bluuebunny/crossref_metadata_2025 huggingface dataset:
Chromosome structural changes in diploid and tetraploid A genomes ofGossypium
Authors: Desai Aparna , Chee Peng W , Rong Junkang , May O Lloyd , Paterson Andrew H
Published: May 2006

The genus Gossypium, which comprises a divergent group of diploid species and several recently formed allotetraploids, offers an excellent opportunity to study polyploid genome evolution. In this study, chromosome structural variation among the A, At, and D genomes of Gossypium was evaluated by comparative genetic linkage mapping. We constructed a fully resolved RFLP linkage map for the diploid A genome consisting of 275 loci using an F2interspecific Gossypium arboreum × Gossypium herbaceum family. The 13 chromosomes of the A genome are represented by 12 large linkage groups in our map, reflecting an expected interchromosomal translocation between G. arboreum and G. herbaceum. The A-genome chromosomes are largely collinear with the D genomes, save for a few small inversions. Although the 2 diploid mapping parents represent the closest living relatives of the allotetraploid At-genome progenitor, 2 translocations and 7 inversions were observed between the A and Atgenomes. The recombination rates are similar between the 2 diploid genomes; however, the Atgenome shows a 93% increase in recombination relative to its diploid progenitors. Elevated recombination in the Dtgenome was reported previously. These data on the Atgenome thus indicate that elevated recombination was a general property of allotetraploidy in cotton.Key words: comparative mapping, polyploidy, genome evolution, inversions, translocations, RFLP.
Impact of concentration, temperature, and pH on inactivation of Salmonella spp. by volatile fatty acids in anaerobic digestion
Authors: Salsali H R , Parker W J , Sattar S A
Published: May 2006

It is known that the presence of volatile fatty acids may play a role in the inactivation of pathogens for systems that employ an acid phase reactor. This study was conducted to investigate the influence of volatile fatty acids on the inactivation of Salmonella spp. over a range of digestion temperatures. In this study, digesters that were treating municipal wastewater treatment plant sludges were operated at temperatures that ranged from 35 to 49 °C and had a solids residence time of 15 days. Samples collected from the effluent of the digesters were dosed with solutions containing acetic, propionic, and butyric acids alone and in mixtures, and the dosed effluents were analyzed for Salmonella spp. over time. In the first round of testing, the digester effluents were dosed with individual organic acids and also a mixture containing all three volatile fatty acids over a range of concentrations from 750 to 6000 mg/L, and the pH of the samples was fixed at a value of 5.5. In the second round of testing, the sample sludges were spiked with a fixed amount of organic acid mixture, and the pH was varied from 4.5 to 7.5. The reduction of Salmonella spp. in digester effluents, when dosed with volatile organic acids, was found to depend on pH, temperature, the chain length of the acids, and the concentration and composition of the acids present. Increases in temperature appeared to increase the inhibitory effects of the volatile organic acids. At mesophilic temperatures, acidic pHs resulted in a greater inhibition of Salmonella spp.; whereas at higher temperatures neutral pHs were found to be more inhibitory. The results suggest that acid phase digesters that operate at elevated temperatures and low pH can achieve substantial reduction of Salmonella spp.Key words: anaerobic digestion, decay kinetics, mesophilic, Salmonella spp., volatile organic acids.
Occurrence of parasporin-producingBacillus thuringiensisin Vietnam
Authors: Yasutake Koichi , Binh Ngo Dinh , Kagoshima Kumiko , Uemori Akiko , Ohgushi Akira , Maeda Minoru , Mizuki Eiichi , Yu Yong Man , Ohba Michio
Published: May 2006

A total of 63 Bacillus thuringiensis isolates were recovered from urban soils of Hanoi, Vietnam. Of these, 34 were identified to 12 H serogroups. None of the isolates showed larvicidal activities against three lepidopterous insects. Three isolates belonging to the two serovars, colmeri (H21) and konkukian (H34), were highly toxic to larvae of the mosquito Aedes aegypti. Parasporal inclusion proteins of four isolates exhibited cytocidal activities against HeLa cells. Immunologically, proteins of four isolates were closely related to parasporin-1 (Cry31Aa), a parasporal protein that preferentially kills human cancer cells. Haemolytic activities were associated with parasporal proteins of the three mosquitocidal isolates but not with those of the four cancer-cell-killing isolates. PCR experiments and nucleotide sequence analysis revealed that the genes of four anti-cancer isolates are closely related to the gene parasporin-1 (cry31Aa) but are dissimilar to those of the three other existing parasporins. Our results suggest that the soil of northern Vietnam is a good reservoir of parasporin-producing B. thuringiensis.Key words: Bacillus thuringiensis, soil isolate, Vietnam, mosquitocidal activity, parasporin, cancer-cell-killing activity.
Expression of a pertussis toxin S1 fragment by inducible promoters in oralStreptococcusand the induction of immune responses during oral colonization in mice
Authors: Mallaley P P , Halperin S A , Morris A , MacMillan A , Lee S F
Published: May 2006

