bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidural volume extension in combined spinal epidural anaesthesia for elective caesarean section: a randomised controlled trial
Authors: Loubert C. , O’Brien P. J. , Fernando R. , Walton N. , Philip S. , Addei T , Columb M. O. , Hallworth S.
Published: March 2011

We investigated the effect of epidural volume extension on spinal blockade in pregnant women undergoing elective caesarean section with a combined spinal‐epidural technique. We randomly allocated 90 healthy subjects to three groups to receive spinal hyperbaric bupivacaine 7.5 mg (group B7.5), spinal hyperbaric bupivacaine 7.5 mg immediately followed by epidural volume extension with saline 5 ml (group B7.5‐EVE) or spinal hyperbaric bupivacaine 10 mg without epidural volume extension (group B10). We evaluated the height of the block every 5 min for 15 min following the spinal injection. The overall sensory block level increased with time (p < 0.001), regardless of the group studied, and there were significantly fewer failures of block in the group B10 compared with both B7.5 and B7.5‐EVE groups (p = 0.001). In conclusion, we could not demonstrate a benefit in using epidural volume extension with 5 ml saline as part of a combined spinal epidural technique in term parturients undergoing elective caesarean section.
Efficacy and safety of high‐dose peanut oral immunotherapy with factors predicting outcome
Authors: Anagnostou K. , Clark A. , King Y. , Islam S. , Deighton J. , Ewan P.
Published: March 2011

Background
Peanut allergy is severe and rarely resolves.

Objective
To test the efficacy and safety of a new oral immunotherapy (OIT) protocol for peanut allergy.

Method
Twenty‐two peanut‐allergic children underwent oral challenge. OIT was administered by gradual updosing with 2‐weekly increments (8–38 weeks) to 800 mg of protein (5 peanuts/day) followed by 30‐week maintenance. Oral challenge was repeated after 6 and 30 weeks maintenance.

Results
Twenty‐two children (median 11 years) had positive challenges (threshold 1–110 mg). Nineteen of 22 (86%) tolerated updosing and maintenance at 800 mg protein/day. One of 22 dropped out; 2/22 tolerated updosing and maintenance at 200–400 mg protein. Reactions, mostly mild, occurred in 86% during immunotherapy, adrenaline was not required. Eight of 8 with pre‐immunotherapy peanut IgE<27.3 kU/L required no dose adjustment compared with 5/13 with pre‐immunotherapy peanut IgE27.3 kU/L. Twelve of 22 (54%) required a transient dose reduction because of reactions possibly related to extrinsic factors: tiredness, infection and exercise. After 6 weeks, 12/22 (54%) had no reaction to a 2.6 g protein challenge. After 30 weeks, 14/22 (64%) tolerated 6.6 g protein. The median tolerated peanut dose increased 1000‐fold following immunotherapy, from 6 to 6459 mg of protein.

Conclusions and Clinical Relevance
We used a novel protocol using gradual updosing, and higher maintenance dose resulting in a better outcome compared with rush protocols. There was a 1000‐fold increase in the amount of peanut tolerated with a good safety profile. No serious adverse events occurred. Most subjects tolerated five peanuts and all were protected against amounts likely during accidental ingestion. New information is provided on ‘extrinsic factors’, updosing method and factors associated with success (trial registration http://ClinicalTrials.gov– ID number NCT01259804).

Cite this as: K. Anagnostou, A. Clark, Y. King, S. Islam, J. Deighton and P. Ewan, Clinical & Experimental Allergy, 2011 (41) 1273–1281.
Morphological and immunohistochemical investigation of non‐Hodgkin's lymphoma combined with Hodgkin's disease
Authors: Hansmann M. L. , Fellbaum Ch. , Hui P. K. , Lennert K.
Published: March 2011

Twenty cases with a morphological picture highly suspicious for a combination of non‐Hodgkin's lymphoma and Hodgkin's disease were investigated. The infiltrates of Hodgkin's disease differed from those of non‐Hodgkin's lymphoma in their cellular component of Hodgkin and Sternberg‐Reed cells and the irregularity in the fibre pattern. Based upon histological and immunohistochemical criteria the 20 cases were divided into three groups. Group 1 (n = 10) contained seven chronic lymphocytic leukaemias of B type, one lymphoplasmacytoid immunocytoma, and two centroblastic/centrocytic lymphomas. The non‐Hodgkin's lymphoma components showed a monotypic immunoglobulin distribution pattern and/or leukaemic blood picture. Adjacent to the non‐Hodgkin's lymphoma was typical Hodgkin's disease in which Hodgkin and Sternberg‐Reed cells were positive for both immunoglobulin light chains and IgG and reacted with anti‐CD15. Group 2 (n = 5) consisted exclusively of centroblastic/centrocytic lymphoma in combination with Hodgkin's disease in which the few Hodgkin and Sternberg‐Reed cells were negative with anti‐CD15 monoclonal antibody. Group 3 (n = 5) consisted of four chronic lymphocytic leukaemias of B type and one lymphoplasmacytoid immunocytoma. In these cases no combination with Hodgkin's disease could be diagnosed apart from the presence of partially CD15 positive Hodgkin and Sternberg‐Reed cells. The following conclusions were drawn: anti‐CD15 (LeuM1 and 3C4/C3D‐1) can neither confirm nor exclude Hodgkin's disease since, while they do not detect Hodgkin and Sternberg‐Reed cells in all cases of Hodgkin's disease, they do recognize Hodgkin and Sternberg‐Reed cells in some B‐cell lymphomas; anti‐CD30 (Ber‐H2) reacted with Hodgkin and Sternberg‐Reed cells in all cases of Hodgkin's disease and also detected these cells in cases of non‐Hodgkin's lymphoma.
Choroid plexus papillomas: an immunohistological study of 16 cases
Authors: Cruz‐Sanchez F. F. , Rossi M. L. , Hughes J. T. , Coakham H. B. , Figols J. , Eynaud P. M.
Published: March 2011

