bluuebunny/crossref_metadata_2025 huggingface dataset:
The anaesthetic management of patients with congenital insensitivity to pain with anhidrosis
Authors: Rozentsveig V. , Katz A. , Weksler N. , Schwartz A. , Schilly M. , Klein M. , Gurman G.M.
Published: December 2004

Background : Congenital insensitivity to pain with anhidrosis (CIPA, or hereditary sensory and autonomic neuropathy type IV) is a rare, autosomal recessive disease, related to a mutation in the TrkA gene, characterized by inability to sweat, insensitivity to pain and recurrent episodes of hyperpyrexia. There are two Bedouin tribes in Israel with different mutations of the TrkA gene: one in the southern region and the other in the northern region. The Soroka University Medical Center is the referral centre for the entire southern region of Israel. One in 4500 anaesthesia cases involves a patient with CIPA.

Methods : We reviewed 40 anaesthesia records of 20 patients with CIPA for anaesthetic technique and incidence of side‐effects.

Results : Sixteen patients developed complications in the immediate perioperative period: mild hypothermia in one patient and cardiovascular events in 15 others with one case of cardiac arrest. These complications were unrelated to the anaesthetic drug administered. There were no events of hyperthermia or postoperative nausea.

Conclusions : Cardiovascular complications following anaesthesia are common in patients with the southern Israel variant of CIPA. Hyperthermia, previously recognized as a major concern in patients with congenital insensitivity to pain with anhydrous, was not seen in our patients. We conclude that cardiovascular involvement is frequently encountered in CIPA patients following anaesthesia and is the major concern in their anaesthetic management.
Anaesthetic management of a patient with the intracardiac extension of Wilms’ tumour
Authors: Shiratori Tohru , Fujisawa Tatsurou , Ichino Takashi , Mitono Yuusuke , Inokuti Mari , Ohata Jun
Published: December 2004

Wilms’ tumour (nephroblastoma) is known to invade the inferior vena cava and extend to the intracardiac chambers. We describe the treatment and surgical removal of the intracardiac extension of a Wilms’ tumour using cardiopulmonary bypass in a 4‐year‐old girl. Techniques to avoid paradoxical embolism in the presence of a patent foramen ovale and to deal with excessive hepatic venous blood flow using the Pringle manoevre (hepatic inflour occlusion) are described. Good communication between anaesthesiologists, surgeons and perfusionists was indispensable. The anaesthesiologist is an important member of the team during performance of a complicated procedure.
Impact of Atrial Fibrillation on the Voltage of Bipolar Signals Acquired from the Left and Right Atria
Authors: NDREPEPA GJIN , SCHNEIDER MICHAEL A.E. , KARCH MARTIN R. , WEBER STEFAN , SCHREIECK JÜRGEN , ZRENNER BERNHARD , SCHMITT CLAUS
Published: December 2004

NDREPEPA, G., et al.: Impact of Atrial Fibrillation on the Voltage of Bipolar Signals Acquired from the Left and Right Atria.
A detailed analysis of the impact of atrial fibrillation (AF) on the voltage of the atrial signals acquired from various right and left atrial regions has not been reported. Thirteen patients (mean age

55 ± 11

years, range 39–67 years, 5 women) with AF were included in this study. Mapping of the left and the right atrium was performed with 64‐electrode basket catheters. AF cycle lengths were calculated over 10‐second time intervals using a custom‐made software. Voltage of the bipolar signals during AF was calculated by measuring the amplitudes of 30 consecutive signals in the left and the right atria. During sinus rhythm voltage differences between the left

(3 ± 2.9 mV)

and the right atrium

(2.8 ± 2.4 mV, P = 0.15)

were insignificant. During AF, as compared to sinus rhythm, voltages of the bipolar signals were significantly reduced in the left

(0.9 ± 0.6 mV)

and the right

(1.3 ± 1.1 mV)

atria (

P < 0.001

compared with sinus rhythm). In the left atrium, the posterior wall showed the most pronounced voltage reduction (

1.1 ± 0.8 mV

vs

5.3 ± 4.6 mV, P < 0.001

). In the right atrium the septal wall showed the greatest reduction in voltage amplitude (

0.8 ± 0.6 mV

vs

2.5 ± 1.5 mV, P < 0.001

). There was a close correlation between the voltage values and the AF cycle length. The smallest voltage values and greatest amplitude reductions were observed during faster and more disorganized AF activity. It is concluded that during AF, the voltage of bipolar signals is significantly reduced as compared to sinus rhythm. The reduction in voltage expresses atrial and regional disparity and correlates strongly with local AF cycle lengths and the degree of AF disorganization. (PACE 2003; 26[Pt. I]:862–869)
Pacemaker Lead Infection in Young Patients
Authors: KLUG DIDIER , VAKSMANN GUY , JARWÉ MOUSTAPHA , WALLET FRÉDÉRIC , FRANCART CHARLES , KACET SALEM , REY CHRISTIAN
Published: December 2004

