bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of the naturally‐occurring disaccharides, palatinose and sucrose, on incretin secretion in healthy non‐obese subjects
Authors: Maeda Aya , Miyagawa Jun‐ichiro , Miuchi Masayuki , Nagai Etsuko , Konishi Kosuke , Matsuo Toshihiro , Tokuda Masaru , Kusunoki Yoshiki , Ochi Humihiro , Murai Kazuki , Katsuno Tomoyuki , Hamaguchi Tomoya , Harano Yutaka , Namba Mitsuyoshi
Published: February 2013

Aims/Introduction

Incretins might play some pathophysiological role in glucose metabolism in diabetes and obesity; it is not clear whether or not the amount and the pattern of incretin secretion vary with different types of sugars. To evaluate the effect of two types of disaccharides on glucose metabolism and the kinetics of incretin secretion, plasma levels were measured after palatinose or sucrose ingestion in non‐obese healthy participants.

Materials and Methods

The study was carried out on healthy participants who were given a solution containing 50 g of palatinose or sucrose for ingestion. Blood samples were obtained before loading and after ingestion. Insulin, glucagon and incretins hormones were measured by the enzyme‐linked immunosorbent assay method.

Results

When the data were compared between palatinose and sucrose ingestion, both plasma glucose values at 15, 30 and 60 min, and plasma insulin values at 15 and 30 min after palatinose loading were significantly lower than those after sucrose loading. Plasma levels of total glucose‐dependent insulinotropic polypeptide at 15–90 min after palatinose loading were significantly lower than those after sucrose loading. Plasma levels of total and active glucagon‐like peptide‐1 at 90 min and the area under the curve (60–120 min) of the total glucagon‐like peptide‐1 were significantly higher with palatinose‐loading than with sucrose loading.

Conclusion

Compared with sucrose, palatinose appears to have a more favorable effect on glucose metabolism and protection of pancreatic islets as a result of less hyperglycemic and hyperinsulinemic potency.
Paternity testing using the poisonous sting in captive white‐spotted eagle rays Aetobatus narinari: a non‐invasive tool for captive sustainability programmes
Authors: Janse M. , Kappe A. L. , Van Kuijk B. L. M.
Published: February 2013

A group of captive white‐spotted eagle rays Aetobatus narinari produced 20 offspring, with an unknown father. Part of the poisonous sting was removed from each fish and DNA was extracted from the epidermis for paternity research using eight microsatellite markers of which four were from another species Aetobatus flagellum. This non‐invasive sampling technique can be applied on all members of Myliobatiformes.
Assessment of perception of morphed facial expressions using the Emotion Recognition Task: Normative data from healthy participants aged 8–75
Authors: Kessels Roy P.C. , Montagne Barbara , Hendriks Angelique W. , Perrett David I. , de Haan Edward H.F.
Published: February 2013

The ability to recognize and label emotional facial expressions is an important aspect of social cognition. However, existing paradigms to examine this ability present only static facial expressions, suffer from ceiling effects or have limited or no norms. A computerized test, the Emotion Recognition Task (ERT), was developed to overcome these difficulties. In this study, we examined the effects of age, sex, and intellectual ability on emotion perception using theERT. In this test, emotional facial expressions are presented as morphs gradually expressing one of the six basic emotions from neutral to four levels of intensity (40%, 60%, 80%, and 100%). The task was administered in 373 healthy participants aged 8–75. In children aged 8–17, only small developmental effects were found for the emotions anger and happiness, in contrast to adults who showed age‐related decline on anger, fear, happiness, and sadness. Sex differences were present predominantly in the adult participants.IQonly minimally affected the perception of disgust in the children, while years of education were correlated with all emotions but surprise and disgust in the adult participants. A regression‐based approach was adopted to present age‐ and education‐ orIQ‐adjusted normative data for use in clinical practice. Previous studies using theERThave demonstrated selective impairments on specific emotions in a variety of psychiatric, neurologic, or neurodegenerative patient groups, making theERTa valuable addition to existing paradigms for the assessment of emotion perception.
Introduction: Special Issue on Adolescents in the Majority World
Authors: Raffaelli Marcela , Lazarevic Vanja , Koller Silvia H. , Nsamenang A. Bame , Sharma Deepali
Published: February 2013

This special issue showcases research on the 90% of the world's adolescents growing up in the “majority world” (i.e., Asia, Africa, Latin America and the Caribbean). Articles were solicited that addressed three focal areas by (1) evaluating existing developmental models or proposing culturally based approaches to studying adolescent development; (2) describing successful models of interventions to improve the well‐being of youth; and (3) examining how global factors are experienced locally by adolescents. Contributors address these themes in a range of adolescent populations from majority world nations. We hope this special issue will be a useful resource to scholars who conduct research and teach about adolescence, to practitioners working with adolescents from different national backgrounds, and policymakers working on international issues.
Globalization and the Identity Remix Among Urban Adolescents in India
Authors: Rao Mrinalini A. , Berry Ruhi , Gonsalves Ayesha , Hastak Yogita , Shah Mukti , Roeser Robert W.
Published: February 2013

