bluuebunny/crossref_metadata_2025 huggingface dataset:
Giant ileal inflammatory fibroid polyp causing small bowel obstruction: a case report and review of the literature
Authors: Mohamud Sagal O , Motorwala Shahina A , Daniel AM Rebecca , Tworek Joseph A , Shehab Thomas M
Published: May 2012

Introduction

There are several types of small bowel pathology that can lead to small bowel obstruction or intussusception. The etiology causing small bowel obstruction varies by age. Benign disease is the typical cause in children and adolescents while malignant or adhesive disease is far more common in older patients. Although cases of adult intussusception caused by benign processes are rare, there are reports of inflammatory fibroid polyps causing adult intussusception of the terminal ileum published in the literature.

Case presentation

We present the case of a 70-year-old man with a multiple year history of intermittent episodes of bowel obstruction who was found to have a giant ileal inflammatory fibroid polyp causing intermittent small bowel obstruction. The patient underwent operative intervention and has now been symptom-free for three years.

Conclusion

Small bowel lesions include both malignant and benign etiologies. The malignant etiologies include adenocarcinoma, carcinoid or lymphoma while benign lesions are typically lipomas, inflammatory polyps or adenomas. Inflammatory fibroid polyps are rare, benign lesions that can occur anywhere within the gastrointestinal tract. They are typically an incidental finding, but on rare occasions have been presented as the source of intussusception or obstruction.
Acute respiratory distress secondary to posterior mediastinal goiter: a case report
Authors: Jaroszewski Dawn E , Bakaeen Faisal G , Huh Joseph
Published: May 2012

Large posterior mediastinal goiters are extremely rare. Progressive enlargement and possible compression of adjacent structures, as well as malignant potential necessitate that these goiters should be surgically excised. A review of mediastinal tumors, specifically intra-thoracic goiters is presented along with a case report of acute respiratory compromise secondary to tracheal compression by a large posterior goiter.
Anaesthetic management of an adult patient with DOOR syndrome: a case report
Authors: Michalek Pavel , Donaldson William , Abraham Alexander
Published: May 2012

We report the anaesthetic management of a 48-year-old male patient with Deafness, Onycho-Osteodystrophy and mental Retardation syndrome, epilepsy and cerebral palsy who had two dental procedures under anaesthetic care. For the first short examination sedoanalgesia was employed and the second, longer, procedure was performed under general anaesthesia. His airway management was moderately difficult and the postoperative period was complicated by partial seizures involving the upper extremity and a short period of decreased oxygen saturation. The potential anaesthetic implications of Deafness, Onycho-Osteodystrophy and mental Retardation syndrome are highlighted.
Severe reaction in a child with asymptomatic codfish allergy: Food challenge reactivating recurrent pancreatitis
Authors: Pellegrino Katia , D’Urbano Leila Emma , Artesani Maria Cristina , Riccardi Carla , Mancini Sandro , Bella Sergio , Alghisi Federico , Cavagni Giovanni
Published: May 2012

An 8-year-old child during the first year of life manifested severe atopic dermatitis and chronic diarrhea with mucorrhea and rectal bleeding; a fish-free diet was started based on weakly positive skin-prick tests to codfish extract. At the age of 4 years the child began to suffer of recurrent pancreatitis. When he came to our attention for the evaluation of his fish allergy, he was asymptomatic; a weak reactivity to codfish was observed (SPTs: cod, 4 mm, sIgE ImmunoCAP: cod, 1.30kU/l). The food challenge test with cod was negative. When the child ate cod again, within 5 minutes, developed anaphylactic reaction and complained of abdominal pain compatible with pancreatitis (enzyme serum levels risen and parenchymal oedema at ultrasonography), that resolved within 7 days after specific therapy. This case raises two issues: the elimination diet in asymptomatic food allergy on the basis only of SPT and the ethicality of food challenge in gastrointestinal chronic disease.
Age and Geographical Distribution in Families with BRCA1/BRCA2 Mutations in the Slovak Republic
Authors: Ciernikova Sona , Tomka Miroslav , Kovac Michal , Stevurkova Viola , Zajac Vladimir
Published: May 2012

Molecular diagnostics of hereditary breast and/or ovarian cancer is mainly based on detection of BRCA1 and BRCA2 germline mutations in suspected families. The aim of the study was to determine the frequency, age and geographical distribution in 130 Slovak hereditary breast and ovarian cancer (HBOC) families diagnosed within the years 2000-2004. Mutation screening was performed by single-strand conformation polymorphism (SSCP), heteroduplex analysis (HDA) and sequencing of PCR products showing an abnormal migration pattern. Twenty of 130 (15.6%) HBOC suspected families were found to carry mutations in BRCA1 or BRCA2 genes. The glossary data from the National Cancer Registry of Slovakia (NCRS) were compared with the results from HBOC suspected kindreds. Age distribution of breast cancer onset in our study group showed the highest proportion of onset in HBC families within the 5th decade of life, while NCRS reports at least a ten year later onset. These findings confirmed that cases of breast cancer under 50 years of age can be used as one of the principal criteria to assign a family as a hereditary breast and/or ovarian cancer kindred. In contrast with unselected ovarian cancer cases, about 75% of all HOC index cases were diagnosed between 40 and 49 years of age. To study the geographical distribution of hereditary breast and/or ovarian cancer, Slovakia was divided into three parts. The distribution of HBOC suspected families approximately follows this division, with an increasing number in the western area of the country.
Comparison of accuracy of optic nerve ultrasound for the detection of intracranial hypertension in the setting of acutely fluctuating vs stable intracranial pressure: post-hoc analysis of data from a prospective, blinded single center study
Authors: Rajajee Venkatakrishna , Fletcher Jeffrey James , Rochlen Lauryn Renee , Jacobs Teresa Lee
Published: May 2012

Introduction

Optic nerve sheath diameter (ONSD) measurement with bedside ultrasound has been shown in many studies to accurately detect high intracranial pressure (ICP). The accuracy of point-in-time ONSD measurement in the presence of ongoing fluctuation of ICP between high and normal is not known. Recent laboratory investigation suggests that reversal of optic nerve sheath distension may be impaired following bouts of intracranial hypertension. Our objective was to compare the accuracy of ONSD measurement in the setting of fluctuating versus stable ICP.

