bluuebunny/crossref_metadata_2025 huggingface dataset:
Autonomy of Patients With Type 2 Diabetes With an Insulin Pump Device
Authors: Reznik Yves , Morello Rémy , Zenia Amel , Morera Julia , Rod Anne , Joubert Michael
Published: May 2014

Background:

Insulin pump therapy may be offered to patients with type 2 diabetes that is not controlled by multiple daily injections. Patients with type 2 diabetes may suffer from unrecognized cognitive disabilities, which may compromise the use of a pump device.

Methods:

To predict patient autonomy, we evaluated 39 patients with type 2 diabetes from our database (n = 143) after continuous subcutaneous insulin infusion (CSII) initiation using (1) an autonomy questionnaire evaluating the patient’s cognitive and operative capacities for CSII utilization, (2) the Montreal Cognitive Assessment (MOCA) for the detection of mild cognitive disabilities, (3) the Hospital Anxiety and Depression Scale (HADS) for the detection of anxiety and depression, and (4) the Diabetes Treatment Satisfaction Questionnaire (DTSQ). Patients were selected to constitute 3 groups matched for age, with different degrees of autonomy at discharge after the initial training program: complete (n = 13), partial (n = 13), or no autonomy (n = 13).

Results:

The satisfaction level with the pump device was high. At the last follow-up visit, only 23% of patients did not reach complete autonomy. The autonomy score correlated fairly with the MOCA score ( R = 0.771, P < .001). A receiver operating characteristic (ROC) analysis showed that at a cut-off score of 24, the MOCA identified autonomous versus dependent patients at long-term follow-up (area under the ROC curve [AUC], 0.893; sensitivity, 81%; specificity, 81%). The HADS correlated negatively with the autonomy score, and the sociocultural level also influenced autonomy with pump utilization.

Conclusion:

Patients with type 2 diabetes with partial autonomy at discharge may progress to complete autonomy. The MOCA and HADS may help predict a patient’s ability to manage with a pump device.
Linking Executive Control and Emotional Response
Authors: Cohen Noga , Mor Nilly , Henik Avishai
Published: May 2014

Rumination, a maladaptive self-reflection, is a risk factor for depression, thought to be maintained by executive control deficits that impair ruminators’ ability to ignore emotional information. The current research examined whether training individuals to exert executive control when exposed to negative stimuli can ease rumination. A total of 85 participants were randomly assigned to one of two training conditions. In the experimental condition activation of executive control was followed predominantly by the presentation of negative pictures, whereas in the control condition it was followed predominantly by neutral pictures. As predicted, participants in the experimental group showed reduced state rumination compared with those in the control group. Furthermore, trait rumination, and particularly its maladaptive subtype brooding, was associated with increased sadness only among participants in the control group, and not in the experimental group. We argue that training individuals to exert executive control when processing negative stimuli can alleviate ruminative thinking and rumination-related sad mood.
Integrated genetic approaches identify the molecular mechanisms of Sox4 in early B-cell development: intricate roles for RAG1/2 and CK1ε
Authors: Mallampati Saradhi , Sun Baohua , Lu Yue , Ma Haiqing , Gong Yun , Wang Donghai , Lee Ju-Seog , Lin Kevin , Sun Xiaoping
Published: May 2014

Key Points

RAG1/2 and casein kinase 1 ε are key effectors of Sox4 function in progenitor B cells. Sox4 induces B-cell differentiation by suppressing Wnt/β-catenin signaling and activating immunoglobulin gene recombination.
The bleeding score predicts clinical outcomes and replacement therapy in adults with von Willebrand disease
Authors: Federici Augusto B. , Bucciarelli Paolo , Castaman Giancarlo , Mazzucconi Maria G. , Morfini Massimo , Rocino Angiola , Schiavoni Mario , Peyvandi Flora , Rodeghiero Francesco , Mannucci Pier Mannuccio
Published: May 2014

Key Points

The bleeding score helps to predict clinical outcomes in adult patients with von Willebrand disease. High bleeding scores correlate with intensive on-demand therapy and may identify cases requiring regular prophylaxis.
From Janus kinase 2 to calreticulin: the clinically relevant genomic landscape of myeloproliferative neoplasms
Authors: Cazzola Mario , Kralovics Robert
Published: May 2014

Our understanding of the genetic basis of myeloproliferative neoplasms began in 2005, when the JAK2 (V617F) mutation was identified in polycythemia vera, essential thrombocythemia, and primary myelofibrosis. JAK2 exon 12 and MPL exon 10 mutations were then detected in subsets of patients, and subclonal driver mutations in other genes were found to be associated with disease progression. Recently, somatic mutations in the gene CALR, encoding calreticulin, have been found in most patients with essential thrombocythemia or primary myelofibrosis with nonmutated JAK2 and MPL. The JAK-STAT pathway appears to be activated in all myeloproliferative neoplasms, regardless of founding driver mutations. These latter, however, have different effects on clinical course and outcomes. Thus, evaluation of JAK2, MPL, and CALR mutation status is important not only for diagnosis but also for prognostication. These genetic data should now also be considered in designing clinical trials.
Deep-sequencing transcriptome analysis of low temperature perception in a desert tree, Populus euphratica
Authors: Chen Jinhuan , Tian Qianqian , Pang Tao , Jiang Libo , Wu Rongling , Xia Xinli , Yin Weilun
Published: May 2014

Background

Compared with otherPopulusspecies,Populus euphraticaOliv. exhibits better tolerance to abiotic stress, especially those involving extreme temperatures. However, little is known about gene regulation and signaling pathways involved in low temperature stress responses in this species. Recent development of Illumina/Solexa-based deep-sequencing technologies has accelerated the study of global transcription profiling under specific conditions. To understand the gene network controlling low temperature perception inP. euphratica, we performed transcriptome sequencing using Solexa sequence analysis to generate a leaf transcriptome at a depth of 10 gigabases for each sample.

