bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhaled and systemic corticosteroid response in severe asthma assessed by alveolar nitric oxide: a randomized crossover pilot study of add‐on therapy
Authors: Williamson Peter A. , Short Philip M. , Vaidyanathan Sriram , Lipworth Brian J.
Published: May 2012

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Extra fine inhaled corticosteroid formulations such as HFA beclomethasone may be used to target the small airways in asthma. However, it is unclear which outcome measures may detect such small airways effects in patients with severe asthma.

WHAT THIS STUDY ADDS

• The alveolar fraction of exhaled nitric oxide is not a sensitive outcome measure for following effects of extra fine particle inhaled beclomethasone in severe asthma. However there were significant effects on nitric oxide fractions measured at 50 ml s−1 and bronchial flux with the extra fine formulation, which did not produce significant cortisol suppression.

AIMS Alveolar nitric oxide (CANO) is a potential biomarker of small airway inflammation. We investigated effects on CANO of the addition of coarse and fine particle inhaled corticosteroids to standard therapy in severe asthma.

METHODS Severe asthmatics taking ≥1600 µg day−1 budesonide or equivalent performed a randomized open‐label crossover study. Subjects with FEV1 < 80%, gas trapping and CANO≥2 ppb entered a 6 week dose‐ramp run‐in of fluticasone/salmeterol(FPSM) 250/50 µg twice daily for 3 weeks, then 500/50 µg twice daily for 3 weeks. Patients then received additional HFA‐beclomethasone diproprionate (BDP) 200 µg twice daily or FP 250 µg twice daily for 3 weeks in a crossover. Participants then received prednisolone(PRED) 25 mg day−1 for 1 week. Nitric oxide, lung function, mannitol challenge, systemic inflammatory markers and urinary cortisol were measured.

RESULTS Fifteen completed per protocol: mean (SD) age 51 (12) years, FEV1 58 (13)% predicted, residual volume 193 (100)% predicted and mannitolPD10 177 (2.8) µg. There was no significant difference between FPSM and add‐on therapy for CANO. FPSM/BDP and FPSM/PRED suppressed broncial flux (JawNO) and FENO compared with FPSM alone, but there was no significant difference between FPSM/BDP and FPSM/FP. ECP, e‐selectin and ICAM‐1 were suppressed by FPSM/PRED compared with FPSM and FPSM/FP but not FPSM/BDP. Plasma cortisol was significantly suppressed by FPSM/PRED.

CONCLUSION In severe asthma, CANO is insensitive to changes in dose and delivery of inhaled corticosteroids and is not suppressed by systemic corticosteroids. Additional inhaled HFA‐BDP reduced FENO and JawNO without adrenal suppression. There was a trend to reduction in FENO and JawNO with additional FP but this did not reach statistical significance. PRED reduced FENO and JawNO with suppression of systemic inflammatory markers and urinary cortisol.
Functional deficits of pertussis-specific CD4+ T cells in infants compared to adults following DTaP vaccination
Authors: Sharma S K , Pichichero M E
Published: May 2012

Understanding the immune responses that explain why infants require multiple doses of pertussis vaccine to achieve protection against infection is a high priority. The objective of this study was to compare the function and phenotypes of antigen-specific CD4+ T cells in adults (n = 12), compared to infants (n = 20), following vaccination with acellular pertussis (DTaP) vaccine. Peripheral blood mononuclear cells (PBMCs) were stimulated with pertussis toxoid (PT), pertactin (PRN) and filamentous haemagglutinin (FHA). Multi-parameter flow cytometry was used to delineate CD4+ T cell populations and phenotypes producing interferon (IFN)-γ, interleukin (IL)-2, tumour necrosis factor (TNF)-α and IL-4. Based on surface CD69 expression, infants demonstrated activation of vaccine antigen-specific CD4+ T cells similar to adults. However, among infants, Boolean combinations of gates suggested that type 1 (Th-1) CD4+ T cell responses were confined largely to TNF-α+IL-2+IFN-γ– or TNF-α+IL-2–IFN-γ–. A significantly lower percentage of polyfunctional T helper type 1 (Th1) responses (TNF-α+IFN-γ+IL-2+) and type 2 (Th2) responses (IL-4) were present in the infants compared to adults. Moreover, a significantly higher percentage of infants' functional CD4+ T cells were restricted to CD45RA–CCR7+CD27+ phenotype, consistent with early-stage differentiated pertussis-specific memory CD4+ T cells. We show for the first time that DTaP vaccination-induced CD4+ T cells in infants are functionally and phenotypically dissimilar from those of adults.
Sleep timing may modulate the effect of sleep loss on testosterone
Authors: Schmid Sebastian M. , Hallschmid Manfred , Jauch‐Chara Kamila , Lehnert Hendrik , Schultes Bernd
Published: May 2012

Background

Sleep loss has been shown to reduce secretory activity of the pituitary–gonadal axis in men, but the determinants of this effect are unknown.

Objective

To discriminate the effects of sleep duration and sleep timing on serum concentrations of luteinizing hormone (LH), testosterone (T) and prolactin (PRL).

Methods

Fifteen young, healthy men (27·1 ± 1·3 years; BMI, 22·9 ± 0·3 kg/m2) were examined in a condition of sleep time restriction to 4 h (bedtime, 02:45 –07:00 h) for two consecutive nights and in a control condition of 8 h regular sleep (bedtime, 22:45–07:00 h). After the second night, serum concentrations of LH, T and PRL were monitored over a 15‐h period. In addition, these hormones were measured in serum samples obtained in a further experiment in eight healthy men (24·5 ± 1·1 years; BMI, 23·7 ± 0·6 kg/m2) in the morning after one night of total sleep deprivation, of 4·5 h sleep (bedtime, 22:30–03:30 h), and of regular 7 h sleep (bedtime, 22:30–06:00 h).