Methods

This was a retrospective analysis of data from prospective study comparing ONSD to invasive ICP. Patients with invasive ICP monitors in the ICU underwent ONSD measurement with simultaneous blinded recording of ICP from the invasive monitor. Three measurements were made in each eye. Significant acute ICP fluctuation (SAIF) was defined in two different ways; as the presence of ICP both above and below 20 mmHg within a cluster of six measurements (Definition 1) and as a magnitude of fluctuation >10 mmHg within the cluster (Definition 2). The accuracy of point-in-time ONSD measurements for the detection of concurrent ICP >20 mmHg within clusters fulfilling a specific definition of SAIF was compared to the accuracy of ONSD measurements within clusters not fulfilling the particular definition by comparison of independent receiver operating characteristic (ROC) curves.

Results

A total of 613 concurrent ONSD-ICP measurements in 109 clusters were made in 73 patients. Twenty-three (21%) clusters fulfilled SAIF Definition 1 and 17 (16%) SAIF Definition 2. For Definition 1, the difference in the area under the curve (AUC) of ROC curves for groups with and without fluctuation was 0.10 (P = 0.0001). There was a fall in the specificity from 98% (95% CI 96 to 99%) to 74% (63 to 83%) and in the positive predictive value from 89% (80 to 95%) to 76% (66 to 84%) with fluctuation. For Definition 2, also, there was a significant difference between the AUC of ROC curves of groups with fluctuation-magnitude >10 mmHg and those with fluctuation-magnitude 5 to 10 mmHg (0.06, P = 0.04) as well as <5 mmHg (0.07, P = 0.01).

Conclusions

Specificity and PPV of ONSD for ICP >20 mmHg are substantially decreased in patients demonstrating acute fluctuation of ICP between high and normal. This may be because of delayed reversal of nerve sheath distension.
NLRs, inflammasomes, and viral infection
Authors: Jacobs Sarah R , Damania Blossom
Published: May 2012

Review on the interplay between NLR proteins, and RNA and DNA viruses.

NLR proteins are innate immune sensors that respond to microbial infection. Upon pathogen infection, some NLR proteins form large complexes, called inflammasomes, which activate caspase-1 and induce the production of active IL-1β and IL-18. Activation of inflammasomes can also lead to an inflammatory cell death program, named pyroptosis. In this review, we will discuss the role of various NLR proteins in sensing different viral infections, as well as the strategies used by several RNA and DNA viruses to counteract the antiviral effects of NLR-dependent inflammasomes.
Fast randomized full-waveform inversion with compressive sensing
Authors: Li Xiang , Aravkin Aleksandr Y. , van Leeuwen Tristan , Herrmann Felix J.
Published: May 2012

Wave-equation-based seismic inversion can be formulated as a nonlinear least-squares problem. The demand for higher-resolution models in more geologically complex areas drives the need to develop techniques that exploit the special structure of full-waveform inversion to reduce the computational burden and to regularize the inverse problem. We meet these goals by using ideas from compressive sensing and stochastic optimization to design a novel Gauss-Newton method, where the updates are computed from random subsets of the data via curvelet-domain sparsity promotion. Two different subset sampling strategies are considered: randomized source encoding, and drawing sequential shots firing at random source locations from marine data with missing near and far offsets. In both cases, we obtain excellent inversion results compared to conventional methods at reduced computational costs.
Angiopoietins/TIE2 System and VEGF Are Involved in Ovarian Function in a DHEA Rat Model of Polycystic Ovary Syndrome
Authors: Abramovich Dalhia , Irusta Griselda , Bas Diana , Cataldi Natalia Isabel , Parborell Fernanda , Tesone Marta
Published: May 2012

Polycystic ovary syndrome (PCOS) is the most common endocrinological pathology among women of reproductive age. It is characterized by anovulation, oligo- or amenorrhea, hyperandrogenism, obesity, and insulin resistance. PCOS patients present with elevated levels of vascular endothelial growth factor (VEGF) in serum and follicular fluid. In this study, we examined the ovarian expression of angiopoietins (ANGPT) and their receptor tyrosine kinase receptor (TIE2), involved in the stabilization of blood vessels, in a rat model of dehydroepiandrosterone-induced PCOS. We also analyzed the effect of ovarian VEGF inhibition on ANGPT/TIE2, follicular development, and vascular stability. VEGF levels were increased in the PCOS ovaries, whereas the levels of its receptor fetal liver kinase-1 were decreased. In addition, the periendothelial cell area and the ANGPT1 to ANGPT2 ratio in the ovary were increased in the PCOS group. Percentage of primary follicles was increased and the percentage of preantral follicles and corpora lutea was decreased in the PCOS group. VEGF inhibition decreased the percentage of primary follicles close to control values. Interestingly, despite the presence of cysts in the ovaries from VEGF inhibitor-treated PCOS rats, its percentage was lower than the PCOS group without treatment. In summary, this study describes an alteration not only in the VEGF/fetal liver kinase-1 system but also in the ANGPT/TIE2 system in a dehydroepiandrosterone-induced PCOS rat model. This leads to an increase in periendothelial cell recruitment. We also demonstrated that ovarian VEGF inhibition can partially restore the accumulation of small follicles in PCOS rats and reduces cyst formation, improving ovulation and follicular development. Therefore, the inhibition of VEGF could be considered, in addition to other currently applied treatments, as a new strategy to be studied in PCOS patients to restore ovarian function.
A survey of the sexual and reproductive health of HIV-positive women in Leicester
Authors: Moses S H , Dhar J
Published: May 2012