Transvenous pacing has become widespread in the pediatric population, but related pacemaker lead infection in young patients has rarely been reported. To determine prevalence and optimal management of pacemaker lead infection in children and young adults, the authors reviewed their pacing database including 4,476 patients who previously had pacemaker implantations from 1975 to 2001. A pacemaker was implanted in 304 patients under the age of 40. Of these patients 217 of them had congenital heart disease: 108 with structural defect, 109 without (mainly complete AV blocks). Among patients with congenital heart disease, 12 developed a pacemaker lead infection (5.5%, 6 patients with structural defect, 6 without). This incidence was significantly higher than in patients < 40 years at first implantation without congenital heart disease (2.3%) and in > 40‐year‐old patients(1.2%, P < 0.001). However, the number of reinterventions at the pulse generator site was higher in patients having had their first implantation before the age of 40. In patients with structural cardiac defect: two died after surgical lead extraction and one died before the scheduled lead extraction. The three remaining patients had successful surgical (n = 1) or percutaneous (n = 2) lead extractions. In patients without structural cardiac defect successful percutaneous extraction (5/6) or surgical extraction (1/6 with vegetation > 25 mm) was performed. One patient with percutaneous extraction developed chronic cor pulmonale during follow‐up. One infection recurred in one patient with structural cardiac defect although complete removal of the pacing material had been performed. The prevalence of pacemaker lead infection is higher in younger patients, perhaps in part due to a higher number of procedures at the pacemaker site than in the general population of patients with a pacemaker. Patients with structural cardiac defect who underwent surgical lead removal were at high risk for death. Patients with percutaneous lead extraction may develop cor pulmonale. (PACE 2003; 26[Pt. I]:1489–1493)
Mortality, Morbidity, and Complications in 3,344 Patients with Implantable Cardioverter Defibrillators:
Authors: GRADAUS RAINER , BLOCK MICHAEL , BRACHMANN JOHANNES , BREITHARDT GÜNTER , HUBER HANS G. , JUNG WERNER , KRANIG WOLFGANG , MLETZKO RALPH U. , SCHOELS WOLFGANG , SEIDL KARLHEINZ , SENGES JOCHEN , SIEBELS JÜRGEN , STEINBECK GERHARD , STELLBRINK CHRISTOPH , ANDRESEN DIETRICH ,   German EURID Registry
Published: December 2004

ICDs are the therapy of choice in patients with life‐threatening ventricular arrhythmias. Mortality, morbidity, and complication rates including appropriate and inappropriate therapies are unknown when ICDs are used in routine medical care and not in well‐defined patients included in multicenter trials. Therefore, the data of 3,344 patients (

61.1 ± 12.1  years

; 80.2% men; CAD 64.6%, dilated cardiomyopathy 18.9%; NYHA Class I–III: 19.1%, 54.3%, 20.1%, respectively;

LVEF > 0.50

: 0.234, LVEF 0.30–0.50: 0.472,

LVEF < 0.30

: 0.293, respectively) implanted in 62 German hospitals between January 1998 and October 2000 were prospectively collected and analyzed as a part of the European Registry of Implantable Defibrillators (EURID Germany). The 1‐year survival rate was 93.5%. Patients in NYHA Class III and a

LVEF < 0.30

had a lower survival rate than patients in NYHA Class I and a preserved LVEF (0.852 vs 0.975,

P = 0.0001

). Including the 1‐year follow‐up, 49.5% of patients had an intervention by the ICD, 39.8% had appropriate ICD therapies, 16.2% had inappropriate therapies. Overall, 1,691 hospital readmissions were recorded. The main causes for hospital readmissions were ventricular arrhythmias (61.3%) and congestive heart failure symptoms (12.9%). Thus, demographic data and mortality of patients treated with an ICD in conditions of standard medical care seems to be comparable and based on, or congruent with, the large secondary preventions trials. When ICDs are used in standard medical care, the 1‐year survival rate is high, especially in patients with NYHA Class I and preserved LVEF. However, nearly half of all patients suffer from ICD intervention. (PACE 2003; 26[Pt. I]:1511–1518)
Disappearance of the Brugada‐Type Electrocardiogram After Surgical Castration:
Authors: MATSUO KIYOTAKA , AKAHOSHI MASAZUMI , SETO SHINJI , YANO KATSUSUKE
Published: December 2004

We describe two cases of asymptomatic Brugada syndrome that displayed a persistent ECG manifestation, but in which the typical ECG pattern disappeared following surgical castration for prostate cancer. These facts suggest a possible association between manifestation of the Brugada‐type ECG pattern and testosterone. (PACE 2003; 26[Pt. I]:1551–1553)
An Endovascular Approach to Cardioembolic Stroke Prevention in Atrial Fibrillation Patients
Authors: NAKAI TOSHIKO , LESH MICHAEL , OSTERMAYER STEFAN , BILLINGER KAI , SIEVERT HORST
Published: December 2004

This report is of a 62‐year‐old woman presenting with a 3‐year history of chronic atrial fibrillation (AF) and unable to tolerate chronic warfarin therapy due to bleeding episodes and unstable INR values. Additional high risk factors for stroke are a history of congestive heart failure and previous embolic stroke. Percutaneous left atrial appendage transcatheter occlusion (PLAATO™) was performed to seal the LAA. A transesophageal echocardiography (TEE) at the 1‐ and 6‐month follow‐up showed no device migration and no new thrombus related to the implant. The patient has been doing well on postprocedure aspirin with no embolic events. (PACE 2003; 26[Pt. II]:1604–1606)
Ostial PV Isolation:
Authors: ERNST SABINE , ANTZ MATTHIAS , OUYANG FEIFAN , VOGTMANN THOMAS , GOYA MASAHIKO , BÄNSCH DIETMAR , SCHAUMANN ANSELM , KUCK KARL‐HEINZ
Published: December 2004