Results

Serum LH, T and PRL concentrations showed characteristic diurnal variations across the 15‐h period without any differences between the 4‐ and 8‐h sleep conditions. However, total sleep deprivation and 4·5 h of sleep restricted to the first night‐half markedly decreased morning T and PRL concentrations (both P ≤ 0·05).

Conclusion

Collectively, our data suggest that the effect of sleep restriction on pituitary–gonadal secretory activity may be modulated by sleep timing. While sleep loss in the early part of the night does not affect T and PRL, early awakening and wakefulness during the second part of the night reduces morning circulating T and PRL concentrations.
Pathophysiology of thrombosis and pregnancy morbidity in the antiphospholipid syndrome
Authors: Oku Kenji , Amengual Olga , Atsumi Tatsuya
Published: May 2012

Eur J Clin Invest 2012; 42 (10): 1126–1135

In patients with the antiphospholipid syndrome (APS), the presence of a group of pathogenic autoantibodies called antiphospholipid antibodies causes arteriovenous thrombosis and pregnancy complications. To date, the pathogenicity of the antiphospholipid antibodies has been the focus of analysis. Recently, the antibodies were reported to be capable of direct cell activation, and research on the underlying mechanism is ongoing. The antiphospholipid antibodies bind to the membranes of vascular endothelial cells, monocytes and platelets, provoking tissue factor expression and platelet aggregation. This activation functions as intracellular signalling, independent of the cell type, to activate p38MAPK and the transcription factor NFκB. Currently, there are multiple candidates for the membrane receptors of the antiphospholipid antibodies that are being tested for potential in specific therapy. Recently, APS was reported to have significant comorbidity with complement activation, and it was proposed that this results in placental damage and cell activation and, therefore, could be the primary factor for the onset of pregnancy complications and thrombosis. The detailed mechanism of complement activation remains unknown; however, an inflammation‐inducing substance called anaphylatoxin, which appears during the activation process of the classical complement pathway, is thought to be a key molecule. Complement activation occurs in tandem, regardless of the pathology of APS or the type of antiphospholipid antibody, and it is thought that this completely new understanding of the mechanism will contribute greatly to comprehension of the pathology of APS.
Prenatal and postnatal parental effects on immunity and growth in ‘lactating’ pigeons
Authors: Jacquin Lisa , Blottière Lydie , Haussy Claudy , Perret Samuel , Gasparini Julien
Published: May 2012

1. Parental effects can have profound consequences on offspring phenotype. Still, little is known about the relative influence of prenatal versus postnatal parental effects of parasite exposure of parents on offspring traits.

2. In this study, we investigated the respective role of a prenatal and a postnatal immune challenge of parent feral pigeons (Columba livia) on offspring humoral immunity, growth and survival. We used a cross‐fostering design and antigen injections in biological and foster parents. Feral pigeons are particularly suitable for studying the effects of parental immune challenges because they can affect the phenotype of their young through the transmission of prenatal antibodies in the egg and postnatal antibodies in the ‘crop milk’, a substance produced in the crop of both parents.

3. Results show that a prenatal immune challenge of biological parents with keyhole limpet haemocyanin (KLH) antigen decreased the humoral response against KLH of nestlings injected at 14 days of age. In contrast, a postnatal immune challenge of foster parents with KLH enhanced the humoral response of 1‐year‐old juveniles exposed to a second KLH injection, but only when these juveniles had received their first injection at 3 days of age.

4. No effect on nestling and juvenile response to another antigen (NDV) was observed, indicating that the changes in humoral responses were specific to the KLH injected in parents. In addition to this, prenatal and postnatal parental immune challenges had an interaction effect on fledging body mass, but no effect on juvenile survival.

5. This study shows that pre‐ and postnatal exposure to antigens in parents has contrasted effects on offspring humoral response and growth. Moreover, it shows that the timing of an early exposure to antigens in nestlings has important effects on their specific humoral response.

6. This study thus suggests that pre‐ and postnatal parental effects have distinct roles in shaping the phenotype of the offspring on different time scales and calls for further investigations on the potential adaptive role of combined parental effects. Moreover, it suggests that pigeon milk has positive effects on offspring humoral immunity and thus could potentially have a similar immune role as mammalian milk.
Discovered on gastrointestinal stromal tumours 1 (DOG1) expression in non‐gastrointestinal stromal tumour (GIST) neoplasms
Authors: Hemminger Jessica , Iwenofu O Hans
Published: May 2012

Hemminger J & Iwenofu O H  (2012) Histopathology 61, 170–177

Discovered on gastrointestinal stromal tumours 1 (DOG1) expression in non‐gastrointestinal stromal tumour (GIST) neoplasms

Aims:  To further characterize discovered on GIST1 (DOG1) antibody clone K9 expression in a broad range of mesenchymal and epithelial tumours.

