bluuebunny/crossref_metadata_2025 huggingface dataset:
Nursing diagnoses, interventions and outcomes – application and impact on nursing practice: systematic review
Authors: Müller‐Staub Maria , Lavin Mary Ann , Needham Ian , Van Achterberg Theo
Published: October 2006

Aim.  This paper reports a systematic review on the outcomes of nursing diagnostics. Specifically, it examines effects on documentation of assessment quality; frequency, accuracy and completeness of nursing diagnoses; and on coherence between nursing diagnoses, interventions and outcomes.

Background.  Escalating healthcare costs demand the measurement of nursing's contribution to care. Use of standardized terminologies facilitates this measurement. Although several studies have evaluated nursing diagnosis documentation and their relationship with interventions and outcomes, a systematic review has not been carried out.

Method.  A Medline, CINAHL, and Cochrane Database search (1982–2004) was conducted and enhanced by the addition of primary source and conference proceeding articles. Inclusion criteria were established and applied. Thirty‐six articles were selected and subjected to thematic content analysis; each study was then assessed, and a level of evidence and grades of recommendations assigned.

Findings.  Nursing diagnosis use improved the quality of documented patient assessments (n = 14 studies), identification of commonly occurring diagnoses within similar settings (n = 10), and coherence among nursing diagnoses, interventions, and outcomes (n = 8). Four studies employed a continuing education intervention and found statistically significant improvements in the documentation of diagnoses, interventions and outcomes. However, limitations in diagnostic accuracy, reporting of signs/symptoms, and aetiology were also reported (14 studies). One meta‐analysis of eight trials including 1497 patients showed no evidence that standardized electronic documentation of nursing diagnosis and related interventions led to better nursing outcomes.

Conclusion.  Despite variable results, the trend indicated that nursing diagnostics improved assessment documentation, the quality of interventions reported, and outcomes attained. The study reveals deficits in reporting of signs/symptoms and aetiology. Consequently, staff educational measures to enhance diagnostic accuracy are recommended. The relationships among diagnoses, interventions and outcomes require further evaluation. Studies are needed to determine the relationship between the quality of documentation and practice.
Low‐perceived work ability, ageing and intention to leave nursing: a comparison among 10 European countries
Authors: Camerino Donatella , Conway Paul Maurice , Van der Heijden Beatrice Isabella Johanna Maria , Estryn‐Behar Madeleine , Consonni Dario , Gould Dinah , Hasselhorn Hans‐Martin ,   the NEXT‐Study Group
Published: October 2006

Aim.  This paper reports a study exploring nurses’ perceived work ability and its associations with age and intention to leave nursing in a representative sample of Registered Nurses in 10 European countries.

Background.  Throughout Europe, there is now a substantial shortage of Registered Nurses and unless steps are taken to reverse this trend, numbers are likely to decline further. A study exploring nurses’ perceived work ability will provide baseline evidence, which may lead to improved working conditions and increased nursing retention.

Methods.  A cross‐sectional study design was employed. Questionnaire data were collected from 25,976 nurses in 10 member states of the European Union between October 2002 and June 2003. The response rate was 52·9% for the total investigation and varied between countries from 32·4% to 76·9%. Perceived work ability was assessed using the Work Ability Index. Intention to leave was measured by asking nurses how often they thought about leaving nursing. Data were examined using analysis of covariance and adjusted logistic regression.

Results.  In all 10 European countries, scores on the Work Ability Index were significantly lower (P < 0·01) among older nurses (≥45 years). Work ability varied among countries and differences between younger and older nurses were more pronounced in some countries. In all countries, there was a significant association between low Work Ability Index and intention to leave nursing (odds ratios between 1·98 and 21·46), especially among younger nurses. The association between work ability and intention to leave was most marked for those items on the Work Ability Index which explored subjective rather than objective aspects of work ability.

Conclusion.  Attempts to redress nursing shortages could include institutional policies to sustain work ability through better working conditions, improving quality of the working environment and finding suitable alternative nursing work for those no longer able to cope in their current post. These approaches should include nurses in all age categories.
The motivation of health professionals to explore research evidence in their practice: an intervention study
Authors: Henderson Amanda , Winch Sarah , Holzhauser Kerri , De Vries Sue
Published: October 2006

Aim.  To assess the impact of multifaceted clinically focused educational strategies that concentrated on introducing dementia care research evidence on health professionals’ awareness and inclination to use research findings in their future practice.

Background.  The promise of evidence‐based practice is slow to materialize with the limitations of adopting research findings in practice readily identifiable.

Method.  A pre‐ and post‐test quasi experimental design. The study involved the administration of: a pretest (baseline), an intervention phase, and a post‐test survey, the same research utilization survey.

Tool.  The Edmonton Research Orientation Survey (EROS), a self‐report tool that asks participants about their attitudes toward research and about their potential to use research findings, was used to determine health professionals' orientation to research.

Intervention.  The introduction of dementia care research evidence through multifaceted clinically focused educational strategies to improve practice. This was achieved through a resource team comprising a Clinical Nurse Consultant, as a leader and resource of localized evidence‐based knowledge in aged care; an experienced Registered Nurse to support the introduction of strategies and a further experienced educator and clinician to reinforce the importance of evidence in change.

Results.  Across all the four subscales that are measured in the Edmonton Research Orientation Survey, statistical analysis by independent samples t‐test identified that there was no significant change between the before and after measurements.

