bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparative study on efficacy of UVA1 vs. narrow‐band UVB phototherapy in the treatment of vitiligo
Authors: El‐Zawahry Bakr Mohamed , Bassiouny Dalia Ahmed , Sobhi Rehab Mohamed , Abdel‐Aziz Eman , Zaki Naglaa Sameh , Habib Dawoud Fakhry , Shahin Dalia Mamdouh
Published: March 2012

Background/Purpose

Narrow‐band ultraviolet B (NB‐UVB) is considered the most effective and safe initial treatment for moderate‐to‐severe vitiligo but phototoxicity and possible carcinogenicity are the reported side effects. Ultraviolet A1 (UVA1) phototherapy has overlapping biological effects to NB‐UVB and is relatively free of side effects associated with other phototherapy regimens.

Methods

Forty patients with vitiligo were included in this prospective, randomized controlled comparative clinical trial. Twenty patients received NB‐UVB and 20 received UVA1 three times weekly for 12 weeks. The UVA1 group was divided into two subgroups. Ten patients received moderate and 10 received low dose of UVA1. Serum samples were collected before and after 36 sessions to assess soluble interleukin 2 receptor level. Patients were clinically evaluated before therapy then monthly according to Vitiligo Area Scoring Index (VASI) and Vitiligo European Task Force (VETF) scores. In addition, extent of response was determined by a blinded dermatologist comparing before and after therapy photographs. Pattern of response and side effects were recorded.

Results

NB‐UVB was superior to UVA1 with a significant difference in blinded dermatological assessment (P < 0.001), percentage change in VASI score (P < 0.001) and percentage change in VETF area score (P = 0.001). No significant difference in side effects was observed between both groups. Comparing UVA1 subgroups, better response in moderate‐dose group was found as regard to percentage change in VASI (P < 0.001) and percentage change in VETF area score (P = 0.001), while no significant difference was found in blinded dermatological assessment (P = 0.121).

Conclusion

NB‐UVB phototherapy remains to be an effective and safe therapeutic option in vitiligo. Response to UVA1 in vitiligo seems to be dose dependent and seems to be of limited value in treatment of vitiligo as a monotherapy. Further studies combining it with other lines of therapy such as systemic steroids may prove beneficial.
Treatment of oral lichen planus with methylene blue mediated photodynamic therapy – a clinical study
Authors: Sadaksharam Jayachandran , Nayaki K. P. Thanigai , Panneer Selvam Niranzena
Published: March 2012

Background/Purpose

Oral lichen planus is an autoimmune disorder that has posed a challenge in spite of the several treatment modalities available. Here, we have proposed yet another treatment modality, photodynamic therapy, for this condition. The aim of the study was to treat patients having symptomatic oral lichen planus with photodynamic therapy with methylene blue as photosensitizer.

Methods

Twenty patients with symptomatic oral lichen planus were included in the study. They were treated with 5% methylene blue mediated photodynamic therapy (light source: Xenon arc lamp, wavelength: 630 ± 5 nm, total dose: 120 J/cm2 per sitting) in four sessions (1st, 4th, 7th and 15th day). Follow‐up was done on second and fourth week after the therapy.

Results

There was significant improvement in signs and symptoms of the lesion at first and second follow‐up visits (P‐value < 0.001).

Conclusion

There was satisfactory reduction in signs and symptoms of oral lichen planus without any side effects. Thus, methylene blue mediated photodynamic therapy seems to be a promising alternative for the control of oral lichen planus.
Survival estimates for elite male and female Olympic athletes and tennis championship competitors
Authors: Coate D. , Sun R.
Published: March 2012

In this paper, we report survival estimates for male and female Olympic medal winners and for male and female finalists at the British and U
S national tennis championships. We find a consistent longevity advantage of Olympic medal‐winning female athletes over Olympic medal‐winning male athletes competing separately in the same events since 1900 and for female finalists over male finalists competing separately in the finals of the national tennis championships of Britain and of the United States since the 1880s. This is the case for sample mean comparisons, for Kaplan–Meier survival function estimates, including life expectancy, and for Cox proportional hazard estimates, which show statistically significant lower hazard rates for women with birth year and other variables constant. The female longevity advantage over males is similar in the early period samples (birth years before1920) and in the full period samples, and is 5–7 years.
Relationships among steroid hormone levels in newborn piglets, birth weight, placental weight, vitality of offspring and litter size
Authors: OHTAKI Tadatoshi , MORIYOSHI Masaharu , NAKADA Ken , NAKAO Toshihiko , SAWAMUKAI Yutaka
Published: March 2012

Blood estrone sulfate (E1S), estrone (E1), estradiol (E2) and progesterone (P4) in newborn piglets were measured to clarify the relationships among birth and placental weight, vitality of offspring and litter size. First, the association between vital status (normal, weak and stillborn) from 165 newborn piglets of 18 litters and steroid concentrations; second, steroid concentrations from 152 newborn normal piglets and litter size; and third, steroid content in fetal placenta from 50 newborn normal piglets of six litters and litter size, were investigated. In the normal group, the birth and placental weight were significantly higher than those in the other groups. Blood E1S levels in the stillborn group were significantly lower, whereas E1, E2 and P4 were significantly higher compared to the normal group. Blood and placental E1S levels in the small litter group were significantly higher than those in the other groups. However, there was no significant difference among the three litter size groups in the levels of steroid hormones in maternal blood. These results indicate that vitality of newborn piglets is related to E1S concentration of neonate, to birth weight and placental weight. However, steroid hormone concentrations of newborn piglets were greatly affected by the number of littermates.
Cryopreservation of immature buffalo oocytes: Effects of cytochalasin B pretreatment on the efficiency of cryotop and solid surface vitrification methods
Authors: LIANG Yuanyuan , RAKWONGRIT Damrongrak , PHERMTHAI Tatsanee , SOMFAI Tamas , NAGAI Takashi , PARNPAI Rangsun
Published: March 2012

