bluuebunny/crossref_metadata_2025 huggingface dataset:
Benefits of Investing in Ecosystem Restoration
Authors: DE GROOT RUDOLF S. , BLIGNAUT JAMES , VAN DER PLOEG SANDER , ARONSON JAMES , ELMQVIST THOMAS , FARLEY JOSHUA
Published: October 2013

Measures aimed at conservation or restoration of ecosystems are often seen as net‐cost projects by governments and businesses because they are based on incomplete and often faulty cost‐benefit analyses. After screening over 200 studies, we examined the costs (94 studies) and benefits (225 studies) of ecosystem restoration projects that had sufficient reliable data in 9 different biomes ranging from coral reefs to tropical forests. Costs included capital investment and maintenance of the restoration project, and benefits were based on the monetary value of the total bundle of ecosystem services provided by the restored ecosystem. Assuming restoration is always imperfect and benefits attain only 75% of the maximum value of the reference systems over 20 years, we calculated the net present value at the social discount rates of 2% and 8%. We also conducted 2 threshold cum sensitivity analyses. Benefit‐cost ratios ranged from about 0.05:1 (coral reefs and coastal systems, worst‐case scenario) to as much as 35:1 (grasslands, best‐case scenario). Our results provide only partial estimates of benefits at one point in time and reflect the lower limit of the welfare benefits of ecosystem restoration because both scarcity of and demand for ecosystem services is increasing and new benefits of natural ecosystems and biological diversity are being discovered. Nonetheless, when accounting for even the incomplete range of known benefits through the use of static estimates that fail to capture rising values, the majority of the restoration projects we analyzed provided net benefits and should be considered not only as profitable but also as high‐yielding investments.

Beneficios de Invertir en la Restauración de Ecosistemas
Activation of non‐sensitizing or low‐sensitizing fragrance substances into potent sensitizers – prehaptens and prohaptens
Authors: Karlberg Ann‐Therese , Börje Anna , Duus Johansen Jeanne , Lidén Carola , Rastogi Suresh , Roberts David , Uter Wolfgang , White Ian R.
Published: October 2013

Experimental and clinical studies have shown that fragrance substances can act as prehaptens or prohaptens. They form allergens that are more potent than the parent substance by activation outside or in the skin via abiotic (chemical and physical factors) and/or biotic activation, thus, increasing the risk of sensitization.

In the present review a series of fragrance substances with well documented abiotic and/or biotic activation are given as indicative and illustrative examples of the general problem.

Commonly used fragrance substances, also found in essential oils, autoxidize on contact with air, forming potent sensitizers that can be an important source for contact allergy to fragrances and fragranced products. Some of them can act as prohaptens and be activated in the skin as well. The experimental findings are confirmed in large clinical studies.

When substances with structural alerts for acting as prohaptens and/or prehaptens are identified, the possibility of generating new potent allergens should be considered. Predictive testing should include activation steps. Further experimental and clinical research regarding activation of fragrance substances is needed to increase consumer safety.
Recommendation to include formaldehyde 2.0% aqua in the European baseline patch test series
Authors: Pontén Ann , Goossens An , Bruze Magnus
Published: October 2013

Background

The currently used patch test concentration of formaldehyde (1.0% aqua; 0.30 mg/cm2) has been shown to fail to detect ˜ 50% of contact allergies to formaldehyde.

Objectives

To justify the inclusion of formaldehyde 2.0% aqua (0.60 mg/cm2) in the European baseline patch test series.

Methods

A survey of the reported frequencies of contact allergy to formaldehyde found with formaldehyde 2.0% aqua as compared with 1.0% aqua was performed. Studies that describe a standardized patch test technique for obtaining a correct dose per unit area were included. Experimental provocation tests in patients with contact allergy to formaldehyde detected only with 2.0% aqua were also surveyed.

Results

In a multicentre study performed in 12 dermatology clinics among 3591 individuals, 3.4% reacted to 2.0%, and 1.8% reacted to 1.0% (p < 0.001). A randomized double‐blind repeated open application test performed in individuals reacting only to 2.0% but not to 1.0% showed that 9 of 17 formaldehyde‐allergic individuals reacted to a moisturizer that contained formaldehyde (p < 0.001).

Conclusions

It is recommended that formaldehyde 2.0% aqua (0.60 mg/cm2) should replace formaldehyde 1.0% in the European baseline series from 2014. With the Finn Chamber® technique, a standardized amount of 15 µl of the solution obtained by using a micropipette should be used.
Omentoplasty to assist perineal defect closure following laparoscopic abdominoperineal resection
Authors: Killeen S. , Mannion M. , Devaney A. , Winter D. C.
Published: October 2013

Aim

This technical note describes laparoscopic production of a well vascularized, omental flap of adequate size to fill the pelvic floor defect in the course of laparoscopic abdominoperineal resection (LAPR).

Method

The omentum is laparoscopically mobilized and transposed to the pelvis following full LAPR in three discrete stages.

Results

Laparoscopic omental mobilization, transfer and buttressing of a primary perineal repair reduces pelvic dead space and facilitates closure following LAPR with minimal additional operative time or complications and a potential reduction in perineal wound associated morbidity.

Conclusion

Laparoscopic omental mobilization is technically feasible and provides a safe method to aid perineal wound closure.
Preoperative mapping of fistula‐in‐ano: a new three‐dimensional MRI‐based modelling technique
Authors: Day N. J. , Earnshaw D. , Salazar‐Ferrer P. , Walsh C. J.
Published: October 2013

Aim

We aimed to develop an intuitive, interactive, three‐dimensional (3D) MRI modelling technique to produce a 3D image of fistula–in‐ano.