Relevance to clinical practice.  Successful integration of changes based on evidence does not necessarily mean that staff become more aware or are more inclined to use research findings in future to address problems.
Cardiovascular Actions of Orexin‐A in the Rat Subfornical Organ
Authors: Smith P. M. , Samson W. K. , Ferguson A. V.
Published: October 2006

Orexin‐A is a neuropeptide, primarily produced in the lateral hypothalamic/perifornical hypothalamus. Orexin receptors and immunoreactive neuronal fibres are widely distributed throughout the brain, suggesting integrative neurotransmitter roles in a variety of physiological systems. Intracerebroventricular injections of orexin‐A increase blood pressure and stimulate drinking, and the subfornical organ (SFO), a circumventricular structure implicated in autonomic control, is a potential site at which orexin may act to exert these effects. We have therefore used microinjection techniques to examine the effects of orexin‐A administered directly into the SFO on blood pressure and heart rate in urethane anaesthetised male Sprague‐Dawley rats. Orexin‐A microinjection (50 fmol) into the SFO caused site‐specific decreases in blood pressure (SFO: mean area under curve (AUC) = −681.7 ± 46.8 mmHg*s, n = 22 versus non‐SFO: 63.68 ± 54.69 mmHg*s, n = 15, P < 0.001), and heart rate (SFO: mean AUC = −26.7 ± 2.8 beats, n = 22, versus non‐SFO: mean AUC = 1.62 ± 2.1 beats, n = 15, P < 0.001). Vagotomy did not alter the hypotensive or bradycardic responses elicited by orexin‐A microinjection. Prior α‐adrenoceptor blockade with phenoxybenzamine (1 mg/kg, i.v.) masked the orexin‐A induced blood pressure (mean AUC = −122.6 ± 17.6 mmHg*s, n = 4, P < 0.01 paired t‐test) and heart rate (mean AUC = −6.7 ± 1.7 beats, n = 4, P < 0.05, paired test) response. The orexin‐A induced heart rate response was attenuated when β‐adrenoceptors were blocked with propranolol (1 mg/kg, i.v.; mean AUC = 0.6 ± 2.8 beats, n = 5, P < 0.01 paired t‐test). These studies demonstrate that microinjection of orexin‐A into the SFO causes site specific decreases in blood pressure and heart rate which is mediated by a reduction in sympathetic tone.
phyA dominates in transduction of red‐light signals to rapidly responding genes at the initiation of Arabidopsis seedling de‐etiolation
Authors: Tepperman James M. , Hwang Yong‐Sic , Quail Peter H.
Published: October 2006

Contrary to expectations based on the visible phenotypic behavior of seedlings undergoing de‐etiolation in response to continuous red light (Rc), previous gene expression profiling showed that one or more of the five‐membered phytochrome (phy) family of Arabidopsis, other than phyB, is predominantly responsible for transducing the Rc signals to light‐responsive genes. To begin to identify which phys are involved, and to define potential primary targets of phy signaling, we have examined the genome‐wide expression profiles of genes responding to Rc within 1 h (early response genes) of initial exposure of dark‐grown wild‐type,phyA,phyBandphyAphyBdouble mutant seedlings to the light signal. The data show that phyA has a quantitatively dominant role in Rc‐induced expression of these early response genes, that phyB has minimal detectable regulatory activity in the presence of phyA, but assumes a quantitatively larger role in its absence, and that phyA and phyB combined are responsible for the full extent of Rc responsiveness of 96% of these genes. No evidence was obtained of a significant role for the remaining family members, phyC, phyD or phyE, in this process. In striking contrast, Rc‐imposed repression of early response gene expression remains quantitatively strong in thephyAphyBdouble mutant, as well as the monogenic mutants, suggesting a significant role for one or more of the other three phys in this response. Examination of the established or predicted functional roles of the early response genes indicates that genes encoding transcription factors represent the largest single category, at a frequency three times their prevalence genome‐wide. This dominance is particularly striking among those genes responding most robustly to the Rc signal, where >50% are classified as involved in transcriptional regulation, suggesting that these may have potentially primary regulatory roles at the interface between phy signaling and the light‐responsive transcriptional network. Integration of the present data with those of a previous genome‐scale transcriptional analysis of apif3mutant, suggests a complex network involving perception and transduction of inductive Rc signals by both phyA and phyB through both PIF3 and other undefined signaling partners to early response genes.
Concomitant psoriasis and bullous pemphigoid: coincidence or pathogenic relationship?
Authors: Wilczek Agnes , Sticherling Michael
Published: October 2006

Psoriasis vulgaris and bullous pemphigoid represent two clinically well‐characterized, chronic, inflammatory skin diseases. The concomitant occurrence of these two entities in a patient is rare, and the pathogenic implications of this phenomenon are unknown. We describe a 55‐year‐old woman with a 25‐year history of plaque‐type psoriasis who presented with disseminated tense bullae. Skin biopsies showed the typical histologic and immunohistochemical traits of bullous pemphigoid, and she had circulating immunoglobulin G (IgG) antibodies against the basement membrane zone, specifically the BP180 antigen. The bullous eruption was successfully treated with oral methylprednisolone and dapsone.

