bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lipid analysis of normal dermis and hypertrophic scars
Authors: Nomura Tadashi , Terashi Hiroto , Omori Makoto , Sakurai Atsushi , Sunagawa Takeru , Hasegawa Masumi , Tahara Shinya 
Published: October 2007

ABSTRACTHypertrophic scars (HS) are a consequence of abnormal wound healing. We examined fatty acids that are contained within, and participate in, every reaction through the membrane; then, we analyzed the percentage composition of the fatty acids in deepithelialized normal dermis (ND) and HS. In vivo HS samples were obtained from six patients undergoing surgical excision, and ND samples from five patients undergoing skin grafting surgery for excess. In vitro, cultured fibroblasts from HS and ND were also analyzed. The percentage composition of fatty acids extracted from all the samples was analyzed. In vivo, arachidonic acid (20:4) was significantly more abundant in HS than in ND, in the phospholipids from both whole tissue and cell membranes. In vitro, there were no significant differences among ND, HS, and 10% fetal calf serum. The results suggest that HS formation does not necessarily involve simple excess of 20:4; however, there are considerable differences in the percentage composition of 20:4 between ND and HS. Arachidonic acid probably participates in the formation and maintenance of HS, whereas in vitro cultured fibroblasts are affected largely by fetal calf serum.
CARDIOVASCULAR AND SURVIVAL PARADOXES IN DIALYSIS PATIENTS: How to Reconcile Conventional and Altered Risk Factor Patterns in Dialysis Patients
Authors: Kopple Joel D. 
Published: October 2007

AbstractEpidemiological relationships between risk factors and outcome in patients with chronic kidney failure (CKF), including individuals with end‐stage kidney failure, can be categorized into three types: risk factor relationships that are similar to those observed in the general population; risk factor relationships that differ from those observed in the general population; and risk factor patterns that are difficult or not possible to compare to the general population, possibly because such risk factors have not been studied or are not capable of being studied in normal individuals. These latter risk factor patterns may or may not be different from what might commonly be anticipated. It is recommended that risk factor relationships in CKF patients which differ from those observed in the general population should be referred to as altered risk factor patterns (ARFPs). The causes for ARFPs include protein‐energy wasting and inflammatory disorders, which occur commonly in patients with CKF. Epidemiological and other evidence is presented suggesting that the ARFPs may also have other causes. Since ARFPs are common in CKF, it is important to understand the causes and appropriate therapeutic goals concerning these risk factors. Studies, including interventional clinical trials, are indicated to ascertain the causes of ARFPs and the therapeutic targets for these risk factors for individuals with chronic kidney disease and CKF.
Conivaptan: A Dual Receptor Vasopressin V1a/V2Antagonist
Authors: Ali Farhan , Raufi M. Adnan , Washington Barbara , Ghali Jalal K. 
Published: October 2007

ABSTRACTSeveral fluid retentive states such as heart failure, cirrhosis of the liver, and syndrome of inappropriate antidiuretic hormone secretion are associated with inappropriate elevation in plasma levels of arginine vasopressin (AVP), a neuropeptide that is secreted by the hypothalamus and plays a critical role in the regulation of serum osmolality and in circulatory homeostasis. The actions of AVP are mediated by three receptor subtypes V1a, V2, and V1b. The V1areceptor regulates vasodilation and cellular hypertrophy while the V2receptor regulates free water excretion. The V1breceptor regulates adrenocorticotropin hormone release. Conivaptan is a nonpeptide dual V1a/V2AVP receptor antagonist. It binds with high affinity, competitively, and reversibly to the V1a/V2receptor subtypes; its antagonistic effect is concentration dependent. It inhibits CYP3A4 liver enzyme and elevates plasma levels of other drugs metabolized by this enzyme. It is approved only for short‐term intravenous use. Infusion site reaction is the most common reason for discontinuation of the drug. In animals conivaptan increased urine volume and free water clearance. In heart failure models it improved hemodynamic parameters and free water excretion. Conivaptan has been shown to correct hyponatremia in euvolemic or hypervolemic patients. Its efficacy and safety for short‐term use have led to the Food and Drug Administration (FDA) approval of its intravenous form for the correction of hyponatremia in euvolemic and hypervolemic states. Despite its ability to block the action of AVP on V1areceptors, no demonstrable benefit from this action was noted in patients with chronic compensated heart failure and it is not approved for this indication. Consideration should be given to further evaluation of its potential benefits in patients with acute decompensated heart failure.
Edifoligide: A Transcription Factor Decoy to Modulate Smooth Muscle Cell Proliferation in Vein Bypass
Authors: Hoel Andrew W. , Conte Michael S. 
Published: October 2007

