bluuebunny/crossref_metadata_2025 huggingface dataset:
Synchronous work: myth or reality? A critical study of teams in health and medical care
Authors: Berlin Johan M.
Published: August 2010

Rationale, aims and objectives  In this article, ideal conceptions about teamwork are tested. The research question posed is: How are teams in psychiatry formed? Three theoretical concepts that distinguish groups from teams are presented: sequentiality, parallelism and synchronicity. The presumption is that groups cooperate sequentially and teams synchronously, while the parallel work mode is a transitional form between group and team.

Methods  Three psychiatric outpatient teams at a university hospital specialist clinic were studied. Data were collected through 25 personal interviews and 82 hours of observations. The data collection was carried out over 18 months (2008–2009).

Results  Results show: (1) that the three theoretical distinctions between group and team need to be supplemented with two intermediate forms, semiparallel and semisynchronous teamwork; and (2) that teamwork is not characterized by striving towards a synchronous ideal but instead is marked by an adaptive interaction between sequential, parallel and synchronous working modes.

Conclusions  The article points to a new intermediate stage between group and team. This intermediate stage is called semiparallel teamwork. The study shows that practical teamwork is not characterized by a synchronous ideal, but rather is about how to adaptively find acceptable solutions to a series of practical problems. The study emphasizes the importance of the team varying between different working modes, so‐called semisystematics.
METABOLIC TRAITS IN MENTALLY RETARDED CHILDREN AS COMPARED WITH NORMAL POPULATIONS: PHENYLALANINE AND TYROSINE IN SERUM AND URINE
Authors: HIRSCH W. , MEX ANNEMARIE , VOGEL F.
Published: August 2010

A large sample of mentally subnormal patients aged 2 to 14 years admitted to Wiesengrand Children's Psychiatric Hospital, Berlin were investigated and subjected to detailed physical and mental examination. Those children without definite evidence of organic disease and in the IQ range of 60 to 90 were selected for biochemical studies and comparison with controls and relatives, using paper and column chromatography.

There was a distinct increase in the serum and urinary phenylalanine of the patient sample and a less pronounced decrease in urinary tyrosine level.

Patients with a phenylalanine, tyrosine ratio greater than or equal to 1 demonstrated slight but definite evidence of neurological disturbance compared with those with a P/T ratio less than 1. A daily variation in the P/T quotient was found.

Evidence is produced to suggest that these anomalies, which are not of the metabolic block type, are of genetical origin and not determined by environmental factors.
Tourettism in a patient with Down's syndrome
Authors: COLLACOTT R. A. , ISMAIL I. A.
Published: August 2010

ABSTRACT. A female patient is described in whom autistic traits and Tourettism are associated. The nature of this association is discussed.
The role of attention in the elimination of chronic, life‐threatening vomiting
Authors: KELLY M. B. , HEFFNER H. E.
Published: August 2010

ABSTRACT. A 24‐year‐old retarded client, whose weight over 7 years had fallen from 130 pounds to 72 pounds due to vomiting, was being kept alive for 2 weeks by tube feeding. Behavioural treatment consisted of (a) 30 minutes of non‐contingent staff attention, (b) 2 minutes of no attention contingent on vomiting, and (c) a resulting 2‐minute delay in cleaning expelled vomitus. In 2 weeks, vomiting of 7 years history was reduced to zero. Through 2 months of follow‐up, vomiting remained at zero and weight increased to 97 pounds. The results support previous studies which suggested that vomiting may be reduced and eliminated by manipulating attention.
A low‐cost method for simultaneous video‐recording of ambulant subject and electroencephalograph: the Quarrier's system*
Authors: KERR A. M. , AMOS P. M. , ETCHELLS A. H. , IRWIN A. W. M. , HOLMES T. , STEPHENSON J. B. P.
Published: August 2010

ABSTRACT. A system is described by means of which the ambulant subject may be video‐filmed over several hours with the electroencephalograph superimposed on the same tape, allowing correlations to be observed in the active state. Our first subjects have been girts with Rett syndrome. Requirements are: one portable video camera/recorder, a conventional e.e.g. machine, the ‘Medilog 9000’ system for prolonged ambulatory recording (Oxford Medical), a specialized video mixer (videogram For AFVG600, commercially available) a video timer, a conventional video casette recorder and a television monitor. The cost is small for a department already equipped to carry out ordinary ambulatory e.e.g. monitoring. The method is safe, well tolerated, simple to use and adaptable. To the best of the authors’ knowledge, they are the first to use this system and they believe that it should find wider application when it is desirable to correlate the behaviour of a subject with physiological parameters, on a restricted budget.
Assessing the understanding of emotional states in a population of adolescents and young adults with mental handicaps
Authors: REED J. , CLEMENTS J.
Published: August 2010

