109 sem 1_-_kasdorf

XML Workflows:

Bill Kasdorf
President, Impressions Book and Journal Services
Madison, Wisconsin and Ann Arbor, Michigan
© Copyright 2003, Impressions Book and Journal Services, Inc.

XML Workflows:
XML Works!
Bill Kasdorf
President, Impressions Book and Journal Services
Madison, Wisconsin and Ann Arbor, Michigan

XML Workflows: XML Works!

➤ XML is no longer “cutting edge”—
It’s a core technology of the digital era


• Liberates content from a particular
presentation of that content


• Enables interchange with unrelated parties
allowing reformatting, manipulation


• Enables interchange with unrelated parties
allowing reformatting, manipulation
• Most valuable archive to enable reuse,
revision, adaptation to future options


➤Publishers need both XML and PDF
• PDF is for Electronic Page Images
—Describes appearance of typeset page
—Main virtue: Inflexibility (=stability)
• XML is for Structured Information
—Describes what elements are and do
—Main virtue: Flexibility (=adaptability)


PDF:
think
Pages


➤When do we want electronic PAGES?
• Local and remote proofs during comp
—Can view, print, annotate PDFs
• Reliable files for film, platesetting
• Same files for digital printing
—Short run, on demand, course packs
• Delivering pages to users over the Web
• Some eBooks: e.g., ebrary, Adobe eBooks
➤The best technology for these is PDF


XML:
think
Flexibility


➤When do we need to change the pages?
• Viewing in a Web browser
—Limited fonts, lines reflow to fit screen
• Adapting to different devices, formats
—Print, PC screen, PDAs, most eBooks
• Using parts in new contexts
• Rearranging, changing, updating
• Adapting to options not invented yet
➤The best technology for these is XML


➤Think you don’t need flexibility?


If you don’t now, you will in the future.


• Publishing technology’s evolving rapidly


• Constant demand for new formats


• Take advantage of new production options


• Opportunities to license & acquire content


• Need to relate to non-publishing systems


• Need to relate to non-publishing systems
• Pouring money & time into conversion
gets old real fast—do it right up front!


➤The good news: it works, you can do it!


• Broad agreement on basic standards


• XML and PDF are a stable foundation


• Tools & techniques are rapidly evolving


• XML lets them work well together


• Experience & knowledge advancing too


• Experience & knowledge advancing too
➤Many possible workflows
• There is no “one best way”
• Remember, XML is for FLEXIBILITY!


➤Here are six real-life case studies,
and the different workflows they use
• Converting XML from normal Quark files
• Using XML in Quark (Autopage, XMLxt)
• Composing with native XML files
• Working with XML created for a purpose
other than publishing
• Producing 3 products from the same XML
• Using an XML-based Content Mgmt. Syst.

Workflow #1

“I’ll think about XML later,
just set the damn pages.”


➤Getting XML out of [any old] Quark
• The sad truth: this is a common situation
• Pubs haven’t anticipated XML (or HTML!)
• Files are inconsistently coded & styled
—Done by various people at various times
—Focus is on visual result, not structure
—“Flows” not always clear or connected
• Need to get uniformly tagged XML
• Here’s how we do it . . .


➤Case Study: Converting from Quark
• History reference publisher
• 50–75,000 pages set by Quark freelancers
• Has extensive in-house database
• Needs to publish in various elec. contexts
—Their own Web site, CD-ROMs
—netLibrary (now OCLC) flavor of OeB
—Adapt to new options (Baker & Taylor)
• Linked, enriched content very valuable

3
DEITIES, THEMES, AND CONCEPTS

ÆGIR
The sea personified; a famous host to the gods but listed among the jötnar.
The name appears to be identical to a noun for “sea” in skaldic poetry, and that
noun, or the name of the figure under discussion here, is the base word in many
kennings. For example, “Ægir’s horse” is a ship, and “daughters of Ægir” are
waves. In Skáldskaparmál, Snorri says that Rán is the wife of Ægir and that they
have nine daughters, most of whom bear names meaning “wave.” Since Rán is
listed among the goddesses in the thulur and Ægir has a peaceful relationship
with the gods, his inclusion in the thulur as a giant seems questionable.
The eddic poems often show Ægir as host to the gods. Hymiskvida is set in
motion because the gods expect to visit Ægir and will need a huge cauldron in
which to brew the beer that will be consumed. The poem tells how Thor
acquires the cauldron from the giant Hymir. The next poem in Codex Regius of
the Poetic Edda is Lokasenna, Loki’s flyting (that is, verbal duel) with the gods,
and it is set at a feast hosted by Ægir. Indeed, paper manuscripts call the poem
Ægisdrekka (Ægir’s Drinking Party). According to the prose header to the poem,
“Ægir, who was also called Gymir, had prepared beer for the æsir.” After enu-
merating the guest list (most of the æsir except Thor, who was away to the east
bashing trolls), the author reports that bright gold was used there in place of fire-
light, and the beer served itself. It was a great place of sanctuary, but Loki kills
Ægir’s servant Fimafeng, and Eldir, Ægir’s other servant, is the first with whom
Loki exchanges words in the series of flytings that make up the poem. Loki’s last
words are reserved for Ægir:

You made the beer, Ægir, and you never more will
Have a feast again;
All your possessions, which are here inside,
May fire play over,
And may it burn your back.

47

<publication pub-id="NORSE" class="encyclopedia">

<part type="body">
<div id="NORSE.27" type="part">
<label><page number="47"/>3</label>
<head>Deities, themes, and concepts</head></div>
<entry id="NORSE.28">
<title>ÆGIR</title>
<div0 id="NORSE.29">
<opener>The sea personified; a famous host to the gods but listed among the
jötnar.</opener>
<p indent="no">The name appears to be identical to a noun for
“sea” in skaldic poetry, and that noun, or the name of the figure
under discussion here, is the base word in many kennings. For example,
“Ægir’s horse” is a ship, and “daughters of
Ægir” are waves. In <i>Skáldskaparmál,</i> Snorri
says that Rán is the wife of Ægir and that they have nine daughters,
most of whom bear names meaning “wave.” Since Rán is
listed among the goddesses in the thulur and Ægir has a peaceful
relationship with the gods, his inclusion in the thulur as a giant seems
questionable.</p>
<p>The eddic poems often show Ægir as host to the gods.
<i>Hymiskvida</i> is set in motion because the gods expect to visit Ægir
and will need a huge cauldron in which to brew the beer that will be consumed.
The poem tells how Thor acquires the cauldron from the giant Hymir. The next
poem in <i>Codex Regius</i> of the <i>Poetic Edda</i> is <i>Lokasenna,</i>
Loki’s flyting (that is, verbal duel) with the gods, and it is set at a feast
hosted by Ægir. Indeed, paper manuscripts call the poem
<i>Ægisdrekka</i> (Ægir’s Drinking Party). According to the
prose header to the poem, “Ægir, who was also called Gymir, had
prepared beer for the æsir.” After enumerating the guest list (most

of the æsir except Thor, who was away to the east bashing trolls), the
author reports that bright gold was used there in place of firelight, and the beer
served itself. It was a great place of sanctuary, but Loki kills Ægir’s
servant Fimafeng, and Eldir, Ægir’s other servant, is the first with
whom Loki exchanges words in the series of flytings that make up the poem.
Loki’s last words are reserved for Ægir:</p>
<poem>
<poemline>You made the beer, Ægir, and you never more will</poemline>
<poemline>Have a feast again;</poemline>
<poemline>All your possessions, which are here inside,</poemline>
<poemline>May fire play over,</poemline>
<poemline>And may it burn your back.</poemline></poem>

</div0>
</entry>
</part>
</publication>

<!DOCTYPE html SYSTEM 'oebdoc101.dtd'>
<html>
<head>
<title>Handbook of Norse Mythology</title>
<link rel="stylesheet" type="text/css" href="abc_oeb.css" title="Default" />
</head>
<body>

<a id="NORSE.27"></a>
<h3 class="chtitle"><a id="page_47"></a>3<br/>
Deities, themes, and concepts</h3>

