bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective Randomized Comparison of Cold Snare Polypectomy and Conventional Polypectomy for Small Colorectal Polyps
Authors: Ichise Yasuyuki , Horiuchi Akira , Nakayama Yoshiko , Tanaka Naoki
Published: April 2011

Background and Aim: The ideal method to remove small colorectal polyps is unknown. We compared removal by colon snare transection without electrocautery (cold snare polypectomy) with conventional electrocautery snare polypectomy (hot polypectomy) in terms of procedure duration, difficulty in retrieving polyps, bleeding, and post-polypectomy symptoms. Methods: Patients with colorectal polyps up to 8 mm in diameter were randomized to polypectomy by cold snare technique (cold group) or conventional polypectomy (conventional group). The principal outcome measures were abdominal symptoms within 2 weeks after polypectomy. Secondary outcome measures were the rates of retrieval of colorectal polyps and bleeding. Results: Eighty patients were randomized: cold group, n = 40 (101 polyps) and conventional group, n = 40 (104 polyps). The patients’ demographic characteristics and the number and size of polyps removed were similar between the two techniques. Procedure time was significantly shorter with cold polypectomy vs. conventional polypectomy (18 vs. 25 min, p < 0.0001). Complete polyp retrieval rates were identical [96% (97/101) vs. 96% (100/104)]. No bleeding requiring hemostasis occurred in either group. Abdominal symptoms shortly after polypectomy were more common with conventional polypectomy (i.e. 20%; 8/40) than with cold polypectomy (i.e. 2.5%; 1/40; p = 0.029). Conclusion: Cold polypectomy was superior to conventional polypectomy in terms of procedure time and post-polypectomy abdominal symptoms. The two methods were otherwise essentially identical in terms of bleeding risk and complete polyp retrieval. Cold polypectomy is therefore the preferred method for removal of small colorectal polyps.
Whole-Chromosome Aneuploidy Analysis in Human Oocytes: Focus on Comparative Genomic Hybridization
Authors: Obradors A. , Rius M. , Daina G. , Ramos L. , Benet J. , Navarro J.
Published: April 2011

The study of aneuploidy in human oocytes, discarded from IVF cycles, has provided a better understanding of the incidence of aneuploidy of female origin and the responsible mechanisms. Comparative genomic hybridization (CGH) is an established technique that allows for the detection of aneuploidy in all chromosomes avoiding artifactual chromosome losses. In this review, results obtained using CGH in single cells (1PB and/or MII oocytes) are included. The results of oocyte aneuploidy rates obtained by CGH from discarded oocytes of IVF patients and of oocyte donors are summarized. Moreover, the mechanisms involved in the aneuploid events, e.g. whether alterations occurred due to first meiotic errors or germ-line mitotic errors are also discussed. Finally, the incidence of aneuploid oocyte production due to first meiotic errors and germ-line mitotic errors observed in oocytes coming from IVF patients and IVF oocyte donors was assessed.
Regenerative Medicine for Stroke – Are We There Yet?
Authors: Onteniente Brigitte , Polentes Jérôme
Published: April 2011

With the development of stem cell (SC) biology, cell-based therapy has become a highly challenging field for experimental and clinical research. Among neurological disorders, stroke has pioneered the clinical application of SC. Safety concerns have prevailed for pilot clinical studies and important preclinical work is ongoing to help SC therapy reach the level of generalization. Stroke is classically divided into an acute, a subacute and a chronic phase. Each phase is defined by a complex array of events with overlapping and distinct kinetics that lead to both rapid tissue degeneration and long-lasting remodeling. Each SC type possesses intrinsic properties – transposed via cell-autonomous and non-cell-autonomous signaling – that would more specifically address some of these events. A better definition of what is expected from SC therapy in stroke might help assign SC sources to the acute or chronic phases and possibly optimize their use in the clinic.
Aquaporins in Cerebrovascular Disease: A Target for Treatment of Brain Edema
Authors: Badaut J. , Ashwal S. , Obenaus A.
Published: April 2011

In cerebrovascular disease, edema formation is frequently observed within the first 7 days and is characterized by molecular and cellular changes in the neurovascular unit. The presence of water channels, aquaporins (AQPs), within the neurovascular unit has led to intensive research in understanding the underlying roles of each of the AQPs under normal conditions and in different diseases. In this review, we summarize some of the recent knowledge on AQPs, focusing on AQP4, the most abundant AQP in the central nervous system. Several experimental models illustrate that AQPs have dual, complex regulatory roles in edema formation and resolution. To date, no specific therapeutic agents have been developed to inhibit water flux through these channels. However, experimental results strongly suggest that this is an important area for future investigation. In fact, early inhibition of water channels may have positive effects in the prevention of edema formation. At later time points during the course of disease, AQP is important for the clearance of water from the brain into blood vessels. Thus, AQPs, and in particular AQP4, have important roles in the resolution of edema after brain injury. The function of these water channel proteins makes them an excellent therapeutic target.
Impact of a Combined Intravenous/ Intra-Arterial Approach in Octogenarians
Authors: Mazighi Mikael , Labreuche Julien , Meseguer Elena , Serfaty Jean-Michel , Laissy Jean-Pierre , Lavallée Philippa C. , Cabrejo Lucie , Guidoux Céline , Lapergue Bertrand , Klein Isabelle F. , Olivot Jean-Marc , Abboud Halim , Simon Olivier , Schouman-Claeys Elisabeth , Amarenco Pierre
Published: April 2011