ABSTRACTThe era of genomics and recombinant DNA technology has ushered in an entirely new class of therapeutic agents designed to influence disease progression at a genetic level. The scope and utility of this technology is not fully realized. However, multiple trials of therapeutic agents have been completed and many more are ongoing. Here we report on edifoligide, a double‐stranded oligodeoxynucleotide (ODN) that competitively inhibits the transcription factor E2F, a critical regulator of the cell cycle. Edifoligide has undergone extensive clinical testing for the treatment of intimal hyperplasia following vascular bypass procedures. In this review we address the rationale for targeting E2F in vascular disease, the pharmacology of edifoligide, and the results of preclinical and clinical studies using this novel compound.
The Amygdala Regulates the Antianxiety Sensitization Effect of Flumazenil During Repeated Chronic Ethanol or Repeated Stress
Authors: Knapp Darin J. , Overstreet David H. , Angel Robert A. , Navarro Montserrat , Breese George R. 
Published: October 2007

Background: The benzodiazepine receptor antagonist flumazenil reduces anxiety‐like behavior and sensitization of anxiety‐like behavior in various models of ethanol withdrawal in rodents. The mechanism and brain region(s) that account for this action of flumazenil remain unknown. This investigation explored the potential role of several brain regions (amygdala, raphe, inferior colliculus, nucleus accumbens, and paraventricular hypothalamus) for these actions of flumazenil.Methods: Rats were surgically implanted with guide cannulae directed over the brain region of interest and then treated with an ethanol diet for three 7‐day dietary cycles (5 days on ethanol diet followed by 2 days on control diet). At approximately 4 hours, flumazenil was administered intracranially into each of the first 2 withdrawals. Examinations of anxiety‐like behavior followed 1 week later during a third withdrawal. In other animals, restraint stress sessions or intra‐amygdala DMCM (methyl‐6,7‐dimethoxy‐4‐ethyl‐β‐carboline‐3‐carboxylate) injections, preceded by intraperitoneal flumazenil injections, were substituted for the first 2 ethanol treatment cycles to assess the potential anxiety‐sensitizing action of stress or a benzodiazepine receptor inverse agonist, respectively.Results: Flumazenil treatment of the amygdala during the first 2 withdrawals blocked the development of sensitized anxiety seen during a third withdrawal. Similar actions of flumazenil were found when stress sessions substituted for the first 2 cycles of ethanol exposure and withdrawal. Amygdala treatment with DMCM magnified the anxiety response to the single subthreshold chronic ethanol treatment, and prophylactic flumazenil blocked this effect.Conclusions: Intra‐amygdala flumazenil inhibits the development of anxiety sensitized by repeated ethanol withdrawal, stress/ethanol withdrawal, or DMCM/ethanol withdrawal. These actions suggest that site‐specific and persistent effects of flumazenil on γ‐aminobutyric acid‐modulatory processes in this brain region are relevant to sensitized behavioral effects seen in alcoholism.
Introduction to the Assessing Care of Vulnerable Elders‐3 Quality Indicator Measurement Set
Authors: Wenger Neil S. , Roth Carol P. , Shekelle Paul ,   the ACOVE Investigators
Published: October 2007