<h5 class="H1">ÆGIR</h5>
<p class="opener">The sea personified; a famous host to the gods but listed
among the jötnar.</p>
<p class="noindent">The name appears to be identical to a noun for
“sea” in skaldic poetry, and that noun, or the name of the figure
under discussion here, is the base word in many kennings. For example,
“Ægir’s horse” is a ship, and “daughters of
Ægir” are waves. In <i>Skáldskaparmál,</i> Snorri
says that Rán is the wife of Ægir and that they have nine daughters,
most of whom bear names meaning “wave.” Since Rán is
listed among the goddesses in the thulur and Ægir has a peaceful
relationship with the gods, his inclusion in the thulur as a giant seems
questionable.</p>
<p>The eddic poems often show Ægir as host to the gods.
<i>Hymiskvida</i> is set in motion because the gods expect to visit Ægir

and will need a huge cauldron in which to brew the beer that will be consumed.
The poem tells how Thor acquires the cauldron from the giant Hymir. The next
poem in <i>Codex Regius</i> of the <i>Poetic Edda</i> is <i>Lokasenna,</i>
Loki’s flyting (that is, verbal duel) with the gods, and it is set at a feast
hosted by Ægir. Indeed, paper manuscripts call the poem
<i>Ægisdrekka</i> (Ægir’s Drinking Party). According to the
prose header to the poem, “Ægir, who was also called Gymir, had
prepared beer for the æsir.” After enumerating the guest list (most
of the æsir except Thor, who was away to the east bashing trolls), the
author reports that bright gold was used there in place of firelight, and the beer
served itself. It was a great place of sanctuary, but Loki kills Ægir’s
servant Fimafeng, and Eldir, Ægir’s other servant, is the first with
whom Loki exchanges words in the series of flytings that make up the poem.
Loki’s last words are reserved for Ægir:</p>
<ul class="poem">
<li>You made the beer, Ægir, and you never more will</li>
<li>Have a feast again;</li>
<li>All your possessions, which are here inside,</li>
<li>May fire play over,</li>
<li>And may it burn your back.</li></ul>

</body>
</html>


➤Workflow 1: Getting XML out of Quark
QuarkXpress Well Formed Valid, correct
files XML files XML files

Scripts +
Roustabout Scripts
Handwork

Name HTML files
Mapping
Font DTD or OeB PS files
Encoding DTDs
Other files

XML Workflows: XML book:
300-pg Works!
7–10 hrs work


M

Scripts +
Roustabout Scripts
Handwork

Name HTML files
Mapping
Encoding DTDs
Other files



Scripts +

M
Roustabout Scripts
M
M Handwork

SOME TOOLS: SOME TOOLS:
Name
• Perl & Python
HTML files
• Roustabout
•Mapping
Xtend-Xport • Omnimark
• EasyPress Atomik Font DTD orXSLT
• OeB PS files
& Roundtrip Encoding DTDs
Other files

Workflow #2

“Maybe if we get organized
this will be easier.”


➤Optimizing Quark for XML extraction
• Start with consistent set of elements/DTD
• Use STYLES, avoid “local formatting”
—Word styles ឈ XML ឈ Xpress Tags/Xtags
—Starting & ending w/ same XML helps
• Link text boxes in Quark to specify flow
• Use standard fonts & keep them w/ job
• Limited to flat structures, no “nesting”
• Extracting XML takes < half as much time

XML Workflows: XML book:
300-pg Works!
2–3 hrs work

➤Workflow 2: XML from Optimized Quark

M

Scripts +
Roustabout Scripts
Handwork

Name HTML files
Mapping
Encoding DTDs
Other files

Workflow #3

“Isn’t there some way
to automate this?”


➤Using Autopage & XMLxt with Quark
• Requires special software—& knowledge
• The work is in the setup (can be extensive)
• XML tags are hidden with XMLxt
• XML tags are converted to Xtags
• Paging is automated with Autopage
• After comp, XML can be extracted
• Must USE the codes: don’t subvert them!
• Be careful not to interfere w/ hidden XML


➤Case Study: Using XML in Quark
• Textbook publisher wants XML archive
• Custom designed XML/Quark workflow
• Well-evolved coding scheme but no DTD
• Uses Xtags, Autopage, and XMLxt
• First use: computer manuals (print+elec.)
• Starting to use for all textbook production
• Totally electronic workflow (no paper)
• Makes composition faster & cheaper!

42 Web Collaboration Using Office XP and NetMeeting Project 1 Microsoft Word and Web Collaboration

To Create a Hyperlink to an E-mail Address
A In the table of contents document, select the text Contact the Authors.
This text represents the hyperlink.
B Click the Insert Hyperlink button on the Standard toolbar, or choose Insert,
Hyperlink to open the Insert Hyperlink dialog box.
C Click E-mail Address in the Link to area.
This opens the dialog box shown in Figure 1.39.

Enter e-mail address

Figure 1.39
D Type in an E-mail address, or select one from the Recently used e-mail
addresses list.
As you type in an e-mail address, the prefix mailto: is automatically inserted before the
address.
Use the e-mail address of someone who does not mind receiving a test message from you.
E Enter a Subject and ScreenTip, and click OK.
When you click the hyperlink, your e-mail program opens with the e-mail address popped
in the To box and the subject popped in the Subject box.
F Send a test message.
G Save and close the table of contents document.

There are many more things that can be done with hyperlinks. But two are worth mentioning before
wrapping up the topic. You can change attributes of an existing hyperlink by right-clicking the hyper-
link and selecting Edit Hyperlink. At this point, you can change the displayed text that represents the
hyperlink, the ScreenTip, the target frame, and the destination address.

If you want to remove a hyperlink from a document, you can completely remove the hyperlink, or
remove the hyperlink and leave the existing text or image. To completely remove the hyperlink,
select the hyperlink and click ∂. To remove the hyperlink but leave the text or image, right-click
the hyperlink and select Remove Hyperlink from the shortcut menu.

To extend your knowledge…
Creating Hyperlinks to Other Applications
To create a hyperlink to a location in an Excel workbook, open the workbook and select a range
of cells you want to jump to. Click Insert, point to Name, and click Define. Enter a name, and click
OK. Go to your Word document, select the text or object that is to represent the hyperlink; then

Text in this color is Xtags/Autopage tagging.
Text in this color is XML.

@EXR_TTL:<$>[{<<>EXR>}][{<<>TTL>}]To Create a Hyperlink to an E<#45>mail Address[{<<>/TTL>}]
@EXR_NL_ITEM:<$>[{<<>NL>}][{<<>ITEM>}]<@EXR_NL_NUM><#009>A<#009><@$p>In the
<@TERM>[{<<>TERM>}]table of contents[{<<>/TERM>}]<@$p> document, select the text
<@TERM>[{<<>TERM>}]Contact the Authors[{<<>/TERM>}]<@$p>.
@EXR:<$>This text represents the hyperlink.[{<<>/ITEM>}]
@EXR_NL_ITEM:<$>[{<<>XREF
ID="xIc031"/>}][{<<>ITEM>}]<@EXR_NL_NUM><#009>B<#009><@$p>[[SR 031
V=1]]<&pbu2(,,(120,S,1,),(36,S,1,),,,,n,,,,,K,15,,,,,,,,,"Maxtor 38 GB
HD:Essentials:EssentialsCollabicons:xIc031.tif",,"")><&tbu2((0,TL,1),2,20,20,,,,n,,,,,n,,,1,,,,,t,,"")>@SRLABE
L:<z7>[[S 031 C=I V=1]]<&te><&g(2,1)>Click the Insert Hyperlink button on the Standard toolbar, or choose
[{<<>STK>}]<U>I[{<<>/STK>}]<U>nsert, Hyperl[{<<>STK>}]<U>i[{<<>/STK>}]<U>nk to open the Insert
Hyperlink dialog box.[{<<>/ITEM>}]
@EXR_NL_ITEM:<$>[{<<>ITEM>}]<@EXR_NL_NUM><#009>C<#009><@$p>Click
E<#45>[{<<>STK>}]<U>m[{<<>/STK>}]<U>ail Address in the <@TERM>[{<<>TERM>}]Link
to[{<<>/TERM>}]<@$p> area.
@EXR:<$>This opens the dialog box shown in Figure[{<<>FIGIND NUM="39"
ID="01FIG39"/>}]<&pbu2(,,(40p,S,2,),(40p,S,1,),0,0,,n,,,,,N,,,m,100,100,1,1,0,0,":WebCollP01Figs:01fig39.p
s",,"")><&tbu2((2,BL,1),3,20p,1p6,,,,N,,,,,N,,,1,,,,,t,,)>[[A 01FIG39 I=Y]]<&te><&g(2,1)><!s>1.39[[AR
01FIG39 T=E]].
@EXR_NL_ITEM:<$>[{<<>INDEXTERM><<>PRIMARY>formatting<<>/PRIMARY><<>SECONDARY>h
yperlinks<<>/SECONDARY><<>TERTIARY>e<#45>mail
addresses<<>/TERTIARY>}][{<<>/INDEXTERM>}]<<>$I~formatting;hyperlinks;e<#45>mail
addresses>[{<<>INDEXTERM><<>PRIMARY>hyperlinks<<>/PRIMARY><<>SECONDARY>e<#45>mail
addresses<<>/SECONDARY>}][{<<>/INDEXTERM>}]<<>$I~hyperlinks;e<#45>mail
addresses>[{<<>INDEXTERM><<>PRIMARY>applying<<>/PRIMARY><<>SECONDARY>hyperlinks<<
>/SECONDARY><<>TERTIARY>e<#45>mail
addresses<<>/TERTIARY>}][{<<>/INDEXTERM>}]<<>$I~applying;hyperlinks;e<#45>mail
addresses>[{<<>INDEXTERM><<>PRIMARY>documents<<>/PRIMARY><<>SECONDARY>hyperlinks<


➤Workflow 3: Quark w/ Autopage, XMLxt
Word files w/ Quark files w/
Style Names embedded XML

Quark w/
Scripts or Xtags Autopage &
Template Conversion XMLxt

Well Formed XML PDF
XML files files files



Quark w/
Template Conversion XMLxt

Well Formed 300-pg book: XML PDF

M
XML files 1 hr work files files

(Plus the composition is WAY faster!)



