bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of small airways in monitoring the response to asthma treatment: what is beyond FEV1?
Authors: Scichilone N. , Battaglia S. , Olivieri D. , Bellia V.
Published: August 2009

The definition of asthma has evolved from that of an episodic disease characterized by reversible airways constriction to a chronic inflammatory disease of the airways, with at least partially reversible airway constriction. Increasing evidence supports the notion that small and large airways play a central role in asthma pathophysiology with regard to inflammation, remodeling and symptoms. The contribution of the distal airways to the asthma phenotype carries implications for the delivery of inhaled medications to the appropriate areas of the lung and for the monitoring of the response to asthma treatment. Asthma control is evaluated on the basis of symptoms, lung function and exacerbations. However, evidence suggests that dissociation between lung function and respiratory symptoms, quality of life and airway inflammation exists. In this study, common spirometric parameters offer limited information with regard to the peripheral airways, and it is therefore necessary to move beyond FEV1. Several functional parameters and inflammatory markers, which are discussed in the present study, can be employed to evaluate distal lung function. In this study, extrafine formulations deliver inhaled drugs throughout the bronchial tree (both large and small airways) and are effective on parameters that directly or indirectly measure air trapping/airway closure.
The clinical spectrum of neurologic disorders after intestinal and multivisceral transplantation
Authors: Živković Saša A. , Eidelman Benjamin H. , Bond Geoffrey , Costa Guilherme , Abu‐Elmagd Kareem M.
Published: August 2009

Živković SA, Eidelman BH, Bond G, Costa G, Abu‐Elmagd KM. The clinical spectrum of neurologic disorders after intestinal and multivisceral transplantation. Clin Transplant 2009: DOI: 10.1111/j.1399‐0012.2009.01065.x © 2009 John Wiley & Sons A/S.

Abstract:  Background:  Intestinal transplantation has evolved into an effective therapy for patients with intestinal failure and the inability to be maintained on total parenteral nutrition. Long‐term heavy immunosuppression and complex systemic disturbances increase the risk of the neurologic complications.

Methods:  This retrospective analysis identified the post‐transplant neurologic complications in adult patients who underwent intestinal transplantation at the University of Pittsburgh Medical Center between May 1990 and August 1998. The recipients received 28 isolated intestine, 17 composite liver‐intestine, and nine multivisceral allografts.

Results:  With a median follow‐up of 25 months, 46 of 54 recipients (68%) developed headaches (n = 27; 50%), encephalopathy (n = 23; 43%), seizures (n = 9; 17%), neuromuscular disorders (n = 4; 7%), opportunistic CNS infections (n = 4; 7%), and ischemic stroke (n = 2; 4%).

Conclusions:  Under high maintenance immunosuppression, intestinal transplant recipients were at high risk for neurologic complications. Future studies are needed to describe post‐transplant neurologic complications with modern immunosuppression protocols.
Infectious complications associated with alemtuzumab use for allogeneic hematopoietic stem cell transplantation: comparison with anti‐thymocyte globulin
Authors: Park S.H. , Choi S.‐M. , Lee D.‐G. , Choi J.‐H. , Yoo J.‐H. , Kim S.‐H. , Kim H.‐J. , Cho S.‐G. , Eom K.‐S. , Lee J.‐W. , Min W.‐S. , Shin W.‐S. , Kim C.‐C.
Published: August 2009

Objectives. To evaluate the incidence of infectious complications after receiving alemtuzumab as part of a conditioning regimen for allogeneic hematopoietic stem cell transplantation (HSCT) in Korean patients.

Methods. From November 2004 to January 2006, 12 patients who received alemtuzumab‐based conditioning regimens for allogeneic HSCT were evaluated retrospectively until death or until the end of the follow‐up in July 2007; they were compared with 18 patients who received rabbit anti‐thymocyte globulin (ATG)‐containing conditioning regimens from January 2002 to January 2006.

Results. Post‐engraftment infections occurred more frequently in the alemtuzumab recipients than in the ATG recipients; the mean number of infections, excluding cytomegalovirus (CMV) infections, per patient during the follow‐up period was 2.6±1.4 vs. 1.0±0.8 (P=0.003), respectively. Although there was no statistical difference in the cumulative incidence of CMV  infection between the 2 groups (91.7% vs. 55.6%, P=0.381), the alemtuzumab recipients had a higher incidence of CMV  diseases (41.6% vs. 0%, P=0.0006) and a higher recurrence rate of CMV infection (90.0% vs. 27.3%, P=0.008) than did the ATG recipients, irrespective of the dose of alemtuzumab. Hemorrhagic cystitis (HC) (66.7% vs. 16.7%, P=0.009) and BK virus‐associated HC (41.7% vs. 5.6%, P=0.026) developed more frequently in the alemtuzumab recipients. The all‐cause mortality rate was not significantly different between the alemtuzumab and the ATG recipients (75% vs. 55.6%, P=0.28).

