bluuebunny/crossref_metadata_2025 huggingface dataset:
The Implications of Missed Opportunities to Diagnose Appendicitis in Children
Authors: Naiditch Jessica A. , Lautz Timothy B. , Daley Susan , Pierce Mary Clyde , Reynolds Marleta
Published: June 2013

Objectives

The purpose of this study was to determine the fraction of children with acute appendicitis who had recent false‐negative diagnoses and to analyze the association of a missed diagnosis of appendicitis with patient outcome.

Methods

The records of all 816 patients who underwent appendectomy for suspected appendicitis at a free‐standing children's hospital between 2007 and 2010 were reviewed. A patient admitted or evaluated in the emergency department (ED), discharged without a diagnosis of appendicitis, and then readmitted with histopathologically confirmed appendicitis within 3 days was considered to have a “missed diagnosis.” Outcomes for this missed group were compared to those of the remainder of the appendectomy cohort.

Results

Thirty‐nine patients with appendicitis (4.8%) were missed at initial presentation. The most common initial discharge diagnoses were acute gastroenteritis (43.6%), constipation (10.3%), and emesis (10.3%). The median duration from the initial evaluation to the appendicitis admission was 28.3 hours (interquartile range [IQR] = 17.0 to 39.6 hours). A missed diagnosis was associated with a longer median hospitalization (5.8 days [IQR = 4.0 to 8.1 days] vs. 2.5 days [IQR = 1.8 to 4.6 days]; p < 0.001), higher rate of perforation (74.4% vs. 29.0%; p < 0.001), higher complication rate (28.2% vs. 10.4%; p = 0.002), and higher rate of reintervention (20.5% vs. 6.2%; p = 0.003).

Conclusions

Of children diagnosed with appendicitis, 4.8% may have had a missed opportunity for earlier diagnosis. These false‐negative diagnoses are associated with higher rates of perforation, postoperative complications, and need for postoperative interventions, as well as longer hospitalizations.
Computer‐facilitated Review of Electronic Medical Records Reliably Identifies Emergency Department Interventions in Older Adults
Authors: Biese Kevin J. , Forbach Cory R. , Medlin Richard P. , Platts‐Mills Timothy F. , Scholer Matthew J. , McCall Brenda , Shofer Frances S. , LaMantia Michael , Hobgood Cherri , Kizer J. S. , Busby‐Whitehead Jan , Cairns Charles B.
Published: June 2013

Objectives

An estimated 14% to 25% of all scientific studies in peer‐reviewed emergency medicine (EM) journals are medical records reviews. The majority of the chart reviews in these studies are performed manually, a process that is both time‐consuming and error‐prone. Computer‐based text search engines have the potential to enhance chart reviews of electronic emergency department (ED) medical records. The authors compared the efficiency and accuracy of a computer‐facilitated medical record review of ED clinical records of geriatric patients with a traditional manual review of the same data and describe the process by which this computer‐facilitated review was completed.

Methods

Clinical data from consecutive ED patients age 65 years or older were collected retrospectively by manual and computer‐facilitated medical record review. The frequency of three significant ED interventions in older adults was determined using each method. Performance characteristics of each search method, including sensitivity and positive predictive value, were determined, and the overall sensitivities of the two search methods were compared using McNemar's test.

Results

For 665 patient visits, there were 49 (7.4%) Foley catheters placed, 36 (5.4%) sedative medications administered, and 15 (2.3%) patients who received positive pressure ventilation. The computer‐facilitated review identified more of the targeted procedures (99 of 100, 99%), compared to manual review (74 of 100 procedures, 74%; p < 0.0001).

Conclusions

A practical, non–resource‐intensive, computer‐facilitated free‐text medical record review was completed and was more efficient and accurate than manually reviewing ED records.
Emergency Ultrasound‐assisted Examination of Skin and Soft Tissue Infections in the Pediatric Emergency Department
Authors: Marin Jennifer R. , Dean Anthony J. , Bilker Warren B. , Panebianco Nova L. , Brown Naomi J. , Alpern Elizabeth R.
Published: June 2013

Objectives

The objective was to evaluate the test characteristics of clinical examination (CE) with the addition of bedside emergency ultrasound (CE+EUS) compared to CE alone in determining skin and soft tissue infections (SSTIs) that require drainage in pediatric patients.

Methods

This was a prospective study of CE+EUS as a diagnostic test for the evaluation of patients 2 months to 19 years of age evaluated for SSTIs in a pediatric emergency department (ED). Two physicians clinically and independently evaluated each lesion, and the reliability of the CE for diagnosing lesions requiring drainage was calculated. Trained pediatric emergency physicians performed US following their CEs. The authors determined and compared the test characteristics for evaluating a SSTI requiring drainage for CE alone and for CE+EUS for those lesions in which the two physicians agreed and were certain regarding their CE diagnosis (clinically evident). The performance of CE+EUS was evaluated in those lesions in which the two physicians either disagreed or were uncertain of their diagnosis (not clinically evident). The reference standard for determining if a lesion required drainage was defined as pus expressed at the time of the ED visit or within 2 days by follow‐up assessment.