Previous work aimed at developing a live oral vaccine expressing pertussis toxin S1 fragment on the surface of the bacterium Streptococcus gordonii elicited a lower than expected antibody response, perhaps because of low antigen expression. In this study, in-frame promoter fusions were constructed to investigate whether an increase in antigen production by the streptococcal vaccine strain results in a better antibody response. The promoters tested were (i) the Streptococcus mutans sucrose-inducible fructosyltransferase (ftf) promoter and (ii) the Bacillus subtilis/Escherichia coli chimeric tetracycline-inducible xyl/tetO promoter. Each of these two promoters was placed upstream of the spaP/s1 fusion gene to drive its expression. The constructs were introduced into S. gordonii DL1 and S. mutans 834. The inducibility of the promoters was confirmed through the determination of SpaP/S1 production via Western blottings. Induced production of SpaP/S1 was observed in S. gordonii and S. mutans with each of the promoters, but the level of expression was the highest in S. mutans, using the xyl/tetO promoter. Thus, S. mutans carrying the xyl/tetO/spaP/s1 construct (S. mutans PM14) was used in oral colonization studies in BALB/c mice. Streptococccus mutans PM14 was able to colonize the animals for the 14-week duration of experimentation. A mucosal IgA response was observed in all the treatment groups but was highest in mice receiving tetracycline induction. In the mouse model of Bordetella pertussis respiratory infection, animals colonized with S. mutans PM14 showed a decreased in B. pertussis lung colony count (P = 0.03) on day 3 compared with control mice colonized by the parent S. mutans 834.Key words: pertussis, Streptococcus mutans, Streptococcus gordonii, oral colonization.
Tolerance and biosorption of copper and zinc byPseudomonas putidaCZ1 isolated from metal-polluted soil
Authors: Chen XinCai , Shi JiYan , Chen YingXu , Xu XiangHua , Xu ShengYou , Wang YuanPeng
Published: May 2006

A strain of Pseudomonas sp. CZ1, which was isolated from the rhizosphere of Elsholtzia splendens obtained from the heavy-metal-contaminated soil in the north-central region of the Zhejiang province of China, has been studied for tolerance to copper (Cu) and zinc (Zn) and its capacities for biosorption of these metals. Based on 16S ribosomal DNA sequencing, the microorganism was closely related to Pseudomonas putida. It exhibited high minimal inhibitory concentration values (about 3 mmol Cu·L–1and 5 mmol Zn·L–1) for metals and antibiotic resistance to ampicillin but not to kanamycin. Based on the results of heavy metal toxicity screening, inhibitory concentrations in solid media were lower than those in liquid media. Moreover, it was found that the toxicity of Cu was higher than that of Zn. Pseudomonas putida CZ1 was capable of removing about 87.2% of Cu and 99.8% of Zn during the active growth cycle, with specific biosorption capacities of 24.2 and 26.0 mg·L–1, respectively. Although at low concentrations, Cu and Zn slightly damage the surface of some cells, P. putida demonstrated high capacities for biosorption of Cu and Zn. Since P. putida CZ1 could grow in the presence of significant concentrations of metals and because of its high metal uptake capacity in aerobic conditions, this bacterium may be potentially applicable in bioreactors or in situ bioremediation of heavy-metal-contaminated aqueous or soil systems.Key words: Pseudomonas putida, copper, zinc, tolerance, biosorption.
Electrical resistivity monitoring of a collapsing meta-stable soil
Authors: Jackson P.D. , Northmore K.J. , Entwisle D.C. , Gunn D.A. , Milodowski A.E. , Boardman D.I. , Zourmpakis A. , Rogers C.D.F. , Jefferson I. , Dixon N.
Published: May 2006

Amodel of electrical conduction through clay-coated, silt-sized quartz-grains inter-connected by clay-bridges (e.g. brickearth) is developed. Underpinned by SEM studies of brickearth, the model predicts resistivity to be proportional to the size of the quartz-grains, where the resistance afforded by clay grain-coatings and clay-bridges is comparable. The model accommodates resistivity that increases through bridge breakage and decreases through bridge compression. The resistivity of
in-situ
undisturbed brickearth was found to be in the range 15 to 35 ohm-m. At such low values we demonstrate that electrical flow is dominated by conduction within clay-coatings and their interconnecting clay-bridges, rather than in mobile pore-water. A small electrode array, buried at shallow depth beneath the load plate (1.0 m by 1.0 m) of a field collapse experiment, monitored resistivity to a depth of 1.5 m over a 260 hour period. While the water level beneath the load plate remained below 1.0 m depth, the resulting 3D inverted resistivity models detected water injected immediately beneath the plate; recording rapid increases, in stages over 90 minutes, in the depth interval 0.45 to 0.75 m directly under the plate, during what appears to be collapse. These increases are attributed to breaking of clay-bridges weakened by injected water.
Ionic channels and conductance-based models for hypothalamic neuronal thermosensitivity
Authors: Wechselberger Martin , Wright Chadwick L. , Bishop Georgia A. , Boulant Jack A.
Published: May 2006

Thermoregulatory responses are partially controlled by the preoptic area and anterior hypothalamus (PO/AH), which contains a mixed population of temperature-sensitive and insensitive neurons. Immunohistochemical procedures identified the extent of various ionic channels in rat PO/AH neurons. These included pacemaker current channels [i.e., hyperpolarization-activated cyclic nucleotide-gated channels (HCN)], background potassium leak channels (TASK-1 and TRAAK), and transient receptor potential channel (TRP) TRPV4. PO/AH neurons showed dense TASK-1 and HCN-2 immunoreactivity and moderate TRAAK and HCN-4 immunoreactivity. In contrast, the neuronal cell bodies did not label for TRPV4, but instead, punctate labeling was observed in traversing axons or their terminal endings. On the basis of these results and previous electrophysiological studies, Hodgkin–Huxley-like models were constructed. These models suggest that most PO/AH neurons have the same types of ionic channels, but different levels of channel expression can explain the inherent properties of the various types of temperature-sensitive and insensitive neurons.
Manipulation of dietary carbohydrates after prolonged effort modifies muscle sarcoplasmic reticulum responses in exercising males
Authors: Duhamel T. A. , Perco J. G. , Green H. J.
Published: May 2006

