bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of lung volume reduction surgeryversusrehabilitation on quality of life
Authors: Mineo T.C. , Ambrogi V. , Pompeo E. , Elia S. , Mineo D. , Bollero P. , Nofroni I.
Published: February 2004

This study aims at evaluating the effects of lung volume reductionversusrespiratory rehabilitation on quality of life, assessed by three different questionnaires.

Sixty emphysematous patients were randomised by computer to receive either surgery (n=30) or rehabilitation (n=30). Life quality was evaluated by the Nottingham Health Profile, the Short Form (SF)‐36 item and the St George's questionnaires.

As reported previously, dyspnoea index, forced expiratory volume in one second, residual volume, 6‐min walk test and arterial oxygen tension improved after surgery more than after rehabilitation. Quality of life was significantly improved after surgery as follows Nottingham Health Profile physical mobility; SF‐36 physical and social functioning, mental and general health, emotional role; St George's general, activity.

At multivariate analysis 6‐ and 12‐month changes after surgery of Short Form‐36 physical functioning, general health, and St George's activity domains were significantly correlated with forced expiratory volume in one second, while Short Form‐36 social functioning and Nottingham Health Profile isolation correlated with residual volume. Functional and especially symptomatic improvements persisted: dyspnoea index, residual volume, and Short Form‐36 and St Georges's physical scores were still significant at 4 yrs. Surgery produces greater and longer effects than rehabilitation on quality of life by improving both physical and psychosocial domains. Symptomatic improvements persisted at 4 yrs.
Reversible inhibition of mitochondrial complex IV activity in PBMC following acute smoking
Authors: Alonso J-R. , Cardellach F. , Casademont J. , Miró Ò.
Published: February 2004

Smoking causes a decrease of mitochondrial complex IV activity in chronic smokers. However, it is not known if this toxic effect is due to the acute effect of cigarette smoke itself or is a secondary phenomenon related to other smoking factors.

The study assessed mitochondrial respiratory chain function in peripheral blood mononuclear cells of 15 healthy nonsmoker individuals before smoking (t0), immediately after smoking five cigarettes in 45 min (t1) and 24 h later (t2). Blood carboxyhaemoglobin (COHb) and carbon monoxide concentrations in exhaled air (COEA) were determined to ascertain smoke inhalation status.

After acute smoking, COHb increased from 0.5±0.3% to 3.3±1.5%, and COEA from 2.9±2.5 to 26.1±9.9 ppm. Complex II and III enzyme activities did not change along the study. Complex IV activity showed a 23% inhibition at t1but returned to initial (t0) levels at t2. A decay in oxygen consumption was observed after the correction for mitochondrial content. Lipid peroxidation of cell membranes remained unchanged.

Short-time smoking causes an acute and reversible mitochondrial complex IV inhibition in human mononuclear cells. These results suggest that smoke itself is one of the causes for the decrease of complex IV activity observed in chronic smokers.
Medical complications of lung transplantation
Authors: Kotloff R.M. , Ahya V.N.
Published: February 2004

Surgical advances, in conjunction with more effective immunosuppressive strategies, have propelled the field of lung transplantation forward and have made intermediate-term survival an achievable goal. Nonetheless, the post-transplant course is often marked by complications that threaten both the quality and duration of the recipient's life.

Many of the medical complications that arise are the direct consequence of the need to administer potent immunosuppressive agents, with their attendant risks of infection, malignancy and drug toxicity.

This article will review the major medical complications, excluding allograft rejection, which may be encountered in the lung transplant recipient. Familiarity with, and vigilance for, these problems should facilitate earlier recognition, more expeditious intervention and more favourable outcomes.
Exaggerated bronchoconstriction due to inhalation challenges with occupational agents
Authors: Malo J‐L. , Cartier A. , Lemière C. , Desjardins A. , Labrecque M. , L'Archevêque J. , Perrault G. , Lesage J. , Cloutier Y.
Published: February 2004

Inhalation challenges with occupational agents are used to confirm the aetiology of occupational asthma. It has been proposed that using closed-circuit equipment rather than the realistic challenge method would improve the methodology of these tests.

Changes in forced expiratory volume in one second (FEV1) were examined in 496 subjects with “positive specific inhalation challenges”,i.e.changes in FEV1of ≥20% after exposure to an occupational agent, including 357 subjects exposed by the realistic method, 108 using the closed-circuit method and 31 by both methods.

For immediate reactions, 18 of 95 (19%) showed changes in FEV1of ≥30% with the closed-circuit method, whereas a significantly larger proportion,i.e.77 of 200 (38.5%), showed such changes using the realistic method. As regards nonimmediate reactions, changes in FEV1of ≥30% occurred in 16 of 43 (37%) cases with the closed-circuit method as compared to a larger proportion,i.e.87 of 180 (48%) cases, using the realistic method. This favourable effect was significantly more pronounced in workers with higher levels of bronchial hyperresponsiveness to methacholine.

