bluuebunny/crossref_metadata_2025 huggingface dataset:
Subclinical hypothyroidism and its association with lupus nephritis: a case control study in a large cohort of Chinese systemic lupus erythematosus patients
Authors: Gao H , Li C , Mu R , Guo Y-Q , Liu T , Chen S , Su Y , Li Z-G
Published: June 2011

The aim of this study was to evaluate the prevalence of thyroid diseases in Chinese systemic lupus erythematosus (SLE) patients and the relevance of subclinical hypothyroidism (SCH) with lupus nephritis (LN). A large cohort of 1006 SLE patients was retrospectively analyzed. The prevalence of autoimmune thyroid disease was 2.78%, clinical hypothyroidism 1.69%, subclinical hypothyroidism 10.04%, central hypothyroidism 1.29%, hyperthyroidism 1.19%, euthyroid sick syndrome (ESS) 9.54%, and nodules 1.09%, respectively. Compared with the prevalence of thyroid abnormalities in the general Chinese population (0.91–6.05%), SCH was much higher (10.04%) in this study. In addition, SCH was more frequent in patients with LN (13.4%) than those without LN (7.3%, p = 0.001). Case control study was performed to explore the relative risk factors of SCH. In multiple logistic regression models, 24 h urine protein and estimated glomerular filtration rate (eGFR) were retained as independent correlates of SCH after adjusting for demographic variables, risk factors, and other potential confounders. The results of the present study suggest that SCH is a common complication in SLE patients, and closely related with LN.
Vitamin D insufficiency in Brazilian patients with SLE: prevalence, associated factors, and relationship with activity
Authors: Souto MID , Coelho A , Guo C , Mendonça LMC , Argolo S , Papi JAS , Farias MLF
Published: June 2011

The influence of vitamin D on the severity of systemic lupus erythematosus (SLE) has been studied. Our objectives were to determine the prevalence of vitamin D insufficiency in Brazilian lupus patients and its relationship with demographic, clinical, and laboratory variables and to study the relationship between vitamin D insufficiency and disease activity. This is a cross-sectional study of 159 SLE patients. Levels of serum 25-hydroxyvitamin D (25(OH)D) <30 ng/ml were defined as vitamin D insufficiency and <20 ng/ml as deficiency. Data collected included sex, age, ethnicity, postmenopausal status, disease duration, cumulative amount of oral glucocorticoids (GC) in the last six months, duration of GC usage, calcium and vitamin D supplements, photosensitivity, sunscreen usage, sun exposure, diabetes mellitus, creatinine clearance, lifestyle habits, and smoking. Disease activity was measured by the SLE Disease Activity Index 2000 (SLEDAI-2K). Bivariate statistical analysis was performed using the Mann–Whitney test, Spearman’s correlation coefficient, Chi-square test, and Fisher’s exact test. Multivariate analysis was performed with multiple linear regression. The prevalence of vitamin D insufficiency and deficiency were 37.7% and 8.2%, respectively. Levels of 25(OH) D were not associated with lupus activity score, disease duration, sun exposure, vitamin D supplementation, or use of corticosteroids.
Nursing under the influence
Authors: Kunyk Diane , Austin Wendy
Published: June 2011

When nurses have active and untreated addictions, patient safety may be compromised and nurse-health endangered. Genuine responses are required to fulfil nurses' moral obligations to their patients as well as to their nurse-colleagues. Guided by core elements of relational ethics, the influences of nursing organizational responses along with the practice environment in shaping the situation are contemplated. This approach identifies the importance of consistency with nursing values, acknowledges nurses interdependence, and addresses the role of nursing organization as moral agent. By examining the relational space, the tension between what appears to be opposing moral responsibilities may be healed. Ongoing discourse to identify authentic actions for the professional practice issue of nursing under the influence is called upon.
The ethical component of professional competence in nursing: An analysis
Authors: Paganini Maria Cristina , Yoshikawa Egry Emiko
Published: June 2011

The purpose of this article is to initiate a philosophical discussion about the ethical component of professional competence in nursing from the perspective of Brazilian nurses. Specifically, this article discusses professional competence in nursing practice in the Brazilian health context, based on two different conceptual frameworks. The first framework is derived from the idealistic and traditional approach while the second views professional competence through the lens of historical and dialectical materialism theory. The philosophical analyses show that the idealistic view of professional competence differs greatly from practice. Combining nursing professional competence with philosophical perspectives becomes a challenge when ideals are opposed by the reality and implications of everyday nursing practice.
Nursing strikes: An ethical perspective on the US healthcare community
Authors: Neiman Paul
Published: June 2011

Recent labor disputes between registered nurses and hospitals in Minnesota, California, and Pennsylvania raise moral questions about nurses’ professional obligations, nurses’ right to collectively bargain to preserve or improve wages, benefits, and working conditions, and patients’ right to medical care. Deontology and consequentialism focus too narrowly on nurses and patients, and thus ignore the nature of the healthcare community as a system of competing interests. When considered in this context, nurses’ strikes are shown to be consistent with this system of competing interests, and thus are morally permissible.
Service Quality in Health Care Organisations
Authors: Ramanujam P.G.
Published: June 2011