Background: Intravenous (IV) alteplase is not currently recommended in octogenarian patients, and the benefit/risk ratio of endovascular (intra-arterial, IA) therapy remains to be determined. The aim of this study was to determine the impact of a combined IV-IA approach in octogenarians. Methods: From a single-centre interventional study, we report age-specific outcomes of patients treated by a combined IV-IA thrombolytic approach. Patients ≧80 years with documented arterial occlusion treated by conventional IV thrombolysis constituted the control group. Results: Among 84 patients treated by the IV-IA approach, those ≧80 years (n = 25) had a similar rate of early neurological improvement to that of patients <80 years, whereas the 90-day favourable outcome rate was lower in octogenarians (adjusted odds ratio, OR, 0.21; 95% confidence interval, CI, 0.06–0.75). No difference in symptomatic intracranial haemorrhage was observed whereas a higher rate of 90-day mortality (adjusted OR, 3.27; 95% CI, 0.76–14.14) and asymptomatic intracranial haemorrhage (adjusted OR, 6.39; 95% CI, 1.54–26.63) were found in patients ≧80 years old. Among octogenarians, and compared to IV-thrombolysis-treated patients (n = 24), patients treated by the IV-IA approach had a higher rate of recanalization (76 vs. 33%, p = 0.003) associated with increased early neurological improvement (32 vs. 8%, p = 0.07). Although there was a higher rate of asymptomatic intracranial haemorrhage (44 vs. 8%, p = 0.005) observed in the IV-IA group, no difference existed in symptomatic intracranial haemorrhage rates and 90-day favourable outcome. Conclusion: The IV-IA approach in octogenarians was associated with lower efficacy at 3 months and higher mortality and asymptomatic haemorrhagic complications than in patients <80 years old. Definite recommendations cannot be given, but an endovascular approach may cause more harm than positive effects in patients over 80 years and should not be considered outside an approved protocol.
Association between Left-Handedness and Gastrointestinal Symptoms
Authors: Fujiwara Yasuhiro , Kubo Makiko , Kohata Yukie , Yamagami Hirokazu , Tanigawa Tetsuya , Watanabe Kenji , Watanabe Toshio , Tominaga Kazunari , Arakawa Tetsuo
Published: April 2011

Objective: Several studies have shown associations between left-handedness and several chronic diseases such as bronchial asthma and inflammatory bowel disease. Perceptual responses within the brain-gut axis play a crucial role in the development of the cardinal symptoms of functional gastrointestinal (GI) diseases, including dyspepsia and irritable bowel syndrome (IBS). The aim of this study was to determine the association between left-handedness and GI symptoms or diseases. Methods: 2,447 Japanese who underwent a routine health check-up were asked to complete a self-report questionnaire regarding age, gender, writing handedness and GI symptoms experienced over the past 3 months, including heartburn, acid regurgitation, epigastric pain, postprandial fullness, abdominal pain/discomfort, nausea and/or chest pain. Symptoms were positive when their frequency was 2 to 3 days per month or more. Diagnosis of dyspepsia and IBS was performed according to the Rome III Integrative Questionnaire. Results: Left-handedness was observed in 177 (7.2%) subjects. Early satiation, abdominal pain/fullness and postprandial fullness were less commonly observed in left-handed individuals. After adjustment for age and sex, left-handedness was found to be significantly associated with decreased OR for early satiation (OR = 0.43; 95% CI: 0.23–0.78). There were no significant associations between left-handedness and GERD (gastroesophageal reflux disease), dyspepsia or IBS. Conclusions: This study demonstrated a significant negative association between left-handedness and early satiation. The findings suggest that cerebral lateralization may affect the development of GI symptoms.
A Population-Based Survey in Australia of Men’s and Women’s Perceptions of Genetic Risk and Predictive Genetic Testing and Implications for Primary Care
Authors: Taylor S.
Published: April 2011

Background: Community attitudes research regarding genetic issues is important when contemplating the potential value and utilisation of predictive testing for common diseases in mainstream health services. This article aims to report population-based attitudes and discuss their relevance to integrating genetic services in primary health contexts. Methods: Men’s and women’s attitudes were investigated via population-based omnibus telephone survey in Queensland, Australia. Randomly selected adults (n = 1,230) with a mean age of 48.8 years were interviewed regarding perceptions of genetic determinants of health; benefits of genetic testing that predict ‘certain’ versus ‘probable’ future illness; and concern, if any, regarding potential misuse of genetic test information. Results: Most (75%) respondents believed genetic factors significantly influenced health status; 85% regarded genetic testing positively although attitudes varied with age. Risk-based information was less valued than certainty-based information, but women valued risk information significantly more highly than men. Respondents reported ‘concern’ (44%) and ‘no concern’ (47%) regarding potential misuse of genetic information. Conclusions: This study contributes important population-based data as most research has involved selected individuals closely impacted by genetic disorders. While community attitudes were positive regarding genetic testing, genetic literacy is important to establish. The nature of gender differences regarding risk perception merits further study and has policy and service implications. Community concern about potential genetic discrimination must be addressed if health benefits of testing are to be maximised. Larger questions remain in scientific, policy, service delivery, and professional practice domains before predictive testing for common disorders is efficacious in mainstream health care.
Minimal Atrophy of the Entorhinal Cortex and Hippocampus: Progression of Cognitive Impairment
Authors: Varon Daniel , Loewenstein David A. , Potter Elizabeth , Greig Maria T. , Agron Joscelyn , Shen Qian , Zhao Weizhao , Celeste Ramirez Maria , Santos Isael , Barker Warren , Potter Huntington , Duara Ranjan
Published: April 2011