Results

A total of 387 lesions underwent CE+EUS and were analyzed. CE agreement between physicians was fair (κ = 0.38). For the 228 lesions for which physicians agreed and were certain of their diagnoses, sensitivity was 94.7% for CE and 93.1% for CE+EUS (difference = –1.7%; 95% confidence interval [CI] = –3.4% to 0%). The specificity of CE was 84.2% compared to 81.4% for CE+EUS (difference = –2.8%; 95% CI = –9.7% to 4.1%). For lesions not clinically evident based on CE, the sensitivity of CE was 43.7%, compared with 77.6% for CE+EUS (difference = 33.9%; 95% CI = 1.2% to 66.6%). The specificity of CE for this group was 42.0%, compared with 61.3% for CE+EUS (difference = 19.3%; 95% CI = –13.8% to 52.4%).

Conclusions

For clinically evident lesions, the addition of ultrasound (US) did not significantly improve the already highly accurate CE for diagnosing lesions requiring drainage in this study population. However, there were many lesions that were not clinically evident, and in these cases, US may improve the accuracy of the CE.
Automatic Processes and the Drinking Behavior in Early Adolescence: A Prospective Study
Authors: Peeters Margot , Monshouwer Karin , van de Schoot Rens A. G. J. , Janssen Tim , Vollebergh Wilma A. M. , Wiers Reinout W.
Published: June 2013

Background

This study examined the bi‐directional prospective link between automatic alcohol‐approach tendencies and alcohol use in a group of young adolescents (mean age = 13.6 years). The adolescents in the present study were assumed to be at‐risk of early alcohol use and later problem drinking. It was hypothesized that alcohol use and automatic approach tendencies would reinforce one another particularly in the absence of well‐developed inhibition skills.

Methods

A total of 347 adolescents (N = 279 at follow‐up) from special secondary education, a risk group for the development of substance use problems, participated in the study. Automatic approach tendencies were assessed with the alcohol‐approach avoidance task, inhibition skills were assessed with the Stroop task, and alcohol used was measured using a self‐report measure.

Results

Zero‐inflated Poisson analysis revealed a significant effect of automatic approach tendencies predicting alcohol use 6 months later, although only for adolescents with weaker inhibition skills.

Conclusions

Automatic approach tendencies predict future drinking behavior of young adolescents with relatively weak inhibition skills. The findings of the present study have important implications for alcohol interventions for adolescents. Results are discussed in terms of risk factors for the development of problematic alcohol use in young adolescents.
Female‐only sex‐linked amplified fragment length polymorphism markers support ZW/ZZ sex determination in the giant freshwater prawn Macrobrachium rosenbergii
Authors: Jiang Xue‐Hui , Qiu Gao‐Feng
Published: June 2013

Sex determination mechanisms in many crustacean species are complex and poorly documented. In the giant freshwater prawn, Macrobrachium rosenbergii, a ZW/ZZ sex determination system was previously proposed based on sex ratio data obtained by crosses of sex‐reversed females (neomales). To provide molecular evidence for the proposed system, novel sex‐linked molecular markers were isolated in this species. Amplified fragment length polymorphism (AFLP) using 64 primer combinations was employed to screen prawn genomes for DNA markers linked with sex loci. Approximately 8400 legible fragments were produced, 13 of which were uniquely identified in female prawns with no indication of corresponding male‐specific markers. These AFLP fragments were reamplified, cloned and sequenced, producing two reliable female‐specific sequence characterized amplified region (SCAR) markers. Additional individuals from two unrelated geographic populations were used to verify these findings, confirming female‐specific amplification of single bands. Detection of internal polymorphic sites was conducted by designing new primer pairs based on these internal fragments. The internal SCAR fragments also displayed specificity in females, indicating high levels of variation between female and male specimens. The distinctive feature of female‐linked SCAR markers can be applied for rapid detection of prawn gender. These sex‐specific SCAR markers and sex‐associated AFLP candidates unique to female specimens support a sex determination system consistent with female heterogamety (ZW) and male homogamety (ZZ).
In Vitro Cardiovascular System Emulator (Bioreactor) for the Simulation of Normal and Diseased Conditions With and Without Mechanical Circulatory Support
Authors: Ruiz Paula , Rezaienia Mohammad Amin , Rahideh Akbar , Keeble Thomas R. , Rothman Martin T. , Korakianitis Theodosios
Published: June 2013

This article presents a new device designed to simulate in vitro flow rates, pressures, and other parameters representing normal and diseased conditions of the human cardiovascular system. Such devices are sometimes called bioreactors or “mock” simulator of cardiovascular loops (SCVLs) in literature. Most SCVLs simulate the systemic circulation only and have inherent limitations in studying the interaction of left and right sides of circulation. Those SCVLs that include both left and right sides of the circulation utilize header reservoirs simulating cycles with constant atrial pressures. The SCVL described in this article includes models for all four chambers of the heart, and the systemic and pulmonary circulation loops. Each heart chamber is accurately activated by a separate linear motor to simulate the suction and ejection stages, thus capturing important features in the perfusion waveforms. Four mechanical heart valves corresponding to mitral, pulmonary, tricuspid, and aortic are used to control the desired unidirectional flow. This SCVL can emulate different physiological and pathological conditions of the human cardiovascular system by controlling the different parameters of blood circulation through the vascular tree (mainly the resistance, compliance, and elastance of the heart chambers). In this study, four cases were simulated: healthy, congestive heart failure, left ventricular diastolic dysfunction conditions, and left ventricular dysfunction with the addition of a mechanical circulatory support (MCS) device. Hemodynamic parameters including resistance, pressure, and flow have been investigated at aortic sinus, carotid artery, and pulmonary artery, respectively. The addition of an MCS device resulted in a significant reduction in mean blood pressure and re‐establishment of cardiac output. In all cases, the experimental results are compared with human physiology and numerical simulations. The results show the capability of the SCVL to replicate various physiological and pathological conditions with and without MCS.
Low cdc27 and high securin expression predict short survival for breast cancer patients
Authors: Talvinen Kati , Karra Henna , Pitkänen Reino , Ahonen Ilmari , Nykänen Marjukka , Lintunen Minnamaija , Söderström Mirva , Kuopio Teijo , Kronqvist Pauliina
Published: June 2013

