Home About us Contact
|
Home About us Contact | ||
|
|
||
Major Cause (major + cause)
Selected AbstractsEmergence of Salmonella paratyphi A as a Major Cause of Enteric Fever: Need for Early Detection, Preventive Measures, and Effective VaccinesJOURNAL OF TRAVEL MEDICINE, Issue 5 2008Monthida Fangtham MD First page of article [source] Antibody-Mediated Microcirculation Injury Is the Major Cause of Late Kidney Transplant FailureAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2010A. Loupy No abstract is available for this article. [source] Antibody-Mediated Microcirculation Injury Is the Major Cause of Late Kidney Transplant Failure: Response to Dr. Loupy et al.AMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2010G. Einecke No abstract is available for this article. [source] Antibody-Mediated Microcirculation Injury Is the Major Cause of Late Kidney Transplant FailureAMERICAN JOURNAL OF TRANSPLANTATION, Issue 11 2009G. Einecke We studied the phenotype of late kidney graft failure in a prospective study of unselected kidney transplant biopsies taken for clinical indications. We analyzed histopathology, HLA antibodies and death-censored graft survival in 234 consecutive biopsies from 173 patients, taken 6 days to 31 years posttransplant. Patients with late biopsies (>1 year) frequently displayed donor-specific HLA antibody (particularly class II) and microcirculation changes, including glomerulitis, glomerulopathy, capillaritis, capillary multilayering and C4d staining. Grafts biopsied early rarely failed (1/68), whereas grafts biopsied late often progressed to failure (27/105) within 3 years. T-cell-mediated rejection and its lesions were not associated with an increased risk of failure after biopsy. In multivariable analysis, graft failure correlated with microcirculation inflammation and scarring, but C4d staining was not significant. When microcirculation changes and HLA antibody were used to define antibody-mediated rejection, 17/27 (63%) of late kidney failures after biopsy were attributable to antibody-mediated rejection, but many were C4d negative and missed by current diagnostic criteria. Glomerulonephritis accounted for 6/27 late losses, whereas T-cell-mediated rejection, drug toxicity and unexplained scarring were uncommon. The major cause of late kidney transplant failure is antibody-mediated microcirculation injury, but detection of this phenotype requires new diagnostic criteria. [source] Prevention of pneumococcal disease in children.ACTA PAEDIATRICA, Issue 5 2001Pneumococcal conjugate vaccines: their use globally could have a major impact on public health Pneumococcal disease is a major cause of morbidity and mortality in infants and young children worldwide. New pneumococcal conjugate vaccines include 7 to 11 serotypes, which are the most common cause of paediatric disease in most parts of the world. The efficacy of a 7-valent conjugate vaccine was 97.4% (95% CI, 82.7,99.9) against invasive pneumococcal disease, and 57% (95% CI, 44,67) against otitis media, caused by vaccine serotypes. Evidence shows that the vaccine has the potential to prevent pneumonia. Pneumococcal conjugate vaccination has also been shown to reduce nasopharyngeal carriage of vaccine serotypes (particularly serotypes associated with antibiotic resistance). Thus widespread use of pneumococcal conjugate vaccine could substantially reduce the burden of invasive disease and would have the potential to control the global spread of antibiotic resistance in pneumococci. Conclusion: It is important that these highly effective vaccines should be made available to children in the developing countries. [source] Recurrent abdominal pain, food allergy and endoscopyACTA PAEDIATRICA, Issue 1 2001Steffen Husby Gastrointestinal food allergy, a well-recognized clinical entity, has a wide spectrum of clinical features, including cutaneous, respiratory and gastrointestinal symptoms and objective abnormalities. The gastrointestinal alterations in food allergy have been described throughout the gastrointestinal tract. Recurrent abdominal pain (RAP) is a common complaint in school-age children. The findings among children with RAP of an underlying food allergy associated with mucosal pathology of the foregut may support a causal relationship between food allergy and RAP. Further studies are needed to elucidate whether well-documented food allergy (based on double-blind placebo-controlled food challenges) is a major cause of RAP. [source] Congenital Cardiovascular Disease in Turner SyndromeCONGENITAL HEART DISEASE, Issue 1 2008Carolyn A. Bondy MD ABSTRACT Turner syndrome (TS), or monosomy X, occurs in ,1/2000 live born females. Intelligence is normal and short stature is the most obvious and consistent feature of the syndrome. Congenital cardiovascular disease affects ,50% of individuals and is the major cause of premature mortality in adults. Unfortunately, this most important aspect of the syndrome has received little attention outside of pediatric medicine, and adult cardiological follow-up is seriously lacking. This review describes the spectrum of cardiovascular defects with particular attention to identifying risk factors for aortic dissection/rupture. X-chromosome genetic pathways implicated in Turner cardiovascular disease, including