The aim of the present study was to compare the efficiency of the solid surface (SSV), cryotop (CT) vitrification methods and cytochalasin B (CB) pretreatment for cryopreservation of immature buffalo oocytes. Cumulus‐oocyte complexes (COCs) were placed for 1 min in TCM199 containing 10% dimethylsulfoxide (DMSO), 10% ethylene glycol (EG), and 20% fetal bovine serum, and then transferred for 30 s to base medium containing 20% DMSO, 20% EG and 0.5 mol/L sucrose. CB pretreated ((+)CB) or non‐pretreated ((−)CB) COCs were vitrified either by SSV or CT. Surviving vitrified COCs were selected for in vitro maturation (IVM) and in vitro fertilization (IVF). The rate of viable oocytes after vitrification in CT groups (82%) was significantly lower (P < 0.05) than that in a fresh control group (100%), but significantly higher (P < 0.05) than those in SSV groups (71–72%). Among vitrified groups, the highest maturation rate was obtained in the CT (−)CB group (32%). After IVF, the cleavage and blastocyst formation rates were similar among vitrified groups but significantly lower than those of the control group. In conclusion, a higher survival rate of oocytes after vitrification and IVM was obtained in the CT group compared with that in the SSV group, indicating the superiority of the CT method. Pretreatment with CB did not increase the viability, maturation or embryo development of vitrified oocytes.
Negative and Positive Caregiving Experiences: A Closer Look at the Intersection of Gender and Relationship
Authors: Lin I‐Fen , Fee Holly R. , Wu Hsueh‐Sheng
Published: March 2012

Using data from the 2004 wave of the National Long‐Term Care Survey, we examined how negative and positive caregiving experiences differ by caregivers' gender and relationship to care recipients. We further considered how their caregiving experiences are affected by caregivers' demographic characteristics, care recipients' problem behavior and dependency, caregivers' involvement, reciprocal help from care recipients, and social support available for caregivers. We found that female and adult‐child caregivers, in general, reported having had more negative experiences than male and spouse caregivers, respectively. Wife caregivers were least likely to report positive experiences. We also found different risk factors for negative and positive caregiving experiences, and these factors varied depending on caregivers' gender and relationship to the care recipient. The findings underscore the heterogeneity of caregiving experiences. To sustain informal care, state and local agencies need to tailor services to wife, husband, daughter, and son caregivers' unique needs.
Mothering While Imprisoned: The Effects of Family and Child Dynamics on Mothering Attitudes
Authors: Stringer Ebonie Cunningham , Barnes Sandra L.
Published: March 2012

Since the early 1990s, the number of children with imprisoned mothers has increased 131%. A mother's imprisonment potentially exposes children to a concentrated disadvantage that undermines their cognitive, emotional, and intellectual abilities. Additionally, such experiences can have deleterious effects on mother‐child relationships, stand‐in caregivers, foster care caseloads, the penal system, and society. Less may be understood, however, about how imprisonment affects the ways in which women view themselves as mothers. This study examines mothering attitudes for a sample of 210 Black, White, and Hispanic imprisoned mothers. Nested modeling results suggest a positive relationship between favorable views about mothering and children's profiles and mothers' expectations about future custody. Regular contact with their children through letter writing and telephone calls foster the most favorable views.
Family Interactions, Exposure to Violence, and Emotion Regulation: Perceptions of Children and Early Adolescents at Risk
Authors: Houltberg Benjamin J. , Henry Carolyn S. , Morris Amanda Sheffield
Published: March 2012

This study examined the protective nature of youth reports of family interactions in relation to perceived exposure to violence and anger regulation in 84 children and early adolescents (mean age of 10.5; 7– 15 years old) primarily from ethnic minority groups and living in high‐risk communities in a large southwestern city. Path analysis and bootstrapping methodology indicated that overall family system variables were primarily associated with anger regulation and exposure to violence through parenting behaviors. Specifically, perceptions of family cohesion and adaptability were indirectly associated with anger regulation through a positive association with parental support. Family cohesion and adaptability were indirectly associated with anger regulation and exposure to violence through parental supervision in different ways. Family cohesion was positively associated with parental supervision, whereas family adaptability was negatively associated with parental supervision. Implications are discussed for intervention and prevention programs aimed at youth residing in areas with economic disadvantage.
Imagining a National Church: Election and Education in the Works of Anne Cooke Bacon
Authors: Magnusson Lynne
Published: March 2012