This project reports results from a questionnaire survey of sexual practices, contraception use and pregnancy plans in HIV-positive women in Leicester, UK, in order to establish the need for a dedicated sexual and reproductive health (SRH) clinic. The majority (96%) of women were aware of the benefits of antiretroviral therapy (ART) in pregnancy and 39% were planning a future pregnancy. Most (74%) used condoms consistently but their use decreased with the addition of another contraceptive method. Condoms were mostly obtained from non-National Health Service (NHS) settings. Long-acting reversible contraception (LARC) use was higher in this group of women than the general population and mainly provided by family planning services. A dedicated SRH clinic was thought to be useful by 79% of women. Data also identified some limitations of the existing service and need to provide holistic and integrated care.
Adeno-associated virus may play a protective role against human papillomavirus-induced cervical lesions independent of HIV serostatus
Authors: de Freitas L Bueno , de Mattos A Tonani , Lima B M C , Miranda A E , Spano L C
Published: May 2012

This study investigated the prevalence of adeno-associated virus (AAV) and human papillomavirus (HPV) DNA in cervical samples of HIV-seropositive and -seronegative women attending a clinic in south-eastern Brazil. Both viruses were investigated by polymerase chain reaction (PCR) and cytological exams were performed. AAV was typed by PCR and restriction fragment length polymorphism analysis. AAV prevalence was 19.7% (56/284), with 18.7% (21/112) and 20.3% (35/172) in HIV-positive and -negative women, respectively. AAV type 2 was the single virus type detected. AAV was detected with higher frequency in HPV-infected women ( P < 0.05) as was HPV in HIV-positive women ( P < 0.05). The AAV–HPV co-infected women showed a lower rate of atypical squamous cells of undetermined significance or cervical intraepithelial neoplasia development compared with those infected only with HPV. The prevalence of AAV2 confirms this type as the most common in human samples. This is the first report examining AAV in cervical samples of HIV-infected women and indicates that HIV infection does not appear to influence AAV prevalence or AAV–HPV co-infection.
Pruritus in HIV-infected patients in the era of combination antiretroviral therapy: a study of its prevalence and causes
Authors: Blanes M , Belinchón I , Portilla J , Betlloch I , Reus S , Sánchez-Payá J
Published: May 2012

Pruritus is a common symptom in HIV-infected patients. However, there is a lack of studies examining this symptom. We investigated the prevalence of pruritus and its causes in this population by offering the possibility of participating in a skin health programme to all HIV-infected patients who attended our service in Alicante, Spain. Those who accepted ( n = 303) underwent an interview and a detailed physical examination by specialists from the Dermatology Department. Between May 2003 and October 2003, 94 patients (31%) reported pruritus: xerosis, seborrhoeic eczema and interdigital tinea pedis were the most frequent dermatological entities responsible for this symptom. Patients with pruritus had higher viral loads ( P = 0.006). We conclude that pruritus is still a frequent symptom in HIV-infected patients. To the best of our knowledge this is the first prevalence study of pruritus in an HIV population in the combination antiretroviral therapy (cART) era.
Successful therapeutic splenectomy in an HIV patient with relapsing visceral leishmaniasis
Authors: Alon D , Chowers M
Published: May 2012

A 43-year-old HIV-positive Ethiopian immigrant presented with persistent diarrhoea, hepatosplenomegaly and pancytopaenia. Visceral leishmaniasis was diagnosed by multiple gastrointestinal tract biopsies. Blood polymerase chain reaction (PCR) was positive for Leishmania donovani. Despite highly active antiretroviral therapy (HAART) and multiple courses of antileishmanial treatments, including liposomal amphotericin and sodium stibogluconate, the patient had multiple relapses. CD4 counts remained at 40–60 cells/µL although viral loads were undetectable. Splenectomy resulted in resolution of the patient's pancytopaenia and in rising CD4 levels, which enabled a long-lasting remission.
Migration/mobility and risk factors for HIV among female sex workers in Andhra Pradesh, India: implications for HIV prevention
Authors: Reed E , Gupta J , Biradavolu M , Blankenship K M
Published: May 2012