Results

Using the Trinity method, 52,081,238 high-quality trimmed reads were assembled into a non-redundant set and 108,502 unigenes with an average length of 1,047 bp were generated. After performing functional annotations by aligning all-unigenes with public protein databases, 85,584 unigenes were annotated. Differentially expressed genes were investigated using the FPKM method by applying the Benjamini and Hochberg corrections. Overall, 2,858 transcripts were identified as differentially expressed unigenes in at least two samples and 131 were assigned as unigenes expressed differently in all three samples. In 4°C-treated sample and -4°C-treated sample, 1,661 and 866 differently expressed unigenes were detected at an estimated absolute log2-fold change of > 1, respectively. Among them, the respective number of up-regulated unigenes in C4 and F4 sample was 1,113 and 630, while the respective number of down-regulated ungenes is 548 and 236. To increase our understanding of these differentially expressed genes, we performed gene ontology enrichment and metabolic pathway enrichment analyses. A large number of early cold (below or above freezing temperature)-responsive genes were identified, suggesting that a multitude of transcriptional cascades function in cold perception. Analyses of multiple cold-responsive genes, transcription factors, and some key transduction components involved in ABA and calcium signaling revealed their potential function in low temperature responses inP. euphratica.

Conclusions

Our results provide a global transcriptome picture ofP. euphraticaunder low temperature stress. The potential cold stress related transcripts identified in this study provide valuable information for further understanding the molecular mechanisms of low temperature perception inP. euphratica.
The prevalence and burden of subthreshold generalized anxiety disorder: a systematic review
Authors: Haller Heidemarie , Cramer Holger , Lauche Romy , Gass Florian , Dobos Gustav J
Published: May 2014

Background

To review the prevalence and impact of generalized anxiety disorder (GAD) below the diagnostic threshold and explore its treatment needs in times of scarce healthcare resources.

Methods

A systematic literature search was conducted until January 2013 using PUBMED/MEDLINE, PSYCINFO, EMBASE and reference lists to identify epidemiological studies of subthreshold GAD, i.e. GAD symptoms that do not reach the current thresholds of DSM-III-R, DSM-IV or ICD-10. Quality of all included studies was assessed and median prevalences of subthreshold GAD were calculated for different subpopulations.

Results

Inclusion criteria led to 15 high-quality and 3 low-quality epidemiological studies with a total of 48,214 participants being reviewed. Whilst GAD proved to be a common mental health disorder, the prevalence for subthreshold GAD was twice that for the full syndrome. Subthreshold GAD is typically persistent, causing considerably more suffering and impairment in psychosocial and work functioning, benzodiazepine and primary health care use, than in non-anxious individuals. Subthreshold GAD can also increase the risk of onset and worsen the course of a range of comorbid mental health, pain and somatic disorders; further increasing costs. Results are robust against bias due to low study quality.

Conclusions

Subthreshold GAD is a common, recurrent and impairing disease with verifiable morbidity that claims significant healthcare resources. As such, it should receive additional research and clinical attention.
Melanin-templated rapid synthesis of silver nanostructures
Authors: Kiran George Seghal , Dhasayan Asha , Lipton Anuj Nishanth , Selvin Joseph , Arasu Mariadhas Valan , Al-Dhabi Naif Abdullah
Published: May 2014

Background

As a potent antimicrobial agent, silver nanostructures have been used in nanosensors and nanomaterial-based assays for the detection of food relevant analytes such as organic molecules, aroma, chemical contaminants, gases and food borne pathogens. In addition silver based nanocomposites act as an antimicrobial for food packaging materials. In this prospective, the food grade melanin pigment extracted from sponge associated actinobacterium Nocardiopsis alba MSA10 and melanin mediated synthesis of silver nanostructures were studied. Based on the present findings, antimicrobial nanostructures can be developed against food pathogens for food industrial applications.

Results

Briefly, the sponge associated actinobacterium N. alba MSA10 was screened and fermentation conditions were optimized for the production of melanin pigment. The Plackett-Burman design followed by a Box-Behnken design was developed to optimize the concentration of most significant factors for improved melanin yield. The antioxidant potential, reductive capabilities and physiochemical properties of Nocardiopsis melanin was characterized. The optimum production of melanin was attained with pH 7.5, temperature 35°C, salinity 2.5%, sucrose 25 g/L and tyrosine 12.5 g/L under submerged fermentation conditions. A highest melanin production of 3.4 mg/ml was reached with the optimization using Box-Behnken design. The purified melanin showed rapid reduction and stabilization of silver nanostructures. The melanin mediated process produced uniform and stable silver nanostructures with broad spectrum antimicrobial activity against food pathogens.

