bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic head‐down‐tilt sleeping as physiological regulator of bone remodelling during diminished muscular activity in humans
Authors: Kakuris Kostas K. , Yaroshenko Yuri N. , Charapakhin Kirill P. , Neofitov Nikolay H.
Published: December 2015

Objectives

Head‐down‐tilt (HDT) sleeping with periodic fluid redistribution (PFR) assumes a significant importance by the possibility of regulating bone remodelling. We hypothesized that HDT sleeping with chronic PFR which expands fluid volume would contribute to and/or increase bone formation. Therefore, we studied the potential benefits of osteogenesis with HDT sleeping of chronic PFR during diminished muscular activity (hypokinesia; HK).

Methods

Studies were conducted on 40 male healthy volunteers. They were divided into four groups: head‐down‐tilt sleeping control subjects (HDTSCS), head‐down‐tilt sleeping hypokinetic subjects (HDTSHS), active control subjects (ACS) and hypokinetic subjects (HKS). The iliac crest cancellous bone and trabecular bone volume and cortical thickness were measured during pre‐experimental period of 390 days and experimental period of 360 days.

Results

Iliac crest cancellous bone and trabecular bone volume and cortical thickness were increased (P<0·05) in the HDTSHS group compared to the HKS group. Iliac crest cancellous bone volume, cortical thickness and trabecular bone volume were reduced (P<0·05) in the HKS group compared to their pre‐experimental values and the level in the other groups. In the HDTSCS group, iliac crest cancellous bone volume, cortical thickness and trabecular bone volume were increased much less than in the HDTSHS group. Bone mineral density was not affected in the ACS group compared to their pre‐experimental values.

Conclusion

The current study shows the impact of chronic HDT sleeping with PFR on increases formation of bone demonstrating osteogenesis of bone during diminished muscular activity.
Prevalence and correlates of alcohol use among adolescents attending school in Kerala, India
Authors: Jaisoorya T.S. , Beena K.V. , Beena M. , Ellangovan K. , Jose Dalia C. , Thennarasu K. , Benegal Vivek
Published: December 2015

Introduction and Aims

Concern around potentially increasing alcohol use among young people has been growing in public discourse in India. However, there are few published studies on this issue. We studied the prevalence, patterns and correlates of alcohol use among adolescents in Ernakulam, Kerala State, India.

Design and Methods

A total of 7560 students in the age group 12–19 years from 73 schools completed a self‐administered questionnaire incorporating standardised instruments to assess alcohol use.

Results

The overall prevalence of lifetime alcohol among adolescents use was 15% (23.2% among boys and 6.5% among girls) with prevalence increasing with age, and 25.3% of drinkers reported hazardous alcohol use. The mean age at onset of alcohol use was 13.6 years. Initiation of alcohol use typically preceded use of tobacco and illicit drugs. Most students reported initiation into alcohol use by family members in the context of family celebrations. The prevalence of alcohol use was higher among students from urban areas and those with a part‐time job. Lower use was seen among Muslims. Lifetime alcohol use was associated with significantly higher tobacco and illicit drug use, suicidal thoughts, attention deficit hyperactivity disorder symptom‐scores, history of non‐contact sexual abuse and with poor academic performance.

Discussion and Conclusions

Alcohol use among adolescents in India deserves greater attention than it has previously received, marked as it is by an early onset and associated with a range of negative mental health problems. [ Jaisoorya T S, Beena K V, Beena M, Ellangovan K, Jose D C, Thennarasu K, Benegal V. Prevalence and correlates of alcohol use among adolescents attending school in Kerala, India. Drug Alcohol Rev 2016;35:523–529]
Verzögerte Soforttyp‐Allergie gegen rotes Fleisch und Innereien: aktueller Wissensstand zu einem neuen Krankheitsbild
Authors: Fischer Jörg , Biedermann Tilo
Published: December 2015

In der In‐vitro‐Allergiediagnostik hat die Entwicklung hin zu Einzelkomponenten statt die Verwendung von Gesamtextrakten in den letzten Jahren große Fortschritte gebracht. Besonders eindrücklich ist die Identifizierung von neuen Krankheitsentitäten, die mit dem Nachweis von IgE‐Antikörpern gegen bestimmte Einzelkomponenten einhergehen. Eine besondere Bedeutung kommt der verzögerten Soforttypallergie gegen rotes Fleisch und Innereien zu. Dieses Krankheitsbild ist im deutschsprachigen Raum häufiger als zunächst angenommen und wird wahrscheinlich immer noch unterdiagnostiziert. Betroffene Patienten reagieren verzögert mit Typ‐I‐Reaktionen auf rotes Fleisch oder, etwas früher, nach Verzehr von Innereien. Bei allen Patienten können IgE‐Antikörper gegen das Oligosaccharid Galaktose‐α‐1,3‐Galaktose, kurz α‐Gal, nachgewiesen werden. Betroffene müssen auch α‐Gal‐haltige Medikamente wie Cetuximab oder Gelatine‐haltige Volumenersatzmittel meiden. Das Krankheitsbild, das auch α‐Gal‐Syndrom genannt wird, ist insofern neuartig als es sich um eine Soforttypallergie gegen einen Zucker und nicht gegen ein Protein handelt. Da viele Patienten eine Krankengeschichte mit wiederholten Schüben einer akuten Urtikaria oder von Angioödemen aufweisen, sollte das α‐Gal‐Syndrom Dermatologen geläufig sein.
Investigation of factors associated with health‐related quality of life and psychological distress in vitiligo
Authors: Bonotis Konstantinos , Pantelis Konstantinos , Karaoulanis Sokratis , Katsimaglis Chrysanthos , Papaliaga Maria , Zafiriou Efterpi , Tsogas Panagiotis
Published: December 2015

Background and objectives

Skin diseases distort the body image with possible negative effects on the quality of life and psychosocial health of patients. While vitiligo does not affect the physical well‐being, it may be psychologically distressing. The present study was based on the hypothesis that particular factors might be critical regarding the adjustment to the disease.

