bluuebunny/crossref_metadata_2025 huggingface dataset:
Antibiotic Eluting Chitosan Glycerophosphate Implant in the Setting of Acute Bacterial Sinusitis: A Rabbit Model
Authors: Bleier Benjamin S. , Kofonow Jennifer M. , Hashmi Nazish , Chennupati Sri K. , Cohen Noam A.
Published: March 2010

Background

Topical therapy offers the potential for treatment of sinonasal disease with minimal systemic side effects. Chitosan glycerophosphate (CGP) is a mucoadhesive polymer that can be used as an antibiotic eluting sinonasal implant in the treatment of sinusitis. The purpose of this study was to assess the potential for CGP as an antibiotic impregnated implant in a rabbit model of acute bacterial sinusitis.

Methods

The Institutional Animal Care and Use Committee approved study of acute bacterial sinusitis in 12 New Zealand white rabbits using either Pseudomonas aeruginosa (n = 6) or Staphylococcus aureus (n = 6). CGP impregnated with 50 mg of either gentamicin or vancomycin was bilaterally implanted in two rabbits in each arm, respectively. The sinuses were irrigated with saline for 4 days and the lavage was collected for colony-forming unit (CFU) determination. Within each group, the CFU log reduction in the lavage was compared with that of rabbits receiving saline alone (n = 2) or a daily 80-microgram/mL gentamicin or vancomycin irrigation (n = 2) and analyzed using a Student's t-test.

Results

Within the S. aureus group, the CFU log reduction using CGP + vancomycin (–2.57 ± 0.21) was greater than vancomycin irrigation (–1.66 ± 0.5; p = NS) and significantly greater than saline alone (2.46 ± 0.97; p = 0.018). Within the P. aeruginosa group, the CFU log reduction using the CGP + gentamicin (–4.62 ± 0.74) was greater than gentamicin irrigation (–4.09 ± 0.70) and saline alone (–1.90 ± 0.90); however, the results were not significant. In all rabbits receiving the CGP + antibiotic implant, no viable bacteria were present in the lavage by day 4.

Conclusion

Placement of a single antibiotic impregnated CGP implant in the setting of an acute Gram-positive or Gram-negative bacterial sinusitis resulted in a greater log reduction of CFU than daily antibiotic irrigation and led to complete sterilization of the lavage within 4 days.
Long-Term Effects of Rapid Maxillary Expansion on Nasal Area and Nasal Airway Resistance
Authors: Matsumoto Mírian Aiko Nakane , Itikawa Carla Enoki , Pereira Valera Fabiana Cardoso , Faria Gisele , Anselmo-Lima Wilma Terezinha
Published: March 2010

Background

Rapid maxillary expansion (RME) may improve the nasal respiratory pattern. This study was performed to evaluate the effect of RME on the nasal cavity by acoustic rhinometry and computed rhinomanometry and to determine nasal and maxillary width by posteroanterior cephalometric radiography, up to 30 months after the orthodontic procedure.

Methods

Twenty-seven children with oral breathing, ranging in age from 7 to 10 years, and with mixed dentition were selected. The children had unior bilateral posterior crossbite involving deciduous canines and the first permanent molars. All subjects were submitted to nasofibroscopy, acoustic rhinometry, and computed rhinomanometry and posteroanterior cephalometric radiography at four different times, i.e., before expansion, immediately, 90 days and 30 months after expansion.

Results

The mean linear left-to-right nasal cavity lateral prominence and left-to-right jugal points cephalometric measures increased considerably after expansion and this increase was maintained throughout the period of evaluation. There was an immediate significant decrease in nasal resistance, up to 90 days after RME, but the nasal resistance increased 30 months after the procedure. The acoustic rhinometry results did not show any difference in values throughout time.

Conclusion

RME significantly increased nasal and maxillary width as measured by frontal cephalometry, but the nasal mucosal effects were more subtle. Also, the influence of RME on nasal resistance was not stable, and nasal resistance values returned to close to the initial ones after 30 months.
Endoscopic Surgery for Juvenile Angiofibroma: A Critical Review of Indications after 46 Cases
Authors: Nicolai Piero , Villaret Andrea Bolzoni , Farina Davide , Nadeau Sylvie , Yakirevitch Arkadi , Berlucchi Marco , Galtelli Cristina
Published: March 2010

Background

At present, transnasal endoscopic surgery is considered a viable option in the management of small–intermediate size juvenile angiofibromas (JAs). The authors critically review their 14-year experience in the management of this lesion to refine selection criteria for an endoscopic approach.

Methods

From January 1994 to May 2008, 46 patients were treated by a pure endoscopic resection after vascular embolization (87%). The lesions were classified according to Andrews (Andrews JC, et al., The surgical management of extensive nasopharyngeal angiofibromas with the infratemporal fossa approach, Laryngoscope 99:429–437, 1989) and Önerci (Önerci M, et al. Juvenile nasopharyngeal angiofibroma: A revised staging system, Rhinology 44:39–45, 2006) staging systems. All patients were followed by regular endoscopic and magnetic resonance imaging (MRI) examinations.

Results

Lesions were classified as follows: stage I, n = 5; stage II, n = 24; stage IIIa, n = 14; stage IIIb, n = 3 according to Andrews classification system; stage 1, n = 9; stage II, n = 12; stage III, n = 26 according to Önerci's system. Unilateral blood supply was detected in 39 (85%) cases. Feeding vessels from the internal carotid artery (ICA) were also reported in 14 (30%) patients. Intraoperative blood loss ranged from 250 to 1300 mL (mean, 580 mL). In four (8.7%) cases, suspicious residual disease was detected by MRI. In one patient, a 1-cm persistent lesion was endoscopically removed because septoplasty was required and a slight increase in size was noticed. The other three lesions, all located in the root of the pterygoid plate, are nearly stable in size and are currently under MRI follow-up.