This study examined adolescents' perceptions of cultural change and identity development during an age of globalization in India. Analyses of data from 1497 Indian, urban, middle‐class 12–15‐year‐olds (46% girls) revealed that these youth were aware of changes in their daily lives due to globalization and evaluated such changes in a pragmatic light of losses, gains, and a need for adaptation. Furthermore, results showed adolescents remained strongly identified with traditional Indian collectivist beliefs, values, and practices but also identified and participated in individualistic, “minority world” beliefs, values, and practices as well. Findings revealed that a blending of traditional‐ and minority‐world identity elements (the identity remix) was a common response to globalization among urban middle‐class adolescents in India today.
Increased regulatory T cells and impaired functions of circulating CD8 T lymphocytes is associated with viral persistence in Hepatitis B virus‐positive newborns
Authors: Shrivastava S. , TrehanPati N. , Patra S. , Kottilil S. , Pande C. , Trivedi S. S. , Sarin S. K.
Published: February 2013

Hepatitis B Virus (HBV) infection in infancy or early childhood leads to high rate of persistent infection (25–90%). The immunological basis of high rate of viral persistence in vertically acquired HBV infections is not completely understood. CD8 T cells play a pivotal role in clearing the Hepatitis B virus infection in adults. Herein, we sought to delineate the role of T cells in viral persistence in HBsAg+ve newborns. At birth peripheral and cord blood of HBsAg+ve (N = 12), HBsAg‐ve (N = 10) and healthy newborns (HC: N = 15) were evaluated for T‐cell frequency and functionality by flow cytometry. No significant differences were observed in the frequency of CD8 and CD4 T cells in all the three groups. However, significantly higher frequency of FoxP3 expressing regulatory T cells were observed in HBsAg+ve (63.79%) compared with HBsAg‐ve (28.12%) and HC (11.06%) (P < 0.05). Moreover, HBsAg+ve newborns showed functional defect in CD8 T cells by decreased IFN‐γ production and lower CD107A expression (cytotoxic capacity) compared with HBsAg‐ve and HC, which positively correlated with decreased TCRζ‐chain expression CD8 T cells (r2 > 0.93, P < 0.05). Despite equal frequency of CD8 T cells in all the three groups, CD8 T cells in HBsAg+ve newborns are dysfunctional. An expansion of regulatory T cells and impaired TCR signalling may represent the immune tolerant state of the adaptive immune system in response to chronic HBV infection.
Minireview: host defence in invasive aspergillosis
Authors: Lass‐Flörl Cornelia , Roilides Emmanuel , Löffler Jürgen , Wilflingseder Doris , Romani Luigina
Published: February 2013

Aspergillus is a saprophytic fungus, which mainly becomes pathogenic in immunosuppressed hosts. A failure of host defences results in a diverse set of illnesses, ranging from chronic colonisation, aspergilloma, invasive disease and hypersensitivity. A key concept in immune responses to Aspergillus species is that host susceptibility determines the morphological form, antigenic structure and physical location of the fungus. Traditionally, innate immunity has been considered as a first line of defence and activates adaptive immune mechanisms by the provision of specific signals; innate and adaptive immune responses are intimately linked. The T‐helper cell (TH1) response is associated with increased production of inflammatory cytokines IFN‐γ, IL‐2 and IL‐12 and stimulation of antifungal effector cells. Alternatively, TH2‐type responses are associated with suppression of antifungal effector cell activity, decreased production of IFN‐γ and increased concentrations of IL‐4 and IL‐10, which promote humoral responses to Aspergillus. The host’s defensive capacity is defined by the sum of resistance and tolerance. Resistance displays the ability to limit fungal burden and elimination of the pathogen, and tolerance means the ability to limit host damage caused by immune response.
The body and ethics in Thomas Aquinas' Summa Theologiae
Authors: Rose Marika
Published: February 2013

This article explores the role of the body in Thomas Aquinas’ ethical
thought, focusing on the Summa Theologiae.
Drawing on Thomas’ account of human nature, teleology and ethics, it traces
Thomas’ account of human embodiment through his discussion of the
relationship between human and angelic nature, the beatific vision, law and
virtue, and the active and contemplative lives. Against several recent
accounts which have presented versions of Thomas as a thinker who is
generally positive in his assessment of the human body, it argues that there
is a basic tension in Thomas’ thought between the desire to locate human
distinctiveness in the conjunction of body and soul and the sense that after
a certain point, embodiment is precisely that which obstructs progress
towards God. This tension is inextricably connected to Thomas’ understanding
of human calling and discipleship and poses serious challenges to any
attempts to draw on Thomas’ work as an ethical resource.
A case of more than 20 years survival with glioblastoma, and development of cavernous angioma as a delayed complication of radiotherapy
Authors: Fukushima Shintaro , Narita Yoshitaka , Miyakita Yasuji , Ohno Makoto , Takizawa Tsuguto , Takusagawa Yutaka , Mori Masaya , Ichimura Koichi , Tsuda Hitoshi , Shibui Soichiro
Published: February 2013