Conclusion. Alemtuzumab recipients had a high incidence of CMV disease as well as BK virus‐associated HC compared with the ATG recipients. The dose of alemtuzumab should be tailored to patients' risk; in addition, the implementation of the appropriate prophylaxis for CMV and early detection strategies for BK virus are recommended.
Paediatric liver transplantation: A 10 year experience in Taiwan
Authors: CHEN CHAO‐LONG , CHEN YAW‐SEN , CHIANG YUAN‐CHENG , CHENG YU‐FAN , HUANG TUNG‐LIANG , ENG HOCK‐LIEW
Published: August 2009

Between March 1984 and August 1994, 13 orthotopic liver transplantations were performed in 13 patients ≦ 25 years of age. The indications included Wilson's disease (n= 7), biliary atresia (n= 4), choledochal cyst (n=1) and hepatitis C cirrhosis (n=1). Technical variants included full‐size (n=11), reduced‐size (n=1) and living‐related (n=1) liver transplantation. These recent technical innovations have offered an expanded donor pool for earlier transplantation, shorter waiting times and excellent quality grafts. Surgical complications occurred in six patients; all required additional surgery. Biliary complications were encountered more commonly in our earlier patients. Our actuarial patient and graft survival rate is 92% at 2 years. The long‐term follow‐up of our liver‐transplanted Wilson's disease patients provides confirmatory evidence that orthotopic liver transplantation cures the underlying metabolic defect with complete normalization of biochemical abnormalities of copper metabolism, reversal of neurological impairments and the disappearance of Kayser‐Fleischer corneal rings. The high rate of patient survival and excellent rehabilitation indicate that with prudent clinical judgement, liver transplantation can be achieved with an acceptable rate of morbidity, mortality and cost in a setting where manpower and donor organs are very limited.
Pre‐ and postoperative nutritional care in liver transplantation in children
Authors: SHEPHERD ROSS W.
Published: August 2009

Orthotopic liver transplantation (OLT) is now a definitive treatment option for most cases of endstage liver disease (ESLD) in children. Efforts now focus on active supportive treatment to maintain, if not improve, the patient's clinical status before OLT and to ensure normal patterns of growth and development after OLT. Malnutrition adversely affects the outcome of OLT and is probably the single area in pre‐operative management where the largest potential improvement can be made. Our studies indicate significant abnormalities of protein energy metabolism and body composition in children referred for OLT. We have shown that the use of enteral formulae, enriched with branched‐chain amino acids, have significant advantages. Other adjunctive therapy, such as growth hormone, is the subject of current investigation. Following transplantation, catch‐up weight and growth does occur with the advent of normal liver functioning, but patients at continuing risk for undernutrition, such as those with rejection and/or chronic infection, need to be targeted for specific nutritional therapy.
Hypovolemic shock due to massive edema of a pedunculated uterine myoma after delivery
Authors: Koide Keiko , Sekizawa Akihiko , Nakamura Masamitsu , Matsuoka Ryu , Okai Takashi
Published: August 2009

Although most patients with uterine myomas are asymptomatic during pregnancy, profound enlargement of a pedunculated myoma has serious consequences. In the present case, gradual enlargement of a pedunculated myoma was observed throughout a woman's pregnancy, worsening after delivery and causing hypovolemic shock, without evidence of external or intra‐abdominal hemorrhage. Laparotomy revealed a severely edematous myoma containing a large amount of blood. It is speculated that partial occlusion had obstructed venous return, but not arterial blood flow, which caused rapid enlargement of the myoma.
High‐risk human papillomavirus testing for monitoring patients treated for high‐grade cervical intraepithelial neoplasia
Authors: Jeong Nan Hee , Lee Nak Woo , Kim Hai Joong , Kim Tak , Lee Kyu Wan
Published: August 2009

Aim:  The aim of the present study was to examine the accuracy of high‐risk human papillomavirus (HR‐HPV) DNA detection as a predictor of residual or recurrent cervical intraepithelial neoplasia (CIN) after treatment of high‐grade CIN.

Methods:  Ninety‐five women treated by conization and loop electrosurgical excision procedure (LEEP) for high‐grade CIN were followed‐up with HR‐HPV DNA testing (Hybrid Capture II test, Digene Diagnostics, Gaithersburg, MD, USA) and cytology at 3, 6, 12, 18 and 24 months after treatment. The outcome of our study was to detect the presence of CIN using colposcopy‐directed biopsy within 24 months after treatment.

Results:  Women with recurrent or residual disease did not differ from women who were cured within clinicopathologic parameters at treatment. Pre‐treatment HR‐HPV testing was positive in all cases. In the recurrent pre‐treatment group HR‐HPV loads were significantly higher than in the group with no recurrence (1065.5 ± 852.3 vs 527.7 ± 669.6, P = 0.003). Residual or recurrent disease was identified in 17 patients (17.9%) during a 24‐month period. A Pap smear significantly predicted disease recurrence at the first follow‐up visit only. At the 6‐month visit, HR‐HPV testing showed 100% sensitivity and negative predictive value (NPV). When both a Pap smear and a HR‐HPV test were used together, 82% sensitivity, 76% specificity and 95% NPV was noted. Performance of resection margins (odds ratio (OR) 9.8; 95% confidence interval (CI), 3.0–32.7) and post‐treatment HR‐HPV load >100 RLU (OR 9.3; 95% CI, 2.2–38.2) were also significant.

Conclusion:  HR‐HPV testing in conjunction with Pap smear offers clear advantages over single cytology when monitoring women treated for high‐grade CIN.
McGill Pain Questionnaire: A multi‐dimensional verbal scale assessing postoperative changes in pain symptoms associated with severe endometriosis
Authors: Fabbri Elena , Villa Gioia , Mabrouk Mohamed , Guerrini Manuela , Montanari Giulia , Paradisi Roberto , Venturoli Stefano , Seracchioli Renato
Published: August 2009

Background:  Objective evaluation of pelvic pain symptoms using a standard pain questionnaire is essential to assessing the treatment of endometriosis and related pain.

