bluuebunny/crossref_metadata_2025 huggingface dataset:
Thalamic innervation of striatal and subthalamic neurons projecting to the rat entopeduncular nucleus
Authors: Lanciego José L. , Gonzalo Nancy , Castle Maria , Sanchez‐Escobar Carlos , Aymerich Maria S. , Obeso Jose A.
Published: March 2004

The present study analyses the anatomical arrangement of the projections linking the Wistar rat parafascicular thalamic nucleus (PF) and basal ganglia structures, such as the striatum and the subthalamic nucleus (STN), by using neuroanatomical tract‐tracing techniques. Both the thalamostriatal and the striato‐entopeduncular projections were topographically organized, and several areas of overlap between identified circuits were noticed, sustaining the existence of up to three separated channels within the Nauta–Mehler loop. Thalamic afferents arising from dorsolateral PF territories are in register with striatofugal neurons located in dorsolateral striatal areas, which in turn project to dorsolateral regions of the entopeduncular nucleus (ENT). Medial ENT regions are innervated by striatal neurons located within medial striatal territories, these neurons being the target for thalamic afferents coming from medial PF areas. Finally, afferents from neurons located in ventrolateral PF areas approached striatal neurons in ventral and lateral striatal territories, which in turn project towards ventral and lateral ENT regions. Efferent STN neurons projecting to ENT were found to be the apparent postsynaptic target for thalamo‐subthalamic axons. The thalamo‐subthalamic projection was also topographically organized. Medial, central and lateral STN territories are innervated by thalamic neurons located within medial, ventrolateral and dorsolateral PF areas, respectively. Thus, each individual PF subregion projects in a segregated fashion to specific parts of the striato‐entopeduncular and subthalamo‐entopeduncular systems. These circuits enabled the caudal intralaminar nuclei to modulate basal ganglia output.
Ultrastructural study of depolarization‐induced translocation of NRF‐2 transcription factor in cultured rat visual cortical neurons
Authors: Yang Shou Jing , Liang Huan Ling , Ning Gang , Wong‐Riley Margaret T. T.
Published: March 2004

Nuclear respiratory factor (NRF)‐2 or GA‐binding protein is a potential transcriptional, bigenomic coordinator of mitochondrial and nuclear‐encoded subunits of cytochrome oxidase genes. It is composed of an α subunit that binds DNA and a β subunit that has the transactivating domain. Previously, we found that the level of NRF‐2 paralleled that of cytochrome oxidase under normal and functionally altered states. The goal of our present study was to increase the resolution to the ultrastructural level and to quantify changes before and after depolarizing stimulation. We used a pre‐embedding immunogold–silver method for the two subunits of NRF‐2 in cultured rat visual cortical neurons. NRF‐2α and β were normally located in both the nucleus and the cytoplasm. In the nucleus, both subunits were associated primarily with euchromatin rather than heterochromatin, consistent with active involvement in transcription. In the cytoplasm, they were associated mainly with free ribosomes and occasionally with the Golgi apparatus and the outer membrane of the nuclear envelope. Labelling was not found in the mitochondria, confirming the specificity of the antibodies. Neuronal depolarization by KCl for 5 h induced a six‐ to seven‐fold increase in the nuclear‐to‐cytoplasmic ratio of both subunits (P < 0.001) without increases in total labelling densities. These results strongly indicate that both NRF‐2α and NRF‐2β respond to increased neuronal activity by translocating from the cytoplasm to the nucleus, where they engage in transcriptional activation of target genes. Our results also indicate that the cytoplasmic to nuclear movement of transcription factors is a dynamic process induced by neuronal activity.
Dynamic changes in glypican‐1 expression in dorsal root ganglion neurons after peripheral and central axonal injury
Authors: Bloechlinger Stefan , Karchewski Laurie A. , Woolf Clifford J.
Published: March 2004

Glypican‐1, a glycosyl phosphatidyl inositol (GPI)‐anchored heparan sulphate proteoglycan expressed in the developing and mature cells of the central nervous system, acts as a coreceptor for diverse ligands, including slit axonal guidance proteins, fibroblast growth factors and laminin. We have examined its expression in primary sensory dorsal root ganglion (DRG) neurons and spinal cord after axonal injury. In noninjured rats, glypican‐1 mRNA and protein are constitutively expressed at low levels in lumbar DRGs. Sciatic nerve transection results in a two‐fold increase in mRNA and protein expression. High glypican‐1 expression persists until the injured axons reinnervate their peripheral targets, as in the case of a crushed nerve. Injury to the central axons of DRG neurons by either a dorsal column injury or a dorsal root transection also up‐regulates glypican‐1, a feature that differs from most DRG axonal injury‐induced genes, whose regulation changes only after peripheral and not central axonal injury. After axonal injury, the cellular localization of glypican‐1 changes from a nuclear pattern restricted to neurons in noninjured DRGs, to the cytoplasm and membrane of injured neurons, as well as neighbouring non‐neuronal cells. Sciatic nerve transection also leads to an accumulation of glypican‐1 in the proximal nerve segment of injured axons. Glypican‐1 is coexpressed with robo 2 and its up‐regulation after axonal injury may contribute to an altered sensitivity to axonal growth or guidance cues.
The psychology behind the masks: Psychological responses to the severe acute respiratory syndrome outbreak in different regions
Authors: Cheng Cecilia , Tang Catherine So‐kum
Published: March 2004