Pulmonary vein (PV) isolation by elimination of spike potentials has been reported to cure drug refractory atrial fibrillation. Because of the heterogenous morphology of the PVs, sequential electroanatomic reconstruction of the PVs was performed in 39 patients (group A), who underwent subsequent PV isolation by interruption of all conductive myocardial fibers by distinct RF current applications using a “lasso” approach. In group B (157 patients), only biplane two‐dimensional fluoroscopy was performed to guide the diagnostic and the ablation catheters. After reprocedures (in 7% of patients in group A and 22% of group B), which depicted a recurrence of a spike potential inside or at the ostium of  >1 previously isolated PV in all restudied patients, stable sinus rhythm was documented in 69% of patients in group A and 60% of patients in group B. Reasons for the relapse of the previously eliminated spike potentials include a temporary ablation effect and a too distal interruption of the conducting myocardial fiber. Detailed knowledge of the individual three‐dimensional morphology enhanced the clinical success rate of PV isolation but is time‐consuming using CARTO

(8.0 ± 1.7 vs 5.0 ± 1.6, P < 0.001)

. Further technical improvement to fuse the individual three‐dimensional anatomy and the electrophysiological markers to a composed “electroanatomic” map may overcome this limitation in the future. (PACE 2003; 26[Pt. II]:1624–1630)
Plant genome archaeology: evidence for conserved ancestral chromosome segments in dicotyledonous plant species
Authors: Dominguez Isabelle , Graziano Enrique , Gebhardt Christiane , Barakat Abdelali , Berry Simon , Arús Pere , Delseny Michel , Barnes Stephen
Published: December 2004

We have developed genetic maps, based on expressed sequence tags (ESTs) that are homologous to Arabidopsis genes, in four dicotyledonous crop plant species from different families. A comparison of these maps with the physical map of Arabidopsis reveals common genome segments that appear to have been conserved throughout the evolution of the dicots. In the four crop species analysed these segments comprise between 16 and 33% of the Arabidopsis genome. Our findings extend the synteny patterns previously observed only within plant families, and indicate that structural and functional information from the model species will be, at least in part, applicable in crop plants with large genomes.
Genes and signalling in root development
Authors: Casson Stuart A. , Lindsey Keith
Published: December 2004

The plant root plays a range of roles, such as in the acquisition of water and nutrients, the provision of structural support and as the site of interactions with mycorrhizae, nitrogen fixing organisms (in certain taxa) and diverse pests and pathogens. It also provides an important experimental system to study different aspects of plant organogenesis, including the regulation of pattern formation, cell division, intercellular signalling and cell differentiation. With the completion of the Arabidopsis sequencing programme, and the availability of very large collections of Arabidopsis mutants, it is feasible rapidly to gain new information on the control of each of these aspects of root development. Drawing principally from experimental work using this model organism, which has proved extremely amenable to genetic and physiological analysis, we aim to bring together recent advances in knowledge and understanding of the molecular basis of root organogenesis, from origins in embryogenesis to postgermination architecture.

Contents

I.
Introduction
11

II.
Cellular origins of root meristems
12

III.
Regulation of cell identity in the root
13

IV.
Hormonal signals in root development
14

V.
The genetics of root pattern
19

VI.
Root architecture: regulation of de novo root formation
24

VII.
Conclusions
33

References
33
Effect of culture conditions on the lipid composition of Phytophthora infestans
Authors: Griffiths Robert G. , Dancer Jane , O'Neill Elizabeth , Harwood John L.
Published: December 2004

Phytophthora infestans is one of the most important of all plant pathogens and there is a demand for its more effective control. One target area for pesticides is lipid metabolism. To provide background information for studies with pesticides, we examined the lipids of P. infestans and how their composition is altered by culture conditions.

Phytophthora infestans was grown in a pea‐broth and three different minimal media. Acyl lipids were extracted, separated by thin‐layer chromatography, identified and quantified. Total fatty acid patterns and those in individual lipid classes were measured by gas–liquid chromatography.

Major polar lipids were the phosphoglycerides, phosphatidylcholine > phosphatidylethanolamine > phosphatidylinositol. The proportion of total polar lipids was reduced in minimal media. The similar fatty acid patterns of phosphatidylcholine and phosphatidylethanolamine were consistent with their metabolic relationship. Phytophthora infestans contained significant amounts of 22C unsaturated fatty acids, in addition to common fungal or oomycete fatty acids. Growth on minimal media caused changes in fatty acid patterns with increases in palmitate and linoleate and decreases in oleate being most obvious. Particular changes were also associated with the specific fatty acid patterns of individual lipids.

The changes found in total fatty acids and in the acyl profiles of individual lipids suggest that desaturase activities are altered by growth conditions. These results and the greater proportions of storage triacylglycerol in minimal media agree with data for some other lower plants or fungi.
Uptake and distribution of nickel and other metals in the hyperaccumulator Berkheya coddii
Authors: Robinson B. H. , Lombi E. , Zhao F. J. , McGrath S. P.
Published: December 2004

Berkheya coddii is a fast‐growing, high biomass nickel (Ni) hyperaccumulator plant that has recently attracted attention for its possible use in the phytoextraction of Ni. The mechanisms of Ni accumulation, however, are not well understood in this plant.

Plants were grown hydroponically in varying Ni concentrations to assess the uptake and distribution of Ni, and other metals, at the whole plant level. X‐ray microanalyses (EDXA) of frozen hydrated tissues were conducted to determine the distribution of Ni at the cellular level in the leaves.

Most Ni was found in the shoots, especially in the leaves. Leaf Ni concentration increased with age, whereas older stem sections had lower Ni concentrations than new growth. EDXA analyses revealed that the cuticle of the upper epidermis had a significantly higher Ni concentration than the rest of the leaf. The Ni concentrations in the other leaf tissues were not significantly different.