The hypothesis tested was that disturbances in the sarcoplasmic reticulum (SR) Ca2+-cycling responses to exercise would associate with muscle glycogen reserves. Ten untrained males [peak O2consumption (V̇o2 peak) = 3.41 ± 0.20 (SE) l/min] performed a standardized cycle test (∼70% V̇o2 peak) on two occasions, namely, following 4 days of a high (Hi CHO)- and 4 days of a low (Lo CHO)-carbohydrate diet. Both Hi CHO and Lo CHO were preceded by a session of prolonged exercise designed to deplete muscle glycogen. SR Ca2+cycling in crude homogenates prepared from vastus lateralis samples indicated higher ( P < 0.05) Ca2+uptake (μM·g protein−1·min−1) in Hi CHO compared with Lo CHO at 30 min (2.93 ± 0.10 vs. 2.23 ± 0.12) and at 67 min (2.77 ± 0.16 vs. 2.10 ± 0.12) of exercise, the point of fatigue in Lo CHO. Similar effects ( P < 0.05) were noted between conditions for maximal Ca2+-ATPase (μM·g protein−1·min−1) at 30 min (142 ± 8.5 vs. 107 ± 5.0) and at 67 min (130 ± 4.5 vs. 101 ± 4.7). Both phase 1 and phase 2 Ca2+release were 23 and 37% higher ( P < 0.05) at 30 min of exercise and 15 and 34% higher ( P < 0.05), at 67 min during Hi CHO compared with Lo CHO, respectively. No differences between conditions were observed at rest for any of these SR properties. Total muscle glycogen (mmol glucosyl units/kg dry wt) was higher ( P < 0.05) in Hi CHO compared with Lo CHO at rest (+36%), 30 min (+53%), and at 67 min (+44%) of cycling. These results indicate that exercise-induced reductions in SR Ca2+-cycling properties occur earlier in exercise during low glycogen states compared with high glycogen states.
Influence of acute plasma volume expansion on V̇o2 kinetics, V̇o2peak, and performance during high-intensity cycle exercise
Authors: Berger Nicolas J. A. , Campbell Iain T. , Wilkerson Daryl P. , Jones Andrew M.
Published: May 2006

The purpose of this study was to examine the influence of acute plasma volume expansion (APVE) on oxygen uptake (V̇o2) kinetics, V̇o2peak, and time to exhaustion during severe-intensity exercise. Eight recreationally active men performed “step” cycle ergometer exercise tests at a work rate requiring 70% of the difference between the gas-exchange threshold and V̇o2max on three occasions: twice as a “control” (Con) and once after intravenous infusion of a plasma volume expander (Gelofusine; 7 ml/kg body mass). Pulmonary gas exchange was measured breath by breath. APVE resulted in a significant reduction in hemoglobin concentration (preinfusion: 16.0 ± 1.0 vs. postinfusion: 14.7 ± 0.8 g/dl; P < 0.001) and hematocrit (preinfusion: 44 ± 2 vs. postinfusion: 41 ± 3%; P < 0.01). Despite this reduction in arterial O2 content, APVE had no effect on V̇o2 kinetics (phase II time constant, Con: 33 ± 15 vs. APVE: 34 ± 12 s; P = 0.74), and actually resulted in an increased V̇o2peak (Con: 3.90 ± 0.56 vs. APVE: 4.12 ± 0.55 l/min; P = 0.006) and time to exhaustion (Con: 365 ± 58 vs. APVE: 424 ± 64 s; P = 0.04). The maximum O2 pulse was also enhanced by the treatment (Con: 21.3 ± 3.4 vs. APVE: 22.7 ± 3.4 ml/beat; P = 0.04). In conclusion, APVE does not alter V̇o2 kinetics but enhances V̇o2peak and exercise tolerance during high-intensity cycle exercise in young recreationally active subjects.
Aging, muscle fiber type, and contractile function in sprint-trained athletes
Authors: Korhonen Marko T. , Cristea Alexander , Alén Markku , Häkkinen Keijo , Sipilä Sarianna , Mero Antti , Viitasalo Jukka T. , Larsson Lars , Suominen Harri
Published: May 2006

Biopsy samples were taken from the vastus lateralis of 18- to 84-yr-old male sprinters ( n = 91). Fiber-type distribution, cross-sectional area, and myosin heavy chain (MHC) isoform content were identified using ATPase histochemistry and SDS-PAGE. Specific tension and maximum shortening velocity ( Vo) were determined in 144 single skinned fibers from younger (18–33 yr, n = 8) and older (53–77 yr, n = 9) runners. Force-time characteristics of the knee extensors were determined by using isometric contraction. The cross-sectional area of type I fibers was unchanged with age, whereas that of type II fibers was reduced ( P < 0.001). With age there was an increased MHC I ( P < 0.01) and reduced MHC IIx isoform content ( P < 0.05) but no differences in MHC IIa. Specific tension of type I and IIa MHC fibers did not differ between younger and older subjects. Vo of fibers expressing type I MHC was lower ( P < 0.05) in older than in younger subjects, but there was no difference in Vo of type IIa MHC fibers. An aging-related decline of maximal isometric force ( P < 0.001) and normalized rate of force development ( P < 0.05) of knee extensors was observed. Normalized rate of force development was positively associated with MHC II ( P < 0.05). The sprint-trained athletes experienced the typical aging-related reduction in the size of fast fibers, a shift toward a slower MHC isoform profile, and a lower Vo of type I MHC fibers, which played a role in the decline in explosive force production. However, the muscle characteristics were preserved at a high level in the oldest runners, underlining the favorable impact of sprint exercise on aging muscle.
Differentiation of Lymphatic Endothelial Cells From Embryonic Stem Cells on OP9 Stromal Cells
Authors: Kono Tomoya , Kubo Hajime , Shimazu Chikashi , Ueda Yoshihide , Takahashi Meiko , Yanagi Kentoku , Fujita Naoya , Tsuruo Takashi , Wada Hiromi , Yamashita Jun K.
Published: May 2006