In today’s customer-driven market, it is being felt increasingly that it is quality that will ultimately decide the value of the services. With in-creasing awareness among consumers about their rights, the patient, as a consumer of health services, expect and demand quality health care. The health care customer is changing qualitatively. The rising literacy rate, higher levels of income and increasing awareness through deeper penetration of the media, has brought the Indian consumer closer to demand quality health care. All these factors have not only contributed to the growth of health care sector in India but also for quality health care services. In the light of these developments, health care providers need to have a closer look at the perception of their patients and try to provide quality medical and health services to meet their expectations. It is the professional excellence, personal-touch-in-service, humanitarian approach and ethical values of the employees that play a significant role in the satisfaction of patients. The study of service quality perceptions from the patient viewpoint provides a basic feedback to the hospitals in the light of their patient-oriented and patient-centric efforts in attracting and satisfying the patients. In view of the above, an attempt is made in the study to examine how well the corporate hospitals in the private sector in Hyderabad are meeting the customers’ expectations on the service quality dimensions.
Service Quality as Predicator of Patient Satisfaction
Authors: Mehta Seema
Published: June 2011

Satisfaction has been shown to predict important health-related behaviour, such as adhering to treatment recommendations and maintaining continuity of care. The study resulted in two self-designed standardised questionnaires which were used to evaluate service quality and patient satisfaction. The study has yielded three factors of service quality namely promptness, medical aid and patient interest for service quality and amenities, clinical services and physical services. The study explains that service quality and patient satisfaction are more strongly associated with adherence and continuity of visit; when service quality and patient satisfaction were placed in the regression model, they are positively associated. The findings suggest that service quality and satisfaction level of the patients will be important for improving the outcomes in health care settings.
Cultural Beliefs and Coping Strategies Related to Childhood Cancer
Authors: Banerjee Ananya Tina , Watt Lisa , Gulati Sonia , Sung Lillian , Dix David , Klassen Robert , Klassen Anne F.
Published: June 2011

The purpose of this study is to describe cultural beliefs and coping strategies related to dealing with childhood cancer identified through a qualitative study of the caregiving experiences of first-generation South Asian immigrant parents of children with cancer. A constructivist grounded theory approach was employed. Families with a child at least 6 months postdiagnosis were recruited from 5 Canadian pediatric oncology centers. In-depth semistructured interviews were conducted in English, Hindi, Punjabi, or Urdu with a sample of 25 South Asian parents. Analysis of interviews involved line-by-line coding and using the constant comparison method. The following 2 central themes related to culture and coping emerged: (a) cultural beliefs about childhood cancer being incurable, rare, unspeakable, and understood through religion and (b) parental coping strategies included gaining information about the child’s cancer, practicing religious rituals and prayers, trusting the health care professionals, and obtaining mutual support from other South Asian parents. These cultural beliefs and coping strategies have important implications for health care providers to understand the variations in the perceptions of childhood cancer and coping in order to implement culturally sensitive health care services.
Infant Distress
Authors: Hatfield Linda A. , Polomano Rosemary C.
Published: June 2011

Infants’ inability to articulate their pain and distress and the diverse range of behavioral responses evoked by painful stimuli may partially explain the challenges associated with the treatment of pain in neonates and infants. To assist nurses in distinguishing nonspecific distress responses from specific pain responses, a concept analysis using Wilson’s method was preformed. An evaluation of published, peer reviewed literature referencing distress in neonates and infants was conducted to extract meaningful information related to distress. This article examines the essential features, antecedents, and consequences of infant distress to generate an evidence-based definition that has relevance for neonatal and pediatric research and clinical practice.
An intelligent sliding mode controller for vibration suppression in flexible structures
Authors: Li De Z , Wang Wilson
Published: June 2011

A novel sliding mode (SM) control system with an embedded neuro-fuzzy approximator is developed in this paper to provide more effective vibration suppression, especially in flexible structures. It aims to force system state to move to, and maintain on, the defined sliding surface without chattering. A new hybrid training technique based on an extended gradient method is proposed to optimize the neuro-fuzzy system to approximate unknown nonlinear functions and to enhance control performance. When the principle of the terminal attractor is incorporated into the classical gradient method and/or SM control systems, some implementation problems arise especially when the error is close to its origin. The proposed extended gradient method can enhance the SM control to not only speed up convergence but also overcome the existing implementation problems of the terminal attractor. The Lyapunov stability analysis demonstrates that the approximation with the proposed hybrid training technique is stable and can converge to the optimal approximation. The effectiveness of the developed control system and the hybrid training technique is verified experimentally corresponding to nonlinear and time-varying system control.
Ideology at work: Ambiguity and irony of value-based management in Bang & Olufsen
Authors: Krause-Jensen Jakob
Published: June 2011

Over the past few decades, the ambition of establishing a ‘corporate culture’ has largely vanished from corporate agendas. Instead, resources and energy are spent on creating ‘value-based’ organizations. Based on ethnographic fieldwork in the Human Resources Department of Bang & Olufsen, a Danish producer of ‘high-end’ home electronics, I offer an explanation of this shift in managerial ideology from ‘culture’ to ‘value’ — I argue that much of the attraction of value-based management resides in the double-edged semantics of the word ‘value’ and its promise to accommodate economic bottom-line value and deep-seated moral and aesthetic values. My material suggests, however, that this ambiguity confuses more than it clarifies and leads to ironic and counter-intentional consequences. The identification of the values, which was meant to congregate the employees, came to symbolize and engender a split between staff and other parts of the company.
Continuous Surveillance of Lower Limb Perfusion During Aortic Surgery With Near-Infrared Spectroscopy: A Pilot Study
Authors: Boezeman R.P.E. , Kelder J.C. , Waanders F.G.J. , de Vries J.P.P.M.
Published: June 2011