Conclusions

The melanin pigment produced by N. alba MSA10 can be used for environmentally benign synthesis of silver nanostructures and can be useful for food packaging materials. The characteristics of broad spectrum of activity against food pathogens of silver nanostructures gives an insight for their potential applicability in incorporation of food packaging materials and antimicrobials for stored fruits and foods.
Cu-doped ZnO nanorod arrays: the effects of copper precursor and concentration
Authors: Babikier Musbah , Wang Dunbo , Wang Jinzhong , Li Qian , Sun Jianming , Yan Yuan , Yu Qingjiang , Jiao Shujie
Published: May 2014

Cu-doped ZnO nanorods have been grown at 90°C for 90 min onto a quartz substrate pre-coated with a ZnO seed layer using a hydrothermal method. The influence of copper (Cu) precursor and concentration on the structural, morphological, and optical properties of ZnO nanorods was investigated. X-ray diffraction analysis revealed that the nanorods grown are highly crystalline with a hexagonal wurtzite crystal structure grown along the c-axis. The lattice strain is found to be compressive for all samples, where a minimum compressive strain of −0.114% was obtained when 1 at.% Cu was added from Cu(NO3)2. Scanning electron microscopy was used to investigate morphologies and the diameters of the grown nanorods. The morphological properties of the Cu-doped ZnO nanorods were influenced significantly by the presence of Cu impurities. Near-band edge (NBE) and a broad blue-green emission bands at around 378 and 545 nm, respectively, were observed in the photoluminescence spectra for all samples. The transmittance characteristics showed a slight increase in the visible range, where the total transmittance increased from approximately 80% for the nanorods doped with Cu(CH3COO)2 to approximately 90% for the nanorods that were doped with Cu(NO3)2.
Types of sensitization to aeroallergens: definitions, prevalences and impact on the diagnosis and treatment of allergic respiratory disease
Authors: Migueres Michel , Dávila Ignacio , Frati Franco , Azpeitia Angel , Jeanpetit Yasmine , Lhéritier‐Barrand Michèle , Incorvaia Cristoforo , Ciprandi Giorgio ,   PlurAL study group
Published: May 2014

The type of allergic sensitization is of central importance in the diagnosis and treatment of respiratory allergic diseases. At least 10% of the general population (and more than 50% of patients consulting for respiratory allergies) are polysensitized. Here, we review the recent literature on (i) the concepts of polysensitization, paucisensitization, co‐sensitization, co‐recognition, cross‐reactivity, cross‐sensitization, and polyallergy, (ii) the prevalence of polysensitization and (iii) the relationships between sensitization status, disease severity and treatment strategies. In molecular terms, clinical polysensitization can be divided into cross‐sensitization (also known as cross‐reactivity, in which the same IgE molecule binds to several allergens with common structural features) and co‐sensitization (the simultaneous presence of different IgEs binding to allergens that may not necessarily have common structural features). There is a strong overall association between sensitization in skin prick tests and total IgE values but there is debate as to whether IgE thresholds are useful guides to the presence or absence of clinical symptoms in individual cases. Molecular information from component‐resolved techniques appears to be of value for diagnosis and treatment decisions. Polysensitization develops over time and is a risk factor for respiratory allergy (being associated with disease severity) and therefore has clinical relevance for treatment decisions. The subterm polysensitization has been defined as polysensitization to between two and four allergens. Polyallergy is defined as clinically confirmed allergy to two or more allergens. Single‐allergen grass pollen allergen immunotherapy (AIT) is safe and effective in polysensitized patients, whereas multi‐allergen AIT requires more supporting evidence. Given that AIT may be more efficacious in moderate‐to‐severe disease than in mild disease, polysensitization could be an indication for this type of treatment. There is a need for flowcharts or decision trees for choosing the allergens for AIT in polysensitized patients and polyallergic patients.
Precocious initiation of spermatogenesis in a 19-month-old boy with Hurler syndrome
Authors: Milazzo Jean-Pierre , Bironneau Amandine , Vannier Jean-Pierre , Liard-Zmuda Agnes , Macé Bertrand , Nathalie Rives
Published: May 2014

Mucopolysaccharidosis type IH (MPS IH) is a rare autosomal recessive lysosomal storage disorder. Haematopoietic stem cell transplantation (HSCT) has been proposed for the treatment of MPS IH patients and offers the possibility to grow into their adulthood. Precocious puberty has been described in few MPS patients. We report, to the best of our knowledge and for the first time, the initiation of the first waves of spermatogenesis fortuitously observed in seminiferous tubules of a pre-pubertal 19-month-old boy, affected by MPS IH and who did not present any clinical signs of precocious puberty. This patient benefited from testicular tissue cryopreservation before HSCT. Seminiferous tubule size, germ cell differentiation and Sertoli cell expression of androgen receptor and anti-müllerian hormone corresponded to the pattern observed in a pubertal boy. The Hurler syndrome may be responsible for the precocious initiation of spermatogenesis. A specific follow-up during childhood may be useful to confirm if such abnormal testis development is common in young boys with MPS IH and if it may lead to precocious onset of puberty in survivors despite HSCT. Furthermore, we have observed that Sertoli cell maturation (up-regulation of AR expression, down-regulation of AMH expression) occurred before the clinical signs of puberty and before the increase of testosterone plasmatic level.
LAP degradation product reflects plasma kallikrein-dependent TGF-β activation in patients with hepatic fibrosis
Authors: Hara Mitsuko , Kirita Akiko , Kondo Wakako , Matsuura Tomokazu , Nagatsuma Keisuke , Dohmae Naoshi , Ogawa Shinji , Imajoh-Ohmi Shinobu , Friedman Scott L , Rifkin Daniel B , Kojima Soichi
Published: May 2014