Severe acute respiratory syndrome (SARS) was first reported in China, and spread to 29 regions, affecting over 8000 people worldwide. For the general public, the psychological impact of SARS may have been greater than the physical health danger of the disease. The present paper proposes the influence of psychological factors on people's cognitive, affective, and behavioral responses during the SARS outbreak. The various papers in this special issue of the Journal reveal how people have reacted during the SARS outbreak: People's general coping styles may be related to their health behavior during the outbreak. Cultural differences were evident in the perception of SARS, and individuals’ perceptual styles may have influenced their ability to cope with the outbreak. The way in which individuals coped with SARS‐related stressful events was different from their usual practices of managing daily stress. Individual differences in the adoption of preventive measures were related to the distinct susceptibility to several social‐cognitive biases.
Coping with the threat of severe acute respiratory syndrome: Role of threat appraisals and coping responses in health behaviors
Authors: Lee‐Baggley Dayna , DeLongis Anita , Voorhoeave Paul , Greenglass Esther
Published: March 2004

The present study examines the psychological impact of severe acute respiratory syndrome (SARS) by exploring the coping strategies and health behaviors enacted in response to the SARS epidemic. Hierarchical linear regression indicated that the use of wishful thinking in response to the threat of SARS was related to both avoiding public places and avoiding people perceived to be possible  carriers  of  the  SARS  virus,  but  was  not  associated  with  the  use  of more adaptive health behaviors, such as using disinfectants and hand washing. Conversely, those who reported engaging in empathic responding in response to the threat of SARS were both less likely to report avoiding people perceived as being at a high risk for SARS and more likely to report engaging in effective health behaviors. Support seeking was not a significant predictor of the health behaviors examined in the present study. Results are discussed in terms of coping with health threats and health promotion.
Optimism across cultures: In response to the severe acute respiratory syndrome outbreak
Authors: Ji Li‐Jun , Zhang Zhiyong , Usborne Esther , Guan Yanjun
Published: March 2004

Based on our early research, we predicted that the Chinese may be more optimistic and less pessimistic than North Americans in response to negative life events. A survey was conducted to investigate optimism cross culturally in the context of the severe acute respiratory syndrome (SARS) outbreaks in Canada and China. Chinese students in Beijing and European Canadians in Toronto answered questions about their perceptions of SARS. No significant cultural difference was found on dispositional optimism, as measured by the Revised Life Orientation Test (LOT‐R). Unrealistic optimism was measured in the context of SARS. Both groups demonstrated unrealistic optimism (i.e. reporting that the self was less likely than an average person to get infected with SARS). Such optimistic bias was stronger among Chinese than among Canadians. Compared to the actual infection rates in Beijing and Toronto, both Chinese and Canadian participants overestimated their own chances of getting infected, indicating that they were being pessimistic. Indeed, Chinese were less pessimistic than Canadians. In addition, even though the Chinese reported more inconvenience brought by SARS than did Canadians, they also reported more positive changes brought by SARS, reflecting the Chinese dialectical views of events. Implications for research on optimism in context are discussed.
Constant vigilance: Heritage values and defensive pessimism in coping with severe acute respiratory syndrome in Singapore
Authors: Chang Weining C. , Sivam Ruben‐Wen
Published: March 2004

The present study investigates the congruency of defensive pessimism in the Asian context and its role in coping with the severe acute respiratory syndrome (SARS) crisis in Singapore. Data collected from 174 Singaporeans supported the hypothesized relationships among Chinese values, defensive pessimism, SARS‐related fears, compliance to preventive health‐related behaviors and negative outcomes. Path analysis revealed that individuals’ endorsement of Chinese value clusters − prudence, industry, and civic harmony − positively predicted their levels of defensive pessimism. The results also indicated that defensive pessimism had a direct positive effect on SARS‐related fears and, SARS‐related fears, in turn, were directly related to direct preventive health‐related behaviors but not related to indirect preventive behaviors. In addition to the indirect effect of Chinese values on direct preventive health‐related behaviors, Chinese values had a direct positive effect on both direct and indirect preventive health‐related behaviors. Consistent with our contention that defensive pessimism has the potential for leading to particular negative outcomes, defensive pessimism was found to influence negative outcomes but this relationship was partially mediated by SARS‐related fears.
Biases in the perceived prevalence and motives of severe acute respiratory syndrome prevention behaviors among Chinese high school students in Hong Kong
Authors: Tam Kim‐Pong , Lau Ivy Yee‐Man , Chiu Chi‐Yue
Published: March 2004

In two studies conducted in Hong Kong during and immediately after the outbreak of severe acute respiratory syndrome (SARS), participants displayed several social cognitive biases when they estimated the prevalence of and inferred the motives underlying SARS preventive behaviors. First, participants who practiced preventive behaviors (practicers) consistently estimated that more people practiced such behaviors than did non‐practicers (false consensus bias). Second, for some preventive behaviors, participants believed that their own behaviors were more motivated by prosocial concerns (relative to self‐interest) than were other practicers (pluralistic ignorance). Finally, non‐practicers underestimated the importance of prosocial concerns underlying some preventive behaviors (actor‐observer bias). We discussed the relevance of these social cognitive biases to health education and to Hong Kong people's psychological reactions to SARS.
Paternalistic leadership and subordinate responses: Establishing a leadership model in Chinese organizations
Authors: Cheng Bor‐Shiuan , Chou Li‐Fang , Wu Tsung‐Yu , Huang Min‐Ping , Farh Jiing‐Lih
Published: March 2004

