bluuebunny/crossref_metadata_2025 huggingface dataset:
Research on the relationship among corporate governance environment, governance behavior and governance performance
Authors: Runhui Lin , Jianhong Fan , Yang Zhao , Hongjuan Zhang , Rujing Hou
Published: October 2011

Purpose

The purpose of this paper is to focus on the relationship between the corporate governance (CG) environment, governance behavior and governance performance and place it into the research of the evolution and revolution of the Chinese telecommunication industry, a complex economic system.

Design/methodology/approach

On the basis of information about the Chinese telecommunication industry from 1949 to 2009 and China Mobile from 1997 to 2007, the authors analyze the Chinese telecommunication industry from two levels, namely industry level and firm level, with the combination of a critical incident method and time series method.

Findings

The results demonstrate that the evolution of the Chinese CG environment and governance behavior presents characteristics of punctuated equilibrium; governance behavior lags behind governance environment and it can cause the governance environment to evolve to benefit its development through exerting active effects; governance environment and governance performance strongly relate to and have an effect on each other; and the improvement of governance structure and mechanisms, together with the enhancement of strategic capability, can greatly contribute to the governance performance of firms.

Originality/value

This paper has divided the development of the Chinese telecommunication industry into four stages, revealing the relationship between governance environment, governance behavior and governance performance with a case study of the Chinese telecommunication industry and China Mobile.
Applying the dialogic theory to social networking sites
Authors: Waters Richard D. , Canfield Rachel R. , Foster Jenny M. , Hardy Eva E.
Published: October 2011

Purpose

The purpose of this paper is to examine how US universities' health centers are using dialogue and engagement on social networking sites to educate students and their followers about health issues.

Design/methodology/approach

Through a content analysis of health centers' Facebook profiles, the research team examines the use of Kent and Taylor's dialogic principles of communication.

Findings

Results indicate that when a health center attracts a large number of followers online, their usage of the outlet as a dialogic tool increases significantly.

Practical implications

The study found that university health centers have a presence on Facebook, but they really are not using the site strategically to gain followers and educate them about health issues that they have pledged to address on their campuses.

Originality/value

The dialogic principles of communication have been examined significantly on web sites and blogs, but this is one of the first studies to test them in the social networking site environment.
Systematic review: the role of tacrolimus in the management of Crohn’s disease
Authors: McSharry K. , Dalzell A. M. , Leiper K. , El‐Matary W.
Published: October 2011

Aliment Pharmacol Ther 2011; 34: 1282–1294

Background  Several published studies have evaluated the efficacy of tacrolimus in the management of Crohn’s disease with variable conclusions.

Aim  To review systematically the evidence examining the efficacy and safety of tacrolimus in treating Crohn’s disease.

Methods  The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (PUBMED) and EMBASE (1984 to January 2011) were searched. Also, references from selected articles were examined. Case series (five or more patients), cohort and randomised controlled trials were eligible for inclusion, incorporating oral, intravenous or topical tacrolimus therapy. The primary outcome was induction of remission of active Crohn’s disease.

Results  Eleven studies met the inclusion criteria which included 163 patients, of which 127 received tacrolimus therapy. In patients with luminal Crohn’s disease, the crude pooled remission rate for tacrolimus was 44.3% (range, 7–69%) and the crude pooled response rate was 37.1% (range, 14–57%). For patients with perianal disease using systemic tacrolimus, crude pooled remission rate was 28.6% (range, 0–64%) and crude pooled response rate was 38.8% (range, 0–57%). Combining data from two studies using topical tacrolimus, 35.7% of patients achieved remission and 28.6% partial response. Nonserious adverse effects are common, particularly tremor, paraesthesia and headache. Reversible nephrotoxity occurred in 16% of patients.

Conclusions  The current evidence; although of a poor quality, appears to support the use of tacrolimus in Crohn’s disease. High quality randomised controlled trials are needed.
‘It's about changing services and building relationships’: evaluating the development of Children in Care Councils
Authors: Thomas Nigel , Percy‐Smith Barry
Published: October 2011

The introduction of Children in Care Councils under the Care Matters reforms in England set a challenge for local authorities to find effective ways by which children in care could contribute their views to the planning and provision of services. This paper discusses a review of progress across London which combined a survey of boroughs with focus group discussions with young people, local authority staff and elected members. The research found that considerable progress had been made in that virtually all boroughs had some mechanism for representing children in care, and that staff and young people were proud of their achievements. However, major challenges remain – to embed a culture of participation in services, to ensure continuity, to reach all children including the many placed ‘out of borough’ and to defend what has been achieved in the face of severe cuts in public spending. The paper highlights a tension between empowering young people and meeting targets as corporate parents. The results support other research pointing to the need for a better understanding of the relationship between participation in governance and participation grounded in ordinary life.
Iatrogenic hyperthyroidism does not promote weight loss or prevent ageing‐related increases in body mass in thyroid cancer survivors
Authors: Polotsky Hanah N. , Brokhin Matvey , Omry Gal , Polotsky Alex J. , Tuttle R Michael
Published: October 2011

Context  Thyroid cancer survivors represent a unique population in which the potential long‐term effects of brief periods of intentional thyroid hormone withdrawal and/or prolonged periods of iatrogenic hyperthyroidism on body weight and body mass were evaluated.

Objectives  The objectives of this study were to characterize body mass changes over several years in a cohort of thyroid cancer patients with iatrogenic hyperthyroidism and to compare these changes with the expected weight gain in age‐matched healthy control populations. We also evaluated the possibility that the method of preparation [thyroid hormone withdrawal (THW) vs recombinant human TSH (rhTSH)] for radioactive iodine remnant ablation may be associated with differences in body mass at the time of the final follow‐up.