Byproducts of cytokine activation are sometimes useful as surrogate biomarkers for monitoring cytokine generation in patients. Transforming growth factor (TGF)-β plays a pivotal role in pathogenesis of hepatic fibrosis. TGF-β is produced as part of an inactive latent complex, in which the cytokine is trapped by its propeptide, the latency-associated protein (LAP). Therefore, to exert its biological activity, TGF-β must be released from the latent complex. Several proteases activate latent TGF-β by cutting LAP. We previously reported that Camostat Mesilate, a broad spectrum protease inhibitor, which is especially potent at inhibiting plasma kallikrein (PLK), prevented liver fibrosis in the porcine serum-induced liver fibrosis model in rats. We suggested that PLK may work as an activator of latent TGF-β during the pathogenesis of liver diseases in the animal models. However, it remained to be elucidated whether this activation mechanism also functions in fibrotic liver in patients.

Here, we report that PLK cleaves LAP between R58and L59residues. We have produced monoclonal antibodies against two degradation products of LAP (LAP-DP) by PLK, and we have used these specific antibodies to immunostain LAP-DP in liver tissues from both fibrotic animals and patients.

The N-terminal side LAP-DP ending at R58(R58LAP-DP) was detected in liver tissues, while the C-terminal side LAP-DP beginning at L59(L59LAP-DP) was not detectable. The R58LAP-DP was seen mostly in α-smooth muscle actin-positive activated stellate cells.

These data suggest for the first time that the occurrence of a PLK-dependent TGF-β activation reaction in patients and indicates that the LAP-DP may be useful as a surrogate marker reflecting PLK-dependent TGF-β activation in fibrotic liver both in animal models and in patients.
Ginsenoside Rh1 potentiates dexamethasone’s anti-inflammatory effects for chronic inflammatory disease by reversing dexamethasone-induced resistance
Authors: Li Jun , Du Juan , Liu Dong , Cheng Binbin , Fang Fanfu , Weng Li , Wang Chen , Ling Changquan
Published: May 2014

Introduction

Acquired resistance to glucocorticoids constitutes a major clinical challenge, often overlooked in the search for compounds to improve the effect of classic steroids. We sought to unravel how a plant-original compound, ginsenoside Rh1, potentiates dexmethasone (DEX)’s potential anti-inflammation properties.

Methods

Ginsenoside Rh1 combined with DEX was applied in a short-term and long-term treatment protocol for inflammation. Its potential mechanism on anti-inflammation was explored. In addition, the effect of Rh1 on the side-effect induced by DEX was studied. Furthermore, the in vivo anti-inflammatory effects of Rh1 combined with DEX were evaluated in a collagen-induced arthritis (CIA) mice model.

Results

Ginsenoside Rh1 potentiates DEX’s anti-inflammatory effects even after prolonged DEX treatment. Rh1 could improve the glucocorticoid receptor (GR)’s transrepression on nuclear factor kappa B (NF-κB) and transactivation on dual specificity protein phosphatase 1 (DUSP1), which is responsible for DEX’s anti-inflammatory effects. Parallel Western blot assay and radioligand binding analysis revealed that Rh1 could increase the expression and binding of GR. This is in sharp contrast to DEX alone, showing a direct link among prolonged treatment, decreasing GR and the abolishment of anti-inflammation. Interestingly, Rh1 does not enhance the transactivation of glucocorticoid-responsive elements (GRE) driven genes - gluconeogenic enzyme glucose-6-phosphatase (G6P) and phosphoenolpyruvate carboxykinasee phosphatase (PEPCK) in primary mouse hepatocytes, a mechanism partly held accountable for the metabolic side-effects. Similar results were found in CIA mice.

Conclusion

Rh1 could potentiate DEX’s anti-inflammatory effects and does not cause a hyperglycemic side effect. Ginsenoside Rh1 combined with DEX may be a promising candidate treatment option for chronic inflammatory diseases in need of long-term immunosuppression therapies.
Gene targeting using the Agrobacterium tumefaciens-mediated CRISPR-Cas system in rice
Authors: Xu Rongfang , Li Hao , Qin Ruiying , Wang Lu , Li Li , Wei Pengcheng , Yang Jianbo
Published: May 2014

Background

The type II clustered, regularly interspaced, short palindromic repeat (CRISPR)/ CRISPR-associated protein 9 (Cas9) system is a novel molecular tool for site-specific genome modification. The CRISPR-Cas9 system was recently introduced into plants by transient or stable transformation.

Findings

Here, we report gene targeting in rice via the Agrobacterium tumefaciens-mediated CRISPR-Cas9 system. Three 20-nt CRISPR RNAs were designed to pair with diverse sites followed by the protospacer adjacent motif (PAM) of the rice herbicide resistance gene BEL. After integrating the single-guide RNA (sgRNA) and Cas9 cassette in a single binary vector, transgenic rice plants harboring sgRNA:Cas9 were generated by A. tumefaciens-mediated stable transformation. By analyzing the targeting site on the genome of corresponding transgenic plants, the mutations were determined. The mutagenesis efficiency was varied from ~2% to ~16%. Furthermore, phenotypic analysis revealed that the biallelic mutated transgenic plant was sensitive to bentazon.