Methods and results:  Formalin‐fixed paraffin‐embedded sections of various tumours were stained with the anti‐DOG1 monoclonal antibody clone K9. The tumours (n = 187) included: gastrointestinal stromal tumours (GISTs) (n = 20); malignant melanoma (n = 19); schwannoma (n = 10); neurofibroma (n = 10); leiomyosarcoma (n = 10); low‐grade fibromyxoid sarcoma (n = 5); angiosarcoma, (n = 10); epithelioid sarcoma (n = 5); clear cell sarcoma (n = 3); synovial sarcoma (n = 10); malignant peripheral nerve sheath tumour (MPNST) (n = 12); alveolar soft part sarcoma (n = 3); chordoma (n = 5); pleomorphic undifferentiated sarcoma (n = 5); perineurioma (n = 4); granular cell tumour (n = 6); acinic cell carcinoma (n = 5); adenocarcinoma, lung (n = 5), colon (n = 10), endometrioid (n = 10), prostate (n = 10) and renal cell (n = 10). Nineteen of 20 GISTs expressed DOG‐1 and 12 of 20 were diffusely positive (≥95%) with moderate to strong intensity. There was focal, predominantly luminal staining of colorectal (three of 10), endometrioid (four of 10) and acinic cell carcinomas (four of five). One case each of spindle cell/desmoplastic melanoma (2+), schwannoma (trace) and MPNST (2+) showed DOG‐1 expression.

Conclusions:  Our study supports that DOG‐1 is a highly sensitive and specific marker for GISTs and also highlights hitherto unrecognized and unusual patterns of expression in non‐mesenchymal neoplasms.
Hepatic sinusoidal obstruction syndrome (SOS) reduces the effect of oxaliplatin in colorectal liver metastases
Authors: Vreuls Celien P H , Van Den Broek Maartje A , Winstanley Alison , Koek Ger H , Wisse Eddie , Dejong Cornelis H , Olde Damink Steven W M , Bosman Fred T , Driessen Ann
Published: May 2012

Vreuls C P H, Van Den Broek M A, Winstanley A, Koek G H, Wisse E, Dejong C H, Olde Damink S W M, Bosman F T & Driessen A  (2012) Histopathology 61, 314–318

Hepatic sinusoidal obstruction syndrome (SOS) reduces the effect of oxaliplatin in colorectal liver metastases

Aims:  Oxaliplatin is an important chemotherapeutic agent used to reduce hepatic colorectal metastases, resulting in tumour reduction and permitting surgical resection. This treatment has significant side effects, as oxaliplatin can induce sinusoidal obstruction syndrome (SOS) in the non‐tumour‐bearing liver, resulting in increased morbidity. We hypothesized that SOS might impede hepatic perfusion, thereby interfering with the tumour environment and attenuate the response to the chemotherapy.

Methods and results:  From the prospective database of the Maastricht University Medical Centre we collected 50 patients with hepatic colorectal carcinoma metastases. All patients received neo‐adjuvant oxaliplatin followed by partial hepatectomy. Metastases and non‐tumour‐bearing liver were studied histopathologically. Thirty‐two of 50 (64%) patients showed SOS lesions, classified as mild (26%) and moderate–severe (38%). The response to treatment, as expressed in the tumour regression grade (TRG), was grade 1 (10%); grade 2 (14%); grade 3 (28%); grade 4 (32%) and grade 5 (16%). Statistical analysis showed that a higher grade of SOS was associated with a higher grade of TRG (P = 0.016).

Conclusion:  Developing SOS is associated with a lower tumour response to neo‐adjuvant oxaliplatin treatment. Hepatic hypoperfusion due to sinusoidal obstruction syndrome might induce hepatic hypoxia, diminishing the response to chemotherapy.
Involvement of α‐ and β‐catenins and E‐cadherin in the development of mammary phyllodes tumours
Authors: Tsang Julia Y S , Mendoza Paulo , Lam Christopher C F , Yu Alex M C , Putti Thomas C , Karim Rooshdiya Z , Scolyer Richard A , Lee Cheok Soon , Tan Puay Hoon , Tse Gary M
Published: May 2012

Tsang J Y S, Mendoza P, Lam C C F, Yu A M C, Putti T C, Karim R Z, Scolyer R A, Lee C S, Tan P H & Tse G M  (2012) Histopathology 61, 667–674

Involvement of α‐ and β‐catenins and E‐cadherin in the development of mammary phyllodes tumours

Aims:  Phyllodes tumours (PT) are rare but clinically important fibroepithelial tumours of the breast. β‐Catenin, a key component in Wnt signalling, has been shown to be important in the development of PT. It also functions as a component of the cadherin complex, which may therefore be implicated in PT pathogenesis. By assessing stromal α‐catenin, β‐catenin and E‐cadherin expression in 158 PT cases using immunohistochemistry and examining associations with clinicopathological features, we aimed to determine the role of these proteins in PT pathogenesis.

Methods and results:  Cytoplasmic β‐catenin correlated with α‐catenin expression. A significantly higher expression of both markers was observed in borderline than in benign PT (P = 0.003 and <0.001, respectively), but a lower level was found in malignant PT. Cytoplasmic E‐cadherin expression was significantly higher in borderline and malignant than in benign PT (P = 0.001 and 0.012, respectively), but was not correlated with other markers. Both E‐cadherin and α‐catenin showed stronger correlations with histological parameters than β‐catenin. α‐Catenin showed a significant correlation with recurrence (P = 0.005 and 0.016, respectively).