Eleven benign and five malignant choroid plexus papillomas in children and adults were studied immunohistologically with a panel of antibodies against glial fibrillary acidic protein, S‐100 protein, vimentin, desmin, epithelial membrane antigen and two different cytokeratins (LP34 and CAM 5.2). Glial fibrillary acidic protein was focally present in epithelial tumour cells, in cells within solid areas and in clusters of cells within the stroma. S‐100 protein was diffusely present in tumour cells with focal accentuation. Vimentin was present in all cases, the epithelial tumour cells demonstrating strong and diffuse positivity with perinuclear accentuation; malignant tumours, however, showed stronger positivity than benign ones. Desmin was negative in all tumours. Epithelial membrane antigen and cytokeratin (LP34) were demonstrated in four of five malignant tumours but were absent in the benign ones; CAM 5.2 reacted with four of five malignant tumours and also reacted with eight of the 11 benign ones. The significance of these findings is discussed in respect of the ontogeny of these tumours.
DNA flow cytometry of thymomas
Authors: Davies S. E. , Macartney J. C. , Camplejohn R. S. , Morris R. W. , Ring N. P. , Corrin B.
Published: March 2011

Forty‐seven thymomas have been examined by DNA flow cytometry and results correlated with histology, stage, associated clinical features and survival. Twenty‐five cases were DNA diploid, 14 were ancuploid and no results could be obtained for eight cases. The presence of ancuploidy correlated with more advanced (stage II and III) disease and the presence of myasthenia gravis and was more frequent in epithelial predominant thymomas. Tumour recurrence was more frequent in DNA aneuploid tumours, stage II/III disease and epithelial predominant neoplasms. Multifactorial analysis showed that DNA aneuploidy was predictive of tumour recurrence independent of the effects of stage and histology.
A study of 39 retinoblastomas with particular reference to morphology, cellular differentiation and tumour origin
Authors: Shuangshoti S. , Chaiwun B. , Kasantikul V.
Published: March 2011

A series of 39 retinoblastomas was studied using light microscopy and immunohistochemistry for localization of neurone‐specific enolase and glial fibrillary acidic protein. Thirty‐eight retinoblastomas (97.4%) occurred in children less than 6 years of age; one was in a 61‐year‐old man (2.6%); the mean age, excluding the 61‐year‐old, was 32.1 months. Unilateral tumours were found in 74.4% of patients and bilateral tumours in 25.6%; bilateral lesions occurred in a younger age group, mean age of 21.7 vs 35.9 months. The male to female ratio was 1.4:1. Morphologically, arrangement of tumour cells into trabeculae was noted in 69.2% of retinoblastomas and glomeruluslike structures in 43.6%. These two patterns of cellular arrangement were encountered where the choroid and sclera were invaded by neoplastic cells. Homer Wright rosettes were observed in all tumours, Flexner‐Winstersteiner rosettes in 33.3% and fleurettes in 2.6%. Differentiation into neoplastic neurones as well as in the form of Flexner‐Winstersteiner rosettes and fleurettes was noted in 46.1%, neoplastic ependymal cells in 100.0%, astrocytes in 58.9%, oligodendrocytes in 23.1%, and glioblastomas in 2.6%. These data suggest that retinoblastoma is a primitive stem cell neuroectodermal tumour with the capacity for differentiation in both neuronal and neuroglial directions.
Basement membrane deposition in benign and malignant naevo‐melanocytic lesions: an immunohistochemical study with antibodies to type IV collagen and laminin
Authors: Havenith M. G. , Van Zandvoort E. H. M. , Cleutjens J. P. M. , Bosman F. T.
Published: March 2011

Patterns of basement membrane deposition were investigated in benign and malignant naevo‐melanocytic lesions using antibodies to type IV collagen and laminin. Paraffin sections required pretreatment with 6 m guanidine‐HCl in addition to pepsin pretreatment. Basement membrane deposition was found around clusters as well as individual naevo‐melanocytic cells in contact with dermal stroma. However, between keratinocytes and intra‐epidermally located naevo‐melanocytic cells, basement membrane immunostaining could not be detected. Tumour cell‐stromal interaction is apparently a prerequisite for basement membrane deposition in naevo‐melanocytic lesions. Basement membrane discontinuities, in the absence of inflammatory infiltrate, appeared, in doubtful cases, to be evidence in favour of malignant melanoma. The general pattern of basement membrane deposition in benign and malignant lesions was found to be similar and therefore of no help in differential diagnosis. Identification of hyaline bodies, which show immunoreactivity with antibodies to basement membrane components, may be helpful in distinguishing between Spitz naevi and malignant melanomas. Detection of vascular invasion, a prognostic indicator in malignant melanoma, is facilitated by basement membrane immunostaining.
The sites of hormone storage in normal and diseased parathyroid glands: a silver impregnation and immunohistochemical study
Authors: Pesce C. , Tobia F. , Carli F. , Antoniotti G. V.
Published: March 2011