Objectives—

The discovery of vascular endothelial growth factor C (VEGF-C) and VEGF receptor-3 (VEGFR-3) has started to provide an understanding of the molecular mechanisms of lymphangiogenesis. The homeobox gene prox1 has been proven to specify lymphatic endothelial cells (ECs) from blood ECs. We investigated the process of lymphatic EC (LEC) differentiation using embryonic stem (ES) cells.

Methods and Results—

VEGFR-2
+
cells derived from ES cells differentiated into LECs at day 3 on OP9 stromal cells defined by the expression of prox1, VEGFR-3, and another lymphatic marker podoplanin. VEGFR-2
+
cells gave rise to LYVE-1
+
embryonic ECs, which were negative for prox1 on day 1 but turned to prox1
+
LECs by day 3. VEGFR-3-Fc or Tie2-Fc, sequestering VEGF-C or angiopoietin1 (Ang1), suppressed colony formation of LECs on OP9 cells. However, addition of VEGF-C and Ang1 in combination with VEGF to the culture of VEGFR-2
+
cells on collagen-coated dishes failed to induce LECs. LEC-inducing activity of OP9 cells was fully reproduced on paraformaldehyde-fixed OP9 cells with the conditioned medium.

Conclusion—

We succeeded in differentiating LECs from ES cells and revealed the requirements of VEGF-C, Ang1, and other unknown factors for LEC differentiation.
Bradycardia and Slowing of the Atrioventricular Conduction in Mice Lacking Ca
V
3.1/α
1G
T-Type Calcium Channels
Authors: Mangoni Matteo E. , Traboulsie Achraf , Leoni Anne-Laure , Couette Brigitte , Marger Laurine , Le Quang Khai , Kupfer Elodie , Cohen-Solal Anne , Vilar José , Shin Hee-Sup , Escande Denis , Charpentier Flavien , Nargeot Joël , Lory Philippe
Published: May 2006

The generation of the mammalian heartbeat is a complex and vital function requiring multiple and coordinated ionic channel activities. The functional role of low-voltage activated (LVA) T-type calcium channels in the pacemaker activity of the sinoatrial node (SAN) is, to date, unresolved. Here we show that disruption of the gene coding for Ca
v
3.1/α
1G
T-type calcium channels (
cacna1g
) abolishes T-type calcium current (
I
Ca,T
) in isolated cells from the SAN and the atrioventricular node without affecting the L-type Ca
2+
current (
I
Ca,L
). By using telemetric electrocardiograms on unrestrained mice and intracardiac recordings, we find that
cacna1g
inactivation causes bradycardia and delays atrioventricular conduction without affecting the excitability of the right atrium. Consistently, no
I
Ca,T
was detected in right atrium myocytes in both wild-type and Ca
v
3.1
−/−
mice. Furthermore, inactivation of
cacna1g
significantly slowed the intrinsic in vivo heart rate, prolonged the SAN recovery time, and slowed pacemaker activity of individual SAN cells through a reduction of the slope of the diastolic depolarization. Our results demonstrate that Ca
v
3.1/T-type Ca
2+
channels contribute to SAN pacemaker activity and atrioventricular conduction.
Common Protective and Diverse Smooth Muscle Cell Effects of AAV-Mediated Angiopoietin-1 and -2 Expression in Rat Cardiac Allograft Vasculopathy
Authors: Nykänen Antti I. , Pajusola Katri , Krebs Rainer , Keränen Mikko A.I. , Raisky Olivier , Koskinen Petri K. , Alitalo Kari , Lemström Karl B.
Published: May 2006

Angiopoietin-1 (Ang1) and Ang2 regulate the maintenance of normal vasculature by direct endothelial and indirect smooth muscle cell (SMC) effects. Dysfunction of vascular wall cells is considered central in cardiac allograft vasculopathy (CAV), where inflammation and arterial injury initiate subsequent intimal SMC proliferation. In this study, we investigated the effect of exogenous Ang1 and Ang2 in chronically rejecting rat cardiac allografts by intracoronary adeno-associated virus (AAV)-mediated gene transfer. Bioluminescent imaging of AAV-transfected syngeneic grafts revealed gradual and stable transgene expression in graft cardiomyocytes. In cardiac allografts, both AAV-Ang1 and AAV-Ang2 decreased inflammation and increased antiapoptotic Bcl-2 mRNA and Bcl-2/Bax ratio at 8 weeks. Only AAV-Ang2 decreased the development of CAV, whereas AAV-Ang1 activated arterial SMC and increased PDGF-A mRNA in the allograft. Collectively, our results show that exogenous Ang1 and Ang2 have similar antiinflammatory and antiapoptotic effects in cardiac allografts. Prolonged AAV-mediated Ang1 transgene expression also induced SMC activation, whereas AAV-Ang2 lacked the SMC activating effects and decreased CAV. Our results thus highlight the common protective and diverse SMC effects of Ang1 and Ang2 in cardiac allograft microenvironment and the importance of timing of angiopoietins to achieve therapeutic effects.
Effects of Congestive Heart Failure on Ca
2+
Handling in Skeletal Muscle During Fatigue
Authors: Lunde Per Kristian , Sejersted Ole M. , Thorud Hanne-Mari Schiøtz , Tønnessen Theis , Henriksen Unni Lie , Christensen Geir , Westerblad Håkan , Bruton Joseph
Published: May 2006