Conclusion

The improvement of surgical instrumentation and the experience acquired during a 14-year period have contributed to expanding the indications for endoscopic surgery in the management of JAs. Even stage III lesions may be successfully managed, unless the ICA is encased or if it provides an extensive blood supply. An external approach may be required when critical structures such as the ICA, cavernous sinus, or optic nerve are involved by lesions that are persistent after previous treatment; such a situation may prevent safe and radical dissection with a pure endoscopic approach. Better understanding of the factors influencing the growth of residual lesions is needed to differentiate those requiring re-treatment from those which can be simply observed.
Dietary Polyphenols Affect Muc5Ac Expression and Ciliary Movement in Respiratory Cells and Nasal Mucosa
Authors: Chang Jung Hyun , Song Kee Jae , Kim Hyun-Jun , Kim Jeong Hong , Kim Na Hyun , Kim Kyung-Su
Published: March 2010

Background

Dietary polyphenols have been widely consumed in food, and their anti-inflammatory and anticancer activities have been recently studied. Although the effects of dietary polyphenols on mucin hypersecretion have been studied to some extent, the effects of mucociliary movement have not been elucidated thus far. Therefore, we investigated whether dietary polyphenols inhibit MUC5AC gene expression in NCI-H292 cells, and, if so, whether they would have an effect on ciliary beat frequency (CBF) of human nasal mucosa.

Methods

NCI-H292 cells were pretreated with four different dietary polyphenols ([6]-gingerol, epigallocatechin gallate (EGCG), curcumin, and quercetin) and were treated with IL-1beta (10 ng/mL). Proliferation of NCI-H292 cells was analyzed. The mRNA expression of MUC5AC was determined by real-time polymerase chain reaction. CBF of normal nasal mucosa, which was obtained from the ethmoid sinus and treated with the polyphenols, was assessed via inverted microscope and computerized program.

Results

Minimal inhibitory concentration (MIC) of MUC5AC expression of each polyphenol was found as follows: [6]-gingerol, 1 μM; EGCG, 20 μM; quercetin, 40 μM; and curcumin, 10 μM. No polyphenol influenced cell proliferation at this MIC. CBF was not affected by [6]-gingerol, quercetin, or EGCG, but ciliary movement decreased in curcumin.

Conclusion

[6]-Gingerol, quercetin, and EGCG may be considered as antihypersecretory agents because they effectively inhibit mucus secretion of respiratory epithelial cells while maintaining normal nasal ciliary movement.
Endoscopic Diode Laser Polypectomy and High-Dose Intranasal Steroids in Recurrent Nasal Polyposis
Authors: Caffier Philipp P. , Neumann Konrad , Enzmann Harald , Paschen Christian , Scherer Hans , Göktas Önder
Published: March 2010

Background

The aim of this clinical investigation was to determine the outcomes of an outpatient videoendoscopic diode laser polypectomy (DLPE) and subsequent topical high-dose corticosteroid application in chronic rhinosinusitis with recurrent nasal polyposis (NP).

Methods

After ineffective revision sinus surgery and prolonged mometasone furoate application, 19 consecutive mild and moderate NP patients suffering from nasal obstruction (NO) and olfactory dysfunction (OD) were prospectively entered into the study to undergo DLPE under topical anesthesia. Beginning 1 week postoperatively, 250 μg of beclomethasone dipropionate aerosol spray (BDPAS) was self-administered into each nostril twice a day. Treatment efficacy was assessed after 1, 6, and 12 weeks and at quarterly long-term follow-ups based on objective parameters (videoendoscopic photodocumentation and rhinomanometry) and subjective evaluation of NO, OD, and satisfaction (visual analog scales [VASs]).

Results

VASs indicated very low values for intraoperative pain and discomfort and high postoperative satisfaction. After 6 weeks, subjective and objective data revealed a significant improvement of NO and OD (p < 0.0005). Topical BDPAS application was well tolerated. At a median follow-up of 32 months (range, 1–4 years), 21% of the patients developed NP disappearance, 53% had a stable disease, and 26% had a progressive disease.

Conclusion

In therapy-refractory NP, endonasal DLPE represents a minimally invasive, symptom-oriented, safe and easily reapplicable outpatient treatment option that provides effective improvement of NO and OD. Compared with the pre-DLPE period, the proposed long-term quarterly follow-up combined with high-dose topical BDPAS application might reduce or delay the need for major surgery and appears to be suitable for disease control.
An English Window on the Huguenot Struggle for Recognition: Nicolas Des Gallars and the Colloquy of Poissy
Authors: Olson Jeannine
Published: March 2010

Abstract:

The English had a unique window on the Colloquy of Poissy in 1561 through the Parisian pastor of the French-speaking congregation of the Stranger Church in London, Nicolas de Gallars, lately a pastor of Geneva and a delegate to the colloquy, which was a gathering, called by the French Crown, of Reformed pastors, meeting with Catholic prelates to try to reach agreement that would avoid wars of religion in France. It failed at that but was a step ahead in the Huguenot struggle for recognition in France. Des Gallars's letters to the English ambassador to France, Nicolas Throckmorton, provided the English with information on the closed meetings of the colloquy and copies of the major presentations. Besides his unedited letters, Des Gallars wrote an account of the proceedings, which was published in English by “J.D.”
The predictive power of balloon shape and change of sensory functions on outcome of percutaneous balloon compression for trigeminal neuralgia
Authors: Asplund Pär , Linderoth Bengt , Bergenheim A. Tommy
Published: March 2010