The results of Grimelius” silver impregnation method and of two immunohistochemical methods for the demonstration of the sites of storage of parathyroid hormone (PTH) were compared in a series of parathyroid glands from 39 patients affected by either hyperplasia or adenoma and from 10 normal subjects. An indirect immunoperoxidase method using an anti‐bovine PTH serum gave unsatisfactory results. In contrast a biotin‐streptavidin immunoperoxidase method using an antibody against the 44–68 amino acid sequence of human PTH yielded similar results to those with Grimelius” silver impregnation method. This supports the view that argyrophil granules correspond to the secretory granules of PTH. The degree of silver impregnation, however, varied considerably in duplicate sections, probably because of difficulties in standardization of the Grimelius” method. The biotin‐streptavidin method appeared more sensitive and was reproducible. The immunohistochemical demonstration of PTH may prove useful in defining the sites of hormone storage in normal and pathological conditions.
Patterns of reactivity with the monoclonal antibodies HMFG1 and HMFG2 in normal endometrium, endometrial hyperplasia and adenocarcinoma
Authors: Morris W. P. R. , Griffin N. R. , Wells M.
Published: March 2011

Using an indirect immunoperoxidase technique the expression of the epitopes in human milk fat globule (HMFG) membranes detected by the monoclonal antibodies HMFG1 and HMFG2 was studied in the normal endometrium and in cases of cystic glandular hyperplasia, glandular hyperplasia with architectural atypia (complex hyperplasia), glandular hyperplasia with cytological atypia (atypical hyperplasia) and invasive adenocarcinoma. Luminal reactivity with HMFG1 was seen in cases of normal endometrium, cystic glandular hyperplasia and glandular hyperplasia with architectural atypia. In contrast most cases of glandular hyperplasia with cytological atypia and invasive adenocarcinoma also showed areas of cytoplasmic reactivity. Reactivity with HMFG2 was scanty.
An investigation of NCRC11 immunoreactivity in normal and neoplastic epithelia of the female genital tract and ovary
Authors: Hitchcock A. , Ellis I. O. , Bell J. , Robins A.
Published: March 2011

An investigation of NCRC11 immunoreactivity in normal and neoplastic epithelia of the female genital tract and ovary

NCRC11 is a monoclonal antibody raised against human mammary carcinoma cells. The prognostic value of tumour cell immunoreactivity to NCRC11 in breast cancer has been shown previously. This study describes NCRC11 immunoreactivity in a wide range of normal and neoplastic epithelial types from the female genital tract and ovary. In the tumours examined, a wide range of staining patterns was seen. The implications of these findings are discussed in relation to the potential uses of this antibody in diagnosis and monitoring of gynaecological diseases.
Hyalinizing trabecular adenoma of the thyroid. A report of three cases with immunohistochemical and ultrastructural studies
Authors: Katoh R. , Jasani B. , Williams E. D.
Published: March 2011

We have studied three examples of benign thyroid tumours which conform to the lesion recently described as hyalinizing trabecular adenoma. The prominent feature of this trabecular epithelial lesion is the extracellular deposition of an eosinophilic material that does not show the features of amyloid; the epithelial cells may be elongated, sometimes radially arranged around the eosinophilic material. All three tumours showed positive immunocytochemical staining for thyroglobulin, keratin, chromogranin and neuron‐specific enolase. One tumour showed isolated cells with immunoreactivity for somatostatin, argyrophil cytoplasmic granularity with the Grimelius technique, and ultrastructurally demonstrable cytoplasmic electron‐dense endocrine granules. The hyaline extracellular material in all three tumours showed strong immunoreactivity for both type IV collagen and laminin. Previous radiation may be important in the causation of this tumour, and it shows a frequent association with severe thyroiditis. We conclude that the main histological feature of this lesion, the hyaline material, is due to the overproduction of a basement membrane‐like material by the neoplastic follicular cells. The presence in one tumour of evidence of endocrine differentiation may reflect the potential for follicular cells to show biphasic differentiation, a feature which may be more frequent than has been previously recognized. Several of the other features of this tumour–‐for example the frequent intranuclear cytoplasmic inclusions–‐may lead to diagnostic problems, and the entity deserves wider recognition.
Diagnosis of T‐cell lymphoma using beta F1, anti‐T‐cell receptor beta chain antibody
Authors: Krajewski A. S. , Myskow M. W. , Salter D. M. , Cunningham D. S. , Ramage E. F.
Published: March 2011

The reactivity of a new monoclonal antibody to the T‐cell beta chain antigen receptor (beta F1) with routinely processed paraffin sections from patients with T‐cell lymphoma is described. Staining of tumour cells was seen in 36/47 cases of T‐cell lymphoma. No staining was seen in any cases of B‐cell lymphoma (0/21 cases), nine of which had previously been shown to react with other T‐cell antibodies (MT1/UCHL1). We conclude that beta F1 is a specific marker for demonstrating a T‐cell histogenesis of lymphoma and with advantages over other currently available antibodies reactive with paraffin sections.
Thin regressing malignant melanoma: Significance of concurrent regional lymph node metastases
Authors: Shaw H. M. , Mccarthy S. W. , Mccarthy W. H. , Thompson J. F. , Milton G. W.
Published: March 2011

We attempted to clarify the prevailing controversy regarding the significance of regression in thin (<0.76 mm) primary melanomas. Of 7540 patients with cutaneous melanomas treated at the Sydney Melanoma Unit, 28 first presented with a thin primary lesion and concurrent regional lymph node metastases (stage II). Major differences in tumour histology existed between these patients and stage I patients with thin lesions that subsequently recurred. Regression was present in all 28 lesions in stage II patients. In 61 stage I patients ultimately developing a recurrence, 67% of lesions displayed regression. Significantly, however, in 735 stage I patients ultimately not developing a recurrence, 61% of lesions also displayed regression. Why regression occurs so frequently in thin lesions which never recur is unclear. Our results suggest that the histology of thin primary melanomas may be influenced by the presence or absence of metastases in patients at that time.
S‐100 protein: Is it useful as a tumour marker in diagnostic immunocytochemistry?
Authors: Schmitt F. C. , Bacchi C. E.
Published: March 2011

S‐100 protein: Is it useful as a tumour marker in diagnostic immunocytochemistry?