Background: In Alzheimer’s disease, neurodegenerative atrophy progresses from the entorhinal cortex (ERC) to the hippocampus (HP), limbic system and neocortex. The significance of very mild atrophy of the ERC and HP on MRI scans among elderly subjects is unknown. Methods: A validated visual rating system on coronal MRI scans was used to identify no atrophy of the HP or ERC (HP₀; ERC₀), or minimal atrophy of the HP or ERC (HPma; ERCma), among 414 participants. Subjects fell into the following groups: (1) ERC₀/HP₀, (2) ERCma/HP₀, (3) ERC₀/HPma, and (4) ERCma/HPma. HP volume was independently measured using volumetric methods. Results: In comparison to ERC₀/HP₀ subjects, those with ERC₀/HPma had impairment on 1 memory test, ERCma/HP₀ subjects had impairment on 2 memory tests and the Mini Mental State Examination (MMSE), while ERCma/HPma subjects had impairment on 3 memory tests, the MMSE and Clinical Dementia Rating. Progression rates of cognitive and functional impairment were significantly greater among subjects with ERCma. Conclusion: Minimal atrophy of the ERC results in greater impairment than minimal atrophy of the HP, and the combination is additive when measured by cognitive and functional tests. Rates of progression to greater impairment were higher among ERCma subjects.
Human Galectins Induce Conversion of Dermal Fibroblasts into Myofibroblasts and Production of Extracellular Matrix: Potential Application in Tissue Engineering and Wound Repair
Authors: Dvořánková Barbora , Szabo Pavol , Lacina Lukas , Gal Peter , Uhrova Jana , Zima Tomas , Kaltner Herbert , André Sabine , Gabius Hans-Joachim , Sykova Eva , Smetana, Jr. Karel
Published: April 2011

Members of the galectin family of endogenous lectins are potent adhesion/growth-regulatory effectors. Their multifunctionality opens possibilities for their use in bioapplications. We studied whether human galectins induce the conversion of human dermal fibroblasts into myofibroblasts (MFBs) and the production of a bioactive extracellular matrix scaffold is suitable for cell culture. Testing a panel of galectins of all three subgroups, including natural and engineered variants, we detected activity for the proto-type galectin-1 and galectin-7, the chimera-type galectin-3 and the tandem-repeat-type galectin-4. The activity of galectin-1 required the integrity of the carbohydrate recognition domain. It was independent of the presence of TGF-β1, but it yielded an additive effect. The resulting MFBs, relevant, for example, for tumor progression, generated a matrix scaffold rich in fibronectin and galectin-1 that supported keratinocyte culture without feeder cells. Of note, keratinocytes cultured on this substratum presented a stem-like cell phenotype with small size and keratin-19 expression. In vivo in rats, galectin-1 had a positive effect on skin wound closure 21 days after surgery. In conclusion, we describe the differential potential of certain human galectins to induce the conversion of dermal fibroblasts into MFBs and the generation of a bioactive cell culture substratum.
Pain Relief and Functional Recovery in Patients with Complex Regional Pain Syndrome after Motor Cortex Stimulation
Authors: Fonoff Erich Talamoni , Hamani Clement , Ciampi de Andrade Daniel , Yeng Lin Tchia , Marcolin Marco Antonio , Jacobsen Teixeira Manoel
Published: April 2011

In addition to pain and neurovegetative symptoms, patients with severe forms of complex regional pain syndrome (CRPS) develop a broad range of symptoms, including sensory disturbances, motor impairment and dystonic posturing. While most patients respond to medical therapy, some are considered refractory and become surgical candidates. To date, the most commonly used surgical procedure for CRPS has been spinal cord stimulation. This therapy often leads to important analgesic effects, but no sensory or motor improvements. We report on 2 patients with pain related to CRPS and severe functional deficits treated with motor cortex stimulation (MCS) who not only had significant analgesic effects, but also improvements in sensory and motor symptoms. In the long term (27 and 36 months after surgery), visual analog scale pain scores were improved by 60–70% as compared to baseline. There was also a significant increase in the range of motion in the joints of the affected limbs and an improvement in allodynia, hyperpathia and hypoesthesia. Positron emission tomography scan in both subjects revealed that MCS influenced regions involved in the circuitry of pain.
MRI-Related Heating near Deep Brain Stimulation Electrodes: More Data Are Needed
Authors: Gupte Akshay A. , Shrivastava Devashish , Spaniol Maggie A. , Abosch Aviva
Published: April 2011