Cell cycle regulators cdc27 and securin participate in control of the mitotic checkpoint and survey the mitotic spindle to maintain chromosomal integrity. This is achieved by their functions in metaphase–anaphase transition, DNA damage repair, enhancement of mitotic arrest and apoptosis. We report on the roles of cdc27 and securin in aneuploidy and prognosis of breast cancer. The study comprises 429 breast cancer patients with up to 22 years of follow‐up. DNA content was determined by image cytometry, and immunopositivity for cdc27 and securin was based on tissue microarrays. An inverse association between cdc27 and securin expression was observed in both image cytometric and immunohistochemical analyses. Low cdc27 and high securin expression identified patients with significant difference in disease outcome. Cdc27 and securin immunoexpression identified patients at risk of early cancer death within five years from diagnosis. In multivariate analysis, the combination of cdc27 and securin immunohistochemistry was the strongest predictor of cancer death after lymph node status. We demonstrate, for the first time in human breast cancer, the prognostic value of cdc27 and securin immunohistochemistry. Cdc27 and securin appear promising biomarkers for applications in predicting disease progression, prognostication of individual patients and potential in anti‐mitotic drug development.
Early discharge after laparoscopic or robotic partial nephrectomy: care pathway evaluation
Authors: Patel Amit , Golan Shay , Razmaria Aria , Prasad Sandip , Eggener Scott , Shalhav Arieh
Published: June 2013

Objective

To determine the success of our clinical care pathway for laparoscopic (LPN) and robotic partial nephrectomy (RPN) and to examine factors predictive for success.

Patients and Methods

A retrospective review of our Institutional Review Board‐approved prospectively maintained minimally invasive PN database yielded 263 consecutive minimally invasive PNs from 2003 to 2010.

Patient, disease and surgery‐related factors were collected. The primary endpoint was successful implementation of the clinical pathway with discharge on postoperative day (POD 1).

Associated factors were modelled using univariate and multivariable logistic regression to determine factors predictive for success of the pathway.

Results

Overall, 157 (60%) of the patients had successful care pathway implementation with POD1 discharge, of which 46 (17%) were RPNs.

The overall readmission rate was 5% (12/263) and similar for patients discharged on POD 1, 4.5% (7/157).

Several patient‐related, tumour‐related, and surgical factors were associated with care pathway success.

In a multiple logistic regression model, only surgery period (late cohort vs early cohort) was significant for successful pathway implementation (odds ratio 4.2; 95% confidence interval 2.1–8.4, P < 0.001).

Conclusions

Early discharge care pathways can be successfully implemented for LPN or RPN with low readmission rates. Care pathway success improves with institutional experience.
Does robot‐assisted laparoscopic ileocystoplasty (RALI) reduce peritoneal adhesions compared with open surgery?
Authors: Razmaria Aria A. , Marchetti Pablo E. , Prasad Sandip M. , Shalhav Arieh L. , Gundeti Mohan S.
Published: June 2013

Objectives

To compare perioperative outcomes between open ileocystoplasty and robot‐assisted laparoscopic ileocystoplasty (RALI) in a porcine model, as objective data comparing outcomes between these two approaches in children with neurogenic bladder are lacking.

We specifically examined differences in postoperative peritoneal adhesion formation between the groups.

Materials and Methods

In all, 20 pigs were assigned to an open ileocystoplasty or RALI study arm. All the pigs underwent an initial urodynamic study (UDS).

In the RALI arm, reconstructive steps were performed intracorporeally using a standard da Vinci® system. Postoperatively, variables including first stool, weight gain, and complications were recorded.

After 42 days, the pigs underwent a final UDS followed by adhesion assessment.

Intraperitoneal adhesions were quantified by a third‐party ‘blinded’ surgeon according to previously described objective scoring systems.

Results

Preoperative variables including UDS were similar in both groups.

Overall operating time was significantly shorter for open ileocystoplasty than for RALI (149 vs 287 min, P < 0.001, respectively). Postoperatively, all variables including time to first stool, weight gain, and urodynamic parameters were similar amongst the groups.

Pigs in the open arm developed significantly more adhesions (P = 0.02) and adhesions with a higher complexity (P = 0.04).

Conclusions

In this porcine model, RALI achieved similar functional outcomes as the open approach, but required longer procedural times.

The number and complexity of surgical adhesions among the groups favoured the RALI cohort. This may be of clinical significance in the paediatric spina bifida population, who generally undergo multiple surgical procedures in their lifetime, with increased risk for development of adhesions and subsequent intestinal obstruction.
School participation, supports and barriers of students with and without disabilities
Authors: Coster W. , Law M. , Bedell G. , Liljenquist K. , Kao Y.‐C. , Khetani M. , Teplicky R.
Published: June 2013

Background

We compared school participation patterns of students ages 5–17 with and without disabilities and examined whether features of the school environment were perceived to help or hinder their participation.

Methods

Parents (n = 576) residing in the USA and Canada completed the Participation and Environment Measure for Children and Youth (PEM‐CY) via the internet.