Bullous pemphigoid is the autoimmune blistering disease that has most often been associated with psoriasis. Forty cases have been described in the literature. Classical psoriasis and psoriasis associated with bullous pemphigoid are identical. The pathogenic relationship between psoriasis and bullous pemphigoid is unclear. It has been postulated that the autoimmune process responsible for bullous pemphigoid lesions may be induced by ultraviolet light therapy, topical corticosteroids, and/or the inflammatory processes that occur in psoriasis. Immunomodulatory therapy may positively influence shared as well as distinct inflammatory mechanisms in patients who have psoriasis and bullous pemphigoid.
Pressure‐controlled ventilation is superior to volume‐controlled ventilation with a laryngeal mask airway in children
Authors: Bordes M. , Semjen F. , Degryse C. , Bourgain J. L. , Cros A. M.
Published: October 2006

Background:  This prospective, randomized, crossover study had two purposes: first, to determine whether pressure‐controlled ventilation (PCV) is safer than volume‐controlled ventilation (VCV) by preventing gastric insufflation in children ventilated through an laryngeal mask airway (LMA); second, to assess whether the measurement of LMA leak pressure (Pleak) is useful for preventing leakage during positive pressure ventilation (PPV).

Methods:  Forty‐one, 2 to 15‐year‐old children underwent general anesthesia with an LMA. The expiratory valve was set at 30 cmH2O and Pleak was measured using constant gas flow. Children were randomly ventilated using PCV or VCV for 5 min in order to reach a PETCO2 not exceeding 45 mm Hg, and then they were ventilated with the alternative mode. If the target PETCO2 could not be obtained in one mode, we switched to the other. If both modes failed, children were intubated. Tidal volumes, PETCO2 and airway pressures were noted and compared between modes. Gastric insufflation was checked by epigastric auscultation.

Results:  PCV provided more efficient ventilation than VCV, as targeted PETCO2 was obtained without gastric insufflation using PCV in all cases except one, whereas VCV failed in three cases. No gastric insufflation occurred when ventilating below peak.

Conclusions:  These findings suggest that in the age group studied, PCV is more efficient than VCV for controlled ventilation with a laryngeal mask. Gastric insufflation did not occur with this mode.
Levosimendan cardioprotection reduces the metabolic response during temporary regional coronary occlusion in an open chest pig model
Authors: Metzsch C. , Liao Q. , Steen S. , Algotsson L.
Published: October 2006

Background:  Inotropic and myocardial anti‐ischemic effects have been demonstrated with levosimendan. The comparison of levosimendan started before an ischemia‐reperfusion event as compared with levosimendan started during ischemia has not been studied.

Methods:  In anesthetized pigs, a major branch of the circumflex artery was completely occluded for 30 min and then reperfused. The metabolism in the ischemic myocardium and in non‐ischemic control myocardium was studied with microdialysis concomitantly with monitoring of global hemodynamics and coronary artery flow in the chosen artery. In the protection group (PRO, n= 6), a levosimendan infusion was started 30 min before coronary artery occlusion, and in the treatment group (TRE, n= 6), a levosimendan infusion was started 10 min after the coronary artery occlusion with a loading dose of 13.3 μg/kg followed by an infusion of 0.67 μg/kg/min. A two‐way repeated measures ANOVA completed with Bonferroni’s multiple comparison procedure was applied to the data. A P < 0.05 was considered significant.

Results:  During the ischemic period, the cardiac output and contractility (dp/dtmax) were higher in the PRO as compared with the TRE and the systemic vascular resistance was lower. The myocardial microdialysate glucose concentration in the ischemic area during ischemia was higher in the PRO as compared with the TRE, and the lactate/pyruvate ratio and the lactate concentration were lower. The differences in the metabolites persisted into the first 10 min of reperfusion. No differences were found for the non‐ischemic areas.

Conclusion:  Levosimendan used throughout myocardial ischemia‐reperfusion might have a cardioprotective affect on the response to myocardial ischemia as compared with levosimendan started during the ischemia.
A woman who required long‐term mechanical ventilation to treat limbic encephalitis during pregnancy
Authors: Nishiyama K. , Komori M. , Narushima M. , Yoshizawa H. , Kawamata M. , Ozaki M.
Published: October 2006

We describe our experience with a woman who had severe non‐herpetic acute limbic encephalitis at 20 weeks’ gestation. Despite receiving mechanical ventilation for about 3 months because of impaired consciousness and frequent convulsions, she had a normal delivery and an uneventful recovery with no sequelae. The patient did not respond to treatment with antiviral agents. Anticonvulsant agents were given while monitoring plasma drug concentrations. Early treatment and the prevention of complications apparently contributed to good outcomes in the mother and child.
Outcome from intensive care after cardiac arrest: comparison between two patient samples treated in 1986–87 and 1999–2001 in Finnish ICUs
Authors: Niskanen M. , Reinikainen M. , Kurola J.
Published: October 2006

Background:  The aim of the study was to find out whether the characteristics of patients and the outcome from intensive care after cardiac arrest have changed over time.

Methods:  Two nationwide databases were compared: (i) The Finnish National Intensive Care Study data in 1986–87 and (ii) data on 28,640 admissions to Finnish ICUs in 1999–2001. Patients whose reason for ICU admission was cardiac arrest were included. The former study included 604 patients treated in 18 medical and surgical ICUs in and the latter 1036 patients in 25 medical and surgical ICUs. Data on the components of Acute Physiology and Chronic Health Evaluation (APACHE II) were prospectively collected in both study periods. Logistic regression analysis was used to test the independent contribution of the study period on hospital mortality.