Aim:  To evaluate the McGill Pain Questionnaire (MPQ) as a multi‐dimensional verbal scale in providing information about chronic pelvic pain associated with endometriosis, before and after laparoscopic surgery.

Methods:  Fifty‐five women undergoing laparoscopy for severe endometriosis were asked to complete the MPQ before surgery and at the 6‐month follow up. All patients presented with preoperative pain symptoms of variable severity. We obtained the pain indexes and studied their relation with: patients' characteristics (age, body mass index, parity, qualification, occupation); operative findings (number, site and size of endometriotic lesions and presence of pelvic adhesions); and postoperative evolution of variable MPQ pain indexes at the 6‐month follow up.

Results:  Median present pain index (PPI) (index of pain intensity), before surgical treatment was 3 (2–4): preoperative PPI was <2 in 25% of patients while 25% of patients had PPI > 4. Overall median PPI after surgical treatment was 1 (0–2): postoperative index of pain intensity was <1 in 50% of patients, >2 in 25% of patients while 25% of patients did not experience postoperative pain. Overall pain intensity significantly decreased after laparoscopic treatment of endometriosis (Wilcoxon test P < 0.0005). None of the patients' characteristics were found to be significantly correlated with the severity or improvement of preoperative pain at postoperative follow up (P > 0.05), and the intensity of preoperative pain was not correlated to any of the operative variables. There was a significant reduction in all individual MPQ pain indexes; however 18.2% of women did not show improvement of pain symptoms after laparoscopic surgery. An increasing endometrioma diameter was associated with a significant decrease in the difference in evaluative rank score of pain rating index between pain indexes at the 6‐month follow up and preoperatively (P = 0.04, Spearman's rank correlation Rho = −0.277).

Conclusions:  MPQ appears to be useful as a multi‐dimensional scale in describing patients' pain semiology and evaluating pain evolution after surgical treatment. However, due to the extreme variability of pain experience, MPQ results don't clarify the relationship between pain intensity and the severity of endometriosis.
Urine leakage related to physical fatigue in women with urinary stress incontinence
Authors: Deffieux Xavier , Hubeaux Katelyne , Dick John , Ismael Samer Sheikh , Raibaut Patrick , Amarenco Gérard
Published: August 2009

Objective:  To evaluate the frequency of urine leakage related to physical fatigue in women presenting with urinary stress incontinence using a specific questionnaire, and to assess its association with the Bristol Female Lower Urinary Tract Symptoms questionnaire and urodynamic findings.

Design:  Prospective observational descriptive study.

Setting:  University hospital (urodynamics laboratory).

Participants:  Sixty‐one women presenting with urinary stress incontinence and 10 continent women.

Interventions:  Not applicable.

Main Outcome Measures:  The participants underwent urethral pressure profile measurement and completed a Bristol Female Lower Urinary Tract Symptoms questionnaire and a specific questionnaire focused on urine leakage related to physical fatigue.

Results:  Twenty‐three (37%) women with urinary stress incontinence claimed to exhibit urine leakage related to physical fatigue more often than one third of the time and 47% claimed to exhibit urinary leakage only after more than one cough. There was a positive correlation between the findings of the specific questionnaire and the presence of a sharp decrease in urethral pressure following repeated cough efforts: question #1 (P = 0.02); question #2 (P = 0.00002); question #3 (P = 0.04).

Conclusion:  There is a strong association between this questionnaire focused on urine leakage related to fatigue and the presence of a decrease in urethral pressure following repeated coughs.
Use of Chinese herbal medicine ‘meizitanc’ in pregnancy: Report of three cases
Authors: Çayan Filiz , Dilek Umut , Akbay Esen , Gen Ramazan , Dilek Saffet
Published: August 2009

The Chinese herbal medicine ‘meizitanc’, known as ‘LiDa Dai Dai Hua Jiao Nang’ (Kunming Dali Industry and Trade, Kunming, Yunnan, China) has been used by many women to support weight loss, even though life‐threatening side‐effects and deaths have been reported. We report the outcomes of three cases of exposure to ‘meizitanc’ during early pregnancy. In the first case, the pregnancy continued after the patient stopped taking the drug and at 38 weeks of gestation, the patient delivered a healthy infant. However, in the second and third cases fetal cardiac activities were not detected on obstetric follow‐up and both pregnancies were terminated due to missed abortion. To our knowledge, this is the first report of exposure to meizitanc during pregnancy. Although herbal medicines are presumed to be safe because of their natural origin, consumption of such products may be dangerous due to the content of undeclared drugs, adulteration with multiple substances and contamination with toxic metals.
Unilateral ovarian metastasis in a case of squamous cervical carcinoma IA1
Authors: Kang Woo D. , Kim Cheol H. , Cho Moon K. , Kim Jong W. , Kim Yoon H. , Choi Ho S. , Kim Seok M.
Published: August 2009

Ovarian metastasis from early‐stage squamous cervical cancer is rare. We report a case of unilateral ovarian metastasis from squamous cervical cancer IA1. Although ovarian metastasis from early‐stage squamous cervical cancer is rare, gynecological oncologists should not overlook its possibility.
Evaluation of D‐dimer during pregnancy
Authors: Nishii Ayano , Noda Yoshito , Nemoto Reiko , Ushiro Ken , Ohno Tsutomu , Mochizuki Yoshio , Yoshihara Hajime , Taguchi Akira , Uchino Naoki , Ohkawara Satoshi
Published: August 2009

Aim:  The purpose of the present study was to elucidate the change of D‐dimer and the possibility of deep vein thrombosis screening by D‐dimer during pregnancy.