It is concluded that, for agents that can be generated using the closed-circuit method, use of such apparatus results in a smaller proportion of exaggerated bronchoconstriction than does the realistic method, this being particularly true for low-molecular weight agents.
The Arg753Gln polymorphism of the human Toll-like receptor 2 gene in tuberculosis disease
Authors: Ogus A.C. , Yoldas B. , Ozdemir T. , Uguz A. , Olcen S. , Keser I. , Coskun M. , Cilli A. , Yegin O.
Published: February 2004

Toll-like receptor 2 (TLR2), a member of the Toll-like receptor family, plays an important role in recognition of, and subsequent immune response activation against, mycobacteria. The genetic polymorphism of TLR2 (arginine to glutamine substitution at residue 753 (Arg753Gln)) has been associated with a negative influence on TLR2 function, which may, in turn, determine the innate host response to mycobacteria. The aim of the present study was to investigate the Arg753Gln single nucleotide polymorphism of the TLR2 gene in tuberculosis (TB) patients compared to healthy controls.

A retrospective case/control study was carried out. The Arg753Gln polymorphism of the TLR2 gene was studied in 151 TB patients compared to 116 ethnically and age-matched healthy control subjects.

The TLR2 polymorphism (adenine (A) allele) was observed in 17.9 and 7.7% of TB patients and controls, respectively. When the ratios of the three genotypes were compared between the two groups, the AA genotype was found to be more significantly associated with TB. Allele frequencies for guanine (G) and A were found to be 0.95 and 0.05 in the control group and 0.86 and 0.14 in the TB patient group, respectively. The risk of developing TB disease was increased 6.04‐ and 1.60‐fold for carriers of the AA and GA genotypes, respectively.

In conclusion, the present data suggest that the arginine to glutamine substitution at residue 753 polymorphism of the Toll-like receptor 2 gene influences the risk of developing tuberculosis.
Chronic tonsillar enlargement and cough: preliminary evidence of a novel and treatable cause of chronic cough
Authors: Birring S.S. , Passant C. , Patel R.B. , Prudon B. , Murty G.E. , Pavord I.D.
Published: February 2004

Tonsillar enlargement is sometimes seen in patients with otherwise unexplained chronic cough although its significance is unclear. In this study, the authors set out to test the hypothesis that cough symptoms and cough reflex sensitivity will improve after tonsillectomy in patients with otherwise unexplained chronic cough and enlarged tonsils.

Eight consecutive patients with unexplained chronic cough and enlarged tonsils were recruited from 236 patients seen in a cough clinic between 2000 and 2001. Six patients with enlarged tonsils and no cough who were undergoing tonsillectomy for other reasons were recruited as a control group. All patients rated cough severity on a cough visual analogue score (0–100 mm) and had capsaicin cough reflex sensitivity measurement twice before and again 3 months after tonsillectomy.

Patients with a chronic cough had heightened cough reflex sensitivity compared with the control group at baseline. There was a significant improvement in mean cough visual analogue score 3 months after tonsillectomy in patients with chronic cough (mean difference 30 mm; 95% confidence interval of difference 8–51 mm). The geometric mean concentration of capsaicin required to cause five coughs increased from 4 to 207 µmol·L−1after tonsillectomy in patients with chronic cough (mean difference from baseline 5.6 doubling concentrations; 95% confidence interval of difference 3.1–8.2). There was no change in cough reflex sensitivity in control patients after tonsillectomy.

These preliminary findings suggest for the first time a possible role for tonsillectomy in patients with enlarged tonsils in whom other causes of cough have been ruled out.
Genetic background affects susceptibility in nonfatal pneumococcal bronchopneumonia
Authors: Preston J.A. , Beagley K.W. , Gibson P.G. , Hansbro P.M.
Published: February 2004

A nonfatal pneumococcal lung infection model was required to investigate immune responses during recovery, and the interaction of other diseases subsequent to infection. A murine model of nonfatal pneumococcal lung infection was developed and the effect of genetic background on susceptibility was determined in BALB/c and C57BL/6 mice.

Bacteria colonised the lungs and mice developed mild clinical illness with pathophysiology similar to human bronchopneumonia. Recovery was associated with immune cell influx, which cleared bacteria but induced tissue damage characteristic of pneumococcal bronchopneumonia.

After clearance, immune cell populations returned to normal and tissues appeared less inflamed. Although bacterial exposure and clearance were similar, the extent of immune cell influx and tissue damage differed significantly. Larger numbers of neutrophils and lymphocytes entered lung tissue and the affected area was greater in BALB/c compared with C57BL/6 mice.

An inflammatory basis for differences was determined with greater levels of phagocytosis and oxidative burst observed in BALB/c mice. C57BL/6 mice cleared the low inoculum with a reduced immune response; however, C57BL/6 mice are more susceptible to larger inocula, which overwhelms the immune system. These different susceptibilities result from a greater inflammatory response in BALB/c compared with C57BL/6 mice.
One-year cost-effectiveness of tiotropiumversusipratropium to treat chronic obstructive pulmonary disease
Authors: Oostenbrink J.B. , Rutten-van Mölken M.P.M.H. , Al M.J. , Van Noord J.A. , Vincken W.
Published: February 2004

The aim of this paper is to assess the health economic consequences of substituting ipratropium with the new, once-daily bronchodilator tiotropium in patients with a diagnosis of chronic obstructive pulmonary disease (COPD).

This prospective cost-effectiveness analysis was performed alongside two 1‐yr randomised, double-blind clinical trials in the Netherlands and Belgium. Patients had a diagnosis of COPD and a forced expiratory volume in one second (FEV1) ≤65% predicted normal. Patients were randomised to tiotropium (18 µg once daily) or ipratropium (2 puffs of 20 µg administered four times daily) in a ratio of 2:1.