Paternalistic leadership (PL) is the prevalent leadership style in Chinese business organizations. With an approach similar to patriarchy, PL entails an evident and powerful authority that shows consideration for subordinates with moral leadership. Although PL is widespread in Chinese business organizations, very few studies have focused on this leadership style and those that have were simply conceptual analyses and not empirical studies. We sampled 543 subordinates from local businesses in Taiwan to investigate PL, Western transformational leadership, and subordinate responses to these two leadership styles. Our hypotheses were as follows: (1) PL has a significant and unique effect on subordinate responses compared to Western transformational leadership; (2) there exists an interaction between the three elements of PL (benevolence, morality, and authoritarianism) and subordinate responses; and (3) the authority orientation of a subordinate's traditionality has a moderating effect upon the relation between PL and subordinate responses. Statistical analyses generally supported these hypotheses. Directions for follow‐up studies are offered and implications for leadership theory and practice are discussed.
Book Reviews
Authors: No Sun
Published: March 2004

From prejudice to intergroupemotions: Differentiated reactions to social groups

Diane M. Mackie and Eliot R. Smith (Eds). Psychology Press, NewYork, 2002. 299 pp.

ISBN 1‐84169‐047‐3. Price US $75.00, hardcover.
Book Reviews
Authors: Ho Samuel M. Y.
Published: March 2004

The Spiritual Recovery Manual. Vedic Knowledge and Yogic Techniques to Accelerate Recovery for Addicts, Codependents and Adult Children of Dysfunctional Families.

Patrick Gresham Williams (Ed). Incandescent Press, Palo Alto, CA, 2002. 272 pp.

ISBN 0‐9709078‐1‐8. Price US $35.00, paperback.
Idealism and Williams's Semantic Paradox
Authors: Jacquette Dale
Published: March 2004

Bernard Williams's essay ‘Wittgenstein and Idealism’ argues that that the conventionality of language entails the dependence of the truth of sentences and ultimately of corresponding states of affairs as truth‐makers on the existence of thinking subjects. Peter Winch and Colin Lyas try to avoid William's paradox by distinguishing between the existence conditions of a sentence and its assertion. The Winch‐Lyas solution is criticized and a stronger Winch‐Lays resistant version of Williams's paradox is proposed. A more satisfactory countercriticism is given, involving an ineliminable modal fallacy occurring in the paradox inference, that arises because of the argument's invalid combination of categorical and counterfactual assumptions and conclusions.
A Religious Point of View
Authors: Wolgast Elizabeth
Published: March 2004

The purpose of this paper is to show connections between Wittgenstein's approach to philosophy and the writings on religion of two authors whom we know Wittgenstein read and admired: William James and Leo Tolstoy. Wittgenstein stresses certain attitudes toward philosophical ‘problems’ which resemble the attitudes that James and Tolstoy connect with religious faith. There are also similarities of phrases and expressions.

It is not possible to say that these writers influenced the way Wittgenstein regarded philosophy, but it suggests that he recognized the similarities between their approaches and his despite the differences in subject. Consequently it helps to clarify why he would speak of his approach to problems as being from ‘a religious point of view’ even though its orientation is not specifically religious.
Kinds of Context: A Wittgensteinian Approach to Proper Names and Indexicals
Authors: Corazza Eros
Published: March 2004

In focusing on indexicals and proper names and on the different ways in which their references are fixed, I illustrate how our linguistic practice rests on context, broadly construed. The following theses are discussed and defended:

There are two main kinds of information: (i) anchored information, i.e. the information one gathers in using and entertaining indexical expressions and (ii) unanchored information, i.e. the information one may gain in hearing a proper name.

Indexical expressions differ from proper names; this difference relies on the differing ways in which extra‐linguistic context enters the scene.

The Kaplanian framework in particular, and the framework of direct reference in general, are best understood and appreciated against the background of a Wittgensteinian conception of language.
Techniques of vision: photography, disco and renderings of present perceptions in highland Papua
Authors: Hirsch Eric
Published: March 2004

This article draws on ethnographic and historical materials to interpret several related photographs and ritual images created by Fuyuge‐speakers of highland Papua. The images are analysed as techniques of vision. That is, the images are shown to bring forth present perceptions in a timely manner, as evaluated by Fuyuge men and women. It is shown how the representations are informed by distinctive Fuyuge retentions of the past in the present, and extensions of the present in the future. The article suggests that the tendency to ‘read’ photographic images for their semiotic connotations misses the local perceptions at work in their creation and use. Rather, photographic and ritual images are analogous to the relations of persons that produce them, with their mutually connected temporality.
The revealing muteness of rituals: a psychoanalytical approach to a Spanish ceremony
Authors: Molinié Antoinette
Published: March 2004