Design/Setting/Patients/Interventions  A retrospective review identified 153 patients with thyroid cancer who underwent total thyroidectomy at one major medical centre. Of the 153 patients, 143 also had radioactive iodine remnant ablation: 70 after THW and 73 after rhTSH.

Main Outcome Measures  Change in weight and BMI at 1–2 and 3–5 years of follow‐up points were examined. Annualized weight variation within the cohort was compared with age‐matched population controls expressed in kilogram/year.

Results  Significant weight gain was noted for the full cohort after 3–5 years of follow‐up as compared to baseline (76 ± 21 kg at baseline vs 79 ± 23 kg at 3–5 years of follow‐up, P < 0·01), which represented a 3·2% increase. Female and male patients with thyroid cancer experienced 0·46 and 0·94 kg/year gain in weight, respectively, which is similar or somewhat higher than previously published age‐matched population controls (ranging from 0·23 to 0·34 kg/year). When expressed as per cent change and comparing the final weight to the pre‐operative baseline, the rhTSH group experienced approximately a 1·7% increase in weight compared with the 3·9% increase seen with THW patients (P = 0·02). When expressed as kg/year change, the rhTSH cohort had 0·34 kg/year change compared with the 0·64 kg/year change seen in the thyroid hormone withdrawal patients (P = 0·02).

Conclusion  In otherwise, healthy patients with differentiated thyroid cancer, significant weight gain occurred during the 3–5 years of follow‐up despite ongoing thyrotropin suppression. The data suggest that mild iatrogenic hyperthyroidism does not promote weight loss or prevent ageing‐related weight gain. Greater weight gain was seen in patients prepared for radioactive remnant ablation with THW than with rhTSH.
Urinary liver‐type fatty acid‐binding protein level as a predictive biomarker of contrast‐induced acute kidney injury
Authors: Manabe Kenichi , Kamihata Hiroshi , Motohiro Masayuki , Senoo Takeshi , Yoshida Susumu , Iwasaka Toshiji
Published: October 2011

Eur J Clin Invest 2012; 42 (5): 557–563

Background  Contrast‐induced acute kidney injury (CI‐AKI) is a well‐known complication of contrast medium exposure in patients with chronic kidney disease. However, there are no biological markers to accurately predict the onset of CI‐AKI. Liver‐type fatty acid‐binding protein (L‐FABP), an intracellular carrier protein for free fatty acids, is markedly upregulated and abundantly expressed in the proximal tubules after renal ischaemia. We prospectively investigated whether urinary L‐FABP is a suitable marker for the prediction of CI‐AKI.

Methods  We performed a prospective study of 220 consecutive patients with chronic kidney disease who underwent elective catheterization [serum creatinine (Cr) ≥ 1·2 mg/dL (106 M)]. Serum Cr and L‐FABP levels were measured immediately before and 1 and 2 days after the procedure. CI‐AKI was defined as an increase in serum Cr level of ≥ 0·3 mg/dL within 48 h after the procedure.

Results  We observed the development of CI‐AKI in 19 patients (8·6%). Urinary L‐FABP levels were significantly higher in patients with CI‐AKI than those without CI‐AKI before contrast medium exposure. Receiver operating characteristic analysis showed that baseline urinary L‐FABP level exhibited 82% sensitivity and 69% specificity, at a cut‐off value of 24·5 μg/g Cr. Using multivariate analysis, we found that independent predictors of CI‐AKI development were L‐FABP level of ≥ 24·5 μg/g Cr [odds ratio (OR): 9·10; 95% confidence interval (CI), 3·20–28·9], and left ventricular ejection fraction ≤ 40% (OR, 3·42; 95% CI, 1·07–10·8).

Conclusions  Urinary L‐FABP level is useful for predicting the onset of CI‐AKI before contrast medium exposure.
Ultrasonography of haemophilic arthropathy
Authors: MUÇA‐PERJA M. , RIVA S. , GROCHOWSKA B. , MANGIAFICO L. , MAGO D. , GRINGERI A.
Published: October 2011

Summary.  Imaging is an essential tool for evaluation and monitoring of haemophilic arthropathy. Ultrasonography is increasingly used for joint assessment, due to its great sensitivity for soft tissue and relatively low cost. To assess the joint status and the role of ultrasonography in routine diagnosis and monitoring of joint disease in cohort haemophilic patients. Findings of patients with haemophilia, who routinely underwent ultrasonography were retrospectively evaluated to assess their joint status and the role of ultrasonography in routine diagnosis and monitoring of joint disease. Out of 325 joints examined (115 ankles, 210 knees), ultrasonography identified damages in 50% of ankles and 33% of knees in overall 111 patients, aged 7–80 years (median = 29 years). Synovial hypertrophy and cartilage abnormalities were the most frequent observations (88% and 76% in affected knees, respectively). Pristine joints were more frequently found in patients on primary prophylaxis, young age or no bleeding in the year prior to examination. Furthermore, no concordance was found between presence of joint changes at ultrasonography, and clinical joint status. Ultrasonography was shown to be able to detect joint damage involving soft tissues and bone surface. Its use might allow frequent monitoring of patients with haemophilia and early detection of arthropathy. For these reasons it might represent a valid tool in the routine management of haemophilia.
B‐cell agonists up‐regulate AID and APOBEC3G deaminases, which induce IgA and IgG class antibodies and anti‐viral function
Authors: Seidl Thomas , Whittall Trevor , Babaahmady Kaboutar , Lehner Thomas
Published: October 2011