The mean number of exacerbations was reduced from 1.01 in the ipratropium group (n=175) to 0.74 in the tiotropium group (n=344). The percentages of patients with a relevant improvement on the St. George's Respiratory Questionnaire (SGRQ) were 34.6% and 51.2% respectively. Compared to ipratropium, the number of hospital admissions, hospital days and unscheduled visits to healthcare providers was reduced by 46%, 42% and 36% respectively. Mean annual healthcare costs including the acquisition cost of the study drugs were 1721 (sem 160) in the tiotropium group and 1,541 (SEM 163) in the ipratropium group (difference 180). Incremental cost-effectiveness ratios were 667 per exacerbation avoided and 1084 per patient with a relevant improvement on the SGRQ.

Substituting tiotropium for ipratropium in chronic obstructive pulmonary disease patients offers improved health outcomes and is associated with increased costs of 180 per patient per year.
Innate immunity in the lung: how epithelial cells fight against respiratory pathogens
Authors: Bals R. , Hiemstra P.S.
Published: February 2004

The human lung is exposed to a large number of airborne pathogens as a result of the daily inhalation of 10,000 litres of air. The observation that respiratory infections are nevertheless rare is testimony to the presence of an efficient host defence system at the mucosal surface of the lung.

The airway epithelium is strategically positioned at the interface with the environment, and thus plays a key role in this host defence system. Recognition systems employed by airway epithelial cells to respond to microbial exposure include the action of the toll-like receptors.

The airway epithelium responds to such exposure by increasing its production of mediators such as cytokines, chemokines and antimicrobial peptides. Recent findings indicate the importance of these peptides as effector molecules of innate immunity by killing microorganisms, but also as regulators of inflammation, immunity and wound repair. Finally, the clinical relevance of the functions of the airway epithelium in innate immunity is discussed.
Long- and medium-term ozone effects on lung growth including a broad spectrum of exposure
Authors: Ihorst G. , Frischer T. , Horak F. , Schumacher M. , Kopp M. , Forster J. , Mattes J. , Kuehr J.
Published: February 2004

The effects of semi-annual and 3.5 yr mean ozone (O3) concentrations on children's forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were assessed over a study period of 3.5 yrs in 2,153 schoolchildren from 15 study sites in South Western Germany and Lower Austria.

Spirometric parameters were assessed twice a year, and differences between consecutive measurements divided by days were considered as a measure of lung growth. Exposure was analysed in four classes, separately for winter and summer (semi-annual mean O3concentrations 22–30, 30–38, 38–46, 46–54 parts per billion (ppb) in summer and 4–12, 12–20, 20–28, 28–36 ppb in winter).

Regression methods for repeated measurements were used, and these revealed a significantly lower FVC (FEV1) increase estimated at −19.2 (−18.5) mL·100 days−1for semi-annual mean O3exposure in summer between 46 and 54 ppb compared to exposure between 22 and 30 ppb. However, in winter, the estimated difference in FVC (FEV1) was 16.4 (10.9) mL·100 days−1between the semi-annual O3class 28–36 ppb and the 4–12 ppb class. By means of linear regression the study found that there was no association between growth rates and mean summer O3for FVC and FEV1over a 3.5 yr period.

The authors conclude that medium-term effects on schoolchildren's lung growth are possibly present, but are in the long-term not detectable for forced vital capacity and forced expiratory volume in one second over a 3.5 yr period due to partial reversibility.
Computed tomography features of liparitosis: a pneumoconiosis due to amorphous silica
Authors: Mazziotti S. , Gaeta M. , Costa C. , Ascenti G. , Barbaro Martino L. , Spatari G. , Settineri N. , Barbaro M.
Published: February 2004

The purpose of this study was to describe the radiological features of pleural, parenchymal and mediastinal damage due to occupational inhalation of pumice.

In total, 31 workers were evaluated for annual follow-up. Spiral computed tomography (CT) was obtained in the three patients with evident parenchymal abnormalities at chest radiograph. High-resolution computed tomography (HRCT) was performed in the remaining 28 subjects with no radiographical evidence of pleuro-pulmonary damage or evidence of pleural plaques, in order to exclude parenchymal involvement. Pumice samples were analysed by radiograph diffraction and scanning electron microscopy.

Spiral CT showed parahilar conglomerate masses containing fine reticular calcifications in three of 31 (9.7%) patients. HRCT showed several bilateral pleural plaques, without any parenchymal lesion in eight of 28 (28.6%) cases. Statistical analysis indicated correlation between CT findings and pulmonary function, as well as exposure to pumice. The analysis of pumice excluded the presence of asbestos.

The findings from this study suggest that pleural plaque may be the only sign of disease in patients with a history of pumice inhalation. However, conglomerate parahilar masses are probably due to exposure to massive amounts of heated pumice, and seem to have different pathogenesis and histopathological characteristics to silicosis.
Chronic bronchiolitis in a 5‐yr-old child after exposure to sulphur mustard gas
Authors: Dompeling E. , Jöbsis Q. , Vandevijver N.M.A. , Wesseling G. , Hendriks H.
Published: February 2004

Exposure to sulphur mustard (SM) gas may have extensive immediate effects on the respiratory system. However, long-term effects are far less known. This case report describes a Kurdish male child who was exposed to SM gas during a chemical attack in Iraq at 5 yrs of age.