Object

Percutaneous balloon compression is a simple and effective treatment of trigeminal neuralgia. However, results between and within different series are varying. To further improve the results in terms of pain relief, the authors believe that a careful study of the surgical procedure is important. The object of this study was to analyze the impact of balloon shape, balloon position, balloon volume, and compression time on duration of the therapeutic effect following percutaneous balloon compression. Furthermore, they analyzed the sensory side effects associated with this treatment, and how these relate to surgical parameters.

Methods

Medical records and intraoperative radiographs from 87 balloon compressions were reviewed, and different surgical parameters were categorized. Univariate and multivariate analyses were performed to correlate surgical parameters to pain relief. Sensory testing with a transcutaneous electrical stimulation technique and clinical examination data were reviewed to analyze changes in sensory function.

Results

The balloon shape had a significant impact on time to recurrence of pain. A pear-shaped balloon resulted in a far better surgical result than a non–pear-shaped balloon (p < 0.001). The difference between a distinct and a less distinct pear shape was not significant (p = 0.14). Statistical significance was not reached for any of the other parameters in relation to duration of therapeutic effect. A pear-shaped balloon was also significantly associated with increased thresholds for percutaneous electrical stimulation in the immediate postoperative period, but the perception thresholds were normalized at the late follow-up at 3–9 months. A similar outcome was found for clinical testing with light touch and pinprick.

Conclusions

The authors have demonstrated that using a pear-shaped balloon when performing percutaneous balloon compression for trigeminal neuralgia results in longer pain relief than non–pear-shaped balloons. Other surgical parameters seemed less important with respect to pain relief. Balloon compression also, in many cases, results in hypesthesia.
Posttreatment prognosis of patients with esthesioneuroblastoma
Authors: Kane Ari J. , Sughrue Michael E. , Rutkowski Martin J. , Aranda Derick , Mills Steve A. , Buencamino Raphael , Fang Shanna , Barani Igor J. , Parsa Andrew T.
Published: March 2010

Object

There is no Class I evidence to guide the appropriate management of esthesioneuroblastoma (EN). Most data currently guiding treatment come from small- or modest-sized series gathered at individual centers that have concluded that surgery with radiotherapy is the preferred treatment. In this study, the authors summarize the published literature on treatment outcomes in patients with EN. The objective was to ascertain what variables predict prognosis in these patients and to determine the relative effect of different therapies.

Methods

The authors identified 205 published studies containing treatment outcomes for surgery, radiotherapy, chemotherapy, or multimodal treatment. Using Kaplan-Meier analysis, the survival of patients who received surgery was compared with that in those who received surgery and radiotherapy. Additionally, Kadish staging was compared with low- and high-grade Hyams criteria to assess for subgroup prognostic significance in survival differences.

Results

Nine hundred fifty-six patients met the inclusion criteria, with a median follow-up time of 3 years. Kaplan-Meier analysis demonstrated no difference in survival between patients who underwent surgery alone and those who underwent surgery plus radiotherapy at 5 years (78 vs 75%) or 10 years (67 vs 61%, respectively) (p = 0.3). Univariate analysis demonstrated worse survival in cases involving Kadish Grade C tumors, Hyams Grade 3 and 4 tumors, and in patients older than 65 years of age. Multivariate analysis demonstrated that Hyams Grade 3 and 4 lesions carried significant risk (proportional hazard = 4.83, p < 0.001) with 5- and 10-year survival of 47 and 31%.

Conclusions

A biopsy should always be obtained in cases suspected of EN because histology is a strong prognostic indicator and will help guide appropriate treatment. Unimodal surgery and combined surgery/radiotherapy appear to be of equivalent efficacy with respect to survival in patients with EN. Chemotherapy should be considered in high-grade EN.
Temporal neocortical origin of pilomotor seizures in association with an infiltrating glioma: a case confirmed by intracranial electroencephalography monitoring
Authors: Mittal Sandeep , Oni-Orisan Akinwunmi , Stenz Justin , Shah Aashit K.
Published: March 2010

Patients with seizures occasionally present with autonomic symptoms. Pilomotor seizures are uncommon and usually accompanied by other manifestations of complex partial seizures of limbic origin. Activation of the central autonomic network appears to be necessary for the development of ictal goose bumps. Pilomotor seizures have been reported to originate in the temporal lobe and other medial limbic structures. Ictal piloerection can arise due to a variety of brain pathologies. Isolated pilomotor seizures are very rare. The authors present the first case in which intracranial electroencephalography monitoring was used to confirm pilomotor seizures of temporal neocortical origin in association with an infiltrating tumor.
Infected giant ophthalmic artery aneurysm remnant following craniotomy for surgical clip ligation
Authors: Haque Atif , Raisanen Jack M. , Barnett Samuel L. , Samson Duke S.
Published: March 2010