B cells express two critical deaminases in the development of adaptive and innate immunity. Activation‐induced cytidine deaminase (AID) functions in class switch recombination, somatic hypermutation and may result in affinity maturation of antibodies. Apolipoprotein B mRNA‐editing enzyme catalytic polypeptide‐like 3G (APOBEC3G; A3G) is an innate anti‐retroviral factor that inhibits HIV replication. We have studied a number of B‐cell agonists with the aim of identifying the most effective agents that will up‐regulate both deaminases and thereby enhance adaptive and innate immunity. CD40 ligand (CD40L) with interleukin‐4 or HLA‐class II antibodies significantly up‐regulated both AID and A3G in isolated human CD19+ B cells. The functions of these deaminases were demonstrated by enhancement of B‐cell surface expression of IgA and IgG and inducing significantly higher IgA and IgG4 antibodies. An enhanced A3G function was then demonstrated by inhibition of HIV‐1 replication in co‐culture of CD4+ T cells with autologous B cells, treated with CD40L and CD4 or HLA antibodies, compared with unstimulated human B cells. The dual B‐cell‐induced deaminase functions may be critical in IgA and IgG antibodies inhibiting pre‐entry and A3G that of post‐entry HIV‐1 transmission and suggests a novel strategy of immunization, especially relevant to mucosal infections.
Lévy flight and Brownian search patterns of a free‐ranging predator reflect different prey field characteristics
Authors: Sims David W. , Humphries Nicolas E. , Bradford Russell W. , Bruce Barry D.
Published: October 2011

1. Search processes play an important role in physical, chemical and biological systems. In animal foraging, the search strategy predators should use to search optimally for prey is an enduring question. Some models demonstrate that when prey is sparsely distributed, an optimal search pattern is a specialised random walk known as a Lévy flight, whereas when prey is abundant, simple Brownian motion is sufficiently efficient. These predictions form part of what has been termed the Lévy flight foraging hypothesis (LFF) which states that as Lévy flights optimise random searches, movements approximated by optimal Lévy flights may have naturally evolved in organisms to enhance encounters with targets (e.g. prey) when knowledge of their locations is incomplete.

2. Whether free‐ranging predators exhibit the movement patterns predicted in the LFF hypothesis in response to known prey types and distributions, however, has not been determined. We tested this using vertical and horizontal movement data from electronic tagging of an apex predator, the great white sharkCarcharodon carcharias, across widely differing habitats reflecting different prey types.

3. Individual white sharks exhibited movement patterns that predicted well the prey types expected under the LFF hypothesis. Shark movements were best approximated by Brownian motion when hunting near abundant, predictable sources of prey (e.g. seal colonies, fish aggregations), whereas movements approximating truncated Lévy flights were present when searching for sparsely distributed or potentially difficult‐to‐detect prey in oceanic or shelf environments, respectively.

4. That movement patterns approximated by truncated Lévy flights and Brownian behaviour were present in the predicted prey fields indicates search strategies adopted by white sharks appear to be the most efficient ones for encountering prey in the habitats where such patterns are observed. This suggests thatC. carchariasappears capable of exhibiting search patterns that are approximated as optimal in response to encountered changes in prey type and abundance, and across diverse marine habitats, from the surf zone to the deep ocean.

5. Our results provide some support for the LFF hypothesis. However, it is possible that the observed Lévy patterns of white sharks may not arise from an adaptive behaviour but could be an emergent property arising from simple, straight‐line movements between complex (e.g. fractal) distributions of prey. Experimental studies are needed in vertebrates to test for the presence of Lévy behaviour patterns in the absence of complex prey distributions.
Cognitive balanced model: a conceptual scheme of diagnostic decision making
Authors: Lucchiari Claudio , Pravettoni Gabriella
Published: October 2011

Rationale  Diagnostic reasoning is a critical aspect of clinical performance, having a high impact on quality and safety of care. Although diagnosis is fundamental in medicine, we still have a poor understanding of the factors that determine its course.

According to traditional understanding, all information used in diagnostic reasoning is objective and logically driven. However, these conditions are not always met. Although we would be less likely to make an inaccurate diagnosis when following rational decision making, as described by normative models, the real diagnostic process works in a different way. Recent work has described the major cognitive biases in medicine as well as a number of strategies for reducing them, collectively called debiasing techniques. However, advances have encountered obstacles in achieving implementation into clinical practice.

Aims and objectives  While traditional understanding of clinical reasoning has failed to consider contextual factors, most debiasing techniques seem to fail in raising sound and safer medical praxis. Technological solutions, being data driven, are fundamental in increasing care safety, but they need to consider human factors. Thus, balanced models, cognitive driven and technology based, are needed in day‐to‐day applications to actually improve the diagnostic process. The purpose of this article, then, is to provide insight into cognitive influences that have resulted in wrong, delayed or missed diagnosis.

Conclusions  Using a cognitive approach, we describe the basis of medical error, with particular emphasis on diagnostic error. We then propose a conceptual scheme of the diagnostic process by the use of fuzzy cognitive maps.
Timeliness in discharge summary dissemination is associated with patients' clinical outcomes
Authors: Li Jordan Y. Z. , Yong Tuck Y. , Hakendorf Paul , Ben‐Tovim David , Thompson Campbell H.
Published: October 2011

Rationale, aims and objectives  To determine the relation of the readmission rate of general medical patients to either the existence of a discharge summary or the timeliness of its dispatch.