In the acute phase, the child developed severe respiratory symptoms with a chemical pneumonia. Extensive burning of the skin occurred. In the course of 10 yrs, lung function deteriorated progressively to a forced expiratory volume in one second of 30% of predicted value. Severe air-trapping occurred. The lung function abnormalities were not reversed by treatment with corticosteroids or bronchodilators. Infectious exacerbations of the child's lung disease occurred. High resolution computed tomography scan showed multiple bronchiectasis. The histological picture of an open lung biopsy was best described as a “chronic bronchiolitis”.
Systemic lupus erythematosus with hepatic aneurysm, Valsalva sinus aneurysm and associated polyangiitis: aneurysmal wall remodeling with dense fibrosis and calcification mediated by residual smooth muscle cells
Authors: Yamazaki K
Published: February 2004

Isolated case reports have demonstrated the combination of hepatic aneurysm and systemic lupus erythematosus (SLE). The author experienced a rare autopsy case of a 36-year old Japanese male with SLE, a hepatic aneurysm, a Valsalva sinus aneurysm and associated polyangiitis. In the histopathological and ultrastructural examinations of the postmortem organs, most of the angiitis lesions were in the scar phase associated with the histopathological features of collagenous fibrosis with the diminution of the smooth muscle cells and elastic fibre layers. Massive calcification was seen on the wall and obliterative changes in the lumen with calcified thrombi. In the dense collagenous stroma of the aneurysmal wall, residual atrophic smooth muscle cells with immunohistochemical (HHF35, alpha-smooth-muscle actin, vimentin and desmin almost-) and ultrastructural features (spindle-shapedcells with a few rER and rich intracytoplasmicfilaments with peripheraldense patches)were assumed to be involvedin the histogenesisof the aneurysmalwall. Massivecalcification and degenerationor dynamic remodelingof the extracellularmatrices in the aneurysmalwall might be mediated by the residual smooth muscle cells. It was suspected that the generalized polyangiitis as a complication of SLE might have involved the intrahepatic arteries and Valsalva sinus wall and subsequently generated the aneurysm.
Factor XIII Val34Leu polymorphism does not contribute to the prevention of thrombotic complications in patients with antiphospholipid syndrome
Authors: Diz-Kucukkaya R , Hancer V S , Inanc M , Nalcaci M , Pekcelen Y
Published: February 2004

The effect of thrombophilic mutations in the development of thrombosis in patients with antiphospholipid syndrome (APS) has been extensively investigated. Factor XIII (FXIII) Val34Leu polymorphism is a newly described polymorphism which is located in the three amino acids away from the thrombin activation site of the FXIII-A subunit. It has been reported that the Leu allele decreases the risk of both arterial and venous thrombosis. In the present study, we examined the associationbetween the FXIII Val34Leu polymorphismand the developmentof thrombosisin patients with APS. Sixty APS patients with arterial and venous thrombosis, 22 antiphospholipid antibody (aPLA) positive patients with first trimester abortus and/or thrombocytopenia,126 healthy controls, and 60 healthy subjects who were age- and sex-matched with thrombotic APS group were included into the study. FXIII Leu allele frequencies in the APS patients with thrombosis, aPLA-positive patients without thrombosis, healthy controls, and matched controls were 13.3, 16, 19.5, and 18.3%, respectively. When we compared Leu allele frequencies between APS patients with thrombosis and aPLA-positive patients without thrombosis, healthy controls or matched controls, we could not find any difference (x 2, P 0.43, and P 0.09, P 0.67, respectively). Our results showed that the FXIII Leu allele has no protectiveeffect in the developmentof thrombosis in APS.
Intrauterine fetal death in mice caused by cytomegalovirus-derived peptide induced aPL antibodies
Authors: Gharavi A E , Vega-Ostertag M , Espinola R G , Liu X , Cole L , Cox N T , Romagnoli P , Labat K , Pierangeli S S
Published: February 2004

Immunization of mice with β2 glycoprotein I (β2 GPI) and also with GDKV, a synthetic peptide representing the phospholipid (PL)-binding site of β2 GPI, induced pathogenic aPL antibodies that bind and activate endothelial cells, enhanced thrombus formation and caused fetal death in pregnant mice. TIFI is a PL-binding peptide spanning the Thr101-Thr120 of ulb0-hcmva from human cytomegalovirus (CMV), which shares structural similarity with the PL-binding site of β2 GPI. Immunization with this peptide induced pathogenic aPL and anti-β2 GPI antibodies in mice. These antibodies activated endothelial cells and enhanced thrombus formation in vivo, but whether these antibodies cause fetal death in mice is not known. The objectiveof this study was to examine the effects of these antibodieson pregnancyoutcomein mice. Two groups of pregnantBALB/c mice were injected with either hybridoma supernatant containing D3/AC10, a CMV-peptide-induced monoclonal aPL, at days four, eight and 12 of the pregnancy, 100 m g per mouse (study group) or with culture media alone (control group). The litter size was significantly smaller in the study group (4.80 + 1.15 versus 7.28 + 0.18, t =- 2.526, P < 0.03). In conclusion, aPL induced by CMV peptides may have pathogenic properties similar to human autoimmune aPL. These findings further support the hypothesis that at least in some patients with APS, pathogenic aPL antibodies may be generated by immunization with CMV products during incidental exposure to the virus via a molecular mimicry mechanism.
Long-term efficacy of immunoadsorbent plasmapheresis in a patient with Budd-Chiari syndrome due to antiphospholipid syndrome: case report with nine-year follow-up
Authors: Yagi K , Kawano M , Haraki T , Higashikata T , Ueda K , Okada T , Koni I , Mabuchi H
Published: February 2004