Magnetic resonance imaging (MRI) of patients with implanted deep brain stimulation (DBS) devices poses a challenge for healthcare providers. As a consequence of safety concerns about magnetic field interactions with the device, induced electrical currents and thermal damage due to radiofrequency heating, a number of stringent guidelines have been proposed by the device manufacturer. Very few detailed investigations of these safety issues have been published to date, and the stringent manufacturer guidelines have gone unchallenged, leading some hospitals and imaging centers around the world to ban or restrict the use of MRI in DBS patients. The purpose of this review is to stimulate research towards defining appropriate guidelines for the use of MRI in patients with DBS. Additionally, this review is intended to help healthcare providers and researchers make sound clinical judgments about the use of MRI in the setting of implanted DBS devices.
Attitudes toward Genetic Research Review: Results from a Survey of Human Genetics Researchers
Authors: Edwards K.L. , Lemke A.A. , Trinidad S.B. , Lewis S.M. , Starks H. , Quinn Griffin M.T. , Wiesner G.L. ,   The GRRIP Consortium
Published: April 2011

Background: Researchers often relate personal experiences of difficulties and challenges with Institutional Review Board (IRB) review of their human genetic research protocols. However, there have been no studies that document the range and frequency of these concerns among researchers conducting human genetic/genomic studies. Methods: An online anonymous survey was used to collect information from human genetic researchers regarding views about IRB review of genetic protocols. Logistic regression was used to test specific hypotheses. Results from the national online survey of 351 human genomic researchers are summarized in this report. Results: Issues involving considerable discussion with IRBs included reconsent of subjects (51%), protection of participants’ personal information (39%) and return of results to participants (34%). Over half of the participants had experienced one or more negative consequences of the IRB review process and approximately 25% had experienced one or more positive consequences. Respondents who had served on an IRB were about 80% more likely to report positive consequences of IRB review than their colleagues who had never served on an IRB (p = 0.03). Survey responses were mixed on the need for reconsent before data sharing and risks related to participant reidentification from genomic data. Conclusion: The results from this study provide important perspectives of researchers regarding genetic research review and show lack of consensus on key research ethics issues in genomic research.
Absence of Mutations on the SNF5 Gene in Hematological Neoplasms with Chromosome 22 Abnormalities
Authors: Mori Naoki , Inoue Kaoru , Okada Michiko , Motoji Toshiko
Published: April 2011

Background: The relation with SNF5 mutation and chromosome 22 abnormalities is not clear in hematological neoplasms. Methods: To elucidate the relevance of the SNF5 gene on 22q11.2, karyotypes were reviewed in 283 hematological neoplasms. Loss of heterozygosity (LOH) on 22q was analyzed in 21 plasma cell myelomas without chromosome 22 abnormalities. Polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) on the SNF5 gene was analyzed in 8 hematological neoplasms with 22q- or -22, and 8 chronic myelogenous leukemias (CMLs) in blast crisis. Fluorescence in situ hybridization (FISH) was performed in 1 myelodysplastic syndrome (MDS) case with -22,del(22)(q11.2 q13). Results: 22q- or -22 was observed in 36 patients. LOH on 22q was detected in 1 of the 21 myelomas. Mobility shifts were found by PCR-SSCP analysis in 2 CMLs, whereas sequence analysis showed polymorphisms. FISH analysis revealed the SNF5 gene was not deleted in the MDS case. Conclusion: These results suggest that alterations of the SNF5 gene are rare in hematological neoplasms with chromosome 22 abnormalities. Haploinsufficiency may contribute to the development of these neoplasms.
Validation of the French Version of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)
Authors: Khan Riaz , Chatton Anne , Nallet Audrey , Broers Barbara , Thorens Gabriel , Achab-Arigo Sophia , Poznyak Vladimir , Fleischmann Alexandra , Khazaal Yasser , Zullino Daniele
Published: April 2011

Background: The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was developed to detect substance use disorders. Aims: The objective of the present study was to evaluate the psychometric properties of the French version of ASSIST in various clinical groups with different levels of substance use. Methods: 150 subjects were recruited from clients attending primary health care, psychiatric and addiction treatment facilities. Measures included ASSIST, Addiction Severity Index (ASI), Mini-International Neuropsychiatric Interview (MINI-Plus), Alcohol Use Disorders Identification Test (AUDIT) and Revised Fagerstrom Tolerance Questionnaire-Smoking (RTQ). Results and Conclusion: Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from ASI, AUDIT and RTQ, as well as significantly greater ASSIST scores for patients with a MINI-Plus diagnosis of abuse or dependence. The ASSIST questionnaire was found to have high internal consistency for the total substance involvement as well as for specific substance involvement as assessed with Cronbach’s α, ranging from 0.74 to 0.93. When possibly computed, ASSIST cutoff scores have interesting sensitivity and specificity for discrimination between use and abuse and between abuse and dependence. The findings demonstrated that the French version of ASSIST is a valid screening test for identifying substance use disorders in various health care settings, including psychiatric settings.
Comprehensive Evaluation of Coronary Artery Disease and Aortic Atherosclerosis in Acute Ischemic Stroke Patients: Usefulness Based on Framingham Risk Score and Stroke Subtype
Authors: Cho Hyun-Ji , Lee Joon-Hwa , Kim Young-Jin , Moon Yeonsil , Ko Sung-Min , Kim Hahn Young
Published: April 2011