Method

The 3D model was created from standard two‐dimensional (2D) MRI sequences to produce an image that is anatomically correct. Individual muscle and soft‐tissue layers were extracted from T1‐weighted sequences and fistula pathology from short TI inversion recovery (STIR) sequences, to produce two separate volumes. These were then fused using postprocessing software (Vitrea Workstation version 6.3) to generate a 3D model.

Results

The final 3D model was incorporated into a PDF file that has an integrated computer aided design (CAD) viewer, allowing the surgeon to rotate it in any direction during preoperative planning or whilst in theatre.

Conclusion

As an adjunct to 2D MRI images and the associated radiology report, this model communicates the fistula anatomy to the clinician more clearly and should be particularly useful in complex cases.
Deprivation and access to treatment for colorectal cancer in southeast Scotland 2003–2009
Authors: Paterson H. M. , Mander B. J. , Muir P. , Phillips H. A. , Wild S. H.
Published: October 2013

Aim

Socioeconomic deprivation is associated with poorer survival from colorectal cancer. We examined the association of deprivation with access to treatment, disease stage at presentation and choice of treatment for colorectal cancer within a regional managed clinical network.

Method

We performed a retrospective analysis of data from the Southeast Scotland Cancer Network colorectal database for the period 2003–2009. Socioeconomic status was assigned into five categories using postcode of residence and the Scottish Index of Multiple Deprivation score. Outcomes were access to consultation and treatment, stage of disease at presentation and treatment factors (type of surgery, adjuvant radiotherapy and adjuvant chemotherapy).

Results

Of 4960 colorectal cancer patients, 4016 patients (81%) underwent operative treatment. Deprivation was not associated with age, gender, tumour site, disease stage, delay in treatment pathway or permanent stoma rate. Primary tumour resection (P = 0.006) and chemotherapy treatment (P = 0.018) were higher in the least deprived compared with the most deprived quintile. Socioeconomic status was associated with both primary tumour resection [odds ratio for the most affluent compared with the most deprived quintiles (OR) 1.34, 95% confidence interval (CI) 1.05–1.72, P = 0.018] and chemotherapy treatment (OR 1.44, 95% CI 1.15–1.80, P = 0.001). However, when health board of treatment was added to the model, only chemotherapy treatment was independently associated with deprivation (OR 1.46, 95% CI 1.16–1.83, P = 0.001).

Conclusion

Deprivation is not associated with treatment delay or more advanced disease stage at presentation. An apparent association between deprivation and treatment choice may be explained by other differences between patients treated in different areas.
The use of cardiac output monitoring to guide the administration of intravenous fluid during hyperthermic intraperitoneal chemotherapy
Authors: Thanigaimani K. , Mohamed F. , Cecil T. , Moran B. J. , Bell J.
Published: October 2013

Aim

The optimal strategy for intravenous (IV) fluid management during administration of hyperthermic intraperitoneal chemotherapy (HIPEC) is unclear. In this prospective study we describe the use of a LiDCOrapid™ (LiDCO, Cambridge, UK) cardiac output monitor to guide IV fluid management during cytoreductive surgery (CRS) with HIPEC. The aim of this study was to determine whether cardiac output monitoring will allow close maintenance of physiological parameters during the HIPEC phase.

Method

Twenty‐five patients who underwent CRS combined with HIPEC were included in the study. Intra‐operative IV fluid boluses were titrated using parameters measured by the LiDCOrapid™ monitor. Stroke volume variation was maintained below 10% with fluid boluses and mean arterial pressure was maintained within 20% of the baseline figure with vasopressors.

Results

There was no significant change in heart rate and cardiac output. The systemic vascular resistance dropped from an average of 966 dyn.s/cm‐5 to 797 dyn s/cm5 at 60 min during the HIPEC phase (P = 0.62) despite an increase in the dose of phenylepherine. The average total volume of fluid given was 748 ml in the first 30 min and 630 ml in the second 30 min with an average urine output of 307 and 445 ml, respectively. The change in lactate levels was not statistically or clinically significant.

Conclusion

LiDCOrapid™ is an effective noninvasive tool for guiding fluid management in this population. It allows the anaesthesiologist to maintain tight control of essential physiological parameters during a phase of the procedure in which there is a risk of renal injury.
Evaluations Versus Expectations: Children's Divergent Beliefs About Resource Distribution
Authors: DeJesus Jasmine M. , Rhodes Marjorie , Kinzler Katherine D.
Published: October 2013

Past research reveals a tension between children's preferences for egalitarianism and ingroup favoritism when distributing resources to others. Here we investigate how children's evaluations and expectations of others' behaviors compare. Four‐ to 10‐year‐old children viewed events where individuals from two different groups distributed resources to their own group, to the other group, or equally across groups. Groups were described within a context of intergroup competition over scarce resources. In the Evaluation condition, children were asked to evaluate which resource distribution actions were nicer. In the Expectation condition, children were asked to predict which events were more likely to occur. With age, children's evaluations and expectations of others' actions diverged: Children evaluated egalitarian actions as nicer yet expected others to behave in ways that benefit their own group. Thus, children's evaluations about the way human social actors should behave do not mirror their expectations concerning those individuals' actions.
Haematoxylin sorption onto yak hair: kinetic and thermodynamic studies
Authors: Gao Lihong , Gao Haiyan
Published: October 2013