Conclusions

Our results indicate that the agricultural trait could be purposely modified by sgRNA:Cas9-induced gene targeting. CRISPR-Cas9 system could be exploited as a powerful tool for trait improvements in crop breeding.
Color Directional Local Quinary Patterns for Content Based Indexing and Retrieval
Authors: Vipparthi Santosh Kumar , Nagar Shyam Krishna
Published: May 2014

This paper presents a novel evaluationary approach to extract color-texture features for image retrieval application namely Color Directional Local Quinary Pattern (CDLQP). The proposed descriptor extracts the individual R, G and B channel wise directional edge information between reference pixel and its surrounding neighborhoods by computing its grey-level difference based on quinary value (−2, −1, 0, 1, 2) instead of binary and ternary value in 0°, 45°, 90°, and 135° directions of an image which are not present in literature (LBP, LTP, CS-LBP, LTrPs, DExPs, etc.). To evaluate the retrieval performance of the proposed descriptor, two experiments have been conducted on Core-5000 and MIT-Color databases respectively. The retrieval performances of the proposed descriptor show a significant improvement as compared with standard local binary pattern LBP, center-symmetric local binary pattern (CS-LBP), Directional binary pattern (DBC) and other existing transform domain techniques in IR system.
Class III correction using an inter-arch spring-loaded module
Authors: Vanlaecken Robert , Williams Michael O , Razmus Thomas , Gunel Erdogan , Martin Chris , Ngan Peter
Published: May 2014

Background

A retrospective study was conducted to determine the cephalometric changes in a group of Class III patients treated with the inter-arch spring-loaded module (CS2000®, Dynaflex, St. Ann, MO, USA).

Methods

Thirty Caucasian patients (15 males, 15 females) with an average pre-treatment age of 9.6 years were treated consecutively with this appliance and compared with a control group of subjects from the Bolton-Brush Study who were matched in age, gender, and craniofacial morphology to the treatment group. Lateral cephalograms were taken before treatment and after removal of the CS2000® appliance. The treatment effects of the CS2000® appliance were calculated by subtracting the changes due to growth (control group) from the treatment changes.

Results

All patients were improved to a Class I dental arch relationship with a positive overjet. Significant sagittal, vertical, and angular changes were found between the pre- and post-treatment radiographs. With an average treatment time of 1.3 years, the maxillary base moved forward by 0.8 mm, while the mandibular base moved backward by 2.8 mm together with improvements in the ANB and Wits measurements. The maxillary incisor moved forward by 1.3 mm and the mandibular incisor moved forward by 1.0 mm. The maxillary molar moved forward by 1.0 mm while the mandibular molar moved backward by 0.6 mm. The average overjet correction was 3.9 mm and 92% of the correction was due to skeletal contribution and 8% was due to dental contribution. The average molar correction was 5.2 mm and 69% of the correction was due to skeletal contribution and 31% was due to dental contribution.

Conclusions

Mild to moderate Class III malocclusion can be corrected using the inter-arch spring-loaded appliance with minimal patient compliance. The overjet correction was contributed by forward movement of the maxilla, backward and downward movement of the mandible, and proclination of the maxillary incisors. The molar relationship was corrected by mesialization of the maxillary molars, distalization of the mandibular molars together with a rotation of the occlusal plane.
Pharmacological treatment of bipolar depression
Authors: Vázquez Gustavo H. , Tondo Leonardo , Undurraga Juan , Zaratiegui Rodolfo , Selle Valerio , Baldessarini Ross J.
Published: May 2014

Bipolar depression remains a major challenge for psychiatric therapeutics. It is associated with disability and excess mortality, and accounts for three-quarters of the time spent in morbid states by treated patients with bipolar disorder. Major limitations of research on the treatment of depression in bipolar disorder include a paucity of short-term and lack of long-term trials, probably reflecting concern about inducing mania. In addition, polytherapy with multiple drugs appears to be widespread, but it is virtually untested for efficacy and safety. Here, we summarise the evidence concerning efficacy of treatment of bipolar depression with antidepressants, mood-stabilising anticonvulsants, lithium and second-generation antipsychotics.

LEARNING OBJECTIVES

•

Gain critical appreciation of the paucity of research on the treatment of bipolar depression.

•

Rationally balance the benefits and risks of using antidepressants in patients with bipolar disorder.

•

Assess the evidence supporting a range of research-based treatment options for bipolar depression.
Interventions for challenging behaviour in intellectual disability
Authors: Ali Afia , Blickwedel Jessica , Hassiotis Angela
Published: May 2014

Challenging behaviour is common in intellectual disability but it is difficult to diagnose and manage. It can adversely affect the quality of life of the individual and cause the breakdown of community placements, resulting in hospital admission. This article discusses the aetiology of challenging behaviour (including the complex relationship with mental illness), diagnostic problems, the current evidence base in relation to psychosocial and pharmacological treatments, and service delivery.

LEARNING OBJECTIVES

•

Understand the aetiological basis of challenging behaviour.

•

Understand the role of functional analysis.

•

Appreciate the evidence base in relation to the psychological and pharmacological treatment of challenging behaviour.
Getting the measure of outcomes in clinical practice
Authors: Lewis Glyn , Killaspy Helen
Published: May 2014

It has been argued that the routine use of patient-reported outcome measures (PROMs) should be encouraged in order to improve the quality of services and even to determine payment. Clinician-rated outcome measures (CROMs), patient-reported experience measures (PREMs) and process measures also should be considered in evaluating healthcare quality. We discuss difficulties that the routine use of outcome measures might pose for psychiatric services. When outcome and experience measures are used to evaluate services they are difficult to interpret because of differences in case mix and regression to the mean. We conclude that PROMs and CROMs could be useful for monitoring the progress of individuals and that clinical audit still has an important role to play in improving the quality of services.