Results

Parents of students with disabilities reported that their children participated less frequently in school clubs and organizations and getting together with peers outside the classroom and that they were less involved in all school activities. Parents of students with disabilities also were significantly more likely to report that features of the environment hindered school participation and that resources needed to support their child's participation were not adequate.

Conclusions

Parents of students with disabilities report that their children are participating less in important school‐related activities. Barriers limiting school participation include features of the physical and social environment as well as limited resources.
The Questionnaire of Young People's Participation (QYPP): a new measure of participation frequency for disabled young people
Authors: Tuffrey C. , Bateman B. J. , Colver A. C.
Published: June 2013

Introduction

The concept of participation was introduced by the World Health Organisation in the International Classification of Functioning, Disability and Health, 2001. Instruments to measure participation have been developed for children and adults, but none specifically for adolescents. Adolescence is a life stage with distinct patterns of participation, and previous research has shown that young people with disabilities have poorer participation than the general population. The aim of this study was to develop a measure of participation frequency, covering all major domains, for young people with cerebral palsy (CP). CP was chosen as an exemplar because it is a significant cause of disability in young people, with affected individuals experiencing a range of different impairments of varying severity.

Methods

A pool of 88 items was developed using the published literature, existing measures and qualitative data from young people. The item pool was revised following expert review by 17 experts. Cognitive interviews on the items were carried out with 12 young people and 12 carers; field‐testing was then undertaken with 107 young people with CP aged 13–21 years, and 540 young people from the general population to enable item reduction and to examine reliability and construct validity.

Results

The content review resulted in a 92‐item draft questionnaire, content validity index of 93%. Cognitive interviews led to further wording changes. Following field‐testing, the questionnaire was shortened to 45 items. Known‐groups validity was demonstrated by correlation with impairment severity. Test–retest reliability was satisfactory for all domains. Internal consistency varied between domains.

Conclusion

This is the first instrument developed specifically to measure frequency of participation across multiple domains for young people with disability. Use of the questionnaire in research and clinical work will enable its properties to be better understood and its generalizability to wider groups to be clearer.
A clinical study of the spectrum of photodermatoses in dark-skinned populations
Authors: Wadhwani A. R. , Sharma V. K. , Ramam M. , Khaitan B. K.
Published: June 2013

Background

Photodermatoses are characterized by an abnormal cutaneous response to ‘ordinary’ light exposure.

Aim

To study the spectrum of photodermatoses in populations with dark skin (skin types IV–VI) at a tertiary referral centre.

Methods

Consecutive patients with skin lesions confined to or predominantly located on photoexposed parts of the body and/or with photosensitivity were enrolled in the study, and their clinical details were recorded. Diagnosis was made on clinical grounds, and relevant investigations were carried out if required. Patch and photopatch testing were carried out in patients with chronic actinic dermatitis (CAD). Selected patients with CAD also underwent phototesting with UV (ultraviolet) A and broadband UVB light.

Results

We enrolled 362 patients (146 men, 216 women; mean age 35.6 ± 13.6 years), with mean disease duration of 3.4 years. The Fitzpatrick skin types were IV and V (52.8% and 47.2% of patients, respectively). Polymorphic light eruption (PMLE) was the commonest photodermatosis seen, affecting 59.7% of patients, followed by CAD (13.8%), collagen vascular disorders (7.7%), photoaggravated atopic dermatitis (6.1%), actinic lichen planus (ALP; 2.2%) and lichen planus pigmentosus (LPP; 1.6%). The majority (84.5%) of patients were involved in indoor work. Papular PMLE (37%) was the most common variant of PMLE, followed by pinpoint (31%), eczematous (22.2%), lichenoid (5.5%) and plaque-type (4.1%) PMLE.

Conclusions

The spectrum of photodermatoses in Indian patients with dark skin phototypes (IV and V), is similar to that reported from other parts of the world. PMLE was the commonest photodermatosis seen, with the pinpoint and lichenoid variants accounting for over one-third of the PMLE cases. ALP and LPP were also not uncommon in our dark-skinned population.
Compound muscle action potential of the external anal sphincter
Authors: Nockolds C. L. , Hosker G. L. , Kiff E. S.
Published: June 2013

Aim

Pudendal nerve terminal motor latency (PNTML) assesses distal innervation of the external anal sphincter (EAS) but it is insensitive to early nerve damage. We propose to extend the assessment of PNTML to the measurement of the compound muscle action potential (CMAP) of the EAS to understand its progressive denervation.

Method

Ninety women with faecal incontinence were prospectively examined and compared with 36 asymptomatic women who acted as controls. PNTML was performed bilaterally and the muscle response analysed for CMAP to include amplitude, area and duration. Anorectal manometry was measured by a station‐pull technique using a water‐filled microballoon. spss version 11.5 was used for statistical analysis.

Results

In asymptomatic women the CMAP on the left side was greater in nulliparous (n = 7) than parous (n = 27, P < 0.05) individuals. There was a positive correlation with maximum squeeze pressure and area on the left side (P < 0.05, r = 0.397). In women with faecal incontinence, CMAP on the left side had a negative correlation with age (n = 75, P < 0.05), there was no correlation with parity or anorectal manometry. Nulliparous asymptomatic women had a greater CMAP (P < 0.05) on the left side than asymptomatic parous women and parous women with faecal incontinence. Right‐side measurements were not conclusive.