We examined the relation between high mobility/migration (sex work in three or more villages/towns within the past year) and HIV risk factors among a sample of female sex workers (FSWs) in Andhra Pradesh, India. We recruited FSWs aged ≥18 years ( n = 673) through respondent-driven sampling for a survey on HIV risk. Adjusted logistic and linear regression models assessed high mobility in relation to sexual and physical victimization, sexually transmitted infection (STI) symptoms and treatment, condom use and negotiation, number and/or types of sex trades, number of clients and number of days worked. Twelve percent ( n = 82) of FSWs were highly mobile; those with high mobility were more likely to report recent HIV risk factors: sexual violence (adjusted odds ratio [AOR] = 5.2; 95% confidence interval [CI]: 3.0–8.9), physical violence (AOR = 1.7; 95% CI: 1.1–2.7), unprotected sex for more money (AOR = 1.7; 95% CI: 1.1–3.0), at least one STI symptom (AOR = 1.9; 95% CI: 1.1–3.1), a greater number of vaginal sex trades ( β = 3.9, P = 0.003), a greater number of clients ( β = 2.5, P = 0.02) and anal sex with clients (AOR = 2.4; 95% CI: 1.4–4.1). Findings from this study underscore the violence and HIV-related vulnerability faced by mobile/migrant FSWs and highlight the need to inform and tailor related prevention strategies.
The relationship between HIV testing and CD4 counts at HIV diagnosis among newly diagnosed HIV-1 patients in Japan
Authors: Takano M , Okada M , Oka S , Wagatsuma Y
Published: May 2012

The aim of this study was to investigate the factors relating to CD4 level at HIV diagnosis and HIV testing behaviour. Participants were newly diagnosed patients ( n = 654) in Japan from 2000 to 2005. Around 75% of participants were diagnosed at hospital and clinics. Mean CD4 counts at diagnosis through voluntary HIV testing, screening tests and testing due to concomitant sexually transmitted infection (STI) were 368, 336 and 316 cells/μL, respectively. In contrast, the mean CD4 count where testing was due to the presence of HIV-related clinical symptoms was 151 cells/μL ( P < 0.0001). Compared with those diagnosed at their first HIV test, those who had undertaken multiple HIV tests prior to diagnosis showed CD4 counts that increased significantly ( P < 0.0001) in relation to the number of tests undertaken: CD4 count at first test was 232 cells/μL, second test 346 cells/μL and third or additional tests 439 cells/μL. According to our results, HIV testing policy that promotes HIV testing in medical settings and among STI patients is needed to facilitate earlier HIV diagnosis in Japan.
Use of conjoint analysis to assess HIV vaccine acceptability: feasibility of an innovation in the assessment of consumer health-care preferences
Authors: Lee S J , Newman P A , Comulada W S , Cunningham W E , Duan N
Published: May 2012

Engaging consumers in prospectively shaping strategies for dissemination of health-care innovations may help to ensure acceptability. We examined the feasibility of using conjoint analysis to assess future HIV vaccine acceptability among three diverse communities: a multiethnic sample in Los Angeles, CA, USA ( n = 143); a Thai resident sample in Los Angeles (three groups; n = 27) and an Aboriginal peoples sample in Toronto ( n = 13). Efficacy had the greatest impact on acceptability for all three groups, followed by cross-clade protection, side-effects and duration of protection in the Los Angeles sample; side-effects and duration of protection in the Thai-Los Angeles sample; and number of doses and duration of protection in the Aboriginal peoples-Toronto sample. Conjoint analysis provided insights into universal and population-specific preferences among diverse end users of future HIV vaccines, with implications for evidence-informed targeting of dissemination efforts to optimize vaccine uptake.
Human papillomavirus prevalence, cervical abnormalities and risk factors among female sex workers in Lima, Peru
Authors: Brown B , Blas M M , Cabral A , Byraiah G , Guerra-Giraldez C , Sarabia-Vega V , Carcamo C , Gravitt P E , Halsey N A
Published: May 2012

Female sex workers (FSWs) are at high risk of human papillomavirus (HPV) infection. Questionnaires were administered to 200 FSWs aged 18–26 years in Lima, Peru, to gather risk behaviours, and cervical swab samples were collected for Pap smears and HPV DNA testing as part of a longitudinal study. Participants reported a median of 120 clients in the past month, and 99.2% reported using condoms with clients. The prevalence of any HPV in cervical samples was 66.8%; 34 (17.1%) participants had prevalent HPV 16 or 18, and 92 (46.2%) had one or more oncogenic types. Fifteen women had abnormal Pap smears, 13 of which were HPV DNA positive. Fewer years since first sex was associated with oncogenic HPV prevalence in a model adjusted for previous sexually transmitted infection (STI) status and condom use with partners (prevalence ratio = 0.77, 95% confidence interval [CI] = 0.60–0.97). Our data confirm the high rates of HPV transmission among FSWs in Peru, highlighting the need for early and effective strategies to prevent cervical cancer.
HIV prevalence among men who have sex with men in New Zealand 1985–2009: 25 years of public health monitoring
Authors: Saxton P J W , Dickson N P , McAllister S M , Hughes A J , Sharples K
Published: May 2012

Annual population-based estimates of the number of men who have sex with men (MSM) with diagnosed HIV infection (HIV prevalence pool), and the proportion of all MSM this represents (HIV prevalence), have been insufficiently described over the long term. We investigated the dynamic effects of ongoing HIV diagnoses, lower mortality due to treatment and growth in the MSM population over time on these two epidemic indicators using national HIV/AIDS surveillance data in New Zealand, 1985–2009. The diagnosed HIV prevalence pool rose 79% between 1989 and 1999, and 137% between 1999 and 2009. Estimates of diagnosed HIV prevalence as a proportion of MSM were 0.2% of MSM in 1985, and were between 1.5% and 5.0% of MSM by 2009. New Zealand continues to have a relatively low-prevalence HIV epidemic among MSM; however, the number of MSM living with diagnosed infection is growing rapidly 25 years after HIV testing was introduced.
Sexual risk behaviours, condom use and sexually transmitted infection treatment-seeking behaviours among female sex workers and truck drivers in Uganda
Authors: Matovu J K B , Ssebadduka B N
Published: May 2012