Methods  This was a retrospective study on discharge summaries of all discharges from the general medical service at a tertiary referral teaching hospital from January 2005 to December 2009. The main outcome measures were readmission rate to hospital within 7 or 28 days of discharge

Results  A total of 16 496 patient admissions were included in the analysis. Of these discharges, 3397 (20.6%) patients did not have a summary completed within a week of discharge. There were significant linear trends between patients' readmission rates within 7 (P < 0.001) or 28 days (P < 0.001) and categories reflecting the delay in dispatch of their discharge summaries. The absence of a discharge summary was associated with a 79% increase in the rate of readmission within 7 days [95% confidence interval (CI) 42 to 124% increase; P < 0.001] and a 37% increased rate of readmission within 28 days (95% CI 17 to 61% increase; P < 0.001). If aged less than 80 years, the absence of a discharge summary was associated with a 127% increase in readmission rate within 7 days (95% CI 72 to 202% increase; P < 0.001) and a 55% increase within 28 days (95% CI 25 to 91% increase; P < 0.001) after discharge.

Conclusions  Delayed transmission or absence of a discharge summary is associated with readmission of the patient; more so in patients less than 80 years old. If no summary is generated by 7 days after discharge, the rate of readmission within 7 or 28 days after discharge is indistinguishable from no summary being written at all.
High‐resolution cell outline segmentation and tracking from phase‐contrast microscopy images
Authors: AMBÜHL M.E. , BREPSANT C. , MEISTER J.‐J. , VERKHOVSKY A.B. , SBALZARINI I.F.
Published: October 2011

Accurate extraction of cell outlines from microscopy images is essential for analysing the dynamics of migrating cells. Phase‐contrast microscopy is one of the most common and convenient imaging modalities for observing cell motility because it does not require exogenous labelling and uses only moderate light levels with generally negligible phototoxicity effects. Automatic extraction and tracking of high‐resolution cell outlines from phase‐contrast images, however, is difficult due to complex and non‐uniform edge intensity. We present a novel image‐processing method based on refined level‐set segmentation for accurate extraction of cell outlines from high‐resolution phase‐contrast images. The algorithm is validated on synthetic images of defined noise levels and applied to real image sequences of polarizing and persistently migrating keratocyte cells. We demonstrate that the algorithm is able to reliably reveal fine features in the cell edge dynamics.
Sleep disorders in Behçet’s disease, and their relationship with fatigue and quality of life
Authors: TASCILAR NIDA F. , TEKIN NILGÜN S. , ANKARALI HANDAN , SEZER TUNA , ATIK LEVENT , EMRE UFUK , DUYSAK SIBEL , CINAR FIKRET
Published: October 2011

Behçet’s disease, a systemic vasculitis, can cause varying degrees of activity limitation, fatigue and quality of life impairment. To date, there have been no studies regarding sleep disturbance and its relationship with fatigue and life quality in Behçet’s disease. We aimed to evaluate sleep disorders and polysomnographic parameters, and to determine their relationship with fatigue and quality of life in Behçet’s disease. Fifty‐one patients with Behçet’s disease without any neurological involvement were interviewed regarding sleep disorders. Twenty‐one subjects with no sleep complaints were included as the control group. Sleep‐related complaints were evaluated in a face‐to‐face interview. Sleep quality, excessive daytime sleepiness, fatigue, depression, anxiety, disease activity/severity, and quality of life questionnaires and an overnight polysomnography were performed. Prevalences of restless legs syndrome (35.3%) and obstructive sleep apnea syndrome with/without other sleep disorders (32.5%) were higher than in the control group and the general population. Fatigue was higher in patients with restless legs syndrome and obstructive sleep apnea syndrome, and in those with lower minimum oxygen saturation; hence, only patients with restless legs syndrome had quality of life impairment. Sleep efficiency index and sleep continuity index were lower, and wake after sleep onset, respiratory disturbance index and apnea–hypopnea index were higher than in controls (P < 0.01). Neither sleep disorders nor polysomnographic parameters were related to disease activity and severity. In conclusion, it is important to question sleep disorder followed by a polysomnography, if necessary, in order to improve quality of life and fatigue in Behçet’s disease.
Effect of upper airway surgery on heart rate variability in patients with obstructive sleep apnoea syndrome
Authors: CHOI JI HO , YI JONG SOOK , LEE SEUNG HOON , KIM CHEON SIK , KIM TAE HOON , LEE HEUNG MAN , LEE BONG‐JAE , LEE SANG HAG , CHUNG YOO‐SAM
Published: October 2011