Conclusions:  α‐ and β‐catenins may be important in the early stages of PT development, while E‐cadherin may be required for malignant development. The correlation of α‐catenin expression with tumour recurrence may be relevant in predicting PT behaviour.
Mothers’ online message board questions about parenting infants and toddlers
Authors: Porter Noriko , Ispa Jean M.
Published: May 2012

porter n. & ispa j.m. (2013) Mothers’ online message board questions about parenting infants and toddlers. Journal of Advanced Nursing69(3), 559–568. doi: 10.1111/j.1365‐2648.2012.06030.x

Aim.  To report a study conducted to explore childrearing concerns through an analysis of online parenting message boards managed by popular parenting magazines.

Background.  Increasingly, mothers appear to be turning to the Web for childrearing advice and support. However, no previous studies have examined the childrearing concerns of mothers of infants and toddlers through the analysis of online message board postings.

Design.  Ethnographic content analysis methods were used to analyse the online postings.

Methods.  A total of 120 messages posted in 2007 by mothers of 0–2 year olds on the websites of two best‐selling parenting magazines in the United States were submitted to ethnographic content analysis. Each message pertained to one or more of six childrearing domains: Feeding/Eating, Sleep, Development, Discipline, Toilet‐Training and Mother–Child Relationships.

Results.  Questions and pleas for support were most prominently centred on feeding/eating and sleep issues. Mothers expressed concerns about when and how their children should begin to sleep and eat independently. In addition to the themes specific to particular domains, across‐domain themes were identified involving mothers’ parenting stress, questioning of advice from families/paediatricians and worries that children were not developing normally.

Conclusion.  Online forums have become a space where mothers can openly describe their own negative emotions towards parenting and ask questions or gain reassurance to resolve mixed messages about how one should rear infants and toddlers. Paediatric nurses should be aware that mothers are confused about conflicting messages, especially in the domains of sleeping and eating. Reviewing parenting message boards occasionally would give nurses continuing insight into common parenting concerns.
Analysis of scientific truth status in controlled rehabilitation trials
Authors: Kerry Roger , Madouasse Aurélien , Arthur Antony , Mumford Stephen D.
Published: May 2012

Rationale, aims and objectives  Systematic reviews, meta‐analyses and clinical guidelines (reviews) are intended to inform clinical practice, and in this sense can be thought of as scientific truthmakers. High‐quality controlled trials should align to this truth, and method quality markers should predict truth status. We sought to determine in what way controlled trial quality relates to scientific truth, and to determine predictive utility of trial quality and bibliographic markers.

Method  A sample of reviews in rehabilitation medicine was examined. Two scientific truth dimensions were established based on review outcomes. Quality and bibliographic markers were extracted from associated trials for use in a regression analysis of their predictive utility for trial truth status. Probability analysis was undertaken to examine judgments of future trial truth status.

Results  Of the 93 trials included in contemporaneous reviews, overall, n = 45 (48%) were true. Randomization was found more in true trials than false trials in one truth dimension (P = 0.03). Intention‐to‐treat analysis was close to significant in one truth dimension (P = 0.058), being more commonly used in false trials. There were no other significant differences in quality or bibliographic variables between true and false trials. Regression analysis revealed no significant predictors of trial truth status. Probability analysis reported that the reasonable chance of future trials being true was between 2 and 5%, based on a uniform prior.

Conclusions  The findings are at odds with what is considered gold‐standard research methods, but in line with previous reports. Further work should focus on scientific dynamics within healthcare research and evidence‐based practice constructs.
Diagnosis and management of acute coronary syndrome in an outpatient setting: good guideline adherence in Swiss primary care
Authors: Tandjung Ryan , Senn Oliver , Rosemann Thomas , Loy Monika
Published: May 2012

Background  Switzerland lacks of national guidelines for the initial treatment of an acute coronary syndrome (ACS). ACS is not as frequent in an outpatient setting as in an emergency department; nevertheless, missing an ACS is associated with high morbidity and mortality. We wanted to observe actual infrastructure and performance based on case vignettes in outpatient general practitioners (GPs) and cardiologists (CAs); as a second outcome, we wanted to compare GPs to CAs.

Methods  We conducted a postal vignette‐based survey to investigate the management of outpatients presenting with acute chest pain by doctors in private practice. The use of troponin and cardiac stress testing for the evaluation of acute chest pain as well as referral practice and use of antiplatelet agents were assessed and compared between GPs and CAs.

Results  There were 507 of the 571 respondents (response rate 39.7%) who were CAs (36) or GPs (471) and were included in the analysis. Whereas all CAs were equipped with electrocardiogram (ECG), cardiac stress testing and troponin assays, the majority of GPs had an ECG (97.8%) and applied troponin testing (76.3%), and 38.7% performed cardiac stress testing. The vast majority responded to directly refer a STEMI to the next catheter lab (87.7%), or in the case of a troponin‐positive NSTEMI, to an inpatient ward (94.1%) with no difference between GPs and CAs. A majority of the GPs responded to use antiplatelet agents in the case of a STEMI (89.6%) and reported further workup with cardiac stress testing in the case of a troponin‐negative acute chest pain (78.7%), which was lower compared to CAs who applied antiplatelet agents and cardiac stress testing in 100% and 97.0%.