Quark w/
M
Template
M
Conversion XMLxt
NOTE: NOTE:

Not needed with Not available for
Adobe InDesign Adobe InDesign
Well Formed XML PDF
XML files files files

Workflow #4

“Aren’t there any systems
designed to use XML?”


➤Composing in native XML
• XML is the comp coding (no conversion)
• Some systems integrate XML editing
• Can handle deep, hierarchical structures
• Can do context-sensitive formatting
• Maps XML structure to stylesheet
• “PIs” permit “futzing” for pretty pages
• Operators need to “think in XML” more
• Post-comp extraction of XML can be trivial


➤Case Study: Composing in native XML
• Journal publisher wants to control files
• Edits in Word, scripts/macros make XML
• Buys pagination on high-end system that
automates comp from fully-coded XML
• Makes own corrs, submits new XML
• Comp “proofs” XML, creates graphics
• Uses same data for print and online pubs
• Saves time and money on alts, conversion

Clinical Outcomes Following a Trial of Sertraline
in Rheumatoid Arthritis

JAMES R. SLAUGHTER, M.D., JERRY C. PARKER, PH.D.
MATTHEW P. MARTENS, M.A., KAREN L. SMARR, M.A.
JAMES E. HEWETT, M.A.

We report an open-label trial of sertraline in the treatment of major depression in 54 consecutive
rheumatoid arthritis (RA) patients meeting DSM-IV criteria for major depressive disorder. We
initially surveyed 628 RA outpatients with the Center for Epidemiologic Studies Depression Scale
(CES-D) and invited those with depression to be evaluated further and treated. Eighty-four RA
patients reporting depressive symptoms agreed to participate in person, and 56 met the criteria
for major depressive disorder. Of these 56 patients, 54 agreed to medication treatment and were
enrolled in the study. Patients were also randomized to one of three psychological treatment con-
ditions, but for this study, conditions were collapsed because previous research on this sample
indicated no significant between-group differences in depression after treatment. Patients were
assessed with the CES-D and the Hamilton Rating Scale for Depression after the intervention, at
6-month follow-up, and at 15-month follow-up. At the last follow-up, 41 patients remained for
assessment. In this study, sertraline was found to be a safe and efficacious treatment of depres-
sion complicating RA. (Psychosomatics 2002; 43:36–41)

I ndividuals with rheumatoid arthritis (RA) experience
more psychological distress than healthy individuals
without RA,1,2 and research indicates that RA patients are
triptyline led to significant improvement relative to baseline
on several mood measures, including life dissatisfaction,
self-esteem, down mood, social isolation, negative affect,
especially susceptible to depression.3–9 Although several chronic fatigue, and self-blame. Although these mood mea-
studies have examined the effectiveness of psychological sures may be related to major depression, they do not assess
interventions in treating depression in RA,10–12 the effec- depression per se. Sarzi Puttini et al.14 reported that de-
tiveness of pharmacologic interventions is not well estab- pressed RA patients taking dothiepin (a tricyclic antidepres-
lished. In a 32-week, double-blind, crossover trial of ami- sant available in Europe) experienced significant improve-
triptyline, desipramine, trazodone, and placebo, Frank et ment on Hamilton Rating Scale for Depression (Ham-D)15
al.13 found that treatment with amitriptyline led to signifi- scores, while also improving significantly on pain scores,
cant reductions in pain measures relative to both placebo when compared with placebo. These two studies, however,
and baseline, but the authors did not report the effect of are the only ones identified by MEDLINE that addressed
treatment on depression. However, they reported that ami- pharmacologic treatment of depression in RA, and treatment
was not the major focus of the research in these studies.
Received November 2, 2000; revised October 10, 2001; accepted October In a recent study, Smarr et al.16 reported on a combined
18, 2001. From the Department of Psychiatry and Neurology, University psychological-pharmacologic intervention. In this study,
of Missouri, Columbia, Missouri. Address correspondence and reprint 54 subjects diagnosed with classic or definite RA were ran-
requests to Dr. Slaughter, Department of Psychiatry and Neurology, Uni-
versity of Missouri, One Hospital Dr, Columbia, Missouri 65212. domly divided into three groups: a group that received both
Copyright ᭧ 2002 The Academy of Psychosomatic Medicine. cognitive-behavioral therapy and an antidepressant medi-

36 Psychosomatics 43:1, January-February 2002

HOME HELP FEEDBACK SUBSCRIPTIONS ALL ISSUES SEARCH TABLE OF CONTENTS
Sara Gryske || Change Password || View/Change User Information || CiteTrack Personal Alerts ||
Subscription HELP || Sign Out

Psychosomatics 42:477-481, December 2001
© 2001 The Academy of Psychosomatic Medicine Abstract of this Article
Reprint (PDF) Version of this Article
Similar articles found in:
Olanzapine for the Treatment Psychosomatics Online
PubMed
of Psychosis in Patients With PubMed Citation
Parkinson's Disease and Search Medline for articles by:
Marsh, L. || Reich, S. G.
Dementia Alert me when:
new articles cite this article
Laura Marsh, M.D., Constantine Lyketsos, M.D. Download to Citation Manager
and Stephen G. Reich, M.D.
Collections under which this article appears:
Neuropsychiatric Disorders:
Received February 27, 2001; revised June 28, 2001;
Alzheimer's Disease
accepted July 19, 2001. From the Morris K. Udall
Parkinson's Disease Research Center of Excellence at
Johns Hopkins, the Neuropsychiatry Service, Department of Psychiatry and Behavioral Sciences, and the
Movement Disorders Center, Department of Neurology, Johns Hopkins University School of Medicine,
Johns Hopkins University, Baltimore, MD. Address correspondence and reprint requests to Dr. Marsh,
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 600 N
Wolfe St. Baltimore, MD 21287.

ABSTRACT
TOP
Psychotic symptoms are a common complication in Parkinson's disease ABSTRACT
with dementia. The authors conducted an open-label 6-week trial of INTRODUCTION
METHOD
olanzapine preceded by a placebo lead-in in five subjects with Parkinson's RESULTS
disease, mild to moderately severe dementia, and psychosis. Four of the DISCUSSION
REFERENCES
subjects terminated the trial early because of worsening motor function,
sedation, or paranoia. There was no improvement in psychotic
symptoms, and functional abilities declined significantly. Olanzapine appears to
be poorly tolerated in patients with Parkinson's disease, psychotic symptoms, and dementia.

Key Words: Dementia • Psychosis • Parkinson's Disease

INTRODUCTION
TOP
Psychosis develops in up to 40% of patients with Parkinson's disease ABSTRACT
(PD) and is the most common cause of nursing home INTRODUCTION
METHOD
placement.1 Although antiparkinsonian therapies are often implicated,
RESULTS
advanced disease and cognitive impairment are additional specific DISCUSSION
2 REFERENCES

risks for psychosis Trials of antipsychotics in those with
PD typically focus on drug-induced psychosis and exclude patients with
dementia, whose response to antipsychotic medications may differ from PD patients without
D
dementia. Because PD patients with dementia and psychosis are a significant source of
ant
morbidity, caregiver burden, and complex management issues, 3 treatment guidelines are
t
needed.

This study examined the efficacy and safety of olanzapine for the treatment of psychosis in
nt
PD patients with dementia. Olanzapine is an atypical neuroleptic with a low affinity for
striatal D2 receptors and a reduced propensity for causing extrapyramidal symptoms.4 Its
clinical qualities are similar to clozapine, an atypical neuroleptic that is generally effective and
rally
5 t
tolerated for psychosis in patients with PD. However, olanzapine does not have hematological
side effects that require weekly blood monitoring.