This essay is one of a Literature Compass conference cluster based on a panel presented at the Renaissance Society of America convention 2010. The essays by Danielle Clarke, Johanna Harris, Lynne Magnusson and Elizabeth Scott‐Baumann will appear in longer form in The Intellectual Culture of Puritan Women, 1558–1680, ed. Johanna Harris and Elizabeth Scott‐Baumann (Palgrave, forthcoming 2010). In this paper, Magnusson argues that over 50 years and three reigns, Anne Bacon put her education to use to advance ‘right reformation’ in England. This paper explores the consistent humanist basis of her contribution towards the erection of a national church, especially during the period of her widowhood when she actively supports the losing presbyterian cause. It considers the afterlife in the 1580s and 1590s of her 1564 translation of the Apologie…of the Churche of Englande, showing how the bishops cited her words to support positions radically divided from her own views. Arguing against the widespread perception that her patronage of radical preachers in the 1580s and 1590s marked a descent into zealotry and a falling away from humanist ideals, Magnusson reads her 1585 epistle to Lord Burghley calling for a fair hearing of the radical puritan cause as a humanist’s civic speech act and active intervention into the contentious religious politics of the time. Throughout her life, the combined ideals of civic humanism and Calvinist election shaped an energizing sense both of a significant personal vocation and of an effectual imagined community in which she and all the faithful could be fully contributing members. That is, humanism and protestantism opened up the prospect of a reformed church and social order, a reformed English nation, with imagined roles and relationships that motivated her action and shaped her identity. Bacon might be regarded as an exemplary officer of a church never fully erected, an exemplary citizen of a state that never came fully into being.
Lady Brilliana Harley’s Letters and Puritan Intellectual Culture
Authors: Harris Johanna
Published: March 2012

The letters of Brilliana Harley (c. 1600–1643) witness to the intellectual consistency of early modern English puritanism. However, the insight these letters give to Harley’s intellectualism has not been systematically explored, nor has the concept of epistolary community been recognised for its centrality to early modern puritanism. Harley’s letters reflect her classical and Christian humanist education fuelled by a radical Protestant heritage, her political acuity and discussion of ecclesiastical disputes, and the breadth of her literary influences. Harley’s letter writing enables us to examine her intellectual formation and to observe the centrality of the genre itself to the practical and pastoral needs of the early Stuart puritan community. It embodies the literal unification of a self‐identifying community and acts as a factional means of negotiating doctrinal orthodoxy within it.
Molecular mechanisms of the PRL phosphatases
Authors: Rios Pablo , Li Xun , Köhn Maja
Published: March 2012

The phosphatases of regenerating liver (PRLs) are an intriguing family of dual specificity phosphatases due to their oncogenicity. The three members are small, single domain enzymes. We provide an overview of the phosphatases of regenerating liver, compare them to related phosphatases, and review recent reports about each phosphatase. Finally, we discuss similarities and differences between the phosphatases of regenerating liver, focusing on their molecular mechanisms and signalling pathways.
Prevalence, pattern, sensitivity and resistance to antibiotics of different bacteria isolated from port site infection in low risk patients after elective laparoscopic cholecystectomy for symptomatic cholelithiasis at tertiary care hospital of Kashmir
Authors: Mir Mohd Altaf , Malik Umar Younus , Wani Hamza , Bali Biant Singh
Published: March 2012

The aim of this study was to determine specific pattern of port site microbial colonisation, sensitivity and resistance to different antibiotics of bacteria isolated from port site infection (PSI) in low risk patients after elective laparoscopic cholecystectomy in surgical wards at tertiary care hospital of Kashmir. This is a prospective study. The study included 675 consecutive patients of postoperative PSI after elective laparoscopic cholecystectomy for symptomatic cholelithiasis over a period of 12 months. Culture swabs were taken from port sites with signs of PSI and transported to the microbiology laboratory. The positive swab cultures were subjected to antibiotic susceptibility test. The data obtained was analysed by using appropriate statistical analytical tests. The incidence of PSI after elective laparoscopic cholecystectomy is 6·7%. The commonest organism responsible for PSI is pseudomonas, 19 (42·2%) cases. Most of the strains of organisms isolated were resistant to commonly used antibiotics in the hospital,pseudomonas was found 100% resistant to the combination of ampicillin + sulbactum and ceftriaxone and it was sensitive to imipenem, amikacin and vancomycin in 89·47,57 and 52·63% of cases respectively. Our study will be helpful in choosing effective empirical prophylactic antibiotic therapy in cases of elective laparoscopiccholecystectomy and will have a great impact on morbidity and mortality in them because of PSI.
Ag‐Loaded WO3 Ceramic Nanomaterials: Characterization and Moisture Sensing Studies
Authors: Pandey Narendra Kumar , Tiwari Karunesh , Roy Akash , Mishra Aradhana , Govindan Anil
Published: March 2012

Pellet samples of 0–4% weight Ag‐loaded WO3 prepared through soft chemical route were sintered at 700°C and exposed to humidity. Resistance of the pellets decreased with increase in relative humidity. Sensitivity increased with increase in the % loading of Ag. Four percent Ag‐loaded WO3 showed maximum sensitivity of 2.38 MΩ/% RH in 20–90% relative humidity range. This sensing element manifests highest crystallinity as well as maximum void concentration. Hysteresis and repeatability for this sensing element after 6 months are within ±2%. A polynomial fit of the humidification data revealed a strong correlation between resistance and relative humidity.
Effect of Polyacrylic Acid Addition on Rheology of SiC‐Al2O3‐ZrO2(3Y) Mixed Suspensions
Authors: Zhang Ning , Liang Bin , Zhao Xiaojun , Cui Xingyu , Kan Hongmin , Liu Hao
Published: March 2012