Conclusion

Compound muscle action potential demonstrated progressive denervation with age in women with faecal incontinence but did not reliably identify early signs of denervation in asymptomatic women. The area on the left side related to muscle function in asymptomatic women but not in women with faecal incontinence. CMAP can distinguish between parous women with faecal incontinence and nulliparous asymptomatic women but is not a useful test of function of the EAS.
How to Bootstrap a Human Communication System
Authors: Fay Nicolas , Arbib Michael , Garrod Simon
Published: June 2013

How might a human communication system be bootstrapped in the absence of conventional language? We argue that motivated signs play an important role (i.e., signs that are linked to meaning by structural resemblance or by natural association). An experimental study is then reported in which participants try to communicate a range of pre‐specified items to a partner using repeated non‐linguistic vocalization, repeated gesture, or repeated non‐linguistic vocalization plus gesture (but without using their existing language system). Gesture proved more effective (measured by communication success) and more efficient (measured by the time taken to communicate) than non‐linguistic vocalization across a range of item categories (emotion, object, and action). Combining gesture and vocalization did not improve performance beyond gesture alone. We experimentally demonstrate that gesture is a more effective means of bootstrapping a human communication system. We argue that gesture outperforms non‐linguistic vocalization because it lends itself more naturally to the production of motivated signs.
Everolimus leads to a lower risk of BKV viremia than mycophenolic acid in de novo renal transplantation patients: a single‐center experience
Authors: Moscarelli Luciano , Caroti Leonardo , Antognoli Giulia , Zanazzi Maria , Di Maria Lorenzo , Carta Paolo , Minetti Enrico
Published: June 2013

Background

There are limited published data concerning the effects of different immunosuppressive regimens on the development of polyomavirus (BKV) viremia. We examined the risk of developing BKV viremia in kidney transplant recipients receiving everolimus (EVR) or mycophenolic acid (MPA) as maintenance therapy.

Methods

We observationally analyzed 296 patients who underwent renal transplantation at our center between 2005 and 2010: 58 were treated with EVR and low‐dose cyclosporine (LD‐CyA) (group 1) and 238 with MPA and standard‐dose CyA (group 2). All of the patients received induction therapy with basiliximab and maintenance steroids. BKV viremia (a whole‐blood viral load of >850 copies/mL) was measured by means of real‐time polymerase chain reaction at least once a month during a 12‐month follow‐up period.

Results

BKV viremia was detected in 57 patients (19%), five (9%) in group 1 and 52 (22%) in group 2. Kaplan–Meier analyses showed that freedom from BKV viremia was significantly more frequent in group 1. The mean time of onset of BKV viremia was about four months after transplantation in both groups. The median viral load was greater in group 2 (12.5 ± 6.1 vs. 2.5 ± 1.8 × 104 copies/mL; p = 0.01). After the onset of BKV viremia, graft function significantly declined in group 2: 11 patients developed polyomavirus‐associated nephropathy (PVAN) and four presumptive PVAN; nine experienced an acute rejection after the discontinuation of MPA, and 11 (21%) lost their graft. There was no graft loss in group 1.

Conclusion

These findings suggest that in comparison with MPA and Cya, an EVR and LD‐CyA regimen lowers the risk of BKV viremia after kidney transplantation and favorably alters outcomes.
Effect of mycophenolate mofetil on hematological side effects incidence in renal transplant recipients
Authors: Sobiak Joanna , Kamińska Jolanta , Głyda Maciej , Duda Grażyna , Chrzanowska Maria
Published: June 2013

Mycophenolate mofetil (MMF), an immunosuppressant administered after solid organ transplantation, is generally well tolerated; however, it frequently causes hematological toxicity. In this study, we aimed to assess the relation between the pharmacokinetic parameters of MMF metabolites (mycophenolic acid [MPA] and 7‐O‐MPA glucuronide [MPAG]) and the adverse effects on the hematopoietic system in renal transplant recipients. The four‐h pharmacokinetic profiles of MPA and MPAG were determined using the HPLC method for MMF‐treated patients (n = 61) among 106 renal transplant recipients (during the late post‐transplant period) participating in the study. Anemia was more frequently observed in the study group compared with the control group (30.7% vs. 20.0%) and although the difference was insignificant, plasma iron concentrations were significantly higher in patients treated with MMF (32.9 ± 9.4 μmol/L vs. 28.7 ± 9.4 μmol/L; p = 0.032). Iron supplementation was more frequently applied to patients with anemia (48.2%) compared with patients with hemoglobin within the norm (20.3%; p = 0.005). As all MPAG pharmacokinetic parameters correlated negatively with hemoglobin and hematocrit, and MPAG pharmacokinetic parameters were higher in patients with anemia, MPAG may be the predicting factor of MMF side effects. In renal transplant recipients, especially with deteriorated renal function, extensive iron supplementation may be ineffective as anemia was associated with declined renal function and was not caused by low iron concentration.
Normal adiponectin levels in kidney transplant patients with hypertension
Authors: Leibowitz Avshalom , Peleg Edna , Ben‐David Aharon , Sharabi Yehonatan , Kamari Yehuda , Holzman Eliezer , Grossman Ehud
Published: June 2013

Background

Kidney transplant patients are a unique population where despite correction of their kidney function they are still considered to be at high cardiovascular (CV) risk. Adiponectin, an adipokine secreted from adipocytes, has protective CV properties. Patients with essential hypertension (HTN) have low adiponectin levels that are associated with a high CV risk. The aim of this study was to assess adiponectin levels in hypertensive renal transplant recipients.