Results:  In 1986–87, patients were younger and the proportion of males was lower than in 1999–2001. The hospital mortality in 1986–87 was 61.3% and in 1999–2001 59.1% (P= 0.396). Among patients aged < 57 years, the hospital mortality in 1986–87 was 62.1% and in 1999–2001 48.8% (P < 0.01). In multivariate analysis, controlling for age, gender, Glasgow coma score (GCS), chronic health evaluation points and source of admission, treatment during 1986–87 was an independent predictor for hospital death among all patients (OR 1.273; 95% CI 1.015–1.594), those aged < 57 years (OR 1.959; 95% CI 1.270–3.021) and among males (OR 1.384; 95% CI 1.050–1.825).

Conclusion:  Since the late 1980s, the outcome from intensive care after cardiac arrest may have improved especially among younger patients and males.
Comparison of a propofol target‐controlled infusion and inhalational sevoflurane for fibreoptic intubation under spontaneous ventilation
Authors: Bonnin M. , Therre P. , Albuisson E. , Beaujard H. , Barthelemy I. , Mondie J.‐M. , Bazin J.‐E.
Published: October 2006

Background:  A propofol target‐controlled infusion (TCI) is often proposed for the management of difficult airway intubation and fibreoptic intubation under anaesthesia and spontaneous ventilation. No data are available about sevoflurane. The aim of the present study was to compare propofol and sevoflurane as hypnotics during fibreoptic intubation under spontaneous ventilation.

Methods:  After regional ethical committee approval, 52 ASA I–II patients without any predictors for difficult intubation gave their informed consent. They were randomly assigned to one of two groups. After 3 min of pre‐oxygenation, patients received either propofol with a plasmatic target concentration of 4 mg/l (group P; n= 26) or sevoflurane 4% with tidal volume ventilation (group S; n= 26). After 2 min, propofol was increased by 1 mg/l and sevoflurane was increased by 1% every 2 min until there was no reaction during mandible translation. This concentration was maintained for 4 min before starting nasotracheal fibrescopy for intubation. During both induction and fibrescopy, pulse oximetry, bispectral index (BIS), heart rate, and arterial blood pressure were monitored. Quality of intubation and operator satisfaction were evaluated. Data were compared using Student’s t‐test, Mann‐Withney U‐test or chi‐square test. A P‐value < 0.05% was considered to be significant.

Results:  During induction, no difference in pulse oximetry, BIS values at the end of induction, or duration of induction were noticed. Five episodes of desaturation under 90% occurred during fibreoptic intubation in group P compared with none in group S.

Conclusion:  Sevoflurane provides good fibreoptic intubation conditions to spontaneously breathing patients without any hypoxemic episodes such as those observed with propofol.
Analytical and clinical sensitivity of the Procleix Ultrio HIV‐1/HCV/HBV assay in samples with a low viral load
Authors: Katsoulidou A. , Moschidis Z. , Sypsa V. , Chini M. , Papatheodoridis G. V. , Tassopoulos N. C , Mimidis K. , Karafoulidou A. , Hatzakis A.
Published: October 2006

Background and Objectives  The Procleix Ultrio human immunodeficiency virus type 1 (HIV‐1)/hepatitis C virus (HCV)/hepatitis B virus (HBV) (Ultrio) assay simultaneously detects HIV‐1 RNA, HCV RNA and HBV DNA in individual blood donations. The main objective of the study was to assess the analytical and clinical sensitivity of the multiplex and discriminatory probe assays in samples with a low viral load.

Material and Methods  The VQC HIV RNA genotype B, HCV RNA genotype 1 and HBV DNA genotype A standard dilutions were tested in 26 repeats. The probability of detection by Ultrio was compared with previously obtained data of the Procleix Duplex HIV‐1/HCV assay on the same reference panels. A selection of 121 anti‐HIV‐1, 138 anti‐HCV and 190 HBsAg positive samples from patients receiving antiviral therapy were tested. The majority of patient samples had a viral load below the detection limit of the diagnostic nucleic acid test assays, which made them suitable to evaluate the performance of the multiplex and discriminatory assays on yield cases with a similar low viral load.

Results  The 95% and 50% detection end‐points of the Ultrio assay along with the corresponding 95% confidence intervals are 53·7 (32·9–117·2) and 8·6 (6·2–12·1) geq/ml for HIV‐1 RNA, 30·3 (19·0–62·4) and 5·2 (3·7–7·2) geq/ml for HCV RNA and 393·7 (147·9–6978) and 54·5 (22·4–143·8) geq/ml for HBV DNA. The analytical sensitivity of Ultrio expressed as a potency factor relative to previously obtained Duplex results on the same HIV‐1 RNA and HCV‐RNA standard dilutions was 1·09 (0·20–6·10) and 1·11 (0·21–5·89), respectively. The assay detected all 22 HIV‐1 infected patients with viral load > 50 copies/ml, and 41 of 99 patients (41%) with viral load < 50 copies/ml, of which 23 (56%) were detected by the discriminatory assay. All 47 patients with HCV RNA load > 521 IU/ml and 10/91 polymerase chain reaction‐negative patients with viral load < 50 IU/ml tested positive in Ultrio assay of which five were missed in the discriminatory test. The assay detected 53/55 HBV infected patients (96%) with viral load > 250 copies/ml and 108/135 patients (80%) with viral load < 250 copies/ml of which 17 (16%) were missed by the discriminatory test.