The kinetic and thermodynamic behaviours of haematoxylin sorption onto yak hair as a model system were investigated. It was found that the sorption kinetics of haematoxylin on hair followed a pseudo‐second‐order kinetic model. The equilibrium sorption capacity increased as the temperature increased from 303 to 313 K, but dropped gradually as the temperature increased beyond 313 K. The maximum equilibrium sorption capacity was 24.04 mg g−1 at T = 313 K. Meanwhile, the sorption isotherm data were ingood agreement with the Freundlich isotherm, presenting high coefficients (R2 > 0.99). The free energy change (ΔG), enthalpy change (ΔH), and entropy change (ΔS) terms for haematoxylin dyeing were also determined, the negative values of ΔG and ΔH obtained indicated that the haematoxylin dye sorption process is a spontaneous and an exothermic one. Also, positive values of ΔS showed an increase in disorder of the system of haematoxylin sorption onto hair. Haematoxylin could be a good candidate as a natural green dye for hair fibre.
Accuracy of MRI technique in measuring tendon cross‐sectional area
Authors: Couppé C. , Svensson R. B. , Sødring‐Elbrønd V. , Hansen P. , Kjær M. , Magnusson S. P.
Published: October 2013

Magnetic resonance imaging (MRI) has commonly been applied to determine tendon cross‐sectional area (CSA) and length either to measure structural changes or to normalize mechanical measurements to stress and strain. The ability to reproduce CSA measurements on MRI images has been reported, but the accuracy in relation to actual tendon dimensions has never been investigated. The purpose of this study was to compare tendon CSA measured by MRI with that measured in vitro with the mould casting technique. The knee of a horse was MRI‐scanned with 1.5 and 3 tesla, and two examiners measured the patellar tendon CSA. Thereafter, the patellar tendon of the horse was completely dissected and embedded in an alginate cast. The CSA of the embedded tendon was measured directly by optical imaging of the cast impression. 1.5 tesla grey tendon CSA and 3 tesla grey tendon CSA were 16.5% and 13.2% lower than the mould tendon CSA, respectively. Also, 3 tesla tendon CSA, based on the red‐green border on the National Institute of Health (NIH) colour scale, was lower than the mould tendon CSA by 2.8%. The typical error between examiners was below 2% for all the measured CSA. The typical error between examiners was below 2% for all the measured CSA. These data show that measuring tendon CSA on the grey‐scale MRI images is associated with an underestimation, but by optimizing the measurement using a 3 tesla MRI and the appropriate NIH colour scale, this underestimation could be reduced to 2.8% compared with the direct measurements on the mould.
Efficacy of sublingual immunotherapy for allergic asthma: retrospective meta‐analysis of randomized, double‐blind and placebo‐controlled trials
Authors: Tao Lianqin , Shi Baoyu , Shi Guochao , Wan Huanying
Published: October 2013

Background

Allergen‐specific immunotherapy (SIT) is the only available curative choice with a disease‐modifying effect against respiratory allergies. The efficacy of SIT via the sublingual route was demonstrated by a number of clinical trials. This meta‐analysis was performed to investigate the clinical efficacy and safety of sublingual‐specific immunotherapy (SLIT) for allergic asthma.

Methods

PubMed, EMBASE and the Cochrane Central Register of Controlled Trials were searched for randomized, double‐blind and placebo‐controlled (DBPC) trials evaluating the efficacy and safety of SLIT on allergic asthma. Subgroup analyses were performed according to age, type of allergen and duration of SLIT treatment.

Results

Sixteen randomized DBPC trials comprising 794 patients in total met the inclusion criteria. The results suggest that SLIT significantly reduces both symptom [standardized mean difference (SMD), −0.74; P = 0.006] and medication scores (SMD, −0.78; P = 0.02) compared with placebo. SLIT offers a better clinical response in mite sensitive asthmatics but without confirmed proof from subgroup analyses. Prolonged duration of treatment for more than 12 months brings no additive effects. Improvement in the skin prick test was also observed following immunotherapy. There was no consistent effect on forced expiratory volume in 1 s, serum levels of antigen‐specific immunoglobulin G4 and immunoglobulin E in the treated group. The risk of adverse effects was relative risk 2.23 (P = 0.01).

Conclusions

SLIT is safe and clinically effective in reducing symptoms and medication use for allergic asthma. Our subgroup analyses failed to identify a disproportionate benefit of SLIT in any specific group of asthmatics, but some possible trends did emerge.
DCE‐MRI findings of invasive aspergillosis in patient with acute myeloid leukemia
Authors: Araz Ömer , Karaman Adem , Ucar Elif Yılmazel , Bilen Yusuf , Durur Subası Irmak
Published: October 2013

Thoracic radiography and high resolution computerized tomography is used to diagnose pulmonary infections in immunosuppressed patients, although in some cases these do not provide enough information about the lesion. Dynamic contrast‐enhanced magnetic resonance imaging may be useful in these cases, especially for the characterization of cavitary lesions and assessment of their contrast diffusion.
Incidence of arteriovenous fistula closure due to high‐output cardiac failure in kidney‐transplanted patients
Authors: Schier Tabea , Göbel Georg , Bösmüller Claudia , Gruber Ingrid , Tiefenthaler Martin
Published: October 2013

Background

Some hemodialysis patients develop arteriovenous (AV) fistulas with high flows. This volume overload can result in high‐output cardiac failure. To date, predisposing access flow rates are unknown.