Materials and methods

Fasting blood adiponectin levels were measured in hypertensive kidney transplant patients (n = 18), patients with essential HTN (n = 17) and healthy subjects (n = 14). Patients with diabetes mellitus and renal failure were excluded from the study. Anthropomorphic and metabolic parameters were also measured.

Results

Patients with essential HTN had lower adiponectin levels than healthy controls (6 ± 0.7 μg/mL vs. 11 ± 0.9 μg/mL, p < 0.001), whereas hypertensive kidney transplant patients had adiponectin levels that were similar to adiponectin levels found in normal controls (11 ± 1.1 μg/mL). Adiponectin levels in healthy subjects were inversely correlated with plasma triglycerides (r = −0.876, p < 0.001) and with body weight (r = −0.7, p < 0.001). There was no such a correlation in patients with HTN.

Conclusion

Adiponectin in hypertensive kidney transplant recipients is not an appropriate CV risk marker as it does not adequately distinguish these patients from normal controls.
The Evolving Localism (and Neoliberalism) of Urban Renewable Energy Projects
Authors: Morris Jason
Published: June 2013

This paper contributes to the development of an anthropological understanding of the emerging political economies of renewable energy in the contemporary United States. It explores efforts to develop place‐based, local systems of renewable energy production and places them in the context of a larger history of the political economy and social construction of U.S. energy systems. Marked by emancipatory discourses of local self‐reliance, decentralization, ecological sustainability, energy security, and community‐scale governance, contemporary renewable energy initiatives bear a strong resemblance to the small‐scale, grassroots energy actions that emerged during the energy crises of the 1970s. Both past and current local renewable energy efforts are also deeply embedded within and subject to contemporary regimes of environmental governance, ecological modernization, and neoliberal responses to ecological crises. Using emerging energy initiatives in Washington, DC as a case study, I discuss three key elements of the political and social construction of contemporary local renewable energy production—ownership, governance, and sustainable urban place‐making—and examine the problematic theme of “localism” that links them.
Sclerotic bodies beyond nephrogenic systemic fibrosis
Authors: Bhawan Jag , Perez‐Chua Tanya A. , Goldberg Lynne
Published: June 2013

Sclerotic bodies are round to oval structures made up of collagen with entrapped elastic fibers, which may be sometimes ossified. These bodies may be found in skin biopsies from patients with nephrogenic systemic fibrosis (NSF), a disease linked to the use of gadolinium in radiologic procedures and chronic renal failure. Sclerotic bodies have not been reported in other diseases. Herein, we report sclerotic bodies as an incidental finding in a re‐excision specimen of a squamous cell carcinoma (SCC) from the forearm of an 85‐year‐old man with chronic renal failure. The patient had had multiple SCC removed over time. Additional clinical history revealed patient having received gadolinium in 2003 and 2004, preceding his dialysis that began in 2009. All of his excision specimens revealed sclerotic bodies in 20 of 30 specimens from 2008. None of the 26 re‐excision specimens prior to gadolinium exposure had these bodies. Our findings suggest that sclerotic bodies are the result of gadolinium exposure in patients with chronic renal insufficiency. Because the bodies were found near the re‐excision scar, it may be that gadolinium or its metabolites activate fibroblasts in the setting of wound healing. The reasons why this patient did not develop NSF are unclear.
Real‐time continuous glucose monitoring during labour and delivery in women with Type 1 diabetes — observations from a randomized controlled trial
Authors: Cordua S. , Secher A. L. , Ringholm L. , Damm P. , Mathiesen E. R.
Published: June 2013

Aims

To explore whether real‐time continuous glucose monitoring during labour and delivery supplementary to hourly self‐monitored plasma glucose in women with Type 1 diabetes reduces the prevalence of neonatal hypoglycaemia.

Methods

Women with Type 1 diabetes participating in a randomized controlled trial on the effect of real‐time continuous glucose monitoring in pregnancy were included in this study. Twenty‐seven of 60 (45%) women in the intervention arm used real‐time continuous glucose monitoring during labour and delivery, supplementary to hourly self‐monitored plasma glucose. Real‐time continuous glucose monitoring glucose data covering the last 8 h prior to delivery were retrospectively evaluated, and maternal hypo‐ and hyperglycaemia were defined as glucose values ≤ 3.9 mmol/l and > 7.0 mmol/l, respectively. Women in the control arm (n = 59) solely used self‐monitored plasma glucose. Neonatal hypoglycaemia was defined as a 2‐h plasma glucose < 2.5 mmol/l.

Results

In infants of women using real‐time continuous glucose monitoring during labour and delivery, 10 (37%) developed neonatal hypoglycaemia vs. 27 (46%) infants in the control arm (P = 0.45). Among 10 infants with and 17 infants without neonatal hypoglycaemia within the real‐time continuous glucose monitoring arm, median maternal self‐monitored plasma glucose was 6.2 (range 4.2–7.8) vs. 5.6 (3.3–8.5) mmol/l (P = 0.26) during labour and delivery, with maternal hyperglycaemia present in 17 (0–94) vs. 4 (0–46)% of the time (P = 0.02), and birthweight was 4040 (3102–4322) vs. 3500 (1829–4320) g (P = 0.04). Maternal hypoglycaemia up to delivery was relatively rare.

Conclusions

The prevalence of neonatal hypoglycaemia was comparable between infants of women using real‐time continuous glucose monitoring supplementary to self‐monitored plasma glucose during labour and delivery and infants of women solely using self‐monitored plasma glucose.
Disclosure of psychosocial stressors affecting diabetes care among uninsured young adults with Type 1 diabetes
Authors: Pyatak E. A. , Sequeira P. , Peters A. L. , Montoya L. , Weigensberg M. J.
Published: June 2013

Aims

To determine the disclosure rates of psychosocial issues affecting routine diabetes care.