Conclusions  The new Procleix Ultrio assay is as sensitive as the Procleix Duplex assay for HIV‐1 and HCV detection meeting the requirements of universal guidelines. The ability of the assay to detect HBV DNA in low viral load samples could be useful for screening blood. Inevitable negative results of discriminatory probe assays caused by stochastic sample variation will reduce the chance of recognizing low viraemic blood donors detected by individual donation nucleic acid test.
Rapid resolution of severe disc new vessels in proliferative diabetic retinopathy following a single intravitreal injection of bevacizumab (Avastin)
Authors: Isaacs Timothy W , Barry Chris
Published: October 2006

Abstract

A 70‐year‐old man with asymptomatic proliferative diabetic retinopathy received a single intravitreal injection of bevacizumab (Avastin). One month following treatment there was complete resolution of new vessels.
The relationship between bispectral index and endtidal concentration of sevoflurane during anesthesia and recovery in spontaneously ventilating children
Authors: KERN DELPHINE , FOURCADE OLIVIER , MAZOIT JEAN‐XAVIER , MINVILLE VINCENT , CHASSERY CLEMENT , CHAUSSERAY GERALD , GALINIER P , SAMII KAMRAN
Published: October 2006

Background:  Global inverse correlation between BIS (bispectral index) and depth of anesthesia using sevoflurane has been documented in children in several studies under experimental conditions and in steady‐state conditions during mechanically controlled ventilation. Because sevoflurane mask anesthesia combined with a peripheral nerve block is widely used in children, we studied the relationship between BIS and endtidal concentration of sevoflurane (PEsevo) under these conditions during surgery and emergence.

Methods:  In this prospective blinded study of 32 children, the relationship between BIS and PEsevo was studied during sevoflurane anesthesia via facemask combined with peripheral nerve block. The intraoperative phase was studied during steady‐state conditions (fixed PEsevo) and the emergence phase was studied during fast alveolar washout (FAW). BIS and PEsevo data fitted using the Emax model. Coefficients of variation of BIS and PEsevo during the two periods were compared.

Results:  Fit was adequate with the simple Emax model. Intraoperative variation in BIS was large (28.4%), and larger than at awakening (28.4% vs 8%). At awakening, BIS varied less than PEsevo (8% vs 28.5%). No difference was found between children younger and those older than 5 years.

Conclusions:  Caution is required for intraoperative titration based on BIS when spontaneous ventilation is maintained because of the wide variability compared with PEsevo. During emergence using FAW, BIS varied significantly less than PEsevo, but the clinical relevance of this point could be discussed during anesthesia without tracheal intubation.
Non‐invasive techniques for investigating and modelling root‐feeding insects in managed and natural systems
Authors: Johnson Scott N. , Crawford John W. , Gregory Peter J. , Grinev Dmitry V. , Mankin Richard W. , Masters Gregory J. , Murray Philip J. , Wall Diana H. , Zhang Xiaoxian
Published: October 2006

1 Root‐feeding insects are now considered to play a greater role in ecosystem processes than previously thought, yet little is known about their specific interactions with host plants compared with above‐ground insect herbivores. Methodological difficulties associated with studying these insects in the soil, together with the lack of empirical and theoretical frameworks, have conventionally hindered progress in this area.

2 This paper reviews recent empirical and theoretical developments that have been adopted for studying root‐feeding insects, focusing on the non‐invasive techniques of X‐ray tomography and acoustic field detection and how these can be integrated with new mathematical modelling approaches.

3 X‐ray tomography has been used for studying the movements of several insects within the soil and has helped to characterize the host plant location behaviour of the clover root weevil, Sitona lepidus. Acoustic detection of soil insects has been used in various managed systems, ranging from nursery containers to citrus groves.

4 Mathematical modelling plays a complementary role for investigating root‐feeding insects, illustrated by a number of published models. A model is presented for the movement of S. lepidus in the soil, which suggests that these insects undergo Lévy movements, similar to those recently demonstrated for above‐ground organisms.

5 The future directions and challenges for investigating root‐feeding insects are discussed in the context of the wider ecosystem, incorporating both above and below‐ground organisms.
Algerian graveyard stories
Authors: Scheele Judith
Published: October 2006

Issues surrounding the ways in which people deal with severe political disruption and violence are sometimes obscure, as it is in the nature of both to defy verbal expression and collective attempts to produce sense. Ethnography of Algeria suggests that to look at local graveyards, their layout, and the practices and conflicts associated with them is a way of understanding not only how people deal with death and violence, but also how they construe social order, political legitimacy, and historical continuity, in an environment where all of these have been severely disrupted. Through the social and spatial practices associated with local graveyards, images of upheaval and martyrdom are thus made part of an ongoing process of renegotiation of social hierarchies; these processes, however, can also be seen to break down at times of overwhelming distress.
Blowing in the wind? Identity, materiality, and the destinations of human ashes
Authors: Prendergast David , Hockey Jenny , Kellaher Leonie
Published: October 2006