Conclusions  We could show that international guideline adherence in ACS of GPs is high and GPs perform as well as CAs. Nevertheless there is room for optimization in the antiplatelet therapy and the use of cardiac stress testing in a low‐risk population. National guidelines for treatment of an ACS in an outpatient setting are indicated.
The influence of clinical evidence on surgical practice
Authors: Honeybul S. , Ho K. M.
Published: May 2012

Given the considerable interest in the use of evidence‐based medicine to guide clinical practice, it is surprising that the results of a recent randomized controlled trial have been met with such a limited response. The DECompressive CRAniectomy study investigators have recently published the results of a landmark trial in neurosurgery, comparing early decompressive craniectomy with standard medical therapy in patients who developed intracranial hypertension after diffuse closed traumatic brain injury (TBI). This is the first ever randomized controlled trial investigating the surgical management of adult patients with severe TBI. The trial clearly demonstrated that early decompression did not provide clinical benefit; however, rather than having a significant impact on clinical practice, it has been almost uniformly criticized. While there were some problems with randomization and crossover, we feel that the trial has been somewhat misinterpreted and in this article we address some of the key issues.
The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP©) for use by healthcare staff
Authors: McCarthy H. , Dixon M. , Crabtree I. , Eaton‐Evans M. J. , McNulty H.
Published: May 2012

McCarthy H., Dixon M., Crabtree I., Eaton‐Evans M. J. & McNulty H. (2012) The development and evaluation of the Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP©) for use by healthcare staff.J Hum Nutr Diet.25, 311–318

Background: The early identification of malnutrition and nutrition risk through nutrition screening is common practice in adult clinical care but, in children, this has been hampered by the lack of an appropriate nutrition screening tool. The present study aimed to develop and evaluate a simple, child‐specific nutrition screening tool for administration by non‐nutrition healthcare professionals.

Methods: In a two‐phase observational study, significant predictors of nutrition risk were identified using a structured questionnaire. These were then combined to produce a nutrition screening tool. For evaluation purposes, the reliability, sensitivity and specificity of the newly‐developed Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP©) were estimated by comparing the classification of nutrition risk using the tool with that determined by a full nutritional assessment by a registered dietitian.

Results: A total of 122 children were recruited for development phase and a separate cohort of 238 children was recruited for the evaluation phase. Low percentile weight for age, reported weight loss, discrepancy between weight and height percentile and recently changed appetite were all identified as predictors of nutrition risk. These predictors, together with the expected nutrition risk of clinical diagnoses, were combined to produce STAMP©. Evaluation of STAMP©demonstrated fair to moderate reliability in identifying nutrition risk compared to the nutrition risk classification determined by a registered dietitian (κ = 0.541; 95% confidence interval = 0.461–0.621). Sensitivity and specificity were estimated at 70% (51–84%) and 91% (86–94%), respectively.

Conclusions: The present study describes the development and evaluation of a new nutrition screening tool specifically for use in a UK general paediatric inpatient population.
Genetic structure in a fragmented Northern Hemisphere rainforest: large effective sizes and high connectivity among populations of the epiphytic lichenLobaria pulmonaria
Authors: HILMO OLGA , LUNDEMO SVERRE , HOLIEN HÅKON , STENGRUNDET KIRSTI , STENØIEN HANS K.
Published: May 2012

An extraordinary diversity of epiphytic lichens is found in the boreal rainforest of central Norway, the highest‐latitude rainforest in the world. These rainforest relicts are located in ravine systems, and clear cutting has increased the distance between remaining patches. We hypothesized that the relatively small lichen populations in the remaining forest stands have suffered a depletion of genetic diversity through bottlenecks and founder events. To test this hypothesis, we assessed genetic diversity and structure in the populations of the tripartite lichenLobaria pulmonariausing eight SSR loci. We sampled thalli growing onPicea abiesbranches and propagules deposited in snow at three localities. Contrary to expectations, we found high genetic diversity in lichen and snow samples, and high effective sizes of the studied populations. Also, limited genetic differentiation between populations, high historical migration rates, and a high proportion of first generation immigrants were estimated, implying high connectivity across distances <30 km. Almost all genetic variation was attributed to variation within sites; spatial genetic structures within populations were absent or appeared on small scales (5–10 m). The high genetic diversity in the remaining old boreal rainforests shows that even relict forest patches might be suitable for conservation of genetic diversity.
Coalescence patterns of endemic Tibetan species of stream salamanders (Hynobiidae: Batrachuperus)
Authors: LU BIN , ZHENG YUCHI , MURPHY ROBERT W. , ZENG XIAOMAO
Published: May 2012

Orogenesis of topographically diverse montane regions often drives complex evolutionary histories of species. The extensive biodiversity of the eastern edge of the Tibetan Plateau, which gradually decreases eastwardly, facilitates a comparison of historical patterns. We use coalescence methods to compare species of stream salamanders (Batrachuperus) that occur at high and low elevations. Coalescent simulations reveal that closely related species are likely to have been influenced by different drivers of diversification. Species living in the western high‐elevation region with its northsouth extending mountains appear to have experienced colonization via dispersal followed by isolation and divergence. In contrast, species on the eastern low‐elevation region, which has many discontinuous mountain ranges, appear to have experienced fragmentation, sometimes staged, of wide‐ranging ancestral populations. The two groups of species appear to have been affected differently by glaciation. High‐elevation species, which are more resistant to cooler temperatures, appear to have experienced population declines as recently as the last glaciation (0.016–0.032 Ma). In contrast, salamanders dwelling in the warmer and wetter habitats at low‐elevation environs appear to have been affected less by the relatively recent, milder glaciation, and more so by harsher, extensive glaciations (0.5–0.175 Ma). Thus, elevation, topography and cold tolerance appear to drive evolutionary patterns of diversification and demography even among closely related taxa. The comparison of multiple species in genealogical analyses can lead to an understanding of the evolutionary drivers.
Development of a Prenatal Psychosocial Screening Tool for Post‐Partum Depression and Anxiety
Authors: McDonald Sheila , Wall Jennifer , Forbes Kaitlin , Kingston Dawn , Kehler Heather , Vekved Monica , Tough Suzanne
Published: May 2012

McDonald S, Wall J, Forbes K, Kingston D, Kehler H, Vekved M, Tough S. Development of a prenatal psychosocial screening tool for post‐partum depression and anxiety. Paediatric and Perinatal Epidemiology 2012; ••: ••–••.