Patients and Methods

We investigated the vitiligo‐related quality of life and psychological distress of 216 patients diagnosed with the disease in relation to demographic factors, disease components, and personality traits. For this purpose, we administered the self‐completed questionnaires Dermatological Quality of Life Index, General Health Questionnaire, Eysenck Personality Inventory, and Rosenberg Self‐Esteem Scale.

Results

Statistical analysis revealed a significant positive correlation between patients’ distress and health‐related quality of life. Moreover, the impact of vitiligo on the quality of life was significantly associated with disease variables as well as personality traits and gender. On the other hand, psychological distress was significantly associated with personality traits and gender, but not with disease components.

Conclusions

Our results indicate that the psychosocial adjustment to the disease is mainly influenced by subjective factors. This observation could imply the need for targeted support interventions in the treatment of vitiligo.
Delayed immediate‐type hypersensitivity to red meat and innards: current insights into a novel disease entity
Authors: Fischer Jörg , Biedermann Tilo
Published: December 2015

The development of component‐resolved diagnostics instead of whole extracts has brought about major advances in recent years. Particularly remarkable has been the identification of new disease entities based on the detection of IgE antibodies against specific individual components. In this context, delayed immediate‐type hypersensitivity to red meat and innards plays a key role. This disorder is more common in German‐speaking countries and likely still underdiagnosed. Affected individuals exhibit delayed type I reactions following the consumption of red meat or innards (responses to the latter are more rapid). All patients have IgE antibodies against the oligosaccharide galactose‐α‐1,3‐galactose – alpha‐gal. Those affected also have to avoid alpha‐gal‐containing drugs such as cetuximab or gelatin‐containing colloidal solutions. Also referred to as alpha‐gal syndrome, this condition is unique in that it is characterized by type I hypersensitivity to a sugar instead of a protein. Given that many patients have a history of recurrent episodes of acute urticaria or angioedema, dermatologists should be familiar with the alpha‐gal syndrome.
S2k guideline on diagnosis and treatment of atopic dermatitis – short version
Authors: Werfel Thomas , Heratizadeh Annice , Aberer Werner , Ahrens Frank , Augustin Matthias , Biedermann Tilo , Diepgen Thomas , Fölster‐Holst Regina , Gieler Uwe , Kahle Julia , Kapp Alexander , Nast Alexander , Nemat Katja , Ott Hagen , Przybilla Bernhard , Roecken Martin , Schlaeger Martin , Schmid‐Grendelmeier Peter , Schmitt Jochen , Schwennesen Thomas , Staab Doris , Worm Margitta
Published: December 2015

Atopic dermatitis (AD) represents a pruritic, non‐contagious, chronic or chronically relapsing, inflammatory skin disease. The course of the disease may be complicated by bacterial or viral superinfections. The first manifestation of the disease and further flare‐ups are due to genetic predisposition and also to a variety of further trigger factors. The therapy regimen should be adapted to disease symptoms that are actually present and consider individual features of the disease as reported by the patients or their parents.

This short version of the German guideline on AD provides an overview of evidence‐based diagnostic and treatment options. All recommendations made here are the result of a consensus of the scientific medical societies, working groups and support groups based on scientific data published to date. Abstracts and details of the studies cited are provided in the long version of this guideline (see: www.awmf.org).
Fehldiagnostiziertes mikrozystisches Adnexkarzinom an der seitlichen Stirn und Herausforderungen bei der Rekonstruktion eines bis zum Knochen reichenden Defekts
Authors: Fallaha Amgiad , Thuile Tobias , Tappeiner Lukas , Pichler Maria , Deluca Jenny , Perino Franco , Eisendle Klaus
Published: December 2015

Hintergrund

Das mikrozystische Adnexkarzinom (MAC) ist ein seltenes kutanes Malignom, das durch aggressive lokale Infiltration und starke Tendenz zur perineuralen Invasion gekennzeichnet ist. Da es histologisch leicht mit benignen adnexalen Tumoren verwechselt werden kann, kommt oft zu einer unzureichenden Erstbehandlung. Daher müssen nach verzögerter chirurgischer Exzision häufig ausgedehnte Hautbereiche entfernt werden, was die anschließende Rekonstruktion erschweren kann.

Methoden

Wir berichten über die schwierige Rekonstruktion eines größeren Defekts an der Stirn durch modifizierte A‐T‐Plastik mit Transplantation eines zentralen Burow‐Dreiecks und vorangehender Wundkonditionierung mit Hyaluronsäure nach vollständiger mikrographischer kontrollierter Entfernung des MACs.

Ergebnisse

Eine 80‐jährige gesunde Frau stellte sich vor mit fast sechsjähriger Vorgeschichte eines asymptomatischen, langsam progredienten Hauttumors, der fünf Jahre zuvor biopsiert und als benignes Syringom diagnostiziert worden war. Durch tiefe Biopsien wurde ein MAC bestätigt. Die Patientin unterzog sich einer schrittweisen chirurgischen Exzision, durchgeführt mit der Tübinger Randschnittmethode (Tübinger Torte), bei der das frontale Periost entfernt wurde. Hautersatz aus veresterter Hyaluronsäure wurde drei Wochen lang auf den bis zum Knochen reichenden, 6×7 cm großen Defekt appliziert, was ein gutes Granulationsgewebe über dem Knochen ergab. Die endgültige Rekonstruktion wurde durch eine A‐T‐Plastik in Kombination mit einem Vollhauttransplantat des zentralen „Dog Ear“ erreicht. Das kosmetische Ergebnis war zufriedenstellend und innerhalb von 18 Monaten Nachbeobachtungszeit wurde kein Rezidiv beobachtet.