To determine whether surgery influences cardiovascular autonomic modulation in obstructive sleep apnoea syndrome (OSAS), the present study was performed to evaluate the effect of upper airway (UA) surgery on heart rate variability (HRV) using frequency domain analysis for patient groups who have had either successful or unsuccessful surgery. We compared body mass index (BMI), polysomnographic [apnoea index (AI), apnoea‐hypopnoea index (AHI), minimum SaO2] and HRV [very low frequency (VLF) power, low frequency (LF) power, high frequency (HF) power, HF/LF ratio, LFnu = LF/(LF + HF), HFnu = HF/(LF + HF)] parameters between the unsuccessful (n = 14) and successful (n = 22) surgical groups before and after UA surgery. Significant changes were observed for the successful patient group with respect to mean AI (from 29.1 ± 21.3 to 2.0 ± 3.2 events h−1, P < 0.001), AHI (from 38.6 ± 20.0 to 5.6 ± 5.1 events h−1, P < 0.001), minimum SaO2 (from 73.3 ± 12.7 to 86.3 ± 6.5%, P < 0.001), VLF power (from 25599 ± 12906 to 20014 ± 9839 ms2, P = 0.013), LF power (from 17293 ± 7278 to 14155 ± 4980 ms2, P = 0.016), LFnu (from 0.700 ± 0.104 to 0.646 ± 0.128, P = 0.031) and HFnu (from 0.300 ± 0.104 to 0.354 ± 0.128, P = 0.031); however, mean BMI, HF power and LF/HF ratio did not change significantly after UA surgery. No significant changes were observed in the unsuccessful surgical group. Successful UA surgery may improve cardiac sympathetic and parasympathetic modulation in patients with OSAS.
Cerebral microglial activation in patients with hepatitis c: in vivo evidence of neuroinflammation
Authors: Grover V. P. B. , Pavese N. , Koh S.‐B. , Wylezinska M. , Saxby B. K. , Gerhard A. , Forton D. M. , Brooks D. J. , Thomas H. C. , Taylor‐Robinson S. D.
Published: October 2011

Summary.  Patients with chronic hepatitis C infection may exhibit neuropsychological symptoms and cognitive impairment. Post‐mortem studies of hepatitis C virus HCV quasispecies and replicative intermediates indicate that the brain might act as a separate compartment for viral replication and microglia may be the locus for infection and subsequent neuroinflammatory activity. We sought to use two independent in vivo imaging techniques to determine evidence of neuroinflammation in patients with histologically mild chronic hepatitis C. Using positron emission tomography (PET) with a ligand for microglial/brain macrophage activation, 11C‐(R)‐PK11195 (PK11195) and cerebral proton magnetic resonance spectroscopy, we determined whether there was evidence of neuroinflammation in a pilot study of 11 patients with biopsy‐proven mild chronic hepatitis C, compared to healthy volunteers. Patients were characterized by cognitive testing and the fatigue impact scale to assess for CNS impairment. PK11195 binding potential was significantly increased in the caudate nucleus of patients, compared to normal controls (P = 0.03). The caudate and thalamic binding potential were more significantly increased in six patients with genotype 1 infection (P = 0.007) and positively correlated with viraemia (r = 0.77, P = 0.005). Basal ganglia myo‐inositol/creatine and choline/creatine ratios were also significantly elevated in patients with chronic hepatitis C compared to normal controls (P = 0.0004 and P = 0.01, respectively). Using PET, we demonstrated evidence of microglial activation, which positively correlated with HCV viraemia and altered cerebral metabolism in the brains of patients with mild hepatitis C. This provides further in vivo evidence for a neurotropic role for HCV.
Serum microRNA‐122 levels in different groups of patients with chronic hepatitis B virus infection
Authors: Waidmann O. , Bihrer V. , Pleli T. , Farnik H. , Berger A. , Zeuzem S. , Kronenberger B. , Piiper A.
Published: October 2011

Summary.  miR‐122 is a liver‐specific microRNA, which also circulates in the blood. The levels of miR‐122 in serum and plasma correlate with hepatic necroinflammation in patients with hepatitis B virus (HBV) infection. Here, we investigated whether miR‐122 levels correlate with surrogate markers for viral replication and translation. Furthermore, we examined whether miR‐122 levels differ in the different groups of HBV‐infected patients and whether miR‐122 levels may be useful to identify patients with higher or lower risk for liver disease progression. Therefore, RNA was extracted from sera of therapy‐naïve patients with HBV infection (n = 89) and from healthy volunteers (n = 19). The concentration of miR‐122 was assessed by quantitative real‐time reverse‐transcription PCR. HBs antigen and HBV DNA levels were quantified as surrogate parameters for HBV replication and translation. Liver biopsies were examined according to the histological activity index and the degree of fibrosis was assessed. We found that the miR‐122 serum concentration correlated with the level of ALT, HBV DNA and HBs antigen (r = 0.259, P < 0.05; r = 0.225, P < 0.05; r = 0.508, P < 0.001, respectively). The miR‐122 serum levels discriminated the different patient groups infected with HBV from healthy subjects (P < 0.001), and inactive carrier patients with high (>3500 IU/mL) or low (<3500 IU/mL) levels of HBs antigen could be differentiated by the miR‐122 serum concentration (P < 0.05). As serum miR‐122 levels strongly correlated with HBs antigen, it might be an indicator for viral translation. Furthermore, serum miR‐122 levels discriminated HBV carrier patients with high or low risk for disease progression and may, thus, be an additional marker for risk stratification.
Predictors of antibiotic use in African communities: evidence from medicines household surveys in five countries
Authors: Vialle‐Valentin C. E. , LeCates R. F. , Zhang F. , Desta A. T. , Ross‐Degnan D.
Published: October 2011

Objectives  To investigate antibiotic use in five national household surveys conducted with the WHO methodology to identify key determinants of antibiotic use in the community.

Methods  Data from The Gambia, Ghana, Kenya, Nigeria and Uganda surveys were combined. We used logistic regression models that accounted for the clustered survey design to identify the determinants of care seeking outside the home and antibiotic use for 2914 cases of recent acute illness.