This analysis of a heterodox Corpus Christi ceremony celebrated in Spain emphasizes one of its distinctive features: the ritual is carried out by two moieties, who provide contradictory exegeses of the same ritual performance. Yet, despite their incompatibility, the two theories have a feature in common: the denial of a Jewish presence within the groups that express them. This phenomenon is discussed in the historical context of Christian stereotypes of Jews, enabling recognition of the fact that the ceremonial of Camuñas may be regarded, on a first level of analysis, within the framework of performance theory, as a ritual of memory. Some conceptual tools defined by Sigmund Freud, especially the concepts of negation and disavowal, are then used to analyse the ritual. The denial of reality and the irreconcilable exegeses of the two moieties evoke the split attitude of a fetishist towards castration. Thus, three analytical approaches of increasing depth are proposed to one and the same ritual: structuralist, performative, and psychoanalytical.
‘The trial’:1 a parody of the law amid the mockery of men in post‐colonial Papua New Guinea
Authors: Lipset David
Published: March 2004

According to students of legal pluralism, the relationship between Western law and local dispute management processes, remedies, and so on is multiple and complex. Legal pluralism studies have not ventured very far outside the arenas of conflict resolution, be they authorized or private. In this article, I argue that legal pluralism has imposed methodological blinders upon significant expressive dimensions of its problem. In a satirical mock‐trial that took place in rural Papua New Guinea, legal and indigenous constructions of order met not, as one might expect, instrumentally in the context of negotiating the resolution of a ‘trouble case’, but creatively combining in play to result in a multi‐voiced, comic discourse. The law is shown to have rhetorical value, particularly in colonial and post‐colonial settings where it may be deployed or invoked to represent and convey ambivalent attitudes about both justice and local constructions of personhood.
‘Undoubtedly an expert’? Anthropologists in British asylum courts
Authors: Good Anthony
Published: March 2004

Many British social anthropologists have been asked in recent years to provide expert evidence for use in legal appeals by asylum seekers. This article describes the administrative and legal decision‐making procedures to which asylum claims are subject. It considers how the courts respond to ‘objective evidence’ from ‘country experts’ such as anthropologists, comparing this to legal approaches to evidence from medical experts. The problems which arise – especially in relation to the key issue of an asylum seeker's ‘credibility’– are analysed with reference to diverse forms of reasoning among social scientists and lawyers, and their different understandings as to the nature of ‘fact’ and ‘truth’.
Taking sides and constructing identities: reflections on conflict theory
Authors: Schlee Günther
Published: March 2004

Conflicts are often explained in terms of the interests of the groups involved, especially their competition for resources or gains. There is much merit in this approach. Theories of this type appear more realistic than those which take the legitimizing accounts of participants at face value. What people are fighting about is a fundamental question in conflict analysis, but there is another equally fundamental question that remains poorly understood, namely, who is fighting whom and why? How and why do people draw the distinction between friend and foe precisely where they do?
In search of ritual: tradition, outer world and bad manners in the Amazon
Authors: Sáez Oscar Calavia
Published: March 2004

Ritual is currently a central issue in Indian politics in the Amazon. Ritual implies tradition, and thus ethnic legitimacy. But to some groups, such as the Panoan‐speaking Yaminawa, political and social looseness are handicaps to the invention of shared performances that are recognizable as rituals. Leadership is based both on an outward policy and an inward search for patterned, collective actions that can designate a gathering of kin and followers as an indigenous community. This article focuses on such ritual‐making efforts, describing two otherwise informal parties held on a Brazilian Yaminawa reservation where fieldwork was carried out in 1993.
Becoming a Christian in Fiji: an ethnographic study of ontogeny
Authors: Toren Christina
Published: March 2004

By means of an ethnographic and developmental analysis, this article shows how everyday ritual practice is fundamental to people's constitution over time of ideas that, in this case, inform a specifically Fijian Christianity. Focusing on the developmental process that is the fixation of belief, and on the significance of ritual for this process, it explores transformations in ideas about God, Sunday school, and death ceremonies held by Sawaieke girls and boys between 7 years, 10 months and 13 years old. The broader objective is to demonstrate, first, how data obtained systematically from children can illuminate our understanding of ritual and its significance, and, secondly, how an analysis of the developmental process necessarily entails a concomitant analysis of the social relations that inform it.
THE EUROPEAN COURT: THE FORGOTTEN POWERHOUSE BUILDING THE EUROPEAN SUPERSTATE
Authors: Howe Martin
Published: March 2004

Less attention is paid to the European Court of Justice than to other European Union institutions when discussing the centralising tendencies of the Union. However, the court has given an important impetus to the process of centralisation through its individual decisions and also through its tendency to give effect in its decisions to what it believes to be the‘purpose’of EU treaties rather than to the text of the treaties. The proposed EU constitution will significantly widen the power of the European Court since it includes articles which are wide open to a number of different interpretations, and it will be for the court to decide how they should be interpreted.
TOWARDS DESIGNING AN IDEAL PATENT SYSTEM
Authors: Orlov Alexei G.
Published: March 2004

An ideal patent system balances the returns to inventors and the dissemination of new technologies. This article examines legal policy instruments ‐ encompassing duration, scope and strength of patent protection, as well as invention disclosure and novelty requirements ‐ and R&D subsidies that help sustain growth in GDP. The paper studies the issues associated with designing an effective patent system, surveys the industrial property literature and delineates the focal points of debate among researchers and policy‐makers.
THE MEASURE OF INFLATION
Authors: Lilico Andrew
Published: March 2004

Different measures of inflation have their pros and cons. Changing the Monetary Policy Committee's inflation target to an inflation measure that excludes housing costs and is not widely used by economic decision‐makers may well be problematic.
J.M.KEYNES: AN EMPEROR WITHOUT CLOTHES (ONE NON‐ECONOMIST'S VIEW OF ANOTHER)
Authors: Arthur Terry
Published: March 2004

