Showing papers by "Saint Louis University published in 2005"

Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.

Abstract: Members of the Chamber Quantification Writing Group are: Roberto M. Lang, MD, FASE, Michelle Bierig, MPH, RDCS, FASE, Richard B. Devereux, MD, Frank A. Flachskampf, MD, Elyse Foster, MD, Patricia A. Pellikka, MD, Michael H. Picard, MD, Mary J. Roman, MD, James Seward, MD, Jack S. Shanewise, MD, FASE, Scott D. Solomon, MD, Kirk T. Spencer, MD, FASE, Martin St John Sutton, MD, FASE, and William J. Stewart, MD

Benefits of omalizumab as add-on therapy in patients with severe persistent asthma who are inadequately controlled despite best available therapy (GINA 2002 step 4 treatment): INNOVATE

Abstract: Background: Patients with severe persistent asthma who are inadequately controlled despite Global Initiative for Asthma (GINA) 2002 step 4 therapy are a challenging population with significant unmet medical need. We determined the effect of omalizumab on clinically significant asthma exacerbations (requiring systemic corticosteroids) in the first omalizumab study to exclusively enrol patients from this difficult-to-treat patient population. Methods: Following a run-in phase, patients (12–75 years) inadequately controlled despite therapy with high-dose inhaled corticosteroids (ICS) and long-acting β2-agonists (LABA) with reduced lung function and a recent history of clinically significant exacerbations were randomized to receive omalizumab or placebo for 28 weeks in a double-blind, parallel-group, multicentre study. Results: A total of 419 patients were included in the efficacy analyses. The clinically significant asthma exacerbation rate (primary efficacy variable), adjusted for an observed relevant imbalance in history of clinically significant asthma exacerbations, was 0.68 with omalizumab and 0.91 with placebo (26% reduction) during the 28-week treatment phase (P = 0.042). Without adjustment, a similar magnitude of effect was seen (19% reduction), but this did not reach statistical significance. Omalizumab significantly reduced severe asthma exacerbation rate (0.24 vs 0.48, P = 0.002) and emergency visit rate (0.24 vs 0.43, P = 0.038). Omalizumab significantly improved asthma-related quality of life, morning peak expiratory flow and asthma symptom scores. The incidence of adverse events was similar between treatment groups. Conclusions: In patients with inadequately controlled severe persistent asthma, despite high-dose ICS and LABA therapy, and often additional therapy, omalizumab significantly reduced the rate of clinically significant asthma exacerbations, severe exacerbations and emergency visits. Omalizumab is effective and should be considered as add-on therapy for patients with inadequately controlled severe persistent asthma who have a significant unmet need despite best available therapy.

DECLINING RATES OF PHYSICAL ACTIVITY IN THE UNITED STATES: What Are the Contributors?

Abstract: ▪ Abstract This review describes current patterns and long-term trends (up to 50 years when possible) related to (a) physical activity, (b) employment and occupation, (c) travel behavior, (d) land use, and (e) related behaviors (eg, television watching) On the basis of available data, the following trends were observed according to type of physical activity: relatively stable or slightly increasing levels of leisure-time physical activity, declining work-related activity, declining transportation activity, declining activity in the home, and increasing sedentary activity These result in an overall trend of declining total physical activity Large differences were noted in the rates of walking for transportation across metropolitan statistical areas A strong linear increase existed in vehicle miles traveled per person over the past half century, coupled with a strong and consistent trend toward Americans living in suburbs Although it is difficult to precisely quantify owing to the lack of long-term d

The Genome of the Basidiomycetous Yeast and Human Pathogen Cryptococcus Neoformans

Abstract: Cryptococcus neoformans is a basidionnycetous yeast ubiquitous in the environment, a model for fungal pathogenesis, and an opportunistic human pathogen of global importance. We have sequenced its similar to20-megabase genome, which contains similar to6500 intron-rich gene structures and encodes a transcriptome abundant in alternatively spliced and antisense messages. The genome is rich in transposons, many of which cluster at candidate centromeric regions. The presence of these transposons may drive karyotype instability and phenotypic variation. C. neoformans encodes unique genes that may contribute to its unusual virulence properties, and comparison of two phenotypically distinct strains reveals variation in gene content in addition to sequence polymorphisms between the genomes.

Leading from Within: The Effects of Emotion Recognition and Personality on Transformational Leadership Behavior

Abstract: This study of 145 managers of a large biotechnology/agricultural company examined how leaders' emotion recognition ability and personality characteristics influenced performance of transformational...

Blood-brain barrier transport of cytokines: a mechanism for neuropathology.