Methods

A total of 20 young adults were interviewed regarding the impact of psychosocial stressors on their diabetes care. The interviewer, endocrinologist and case manager reported the prevalence rates of psychosocial stressors. Disclosure rates were compared to determine the prevalence of psychosocial issues and the different patterns of disclosure.

Results

Participants reported a high number of psychosocial stressors, which were associated with poorer glycaemic control (r = 0.60, P = 0.005). Approximately half of all disclosed stressors (50.9%) were identified in routine care; other stressors were identified only through intensive case management and/or in‐depth interviews.

Conclusions

Identifying psychosocial stressors in routine care, and providing referrals to psychological or social services, is a significant unmet need and may improve glycaemic control among certain populations with diabetes. Systematic mechanisms of capturing this information, such as by screening surveys, should be considered.
Magnesium intake decreases Type 2 diabetes risk through the improvement of insulin resistance and inflammation: the Hisayama Study
Authors: Hata A. , Doi Y. , Ninomiya T. , Mukai N. , Hirakawa Y. , Hata J. , Ozawa M. , Uchida K. , Shirota T. , Kitazono T. , Kiyohara Y.
Published: June 2013

Aims

Early studies have shown that magnesium intake decreases the risk of Type 2 diabetes, but the results are still inconsistent. We prospectively examined the association between magnesium intake and incidence of Type 2 diabetes in a general Japanese population.

Methods

A total of 1999 subjects without diabetes aged 40–79 years who underwent a 75‐g oral glucose tolerance test were followed up prospectively for a mean of 15.6 years.

Results

During the follow‐up, 417 subjects developed Type 2 diabetes. The age‐ and sex‐adjusted incidence of Type 2 diabetes significantly decreased with increasing magnesium intake quartile levels (≤ 148.5, 148.6–171.5, 171.6–195.5 and ≥ 195.6 mg/day, P for trend = 0.01). In multivariate analyses, after adjusting for comprehensive risk factors and other dietary factors, the hazard ratio of Type 2 diabetes was 0.67 (95% CI 0.49–0.92; P = 0.01) in the third quartile and 0.63 (95% CI 0.44–0.90; P = 0.01) in the highest quartile compared with the first quartile. In addition, the risk of Type 2 diabetes was 14% lower (P = 0.04) for a 1‐sd increment of log‐transformed magnesium intake in the multivariate‐adjusted model. In stratified analysis, there were statistically significant interactions between magnesium intake and levels of homeostasis model assessment of insulin resistance, high‐sensitivity C‐reactive protein or alcohol intake on the risk of Type 2 diabetes (all P < 0.05).

Conclusions

Our findings suggest that increased magnesium intake was a significant protective factor for the incidence of Type 2 diabetes in the general Japanese population, especially among subjects with insulin resistance, low‐grade inflammation and a drinking habit.
Factors associated with diabetic ketoacidosis at onset of Type 1 diabetes in children and adolescents
Authors: de Vries L. , Oren L. , Lazar L. , Lebenthal Y. , Shalitin S. , Phillip M.
Published: June 2013

Aims

To identify risk factors for diabetic ketoacidosis at diagnosis of Type 1 diabetes in children and adolescents.

Methods

In three time periods (1986–1987, 1996–1997 and 2006–2007) 75, 86 and 245 patients, respectively, aged < 20 years were newly diagnosed with Type 1 diabetes in one tertiary care centre. In this retrospective comparative study, data of clinical characteristics, laboratory evaluation at diagnosis, as well as demographic data were retrieved from the patients' files. Comparative analyses were performed between patients presenting with or without diabetic ketoacidosis and between the three time periods.

Results

Patients presenting with diabetic ketoacidosis were younger (9.2 ± 4.7 vs. 10.4 ± 4.7 years; P < 0.02), thinner (weight standard deviation score –0.59 ± 1.2 vs. –0.25 ± 1.1; P = 0.002) and less frequently had a first‐ and/or second‐degree relative with Type 1 diabetes compared with those without diabetic ketoacidosis at presentation (16.0 vs. 31.2%, respectively; P = 0.001). Children with diabetic ketoacidosis were less likely to have had relevant testing before diagnosis than children without diabetic ketoacidosis. Children aged < 2 years presented more often with diabetic ketoacidosis than the older children (85 vs. 32%; P < 0.001). Children of Ethiopian origin had a higher rate of diabetic ketoacidosis at diagnosis than the rest of the cohort (57.8 vs. 33%; P = 0.04).