We assessed sexual risk behaviours, condom use and sexually transmitted infection (STI) treatment-seeking behaviours among truckers and female sex workers (FSWs) operating at 12 hotspots along two major transport corridors in Uganda. Participants were identified through local contact persons: 261 truckers and 259 FSWs were interviewed. FSWs reported a mean number of 28 partners in the past 30 days while truckers reported a mean of seven partners. Ninety-four percent of FSWs and 87% of truckers reported condom use in the past month; however, only 21% of truckers and 45% of FSWs reported using condoms consistently during that time. More than half of truckers ( n = 261) and 77% of FSWs ( n = 259) reported that they suffered from STIs in the past year, and 93% of FSWs and 92.9% of truckers sought treatment for STIs in the past year. Of these, 78% of truckers and 86% of FSWs sought treatment at least three days following recognition of symptoms. These findings suggest that FSWs and truckers engage in high-risk sexual behaviours characterized by multiple sexual partnerships, low consistent condom use and delayed treatment-seeking behaviours.
Step by step towards a clinical pathway
Authors: Zwaan Esther , Umans Victor
Published: May 2012

Clinical pathways attempt to increase efficiency by organizing the care delivery process into individual analysable steps. We evaluate a digital clinical pathway for electrocardioversion in atrial fibrillation with a nurse coordinator in the ongoing consecutive experience in clinical practice. This paper describes the implementation and effects of introducing a clinical pathway. The pathway was launched in January 2008. Up to January 2009, 450 all-comer elective patients have been treated using this integrated digital clinical pathway without exception. Treatment and outpatient check-up appointments are made immediately for all patients. The pathway reduced walk-through times significantly. A clinical pathway for cardioversion patients is safely and efficaciously introduced in a teaching hospital.
Participation in decision-making when designing care programmes and integrated care pathways
Authors: Kuijpers Relus , Joosten Tom , de Natris Dirk
Published: May 2012

The need for improved quality in health care has forced health-care organizations worldwide to critically review and improve their current care delivery processes. While some of these projects succeed, there are also a number of projects that fail. One of the factors contributing to their success or failure is willingness to change. That is why a number of re-design methods, including care pathway development, emphasize frontline staff involvement to reduce resistance. One of the mechanisms used in care pathway development to involve staff is the sharing of influence or decision-making between superiors and their subordinates. This mechanism is also known as participatory decision-making (PDM). In this research paper, we have addressed this issue by investigating whether or not increasing PDM by developing care pathways and care programmes leads to increased organizational commitment, trust in management and willingness to change. Our research shows that PDM leads to increased trust in management and organizational commitment. Evidence indicating that PDM indirectly contributes to an increased willingness to change was also found. The outcome of our research suggests that increasing PDM when developing care programmes and care pathways can be an effective method of increasing the chances of success for care pathway development projects.
Management of adverse side-effects after chemotherapy in macaques as exemplified by streptozotocin: case studies and recommendations
Authors: Graham Melanie L , Mutch Lucas A , Kittredge Jessica A , Rieke Eric F , Robinson Nicholas A , Zolondek Elizabeth K , Faig Aaron W , DuFour Theresa A , Munson James W , Schuurman Henk-Jan
Published: May 2012

The chemotherapeutic streptozotocin is used for induction of diabetes in animal models including non-human primates. Being a cytotoxic nitrosourea compound, it can be associated with adverse events (AEs), mainly nausea and emesis, nephrotoxicity, elevated liver transaminase levels, pulmonary oedema and, most prominently, metabolic acidosis: these can be severe in some cases. The incidence and gravity are to some extent related to the characteristics of the individual animal, diagnostic tools, prompt recognition of symptoms and supportive measures. Careful animal selection, dose adaptation and supportive actions such as renal protective hydration are the main tools in managing AEs, but do not fully eliminate unavoidable and sometimes life-threatening conditions. In our centre we have built experience in a cohort of 78 cynomolgus and rhesus macaques in which six cases manifested severe AEs (8%). This experience has prompted implementation of strategies for early detection and management of adverse effects, together with an animal refinement programme. We present here specific pretreatment regimens, post-infusion laboratory evaluations, and flow charts to assess/treat metabolic acidosis and precipitating factors. Case reports of the six animals with severe AEs are presented to illustrate management of AEs, especially metabolic acidosis, and criteria for early euthanasia where appropriate. We conclude that improved monitoring and validated tools allow for optimal management of adverse effects in an early stage of their manifestation. Reduced morbidity and mortality not only improve individual animal wellbeing but also avoid model-induced confounding that diminishes the translational value of the experimental protocol.
Chemical Modification of HZSM-5 for Selective Methylation
Authors: Sengupta Sonali , Ghosal Debarpita , Basu Jayanta Kumar , Kamble Prashant
Published: May 2012

Commercial HZSM-5 was modified by treating with phosphoric acid and boric acid for the selective methylation of benzene. The study of the performance with respect to the selectivity of the major products, toluene and xylene is the interest of the work. Catalysts were characterized based on BET surface area and XRD, SEM and NH3-TPD analysis to observe the change in properties due to their modification. Although benzene conversion is the highest with HZSM-5 catalyst, but in terms of selectivity, BZSM-5 and PZSM-5 are found to be the suitable catalyst for toluene and xylenes respectively. Xylene selectivity declines for HZSM-5 with the increase in temperature where as the PZSM-5 and BZSM-5 show slightly increasing tendency.
Zulässigkeit und Grenzen des Freibeweises im Zivilprozess*
Authors: Reißmann Andreas
Published: May 2012