This pattern of distribution contrasts sharply with some other hyperaccumulator species that commonly show a preferential accumulation of Ni and other metals in the vacuoles of the epidermal cells.
The ecological transition in speciation
Authors: Levin Donald A.
Published: December 2004

Ecological transitions are at the core of different modes of speciation. These transitions face both genetic and demographic hurdles. This paper focuses on how these hurdles are overcome, allowing ecological speciation and speciation via hybridization and/or polyploidy. Niche shifting is a two‐step process. First there is the establishment of ill‐adapted populations where ecological opportunity allows. This is followed by the genetic refinement of populations, which allows them to be integrated into novel communities and habitats. These steps are more readily accomplished in unsaturated floras, where competition is less intense. Ecological transitions in saturated floras may be facilitated by disturbance. Invasive species serve as heuristic model systems for understanding the early stages of speciation where niche shifts are involved.
Advances in the study of polyploidy sincePlant speciation
Authors: Soltis Douglas E. , Soltis Pamela S. , Tate Jennifer A.
Published: December 2004

Enormous strides have been made in the study of polyploidy over the last 20 yr. Here, we highlight some of these discoveries and note where our understanding of polyploid evolution has changed. Genetic and genomic studies have dramatically altered the polyploidy paradigm. The estimated frequency of polyploidy has increased, and it is now recognized that multiple origins are the rule for most polyploids. Likewise, autopolyploidy is much more common than traditionally maintained. Rapid genomic rearrangements, genomic downsizing, movement of genetic elements across genomes, and the movement of foreign genetic materials into the polyploid genome illustrate the complex dynamics of polyploid genomes. Following polyploidization, both genetic and epigenetic mechanisms may play an important role in altering gene expression. Ecological studies reveal that plant polyploidy can have profound effects on interactions with animal herbivores and pollinators and that polyploidy may trigger changes in the reproductive biology of a species. Despite the recent advances in our understanding of polyploid evolution, many exciting aspects remain under‐investigated. Some of these include the consequences of genetic and genomic changes in natural polyploid populations, the physiological and ecological effects of polyploidy, and whether recurrent polyploidy prompts evolution to repeat itself.
ERP components associated with successful and unsuccessful stopping in a stop‐signal task
Authors: Kok Albert , Ramautar Jennifer R. , De Ruiter Michiel B. , Band Guido P. H. , Ridderinkhof K. Richard
Published: December 2004

The primary aim of this study was to examine how response inhibition is reflected in components of the event‐related potential (ERP), using the stop‐signal paradigm as a tool to manipulate response inhibition processes. Stop signals elicited a sequence of N2/P3 components that partly overlapped with ERP components elicited by the reaction stimulus. N2/P3 components were more pronounced on stop‐signal trials than on no‐stop‐signal trials. At Cz, the stop‐signal P3 peaked earlier on successful than on unsuccessful stop trials. This finding extends the horse race model by demonstrating that the internal response to the stop signal (as reflected in stop‐signal P3) is not constant, but terminates at different moments in time on successful and unsuccessful stop trials. In addition, topographical distributions and dipole analysis of high density EEG recordings indicated that different cortical generators were involved in P3s elicited on successful and unsuccessful stop‐signal trials. The latter results suggest that P3 on successful stop‐signal trials not only reflects stop‐signal processing per se, but also efficiency of inhibitory control.
Antioxidant Vitamins in the Prevention of Cancer
Authors: Lee I‐Min
Published: December 2004

Cancer is a leading cause of morbidity and mortality in the United States and other developed countries. In searching for preventive strategies against this disease, researchers have postulated that antioxidant vitamins may play a role in preventing cancer since several plausible biological mechanisms exist. This article reviews the epidemiological evidence for a role of antioxidant vitamins (in particular, beta‐carotene, vitamin E, and vitamin C) in the development of cancer. Observational studies provide fairly consistent data for an inverse association between high intake of antioxidant vitamins, especially beta‐carotene and vitamin C, and cancer risk. However, randomized trials generally have not supported the hypothesis. Several explanations for these inconsistent findings are possible. These include: 1) confounding by other healthy dietary and nondietary habits in observational studies; 2) the protective role of a combination of many different nutrients present in fruits and vegetables, rather than the single nutrient or combination of two nutrients that most trials have tested; 3) inadequate duration of follow‐up in most randomized trials; and 4) heterogeneity of the populations studied. Reliable epidemiological evidence regarding whether antioxidant vitamins play a role in preventing cancer will have to come from both observational studies and randomized trials since these different study designs each have unique strengths and limitations. Based on the available evidence, it seems prudent to advocate a diet rich in fruits and vegetables, rather than the consumption of specific antioxidant vitamin supplements, in order to decrease the risk of developing cancer.
Antioxidant Vitamins and Age‐Related Eye Disease
Authors: Christen William G.
Published: December 2004

Basic research studies suggest that oxidative mechanisms may play an important role in the pathogenesis of cataract and age‐related macular degeneration, the two most important causes of visual impairment in older adults. These findings raise the possibility that vitamins and trace minerals with antioxidant properties can be of benefit in preventing the onset or progression of disabling eye disease. Results from observational epidemiological studies in humans, however, are inconclusive. Although findings from several studies, primarily cross‐sectional and case‐control, are generally compatible with a possible protective role for micronutrients in disease development, the data for specific nutrients or specific disease types are inconsistent. The imprecision of dietary exposure data and the likely effects of uncontrolled confounding further limit these observational studies. Well‐designed, large‐scale, randomized trials are required to evaluate definitively the potentially important benefit of vitamin supplementation in eye disease.
Marijuana: Still a “Signal of Misunderstanding”
Authors: Ungerleider J. Thomas
Published: December 2004