Postoperative intracranial infections, although found in only a minority of surgical cases, remain a recognized potential complication following elective craniotomy. In the treatment of intracranial aneurysms, specifically, reports of significant postoperative infections are rare. Significant postoperative infections are usually observed in association with foreign bodies, such as aneurysm clips, endovascular coils, or materials used for aneurysm wrapping. The authors present a case in which a patient underwent craniotomy for surgical clip ligation of a giant ophthalmic artery aneurysm without resection of the aneurysm mass; the patient then presented again approximately 4 months later with a first-time seizure. Following a second craniotomy for resection of the aneurysm mass, the aneurysm contents were noted on pathological examination to contain gram-positive rods, and the aneurysm wall was noted to contain inflammatory cells. Although cultures were not obtained, Propionibacterium acnes was detected using polymerase chain reaction. To the best of the authors' knowledge, this case represents the second reported case of an intraaneurysmal abscess and the first reported instance of a presumed secondary infection of a giant intracranial aneurysm remnant following surgical clip ligation.
The Essential Toxin: Impact of Zinc on Human Health
Authors: Plum Laura M. , Rink Lothar , Haase Hajo
Published: March 2010

Compared to several other metal ions with similar chemical properties, zinc is relatively harmless. Only exposure to high doses has toxic effects, making acute zinc intoxication a rare event. In addition to acute intoxication, long-term, high-dose zinc supplementation interferes with the uptake of copper. Hence, many of its toxic effects are in fact due to copper deficiency. While systemic homeostasis and efficient regulatory mechanisms on the cellular level generally prevent the uptake of cytotoxic doses of exogenous zinc, endogenous zinc plays a significant role in cytotoxic events in single cells. Here, zinc influences apoptosis by acting on several molecular regulators of programmed cell death, including caspases and proteins from the Bcl and Bax families. One organ where zinc is prominently involved in cell death is the brain, and cytotoxicity in consequence of ischemia or trauma involves the accumulation of free zinc. Rather than being a toxic metal ion, zinc is an essential trace element. Whereas intoxication by excessive exposure is rare, zinc deficiency is widespread and has a detrimental impact on growth, neuronal development, and immunity, and in severe cases its consequences are lethal. Zinc deficiency caused by malnutrition and foods with low bioavailability, aging, certain diseases, or deregulated homeostasis is a far more common risk to human health than intoxication.
Compactness Aromaticity of Atoms in Molecules
Authors: Putz Mihai V.
Published: March 2010

A new aromaticity definition is advanced as the compactness formulation through the ratio between atoms-in-molecule and orbital molecular facets of the same chemical reactivity property around the pre- and post-bonding stabilization limit, respectively. Geometrical reactivity index of polarizability was assumed as providing the benchmark aromaticity scale, since due to its observable character; with this occasion new Hydrogenic polarizability quantum formula that recovers the exact value of 4.5 a03 for Hydrogen is provided, where a0 is the Bohr radius; a polarizability based–aromaticity scale enables the introduction of five referential aromatic rules (Aroma 1 to 5 Rules). With the help of these aromatic rules, the aromaticity scales based on energetic reactivity indices of electronegativity and chemical hardness were computed and analyzed within the major semi-empirical and ab initio quantum chemical methods. Results show that chemical hardness based-aromaticity is in better agreement with polarizability based-aromaticity than the electronegativity-based aromaticity scale, while the most favorable computational environment appears to be the quantum semi-empirical for the first and quantum ab initio for the last of them, respectively.
Combating Combination of Hypertension and Diabetes in Different Rat Models
Authors: Rosenthal Talma , Younis Firas , Alter Ariela
Published: March 2010

Rat experimental models are used extensively for studying physiological mechanisms and treatments of hypertension and diabetes co-existence. Each one of these conditions is a major risk factor for cardiovascular disease (CVD), and the combination of the two conditions is a potent enhancer of CVD. Five major animal models that advanced our understanding of the mechanisms and therapeutic approaches in humans are discussed in this review: Zucker, Goto-Kakizaki, SHROB, SHR/NDmcr-cp and Cohen Rosenthal diabetic hypertensive (CRDH) rats. The use of various drugs, such as angiotensin-converting enzyme (ACE) inhibitors (ACEIs), various angiotensin receptor blockers (ARBs), and calcium channel blockers (CCBs), to combat the effects of concomitant pathologies on the combination of diabetes and hypertension, as well as the non-pharmacological approach are reviewed in detail for each rat model. Results from experiments on these models indicate that classical factors contributing to the pathology of hypertension and diabetes combination—Including hypertension, hyperglycemia, hyperinsulinemia and hyperlipidemia—can now be treated, although these treatments do not completely prevent renal complications. Animal studies have focused on several mechanisms involved in hypertension/diabetes that remain to be translated into clinical medicine, including hypoxia, oxidative stress, and advanced glycation. Several target molecules have been identified that need to be incorporated into a treatment modality. The challenge continues to be the identification and interpretation of the clinical evidence from the animal models and their application to human treatment.
In/Out Status Monitoring in Mobile Asset Tracking with Wireless Sensor Networks
Authors: Kim Kwangsoo , Chung Chin-Wan
Published: March 2010

A mobile asset with a sensor node in a mobile asset tracking system moves around a monitoring area, leaves it, and then returns to the region repeatedly. The system monitors the in/out status of the mobile asset. Due to the continuous movement of the mobile asset, the system may generate an error for the in/out status of the mobile asset. When the mobile asset is inside the region, the system might determine that it is outside, or vice versa. In this paper, we propose a method to detect and correct the incorrect in/out status of the mobile asset. To solve this problem, our approach uses data about the connection state transition and the battery lifetime of the mobile node attached to the mobile asset. The connection state transition is used to classify the mobile node as normal or abnormal. The battery lifetime is used to predict a valid working period for the mobile node. We evaluate our method using real data generated by a medical asset tracking system. The experimental results show that our method, by using the estimated battery life time or by using the invalid connection state, can detect and correct most cases of incorrect in/out statuses generated by the conventional approach.
A Time Tree Medium Access Control for Energy Efficiency and Collision Avoidance in Wireless Sensor Networks
Authors: Lee Kilhung
Published: March 2010