Der BGH hat im Jahr 2007 festgestellt, dass er trotz der Einführung des § 284 S. 2–4 ZPO an seiner Rechtsprechung zur Zulässigkeit des Freibeweisverfahrens festhält. Er bleibt darin seiner seit Jahrzehnten gefestigten Rechtsprechung treu, wonach in bestimmten Fallgruppen von den Regeln des Strengbeweisverfahrens abgewichen werden kann. Der vorliegende Beitrag zeichnet zunächst diese Rechtsprechung nach, geht auf die Kritik der hL ein, um dann einen Lösungsvorschlag zu entwickeln, der – die höchstrichterliche Rechtsprechung zugrunde gelegt – den Bedenken der Literatur Rechnung entgegenkommt.
“A Tale Completed in the Mind”: Genre and Imitation in L'Amfiparnaso (1597)
Authors: Schleuse Paul
Published: May 2012

Musical histories before the twentieth century consistently described Orazio Vecchi's L'Amfiparnaso (published in 1597) as an early or nascent form of opera, despite the composer's explanation that the work is an aural spectacle, not a visual one. Later scholars have persisted in viewing L'Amfiparnaso as a fundamentally theatrical work (in a notional genre called madrigal comedy), designed for quasi-dramatic performance before a listening audience. A close reading of this historiography, along with a partial reconstruction of the membership and movements of the Gelosi and Uniti theater companies in the 1590s, disproves the widely held assumption that L'Amfiparnaso was composed and performed in 1594, and suggests that its characters' names refer to specific actors who performed with the Uniti in Bologna in 1595 and 1596. This new account of the book's origin opens it up to interpretation as a recreational collection of musical imitations of theatre, rather than as an incomplete “script” for a novel kind of dramatic performance.

Through its diverse musical styles and poetic registers (Vecchi penned both the poems and the music), as well as its unusual custom-made woodcut illustrations, L'Amfiparnaso presents scenes whose range defies cinquecento theatrical convention. Urban comic dialogues share the imagined stage with tragicomic monologues, idiosyncratic musical dialogues are found alongside serious madrigals, and the woodcuts depict both characteristic comic and pastoral stage settings. As a whole, then, L'Amfiparnaso represents—in Vecchi's words—“almost all the actions of the private man.” This emphasis on variety locates the book firmly within the poetic sphere of Vecchi's other large-scale collections, Selva di varia ricreatione (1590) and Convito musicale (1597), and adds special resonance to his claim that those seeking “a complete tale” in L'Amfiparnaso will find it only “in the mind.”
Mutational analysis of patients with FGF23-related hypophosphatemic rickets
Authors: Kinoshita Yuka , Saito Tasuku , Shimizu Yuichiro , Hori Michiko , Taguchi Manabu , Igarashi Takashi , Fukumoto Seiji , Fujita Toshiro
Published: May 2012

Objective

X-linked hypophosphatemic rickets (XLHR) caused by mutations in the PHEX gene is considered to be the most frequent cause of fibroblast growth factor 23 (FGF23)-related congenital hypophosphatemic rickets. In previous studies, mutations in the PHEX gene were detected in 60–70% of patients with clinical diagnoses of XLHR. This leads to the question whether current screening methods for mutations in the PHEX gene are inadequate or whether there is a substantial number of patients with other genetic causes of hypophosphatemic rickets. We conducted a genetic analysis of patients with FGF23-related hypophosphatemic rickets to clarify their etiology and evaluate the prevalence of XLHR among this group.

Design and methods

We studied 27 patients with familial and sporadic congenital hypophosphatemic rickets in whom serum FGF23 was above 30 pg/ml using an assay for the full-length protein. Exons and exon–intron junctions of genomic DNA of causative genes for FGF23-related hypophosphatemic rickets were sequenced. PHEX mRNA from peripheral blood was analyzed in some patients.

Results

Direct sequencing of genomic DNA identified 11 novel and four known mutations in the PHEX gene. Additionally, there was a large PHEX gene deletion in one case and abnormal PHEX mRNA splicing in another. In summary, 26 patients (96%) had XLHR and one patient had autosomal recessive hypophosphatemic rickets 2.

Conclusions

XLHR is by far the most prevalent cause of FGF23-related hypophosphatemic rickets. We propose that analysis of PHEX mRNA from peripheral blood would be appropriate for the first screening step in determining the etiology of FGF23-related hypophosphatemic rickets.
C-peptide and the risk for incident complications and mortality in type 2 diabetic patients: a retrospective cohort study after a 14-year follow-up
Authors: Bo S , Gentile L , Castiglione A , Prandi V , Canil S , Ghigo E , Ciccone G
Published: May 2012

Objective

C-peptide, a cleavage product of insulin, exerts biological effects in patients with type 1 diabetes mellitus, but its role in type 2 diabetes mellitus is controversial. Our aim was to examine the associations between fasting C-peptide levels and all-cause mortality, specific-cause mortality and the incidence of chronic complications in patients with type 2 diabetes.

Design

Retrospective cohort study with a median follow-up of 14 years.

Methods

A representative cohort of 2113 patients with type 2 diabetes mellitus and a subgroup of 931 individuals from this cohort without chronic complications at baseline from a diabetic clinic were studied.