OBJECTIVES: To update and increase the comprehensiveness of the Assessing Care of Vulnerable Elders (ACOVE) set of process‐of‐care quality indicators (QIs) for the medical care provided to vulnerable elders and to keep up with the constantly changing medical literature, the QIs were revised and expanded.DESIGN: The ACOVE Clinical Committee expanded the number of measured conditions to 26 in the revised (ACOVE‐3) set. For each condition, a content expert created potential QIs and, based on systematic reviews, developed a peer‐reviewed monograph detailing each QI and its supporting evidence. Using these literature reviews, multidisciplinary panels of clinical experts participated in two rounds of anonymous ratings and a face‐to‐face group discussion to evaluate whether the QIs were valid measures of quality of care using a process that is an explicit combination of scientific evidence and professional consensus. The Clinical Committee evaluated the coherence of the complete set of QIs that the expert panels rated as valid.RESULTS: ACOVE‐3 contains 392 QIs covering 14 different types of care processes (e.g., taking a medical history, performing a physical examination) and all four domains of care: screening and prevention (31% of QIs), diagnosis (20%), treatment (35%), and follow‐up and continuity (14%). All QIs also apply to community‐dwelling patients aged 75 and older.CONCLUSION: ACOVE‐3 contains a set of QIs to comprehensively measure the care provided to vulnerable older persons at the level of the health system, health plan, or medical group. These QIs can be applied to identify areas of care in need of improvement and can form the basis of interventions to improve care.
Depressive Symptoms, Inflammation, and Ischemic Stroke in Older Adults: A Prospective Analysis in the Cardiovascular Health Study
Authors: Arbelaez Jose J. , Ariyo Abraham A. , Crum Rosa M. , Fried Linda P. , Ford Daniel E. 
Published: October 2007

OBJECTIVES: To investigate the mediator role of inflammation in any relationship between depressive symptoms and ischemic stroke.DESIGN: Longitudinal prospective study.SETTING: Review of medical records, death certificates, and the Medicare healthcare utilization database for hospitalizations.PARTICIPANTS: Total of 5,525 elderly men and women aged 65 and older who were prospectively followed from 1989 to 2000 as participants in the Cardiovascular Health Study.MEASUREMENTS: Depression symptom scores, inflammatory markers.RESULTS: Greater depressive symptoms were associated with risk of ischemic stroke (unadjusted hazard ratio (HR)=1.32, 95% confidence interval (CI)=1.09–1.59; HR=1.26, 95% CI=1.03–1.54, adjusted for traditional risk factors). When a term for inflammation (C‐reactive protein (CRP)) was introduced in the model, the HRs were not appreciably altered (unadjusted HR=1.31, 95% CI=1.08–1.58; adjusted HR=1.25, 95% CI=1.02–1.53), indicating that CRP at baseline was not a mediator in this relationship. In analyses stratified according to CRP levels, a J‐shaped relationship between depressive symptoms and stroke was evident in the unadjusted analyses; in the fully adjusted model, only CRP in the highest tertile was associated with a higher risk for stroke in the presence of higher depressive symptoms scores.CONCLUSION: The analyses from this prospective study provide evidence of a positive association between depressive symptoms and risk of incident stroke. Inflammation, as measured according to CRP at baseline, did not appear to mediate the relationship between depressive symptoms and stroke.
Improvement in Usual Gait Speed Predicts Better Survival in Older Adults
Authors: Hardy Susan E. , Perera Subashan , Roumani Yazan F. , Chandler Julie M. , Studenski Stephanie A. 
Published: October 2007

OBJECTIVES: To estimate the relationship between 1‐year improvement in measures of health and physical function and 8‐year survival.DESIGN: Prospective cohort study.SETTING: Medicare health maintenance organization and Veterans Affairs primary care programs.PARTICIPANTS: Persons aged 65 and older (N=439).MEASUREMENTS: Six measures of health and function assessed at baseline and quarterly over 1 year. Participants were classified as improved at 1 year, transiently improved, or never improved for each measure using a priori definitions of meaningful change: gait speed (usual walking pace over 4 m), 0.1 m/s; Short Physical Performance Battery, 1 point; Medical Outcomes Study 36‐item Short Form Health Survey physical function, 10 points; EuroQol, 0.1 point; National Health Interview activity of daily living scale, 2 points; and global health change, two levels or reaching the ceiling. Mortality was ascertained from the National Death Index. Covariates included demographics, comorbidity, cognitive function, and hospitalization.RESULTS: Of the six measures, only improved gait speed was associated with survival. Mortality after 8 years was 31.6%, 41.2%, and 49.3% for those with improved, transiently improved, and never improved gait speed, respectively. The survival benefit for improvement at 1 year persisted after adjustment for covariates (hazard ratio=0.42, 95% confidence interval=0.29–0.61, P<.001) and was consistent across subgroups based on age, sex, ethnicity, initial gait speed, healthcare system, and hospitalization.CONCLUSION: Improvement in usual gait speed predicts a substantial reduction in mortality. Because gait speed is easily measured, clinically interpretable, and potentially modifiable, it may be a useful “vital sign” for older adults. Further research is needed to determine whether interventions to improve gait speed affect survival.
Has Mortality After a Hip Fracture Increased?
Authors: Vestergaard Peter , Rejnmark Lars , Mosekilde Leif 
Published: October 2007