Schlussfolgerungen

Wir bestätigen die histologischen Schwierigkeiten bei der Diagnose dieser Tumorentität und die Notwendigkeit einer großräumigen Entfernung des MACs infolge der verzögerten Diagnose und Behandlung. Eine tiefe Exzision des Tumors einschließlich des Periosts kann erforderlich sein, um tumorfreie Ränder zu erhalten. Durch die Applikation von Hyaluronsäureprodukten kann möglicherweise eine schnelle Bildung von Granulationsgewebe über dem Stirnknochen erreicht werden. Die Kombination einer A‐T‐Plastik mit der Transplantation der benachbarten Burow‐Dreiecke ergibt eine optimale Hauttextur und Farbanpassung und scheint eine geeignete Option zum Verschluss selbst umfangreicher Defekte an der Stirn, insbesondere oberhalb der Augenbrauen, zu sein.
Handekzeme – Differenzialdiagnosen, Diagnostik und Therapien
Authors: Mahler Vera
Published: December 2015

Die Pathogenese von Handekzemen ist multifaktoriell. Sowohl Prädisposition (genetische Faktoren) als auch Exposition spielen bei der Entstehung von Handekzemen eine Rolle. Eine hohe Inzidenzrate ist assoziiert mit weiblichem Geschlecht, Kontaktallergien, atopischer Dermatitis und Arbeiten im feuchten Milieu. Die wichtigsten Risikofaktoren für die Persistenz von Handekzemen sind ausgeprägte Ausdehnung, allergische oder atopische Genese, Ekzeme in der Kindheit und Krankheitsbeginn vor dem 20. Lebensjahr. Die durch Handekzeme bedingten Krankheitskosten liegen in gleicher Höhe wie die Kosten der mittelschweren bis schweren Psoriasis.

Die Diagnostik von Handekzemen und ihre differenzialdiagnostische Abgrenzung erfordert eine detaillierte Erfassung von Expositionen im beruflichen und außerberuflichen Umfeld. Besteht die Möglichkeit, dass berufliche Einflüsse an der Entstehung oder Unterhaltung der Handekzeme beteiligt sind, soll eine frühzeitige Information des Unfallversicherungsträgers mittels Hautarztbericht erfolgen. Bei der Hälfte aller Handekzeme ist Kontakt zu einem Kontaktallergen (mit)ursächlich. Bei allen länger als drei Monate bestehenden Handekzemen ist daher eine allergologische Abklärung erforderlich.

Eine erfolgreiche und nachhaltige Therapie des Handekzems beginnt bei der Identifikation der individuellen Auslöser und ihrer Ausschaltung. Dies beinhaltet eine Ersatzstoffprüfung bei identifizierten Kontaktallergenen und Irritanzien sowie Optimierung geeigneter Präventionsmaßnahmen. Eine stadienadaptierte Therapieanpassung, welche die Schwere der Manifestation berücksichtigt, ist notwendig. Dabei können verschiedene validierte Instrumente zur Monitorierung des Therapieerfolges eingesetzt werden.
Association of Apical Longitudinal Rotation with Right Ventricular Performance in Patients with Pulmonary Hypertension: Insights into Overestimation of Tricuspid Annular Plane Systolic Excursion
Authors: Motoji Yoshiki , Tanaka Hidekazu , Fukuda Yuko , Sano Hiroyuki , Ryo Keiko , Sawa Takuma , Miyoshi Tatsuya , Imanishi Junichi , Mochizuki Yasuhide , Tatsumi Kazuhiro , Matsumoto Kensuke , Emoto Noriaki , Hirata Ken‐ichi
Published: December 2015

Background

Current guidelines recommend the routine use of tricuspid annular plane systolic excursion (TAPSE) as a simple method for estimating right ventricular (RV) function. However, when ventricular apical longitudinal rotation (apical‐LR) occurs in pulmonary hypertension (PH) patients, it may result in overestimated TAPSE.

Methods

We studied 105 patients with PH defined as mean pulmonary artery pressure >25 mmHg at rest measured by right heart cardiac catheterization. TAPSE was defined as the maximum displacement during systole in the RV‐focused apical four‐chamber view. RV free‐wall longitudinal speckle tracking strain (RV‐free) was calculated by averaging 3 regional peak systolic strains. The apical‐LR was measured at the peak rotation in the apical region including both left and right ventricle. The eccentricity index (EI) was defined as the ratio of the length of 2 perpendicular minor‐axis diameters, one of which bisected and was perpendicular to the interventricular septum, and was obtained at end‐systole (EI‐sys) and end‐diastole (EI‐dia). Twenty age‐, gender‐, and left ventricular ejection fraction‐matched normal controls were studied for comparison.

Results

The apical‐LR in PH patients was significantly lower than that in normal controls (−3.4 ± 2.7° vs. −1.3 ± 1.9°, P = 0.001). Simple linear regression analysis showed that gender, TAPSE, EI‐sys, and EI‐dia/EI‐sys were associated with apical‐LR, but RV‐free was not. Multiple regression analysis demonstrated that gender, EI‐dia/EI‐sys, and TAPSE were independent determinants of apical‐LR.

Conclusions

TAPSE may be overestimated in PH patients with clockwise rotation resulting from left ventricular compression. TAPSE should thus be evaluated carefully in PH patients with marked apical rotation.
Fracture resistance and failure mode of endodontically treated teeth restored using ceramic onlays with or without fiber posts—an ex vivo study
Authors: Keçeci Ayşe Diljin , Heidemann Detlef , Kurnaz Safa
Published: December 2015

Aim

This study aimed to compare the fracture resistance and fracture modes of ceramic onlay restorations with or without fiber posts in endodontically treated premolars.