premature coronary artery disease, are discussed. Recent guidelines for diagnosis and treatment of girls and women with TS are reviewed. [source] Evaluation of sympathetic vasoconstrictor response following nociceptive stimulation of latent myofascial trigger points in humansACTA PHYSIOLOGICA, Issue 4 2009Y. Kimura Abstract Aim:, Myofascial trigger points (MTrPs) are a major cause of musculoskeletal pain. It has been reported that stimulation of a latent MTrP increases motor activity and facilitates muscle pain via activation of the sympathetic nervous system. However, the magnitude of the sympathetic vasoconstrictor response following stimulation of MTrP has not been studied in healthy volunteers. The aims of this study were to (1) evaluate the magnitude of the vasoconstrictor response following a nociceptive stimulation (intramuscular glutamate) of MTrPs and a breath-hold manoeuvre (activation of sympathetic outflow) and (2) assess whether the vasoconstrictor response can be further modulated by combining a nociceptive stimulation of MTrPs and breath-hold. Methods:, Fourteen healthy subjects were recruited in this study. This study consisted of four sessions (normal breath group as control, breath-hold group, glutamate MTrP injection group and glutamate MTrP injection + breath-hold group). Skin blood flow and skin temperature in both forearms were measured with laser Doppler flowmetry and infrared thermography, respectively, in each session (before the treatment, during the treatment and after the treatment). Results:, Glutamate injection into MTrPs decreased skin temperature and blood flow in the peripheral area. The magnitudes of the reduction were comparable to those induced by the breath-hold manoeuvre, which has been used to induce sympathetic vasoconstrictor response. Conclusion:, The combination of glutamate injection into latent MTrPs together with the breath-hold manoeuvre did not result in further decrease in skin temperature and blood flow, indicating that sympathetic vasoconstrictor activity is fully activated by nociceptive stimulation of MTrPs. [source] Mechanical removal of necrotic periodontal ligament by either Robinson bristle brush with pumice or scalpel blade.DENTAL TRAUMATOLOGY, Issue 6 2007Histomorphometric analysis, scanning electron microscopy Abstract,,, One of the important factors accounting for successful delayed replantation of avulsed teeth is seemingly the type of root surface treatment. Removal of necrotic cemental periodontal ligament remnants may prevent the occurrence of external root resorption, which is the major cause of loss of teeth replanted in such conditions. The purpose of this study was to compare the efficacy of two mechanical techniques for removal of root-adhered periodontal ligament. Preservation or removal of the cementum layer concomitantly with these procedures was also assessed. Forty-five roots of healthy premolars extracted for orthodontic purposes were selected. After extraction, the teeth were kept dry at room temperature for 1 h and then immersed in saline for rehydration for an additional 10 min. Thereafter, the roots were assigned to three groups, as follows: group 1 (control) - the cemental periodontal ligament was preserved; group 2 - removal of the periodontal ligament by scraping root surface with a scalpel blade (SBS); group 3 - periodontal ligament remnants were removed using a Robinson bristle brush at low-speed with pumice/water slurry (RBP). The specimens were analysed histomorphometrically and examined by scanning electron microscopy. The quantitative and qualitative analyses of the results showed that the RBP technique was significantly more effective than the SBS technique for removal of the periodontal ligament remnants adhered to root surface. Both techniques preserved the cementum layer. [source] Neurotrophic rationale in glaucoma: A TrkA agonist, but not NGF or a p75 antagonist, protects retinal ganglion cells in vivoDEVELOPMENTAL NEUROBIOLOGY, Issue 7 2007ZhiHua Shi Abstract Glaucoma is a major cause of vision impairment, which arises from the sustained and progressive apoptosis of retinal ganglion cells (RGC), with ocular hypertension being a major risk or co-morbidity factor. Because RGC death often continues after normalization of ocular hypertension, growth factor-mediated protection of compromised neurons may be useful. However, the therapeutic use of nerve growth factor (NGF) has not proven effective at delaying RGC death in glaucoma. We postulated that one cause for the failure of NGF may be related to its binding to two receptors, TrkA and p75. These receptors have distinct cellular distribution in the retina and in neurons they induce complex and sometimes opposing activities. Here, we show in an in vivo therapeutic model of glaucoma that a selective agonist of the pro-survival TrkA receptor was effective at preventing RGC death. RGC loss was fully prevented by combining the selective agonist of TrkA with intraocular pressure-lowering drugs. In contrast, neither NGF nor an antagonist of the pro-apoptotic p75 receptor protected RGCs. These results further a neurotrophic rationale for glaucoma. © 2007 Wiley Periodicals, Inc. Develop Neurobiol, 2007. [source] Advanced glycation endproducts: what is their relevance to