This article reviews four decades of my professional experience with marijuana, including: 1) my treatment of marijuana‐dependent patients, particularly adolescents; 2) my research on the general effects and medical uses of the government‐grown marijuana and of oral tetrahydrocannabinol (Marinol); and 3) my social policy experiences, both nationally and internationally, as a member of the National Commission on Marijuana Drug Abuse. The article emphasizes the mythology, morality, and misunderstanding that clouds so much of the thinking about marijuana in general and its medical utility in particular.
In Vivo Short‐Term Expression of a Hypertrophic Cardiomyopathy Mutation in Adult Rabbit Myocardium: Myof ibrillar Incorporation without Early Disarray
Authors: Yu Quntao , Zhao Guiling , Marian Ali J.
Published: December 2004

Cardiac myocyte disarray is the pathological hallmark of hypertrophic cardiomyopathy (HCM), a disease of sarcomeric proteins. Mutations in the cardiac troponin T (cTnT), a major gene responsible for HCM, are associated with severe myocyte disarray. To study the pathogenesis of cardiac myocyte disarray, we expressed normal and mutant cTnT proteins in the myocardium of adult rabbits via direct intramyocardial injection of recombinant adenoviruses. Aliquots of 1010 plaque‐forming units of normal (Ad/CMV/cTnT‐Arg92) and mutant (Ad/CMV/cTnT‐Gln92) recombinant viruses or a control vector (Ad/ΔE) virus were mixed with equal aliquots of a reporter virus (Ad/CMV/Lac‐Z) and co‐injected into the myocardium of adult rabbits (n = 12). One week following gene transfer, thin myocardial sections were obtained and analyzed for β‐galactosidase, messenger RNA (mRNA) and protein expression, hematoxylin and eosin, Masson’s trichrome, immunofluorescence staining, and electron microscopy. The efficiency of gene transfer varied from 2% to 60% of the cells in an area 2.5 mm in length. Northern blotting confirmed expression of the transgenes into mRNA. Immunoblotting of the myofibrillar protein extracts and indirect immunofluorescence staining confirmed expression and incorporation of the transgene proteins into myofibrils. Expression of the mutant cTnT was up to 18% of the endogenous. Light and electron microscopic studies showed normal cardiac myocyte and sarcomere structures. Thus, despite incorporation of the mutant cTnT‐Gln92, stable myofibrillar formation and sarcomere assembly proceeded in vivo. The absence of myocyte and sarcomere disarray may reflect the duration, or the level of expression, or the extent of myofibrillar incorporation of the mutant cTnT‐Gln92, as well as the site and timing of expression of the transgenes, and interspecies variation in the pathogenesis of HCM.
A Novel Calcium Sensor Stimulating Inositol Phosphate Formation and [Ca2+]i Signaling Expressed by GCT23 Osteoclast‐Like Cells
Authors: Seuwen Klaus , Boddeke Hendrikus G.W.M. , Migliaccio Silvia , Perez Marie , Taranta Anna , Teti Anna
Published: December 2004

Osteoclast activity is inhibited by elevated [Ca2+]o; however, the underlying molecular mechanism is unknown. We used the human osteoclast‐like cells GCT23 to elucidate their cation‐sensing properties. Cells responded to elevated [Ca2+]o with rpaaid concentration‐dependent [Ca2+]i transients (EC50 = 7.8 mm, time to peak 44 ± 4 sec) that were due to release from intracellular stores, followed by Ca2+ influx across the plasma membrane. Ca2+ store depletion by thpaasigargin, endothelin‐1, or bradykinin activated calcium entry pathways. Cells responded similarly to Ni2+ and Cd2+ with albeit slower kinetics (EC50 <10 μm and <100 μm, times to peak 140 ± 25 sec and 150 ± 24 sec, respectively). The three cations stimulated inositol phosphate production (two‐fold, p < .02) similar to bradykinin (2.5‐fold, p < .002), which activates a phospholipase C (PLC)‐coupled receptor in GCT23 cells. The cells did not respond to 0.1–1 mM Gd3+ or neomycin B, indicating that the parathyroid calcium receptor (PCaR) is not functionally expressed. In confirmation, PCaR could not be detected by reverse transcriptase polymerase chain reaction in GCT23 cells and in mouse osteoclasts, and the calcimimetic compound NPS R‐568 failed to produce the left shift of the concentration‐response curve characteristic for PCaR. Our data demonstrate for the first time that cation sensing by osteoclast‐like GCT23 cells is mediated by a PLC‐coupled receptor that is not identical to PCaR.
Predictors and Outcomes of Cardiac Complications Following Elective Coronary Bypass Grafting
Authors: Charlson Mary , Krieger Karl H. , Peterson Janey C. , Hayes Joseph , Isom O. Wayne
Published: December 2004

Our objective was to determine the predictors of cardiac complications among a cohort of elective coronary artery bypass graft (CABG) surgery patients and to determine the relationship of such complications to subsequent quality of life and symptoms. A total of 248 patients were enrolled and 237 completed 6 month follow‐up. The combined rate of both major and minor cardiac complications was 9.7% (n = 24). Patients in this study were evaluated preoperatively, monitored intraoperatively, followed immediately postoperatively and at 6 months. Major cardiac complications accounted for 3.6% (n = 9) and minor complications for 6% (n = 15). Using multivariable logistic regression analysis, the predictors of major cardiac complications were receiving diuretics preoperatively (p = .01) and increased time during cross‐clamping (p = .006). At 6 months after surgery, 19% of the patients with postoperative cardiac complications experienced worsening of symptoms, in contrast to only 8% of those without cardiac complications (p = .03). We concluded that patients who were on preoperative diuretics and those who had longer cross‐clamp times were at higher risk of cardiac complications. The majority of patients who had acute cardiac complications had improved function and symptoms at 6 months postoperatively.
Free Fatty Acids, Insulin Resistance, and Type 2 Diabetes Mellitus
Authors: Boden Guenther
Published: December 2004