Glioblastoma (GBM) is the most common malignant CNS neoplasm, the prognosis of which remains poor even after multidisciplinary treatment. The 5‐year overall survival rate of GBM is less than 10% and has remained unchanged for more than 50 years. Because GBM patients rarely survive over a decade, only very few cases of delayed complications caused by therapy have been reported. Here, we report the case of a 24‐year‐old man who is still alive 21 years after surgical resection and chemoradiotherapy for GBM. This patient developed a cavernous angioma 19 years after the initial surgery as a delayed complication of radiotherapy. The diagnosis of the initial tumor was confirmed by histopathological review, which indicated that the tumor had immunohistochemical and genetic profiles consistent with GBM. Long‐term survival in the case of this GBM patient likely resulted from a combination of factors, including hypermethylation of the MGMT (O6‐methyl guanine methyl transferase) CpG island, young age at diagnosis, good performance status, and complete surgical resection of the tumor. To the best of our knowledge, this case report describes one of the longest‐surviving GBM patients and is the first on radiation‐induced cavernous angioma in a GBM patient.
Evaluation of salivary biomarker profiles following non‐surgical management of chronic periodontitis
Authors: Prakasam S , Srinivasan M
Published: February 2013

Objectives

Soluble toll‐like receptor‐2 (sTLR‐2) and cytokines in saliva were assessed as clinical markers for chronic periodontitis in a longitudinal study.

Materials and Methods

Unstimulated whole saliva was collected from 20 periodontally healthy individuals and 20 patients with chronic periodontitis at diagnosis and at 1 and 6 weeks following scaling and root planing (SRP). Biomarkers including the cytokines (IL‐4, IL‐6, IL‐10, and IL‐17), sTLR‐2, and sCD14 in saliva were measured by enzyme‐linked immunosorbent assay. Mann–Whitney U‐test and Student's t‐test were used to determine the significance between healthy and chronic periodontitis groups and that between pre‐ and post‐SRP samples, respectively.

Results

Salivary sTLR‐2, IL‐17, and IL‐10 levels were significantly lower and those of sCD14, IL‐6, and IL‐4 were significantly higher in patients with chronic periodontitis as compared with healthy controls. Furthermore, sTLR‐2 and IL‐4 in saliva reached levels comparable to those of healthy individuals at 6‐week re‐evaluation visit, implicating a correlation of the two markers with the disease process.

Conclusions

Our data suggest that salivary sTLR‐2 is a potential prognostic or maintenance marker for chronic periodontitis. The observed variability of salivary cytokines is consistent with the role of these cytokines in the progression of chronic periodontitis.
Understanding the stimulus of an air‐jet aesthesiometer: computerised modelling and subjective interpretation
Authors: Golebiowski Blanka , Lim May , Papas Eric , Stapleton Fiona
Published: February 2013

Purpose

Assessment of corneal sensory function is more frequently being carried out using novel non‐contact methods, which promise better stimulus control and a greater intensity range than more traditional techniques. An examination of the characteristics of the air‐jet stimulus of these ‘non‐contact’ aesthesiometers is important to enable an understanding of how these instruments stimulate the cornea. The purpose of this study was to model the air‐jet stimulus of the CRCERT‐Belmonte Aesthesiometer (CBA) and its interaction with the cornea.

Method

A computerised simulation was used to model the CBA stimulus and this model was then examined in the context of verbal descriptions of the supra‐threshold stimulus provided by 27 human subjects with normal corneas. The computational fluid dynamics model and the subjective descriptions considered CBA airflow values between 70 and 400 mL min−1.

Results

The computational fluid dynamics results showed that the CBA air‐jet stimulus behaves as expected in terms of force exerted and stabilises and subsides quickly during the 1 s duration for which it is turned on/off. The computer modelling demonstrated that the stimulus of the CBA consists of a central core of air flow, similar in diameter to the CBA nozzle, which exerts maximum pressure at the corneal apex. This core is surrounded by a less prominent zone of lower pressure, extending out to the corneal periphery at higher flow rates. The computer modelling results were confirmed by the subjective descriptions of intensity and corneal area stimulated, whereas relation to duration of sensation was more equivocal.

Conclusions

The CBA probably stimulates sensory receptors over a greater area of the ocular surface compared to the traditional nylon filament aesthesiometer and may recruit neurons sensitive to additional stimulus modalities. Future computational models should also incorporate temperature as an important aspect of the corneal response. This study has effectively demonstrated that it is possible to create a virtual model of an air‐jet aesthesiometer stimulus using computational methods and that this model is corroborated by subjective descriptions provided by subjects.
The impact of glaucoma referral refinement criteria on referral to, and first‐visit discharge rates from, the hospital eye service: the Health Innovation & Education Cluster (HIEC) Glaucoma Pathways project
Authors: Ratnarajan Gokulan , Newsom Wendy , French Karen , Kean Jane , Chang Lydia , Parker Mike , Garway‐Heath David F , Bourne Rupert RA
Published: February 2013

Purpose

To assess the impact of referral refinement criteria on the number of patients referred to, and first‐visit discharges from, the Hospital Eye Service (HES) in relation to the National Institute for Health & Clinical Excellence (NICE) Glaucoma Guidelines, Joint College Group Guidance (JCG) and the NICE commissioning guidance.

Methods

All low‐risk (one risk factor: suspicious optic disc, abnormal visual field (VF), raised intra‐ocular pressure (IOP) (22–28 mmHg) or IOP asymmetry (>5 mmHg) and high‐risk (more than one risk factor, shallow anterior chamber or IOP >28 mmHg) referrals to the HES from 2006 to 2011 were analysed. Low‐risk referrals were seen by Optometrists with a specialist interest in glaucoma and high‐risk referrals were referred directly to the HES.