This paper presents a medium access control and scheduling scheme for wireless sensor networks. It uses time trees for sending data from the sensor node to the base station. For an energy efficient operation of the sensor networks in a distributed manner, time trees are built in order to reduce the collision probability and to minimize the total energy required to send data to the base station. A time tree is a data gathering tree where the base station is the root and each sensor node is either a relaying or a leaf node of the tree. Each tree operates in a different time schedule with possibly different activation rates. Through the simulation, the proposed scheme that uses time trees shows better characteristics toward burst traffic than the previous energy and data arrival rate scheme.
The Role of Peritoneal Lavage and the Prognostic Significance of Mesothelial Cell Area in Preventing Encapsulating Peritoneal Sclerosis
Authors: Yamamoto Tadashi , Nagasue Kyoko , Okuno Senji , Yamakawa Tomoyuki
Published: March 2010

♦ Background

Severe peritoneal injury and encapsulating peritoneal sclerosis (EPS) as complications of long-term peritoneal dialysis (PD) are issues of concern. The usefulness of peritoneal lavage after withdrawal of PD and the risk factors for EPS have not been addressed until now. Little is known about mesothelial cell area (MCA) in the effluent as a marker of peritoneal injury. In the present study, we investigated the clinical significance of peritoneal lavage after PD withdrawal and tried to clarify the risk factors related to MCA, with the aim of preventing EPS. We also developed an algorithm for the clinical management of long-term PD patients.

♦ Methods

We assigned 247 PD patients to one of two cohorts after PD withdrawal: a non-lavage group (73 patients) and a lavage group (174 patients). To clarify the risk factors, we studied these potential predictors: PD duration, dialysate-to-plasma ratio of creatinine (D/P Cr) at the time of PD withdrawal, frequency of peritoneal lavage, type of PD or lavage solution, MCA at the time of PD withdrawal (“PD area”), and MCA at the time of peritoneal lavage withdrawal or censoring (“LA area”). Recurrent intestinal obstruction was defined as the main manifestation of EPS. Diagnostic performance and cut-off values were then calculated for the selected risk factors.

♦ Results

The overall incidence of EPS was significantly lower in the lavage group, at 6.9% (5.2% during lavage and 2.5% after lavage), than in the non-lavage group, at 15.1%. The risk factors and cut-off values were PD area (350 μm2) and PD duration (78 months) for the non-lavage group; and PD area (350 μm2) and LA area (320 μm2) for the lavage group. Patients with a PD duration of 78 months or more and a PD area of 350 μm2 or more were defined as high-risk patients in the non-lavage group (risk ratio: 11.14), and patients with a PD area of 350 μm2 or more and an LA area of 320 μm2 or more were defined as high-risk patients in the lavage group (risk ratio: 10.43).

♦ Conclusions

Peritoneal lavage is effective in reducing the incidence of EPS after PD withdrawal. The PD duration and MCA are significant risk factors, and these markers are useful for classifying patients into low- and high-risk groups for the development of EPS.
Factors Associated with Blood Concentrations of Indoxyl Sulfate and p-Cresol in Patients Undergoing Peritoneal Dialysis
Authors: Lee Chien-Te , Kuo Chien-Chun , Chen Yu-Ming , Hsu Chung-Yao , Lee Wen-Chin , Tsai Yu-Che , Ng Hwee-Yeong , Kuo Li-Chueh , Chiou Terry Ting-Yu , Yang Yu-Kun , Cheng Ben-Chung , Chen Jin-Bor
Published: March 2010

Background

Accumulating evidence supports the important role of protein-bound uremic toxins such as indoxyl sulfate and p-cresol in uremic syndrome. They exert direct deleterious effects on a variety of cells and could link to clinical outcome. Factors relevant to indoxyl sulfate and p-cresol levels in peritoneal dialysis (PD) patients have rarely been investigated. We conducted a cross-sectional study to analyze the factors that correlate with both total and free indoxyl sulfate and p-cresol.

Methods

182 stable PD patients with mean PD therapy duration 38.5 ± 33.3 months were enrolled. Their mean age was 48.9 ± 13.5 years; 62.6% (114/182) were female patients. Demographic data, including age, gender, and PD therapy duration, were reviewed and recorded. PD-associated features such as residual kidney function (RKF), peritoneal transport property, and dialysis modality were also recorded. Hemoglobin, blood urea nitrogen (BUN), serum creatinine, C-reactive protein, interleukin (IL)-6, and IL-10 were measured. Levels of total and free indoxyl sulfate and p-cresol were determined.

Results

Patients without RKF had lower Kt/V and weekly creatinine clearance and higher serum creatinine and IL-6 levels. These patients also had higher total and free indoxyl sulfate levels. There was no difference in indoxyl sulfate or p-cresol levels compared to patients with different peritoneal transport properties or with different treatment modalities. Multivariate regression analysis revealed that weekly creatinine clearance and serum creatinine were independent associates of total indoxyl sulfate level; IL-6, total indoxyl sulfate, and free p-cresol were associated with free indoxyl sulfate level. Weekly creatinine clearance and free p-cresol level independently correlated with total p-cresol; while gender, total p-cresol, and free indoxyl sulfate were associated with free p-cresol level.