A heterogeneous group of 159 tumours was studied for the presence of S‐100 protein by the immunoperoxidase technique in order to determine whether this marker may be of value in facilitating immunocytochemical diagnosis. Among cases of melanocytic and pigmented lesions, S‐100 was widely distributed and demonstrated the strongest degrees of reactivity. S‐100 protein was identified in virtually all nerve sheath tumours such as schwannomas, neurofibromas, myxoid sheath nerve tumour and also in some tumours of controversial histogenesis such as granular cell tumours. The great majority of carcinomas did not express S‐100, with only two cases of breast carcinoma displaying focal S‐100 staining. In a miscellaneous group of tumours S‐100 was demonstrated in chordomas, myoepitheliomas and Wilms” tumour with Schwann cell differentiation. Despite its presence in a wide array of cell types, S‐100 protein continues to be an extremely useful marker especially for soft tissue and peripheral nervous system tumours.
Is discharge knee range of motion a useful and relevant clinical indicator after total knee replacement? Part 2
Authors: Naylor Justine M. , Ko Victoria , Rougellis Steve , Green Nick , Mittal Rajat , Heard Rob , Yeo Anthony E. T. , Barnett Anne , Hackett Danella , Saliba Chris , Smith Nicole , Mackey Martin , Harmer Alison , Harris Ian A. , Adie Sam , McEvoy Lynette
Published: March 2011

Objective  Knee range of motion (ROM) at discharge from acute care is used as a clinical indicator following total knee replacement (TKR) surgery. This study aimed to assess the clinical relevance of this indicator by determining whether discharge knee ROM predicts longer‐term knee ROM and patient‐reported knee pain and function.

Methods  A total of 176 TKR recipients were prospectively followed after discharge from acute care. Outcomes assessed included knee ROM and Oxford knee score post rehabilitation and 1 year post surgery. Discharge ROM and other patient factors were identified a priori as potential predictors in multiple linear regression modelling.

Results  A total of 133 (76%) and 141 (80%) patients were available for follow‐up post rehabilitation [mean postoperative week 8.1 (SD 2.7)] and at 1 year [mean postoperative month 12.1 (SD 1.4)], respectively. Greater discharge knee flexion was a significant (P < 0.001) predictor of greater post‐rehabilitation flexion but not 1‐year knee flexion (P < 0.083). Better discharge knee extension was a significant predictor of better post‐rehabilitation (P = 0.001) and 1‐year knee extension (P = 0.013). Preoperative Oxford score and post‐rehabilitation knee flexion independently predicted post‐rehabilitation Oxford score, and gender predicted 1‐year Oxford score. Discharge ROM did not significantly predict Oxford score in either model.

Conclusion  The finding that early knee range predicts longer‐term range provides clinical evidence favouring the relevance of discharge knee ROM as a clinical indicator. Although longer‐term patient‐reported knee pain and function were not directly associated with discharge knee ROM, they were associated with ROM when measured concurrently in the sub‐acute phase. No causal effect has been demonstrated, but the findings suggest it may be important for physiotherapists to maximize range in the early and sub‐acute periods.
Improving perinatal Group B streptococcus screening with process indicators
Authors: Albouy‐Llaty Marion , Nadeau Cédric , Descombes Emmanuelle , Pierre Fabrice , Migeot Virginie
Published: March 2011

Rationale  Group B streptococcus (GBS) neonatal infection can be prevented by screening pregnant women for GBS colonization from the 34th to the 38th week of gestation, as has been recommended in France since 2001. We assessed guideline adherence among midwives and obstetricians.

Methods  From 2006 to 2008, new and mandatory GBS data were added to the obstetric database. We merged the latter with a bacteriological database and a paediatric database and defined process indicators for pregnant women who delivered from the 37th week of gestation in the hospital of Poitiers and for neonates hospitalized for a GBS infection from 2006 to 2008.

Results  We abstracted 5997 pregnant women (1942 in 2006, 1975 in 2007 and 2080 in 2008) and 84 neonates (17 in 2006, 32 in 2007 and 35 in 2008). GBS pregnancy colonization prevalence was 15%, 13% and 18% respectively. Availability of GBS screening status was stable (96%, P = 0.15). The rate of GBS screening during pregnancy increased significantly (86% to 90%, P = 0.002). Percentage of correct‐term screening increased significantly (89% to 96%, P < 0.001). Percentage of women who received intra‐partum antibiotic prophylaxis decreased significantly (84% to 70%, P = 0.001). Percentage of women who received correct intra‐partum antibiotic prophylaxis was stable (75%, P = 0.65). Percentage of neonates whose mother had been correctly screened but negative was 77%, 67% and 68% respectively (P = 0.61).

Conclusion  Our mandatory database entailed guideline adherence over a short lapse of time and resulted in a significant increase of the screening rate at the correct term. However, circumstances where neonates are infected still remain. Screening test performance needs to be re‐evaluated.
Electronic health information system at an opioid treatment programme: roadblocks to implementation
Authors: Louie Ben , Kritz Steven , Brown Jr Lawrence S. , Chu Melissa , Madray Charles , Zavala Roberto
Published: March 2011

Rationale  Electronic health systems are commonly included in health care reform discussions. However, their embrace by the health care community has been slow.

Methods  At Addiction Research and Treatment Corporation, a methadone maintenance programme that also provides primary medical care, HIV medical care and case management, substance abuse counselling and vocational services, we describe our experience in implementing an electronic health information system that encompasses all of these areas.