Evidence is presented that shows that free fatty acids (FFA) are one important link between obesity, insulin resistance, and type 2 diabetes. Plasma FFA levels are elevated in most obese subjects, and physiological elevations of plasma FFA inhibit insulin‐stimulated glucose uptake into muscle. This peripheral insulin resistance is caused by an FFA‐induced defect, which develops 3–4 hr after raising plasma FFA, in insulin‐stimulated glucose transport or phosphorylation, or both. This resistance is also caused by a second defect, which develops after 4–6 hr, consisting of inhibition of glycogen synthase activity. Whether elevated plasma FFA levels inhibit insulin action on endogenous glucose production (EGP), that is, cause central insulin resistance, is more difficult to demonstrate. On the one hand, FFA increase gluconeogenesis, which enhances EGP; on the other hand, FFA increase insulin secretion, which decreases EGP. Basal plasma FFA support approximately one third of basal insulin secretion in diabetic and nondiabetic subjects and, hence, are responsible for some of the hyperinsulinemia in obese, normoglycemic patients. In addition, elevated plasma FFA levels potentiate glucose‐stimulated insulin secretion acutely and during prolonged exposure (48 hr). It is hypothesized that obese subjects who are genetically predisposed to develop type 2 diabetes will become partially “lipid blind,” that is, unable to compensate for their FFA‐induced insulin resistance with FFA‐induced insulin oversecretion. The resulting insulin resistance/secretion deficit will then have to be compensated for with glucose‐induced insulin secretion, which, because of their partial “glucose blindness,” will result in hyperglycemia and eventually in type 2 diabetes.
The Potential Influence of Insulin and Plasminogen Activator Inhibitor Type 1 on the Formation of Vulnerable Atherosclerotic Plaques Associated with Type 2 Diabetes
Authors: Sobel Burton E.
Published: December 2004

Insulin‐resistant states, including type 2 diabetes mellitus, are associated with increased concentrations of plasminogen activator inhibitor type 1 (PAI‐1) in blood and in extracted coronary atheroma, as well as with an increased incidence of acute coronary syndromes, known to be precipitated by the rupture of vulnerable atherosclerotic plaques. However, plaque rupture is potentiated by proteolysis. Accordingly, the parallel relationship between augmentation of concentrations of an inhibitor of proteolysis and plaque vulnerability appears to be paradoxical. The following resolution is proposed. Reduced cellularity of plaques may result when high concentrations of PAI‐1 in early atheroma inhibit the migration of vascular smooth muscle cells into the neointima. Such migrating cells subsequently proliferate. If their total number is reduced, the composition of plaques may be altered throughout development with the reduction of vascular smooth muscle cell content and consequent additional changes. In aggregate, such changes may render mature, complex plaques vulnerable to rupture mediated by proteolysis responsible for the degradation of thin fibrous caps on relatively acellular, lipid‐laden plaques.
The Nramp1 Protein and Its Role in Resistance to Infection and Macrophage Function
Authors: Canonne‐Hergaux François , Gruenheid Samantha , Govoni Gregory , Gros Philippe
Published: December 2004

Susceptibility to infectious diseases is under genetic control in humans. Animal models provide an ideal tool to study the genetic component of susceptibility and to identify candidate genes that can then be tested for association or linkage studies in human populations from endemic areas of disease. The Nramp1 gene was isolated by positional cloning the host resistance locus Bcg/Ity/Lsh, and mutations at this locus impair the resistance of mice to infections with intracellular parasites, such as Salmonella, Leishmania, and Mycobacterium. Allelic variants at the human Nramp1 homologue have recently been found to be associated with susceptibility to tuberculosis and leprosy in humans. The Nramp1 protein is an integral membrane protein expressed exclusively in the lysosomal compartment of monocytes and macrophages. After phagocytosis, Nramp1 is targeted to the membrane of the microbe‐containing phagosome, where it may modify the intraphagosomal milieu to affect microbial replication. Although the biochemical mechanism of action of Nramp1 at that site remains unknown, Nramp homologues have been identified in many other animal species and actually define a protein family conserved from bacteria to humans. Some of these homologues have been shown to be divalent cation transporters. Recently, a second member of the mammalian Nramp family, Nramp2, was discovered and shown to be mutated in animal models of iron deficiency. The Nramp2 protein was subsequently shown to be the major transferrin‐independent iron uptake system of the intestine. Together, these results suggest that Nramp1 may control intracellular microbial replication by actively removing iron or other divalent cations from the phagosomal space.
Human Herpesvirus 8: Is it a Tumor Virus?
Authors: Neipel Frank , Albrecht Jens‐Christian , Fleckenstein Bernhard
Published: December 2004