Results

Two thousand nine hundred and twelve patient records were analysed. The highest Consultant first‐visit discharge rates were for referrals based on IOP alone (45% for IOP 22–28 mmHg) and IOP asymmetry (53%), VF defect alone (46%) and for abnormal IOP and VF (54%). The lowest first‐visit discharge rates were for referrals for suspicious optic disc (19%) and IOP >28 mmHg (22%). 73% of patients aged 65–80 and 60% of patients aged >80 who were referred by the OSI due to an IOP between 22–28 mmHg would have satisfied the JCG criteria for non‐referral. For patients referred with an IOP >28 mmHg and an otherwise normal examination, adherence to the NICE commissioning guidance would have resulted in 6% fewer referrals. In 2010 this scheme reduced the number of patients attending the HES by 15%, which resulted in a saving of £16 258 (13%).

Conclusion

The results support that referrals for a raised IOP alone or in combination with an abnormal VF be classified as low‐risk and undergo referral refinement. Adherence to the JCG and the NICE commissioning guidance as onward referral criteria for specialist optometrists in this referral refinement scheme would result in fewer referrals.
There is a trend for the diagnosis of glaucoma to be made at an earlier stage in 2010 compared to 2008 in Oxford, United Kingdom
Authors: de Silva Samantha R , Riaz Yasmin , Purbrick Robert MJ , Salmon John F
Published: February 2013

Purpose

New guidelines on glaucoma diagnosis and management were published by the National Institute of Clinical Excellence (NICE) in 2009. The aim of this study was to determine whether these guidelines on glaucoma referral have changed the numbers of patients diagnosed with glaucoma in Oxford and whether the severity of disease at presentation has altered between 2008 and 2010.

Methods

A retrospective study was undertaken of patients referred to a glaucoma case‐finding clinic at the Oxford Eye Hospital in 2008 and 2010. Severity of glaucoma was assigned on the basis of the worse eye and defined according to mean deviation (MD) on 24‐2 Humphrey visual field testing, with early glaucomatous visual field defects defined as MD less than −6 dB, moderate defects as MD between −6 and −12  dB and severe defects as MD more than −12 dB. Statistical analysis was undertaken using Chi squared and Mann Whitney tests.

Results

The number of referrals to this clinic increased from 521 patients in 2008, to 895 patients in 2010. 85 (16.3%) patients were diagnosed with ocular hypertension in 2008, compared to 144 (16.1%) in 2010. The number of patients diagnosed with glaucoma increased from 94 cases in 2008 to 113 cases in 2010, although the percentage of referrals diagnosed with glaucoma fell from 18.1% to 12.6%. More patients diagnosed with glaucoma in 2010 had early disease (61.9% in 2010 vs 48.8% in 2008, p = 0.03). Patients found to have glaucoma in 2010 had less severe visual field defects than in 2008: patients presented with a lower mean deviation (−6.36 dB in 2010, −7.95 dB in 2008, p = 0.03) and lower pattern standard deviation (5.44 dB in 2010, 6.64 dB in 2008, p = 0.02). However, there was no significant difference between age of presentation (65.1 years in 2010, 65.2 years in 2008, p = 0.82), and IOP (21.62 mmHg in 2010, 23.15 mmHg in 2008, p = 0.22).

Conclusions

There has been a significant increase in number of referrals to the glaucoma case‐finding clinic in Oxford between 2008 and 2010. The introduction of NICE referral guidelines in 2009 has had the benefit of increasing the absolute number of patients detected with glaucoma and has resulted in more patients being diagnosed with early disease. More effort needs to be made to reduce the number of false positive referrals. In addition, the guidelines on referral of individuals with ocular hypertension need to be reconsidered.
Corneal cross‐linking – a review
Authors: Meek Keith M , Hayes Sally
Published: February 2013

Purpose

To review cross‐linking the cornea using riboflavin and ultraviolet A light, which has been widely adopted, refined and applied in a range of corneal surgeries and pathologies where the strength of the cornea might be compromised.

Recent findings

A large number of clinical trials have been carried out, most of which have demonstrated that standard cross‐linking is a successful method to halt the progression of keratoconus or even aid regression.

This review describes our current understanding of the technique, focussing on how cross‐linking works, how the treatment is being optimised, the clinical results that have been reported to date and the potential use of the therapy in the treatment of other corneal disorders.
A novel missense mutation in the NYX gene associated with high myopia
Authors: Yip Shea Ping , Li Choi Chu , Yiu Wai Chi , Hung Wing Hong , Lam Wai Wa , Lai Man Chi , Ng Po Wah , Fung Wai Yan , Chu Patrick HW , Jiang Bo , Chan Henry HL , Yap Maurice KH
Published: February 2013

Purpose

Myopia is a complex eye disorder. The X‐linked form of complete congenital stationary night blindness (CSNB1A) is usually associated with moderate to high myopia, and is caused by mutations in the NYX gene. We explored if NYX mutations could be associated with high myopia, but not CSNB1A.

Methods

The coding regions of the NYX gene were sequenced for 204 Chinese males with high myopia (−8.00 dioptres or worse for both eyes). The frequencies of any sequence variations identified were determined in 200 Chinese males without myopia. Electro‐oculography, electroretinography and standard cone function tests were performed on a male high myope carrying a mutation.