Background:  Post‐partum depression (PPD) is the most common complication of pregnancy in developed countries, affecting 10–15% of new mothers. There has been a shift in thinking less in terms of PPD per se to a broader consideration of poor mental health, including anxiety after giving birth. Some risk factors for poor mental health in the post‐partum period can be identified prenatally; however prenatal screening tools developed to date have had poor sensitivity and specificity. The objective of this study was to develop a screening tool that identifies women at risk of distress, operationalized by elevated symptoms of depression and anxiety in the post‐partum period using information collected in the prenatal period.

Methods:  Using data from the All Our Babies Study, a prospective cohort study of pregnant women living in Calgary, Alberta (N = 1578), we developed an integer score‐based prediction rule for the prevalence of PPD, as defined as scoring 10 or higher on the Edinburgh Postnatal Depression Scale (EPDS) at 4‐months postpartum.

Results:  The best fit model included known risk factors for PPD: depression and stress in late pregnancy, history of abuse, and poor relationship quality with partner. Comparison of the screening tool with the EPDS in late pregnancy showed that our tool had significantly better performance for sensitivity. Further validation of our tool was seen in its utility for identifying elevated symptoms of postpartum anxiety.

Conclusion:  This research heeds the call for further development and validation work using psychosocial factors identified prenatally for identifying poor mental health in the post‐partum period.
High‐resolution MRI demonstrates detailed anatomy of the axillary brachial plexus. A pilot study
Authors: KJELSTRUP T. , COURIVAUD F. , KLAASTAD Ø. , BREIVIK H. , HOL P. K.
Published: May 2012

Background

Axillary block is the most commonly performed brachial plexus block and may be guided by nerve stimulation or ultrasound. Magnetic resonance imaging (MRI) has proven to be beneficial in presenting anatomy of interest for regional anaesthesia and in demonstrating spread of local anaesthetic. The aim of this pilot study was to demonstrate the anatomy as shown by MRI of the brachial plexus in the axillary region.

Methods

Nine volunteers and nine patients were examined in a 3.0 Tesla MR. The patients had two different brachial plexus blocks. Subsequently, they were scanned by MRI and finally tested clinically for block efficacy before operation. Axial images, with and without local anaesthetics injected, were viewed in a sequence loop to identify the anatomy.

Results

With the high‐resolution MRI, we obtained images of good quality, and cords and all terminal nerves could be identified. When local anaesthetics are injected, neurovascular structures are displaced, and the vein is compressed. Viewing the images in a sequence loop facilitates identification of the different nerves and has high instructive value (links S1–3 to these loops are enclosed).

Conclusion

Clinical high‐field 3.0 Tesla MRI scanner gives good visualization of brachial plexus in the axilla. The superior ability to detect local anaesthetics after it has been injected and the multiplanar imaging capability make MRI a useful tool in studies of the brachial plexus.
Impact of shed blood products on stimulated cytokine release in an in vitro model of transfusion
Authors: SCHNEIDER S. O. , BIEDLER A. E. , BEHMENBURG F. , VOLK T. , RENSING H.
Published: May 2012

Background

Blood transfusion is reported to suppress the recipient's immune system. To avoid allogenic transfusion, post‐operative shed blood retransfusion is a commonly used method. The aim of this study was to investigate the dose‐related impact of post‐operatively collected shed blood products on the stimulated cytokine release in an in vitro model of transfusion.

Methods

Venous blood samples obtained from 20 patients undergoing hip arthroplasty were mixed with post‐operatively collected unprocessed, processed, and irradiated shed blood as well as normal saline as a control. Shed blood was processed by centrifugation and separating the cellular fraction from the soluble fraction and washing the cellular fraction with phosphate buffered saline to eliminate any cell fragments and other substances. Mixing ratios were 1 : 3, 1 : 1, and 3 : 1. Endotoxin‐stimulated release of Tumor Necrosis Factor‐alpha (TNF‐α) was measured after 24 h of culture by enzyme‐linked immunosorbent assay.

Results

Unprocessed, irradiated shed blood and the soluble fraction caused a significant suppression of stimulated TNF‐α release compared to control. The addition of the cellular shed blood fraction had no significant influence on the TNF‐α release compared to control.

Conclusion

Shed blood and its components caused a dose‐independent immunomodulation as indicated by a suppressed stimulated TNF‐α release. Leukocytes seem to play a minor role, as we observed a sustained suppression after transfusion of γ‐irradiated shed blood. Only the elimination of soluble factors by centrifugation and followed by an additional washing step prevented the observed suppression of TNF‐α. Thus, we assume that washing of shed blood can prevent potential detrimental effects.
Wellness program for anesthesiology residents: a randomized, controlled trial
Authors: SAADAT H. , SNOW D. L. , OTTENHEIMER S. , DAI F. , KAIN Z. N.
Published: May 2012

Background

Multiple reports illustrate the deleterious effects of stress on physicians’ mental and physical health, as well as on patient care. This study evaluates the effects of a wellness program on anesthesiology residents’ well‐being.