METHOD
TOP
Subjects ABSTRACT
Subjects were recruited from the Johns Hopkins Movement INTRODUCTION
Disorders Clinic and had idiopathic PD based on the United Kingdom Brain METHOD
6 7 RESULTS
Bank Criteria, dementia secondary to PD based on DSM-IV criteria, and DISCUSSION
hallucinations and/or delusions for at least 4 weeks before study entry REFERENCES
that were not accounted for by another medical or psychiatric cause.
Subjects were recruited only after their antiparkinsonian medications were reduced to the
lowest dose tolerated with respect to motor function. All participants or their caregivers
eir
provided informed consent.

Trial Procedures
Assessments were conducted at screening; baseline; and Weeks 1, 2, 4, and 6.
Antiparkinsonian medications were stable for at least 7 days before patient screening, which
t
ood
included a physical examination, electrocardiogram, urinalysis, complete blood count, and a
comprehensive chemistry panel. After a 4-to 8-day single-blind placebo lead-in, subjects who
ad-in,
maintained a score >2 on the Schedule for the Assessment of Positive Symptoms (SAPS)
mptoms
Hallucinations or Delusions subscale 8 were started on olanzapine (2.5 mg qhs). If treatment

response plateaued and the patient was tolerating olanzapine, the dose was increased in 2.5-
as
mg increments every 3 days (up to 15.0 mg qhs). Dose reductions occurred whenever side
ed
effects were intolerable.

Efficacy was measured as the change in psychosis severity using the SAPS score. Secondary
S
efficacy measures included the Brief Psychiatric Rating Scale, Neuropsychiatric Inventory
tric
symptom severity and caregiver distress scores, 9 and hours of sleep between 2100 and 0900.
ween
The primary safety measure was the Unified Parkinson's Disease Rating Scale (UPDRS) motor
ale
score.10 Additional safety assessments included orthostatic blood pressure and functional and
e
cognitive abilities based on the UPDRS Activities of Daily Living Scale and Mini-Mental State
Exam.11

Statistical Analysis
With SPSS software, we used Wilcoxon's signed rank tests to test the change in rating scales
from baseline to final assessment (last observation carried forward). The small sample size
limits interpretation of these analyses.

RESULTS
TOP
Medication Dosage and Study Completion ABSTRACT
Five patients (2 women, 3 men) with mild to moderately severe dementia INTRODUCTION
METHOD
met enrollment criteria and received olanzapine (Table 1). No patient
RESULTS
tolerated olanzapine at a dose greater than 2.5 mg because of worsened DISCUSSION
parkinsonism, though the maximum dose prescribed was 7.5 mg for one REFERENCES

night. Subject 2 requested termination on Day 14 because of delusional
ideation about the investigators that developed after he took tramadol. Subject 3 was
ubject
withdrawn on Day 15 because of worsening motor function and psychosis. Subject 4 was
.
withdrawn on Day 7 because of worsening motor function and excessive sedation. Subject 5
was hospitalized for delirium, dehydration, and a urinary tract infection after being found
er
unresponsive on the floor of her home. She had not taken olanzapine for at least 24 hours.
Subject 1 completed the trial but discontinued olanzapine approximately 2 months later
because of worsening motor function. The study was terminated because of these events and
published reports 13 of olanzapine use in PD patients raising safety concerns.
ns.

View this table: TABLE 1. Demographic features and effects of olanzapine on
apine
[in this window] secondary outcome measures
[in a new window]

Medication Effects
seline
The UPDRS Activities of Daily Living subscore worsened ( P<0.05) from baseline to the final
observation ( Figure 1 and Table 1). Caregivers reported initial improvements in nocturnal sleep
nts
and psychotic symptom intensity, but there were no statistically significant differences in
t
hours of sleep, vital signs, caregiver distress, cognition, psychiatric symptom ratings, or
om
motor function.

FIGURE 1. Individual effects of olanzapine on psychotic
symptoms, motor function, and Activities of Daily Living scores

View larger version
(28K):
[in this window]
[in a new window]

DISCUSSION
TOP
Psychosis is a common and challenging complication of PD. ABSTRACT
Pharmacotherapy is especially difficult because most neuroleptic INTRODUCTION
3 METHOD
medications aggravate parkinsonism. Atypical antipsychotics such as
RESULTS
olanzapine have a lower risk of extrapyramidal side effects and may DISCUSSION
be useful in patients with PD. However, this small open-label trial was REFERENCES

associated with functional decline, suggesting that olanzapine has limited
rately
utility for the treatment of psychosis in patients with PD and mild to moderately severe
dementia.

Two earlier open-label studies suggest olanzapine is safe and effective for psychosis in PD
patients, but other studies describe poor tolerance. Dosage titration schedules and patient
dules
14
selection might explain the different outcomes. An initial study included only patients
without dementia and a starting dose of 1.0 mg, which is not available commercially and may
mmercially
have limited motor side effects. The final dose ranged from 2 to 15 mg (mean±SD=
ean±SD=
6.5±3.9 mg) and the study allowed for increases in antiparkinsonian medications after 50
cations
days. A subsequent study 15 also reported a favorable response to an 8-week trial of
week
olanzapine starting at 5 mg in PD patients with and without dementia. The patients with
e
dementia were more likely to withdraw from the trial, primarily because of sedation. Other
anecdotal, retrospective, and prospective studies show unacceptable motor side effects with
or
olanzapine.13,16,17–19 In the only controlled trial, olanzapine (mean±SD peak dose=11.4±3.5
eak
mg/day) caused significant worsening of parkinsonism, particularly gait and bradykinesia,
d
relative to clozapine (mean peak dose=25.8±13.5 mg/day). 20

Subjects in our study were terminated from the trial because of worsening parkinsonism or
g
medical complications. Although the effect of olanzapine on motor signs was not
as

significant, the sample size is small and fluctuating motor signs in patients with PD (as shown
in Figure 1) further confound their assessment.21 Functional abilities, however, declined
significantly. This corresponded to greater motor impairment in most cases, but incipient
medical conditions may also have contributed. For most patients, enhanced parkinsonian
effects occurred within the first 2 weeks, but the onset of medication intolerance varied. A
possible explanation for individual differences in extrapyramidal side effects is that disease
stage or dose of antiparkinsonian medications influence the amount of striatal synaptic
dopamine available to compete with olanzapine for the D2 receptor. Although it is a weak D2
antagonist, olanzapine binds relatively tightly to the D2 receptor and is less likely to be rapidly
displaced by dopamine, especially in the setting of reduced dopamine levels.22 In contrast,
some other atypical antipsychotics with higher dissociation constants (e.g., clozapine or
quetiapine) are more loosely bound to the D 2 receptor and are readily displaced by dopamine,
thereby reducing the risk of extrapyramidal signs.

The clinicopathological correlates of dementia and psychosis in PD are poorly understood, but
extranigral pathology is presumed.23 Olanzapine antagonism at other receptors potentially
contributes to nonmotor side effects, including sedation, delirium, and orthostasis, and
patients with dementia tend to be more vulnerable to these side effects. However, olanzapine
did not have adverse cognitive effects in our series, as Mini-Mental State Exam scores were
generally stable. Recent studies show that olanzapine has procholinergic properties, mediated
via 5-HT-6 receptor activity, that potentially offset any adverse anticholinergic effects.24,25

Most atypical antipsychotic medications (olanzapine, risperidone, quetiapine, and clozapine)
have been used with variable success for PD-related psychosis.26 The results of this small
open-label trial, despite its shortcomings, lead us to recommend that olanzapine and other
atypical neuroleptics should be used with caution in PD patients with psychosis and dementia
because of their potential to aggravate motor deficits and confusion, which already contribute
to functional impairment and caregiver burden.

ACKNOWLEDGMENTS
The authors thank Lisette Bunting, R.N., M.Sc.N. for study coordination. This study was
supported by Eli Lilly, Inc, the Morris K. Udall Parkinson' s Disease Research Center of
Excellence at Johns Hopkins (NIH P50-NS-58377), and the General Clinical Research Center at
Johns Hopkins University School of Medicine (National Center for Research Resources/NIH
M01-RR00052).