ABSTRACT. This study investigated emotional awareness, the recognition and understanding of different emotional states, among a non‐clinical population of adolescents and young adults with mental handicaps. While emotional awareness showed a high positive correlation with language comprehension, the results suggest that many of these individuals have specific emotional awareness deficits which are not in line with their language comprehension abilities. This finding suggests that the assessment of emotional awareness would be an important step in the choice of a self‐report measure to assess an individual's emotional state.
Magnetic resonance imaging of moyamoya disease in a child with Down's syndrome
Authors: STORM W. , UHLENBROCK D.
Published: August 2010

ABSTRACT. A case of Down's syndrome and associated moyamoya disease is described in a 2‐year‐old child. The condition was demonstrated by the non‐invasive technique of magnetic resonance imaging.
Vitamin D status in children with Down's syndrome
Authors: DEL ARCO C. , RIANCHO J. A. , LUZURIAGA C. , GONZALEZ‐MACIAS J. , FLÓREZ J.
Published: August 2010

ABSTRACT. The serum levels of the active Vitatnin D metabolites 25‐ hydroxyvitamin D[25(OH)D], 1,25‐dibydroxyvitamiti D[I,25(OH)2D] and 24,25 dihydroxyvitamin D [24,25(OH),D], were studied in 21 children with Down's syndrome (DS) in Cantabria, a northern region of Spain, located at 44N latitude. Serum calcium, magnesium, phosphate, alkaline phosphatase, parathormonc and osteocalcine were also detemiined. In the DS group, the average values of the three Vitamin D metabolites were comparable to those of an age‐matched group both in winter and summer times. No child with DS showed values below the normal range, either in Vitamin D metabolites, or in the other parameters of calcium metabolism. The normal increment of 25(OH)D and 24,25(OH)2 values from March to October was not observed in five children. This anomaly was corrected in three, after adequate rules of sun exposure during summer time were followed. In the other two, the 25(OH)D levels were high throughout the study. This investigation shows that children with DS do not require Vitamin D prescription when appropriate periods of sunlight exposure are provided.
The social validity of an argument supporting a ban on aversive procedures
Authors: GOZA A. B. , RICKETTS R. W. , PERKINS T. S.
Published: August 2010

There is currently a controversy regarding the use of non‐aversive and aversive procedures in the treatment of severe behaviour problems in individuals with mental retardation. One specific criticism directed at professionals who support the non‐aversive position is that they have taken quotations from scientific articles out of context in order to give the impression of empirical support for their position. The present authors addressed this issue by assessing the social validity of references made to selected scientific articles in support of a specific argument in a monograph by Guess et al. (1987). Three groups of individuals were surveyed in this study: (1) psychologists working with individuals with mental retardation at six state schools in Texas (Group I); (2) selected professionals with expertise in the area of self‐injurious behaviour and in the use of behaviour modification techniques with individuals who are mentally retarded (Group II); and (3) the authors of the six journal articles that were selected for the present study (Group III). The study focused on references made to journal articles in support of the‘depersonalization hypothesis’that aversive therapies serve to depersonalize the recipients of these treatments. Results indicate that the authors of the monograph were not completely accurate in their references to the six articles. Sixty per cent of the respondents from Group I, 71 % of respondents from Group II, and two out of the three respondents from Group III rated the citations made in the monograph as inaccurate. In addition, the respondents rated the articles as not supportive of the depersonalization hypothesis for which they were cited. Over half of Group I respondents, and all respondents from Groups II and III rated the articles as non‐supportive of the depersonalization hypothesis. These findings suggest that the authors of the monograph have used references selectively and incorrectly in support of their views in at least some instances. This emphasizes the importance of critical reading and hypotheses based on bodies of knowledge rather than selected sources. Furthermore, this study indicates the need for operationally defined hypotheses which may be examined empirically.
Growth and developmental patterns in Prader‐Willi syndrome
Authors: EHARA H. , OHNO K. , TAKESHITA K.
Published: August 2010