LEARNING OBJECTIVES

Understand the difference between process measurement and outcome measurement.

Understand the limitation of using outcome measures to assess and promote quality of services.

Understand the difficulties in assessing the psychometric properties and validity of outcome measures.
Making decisions in the management of perinatal depression and anxiety
Authors: Wand Anne P. F.
Published: May 2014

The care of women with anxiety and depressive disorders in the perinatal period is complex. The literature in this field is vast and may be difficult for busy clinicians to keep abreast of. The first part of this article provides an overview of the potential risks and benefits of treatment options, including no treatment, at various stages in the perinatal period. The second part explores the frameworks which may assist clinicians in decision-making with their pregnant patients, including risk-benefit analysis, ethical considerations, evaluating capacity, and mental health legislation. The common pitfalls and limitations of these approaches are examined to guide good practice.

LEARNING OBJECTIVES

•

Understand the potential risks and benefits of treating, or not treating, maternal mental illness at various stages in the perinatal period.

•

Understand the limitations of the literature in this field.

•

Be able to use different frameworks for deciding with patients about the management of mental illness in the perinatal period.
Ten books
Authors: Murphy Elaine
Published: May 2014

Only ten books? A quandary: the fewer I can have the more I will expose my prejudices and uncertainties by choosing. ‘We are our choices', as Jean Paul Sartre1 said, probably not thinking of books. I'll throw in another of his lines. ‘All that I know about my life, it seems, I have learned in books'. I would not adopt that sentiment wholeheartedly; I've learned as much from relationships and work as I have from books, but it is true that one can detect one's good and bad selves reflected in books with a clarity no other medium can provide. I am a lifelong greedy reader of anything that comes to hand. I'll read the back of a train ticket if there's nothing else available. But which books influenced me? It is well over 40 years since I chose psychiatry as a career. I can only single out books, mostly novels, which have had an impact on the way I understand other people and their lives, broadened my horizons about the often unfathomable motives and goals of patients and their families, and on the way we practise and organise our services.
Evacuation Behavior and Fatality Rate during the 2011 Tohoku-Oki Earthquake and Tsunami
Authors: Yun Nam Yi , Hamada Masanori
Published: May 2014

Factors influencing tsunami life safety were examined using 1,153 witnesses in the tsunami-inundated areas in the 2011 Tohoku-oki earthquake and tsunami. It was found that evacuation starting time, evacuation location conditions, age and occupation had the greatest influence on survival. Moreover, the data for 101 localities were employed to estimate the fatality rate as a function of the tsunami height, arrival time, evacuation distance, elderly fraction of the community (percentage of people over 65 years old) and types of topography (ria coast versus flat plain). The results provide lessons that communities threatened by tsunami need to develop integrated disaster preparedness, taking into account evacuation behavior, refuge siting, the topography, and community age distribution.
Ultrasonic-sprayed Graphene Oxide and Air-sprayed Silver Nanowire for the Preparation of Flexible Transparent Conductive Films
Authors: Ko Young-Hui , Lee Ju-Won , Choi Won-Kook , Kim Sung-Ryong
Published: May 2014

Simple solution spray coating of graphene oxide (GO) and Ag nanowires (AgNWs) was employed to prepare transparent conductive films (TCFs). We used air and ultrasonic spraying, and the effects of different spraying methods on the properties of TCFs were investigated. Ultrasonic spraying exhibited a significant decrease in the length of AgNWs and increase of sheet resistance. Thin two-dimensional reduced graphene oxide (rGO) prepared by ultrasonic spraying with tightly bound conductive Ag nanowires prepared by air spraying effectively decreased the sheet resistance and increased the transparency of the hybrid films. Air-sprayed rGO (0.25 mL)–AgNW (0.45 mL)/poly(methyl methacrylate) exhibited a sheet resistance of 328 Ω/; however, the ultrasonic-sprayed rGO (0.25 mL)–air-sprayed AgNW (0.45 mL) on a poly(methyl methacrylate) showed a significant improvement of sheet resistance to 86 Ω/ with a light transmittance of 78%. The sprayed rGO–AgNW showed little change in sheet resistance after 200 bending cycles with a radius curvature of 10 mm.
Resistive Switching Memory Based on Size-controlled 1-nm Gold Particles
Authors: Imaoka Takane , Fushimi Mayu , Kimoto Atsushi , Okamoto Yukiyasu , Takanashi Kensaku , Yamamoto Kimihisa
Published: May 2014

Monodispersed Au nanoparticles composed of only 14 atoms were synthesized by a dendrimer-based template method. A spin-coated dendrimer film containing these Au nanoparticles exhibited significant resistive switching functions during the reversible scan of an applied bias.
Encapsulation of Hyperthermophilic β-Glucosidase from Pyrococcus furiosus into Silica Microcapsules
Authors: Watanabe Masahiro , Fujiwara Masahiro , Ishikawa Kazuhiko
Published: May 2014