Methods

A retrospective study of all kidney‐transplant recipients at the Medical University of Innsbruck (MUI) from 2005 to 2010 included 797 patients with the following criteria: previous hemodialysis with a native AV fistula or a graft, sufficient function of the kidney transplant up to the time of the data analysis, and follow‐up care at the MUI.

Results

Twenty‐nine of the 113 patients (25.7%) needed an AV fistula closure, mostly because of symptoms of cardiac failure. The mean shunt flow in the intervention group was 2197.2 mL/min, whereas the mean shunt flow in the non‐intervention group was only 850.9 mL/min. Shunt closures were most frequently made in patients with upper‐arm shunts (41.7%).

Conclusion

The necessity of shunt closure is not a rarity. Patients who underwent an AV fistula ligature had high access flows with about 2200 mL/min. As the symptoms of cardiac failure greatly improved after shunt closure, patients with high access flow may benefit from such an intervention.
Early changes in scores of chronic damage on transplant kidney protocol biopsies reflect donor characteristics, but not future graft function
Authors: Caplin Ben , Veighey Kristin , Mahenderan Arundathi , Manook Miriam , Henry Joanne , Nitsch Dorothea , Harber Mark , Dupont Peter , Wheeler David C. , Jones Gareth , Fernando Bimbi , Howie Alexander J. , Veitch Peter
Published: October 2013

The amount of irreversible injury on renal allograft biopsy predicts function, but little is known about the early evolution of this damage. In a single‐center cohort, we examined the relationship between donor‐, recipient‐, and transplantation‐associated factors and change in a morphometric index of chronic damage (ICD) between protocol biopsies performed at implantation and at 2–3 months. We then investigated whether early delta ICD predicted subsequent biochemical outcomes. We found little evidence to support differences between the study group, who had undergone serial biopsies, and a contemporaneous control group, who had not. In allografts with serial biopsies (n = 162), there was an increase in ICD between implantation (median: 2%, IQR:0–8) and 2–3 months post‐transplant (median 8% IQR:4–15; p < 0.0001). Donation from younger or live donors was independently associated with smaller early post‐transplant increases in ICD. There was no evidence for a difference in delta ICD between donation after cardiac death vs. donation after brain death, nor association with length of cold ischemia. After adjustment for GFR at the time of the second biopsy, delta ICD after three months did not predict allograft function at one yr. These findings suggest that graft damage develops shortly after transplantation and reflects donor factors, but does not predict future biochemical outcomes.
Poor sleep in organ transplant recipients: self‐reports and actigraphy
Authors: Reilly‐Spong M. , Park T. , Gross C. R.
Published: October 2013

Solid organ transplant recipients are at increased risk of poor sleep due to pharmacotherapy and co‐morbidities, but sleep problems are often unrecognized and untreated. Study aims were to measure rates of occurrence, characteristics, and correlates of poor sleep in recipients. The Pittsburgh Sleep Quality Index (PSQI) and sleep parameters measured by wrist actigraphy were obtained at baseline from 143 kidney, liver, heart, lung, or pancreas transplant recipients enrolled in a psychosocial intervention trial to improve symptoms and quality of life. Rates of poor sleep were determined using accepted clinical cutoffs; 41% (58 of 143) were poor sleepers (PSQI > 8) and 36% used sleep medications in the past month. Fifteen percent reported having obstructive sleep apnea (OSA) and 4% reported restless legs syndrome (RLS). Based on actigraphy (n = 73), 69% lacked sleep efficiency (SE), 32% took >30 min to fall asleep, 88% awakened during the night for more than 30 min, and 25% slept less than six h per night. Obesity and use of psychotropics or sleep medications, and pain were independent risk factors for poor objectively measured sleep. Poor sleep is an undertreated problem in transplantation. Screening for sleep problems and behavioral therapies with sleep hygiene instruction may benefit recipients.
Rituximab for Non‐Hodgkin's Lymphoma: A Story of Rapid Success in Translation
Authors: Harrison Andrew M. , Thalji Nassir M. , Greenberg Alexandra J. , Tapia Carmen J. , Windebank Anthony J.
Published: October 2013

Translational stories range from straightforward to complex. In this commentary, the story of the rapid and successful translation of rituximab therapy for the treatment of non‐Hodgkin's lymphoma (NHL) is examined. Development of this monoclonal antibody therapy began in the late 1980s. In 1994, rituximab received its first approval for the treatment of NHL by the United States Food and Drug Administration (FDA). Rituximab has since been approved for additional indications and has transformed medical practice. However, the social and political implications of these rapid successes are only beginning to become clear. In this commentary, key events in the rapid translation of rituximab from the bench to bedside are highlighted and placed into this historical framework. To accomplish this, the story of rituximab is divided into the following six topics, which we believe to be widely applicable to case studies of translation: (1) underlying disease, (2) key basic science, (3) key clinical studies in translation, (4) FDA approval process, (5) changes to medical practice, and (6) the social and political influences on translation.
Measurement of Social Capital among Clinical Research Trainees
Authors: Primack Brian A. , Colditz Jason B. , Cohen Elan , Switzer Galen E. , Robinson Georgeanna F.W.B. , Seltzer Deborah L. , Rubio Doris M. , Kapoor Wishwa N.
Published: October 2013