REFERENCES
TOP
ABSTRACT
1. Goetz CG, Stebbins GT: Risk factors for nursing home placement in INTRODUCTION
advanced Parkinson's disease. Neurology 1993;

METHOD
43:2227-2229[Abstract] RESULTS
2. Aarsland D, Larsen JP, Cummings JL, et al: Prevalence and clinical DISCUSSION
correlates of psychotic symptoms in Parkinson Disease: a REFERENCES
community-based study. Arch Neurol 1999; 56:595-601[Medline]
3. Henderson MJ, Mellers JDC: Psychosis in Parkinson's disease: "between a rock and a hard
en
place." International Review of Psychiatry 2000; 12:319-334
4. Beasley CM, Tollefson G, Tran P, et al: Olanzapine versus placebo and haloperidol: acute
d
phase results of the North American double-blind olanzapine trial.
Neuropsychopharmacology 1996; 14:111-123[Medline]
5. Parkinson Study Group: Low-dose clozapine for the treatment of drug-induced
g-induced
psychosis in Parkinson's disease. N Engl J Med 1999; 340:757-763[Abstract/Full Text]
Abstract/Full
6. Hughes AJ, Daniel SE, Kilford L, et al: Accuracy of clinical diagnosis of idiopathic
f
Parkinson's disease: a clinico-pathological study of 100 cases. J Neurol Neurosurg
ol
Psychiatry 1992; 55:181-184[Abstract]
7. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders,
f
4th Edition. Washington, DC, American Psychiatric Association, 1994
8. Andreasen N, Olsen S: Negative vs positive schizophrenia: definition and validation. Arch
Gen Psychiatry 1982; 39:789-794[Medline]
9. Cummings JL: The Neuropsychiatric Inventory: assessing psychopathology in dementia
hology
patients. Neurology 1997; 48:10-16
10. Fahn S, Elton RL, Members of the UPDRS Development Committee: Unified Parkinson's
disease rating scale, in Recent Developments in Parkinson's Disease II, edited by Fahn S,
I,
Marsden CD, Goldstein M. New York, Macmillan, 1987
11. Folstein MF, Folstein SE, McHugh PR: "Mini-mental state": a practical method for grading
method for
the cognitive state of patients for the clinician. J Psychiatr Res 1975;
12:189-198[Medline]
12. Mattis S: Dementia Rating Scale (DRS) Professional Manual. Odessa, FL: Psychological
Assessment Resources, 1988
13. with olanzapine.
Molho ES, Factor SA: Worsening of motor features of parkinsonism with olanzapine. Mov
Disord 1999; 14:1014-1016[Medline]
14. Wolters EC, Jansen ENH, Tuynman-Qua HG, et al: Olanzapine in the treatment of
dopaminomimetic psychosis in patients with Parkinson's disease. Neurology 1996;
rology
47:1085-1087[Abstract]
15. Aarsland D, Larsen JP, Lim NG, et al: Olanzapine for psychosis in patients with
ents
Parkinson's disease with and without dementia. J Neuropsychiatry Clin Neurosci 1999;
n
11:392-394[Abstract/Full Text]
16. Graham JM, Sussman JD, Ford KS, et al: Olanzapine in the treatment of hallucinosis in
idiopathic Parkinson's disease: a cautionary note. J Neurol Neurosurg Psychiatry 1998;
65:774-777[Abstract/Full Text]
17. Friedman J: Olanzapine in the treatment of dopaminomimetic psychosis in patients with
sis in patients
Parkinson's disease (letter). Neurology 1998; 50:1195-1196
18. zapine
Friedman JH, Goldstein S, Jacques C: Substituting clozapine for olanzapine in
psychiatrically stable Parkinson's disease patients: results of an open label pilot study.
Clin Neuropharmacol 1998; 21:285-288[Medline]
19. Jimenez-Jimenez FJ, Tallon-Barranco A, Orti-Pareja M, et al: Olanzapine can worsen
ne
parkinsonism. Neurology 1998; 50:1183-1184
20. Goetz CG, Blasucci LM, Leurgans S, et al: Olanzapine and clozapine: comparative effects
789-794[Abstract/
on motor function in hallucinating PD patients. Neurology 2000; 55:789-794[Abstract/
Full Text]
21. Lang AE, Fahn S: Assessment of Parkinson's disease, in Quantification of Neurologic
on
Deficit, edited by Munsat TL. Boston, Butterworth, 1989
22. ro
Seeman P, Kapur S: Olanzapine binding to dopamine receptors in vitro and in vivo, in

Olanzapine (Zyprexa): A Novel Antipsychotic, edited by Tran PV, et al. Philadelphia, PA,
Lippincott Williams and Wilkins, 2000
23. Forno LS: Neuropathology of Parkinson's disease. J Neuropathol Exp Neurol 1996;
55:259-272[Medline]
24. Kennedy J, Basson B, Zagar A, et al: The effects of olanzapine on Alzheimer's disease
assessment scale scores in patients with mild to moderate Alzheimer's disease with
psychosis and behavioral disturbances. J Am Geriatr Soc 2000; 48:S111
25. Bymaster F, Falcone JF: Decreased binding affinity of olanzapine and clozapine for clonal
human muscarinic receptor subtypes in intact CHO cells in physiological medium. Eur J
Pharmacol 2000; 390:245-248[Medline]
26. Workman RHJ, Stoebner D, Raicu RG: Management of psychosis and agitation in
demented elderly with Parkinson's disease. Clinical Geriatrics 2000; 8:76-83

Abstract of this Article
Reprint (PDF) Version of this Article
Similar articles found in:
Psychosomatics Online
PubMed
PubMed Citation
Search Medline for articles by:
Marsh, L. || Reich, S. G.
Alert me when:
new articles cite this article
Download to Citation Manager

Collections under which this article appears:
Neuropsychiatric Disorders:
Alzheimer's Disease

HOME HELP FEEDBACK SUBSCRIPTIONS ALL ISSUES SEARCH TABLE OF CONTENTS

<!doctype article system "appij1.dtd" [<!ENTITY S72866T1 SYSTEM
"S72866T1.TIF" NDATA TIFF><!ENTITY S72866T2 SYSTEM "S72866T2.TIF"
NDATA TIFF>] > <ARTICLE><HEADER><JOURNAL
DIRNAME=PSY><PUBLISHER-NAME>American Psychiatric Publishing,
Inc.</PUBLISHER-NAME> <JOURNAL-TITLE>Psychosomatics</JOURNAL-
TITLE> <ISSN>0033-3182</ISSN> <VOLUME>43</VOLUME>
<ISSUE>1</ISSUE> <PUB-DATE><YEAR>2002</YEAR> <SEASON>January-
February</SEASON> </PUB-DATE></JOURNAL> <FIRST-PAGE></FIRST-
PAGE><LAST-PAGE></LAST-
PAGE><SEQUENCE></SEQUENCE><LANGUAGE>EN</LANGUAGE><LHR>
Depression and Arthritis</LHR> <RHR>Slaughter <CHAR ID="ITAL">et
al.</CHAR></RHR> <IMABBR>Psychosomatics</IMABBR> <ARTICLE-TYPE
TYPE="regular" NUMBER="1"> <TWODIGIT-ID>S7</TWODIGIT-ID><QADOC-
ID>2866</QADOC-ID> <PDF FILENAME=02PSY.PDF><SUBJECT
CODE="18, 24, 1"><KEYWORD>Depression</KEYWORD>
<KEYWORD>Sertraline</KEYWORD> <KEYWORD>Rheumatoid
Arthritis</KEYWORD>
<ARTICLE-TITLE>Clinical Outcomes Following a Trial of Sertraline in
Rheumatoid Arthritis</ARTICLE-TITLE>
<AUTHOR-LIST><AUTHORNAME><FIRST-NAME>James</FIRST-NAME>
<MIDDLE-NAME>R.</MIDDLE-NAME> <LAST-NAME>Slaughter</LAST-
NAME> <SUFFIX>M. D.</SUFFIX></AUTHORNAME>
<AUTHORNAME><FIRST-NAME>Jerry</FIRST-NAME> <MIDDLE-
NAME>C.</MIDDLE-NAME> <LAST-NAME>Parker</LAST-NAME>
<SUFFIX>Ph.D.</SUFFIX></AUTHORNAME>
<AUTHORNAME><FIRST-NAME>Matthew</FIRST-NAME> <MIDDLE-
NAME>P.</MIDDLE-NAME> <LAST-NAME>Martens</LAST-NAME>
<SUFFIX>M.A.</SUFFIX></AUTHORNAME>
<AUTHORNAME><FIRST-NAME>Karen</FIRST-NAME> <MIDDLE-
NAME>L.</MIDDLE-NAME> <LAST-NAME>Smarr</LAST-NAME>
<SUFFIX>M.A.</SUFFIX></AUTHORNAME>