Immobilized enzymes are finding use in bioreactors for a wide range of applications such as in research, medicine, and industry. One of the greatest benefits of immobilized enzymes is that the enzymes can be used repeatedly. In this study, we encapsulated the hyperthermophilic β-glucosidase from Pyrococcus furiosus (BGLPf) into silica microcapsules. BGLPf plays an important role in the high-temperature hydrolysis of cellooligosaccharides found in biomass. This technology provides a new tool for the effective saccharification of biomass.
Direct Synthesis of Liquid Metal Colloids and Their Transmetalation into Noble Metal Nanoparticles
Authors: Sudo Shinya , Nagata Shunjiro , Kokado Kenta , Sada Kazuki
Published: May 2014

Facile mixing of a liquid metal, organic medium, and surfactant by sonication provided well-dispersed and uniformly sized gallium nanoparticles (GaNP). Furthermore, transformation to other noble metal nanoparticles having a similar size distribution was achieved via metal exchanging redox process utilizing the GaNP as the precursor.
Interscapulothoracic resection of tumours of shoulder with a note on reconstruction
Authors: Xie L. , X. D. Tang , Yang R. L. , Guo W.
Published: May 2014

We retrospectively reviewed the outcomes of 33 consecutive patients who had undergone an extra-articular, total or partial scapulectomy for a malignant tumour of the shoulder girdle between 1 July 2001 and 30 September 2013. Of these, 26 had tumours which originated in the scapula or the adjacent soft tissue and underwent a classic Tikhoff–Linberg procedure, while seven with tumours arising from the proximal humerus were treated with a modified Tikhoff-Linberg operation. We used a Ligament Advanced Reinforcement System for soft-tissue reconstruction in nine patients, but not in the other 24.

The mean Musculoskeletal Tumor Society score (MSTS) was 17.6 (95% confidence interval (CI) 15.9 to 19.4); 17.6 (95% CI 15.5 to 19.6) after the classic Tikhoff–Linberg procedure and 18.1 (95% CI 13.8 to 22.3) after the modified Tikhoff–Linberg procedure. Patients who had undergone a LARS soft-tissue reconstruction had a mean score of 18.6 (95% (CI) 13.9 to 22.4) compared with 17.2 (95% CI 15.5 to 19.0) for those who did not.

The Tikhoff–Linberg procedure is a useful method for wide resection of a malignant tumour of the shoulder girdle which helps to preserve hand and elbow function. The method of soft-tissue reconstruction has no effect on functional outcome.

Cite this article: Bone Joint J 2014;96-B:684–90.
A new morphological classification for greater tuberosity fractures of the proximal humerus
Authors: Mutch J. , Laflamme G. Y. , Hagemeister N. , Cikes A. , Rouleau D. M.
Published: May 2014

In this study, we describe a morphological classification for greater tuberosity fractures of the proximal humerus. We divided these fractures into three types: avulsion, split and depression. We retrospectively reviewed all shoulder radiographs showing isolated greater tuberosity fractures in a Level I trauma centre between July 2007 and July 2012. We identified 199 cases where records and radiographs were reviewed and included 79 men and 120 women with a mean age of 58 years (23 to 96). The morphological classification was applied to the first 139 cases by three reviewers on two occasions using the Kappa statistic and compared with the AO and Neer classifications. The inter- and intra-observer reliability of the morphological classification was 0.73 to 0.77 and 0.69 to 0.86, respectively. This was superior to the Neer (0.31 to 0.35/0.54 to 0.63) and AO (0.30 to 0.32/0.59 to 0.65) classifications. The distribution of avulsion, split and depression type fractures was 39%, 41%, and 20%, respectively. This classification of greater tuberosity fractures is more reliable than the Neer or AO classifications. These distinct fracture morphologies are likely to have implications in terms of pathophysiology and surgical technique.

Cite this article: Bone Joint J 2014;96-B:646–51.
Three-dimensional morphology and bony range of movement in hip joints in patients with hip dysplasia
Authors: Nakahara I. , Takao M. , Sakai T. , Miki H. , Nishii T. , Sugano N.
Published: May 2014

To confirm whether developmental dysplasia of the hip has a risk of hip impingement, we analysed maximum ranges of movement to the point of bony impingement, and impingement location using three-dimensional (3D) surface models of the pelvis and femur in combination with 3D morphology of the hip joint using computer-assisted methods. Results of computed tomography were examined for 52 hip joints with DDH and 73 normal healthy hip joints. DDH shows larger maximum extension (p = 0.001) and internal rotation at 90° flexion (p < 0.001). Similar maximum flexion (p = 0.835) and external rotation (p = 0.713) were observed between groups, while high rates of extra-articular impingement were noticed in these directions in DDH (p < 0.001). Smaller cranial acetabular anteversion (p = 0.048), centre-edge angles (p < 0.001), a circumferentially shallower acetabulum, larger femoral neck anteversion (p < 0.001), and larger alpha angle were identified in DDH. Risk of anterior impingement in retroverted DDH hips is similar to that in retroverted normal hips in excessive adduction but minimal in less adduction. These findings might be borne in mind when considering the possibility of extra-articular posterior impingement in DDH being a source of pain, particularly for patients with a highly anteverted femoral neck.