Skeletal muscle weakness and decreased exercise capacity are major symptoms reported by patients with congestive heart failure (CHF). Intriguingly, these skeletal muscle symptoms do not correlate with the decreased heart function. This suggests that CHF leads to maladaptive changes in skeletal muscles, and as reported most markedly in slow-twitch muscles. We used rats at 6 weeks after infarction to measure expression of key proteins involved in SR Ca
2+
release and uptake in slow-twitch soleus muscles. We also measured force and myoplasmic free [Ca
2+
] ([Ca
2+
]
i
) in intact single fibers of soleus muscles. CHF rats showed clear signs of severe cardiac dysfunction with marked increases in heart weight and left ventricular end-diastolic pressure compared with sham operated rats (Sham). There were small, but significant, changes in the content of proteins involved in cellular Ca
2+
handling in CHF muscles: slight increases in SR Ca
2+
release channels (ie, the ryanodine receptors) and in SR Ca
2+
-ATPase. Tetanic force and [Ca
2+
]
i
were not significantly different between CHF and Sham soleus fibers under resting conditions. However, during the stimulation period there was a decrease in tetanic force without changes in [Ca
2+
]
i
in CHF fibers that was not observed in Sham fibers. The fatigue-induced changes recovered rapidly. We conclude that CHF soleus fibers fatigue more rapidly than Sham fibers because of a reversible fatigue-induced decrease in myofibrillar function.
Proportions of Stroke Subtypes Among Men and Women ≥40 Years of Age in an Urban Japanese City in 1992, 1997, and 2002
Authors: Kitamura Akihiko , Nakagawa Yuko , Sato Minoru , Iso Hiroyasu , Sato Shinichi , Imano Hironori , Kiyama Masahiko , Okada Takeo , Okada Hiroshi , Iida Minoru , Shimamoto Takashi
Published: May 2006

Background and Purpose—

Higher proportions of hemorrhagic stroke and lacunar infarction were reported in rural Japan compared with those in Western countries. We examined the relative proportions of stroke subtypes in an urban Japanese city where westernized lifestyles are more common than in rural areas.

Methods—

Stroke registration was performed in 1992, 1997, and 2002 for residents ≥40 years of age who were admitted with acute strokes to all of the 10 hospitals with ≥90 beds in Yao City, Osaka, Japan. Strokes were classified as intraparenchymal hemorrhage, subarachnoid hemorrhage, or ischemic strokes (embolic infarction, large-artery occlusive infarction, lacunar infarction, and unclassified thrombotic infarction) by criteria using computed tomography or MRI.

Results—

A total of 650 first-ever strokes were registered. The age-adjusted proportion of each stroke subtype was not significantly different among the 3 study periods in both men and women. Throughout the 3 periods, intraparenchymal hemorrhage, subarachnoid hemorrhage, and ischemic stroke accounted for 26%, 7%, and 65% in men, respectively. In women, the respective proportions were 29%, 21%, and 44%. The proportion of each subtype for total ischemic strokes was as follows: 51% to 61% lacunar infarction, 25% to 26% large-artery occlusive infarction, and 11% to 17% embolic infarction.

Conclusions—

Our study showed that hemorrhagic stroke represented a large proportion of all strokes, especially among women, and lacunar infarction was the most common subtype of ischemic stroke among both men and women in Yao City, which differed from findings in Western countries.
Vascular Disease and Risk Factors, Rate of Progression, and Survival in Alzheimer’s Disease
Authors: Bhargava Deepika , Weiner Myron F. , Hynan Linda S. , Diaz-Arrastia Ramon , Lipton Anne M.
Published: May 2006

Two hundred forty-seven patients with early Alzheimer’s disease were studied for the association of demographic, functional, and cognitive status and vascular comorbidities and risk factors present at index visit to rate of clinical disease progression over 3 years and to survival time. Patients who progressed to the moderate stage were designated fast progressors; those who remained in the early stage were designated slow progressors. At index visit, Mini-Mental State Exam score was significantly lower for the fast than the slow group; global impairment was significantly higher for the fast group. Cognitive scores showed greater annual decline in the fast group, and the fast group also had a greater annualized global change. The fast group had a shorter median survival time from onset, but age at onset, age at initial visit, history of heart problems, myocardial infarct, stroke, hypertension, diabetes, or past or current smoking did not differ between groups.
A comparison of hospice in the UK and the US
Authors: Chapman Karen Y. , Bass Lessie
Published: May 2006

This article presents a comparison of hospice services in the United Kingdom and the United States. The article includes a brief history of the development of the modern hospice movement in the United States and the United Kingdom, with emphasis on funding, regulatory standards, and demographics.
Educational needs of home caregivers of terminally ill patients: Literature review
Authors: Thielemann Patricia
Published: May 2006