Results  We describe the challenges and opportunities of this process in terms of change management, hierarchy of corporate objectives, process mastering, training issues, information technology governance, electronic security, and communication and collaboration.

Conclusion  This description may provide practical insights to other institutions seeking to pursue this technology.
Pharmacists contribute to the improved efficiency of medical practices in the outpatient cancer chemotherapy clinic
Authors: Iihara Hirotoshi , Ishihara Masashi , Matsuura Katsuhiko , Kurahashi Sayoko , Takahashi Takao , Kawaguchi Yoshihiro , Yoshida Kazuhiro , Itoh Yoshinori
Published: March 2011

Rationale, aims and objectives  Outpatient cancer chemotherapy is increasing with the development of anticancer agents, and roles of medical staff are becoming more and more important in cancer chemotherapy. We showed here roles of pharmacists with experience in oncology and evaluated outcomes of their activities in medical practices in cancer chemotherapy clinic.

Methods  Two pharmacists were newly assigned to the outpatient cancer chemotherapy clinic, where they were in charge of verification of prescription orders, mixing of anticancer injections, monitoring adverse drug reactions, implementation of supportive care and provision of information about cancer chemotherapy to medical staff and patients. The number of patients, amounts of mixing of anticancer injections and hospital revenue were compared before and after assignment of pharmacists. Management of chemotherapy‐induced nausea and vomiting in breast cancer patients receiving the combination chemotherapy with anthracycline and cyclophosphamide were also compared.

Results  Pharmacists spent 75 hours per month in patient education and adverse drug reactions monitoring, which led to the reduction of the workload of physicians. As a consequence, the number of outpatients and the resultant hospital revenue markedly increased. In addition, facilitation of proper use of anti‐emetic drugs led to the improved control of chemotherapy‐induced nausea with reducing the cost for anti‐emesis by 16%.

Conclusions  Pharmacists contributed to the improved efficiency of medical practices.
Contribution of the glycolytic flux and hypoxia adaptation to efficient biofilm formation by Candida albicans
Authors: Bonhomme Julie , Chauvel Murielle , Goyard Sophie , Roux Pascal , Rossignol Tristan , d'Enfert Christophe
Published: March 2011

The fungal pathogen Candida albicans forms therapeutically challenging biofilms on biomedical implants. Using a transcript profiling approach genes whose expression is favoured upon biofilm growth compared with planktonic growth have been previously identified. Knock‐out mutants for 38 of these genes were constructed, six of which showed a specific defect in biofilm formation. Among these genes, TYE7 that encodes a transcriptional activator of glycolytic genes in planktonic and biofilm growth conditions was identified as being required for the cohesiveness of biofilms. Biofilms formed by the tye7Δ knock‐out mutant showed a hyperfilamentous morphology, and growth of this mutant on solid medium under hypoxia was also associated with the production of hyphae. Similar to TYE7 inactivation, inhibition of glycolysis or ATP synthesis using oxalate or an uncoupler, respectively, triggered morphogenesis when a wild‐type strain was grown under hypoxia. These treatments also induced the formation of weakly cohesive, hyper‐filamentous biofilms by a wild‐type strain. Our data indicate that a hypoxic environment is generated within C. albicans biofilms and that continued biofilm development requires a Tye7p‐dependent upregulation of glycolytic genes necessary to adapt to hypoxia and prevent uncontrolled hyphal formation. Thus, adaptation to hypoxia is an integral component of biofilm formation in C. albicans.
Deep electrical resistivity structure of the northern Gibraltar Arc (western Mediterranean): evidence of lithospheric slab break‐off
Authors: Rosell Oriol , Martí Anna , Marcuello Àlex , Ledo Juanjo , Queralt Pilar , Roca Eduard , Campanyà Joan
Published: March 2011

Terra Nova, 23, 179–186, 2011

Uncertainties about the lithospheric structure of the Gibraltar Arc have led to the proposal of several contradictory models to explain its geodynamic setting. Herein, we present a novel 3‐D model of the lithospheric electrical resistivity distribution beneath the whole Betic Cordillera obtained by inverting both broad‐band and long‐period magnetotelluric data. The lithosphere–asthenosphere boundary under SW Iberia is shown to be deeper than under the Alboran Basin. In addition, the sensitivity tests confirm the presence of a N–S oriented low‐resistivity anomaly at lithospheric mantle depths east of the 4°W meridian. It coincides with an area of low velocities without earthquake hypocenters and is interpreted as asthenospheric material intruded by the lateral lithospheric tearing and breaking‐off of the E‐directed subducting Ligurian slab under the Alboran Domain. This scenario suggests that the opening of the Alboran Basin is related to the westward rollback of this E‐directed subducting slab.
Adiponectin expression in subcutaneous adipose tissue is reduced in women with cellulite
Authors: Emanuele Enzo , Minoretti Piercarlo , Altabas Karmela , Gaeta Elio , Altabas Velimir
Published: March 2011

Background  Cellulite, which appears as orange peel‐type or cottage cheese‐like dimpling of the skin on the thighs and buttocks, is a complex, multifactorial, cosmetic disorder of the subcutaneous fat layer and the overlying superficial skin. Adiponectin is an adipocyte‐derived hormone mainly produced by subcutaneous fat that shows important protective anti‐inflammatory and vasodilatory effects. We hypothesized that adiponectin expressed in the subcutaneous adipose tissue (SAT) might play a role in the pathogenesis of cellulite. We reasoned that a reduction in the expression of adiponectin – a humoral vasodilator – in the SAT of cellulite areas might contribute to the altered microcirculation frequently found in these regions.