OBJECTIVES: To study changes in mortality and causes of death in patients suffering a hip fracture between 1981 and 2001.DESIGN: Historic, register‐based cohort study.SETTING: Nationwide cohort study in Denmark.PARTICIPANTS: All 163,313 patients suffering a hip fracture between 1981 and 2001 in Denmark and 505,960 age‐ and sex‐matched controls.INTERVENTIONS: Osteosynthesis, arthroplasty, or other management for the hip fracture.MEASUREMENTS: Mortality and cause of death at 30 days and 1 year.RESULTS: The mean age of the patients with hip fracture increased (from 75.8 in 1981 to 78.1 in 2001, P<.01), and the proportion of men with hip fracture also increased (from 25.5% to 29.8%, P<.01). A statistically significant decrease was observed in crude 1‐year survival. Mortality increased in subjects with a hip fracture from 1981/85 to 1986/2001, whereas it decreased among controls. There was significantly greater mortality in patients undergoing arthroplasty (relative risk=1.05, 95% confidence interval=1.03–1.07) than in those undergoing osteosynthesis. Causes of death related to the trauma that caused the fracture explained most of the deaths (68–76%) within the first 30 days after the fracture.CONCLUSION: Significant demographic changes took place, with older people and more men experiencing hip fracture. After adjustment for age, sex, and comorbidity, survival was poorer in patients suffering a hip fracture than in controls. This calls for measures to improve survival.
Electrophysiologic and Anatomic Characterization of Sites Resistant to Electrical Isolation During Circumferential Pulmonary Vein Ablation for Atrial Fibrillation: A Prospective Study
Authors: KISTLER PETER M. , HO SIEW YEN , RAJAPPAN KIM , MORPER MICHAEL , HARRIS STUART , ABRAMS DOMINIC , SPORTON SIMON C. , SCHILLING RICHARD J. 
Published: October 2007

Background: Catheter ablation (CA) by wide encirclement of pulmonary veins (WEPV) restores sinus rhythm in up to 95%. Complex PV–left atrial (LA) connections make achieving electrical isolation (EI) challenging. We examined anatomical and technical features associated with resistance to EI during WEPV in a prospective study. Methods: One hundred one consecutive patients with symptomatic AF underwent first‐time CA guided by electroanatomic mapping and CT integration (Cartomerge™). Following double‐transseptal access, WEPV was performed. After completion of PV encirclement, the line was mapped and where no signal could be obtained, CA was performed inside the WE line at the site of earliest PV breakthrough on the circular mapping catheter. Sites of EI were tagged. Anatomic studies of corresponding regions of the venoatrial junction in 24 adult hearts were performed. Results: Sites resistant to EI were located at the inferior quadrant (P < 0.001) for the RSPV, superior quadrant (P < 0.001) for the RIPV, and the inferior and anterior quadrants (P < 0.001) for the LSPV. EI was significantly less frequent at the posterior quadrant (P < 0.001) for the LIPV. To achieve EI, CA was necessary inside the WE on the intervenous ridge on the right in 51% and on the left in 41%. The LPV/LAA ridge was investigated by anatomic studies that demonstrated considerable variation in the narrowest width (3–23.7 mm) and transmural thickness (1–5 mm). Conclusion: Sites of EI after WEPV have a preferential distribution determined by anatomic features. CA on the intervenous ridge is required in a significant proportion of patients to achieve EI. Atrial folds and ridges increase myocardial thickness creating technical and anatomic challenges for achieving transmural lesions.
Azimilide for the Treatment of Atrial Fibrillation, Atrial Flutter, and Paroxysmal Supraventricular Tachycardia: Results of a Randomized Trial and Insights on the Concordance of Symptoms and Recurrent Arrhythmias
Authors: PAGE RICHARD L. , PRITCHETT EDWARD L.C. , CONNOLLY STUART , WILKINSON WILLIAM E. ,   For the SVA‐4 Investigators
Published: October 2007