We describe the safety and efficacy of long-term immunoadsorbent plasmapheresis (IAPP) with dextran sulfate-cellulosebead columnsin antiphospholipidsyndrome (APS). IAPP was administeredto a 38-year old male Japanese patient with APS with Budd-Chiari syndrome (BCS), who had presented with refractory lower leg skin ulcers and arterial and venous thromboses including BCS. After hepatic vein transluminal angioplasty was performed, the combination of corticosteroid, aspirin and IAPP was administeredbecause of an underlyingbleedingtendencyrelated to liver dysfunction.From February 1994 to February 2003, a total of 228 procedureswere performed. No further thrombosis-relatedsymptoms or bleeding have occurred for more than nine years, suggesting that IAPP with dextran sulfate-cellulose columns is safe and effective for APS in preventingadditional thrombotic events. This IAPP supplements anticoagulation, antiplatelet, corticosteroid and immunosuppressant therapies.
Expression and activity analyses of CTLA4 in peripheral blood lymphocytes in systemic lupus erythematosus patients
Authors: Hirashima M , Fukazawa T , Abe K , Morita Y , Kusaoi M , Hashimoto H
Published: February 2004

The objective of this study was to determine the expression and activity of CTLA4 in T-cells of systemic lupus erythematosus (SLE) patients. Expression of CTLA4 on freshly isolated peripheral blood T-cells was evaluated in 33 SLE patients and 25 controls using flow cytometry.The T-cells from 19 SLE patients and 22 controls were stimulated and cultured with Chinese hamster ovary cells expressing CD80 (CHO-CD80) or with CHO cells. T-cell proliferation was determined with [3H] thymidine incorporation (CPM), and the inhibitory effect of CTLA4 on T-cell proliferation was evaluated by the ratio of CPM for T-cells with CHO -CD80 cells to that of T-cells with CHO cells (the CHO -CD80/CHO ratio). IntracellularCTLA4 expressionin freshly isolated peripheral blood T-cells was significantly higher in SLE patients than the controls (P < 0.05), but there was no correlation with clinical features or disease activity. The CHO -CD80/CHO ratio of SLE patients was significantly higher than that of the controls(P < 0.05). Among SLE patients, the CHO -CD80/CHO ratio of patients with lupus nephritis was significantly higher than that of patients without lupus nephritis (P < 0.05). In conclusion, our data suggest that CTLA4 expression is not impaired in SLE patients, but there is a possibility of decreased inhibitory effect of CTLA4 involved in the pathogenesis of SLE.
Role of nitric oxide modified DNA in the etiopathogenesis of systemic lupus erythematosus
Authors: Dixit K , Ali R
Published: February 2004

The role of the nitric oxide(NO) radicalin systemic lupus erythematosus(SLE) pathogenesishas been investigated in the present study. The binding characteristics of SLE autoantibodies with native calf thymus DNA, native and NO-modified plasmid DNA were assessed. Binding characteristics and specificity of antibodies were analysed by direct binding and inhibition ELISA, gel retardation assay and quantitativeprecipitin titration.The data shows preferentialbinding of SLE autoantibodiesto NO-modified plasmid DNA (NO-DNA) in comparison with native plasmid DNA. Inhibition ELISA reiterates the direct binding results. Gel retardation assay further substantiated the enhanced recognition of NO-DNA by anti-DNA autoantibodies. The binding affinity of modified and native plasmid DNA with one of the SLE IgGs was calculated, using the Langmuir plot. The apparent association constant for NO-plasmid DNA was found to be highest, followed by native calf thymus DNA and native plasmid DNA. The results suggest that the NO radical modification of plasmid DNA causes perturbations, resulting in the generation of neo-epitopes, and making it a potential immunogen. The DNA modified with the NO radical may be one of the factors for the induction of circulating SLE anti-DNA autoantibodies.
Dobutamine stress echocardiography in women with systemic lupus erythematosus: increased occurrence of left ventricular outflow gradient
Authors: Codish S , Liel-Cohen N , Rovner M , Sukenik S , Abu-Shakra M
Published: February 2004