Methods  A total of 15 lean (body mass index [BMI] < 25 kg/m2) women with cellulite and 15 age‐ and BMI‐matched women without cellulite participated in this study. Real‐time reverse transcription polymerase chain reaction (RT‐PCR) was used to assess adiponectin gene expression. Plasma adiponectin levels were measured using a commercial enzyme immunoassay kit.

Results  Adiponectin mRNA expression in the SAT of the gluteal region was significantly lower in areas with cellulite compared with those without (12.6 ± 3.1 AU versus 16.6 ± 4.1 AU; P = 0.006). However, plasma adiponectin levels did not differ between women with (20.3 ± 7.3 μg/ml) and without (19.3 ± 6.1 μg/ml) cellulite (P = 0.69).

Conclusions  Adiponectin expression is significantly reduced in the SAT in areas affected by cellulite. Our findings provide novel insights into the nature of cellulite and may give clues to the treatment of this cosmetic issue.
Measuring herpes zoster, zoster‐associated pain, post‐herpetic neuralgia‐associated loss of quality of life, and healthcare utilization and costs in Thailand
Authors: Aunhachoke Kobkul , Bussaratid Valai , Chirachanakul Pornchai , Chua‐Intra Boosbun , Dhitavat Jittima , Jaisathaporn Kanokporn , Kaewkungwal Jaranit , Kampirapap Kowit , Khuhaprema Thiravud , Pairayayutakul Kulprapat , Pitisuttithum Punnee , Sindhvananda Jirot , Thaipisuttikul Yupin ,   for the Thai Herpes Zoster Study Group
Published: March 2011

Objectives  This study aimed to measure the herpes zoster‐associated burden of illness, healthcare utilization, and costs among Thai patients.

Methods  This prospective cohort study of 180 patients aged ≥ 50 years and healthy, or ≥ 20 years and immunosuppressed, with zoster rash, was conducted in Bangkok and its environs, Thailand, during 2007–2008. Each patient was followed for six months for zoster‐associated rash, pain, quality of life (QoL), and healthcare utilization and costs.

Results  A total of 180 subjects were enrolled in the study. Their mean ± standard deviation (SD) age was 58.9 ± 13.8 years. Of the 180 patients enrolled, 138 (76.7%), 34 (18.9%) and eight (4.4%) patients were elderly, HIV‐infected, and receiving immunosuppressive agents, respectively; 35 (19.4%) had post‐herpetic neuralgia (PHN), and 13 (7.2%) had zoster ophthalmicus. The severity of zoster pain was moderately highly correlated with activities of daily living (ADL), at 0.68 ≤ ρ ≤ 0.76. Most patients required only one or two outpatient visits. The mean ± SD total of direct healthcare costs was 3083.4 ± 5047.0 Thai baht or ∼ 1.1% of annual income per capita.

Conclusions  Herpes zoster contributes a significant burden of illness to both patients and the wider community.
Pruritic eruption on the buttocks
Authors: Chiu Melvin W. , Alamdari Habibollah S.
Published: March 2011

What is your diagnosis?
Contact hypersensitivity in patients with primary cutaneous lymphoproliferative disorders
Authors: Khamaysi Ziad , Weltfriend Sara , Khamaysi Khozayma , Bergman Reuven
Published: March 2011

Background  One of the suggested causes of primary cutaneous lymphoproliferative disorders is persistent antigenic stimulation.

Objective  To study the prevalence of contact hypersensitivity in patients with primary cutaneous lymphoproliferative disorders other than mycosis fungoides (MF).

Materials and methods  Thirty consecutive patients with primary cutaneous lymphoproliferative disorders other than MF were patch tested to a European Standard & partial metal series. The results were compared with those of 792 consecutive patients with other skin diseases referred to our clinic and a large published series of 9760 healthy individuals from North America.

Results  Twenty‐two patients with primary cutaneous lymphoma other than MF and eight patients with pseudolymphomas were included in the study. Altogether there were 23 positive patch tests in 13 patients. Only the prevalence of positive patch tests to cobalt (5/30 patients = 17%) was found to be significantly higher in the studied group than in the two control groups (P < 0.01 and P = 0.05, respectively). The contact hypersensitivity to cobalt and the other allergens, however, could not be related causally to the pathogenesis of the lesions.

Conclusions  The relative prevalence of contact hypersensitivity to cobalt only was found to be increased in a group of primary cutaneous lymphoproliferative disorders, but a causal relationship to the lymphoproliferative disorders could not be established.
Recruiting underserved populations to dermatologic research: a systematic review
Authors: Spears Chaya R. , Nolan Bridgit V. , O’Neill Jenna L. , Arcury Thomas A. , Grzywacz Joseph G. , Feldman Steven R.
Published: March 2011

Recruitment of participants to dermatologic research studies can be challenging, particularly with historically underserved populations. Recruitment of these groups is essential to ethical, valid, and useful dermatologic research. This article discusses findings from a review of 78 studies that examined factors influencing participation in health research studies with an emphasis on underserved populations, particularly women and ethnic minorities. The most commonly encountered barriers to research participation are mistrust of research, lack of access to research programs, and culturally incompetent research design. Motives to participate in research include receipt of benefit from participation, perceived opportunities to help others, and culturally competent research design. Practical methods for addressing barriers and enhancing research participation include culturally competent research design, community‐based recruitment, and easily understandable informed consent. These factors should be considered when recruiting subjects for dermatologic research, especially when recruitment of underserved populations is desired. In addition, the literature demonstrates a paucity of research among rural residents, infants, and children, as well as within clinical dermatologic research.
High frequency of the TARDBP p.Ala382Thr mutation in Sardinian patients with amyotrophic lateral sclerosis
Authors: Orrù S , Manolakos E , Orrù N , Kokotas H , Mascia V , Carcassi C , Petersen MB
Published: March 2011

Orrù S, Manolakos E, Orrù N, Kokotas H, Mascia V, Carcassi C, Petersen MB. High frequency of the TARDBP p.Ala382Thr mutation in Sardinian patients with amyotrophic lateral sclerosis.