Background: Near-infrared spectroscopy (NIRS) is a noninvasive technique that allows continuous monitoring of the regional hemoglobin oxygen saturation (rSO2) index. We evaluated its application to survey perioperative lower limb perfusion. Methods: A total of 10 patients (7 men, aged 71) were monitored during abdominal surgery for aortic aneurysms. The rSO2 index was measured at the M gastrocnemius (optode 1) and at the dorsum of the foot (optode 2). Results: Mean baseline rSO2 values for optodes 1 and 2 were 67 and 66, respectively. After clamping the aorta or iliacofemoral arteries, rSO2 dropped to 32 for optode 1 (P < .0001) and to 27 for optode 2 (P < .0001). After declamping, rSO2 increased to 74 for optode 1 (P = .0012 vs baseline) and also to 74 for optode 2 (P = .0018 vs baseline). Conclusion: Near-infrared spectroscopy is an easily applicable, noninvasive tool for continuous surveillance of lower extremity perfusion during aortic reconstruction.
Intensity of Continuous Renal Replacement Therapy in Acute Kidney Injury in the Intensive Care Unit: A Systematic Review and Meta-Analysis
Authors: Negash Daniel T. , Dhingra Vinay K. , Copland Michael , Griesdale Donald , Henderson William
Published: June 2011

Background and Objective: Acute kidney injury is a common finding among patients in the intensive care unit (ICU) and is an independent predictor of mortality. The optimal intensity and timing of continuous renal replacement therapy (CRRT), in critically ill patients remain unclear. The purpose of this study was to conduct a systematic review and meta-analysis of all prospective randomized controlled trials (RCTs) to determine the effect of intensity of CRRT on the survival of patients with acute renal failure (ARF) in ICU setting. Methods: Search strategy and data source. Electronic databases were searched on MEDLINE (through February 2010), ISIWeb of Science, and Cochrane Central Register of Controlled Trials (2010); Pub Med ‘‘Related articles.’’ Trial authors were also contacted for additional information. Study selection and data abstraction. All prospective clinical trials comparing the intensity of CRRT in adult patients with ARF and with explicit reporting of mortality were included. Three authors independently evaluated articles for eligibility and extracted data on study quality and outcomes. Meta-analysis used a random-effects model. Result: Of the 322 citations, 5 trials (n = 2402) were included in the meta-analysis, which met all the inclusion and exclusion criteria. Meta-analysis showed that in critically ill patients with acute kidney injury, the high-dose CRRT did not reduce mortality at 28 days. (risk ratio [RR], 0.88; 95% confidence interval [CI], 0.70-1.11; P = 0.28). Conclusion: In critically ill patients with acute kidney injury, the high-dose CRRT did not reduce mortality at 28 days.
Carotid Tortuosity in Patients With Prior Cervical Radiation
Authors: DeRubertis Brian G. , Hynecek Robert L. , Kent K. Craig , Faries Peter L.
Published: June 2011

Introduction: Anatomic distortion associated with radiation-induced tissue changes may pose challenges for patients with prior cervical irradiation undergoing carotid stenting. We sought to evaluate the effect of these changes on carotid intervention. Methods: Carotid angioplasty and stenting (CAS) for high-grade stenosis was performed in 203 patients. In all, 12 consecutive patients with prior ipsilateral cervical irradiation were age-/sex-matched to 24 controls. Degree of internal carotid (IC) tortuosity was assessed by 4 methods: ( a) deviation of IC from common carotid (CCA) axis, ( b) number of intersections between this axis and the course of the IC, ( c) total degrees of angulation along the course of the extracranial IC, and ( d) the IC length to straight-line distance ratio. Results: Carotid angioplasty and stenting was successful in all patients. Mean age was 72.8 ± 10 years; 58.4% were male. Twenty-nine percent were symptomatic (14.4% transient ischemic attack [TIA], 8.5% cardiovascular accident [CVA], and 6.5% amaurosis). Comorbidities were similar between the entire cohort and the subgroups of irradiated/control patients. The IC revealed a higher degree of deviation from the axis of the CCA in the previously irradiated patients compared to those without radiation (29.2° ± 4.5° vs 13.0° ± 2.0°, P = .001) and was more likely to intersect this axis in those with a history of cervical irradiation (83.3% vs 14.3%, P < .05). Irradiated patients also exhibited a significantly greater degree of tortuosity versus nonirradiated patients when assessed by total angulation along the course of the carotid (171.8° ± 26.0° vs 74.2° ± 20.2°, P = .014) and by the IC length:distance ratio (1.14 ± 0.05 vs 1.04 ± 0.03, P = .020). Despite increased IC tortuosity in patients with prior irradiation, all procedures were successfully completed and there did not appear to be a predilection for a specific filter type. Conclusions: A history of cervical irradiation is associated with increased tortuosity of the IC, leading to potential challenges for filter and stent deployment. However, this increased procedural complexity did not affect technical success rate or device selection in this series.
Case Report of a Hybrid Endovascular Approach to an Abdominal Aortic Dissection With Retrograde Thoracic Extension and Infrarenal Aneurysm
Authors: Campbell Michael J. , Raker Edmond J. , Farrokhi Ellen
Published: June 2011

Spontaneous abdominal aortic dissection (AAD) with retrograde thoracic extension is an extremely rare occurrence with a high mortality. Abdominal aortic dissection can be associated with an abdominal aortic aneurysm (AAA) and the presence of an AAD with an AAA mandates surgical intervention because of a high rate of rupture. We present the case of a 53-year-old woman with a spontaneous AAD that extended retrograde into the thoracic aorta with a concomitant supraceliac intimal tear and an infrarenal AAA repaired electively with a hybrid approach using a supraceliac stent graft and an open infrarenal aortobiiliac graft. This hybrid approach provided an excellent outcome of this rare and complex vascular pathology.
The analysis of shielding gases in laser–arc hybrid welding processes
Authors: Kah P , Salminen A , Martikainen J
Published: June 2011

Acceptable quality laser–arc hybrid welds can be produced with many different process gas compositions, but if the objective is high productivity, low gas costs, a reliable process, and the best quality, the shielding gas composition makes a remarkable difference in the laser–arc hybrid welding of steels. The present paper mostly concentrates on the welding of steel. The gas type used in such processes has a significant influence upon plasma formation, process stability, and the weld bead shape. In this paper, different process gases have been studied in various laser–arc hybrid welding processes. The aim of the review is to assess the influence of shielding gases in the production of a weld.