Eleven Japanese patients with Prader‐Willi syndrome were studied from infancy, and examined with respect to their growth and development. The chromosomal aberration was observed in 40% ofthe patients using a high‐resolution chromosome banding technique. The birth weight in 10 out of the 11 patients was below the mean and the rate of body weight gain was severely retarded by 6 months in all cases, which suggested an insufficient utilization of nutrients in uterine life and in early infancy. The rate of height increase as well as that of body weight increase were also transiently retarded from 10 to 18 months of age in eight cases, and the body weight gain increased dramatically after 10–18 months due to hyperphagia. The patients' mean milestones of development were delayed (the mean developmental quotient was 50) in comparison with those of control patients; there was no difference between the developmental milestones of the two groups with and without the chromosomal aberration.
West syndrome with cerebellar porencephalus
Authors: KOIDE H. , SHIME H.
Published: August 2010

The authors report six very low birth weight newborn infants who had RDS, IVH and cerebellar porencephalus and later suffered from West syndrome. Four of them have been followed up to the present time and have had MRI scans performed. Their present clinico‐neurological features and MRI findings are described. The authors also raise the possibility of prevention of mental deterioration if anticipatory treatment is started early. Very low birth weight newborn infants with cerebellar porencephalus should be observed more carefully with clinical and EEG examinations to detect Infantile spasms earlier and to protect them from further mental deterioration.
Lithium treatment for people with learning disability: patients ‘and carers’ knowledge of hazards and attitudes to treatment
Authors: CLARKE D. J. , PICKLES K. J.
Published: August 2010

ABSTRACT. Twenty‐five people with a learning disability who were receiving lithium were assessed with regard to their knowledge of lithium and itsadverse effects, and their attitude to treatment. Questionnaires developed for use by people with mental illness were employed, and information was gathered both from people receiving lithium and their carers. Knowledge of the effects of lithium amongst this group was similar to that found in studies of mentally ill people. There was no significant difference in knowledge according to place of residence (with family, in a community residential facility or in hospital). Most people had a positive altitude to lithium treatment; those with more knowledge had more positive attitudes. People with learning disabilities who are prescribed lithium (and their carers) should receive written information about the effect of the drug. The prescriber should check that sufficient knowledge has been acquired to ensure safety
Mental and physical health and ageing in mental handicap: a review
Authors: DAY K. , JANGAR J.
Published: August 2010

With some exceptions, the mental and physical health problems of elderly mentally handicapped people are similar to those of the elderly population as a whole. Psychiatric disorder is more common due to a higher frequency of behaviour disorders. Increased longevity has been accompanied by a progressive increase in deaths from age‐related conditions and in individuals with Down's syndrome exposed a predisposition to premature senility and dementia. Service issues include general health care, preventive measures, provision for those with psychiatric and age‐related problems, and staff training.
Mental health problems in elderly people with and without Down's syndrome
Authors: HAVEMAN M. J. , MAASKANT M. A. , VAN SCHROJENSTEIN LANTMAN H. M. , URLINGS H. F. J. , KESSELS A. G. H.
Published: August 2010

ABSTRACT. This article reports on age‐specific findings of mental health problems among residents with Down's syndrome (DS) (n=307) and without (non‐DS) (n=1274 in dutch group homes and institutes for people with mental retardation. Whereas a proportional increase of psychological problems was found for elderly DS persons with severe mental retardation, non‐DS residents did not show such age‐specific differences. High ratings of psychological problems for the elderly DS residents corresponded very well with the diagnosis of ‘dementia’ made by the physicians. Only for non‐DS persons with severe mental retardation was a proportional decrease of challenging behaviour found with advanced age. Whereas psychological problems in elderly DS persons could be explained for the greater part of the diagnosis ‘dementia’, challenging behaviour‐although also common in elderly DS‐was shown to be a more independent phenomenon. With regard to psychiatric diagnosis, non‐DS residents with mild retardation had six times as much a mental disorder, and non‐DS residents with severe or profound mental retardation had up to 15 times as much, compared with their DS peers.
Abnormal pinna type and hearing loss correlations in Down's syndrome
Authors: MAZZONI D. S. , ACKLEY* R. S. , NASH D. J.
Published: August 2010