Methods:  One thousand, one hundred and thirty‐one pregnant women were enrolled in the study from April 2006 to March 2007. D‐dimer was measured by latex immunoassay at 6 to 14 and 30 to 36 weeks of gestation, respectively, and the veins of the lower extremities were examined by ultrasound at 30 to 36 weeks of gestation.

Results:  The mean and standard error of D‐dimer was 1.1 ± 1.0 µg/mL in the first trimester and 2.2 ± 1.1 µg/mL in the third trimester, and both values were significantly higher than adult values. In addition, D‐dimer significantly increased during pregnancy.

D‐dimer was not significantly different between singleton and twin pregnancies in the first trimester, but in the third trimester, the values of twin pregnancies were higher than singleton pregnancies (2.2 ± 1.6 vs 3.7 ± 2.5 µg/mL).

The mean value of D‐dimer of ultrasonographically positive women was 2.6 ± 2.0 µg/mL, which was significantly higher than the value for negative woman during the third trimester (2.2 ± 1.6 µg/mL). The positive predictive value was 7.4% and negative predictive value was 95.5% for ultrasonographically positive women when D‐dimer was set at 3.2 µg/mL.

Conclusion:  We clearly found a change of D‐dimer during pregnancy. When D‐dimer was higher than 3.2 µg/mL, the percentage of ultrasonographically positive women was high. We propose that women with D‐dimer higher than 3.2 µg/mL are closely monitored for prevention of pulmonary thromboembolism.
Uterine compression suture against impending recurrence of uterine inversion immediately after laparotomy repositioning
Authors: Matsubara Shigeki , Yano Hitoshi , Taneichi Akiyo , Suzuki Mitsuaki
Published: August 2009

Uterine compression suture to prevent impending recurrence of uterine inversion after laparotomy repositioning has not been reported previously. A 28‐year‐old primigravid woman demonstrated uterine inversion. Although Huntington's procedure had successfully repositioned the uterus, acute recurrence of inversion with uterine atony appeared to be impending during the surgery. We applied modified uterine compression sutures, which prevented the recurrence of inversion and achieved complete hemostasis. Three years later, the patient became pregnant and vaginally delivered a term infant. Thereafter, uterine inversion recurred, and was repositioned manually. Uterine compression suture may be of use not only for hemostasis for postpartum hemorrhage, but also for prophylaxis against acute recurrence of uterine inversion.
Chlamydia trachomatis infections and the risk of ectopic pregnancy in Khon Kaen women
Authors: Pientong Chamsai , Ekalaksananan Tipaya , Wonglikitpanya Naroemit , Swadpanich Ussanee , Kongyingyoes Bunkerd , Kleebkaow Pilaiwan
Published: August 2009

Aim:  To determine the prevalence of Chlamydia trachomatis infection and to evaluate the relation of previous and persistent chlamydial infection to ectopic pregnancy (EP) among women in Khon Kaen, Thailand.

Methods:  We enrolled 32 EP patients in the case group. Control subjects were 57 women undergoing tubal ligation after normal labor. Serum immunoglobulin (Ig)G and IgA antibodies to C. trachomatis were determined using ELISA. Chlamydial DNA was investigated using polymerase chain reaction.

Results:  The prevalence of chlamydial DNA in fallopian tube tissue was 34.38% of EP patients whereas none was detected in controls. In cervical cells, however, no significant difference in chlamydial DNA between cases (3.13%) and controls (3.51%) was detected. Serum‐specific IgG was found more in the EP group than in the control group (21.88% and 5.26%, respectively; P < 0.05). Serum‐specific IgA was detected in 5.26% of the control women but not in the EP group. Analysis by multivariate conditional logistic regression revealed a significant association between EP and the various risk factors. Among these, abortion, previous EP and age at first intercourse <15 years were strong predictors of EP. However, the association between specific IgG and EP became non‐significant in this analysis.

Conclusions:  No strong independent association was shown between chlamydial antibodies and the EP risk in Thai women despite DNA detection in fallopian tube tissue. In contrast, factors including abortion, previous EP, and age at first intercourse <15 years were the significant predictors of EP. Efforts to address these other variables will help more in reducing the EP burden in Thai women compared to eliminating C. trachomatis.
Neonatal C‐reactive protein value in prediction of Outcome of Preterm Premature Rupture of Membranes: Comparison of Singleton and Twin Pregnancies
Authors: Taghavi Simin , Melli Manijeh Sayyah , Barband Alireza , Atashkhoui Simin , Sheikhvatan Mehrdad
Published: August 2009

Aim:  The clinical importance of preterm premature rupture of the membranes (PPROM) is its relationship to maternal and neonatal mortality and morbidity, especially in twin pregnancies. The aim of this study was to determine and compare the role of inflammatory factors as predictors of the PPROM outcome between singleton and twin pregnancies.

Methods:  The medical records of 22 twins delivered between 28 and 34 weeks and complicated by PPROM were reviewed at the Al‐Zahra Hospital in Tabriz, Iran. Also among singletons, 55 cases of matched gestational age were randomly selected as a control group. Three laboratory indices of neonatal white blood cell (WBC) count and C‐reactive protein (CRP) in the two groups were measured immediately after delivery and the effects of two factors on neonatal outcome were assessed.