Central bank policy causes economic dislocation and recession. Keynes's work assumes away much of what is important in economic analysis. As a result, Keynesian conclusions on how to deal with recessions are wrong.
THE NORTH AMERICAN BLACKOUT AND ELECTRICITY POLICY: ALTERNATIVES TO TRANSMISSION CONSTRUCTION
Authors: Kiesling Lynne
Published: March 2004

It is time to stop regulating the electricity industry as if it were a natural monopoly. Technology has moved on and competition must not be discouraged by regulation. Competition is not only necessary for lower prices to consumers: the particular technological developments that have taken place in recent years mean that competition can diversify supply sources and contribute to increased security of supply.
CONSTITUTIONALISM, FEDERALISM AND THE EUROPEAN UNION
Authors: Barry Norman
Published: March 2004

The purpose of a constitution should be to restrain governments. The proposed EU constitution does not do that ‐ it provides agendas for government action. There is also no mechanism to facilitate jurisdictional competition. As such, if adopted, it will lead to further centralisation and abuse of statutory powers.
ECONOMIC ANALYSIS AND INTER‐JURISDICTIONAL COMPETITION
Authors: Ricketts Martin
Published: March 2004

The European Union does not set its regulatory principles in line with those that the theory of public goods suggests. The Union does not have full competence in areas such as defence that might involve public goods over a Europe‐wide area. Yet it does have competence over many areas that should be left to member states or local government. However, if competition between jurisdictions is prevented, there will be a drift towards centralisation of economic decision‐making. This paper analyses this trend from the point of view of the theory of clubs and theories of market failure.
Evidence of thymic reconstitution after highly active antiretroviral therapy in HIV‐1 infection
Authors: Hardy G , Worrell S , Hayes P , Barnett CM , Glass D , Pido‐Lopez J , Imami N , Aspinall R , Dutton J , Gazzard B , Peters AM , Gotch FM
Published: March 2004

Objectives

We aimed to provide evidence of thymic reconstitution after highly active antiretroviral therapy (HAART) in HIV‐1 infected patients and to correlate this with the restoration of peripheral naïve T cells.

Methods

Positron emission tomography (PET) enables definitive evidence of thymic activity, indicating functional potential. In this case study, a single patient who initiatiated HAART demonstrated reconstitution of the naïve T‐cell pool and underwent thymic PET scans at baseline and 2 and 6 months following initiation of therapy. Two patients who failed to demonstrate such reconstitution acted as controls. These patients (mean age 27 years) had chronic HIV infection with low CD4 T‐cell counts (mean 82, range 9–160 cells/μL blood). Increased function of the thymus visualized by PET was correlated with phenotypic changes in CD4 and CD8 T cells in the periphery measured by flow cytometry, and with numbers of recent thymic emigrants measured by quantification of the numbers of T‐cell receptor excision circles (TRECs) in peripheral cells.

Results

In one patient, clear correlations could be drawn between visible activity within the thymus, as measured by increased [F18]fluorodeoxyglucose (FDG) uptake, and regeneration of naïve CD4 (CD45RA/CD62L) T cells, increased numbers of CD4 T cells, controlled viraemia and increased numbers of recent thymic emigrants. A second patient displayed no increase in peripheral CD4 count and no increase in thymic activity. The third patient elected to stop therapy following the 2‐month time point.

Conclusions

The use of PET suggests that thymic activity may increase after HAART, indicating that the thymus has the potential to be functional even in HIV‐1 infected persons with low CD4 T‐cell counts.
Haemodynamic crisis and reversible multiorgan failure caused by HIV post‐exposure prophylaxis after needle‐stick injury in a health care worker
Authors: Feldt T , Oette M , Goebels K , Wenning M , Kroidl A , Häussinger D
Published: March 2004

We report the case of a 59‐year‐old nurse from our HIV ward who developed a severe haemodynamic crisis with concomitant acute multiorgan failure after initiation of a post‐exposure prophylaxis (PEP) with zidovudine/lamivudine (CombivirTM) and lopinavir/ritonavir (KaletraTM) after a needle‐stick injury with an HIV‐contaminated needle. Although serious and life‐threatening adverse effects of post‐exposure prophylaxis have been documented in several cases, this is the first report of a severe acute cardiovascular incident following PEP initiation.
A randomized open‐label study of immediate versus delayed polylactic acid injections for the cosmetic management of facial lipoatrophy in persons with HIV infection
Authors: Moyle GJ , Lysakova L , Brown S , Sibtain N , Healy J , Priest C , Mandalia S , Barton SE
Published: March 2004

Background

Polylactic acid (PLA, New‐Fill®; Medifill, London, UK and Dermic Labs, a division of Eventis, Strasbourg, France) injections into the deep dermis increase fibroblast numbers and collagen production. The substance is widely used in medical applications including cosmetic procedures.

Methods

HIV‐positive individuals with facial lipoatrophy (based on physician assessment) were randomized to immediate (weeks 0, 2 and 4) or delayed (weeks 12, 14 and 16) PLA given as three bilateral injections 2 weeks apart into the deep dermis overlying the buccal fat pad. Assessments included facial ultrasound, visual analogue scales, the Hospital Anxiety and Depression Scale (HADS) and assessment using photographs at weeks 0, 12 and 24.