This article asks whether the recent UK‐based practice of removing ashes from crematoria has led to entirely new, innovative rituals of disposal, or whether contemporary practice is an appropriation of late nineteenth‐century Romantic values and beliefs. Drawing on findings from a major empirical study among both professionals and lay people involved in the removal of ashes, it explores the potentiality of ash remains as a mobile material residue of the corpse, and considers whether they enable disposal strategies which no longer reflect concerns with space and place – particularly those associated with traditional burial grounds.
‘In the past we were a bit “Chamar”’: education as a self‐ and community engineering process in northern India
Authors: Ciotti Manuela
Published: October 2006

This article analyses the ideological uses of formal education in a community of Chamars (former ‘Untouchables’ or Dalits) in northern India. In particular, it focuses on the ways it is deployed for self‐ and community improvement. Education is especially needed to forge an alternative to the inherited, essentialized, and derogatory Chamar identity. Furthermore, recent anti‐establishment political mobilization amongst the low castes in northern India has provided new impetus for accelerating identity change. In order to grasp the nature and extent of Chamar social transformation, I explore notions of the past, aspects of ritual, and folk theories of socialization. Drawing from these, an underlying protean self and community substance emerges in which the remaking of the present is tied to the remaking of the past. Against this backdrop, I show the contradictory nature of the effects of education. On the one hand, there is the constructed and shared ‘educated’ substance which acts as a unifying force amongst the Chamarsvis‐à‐visoutsiders. On the other, education as an individualizing experience and related processes of upward mobility fragment the community body politic, leaving the ‘liberating’ effect of education embedded in the production of new inequalities.
Immunohistochemical localization and biological activity of the steroidogenic enzyme cytochrome P450 17α‐hydroxylase/C17, 20‐lyase (P450C17) in the frog brain and pituitary
Authors: Do Rego Jean Luc , Tremblay Yves , Luu‐The Van , Repetto Emanuela , Castel Hélène , Vallarino Mauro , Bélanger Alain , Pelletier Georges , Vaudry Hubert
Published: October 2006

It is now clearly established that the brain has the capability of synthesizing various biologically active steroids including 17‐hydroxypregnenolone (17OH‐Δ5P), 17‐hydroxyprogesterone (17OH‐P), dehydroepiandrosterone (DHEA) and androstenedione (Δ4). However, the presence, distribution and activity of cytochrome P450 17α‐hydroxylase/C17, 20‐lyase (P450C17), a key enzyme required for the conversion of pregnenolone (Δ5P) and progesterone (P) into these steroids, are poorly documented. Here, we show that P450C17‐like immunoreactivity is widely distributed in the frog brain and pituitary. Prominent populations of P450C17‐containing cells were observed in a number nuclei of the telencephalon, diencephalon, mesencephalon and metencephalon, as well as in the pars distalis and pars intermedia of the pituitary. In the brain, P450C17‐like immunoreactivity was almost exclusively located in neurons. In several hypothalamic nuclei, P450C17‐positive cell bodies also contained 3β‐hydroxysteroid dehydrogenase‐like immunoreactivity. Incubation of telencephalon, diencephalon, mesencephalon, metencephalon or pituitary explants with [3H]Δ5P resulted in the formation of several tritiated steroids including 17OH‐Δ5P, 17OH‐P, DHEA and Δ4. De novo synthesis of C2117‐hydroxysteroids and C19ketosteroids was reduced in a concentration‐dependent manner by ketoconazole, a P450C17inhibitor. This is the first detailed immunohistochemical mapping of P450C17in the brain and pituitary of any vertebrate. Altogether, the present data provide evidence that CNS neurons and pituitary cells can synthesize androgens.
Hypothalamic Hamartoma and Infantile Spasms
Authors: Kerrigan John F. , Ng Yu‐tze , Prenger Erin , Krishnamoorthy Kalpathy S. , Wang Norman C. , Rekate Harold L.
Published: October 2006

Summary: Purpose:A small number of patients with hypothalamic hamartoma (HH) present with infantile spasms (IS) as an initial or early seizure type. We describe the clinical features of IS associated with HH.

Methods:Our series of patients with HH and epilepsy was reviewed to identify cases with a history of IS. The clinical features and neuroradiological findings in this study group were compared to a control group of patients with HH and refractory epilepsy, but without a history of IS.

Results:We identified six patients with HH and a history of IS in this series (n = 122, 4.9%). Five of the six are male. Four of the six patients (67%) developed IS as their first seizure type. The mean age for onset of IS was 6.2 months (range 4–9 months). Results of electroencephalographic (EEG) study at the time of IS diagnosis showed hypsarrhythmia in two (33%). Five patients were treated with adrenocorticotropic hormone (ACTH), and four of the five (80%) responded with control of IS. However, these patients developed other seizure types, and were ultimately refractory to medical management. Aside from the IS, no significant differences in clinical and imaging features were determined between the study group and the control group.

Conclusions:HH should be included in the differential diagnosis for infants presenting with IS. These patients may have hypsarrhythmia on initial EEG, and may respond to ACTH treatment with improvement of IS. However, all became refractory with other seizure types, more commonly seen in HH patients. Focal pathologies associated with IS may be subcortical, as well as cortical, in nature. We have not identified any predictive features for the occurrence of IS in the HH population.
Patterns of Regional Brain Activity in Alcohol‐Dependent Subjects
Authors: Hayden Elizabeth P. , Wiegand Ryan E. , Meyer Eric T. , Bauer Lance O. , O'Connor Sean J. , Nurnberger John I. , Chorlian David B. , Porjesz Bernice , Begleiter Henri
Published: October 2006

Background: Electroencephalographic (EEG) measures of hemispheric asymmetry in anterior brain activity have been related to a variety of indices of psychopathology and emotionality. However, little is known about patterns of frontal asymmetry in alcohol‐dependent (AD) samples. It is also unclear whether psychiatric comorbidity in AD subjects accounts for additional variance in frontal asymmetry, beyond a diagnosis of AD alone.