Material and methods

Fifty extracted human premolars with similar anatomic features were used in this study. Four groups (n = 10) were treated endodontically. Onlay cavities extended to the buccal and palatal cusps and reached out the endodontic accesses were prepared. Ceramic onlay restorations with or without fiber posts were categorized as Group CO (ceramic onlays without posts), Group COQF (ceramic onlays and quartz fiber posts), and Group COGF (ceramic onlays and glass fiber posts). Positive control group was left as non‐restored (Group NR). Ten intact teeth were stored as negative control group (Group IT). Fracture resistance was measured using a universal load‐testing machine applying compressive load at a crosshead speed of 1 mm min−1 until fracture. Fracture resistance and modes were evaluated statistically.

Results

Ceramic onlay restorations (Groups CO, COQF, COGF) increased the fracture resistance significantly, when compared with non‐restored teeth (P < 0.05). However, no significant differences were found in the groups with fiber posts in terms of fracture resistance (P > 0.05). Negative control group (IT) had significantly higher fracture resistance than all others (P < 0.05). Fracture types had significant differences among the groups (P < 0.01).

Conclusions

Within the limitations of this ex‐vivo study, partial coverage with ceramic onlays resulted in a significant improvement of the fracture resistance of endodontically treated premolars. However, insertion of glass or quartz fibers did not increase the fracture resistance significantly.
Heating methods for reducing unevenness softening of mouthguard sheets in vacuum–pressure formation
Authors: Takahashi Mutsumi , Koide Kaoru , Satoh Yoshihide , Iwasaki Shin‐ichi
Published: December 2015

Background

Unevenness in softening of the plastic sheet leads to a decrease in the mouthguard thickness during thermoforming. In this study, we examined the heating methods for reducing unevenness when softening mouthguard sheets during vacuum–pressure formation.

Materials and methods

Ethylene vinyl acetate mouthguard sheets and olefin copolymer sheets (thickness: 4.0 mm) were used. The following three heating conditions were compared: condition A—the sheet was molded when it sagged 15 mm from the sheet frame (under normal condition); condition B—the heater was turned off when the sheet sagged by 10 mm from the frame, followed by the sheet molding when the sagging reached 15 mm below the frame; and condition C—the sheet was inverted after heating when the sheet sagged 10 mm and was molded when the sagging reached 15 mm below the frame. The sheet was heated and pressed over the model using a vacuum–pressure machine; then, 10 s of vacuum forming and 2 min of pressure molding were applied. The sheet temperatures were measured using a radiation thermometer. Thickness of the fabricated sheets was determined for the incisal and the molar portion using a measuring device. Thickness data for each condition were analyzed by one‐way anova followed by Bonferroni's multiple comparison tests.

Results

On both sheets, condition B was smallest for temperature difference between the heated and the non‐heated surface, and thicknesses after molding were greatest at all measuring portions.

Conclusion

By comparing changes in sheet temperatures at molding and variation in thicknesses when applying the heating method using a vacuum–pressure molding machine, we found that reduced unevenness in sheet softening occurred when the heater was turned off when the sag distance of the sheet was 5 mm less than the conventional molding, and then, the sheet was pressed when the conventional sag distance was reached.
Risk factors for surgical site infection following laparotomy: Effect of season and perioperative variables and reporting of bacterial isolates in 287 horses
Authors: Isgren C. M. , Salem S. E. , Archer D. C. , Worsman F. C. F. , Townsend N. B.
Published: December 2015

Reasons for performing study

Surgical site infection (SSI) is an important cause of post operative morbidity following laparotomy.

Objectives

To investigate risk factors forSSI, including effect of season and surgery performed outside normal working hours, and to report bacterial isolates and antimicrobial resistance patterns.

Study design

Retrospective cohort study.

Methods

Data were obtained from horses that had undergone exploratory laparotomy over a 3‐year period (2010–2013) in aUKhospital population.SSIwas defined as any purulent or serous discharge from the laparotomy incision of >24 h duration that developed during hospitalisation. Multivariable logistic regression was used to identify associations between pre‐, intra‐ and post operative variables and altered likelihood ofSSI.

Results

Surgical site infection developed in 73/287 (25.4%) horses during hospitalisation. Horses of greater bodyweight (odds ratio [OR] 1.002, 95% confidence interval [CI] 1.0002–1.005, P = 0.03), increased packed cell volume (≥48%) on admission (OR3.03, 95%CI1.32–6.94, P = 0.01), small intestinal resection (OR2.27, 95%CI1.15–4.46, P = 0.02) and post operative colic (OR2.86, 95%CI1.41–5.79, P = 0.003) were significantly associated with increased likelihood ofSSIin a multivariable model.SSIwas also significantly more likely to occur during winter (OR3.84, 95%CI1.38–10.70, P = 0.01) and summer (OR5.63, 95%CI2.07–15.3, P = 0.001) months in the model. Three‐layer closure of the incision was protective (OR0.31, 95%CI0.16–0.58, P<0.001) compared to 2‐layer closure. There was no effect of surgery being performed outside normal working hours (P = 0.5). The most common bacterial isolates wereEscherichia coli(59.5%), Enterococcusspp. (42.4%) andStaphylococcusspp. (25.4%). Penicillin resistant isolates accounted for 92% (96/104) of isolates while 18% (21/119) of isolates were gentamicin resistant.