Background: Evaluation of coronary artery disease (CAD) and aortic atherosclerosis has been performed in patients with acute ischemic stroke. We investigated the usefulness of a dual-source CT (DSCT) protocol enabling the comprehensive evaluation of CAD and aortic atherosclerosis. The clinical characteristics of those patients who would benefit more from this protocol were investigated based on vascular risk factors, Framingham Risk Score (FRS), and stroke subtype. Methods: Of 469 patients with acute ischemic stroke, the 274 who had no history of CAD and had undergone DSCT were analyzed. Predictors of CAD (≧50% stenosis) or complicated aortic plaque (CAP) were evaluated based on vascular risk factors, FRS and stroke subtype. Results: Of the 274 patients analyzed, asymptomatic CAD (≧50% stenosis) was found in 61 (22.3%) and CAP in 58 (21.2%). Furthermore, the severity of CAD or aortic atherosclerosis was correlated with FRS (CAD, r = 0.291, p < 0.001 and aortic atherosclerosis, r = 0.297, p < 0.001). Additionally, severe CAD and aortic atherosclerosis were independent predictors of each other: CAP for the presence of CAD (≧50% stenosis) [odds ratio (OR), 5.71; 95% confidence interval (CI), 1.94–16.87]; CAD (≧50% stenosis) for the presence of CAP (OR, 4.20; 95% CI, 1.82–9.72). Specific stroke subtypes as well as large-artery atherosclerosis (OR, 5.25; 95% CI, 2.24–12.31) and cardioembolism (OR, 5.22; 95% CI, 1.75–15.60) were associated with the presence of CAP. Conclusions: A comprehensive evaluation protocol for CAD and aortic atherosclerosis may be useful in acute ischemic stroke patients, especially in those with higher FRS or specific stroke subtypes.
Natural Evolution of Spitz Nevi
Authors: Argenziano Giuseppe , Agozzino Marina , Bonifazi Ernesto , Broganelli Paolo , Brunetti Bruno , Ferrara Gerardo , Fulgione Elisabetta , Garrone Alessandro , Zalaudek Iris
Published: April 2011

Background: The natural evolution of melanocytic nevi is a complex, multifactorial process that can be studied by monitoring nevi on a long-term basis. Methods: To assess the evolution pathway of Spitz nevi, lesions with clinical and dermoscopic features suggestive of Spitz nevi were monitored and baseline and follow-up images compared. Results: Sixty-four patients (mean age 10.4 years) with lesions suggestive of Spitz nevi were included. Lesions were monitored for a mean follow-up period of 25 months. Upon side-by-side evaluation of baseline and follow-up images, 51 (79.7%) lesions showed an involution pattern and 13 (20.3%) lesions showed a growing or stable pattern. No significant differences were found between growing and involving lesions in terms of patient age and sex and the location and palpability of lesions. The great majority of growing lesions were pigmented or partially pigmented (92.3%), whereas 47.1% of lesions in involution were amelanotic (p = 0.005). Conclusion: In this series of lesions clinically and dermoscopically diagnosed as Spitz nevi, spontaneous involution seems to be the most common biologic behavior.
A New Method for Recording Complex Positional Behaviours and Habitat Interactions in Primates
Authors: Myatt J.P. , Crompton R.H. , Thorpe S.K.S.
Published: April 2011

In an arboreal habitat, primates have to cope with a complex meshwork of flexible supports in order to obtain food, find mates and avoid predators. To understand how animals interact with such complex environments we can study their positional behaviour. However, due to the intricate variation in locomotion and posture it can be difficult to capture details such as limb use (i.e. weight and balance), limb flexion and substrate use. This paper presents a suitable method replicable for any primate species, based on the movement notation technique, Sutton Movement Writing (SMW), aiming to record the spatial arrangement of limbs during positional behaviours on multiple, compliant supports. This method was piloted during a year-long field study of wild orangutans (Pongo abelii) and validated and tested for inter- and intraobserver reliability using videos from the field. Overall, SMW shows considerable promise for increasing the resolution with which positional behaviours can be recorded under field conditions and provides a way to extract numerical data for use in statistical analyses. This will facilitate our understanding of how behaviours vary in response to the environment, and the capabilities of primates to perform key tasks in their distinct niches.
Childhood-Adolescent Obesity in the Cardiorenal Syndrome: Lessons from Animal Models
Authors: Hayden Melvin R. , Sowers James R.
Published: April 2011

Background/Aims: Childhood-adolescent overweight and obesity have grown to pandemic proportions during the past decade. The onset of obesity in younger adults will likely be manifested as earlier onset of myocardial and renal end-organ disease in younger adults. For the first time, it is estimated that the current generation may not live to be as old as their parents. Thus, it is important to develop animal models of childhood obesity to understand fundamental pathological organ changes. Methods: In this regard, we utilize transmission electron microscopy evaluation to evaluate early remodeling changes of two adolescent rodent obesity models: the Zucker obese (fa/fa) rat and the db/db mouse models of obesity. We have concentrated on the initial ultrastructural remodeling (obese adipose tissue, skeletal muscle, and islet remodeling) and the associated changes in target end organs (including the myocardium and kidney) in young rodent models of obesity and insulin resistance, collectively manifesting as the cardiorenal metabolic syndrome (CRS). Results: Briefly, tissues revealed the following ultrastructural remodeling abnormalities: inflammation, hypertrophy, and early fibrosis in adipose tissue; loss of mitochondria in skeletal muscles, hyperplasia, fibrosis, and depletion of insulin-secretory granules in pancreatic islets; increased intramyocardial lipid accumulation, fibrosis, and mitochondrial deposition in the myocardium, and obesity-related glomerulopathy and tubulopathy in the kidney. Conclusion: Based on the current knowledge and ultrastructural observations of organ pathology, we propose mechanisms whereby obesity appears to be the driving force behind the development of the CRS.
Use of Metformin in Patients with Kidney and Cardiovascular Diseases
Authors: Klachko David , Whaley-Connell Adam
Published: April 2011