Results

A missense mutation (c.529_530GC>AT or p.Ala177Met) was identified in one male subject with high myopia, but not in 200 male emmetropes. Neither was this variant found in any of the 529 male and 567 female subjects of various ethnic backgrounds whose genome sequences are documented in the 1000 Genomes Project database. The mutation was predicted to affect the protein function. From ocular electrophysiological tests, the proband was found to have normal rod function, but mildly abnormal cone function and inner retina function. He did not seem to suffer from CSNB1A.

Conclusions

One novel missense NYX mutation was identified in an adult male presented with high myopia, but without the major electrophysiological features normally associated with CSNB1A. NYX gene mutations may be considered as one of the rare genetic risk factors for high myopia without key features of CSNB1A.
LEADING REFORM AMIDST TRANSBOUNDARY CRISES: LESSONS FROM GREECE
Authors: ZAHARIADIS NIKOLAOS
Published: February 2013

Applying a leadership–task perspective within the context of the Greek sovereign debt crisis (2009–12), the study finds that the imperatives of short‐term crisis management conflict with the ability of Greek leaders to effectively implement long‐term reforms. Electoral gains, crisis duration, centralized decision‐making, and the degree of external actor involvement explain the choice between credible response and effective recovery. Despite beneficial effects, the activation of external stakeholders ultimately weakens the impetus for reform. The study has implications for political leadership and EU crisis management.
Inheritance of resistance to Ascochyta rabiei in 15 chickpea germplasm accessions
Authors: Labdi Mohamed , Malhotra Rajinder S. , Benzohra Ibrahim E. , Imtiaz Muhammad
Published: February 2013

Inheritance of resistance to race 4 of Ascochyta rabiei was studied in fifteen chickpea accessions known internationally for Ascochyta blight (AB) resistance. Resistance in ILC 200, ILC 5921, ILC 6043 and ILC 6090 was governed by a single recessive gene. Resistance in ILC 202 and ILC 2956 was conferred by two recessive complementary genes. In the case of ILC 5586, resistance was controlled by two dominant complementary genes and in the case of ILC 2506, two recessive genes with epistasis interaction were responsible for resistance. Resistance in ILC 3279, ILC 3856 and ILC 4421 was controlled either by three recessive genes or two recessives duplicated genes and in ILC 72, ILC 182 and ILC 187 resistance was polygenic in nature. The study provided insights into the genetics of Ascochyta blight resistance, and these could be used in crossing programmes to develop durable resistance. While the virulence spectrum of the pathogen in a region plays a crucial role in the deployment of resistance, ILC72, ILC182, ILC200, ILC442 and ILC6090 could provide acceptable level of resistance if incorporated into commercial cultivars.
Differential response of cocoa (Theobroma cacao) families to field establishment stress
Authors: Padi Francis Kwame , Adu‐Gyamfi Paul , Akpertey Abraham , Arthur Alfred , Ofori Atta
Published: February 2013

High seedling mortality during the establishment phase of cocoa has become a critical constraint to sustainable cocoa farming. The objective of this study was to develop varieties with higher seedling survival compared with cultivars currently recommended for planting in denuded regions. Thirty‐seven families composed into two sets of 18 (families from recommended clones) and 19 (families from recently introduced clones) were evaluated for field survival under full sunlight and dry weather conditions. Families differed significantly for vigour (increase in trunk cross‐sectional area, TCSA) and percentage of survived seedlings by the end of the dry weather conditions. Survival and vigour were significantly correlated in only one set of families. The contribution of general combining ability (GCA) to seedling survival was low to moderate. An Amelonado clone and clones from the Iquitos genetic group had negative GCA estimates for both increase in TCSA and survival. Clones of Scavina origin had the most positive contribution to survival. The key outcome of the study was that cocoa families with higher establishment success can be obtained from the currently available germplasm.
Therapeutic Patient Education in Atopic Dermatitis: Worldwide Experiences
Authors: Stalder Jean‐Francois , Bernier Claire , Ball Alan , De Raeve Linda , Gieler Uwe , Deleuran Mette , Marcoux Danielle , Eichenfield Lawrence F. , Lio Peter , Lewis‐Jones Sue , Gelmetti Carlo , Takaoka Roberto , Chiaverini Christine , Misery Laurent , Barbarot Sébastien ,   for the Oriented Patient‐Education Network in Dermatology (OPENED)
Published: February 2013

Therapeutic patient education (TPE) has proven effective in increasing treatment adherence and improving quality of life (QoL) for patients with numerous chronic diseases, especially atopic dermatitis (AD). This study was undertaken to identify worldwide TPE experiences in AD treatment. Experts from 23 hospitals, located in 11 countries, responded to a questionnaire on 10 major items. Patients in TPE programs were mainly children and adolescents with moderate to severe AD or markedly affected QoL. Individual and collective approaches were used. Depending on the center, the number of sessions varied from one to six (corresponding to 2 to 12 hours of education), and 20 to 200 patients were followed each year. Each center's education team comprised multidisciplinary professionals (e.g., doctors, nurses, psychologists). Evaluations were based on clinical assessment, QoL, a satisfaction index, or some combination of the three. When funding was obtained, it came from regional health authorities (France), insurance companies (Germany), donations (United States), or pharmaceutical firms (Japan, Italy). The role of patient associations was always highlighted, but their involvement in the TPE process varied from one country to another. Despite the nonexhaustive approach, our findings demonstrate the increasing interest in TPE for managing individuals with AD. In spite of the cultural and financial differences between countries, there is a consensus among experts to integrate education into the treatment of eczema.
Cutaneous Histologic Artifact Associated with the Use of a Needle‐Free Anesthesia Device for Skin Biopsy
Authors: Smith Jessica A. , Zhang Cathryn Z. , Rupani Reena , Lian Fangru
Published: February 2013