Results:  In singletons, there was adverse relationship between the mean of WBC count and duration of latency (P = 0.007). Also, a positive relationship between the means of ventilation time and WBC count in second twins was found (P = 0.034). Positive CRP was the main predictor of neonatal intensive care unit admission in both singletons (odds ratio: 4.929, P = 0.042) and first twins (odds ratio: 9.000, P = 0.005). However, positive CRP did not influence the existence of metabolic acidosis or duration of latency in either of the two groups.

Conclusion:  Neonatal WBC count was a predictor for the duration of latency in singletons and for ventilation time in twins. Positive neonatal CRP was an important factor for the prediction of neonatal intensive care unit admission in both types of pregnancy; its role in twins is clearer than in singletons.
Fetal arrhythmia: Prenatal diagnosis and perinatal management
Authors: Maeno Yasuki , Hirose Akiko , Kanbe Taro , Hori Daizo
Published: August 2009

The importance of managing fetal arrhythmia has increased over the past three decades. Although most fetal arrhythmias are benign, some types cause fetal hydrops and can lead to fetal death. With the aim of improving the outcome in such cases, various studies for prenatal diagnosis and perinatal management have been published. Detailed analysis of the type of arrhythmia in utero is possible using M‐mode and Doppler echocardiography. In particular, a simultaneous record of Doppler waveform at the superior venous cava and the ascending aorta has become an important and useful method of assessing the interval between atrial and ventricular contractions. Common causes of fetal tachycardia (ventricular heart rate faster than 180 bpm), are paroxysmal supraventricular tachycardia (SVT) with 1:1 atrioventricular (AV) relation and atrial flutter with 2:1 AV relation. Of fetal SVT, short ventriculo‐atrial (VA) interval tachycardia due to atrioventricular reentrant tachycardia is more common than long VA interval. Most fetuses with tachycardia are successfully treated in utero by transplacental administration of antiarrhythmic drugs. Digoxin is widely accepted as a first‐line antiarrhythmic drug. Sotalol, flecainide and amiodarone are used as second‐line drugs when digoxin fails to achieve conversion to sinus rhythm. Fetal bradycardia is diagnosed when the fetal ventricular heart rate is slower than 100 bpm, mainly due to AV block. Approximately half of all cases are caused by associated congenital heart disease, and the remaining cases that have normal cardiac structure are often caused by maternal SS‐A antibody. The efficacy of prenatal treatment for fetal AV block is limited compared with treatment for fetal tachycardia. Beta stimulants and steroids have been reported as effective transplacental treatments for fetal AV block. Perinatal management based on prospective clinical study protocol rather than individual experience is crucial for further improvement of outcome in fetuses with tachycardia and bradycardia.
Effects of corticosterone and the β‐agonist isoproterenol on glutamate receptor‐mediated synaptic currents in the rat basolateral amygdala
Authors: Liebmann Lutz , Karst Henk , Joëls Marian
Published: August 2009

Behavioral and field potential studies suggest that – shortly after stress – noradrenaline and corticosterone interact to affect the function of basolateral amygdala (BLA) neurons. Here, we tested, at the single‐cell level, to what extent α‐amino‐3‐hydroxyl‐5‐methyl‐4‐isoxazole‐propionate (AMPA) receptor‐mediated and N‐methyl‐d‐aspartate (NMDA) receptor‐mediated synaptic responses of identified BLA neurons are affected by relatively low concentrations of the β‐agonist isoproterenol, how this is influenced by concomitant application of corticosterone, and how isoproterenol effects are influenced by corticosterone given several hours in advance. We observed that isoproterenol concentration‐dependently enhances AMPA receptor‐mediated (but not NMDA receptor‐mediated) responses; near‐maximal effects were induced by 1 μm isoproterenol. Corticosterone alone did not rapidly affect AMPA and NMDA‐mediated responses. NMDA‐mediated responses were also not affected by the hormone in a delayed manner; AMPA‐mediated responses were slowly suppressed by corticosterone, but only with high stimulation intensities. If corticosterone was co‐applied with isoproterenol (0.4 or 1 μm), facilitation of AMPA‐mediated responses was comparable to that seen with isoproterenol alone. However, if corticosterone was applied several hours in advance of the β‐agonist, the effect of 0.4 μm isoproterenol on AMPA‐mediated responses was reduced. This supports the notion that, in the BLA, isoproterenol facilitates synaptic transmission, a process that can be suppressed by corticosterone in a slow manner. Overall, the data suggest that, despite the previously reported ability of corticosterone to cause long‐term increases in excitability in the BLA, the hormone still retains some capacity to slowly exert a normalizing action on local activity.
Long‐term follow‐up of the treatment of renal angiomyolipomas after selective arterial embolization with alcohol
Authors: Chick Christopher M. , Tan Bien‐Soo , Cheng Christopher , Taneja Manish , Lo Richard , Tan Yeh‐Hong , Lin Shueh‐En , Tay Kiang‐Hiong
Published: August 2009

Study Type – Therapy (case series)  Level of Evidence 4

OBJECTIVE

To present our institution’s experience of selective embolization of renal angiomyolipomas with alcohol and the long‐term follow up data.

PATIENTS AND METHODS

This retrospective study included 34 patients treated between October 1997 and October 2007 (29 women and five men, mean age 44 years). Of these patients, nine had tuberous sclerosis, 14 were bilateral and 16 were multifocal. Indications for treatment were previous haemorrhage (14), size >4 cm (19) and increasing size over a short period (one). The largest treated lesion was 24.4 cm, and the mean (range) size was 11.9  (2.9–24.4) cm. All patients were treated by selective embolization using a mixture of alcohol and lipiodol. Three patients also had coiling of aneurysms and two patients had additional embolization with polyvinyl alcohol particles. The follow‐up was both radiological and clinical, with recurrence defined as growth by >2 cm or symptoms requiring further treatment.