Methods

Sixty residents were randomly assigned to one of three groups: (1) wellness intervention group, (2) no‐treatment control with release time, and (3) no‐treatment control with routine duties. Coping, stressors, social support, psychological symptoms, and alcohol and tobacco use were measured using a pre‐test–post‐test design.

Results

Residents in the wellness program reported significantly fewer stressors in their role as parent, increased social support at work, greater problem‐solving coping, and less anxiety as compared with one or both of the control groups. Findings related to reducing avoidance coping and alcohol consumption also were suggestive of positive intervention effects.

Conclusions

An intervention to increase the use of active coping and social support, to reduce reliance on avoidance coping, and to decrease work and family stressors had an overall pattern of beneficial effects on residents’ well‐being. The importance of offering such programs during residency training, ways to strengthen intervention effectiveness, and areas for future research are discussed.
High‐frequency TENS in post‐episiotomy pain relief in primiparous puerpere: A randomized, controlled trial
Authors: Pitangui Ana Carolina Rodarti , de Sousa Ligia , Gomes Flávia Azevedo , Ferreira Cristine Homsi Jorge , Nakano Ana Márcia Spanó
Published: May 2012

Aim:  We evaluated the effectiveness of high‐frequency transcutaneous electrical nerve stimulation (TENS) as a pain relief resource for primiparous puerpere who had experienced natural childbirth with an episiotomy.

Methods:  A controlled, randomized clinical study was conducted in a Brazilian maternity ward. Forty puerpere were randomly divided into two groups: TENS high frequency and a no treatment control group. Post‐episiotomy pain was assessed in the resting and sitting positions and during ambulation. An 11‐point numeric rating scale was performed in three separate evaluations (at the beginning of the study, after 60 min and after 120 min). The McGill pain questionnaire was employed at the beginning and 60 min later. TENS with 100 Hz frequency and 75 µs pulse for 60 min was employed without causing any pain. Four electrodes ware placed in parallel near the episiotomy site, in the area of the pudendal and genitofemoral nerves.

Results:  An 11‐point numeric rating scale and McGill pain questionnaire showed a significant statistical difference in pain reduction in the TENS group, while the control group showed no alteration in the level of discomfort. Hence, high‐frequency TENS treatment significantly reduced pain intensity immediately after its use and 60 min later.

Conclusion:  TENS is a safe and viable non‐pharmacological analgesic resource to be employed for pain relief post‐episiotomy. The routine use of TENS post‐episiotomy is recommended.
Is there any association between retroperitoneal lymphadenectomy and survival benefit in advanced stage epithelial ovarian carcinoma patients?
Authors: Sakai Kotaro , Kajiyama Hiroaki , Umezu Tomokazu , Shibata Kiyosumi , Mizuno Mika , Suzuki Shiro , Kawai Michiyasu , Nagasaka Tetsuro , Kikkawa Fumitaka
Published: May 2012

Aim:  The effect of systematic retroperitoneal lymphadenectomy (SRL) remains controversial in patients with advanced epithelial ovarian cancer (aEOC) who are optimally debulked.

Material and Methods:  Demographic and clinicopathologic data were obtained from the Tokai Ovarian Tumor Study Group between 1986 and 2009. All patients were divided into two groups. Group A (n = 93): (i) patients did not undergo SRL; and (ii) lymph node exploration or sampling was optional. Group B (n = 87): patients underwent SRL. Survival curves were calculated using the Kaplan–Meier method. Differences in survival rates were analyzed using the log–rank test.

Results:  All pT3–4 aEOC patients were optimally debulked (residual tumor <1 cm). The median age was 55 years (range: 18–84). The 5‐year progression‐free survival (PFS) rates of groups A and B were 46.7 and 41.9%, respectively (P = 0.658). In addition, the 5‐year overall survival (OS) rates were 62.9 and 59.0%, respectively (P = 0.853). Subsequently, there was no significant difference in OS and PFS in the two groups stratified to histological type (serous or non‐serous type). Furthermore, there was no significant difference in recurrence rates in retroperitoneal lymph nodes regardless of completion of lymphadenectomy.

Conclusion:  Our data suggest that aEOC patients with optimal cytoreduction who underwent SRL did not show a significant improvement in survival irrespective of each histological type.
Shakuyaku‐kanzo‐to inhibits smooth muscle contractions of human pregnant uterine tissue in vitro
Authors: Tsuji Shoko , Yasuda Katsuhiko , Sumi Genichiro , Cho Hisayuu , Tsuzuki Tomoko , Okada Hidetaka , Kanzaki Hideharu
Published: May 2012

Aim:  Shakuyaku‐kanzo‐to (SK) is a herbal medicine and is known to possess an antispasmodic effect on skeletal muscle and intestinal smooth muscle. However, it is unclear whether SK is effective in antagonizing uterine smooth muscle contractions. Herein, we investigated the effects of SK on smooth muscle contractions of human pregnant uterine samples.

Material and Methods:  We prepared myometrial strips from uterine tissues of pregnant women who underwent cesarean section for obstetrical indications, and examined the inhibitory effects of SK and its components, shakuyaku (S) and kanzo (K), on agonist‐induced and spontaneous contractions in vitro. Oxytocin, prostaglandinF2α, and high KCl were utilized as agonists in this study.