<AUTHORNAME><FIRST-NAME>James</FIRST-NAME> <MIDDLE-
NAME>E.</MIDDLE-NAME> <LAST-NAME>Hewett</LAST-NAME>
<SUFFIX>M.A.</SUFFIX></AUTHORNAME></AUTHOR-LIST>
<ABSTRACT>We report an open-label trial of sertraline in the treatment of major
depression in 54 consecutive rheumatoid arthritis (RA) patients meeting DSM-IV
criteria for major depressive disorder. We initially surveyed 628 RA outpatients
with the Center for Epidemiologic Studies Depression Scale (CES-D) and invited
those with depression to be evaluated further and treated. Eighty-four RA
patients reporting depressive symptoms agreed to participate in person, and 56
met the criteria for major depressive disorder. Of these 56 patients, 54 agreed to
medication treatment and were enrolled in the study. Patients were also
randomized to one of three psychological treatment conditions, but for this study,
conditions were collapsed because previous research on this sample indicated
no significant between-group differences in depression after treatment. Patients
were assessed with the CES-D and the Hamilton Rating Scale for Depression
after the intervention, at 6-month follow-up, and at 15-month follow-up. At the last
follow-up, 41 patients remained for assessment. In this study, sertraline was
found to be effective with both measures and at all time points in treating major
depression in the context of RA.</ABSTRACT></HEADER><BODY><SECT1>
<PARA><CHAR ID="DC">I</CHAR>ndividuals with rheumatoid arthritis (RA)
experience more psychological distress than healthy individuals without
RA,<XREF ID=S728661>1</XREF>,<XREF ID=S728662>2</XREF> and
research indicates that RA patients are especially susceptible to
depression.<XREF ID=S728663>3</XREF>–<XREF
ID=S728669>9</XREF> Although several studies have examined the
effectiveness of psychological interventions in treating depression in RA,<XREF
ID=S7286610>10</XREF>–<XREF ID=S7286612>12</XREF> the
effectiveness of pharmacologic interventions is not well established. In a 32-
week, double-blind, crossover trial of amitriptyline, desipramine, trazodone, and
placebo, Frank et al.<XREF ID=S7286613>13</XREF> found that treatment with
amitriptyline led to significant reductions in pain measures relative to both

placebo and baseline, but the authors did not report the effect of treatment on
depression. However, they reported that amitriptyline led to significant
improvement relative to baseline on several mood measures, including life
dissatisfaction, self-esteem, down mood, social isolation, negative affect, chronic
fatigue, and self-blame. Although these mood measures may be related to major
depression, they do not assess depression per se. Sarzi Puttini et al.<XREF
ID=S7286614>14</XREF> reported that depressed RA patients taking dothiepin
(a tricyclic antidepressant available in Europe) experienced significant
improvement on Hamilton Rating Scale for Depression (Ham-D)<XREF
ID=S7286615>15</XREF> scores, while also improving significantly on pain
scores, when compared with placebo. These two studies, however, are the only
ones identified by <CHAR ID="ITAL">MEDLINE</CHAR> that addressed
pharmacologic treatment of depression in RA, and treatment was not the major
focus of the research in these studies.</PARA>

<PARA>In a recent study, Smarr et al.<XREF ID=S7286616>16</XREF>
reported on a combined psychological-pharmacologic intervention. In this study,
54 subjects diagnosed with classic or definite RA were randomly divided into
three groups: a group that received both cognitive-behavioral therapy and an
antidepressant medication (CB-PHARM), an attention control group that received
both educational materials about RA and an antidepressant medication (AC-
PHARM), and a control group that received the antidepressant medication only
(CN-PHARM). The purpose of the study was to determine whether the CB-
PHARM group would have better outcomes than either control group. Data were
collected at baseline, after the intervention, at 6-month follow-up, and at 15-
month follow-up. Results indicated no significant differences in depression scores
among the three groups, but all three groups demonstrated significant
differences from baseline after the intervention, at 6-month follow-up, and at 15-
month follow-up. The lack of significant differences on the mean scores of
various depression instruments among the groups indicates that subjects in the


➤Workflow 4a: Composing in native XML
Word files w/ PDF
Style Names proof Recomposition PDF
of final pages files

M
Run macros, Composition
parse to DTD, w/ native (Corrs can be done
hand fix XML in comp system or
in editing system)

Valid XML Corrected & HTML
M

Scripts
files updated XML files


Word files w/ PDF

parse to DTD, w/ native 300-pg book:
hand fix XML 5–10 minutes

Valid XML
files
Corrected &
updated XML M Scripts HTML
files


Word files w/ PDF
M

SOME TOOLS:

M
• Inera eXtyles
parse to DTD,
• HyperVision Worx w/ native
• ArborTexthand fix
Epic
• XMetaL XML
SOME TOOLS:
• Penta • Arbor-
• XyVision text
Valid XML Corrected & Scripts
• Miles33 • Frame-
HTML
files updated XML • 3B2 maker files


➤Case Study: 3 products from same XML
• Medical reference needed in 3 formats:
—Manual (8.5 x 11) is master reference
—Handbook (4.5 x 8), sans forms
—Also needed as Palm eBook
• Edited in Word system with XML output
• Content perfected during comp of Manual
• All 3 formats output from final XML files
• Index embedded in XML, for 3 indexes

3
Lip and Oral Cavity
(Nonepithelial tumors such as those of lymphoid tissue, 2
soft tissue, bone, and cartilage are not included.)

C00.0 External upper lip C02.2 Ventral surface of tongue, NOS C04.9 Floor of mouth, NOS
C00.1 External lower lip C02.3 Anterior two-thirds of tongue, C05.0 Hard palate
C00.2 External lip, NOS NOS C05.8 Overlapping lesion of palate
C00.3 Mucosa of upper lip C02.8 Overlapping lesion of tongue C05.9 Palate, NOS
C00.4 Mucosa of lower lip C02.9 Tongue, NOS C06.0 Cheek mucosa
C00.5 Mucosa of lip, NOS C03.0 Upper gum C06.1 Vestibule of mouth
C00.6 Commissure of lip C03.1 Lower gum C06.2 Retromolar area
C00.8 Overlapping lesion of lip C03.9 Gum, NOS C06.8 Overlapping lesion of other and
C00.9 Lip, NOS C04.0 Anterior floor of mouth unspecified parts of mouth
C02.0 Dorsal surface of tongue, NOS C04.1 Lateral floor of mouth C06.9 Mouth, NOS
C02.1 Border of tongue C04.8 Overlapping lesion of floor of
mouth

SUMMARY OF CHANGES

• T4 lesions have been divided into T4a (resectable) and T4b (unresectable),
leading to the division of Stage IV into Stage IVA, Stage IVB, and Stage
IVC.

ANATOMY gutter to the junction of the hard palate. Its posterior margin
is the upper end of the pterygopalatine arch.
Primary Site. The oral cavity extends from the skin- Retromolar Gingiva (Retromolar Trigone). This is the at-
vermilion junction of the lips to the junction of the hard and tached mucosa overlying the ascending ramus of the man-
soft palate above and to the line of circumvallate papillae dible from the level of the posterior surface of the last molar
below and is divided into the following specific areas: tooth to the apex superiorly, adjacent to the tuberosity of the
Mucosal Lip. The lip begins at the junction of the ver- maxilla.
milion border with the skin and includes only the vermilion Floor of the Mouth. This is a semilunar space over the
surface or that portion of the lip that comes into contact with myelohyoid and hyoglossus muscles, extending from the in-
the opposing lip. It is well defined into an upper and lower ner surface of the lower alveolar ridge to the undersurface of
lip joined at the commissures of the mouth. the tongue. Its posterior boundary is the base of the anterior
Buccal Mucosa. This includes all the membrane lining of pillar of the tonsil. It is divided into two sides by the frenu-
the inner surface of the cheeks and lips from the line of lum of the tongue and contains the ostia of the submaxillary
contact of the opposing lips to the line of attachment of mu- and sublingual salivary glands.
cosa of the alveolar ridge (upper and lower) and pterygo- Hard Palate. This is the semilunar area between the upper
mandibular raphe. alveolar ridge and the mucous membrane covering the pal-
Lower Alveolar Ridge. This refers to the mucosa overlying atine process of the maxillary palatine bones. It extends from
the alveolar process of the mandible which extends from the the inner surface of the superior alveolar ridge to the pos-
line of attachment of mucosa in the buccal gutter to the line terior edge of the palatine bone.
of free mucosa of the floor of the mouth. Posteriorly it ex- Anterior Two-Thirds of the Tongue (Oral Tongue). This is
tends to the ascending ramus of the mandible. the freely mobile portion of the tongue that extends anteri-
Upper Alveolar Ridge. This refers to the mucosa overlying orly from the line of circumvallate papillae to the undersur-
the alveolar process of the maxilla which extends from the face of the tongue at the junction of the floor of the mouth.
line of attachment of mucosa in the upper gingival buccal It is composed of four areas: the tip, the lateral borders, the

American Joint Committee on Cancer • 2002 23

3
Lip and Oral Cavity
(Nonepithelial tumors such as those of lymphoid tissue, soft tissue, bone, and cartilage
are not included.)