A suspension with good rheology and high stability is crucial for slip casting and gelcasting technology. However, a mixed suspension from two or more different powders usually has bad rheology because of the easy agglomeration of mixed powders caused by the attractive force between the powders with heterocharges. We studied the surface modification of the each single‐component powders (SiC, Al2O3, ZrO2(3Y) powders) and the SiC‐Al2O3‐ZrO2(3Y) mixed powders to increase the repulsive force by adjusting the pH value and adding polyacrylic acid (PAA) as dispersant. The PAA addition effects on the SiC‐Al2O3‐ZrO2(3Y) mixture were investigated in terms of zeta potential, pH range for heterocharge region, dispersion of the mixed powders and rheology of the mixed slurry based on the study of each unary suspensions. The results show that before surface modification the SiC‐Al2O3‐ZrO2(3Y) mixed powders were agglomerated severely because they were in the heterocharge region with a broad pH range from 3.5 to 8.25, while after surface modification (pH = 10.5, PAA = 0.8wt%) the heterocharge region was narrowed with a relatively narrower pH range from 2.6 to 3.7. The mixed powders with homocharges were dispersed well because of the great electrostatic repulsive force and steric hindrance offered by PAA and the mixed suspensions had favorable rheology.
Influence of Phenolic Resin Impregnation on the Properties of Reaction‐Bonded Silicon Carbide
Authors: Luo Zhaohua , Jiang Dongliang , Zhang Jingxian , Lin Qingling , Chen Zhongming , Huang Zhengren
Published: March 2012

Reaction‐bonded silicon carbide ceramics fabricated from tape casting and Si infiltration have been reported in previous studies. To reduce the residual Si content in the sintered bodies, impregnation of phenol–formaldehyde resin (PF) into the porous green preforms before Si infiltration was proposed and studied in this work. The impregnation of PF solution not only helped to reduce the porosity and increase the carbon content of the green preforms, but also improved their strength. As a result, the flexural strength of the RBSC increased a lot and reached 856 ± 161MPa, whereas the residual Si content was reduced to 10 vol%.
Narrative Ethics
Authors: Roberts Robert
Published: March 2012

This paper explores the relationships between philosophical ethics and literary narratives. The focus on virtues and vices in recent ethics has made narratives more integrally relevant to ethics. Some of the best literature displays moral (and immoral) character in richer ways than philosophy alone has resources to do, but philosophy brings to its description a schematic precision that narrative alone cannot supply. As traits of character, virtues differ from events like the actions, thoughts, emotions, and episodic desires that express the traits; traits are not episodes, but dispositions, and so require cumulative diachronic representation of such episodes. The paper illustrates this point particularly with respect to emotions. It ends with reflections on the constitutive narratives by which the grammar of the virtues of some moral traditions, such as Judaism and Christianity, is shaped.
Stable performance of non‐aerated two‐stage partial nitritation/anammox (PANAM) with minimal process control
Authors: Bagchi Samik , Biswas Rima , Vlaeminck Siegfried E. , Roychoudhury Kunal , Nandy Tapas
Published: March 2012

Partial nitritation/anammox (PANAM) technologies have rapidly developed over the last decade, but still considerable amounts of energy are required for active aeration. In this study, a non‐aerated two‐stage PANAM process was investigated. In the first‐stage upflow fixed‐film bioreactor, nitratation could not be prevented at ammonium loading rates up to 186 mg N l−1 d−1 and low influent dissolved oxygen (0.1 mg O2 l−1). Yet, increasing the loading rate to 416 and 747 mg N l−1 d−1 by decreasing the hydraulic retention time to 8 and 5 h, respectively, resulted in partial nitritation with the desired nitrite to ammonium nitrogen ratio for the subsequent anammox stage (0.71–1.05). The second‐stage anammox reactor was established with a synthetic feeding based on ammonium and nitrite. After establishing anammox at low biomass content (0.5 g VSS l−1), the anammox influent was switched to partial nitritation effluent at a loading rate of 71 mg N l−1 d−1, of which 78% was removed at the stoichiometrically expected nitrite to ammonium consumption ratios (1.19) and nitrate production to ammonium consumption ratio (0.24). The combined PANAM reactors were operated for 3 months at a stable performance. Overall, PANAM appeals economically, saving about 50% of the energy costs, as well as technically, given straightforward operational principles.
Interkingdom adenosine signal reduces Pseudomonas aeruginosa pathogenicity
Authors: Sheng Lili , Pu Mingming , Hegde Manjunath , Zhang Yuanxing , Jayaraman Arul , Wood Thomas K.
Published: March 2012

Pseudomonas aeruginosa is becoming recognized as an important pathogen in the gastrointestinal (GI) tract. Here we demonstrate that adenosine, derived from hydrolysis of ATP from the eucaryotic host, is a potent interkingdom signal in the GI tract for this pathogen. The addition of adenosine nearly abolished P. aeruginosa biofilm formation and abolished swarming by preventing production of rhamnolipids. Since the adenosine metabolite inosine did not affect biofilm formation and since a mutant unable to metabolize adenosine behaved like the wild‐type strain, adenosine metabolism is not required to reduce pathogenicity. Adenosine also reduces production of the virulence factors pyocyanin, elastase, extracellular polysaccharide, siderophores and the Pseudomonas quinolone signal which led to reduced virulence with Caenorhabditis elegans. To provide insights into how adenosine reduces the virulence of P. aeruginosa, a whole‐transcriptome analysis was conducted which revealed that adenosine addition represses genes similar to an iron‐replete condition; however, adenosine did not directly bind Fur. Therefore, adenosine decreases P. aeruginosa pathogenicity as an interkingdom signal by causing genes related to iron acquisition to be repressed.
Scorzonera ahmet‐duranii sp. nov. (Asteraceae) from southwest Anatolia, and its phylogenetic position
Authors: Makbul Serdar , Coskuncelebi Kamil , Gültepe Mutlu , Okur Seda , Güzel Murat Erdem
Published: March 2012