Recently, rare mutations in the TARDBP gene have been identified in familial and sporadic amyotrophic lateral sclerosis (ALS) patients. The purpose of this study was to characterize the genetic variability of the TARDBP gene in a cohort of Sardinian ALS patients. The coding region of the gene was analyzed in 97 unrelated patients previously tested negative for superoxide dismutase (SOD1) mutations. The p.Ala382Thr (c.1144G>A) mutation was found in 30 patients (30.9%). The mutation was predominant in familial ALS patients (FALS) as it was represented in 24 of 30 FALS cases (80%) (p < 0.0003). Six cases were apparently sporadic (9% of sporadic ALS patients). No further mutation of TARDBP was found in our cohort of ALS patients. Patients carrying the mutation showed spinal site of onset in 24 cases (80%), an average age at onset of 54.7 ± 11.1 years, not significantly different from patients not harboring TARDBP mutations (56.7 ± 9.6) and a female:male gender ratio of 1:1.1. The haplotype analysis carried out using eight microsatellite markers flanking the gene showed a founder effect for this mutation. Finally, we estimated the age‐specific penetrance of the TARDBP p.Ala382Thr mutation in an additional sample of 47 carriers (20 affected and 27 unaffected). The average penetrance to 70 years was 60% (95% confidence interval 41–79%). A trend toward a higher penetrance in males was observed. Even in the presence of a causal mutation, most of the ALS clinical heterogeneity, however, draws upon from a multifactorial context.
An association of ABO non‐identical platelet and cryoprecipitate transfusions with altered red cell transfusion needs in surgical patients
Authors: Refaai Majed A. , Fialkow Lawrence B. , Heal Joanna M. , Henrichs Kelly F. , Spinelli Sherry L. , Phipps Richard P. , Masel Edward , Smith Brian H. , Corsetti James P. , Francis Charles W. , Bankey Paul E. , Blumberg Neil
Published: March 2011

Background  Transfusion of ABO non‐identical plasma, platelets and cryoprecipitate is routine practice even though adverse effects can occur.

Methods and Materials  Our hospital changed transfusion practice in 2005 and adopted a policy of providing ABO‐identical blood components to all patients when feasible. We retrospectively compared the transfusion requirements, length of stay and in‐hospital mortality in relation to ABO blood group in surgical patients who received platelet transfusions before and after this change to determine whether it resulted in any benefit.

Results  Prior to the change in practice, both group B and AB patients received more ABO non‐identical platelet transfusion (P = 0·0004), required significantly greater numbers of red cell transfusions (P = 0·04) and had 50% longer hospital stays (P = 0·039) than group O and A patients. Following the policy change, there was a trend for fewer red cell transfusions (P = 0·17) and length of stay in group B and AB patients than group O or A patients. Overall, the mortality rate per red cell transfusion decreased from 15·2 per 1000 to 11·0 per 1000 (P = 0·013).

Conclusions  These results, in the context of previous findings, suggest that providing ABO‐identical platelets and cryoprecipitate might be associated with reduction in transfusion requirements and improve outcomes in surgical patients.
In vitro storage characteristics of platelet concentrates suspended in 70% SSP+TM additive solution versus plasma over a 14‐day storage period
Authors: Saunders C. , Rowe G. , Wilkins K. , Holme S. , Collins P.
Published: March 2011

Background and Objectives  The non‐paired two‐arm study compared the in vitro storage characteristics of platelets suspended as concentrates in either 100% plasma or a mixture of additive solution (SSP+™, MacoPharma, Mouveaux, France) and autologous plasma in a 70:30 ratio over a 14‐day storage period.

Materials and Methods  The buffy coat‐derived pooled platelet concentrates were sampled on days 1, 2, 3, 6, 8, 10 and 14 and tests performed to determine platelet morphology, function, metabolism, activation and apoptosis‐like activity.

Results  Swirling remained strong (score = 3) in SSP+™, whilst scores of 1 and 0 were noted for plasma units by end of storage. In contrast to units in plasma, pH levels remained above seven in SSP+™ units, increasing after day 10. Percent positive expression of CD62P was similar in both groups on day 1 (median of 54% and 56% for plasma (n = 13) and SSP+™ (n = 12), respectively), with SSP+™ units showing a more moderate increase in activation after day 10. A progressive decrease in mitochondrial membrane potential was evident in both groups from day 1, whilst annexin V binding was relatively stable from days 1 to 3, with median values remaining below 6%. Subsequent to this, the percentage of platelets binding annexin V increased to approximately 30% by day 14.