Dobutamine stress echocardiography(DSE) is an accurate noninvasivetest used for the diagnosis and evaluation of patients with known or suspected coronary artery disease (CAD). The aim of this study was to determine the rate of positive findings in DSE, to define the echocardiographic and clinical characteristicsof women with systemic lupus erythematosus (SLE) and to evaluate the safety of DSE in SLE patients.Thirty consecutiveSLE patients were enrolled in the study and underwentDSE study. The mean age of patients was 44 years (range 20-76). Mean duration of SLE was 8.1 years and mean SLEDAI was 5.5. None of the DSE tests performed were positive for myocardial ischaemia. A left ventricular outflow gradient (LVOG) was found in 15/28 (54%) patients who completed the test, a result higher than the reported 20% prevalence of this finding in the literature. There were no significant differences in baseline characteristics between patients who developed a gradient and patients in whom a gradient was not found. There were no significant adverse effects during the study. In the general population, LVOG has been reported to be associated with an increased rate of chest discomfort and with a significantly lower prevalence of CAD. Whether this is true for SLE patients requires further study.
Therapy with intermittent pulse cyclophosphamide for pulmonary hypertension associated with systemic lupus erythematosus
Authors: Gonzalez-Lopez L , Cardona-Muñoz E G , Celis A , García-de la Torre I , Orozco-Barocio G , Salazar-Paramo M , Garcia-Gonzalez C , Garcia-Gonzalez A , Sanchez-Ortiz A , Trujillo-Hernandez B , Gamez-Nava J I
Published: February 2004

The aim of this study was to compare the efficacy of intravenouscyclophosphamide(IVCYC) versus oral enalapril in mild or moderate pulmonary hypertension (PH) in systemic lupus erythematosus (SLE). Thirty-four patients with SLE who had systolic pulmonary artery pressure (SPAP) > 30mmHg by Doppler echocardiography were randomized to receive IVCYC (0.5g/mt2 body surface area, monthly), or oral enalapril (10mg/day) for six months. The primary outcome was the significant decrease in SPAP. An additional outcome measure included the improvement in the heart functional class (NYHA). Sixteen patients received cyclophosphamide and 18 enalapril. IVCYC decreased the median values of SPAP from 41 to 28mmHg (P < 0.001), and enalapril from 35 to 27mmHg (P 0.02). IVCYC reduced more than twice as much SPAP than enalapril (P 0.04). In those patients with SPAP ≥35mmHg, cyclophosphamidedecreased from 43 to 27mmHg (P 0.003), but enalapril was not effective (P 0.14). The NYHA functional class improved only in those with cyclophosphamide (P 0.021). Also IVCYC had a higher frequency of side effects including infections (RR 1.6; 95% CI, 1.001-2.47), and gastrointestinal side effects (RR 14.6; 95% CI,2.15-99.68). We concluded that IVCYC was effective in mild and moderate PH associated with SLE. Further research is needed to evaluate its long-term efficacy.
Factors associated with chloroquine-induced retinopathy in rheumatic diseases
Authors: Araiza-Casillas R , Cárdenas F , Morales Y , Cardiel M H
Published: February 2004

Antimalarials are very useful drugs in the treatment of various rheumatic diseases. One of their main side effects is ocular toxicity, specifically retinopathy. Our objective was to identify risk factors associated with chloroquine retinopathy. A single, trained evaluator reviewed patient records with rheumatic diseases. They were taking chloroquine and identified by the ophthalmologydepartment as having retinopathy during their routine eye evaluation. These cases were classified according to clinical evaluation, visual fields and fluorangiographic study. Up to four controls were selected for each case, matched by age, gender, diagnosisand similar time on chloroquine.In all, 34 variableswere studied, among these: weight, age, disease duration, keratopathy, total cumulative dose (TCD), mean daily dose (MDD), lean body weight adjusted daily dose (LBWDD) and laboratory tests. Descriptive and inferential statistics comparing cases and controls in all patients and subgroup analysis were carried out. Significance was set at the 0.05 level. Odds ratio and 95% confidence intervals were calculated. Sixteen cases of chloroquine retinopathy were identified, eight patients with rheumatoid arthritis (RA), seven with systemic lupus erythematosus (SLE) and one with dermatomyositis. All were female. Mean age was 47.3 + 12.2 years; weight 59.5 + 10.7 kg; disease duration 12.8 + 6.0 years; time on chloroquine 54.1 + 27.8 (min-max: 30-197) months. There was a significant difference in the following variables in all patients: MDD 212.3 + 52.6 versus 170 + 51.3, p 0.009; and LBWDD 5 + 1 versus 4.2 + 1.5, p 0.03, for cases and controls, respectively. In subgroup analysis the MDD remained significantly different (235.5 + 45.8 versus 169.7 + 46.l, p 0.004) only in RA, whereas LBWDD was different both in SLE and RA. Keratopathy increased the risk for retinopathy: OR, 95% CI: 5, 1.4-l7.6, p 0.01. In conclusion, in accordance with previous studies, the MDD, LBWDD and keratopathy were risk factors associated with chloroquine retinopathy. Periodic ophthalmologic evaluations are mandatory.
Microplasma powder deposition as a new solid freeform fabrication process
Authors: Wang H , Jiang W , Valant M , Kovacevic R
Published: February 2004

This paper attempts to apply microplasma powder deposition (MPPD) for solid freeform fabrication (SFF). The relationship between the geometric features of the deposited layers and the welding parameters is investigated. The arc length is controlled through the monitoring of arc voltage. The microstructure and the properties of the deposited layers are analysed. The experimental results show that the MPPD process is a promising welding-based SFF technology that is capable of building relatively small-size parts with low cost. The result of building parts with functionally graded components by the MPPD process is shown as well.
Dynamic distortion measurements during laser forming of Ti’6Al’4V and their comparison with a finite element model
Authors: Reeves M , Moore A J , Hand D P , Jones J D C , Cho J R , Reed R C , Edwardson S P , Dearden G , French P , Watkins K G
Published: February 2004