RESULTS

The technical success rate was 100%, with only one significant complication of non‐target renal embolization, with self‐limiting effects. Minor complications included 11 patients with post‐embolization syndrome, all of which settled with conservative measures. The mean (range) combined radiological and clinical follow‐up was 44.2 (12–116) months, with all patients having a follow‐up of >1 year. Radiological success was achieved in 97%, with only one lesion growing by >2 cm. The combined clinical and radiological success rate was 85%, with two patients undergoing surgery, two having repeat embolization and one currently offered surgery due to a recent increase in size.

CONCLUSION

Our study provides long‐term evidence that selective arterial embolization with alcohol is a safe and effective method for improving clinical symptoms (85%) and preventing tumour progression (97%) in patients with renal angiomyolipoma.
Heterodox Reform Symbioses: The Political Economy of Investment Climate Reforms in Solo, Indonesia*
Authors: Von Luebke Christian , McCulloch Neil , Patunru Arianto A.
Published: August 2009

Much of the existing investment climate literature promotes a rule‐based ‘good governance’ approach, in which less advanced economies are advised to adopt orthodox, OECD‐type practices in order to facilitate higher investment and growth. Although credible property rights, efficient bureaucracies and low corruption are desirable objectives, it remains questionable whether orthodox prescriptions are the most promising pathway to get there. By taking a detailed look into the political economy of the Javanese city Solo, it is found that informal, relation‐based cooperation can provide a constructive platform for policy reform. In the present paper, it is demonstrated that a ‘heterodox reform symbiosis’ between a dedicated government leader and a diverse range of local firms can bring about important regulatory and administrative reforms and provide important impulses for private investment.
Optimal Structure of Technology Adoption and Creation: Basic versus Development Research in Relation to the Distance from the Technological Frontier*
Authors: Ha Joonkyung , Kim Yong Jin , Lee Jong‐Wha
Published: August 2009

Many economists maintain that in order to advance economic growth Asian countries should focus more on basic research than on technology adoption, and more on the supply of skilled workers than the supply of unskilled workers. In this context, this paper presents a theoretical model and empirical evidence to explain the observation that a country in which the level of technology approaches the technology frontier tends to rely more on technology creation than adoption, and invest more in basic research than in development. The model shows that technology creation involves both basic and development research processes, whereas technology adoption uses only the latter process. Therefore, R&D investment in our model involves three different processes: basic research in technology creation, development in technology creation, and development in technology adoption. The results suggest first that the rate of growth is positively correlated with the level of basic research activities in the technology creation sector, if a country's technology gap with the technology frontier is small enough. Second, an increase in the efficiency of the education system for highly skilled workers raises the level of basic research and the rate of growth. Third, verifying these theoretical results, empirical analyses using panel data from Korea, Japan and Taipei, China show that the narrower the distance to the technological frontier, the higher the growth effect of basic R&D, which indicates that the share of basic R&D matters for economic growth. Finally, the results also show that the quality of tertiary education has a significantly positive effect on the productivity of R&D.
Corporate Tax Policy and Unemployment in Europe: An Applied General Equilibrium Analysis
Authors: Bettendorf Leon , Horst Albert van der , De Mooij Ruud A.
Published: August 2009

This paper analyses the impact of corporate taxes on structural unemployment, using an applied general equilibrium model for the European Union. We find that the unemployment and welfare effects of corporate taxes differ considerably among European countries. The magnitude of these effects rises in particular in the broadness of the corporate tax base of a country, and the strength of international spillover effects through foreign direct investment. The effect on unemployment is smaller if the substitution elasticity between labour and capital is large, if international spillover effects operate primarily via multinational profit shifting, and with small labour market imperfections. Although the effect of corporate taxes on unemployment may be smaller than the effect of labour and value‐added taxes (e.g. under relatively strong real wage resistance), the welfare costs of corporate taxation are typically larger for most European countries under plausible parameters, especially under strong international spillovers.
The Decentering of the Global Firm
Authors: Desai Mihir A.
Published: August 2009

This paper describes recent changes in the relationship between firms and nation states. Firms are typically linked to the nation in which they began and are considered to have fixed national identities. While firms have reallocated various activities around the world in response to value creation opportunities, they have largely retained their national identities and their headquarter activities have remained bundled in their home countries. This characterisation is increasingly tenuous. Firms are redefining their homes by unbundling their headquarters functions and reallocating them opportunistically across nations. A firm’s legal home, its financial home and its homes for managerial talent no longer need to be co‐located and, consequently, the idea of firms as national actors rooted in their home countries is rapidly becoming outdated. The implications for policymakers and researchers are outlined.
Competition from Low‐wage Countries and the Decline of Corporate Tax Rates: Evidence from European Integration
Authors: Overesch Michael , Rincke Johannes
Published: August 2009

We exploit the rapid economic integration of Eastern and Western Europe after 1989 as a natural experiment to assess the effect of international competition for mobile capital on corporate tax rates. By means of a series of difference‐in‐difference estimations, we show that Western European countries which have been directly exposed to neighbours in Eastern Europe have reacted to the intensified competition by cutting their corporate tax rates by 8.1 to 10.5 percentage points relative to those countries which do not share a common border with countries in Eastern Europe. It seems that this effect has mainly worked through Eastern European countries offering lower wages and less through competition over corporate tax rates.
Reasons and Causes
Authors: Setiya Kieran
Published: August 2009