A needle‐free system that delivers lidocaine to the dermis using pressurized gas is often used as an alternative anesthetic for venipuncture and intravenous catheterization in children. This case report illustrates the potential histologic artifacts that may arise when using a needleless device for a cutaneous punch biopsy. We suggest against using a needleless system for pediatric skin biopsies.
Agenesis of the Inferior Vena Cava in H Syndrome Due to a Novel SLC29A3 Mutation
Authors: Mutlu Gül Yesiltepe , Ramot Yuval , Babaoglu Kadir , Altun Gurkan , Zlotogorski Abraham , Molho‐Pessach Vered
Published: February 2013

We present a 10‐year‐old girl with typical clinical features of H syndrome. Complete agenesis of the inferior vena cava was found on echocardiography and radiologic studies. Mutation analysis of the SLC29A3 gene revealed a novel nonsense mutation. This unique case extends the clinical and mutation spectrum associated with H syndrome and underlines the importance of routine cardiac screening in this disorder.
An Unusual Case of Dermatitis Herpetiformis
Authors: Clark Kara , Powers Roxann , Kovach Rodney
Published: February 2013

An adolescent boy whose initial presentation consisted of an asymmetric, nonvesicular rash was eventually diagnosed with dermatitis herpetiformis (DH). Certain factors, including lesions limited to the genitals, an initial biopsy revealing nonspecific findings on microscopy studies, and the absence of characteristic direct immunofluorescence findings lessened initial clinical suspicions of DH over that of scabies infestation. Classic microscopic findings of DH were identified on repeat biopsy. Serologic studies revealed immunoglobulin A (IgA) endomysial and IgA tissue transglutaminase positivity. Response to dapsone proved dramatic. Histopathologic findings, serology, and response to treatment rather than classical clinical findings and direct immunofluorescence supported the diagnosis of DH in this case.
Dermoscopy for the Pediatric Dermatologist Part I: Dermoscopy of Pediatric Infectious and Inflammatory Skin Lesions and Hair Disorders
Authors: Haliasos Elena C. , Kerner Miryam , Jaimes‐Lopez Natalia , Rudnicka Lidia , Zalaudek Iris , Malvehy Josep , Hofmann‐Wellenhof Rainer , Braun Ralph P. , Marghoob Ashfaq A.
Published: February 2013

The dermoscope allows physicians to examine the macroscopic and microscopic primary morphology of skin lesions, identify subtle clinical clues, confirm naked‐eye clinical diagnoses, and monitor treatment progress while posing little threat to the young patient. This review summarizes important dermoscopic structures seen in infectious and inflammatory skin conditions and hair disorders in children. Scabies, pediculosis, phthiriasis, molluscum contagiosum, tinea nigra, and verrucae are well characterized dermoscopically by delta‐shaped structures, ovoid‐shaped nits, the crab louse, red corona, brown strands or spicules, and multiple densely packed papilla with a central black dot surrounded by a whitish halo, respectively. These dermoscopic structures will be discussed, focusing on the dermoscopic morphologies and dermoscopic sensitivity for diagnosis and its utility in monitoring treatment progress. Dermoscopy has also been shown to significantly improve the clinician's diagnostic and monitoring accuracy of inflammatory skin lesions such as psoriasis, which is characterized dermoscopically by uniformly distributed dotted blood vessels, and lichen planus, which is characterized by whitish lines on a purple to reddish background. Dermoscopy of the hair and scalp (trichoscopy) facilitates the differential diagnosis of hair diseases in children, including alopecia areata, trichotillomania, and tinea capitis. It can also assist in the diagnosis of multiple genetic hair shaft disorders, such as monilethrix, trichorrhexis invaginata, trichorrhexis nodosa, pili torti, and pili annulati.
Hypohidrotic Ectodermal Dysplasia, Osteopetrosis, Lymphedema, and Immunodeficiency in an Infant with Multiple Opportunistic Infections
Authors: Carlberg Valerie M. , Lofgren Sabra M. , Mann Julianne A. , Austin Jared P. , Nolt Dawn , Shereck Evan B. , Davila‐Saldana Blachy , Zonana Jonathan , Krol Alfons L.
Published: February 2013

Osteopetrosis, lymphedema, hypohidrotic ectodermal dysplasia, and immunodeficiency (OL‐HED‐ID) is a rare X‐linked disorder with only three reported prior cases in the English‐language literature. We describe a case of OL‐HED‐ID in a male infant who initially presented with congenital lymphedema, leukocytosis, and thrombocytopenia of unknown etiology at 7 days of age. He subsequently developed gram‐negative sepsis and multiple opportunistic infections including high‐level cytomegalovirus viremia and Pneumocystis jiroveci pneumonia. The infant was noted to have mildly xerotic skin, fine sparse hair, and periorbital wrinkling, all features suggestive of ectodermal dysplasia. Skeletal imaging showed findings consistent with osteopetrosis, and immunologic investigation revealed hypogammaglobulinemia and mixed T‐ and B‐cell dysfunction. Genetic testing revealed a novel mutation in the nuclear factor kappa beta (NF‐KB) essential modulator (NEMO) gene, confirming the diagnosis of OL‐HED‐ID. Mutations in the NEMO gene have been reported in association with hypohidrotic ectodermal dysplasia with immunodeficiency (HED‐ID), OL‐HED‐ID, and incontinentia pigmenti. In this case, we report a novel mutation in the NEMO gene associated with OL‐HED‐ID. This article highlights the dermatologic manifestations of a rare disorder, OL‐HED‐ID, and underscores the importance of early recognition and prompt intervention to prevent life‐threatening infections.
Globally Engaged Nursing Education with Local Immigrant Populations
Authors: Riner Mary E.
Published: February 2013