C00.0 External upper lip C02.3 Anterior two-thirds of C04.9 Floor of mouth, NOS
C00.1 External lower lip tongue, NOS C05.0 Hard palate
C00.2 External lip, NOS C02.8 Overlapping lesion of C05.8 Overlapping lesion of
C00.3 Mucosa of upper lip tongue palate
3
C00.4 Mucosa of lower lip C02.9 Tongue, NOS C05.9 Palate, NOS
C00.5 Mucosa of lip, NOS C03.0 Upper gum C06.0 Cheek mucosa
C00.6 Commissure of lip C03.1 Lower gum C06.1 Vestibule of mouth
C00.8 Overlapping lesion of lip C03.9 Gum, NOS C06.2 Retromolar area
C00.9 Lip, NOS C04.0 Anterior floor of mouth C06.8 Overlapping lesion of
C02.0 Dorsal surface of tongue, C04.1 Lateral floor of mouth other and unspecified
NOS C04.8 Overlapping lesion of parts of mouth
C02.1 Border of tongue floor of mouth C06.9 Mouth, NOS
C02.2 Ventral surface of
tongue, NOS

SUMMARY OF CHANGES
• T4 lesions have been divided into T4a (resectable) and T4b (unresectable),
leading to the division of Stage IV into Stage IVA, Stage IVB, and Stage
IVC.

ANATOMY

Primary Site. The oral cavity extends from the skin-vermilion junction
of the lips to the junction of the hard and soft palate above and to the line
of circumvallate papillae below and is divided into the following specific
areas:
Mucosal Lip. The lip begins at the junction of the vermilion border
with the skin and includes only the vermilion surface or that portion of
the lip that comes into contact with the opposing lip. It is well defined
into an upper and lower lip joined at the commissures of the mouth.
Buccal Mucosa. This includes all the membrane lining of the inner
surface of the cheeks and lips from the line of contact of the opposing lips
to the line of attachment of mucosa of the alveolar ridge (upper and lower)
and pterygomandibular raphe.
Lower Alveolar Ridge. This refers to the mucosa overlying the alveolar
process of the mandible which extends from the line of attachment of
mucosa in the buccal gutter to the line of free mucosa of the floor of the
mouth. Posteriorly it extends to the ascending ramus of the mandible.
Upper Alveolar Ridge. This refers to the mucosa overlying the alveolar
process of the maxilla which extends from the line of attachment of mu-
cosa in the upper gingival buccal gutter to the junction of the hard palate.
Its posterior margin is the upper end of the pterygopalatine arch.
Retromolar Gingiva (Retromolar Trigone). This is the attached mucosa
overlying the ascending ramus of the mandible from the level of the pos-

American Joint Committee on Cancer • 2002 1


➤Workflow 4b: 3 products from same XML
Word files w/ Corrected Embedded
Style Names Valid XML indexing
Scripts

Run macros, Composition Indexed
parse to DTD, in XML-based Valid XML OeB PS
hand fix system files

PDF for PDF for Palm
Valid XML Manual Handbook eBook


➤Case Study: Working with XML created
for a purpose other than publishing
• Major scientific reference (many vols, yrs)
• XML was created for the scientists to use
—Organizes data the way they think of it
—Not structured to help composition
• Other examples: catalog from product
database, directory for membership data
• Comp uses XML, returns corrected XML

GENUS VIII. THERMOSPHAERA 191

T. aggregans was isolated from Obsidian Pool, a terrestrial hot
spring in Yellowstone National Park, WY, USA.

ENRICHMENT AND ISOLATION PROCEDURES
T. aggregans was originally enriched and obtained in pure culture
by a newly developed procedure, which allowed the isolation of
a 16S rDNA sequence-predicted, hyperthermophilic archaeum
from a natural environment for the first time. This procedure is
a combination of in situ 16S rDNA sequence analysis, specific
cell hybridization within enrichment cultures, and “selected cell
cultivation” by the use of a laser microscope (“optical tweezers”;
Barns et al., 1994; Huber et al., 1995a; Beck and Huber, 1997).

MAINTENANCE PROCEDURES
T. aggregans can be stored in liquid nitrogen at ‫041מ‬ЊC in the
presence of 5% DMSO.

DIFFERENTIATION OF THE GENUS THERMOSPHAERA FROM
OTHER GENERA

Based on 16S rDNA sequence data, T. aggregans can be distin-
guished from the genera Staphylothermus, Desulfurococcus, and Sul-
fophobococcus. T. aggregans can be further distinguished from Sul-
fophobococcus on the basis of different conserved bases in the 16S
rDNA sequence. T. aggregans differs from Desulfurococcus and Sta-
FIGURE A1.12. Platinum-shadowed cell aggregate of Thermosphaera ag- phylothermus by the lack of significant DNA similarity, the presence
gregans. of cyclic tetraether lipids in its membrane and the absence of a
regular cell surface lattice.
FURTHER READING
T. aggregans grows optimally under anaerobic conditions at
Huber, R., S. Burggraf, T. Mayer, S.M. Barns, P. Rossnagel and K.O.
85ЊC, pH 6.5, and in the absence of exogenous sodium chloride.
Stetter. 1995. Isolation of a hyperthermophilic archaeum predicted
The optimal doubling time at 85ЊC is 110 min. The apparent
by in situ RNA analysis. Nature (Lond.) 376: 57–58.
activation energy for growth is about 149 kJ‫ .1מ‬No growth on Stetter, K.O. 2000. Volcanoes, hydrothermal venting, and the origin of
meat extract, bovine heart infusion, peptone, amylose, glycogen, life. In Marit and Ernst (Editors), Volcanoes and the Environment,
cellulose, cellobiose, maltose, raffinose, pyruvate, and acetate. Cambridge University Press, Cambridge, in press.

List of species of the genus Thermosphaera
1. Thermosphaera aggregans Huber, Dyba, Huber, Burggraf Description is the same as for the genus.
and Rachel 1998b, 36.VP The mol% G ‫ ם‬C of the DNA is: 46 (Tm).
agЈgre.gans. L. v. aggregare referring to the ability of the cells Type strain: M11TL, DSMZ 11486.
to form grapelike aggregates. GenBank accession number (16S rRNA): X99556.

Family II. Pyrodictiaceae Burggraf, Huber and Stetter 1997b, 659VP
HARALD HUBER AND KARL O. STETTER
Pyr.o.dicЈti.a.ce.ae. M.L. neut. n. Pyrodictium type genus of the family; -aceae ending to denote
a family; M.L. fem. pl. n. Pyrodictiaceae the Pyrodictium family.
Coccoid to disc-shaped cells, Pyrodictium species form a network tors. Three genera are described: Pyrodictium, Hyperthermus and
of cannulae. Hyperthermophilic, maximal growth temperature Pyrolobus.
between 108 and 113ЊC. Grows either chemolithoautotrophically Type genus: Pyrodictium Stetter, Konig and Stackebrandt 1984,
¨
by gaining energy from the reduction of S0 or thiosulfate to H2S 270, emend. Pley and Stetter in Pley, Schipka, Gambacorta, Jan-
using CO2 as sole carbon source or by fermentation. Some genera nasch, Fricke, Rachel and Stetter 1991, 251 (Effective publica-
gain energy by respiration using O2 or nitrate as electron accep- tion: Stetter, Konig and Stackebrandt 1983, 549).
¨

Key to the genera of the family Pyrodictiaceae
1. Cells are discs within a network of cannulae. Obligately anaerobic; H2/S0 autotrophy and sulfur
respiration with complex organic substrates. Temperature optimum: 105ЊC; temperature maxi-
mum: 110ЊC.
Genus I. Pyrodictium.