Metformin is an insulin-sensitizing agent with anti-hyperglycemic properties that is widely used for the treatment of type-2 diabetes. The efficacy of metformin in reducing hyperglycemia is well established, and there is emerging evidence that its chronic use is associated with cancer and cardiovascular disease (CVD) risk reduction. While the hypoglycemic properties of metformin are largely attributed to suppression of hepatic glucose production and increases in peripheral tissue insulin sensitivity, the precise mechanism of the hypoglycemic action of metformin remains unclear. There is evidence that metformin use interrupts mitochondrial oxidative stress in the liver and corrects abnormalities of intracellular calcium metabolism in insulin-sensitive tissues (liver, skeletal muscle, and adipocytes) and cardiovascular tissue. However, the use of metformin in patients with kidney disease, a high-risk CVD state, is confounded by confusion regarding appropriate concerns about the development of lactic acidosis in this population. Thus, we will review current evidence on metformin use for improving CVD outcomes and its therapeutic use in kidney disease.
The Kurashiki Prehospital Stroke Scale Is a Prehospital Scale That Can Predict Long-Term Outcome of Patients with Acute Cerebral Ischemia
Authors: Iguchi Yasuyuki , Kimura Kazumi , Shibazaki Kensaku , Sakamoto Yuki , Sakai Kenichiro , Fujii Shuichi , Uemura Junichi
Published: April 2011

Background and Purpose: Our aim was to confirm the clinical relationship between the Kurashiki Prehospital Stroke Scale (KPSS) scored by paramedics and favorable outcomes in patients with modified Rankin scale (mRS) scores of 0–1 assessed 3 months after symptom onset. Methods: We enrolled patients with acute stroke and transient ischemic attack showing symptoms on admission. Paramedics transferred patients to our hospital after estimating stroke severity using the KPSS. After categorizing patients into either the mRS 0–1 group (favorable outcome) or the mRS 2–6 group (no favorable outcome), we compared the background data between the two groups. We assessed KPSS scores predictive of a favorable outcome. Multivariate regression modeling was conducted to identify factors independently associated with a favorable outcome. Results: The study cohort comprised 147 patients with a premorbid status of mRS 0–1: 69 patients (47%) of them were in the mRS 0–1 group and 78 (53%) in the mRS 2–6 group at the follow-up 3 months after symptom onset. The median KPSS score was lower in the mRS 0–1 group than in the mRS 2–6 group (1 vs. 4, p < 0.001). After classifying the 147 patients into KPSS tertiles with thresholds of 2 and 4, the frequency of mRS 0–1 gradually decreased with increasing KPSS score (lower KPSS, 67.2%; middle KPSS, 47.6%, and higher KPSS, 21.3%; p < 0.001). KPSS score <3 was able to predict a favorable outcome with 67% sensitivity and 71% specificity, and independently associated with mRS 0–1 (odds ratio, 3.0; 95% confidence interval, 1.2–7.3; p = 0.015). Conclusion: KPSS score <3 apparently presents a reasonable cutoff for predicting a favorable outcome in patients with acute cerebral ischemia.
Marguerite Bottard (1822–1906), Nurse under Jean-Martin Charcot, Portrayed by G. Gilles de la Tourette
Authors: Walusinski Olivier
Published: April 2011

Hospitals in Paris underwent considerable change at the end of the 19th century. As they moved from providing accommodation to care, their mission shifted from helping to healing. The glorification of scientific progress, as opposed to religious obscurantism, affected all of French ‘Republican’ society, in particular a significant part of the medical profession, led by figures such as D.M. Bourneville, former interne (house officer) under J.M. Charcot and also his publisher. Bourneville helped bring about the creation of nursing schools and the gradual replacement of religious orders by educated secular nurses. Marguerite Bottard, Charcot’s chief nurse made famous by A. Brouillet’s painting ‘Une leçon clinique à La Salpêtrière’, would be glorified and decorated as a model for this movement. A letter by G. Gilles de la Tourette to Charcot’s successor F. Raymond, never before published, illustrates this progressive current of thought and revisits the struggle to secularise hospitals under the Third Republic in France. At the same time, it renews interest in the exemplary career of a nurse whose name was recently given to a building at La Salpêtrière Hospital.
Elevated B-Type Natriuretic Peptide Is Associated With Increased In-Hospital Mortality or Cardiac Arrest in Patients Undergoing Implantable Cardioverter-Defibrillator Implantation
Authors: Wei Shaokui , Loyo-Berríos Nilsa I. , Haigney Mark C.P. , Cheng Hong , Pinnow Ellen E. , Mitchell Kristi R. , Beachy James H. , Woodward Albert M. , Wang Yongfei , Curtis Jeptha P. , Marinac-Dabic Danica
Published: April 2011

Background—

The implantable cardioverter-defibrillator (ICD) is the most effective treatment for preventing arrhythmic deaths in patients with heart failure, but periprocedural complications, including in-hospital mortality or cardiac arrest, may occur, and little is known about risk factors. We asked whether elevated B-type natriuretic peptide (BNP) level is associated with increased risk of in-hospital mortality or cardiac arrest in patients undergoing ICD implantation.