Results

Patients with higher C-peptide levels had higher baseline BMI and triglyceride and lower HDL-cholesterol values. During the follow-up, 46.1% of the patients died. In a Cox proportional hazard model, after multiple adjustments, no significant association was found between the C-peptide tertiles and all-cause mortality or mortality due to cancer, diabetes or cardiovascular diseases. In the subgroup of 931 patients without chronic complications at baseline, the incidence of microvascular complications decreased from the first to the third C-peptide level tertile, while the incidence of cardiovascular disease did not differ. The risks for incident retinopathy (hazard ratio (HR)=0.33; 95% confidence interval (CI) 0.23–0.47), nephropathy (HR=0.27; 95% CI 0.18–0.38) and neuropathy (HR=0.39; 95% CI 0.25–0.61) were negatively associated with the highest C-peptide tertile, after adjusting for multiple confounders.

Conclusions

Higher baseline C-peptide levels were associated with a reduced risk of incident microvascular complications but imparted no survival benefit to patients with type 2 diabetes mellitus.
MEN1-related hyperparathyroidism: response to cinacalcet and its relationship with the calcium-sensing receptor gene variant Arg990Gly
Authors: Filopanti Marcello , Verga Uberta , Ermetici Federica , Olgiati Luca , Eller-Vainicher Cristina , Corbetta Sabrina , Persani Luca , Beck-Peccoz Paolo , Spada Anna
Published: May 2012

Objective

Primary hyperparathyroidism (PHPT) is a challenging problem in type 1 multiple endocrine neoplasia (MEN1) due to the high postsurgery recurrence rate. The aim was to evaluate the efficacy of cinacalcet in MEN1 patients in comparison with patients with sporadic PHPT (sPHPT) and the effect of Arg990Gly calcium-sensing receptor (CASR) polymorphism on the response to treatment.

Design

This is a randomized, crossover, double-blind study carried out in the University Hospitals.

Methods

Fifteen MEN1 patients with PHPT were randomized to two groups, one administered with 30 mg daily cinacalcet, titrated until calcium normalization, and one with placebo. After 3 months, patients were reassessed and after washout switched to the other treatment. For comparison, 20 sPHPT patients with similar calcium levels were administered with cinacalcet for 3 months. Ionized and total calcium, phosphate, and parathyroid hormone (PTH) were evaluated. CASR Arg990Gly was genotyped on blood DNA by direct sequencing.

Results

Cinacalcet normalized calcium, increased phosphate, and reduced PTH levels in all patients. Cinacalcet dosage required to normalize calcium in MEN1 and sPHPT was not significantly different (45±21 vs 54±25 mg/day). Few mild adverse events, not requiring drug withdrawal, were observed in both the groups. No association between Arg990Gly CASR polymorphism and response to cinacalcet was found.

Conclusions

This short-term prospective study demonstrated that the efficacy profile of cinacalcet in patients with MEN1-related PHPT and in those with sPHPT was similar and was not influenced by the 990 CASR variant. Although long-term safety and efficacy data are required, cinacalcet might be considered a treatment option in MEN1 patients who have contraindications to surgery or persistent PHPT after surgery.
Rabbit as a reproductive model for human health
Authors: Fischer Bernd , Chavatte-Palmer Pascale , Viebahn Christoph , Navarrete Santos Anne , Duranthon Veronique
Published: May 2012

The renaissance of the laboratory rabbit as a reproductive model for human health is closely related to the growing evidence of periconceptional metabolic programming and its determining effects on offspring and adult health. Advantages of rabbit reproduction are the exact timing of fertilization and pregnancy stages, high cell numbers and yield in blastocysts, relatively late implantation at a time when gastrulation is already proceeding, detailed morphologic and molecular knowledge on gastrulation stages, and a hemochorial placenta structured similarly to the human placenta. To understand, for example, the mechanisms of periconceptional programming and its effects on metabolic health in adulthood, these advantages help to elucidate even subtle changes in metabolism and development during the pre- and peri-implantation period and during gastrulation in individual embryos. Gastrulation represents a central turning point in ontogenesis in which a limited number of cells program the development of the three germ layers and, hence, the embryo proper. Newly developed transgenic and molecular tools offer promising chances for further scientific progress to be attained with this reproductive model species.
Isolation and antifungal susceptibility testing of Trichosporon asahii in Ceará, Brazil
Authors: Menezes Everardo Albuquerque , Marinho José Arlécio de Sousa , Angelo Maria Rozzelê F. , Cunha Maria da Conceição dos Santos Oliveira , Cunha Francisco Afrânio , Vasconcelos Júnior Antônio Alexandre de
Published: May 2012

Trichosporon spp. are yeasts capable of causing invasive disease, which mainly affect immunocompromised patients. A clinical strain of T. asahii was isolated from the blood cultures of patients admitted to the General Hospital of Fortaleza. Susceptibility tests were conducted by disk diffusion and broth microdilution. The isolated strain of T. asahii was resistant to fluconazole. The patient used amphotericin B and caspofungin in order to facilitate the microbiological cure. It was the first isolation and identification of T. asahii in blood culture in Ceará, Brazil.
Review of genitourinary tuberculosis with focus on end-stage renal disease
Authors: Lima Neiberg A. , Vasconcelos Carol C. , Filgueira Pedro Henrique O. , Kretzmann Meissa , Sindeaux Ticiano A. S. , Feitosa Neto Beni , Silva Junior Geraldo B. , Daher Elizabeth F.
Published: May 2012