Hospice care continues to be a rapidly growing philosophy of care at the end of life. One of the fundamental principles of hospice is the role of a primary caregiver to provide for the needs of the terminally ill loved one. Typically, a spouse, adult child, sibling, close friend, or significant other fills this role. Usually, the caregiver has no formal training in caregiving and is learning all aspects of providing for all the needs of the patient. This is an awesome responsibility and quite overwhelming for most caregivers. A research synthesis was completed to assess the educational needs of caregivers of terminally ill patients. The computerized literature search of several databases found very few studies on the educational needs of caregivers. The few studies that have been done have used both quantitative and qualitative approaches, using a variety of assessment tools, looking at several different populations, over varied time periods. In spite of the variety of methods and populations studied, all the studies came to similar conclusions. The needs of the studied caregivers fall into three main categories: needing information on meeting the physical needs of the patients, community resources, and the patient’s illness. The findings provide a basis for further research to build a comprehensive educational program that maximizes the role of the caregivers of terminally ill patients.
Performance improvement in pain management for home care and hospice programs
Authors: Braveman Carla , Rodrigues Carol
Published: May 2006

This performance improvement project was undertaken to determine staff competency in pain management in several home care and hospice programs. The process used involved identifying and establishing the project, diagnosing the cause, remedying the cause, and holding the gains. Once the problem was identified and confirmed, the group worked to improve the competency of staff.
Overcoming the tendency to lie to dying patients
Authors: Stolick Matt
Published: May 2006

A meaningful death can be fostered for a patient and his or her family with the aid of medical treatment, specifically through the alleviation of the patient’s suffering and pain. To recognize the dying process is a part of the art of medicine. Compassionate care for dying patients includes a move from a curative model of care to a palliative model of care in defining the primary goal. Hospice volunteer training and practice is sufficient palliative care training to develop these skills. The time has come for incorporating palliative care into the curriculum of medical school.
A phase II study of hydrocodone for cough in advanced cancer
Authors: Homsi Jade , Walsh Declan , Nelson Kristine A. , Sarhill Nabeel , Rybicki Lisa , LeGrand Susan B. , Davis Mellar P.
Published: May 2006

Purpose: Cough is a common symptom in advanced cancer. The use of hydrocodone as an antitussive has not been studied previously in this setting. This study evaluates hydrocodone for cough in advanced cancer.

Methods: The results presented are from a phase II study with dose titration.

Setting: Palliative medicine program in a tertiary referral center.

Patients: 25 consecutive patients with cough from irreversible causes, on a stable opioid regimen for the prior 24 hours, and no previous or current use of hydrocodone for cough.

Intervention: 5 mg hydrocodone was administered twice daily. The dose was then titrated daily (maximum: 60 mg/24 h), if needed, until a 3 50 percent improvement of the frequency of cough was achieved and then maintained for three consecutive days.

Measurements: Cough severity, frequency, complications, and hydrocodone side effects.

Results: 20 persons (10 women and 10 men) completed study evaluation. Median age was 63 years (range: 42-82). Nine patients had lung cancer and seven had lung or pleura metastases; 19 patients had at least 50 percent improvement of their cough frequency. The median best response was 70 percent improvement in the cough frequency (range: 50-90 percent). Median hydrocodone dose associated with the best response was 10 mg/day (range: 5-30 mg/day). Cough severity, frequency, associated symptoms and complications, and activities of daily living improved significantly. Side effects of hydrocodone (dry mouth, nausea, and drowsiness) were tolerable and rated as mild.

Conclusions: Hydrocodone is effective and safe to treat cough in advanced cancer. A starting dose of 10 mg per day in divided doses seems effective. Dose escalation may be required. Most improved within one day.
Assessing complementary therapy services in a hospice program
Authors: Demmer Craig , Sauer Janice
Published: May 2006

Increasing numbers of people have been supplementing their health care needs with complementary therapies. Complementary therapies have been used to promote health and treat patients with a variety of ailments. Types of complementary therapies used with terminally ill patients have included massage, therapeutic touch, Reiki, art and music therapy, aromatherapy, and hypnotherapy. The purpose of this study was to survey primary caregivers (PCGs) regarding their perceptions and satisfaction with a hospice complementary therapy program. Perhaps this study’s most interesting finding is that patients who received complementary therapies were generally more satisfied with overall hospice services.
Can illness narratives contribute to the delay of hospice admission?
Authors: Myers Gary E.
Published: May 2006

Patients who could benefit from the end-of-life care that hospice provides frequently underuse this service because their admission occurs very late in the course of their dying. Admission to hospice requires that patients and their physicians shift their treatment goals from cure to comfort care. However, this shift is not likely to occur unless there is a parallel shift of hope, from hope for a cure to hope for the best possible quality of life. This study considers how a prominent type of illness narrative, the restitution narrative, delays decisions for hospice by inhibiting the transformation of hope from a hope for cure to a hope for quality at life’s end.
The wounded healer archetype: Applications to palliative care practice
Authors: Laskowski Cheryl , Pellicore Karen
Published: May 2006

This paper explores the theoretical roots of the wounded healer archetype and the shadow side of the wounded healer. Our emphasis is on reflectivity as a means of expanding self-understanding and clinical consultation as a way of enhancing reflectivity. A case vignette presented in this article is taken from the clinical practice of one of the authors (KP), who, literally and figuratively, lives the role of wounded healer.
Opioids, respiratory function, and dyspnea
Authors: LeGrand Susan B. , Khawam Elias A. , Walsh Declan , Rivera Nilo I.
Published: May 2006