diabetic complications?DIABETES OBESITY & METABOLISM, Issue 3 2007N. Ahmed Glycation is a major cause of spontaneous damage to proteins in physiological systems. This is exacerbated in diabetes as a consequence of the increase in glucose and other saccharides derivatives in plasma and at the sites of vascular complications. Protein damage by the formation of early glycation adducts is limited to lysine side chain and N-terminal amino groups whereas later stage adducts, advanced glycation endproducts (AGEs), modify these and also arginine and cysteine residues. Metabolic dysfunction in vascular cells leads to the increased formation of methylglyoxal which adds disproportionately to the glycation damage in hyperglycaemia. AGE-modified proteins undergo cellular proteolysis leading to the formation and urinary excretion of glycation free adducts. AGEs may potentiate the development of diabetic complications by activation of cell responses by AGE-modified proteins interacting with specific cell surface receptors, activation of cell responses by AGE free adducts, impairment of protein,protein and enzyme,substrate interactions by AGE residue formation, and increasing resistance to proteolysis of extracellular matrix proteins. The formation of AGEs is suppressed by intensive glycaemic control, and may in future be suppressed by thiamine and pyridoxamine supplementation, and several other pharmacological agents. Increasing expression of enzymes of the enzymatic defence against glycation provides a novel and potentially effective future therapeutic strategy to suppress protein glycation. [source] Insulin resistance, diabetes and cardiovascular risk: approaches to treatmentDIABETES OBESITY & METABOLISM, Issue 6 2005Daniel E. Rosenberg Abstract:, The prevalence of diabetes is increasing worldwide. Insulin resistance and diabetes mellitus are major predictors of cardiovascular ischaemic disease. Other risk factors for cardiovascular death including hypertension, dyslipidaemia, smoking and visceral obesity are especially lethal in diabetics. C-reactive protein, plasminogen activator inhibitor-1, matrix metalloproteinases and other emerging risk factors and their roles are continually being researched and discovered. Treatment of this syndrome must be aimed at lifestyle modification, glycaemic control and management of concomitant risk factors. Diet and exercise play a vital role in the treatment of diabetes and the metabolic syndrome. Weight reduction and increased physical activity will improve insulin resistance, hyperglycaemia, hypertension and dyslipidaemia. Hypertension management has been shown to be especially important in diabetics to prevent cardiovascular events. Likewise, multiple clinical trials show that reduction of cholesterol is even more vital in diabetics than the general population for risk reduction of coronary disease. There is a great deal of evidence that tight control of glycaemia is essential to treatment of this condition. There are a variety of available pharmacological agents available including metformin, insulin secretagogues, alpha-glucosidase inhibitors, thiazolidinediones and insulin. The mechanisms and side effects of these medications are discussed. As macrovascular disease is the major cause of morbidity and mortality, an early, aggressive, multi-factorial approach to treatment of the metabolic syndrome and diabetes is vital to prevent adverse cardiac outcomes. [source] Higher arterial stiffness, greater peripheral vascular resistance and lower blood flow in lower-leg arteries are associated with long-term hyperglycaemia in type 2 diabetic patients with normal ankle-brachial indexDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 4 2009Eiji Suzuki Abstract Background Higher arterial stiffness and greater peripheral vascular resistance reduce blood flow in lower-leg arteries and contribute to the development of ischaemic limb in diabetic patients even without peripheral artery occlusive disease. The aim of this study was to clarify whether these vascular parameters are associated with long-term hyperglycaemia in diabetic patients. Methods We examined 45 type 2 diabetic patients and 38 age-matched nondiabetic subjects without peripheral artery occlusive disease assessed by ankle-brachial index consecutively admitted to our hospital, and followed them over a 3-year period (3.7 ± 0.7 years) with no vasodilative medication. Blood flow and resistive index, a measure of peripheral vascular resistance, at the popliteal artery were evaluated using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. Brachial-ankle pulse wave velocity was measured to assess arterial stiffness. Results At baseline, consistent with our previous report, diabetic patients showed higher brachial-ankle pulse wave velocity (p < 0.0001) and resistive index (p < 0.0001) and lower flow volume (p = 0.0044) than those of nondiabetic subjects. Stepwise multiple regression analysis revealed that duration of diabetes, mean HbA1c during the study, use of renin-angiotensin system inhibitors and change per year in resistive index were identified as significant independent variables predicting change per year in blood flow (r2 = 0.733, p < 0.0001) in diabetic patients. Mean HbA1c during the study was positively correlated with