Laser forming is, potentially, an attractive flexible manufacturing technique for the controlled forming of aerospace alloys. Laser forming experiments using a continuous-wave CO2 laser were performed on coupons of material 80 mm × 80mm in area and 2mm thick, with sequential passes of the laser beam, at a surface scanning rate of 20 mm/s with 90 s of convective cooling between passes. A novel surface profilometer that was specifically developed to operate under the conditions of high vibration and stray light typically found in laser machining applications recorded transient surface shape changes during individual laser passes at frame rates of 4 and 0.2 Hz. A finite element model was developed using ABAQUS for the laser forming of linear bends in free Ti-6A1-4V sheets, with sequentially coupled thermal and elastic-plastic analysis incorporating temperature-dependent material properties. Transient heat source scanning was implemented to simulate the experiment. Good agreement was found between the experimental three-dimensional shape data and those predicted by the transient model. In particular, the formation of an unwanted ‘camber’ distortion perpendicular to the desired main bend was correctly predicted; its magnitude and temporal evolution throughout the three laser passes, and during the periods of convective cooling, agreed well with the experimental data. The model and the shape measurement technique will enable the future predictive controlled laser forming of more complex three-dimensional shapes.
Machinability of titanium alloy (Ti’6Al’4V) by abrasive waterjets
Authors: Seo Y W , Ramulu M , Kim D
Published: February 2004

Titanium alloy is known as one of the difficult-to-machine materials using conventional machining processes, although it has superior formability. In the present study, a widely used aircraft structural titanium alloy (Ti—6A1—4V) was machined with an abrasive waterjet (AWJ) to investigate its machinability under varying cutting conditions. Machinability was evaluated in terms of kerf geometry, cut surface quality and microstructural integrity. Quality of the machined surface and microstructure features were examined using surface profilometry, scanning electron microscopy and energy dispersive X-ray (EDX) analysis. The surface roughness was ranged several micrometres near the jet entrance region and was observed to increase at the jet exit of the workpiece. Scanning electron microscopy (SEM) analysis of the surface microstructure revealed that the mechanism of material removal was a combination of scooping induced ductile shear and ploughing actions of the abrasive particles. EDX analysis showed garnet particle embedment in titanium throughout the cutting depth, and the particle size was estimated to be several tens of micrometres.
Influence of machining paths on hydro propeller performance
Authors: Brient A , Martineau J P , Hascoët J Y
Published: February 2004

This paper presents a multidiscipline approach to propeller engineering. Surface finish is a stringent constraint for propeller blade hydrodynamic performance and leads manufacturers to add a polishing phase in the manufacturing process, therefore increasing the realization costs. A combined approach involving the definition of tool paths relevant to both domains, manufacturing and hydrodynamics, could improve the process by avoiding the polishing phase. To build such a strategy, relationships between the machined surface finish and hydrodynamic performance must be understood. A study has been carried out on the influence of roughness heights and lays on the hydrodynamic performance of bidimensional hydrofoils.
An automated low-cost condition monitoring system for quality control of automotive speedometers
Authors: Al-Habaibeh A , Parkin R M
Published: February 2004

The growing demands for high-quality products with improved specifications increase the requirements for condition monitoring and quality evaluation to ensure that no defective or below-specification products reach the customer. This paper presents a low-cost condition-monitoring system using acoustics to evaluate the quality of mechanically driven automotive speedometers during manufacture. Signal conditioning methods employ discrete cosine transformation to simplify the frequency spectrum of the signals. A novelty detection approach is optimized to characterize the ‘normal’ conditions of the speedometers and to reject any speedometers that are not so categorized on the basis of the sound waves produced from experimental running of the speedometers. The suggested techniques are found useful in developing an automated condition-monitoring system for deselecting low-quality automotive speedometers.
Computational studies of air-assisted spray impingement on a flat plate
Authors: Chang D-L , Lee C-f F
Published: February 2004

Fuel impingement and film formation are critical issues for the goal of reducing hydrocarbon emissions from automotive gasoline direct injection engines. This computational study compares fuel impingement from a simulated air-assisted spray with that of a simulated spray from a swirl atomizer. Impingement occurs on a flat plate in a low ambient pressure case that approximates an early-injection condition and in a high ambient pressure case that approximates a late-injection condition. The simulated results suggest that the air-assisted injector produces substantially less fuel film and impingement than the swirl atomizer because of faster vaporization of smaller droplets and slower penetration. Although the swirl atomizer produces more splashing, much of the splashed fuel mass returns to the plate. More detailed numerical studies of the air-assisted injector were also conducted to ascertain the effects of turning the vaporization model off, employing a very fine grid, having angled impingement and changing the injector design to increase the initial spray angle.
Too Few Dentists? Workforce Planning 1996–2036
Authors: Try Graham
Published: February 2004