ABSTRACT. Significant hearing loss and external pinna malformations are two of the most common defects evident in Down's syndrome. The external and middle ears are linked embryologically, both arising from the first and second branchial arches. Evidence indicates that the majority of hearing loss in Down's syndrome is conductive in nature, originating from malformations of the middle ear ossicles and/or the eustachian tube. Recent studies also have indicated that hearing loss is a contributing factor to the IQ and learning deficits that afflict most individuals with Down's syndrome. Therefore, an early, external diagnostic feature for predicting conductive hearing loss would be desirable. In the current study, people with Down's syndrome, people with non‐Down's mental retardation and control subjects were examined in a clinical environment for the presence of hearing loss and pinna defects. It was found that 90% of the Down's syndrome population had significant hearing loss, compared to slightly more than 50% in the non‐Down's group and no hearing loss in the controls. Also, the majority of hearing loss among individuals with Down's syndrome was conductive, while all hearing loss in the non‐Down's group was sensorineural The Down's syndrome population exhibited nearly 3.5 pinna defects per ear, with malformations of the helix being very evident. The non‐Down's population exhibited 2.5 pinna defects per ear, with concha defects being the most common.
Is there an inverse relationship between Down's syndrome and bipolar affective disorder? Literature review and genetic implications
Authors: CRADDOCK N. , OWEN M.
Published: August 2010

ABSTRACT. Several authors have suggested the existence of an inverse relationship between bipolar affective disorder and Down's syndrome (DS). The present authors have examined this hypothesis by a critical review of the literature. The present findings are consistent with a reduced rate of bipolar disorder in subjects with DS when compared with non‐DS mentally retarded adults and with the general population. Thus, possession of an extra copy of chromosome 21 may confer protection against bipolar disorder. This could be the result of non‐specific mechanisms or the action of a disease‐modifying gene. However, the most interesting possibility is that either dominant or recessive alleles act at a major susceptibility locus for bipolar disorder on chromosome 21. Testable predictions result from the major susceptibility locus models. In order to investigate these hypotheses further, the present authors suggest the following: (1) further studies of the prevalence of bipolar disorder in DS; and (2) the reporting of all cases of bipolar disorder in trisomy 21 with details of the meiotic origin of the non‐disjunction and details about affective disorder in relatives of the proband.
Employment, retirement and elderly persons with an intellectual disability
Authors: Ashman A. F. , Suttie J. N. , Bramley J.
Published: August 2010

A national Australian study of people with an intellectual disability of 55 years of age and over investigated their employment and retirement patterns, attitudes to work and retirement, and the degree to which they were involved in leistire or recreational programmes. Two cohorts were recruited: one included all known members of the target group who agreed to participate in the study in the states of Queensland and Western Australia; and the second was a proportional, random sample drawn from a national database on a state population basis. A large number of the participants had never been involved in full‐ or part‐time employment, either in a competitive or supported environment, or in workshops. The majority of those who had worked expressed strong positive attitudes toward employment and concern about retirement, suggesting the need for pre‐retirement programmes including transition and choice‐making skills to prepare participants for the future.
Electron microscopic observations of human hair medulla
Authors: DE CÁSSIA COMIS WAGNER RITA , KIYOHARA PEDRO KUNIHIKO , SILVEIRA MARINA , JOEKES INÉS
Published: August 2010

In the study of human hair, medulla is the less studied structure because it is believed that it has no influence on the fibre properties. The aim of this paper is to contribute to the better understanding of medulla morphology. Using reproducible methods for hair samples preparations allowed observing the inner fibre by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Three medulla subunits were observed in cryofractured samples. In addition, the application of plasma etching on samples allowed accessing chemical differences between them. Two kinds of medulla were identified using stereomicroscopy: thin and thick medulla. They were morphologically differentiated using TEM. These methods can be used to study systematically the effects of medulla on hair properties and to evaluate the efficiency of cosmetic products.
Modelling the application of adaptive optics to wide‐field microscope live imaging
Authors: KAM ZVI , KNER PETER , AGARD DAVID , SEDAT JOHN W.
Published: August 2010