Conclusion  Platelets suspended in a medium of 70:30 SSP+™ to plasma ratio performed at least as well as platelets in 100% autologous plasma for up to 10 days of storage. Further, results are suggestive of an apoptosis‐like process being involved in the platelet storage lesion.
Current status of research on cognitive therapy/cognitive behavior therapy in Japan
Authors: Ono Yutaka , Furukawa Toshi A. , Shimizu Eiji , Okamoto Yasumasa , Nakagawa Akiko , Fujisawa Daisuke , Nakagawa Atsuo , Ishii Tomoko , Nakajima Satomi
Published: March 2011

Cognitive therapy/cognitive behavior therapy was introduced into the field of psychiatry in the late 1980s in Japan, and the Japanese Association for Cognitive Therapy (JACT), founded in 2004, now has more than 1500 members. Along with such progress, awareness of the effectiveness of cognitive therapy/cognitive behavioral therapy has spread, not only among professionals and academics but also to the public. The Study Group of the Procedures and Effectiveness of Psychotherapy, funded by the Ministry of Health, Labor and Welfare, has conducted a series of studies on the effectiveness of cognitive therapy/cognitive behavior therapy since 2006 and shown that it is feasible for Japanese patients. As a result, in April 2010 cognitive therapy/cognitive behavior therapy for mood disorders was added to the national health insurance scheme in Japan. This marked a milestone in Japan's psychiatric care, where pharmacotherapy has historically been more common. In this article the authors review research on cognitive therapy/cognitive behavior therapy in Japan.
Functional magnetic resonance imaging study on the effects of acute single administration of paroxetine on motivation‐related brain activity
Authors: Marutani Toshiyuki , Yahata Noriaki , Ikeda Yumiko , Ito Takehito , Yamamoto Manami , Matsuura Masato , Matsushima Eisuke , Okubo Yoshiro , Suzuki Hidenori , Matsuda Tetsuya
Published: March 2011

Aim:  The aim of the present study was to investigate the effects of acute paroxetine administration on brain activity related to motivation.

Methods:  Sixteen healthy subjects participated in a randomized, single‐blind, no‐drug/placebo‐controlled, cross‐over study. After administration of no drug, placebo or paroxetine (selective serotonin reuptake inhibitor; 20 mg), subjects underwent functional magnetic resonance imaging while performing a monetary incentive delay task. We analyzed the differences in brain activities of the reward anticipation/motor preparation period that are subject to motivational modulation. For this purpose, we subdivided the incentive trials on the basis of whether the reaction times (RT) were slower or faster than the subject's mean RT (slow RT and fast RT trials).

Results:  No drug and placebo showed robust activation differences in the globus pallidus and putamen for the fast RT trials compared to the slow RT trials, whereas paroxetine showed none. Paroxetine showed significantly lower activations in the globus pallidus, insula, putamen and dorsolateral prefrontal cortex compared to no drug in the fast RT trials.

Conclusions:  Paroxetine single acute administration diminished brain activity induced by motivation in healthy subjects. This may partially explain the increased lack of motivation seen in patients with relatively mild symptoms after taking a dose of paroxetine for the first time.
Cerebral oximetry for pediatric anesthesia: why do intelligent clinicians disagree?
Authors: Kasman Nicholette , Brady Ken
Published: March 2011

Reflectance near‐infrared spectroscopy has been used to measure cortical tissue oximetry for more than 30 years. In that time, many centers have adopted the routine use of the cerebral oximeter for children having repair of congenital heart lesions, while some prominent academic centers have resisted routine use of these monitors citing lack of definitive evidence for outcome benefit. In this review, we provide an overview of the method used to measure cerebral oximetry, as well as validation and clinical outcome data that have accrued from the use of cerebral oximeters. We discuss the peculiarities of evidentiary review for monitoring devices, and the confounding errors that occur when a monitor is evaluated as a therapeutic intervention. We outline the physiologic basis of cerebral desaturation and the shifts in practice that have occurred with implementation of NIRS monitoring.
Transition from pediatric to adult health services: the perioperative care perspective
Authors: Brennan Liam J. , Rolfe Paul M.
Published: March 2011

Increasing numbers of children with congenital and chronic diseases are surviving beyond adolescence. Consequently, arrangements must be put in place to ensure that these groups of patients continue to receive high‐quality care into adulthood. Although some medical disciplines have reacted positively to this growing challenge, perioperative care has lagged behind. This review explores some of the difficulties in delivering optimal perioperative care in the transitional period. Key issues, including the paucity of experience in the management of pediatric diseases among adult‐trained clinicians and unfamiliarity with child/family focused care, are discussed. We provide some suggestions for the development of transitional healthcare policies.
Fasting times and gastric contents volume in children undergoing deep propofol sedation – an assessment using magnetic resonance imaging
Authors: Schmitz Achim , Kellenberger Christian J. , Neuhaus Diego , Schroeter Elke , Deanovic Dubravka , Prüfer Friederike , Studhalter Martina , Völlmer Lieselore , Weiss Markus
Published: March 2011

Aim:  To investigate the effect of fasting times for clear fluids and solids/non‐clear fluids on gastric content volume using magnetic resonance imaging (MRI).

Methods:  Pediatric patients undergoing diagnostic MRI under deep propofol sedation, with the stomach located within the area of diagnostic study, were included in this clinical observational study. According to standard institutional guidelines, children were allowed to eat/drink until 4 h and to drink clear fluids until 2 h before scheduled induction time of anesthesia. Gastric content volume per kg body weight (GCVw) was determined using MRI and compared with actual fasting times prior to induction.

Results:  Overall 68 patients aged from 0.3 to 19.6 (2.8) years were investigated. Fasting time for clear fluids ranged from 1.1 to 15.5 (5.5) h, for non‐clear fluids/solids from 4.0 to 20.2 (6.7) h. GCVw ranged from 0.2 to 6.3 (0.75) ml·kg−1 and showed no significant negative correlation to fasting times for clear fluids (r = −0.07, P = 0.60) and non‐clear fluids/solids (r = −0.08, P = 0.51).

Conclusions:  Based on this preliminary data, GCVw showed considerable variation but did not correlate with fasting times in children and adolescent patients. Recommended fasting times were often exceeded.