Conclusion

The free forms of indoxyl sulfate and p-cresol constituted a small portion of their total forms. The presence of RKF affected levels of free and total indoxyl sulfate. IL-6 level was significantly associated with free indoxyl sulfate level. There was a close relationship between indoxyl sulfate and p-cresol levels in their free forms in PD patients.
An evaluation of a psychosocial stress and coping model in the police work context
Authors: Louw Gerrit J. , Viviers Adriaan
Published: March 2010

Orientation: Stress is a social reality which does not exist in isolation, but in many social situations, especially work-related environments. Police officers in particular suffer from highly negative stress related outcomes.Research purpose: The purpose of the study was to determine how Moos's hypothesised stress and coping model (1994) fitted a sample of police officers.Motivation for the study: The study was an attempt to understand police officers' unique needs and how the frequency and/or intensity of perceived stress could be reduced so that they would be able to cope more effectively with stress.Research design, approach and method: A non-experimental survey design, following the quantitative tradition, was used in pursuit of the research objectives. A random sample of 505 participants was extracted from a population of serving male and female police officers reflecting the typical South African ethnic groups. Structural equation modelling (SEM) was used to establish the adequacy of between the hypothesised Moos model and the sample.Main findings: The hypothesised theoretical framework was disproved. A respecified model and inter-correlations confirm that some officers experience burnout, while, paradoxically, others continue to be unaffected because of the buffering effect of social support, personality factors and other resilience factors not revealed in this study.Practical/managerial implications: The study calls on police management for awareness of the negative health consequences of prolonged stressors. Simultaneously, employee assistance programmes could be directed to problem-solving strategies, perceived self-efficacy and learned resourcefulness to improve control over prolonged negative stress consequences among members.Contribution/value-add: This research provides a theoretical framework to understand, describe and assess individual well-being in the police work context.
Spatio-Temporal Patterns in kdr Frequency in Permethrin and DDT Resistant Anopheles gambiae s.s. from Uganda
Authors: Verhaeghen Katrijn , Bortel Wim Van , Roelants Patricia , Okello Paul Edward , Talisuna Ambrose , Coosemans Marc
Published: March 2010

The planned upscaling of vector control strategies requires insight into the epidemiological consequences of vector resistance. Therefore, the pyrethroid and DDT resistance status of Anopheles gambiae s.l. was assessed in Uganda from 2004 to 2006, and spatial and seasonal variations in knockdown resistance (kdr) frequencies were analyzed in terms of epidemiological significance. Anopheles gambiae s.l. was DDT and pyrethroid resistant in central and eastern Uganda. The L1014S kdr allele frequencies varied from 3% to 48% in An. gambiae s.s. Although the homozygous resistant genotype was the most prevalent genotype among survivors, the genotypes could not entirely explain the bioassay results. In the dry season, the kdr frequency was significantly higher in Plasmodium falciparum-infected mosquitoes, indicating that mosquitoes bearing a kdr mutation have a better adult survival, hence a higher likelihood of becoming infectious. This study showed that kdr might have an epidemiological impact that could jeopardize the vector control strategies.
Syndromic Diagnosis of Malaria in Rural Sierra Leone and Proposed Additions to the National Integrated Management of Childhood Illness Guidelines for Fever
Authors: Nnedu Obinna N. , Rimel Bryan , Terry Carey , Jalloh-Vos Heidi , Baryon Brima , Bausch Daniel G.
Published: March 2010

Many countries in Africa, including Sierra Leone, have adopted artemisinin-based combination therapy as first-line therapy for treatment of patients with malaria. Because laboratory testing is often unavailable in rural areas, the cost-benefit and viability of this approach may depend on accurately diagnosing malaria by using clinical criteria. We assessed the accuracy of syndromic diagnosis for malaria in three peripheral health units in rural Sierra Leone and determined factors that were associated with an accurate malaria diagnosis. Of 175 children diagnosed with malaria on syndromic grounds, 143 (82%) were confirmed by the Paracheck-Pf test. In a multivariate analysis, splenomegaly (P = 0.04) was the only clinical sign significantly associated with laboratory-confirmed malaria, and sleeping under a bed net was protective (P = 0.05). Our findings show that clinical malaria is diagnosed relatively accurately in rural Sierra Leone. Incorporating bed net use and splenomegaly into the national Integrated Management of Childhood Illness guidelines for evaluation of fever may further enhance diagnostic accuracy for malaria.
Treatment with Coartem (Artemether-Lumefantrine) in Papua New Guinea
Authors: Schoepflin Sonja , Lin Enmoore , Kiniboro Benson , DaRe Jeana T. , Mehlotra Rajeev K. , Zimmerman Peter A. , Mueller Ivo , Felger Ingrid
Published: March 2010