The development and use of forecasting models can stimulate the debate on workforce planning for dentists by improving the quality of the data available, by providing a framework within which the debate can be conducted and by providing a means whereby the effects of different trends and policy options can be measured in a consistent way. The number of dentists on the Dentists Register aged under 60 years may well fall over the 40 years between 1996–2036, while the proportion of female dentists is likely to grow from under 30% to almost 50%. If the present gender differences in dentists’ output persist, the effective ‘whole-time equivalent’ (WTE) size of the dentist workforce could fall by 15%. While future patterns of disease and the efficacy of future treatments are difficult to predict, the demand for dentistry is very likely to increase, given the forecast ageing of the UK population. The number of people aged 65–74 years could increase by 50% to eight million and those over 75 years by 70% towards seven million. Further, almost of all of this greatly increased older population will have retained some of their own teeth. The edentulous adult population was 37% in 1968 and might fall to less than 5% by 2036. These trends taken together could increase the number of courses of treatment per WTE dentist by as much as 40% over these 40 years. Such modelling can help to reduce the degree of uncertainty in future workforce planning.
Dopamine and Glutamate Control Area-Restricted Search Behavior inCaenorhabditis elegans
Authors: Hills Thomas , Brockie Penelope J. , Maricq Andres V.
Published: February 2004

Area-restricted search (ARS) is a foraging strategy used by many animals to locate resources. The behavior is characterized by a time-dependent reduction in turning frequency after the last resource encounter. This maximizes the time spent in areas in which resources are abundant and extends the search to a larger area when resources become scarce. We demonstrate that dopaminergic and glutamatergic signaling contribute to the neural circuit controlling ARS in the nematodeCaenorhabditis elegans. Ablation of dopaminergic neurons eliminated ARS behavior, as did application of the dopamine receptor antagonist raclopride. Furthermore, ARS was affected by mutations in the glutamate receptor subunits GLR-1 and GLR-2 and the EAT-4 glutamate vesicular transporter. Interestingly, preincubation on dopamine restored the behavior in worms with defective dopaminergic signaling, but not inglr-1,glr-2, oreat-4mutants. This suggests that dopaminergic and glutamatergic signaling function in the same pathway to regulate turn frequency. Both GLR-1 and GLR-2 are expressed in the locomotory control circuit that modulates the direction of locomotion in response to sensory stimuli and the duration of forward movement during foraging. We propose a mechanism for ARS inC. elegansin which dopamine, released in response to food, modulates glutamatergic signaling in the locomotory control circuit, thus resulting in an increased turn frequency.
Dynamics of Precise Spike Timing in Primary Auditory Cortex
Authors: Elhilali Mounya , Fritz Jonathan B. , Klein David J. , Simon Jonathan Z. , Shamma Shihab A.
Published: February 2004

Although single units in primary auditory cortex (A1) exhibit accurate timing in their phasic response to the onset of sound (precision of a few milliseconds), paradoxically, they are unable to sustain synchronized responses to repeated stimuli at rates much beyond 20 Hz. To explore the relationship between these two aspects of cortical response, we designed a broadband stimulus with a slowly modulated spectrotemporal envelope riding on top of a rapidly modulated waveform (or fine structure). Using this stimulus, we quantified the ability of cortical cells to encode independently and simultaneously the stimulus envelope and fine structure. Specifically, by reverse-correlating unit responses with these two stimulus dimensions, we measured the spectrotemporal response fields (STRFs) associated with the processing of the envelope, the fine structure, and the complete stimulus. A1 cells respond well to the slow spectrotemporal envelopes and produce a wide variety of STRFs. In over 70% of cases, A1 units also track the fine-structure modulations precisely, throughout the stimulus, and for frequencies up to several hundred Hertz. Such a dual response, however, is contingent on the cell being driven by both fast and slow modulations, in that the response to the slowly modulated envelope gates the expression of the fine structure. We also demonstrate that either a simplified model of synaptic depression and facilitation, and/or a cortical network of thalamic excitation and cortical inhibition can account for major trends in the observed findings. Finally, we discuss the potential functional significance and perceptual relevance of these coexistent, complementary dynamic response modes.
Functional Magnetic Resonance Imaging Examination of Two Modular Architectures for Switching Multiple Internal Models
Authors: Imamizu Hiroshi , Kuroda Tomoe , Yoshioka Toshinori , Kawato Mitsuo
Published: February 2004

An internal model is a neural mechanism that can mimic the input–output properties of a controlled object such as a tool. Recent research interests have moved on to how multiple internal models are learned and switched under a given context of behavior. Two representative computational models for task switching propose distinct neural mechanisms, thus predicting different brain activity patterns in the switching of internal models. In one model, called the mixture-of-experts architecture, switching is commanded by a single executive called a “gating network,” which is different from the internal models. In the other model, called the MOSAIC (MOdularSelectionAndIdentification forControl), the internal models themselves play crucial roles in switching. Consequently, the mixture-of-experts model predicts that neural activities related to switching and internal models can be temporally and spatially segregated, whereas the MOSAIC model predicts that they are closely intermingled. Here, we directly examined the two predictions by analyzing functional magnetic resonance imaging activities during the switching of one common tool (an ordinary computer mouse) and two novel tools: a rotated mouse, the cursor of which appears in a rotated position, and a velocity mouse, the cursor velocity of which is proportional to the mouse position. The switching and internal model activities temporally and spatially overlapped each other in the cerebellum and in the parietal cortex, whereas the overlap was very small in the frontal cortex. These results suggest that switching mechanisms in the frontal cortex can be explained by the mixture-of-experts architecture, whereas those in the cerebellum and the parietal cortex are explained by the MOSAIC model.