This case study describes how a community health nursing practicum course was redesigned to increase undergraduate students' knowledge of and interactions with local immigrant populations. The goal of this tailored practicum is to develop students' sense of global engagement while remaining in the local community. The GENE framework is applied to course planning, delivery, and evaluation of the experience. The key components of the GENE framework are organizational mission/course goals, global health core content, program characteristics, learner characteristics, reflection, and transformational learning. The practicum design, learning objectives, and community partnership development served to create a co‐learning environment. Use of an experiential education philosophy allowed the practicum to evolve as students, faculty, agency staff, and community residents learned together over the practicum. Students developed a more complex understanding of health and social conditions of immigrant populations. They moved from a primarily mono‐ to an increasingly multicultural orientation. The GENE model was useful in offering a globally focused learning experience within a local community.
Ring‐Opening Photoreactions of 5‐Methylcytosine with 3‐Mercaptopropionic Acid and Other Thiols
Authors: Shetlar Martin D. , Chung Janet
Published: February 2013

The photoproducts from reaction of thymine with cysteine, an amino acid containing a sulfhydryl group, have been studied in detail, whereas results of less extensive studies have been reported for the uracil–cysteine system. However, products arising from corresponding reactions of cytosine and related compounds with compounds containing a sulfhydryl group have not been similarly studied. We report here the results of our study of the photoreaction of 5‐methylcytosine (5MeCyt), a minor base occurring in mammalian DNA, with 3‐mercaptopropionic acid (3MP), a model compound for cysteine. We found that this reaction proceeds at pH 7 to yield N‐(N'‐(2′‐carboxyethyl)thiocarbamoyl)‐3‐amino‐2‐methylacrylamidine (Ia) as a primary photoproduct. A secondary thermal product, identified as 3‐(2′‐carboxyethylthio)‐2‐methylacrylamidine (IIa), appears if photoreacted solution is allowed to stand for appreciable times prior to workup; this latter compound is formed via an intermediate product. Heating of purified Ia at 100°C or standing at lower temperatures produces 3‐amino‐2‐methylacrylamidine (IId); similarly, irradiation of Ia with UVB light in aqueous solution converts it into IId. Results from exploratory studies suggest that 5MeCyt similarly reacts with other thiols (2‐mercaptoethanol, 2‐mercaptoacetic acid) to form analogs of Ia and IIa. Other preliminary results suggest that 5‐methyl‐2′‐deoxycytidine and 1,5‐dimethylcytosine photoreact with 3MP to form compounds similar to Ia.
Using an Electronic Self‐Management Tool to Support Patients with Chronic Kidney Disease (CKD): A CKD Clinic Self‐Care Model
Authors: Ong Stephanie W. , Jassal Sarbjit V. , Porter Eveline , Logan Alexander G. , Miller Judith A.
Published: February 2013

New healthcare delivery models are needed to enhance the patient experience and improve quality of care for individuals with chronic conditions such as kidney disease. One potential avenue is to implement self‐management strategies. There is growing evidence that self‐management interventions help optimize various aspects of chronic disease management. With the increasing use of information technology (IT) in health care, chronic disease management programs are incorporating IT solutions to support patient self‐management practices. IT solutions have the ability to promote key principles of self‐management, namely education, empowerment, and collaboration. Positive clinical outcomes have been demonstrated for a number of chronic conditions when IT solutions were incorporated into self‐management programs. There is a paucity of evidence for self‐management in chronic kidney disease (CKD) patients. Furthermore, IT strategies have not been tested in this patient population to the same extent as other chronic conditions (e.g., diabetes, hypertension). Therefore, it is currently unknown if IT strategies will promote self‐management behaviors and lead to improvements in overall patient care. We designed and developed an IT solution called My KidneyCare Centre to support self‐management strategies for patients with CKD. In this review, we discuss the rationale and vision of incorporating an electronic self‐management tool to support the care of patients with CKD.
Bridging the Gap: Innovative Approaches to Continuing Education in Rural, Remote, and Isolated First Nation Communities
Authors: Scott Tracy , Menzies Cynthia , Chenard Glen , Spence Melissa
Published: February 2013

Access to education, communication, and support is essential for achieving and maintaining a skilled healthcare workforce. Delivering affordable and accessible continuing education for healthcare providers in rural, remote, and isolated First Nation communities is challenging due to barriers such as geography, isolation, costs, and staff shortages. The innovative use of technology, such as on‐line courses and webinars, will be presented as a highly effective approach to increase access to continuing education for healthcare providers in these settings. A case study will be presented demonstrating how a national, not‐for‐profit health care organization has partnered with healthcare providers in these communities to support care at the local level through various technology‐based knowledge exchange activities.
Stochastic differential equation modeling the prevalence of rare chronic diseases with an application to systemic lupus erythematosus
Authors: Brinks Ralph , Fischer‐Betz Rebecca , Landwehr Sandra , Schneider Matthias , Giani Guido
Published: February 2013