A recent drug efficacy trial reported Coartem (artemether-lumefantrine) to be highly effective against Plasmodium falciparum in children less than 5 years of age in Papua New Guinea (PNG). In contrast, we have observed high levels of treatment failures in non-trial conditions in a longitudinal cohort study in the same age group in PNG. Recrudescences were confirmed by genotyping of three different marker genes to provide optimal discrimination power between parasite clones. After excluding genetic host factors by genotyping potentially relevant cytochrome P450 loci, the high number of treatment failures in our study is best explained by poor adherence to complex dosing regimens in combination with insufficient fat supplementation, which are both crucial parameters for the outcome of Coartem treatment. In contrast to the situation in classic drug trials with ideal treatment conditions, our field survey highlights potential problems with unsupervised usage of Coartem in routine clinical practice and under program conditions.
Epidemiology of Spotted Fever Group and Typhus Group Rickettsial Infection in the Amazon Basin of Peru
Authors: Forshey Brett M. , Stewart Allison , Morrison Amy C. , Gálvez Hugo , Rocha Claudio , Astete Helvio , Eza Dominique , Chen Hua-Wei , Chao Chien-Chung , Montgomery Joel M. , Bentzel David E. , Ching Wei-Mei , Kochel Tadeusz J.
Published: March 2010

A seroprevalence study for IgG antibodies against spotted fever group (SFGR) and typhus group (TGR) Rickettsia among humans and domestic pets was conducted in the city of Iquitos, located in the Amazon basin of Peru. Of 1,195 human sera analyzed, 521 (43.6%) and 123 (10.3%) were positive for SFGR and TGR antibodies, respectively. District of residence and participant age were associated with antibody positivity for both groups, whereas rodent sightings in the home were associated with TGR antibody positivity. Of the 71 canines tested, 42 (59.2%) were positive for SFGR antibodies, and two (2.8%) were positive for TGR antibodies; one active SFGR infection was detected by polymerase chain reaction. An uncharacterized SFGR species was detected in 95.9% (71/74) of Ctenocephalides felis pools collected from domestic pets. These data suggest that rickettsial transmission is widespread in Iquitos. Rickettsia species should be further explored as potential causes of acute febrile illnesses in the region.
First Cases of Cutaneous Leishmaniasis Caused by Leishmania (Viannia) naiffi Infection in Surinam
Authors: van Thiel Pieter-Paul A. M. , Gool Tom van , Kager Piet A. , Bart Aldert
Published: March 2010

Cutaneous leishmaniasis in Surinam is generally caused by infection by Leishmania guyanensis. We report three cases of infection with Leishmania (Viannia) naiffi, a Leishmania species not described from Surinam before. Treatment with pentamidine proved to be effective.
Development of a Reverse Transcriptase Loop-Mediated Isothermal Amplification (LAMP) Assay for the Sensitive Detection of Leishmania Parasites in Clinical Samples
Authors: Adams Emily R. , Schoone Gerard J. , Ageed Al Farazdag , Safi Sayda El , Schallig Henk D. F. H.
Published: March 2010

Here we describe a generic, reverse transcriptase-loop-mediated isothermal amplification (RT-LAMP) assay, for the identification of Leishmania species from clinical samples. LAMP is an isothermal reaction recently developed as a point-of-care diagnostic tool. Primers were designed in the conserved region of the 18S ribosomal RNA (rRNA) gene; amplification was visualized by the pre-amplification addition of fluorescent detection reagent (FDR) and a simple UV lamp. By using a reverse-transcriptase step, the system detected infections between 10 and 100 parasites per mL. The assay was tested on a range of nucleic acid extracts from Leishmania species, visceral leishmaniasis (VL) patients from Sudan, and cutaneous leishmaniasis (CL) patients from Suriname. The sensitivity of RT-LAMP from the blood of VL patients was 83% (N = 30) compared with microscopy of bone-marrow and lymph-node aspirates; for CL patients the observed sensitivity was 98% (N = 43). The potential to use LAMP as a diagnostic tool for leishmaniasis is discussed.
Human Trypanosomiasis in the Eastern Region of the Panama Province: New Endemic Areas for Chagas Disease
Authors: Calzada José E. , Pineda Vanesa , Garisto Juan D. , Samudio Franklyn , Santamaria Ana Maria , Saldaña Azael
Published: March 2010

The epidemiology of Chagas disease was studied in five rural communities located in the eastern region of the Panama Province. Serological tests for Trypanosoma cruzi infection revealed a prevalence of 5.88% (12/204). Hemocultures coupled with polymerase chain reaction (PCR) analysis showed a Trypanosoma rangeli infection rate of 5.88% (12/204). An overall trypanosome infection index of 11.76% (24/204) was detected in this population. A total of 121 triatomine specimens were collected in domestic and peridomestic habitats. Rhodnius pallescens was confirmed as the predominant species. Molecular analysis showed that 17.8% (13/73) of the examined insects were positive for T. cruzi, 17.8% (13/73) for T. rangeli, and 35.6% (26/73) presented mixed infections. Among 73 R. pallescens evaluated, 16.4% (12/73) contained opossum blood meals. The epidemiological implications of these findings are discussed.
A Comparison of Two Short-Course Primaquine Regimens for the Treatment and Radical Cure of Plasmodium vivax Malaria in Thailand
Authors: Pukrittayakamee Sasithon , Imwong Mallika , Chotivanich Kesinee , Singhasivanon Pratap , Day Nicholas P. J. , White Nicholas J.
Published: March 2010