Scorzonera ahmet‐duranii S. Makbul & Coskuncelebi sp. nov. (Asteraceae) is described and illustrated as a new species endemic to Turkey. It is morphologically similar to S. semicana DC., but differs by its rootstock, deeply undulating basal leaves and glabrous achenes. Additionally, the size and micro‐morphological properties of achenes and some anatomical traits of the leaf and stem are helpful in distinguishing these closely related taxa. A phylogenetic analysis based on nrDNA ITS sequence data showed that S. semicana is the sister species of the new taxon presented in this study.
Microlepia boluoensis sp. nov. (Dennsteadtiaceae) from Guangdong, China
Authors: Yuan Yi , Fu Lin , Ma Chao‐Ying
Published: March 2012

Microlepia boluoensis Y. Yuan & L. Fu, a new species of the genus Microlepia from Luofu mountain, Boluo county, Guangdong province, China, is described and illustrated. Its gametophytic chromosome number is n =47. Microlepia boluoensis has a similar morphology to M. scyphoformis, M. speluncae and M. hancei, such as creeping rhizomes, bipinnate‐tripinnatified laminas, intramarginal sori, cup‐shaped indusium and trilete spores, but it has a shorter creeping rhizome, larger frond (up to 351 cm), dry chartaceous, longer stipe (up to 139 cm), 23 pairs of primary pinnae, 1–13 sori, and spores with a distinct and raised laesurae.
Stipa narynica sp. nov. (Poaceae) from the western Tian‐Shan Mountains
Authors: Nobis Marcin
Published: March 2012

Stipa narynica M. Nobis sp. nov. from the western Tian‐Shan Mts (western Kyrgyzstan) is described and illustrated. The new species belongs to sect. Smirnovia Tzvel. Morphologically the species is similar to S. aktauensis, a species from which it is easily distinguished by its longer glumes (41–)44–55(–62) mm vs 35–45 mm, longer anthecium (11.5–) 12.0–14.2(–14.8) mm vs 9.5–11.2(–11.7) mm, longer hairs on the seta (5.5–)6.0–8.0(–8.5) mm vs (3.0–)3.8–5.5(–6.0) mm and by the top of the lemma which in S. narynica is either glabrous or with a poorly developed ring of short hairs, while in S. aktauensis, the top of lemma is always distinctly and densely pilose. The lemma and leaf blade structure of both species were examined by means of SEM. The main features differentiating S. narynica and S. aktauensis and distribution of the taxa are presented. An original key to the middle Asiatic species of the sect. Smirnovia, the most similar to Stipa narynica is provided.
Effect of weight loss after gastric bypass surgery on thyroid function in euthyroid people with morbid obesity
Authors: MacCuish A. , Razvi S. , Syed A. A.
Published: March 2012

Obesity is positively associated with serum thyrotropin (TSH) concentrations at the high end of the normal range. The relationship between weight loss and thyroid function is less clear and studies to date have yielded inconsistent results. Our aim was to describe changes in thyroid function in obese people in relation to durable and significant weight loss after Roux‐en‐Y gastric bypass (RYGB) surgery. We recorded percentage of excess weight loss (% EWL), serum TSH and free thyroxine (fT4) before and median 4.5, 15 and 24 months after RYGB in 55 euthyroid patients with morbid obesity ranging in age from 18 to 64 years in a retrospective cohort analysis in a university hospital in Greater Manchester. Mean ± standard error preoperative weight was 135.13 ± 4.23 kg and BMI 48.08 ± 1.58 kg m−2. Patients attained nadir %EWL of 68% by median 15 months after RYGB. TSH was 2.00 ± 0.14 mU L−1 at baseline and 2.02 ± 0.22 mU L−1 at 24 months after RYGB (non‐significant). Baseline fT4 was 13.46 ± 0.28 pmol L−1, and increased significantly to 15.14 ± 0.55 pmol L−1 at 24 months (P < 0.004). In conclusion, we report that weight loss after RYGB was accompanied by significant increase in serum fT4 but no change in TSH concentrations. Further study to elucidate the effect of significant weight loss on the thyroid axis is required.
A systematic review of simulated-patient methods used in community pharmacy to assess the provision of non-prescription medicines
Authors: Xu Tina , de Almeida Neto Abilio C , Moles Rebekah J
Published: March 2012

Objective

To explore the use of simulated-patient methods in community pharmacy for non-prescription medicines.

Methods

The databases IPA (International Pharmaceutical Abstracts), EMBASE and MEDLINE were searched for articles published between 1990 and 2010 outlining studies using simulated-patient methods.

Key findings

Thirty studies from 31 articles were reviewed. The majority used simulated-patient methods to purely assess counselling behaviour of pharmacy staff, rather than as an opportunity to provide educational feedback to improve counselling behaviour.