Dyspnea, the sensation of difficult breathing, is a common debilitating symptom in advanced cancer and chronic progressive cardiopulmonary disease. Primary treatment is correction of the underlying etiology. In incurable illness wherein the cause is irreversible and the goal is palliation, opioids are the drugs of choice for symptomatic relief. This article reviews current knowledge in the pathophysiology of dyspnea, proposed opioid mechanism of action, and evidence of efficacy.
Management of hiccups in the palliative care population
Authors: Smith Howard S. , Busracamwongs Atichat
Published: May 2006

There are close to a hundred causes for hiccups, or singultus, the most common of which are gastrointestinal. Causes may be natural or drug induced, and the same agents that are used to treat hiccups may also induce them. Hiccups can be classified by their duration, as follows: up to 48 hours, acute; longer than 48 hours, persistent; and more than two months, intractable. Treatment options for hiccups can include both pharmacologic and nonpharmacologic agents. If the cause of hiccups can be identified, it is, of course, preferable to direct the treatment at that cause. However, many times a cause cannot be identified; in this case, general measures or treatments should be instituted.

Intractable hiccups can occur in the palliative care population. When they do, it can be extremely distressing and have a significant impact on quality of life. Pharmacologic approaches are often the most rational therapies for these patients. Baclofen seems to be a promising drug for use with both palliative care and perioperative patients, and using garabentin as an add-on to baclofen may also be a reasonable option to consider.
The Hawthorne effect in the assessment of pain by house staff
Authors: Gruber Todd , Sharma Asha , Daneschvar Hamidreza , Estfan Bassam
Published: May 2006

Internal medicine residents are one component of the healthcare delivery team in the hospital setting. Their ability to assess and treat pain should be considered in quality improvement efforts. We surveyed our residents, using a 0 to 10 scale to determine how well they assessed their patients’ level of pain. We then asked half of these residents to write down their patients’ pain score as a fifth vital sign in the medical record. We repeated the house staff survey three weeks later. The residents improved their assessment as a whole, with the nonintervention group faring better on the follow-up surveys. We believe that the residents’ improvement can be attributed to the Hawthorne effect, in which a group that is singled out for special study or consideration has its performance positively affected. The residents’ ability to accurately rate patients with moderate and severe pain is still an area for further development. Improvements in our palliative care curriculum have been implemented to enhance our residents’ education and performance in this area.
Satisfaction of families using end-of-life care: Current successes and challenges in the hospice industry
Authors: Miceli Penny J. , Mylod Deirdre E.
Published: May 2006

This study examined the satisfaction of family members with the end-of-life care their loved ones received. Data were collected from 1,839 individuals receiving care from 17 different care agencies nationwide. Although family satisfaction with hospice care was generally quite high, situational factors played a role. The timing of the referral was critical, with families rating services lower almost across the board when the referral to hospice was deemed “too late.” Additionally, families expressed greater satisfaction when the patient’s care was overseen by the hospice director, rather than a personal physician. Each of these findings has important implications for physicians, patients, and families as they begin to plan for end-of-life care.
On projective identification, containment, and feeling special: Some thoughts about hospice nurses’ experiences
Authors: Jones Alun
Published: May 2006

This discussion is derived from a qualitative research study that examined the benefits of small group supervision for hospice nurses. Sigmund Freud’s beliefs about early human development, Melanie Klein’s theories of projective identification, and the later developments by Wilfred Bion concerning the container and contained, form a framework for understanding events. Alternative ideas are drawn from early psychoanalytic research with nurses. Individual comments from hospice nurses illustrate the profundity of working with issues of serious illness, while the work of a hospice nurse is illustrated with a single clinical narrative. The discussion poses questions rather than offering answers to the complexities of human service. It shows how some people throughout the event of serious illness may signal their readiness to make important changes in their lives or, conversely, intensify normal unhelpful modes of communicating with others. With the support of other members of the team, a hospice nurse was able to help a man ill with cancer to decide how to live the brief life that was left to him and make closer relationships. Thoughtful work discussions also seem to offer much to hospice nursing practices in the way of learning and support.
The Ohio Hospice Bereavement Study: Meeting NHPCO standards
Authors: Rathbun Ann , Denham Sharon A. , McCarthy Craig C.
Published: May 2006

Little attention has been paid to documenting the quality and impact of hospice bereavement programs. While quality of life, quality of dying, and quality of end-of-life measures are common indicators of effective clinical service, they are not adequate gauges of quality from a bereavement perspective. The National Hospice and Palliative Care Organization (NHPCO) published standards for hospice and palliative care programs that included a section on bereavement care. 1 Little evaluative work has been done to discover whether hospice programs nationwide are compliant with these standards. The purpose of this study was to evaluate whether hospice programs (n = 32) in the state of Ohio were meeting the NHPCO bereavement standards. Findings indicated that the participating hospice programs were 83 percent compliant at least some of the time.
Palliative care at the end of life: Comparing quality in diverse settings
Authors: Paice Judith A. , Muir J. Cameron , Shott Susan
Published: May 2006