Introduction: Azimilide hydrochloride is an investigational antiarrhythmic medication that had shown evidence of efficacy in prolonging the time to recurrence of atrial fibrillation (AF) or atrial flutter (AFL) and paroxysmal supraventricular tachycardia (PSVT). This study was designed to confirm efficacy of 125 mg daily azimilide. Methods and Results: The primary endpoint was ECG‐documented recurrence of AF, AFL, or PSVT, followed for a maximum of 180 days. Four hundred eighty‐two patients were enrolled in the United States and Canada (422 with AF or AFL and 60 with PSVT). The primary efficacy analysis included 402 patients with AF‐AFL and 56 patients with PSVT. There was no significant difference in the time to first recurrence of symptomatic supraventricular arrhythmia in the AF‐AFL stratum (median of 38 days for azimilide versus 27 days for placebo; hazard ratio [HR] of 1.14, P = 0.29). Similarly, there was no difference in time to recurrence in the PSVT stratum (>180 days for azimilide versus 135 days for placebo; HR = 1.28, P = 0.55). There were three deaths in the azimilide group and one in the placebo group. Four patients had nonsustained ventricular tachycardia (one torsades de pointes), all in the azimilide group. Asymptomatic recurrence was frequent in the AF‐AFL group (8% with azimilide and 11% with placebo), but was absent in the PSVT group. False recurrence was common in both groups. Conclusion: Azimilide 125 mg daily was not associated with significant prolongation of the time to recurrent symptomatic supraventricular arrhythmias. There was substantial discordance between symptoms and recurrence.
A case of nodular sclerosis Hodgkin’s lymphoma repeatedly relapsing in the context of composite plasma cell‐hyaline vascular Castleman’s disease: successful response to rituximab and radiotherapy
Authors: Falchi Lorenzo , Capello Daniela , Palumbo Barbara , Rauco Annamaria , Emili Rita , Cianciulli Michele , Pace Roberta , Capparella Vincenzo , Liberati Fabrizio , Liberati Anna Marina 
Published: October 2007

AbstractWe report the case of an Epstein‐Barr virus (EBV)‐ and human immunodeficiency virus‐serum negative patient suffering from repeatedly relapsing classical Hodgkin’s Lymphoma (cHL) associated with a histological picture of plasma cell‐hyaline vascular (PC‐HV) form of Castleman’s disease (CD). The CD30‐ and CD15‐ positive, Reed‐Sternberg/Hodgkin cells, only occasionally expressed the CD20 molecule, but not leukocyte common antigen and latent membrane protein‐1. Single‐strand polymerase chain reaction failed to detect human herpesvirus 8 or EBV in the involved tissues. At the time of second relapse in July 2005, the clinical picture was characterized by a palpable right hypogastric mass, disclosed at physical exam, in the absence of other enlarged peripheral lymph nodes, subjective symptoms or laboratory profile alterations. Combined hybrid‐(18)F‐fluorodeoxyglucose positron emission‐computerized tomography (18F‐FDG PET/CT) showed increased radionuclide uptake in multiple external iliac lymph nodes [standardized uptake value (SUV) of 7.4] and non‐palpable left supraclavicular lymph nodes (SUV of 5.8). Relapsing cHL in the context of mixed PC‐HV CD was documented in two of three surgically excised abdominal lymph nodes never previously enlarged or involved by any lymphoproliferative disease. Because of the limited disease extension and failure to induce continuous remission with previous conventional chemoradiotherapy, the patient was treated with six rituximab injections. This immunotherapy induced significant reduction in size of supraclavicular lymph nodes as evident at ultrasound (US) scan (<1 vs. 2.5 cm, post‐ vs. pretherapy), which was confirmed by the 18F‐FDG PET/CT in October 2005, despite no modification in SUV of 4.2. 18F‐FDG PET/CT also disclosed no radionuclide uptake by abdominal lymph nodes. Thus, a second course of four additional rituximab injections was given and subsequent 18F‐FDG PET/CT indicated persistent, but reduced incorporation of radionuclide compared to the pretherapy value (SUV of 2.7) in the supraclavicular area and confirmed a normal metabolic activity in the iliac external lymph nodes. Because of uncertain persistent disease in the supraclavicular nodal site, involved‐field radiotherapy (RT) was delivered in that area as consolidation treatment. After completion of rituximab and RT for 16 and 14 months respectively, US and 18F‐FDG PET/CT exams were indicative of complete remission. This case is in concordance with previously published data suggesting that rituximab immunotherapy might be a valid option in the treatment of CD and also have a role in the management of relapsing cHL.