Conclusions

Few simulated-patient studies have incorporated performance feedback to encourage behavioural change and improve counselling skills. Studies that incorporated feedback did not provide sufficient detail, and few studies have explored participant perceptions. Additionally, very few studies have employed scenarios involving children's medicines. Future studies should test the feasibility of using the simulated-patient method, with appropriate performance feedback and describe participant perceptions of the value and acceptability of this training method.
Sodium channels, the electrogenisome and the electrogenistat: lessons and questions from the clinic
Authors: Waxman Stephen G.
Published: March 2012

Abstract  In the six decades that have followed the work of Hodgkin and Huxley, multiple generations of neuroscientists and biophysicists have built upon their pivotal contributions. It is now clear that, in mammals, nine genes encode nine distinct voltage‐gated sodium channels with different amino acid sequences and different physiological and pharmacological properties. The different sodium channel isoforms produce a multiplicity of distinct sodium currents with different time‐dependent characteristics and voltage dependencies, which interact with each other and with the currents produced by other channels (including calcium and potassium channels) to shape neuronal firing patterns. Expression of these sodium channel isoforms is highly dynamic, both in the normal nervous system, and in the injured nervous system. Recent research has shed light on the roles of sodium channels in human disease, a development that may open up new therapeutic strategies. This article examines the pain‐signalling system as an example of a neuronal network where multiple sodium channel isoforms play complementary roles in electrogenesis and a strong link with human disease has been established. Recent research suggests that it may be possible to target specific sodium channel isoforms that drive hyperexcitability in pain‐signalling neurons, thereby providing new therapeutic strategies for chronic pain, and providing an illustration of the impact of the Hodgkin–Huxley legacy in the clinical domain.
Foldable Surgical Stereo Microendoscope With Continuously Adjustable Convergence
Authors: Zoppi Matteo , Trifiletti Paolo , Molfino Rezia
Published: March 2012

The paper presents a new design of a stereo endoscope for minimally invasive surgery with: cameras positioned at the tip of the instrument (inside the patient), angle of convergence of the optical axes of the cameras variable continuously, and a foldable mechanism reducing the outer diameter of the endoscope to almost the diameter of the single camera in order to reduce the size of the insertion port. After the insertion the endoscope is deployed and the two cameras move side by side. A very simple compliant mechanism is used to drive the deployment and the adjustment of the convergence angle.
Impact of Prior Inappropriate Fluconazole Dosing on Isolation of Fluconazole-Nonsusceptible Candida Species in Hospitalized Patients with Candidemia
Authors: Shah Dhara N. , Yau Raymond , Lasco Todd M. , Weston Jaye , Salazar Miguel , Palmer Hannah R. , Garey Kevin W.
Published: March 2012

Prior use of fluconazole is a modifiable risk factor for the isolation of fluconazole-nonsusceptible
Candida
species. Optimization of the use of fluconazole by appropriate dose or duration may be able to minimize the risk of resistance. The objective of this study was to evaluate the effects of prior fluconazole therapy, including the dose and duration, on fluconazole susceptibility among
Candida
species isolated from hospitalized patients with candidemia. A retrospective cohort study of hospitalized patients with a first occurrence of nosocomial candidemia, from 2006 to 2009, was carried out. The relationships between the initial dose and duration of prior fluconazole therapy and the isolation of fluconazole-nonsusceptible
Candida
species were assessed. An initial fluconazole dose greater than 2 mg/kg and less than 6 mg/kg of body weight was considered suboptimal. A total of 177 patients were identified, of whom 133 patients aged 61 ± 16 years (56% male, 51% Caucasian, 51% with an APACHE II score of ≥15) had candidemia more than 2 days after the hospital admission day. Nine of 107 (8%) patients with fluconazole-susceptible
Candida
species and 9 of 26 (35%) patients with fluconazole-nonsusceptible
Candida
species had prior fluconazole exposure (risk ratio [RR], 3.03; 95% confidence interval [95% CI], 1.57 to 5.86;
P
, 0.0022). Preexposure with an initial dose of fluconazole greater than 2 mg/kg and less than 6 mg/kg occurred in 3 of 9 (33%) and 8 of 9 (89%) patients with fluconazole-susceptible and fluconazole-nonsusceptible
Candida
species, respectively (
P
, 0.0498). We conclude that patients with candidemia due to fluconazole-nonsusceptible
Candida
species were more likely to have received prior fluconazole therapy. Suboptimal initial dosing of prior fluconazole therapy was associated with candidemia with fluconazole-nonsusceptible
Candida
species.
Efficacy of Combined Therapy with Liposome-Encapsulated Meglumine Antimoniate and Allopurinol in Treatment of Canine Visceral Leishmaniasis
Authors: da Silva Sydnei M. , Amorim Izabela F. G. , Ribeiro Raul R. , Azevedo Erly G. , Demicheli Cynthia , Melo Maria N. , Tafuri Wagner L. , Gontijo Nelder F. , Michalick Marilene S. M. , Frézard Frédéric
Published: March 2012

An innovative liposomal formulation of meglumine antimoniate (LMA) was recently reported to promote both long-term parasite suppression and reduction of infectivity to sand flies in dogs with visceral leishmaniasis. However, 5 months after treatment, parasites were still found in the bone marrow of all treated dogs. In order to improve treatment with LMA, the present study aimed to evaluate its efficacy in combination with allopurinol. Mongrel dogs naturally infected with
Leishmania infantum
were treated with six doses of LMA (6.5 mg Sb/kg of body weight/dose) given at 4-day intervals, plus allopurinol (20 mg/kg/24 h
per os
) for 140 days. Comparison was made with groups treated with LMA, allopurinol, empty liposomes plus allopurinol, empty liposomes, and saline. Dogs remained without treatment from day 140 to 200 after the start of treatment. The drug combination promoted both clinical improvement of dogs and significant reduction in the parasitic load in bone marrow and spleen on days 140 and 200 compared to these parameters in the pretreatment period. This is in contrast with the other protocols, which did not result in significant reduction of the bone marrow parasite load on day 200. Strikingly, the combined treatment, in contrast to the other regimens, induced negative quantitative PCR (qPCR) results in the liver of 100% of the dogs. Both xenodiagnosis and skin parasite determination by qPCR indicated that the drug combination was effective in blocking the transmission of skin parasites to sand flies. Based on all of the parasitological tests performed on day 200, 50% of the animals that received the combined treatment were considered cured.
The Maltose ABC Transporter in Lactococcus lactis Facilitates High-Level Sensitivity to the Circular Bacteriocin Garvicin ML
Authors: Gabrielsen Christina , Brede Dag A. , Hernández Pablo E. , Nes Ingolf F. , Diep Dzung B.
Published: March 2012