It was concluded from the study that for the constant combination of the laser beam and arc sources, there should be an optimal combination and composition of types of shielding gases. The flowrate of the shielding gas must change the laser-induced plasma plume in order to attain a high coupling coefficient between the laser and the material.

The study is based on a critical literature analysis of the results from a variety of studies carried out by several research groups. The effects of parameters and set-up are detailed in the analysis, which especially assesses the economic feasibility and quality management factors.
Does thermoregulatory behavior maximize reproductive fitness of natural isolates of Caenorhabditis elegans?
Authors: Anderson Jennifer L , Albergotti Lori , Ellebracht Barbara , Huey Raymond B , Phillips Patrick C
Published: June 2011

Background

A central premise of physiological ecology is that an animal's preferred body temperature should correspond closely with the temperature maximizing performance and Darwinian fitness. Testing this co-adaptational hypothesis has been problematic for several reasons. First, reproductive fitness is the appropriate measure, but is difficult to measure in most animals. Second, no single fitness measure applies to all demographic situations, complicating interpretations. Here we test the co-adaptation hypothesis by studying an organism (Caenorhabditis elegans) in which both fitness and thermal preference can be reliably measured.

Results

We find that natural isolates ofC. elegansdisplay a range of mean thermal preferences and also vary in their thermal sensitivities for fitness. Hot-seeking isolates CB4854 and CB4857 prefer temperatures that favor population growth rate (r), whereas the cold-seeking isolate CB4856 prefers temperatures that favor Lifetime Reproductive Success (LRS).

Conclusions

Correlations between fitness and thermal preference in natural isolates ofC. elegansare driven primarily by isolate-specific differences in thermal preference. If these differences are the result of natural selection, then this suggests that the appropriate measure of fitness for use in evolutionary ecology studies might differ even within species, depending on the unique ecological and evolutionary history of each population.
The interplay between surfaces and soluble factors define the immunologic and angiogenic properties of myeloid dendritic cells
Authors: Sprague Leslee , Muccioli Maria , Pate Michelle , Meles Evan , McGinty John , Nandigam Harika , Venkatesh Amritha K , Gu Ming-yu , Mansfield Kristen , Rutowski Andrew , Omosebi Omowaleola , Courreges Maria C , Benencia Fabian
Published: June 2011

Background

Dendritic cells (DCs) are antigen presenting cells capable of inducing specific immune responses against microbial infections, transplant antigens, or tumors. Interestingly, microenvironment conditions such as those present in tumor settings might induce a DC phenotype that is poorly immunogenic and with the capability of promoting angiogenesis. We hypothesize that this plasticity may be caused not only by the action of specific cytokines or growth factors but also by the properties of the surfaces with which they interact, such as extracellular matrix (ECM) components.

Results

Herewith we studied the effect of different surfaces and soluble factors on the biology of DCs. To accomplish this, we cultured murine myeloid(m) DCs on surfaces coated with fibronectin, collagen I, gelatin, and Matrigel using poly-D-lysine and polystyrene as non-biological surfaces. Further, we cultured these cells in the presence of regular DC medium (RPMI 10% FBS) or commercially available endothelial medium (EGM-2). We determined that mDCs could be kept in culture up to 3 weeks in these conditions, but only in the presence of GM-CSF. We were able to determine that long-term DC cultures produce an array of angiogenic factors, and that some of these cultures still retain the capability to induce T cell responses.

Conclusions

Altogether these data indicate that in order to design DC-based vaccines or treatments focused on changing the phenotype of DCs associated with diseases such as cancer or atherosclerosis, it becomes necessary to fully investigate the microenvironment in which these cells are present or will be delivered.
Trends in chlamydia and gonorrhea positivity among heterosexual men and men who have sex with men attending a large urban sexual health service in Australia, 2002-2009
Authors: Vodstrcil Lenka A , Fairley Christopher K , Fehler Glenda , Leslie David , Walker Jennifer , Bradshaw Catriona S , Hocking Jane S
Published: June 2011

Background

To determine whether chlamydia positivity among heterosexual men (MSW) and chlamydia and gonorrhea positivity among men who have sex with men (MSM), are changing.

Methods

Computerized records for men attending a large sexual health clinic between 2002 and 2009 were analyzed. Chlamydia and gonorrhea positivity were calculated and logistic regression used to assess changes over time.