There is growing awareness that pain and other symptoms are often poorly managed at the end of life. The purpose of this quality improvement project was to compare the quality of care provided to a convenience sample of 195 patients who died during a six-month period, using a retrospective chart review. Quality was defined by symptom documentation, use of diagnostic and therapeutic procedures in the final 48 hours of life, and determination of advance directives. Daily and total charges incurred by these patients were also captured. Symptom distress was common, and diagnostic and therapeutic procedures were widespread. These data suggest areas for improvement in clinical practice, in palliative care units, and in all settings where end-of-life care is provided. Also, the data can guide future research into the quality of care provided to dying persons.
Survey of cannabis use in patients with amyotrophic lateral sclerosis
Authors: Amtmann Dagmar , Weydt Patrick , Johnson Kurt L. , Jensen Mark P. , Carter Gregory T.
Published: May 2006

Cannabis (marijuana) has been proposed as treatment for a widening spectrum of medical conditions and has many properties that may be applicable to the management of amyotrophic lateral sclerosis (ALS). This study is the first, anonymous survey of persons with ALS regarding the use of cannabis. There were 131 respondents, 13 of whom reported using cannabis in the last 12 months. Although the small number of people with ALS that reported using cannabis limits the interpretation of the survey findings, the results indicate that cannabis may be moderately effective at reducing symptoms of appetite loss, depression, pain, spasticity, and drooling. Cannabis was reported ineffective in reducing difficulties with speech and swallowing, and sexual dysfunction. The longest relief was reported for depression (approximately two to three hours).
Family caregiver satisfaction with care at end of life: Report from the cultural variations study (CVAS)
Authors: Phipps Etienne J. , Braitman Leonard E.
Published: May 2006

The objective of this study was to examine differences in family caregiver satisfaction with care at end of life based on site of death, in an observational study involving advanced cancer patients and their family caregivers. The study was based on follow-up interviews with 28 family caregivers of 28 patients who died during a two-year prospective study involving 68 patients and 68 family caregivers. Telephone interviews addressed the circumstances of the patients’ death, their satisfaction with the care provided to the patient, and their satisfaction with how well they were attended to by health providers. There were no associations between site of death (died at home vs. did not die at home) and family caregiver satisfaction with the overall care provided to the patient. However, family caregivers of patients who died at home responded that they thought the patient was more at peace (with respect to spiritual and religious matters) than did family care-givers of patients who did not die at home (p = 0.003). Family caregivers of patients who died at home appeared to feel less satisfied with the attention paid to their own wishes regarding the patient’s care (p = 0.13), less satisfied with the emotional support provided to them by healthcare personnel taking care of the patient (p = 0.08), and less satisfied with communication from health providers (p = 0.11). Findings indicate that although dying at home appears to provide a more peaceful death for the patient, it may also distance family care-givers from health professionals and leave them feeling less supported during the patient’s last days of life.
Programmatic barriers to providing culturally competent end-of-life care
Authors: Reese Dona J. , Melton Elizabeth , Ciaravino Karen
Published: May 2006

Despite many efforts to increase access to end-of-life care, culturally diverse groups are still not being served. Interviews of 22 hospice and palliative care program directors in one southeastern state indicated that directors overestimated how well programs are doing in meeting the needs of diverse groups but were very interested in implementing cultural diversity training for their staff. Those who were more concerned about such issues had recruited more diverse volunteers into their programs. The presence of diverse staff or volunteers predicted a more diverse patient population. A number of efforts were underway to develop cultural competence and provide culturally competent care. Several directors reported no efforts in this direction, however. Directors described programmatic barriers and resources needed. The authors concluded that directors should provide leadership in their agencies in welcoming diversity. Implications for further research and work within the larger end-of-life care field are discussed.
End-of-life care: Perspectives of family members of deceased patients
Authors: Marco Catherine A. , Buderer Nancy , Thum Dorothy
Published: May 2006

This study was undertaken to determine the opinions of family members of deceased patients regarding end-of-life care. This multisite cross-sectional survey was administered to 969 volunteer participants during 1997 to 2000. Eligible participants included immediate family members of deceased patients at five local institutions in a regional health system. Among 969 respondents, most (84.4 percent) indicated that the care for their family member was excellent. Reasons cited for satisfaction included overall care (40.2 percent), staff effort (23.2 percent), and communication (16.4 percent). Reasons cited for dissatisfaction included perceived incompetence (9.7 percent), perceived uncaring attitude (8.4 percent), and perceived understaffing (3.7 percent). Respondents were more satisfied with communication from nursing staff (88 percent) than physicians’ communication (78 percent, p < 0.001, Bowker’s test). Respondents indicated higher overall satisfaction with nursing (90 percent) and pastoral care (87 percent), than with physician care (81 percent, p < 0.001 and p = 0.006, Bowker’s test).

A unique survey instrument can be used to measure family perceptions and opinions regarding end-of-life care.
Anticipatory grief and psychological adjustment to grieving in middle-aged children
Authors: Smith Sharon Hines
Published: May 2006

This study examines the effect of anticipatory grief on personal adjustment in middle-aged adult children following the death of their last surviving elderly parent. Data were analyzed from a study of adult children’s perspectives of an elderly parent’s death conducted by the Philadelphia Geriatric Center, Philadelphia, Pennsylvania. 1 The results of this study indicate that adult children who experienced anticipatory grief were likely to report feeling better adjusted to the death of their elderly parent, yet the composite measure used to assess degree of personal adjustment indicates a negative relationship between the anticipation of death and personal adjustment following the actual loss. This finding was consistent across gender and racial and ethnic distinctions among adult children who participated in this study. The significance of this finding for grief work and its implications for future research are discussed.