Wide‐field fluorescence microscopy is an essential tool in modern cell biology. Unfortunately the image quality of fluorescence microscopes is often significantly degraded due to aberrations that occur under normal imaging conditions. In this article, we examine the use of adaptive optics technology to dynamically correct these problems to achieve close to ideal diffraction limited performance. Simultaneously, this technology also allows ultra‐rapid focusing without having to move either the stage or the objective lens. We perform optical simulations to demonstrate the degree of correction that can be achieved.
Chlamydia trachomatis Mip‐like protein
Authors: Lundemose Anker G. , Rouch Duncan A. , Birkelund Svend , Christiansen Gunna , Pearce John H.
Published: August 2010

A 27 kDa Chlamydia trachomatis Mip‐like protein with homology of a 175‐amino‐acid C‐terminal fragment to the surface‐exposed Legionella pneumophila mip‐ gene product has previously been described. In this paper the entire chlamydia Mip‐like sequence of C. trachomatis serovar L2 (lymphogranuloma venereum (LGV) biovar) is presented. The sequence shows high similarity to the legionella Mip protein and its C‐terminal region, like that of the legionella Mip, has high amino acid similarity to eukaryotic and prokaryotic FK506‐binding proteins. The chlamydial mip‐like gene was detected by polymerase chain reaction (PCR) in other C. trachomatis serovars and by sequencing of the mip‐like genes of serovars B and E (trachoma biovar) was shown to be highly conserved within the two major biovars of C. trachomatis. Monoclonal and polyclonal antibodies raised against the recombinant Mip‐like protein failed to demonstrate surface‐exposed epitopes on infectious elementary bodies or reproductive reticulate body forms either by immunofluorescence or immuno‐gold electron microscopy. However, a complement‐dependent inhibition of up to 91% of infectivity for cell cultures was observed with antibodies to the N‐terminal fragment of the Mip‐like protein suggesting that antibody‐accessible epitopes are present on infectious EBs.
Proteolytic processing of CmPP36, a protein from the cytochrome b5 reductase family, is required for entry into the phloem translocation pathway
Authors: Xoconostle‐Cázares Beatriz , Ruiz‐Medrano Roberto , Lucas William J.
Published: August 2010

Cucurbita maxima (pumpkin) phloem sap contains a 31 kDa protein that cross‐reacts with antibodies directed against the red clover necrotic mosaic virus movement protein (RCNMV MP). Microsequence data from phloem‐purified 31 kDa protein were used to isolate a complementary DNA: the open reading frame encodes a 36 kDa protein belonging to the cytochrome b5 reductase (Cb5R) family; the gene was termed CmPP36. Western analyses established that CmPP36, RCNMV MP and CmPP16 (Xoconostle‐Cázares et al., 1999, Science 283, 94–98) are immunologically related, probably due to a common epitope, represented by the NADH+‐binding domain of CmPP36. An N‐terminal 5 kDa membrane‐targeting domain is cleaved to produce the 31 kDa ΔN‐CmPP36 detected in the phloem sap. Microinjection experiments established that ΔN‐CmPP36, but not CmPP36, is able to interact with plasmodesmata to mediate its cell‐to‐cell transport. Thus, intercellular movement of CmPP36 requires proteolytic processing in the companion cell to produce a soluble, movement‐competent, protein. In contrast to RCNMV and CmPP16, ΔN‐CmPP36 interacts with but does not mediate the trafficking of RNA. Northern and in situ RT–PCR studies established that CmPP36 mRNA is present in all plant organs, being highly abundant within vascular tissues. In roots of hydroponically grown pumpkin plants, CmPP36 mRNA levels respond to changes in available iron in the culture solution. Finally, enzymatic assays established that both CmPP36 and ΔN‐CmPP36 could reduce Fe3+‐citrate and Fe3+‐EDTA in the presence of NADH+. These findings are discussed in terms of the possible roles played by CmPP36 in phloem function.
Residence time and potential range: crucial considerations in modelling plant invasions
Authors: Wilson John R. U. , Richardson David M. , Rouget Mathieu , Procheş Şerban , Amis Mao A. , Henderson Lesley , Thuiller Wilfried
Published: August 2010

A prime aim of invasion biology is to predict which species will become invasive, but retrospective analyses have so far failed to develop robust generalizations. This is because many biological, environmental, and anthropogenic factors interact to determine the distribution of invasive species. However, in this paper we also argue that many analyses of invasiveness have been flawed by not considering several fundamental issues: (1) the range size of an invasive species depends on how much time it has had to spread (its residence time); (2) the range size and spread rate are mediated by the total extent of suitable (i.e. potentially invasible) habitat; and (3) the range size and spread rate depend on the frequency and intensity of introductions (propagule pressure), the position of founder populations in relation to the potential range, and the spatial distribution of the potential range. We explored these considerations using a large set of invasive alien plant species in South Africa for which accurate distribution data and other relevant information were available.