Methods: We compared 193 AD subjects with 108 control subjects on resting brain activity in anterior and posterior regions, as indexed by asymmetries in α band power in the left and right hemispheres. Within the AD group alone, we examined whether comorbid major depressive disorder (MDD) or antisocial personality disorder (ASPD) had effects on regional asymmetry.

Results: Compared with control subjects, AD subjects exhibited lower left, relative to right, cortical activation in anterior regions. Evidence that comorbidity in AD subjects accounted for further variance in EEG asymmetry was mixed; AD subjects with comorbid ASPD were not significantly different from those without ASPD, while AD subjects with a lifetime history of MDD showed less asymmetry in anterior regions than those without MDD.

Conclusions: Our findings indicate that AD subjects exhibit a pattern of frontal asymmetry similar to that found in other psychiatric groups. Results examining the effects of comorbidity in AD on EEG asymmetry were inconclusive. The implications of our findings for future work are described.
Glucose intolerance in a xenotransplantation model: studies in alpha‐gal knockout mice
Authors: DAHL KIRSTEN , BUSCHARD KARSTEN , GRAM DORTE X. , D'APICE ANTHONY J. F. , HANSEN AXEL K.
Published: October 2006

Xenotransplantation holds the promise of replacing failing human organs with organs of animal origin. Transplantation of pancreatic islets from pigs to humans might restore glucose homeostasis and offer diabetic patients considerable improvement in their quality of life. The α‐gal epitope, present in all mammals except humans, apes and Old World monkeys, is a decisive obstruction to successful xenotransplantation of vascularized organs as the reaction of α‐gal‐bearing endothelia with natural α‐gal antibodies in the human blood mediates hyperacute rejection of the xenograft. Alpha‐galactosyl transferase knockout mice (α‐GT KO) develop cataract, but no other lesions have been established in these mice. Here we report for the first time that α‐GT KO mice have impaired glucose tolerance (p<0.001) and decreased insulin sensitivity (p<0.0001). Homeostasis model assessment shows impaired β‐cell function (p<0.05). Similar physiological changes have not been examined in the α‐galactosyl transferase pig. However, an association between α‐galactosyl transferase knockout and impaired β‐cell function could have critical importance for islet xenotransplantation.
Selective priming of peripheral blood eosinophils in patients with idiopathic hypereosinophilic syndrome
Authors: LAMPINEN MARIA , ÖBERG GUNNAR , VENGE PER , CARLSON MARIE
Published: October 2006

The idiopathic hypereosinophilic syndrome (HES) is characterised by blood eosinophilia associated with organ involvement. Elevated numbers of blood neutrophils have been observed during episodes of active HES. However, an increased responsiveness of eosinophils to chemotactic and chemokinetic stimuli may explain the selective eosinophil infiltration of the tissue. We have studied the migratory responses of blood eosinophils and neutrophils from 9 patients with HES and from 13 healthy control subjects. Chemokinetic and chemotactic responses to factors acting on both cell types were analysed by means of a modification of the Boyden chamber technique. We found increased migratory responses of the eosinophils, but not of the neutrophils, from the patients with HES. Increased blood neutrophil counts in three of the patients did not coincide with alterations of the neutrophil migratory responses. Our finding of increased migratory responses of eosinophils from patients with HES towards non‐specific chemoattractants suggests selective priming of eosinophils in this disease. Interleukin (IL)‐5 has previously been shown to prime eosinophils for migratory responses, and successful anti‐IL‐5 therapy of patients with HES indicates an important role for this cytokine in the development of hypereosinophilia.
Morphometric examination of native lungs in human lung allograft recipients
Authors: WIEBE B. M. , BURTON C. M. , MILMAN N. , IVERSEN M. , ANDERSEN C. B.
Published: October 2006

The aim of the study was to estimate the degree of lung damage in patients with α1‐antitrypsin (α1AT) deficiency, chronic obstructive pulmonary disease (COPD), and cystic fibrosis (CF) at the time of lung transplantation. Using unbiased stereological methods, lung‐, bronchial‐ and vessel‐volume, capillary length, and alveolar surface area and densities were estimated in recipient lungs from 21 consecutive patients with pre‐transplant diagnoses including COPD (n=7), α1AT deficiency (n=6) and CF (n=8). Six unused adult donor lungs served as controls. Information relating to patient demography and pre‐transplant lung function was obtained by retrospective chart review. Disease groups differed significantly with respect to demographics and pre‐transplant lung function. Total lung volume was similar in all groups. Bronchial volume was significantly larger in CF patients compared to the control group (p<0.0001) and to the other two diagnostic groups: α1AT deficiency (p=0.0001) and COPD (p<0.0001). Alveolar surface density and capillary length density were significantly lower in patients with α1AT deficiency and COPD compared to controls (p<0.0001, respectively) and to patients with CF (p<0.0002, respectively). There were no correlations between clinical lung function and morphometric measurements. We conclude that unbiased microscopic stereological morphometry is an evolving science with the potential to elucidate pulmonary disease pathogenesis.
Plaque form of warty dyskeratoma – acantholytic dyskeratotic acanthoma
Authors: Omulecki Anastazy , Lesiak Aleksandra , Narbutt Joanna , Woźniacka Anna , Piekarski Janusz , Biernat Wojciech
Published: October 2006