Results

All 30 patients completed 24 weeks of treatment. The median age of the patients was 41 years, with a mean of 80 months of nucleoside reverse transcriptase inhibitor (NRTI) therapy and a mean of 44 months of prior protease inhibitor (PI) therapy. The median CD4 count was 428–460 cells/μL, with 47% of patients in the immediate‐treatment group and 93% of patients in the delayed‐treatment groups with<50 HIV‐1 RNA copies/mL at baseline. No differences in immunological, virological, biochemical, haematological or metabolic parameters emerged during the study. Injections were well tolerated with only two adverse events (cellulitis and bruising) recorded, one of which delayed treatment by 1 week. There were no discontinuations. Patient visual analogue assessments, photographic assessments, and anxiety and depression scores improved with treatment. At week 12, immediate‐treatment patients had significantly better visual analogue scores (7 vs. 1, P<0.001) and lower anxiety scores (6 vs. 9, P=0.056) than delayed‐treatment patients. Benefits on visual analogue and HADS scores persisted until week 24.

Conclusions

PLA injections led to improvements in patient self‐perception, anxiety and depression scores in individuals with facial lipoatrophy. Adverse events were uncommon. The benefits of PLA persisted for at least 18 weeks beyond the last injection.
The high cost of medical care for patients who present late (CD4<200 cells/μL) with HIV infection
Authors: Krentz HB , Auld MC , Gill MJ
Published: March 2004

Objective

To compare the direct costs of medical care in the year following HIV diagnosis for patients who present with a CD4 count<200 cells/μL (‘late presenters’) and those who present with a CD4 count >200 cells/μL (‘early presenters’).

Methods

Direct costs (i.e. drugs, laboratory tests, outpatient care, in‐patient care, and home care) for the 12 months following HIV diagnosis, sociodemographic data and clinical data were collected for all patients presenting for HIV care in Southern Alberta, Canada between April 1996 and April 2001. Mean costs are presented as costs in 2001 Canadian dollars.

Results

Thirty‐nine per cent of 241 patients presented with a CD4 count <200 cells/μL. The mean costs for late presenters were more than twice as high as those for early presenters (i.e. $18 448 vs. $8455, respectively). Late presenters were more likely to be older, male and black, and to have a risk activity of men having sex with men (MSM) or heterosexual contact (P<0.05). However, the large difference in mean costs cannot be attributed to differences in characteristics. When characteristics were statistically held constant, the estimated excess cost of late presentation was almost unaffected, at $9723 (z=5.6). Repeating the analysis using disaggregated costing categories suggested that the difference in total costs was largely attributable to differences in HIV‐related hospital care costs, which were 15 times higher for late presenters.

Conclusions

Direct care costs in the year following HIV diagnosis were more than 200% higher for patients who presented late. This difference could not be attributed to differences in patient characteristics. Most costs were attributable to HIV‐related hospital care costs and the immediate initiation of antiretroviral therapy. While early diagnosis in those at risk for HIV remains medically important, the short‐term economic impact is also substantial.
Nevirapine‐ versus efavirenz‐based highly active antiretroviral therapy regimens in antiretroviral‐naïve patients with advanced HIV infection
Authors: Manosuthi W , Sungkanuparph S , Vibhagool A , Rattanasiri S , Thakkinstian A
Published: March 2004

Objective

To compare virological and immunological responses to nevirapine (NVP)‐based and efavirenz (EFV)‐based highly active antiretroviral therapy (HAART) regimens in antiretroviral‐naïve patients with advanced HIV infection.

Methods

A retrospective observational cohort study was conducted on antiretroviral‐naïve HIV‐infected patients whose pretreatment CD4 cell counts were less than 100 cells/μL or whose viral loads were greater than 100 000 HIV‐1 RNA copies/mL.

Results

Baseline characteristics of patients in the NVP (n=24) and EFV (n=29) groups were not different. The proportion of patients with viral loads >100 000 copies/mL was higher in the EFV group. The probability of virological success estimated by the Kaplan‐Meier method showed that 3‐ and 6‐month success rates were 30.8% [95% confidence interval (CI): 16.7–52.2%] and 63.1% (95% CI: 44.7–81.3%) for the NVP group. The corresponding values were 41.2% (95% CI: 25.8–61.0%) and 62.9% (95% CI: 45.7–80.1%) for the EFV‐based group. The median success times of the two groups were about 4 and 3 months (P=0.678), respectively, for NVP and EFV. Cox's proportional hazard was used after adjusting for age, previous opportunistic infections (OIs), and viral load at baseline, and showed that patients who received the NVP‐based regimen had about 25% [hazard ratio (HR)=0.75, 95% CI: 0.37–1.51] less chance of virological success than patients who received the EFV‐based regimen (P=0.415). The median times to CD4≥100 cells/μL were 5.6 and 4.4 months for the NVP‐ and EFV‐based regimens, respectively (log‐rank test, P=0.144).