Conclusions

Laparotomy during winter and summer months was associated with increased likelihood ofSSIbut there was no effect of surgery performed outside normal working hours. This information assists in identifying horses at high risk ofSSIand informing development of preventive strategies.
Does oral prednisolone treatment increase the incidence of acute laminitis?
Authors: Jordan V. J. , Ireland J. L. , Rendle D. I.
Published: December 2015

Reasons for performing study

It is accepted among equine practitioners that glucocorticoid treatment is a risk factor for the development of laminitis. However, there is little published evidence of a link between glucocorticoids and laminitis.

Objectives

To determine whether horses receiving oral prednisolone are at increased risk of laminitis.

Study design

Retrospective case–control study.

Methods

Clinical records of horses registered with the ambulatory service at Liphook Equine Hospital between January 2001 and November 2014 were reviewed retrospectively to identify horses that had received treatment with oral prednisolone. For each treated horse, 2 time‐matched controls that received veterinary attention but were not treated with prednisolone were selected. Incidence of laminitis was compared between the 2 groups and factors associated with laminitis were assessed using Cox regression analysis.

Results

Of the 416 horses treated with prednisolone, 16 (3.8%) were diagnosed with laminitis subsequent to the initiation of prednisolone treatment with an overall incidence of 2.60 (95% CI 1.49–4.22) cases per 100 horse‐years at risk. A total of 7 horses (1.7%) developed laminitis during the course of their treatment and 3 (0.7%) of the horses treated with prednisolone were ultimately subjected to euthanasia as a result of laminitis. A total of 46 (5.7%), of the 814 time‐matched control horses were diagnosed with laminitis during the study period with an overall incidence of 3.46 (95% CI 2.54–4.62) cases per 100 horse‐years at risk. Of these, 12 (1.5%) were subjected to euthanasia as a result of laminitis. There were no significant differences in the overall laminitis incidence rate (P = 0.8), incidence rate during prednisolone treatment (P = 0.09), or probability of laminitis (P = 0.3) between the 2 groups. Mean survival time was greater in the prednisolone than the control group. Equine metabolic syndrome and increasing age were associated with increased risk of laminitis.

Conclusions

Administration of oral prednisolone did not increase the risk of laminitis.
Family Resource Allocation after Firstborns Leave Home: Implications for Secondborns' Academic Functioning
Authors: Jensen Alexander C. , Whiteman Shawn D. , Bernard Julia M. , McHale Susan M.
Published: December 2015

This study assessed secondborn adolescents' perceptions of changes in the allocation of family resources following their firstborn siblings' departure from home after high school, and whether perceived changes were related to changes over 1 year in secondborns' academic functioning. Participants were secondborn siblings (mean age = 16.58, SD = 0.91) from 115 families in which the older sibling had left the family home in the previous year. Allocation of resources was measured via coded qualitative interviews. Most (77%) secondborns reported increases in at least one type of family resource (i.e., parental companionship, attention, material goods), and many reported an increase in multiple types of resources in the year following their older sibling's departure. Consistent with resource dilution theory, perceptions of increases in fathers' companionship, fathers' attention, and mothers' companionship were related to improvements over time in secondborns' academic functioning.
Randomized double‐blind placebo‐controlled multicenter trial of Yokukansan for neuropsychiatric symptoms in Alzheimer's disease
Authors: Furukawa Katsutoshi , Tomita Naoki , Uematsu Daisuke , Okahara Kazunori , Shimada Hiroyuki , Ikeda Masaki , Matsui Toshifumi , Kozaki Koichi , Fujii Masahiko , Ogawa Tatsuji , Umegaki Hiroyuki , Urakami Katsuya , Nomura Hiroshi , Kobayashi Naoto , Nakanishi Aki , Washimi Yukihiro , Yonezawa Hisashi , Takahashi Satoshi , Kubota Masaharu , Wakutani Yosuke , Ito Daisuke , Sasaki Takahiro , Matsubara Etsuro , Une Kaori , Ishiki Aiko , Yahagi Yukie , Shoji Mikio , Sato Hiroyasu , Terayama Yasuo , Kuzuya Masafumi , Araki Nobuo , Kodama Manabu , Yamaguchi Takuhiro , Arai Hiroyuki
Published: December 2015

Aim

Yokukansan (YKS), a traditional herbal medicine, has been used to treat behavioral and psychological symptoms of dementia (BPSD). The present study is the first double‐blind, randomized, placebo‐controlled trial to determine the efficacy and safety of YKS for the treatment of BPSD in Alzheimer's disease (AD).

Methods

A total of 22 sites consisting of clinics, hospitals and nursing homes participated. A total of 145 patients with AD were randomized. Active YKS (7.5 g/day) and placebo were supplied to 75 and 70 participants, respectively. The primary outcome measure was the 4‐week change in total score of the Neuropsychiatric Inventory Brief Questionnaire Form (NPI‐Q), an instrument that evaluates BPSD. Secondary outcome measures included 12‐week changes in NPI‐Q scores, changes in NPI‐Q subcategory scores and total scores of the Mini‐Mental‐State Examination.

Results

Four‐week changes in NPI‐Q total scores did not differ significantly between the treatment and placebo groups. There were also no significant differences between groups in 12‐week changes in total NPI‐Q scores, NPI‐Q subcategory scores or total Mini‐Mental‐State Examination scores. However, a subgroup with fewer than 20 points on the Mini‐Mental‐State Examination at baseline showed a greater decrease in “agitation/aggression” score in the YKS group than in the placebo group (P = 0.007). No serious adverse effects were observed during the study.