Abstract: Cytokines circulating in the blood affect CNS function through a variety of pathways. One of these pathways is by being transported directly across the blood-brain barrier (BBB). Transport of blood-borne cytokines across the BBB is now known to be an operational pathway by which cytokines can directly affect CNS functions. Cytokine transport across the BBB, however, is a complex event. Not all cytokines are transported and, for those which are, transport rates differ among cytokines, among brain regions, with physiological circumstances, and with disease. Here we address some of the major principles and concepts relating to cytokine transport and BBB function which have emerged as important to neuroimmunology and neuropathology.

Cognitive Effort during Note Taking.

Abstract: Note taking is a complex activity that requires comprehension and selection of information and written production processes. Here we review the functions, abbreviation procedures, strategies, and working memory constraints of note taking with the aim of improving theoretical and practical understanding of the activity. The time urgency of selecting key points and recording them while comprehending new information at the same time places significant demands on the central executive and other components of working memory. Dual- and triple-task procedures allow the measurement of the momentary cognitive effort or executive attention allocated to note taking. Comparative data show that note taking demands more effort than reading or learning. However, it requires less effort than the creative written composition of an original text. Copyright © 2004 John Wiley & Sons, Ltd.

Estimating clinically significant differences in quality of life outcomes.

Abstract: Objective: This report extracts important considerations for determining and applying clinically significant differences in quality of life (QOL) measures from six published articles written by 30 international experts in the field of QOL assessment and evaluation. The original six articles were presented at the Symposium on Clinical Significance of Quality of Life Measures in Cancer Patients at the Mayo Clinic in April 2002 and subsequently were published in Mayo Clinic Proceedings. Principal findings: Specific examples and formulas are given for anchor-based methods, as well as distribution-based methods that correspond to known or relevant anchors to determine important differences in QOL measures. Important prerequisites for clinical significance associated with instrument selection, responsiveness, and the reporting of QOL trial results are provided. We also discuss estimating the number needed to treat (NNT) relative to clinically significant thresholds. Finally, we provide a rationale for applying group-derived standards to individual assessments. Conclusions: While no single method for determining clinical significance is unilaterally endorsed, the investigation and full reporting of multiple methods for establishing clinically significant change levels for a QOL measure, and greater direct involvement of clinicians in clinical significance studies are strongly encouraged.

The Emergence of National Electronic Health Record Architectures in the United States and Australia: Models, Costs, and Questions

Abstract: Emerging electronic health record models present numerous challenges to health care systems, physicians, and regulators. This article provides explanation of some of the reasons driving the development of the electronic health record, describes two national electronic health record models (currently developing in the United States and Australia) and one distributed, personal model. The US and Australian models are contrasted in their different architectures (“pull” versus “push”) and their different approaches to patient autonomy, privacy, and confidentiality. The article also discusses some of the professional, practical, and legal challenges that health care providers potentially face both during and after electronic health record implementation. [J Med Internet Res 2005;7(1):e3]

Afferents of the ventral tegmental area in the rat‐anatomical substratum for integrative functions

Abstract: The ventral tegmental area (VTA) is critically important to an organism's capacity to detect rewards and novelty and to enlist appropriate behavioral responses. Although there has been substantial progress concerning information processing at the single cell and molecular levels in the VTA, our knowledge of its overall afferent connections is based principally on the benchmark description by Phillipson ([1979] J. Comp. Neurol. 187:117-144). Given that, since then, the sensitivity of tracing methods and knowledge about the organization of brain structures have increased considerably, we undertook to reevaluate the VTA afferents of the rat. The retrograde tracer Fluoro-Gold was injected into different parts of the VTA, and labeled neurons were visualized by immunocytochemistry. Retrogradely labeled neurons were not confined to nuclei but rather constituted an elongated formation stretching from the prefrontal cortex rostrally to the medulla oblongata caudally. In the case of descending afferents, this formation was centered on the medial forebrain bundle and the fasciculus retroflexus. The input to the VTA in general was bilateral, with a smaller descending and comparable ascending projection from the contralateral side. Injections of the anterograde tracers Phaseolus vulgaris-leucoagglutinin or biotinylated dextran amine into selected forebrain structures revealed a surprisingly sparse terminal arborization in the VTA. Furthermore, structures projecting to the VTA innervate other brain areas with similar or greater robustness, which in turn also provide a strong input to the VTA, indicating an anatomical network. Given the importance of the VTA in basic behaviors, this organization might provide a basis for an extraordinary level of afferent integration.