changes per year in brachial-ankle pulse wave velocity (p = 0.00007) and resistive index (p = 0.0014) and was negatively correlated with that in blood flow (p < 0.0001) in diabetic patients. Conclusions Long-term hyperglycaemia is a major cause of impaired peripheral circulation in lower-leg arteries in diabetic patients without peripheral artery occlusive disease. Copyright © 2009 John Wiley & Sons, Ltd. [source] Some historical aspects of diabetic foot diseaseDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue S1 2008Henry Connor Abstract During the 19th century and for much of the 20th century, disease of the lower limb in diabetic patients was conceptualized not, as it is now, as ,the diabetic foot' or as ,a diabetic foot ulcer' but as ,gangrene in the diabetic foot' or as ,diabetic gangrene'. The prognostically and therapeutically important distinction between gangrene due to vascular insufficiency and gangrene due to infection in a limb with a normal or near normal blood supply was not made until about 1893. The advent of aseptic surgery improved the survival of amputation flaps, but surgery remained a hazardous undertaking until the discovery of insulin. Although insulin therapy reduced the risk of surgical intervention, diabetic foot disease now replaced hyperglycaemic coma as the major cause of diabetic mortality. The increasing workload attributable to diabetic foot disease after the introduction of insulin is reflected in the publications on diabetes in the 1920s. In some hospitals in North America this led to initiatives in prophylactic care and patient education, the importance of which were only more widely appreciated some 60 years later. A continuing emphasis on ischemia and infection as the major causes of diabetic foot disease led to a neglect of the role of neuropathy. In consequence, the management of diabetic neuropathic ulceration entered a prolonged period of therapeutic stagnation at a time when significant advances were being made in the management of lepromatous neuropathic ulceration. Reasons for the revival of progress in the management of diabetic neuropathic ulceration in the 1980s will be discussed. Copyright © 2008 John Wiley & Sons, Ltd. [source] ,Lipoproteins, glycoxidation and diabetic angiopathy'DIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 5 2004Alicia J. Jenkins Abstract The chronic vascular complications of diabetes (nephropathy, retinopathy and accelerated atherosclerosis) are a major cause of morbidity and premature mortality. In spite of the more widespread availability of intensive diabetes management, approximately one in three people with diabetes develop aggressive complications and over 70% die of atherosclerosis-related diseases. Genetic and acquired factors are likely to be contributory. Potential mediators of vascular damage may include the interrelated processes of lipoprotein abnormalities, glycation, oxidation and endothelial dysfunction. Lipoprotein abnormalities encompass alterations in lipid concentrations, lipoprotein composition and subclass distribution and lipoprotein-related enzymes. Nonenzymatic glycation and oxidative damage to lipoproteins, other proteins and to vascular structures may also be deleterious. As atherosclerosis is a chronic condition commencing in youth, and because clinical events may be silent in diabetes, surrogate measures of vascular disease are important for early identification of diabetic patients with or at high risk of vascular damage, and for monitoring efficacy of interventions. The increasing array of biochemical assays for markers and mediators of vascular damage, noninvasive measures of vascular health, and therapeutic options should enable a reduction in the excessive personal and economic burden of vascular disease in type 1 and type 2 diabetes. Copyright © 2004 John Wiley & Sons, Ltd. [source] Vascular endothelial growth factor and diabetic retinopathy: pathophysiological mechanisms and treatment perspectivesDIABETES/METABOLISM: RESEARCH AND REVIEWS, Issue 6 2003Ruth B. Caldwell Abstract Retinal neovascularization and macular edema are central features of diabetic retinopathy, the major cause of blindness in the developed world. Current treatments are limited in their efficacy and are associated with significant adverse effects. Characterization of the molecular and cellular processes involved in vascular growth and permeability has led to the recognition that the angiogenic growth factor and vascular permeability factor vascular endothelial growth factor (VEGF) plays a pivotal role in the retinal microvascular complications of diabetes. Therefore, VEGF represents an exciting target for therapeutic intervention in diabetic retinopathy. This review highlights the current understanding of the mechanisms that regulate VEGF gene expression and mediate its biological effects and how these processes may become altered during diabetes. The cellular and molecular alterations that characterize experimental models of diabetes are considered in relation to the influence of high glucose-mediated oxidative stress on VEGF expression and on the mechanisms of VEGF's actions under hyperglycemic induction. Finally, potential therapeutic strategies for preventing VEGF overexpression or blocking its pathological effects