Methods and Results—

From the National Cardiovascular Data Registry ICD Registry, we identified 53 198 patients who received ICD implants and underwent preoperative BNP measurement from 2006 to 2008. The patients were categorized into 4 groups by BNP levels (<100, 100 to <300, 300 to <1000, and ≥1000 pg/mL). Complication rates were compared among groups, and odds ratios for in-hospital mortality or cardiac arrest were estimated by multiple hierarchical logistic regressions. There were 2952 complications reported, including 510 in-hospital deaths and 365 cardiac arrests. The rate of in-hospital mortality or cardiac arrest significantly increased with elevated BNP level (
P
<0.001). The adjusted odds ratios of in-hospital mortality or cardiac arrest were statistically significant in all 3 higher BNP groups [odds ratio (95% CI), 1.99 (1.17 to 3.39), 2.49 (1.50 to 4.13), and 4.25 (2.57 to 7.06) in the second, third, and fourth groups using <100 as reference]. Among subgroups, the association was more significant in men, patients with renal dysfunction, and patients undergoing biventricular ICD implantation.

Conclusions—

Elevated BNP level was significantly associated with increased risk of in-hospital mortality or cardiac arrest in patients undergoing ICD implant. Strategies aimed at reducing preprocedural BNP or creating systems to manage procedural risk merit further investigation.
Individual and Population Benefits of Daily Aspirin Therapy
Authors: Sussman Jeremy B. , Vijan Sandeep , Choi HwaJung , Hayward Rodney A.
Published: April 2011

Background—

Clinical practice guidelines that help clinicians and patients to understand the magnitude of expected individual risks and benefits would help with patient-centered decision-making and prioritization of care. We assessed the net benefit from taking daily aspirin to estimate the individual and public health implications of a more individualized decision-making approach.

Methods and Results—

We used data from the National Health and Nutrition Examination Survey representing all US persons aged 30 to 85 years with no history of myocardial infarction and applied a Markov model based on randomized evidence and published literature to estimate lifetime effects of aspirin treatment in quality-adjusted life years (QALYs). We found that treatment benefit varies greatly by an individual's cardiovascular disease (CVD) risk. Almost all adults have fewer major clinical events on aspirin, but for most, events prevented would be so rare that even a very small distaste for aspirin use would make treatment inappropriate. With minimal dislike of aspirin use (disutility, 0.005 QALY per year), only those with a 10-year cardiac event risk >6.1% would have a net benefit. A disutility of 0.01 QALY moves this benefit cut point to 10.6%. Multiple factors altered the absolute benefit of aspirin, but the strong relationship between CVD risk and magnitude of benefit was robust.

Conclusions—

The benefits of aspirin therapy depend substantially on an individual's risk of CVD and adverse treatment effects. Understanding who benefits from aspirin use and how much can help clinicians and patients to develop a more patient-centered approach to preventive therapy.
Financial Activism and Global Climate Change: The Rise of Investor-Driven Governance Networks
Authors: MacLeod Michael , Park Jacob
Published: April 2011

This article examines the nexus between financial activism and global environmental governance, analyzing the emergence of what we call “investor-driven governance networks” (IGNs). Our paper seeks to probe the significance of IGNs as a particular manifestation of responsible investor activism and more generally as a financial instrument of environmental governance and sustain-ability. We argue that IGNs, many of which are concerned with climate change governance, have become important actors in the global economy and deserve more analysis by scholars concerned with new forms of authority in global environmental politics. As an example of emerging transnational private governance, IGNs utilize the power of the financial sector to shape the discourse on climate change within the business community and to link the long-term viability of environmental sustainability to the core strategic interests of corporations and investors.
Counting the Environment: The Environmental Implications of International Accounting Standards
Authors: Thistlethwaite Jason
Published: April 2011

Although rarely studied, international accounting standards shape what information regarding a firm's environmental performance is communicated to international financial markets. This article builds on scholarship describing the influence of international accounting standards on private financial markets to show that nominally technical choices regarding how to recognize and measure firms' environmental impacts hold the potential to reduce these impacts. Obscure accounting debates within the International Accounting Standards Board (IASB) mask important political choices about what a firm must disclose to investors about its environmental liabilities and risks. IASB decisions about how these appear on corporate balance sheets change the link between a firm's environmental performance and its economic value and, thereby, contribute to steering private financial markets toward rewarding sustainable behavior within the global economy. This analysis demonstrates the authority of the IASB as an overlooked source of global environmental governance.
The Limits of Carbon Disclosure: Theorizing the Business Case for Investor Environmentalism
Authors: Harmes Adam
Published: April 2011