An Orally Bioavailable Antipoxvirus Compound (ST-246) Inhibits Extracellular Virus Formation and Protects Mice from Lethal Orthopoxvirus Challenge

Abstract: ST-246 is a low-molecular-weight compound (molecular weight = 376), that is potent (concentration that inhibited virus replication by 50% = 0.010 μM), selective (concentration of compound that inhibited cell viability by 50% = >40 μM), and active against multiple orthopoxviruses, including vaccinia, monkeypox, camelpox, cowpox, ectromelia (mousepox), and variola viruses. Cowpox virus variants selected in cell culture for resistance to ST-246 were found to have a single amino acid change in the V061 gene. Reengineering this change back into the wild-type cowpox virus genome conferred resistance to ST-246, suggesting that V061 is the target of ST-246 antiviral activity. The cowpox virus V061 gene is homologous to vaccinia virus F13L, which encodes a major envelope protein (p37) required for production of extracellular virus. In cell culture, ST-246 inhibited plaque formation and virus-induced cytopathic effects. In single-cycle growth assays, ST-246 reduced extracellular virus formation by 10 fold relative to untreated controls, while having little effect on the production of intracellular virus. In vivo oral administration of ST-246 protected BALB/c mice from lethal infection, following intranasal inoculation with 10× 50% lethal dose (LD50) of vaccinia virus strain IHD-J. ST-246-treated mice that survived infection acquired protective immunity and were resistant to subsequent challenge with a lethal dose (10× LD50) of vaccinia virus. Orally administered ST-246 also protected A/NCr mice from lethal infection, following intranasal inoculation with 40,000× LD50 of ectromelia virus. Infectious virus titers at day 8 postinfection in liver, spleen, and lung from ST-246-treated animals were below the limits of detection (<10 PFU/ml). In contrast, mean virus titers in liver, spleen, and lung tissues from placebo-treated mice were 6.2 × 107, 5.2 × 107, and 1.8 × 105 PFU/ml, respectively. Finally, oral administration of ST-246 inhibited vaccinia virus-induced tail lesions in Naval Medical Research Institute mice inoculated via the tail vein. Taken together, these results validate F13L as an antiviral target and demonstrate that an inhibitor of extracellular virus formation can protect mice from orthopoxvirus-induced disease.

Diagnosis of hepatocellular carcinoma

Abstract: Hepatocellular carcinoma (HCC) is responsible for a large proportion of cancer deaths worldwide. HCC is frequently diagnosed after the development of clinical deterioration at which time survival is measured in months. Long-term survival requires detection of small tumors, often present in asymptomatic individuals, which may be more amenable to invasive therapeutic options. Surveillance of high-risk individuals for HCC is commonly performed using the serum marker alfa-fetoprotein (AFP) often in combination with ultrasonography. Various other serologic markers are currently being tested to help improve surveillance accuracy. Diagnosis of HCC often requires more sophisticated imaging modalities such as CT scan and MRI, which have multiphasic contrast enhancement capabilities. Serum AFP used alone can be helpful if levels are markedly elevated, which occurs in fewer than half of cases at time of diagnosis. Confirmation by liver biopsy can be performed under circumstances when the diagnosis of HCC remains unclear.

The diagnosis and management of sinusitis: A practice parameter update

Abstract: These parameters were developed by the Joint Task Force on Practice Parameters, representing the American Academy of Allergy, Asthma and Immunology; the American College of Allergy, Asthma and Immunology; and the Joint Council of Allergy, Asthma and Immunology. The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI) have jointly accepted responsibility for establishing "The diagnosis and management of sinusitis: a practice parameter update." This is a complete and comprehensive document at the current time. The medical environment is a changing environment, and not all recommendations will be appropriate for all patients. Because this document incorporated the efforts of many participants, no single individual, including those who served on the Joint Task force, is authorized to provide an official AAAAI or ACAAI interpretation of these practice parameters. Any request for information about or an interpretation of these practice parameters by the AAAAI or the ACAAI should be directed to the Executive Offices of the AAAAI, the ACAAI, and the Joint Council of Allergy, Asthma and Immunology. These parameters are not designed for use by pharmaceutical companies in drug promotion.

Particle bombardment and the genetic enhancement of crops: Myths and realities

Abstract: DNA transfer by particle bombardment makes use of physical processes to achieve the transformation of crop plants. There is no dependence on bacteria, so the limitations inherent in organisms such as Agrobacterium tumefaciens do not apply. The absence of biological constraints, at least until DNA has entered the plant cell, means that particle bombardment is a versatile and effective transformation method, not limited by cell type, species or genotype. There are no intrinsic vector requirements so transgenes of any size and arrangement can be introduced, and multiple gene cotransformation is straightforward. The perceived disadvantages of particle bombardment compared to Agrobacterium-mediated transformation, i.e. the tendency to generate large transgene arrays containing rearranged and broken transgene copies, are not borne out by the recent detailed structural analysis of transgene loci produced by each of the methods. There is also little evidence for major differences in the levels of transgene instability and silencing when these transformation methods are compared in agriculturally important cereals and legumes, and other non-model systems. Indeed, a major advantage of particle bombardment is that the delivered DNA can be manipulated to influence the quality and structure of the resultant transgene loci. This has been demonstrated in recently reported strategies that favor the recovery of transgenic plants containing intact, single-copy integration events, and demonstrating high-level transgene expression. At the current time, particle bombardment is the most efficient way to achieve plastid transformation in plants and is the only method so far used to achieve mitochondrial transformation. In this review, we discuss recent data highlighting the positive impact of particle bombardment on the genetic transformation of plants, focusing on the fate of exogenous DNA, its organization and its expression in the plant cell. We also discuss some of the most important applications of this technology including the deployment of transgenic plants under field conditions.