Thai adult males (N = 85) with acute Plasmodium vivax malaria and normal glucose-6-phosphate dehydrogenase screening were randomized to receive 30 mg or 60 mg primaquine daily for 7 days (N = 43 and 42, respectively). The regimens were well tolerated and all patients recovered fully. Median fever clearance (47 hours; range 4 to 130 hours), mean ± SD parasite clearance times (87.7 ± 25.3 hours), gametocyte clearance, and adverse effects were similar in the 2 groups. Two patients, 1 from each group, had a 30% reduction in hematocrit. The cumulative 28 day relapse rate (95% confidence interval) by Kaplan Meier survival analysis was 29% (16–49%) in the 30 mg group compared with 7% (2–24%) in the 60 mg group; P = 0.027. Comparison with previous data obtained at this same site suggests that the recurrences comprised approximately 17% recrudescences and 12% relapses in the 30 mg/day group compared with 3% recrudescences and 4% relapses in the 60 mg/day group. These data suggest that the dose-response relationships for primaquine's asexual stage and hypnozoitocidal activities in-vivo are different. A 1 week course of primaquine 60 mg daily is an effective treatment of vivax malaria in this region.
TLR9 Polymorphisms Are Associated with Altered IFN-γ Levels in Children with Cerebral Malaria
Authors: Sam-Agudu Nadia A. , Greene Jennifer A. , Opoka Robert O. , Kazura James W. , Boivin Michael J. , Zimmerman Peter A. , Riedesel Melissa A. , Bergemann Tracy L. , Schimmenti Lisa A. , John Chandy C.
Published: March 2010

Toll-like receptor (TLR) polymorphisms have been associated with disease severity in malaria infection, but mechanisms for this association have not been characterized. The TLR2, 4, and 9 single nucleotide polymorphism (SNP) frequencies and serum interferon-γ (IFN-γ) and tumor necrosis factor-α (TNF-α) levels were assessed in Ugandan children with cerebral malaria (CM, N = 65) and uncomplicated malaria (UM, N = 52). The TLR9 C allele at −1237 and G allele at 1174 were strongly linked, and among children with CM, those with the C allele at −1237 or the G allele at 1174 had higher levels of IFN-γ than those without these alleles (P = 0.03 and 0.008, respectively). The TLR9 SNPs were not associated with altered IFN-γ levels in children with UM or altered TNF-α levels in either group. We present the first human data that TLR SNPs are associated with altered cytokine production in parasitic infection.
Antibody Response from Whole-Cell Pertussis Vaccine Immunized Brazilian Children against Different Strains of Bordetella pertussis
Authors: Pereira Alexandre , Pietro Pereira Aparecida S. , Silva Célio Lopes , de Melo Rocha Gutemberg , Lebrun Ivo , Sant'Anna Osvaldo A. , Tambourgi Denise V.
Published: March 2010

Bordetella pertussis is a gram-negative bacillus that causes the highly contagious disease known as pertussis or whooping cough. Antibody response in children may vary depending on the vaccination schedule and the product used. In this study, we have analyzed the antibody response of cellular pertussis vaccinated children against B. pertussis strains and their virulence factors, such as pertussis toxin, pertactin, and filamentous hemagglutinin. After the completion of the immunization process, according to the Brazilian vaccination program, children serum samples were collected at different periods of time, and tested for the presence of specific antibodies and antigenic cross-reactivity. Results obtained show that children immunized with three doses of the Brazilian whole-cell pertussis vaccine present high levels of serum antibodies capable of recognizing the majority of the components present in vaccinal and non-vaccinal B. pertussis strains and their virulence factors for at least 2 years after the completion of the immunization procedure.
Association between TNF-α and Entamoeba histolytica Diarrhea
Authors: Peterson Kristine M. , Shu Jianfen , Duggal Priya , Haque Rashidul , Mondal Dinesh , Petri William A.
Published: March 2010

An association between tumor necrosis factor α (TNF-α) and Entamoeba histolytica diarrhea was assessed in a cohort of 138 non-related Bangladeshi children who have been prospectively followed since 2001. Peripheral blood mononuclear cells (PBMCs) obtained at study entry were purified, cultured, and stimulated with soluble amebic antigen before cytokine measurement from supernatant. Higher levels of TNF-α were associated with increased risk of first (P = 0.01) and recurrent E. histolytica-related diarrheal episodes (P = 0.005). Children who developed E. histolytica diarrhea had significantly higher TNF-α protein levels than those who experienced asymptomatic E. histolytica infection (P value = 0.027) or no infection (P value = 0.017). Microarray studies performed using RNA isolated from acute and convalescent whole blood and colon biopsy samples revealed higher but non-significant TNF-α messenger RNA (mRNA) levels in subjects with acute E. histolytica diarrhea compared with convalescence. We conclude that there is an association between higher TNF-α production and E. histolytica diarrhea.
Assessing and Maximizing the Acceptability of Global Positioning System Device Use for Studying the Role of Human Movement in Dengue Virus Transmission in Iquitos, Peru
Authors: Paz-Soldan Valerie A. , Stoddard Steven T. , Vazquez-Prokopec Gonzalo , Morrison Amy C. , Elder John P. , Kitron Uriel , Kochel Tadeusz J. , Scott Thomas W.
Published: March 2010

As use of global positioning system (GPS) technology to study disease transmission increases, it is important to assess possible barriers to its use from the perspective of potential study participants. Fifteen focus group discussions stratified by sex, age, and motherhood status were conducted in 2008 in Iquitos, Peru. All participants said they would accept using a GPS unit for study purposes for 2–4 weeks. Participants' main concerns included caring properly for the unit, whether the unit would audio/videotape them, health effects of prolonged use, responsibility for units, and confidentiality of information. A pilot study was then conducted in which 126 persons were asked to carry GPS units for 2–4 weeks; 98% provided consent. All persons used the units expressing minimal concerns, although 44% reported forgetting the device at least once. Our study is the first to highlight participant concerns related to use of GPS for long-term monitoring of individual behavior in a resource-limited setting.