While physical and human capital are established as important predictors of success among early‐career clinical investigators, less is known about the role of social capital. The authors aimed to develop a brief scale to assess social capital in this population and test its reliability and validity. A three‐item assessment was developed based on a conceptual framework and measures of social capital from other fields and was administered to 414 clinical research trainees at the University of Pittsburgh in 2007–2012. The measure exhibited good internal consistency reliability (α = 0.71) and a normal distribution. On a 10‐point scale, mean social capital was 6.4 (SD = 1.7). Social capital was significantly associated with 7 of the 9 expected constructs: sex, age, confidence in research skills, work‐related motivation, burnout, and social support. Exploratory multivariable regression analysis demonstrated that social capital was most strongly associated with higher research confidence (β = 0.35, p < 0.001), higher extrinsic motivation (β = 0.50, p = 0.003), and lower burnout (ptrend = 0.02). This three‐item scale measures social capital in this population with adequate internal consistency reliability, face validity, and construct validity. This brief assessment provides a tool that may be valuable to benchmark social capital of clinical research trainees and to better contextualize programmatic and trainee outcomes.
The Design and Conduct of a Community‐Based Registry and Biorepository: A Focus on Cardiometabolic Health in Latinos
Authors: Shaibi Gabriel Q. , Coletta Dawn K. , Vital Veronica , Mandarino Lawrence J.
Published: October 2013

Background

Latinos are disproportionately impacted by obesity and type 2 diabetes but remain underrepresented in biomedical research. Therefore, the purpose of this project was to develop a research registry and biorepository to examine cardiometabolic disease risk in the Latino community of Phoenix, Arizona. The overarching goal was to establish the research infrastructure that would encourage transdisciplinary research regarding the biocultural mechanisms of obesity‐related health disparities and facilitate access to this research for the Latino community.

Methods

Prior to recruitment, key stakeholders from the local Latino community were engaged to develop a broad rapport within the community and seek advice regarding recruitment, enrollment, and follow‐up. Self‐identified community‐dwelling Latinos underwent a comprehensive cardiometabolic health assessment that included anthropometrics, a fasting laboratory panel, and a 2‐hour oral glucose tolerance test with measures of insulin and glucose to estimate insulin action and secretion. Separate consent was requested for future contact and banking of serum, DNA, and RNA. Research collaborations were sought out based on the cultural and metabolic profile of participants, faculty research agendas, and the potential for generating hypotheses.

Results

A total of 667 participants (20.4% children, and 79.6% adults) were enrolled with 97% consenting to the registry and 94% to banking of samples. The prevalence of overweight/obesity was 50% in children and 81% in adults. Nearly 20% of children and more than 45% of the adults exhibited some degree of hyperglycemia. To date, more than 15 research projects have been supported through this infrastructure and have included projects on the molecular biology of insulin resistance to the sociocultural determinants of health behaviors and outcomes.

Conclusions

The high prevalence of obesity and cardiometabolic disease risk factors coupled with the overwhelming majority of participants consenting to be re‐contacted, highlights the importance of supporting research infrastructure to generate hypotheses about obesity‐related health in Latinos. Future studies that stem from the initial project will likely advance the limited understanding regarding the biocultural determinants of health disparities in the Latino community.
The differential diagnosis of CD8‐positive (“type D”) lymphomatoid papulosis
Authors: McQuitty Elizabeth , Curry Jonathan L. , Tetzlaff Michael T. , Prieto Victor G. , Duvic Madeleine , Torres‐Cabala Carlos
Published: October 2013

Background

Cutaneous CD8+ CD30+ lymphoproliferative lesions are difficult to classify and encompass entities that follow a benign course to overt lymphoma. In order to identify histopathologic criteria for lesions in this spectrum, a series of such cases was reviewed.

Methods

Twenty‐eight biopsies from 27 patients with CD8+ CD30+ cutaneous lymphoid proliferations were evaluated.

Results

Seventeen cases were classified as lymphomatoid papulosis (LyP) ‘type D’, eight as cutaneous anaplastic large cell lymphoma (C‐ALCL) and two as CD8+ mycosis fungoides (MF) with CD30 expression. Features of LyP included spongiosis and/or parakeratosis (90%), epidermotropism by large lymphocytes (90%), with (80%) or without (10%) small lymphocytes; wedge‐shaped infiltrate (70%) with perivascular (100%) and interstitial (80%) pattern; and relative uniformity of CD30+ large atypical cells (90%). C‐ALCL was characterized by ulceration (63%), epidermotropism restricted to small lymphocytes (100%), marked density (63%) and pleomorphism (62%) of CD30+ large atypical cells, and at least focal extension of infiltrate to subcutaneous tissue (88%). CD8+ CD30+ MF had vacuolar interface change and a lichenoid pattern (100%).

Conclusions

We concur with previous authors that distinction of CD8+ LyP from lymphoma in its differential diagnosis is difficult based on histopathology alone. Nonetheless, we propose that certain histopathologic clues may be helpful in this differential diagnosis.
Treatment expectations and satisfaction of treatment‐refractory opioid‐dependent patients in RIOTT, the Randomised Injectable Opiate Treatment Trial, the UK's first supervised injectable maintenance clinics
Authors: Groshkova Teodora , Metrebian Nicola , Hallam Christopher , Charles Vikki , Martin Anthea , Forzisi Luciana , Lintzeris Nicholas , Strang John
Published: October 2013

Introduction and Aims

The study investigates patients' pre‐treatment expectations of, and post‐treatment satisfaction with, supervised injectable opiate treatment delivered within UK's first such clinics within the Randomised Injectable Opiate Treatment Trial (RIOTT) (ISRCTN0133807).