Results  Overall, 95% of individuals with acute illness took medicines, 90% sought care outside their homes and 36% took antibiotics. In multivariate analyses, illness severity was a strong predictor of seeking care outside the home. Among those who sought outside care, the strongest predictor of antibiotic use was the presence of upper respiratory symptoms (OR: 3.02, CI: 2.36–3.86, P < 0.001), followed by gastrointestinal symptoms or difficulty breathing, and antibiotics use was less likely if they had fever. The odds of receiving antibiotics were higher when visiting a public hospital or more than one healthcare facility.

Conclusions  The nature and severity of symptoms and patterns of care seeking had the greatest influence on decisions to take antibiotics. Antibiotics were widely available and inappropriately used in all settings. Policies to regulate antibiotics distribution as well as interventions to educate prescribers, dispensers and consumers are needed to improve antibiotic use.
Daily exhaled nitric oxide measurements and asthma exacerbations in children
Authors: van der Valk R. J. P. , Baraldi E. , Stern G. , Frey U. , de Jongste J. C.
Published: October 2011

To cite this article: van der Valk RJP, Baraldi E, Stern G, Frey U, de Jongste JC. Daily exhaled nitric oxide measurements and asthma exacerbations in children. Allergy 2012; 67: 265–271.

Background:  Fractional exhaled Nitric Oxide (FeNO) is a biomarker for eosinophilic airway inflammation and can be measured at home on a daily basis. A short‐term increase in FeNO may indicate a higher risk of future asthma exacerbations.

Objective:  To assess changes in FeNO before and after asthma exacerbations compared to a stable control period.

Methods:  A post hoc analysis was performed on daily FeNO measurements over 30 weeks in children with asthma (n = 77). Moderate exacerbations were defined by an increase in symptom scores and severe exacerbations by prescription of prednisone. Individual mean and maximum FeNO, the variability of FeNO assessed by the coefficient of variation (CV), and slopes of FeNO in time were all quantified in 3‐week blocks. Cross‐correlation of FeNO with symptoms and autocorrelation of FeNO were assessed in relation to exacerbations and examined as predictors for exacerbations compared to reference periods using logistic regression.

Results:  Fractional exhaled nitric oxide could be assessed in relation to 25 moderate and 12 severe exacerbations. The CV, slope, cross‐correlation, and autocorrelation of daily FeNO increased before moderate exacerbations. Increases in slope were also randomly seen in 19% of 2‐week blocks of children without exacerbations. At least 3–5 FeNO measurements in the 3 weeks before an exacerbation were needed to calculate a slope that could predict moderate exacerbations. No specific pattern of FeNO was seen before severe exacerbations.

Conclusion:  Fractional exhaled nitric oxide monitoring revealed changes in FeNO prior to moderate exacerbations. Whether this can be used to prevent loss of asthma control should be further explored.
Sirolimus as renal and immunological rescue agent in pediatric liver transplant recipients
Authors: Basso Maria‐Sole , Subramaniam Pushpa , Tredger Mike , Verma Anita , Heaton Nigel , Rela Mohamed , Mieli‐Vergani Giorgina , Dhawan Anil
Published: October 2011

Basso M‐S, Subramaniam P, Tredger M, Verma A, Heaton N, Rela M, Mieli‐Vergani G, Dhawan A. Sirolimus as renal and immunological rescue agent in pediatric liver transplant recipients. Pediatr Transplantation 2011: 15: 722–727. © 2011 John Wiley & Sons A/S.

Abstract:  CNI have improved the outcome of LT. However, their inherent potential to nephrotoxic and sometimes‐inadequate immunosuppressive effect has lead to the usage of newer drugs like SRL. Aim of this study was to review children who received SRL. Thirty‐seven (20 women) children post‐LT, median age 10.4 yr (0.8–17.4) with a minimum follow‐up of six months comprised the study group. Indications for SRL were biopsy‐proven resistant acute allograft rejection (n = 12), early CR (n = 12), and CNI‐induced nephropathy with MMF intolerance (n = 11). In two patients, the indication was the recurrence of BSEP disease in the allograft. In patients with acute rejection, AST normalized in 10/12 patients. In patients with CR, AST normalized in 6/12 patients. Those with renal impairment showed improvement in their creatinine levels from a mean baseline of 99–56.7 μm (p = 0.03) and their mean cystatin C was 1.02 after SRL. Side effects leading to discontinuation of SRL were seen in three patients. SRL was effective in rescuing patients with acute and chronic allograft rejection and improving renal function in CNI‐induced nephropathy group.
Red blood cell transfusions in children awaiting heart transplantation
Authors: Mahle William T. , Berg Alexandria M. , Kanter Kirk R.
Published: October 2011

Mahle WT, Berg AM, Kanter KR. Red blood cell transfusions in children awaiting heart transplantation. Pediatr Transplantation 2011: 15: 728–732. © 2011 John Wiley & Sons A/S.

Abstract:  In children awaiting heart transplantation, the benefits of RBC transfusion must be weighed against the potential risks of allosensitization. We sought to describe the use of RBC transfusion and erythropoietin in children with heart failure, as well as assess the impact of these measures on allosensitization. Hospitalized patients listed for heart transplantation between 1/03 and 12/10 were included in the analysis. We excluded patients supported by mechanical support or those highly sensitized prior to listing. Sixty‐seven subjects (median age of 6.2 yr) met inclusion criteria. The mean waitlist time was 19.5 days. The majority of subjects, 50 (75%), received at least one RBC transfusion while listed. For those who were transfused, the median number of RBC transfusion events was 3, range: 1–8. Erythropoietin was given to 37 (55%) of subjects. Erythropoietin administration was not associated with subsequent need for transfusion (p = 0.61). Of the 50 subjects who received RBC transfusion, none developed significant elevation of serum PRA by the time of transplant. RBC transfusion may be commonly undertaken in hospitalized children awaiting transplantation. The likelihood of allosensitization following leukoreduced RBC transfusion is extremely low. The benefits of routine erythropoietin administration to reduce the need for transfusion remain to be determined.
Sewage‐induced polychaete reefs in a SW Atlantic shore: rapid response to small‐scale disturbance
Authors: Garaffo Griselda V. , Jaubet María L. , Sánchez María de los Á. , Rivero María S. , Vallarino Eduardo A. , Elías Rodolfo
Published: October 2011