Conclusions

NVP‐ and EFV‐based HAART regimens as initial regimens in patients with advanced HIV infection are effective and comparable, in term of virological and immunological responses. However, further large‐scale randomized controlled clinical trials in this group of patients with advanced HIV infection are needed.
Lung cancer in patients with HIV infection: is it AIDS‐related?
Authors: Burke M , Furman A , Hoffman M , Marmor S , Blum A , Yust I
Published: March 2004

HIV‐infected individuals have an increased risk of malignancy, especially non‐Hodgkin's lymphoma and Kaposi's sarcoma. Recently, several workers have noted a raised prevalence of lung cancer in HIV‐positive subjects. We describe the diagnosis and clinical course for four HIV‐seropositive patients who presented with lung cancer. All of the patients were young and were heavy smokers. They were all on highly active antiretroviral therapy (HAART), although the adherence varied from poor to excellent. The CD4 cell counts of these patients ranged from 200 to 686 cells/μL and their viral loads ranged from undetectable to 29 000 HIV‐1 RNA copies/mL. After initial diagnosis of HIV infection between 5 and 13 years previously, they all presented with advanced lung cancer, with a very short clinical course, and all four died within 2–9 months of diagnosis. A comparison of the incidence of lung cancer in patients with HIV infection at our centre with that in the general population suggests that there is an increased prevalence in the HIV‐infected patients. We review the literature and discuss whether lung cancer in HIV infection is coincidental or related to the primary disease.
Laparovaginal hysterectomy: A decade of evolution
Authors: Cook Jennifer R. , O'Shea Robert T. , Seman Elvis I.
Published: March 2004

Objective:  To compare surgical outcomes for laparoscopically‐assisted vaginal hysterectomy (LAVH) to total laparoscopic hysterectomy (TLH) and to document the modifications to the technique of laparovaginal hysterectomy which have occurred over the last decade at Flinders Endogynaecology, South Australia, Australia. The method of choice at the start of the decade was LAVH and by the end of the study period it had been superceded by TLH.

Sample:  Seven hundred and ninety‐four consecutive women underwent hysterectomy between January 1992 and December 2001 at Flinders Endogynaecology. This included 424 women who underwent TLH and 370 who underwent LAVH.

Methods:  Retrospective review of case history notes and manual extraction of data.

Main outcome measures:  Demographic data including patient age, weight and parity were extracted. Intraoperative complications including ureteric injury, cystotomy, bowel damage or conversion to open procedure were recorded. The rate of non‐autologous blood transfusion was recorded and miscellaneous data including length of procedure, estimated blood loss, length of hospitalisation, concomitant procedures carried out and re‐admission rates were also recorded.

Results:  There was a statistically significant reduction in major morbidity in the TLH group when compared to the LAVH group. The lower rate of conversion to laparotomy in the TLH group was statistically significant (3.0 vs 0.9%). A non‐significantly higher rate of ureteric injury was observed in the TLH group (0.7 vs 0.3%). Other outcome measures showed a trend toward an improved outcome for TLH but were not statistically significant. This includes a lower rate of bowel injury in the TLH group (0 vs 0.3%), a lower rate of cystotomy in the TLH group (1.4 vs 3.0%) and lower rate in non‐autologous blood transfusion in the TLH group (1.2 vs 3.0%). There was a statistically significant reduction in hospital stay from 4.5 days in the LAVH group to 3.4 days in the TLH group.

Conclusion:  The evolution of laparovaginal hysterectomy from LAVH to TLH over the last 13 years has resulted in improved patient outcomes. Ongoing modification of the technique to ensure ureteric protection must remain a priority.
Laparoscopic treatment of enterocele: A 3‐year evaluation
Authors: Cook Jennifer R. , Seman Elvis I. , O'Shea Robert T
Published: March 2004

Objective:  To report the morbidity associated with the laparoscopic treatment of enteroceles and assess the durability of the repair.

Design:  Prospective observational study.

Setting:  University Teaching Hospital.

Population:  Forty‐five consecutive women with symptomatic enteroceles who underwent laparoscopic treatment of an enterocele.

Main outcome measures:  Objective urogynaecological assessment using the pelvic organ prolapse quantification system.

Results:  The 11% incidence of anterior wall prolapse is lower than that associated with previous reports of surgical procedures to treat enterocele. There is a 4.4% incidence of major complications. The procedure has been demonstrated to have a 93% success rate at 3 years in treating enterocele.

Conclusion:  The laparoscopic enterocele sac excision and vaginal vault suspension fulfils Richardson's requirements for surgical correction of enterocele and provides an anatomic solution to the long‐standing surgical dilemma of enterocele.
Veda‐scope: More comfortable than the bivalve speculum and cytologically equivalent
Authors: Longmore Peter G.
Published: March 2004

Objective: The aim of the present study was to confirm that the Veda‐scope is equivalent to the bivalve speculum in the collection of endocervical cells, as confirmation of adequate cervical sampling for Pap smear testing. The study also aimed to assess the comfort level of the Veda‐scope compared to the traditional bivalve speculum and the patient preference of the Veda‐scope compared to the bivalve speculum.

Methodology: Multicentre, randomised, controlled crossover, cytologist blinded study.

Population: The total number of subjects enrolled in the study were 250. The number of evaluable subjects were 210.