Design and Methods

Data were collected from 127 chronic heroin addicts recruited to RIOTT and randomised to receive supervised injectable (heroin or methadone) treatment or optimised oral maintenance treatment at supervised injectable maintenance clinics in London, Darlington and Brighton.

Results

Of 127 RIOTT patients, 113 (89%) provided responses to structured enquiry about treatment expectations, and 94 (74%) subsequent responses about treatment satisfaction (at six months). Patients were hoping that injectable heroin treatment would: reduce substance misuse (81%); help achieve normality, routine and structure (16%); and increase education and work prospects (15%). At six months, an area of treatment satisfaction most commonly reported by all three trial groups was reduced substance misuse (supervised injectable heroin 59%, supervised injectable methadone 56%, optimised oral methadone 54%). Most found supervision acceptable, but some desired modifications were also identified.

Discussion and Conclusions

Patients previously considered non‐responsive to treatment appear to have similar treatment expectations and aspirations as other drug users in treatment. Supervised injectable opioid treatment patients consistently reported treatment satisfaction but also that more could be done to optimise aspects of current arrangement. This raised the challenging issue of the extent to which opinions of patients need to be taken into consideration in shaping future treatment provision. Future research may need to examine the extent of expectations ‘fit’ and the relationship between treatment sought and received. [Groshkova T, Metrebian N, Hallam C, Charles V, Martin A, Forzisi L, Lintzeris N, Strang J. Treatment expectations and satisfaction of treatment‐refractory opioid dependent patients in Randomised Injectable Opiate Treatment Trial, the UK's first supervised injectable maintenance clinics. Drug Alcohol Rev 2013;32:566–573]
Is narrow‐band imaging useful for histological evaluation of gastric mucosa‐associated lymphoid tissue lymphoma after treatment?
Authors: Nonaka Kouichi , Ohata Ken , Matsuhashi Nobuyuki , Shimizu Michio , Arai Shin , Hiejima Yoshimitsu , Kita Hiroto
Published: October 2013

Background and Aim

Endoscopic diagnosis of stomach mucosa‐associated lymphoid tissue (MALT) lymphoma is often difficult because few specific findings are indicated. Even when MALT lymphoma is suspected by endoscopy, it is still difficult to make a definitive diagnosis by biopsy because lymphoma cells sometimes distribute unevenly. We previously reported that a tree‐like appearance (TLA) is a characteristic finding of MALT lymphoma by narrow‐band imaging (NBI) magnifying endoscopy and it is valuable in the selection of an optimal biopsy site in MALT lymphoma. Here, we study the frequency of TLA and evaluate the relationship between the response to eradication therapy and TLA in MALT lymphoma.

Methods

We retrospectively examined the clinical background, endoscopic findings, response to eradication therapy, and Helicobacter pylori infection status of 16 patients diagnosed with MALT lymphoma who were referred to our hospital from April 2007 to August 2012. The regimen for eradicationtherapy consisted of rabeprazole, with amoxicillin and clarithromycin, all given for 7 days.

Results

TLA was found in 75% (12/16) and H. pylori infection in 75% (12/16) of patients diagnosed with MALT lymphoma by NBI magnifying endoscopy. In all complete regression (CR) patients after eradication treatment, the TLA finding had disappeared (100%); however, in the non‐CR patients, TLA remained the same as before the eradication therapy (P = 0.002).

Conclusion

These results suggest that NBI magnifying endoscopy may be useful not only in the diagnosis but also in the evaluation of the response to eradication therapy of MALT lymphoma of the stomach.
Uncommon and rarely reported adverse events of endoscopic retrograde cholangiopancreatography
Authors: Chavalitdhamrong Disaya , Donepudi Suman , Pu Liping , Draganov Peter V.
Published: October 2013

Endoscopic retrograde cholangiopancreatography (ERCP) has become a primary tool for the treatment of biliary and pancreatic ductal diseases. It is essential for the endoscopist carrying out the ERCP to have a thorough understanding of the potential adverse events. Typically, endoscopists are well familiar with common adverse events such as post‐ERCP pancreatitis, cholangitis, post‐sphincterotomy bleeding, post‐sphincterotomy perforation, and sedation‐related cardiopulmonary compromises. However, there are other less common adverse events that arecritical to promptly recognize in order to provide appropriate therapy and prevent disastrous outcomes. This review focuses on the presentation and management of the less common and rare adverse events of an ERCP from the perspective of the practicing endoscopist.
Contrast‐enhanced endoscopic ultrasound
Authors: Kitano Masayuki , Sakamoto Hiroki , Kudo Masatoshi
Published: October 2013

Compared to other imaging modalities, endoscopic ultrasound (EUS) has limitations in terms of image enhancement. However, with the availability of contrast agents in ultrasonography, EUS has evolved. Contrast‐enhanced Doppler EUS (CD‐EUS) enhances Doppler signals from vessels and is useful for characterizing lesions detected by EUS. Moreover, contrast‐enhanced harmonic EUS (CH‐EUS) with second‐generation ultrasound contrast agents and a broad band transducer allows microvessels and parenchymal perfusion to be visualized. Vascularity can also be quantitatively analyzed during CH‐EUS by generating a time‐intensity curve. CE‐EUS is useful for characterizing pancreatic lesions and can detect pancreatic adenocarcinomas with a sensitivity of 94%and a specificity of 89% as a result of the hypo‐enhancement of these lesions. Indeed, CH‐EUS is superior to multiple detector‐computed tomography in terms of the differential diagnosis of small lesions that are ≤2 cm. CH‐EUS complements EUS‐guided fine‐needle aspiration (EUS‐FNA) as it identifies the EUS‐FNA target and lesions with false‐negative EUS‐FNA findings. CH‐EUS is also used to estimate the malignant potential of gastrointestinal stromal tumors and helps to differentiate between malignant and benign lymphadenopathy.
Influences of vowel and tone variation on emergent word knowledge: a cross‐linguistic investigation
Authors: Singh Leher , Hui Tam Jun , Chan Calista , Golinkoff Roberta Michnick
Published: October 2013