This article examines the potential effectiveness of socially responsible investment (SRI) and investor environmentalism through carbon disclosure in terms of their key goal of creating real financial incentives, through share price performance, for firms to pursue climate change mitigation. It does so by theoretically assessing the two main assumptions which underpin investor environmentalism as promoted by SRI funds and NGOs such as the Carbon Disclosure Project: those concerning the power of institutional investors, and the “business case” for climate change mitigation. In doing so, it argues that the potential of using institutional investors to create real financial incentives for climate change mitigation, in the form of share price performance, has been considerably overestimated and that there is not even a strong theoretical case for why carbon disclosure should work in this regard. This is argued based on the structural constraints faced by most institutional investors, as well as the fundamentally incorrect assumption about climate change, that it is a form of market failure, which theoretically underpins these initiatives.
Catholic Theology
Authors: Kerr Fergus
Published: April 2011

In consideration of Catholic theology, and leaving aside much else that might be mentioned, we focus on ‘the Bible in its traditions’; John Paul II’s ‘theology of the body’ or ‘nuptial theology’; and the renewed debate about the relation between grace and the natural order, including the significance of Henri de Lubac and the continuing place of Thomas Aquinas.
Global Oral Health Inequalities
Authors: Jin L.J. , Armitage G.C. , Klinge B. , Lang N.P. , Tonetti M. , Williams R.C.
Published: April 2011

Periodontal diseases constitute one of the major global oral health burdens, and periodontitis remains a major cause of tooth loss in adults worldwide. The World Health Organization recently reported that severe periodontitis exists in 5-20% of adult populations, and most children and adolescents exhibit signs of gingivitis. Likely reasons to account for these prevalent diseases include genetic, epigenetic, and environmental risk factors, as well as individual and socio-economic determinants. Currently, there are fundamental gaps in knowledge of such fundamental issues as the mechanisms of initiation and progression of periodontal diseases, which are undefined; inability to identify high-risk forms of gingivitis that progress to periodontitis; lack of evidence on how to prevent the diseases effectively; inability to detect disease activity and predict treatment efficacy; and limited information on the effects of integration of periodontal health as a part of the health care program designed to promote general health and prevent chronic diseases. In the present report, 12 basic, translational, and applied research areas have been proposed to address the issue of global periodontal health inequality. We believe that the oral health burden caused by periodontal diseases could be relieved significantly in the near future through an effective global collaboration.
Global Oral Health Inequalities
Authors: Challacombe S. , Chidzonga M. , Glick M. , Hodgson T. , Magalhães M. , Shiboski C. , Owotade F. , Ranganathan R. , Naidoo S.
Published: April 2011

Four oral mucosal infections were identified as Global Oral Health Priorities: (a) HIV and associated viral, bacterial, and fungal infections; (b) tuberculosis; (c) NOMA; and (d) sexually transmitted diseases. Huge global inequalities exist in all four. HIV-associated infections constitute the major challenge. Oral manifestations of AIDS can be specifically diagnostic, indicating a significant role for dentists within health teams. The World Workshops in Oral Health & Disease in AIDS have identified a research program, elements of which are being implemented. Data on oral mucosal involvement in tuberculosis, syphilis, and gonorrhea are incomplete in developed countries and virtually non-existent in low- and middle-income countries, indicating the need for further epidemiological studies. Oral manifestations of tuberculosis and sexually transmitted diseases are largely associated with general health, so action programs should be integrated with agencies treating the systemic diseases. NOMA is very much in the oral health domain. It is a preventable disease associated with malnutrition and unidentified bacterial factors. Prevalence is probably grossly overestimated at present; but nevertheless it constitutes a challenge to the profession, especially in the NOMA belt. Current treatment is surgical, but plans for its eradication should be achievable. The global oral health community, especially the IADR, has a major role to play.
Global Oral Health Inequalities
Authors: Sheiham A. , Alexander D. , Cohen L. , Marinho V. , Moysés S. , Petersen P.E. , Spencer J. , Watt R.G. , Weyant R.
Published: April 2011

This paper reviews the shortcomings of present approaches to reduce oral diseases and inequalities, details the importance of social determinants, and links that to research needs and policies on implementation of strategies to reduce oral health inequalities. Inequalities in health are not narrowing. Attention is therefore being directed at determinants of major health conditions and the extent to which those common determinants vary within, between, and among groups, because if inequalities in health vary across groups, then so must underlying causes. Tackling inequalities in health requires strategies tailored to determinants and needs of each group along the social gradient. Approaches focusing mainly on downstream lifestyle and behavioral factors have limited success in reducing health inequalities. They fail to address social determinants, for changing people’s behaviors requires changing their environment. There is a dearth of oral health research on social determinants that cause health-compromising behaviors and on risk factors common to some chronic diseases. The gap between what is known and implemented by other health disciplines and the dental fraternity needs addressing. To re-orient oral health research, practice, and policy toward a ‘social determinants’ model, a closer collaboration between and integration of dental and general health research is needed. Here, we suggest a research agenda that should lead to reductions in global inequalities in oral health.
Dynamics of Salivary Gland Morphogenesis
Authors: Harunaga J. , Hsu J.C. , Yamada K.M.
Published: April 2011

Salivary glands form during embryonic development by a complex process that creates compact, highly organized secretory organs with functions essential for oral health. The architecture of these glands is generated by branching morphogenesis, revealed by recent research to involve unexpectedly dynamic cell motility and novel regulatory pathways. Numerous growth factors, extracellular matrix molecules, gene regulatory pathways, and mechanical forces contribute to salivary gland morphogenesis, but local gene regulation and morphological changes appear to play particularly notable roles. Here we review these recent advances and their potential application to salivary gland tissue engineering.