Abstract: This paper argues for a causal‐psychological account of acting for reasons. This view is distinguished from a more ambitious causal theory of action, clarified as far as possible, and motivated—against non‐reductive, teleological, and behaviourist alternatives—on broadly metaphysical grounds.
Does the More Risk‐Averse Investor hold a Less Risky Portfolio?*
Authors: WONG GEORGE
Published: August 2009

We study the suitability of using absolute risk aversion as a measure of willingness to take risk in the Arrow–Debreu portfolio framework. We define a global measure of risk for the Arrow–Debreu portfolio, which is measured by the sensitivity of an individual's Arrow–Debreu portfolio payoff to the change in the market return. We call this measure ‘conservatism’ and show that the concept of ‘more conservative’ is stronger than that of ‘more risk‐averse.’ A higher absolute risk aversion is only necessary but not sufficient to induce a less risky Arrow–Debreu portfolio. Our results not only challenge the well‐accepted notion that a more risk‐averse investor holds a less risky portfolio, but also suggest a stronger measure – conservatism – for evaluating the riskiness of portfolio.
Eyewitness testimony after three months: A field study on memory for an incident in everyday life1
Authors: Naka Makiko , Itsukushima Yukio , Itoh Yuji
Published: August 2009

Abstract: There are cases when one is asked to give testimony about an incident that was of no significance until a certain point in time, after which it suddenly became important. Based upon a real case in which a salesclerk gave eyewitness testimony and identified a suspect from a photograph 4 months after the sale, we studied the accuracy of memory for such an incident in everyday life in natural settings. Eighty‐six salesclerks served as subjects. A confederate (customer) visited a store and bought some goods from a clerk. Three months later, the clerk was asked to remember the person (customer) and the event (the sales exchanges), and to identify a photograph of the customer. Half the subjects remembered the details of the person and the event and, of these, two‐thirds were accurate. However, although two‐thirds of the subjects claimed to identify the customer from a photograph, only 13% were accurate. Correlational analyses showed that the quantity (duration of the contact) as well as the quality (the clerk's impression of unusualness of the customer, etc.) predicted accuracy of memory.
Genetic Evidence for Complexity in Ethnic Differentiation and History in East Africa
Authors: Poloni Estella S. , Naciri Yamama , Bucho Rute , Niba Régine , Kervaire Barbara , Excoffier Laurent , Langaney André , Sanchez‐Mazas Alicia
Published: August 2009

The Afro‐Asiatic and Nilo‐Saharan language families come into contact in Western Ethiopia. Ethnic diversity is particularly high in the South, where the Nilo‐Saharan Nyangatom and the Afro‐Asiatic Daasanach dwell. Despite their linguistic differentiation, both populations rely on a similar agripastoralist mode of subsistence. Analysis of mitochondrial DNA extracted from Nyangatom and Daasanach archival sera revealed high levels of diversity, with most sequences belonging to the L haplogroups, the basal branches of the mitochondrial phylogeny. However, in sharp contrast with other Ethiopian populations, only 5% of the Nyangatom and Daasanach sequences belong to haplogroups M and N. The Nyangatom and Daasanach were found to be significantly differentiated, while each of them displays close affinities with some Tanzanian populations. The strong genetic structure found over East Africa was neither associated with geography nor with language, a result confirmed by the analysis of 6711 HVS‐I sequences of 136 populations mainly from Africa. Processes of migration, language shift and group absorption are documented by linguists and ethnographers for the Nyangatom and Daasanach, thus pointing to the probably transient and plastic nature of these ethnic groups. These processes, associated with periods of isolation, could explain the high diversity and strong genetic structure found in East Africa.
Monopolistic Screening with Boundedly Rational Consumers*
Authors: BASOV SUREN
Published: August 2009

In this paper, I revisit the monopolistic screening problem with two types assuming that consumers are boundedly rational. Bounded rationality implies that the revelation principle does not apply and the choice of the selling mechanism entails a loss of generality. I show that if the monopolist restricts attention to the mechanisms that offer menus of two choices, the profits are lower than in the case of fully rational consumers by the term of order ln λ/λ, where λ is the degree of rationality of the consumers. The monopolist, however, can approximate the profits earned when consumers are fully rational by using a more elaborate message game.
Earnings and Languages in the Family: Second‐Generation Australians*
Authors: MESSINIS GEORGE
Published: August 2009

This paper uses Household, Income and Labour Dynamics in Australia data to assess the performance of second‐generation Australians in full‐time employment in 2007. It examines the role of job mismatch and cultural and linguistic diversity at the individual and family levels. The study accounts for non‐random sample selection. The new evidence shows that: (i) over‐education and over‐skilling carry a wage penalty; (ii) there are significant but heterogeneous second‐generation effects; and (iii) language effects explain most of the disadvantage associated with non‐English‐speaking background.
On the mechanism of the persistent action of salmeterol: what is the current position?
Authors: Coleman RA
Published: August 2009

The mechanism of the long duration of action of salmeterol at β2‐adrenoceptors has long been a matter of debate, and is still unresolved. Szczuka and colleagues have both summarized the position to date and suggested a new mechanistic contender, receptor rebinding. Despite this, they still do not come to any clear conclusion. Much of the literature data that they have drawn upon appears contradictory, and mathematical models are inevitably flawed by the questionable validity of key values applied to them. Although the issue will undoubtedly eventually be resolved, it will probably require investigators to apply carefully designed studies on simple experimental systems such as isolated membranes or cultured cells. Only then should studies be extended to more complex systems such as isolated preparations of airways smooth muscle, where tissue bulk inevitably presents a complicating factor, particularly where relatively lipophilic compounds are concerned.
GPCR Theme Editorial
Authors: Milligan G , McGrath JC
Published: August 2009

This themed section of BJP includes 11 reviews on the biology of G‐protein coupled receptors (GPCRs) and the drug targets that these present, 21 research papers on the pharmacology of a range of GPCRs and Commentaries on four of the papers.