To learn words, infants must be sensitive to native phonological contrast. While lexical tone predominates as a source of phonemic contrast in human languages, there has been little investigation of the influences of lexical tone on word learning. The present study investigates infants’ sensitivity to tone mispronunciations in two groups of infants. For one group (Chinese learners), tone is phonemic in their native language, and for the second group (English learners), tone is non‐phonemic and constituted suprasegmental variation. In Experiment 1, English learners were trained on novel word–object pairings and tested on their recognition of correct pronunciations, tone and vowel mispronunciations of these words at 18 and 24 months. In Experiment 2a, bilingual English‐Chinese learners were tested on a similar task translated into Chinese at the same age intervals. Results demonstrate that non‐tonal learners treated tonal and vowel substitutions alike as mispronunciations at 18 months but only treated vowel substitutions as mispronunciations at 24 months. Tonal learners treated both tonal and vowel substitutions as mispronunciations at both ages. In Experiment 2b, bilingual non‐tone language learners were tested on the same set of tasks replicating a similar set of results as monolingual non‐tone language learners (Experiment 1). Findings point to an early predisposition to treat tone as a defining characteristic of words regardless of its lexical relevance at 18 months. Between 18 and 24 months, learners appear to ascribe lexical relevance to tone in a language‐specific manner. The current study identifies the influences of tone variation on memories for newly learned words and the time period during which lexical tone – a highly frequent constituent of human languages – actually becomes lexical for early learners. Findings are contextualized with prevailing models of the developing lexicon.
Ophthalmic abnormalities in children with developmental coordination disorder
Authors: Creavin Alexandra L , Lingam Raghu , Northstone Kate , Williams Cathy
Published: October 2013

Aim

To explore associations between developmental coordination disorder (DCD) and ophthalmic abnormalities in children aged 7 to 8 years.

Method

Cross‐sectional analysis of data from the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort, was performed. DCD was defined according to DSM‐IV criteria. Children with neurological difficulties or IQ less than 70 were excluded. Ophthalmic abnormalities including visual acuity, refraction, and binocular function were assessed using standard tests. Children who achieved less than the 5th centile in the ALSPAC coordination test and either failed the National Curriculum handwriting test, or achieved less than the 10th centile in the Activities of Daily Living scale (ADL) were defined as having severe DCD, while those who scored between the 5th and 15th centiles in the coordination test and either failed the handwriting test, or achieved less than the 15th centile in the ADL were defined as having moderate DCD.

Results

Complete data were available for 7154 children. One hundred and twenty children (1.8%) met the criteria for severe DCD. A further 215 children had moderate DCD. Children with severe DCD were more likely to have the following: abnormal sensory fusion at near (odds ratio [95% confidence interval]) (1.98 [1.13–3.48]) and distance (2.59 [1.16–5.79]) and motor fusion (1.74 [1.07–2.84]); reduced stereoacuity (2.75 [1.78–4.23]); hypermetropia (2.29 [1.1–4.57]) and anisometropia (2.27 [1.13–4.60]). The majority of children found to have both DCD and a refractive error, had been previously prescribed glasses and wore them for the assessments (71%).

Interpretation

Children with severe DCD had abnormalities in binocular vision, refractive error, and ocular alignment. We recommend that children with DCD be assessed for ocular abnormalities as early intervention may improve long‐term visual outcome. The impact of untreated ocular abnormalities such as refractive error on the accuracy of the diagnosis of DCD is difficult to ascertain and further work would be of benefit.
The optimal morning:evening ratio in total dose of twice‐daily biphasic insulin analogue in poorly controlled Type 2 diabetes: a 24‐week multi‐centre prospective, randomized controlled, open‐labelled clinical study
Authors: Jung C. H. , Park J.‐Y. , Cho J. H. , Yoon K.‐H. , Yang H. K. , Lee Y.‐H. , Cha B. S. , Lee B.‐W.
Published: October 2013

Aims

Biphasic insulin analogues are widely used in patients with Type 2 diabetes mellitus suboptimally controlled on oral anti‐diabetic drugs. Several topics in this area remain controversial, including how to divide the daily dose of biphasic insulin analogue. We aimed to determine the optimal dosing ratio of twice‐daily biphasic insulin analogue and to compare the glycaemic efficacy among groups of patients using different initial dosing ratios of biphasic insulin analogue.

Methods

A total of 100 poorly controlled insulin‐naive subjects with Type 2 diabetes [HbA1c ≥ 58 mmol/mol, (7.5%)] on oral anti‐diabetic drugs were randomized into three groups according to initial morning:evening dosing ratio (group I, 50:50; group II, 55:45; group III, 60:40) of twice‐daily biphasic insulin analogue (biphasic insulin aspart 70/30, biphasic insulin aspart 30). The primary outcome measure was the difference in pre‐breakfast to pre‐dinner dose ratio at the end of the study.