 Species introduced earlier and those with larger potential ranges had larger current range sizes, but we found no significant effect of the spatial distribution of potential ranges on current range sizes, and data on propagule pressure were largely unavailable. However, crucially, we showed that: (1) including residence time and potential range always significantly increases the explanatory power of the models; and (2) residence time and potential range can affect which factors emerge as significant determinants of invasiveness. Therefore, analyses not including potential range and residence time can come to misleading conclusions. When these factors were taken into account, we found that nitrogen‐fixing plants and plants invading arid regions have spread faster than other species, but these results were phylogenetically constrained. We also show that, when analysed in the context of residence time and potential range, variation in range size among invasive species is implicitly due to variation in spread rates, and, that by explicitly assuming a particular model of spread, it is possible to estimate changes in the rates of plant invasions through time.

 We believe that invasion biology can develop generalizations that are useful for management, but only in the context of a suitable null model.
Invasive species ofHeracleumin Europe: an insight into genetic relationships and invasion history
Authors: Jahodová Šárka , Trybush Sviatlana , Pyšek Petr , Wade Max , Karp Angela
Published: August 2010

Several species of the genusHeracleum(Umbelliferae) were introduced into Europe from south‐west Asia in the 19th century and are now widespread in many countries. At least three invasive taxa with unresolved relationships to one another are thought to occur in Europe:Heracleum mantegazzianumSommier & Levier,H. sosnowskyiManden, andH. persicumDesf. ex Fischer. They are tall plants forming extensive stands with a high cover. To elucidate genetic relationships between the species, and gain insight into their invasion history, samples were collected from native ranges in Asia and invaded ranges of the three species in Europe and analysed using amplified fragment length polymorphism. Five otherHeracleumspecies were also studied and in total, 189 samples from 72 populations were analysed. The results confirmed that there are three distinct tallHeracleumspecies invading in Europe. Within each of the three species, plants collected in the invaded range are genetically close to those from their native ranges. A close genetic relationship between the three invasiveHeracleumspecies in Europe was also found. A high overall genetic variability detected in the invaded range suggests that the majority of invading populations were not affected by a genetic bottleneck and that rapid evolution, drift, or hybridization played a role in genetic structuring of invading populations. ForH. mantegazzianum, genetic distance of populations in the native range significantly decreased with geographical distance, but not in the invaded range. It is likely that the current pattern of genetic diversity in Europe resulted from multiple introductions of all three species.
Incidence and prevalence of diabetes mellitus in patients with cystic fibrosis undergoing lung transplantation before and after lung transplantation*
Authors: Hadjiliadis Denis , Madill Janet , Chaparro Cecilia , Tsang Anna , Waddell Thomas K , Singer Lianne G , Hutcheon Michael A , Keshavjee Shaf , Elizabeth Tullis D
Published: August 2010

Abstract:  Cystic fibrosis (CF) related diabetes mellitus (DM) occurs in 15% of adult pancreatic insufficient CF patients. Lung transplantation is a treatment option for end‐stage CF. We hypothesized that the prevalence of DM increases after lung transplantation. The study population included adult patients undergoing lung transplantation from March 1988 to March 2002 for end‐stage CF at the University of Toronto. Demographic data, exocrine pancreatic function, presence of DM before and after transplant, as well as timing of its development after transplant were collected. Eighty‐six patients met the study criteria; 77 of 86 (89.5%) of patients were pancreatic insufficient and were further analyzed. Median follow‐up post‐transplant was 3.3 yr (interquartile range: 1.2–7.2). Their mean age was 29.7 ± 8.1 yr and 46 of 77 (59.7%) were male. The prevalence of DM increased from 22 of 77 (28.6%) before transplant to 38 of 77 (49.4%) after transplant (p = 0.008). The median time of DM development after transplant was 80 d (range: 13–4352). Sixteen of 55 (29.1%) of pancreatic insufficient patients who were non‐diabetic prior to transplant, developed DM after transplant. DM is common in CF patients undergoing lung transplantation and the prevalence increases after transplant.
Ursodeoxycholic acid treatment in isolated chronic graft‐vs.‐host disease of the liver
Authors: Arat Mutlu , Idilman Ramazan , Soydan Ender Akcaglayan , Soykan Irfan , Erden Esra , Karayalçın Selim , Akan Hamdi
Published: August 2010