in the diabetic retina are considered. Copyright © 2003 John Wiley & Sons, Ltd. [source] Diabetes control and complications: the role of glycated haemoglobin, 25 years onDIABETIC MEDICINE, Issue 7 2004S. L. Jeffcoate Abstract The long-term complications of diabetes have major consequences for individual subjects and growing healthcare delivery and cost implications for society. Evidence for the benefits of good glycaemic control, as monitored by glycated haemoglobin measurements, has been developed in the 25 years since they were introduced to the point where HbA1c assays play central roles in patient management, clinical guidance and audit, and clinical trial design. In this review this evidence is examined and three classes of uncertainty identified that diminish confidence in the effectiveness of these roles for HbA1c. 1Analytical variability between different methods for HbA1c has restricted the application of clinical targets and this problem has recently been addressed by reference method standardization. There are two approaches to this which result in different HbA1c values and this discrepancy needs to be resolved. 2Biological variability in HbA1c values between individuals also restricts its predictive role when applied to populations. The correlations between HbA1c measurements and various components of glycaemia (overall, fasting, postprandial) are still uncertain and differences in protein glycation and de-glycation are greater between subjects than often thought. The influence of variability in erythrocyte life span is an area where research is needed, especially in diabetic subjects. 3Clinical variability is the most important and complex area of uncertainty. A predictive link between HbA1c and clinical outcomes is not as clear-cut as often stated. The correlation with the development of microvascular disease is well established in Type 1 diabetes, but in Type 2 subjects (90% of those with diabetes) the evidence that HbA1c monitoring is of value in predicting or preventing macrovascular disease is not strong, although it is the major cause of morbidity and early death in this group. It is recommended that, as a matter of urgency, these issues be examined, particularly within the context of self-care in diabetes. Diabet. Med. **, ***,*** (2003) [source] EARLY DIAGNOSIS OF SMALL PANCREATIC CANCER: ROLE OF ENDOSCOPIC ULTRASONOGRAPHYDIGESTIVE ENDOSCOPY, Issue 2009Atsushi Irisawa Advanced pancreatic cancer is a major cause of cancer-related death. However, if surgery achieves clear margins and negative lymph nodes, the prognosis for survival can be prolonged. Therefore, early diagnosis , as early as possible , is important for improving overall survival and quality of life in patients with pancreatic cancer. Because of higher imaging resolution near the pancreas through the gastroduodenal wall, endoscopic ultrasonography enables detection of subtle pancreatic abnormalities. In fact, many investigators have reported the high ability of EUS not only for detection of small lesions but also recognition of chronic pancreatitis, which is the risky status of pancreatic cancer. As a tool for early diagnosis of pancreatic cancer, EUS is a highly anticipated modality. [source] Effects of seismic intensity and socioeconomic status on injury and displacement after the 2007 Peru earthquakeDISASTERS, Issue 4 2010Karen Milch Earthquakes are a major cause of displacement, particularly in developing countries. Models of injury and displacement can be applied to assist governments and aid organisations in effectively targeting preparedness and relief efforts. A stratified cluster survey was conducted in January 2008 to evaluate risk factors for injury and displacement following the 15 August 2007 earthquake in southern Peru. In statistical modelling, seismic intensity, distance to rupture, living conditions, and educational attainment collectively explained 54.9 per cent of the variability in displacement rates across clusters. Living conditions was a particularly significant predictor of injury and displacement, indicating a strong relationship between risk and socioeconomic status. Contrary to expectations, urban, periurban, and rural clusters did not exhibit significantly different injury and displacement rates. Proxies of socioeconomic status, particularly the living conditions index score, proved relevant in explaining displacement, likely due to unmeasured aspects of housing construction practices and building materials. [source] The termination of the last major phase of aeolian sand movement, coastal dunefields, DenmarkEARTH SURFACE PROCESSES AND LANDFORMS, Issue 7 2006Lars B. Clemmensen Abstract Optically stimulated luminescence (OSL) dating of sand samples from stabilized (or inactive) coastal dunes in Denmark provides information on the age of the termination phase of the last major aeolian activity period. A total of 26 sand samples were taken from four different coastal dunefields around the North Sea, Skagerrak and Kattegat coasts of Denmark. The OSL dates indicate that the last major phase of aeolian activity terminated between ad 1860 and 1905. Most of the dunes examined in this study were active around 1820, during a period documented to have been very stormy. A dune management scheme started around 