Results

Twice‐daily biphasic insulin analogue showed a significant improvement in glycaemic control [HbA1c from 70 mmol/mol (8.6%) to 60 mmol/mol (7.6%)] after 24 weeks regardless of the initial dose ratio given. Despite the similar efficacy and safety profiles among three groups, morning dose was significantly increased (from 50:50 to 55:45–60:40) in group I after 24 weeks. However, there was no significant change in splitting ratio in groups II and III (with higher morning dose) over the 24‐week treatment period.

Conclusions

These results indicate that initiating twice‐daily biphasic insulin analogue on regimens with a higher dose before breakfast than before dinner (i.e. ratio approximately 55:45 to 60:40) might be more appropriate in Korean subjects with Type 2 diabetes.
Efficacy and safety of lixisenatide once daily vs. placebo in people with Type 2 diabetes insufficiently controlled on metformin (GetGoal‐F1)
Authors: Bolli G. B. , Munteanu M. , Dotsenko S. , Niemoeller E. , Boka G. , Wu Y. , Hanefeld M.
Published: October 2013

Aims

To assess the efficacy and safety of one‐ and two‐step dose‐increase regimens of lixisenatide once daily in participants with Type 2 diabetes mellitus insufficiently controlled with metformin.

Methods

This was a randomized, double‐blind, placebo‐controlled, parallel‐group, multi‐centre study enrolling participants with Type 2 diabetes (n = 484) treated with metformin. Participants were randomized to receive either lixisenatide in a one‐step dose increase or a two‐step dose increase vs. placebo for 24 weeks, followed by a ≥ 52‐week variable double blind period. Primary outcome was HbA1c reduction at week 24.

Results

Lixisenatide one‐/two‐step once daily significantly improved HbA1c at week 24 compared with placebo (P < 0.0001) and allowed more participants to achieve HbA1c < 53 mmol/mol (< 7.0%) (P ≤ 0.0005). Improvements were observed in fasting plasma glucose (–0.5/–0.6 vs. +0.1 mmol/l; P < 0.001) and body weight (–2.6/–2.7 vs. –1.6 kg; P < 0.005). At week 24, adverse events were reported by 67.7/70.8/65.6% of participants treated with lixisenatide one‐/two‐step/placebo, respectively—nausea and vomiting being reported most frequently. Symptomatic hypoglycaemia occurred in 1.9/2.5% of participants on one‐/two‐step lixisenatide and 0.6% with placebo, with no severe episodes. Lixisenatide continued to be efficacious and well tolerated during the variable double‐blind extension period of at least 52 weeks.

Conclusions

Lixisenatide one‐ or two‐step dose‐increase regimens significantly improved glycaemic control and decreased body weight over 24 weeks and during a long‐term extension period without increasing hypoglycaemia. The study confirmed that tolerability in the one‐step group was at least similar to the two‐step dose increase, with nausea/vomiting and hypoglycaemia frequency being lower in the one‐step regimen.
Early elevation of albumin excretion rate is associated with poor gluten‐free diet adherence in young people with coeliac disease and diabetes
Authors: Pham‐Short A. , C. Donaghue K. , Ambler G. , K. Chan A. , Hing S. , Cusumano J. , E. Craig M.
Published: October 2013

Aims

There are conflicting data on microvascular complications in coexisting Type 1 diabetes and coeliac disease. We compared complications rates in youth with or without coeliac disease and examined the association between gluten‐free diet adherence and complications.

Methods

This was a comparative study of adolescents (2510 without coeliac disease, 129 with coeliac disease); 60 (47%) did not adhere to a gluten‐free diet—defined as elevated anti‐tissue transglutaminase or endomysial immunoglobulin A titres. Retinopathy was detected using 7‐field fundal photography and albumin excretion rate by timed overnight urine collections, with early elevation defined as albumin excretion rate ≥ 7.5 μg/min. Logistic regression was used to examine the association between complications and explanatory variables, including coeliac disease vs. no coeliac disease, gluten‐free diet adherence vs. non‐adherence, diabetes duration and HbA1c.

Results

Median age at last assessment was 16.5 years. Those with coeliac disease vs. those without were younger at diabetes diagnosis (7.1 vs. 8.6 years, P < 0.001) and had longer diabetes duration (9.3 vs. 7.2 years, P < 0.001). HbA1c was lower in those with coeliac disease vs. those without (67 vs. 70 mmol/mol, 8.3 vs. 8.6%, P = 0.04) and adherence to a gluten‐free diet vs. non‐adherence (66 vs. 72 mmol/mol, 8.2 vs. 8.7%, P = 0.003). There were no differences in complication rates between those with coeliac disease vs. those without (retinopathy 22 vs. 23%, elevated albumin excretion rate 31 vs. 28%). Non‐adherence to a gluten‐free diet was associated with elevated albumin excretion rate (40 vs. 23%, P = 0.04). In multivariable logistic regression, elevated albumin excretion rate was associated with non‐adherence to a gluten‐free diet (odds ratio 2.37, 95% CI 1.04–5.40, P = 0.04) and diabetes duration (odds ratio 1.13, 95% CI 1.02–1.25, P = 0.03), but not HbA1c.

Conclusions

While glycaemic control is better in patients with coeliac disease, non‐adherence to a gluten‐free diet is associated with elevated albumin excretion rate. The possible protection of a gluten‐free diet on complications warrants further investigation.