Areas reviewed include molecular interactions, particular in respect of hetero‐dimerisation between receptors and other membrane‐located proteins and other key signalling molecules including cAMP and G12/13 proteins and recently de‐orphanised receptors including the Neuromedins U & S and the Free Fatty Acid receptors FFA2 & FFA3.

The research papers cover the pharmacology of a range of agents acting at GPCRs, including adrenoceptors, purinoceptors, 5HT, opioid, cannabinoid & PAR‐2 receptors. A group of papers is concerned with the interesting and rapidly developing pharmacology of drugs acting at β2‐adrenoceptors.

The reach of GPCRs is illustrated by the range of physiological systems and therapeutic applications involved, including pain, cancer, cardiovascular, gastrointestinal, visual and respiratory and central nervous systems.
An improved methodology of the modern analogues technique for palaeoclimate reconstruction in arid and semi‐arid regions
Authors: JIANG WENYING , GUIOT JOËL , CHU GUOQIANG , WU HAIBIN , YUAN BAOYIN , HATTÉ CHRISTINE , GUO ZHENGTANG
Published: August 2009

Jiang, W., Guiot, J., Chu, G., Wu, H., Yuan, B., Hatté, C. & Guo, Z. 2009: An improved methodology of the modern analogues technique for palaeoclimate reconstruction in arid and semi‐arid regions. Boreas, 10.1111/j.1502‐3885.2009.00115.x. ISSN 0300‐9483.

This study presents an improved method of the plant functional type modern analogues technique (PFT‐MAT) in which environmental proxies and a moisture index (α, i.e. ratio of actual evapotranspiration to potential evapotranspiration) are used to constrain the selection of modern analogues. The method is tested using high‐resolution, precisely dated palaeorecords (pollen, Pediastrum and δ18O of authigenic carbonate) from Lake Bayanchagan, northern China. The unconstrained and constrained PFT‐MAT produces general agreement for Holocene climate changes, with a wet period between 11 000 and 5500 cal. yr BP and a warm interval between 11 000 and 8000 cal. yr BP. However, there are significant differences in the details of their reconstruction. The constrained PFT‐MAT generally yields smaller error bars for the reconstructed climate parameters than the unconstrained PFT‐MAT. In addition, three prominent climatic events are identified from the constrained reconstructions; namely, a cold event around 8400 cal. yr BP and two warm events around 6000 and 2000 cal. yr BP, which is consistent with other regional palaeoclimatic records. Our data show that changes in tree components correlate well with α variations during the entire Holocene, with the highest tree components and highest α values between 8000 and 5500 cal. yr BP, indicating the dominant role of α in the growth of trees in northern China rather than single temperature or precipitation. The improved PFT‐MAT is therefore an efficient method for quantitative reconstructions of palaeoclimate in arid and semi‐arid regions.
Helicobacter pylori and Clinical Aspects of Gastric Cancer
Authors: Bornschein Jan , Rokkas Theodore , Selgrad Michael , Malfertheiner Peter
Published: August 2009

In spite of important new insights into the basic mechanisms of gastric carcinogenesis, progress in the management of gastric cancer has been modest. Some modifications in the chemotherapies used for palliation and strategies for downstaging of the disease prior to surgical intervention are noteworthy. The positive experience with endoscopic mucosal resection (EMR) and submucosal dissection (ESD) for treatment of early gastric cancer has been confirmed and extended. The procedure‐related morbidity and post‐interventional quality of life is clearly favorable compared to open surgical resection in well‐selected patients. New data on Helicobacter pylori revealed that eradication after endoscopic resection of early gastric cancer significantly reduces the incidence of recurrent and metachronous gastric neoplasias. It can further improve healing rates of treatment induced gastric ulcers. Eradication therapy therefore remains the best target for prevention of the disease. Critical is the “point of no return” when mucosal alterations (i.e. intestinal metaplasia, glandular atrophy) are no longer reversible. A population‐based screen‐and‐eradicate strategy for H. pylori infection can at present only be recommended in high incidence regions.
Basic Aspects of Gastric Cancer
Authors: Correia Marta , Machado José Carlos , Ristimäki Ari
Published: August 2009

Gastric cancer is a worldwide health burden, which is still the second most common cause of cancer related deaths with little improvement of long‐term survival during the past decades. Understanding the molecular nature of this disease and its precursor lesions has been under intense investigation and our review attempts to highlight recent progress in this field of cancer research. First, host‐related genetic susceptibility is dealt with genes involved in inflammation and carcinogen metabolism. Next, role of overexpression of a proinflammatory cytokine (interleukin‐1beta) and deletion of a cell‐cell adhesion molecule (E‐cadherin) are described in experimental mouse models of gastric carcinogenesis. Finally, the role of stem cells in gastric cancer is covered.