1792, and this no doubt was a major cause of dunefield stabilization, but an overall decline of storminess, particularly spring and summer storminess, around the end of the 19th century must also have contributed to the increasing inactivity of coastal dunes. The new OSL dates on aeolian sand movement agree well with historical data and data from topographic maps on dune movement. This agreement supports the observation from earlier work that OSL dating of recent aeolian sand movement is accurate over the last few decades to centuries. Copyright © 2005 John Wiley & Sons, Ltd. [source] Experimental and analytical study on pounding reduction of base-isolated highway bridges using MR dampersEARTHQUAKE ENGINEERING AND STRUCTURAL DYNAMICS, Issue 11 2009Anxin Guo Abstract Pounding between adjacent superstructures has been a major cause of highway bridge damage in the past several earthquakes. This paper presents an experimental and analytical study on pounding reduction of highway bridges subjected to earthquake ground motions by using magnetorheological (MR) dampers. An analytical model, which incorporates structural pounding and MR dampers, is developed. A series of shaking table tests on a 1:20 scaled base-isolated bridge model are performed to investigate the effects of pounding between adjacent superstructures on the dynamics of the structures. Based on the test results, the parameters of the linear and the nonlinear viscoelastic impact models are identified. Performance of the semiactive system for reducing structural pounding is also investigated experimentally, in which the MR dampers are used in conjunction with the proposed control strategy, to verify the effectiveness of the MR dampers. Structural responses are also simulated by using the established analytical model and compared with the shaking table test results. The results show that pounding between adjacent superstructures of the highway bridge significantly increases the structural acceleration responses. For the base-isolated bridge model considered here, the semiactive control system with MR dampers effectively precludes pounding. Copyright © 2009 John Wiley & Sons, Ltd. [source] Role of Dobutamine Stress Echocardiography for Preoperative Cardiac Risk Assessment Before Major Vascular Surgery: A Diagnostic Tool Comes of AgeECHOCARDIOGRAPHY, Issue 1 2000DON POLDERMANS M.D. Background: Cardiac complications are a major cause for perioperative mortality and morbidity Also, the presence and severity of underlying coronary artery disease (CAD) determine long-ten prognosis after successful surgery. Aim: This overview evaluates the additional value ofdobutamir, stress echocardiography (DSE) to common clinical cardiac risk factors and other noninvasii cardiac imaging modalities for perioperative and late cardiac prognosis. Results: DSE provides tl attending physician with preoperative prognostic information for perioperative and long-ten prognosis for cardiac events. It also enables the selection of high risk patients for evaluation i cardiac risk reduction therapies. Conclusions: DSE is a useful tool for preoperative cardiac ris evaluation in addition to common clinical cardiac risk factors. (ECHOCARDIOGRAPHY, Vo ume 17, January 2000) [source] Landscape composition and vole outbreaks: evidence from an eight year study of Arvicola terrestrisECOGRAPHY, Issue 6 2000E. Fichet-Calvet This study investigates the relationships between landscape composition and the population dynamics of the fossorial water vole Arvicola terrestris. Land use patterns were studied based on agricultural and forestry data from the French Ministry of Agriculture collected in 1955 and 1988. In the Massif Central, France, water vole populations were monitored from 1985 to 1993 by using index methods. Outbreaks of water vole populations occurred in many dispersed epicentres and spread suddenly and widely over > 7500 km2. At a regional scale, the fluctuation lasts six years on average with an outbreak period lasting from two to three years. Density variation patterns are positively correlated with the proportion of permanent grassland to agricultural land. A high risk of outbreak is linked to a high proportion of permanent grassland (over 90%), whereas a low risk of outbreak is linked to a proportion of < 80%, Conversely, density variation patterns are negatively correlated with the proportion of temporary grassland to agricultural land and with the proportion of forest to total land in the western (major) part of the study area. Temporary grassland thus appears to be a marginal habitat for water voles and extensive forests could act as a brake on outbreaks. The increase in the area of permanent grassland from 1955 to 1988 was apparently the major cause of chronic high densities of water voles. Therefore, land use and landscape management could be one way to control water vole outbreaks. [source] A study of lightning phenomena on distribution lines based on a lightning-surge analysis model for direct lightning strokesELECTRONICS & COMMUNICATIONS IN JAPAN, Issue 10 2008Teru Miyazaki Abstract In order to rationalize the lightning protection design of distribution lines, lightning phenomena on TEPCO's distribution lines were continuously observed. The observations were carried out with