Results

17769 MSW and 8328 MSM tested for chlamydia and 7133 MSM tested for gonorrhea. In MSW, 7.37% (95% CI: 6.99-7.77) were chlamydia positive; the odds of chlamydia positivity increased by 4% per year (OR = 1.04; 95% CI: 1.01-1.07; p = 0.02) after main risk factors were adjusted for. In MSM, 3.70% (95% CI: 3.30-4.14) were urethral chlamydia positive and 5.36% (95% CI: 4.82-5.96) were anal chlamydia positive; positivity could not be shown to have changed over time. In MSM, 3.05% (95% CI: 2.63-3.53) tested anal gonorrhea positive and 1.83% (95% CI: 1.53-2.18) tested pharyngeal gonorrhea positive. Univariate analysis found the odds of anal gonorrhea positivity had decreased (OR = 0.93; 95% CI: 0.87-1.00; p = 0.05), but adjusting for main risk factors resulted in no change. Urethral gonorrhea cases in MSM as a percentage of all MSM tested for gonorrhea also fell (p < 0.001).

Conclusions

These data suggest that chlamydia prevalence in MSW is rising and chlamydia and gonorrhea prevalence among MSM is stable or declining. High STI testing rates among MSM in Australia may explain differences in STI trends between MSM and MSW.
Primary care utilisation patterns among an urban immigrant population in the Spanish National Health System
Authors: Calderón-Larrañaga Amaia , Gimeno-Feliu Luis A , Macipe-Costa Rosa , Poblador-Plou Beatriz , Bordonaba-Bosque Daniel , Prados-Torres Alexandra
Published: June 2011

Background

There is evidence suggesting that the use of health services is lower among immigrants after adjusting for age and sex. This study takes a step forward to compare primary care (PC) utilisation patterns between immigrants and the native population with regard to their morbidity burden.

Methods

This retrospective, observational study looked at 69,067 individuals representing the entire population assigned to three urban PC centres in the city of Zaragoza (Aragon, Spain). Poisson models were applied to determine the number of annual PC consultations per individual based on immigration status. All models were first adjusted for age and sex and then for age, sex and case mix (ACG System®).

Results

The age and sex adjusted mean number of total annual consultations was lower among the immigrant population (children: IRR = 0.79, p < 0.05; adults: IRR = 0.73, p < 0.05). After adjusting for morbidity burden, this difference decreased among children (IRR = 0.94, p < 0.05) and disappeared among adults (IRR = 1.00). Further analysis considering the PC health service and type of visit revealed higher usage of routine diagnostic tests among immigrant children (IRR = 1.77, p < 0.05) and a higher usage of emergency services among the immigrant adult population (IRR = 1.2, p < 0.05) after adjusting for age, sex and case mix.

Conclusions

Although immigrants make lower use of PC services than the native population after adjusting the consultation rate for age and sex, these differences decrease significantly when considering their morbidity burden. These results reinforce the 'healthy migration effect' and discount the existence of differences in PC utilisation patterns between the immigrant and native populations in Spain.
Weight Watchers on prescription: An observational study of weight change among adults referred to Weight Watchers by the NHS
Authors: Ahern Amy L , Olson Ashley D , Aston Louise M , Jebb Susan A
Published: June 2011

Background

The scale of overweight and obesity in the UK places a considerable burden on the NHS. In some areas the NHS has formed partnerships with commercial companies to offer weight management services, but there has been little evaluation of these schemes.

This study is an independent audit of the Weight Watchers NHS Referral scheme and evaluates the weight change of obese and overweight adults referred to Weight Watchers (WW) by the NHS.

Method

Data was obtained from the WW NHS Referral Scheme database for 29,326 referral courses started after 2nd April 2007 and ending before 6th October 2009 [90% female; median age 49 years (IQR 38 - 61 years); median BMI 35.1 kg/m2 (IQR 31.8 - 39.5 kg/m2). Participants received vouchers (funded by the PCT following referral by a healthcare professional) to attend 12 WW meetings. Body weight was measured at WW meetings and relayed to the central database.

Results

Median weight change for all referrals was -2.8 kg [IQR -5.9 - -0.7 kg] representing -3.1% initial weight. 33% of all courses resulted in loss of ≥5% initial weight. 54% of courses were completed. Median weight change for those completing a first course was -5.4 kg [IQR -7.8 - -3.1 kg] or -5.6% of initial weight. 57% lost ≥5% initial weight.

Conclusions

A third of all patients who were referred to WW through the WW NHS Referral Scheme and started a 12 session course achieved ≥5% weight loss, which is usually associated with clinical benefits. This is the largest audit of NHS referral to a commercial weight loss programme in the UK and results are comparable with other options for weight loss available through primary care.
Prevalence and risk factors of childhood allergic diseases in eight metropolitan cities in China: A multicenter study
Authors: Li Fei , Zhou Yingchun , Li Shenghui , Jiang Fan , Jin Xingming , Yan Chonghuai , Tian Ying , Zhang Yiwen , Tong Shilu , Shen Xiaoming
Published: June 2011

Background

Several studies conducted during the past two decades suggested increasing trend of childhood allergic diseases in China. However, few studies have provided detailed description of geographic variation and explored risk factors of these diseases. This study investigated the pattern and risk factors of asthma, allergic rhinitis and eczema in eight metropolitan cities in China.

Methods

We conducted a cross-sectional survey during November-December 2005 in eight metropolitan cities in China. A total of 23791 children aged 6-13 years participated in this survey. Questions from the standard questionnaire of the International Study of Asthma and Allergies in Children (ISAAC) were used to examine the pattern of current asthma, allergic rhinitis and eczema. Logistic regression analyses were performed to assess the risk factors for childhood allergies.