<cultural-characteristics>
<para><species>T. aggregans</species> grows optimally under anaerobic
conditions at 85°C, pH 6.5, and in the absence of exogenous sodium
chloride. The optimal doubling time at 85°C is 110 min. The apparent
activation energy for growth is about 149
kJ<superscript>−1</superscript>. No growth on meat extract, bovine heart
infusion, peptone, amylose, glycogen, cellulose, cellobiose, maltose, raffinose,
pyruvate, and acetate.</para>
</cultural-characteristics>
<ecology>
<para><species>T. aggregans</species> was isolated from Obsidian Pool, a
terrestrial hot spring in Yellowstone National Park, WY, USA.</para>
</ecology></fdi>
<enrichment>
<title></title>
<para><species>T. aggregans</species> was originally enriched and obtained in
pure culture by a newly developed procedure, which allowed the isolation of a
16S rDNA sequence-predicted, hyperthermophilic archaeum from a natural
environment for the first time. This procedure is a combination of <emphasis
display="italic">in situ</emphasis> 16S rDNA sequence analysis, specific cell
hybridization within enrichment cultures, and “selected cell
cultivation” by the use of a laser microscope (“optical
tweezers”; <pub-cite cite-ref="phy1a.0047">Barns et al., 1994</pub-cite>;
<pub-cite cite-ref="phy2.491">Huber et al., 1995a</pub-cite>; <pub-cite cite-
ref="phy2.486">Beck and Huber, 1997</pub-cite>).</para>
</enrichment>
<maintenance>
<title></title>
<para><species>T. aggregans</species> can be stored in liquid nitrogen at
−140°C in the presence of 5% DMSO.</para>
</maintenance>

<differentiation><title><genus>Thermosphaera</genus></title>
<para>Based on 16S rDNA sequence data, <species>T. aggregans</species>
can be distinguished from the genera <genus>Staphylothermus</genus>,
<genus>Desulfurococcus</genus>, and <genus>Sulfophobococcus</genus>.
<species>T. aggregans</species> can be further distinguished from
<genus>Sulfophobococcus</genus> on the basis of different conserved bases in
the 16S rDNA sequence. <species>T. aggregans</species> differs from
<genus>Desulfurococcus</genus> and <genus>Staphylothermus</genus> by
the lack of significant DNA similarity, the presence of cyclic tetraether lipids in its
membrane and the absence of a regular cell surface lattice.</para>
</differentiation>
<reading>
<bibcite biblio-id="phy2.491"><article>
<author><wholename>Huber, R.</wholename></author>
<author><wholename>S. Burggraf</wholename></author>
<author><wholename>T. Mayer</wholename></author>
<author><wholename>S.M. Barns</wholename></author>
<author><wholename>P. Rossnagel</wholename></author>
<author><wholename>K.O. Stetter</wholename></author>
<year>1995</year><pubtitle>Isolation of a hyperthermophilic archaeum
predicted by <emphasis display="italic">in situ</emphasis> RNA
analysis</pubtitle>
<journalabbrev>Nature (Lond.)</journalabbrev><volume>376</volume>
<pages>57–58</pages></article></bibcite>
<bibcite><chapter>
<author><wholename>Stetter, K.O.</wholename></author>
<year>2000</year><pubtitle>Volcanoes, hydrothermal venting, and the origin of
life</pubtitle>
<editor><wholename>Marit</wholename></editor>
<editor><wholename>Ernst</wholename></editor><parenttitle>Volcanoes and
the Environment</parenttitle>

<publisher>Cambridge University Press</publisher><pub-city>Cambridge</pub-
city>
<pages>in press</pages></chapter></bibcite>
</reading>
<species-structure><title><genus>Thermosphaera</genus></title>
<species-list><species-desc>
<species-valid>
<def-pub><taxon-id><species>Thermosphaera aggregans</species></taxon-id>
<def-pub-cite cite-ref="phy1a.0050" validator="vp"><authoringgroup>Huber,
Dyba, Huber, Burggraf and Rachel</authoringgroup><date>1998b,
</date><desc-page>36</desc-page>.</def-pub-cite></def-pub>
<etymology><phonetic>ag′gre.gans. </phonetic><morpheme><lang>L.
</lang><grammar>v. </grammar><source>aggregare </source><trans>referring
to the ability of the cells to form grapelike
aggregates.</trans></morpheme></etymology>
<feature-para>Description is the same as for the genus.</feature-para>
<dnabase-ratio>46 (<emphasis
display="italic">T<subscript>m</subscript></emphasis>).</dnabase-ratio>
<strain-ref><cc-combo><cc-num>M11TL, DSMZ 11486.</cc-num>
<genbank> X99556.</genbank>
</cc-combo></strain-ref></species-valid></species-desc></species-list>
</species-structure></genus-chapter></family-structure>
<family-structure name="pyrodictiaceae"><chap-head><title></title>
<def-pub>
<taxon-id><family>Pyrodictiaceae</family></taxon-id> <def-pub-cite cite-
ref="phy2.874" validator="vp"><authoringgroup>Burggraf, Huber and
Stetter</authoringgroup><date>1997b, </date><desc-page>659</desc-
page></def-pub-cite></def-pub>
<author><name>Harald </name><lname>Huber </lname></author>
<author><name>Karl </name><initial>O.
</initial><lname>Stetter</lname></author>

<etymology>
<phonetic>Pyr.o.dic′ti.a.ce.ae. </phonetic><morpheme><lang>M.L.
</lang><grammar>neut. n. </grammar><source>Pyrodictium
</source><trans>type genus of the family; </trans><source>-aceae
</source><trans>ending to denote a family; </trans><lang>M.L.
</lang><grammar>fem. pl. n. </grammar><source>Pyrodictiaceae
</source><trans>the <?Pub _font Posture="italic">Pyrodictium<?Pub /_font>
family.</trans></morpheme>
</etymology>
</chap-head>
<definition><feature-para><salient-pt>Coccoid to disc-shaped cells,
<genus>Pyrodictium</genus> species form a network of cannulae</salient-pt>.
<salient-pt>Hyperthermophilic</salient-pt>, maximal growth temperature
between 108 and 113°C. <salient-pt>Grows either chemolithoautotrophically
by gaining energy from the reduction of S<superscript>0</superscript></salient-
pt> <salient-pt>or thiosulfate to H<subscript>2</subscript>S</salient-pt> using
CO<subscript>2</subscript> as sole carbon source <salient-pt>or by
fermentation</salient-pt>. Some genera gain energy by respiration using
O<subscript>2</subscript> or nitrate as electron acceptors. Three genera are
described: <genus>Pyrodictium</genus>, <genus>Hyperthermus</genus> and
<genus>Pyrolobus</genus>.</feature-para>
<type-taxon rank="genus"><def-pub><taxon-
id><genus>Pyrodictium</genus></taxon-id> <def-pub-cite cite-
ref="phy1a.0015"><authoringgroup>Stetter, König and
Stackebrandt</authoringgroup><date>1984, </date><desc-page>270,</desc-
page></def-pub-cite> emend. <def-pub-cite cite-
ref="phy1a.0007"><authoringgroup>Pley and Stetter <emphasis
display="italic">in</emphasis> Pley, Schipka, Gambacorta, Jannasch, Fricke,
Rachel and Stetter</authoringgroup><date>1991, </date><desc-page>251
</desc-page></def-pub-cite>(Effective publication: <def-pub-cite cite-
ref="phy1a.0003"><authoringgroup>Stetter, König and

Stackebrandt</authoringgroup><date>1983, </date><desc-page>549</desc-
page></def-pub-cite>).</def-pub></type-taxon></definition>
<key>
<list list-type="ordered" numbering="arabic"><head>Key to the genera of the
family <family>Pyrodictiaceae</family></head>
<item>
<para>Cells are discs within a network of cannulae. Obligately anaerobic;
H<subscript>2</subscript>/S<superscript>0</superscript> autotrophy and sulfur
respiration with complex organic substrates. Temperature optimum: 105°C;
temperature maximum: 110°C.</para>
<para>Genus I. <genus>Pyrodictium</genus>.</para>


➤Workflow 4c: Working with XML created
for a purpose other than publishing
Edit in XML Composition
editing syst PDF
in XML-based file
system
Rich, Valid
XMLfiles

XML files for HTML
researchers Scripts file

Workflow #5

“I don’t want to think about
codes—automate everything.”


➤Using a Content Management System
• Custom designed or customized:
don’t expect to “plug ’n’ play”!
• CMS manages “XML-esque” database:
—Incorporates data from various sources
—Provides tools and/or functionality
—Manages metadata, resources, links
• Can output files (e.g., XML, HTML, OeB)
• Can manage access, delivery, e-commerce


➤Workflow 5: Using a Content Mgmt. Syst.
Legacy data PDF
Content
Word files Management proof
System
Spreadsheets
Composition
Licensed data in XML-based
Updated system
Image files Valid XML
Interface to DB
HTML for PDF for
© Copyright 2003, Impressions
Online Print
Book and Journal Services, Inc.

109 sem 1_-_kasdorf

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Andere mochten auch

Andere mochten auch (20)

Ähnlich wie 109 sem 1_-_kasdorf

Ähnlich wie 109 sem 1_-_kasdorf (20)

Mehr von Society for Scholarly Publishing

Mehr von Society for Scholarly Publishing (20)

109 sem 1_-_kasdorf