Conclusions

Our data did not reach statistical significance regarding the efficacy of YKS against BPSD; however, YKS improves some symptoms including “agitation/aggression” and “hallucinations” with low frequencies of adverse events. Geriatr Gerontol Int 2017; 17: 211–218
Neuroprotective effects of pretreatment of ginsenoside Rb1 on severe cerebral ischemia‐induced injuries in aged mice: Involvement of anti‐oxidant signaling
Authors: Dong Xiao , Zheng Lei , Lu Shujing , Yang Yanbei
Published: December 2015

Aim

Ginsenosides, a class of ginseng compounds of herbal medicine, have been shown to have therapeutic potential for the neuroprotection of brain damage after cerebral ischemia because of their activities including anti‐oxidant and anti‐inflammation. In the elderly population, aging‐induced oxidative stress has been implicated in exacerbating brain injury, which might also be ameliorated by anti‐oxidants, such as ginsenosides. However, this hypothesis has yet to be explored.

Methods

Here we present in vivo studies highlighting a protective function of ginsenoside Rb1, a natural steroid glycoside derivative purified from saponin of Panax ginseng, in neurological injury during aging.

Results

Compared with young mice, the recovery of brain damage after middle cerebral artery occlusion is significantly impaired in aged mice, whereas the long‐term pretreatment with ginsenoside Rb1 through oral administration can greatly prevent the injury in a dose‐dependent manner. In addition, we further explored the involvement of oxidative stress and extracellular signal‐regulated kinase activation in aged mice stimulated by cerebral ischemia, both of which were found to be blocked by ginsenoside Rb1.

Conclusions

These observations suggest that ginsenoside Rb1 could represent promising applications as anti‐oxidants for the anti‐aging treatment of neurological disorders, such as stroke, in elderly patients. Geriatr Gerontol Int 2017; 17: 338–345.
Age‐related differences in dual task performance: A cross‐sectional study on women
Authors: Brustio Paolo R , Magistro Daniele , Rabaglietti Emanuela , Liubicich Monica E
Published: December 2015

Aim

Simultaneous performances of motor and attention‐demanding tasks are common in activities of everyday life. The present cross‐sectional study examined the changes and age‐related differences on mobility performance with an additional cognitive or motor task, and evaluated the relative dual‐task cost (DTC) on the motor performance in young, middle‐aged and older women.

Methods

A total of 30 young (mean age 25.12 ± 3.00 years), 30 middle‐aged (mean age 47.82 ± 5.06 years) and 30 older women (mean age 72.74 ± 5.95 years) were recruited. Participants carried out: (i) single task: Timed Up & Go Test; (ii) cognitive dual‐task: Timed Up & Go Test while counting backwards by three; (iii) manual dual‐task: Timed Up & Go Test while carrying a glass of water. A repeated measures anova with between‐factor as age groups and within‐factor as tasks was carried out to assess the effect of aging on the performance of mobility tasks. DTC was calculated as ([performance in single‐task − performance in dual‐task] / performance in single task) × 100%. One‐way ancova were carried out to compare the DTC among the three age groups.

Results

A significant interaction between age groups and task (F4,172 = 6.716, P < 0.001, partial η2 = 0.135) was observed. Specifically, older women showed a worse mobility performance under dual‐task condition compared with young and middle‐aged groups. Furthermore, DTC differences in cognitive task were observed in older women compared with younger and middle‐aged women (F2,86 = 7.649, P < 0.001, partial η2 = 0.151), but not in manual task.

Conclusion

Dual‐task conditions might affect mobility performance differently across the lifespan, and could be particularly challenging in older women. Geriatr Gerontol Int 2017; 17: 315–321.
Metabolic syndrome and non‐alcoholic fatty liver disease after liver or kidney transplantation
Authors: Mikolasevic Ivana , Orlic Lidija , Hrstic Irena , Milic Sandra
Published: December 2015

Transplantation is a definitive treatment option for patients with end‐stage liver disease, and for some patients with acute liver failure, hepatocellular carcinoma or end‐stage renal disease. Long‐term post‐transplantation complications have become an important medical issue, and cardiovascular diseases (CVD) are now the leading cause of mortality in liver or kidney transplant recipients. The increased prevalence of metabolic syndrome (MS) likely plays a role in the high incidence of post‐transplantation CVD. MS and its hepatic manifestation, non‐alcoholic fatty liver disease (NAFLD), are prevalent among the general population and in pre‐ and post‐transplantation settings. MS components are associated with recurrent or de novo NAFLD in transplant recipients, potentially influencing post‐transplantation survival. Moreover, recent data reveal an important association between NAFLD and risk of incident of chronic kidney disease (CKD). Therefore, NAFLD identification could represent an additional clinical feature for improving the stratification of liver and kidney transplant recipients with regards to risks of CVD, CKD and renal allograft dysfunction. All MS components are potentially modifiable; therefore, it is crucial that hepatologists, nephrologists and primary care physicians become more engaged in managing post‐transplantation metabolic complications. The present review discusses the recent clinical evidence regarding the importance of MS and its components after liver and kidney transplantation, as well as the link between MS and NAFLD after liver and kidney transplantation.
Metabolic syndrome in Moroccan patients with psoriasis
Authors: Meziane Mariame , Kelati Awatef , Najdi Adil , Berraho Amine , Nejjari Chakib , Mernissi Fatim‐Zahra
Published: December 2015

Background

Several recent reports have shown a significant association between psoriasis and metabolic syndrome (MBS).

Objective

The goal of this study was to investigate the prevalence of MBS and, in particular, the main factors that determine this syndrome in Moroccan patients with psoriasis.

Methods

A case–control study has included 150 patients with psoriasis and 300 controls matched for age and sex, the MBS was defined according to the International Diabetes Foundation, and the severity of psoriasis was assessed by body surface area.