The intertidal zone around Mar del Plata’s sewage discharge (38° S, 57° W) is characterized by the presence of the non‐indigenous spionid polychaete Boccardia proboscidea. This species has been classified as tolerant to moderate and high levels of organic contamination. During early stages of colonization this species can reach very high densities without suffering from interspecific competition, building biogenic structures such as reef. The aim of this work was evaluate the recovery time of the reef to a small‐scale experimental physical disturbance. Five independent rocks with B. proboscidea reefs on them were selected randomly and a small‐scale disturbance was generated by corers (16 cm2). At the beginning of the experiment, six corers were collected in each reef to produce the disturbance. The original density of B. proboscidea in each reef was determined in these corers. The reefs with disturbed corer were sampled on successive days to assess the reef recovery time. The number of larvae, juveniles and adults was quantified. Polychaete reefs had very high densities before the disturbance (mean density: 1,021,250 ind m−2). Boccardia proboscidea reefs had a fast recovery rate after small‐scale disturbance. Four days after disturbance the density reached about 50% of the original density and after 5 days the disturbed reefs could not be differentiated from the undisturbed reef. The initial recolonization of disturbed patches occurs as a result of migration which appears to be driven by larvae and juveniles. These reefs can not be seen as biodiversity hotspots and the presence of the species demonstrates great environmental deterioration.
Validity and reliability of the Malay‐language translation of the Rome III Diagnostic Questionnaire for irritable bowel syndrome
Authors: Lee Yeong Yeh , Waid Anuar , Tan Huck Joo , Andrew Chua Seng Boon , Whitehead William E
Published: October 2011

Background and Aim:  The Malay language is widely used within the "Malay Archipelago" particularly in Malaysia, Indonesia, Philippines, Singapore and Brunei with a combined population of 300 million. There are no reliable data on the epidemiology of irritable bowel syndrome (IBS) in the Malay speaking population because the Rome Diagnostic Questionnaire has not been translated and validated for the Malay language. The current study aimed to translate and validate the Rome III IBS Diagnostic Questionnaire, Red Flag and Psychosocial Alarm questionnaires into the Malay language.

Methods:  Forward and backward translations of the source questionnaires were performed according to guidelines from the Rome foundation. The Malay translated questionnaires were assessed for clarity in a group of 10 volunteers. Psychometric properties of the questionnaires were assessed in 31 subjects with IBS based on Rome II symptom criteria and 31 healthy controls prospectively. Test‐retest reliability was assessed using intra‐class correlation (ICC) over a 14‐day interval. The sensitivity and specificity of the IBS diagnostic module for distinguishing IBS patients from controls was tested.

Results:  The ICC for the IBS module was 0.996 (95% confidence interval 0.991–0.998) with good discriminant validity (P < 0.001). ICCs for the Red Flags and Psychosocial Alarm questionnaires were 0.962 and 0.994 respectively. The sensitivity, specificity and positive predictive value of the translated Rome III IBS module against Rome II criteria was 80.65%, 100% and 100%, respectively.

Conclusion:  The translated Malay language Rome III IBS Diagnostic Questionnaire and the questionnaires for Red Flags and Psychosocial Alarm symptoms are valid and reliable.
Oral manifestations of gastroesophageal reflux disease
Authors: Ranjitkar Sarbin , Smales Roger J. , Kaidonis John A.
Published: October 2011

Numerous case‐control and other studies involving confirmation of gastroesophageal reflux disease (GERD) by esophageal pH‐metry and the assessment of dental erosions have shown significant associations between the two conditions in both adults and children. By contrast, when asked to vote on whether GERD may cause dental erosions, only 42% of physicians strongly agreed that such an association existed in adults, and just 12.5% strongly agreed for children, respectively in two global consensus reports. Part of this divergence between the perceptions of physicians and the findings of research publications may reflect a general lack of oral health education during medical training, and cursory oral examinations being made under less‐than‐ideal conditions. Adequate salivary secretions are essential for the protection of the teeth and the oropharyngeal and esophageal mucosa. The quantity and quality of the saliva require monitoring as many drugs, including several of the proton pump inhibitors (PPIs), can cause hyposalivation. In addition, PPIs do not always result in adequate acid suppression. Therefore, collaboration between physicians and dentists is strongly advocated to prevent or ameliorate possible adverse oral effects from both endogenous and exogenous acids, and to promote adequate saliva production in patients with GERD.
Phenotypic and mutation spectrums of Thai patients with isovaleric acidemia
Authors: Vatanavicharn Nithiwat , Liammongkolkul Somporn , Sakamoto Osamu , Sathienkijkanchai Achara , Wasant Pornswan
Published: October 2011

Background:  Isovaleric acidemia (IVA) is an autosomal recessive disorder caused by deficiency of isovaleryl‐CoA dehydrogenase (IVD). Clinical features include vomiting, lethargy, metabolic acidosis, and “sweaty feet” odor. The pathognomonic metabolite, isovalerylglycine, is detected on urine organic acid analysis. Clinical diagnosis of IVA can be confirmed on mutation analysis of the IVD gene.

