostafa Mohamed
Published: October 2004

We tested the hypothesis that biomarkers of bone resorption are increased in hyperprolactinemic amenorrheic patients with estrogen (E) deficiency, augmenting the possible risk of developing osteoporosis. Fifty hyperprolactinemic patients with amenorrhea of more than 12 months and with low serum E2, as well as 30 healthy fertile women (controls), matched for age and body mass index, participated in this study. Bromocriptine was administered orally to hyperprolactinemic patients and blood and urine samples were collected before and 12 weeks after treatment. Serum osteocalcin (OC) and bone-specific alkaline phosphatase (B-ALP), reflecting bone formation, and urinary deoxypridinoline (D-Pyr) and N-telopeptide of type 1 collagen (NTX) excretion, reflecting bone resorption, were measured using direct immunoassays. Hyperprolactinemic patients had higher (p < 0.0005) levels of all the biomarkers compared to control values: (OC, 22 ± 1.2 [SE] vs. 14 ± 0.99 ng/ml (+57 %); B-ALP, 14.2 ± 0.7 vs. 7.5 ± 0.8 ng/ml (+89 %); D-Pyr, 8.8 ± 0.6 vs. 3.2 ± 0.3 nmol/mmol creatinine (+175 %) and NTX, 65 ± 5.1 vs. 25 ± 3.2 nmol bone collagen equivalent (BCE)/mmol creatinine (+160 %)). These results were associated with significantly decreased lumbar spine bone mineral density (LS-BMD), measured by dual energy X-ray absorptiometry (DEXA). Treatment of hyperprolactinemia with bromocriptine restored normal values of bone formation and resorption markers. In conclusion, hyperprolactinemia with estrogen deficiency exhibits a significant increase of bone resorption which is associated with a significant decrease of LS-BMD. These changes may subject the patient to the possible risk of developing osteoporosis.
Serum Ionized Magnesium: Comparison of Results Obtained with Three Ion-Selective Analyzers
Authors: Huijgen Henk J. , Sanders Renata , Cecco Stacey A. , Rehak Nadja N. , Sanders Gerard T. , Elin Ronald J.
Published: October 2004

In a two-center (Academic Medical Center, The Netherlands, and National Institutes of Health, USA) study, we compared ionized magnesium (iMg2+) results in serum determined with the AVL 988/4, KONE Microlyte 6 and NOVA CRT, which are the currently available analyzers equipped with a magnesium ion-selective electrode. The comparison was performed with frozen serum samples from normal individuals and patients. Imprecision and reference intervals were established. We found the best agreement between the KONE(x) and AVL(y) magnesium ion-selective electrodes (y = 0.972x−0.013; n = 138) with samples from patients. With samples from normals, all three analyzers reported significantly different results (p < 0.05). Best precision was found using the NOVA; coefficients of variation established at three levels were all < 4.0%. Coefficients of variation for the AVL and KONE were < 5% at normal and high iMg2+, but 10.7 and 9.4%, respectively, at iMg2+ ≈ 0.30 mmol/l. The reference intervals (mean ± standard deviation) based on measurements in fresh serum samples were different for each analyzer: 0.55–0.63 mmol/l for AVL, 0.470.57 mmol/l for KONE and 0.43–0.55 mmol/l for NOVA. Thus, significant differences among the ionized magnesium concentration obtained with the three analyzers, limit comparison of results in clinical practice, and need to be resolved (e.g. by improvement of specificity and standardization of calibrators).
Recent Activities of EC4 in the Harmonization of Clinical Chemistry in the European Union
Authors: Sanders Gerard T. , Jansen Rob T. , Beastall Graham , Gurr Eberhard , Kenny Desmond , Kohse Klaus P. , Zérah Simone
Published: October 2004

This article describes the recent activities of the European Communities Confederation of Clinical Chemistry (EC4). Main goal of EC4 is harmonization of clinical chemistry in the European Union and Europe. EC4's actions connected to that are training and registration of professionals, and accreditation of laboratories. The 35000 professionals practising clinical chemistry in the EU have different backgrounds (medical, pharmaceutical, science-oriented, veterinary, or microbiological). Thus, for the harmonization of training of clinical chemists, EC4 has published a European Syllabus for Postgraduate Training, and instituted a European Union Register for Clinical Chemists. The Syllabus is an indication of the level of requirements in postgraduate training. The EC4 initiative to implement the European Register for Clinical Chemists is based on the 8 years vocational training necessary to obtain sufficient knowledge in clinical chemistry according to the European Syllabus. A guide to the EC4 Register has been published; registration leads to the title European Clinical Chemist (EurClinChem). The accreditation of laboratories must be based on a total quality management system. EC4 has described guidelines (essential criteria) which it judges appropriate for establishing the quality of medical laboratory service; it does not wish to fulfil the role of an accrediting body. Moreover, a working group has been set up to seek to harmonize the work of national accrediting bodies. Therefore, it is logical that EC4 monitors the activities of the different standardizing bodies that might influence the practice of clinical chemistry in the EU. Finally, some aspects concerning the future strategy of EC4 are brought forward.
Inflammation, the Acute Phase Response and Atherosclerosis
Authors: Whicher John , Biasucci Luigi , Rifai Nader
Published: October 2004

There is increasing evidence that atherosclerosis is a chronic inflammatory disorder resulting from a combination of processes, and that acute exacerbations of this inflammation are associated with the acute coronary syndromes such as myocardial infarction and unstable angina. Measurement of the serum level of acute phase proteins, such as C-reactive protein and serum amyloid A protein, has been used to predict the risk of acute events in patients with atherosclerosis. Prospective studies have shown that higher serum acute phase protein levels, often within the reference range, are associated with increased risk of myocardial infarction (MI), stroke or peripheral vascular disease and predict risk of infarction and death among high-risk patients. These observations have important implications for the assessment of patients and for treatment.