Abstract:  Objectives:  Data regarding the long‐term treatment of ursodeoxycholic acid (UDCA) in individuals of chronic graft‐vs.‐host disease (cGVHD) of the liver are limited. The aims of this prospective study were to determine whether, (i) UDCA treatment is useful as a long‐term treatment for individuals with limited cGVHD of the liver following allogeneic hematopoietic cell transplantation, and (ii) the tolerability of UDCA treatment in such individuals.

Methods:  Fifteen consecutive patients with de novo isolated cGVHD of the liver were included. All individuals were treated with UDCA at a dose of 13 mg/kg/d for 1 yr. Clinical evaluation and laboratory testing were assessed at 30‐d intervals during UDCA therapy and every 30 d after discontinuation of UDCA for a total of 3 months.

Results:  At the end of the treatment, 60% of patients with cGVHD of the liver had normal liver tests, the remaining 40% of patients demonstrated improvement in their abnormal liver tests (partial responders), whereas none of the patients had worsening of the liver tests. When compared with baseline, there was a significant decrease in the serum aminotransferases, alkaline phosphatase and gamma‐glutamyl transpeptidase levels after completion of the UDCA treatment at 12 months (p < 0.01). No significant increase in serum liver enzyme tests was observed at the third month after the completion of therapy. Pruritus in seven of nine patients resolved after UDCA treatment. All patients completed their assigned treatment with no major adverse event.

Conclusion:  Long‐term UDCA therapy appears to be effective, safe and tolerable in individuals with cGVHD presenting with isolated liver involvement.
Interstitial expression of heat‐shock protein 47 correlates with capillary deposition of complement split product C4d in chronic allograft nephropathy
Authors: Ohba Kojiro , Miyata Yasuyoshi , Koga Shigehiko , Nishikido Masaharu , Kanetake Hiroshi , Nazneen Arifa , Razzaque Mohammed S , Taguchi Takashi
Published: August 2010

Abstract:  Background:  Chronic allograft nephropathy (CAN), associated with late‐allograft dysfunction is caused by alloantigen‐dependent and ‐independent mechanisms, and eventually leads to interstitial fibrosis (ci). Activation of complement cascade is considered to be a poor prognostic marker of graft survival. This study was designed to examine the relationship between the expression of C4d and heat‐shock protein 47 (HSP47, a collagen‐specific chaperone) in the development of interstitial fibroproliferative lesions in CAN.

Methods:  Sixty‐three renal allograft biopsy specimens, obtained from 48 patients, were examined for the expression of C4d, HSP47, CD68 and α‐smooth muscle actin (α‐SMA) by immunohistochemistry. Double‐staining was performed to determine the colocalization of C4d and HSP47. The relationship of between the expression of C4d, HSP47, CD68 and α‐SMA and the clinical and histopathological parameters were statistically analysed.

Results:  No expression of C4d was noted in the tubulointerstitium including peritubular capillary (PTC) of the control kidney. C4d was expressed in PTC in one‐third of allograft renal tissues with morphological evidences of CAN. The interstitial cells around the fibrotic areas of the PTC of CAN were positive for the expression of HSP47. The deposition of C4d in PTC correlated with interstitial expression of HSP47 around the PTC. Most HSP47 expressing cells were phenotypically altered myofibroblasts, as determined by the dual staining of α‐SMA.