Results

The average prevalence of childhood asthma, allergic rhinitis and eczema across the eight cities was 3∙3% (95% Confidence interval (CI): 3∙1%, 3∙6%), 9∙8% (95% CI: 9∙4%, 10∙2%) and 5∙5% (95% CI: 5∙2%, 5∙8%), respectively. Factors related to lifestyle, mental health and socio-economic status were found to be associated with the prevalence of childhood allergies. These risk factors were unevenly distributed across cities and disproportionately affected the local prevalence.

Conclusions

There was apparent geographic variation of childhood allergies in China. Socio-environmental factors had strong impacts on the prevalence of childhood allergies; but these impacts differed across regions. Thus public health policies should specifically target at the local risk factors for each individual area.
Interactions between human immunodeficiency virus (HIV)-1 Vpr expression and innate immunity influence neurovirulence
Authors: Na Hong , Acharjee Shaona , Jones Gareth , Vivithanaporn Pornpun , Noorbakhsh Farshid , McFarlane Nicola , Maingat Ferdinand , Ballanyi Klaus , Pardo Carlos A , Cohen Éric A , Power Christopher
Published: June 2011

Background

Viral diversity and abundance are defining properties of human immunodeficiency virus (HIV)-1's biology and pathogenicity. Despite the increasing availability of antiretroviral therapy, HIV-associated dementia (HAD) continues to be a devastating consequence of HIV-1 infection of the brain although the underlying disease mechanisms remain uncertain. Herein, molecular diversity within the HIV-1 non-structural gene, Vpr, was examined in RNA sequences derived from brain and blood of HIV/AIDS patients with or without HIV-associated dementia (HAD) together with the ensuing pathobiological effects.

Results

Cloned brain- and blood-derived full lengthvpralleles revealed that amino acid residue 77 within the brain-derived alleles distinguished HAD (77Q) from non-demented (ND) HIV/AIDS patients (77R) (p< 0.05) althoughvprtranscripts were more frequently detected in HAD brains (p< 0.05). Full length HIV-1 clones encoding the 77R-ND residue induced higherIFN-α,MX1andBST-2transcript levels in human glia relative to the 77Q-HAD encoding virus (p< 0.05) but both viruses exhibited similar levels of gene expression and replication. Myeloid cells transfected with 77Q-(pVpr77Q-HAD), 77R (pVpr77R-ND) or Vpr null (pVpr(-))-containing vectors showed that the pVpr77R-NDvector induced higher levels of immune gene expression (p< 0.05) and increased neurotoxicity (p< 0.05). Vpr peptides (amino acids 70-96) containing the 77Q-HAD or 77R-ND motifs induced similar levels of cytosolic calcium activation when exposed to human neurons. Human glia exposed to the 77R-ND peptide activated higher transcript levels ofIFN-α,MX1,PRKRAandBST-2relative to 77Q-HAD peptide (p< 0.05). The Vpr 77R-ND peptide was also more neurotoxic in a concentration-dependent manner when exposed to human neurons (p< 0.05). Stereotaxic implantation of full length Vpr, 77Q-HAD or 77R-ND peptides into the basal ganglia of mice revealed that full length Vpr and the 77R-ND peptide caused greater neurobehavioral deficits and neuronal injury compared with 77Q-HAD peptide-implanted animals (p< 0.05).

Conclusions

These observations underscored the potent neuropathogenic properties of Vpr but also indicated viral diversity modulates innate neuroimmunity and neurodegeneration.
Systemic Epstein-Barr-virus-positive T cell lymphoproliferative childhood disease in a 22-year-old Caucasian man: A case report and review of the literature
Authors: Tabanelli Valentina , Agostinelli Claudio , Sabattini Elena , Gazzola Anna , Bacci Francesco , Capria Saveria , Mannu Claudia , Righi Simona , Sista Maria Teresa , Meloni Giovanna , Pileri Stefano A , Piccaluga Pier Paolo
Published: June 2011

Introduction

Systemic Epstein-Barr-virus-positive T cell lymphoproliferative disease of childhood is an extremely rare disorder, characterized by clonal proliferation of Epstein-Barr-virus-infected T cells with an activated cytotoxic phenotype. The disease is more frequent in Asia and South America, with only few cases reported in Western countries. A prompt diagnosis, though often difficult, is a necessity due to the very aggressive clinical course of the disease.

Case presentation

We report the clinicopathological features of fulminant T cell lymphoproliferative disease that arose in the setting of acute primary Epstein-Barr virus infection. Our patient, a 23-year-old man, presented to our facility with persisting fever, hepatosplenomegaly and severe pancytopenia. On bone marrow biopsy, an abundant lymphoid infiltrate was observed. Immunophenotypic and molecular studies revealed that the atypical lymphoid cells displayed a CD8+, Epstein-Barr-encoded-RNA-positive T cell phenotype with clonal rearrangement of the T cell receptor genes, the final diagnosis being systemic Epstein-Barr-virus-positive T cell lymphoproliferative disease. On reviewing the literature we found only 14 similar cases, all presenting with very aggressive clinical courses and requiring extensive phenotyping and molecular techniques for final diagnosis.

Conclusion

Though extremely rare, this disease can occur in Europe, and a comprehensive diagnostic approach is thus recommended in all case of Epstein-Barr-virus-positive lymphoproliferative disorders. Unfortunately, at present no specific treatment is available; however, prompt administration of anti- Epstein-Barr virus treatment and rapid attempts to control the hemophagocytic syndrome are indicated.
Relation between mean arterial pressure and renal function in the early phase of shock: a prospective, explorative cohort study
Authors: Badin Julie , Boulain Thierry , Ehrmann Stephan , Skarzynski Marie , Bretagnol Anne , Buret Jennifer , Benzekri-Lefevre Dalila , Mercier Emmanuelle , Runge Isabelle , Garot Denis , Mathonnet Armelle , Dequin Pierre-François , Perrotin Dominique
Published: June 2011

Introduction

Because of disturbed renal autoregulation, patients experiencing hypotension-induced renal insult might need higher levels of mean arterial pressure (MAP) than the 65 mmHg recommended level in order to avoid the progression of acute kidney insufficiency (AKI).