Results

Mild psoriasis was seen in 10.7%, 40.3% had moderate psoriasis, and 49% had severe psoriasis. MBS was higher in cases than in controls with statistical differences (44.7 vs. 2.7%, odds ratio [OR]: 26 CI: [12.4–54.3]; P = 0.000). Abdominal obesity and dyslipidemia were the only metabolic factors significantly related to psoriasis whereas diabetes, hypertension, smoking, alcohol consumption, and cardiovascular diseases were not significant. MBS increases with age in our patients with psoriasis, whereas there was no relationship between MBS and gender. Hypertension (P = 0.007), diabetes (P = 0.003), and increased level of triglycerides (P = 0.05) and high‐density lipoprotein cholesterol (P = 0.003) were associated with the severity of psoriasis.

Conclusion

Metabolic syndrome is an important comorbidity in patients with psoriasis, and vigilance and enhanced screening may be important in this population, especially patients with severe disease.
Role of diffusion‐weighted magnetic resonance imaging in the evaluation of scalp dermatofibrosarcoma protuberans
Authors: Van Steenkiste Eva , Van Laethem An , Biesemans Geert , Pans Steven
Published: December 2015

Background

Dermatofibrosarcoma protuberans (DFSP) is a rare tumor that grows with tentacle‐like projections. In particular, on the scalp this could explain the frequent incomplete resections and the high rate of multiple local recurrences. Adequate pre‐ and postoperative imaging methods to visualize these prolongations are required to determine the extent of the tumor and to intercept recurrences in a short time base.

Methods

A retrospective study was performed on two cases of multiple recurrent scalp DFSP. The use of diffusion‐weighted imaging (DWI) for pre‐ and postoperative assessment of DFSP was evaluated.

Results

Diffusion‐weighted imaging magnetic resonance imaging was able to visualize the horizontal extent of tumor prolongations in the periosteum. Also, residual tumor tissue was distinguished from scar tissue in a large area of previous surgical interventions.

Conclusion

We found DWI magnetic resonance imaging a valuable tool in planning the multidisciplinary therapeutic approach and follow‐up of DFSP on the scalp.
Adverse cutaneous drug reactions in a single quaternary referral hospital
Authors: Botelho Luciane F.F. , Porro Adriana M. , Enokihara Milvia M.S.S. , Tomimori Jane
Published: December 2015

Background

Adverse cutaneous drug reactions are frequent in hospital settings and are responsible for increased morbidity, mortality, and socioeconomic costs. The objective of this study was to identify high risk factors in hospitalized patients with adverse cutaneous drug reactions.

Methods

This descriptive and retrospective study was performed with data from 117 patients admitted to a quaternary hospital over 44 months. We reviewed their epidemiological data, suspected drugs, clinical presentation, histopathological diagnosis, and outcome. Statistical analysis was performed using the chi‐squared test with a significance level of 5%.

Results

Anticonvulsants were responsible for 23.9% of cases followed by antibiotics (22.2%). In 29% of cases, patients were taking multiple medications that could have triggered their reactions. The most common clinical forms were exanthema (37.6%), drug reaction with eosinophilia and systemic symptoms (DRESS) (14.5%), and Stevens–Johnson syndrome/toxic epidermal necrolysis (12.8%). Anticonvulsants were associated with severe forms of adverse drug reactions. Most patients (89.7%) presented clinical improvement after treatment. There was a relationship between the use of anticonvulsants and atypical lymphocytes in the dermal infiltrate, as well as the clinical form DRESS and atypical lymphocytes in the dermal infiltrate.

Conclusions

The use of anticonvulsants was a high risk factor for severe clinical forms of drug reactions. The presence of atypical lymphocyte infiltrates in the dermis could indicate the use of anticonvulsants.
The influence of incontinence on the characteristic properties of the skin in bedridden elderly subjects
Authors: Fujimura Tsutomu , Makino Mayumi , Takagi Miyuki , Maki Kumiko , Murakami Emiko , Tasaka Yoshiko , Sato Noriko , Akiba Shunichi , Hotta Mitsuyuki , Kitahara Takashi , Ando Kikue
Published: December 2015

Background

The mechanisms of skin breakdown induced by incontinence have been proposed from a variety of experimental studies. However, studies on the influence of skin properties caused by incontinence of bedridden subjects are very limited.

Objective

This work was conducted to reveal how incontinence influences skin properties by comparing bedridden incontinent elderly subjects with age‐matched healthy continent elderly and middle‐aged subjects.

Methods

Bedridden incontinent elderly subjects (n = 35, 83.5 ± 9.7 years, mean age ± SD), healthy continent elderly (n = 41, 75.9 ± 5.6 years), and middle‐aged (n = 20, 41.3 ± 2.8 years) were recruited for this study. Skin surface pH, capacitance/hydration, transepidermal water loss, and bacteria on forearm and buttock skin were measured.

Results

Hydration and transepidermal water loss values between healthy elderly subjects and incontinent elderly subjects were significantly different on buttock skin. Significant differences between those two groups were also observed regarding pH and total bacteria levels on buttock skin. The forearm skin showed no significant difference in these parameters. No significant influence was observed between with and without urination at the measurement time except for the pH of buttock skin. No significant correlation was observed except between pH and bacteria levels on buttock skin of incontinent elderly subjects.