Conclusions

Factors affecting the risk of developing diabetic ketoacidosis at diagnosis of Type 1 diabetes may be related to the degree of awareness of symptoms of diabetes among parents and primary care physicians. Prevention programmes should aim at increasing awareness and consider the application of special measures to avoid diabetic ketoacidosis in children aged < 2 years and high‐risk ethnic groups.
IS THERE A PHYSICIAN PEER EFFECT? EVIDENCE FROM NEW DRUG PRESCRIPTIONS
Authors: YANG MUZHE , LIEN HSIEN‐MING , CHOU SHIN‐YI
Published: June 2013

We investigate whether and how physicians' prescriptions of a new drug are influenced by their colleagues in the same hospital during shared working time. We use longitudinal data of physicians who prescribed antipsychotic drugs for schizophrenia patients in Taiwan between 1997 and 2010. We find that peer effects are small, but stronger among physicians of similar age and among those sharing a longer, larger, or more stable group. Peer effects are also stronger when drugs are newly introduced. We also find that peer effects are more likely to be overestimated using fixed‐effect models than using first‐difference models. (JELD01, D83, I10)
Dysregulation of the neuregulin‐1–ErbB network modulates endogenous oligodendrocyte differentiation and preservation after spinal cord injury
Authors: Gauthier Marie‐Krystel , Kosciuczyk Kamilla , Tapley Laura , Karimi‐Abdolrezaee Soheila
Published: June 2013

Spinal cord injury (SCI) results in degeneration of oligodendrocytes that leads to demyelination and axonal dysfunction. Replacement of oligodendrocytes is impaired after SCI, owing to the improper endogenous differentiation and maturation of myelinating oligodendrocytes. Here, we report that SCI‐induced dysregulation of neuregulin‐1 (Nrg‐1)–ErbB signaling may underlie the poor replacement of oligodendrocytes. Nrg‐1 and its receptors, ErbB‐2, ErbB‐3, and ErbB‐4, play essential roles in several aspects of oligodendrocyte development and physiology. In rats with SCI, we demonstrate that the Nrg‐1 level is dramatically reduced at 1 day after injury, with no restoration at later time‐points. Our characterisation shows that Nrg‐1 is mainly expressed by neurons, axons and oligodendrocytes in the adult spinal cord, and the robust and lasting decrease in its level following SCI reflects the permanent loss of these cells. Neural precursor cells (NPCs) residing in the spinal cord ependyma express ErbB receptors, suggesting that they are responsive to Nrg‐1 availability. In vitro, exogenous Nrg‐1 enhanced the proliferation and differentiation of spinal NPCs into oligodendrocytes while reducing astrocyte differentiation. In rats with SCI, recombinant human Nrg‐1β1 treatment resulted in a signifcant increase in the number of new oligodendrocytes and the preservation of existing ones after injury. Nrg‐1β1 administration also enhanced axonal preservation and attenuated astrogliosis, tumor necrosis factor‐α release and tissue degeneration after SCI. The positive effects of Nrg‐1β1 treatment were reversed by inhibiting its receptors. Collectively, our data provide strong evidence to suggest an impact of Nrg‐1–ErbB signaling on endogenous oligodendrocyte replacement and maintenance in the adult injured spinal cord, and its potential as a therapeutic target for SCI.
Mating‐Associated Changes in the Behaviour of Leptothorax gredleri Ant Queens
Authors: Bernadou Abel , Heinze Jürgen
Published: June 2013

Throughout their lives, animals adapt their behaviour to environmental fluctuations and to their own requirements. In social insects, behavioural changes are often particularly conspicuous. For example, in many ant species, reproductive sexuals leave their maternal nests and engage in risky mating and dispersal activities. Female sexuals experience, during a short period of time, dramatic changes in terms of behaviour and environmental conditions. But because sexual activities of ants are not easily observed, few studies have quantified in detail how behaviour alters with maturation and mating. We studied how various behavioural traits of Leptothorax gredleri female sexuals, a species in which female sexuals attract males by ‘female calling’, change before and after mating. We tested the hypothesis that behavioural variation reflects the altered requirements of queens to adapt to a particular situation. To this end, we compared geotactic, phototactic and locomotor behaviour across a wide range of life stages from lightly coloured, unmated female sexuals to old, mated queens. The results showed that female sexuals of L. gredleri change conspicuously their geotactic, phototactic and locomotor behavioural traits over their life stages. Three different behavioural states were evident (1) from light to dark female sexuals, individuals have negative phototaxis and reduced locomotor activity; (2) mature female sexuals during the daily period of sexual activity have strong phototaxis, negative geotaxis and an important locomotor activity; and (3) freshly mated and old mated queens avoid light and decrease their locomotor activity. These sharp differences in behaviour between stages match the transition from the relative safety of the nest chamber to the adversary world outside the nest, and back.
Nitrous oxide emissions in the Shanghai river network: implications for the effects of urban sewage and IPCC methodology
Authors: Yu Zhongjie , Deng Huanguang , Wang Dongqi , Ye Mingwu , Tan Yongjie , Li Yangjie , Chen Zhenlou , Xu Shiyuan
Published: June 2013

Global nitrogen (N) enrichment has resulted in increased nitrous oxide (N2O) emission that greatly contributes to climate change and stratospheric ozone destruction, but little is known about the N2O emissions from urban river networks receiving anthropogenic N inputs. We examined N2O saturation and emission in the Shanghai city river network, covering 6300 km2, over 27 months. The overall mean saturation and emission from 87 locations was 770% and 1.91 mg N2O‐N m−2 d−1, respectively. Nitrous oxide (N2O) saturation did not exhibit a clear seasonality, but the temporal pattern was co‐regulated by both water temperature and N loadings. Rivers draining through urban and suburban areas receiving more sewage N inputs had higher N2O saturation and emission than those in rural areas. Regression analysis indicated that water ammonium (NH4+) and dissolved oxygen (DO) level had great control on N2O production and were better predictors of N2O emission in urban watershed. About 0.29 Gg N2O‐N yr−1 N2O was emitted from the Shanghai river network annually, which was about 131% of IPCC's prediction using default emission values. Given the rapid progress of global urbanization, more study efforts, particularly on nitrification and its N2O yielding, are needed to better quantify the role of urban rivers in global riverine N2O emission.