Methods

In 217 patients with sustained hypotension, enrolled and followed prospectively, we compared the evolution of the mean arterial pressure (MAP) during the first 24 hours between patients who will show AKI 72 hours after inclusion (AKIh72) and patients who will not. AKIh72 was defined as the need of renal replacement therapy or "Injury" or "Failure" classes of the 5-stage RIFLE classification (Risk, Injury, Failure, Loss of kidney function, End-stage renal disease) for acute kidney insufficiency using the creatinine and urine output criteria. This comparison was performed in four different subgroups of patients according to the presence or not of AKI at the sixth hour after inclusion (AKIh6 as defined as a serum creatinine level above 1.5 times baseline value within the first six hours) and the presence or not of septic shock at inclusion.The ability of MAP averaged over H6 to H24 to predict AKIh72 was assessed by the area under the receiver operating characteristic curve (AUC) and compared between groups.

Results

The MAP averaged over H6 to H24 or over H12 to H24 was significantly lower in patients who showed AKIh72 than in those who did not, only in septic shock patients with AKIh6, whereas no link was found between MAP and AKIh72 in the three others subgroups of patients. In patients with septic shock plus AKIh6, MAP averaged over H6 to H24 or over H12 to H24 had an AUC of 0.83 (0.72 to 0.92) or 0.84 (0.72 to 0.92), respectively, to predict AKIh72 . In these patients, the best level of MAP to prevent AKIh72 was between 72 and 82 mmHg.

Conclusions

MAP about 72 to 82 mmHg could be necessary to avoid acute kidney insufficiency in patients with septic shock and initial renal function impairment.
First-Line Treatment for Primary Testicular Diffuse Large B-Cell Lymphoma With Rituximab-CHOP, CNS Prophylaxis, and Contralateral Testis Irradiation: Final Results of an International Phase II Trial
Authors: Vitolo Umberto , Chiappella Annalisa , Ferreri Andrés J.M. , Martelli Maurizio , Baldi Ileana , Balzarotti Monica , Bottelli Chiara , Conconi Annarita , Gomez Henry , Lopez-Guillermo Armando , Martinelli Giovanni , Merli Francesco , Novero Domenico , Orsucci Lorella , Pavone Vincenzo , Ricardi Umberto , Storti Sergio , Gospodarowicz Mary K. , Cavalli Franco , Sarris Andreas H. , Zucca Emanuele
Published: June 2011

Purpose

Primary testicular lymphoma (PTL) has poor prognosis with failures in contralateral testis, CNS, and extranodal sites. To prevent these events, we designed an international phase II trial (International Extranodal Lymphoma Study Group 10 [IELSG-10]) that addressed feasibility and activity of conventional chemoimmunotherapy associated with CNS prophylaxis and contralateral testis irradiation. The trial was conducted by the IELSG and the Italian Lymphoma Foundation.

Patients and Methods

Fifty-three patients (age 22 to 79 years) with untreated stage I or II PTL were treated with six to eight courses of rituximab added to cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) every 21 days (R-CHOP21); four doses of intrathecal methotrexate (IT-MTX) and radiotherapy (RT) to the contralateral testis (30 Gy) for all patients and to regional lymph nodes (30 to 36 Gy) for stage II disease.

Results

All patients received R-CHOP21, 50 received CNS prophylaxis, and 47 received testicular RT. With a median follow-up of 65 months, 5-year progression-free survival and overall survival rates were 74% (95% CI, 59% to 84%) and 85% (95% CI, 71% to 92%), respectively. Ten patients relapsed or progressed: two in lymph nodes, five in extranodal organs, and three in the CNS. The 5-year cumulative incidence of CNS relapse was 6% (95% CI, 0% to 12%). No contralateral testis relapses occurred. Ten patients died: lymphoma (n = 6), secondary leukemia (n = 2), heart failure (n = 1), and gastric cancer (n = 1). Grade 3 to 4 toxicities were neutropenia, 28%; infections, 4%; and neurologic, 13%. No deaths occurred as a result of toxicity.

Conclusion

This international prospective trial shows that combined treatment with R-CHOP21, IT-MTX, and testicular RT was associated with a good outcome in patients with PTL. RT avoided contralateral testis relapses, but CNS prophylaxis deserves further investigation.
Nicotinic Acetylcholine Receptor Polymorphism, Smoking Behavior, and Tobacco-Related Cancer and Lung and Cardiovascular Diseases: A Cohort Study
Authors: Kaur-Knudsen Diljit , Bojesen Stig E. , Tybjærg-Hansen Anne , Nordestgaard Børge G.
Published: June 2011

Purpose

We examined the associations between the nicotinic acetylcholine receptor polymorphism (rs1051730) on chromosome 15q25 marking the gene cluster CHRNA3-CHRNB4-CHRNA5, smoking behavior, and tobacco-related cancer and lung and cardiovascular diseases in the general population.

Methods

Ten thousand three hundred thirty participants from the Copenhagen City Heart Study were genotyped and observed prospectively with up to 18 years of 100% complete follow-up. Smoking behavior was measured at baseline. End points were lung cancer, bladder cancer, chronic obstructive pulmonary disease, ischemic heart disease, and ischemic stroke.