We generated and characterized a series of spontaneous mutants of
Lactococcus lactis
IL1403 with average 6- to 11-fold-lowered sensitivities to the circular bacteriocin garvicin ML (GarML). Carbohydrate fermentation assays highlighted changes in carbohydrate metabolism, specifically loss of the ability to metabolize starch and maltose, in these mutants. PCR and sequencing showed that a 13.5-kb chromosomal deletion encompassing 12 open reading frames, mainly involved in starch and maltose utilization, had spontaneously occurred in the GarML-resistant mutants. Growth experiments revealed a correlation between sensitivity to GarML and carbon catabolite repression (CCR); i.e., sensitivity to GarML increased significantly when wild-type cells were grown on maltose and galactose as sole carbohydrates, an effect which was alleviated by the presence of glucose. Among the genes deleted in the mutants were
malEFG
, which encode a CCR-regulated membrane-bound maltose ABC transporter. The complementation of mutants with these three genes recovered normal sensitivity to the bacteriocin, suggesting an essential role of the maltose ABC transporter in the antimicrobial activity of GarML. This notion was supported by the fact that the level of sensitivity to GarML was dose dependent, increasing with higher expression levels of
malEFG
over a 50-fold range. To our knowledge, this is the first time a specific protein complex has been demonstrated to be involved in sensitivity to a circular bacteriocin.
Further Insights into the Mode of Action of the Lipoglycopeptide Telavancin through Global Gene Expression Studies
Authors: Song Yang , Lunde Christopher S. , Benton Bret M. , Wilkinson Brian J.
Published: March 2012

Telavancin is a novel semisynthetic lipoglycopeptide derivative of vancomycin with a decylaminoethyl side chain that is active against Gram-positive bacteria, including
Staphylococcus aureus
strains resistant to methicillin or vancomycin. A dual mechanism of action has been proposed for telavancin involving inhibition of peptidoglycan biosynthesis and membrane depolarization. Here we report the results of genome-wide transcriptional profiling of the response of
S. aureus
to telavancin using microarrays. Short (15-min) challenge of
S. aureus
with telavancin revealed strong expression of the cell wall stress stimulon, a characteristic response to inhibition of cell wall biosynthesis. In the transcriptome obtained after 60-min telavancin challenge, in addition to induction of the cell wall stress stimulon, there was induction of various genes, including
lrgA
and
lrgB
, lysine biosynthesis operon (
dap
) genes,
vraD
and
vraE
, and
hlgC
, that have been reported to be induced by known membrane-depolarizing and active agents, including carbonyl cyanide
m
-chlorophenylhydrazone, daptomycin, bacitracin, and other antimicrobial peptides These genes were either not induced or only weakly induced by the parent molecule vancomycin. We suggest that expression of these genes is a response of the cell to mitigate and detoxify such molecules and is diagnostic of a membrane-depolarizing or membrane-active molecule. The results indicate that telavancin causes early and significant induction of the cell wall stress stimulon due to strong inhibition of peptidoglycan biosynthesis, with evidence in support of membrane depolarization and membrane activity that is expressed after a longer duration of drug treatment.
Dysfunction of Natural Killer T Cells in Patients with Active Mycobacterium tuberculosis Infection
Authors: Kee Seung-Jung , Kwon Yong-Soo , Park Yong-Wook , Cho Young-Nan , Lee Sung-Ji , Kim Tae-Jong , Lee Shin-Seok , Jang Hee-Chang , Shin Myung-Geun , Shin Jong-Hee , Suh Soon-Pal , Ryang Dong-Wook
Published: March 2012

Natural killer T (NKT) cells are known to play a protective role in the immune responses of mice against a variety of infectious pathogens. However, little is known about the detailed information of NKT cells in patients with
Mycobacterium tuberculosis
infection. The aims of this study were to examine NKT cell levels and functions in patients with active
M. tuberculosis
infection, to investigate relationships between NKT cell levels and clinical parameters, and to determine the mechanism responsible for the poor response to α-galactosylceramide (α-GalCer). NKT cell levels were significantly lower in the peripheral blood of pulmonary tuberculosis and extrapulmonary tuberculosis patients, and the proliferative responses of NKT cells to α-GalCer were also lower in patients, whereas NKT cell levels and responses were comparable in latent tuberculosis infection subjects and healthy controls. Furthermore, this NKT cell deficiency was found to be correlated with serum C-reactive protein levels. In addition, the poor response to α-GalCer in
M. tuberculosis
-infected patients was found to be due to increased NKT cell apoptosis, reduced CD1d expression, and a defect in NKT cells. Notably,
M. tuberculosis
infection was associated with an elevated expression of the inhibitory programmed death-1 (PD-1) receptor on NKT cells, and blockade of PD-1 signaling enhanced the response to α-GalCer. This study shows that NKT cell levels and functions are reduced in
M. tuberculosis
-infected patients and these deficiencies were found to reflect the presence of active tuberculosis.
A retrospective cross-sectional study of risk factors and clinical spectrum of children admitted to hospital with pandemic H1N1 influenza as compared to influenza A
Authors: Morris Shaun K , Parkin Patricia , Science Michelle , Subbarao Padmaja , Yau Yvonne , O'Riordan Sean , Barton Michelle , Allen Upton D , Tran Dat
Published: March 2012

Objective

To compare risk factors for severe disease as measured by admission to hospital and intensive care unit (ICU) and other clinical outcomes in children with pandemic H1N1 (pH1N1) versus those with seasonal influenza.