Incidence and Predictors of Myocardial Infarction after Kidney Transplantation

Abstract: The risk and predictors of post-kidney transplantation myocardial infarction (PTMI) are not well described. Registry data collected by the United States Renal Data System were used to investigate retrospectively PTMI among adult first renal allograft recipients who received a transplant in 1995 to 2000 and had Medicare as the primary payer. PTMI events were ascertained from billing and death records, and participants were followed for up to 3 yr after transplant or until the end of observation (December 31, 2000). Extended Cox's hazards analysis was used to identify independent clinical correlates of PTMI (hazard ratio [HR]) and to examine PTMI as an outcomes predictor. Among 35,847 eligible participants, the cumulative incidence of PTMI was 4.3% (95% confidence interval [CI], 4.1 to 4.5%), 5.6% (95% CI, 5.3 to 5.8%), and 11.1% (95% CI, 10.7 to 11.5%) at 6, 12, and 36 mo, respectively. Risk factors for PTMI included older recipient age, pretransplantation comorbidities (diabetes, angina, peripheral vascular disease, and MI), transplantation from older donors and deceased donors, and delayed graft function. Women, blacks, Hispanics, and employed recipients experienced reduced risk. The hazard of PTMI rose after a diagnosis of posttransplantation diabetes (HR, 1.60; 95% CI, 1.35 to 1.88) and markedly increased after graft failure (HR, 2.78; 95% CI, 2.41 to 3.19). In separate analyses, PTMI predicted death-censored graft failure (HR, 1.89; 95% CI, 1.63 to 2.20) and strongly predicted death in a manner that declined with time after PTMI. Risk factors for PTMI include potentially modifiable posttransplantation complications. Because PTMI in turn predicts graft failure and death, reducing the risk for PTMI may improve outcomes after kidney transplantation.

Adolescent alcohol use is a risk factor for adult alcohol and drug dependence: evidence from a twin design.

Abstract: Background. Early alcohol use is associated with abuse and dependence of licit and illicit substances later in life. The role of genetic and environmental factors in this association is not conclusive.Method. In 1992, data on substance use, abuse/dependence and psychiatric disorders were collected from 8169 male twin members of the Vietnam Era Twin Registry. The interview obtained age of onset of regular drinking (one drink/month for 6 or more months). Regression analyses of twin pairs discordant for early alcohol use tested whether the association between early drinking (before age 17) and adult substance use and abuse/dependence remained after controlling for genetic factors, family environment and covariates. Twin models tested for common genetic and/or environmental influences on early drinking and adult alcohol dependence and ever use and abuse/dependence on marijuana and other drugs.Results. Co-twin analyses suggested the association between early regular alcohol use and adult alcohol dependence, marijuana and other drug use, and marijuana and other drug abuse/dependence could not be entirely explained by common genetic and shared family environmental factors. Genetic contributions to early regular drinking were significantly correlated with those on use of marijuana (rA=0·59), use of other drugs (rA=0·64), alcohol dependence (rA=0·54) and abuse/dependence of marijuana and other drugs (rA=0·63 and 0·66). Small but significant unique environmental correlations (rE range 0·11–0·22) indicated that familial factors could not entirely explain the association between early alcohol use and later substance use, abuse and dependence.Conclusions. Early regular drinking is associated with later alcohol dependence and use, abuse/dependence on drugs. The association is not entirely explained by genetic or shared family environmental factors. This suggests unique environmental factors contribute to transitions from early regular alcohol drinking to use, abuse and dependence on alcohol and other substances.

Infidelity in committed relationships II: a substantive review.

Abstract: This article, a follow-up on our methodological review of infidelity studies, provides a substantive review of the research findings on infidelity in committed relationships The aim of this article is to present the most conclusive findings available to both researcher and practitioner on the subject of infidelity We highlight attitudes toward infidelity; prevalence data; types of infidelity; gender dynamics and infidelity; issues in the primary relationship and their relationship to infidelity; race, culture, and infidelity; education, income, employment, and infidelity; justifications for infidelity; individual issues and their relationship to infidelity; same-sex couples and infidelity; attachment and infidelity; opportunity and infidelity; the aftermath and recovery process from infidelity; and clinical practices