still cameras and lightning surge monitoring sensors. The results elucidate the lightning performance of distribution lines. For example, direct lightning strokes are the major cause of the present distribution line faults. This fact suggests that it is important to investigate observation data on direct lightning strokes. The observation data were analyzed by means of a direct lightning analysis model. The calculated waveforms were compared with the measured waveforms on distribution lines. The probability distributions of the surge currents and voltages were calculated by the Monte Carlo method. These results provide new data on lightning performance. © 2009 Wiley Periodicals, Inc. Electron Comm Jpn, 91(10): 28, 37, 2008; Published online in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ecj.10164 [source] Head injuries related to sports and recreation activities in school-age children and adolescents: Data from a referral centre in Victoria, AustraliaEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2010Louise M Crowe Abstract Objectives:, Head injuries (HI) in children are common and even mild HI can lead to ongoing cognitive and behavioural changes. We set out to determine the causes of sport-related HI in school-age children presenting to a large urban ED as a basis for future interventions. Method:, Identification and medical record review of all sport-related HI in children aged 6,16 years at a tertiary children's hospital ED in Victoria, Australia, over a 1 year period. Information was collected on demographics, injury variables and radiology findings. HI were classified as mild, moderate and severe based on GCS and radiography reports. Results:, Over 12 months there were 406 HI in school-age children. Seventy per cent were male. A large number of HI (129; 33%) were related to sports. Of these, most were classified as mild and 13% were classified as moderate or severe. Among a range of sports, Australian Rules football was associated with more than 30% of all HI attributable to a sport and recreation cause. Equestrian activities were the main cause of moderate HI. Conclusion:, The present study identified sports as a major cause of HI in the Victorian paediatric emergency setting with Australian Rules football the most commonly involved sport. Further prevention initiatives should consider targeting Australian Rules football and equestrian activities. [source] Why should addiction medicine be an attractive field for young physicians?ADDICTION, Issue 2 2009Michael Soyka ABSTRACT Aims The clinical practice and science of addiction are increasingly active fields, which are attracting professionals from diverse disciplines such as psychology and neurobiology. Our scientific knowledge of the pathophysiology of addiction is rapidly growing, along with the variety of effective treatments available to clinicians. Yet, we believe that the medical specialties of addiction medicine/psychiatry are not attracting the interest and enthusiasm of young physicians. What can be done? Methods We offer the opinions of two experience addiction psychiatrists. Results In the US, there has been a decline in the number of psychiatrists seeking training or board certification in addiction psychiatry; about one-third of graduates with such training are not practicing in an addiction psychiatry setting. There is widespread neglect of addiction medicine/psychiatry among the medical profession, academia and national health authorities. This neglect is unfortunate, given the enormous societal costs of addiction (3,5% of the gross domestic product in some developed countries), the substantial unmet need for addiction treatment, and the highly favourable benefit to cost yield (at least 7:1) from treatment. Conclusions We believe that addiction medicine/psychiatry can be made more attractive for young physicians. Helpful steps include widening acceptance as a medical specialty or subspecialty, reducing the social stigma against people with substance use disorders, expanding insurance coverage and increasing the low rates of reimbursement for physicians. These steps would be easier to take with broader societal (and political) recognition of substance use disorders as a major cause of premature death, morbidity and economic burden. [source] Reduced nicotinamide adenine dinucleotide phosphate and the higher incidence of pollution-induced liver cancer in female flounderENVIRONMENTAL TOXICOLOGY & CHEMISTRY, Issue 11 2003Angela Koehler Abstract In biological effect monitoring programs, induction of biotransformation and detoxification enzymes is used as a biomarker for pollution. Yet sex differences are usually neglected in the availability of reduction equivalents needed in these metabolic pathways and may affect biomarker responses. For example, female flounder have a threefold higher incidence of macroscopic liver nodules than males of the same age class in polluted environments of the North Sea that progress toward carcinomas, whereas tumors in males virtually never develop into cancer. Evidence is presented in this review that NADPH plays a significant role in this sex-related response to xenobiotics in liver of flounder. The NADPH is needed for biosynthesis, particularly of lipids and lipoproteins, and detoxification