Design

Retrospective analysis of children admitted to hospital with pH1N1 versus seasonal influenza A.

Setting

Canadian tertiary referral children's hospital.

Participants

All laboratory-identified cases of pH1N1 in children younger than 18 years admitted to hospital in 2009 (n=176) and all seasonal influenza A cases admitted to hospital from influenza seasons 2004–2005 to 2008–2009 (n=200). Children with onset of symptoms more than 3 days after admission were excluded.

Primary and secondary outcome measures

Primary outcomes include admission to hospital and ICU and need for mechanical ventilation. Secondary outcomes include length of stay in hospital and duration of supplemental oxygen requirement.

Results

Children admitted with pH1N1 were older than seasonal influenza A admissions (hospital admission: 6.5 vs 3.3 years, p<0.01; ICU admission: 7.3 vs 3.6 years, p=0.02). Children hospitalised with pH1N1 were more likely to have a pre-existing diagnosis of asthma (15% vs 5%, p<0.01); however, there was no difference in the severity of pre-existing asthma between the two groups. After controlling for obesity, asthma (OR 4.59, 95% CI 1.42 to 14.81) and age ≥5 years (OR 2.87, 95% CI 1.60 to 5.16) were more common risk factors in admitted children with pH1N1. Asthma was a significant predictor of the need for intensive care in patients with pH1N1 (OR 4.56, 95% CI 1.16 to 17.89) but not in patients with seasonal influenza A.

Conclusion

While most pH1N1 cases presented with classic influenza-like symptoms, risk factors for severe pH1N1 disease differed from seasonal influenza A. Older age and asthma were associated with increased admission to hospital and ICU for children with pH1N1.
Do emergency physicians and radiologists reliably interpret pelvic radiographs obtained as part of a trauma series?
Authors: Bent Clare , Chicklore Sugama , Newton Alastair , Habig Karel , Harris Tim
Published: March 2012

Introduction

Interpretation of pelvic radiography is an important component of the primary survey and is commonly performed by emergency physicians. Radiologists bring unique skills to trauma care, including choice of imaging modality and image interpretation. It is not clear if this limited resource is most efficiently used in the resuscitation room. No studies have compared radiologists and trauma clinicians in their ability to interpret pelvic radiographs following trauma.

Objective

To determine the sensitivity and specificity of trauma experienced and trauma inexperienced emergency physicians in detecting pelvic fractures compared with radiologists, the latter subgroup combined report being used as the gold standard.

Setting and methods

Prospective cohort study conducted in two large teaching hospitals in central London. All participants reviewed 144 consecutive pelvic radiographs performed each as part of a ‘trauma series’ and known to have undergone concomitant pelvic CT imaging.

Results

No statistically significant difference was found between radiologists and emergency physicians from a trauma centre in pelvic radiograph interpretation. Radiologist reporting was associated with an improved specificity compared with emergency physicians working in a non-trauma hospital (p=0.049). The study population missed 30% of fractures on plain radiography against the gold standard of CT.

Discussion

The ability to interpret trauma series pelvic radiographs is comparable between emergency physicians and radiologists. If this were also true of trauma chest radiographs, then the most valuable use of the radiologist may not be the resuscitation room but in rapid reporting of more complex imaging techniques. However, plain radiography is insensitive for pelvic fracture detection compared with CT, even in expert hands.
Efficacy of nasal bridles in avoiding percutaneous endoscopic gastrostomy placement
Authors: Webb Gwilym , Gupta Prakash , Fitchett Jo , Simmons Jon , De Silva Aminda
Published: March 2012

Objective

The aim of the study was to report the use of nasogastric tube bridles to avoid dislodging of percutaneous endoscopic gastrostomy tubes. Specifically it was intended to see if they reduced feeding time, medical input and costs.

Design

and setting This was a cohort study in a district hospital setting.

Patients

164 patients admitted with conditions causing acutely impaired swallowing.

Interventions

140 of 164 patients referred received a NGT bridle.

Results

Of these, 49 (35%) died by 28 days and 68 (48.6%) at 1 year; 73 (52.1%) had regained adequate oral intake at 28 days and 27 (19.2%) had proceeded to PEG. Of those not bridled, nine (37.5%) died by 28 days and 10 (41.7%) at 1 year with the remainder eating. There was no significant difference in mortality between groups. There were no complications attributed to bridles.

Conclusion

We conclude that nasogastric bridles are safe and represent an appropriate method to maintain nutrition while seeing if the underlying disease process will stabilise in these critically ill patients. They have the benefits of avoiding unnecessary PEG and the associated complications and cost.
Redundancy: when is it the right decision for a business?
Authors: Gripper Peter
Published: March 2012

Making redundancies may seem like the best option for a practice that is struggling financially. Peter Gripper recommends considering other options, and undertaking a thorough organisational and strategic review, before going ahead.