Results

Multifactorially adjusted and genotype-adjusted subhazard ratios for a cumulative tobacco consumption above 40 pack-years versus 0 pack-years were 32.5 (95% CI, 12.0 to 87.7) for lung cancer, 2.2 (95% CI, 1.1 to 4.5) for bladder cancer, 9.4 (95% CI, 6.9 to 12.7) for chronic obstructive pulmonary disease, 1.5 (95% CI, 1.3 to 1.8) for ischemic heart disease, and 1.1 (95% CI, 0.8 to 1.4) for ischemic stroke. Among smoking noncarriers and homozygotes, daily tobacco consumption was 16 and 18 g/d (P < .001), cumulative tobacco consumption was 28 and 31 pack-years (P = .003), and smoking inhalation was 71.9% and 78.1% (P < .001), respectively. Multifactorially adjusted and smoking behavior–adjusted subhazard ratios for homozygotes versus noncarriers were 1.6 (95% CI, 1.1 to 2.2) for lung cancer, 1.7 (95% CI, 1.0 to 3.0) for bladder cancer, 1.3 (95% CI, 1.1 to 1.6) for chronic obstructive pulmonary disease, 0.9 (95% CI, 0.7 to 1.0) for ischemic heart disease, and 1.1 (95% CI, 0.8 to 1.4) for ischemic stroke.

Conclusion

Although smoking is associated with major tobacco-related diseases in the general population, the nicotinic acetylcholine receptor polymorphism is associated with additional increased risk of lung cancer, bladder cancer, and chronic obstructive pulmonary disease after adjustment for smoking.
Impact of KRAS and BRAF Gene Mutation Status on Outcomes From the Phase III AGITG MAX Trial of Capecitabine Alone or in Combination With Bevacizumab and Mitomycin in Advanced Colorectal Cancer
Authors: Price Timothy J. , Hardingham Jennifer E. , Lee Chee K. , Weickhardt Andrew , Townsend Amanda R. , Wrin Joseph W. , Chua Ann , Shivasami Aravind , Cummins Michelle M. , Murone Carmel , Tebbutt Niall C.
Published: June 2011

Purpose

Mutations affecting the KRAS gene are established predictive markers of outcome with anti–epithelial growth factor receptor (EGFR) antibodies in advanced colorectal cancer (CRC). The relevance of these markers for anti–vascular endothelial growth factor (VEGF) therapy is controversial. This analysis was performed to assess the predictive and prognostic impact of KRAS and BRAF gene mutation status in patients receiving capecitabine with bevacizumab (CG) or capecitabine without bevacizumab in the phase III AGITG MAX (Australasian Gastrointestinal Trials Group MAX) study.

Patients and Methods

Mutation status was determined for 315 (66.9%) of the original 471 patients. Mutation status was correlated with efficacy outcomes (response rate, progression-free survival [PFS], and overall survival [OS]), and a predictive analyses was undertaken.

Results

Mutations in KRAS and BRAF genes were observed in 28.8% and 10.6% of patients, respectively. KRAS gene mutation status (wild type [WT] v mutated [MT]) had no prognostic impact for PFS (hazard ratio [HR], 0.89; CI, 0.69 to 1.14) or OS (HR, 0.97; CI, 0.73 to 1.28). BRAF mutation status (WT v MT) was not prognostic for PFS (HR, 0.80; CI, 0.54 to 1.18) but was prognostic for OS (HR, 0.49; CI, 0.33 to 0.73; P = .001). By using the comparison of capecitabine versus capecitabine and bevacizumab (CB) and CB plus mitomycin (CBM), KRAS gene mutation status was not predictive of the effectiveness of bevacizumab for PFS or OS (test for interaction P = .95 and 0.43, respectively). Similarly, BRAF gene mutation status was not predictive of the effectiveness of bevacizumab for PFS or OS (test for interaction P = .46 and 0.32, respectively).

Conclusion

KRAS gene mutation status was neither prognostic for OS nor predictive of bevacizumab outcome in patients with advanced CRC. BRAF gene mutation status was prognostic for OS but was not predictive of outcome with bevacizumab.
The GUDMAP database – an online resource for genitourinary research
Authors: Harding Simon D. , Armit Chris , Armstrong Jane , Brennan Jane , Cheng Ying , Haggarty Bernard , Houghton Derek , Lloyd-MacGilp Sue , Pi Xingjun , Roochun Yogmatee , Sharghi Mehran , Tindal Christopher , McMahon Andrew P. , Gottesman Brian , Little Melissa H. , Georgas Kylie , Aronow Bruce J. , Potter S. Steven , Brunskill Eric W. , Southard-Smith E. Michelle , Mendelsohn Cathy , Baldock Richard A. , Davies Jamie A. , Davidson Duncan
Published: June 2011

The GenitoUrinary Development Molecular Anatomy Project (GUDMAP) is an international consortium working to generate gene expression data and transgenic mice. GUDMAP includes data from large-scale in situ hybridisation screens (wholemount and section) and microarray gene expression data of microdissected, laser-captured and FACS-sorted components of the developing mouse genitourinary (GU) system. These expression data are annotated using a high-resolution anatomy ontology specific to the developing murine GU system. GUDMAP data are freely accessible at www.gudmap.org via easy-to-use interfaces. This curated, high-resolution dataset serves as a powerful resource for biologists, clinicians and bioinformaticians interested in the developing urogenital system. This paper gives examples of how the data have been used to address problems in developmental biology and provides a primer for those wishing to use the database in their own research.