Cite this article: Bone Joint J 2014;96-B:580–9.
The distribution of heat in bone during radiofrequency ablation of an ex vivo bovine model of osteoid osteoma
Authors: Greenberg A. , Berenstein Weyel T. , Sosna J. , Applbaum J. , Peyser A.
Published: May 2014

Osteoid osteoma is treated primarily by radiofrequency (RF) ablation. However, there is little information about the distribution of heat in bone during the procedure and its safety. We constructed a model of osteoid osteoma to assess the distribution of heat in bone and to define the margins of safety for ablation. Cavities were drilled in cadaver bovine bones and filled with a liver homogenate to simulate the tumour matrix. Temperature-sensing probes were placed in the bone in a radial fashion away from the cavities. RF ablation was performed 107 times in tumours < 10 mm in diameter (72 of which were in cortical bone, 35 in cancellous bone), and 41 times in cortical bone with models > 10 mm in diameter. Significantly higher temperatures were found in cancellous bone than in cortical bone (p <  0.05). For lesions up to 10 mm in diameter, in both bone types, the temperature varied directly with the size of the tumour (p < 0.05), and inversely with the distance from it. Tumours of > 10 mm in diameter showed a trend similar to those of smaller lesions. No temperature rise was seen beyond 12 mm from the edge of a cortical tumour of any size. Formulae were developed to predict the expected temperature in the bone during ablation.

Cite this article: Bone Joint J 2014; 96-B:677–83
Post-operative outcomes of atypical femoral subtrochanteric fracture in patients on bisphosphonate therapy
Authors: Teo B. J. X. , Koh J. S. B. , Goh S. K. , Png M. A. , Chua D. T. C. , Howe T. S.
Published: May 2014

Management of bisphosphonate-associated subtrochanteric fractures remains opinion- or consensus-based. There are limited data regarding the outcomes of this fracture.

We retrospectively reviewed 33 consecutive female patients with a mean age of 67.5 years (47 to 91) who were treated surgically between May 2004 and October 2009. The mean follow-up was 21.7 months (0 to 53). Medical records and radiographs were reviewed to determine the post-operative ambulatory status, time to clinical and radiological union and post-fixation complications such as implant failure and need for second surgery.

The predominant fixation method was with an extramedullary device in 23 patients. 25 (75%) patients were placed on wheelchair mobilisation or no weight-bearing initially. The mean time to full weight-bearing was 7.1 months (2.2 to 29.7). The mean time for fracture site pain to cease was 6.2 months (1.2 to 17.1). The mean time to radiological union was 10.0 months (2.2 to 27.5). Implant failure was seen in seven patients (23%, 95 confidence interval (CI) 11.8 to 40.9). Revision surgery was required in ten patients (33%, 95 CI 19.2 to 51.2).

A large proportion of the patients required revision surgery and suffered implant failure. This fracture is associated with slow healing and prolonged post-operative immobility.

Cite this article: Bone Joint J 2014;96-B:658–64.
Is limb salvage surgery safe for bone sarcomas identified after a previous surgical procedure?
Authors: Gaston C. L. , Nakamura T. , Reddy K. , Abudu A. , Carter S. , Jeys L. , Tillman R. , Grimer R.
Published: May 2014

Bone sarcomas are rare cancers and orthopaedic surgeons come across them infrequently, sometimes unexpectedly during surgical procedures. We investigated the outcomes of patients who underwent a surgical procedure where sarcomas were found unexpectedly and were subsequently referred to our unit for treatment. We identified 95 patients (44 intra-lesional excisions, 35 fracture fixations, 16 joint replacements) with mean age of 48 years (11 to 83); 60% were males (n = 57). Local recurrence arose in 40% who underwent limb salvage surgery versus 12% who had an amputation. Despite achieving local control, overall survival was worse for patients treated with amputation rather than limb salvage (54% vs 75% five-year survival). Factors that negatively influenced survival were invasive primary surgery (fracture fixation, joint replacement), a delay of greater than two months until referral to our oncology service, and high-grade tumours. Survival in these circumstances depends mostly on factors that are determined prior to definitive treatment by a tertiary orthopaedic oncology unit. Limb salvage in this group of patients is associated with a higher rate of inadequate marginal surgery and, consequently, higher local recurrence rates than amputation, but should still be attempted whenever possible, as local control is not the primary determinant of survival.

Cite this article: Bone Joint J 2014;96-B:665–72.
Monostotic fibrous dysplasia of the proximal femur
Authors: Han I. , Choi E. S. , Kim H-S.
Published: May 2014

Monostotic fibrous dysplasia of the proximal femur has a variable clinical course, despite its reported limited tendency to progress.

We investigated the natural history and predisposing factors for progression of dysplasia in a group of 76 patients with a mean follow-up of 8.5 years (2.0 to 15.2). Of these, 31 (41%) presented with an asymptomatic incidental lesion while 45 (59%) presented with pain or a pathological fracture. A group of 23 patients (30%) underwent early operative treatment for pain (19: 25%) or pathological fracture (4: 5%).

Of the 53 patients who were initially treated non-operatively, 45 (85%) remained asymptomatic but eight (15%) needed surgery because of pain or fracture. The progression-free survival of the observation group was 81% (sd 6.4%) at five-years follow-up. An initial presentation of pain (p < 0.001), a limp (p < 0.001), radiological evidence of microfracture (p = 0.001) and younger age (< 17 years) (p = 0.016) were significant predisposing factors for disease progression.

The risk of experiencing pain or pathological fracture is considerable in monostotic fibrous dysplasia of the proximal femur. Patients presenting with pain, a limp or radiological evidence of microfracture have a high chance of needing surgical treatment.

Cite this article: Bone Joint J 2014;96-B:673–6.