Results:  SK inhibited agonist‐induced and spontaneous contractions in a dose‐dependent manner. Inhibition of SK on oxytocin‐induced contractions occurred at a concentration of 100 µg/mL and reached maximum effect at a concentration of more than 1000 µg/mL. The half max inhibitory concentration of SK was approximately 440 µg/mL in oxytocin‐induced contractions. SK at 1000 µg/mL completely inhibited the oxytocin‐ and prostaglandinF2α‐induced contractions but not the high KCl‐induced contractions. The inhibitory effects on agonist‐induced contractions of K, but not S, matched those of SK.

Conclusion:  These results suggest that the inhibitory effect of SK on smooth muscle contractions is due to K. The mechanism of the inhibitory effects of SK on oxytocin‐ and prostaglandinF2α‐induced contractions may differ from that on KCl‐induced contractions.
Early‐onset group B streptococcal disease following culture‐based screening in Japan: A single center study
Authors: Miyata Akane , Takahashi Hironori , Kubo Takahiko , Watanabe Noriyoshi , Tsukamoto Keiko , Ito Yushi , Sago Haruhiko
Published: May 2012

Aim:  We investigated trends in early‐onset group B streptococcal disease (EOD) after the introduction of culture‐based screening in Japan.

Material and Methods:  A retrospective cohort study examined EOD trends in 9506 pregnancies and 10 715 neonates at our center from 2002 to 2009.

Results:  EOD occurred in four neonates (4/7332: 0.55/1000 live births). The EOD incidence among infants born to women positive for GBS by screening was 0.90 cases per 1000 live births (1/1107). In contrast, the EOD incidence among infants negative by GBS screening was 0.48 cases per 1000 live births (3/6225). Thus, of the four affected neonates, three had mothers who tested negative on antepartum GBS screening. Two neonates had symptoms of infection during labor and intrapartum antibiotic agents were administered. The other two neonates received no antibiotics because deliveries were uneventful and they were negative on GBS screening.

Conclusion:  The incidence of EOD is 0.90 cases per 1000 live births among GBS‐positive women and 0.48 cases per 1000 live births among GBS‐negative women. The results of our study implied that EOD can develop regardless of GBS screening and intrapartum clinical course, although the method of sample collection, indications for antibiotic prophylaxis, and the antibiotics regimen should be considered.
Retrospective evaluation of tumor markers in ovarian mature cystic teratoma and ovarian endometrioma
Authors: Kataoka Taeko , Watanabe Yoh , Hoshiai Hiroshi
Published: May 2012

Aim:  The aim of this study was to evaluate the correlation between clinicopathological characteristics and serum levels of tumor markers in patients with ovarian endometrioma (OE) and ovarian mature cystic teratoma (MCT).

Material and Methods:  Values of CA125, CA19‐9, and sialyl Tn antigen (STN) were retrospectively investigated in 321 patients with OE. CA125, CA19‐9, STN, and squamous cell carcinoma antigen (SCC) were examined in 435 patients with MCT.

Results:  Mean values of CA125, CA19‐9, and STN were 105.3 U/mL, 58.0 U/mL, and 31.1 U/mL in OE, while the values were 26.8 U/mL, 246.8 U/mL, and 24.7 U/mL in MCT. Abnormal elevation of CA125, CA19‐9, and STN was observed in 53.3%, 38.9, and 13.5 of OE, and in 12.9, 50.6, and 4.6% of MCT, respectively. CA125 level was significantly higher in bilaterally occurring OE and premenopausal patients with MCT, while the value of CA19‐9 was significantly higher in cases of bilaterally occurring MCT. Furthermore, the levels of CA125 and CA19‐9 showed significant correlations with tumor diameter, while the levels of STN and SCC showed no significant correlations with tumor diameter. The highest CA125 level (9513 U/mL) was observed in OE and the highest CA19‐9 level (25 590 U/mL) was observed in MCT.

Conclusion:  Although abnormal increases in the levels of CA125 and CA19‐9 were often observed, the levels of STN were not influenced by clinicopathologic factors in OE and MCT. Further studies of the clinical usefulness of STN for detecting malignant tumors in OE and MCT are needed.
Xanthogranulomatous salpingitis and oophoritis associated with endometriosis and uterine leiomyoma presenting as intestinal obstruction
Authors: Abeysundara Prabath K. , Padumadasa Goluhewage S. , Tissera Warnakulasooriya G. M. , Wijesinghe Prasantha S.
Published: May 2012

Xanthogranulomatous inflammation is a rare form of chronic granulomatous inflammation. Bacterial infections, immunosuppression, chronic inflammatory conditions, luminal obstruction, endometriosis, leiomyoma, abnormal lipid metabolism, ineffective antibiotic therapy, ineffective clearance of bacteria by phagocytes and chronic irritation of the urachal remnant have been implicated in the pathogenesis. There are very few reported cases of xanthogranulomatous salpingitis and oophoritis. We present such a case in a 34‐year‐old female, with primary subfertility for eight years, endometriosis, uterine leiomyoma, type II diabetes mellitus and a history of surgery for endometriosis and fibroids and surgical wound infection, who presented with symptoms of intestinal obstruction. The patient underwent emergency laparotomy followed by total abdominal hysterectomy and bilateral salpingo‐oophorectomy. Histology revealed xanthogranulomatous salpingitis and oophoritis. Chronic inflammation due to inadequate treatment of bacterial infection, coupled with pelvic endometriosis and uterine leiomyoma may have led to xanthogranulomatous salpingitis and oophoritis.