processes such as one-electron and two-electron biotransformation and conjugation and, therefore, its availability as substrate determines biomarker responses. Biotransformation of xenobiotics is more strongly induced and conjugation processes are less affected in male flounder liver during exposure. In female liver, NADPH is required for production of the yolk precursor protein vitellogenin for oocyte production. The latter process has a higher priority than the NADPH-requiring detoxification processes because reproductive success is more relevant in evolutionary perspectives than the survival of the individual female. The data reviewed here suggest that these sex-related differences in NADPH metabolism are a major cause of the higher incidence of liver cancer in female flounder in polluted environments. [source] Hypertrophic cardiomyopathy: from genetics to treatmentEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 4 2010Ali J. Marian Eur J Clin Invest 2010; 40 (4): 360,369 Abstract Background, Hypertrophic cardiomyopathy (HCM) is the prototypic form of pathological cardiac hypertrophy. HCM is an important cause of sudden cardiac death in the young and a major cause of morbidity in the elderly. Design, We discuss the clinical implications of recent advances in the molecular genetics of HCM. Results, The current diagnosis of HCM is neither adequately sensitive nor specific. Partial elucidation of the molecular genetic basis of HCM has raised interest in genetic-based diagnosis and management. Over a dozen causal genes have been identified. MYH7 and MYBPC3 mutations account for about 50% of cases. The remaining known causal genes are uncommon and some are rare. Advances in DNA sequencing techniques have made genetic screening practical. The difficulty, particularly in the sporadic cases and in small families, is to discern the causal from the non-causal variants. Overall, the causal mutations alone have limited implications in risk stratification and prognostication, as the clinical phenotype arises from complex and often non-linear interactions between various determinants. Conclusions, The clinical phenotype of ,HCM' results from mutations in sarcomeric proteins and subsequent activation of multiple cellular constituents including signal transducers. We advocate that HCM, despite its current recognition and management as a single disease entity, involves multiple partially independent mechanisms, despite similarity in the ensuing phenotype. To treat HCM effectively, it is necessary to delineate the underlying fundamental mechanisms that govern the pathogenesis of the phenotype and apply these principles to the treatment of each subset of clinically recognized HCM. [source] Mechanisms and consequences of bladder cell invasion by uropathogenic Escherichia coliEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2008B. K. Dhakal ABSTRACT Strains of uropathogenic Escherichia coli (UPEC) are the major cause of urinary tract infections worldwide. Multiple studies over the past decade have called into question the dogmatic view that UPEC strains act as strictly extracellular pathogens. Rather, bacterial expression of filamentous adhesive organelles known as type 1 pili and Afa/Dr fibrils enable UPEC to invade host epithelial cells within the urinary tract. Entry into bladder epithelial cells provides UPEC with a protected niche where the bacteria can persist quiescently for long periods, unperturbed by host defences and protected from many antibiotic treatments. Alternately, internalized UPEC can rapidly multiply, forming large intracellular inclusions that can contain several thousand bacteria. Initial work aimed at defining the host and bacterial factors that modulate the entry, intracellular trafficking, and eventual resurgence of UPEC suggests a high degree of host-pathogen crosstalk. Targeted disruption of these processes may provide a novel means to prevent and treat recurrent, relapsing and chronic infections within the urinary tract. [source] Current concepts for the prevention of venous thromboembolismEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2005P. Bramlage Abstract Venous thromboembolism (VTE) is a major cause of morbidity and mortality worldwide and the annual incidence of VTE is 1 per 1000. The individual risk for venous thromboembolism may be substantially higher and is determined by expositional and dispositional factors. Unfractionated heparin and warfarin have been the mainstays for the prevention of VTE until the early 1980s. Bleeding complications and side effects limited the use of these agents and subsequently low molecular weight heparins (LMWH) were introduced into clinical practice. These are most commonly used for the prophylaxis and treatment of VTE today. In the last decade, the pace of development of further anticoagulants has accelerated with the introduction of new treatment regimens and new substances. In this context, novel drugs directed against clotting factor Xa (such as fondaparinux) and direct thrombin inhibitors (such as melagatran/ximelagatran) have been developed. Fondaparinux shows a favourable efficacy/safety profile and has been documented to be cost-effective compared to enoxaparin in the US and the UK. [source] | |||||||||||||||||||||||||||||||||||||||||||