Conclusion

In this study, we clarified the characteristic features of skin induced by incontinence. Our results indicate that these parameters are adequate not only to evaluate the characteristic skin features of bedridden incontinent subjects but also to develop new diapers to avoid the diaper dermatitis caused by incontinence.
Dark chocolate exacerbates acne
Authors: Vongraviopap Saivaree , Asawanonda Pravit
Published: December 2015

The effects of chocolate on acne exacerbations have recently been reevaluated. For so many years, it was thought that it had no role in worsening acne. To investigate whether 99% dark chocolate, when consumed in regular daily amounts, would cause acne to worsen in acne‐prone male subjects, twenty‐five acne prone male subjects were asked to consume 25 g of 99% dark chocolate daily for 4 weeks. Assessments which included Leeds revised acne scores as well as lesion counts took place weekly. Food frequency questionnaire was used, and daily activities were recorded. Statistically significant changes of acne scores and numbers of comedones and inflammatory papules were detected as early as 2 weeks into the study. At 4 weeks, the changes remained statistically significant compared to baseline. Dark chocolate when consumed in normal amounts for 4 weeks can exacerbate acne in male subjects with acne‐prone skin.
The ability of quaternary ammonium groups attached to a urethane bandage to inhibit bacterial attachment and biofilm formation in a mouse wound model
Authors: Tran Phat L , Huynh Eric , Hamood Abdul N , de Souza Anselm , Schultz Gregory , Liesenfeld Bernd , Mehta Dilip , Webster Daniel , Reid Ted W
Published: December 2015

For proper wound healing, control of bacteria or bacterial infections is of major importance. While caring for a wound, dressing material plays a key role as bacteria can live in the bandage and keep re‐infecting the wound. They do this by forming biofilms in the bandage, which slough off planktonic bacteria and overwhelm the host defense. It is thus necessary to develop a wound dressing that will inhibit bacterial growth. This study examines the effectiveness of a polyurethane foam wound dressing bound with polydiallyl‐dimethylammonium chloride (pDADMAC) to inhibit the growth of bacteria in a wound on the back of a mouse. This technology does not allow pDADMAC to leach away from the dressing into the wound, thereby preventing cytotoxic effects. Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii were chosen for the study to infect the wounds. S. aureus and P. aeruginosa are important pathogens in wound infections, while A. baumannii was selected because of its ability to acquire or upregulate antibiotic drug resistance determinants. In addition, two different isolates of methicillin‐resistant S. aureus (MRSA) were tested. All the bacteria were measured in the wound dressing and in the wound tissue under the dressing. Using colony‐forming unit (CFU) assays, over six logs of inhibition (100%) were found for all the bacterial strains using pDADMAC‐treated wound dressing when compared with control‐untreated dressing. The CFU assay results obtained with the tissues were significant as there were 4–5 logs of reduction (100%) of the test organism in the tissue of the pDADMAC‐covered wound versus that of the control dressing‐covered wound. As the pDADMAC cannot leave the dressing (like other antimicrobials), this would imply that the dressing acts as a reservoir for free bacteria from a biofilm and plays a significant role in the development of a wound infection.
Elderly patients hospitalized in the ICU in France: a population‐based study using secondary data from the national hospital discharge database
Authors: Fassier Thomas , Duclos Antoine , Abbas‐Chorfa Fatima , Couray‐Targe Sandrine , West T Eoin , Argaud Laurent , Colin Cyrille
Published: December 2015

Rationale, aims and objectives

In the global context of population ageing, understanding and monitoring intensive care use by the elderly is a strategic issue. National‐level data are needed to overcome sampling biases that often limit epidemiologic studies of the critically ill elderly. The objective of this study was to describe intensive care use for hospitalized elderly patients using secondary data from the French national hospital discharge database.

Method

Structured assessment of the national database coverage and accuracy; cross‐sectional analysis of hospitalizations including at least one admission in an intensive care unit (ICU) for patients aged ≥ 80 years from 1 January to 31 December 2009.

Results

In 2009, people aged ≥ 80 years accounted for 5.4% of the population but 15.3% of the 215 210 adult hospitalizations involving intensive care in France. In this elderly group, the mean age was 84.0 (± 3.56) years, and 51.6% were male. In‐hospital mortality was 33.9%. The median time spent in the ICU was 3 [interquartile range (IQR), 2–8] days, the median time spent in hospital was 14 (IQR, 8–24) days and 9% of hospitalizations ended by the patient's death involved intensive care. A surgical procedure was included in 43% of hospitalizations. Medical and surgical diagnosis‐related group hospitalizations were characterized by significant differences in volume, mortality, ICU days and costs.

Conclusions

There was marked clinical heterogeneity in the population of elderly patients hospitalized in the ICU. These data provide baseline information and prompt further studies comparing intensive care utilization across age groups, between countries and over time.
How defining clinical practices may influence their evaluation: the case of continuous sedation at the end of life
Authors: Raus Kasper , Sterckx Sigrid
Published: December 2015

Rationale, aims and objectives

Continuous sedation at the end of life is an end‐of‐life practice that has gained considerable attention in the international literature. Nevertheless, significant confusion persists, even on how to label or define the practice. Several different terms and definitions exist, and these are often non‐neutral and indicative of one's normative position on sedation at the end of life. This is problematic for two reasons. First, the use of such value‐laden terms or definitions of continuous sedation may make it difficult, if not impossible, to agree on the facts surrounding continuous sedation. Second, including normative criteria in a definition can lead one to make disguised circular or tautological statements.

Methods

This paper identifies commonly used terms and definitions and demonstrates how particular elements present in these are value‐laden and can influence the ethical evaluation of continuous sedation at the end of life.

Results

Two commonly used terms, ‘palliative sedation’ and ‘terminal sedation’, have been strongly criticized. We propose to use another, more descriptive term, namely ‘continuous sedation at the end of life’. As regards the different definitions of sedation, some are general, but most contain very specific elements, thereby clearly limiting the number of cases that are covered by the definition. Some definitions of sedation include the intention one should (not) have, the possible indications for the practice, and the type of patients the practice should be reserved for.

Conclusion

Including value‐laden elements in the very definition of a clinical practice runs the risk of pre‐empting a proper normative debate about the practice. We explain why this is the case and why it is problematic, and we propose an alternative, descriptive, definition that seeks to avoid these problems.