Tuberculosis (TB) is a current public health problem, remaining the most common worldwide cause of mortality from infectious disease. Recent studies indicate that genitourinary TB is the third most common form of extra-pulmonary disease. The diagnosis of renal TB can be hypothesized in a non-specific bacterial cystitis associated with a therapeutic failure or a urinalysis with a persistent leukocyturia in the absence of bacteriuria. We report on the case of a 33-year-old man who presented on admission end stage renal disease (ESRD) secondary to renal TB and a past history of pulmonary TB with important radiologic findings. The diagnosis was based on clinical findings despite all cultures being negative. Empiric treatment with tuberculostatic drugs was started and the patient became stable. He was discharged with no symptom, but without renal function recovery. He is on maintenance hemodialysis three times a week. TB is an important cause of kidney disease and can lead to irreversible renal function loss.
Nephrotic syndrome associated with toxoplasmosis: report of seven cases
Authors: Toporovski Julio , Romano Simone , Hartmann Suzana , Benini Wanda , Chieffi Pedro Paulo
Published: May 2012

The concomitance of nephrotic syndrome and acute infection by Toxoplasma gondii is a rare occurrence in humans. In this paper seven cases of children, ranging from 11 months to 7 year-old, with concomitant nephrotic syndrome and asymptomatic acute T. gondii infection are reported. In one of those patients only the administration of anti-Toxoplasma therapy was enough to control the clinical and laboratory manifestations of the disease. In the other patients it was necessary to introduce corticosteroids or other immunosuppressant drugs. Three patients had complete clinical and laboratory improvement and the remaining showed only a partial response.
A ten-year follow-up of human leptospirosis in Uruguay: an unresolved health problem
Authors: Schelotto Felipe , Hernández Elba , González Sabina , Del Monte Alicia , Ifran Silvana , Flores Karina , Pardo Lorena , Parada Daniel , Filippini Mercedes , Balseiro Victoria , Geymonat Juan Pablo , Varela Gustavo
Published: May 2012

Leptospira spp. are delicate bacteria that cannot be studied by usual microbiological methods. They cause leptospirosis, a zoonotic disease transmitted to humans through infected urine of wild or domestic animals. We studied the incidence of this disease in the Uruguayan population, its epidemiologic and clinical features, and compared diagnostic techniques. After examining 6,778 suspect cases, we estimated that about 15 infections/100,000 inhabitants occurred yearly, affecting mainly young male rural workers. Awareness about leptospirosis has grown among health professionals, and its lethality has consequently decreased. Bovine infections were probably the principal source of human disease. Rainfall volumes and floods were major factors of varying incidence. Most patients had fever, asthenia, myalgias or cephalalgia, with at least one additional abnormal clinical feature. 30-40% of confirmed cases presented abdominal signs and symptoms, conjunctival suffusion and altered renal or urinary function. Jaundice was more frequent in patients aged > 40 years. Clinical infections followed an acute pattern and their usual outcome was complete recovery. Laboratory diagnosis was based on indirect micro-agglutination standard technique (MAT). Second serum samples were difficult to obtain, often impairing completion of diagnosis. Immunofluorescence was useful as a screening test and for early detection of probable infections.
Pandemic influenza A/H1N1 vaccination coverage, adverse reactions, and reasons for vaccine refusal among medical students in Brazil
Authors: Souza Eduardo Pernambuco de , Teixeira Marcelo de Souza
Published: May 2012

The aim of this cross-sectional study was to determine, among medical students at a public university in Rio de Janeiro, Brazil, the acceptance of the pandemic influenza A/H1N1 vaccine during the 2010 mass immunization campaign and the vaccine safety in this group and, among unvaccinated students, the reasons for refusing vaccination. Of a total of 858 students, 678 (79%) participated in the study. Vaccination coverage was 60.4% among students aged 20 to 39 years (an age group targeted for vaccination) and 43.8% among those who did not belong to this age group. The most frequent adverse reactions to the vaccine were pain at the injection site (8.7%) and fever (7.9%). There were no serious adverse reactions. Among students aged 20 to 39 years, the most common reasons for refusing the vaccine were "lack of time" (42.4%), "fear of adverse reactions" (41.9%), and "difficult access to the vaccine" (11.5%). Other reasons for vaccine refusal were "uncertainties about vaccine safety and efficacy" and "vaccination was not needed". To increase the acceptance of the influenza vaccine, a comprehensive immunization program should be offered to these students.
Mais humano que um humano: a halitose como emblema da patologização odontológica
Authors: Emmerich Adauto , Castiel Luis David
Published: May 2012

A perspectiva teórica de análise desenvolvida relaciona-se com o fato de que o conhecimento odontológico não deve ser visto como algo universal, independente da realidade, mas participante da sua construção. Explora a idéia simbolizada na colonização do conhecimento da Odontologia contemporânea para além do "mais humano que um humano". Com o exemplo da crescente patologização da halitose, como uma desordem objetiva não só da saúde bucal, mas que afeta aos indivíduos, este trabalho desenvolve uma análise da (re)invenção de patologias, via tecnologias de visualização, na modernidade tardia. Conclui que a veracidade do conhecimento odontológico, entre os seus principais atores, os seus discursos e suas práticas sociais, nunca é neutra, mas sempre articulada aos interesses com os quais está envolvida permanentemente. O olfato desliza do saber à memória e do espaço ao tempo e certamente das coisas aos seres. A halitose é, muitas vezes, improvável, misturada, singular, incerta em tempo e lugar.