In this article we describe a system of stochastic differential equations to model the age‐specific prevalence of rare chronic diseases from incidence and mortality rates. As an application, the age profile of the prevalence of systemic lupus erythematosus in England and Wales in1995 is calculated. The results are in good agreement with the observed epidemiological measures.
Prognostic factors and outcome of Epstein–Barr virus DNAemia in high‐risk recipients of allogeneic stem cell transplantation treated with preemptive rituximab
Authors: Patriarca F. , Medeot M. , Isola M. , Battista M.L. , Sperotto A. , Pipan C. , Toffoletti E. , Dozzo M. , Michelutti A. , Gregoraci G. , Geromin A. , Cerno M. , Savignano C. , Rinaldi C. , Barbone F. , Fanin R.
Published: February 2013

Aims and methods

This study assessed incidence, predictive factors, and outcome of Epstein–Barr virus (EBV) DNAemia in 100 recipients of allogeneic hematopoietic stem cell transplant. A total of 68 patients received anti‐thymocyte globulin before unrelated grafts.

Results

Cumulative incidence of high‐load EBV DNAemia defined by levels >10,000 copies/mL was 14% at 12 months. In multivariate analysis, a CD4+ T‐lymphocyte count >50 μL at day +30 was the only factor significantly associated with a reduced risk of high‐load EBV DNAemia. Thirteen of 16 patients with high viral loads were preemptively treated with rituximab and achieved EBV DNA negativity. Three patients had already developed post‐transplant lymphoproliferative disorder (PTLD) at the time of detection of high EBV DNA loads, and they obtained complete response after rituximab infusions and chemotherapy. Patients with high EBV DNA load had a significantly higher transplant‐related mortality (TRM) compared with patients with negative or low viral load (54% vs. 16%, P = 0.009) and a trend to lower overall survival (55% vs. 29%, P = 0.060).

Conclusion

We conclude that CD4+ cell count at day +30 is a predictive factor for EBV DNAemia and may help identify patients requiring closer monitoring. Although only 3% of patients progressed to PTLD and were all successfully managed, EBV reactivation was associated with higher TRM, mainly because of infections.
Ascorbic acid improves membrane fragility and decreases haemolysis during red blood cell storage
Authors: Raval J. S. , Fontes J. , Banerjee U. , Yazer M. H. , Mank E. , Palmer A. F.
Published: February 2013

Background

Changes that occur to red blood cells (RBCs) during routine blood bank storage include decreased deformability, increased haemolysis and oxidative damage. Oxidative injury to the RBC membrane and haemoglobin can affect changes in shape and deformability. Ascorbic acid (AA) is an antioxidant that maintains haemoglobin in a reduced state and minimises RBC oxidative injury. We hypothesised that AA would improve membrane fragility and decrease haemolysis during storage.

Methods

Whole blood derived, AS‐5 preserved, pre‐storage leucoreduced RBC units were exposed to either AA or saline control solutions. Several rheological and biochemical parameters were measured serially during storage, including RBC membrane mechanical fragility, percent haemolysis and methaemoglobin levels.

Results

AA exposure significantly reduced mechanical fragility and haemolysis over the entire storage period. The highest two concentrations of AA affected the greatest reductions in mechanical fragility and percent haemolysis. Addition of AA to the RBCs did not significantly alter their biochemical parameters compared to control RBCs incubated with saline.

Conclusion

AA reduced RBC membrane fragility and decreased haemolysis during storage without adversely affecting other RBC biochemical parameters. The clinical significance of these findings needs to be determined.
The metabolic flux phenotype of heterotrophic Arabidopsis cells reveals a complex response to changes in nitrogen supply
Authors: Masakapalli Shyam K. , Kruger Nicholas J. , Ratcliffe R. George
Published: February 2013

The extent to which individual plants utilise nitrate and ammonium, the two principal nitrogen sources in the rhizosphere, is variable and many species require a balance between the two forms for optimal growth. The effects of nitrate and ammonium on gene expression, enzyme activity and metabolite composition have been documented extensively with the aim of understanding the way in which plant cells respond to the different forms of nitrogen, but ultimately the impact of these changes on the organisation and operation of the central metabolic network can only be addressed by analysing the fluxes supported by the network. Accordingly steady‐state metabolic flux analysis was used to define the metabolic phenotype of a heterotrophic Arabidopsis thaliana cell culture grown in Murashige and Skoog and ammonium‐free media, treatments that influenced growth and biomass composition. Fluxes through the central metabolic network were deduced from the redistribution of label into metabolic intermediates and end products observed when cells were labelled with [1‐13C]‐, [2‐13C]‐ or [13C6]glucose, in tandem with 14C‐measurements of the net accumulation of biomass. Analysis of the flux maps showed that: (i) flux through the oxidative pentose phosphate pathway varied independently of the reductant demand for biosynthesis, (ii) non‐plastidic processes made a significant and variable contribution to the provision of reducing power for the plastid, and (iii) the inclusion of ammonium in the growth medium increased cell maintenance costs, in agreement with the futile cycling model of ammonium toxicity. These conclusions highlight the complexity of the metabolic response to a change in nitrogen nutrition.