We report the case of a 64‐year‐old man with a plaque‐like lesion on the lower back. Clinically, squamous cell carcinoma was suspected, but the histological features resembled those of isolated Darier’s disease or pemphigus vegetans. The lesion was removed with the final diagnosis of acantholytic dyskeratotic acanthoma. We discuss this case with special regard to the differential diagnosis of other isolated acantholytic acanthomas.
Mucinous hidradenoma: a report of three cases
Authors: Goh Seng Geok Nicholas , Carr Richard , Dayrit Johannes F. , Calonje Eduardo
Published: October 2006

Mucinous cutaneous adnexal tumors are an uncommon occurrence. We describe three cases of mucinous hidradenoma characterized by diffuse and prominent mucinous cell proliferation and discuss the relevant literature. The patients (two men and one woman) ranged in age from 32 to 72 years. The lesions were completely excised, and all patients were alive without evidence of disease (follow‐up interval 3–4 years). Case 1 presented as a 1.3‐cm eyelid nodule and histology showed a mucinous apocrine hidradenoma with a proliferation of mucinous cells and apocrine glands. Case 2, from the shoulder of a 40‐year‐old man, was a 2.5‐cm well‐circumscribed nodule composed of hyperplastic villoglandular proliferation of mucinous cells with focal squamous whorls and focal columnar glandular cells showing decapitation secretion. The tumor was also interpretated as a mucinous hidradenoma, most likely of follicular‐apocrine origin. Case 3 was a 3.0‐cm scalp nodule. The histology showed a mucinous clear‐cell hidradenoma composed of numerous mucinous glands amidst small squamous cells with clear cytoplasm and a hyalinized fibrovascular stroma.
Low prevalence of RAS‐RAF‐activating mutations in Spitz melanocytic nevi compared with other melanocytic lesions
Authors: Indsto James O. , Kumar Swapna , Wang Lixiang , Crotty Kerry A. , Arbuckle Susan M. , Mann Graham J.
Published: October 2006

Abstract:  Melanocytic lesions, including Spitz nevi (SN), common benign nevi (CBN) and cutaneous metastatic melanoma (CMM), were analyzed for activating mutations in NRAS, HRAS and BRAF oncogenes, which induce cellular proliferation via the MAP kinase pathway. One of 22 (4.5%) SN tested showed an HRAS G61L mutation. Another lesion, a ‘halo’ SN, showed a BRAF V600E (T1796A) mutation. BRAF V600E mutations were found in two thirds (20/31) of CBN, while a further 19% (6/31) showed NRAS codon 61 mutations. One third of CMM (10/30) had various BRAF mutations of codon 600, and a further 6% (2/31) showed NRAS codon 61 mutations. Seventeen SN tested for loss of heterozygosity (LOH) at 9p and 10q regions, known to be frequently deleted in melanoma, showed LOH at the 9p loci D9S942 and IFNA. A further lesion was found with low‐level microsatellite instability at one locus, D10S214. The low rate of RAS‐RAF mutations (2/22, 9.1%) observed in SN suggests that these lesions harbor as yet undetected activating mutations in other components of the RAS‐RAF‐MEK‐ERK‐MAPK pathway. Germline DNA from members of 111 multiple‐case melanoma families, representing a range of known (CDKN2A) and unknown predisposing gene defects, was analyzed for germline BRAF mutations, but none was found.
Expression of Natural Cytotoxicity Receptors and a2V‐ATPase on Peripheral Blood NK Cell Subsets in Women with Recurrent Spontaneous Abortions and Implantation Failures
Authors: Fukui Atsushi , Ntrivalas Evangelos , Gilman‐Sachs Alice , Kwak‐Kim Joanne , Lee Sung‐Ki , Levine Rita , Beaman Kenneth
Published: October 2006

Problem  Natural cytotoxicity receptors (NCRs) are unique markers, which regulate NK cell cytotoxicity and cytokine production. a2V‐ATPase is expressed on subsets of PBMC and regulates the extracellular environment, which facilitates NK cytotoxicity or cytokine secretion. In this study, we aim to investigate the expression of NCRs and a2V‐ATPase in peripheral blood NK cells of women with recurrent spontaneous abortions (RSA) or implantation failures.

Method of study  Peripheral blood NK cells (CD56dim and CD56bright were analyzed for the expression of NCRs (NKp46, NKp44 and NKp30) and a2V‐ATPase using 3‐color flow cytometry in women with RSA (n=24), implantation failures (n=19) or normal healthy women (n=13).

Results  CD56+/NKp46+ cells were markedly decreased (P<0.05) and CD56bright/a2V‐ATPase+ cells were significantly increased (P<0.05) in women with RSA as compared to those of normal controls. In women with RSA or implantation failures, expression of NKp46, NKp44, NKp30, and a2V‐ATPase on CD56bright NK cells was significantly up‐regulated as compared with those of CD56dim NK cells.

Conclusion  The differential expression of NCRs and a2V‐ATPase in NK cell subsets may suggest dysregulation of NK cytotoxicity and cytokine production in women with RSA and implantation failures.