Methods:  The cases of five unrelated Thai patients with IVA, identified on urine organic acid analysis, are described. Mutation analysis of the IVD gene was performed using polymerase chain reaction sequencing of the entire coding regions.

Results:  Four out of the five IVA patients had an acute neonatal form. The hematologic abnormalities were common and thus could be presenting symptoms in the absence of metabolic acidosis. As for the neurological outcome, only one patient had normal intelligence. Mutation analysis of the IVD gene identified the mutations c.457–3_2CA>GG, c.1199A>G (p.Y371C), c.281C>G (p.A65G), c.358G>A (p.G91R), and c.827T>C (p.L247P). The poor outcome in most patients might be explained by the delayed diagnosis and initial unavailability of the metabolic formulas and medications in Thailand. The c.457–3_2CA>GG mutation was identified in all of the present patients. This suggests that it is the most common mutation in the Thai population. Therefore, it could be a founder mutation in Thai subjects. One of the present Thai IVA patients also had the p.Y371C mutation, which is common in Han Chinese subjects. In addition, two novel mutations, p.A65G and p.L247P, were identified.

Conclusion:  The present study provides additional knowledge on the genotype–phenotype of IVA, suggesting that IVD mutations in Asian populations are distinct from these in Western populations.
Screening glaucoma genes in adult glaucoma suggests a multiallelic contribution of CYP1B1 to open‐angle glaucoma phenotypes
Authors: Patel Hussain Y , Richards Amanda J , De Karolyi Betina , Best Stephen J , Danesh‐Meyer Helen V , Vincent Andrea L
Published: October 2011

Abstract

Background:  Despite increasing knowledge of the genetic pathophysiology of glaucoma, mutations in known genes account for less than 15% of disease. Gene screening predominantly remains a research tool rather than an essential part of the clinical work‐up. We aimed to determine the mutational spectrum and frequency in the genes implicated in glaucoma, in a range of glaucoma and ‘glaucoma suspect’ (GS) participants, with a positive family history.

Methods:  Observational large case series. One hundred fifteen patients recruited from public hospital and private clinics had diagnoses of GS, ocular hypertension, pseudoexfoliative glaucoma (PXG) or primary open‐angle glaucoma (POAG), and at least one affected family member. In a university laboratory, DNA samples were screened for mutations in all coding exons of MYOC and CYP1B1, and OPTN (exons 4, 5 and 16). WDR36 (exons 1, 4, 5, 8, 11, 13 and 17) was screened in those with CYP1B1 changes. LOXL1 risk variants were screened in PXG pedigrees. Cascade screening of family members was undertaken.

Results:  Seven out of one hundred fifteen (6.1%) individuals had at least one pathogenic or hypomorphic CYP1B1 allele associated with GS, POAG (5) and PXG phenotypes, including two novel sequence variations (p.Ser6Gly, p.Val243Leu). No pathogenic MYOC change was detected. Five individuals (4.3%) carried an OPTN sequence variation. Three of the seven with CYP1B1 changes had polygenic changes.

Conclusions:  Mutational analysis of known glaucoma genes in a mixed glaucoma population replicates the reported frequency of pathogenic CYP1B1 changes. Heterozygous CYP1B1 changes occurred at a greater frequency than other genes. Glaucoma pathogenesis in the clinic setting is genetically heterogeneous and may be polygenic.
Analysis of lower limb bradykinesia in Parkinson's disease patients
Authors: Kim Ji‐Won , Kwon Yuri , Kim Yu‐Mi , Chung Hong‐Young , Eom Gwang‐Moon , Jun Jae‐Hoon , Lee Jeong‐Whan , Koh Seong‐Beom , Park Byung Kyu , Kwon Dae‐Kyu
Published: October 2011

Aim:  Bradykinesia of the lower limb is an important limiting factor of the quality of life in parkinsonian patients. This study aims to develop quantitative measures of bradykinesia and to investigate the possible dissociation of amplitude and velocity measures and their dependence on movement direction during toe‐tapping.

Methods:  Subjects included 39 patients with PD, as well as 14 healthy control subjects. A gyrosensor on the dorsum of a foot was used to measure ankle joint movement during toe‐tapping. Four representations (root‐mean square, mean peak, coefficient of variation in peaks, peak in the last 5 s) for each of amplitude and velocity and for each of plantar flexion and dorsiflexion movement of toe‐tapping were investigated. Outcome measures were compared between patients and controls, and their correlations with clinical scores were investigated. Category distributions of outcome measures in patients were analyzed.

Results:  All outcome measures were smaller in patients than in controls (P < 0.001) and correlated well with clinical scores (P < 0.01). The mean peak of plantar‐flexion velocity and variation of dorsiflexion velocity best represented the clinical toe‐tapping score (r = 0.72–0.81). All clinical scores showed better correlation with velocity than with amplitude, and velocity was more affected (dispersed from the performance of controls) than amplitude. Movement directions had a slight effect on the results; specifically, the magnitude measures better correlated during plantar flexion and the variation measure better correlated during dorsiflexion.

Conclusion:  The suggested measures represented clinical scores well and are expected to be helpful in clinical diagnosis of lower limb bradykinesia. Possible dissociations of amplitude and speed impairments and of movement directions in PD deserve further investigation. Geriatr Gerontol Int 2012; 12: 257–264.