Results: In primary efficacy analysis, no significant difference was seen between the presence or absence of endocervical cells in the smears using either the Veda‐scope or the bivalve speculum. There was a high concordance level between the diagnosis assigned to each specimen of a paired sample, the diagnosis agreeing in 97.6% cases. The primary reason given by many women for avoidance of regular Pap smear examinations is the discomfort or pain experienced with sample collection with the bivalve speculum. In the present study, 92% of subjects indicated a preference for the Veda‐scope for Pap smear collection, while only 8.4% preferred the bivalve speculum. Subject preference was also assessed with respect to how the subject rated the comfort level of her previous Pap smear. In subjects who rated their previous Pap smear as very comfortable or comfortable, 86% expressed a preference for the Veda‐scope. This rose to 93% in subjects who rated their previous Pap smear as only tolerable.

Conclusion: The results of the present study show that Pap smear collections with the Veda‐scope are of equal quality to those collected with the bivalve speculum, with an equivalent diagnostic outcome. A very strong preference for the Veda‐scope was shown by the women enrolled in the present study based on the comfort levels experienced with the two devices.
Voiding function after tension‐free vaginal tape: A longitudinal study
Authors: Dietz Hans Peter , Ellis Gaye , Wilson Peter Donald , Herbison Peter
Published: March 2004

Background:  The tension‐free vaginal tape (TVT) has become popular for the surgical treatment of urodynamic stress incontinence. It seems to function via an intermittent obstructive effect that is easily demonstrated on imaging, although there is no agreement regarding its effect on voiding.

Aims:  The present study was designed to longitudinally evaluate flowmetry indices and voiding symptoms after TVT placement.

Methods:  A total of 145 consecutive patients were seen at yearly intervals after TVT placement, and 108 have now attended at least twice. A standardised questionnaire was filled in and a clinical stress test performed. The patients were asked to void for flowmetry; ultrasound was performed translabially for residual urine, tape position and mobility.

Results:  After TVT placement, maximum flow rate (MFR) centiles dropped from 49.66 (SD 32.45) to 22.86 (SD 23.56), P < 0.001. However, when first and last postoperative visits were compared, there was a significant increase in MFR centiles (20.07 (SD 20.83) to 24.92 (SD 23.94), P = 0.021). This effect appeared to be almost linear over time when analysed on anova. The residuals decreased highly significantly (P < 0.001). This was accompanied by a reduction in symptoms of voiding dysfunction such as ‘poor stream’ (P = 0.024), ‘straining to void’ (P = 0.038) and ‘incomplete emptying’ (P = 0.019).

Conclusions:  The tension‐free vaginal tape reduces MFR and flow rate centiles. It can have an obstructive effect on voiding, although this does not appear to be a major clinical problem. Voiding seems to improve over time, and this is accompanied by a reduction in the prevalence of symptoms of voiding dysfunction.
Effects of oestrogen replacement therapy on serum C‐reactive protein levels in hysterectomised women
Authors: Kiran Hakan , Kiran Gurkan , Ekerbicer Hasan C. , Guven Alanur M. , Kilinc Metin
Published: March 2004

Background:  It has been hypothesised that oral oestrogen replacement therapy may increase levels of C‐reactive protein (CRP), a marker of inflammation associated with increased risk of future cardiovascular events. However, it is possible that intranasal oestrogen replacement therapy have different effects on serum CRP levels.

Aim:  To investigate the effect of postmenopausal intranasal oestrogen replacement therapy on serum levels of CRP. A prospective comparative study was carried out.

Methods:  Twenty‐nine healthy hysterectomised, postmenopausal women received 300 µg/day of intranasal 17β‐oestradiol (E2). The serum levels of CRP after 3 and 6 months after starting treatment were compared with baseline values.

Results:  There were no significant changes in the values of CRP after 3 and 6 months of treatment (P = 0.305, P = 0.149, respectively).

Conclusions:  The data from the present study suggest that intranasal administration of E2 does not affect CRP levels, possibly by avoiding a hepatic first‐pass effect. The possible cardiovascular protective role of intranasal oestrogen might be related to its effect of not increasing CRP levels.
Magnetic resonance imaging findings following three different vaginal vault prolapse repair procedures: A randomised study
Authors: Rane Ajay , Lim Yik Nyok , Withey Grant , Muller Reinhold
Published: March 2004

Objective:  To compare the vaginal configuration on magnetic resonance imaging following transvaginal sacrospinous fixation (SSF), posterior intravaginal slingplasty (PIVS) (infracoccygeal sacropexy) and sacrocolpopexy (SCP).

Materials and methods:  Twenty‐one patients with vault prolapse requiring surgical treatment were randomly assigned in a balanced way to undergo SSF (n = 7), PIVS (n = 7) or SCP (n = 7). The magnetic resonance imaging of the pelvis were performed preoperatively and at 6–12 weeks postoperatively to assess the vaginal configuration using the method described previously. The two main angles measured were: (i) the angle between the lower vagina and pubococcygeal line ‘d‐angle’ (normal: 53 ± 15°); and (ii) the angle between the lower and upper vagina planes ‘e‐angle’ (normal: 145 ± 7°).

Results:  The mean preoperative/postoperatively measured d‐angles were 69°/62°, 58°/70°, and 49°/52° for SSF, PIVS and SCP, respectively. The corresponding means for the e‐angle were 173°/215°, 189°/146°, and 205°/149°. The changes of the e‐angles proved to be statistically significant (P < 0.05) in each surgical group, while no significant change in the d‐angle could be found in any of the three groups.

Conclusions:  Significant improvements in the restoration of vaginal configuration were achieved in patients who underwent PIVS or SCP. Sacrospinous fixation in contrast seems to increase anatomical distortion of the vaginal configuration.