Human herpesvirus 8 (HHV‐8), also termed Kaposi's sarcoma–associated herpesvirus, was identified in Kaposi's sarcoma (KS) biopsy specimens in 1994. The epidemiological data available to date indicate a strong association of HHV‐8 with KS. It appears that HHV‐8 is necessary for KS development. HHV‐8 DNA is invariably found in all epidemiological forms of KS and primary effusion lymphomas. In contrast, HHV‐8 DNA is rarely found in various tumor and nontumor tissues from patient groups not at risk of KS. Although current serology does not allow us to assess the HHV‐8 prevalence in the general population, high titers of HHV‐8 antibodies are almost exclusively found in KS risk groups. In addition, HHV‐8 seroconversion has been shown to precede KS development. The mechanisms and genes involved in HHV‐8 pathogenesis are less clear. HHV‐8 belongs to a family of transforming viruses, and several candidate oncogenes have been identified by using rodent fibroblast transformation assays. However, expression of most of these genes could not be shown in latently infected tumor cells. As the HHV‐8 genome encodes several cytokines and cytokine receptor homologues, HHV‐8 may also promote KS pathogenesis through paraendocrine mechanisms.
Phospholipase A2 Enzymes in Eicosanoid Generation
Authors: Bingham Clifton O. , Austen K. Frank
Published: December 2004

Phospholipase A2 (PLA2) enzymes cleave esterified fatty acids from membrane glycerophospholipids. The 20‐carbon polyunsaturated fatty acid, arachidonic acid, is used as substrate by intermediate enzymes for the generation of eicosanoids, including leukotrienes and prostanoid products. An expanding number of PLA2 enzymes has now been identified that may participate in arachidonic acid release and thus serve a rate‐limiting role in eicosanoid biosynthesis. Cellular PLA2 function for various members is regulated by constitutive or elicited expression, as well as by posttranslational events such as phosphorylation. In addition, the function of some cellular PLA2 enzymes is regulated by a requirement for calcium or by localization to a particular subcellular compartment. Finally, some PLA2 enzymes are secreted from the cell where they may directly interact with plasma membrane or transmembrane receptors to function as autocrine or paracrine mediators. Evaluating the roles of a number of these functionally similar PLA2 enzymes in the biosynthesis of leukotrienes and other eicosanoids is the focus of this review.
Aspects of the Care of People with HIV/AIDS in South Africa
Authors: Uys Leana R.
Published: December 2004

Abstract  The study was aimed at exploring the realization of counseling, palliative care, and terminal care in the care of people with HIV/AIDS in seven settings in South Africa.

 A descriptive study was performed in seven sites where a model of home‐based care was implemented that links hospitals, clinics, and home‐based care in a continuum. Data was collected from people with HIV/AIDS (PWA), their caretakers, health care workers, and community members using semistructured interviews, observation, taping of onsite meetings, and completion of questionnaires. Descriptive and nonparametric statistics were used to analyze the quantitative data, and the template approach was used to analyze the qualitative data.

 There is a need to extend counseling before and after diagnostic testing to counseling about living with HIV/AIDS. There is also a need to equip counselors to deal with children.

 Fifty‐seven percent of patients died at home or in hospice. There is a significant relationship between a “good” death and dying at home.

 Palliative care in the formal health services was generally poor due mainly to lack of specific training in this field and the stigma associated with this diagnosis.

 Health care providers can change the experience of illness and death for PWA through adequate counseling, palliative care, and terminal care that meet professional standards.
The Effect of Reminiscence on the Elderly Population: A Systematic Review
Authors: Lin Yen‐Chun , Dai Yu‐Tzu , Hwang Shiow‐Li
Published: December 2004

Abstract  Reminiscence therapy is an independent nursing intervention that may be helpful in maintaining or improving self‐esteem and life satisfaction for the elderly, but the effects of reminiscence therapy are difficult to measure. For a greater understanding of reminiscence as a nursing therapeutic, this article reviewed the developmental history and theoretical basis of reminiscence and evaluated the empirical evidence concerning the use and effectiveness of reminiscence in the elderly. A lack of consist research findings resulted from selecting different therapeutic goals, different types of reminiscence, different dependent measures, different data collection tools, different sample populations, and small sample size. Future nursing research should redefine the concept and attempt to standardize the measurement of reminiscence and then forge ahead using rigorous research designs to develop a body of knowledge regarding reminiscence.
Finnish Families' Need for Special Support as Evaluated by Public Health Nurses Working in Maternity and Child Welfare Clinics
Authors: Häggman‐Laitila Arja , Euramaa Katri‐Ina
Published: December 2004

Abstract  The purpose of this study was to describe public health nurses' views of the everyday problems of families and their needs for special support. Seventy‐four nurses filled in a tripartite questionnaire. The needs varied by region and were seen in 4% to 23% of all families expecting a baby or with a child younger than 3 age in the nurses' clientele. Approximately one‐third of the families were considered to have a pressing need for support. More than half of families (54%) had difficulties coping with parenthood and family structure, almost one‐third (30%) with raising their children and with childcare, and nearly one‐third (27%) with their social network. In 20% of the families, the parents experienced problems relating to their relationship as a couple; 20% of the families had problems connected to the children's development, growth, and health; and in 19% of the families, the parents had health problems. Special needs were also caused by the parents' use of alcohol (15%) and by disputes over the children's custody and visiting rights (7%). The information provided by the study can be used in developing clinical services and the family work supporting them.
Discoid Lupus Erythematosus in Children: Clinical, Histopathologic, and Follow‐Up Features in 27 Cases
Authors: Moises‐Alfaro Celia , Berrón‐Pérez Renato , Carrasco‐Daza Daniel , Gutiérrez‐Castrellón Pedro , Ruiz‐Maldonado Ramón
Published: December 2004

Abstract: Among 27 pediatric patients with a clinicopathologic diagnosis of discoid lupus erythematosus (DLE), 15 had localized cutaneous lesions and 12 had disseminated lesions. During a mean follow‐up period of 36 months, seven patients (26%) developed systemic lupus erythematosus (SLE). Four of these patients were less than 10 years of age. No correlation was found between localized and disseminated lesions and evolution to SLE. Three of four patients with a positive family history for rheumatoid disease developed SLE (p < 0.05). Hyperpigmentation was significantly more frequent (p < 0.04) in children less than 10 years of age. There was a female predominance of 5:1 among patients less than 10 years of age. Our findings suggest that onset of DLE prior to 10 years of age does not indicate a greater risk of developing SLE. The occurrence of localized or disseminated lesions does not seem to influence the outcome.
Patch Testing in Children, Adults, and the Elderly: Influence of Age and Sex on Sensitization Patterns
Authors: Wöhrl Stefan , Hemmer Wolfgang , Focke Margarete , Götz Manfred , Jarisch Reinhart
Published: December 2004

Abstract: Patch testing was done on 2776 consecutive patients (76.5% female) with a locally revised standard series of 34 contact allergens and the results analyzed for age‐ and gender‐specific differences. At least one positive epicutaneous test reaction occurred in 48.9% of patients. Nickel (20.9%), ethylmercuric chloride (13.2%), thimerosal (11.8%), fragrance mix (9.3%), metallic mercury (8.9%), palladium (5.8%), balsam of Peru (3.8%), copper (3.7%), cobalt (3.3%), and chromium (2.3%) were the 10 most important sensitizers. The following tested allergens with sensitization rates of more than 1% were not part of the usual standard series: ethylmercuric chloride, metallic mercury, copper, propolis (1.3%), propylene glycol (1.0%). Reactions to nickel, cobalt, and palladium, but not to chromium, were significantly more abundant in females (p < 0.002, chi‐squared test). The overall sensitization rate was highest in children less than 10 years old (62%) and decreased steadily, to be lowest among patients more than 70 years old (34.9%). The rate of positive reactions to nickel and thimerosal decreased with age, while fragrance mix and metallic mercury stayed at the same level through all age groups.
Generalized Acanthosis Nigricans in an Otherwise Healthy Young Child
Authors: Uyttendaele Hendrik , Koss Tamara , Bagheri Bita , Schneiderman Paul , Silfen Miriam E. , Gallagher Mary P. , Garzon Maria , Engler Danielle
Published: December 2004

Abstract: Acanthosis nigricans in children is usually a benign condition most commonly associated with obesity. Generalized acanthosis nigricans is a very rare condition, especially in childhood. We report a 6‐year‐old boy with a 4‐year history of generalized hyperpigmentation and velvety thickening of the skin. Despite an extensive examination, no evidence for an underlying neoplastic or endocrinologic disease was found.
Complications of Subcutaneous Fat Necrosis of the Newborn: A Case Report and Review of the Literature
Authors: Tran Julie Thao , Sheth Anita P.
Published: December 2004

Abstract:Subcutaneous fat necrosis of the newborn is an uncommon, self‐limited panniculitis of neonates. Rare complications such as hypercalcemia, thrombocytopenia, hypertriglyceridemia, and hypoglycemia have been reported. We describe the first case where all of the above complications were encountered in the same infant. Physicians caring for infants with subcutaneous fat necrosis of the newborn should be aware of the above associations in order to provide prompt and appropriate treatment to prevent associated, undesirable sequelae.
AQP1 and AQP3, Psoriasin, and Nitric Oxide Synthases 1–3 are Inflammatory Mediators in Erythema Toxicum Neonatorum
Authors: Marchini Giovanna , Ståbi Berit , Kankes Kanchana , Lonne‐Rahm Solbritt , Østergaard Morten , Nielsen Søren
Published: December 2004

Abstract: Erythema toxicum neonatorum is a common, inflammatory skin reaction in healthy newborn infants characterized by an accumulation of activated immune cells in the lesions. Its etiology and physiologic significance are still unclear. The purpose of this study was to extend the search for possible inflammatory mediators of the rash. We performed immunohistochemistry on punch biopsy cryosections from lesions of four, 1‐day‐old infants and from four matched controls without rash, using antibodies against the water channel proteins aquaporin‐1 (AQP1) and aquaporin‐3 (AQP3), psoriasin, and the nitric oxide synthase (NOS) enzymes, neuronal NOS (nNOS), inducible NOS (iNOS), and endothelial NOS (eNOS). All sections from the lesions showed a dense, nodular cellular infiltrate located near the hair follicle. The vessels in the dermis showed a high incidence of AQP1 and eNOS. Strong staining for AQP1, AQP3, and psoriasin, as well as nNOS, iNOS, and eNOS were seen in the entire epidermal layer. The infiltrate in the dermis contained numerous cells expressing AQP1, AQP3, nNOS, iNOS, and eNOS. Double immunofluorescence staining showed that AQP3 was located in CD1a‐expressing Langerhans cells and other dendritic cells in the dermis, as well as in CD14‐expressing macrophages, CD15‐expressing neutrophils, and EG2‐expressing eosinophils surrounding the hair follicle. Our findings show that AQP1 and AQP3, psoriasin, and NOSs are involved in the activation of the skin immune system at birth.
Fibroblastic Rheumatism: a variant of non‐langerhans cell histiocytoses?
Authors: Zelger Bernhard , Burgdorf Walter
Published: December 2004

The following letter was previously published, in the May/June 2003 issue of PEDIATRIC DERMATOLOGY, with the omission of the first word of the title, which was essential for conveying the authors’ meaning, thus making their thoughts irretrievable by others interested in this issue. Therefore, the Editor has opted to republish this letter, with its correct title, and to extend to its authors our most sincere regrets for the error.