Conclusions:  The increased expression of HSP47 positively correlated with the expression of C4d in PTC, and might contribute to the progression of interstitial ci in CAN.
Mast cell numbers and protease expression patterns in biopsy specimens following renal transplantation from living‐related donors predict long‐term graft function
Authors: Ishida Toshiro , Hyodo Yoji , Ishimura Takeshi , Takeda Masashi , Hara Isao , Fujisawa Masato
Published: August 2010

Abstract:  In human kidney transplantation the main cause of declining long‐term graft function is chronic allograft nephropathy (CAN). Recent studies have implicated human mast cells (MC) in chronic inflammation and fibrosis, MC can be subtyped according to protease content: MCT containing tryptase only and MCTC containing both tryptase and chymase. We investigated immunohistochemically whether numbers and subtypes of MC in biopsy specimens 100 d after transplantation could predict subsequent fibrosis and graft dysfunction. The total number of MC/high‐power field at 100 d after transplantation correlated significantly with change in creatinine clearance (ΔCcr), defined as (Ccr at 100 d) − (Ccr at 3 yr) (R = 0.597, p = 0.0021); fibrosis index (FI) at 100 d (R = 0.583, p = 0.0066); and ΔFI, defined as (FI at 3 yr) − (FI at 100 d) (R = 0.406, p < 0.05). The ratio of MCTC to total MC at 100 d also correlated with ΔCcr (R = 0.491, p = 0.0148), FI at 100 d (R = 0.527, p = 0.0081), and ΔFI (R = 0.417, p < 0.05). Thus, increases in number of total MC and the ratio of MCTC to total MC in early biopsy specimens were related to decline of long‐term graft function and fibrosis.
Anemia in kidney transplanted patients
Authors: Molnar Miklos Zs , Novak Marta , Ambrus Csaba , Kovacs Agnes , Pap Judit , Remport Adam , Szeifert Lilla , Mucsi Istvan
Published: August 2010

Abstract: Background: Although a known cardiovascular risk factor, anemia in the renal transplant recipients has only recently been receiving an increasing attention.

Methods: In a cross‐sectional study, data was obtained from 959 patients followed at a single outpatient transplant clinic. Based on the guideline of the American Society of Transplantation, anemia was defined as hemoglobin (Hb) 130 g/L in males and 120 g/L in females.

Results: About one‐third (34%) of the patients were anemic. The prevalence of anemia was comparable in males and females. Serum Hb concentration was significantly correlated with the estimated glomerular filtration rate (eGFR) (abbreviated modification of diet in renal disease formula) (r = 0.266, p < 0.001), serum transferrin (r = 0.268, p < 0.001) and serum albumin (r = 0.196, p < 0.001). None of the immunosuppressive medications or the use of angiotensin converting enzyme inhibitors was associated with a higher likelihood of anemia. In multivariate analysis the eGFR, serum albumin and serum transferrin, potential markers of nutritional status and/or chronic inflammation, and also iron deficiency were independently and significantly associated with anemia. Erythropoietin was administered only to 63 (19%) anemic patients.

Conclusions: Post‐transplant anemia is a prevalent and under‐treated condition. Based on our results we suggest that, besides other factors, protein/energy malnutrition and/or chronic inflammation may be independently associated with anemia. Further studies are needed to determine whether the presence of anemia and its treatment will have an impact on long‐term outcomes of this population.
Cytomegalovirus infection and new‐onset post‐transplant diabetes mellitus
Authors: Leung Ki En‐Ling , Venetz Jean‐Pierre , Meylan Pascal , Lamoth Fréderic , Ruiz Juan , Pascual Manuel
Published: August 2010

Abstract:  We analyzed data from all consecutive kidney transplant patients at our institution between April 2003 and October 2006. We found 15 cases of late‐onset cytomegalovirus (CMV) infection, two of which developed concurrent post‐transplant diabetes mellitus (PTDM). In these two cases, PTDM was transient and normal glucose tolerance was achieved after an eight‐wk therapeutic course of oral valganciclovir. These findings suggest that CMV infection after organ transplantation may be associated with concurrent PTDM. The distinct causative relationship is yet to be determined.
Age and heart transplantation: results from a heart failure management unit
Authors: Grigioni Francesco , Potena Luciano , Barbieri Andrea , Bianchi Giorgio , Reggianini Letizia , Russo Antonio , Fallani Francesco , Magnani Gaia , Coccolo Fabio , Arpesella Giorgio , Rapezzi Claudio , Modena Maria Grazia , Branzi Angelo
Published: August 2010

Abstract:  Background:  More evidence is needed to assess the pros and cons of maintaining age‐limit policies in heart transplantation (HT).

Methods:  We analyzed clinical data from a heart failure management unit to investigate the impact of age on prognosis of two distinct cohorts: (i) 309 patients (median age, 57 yr; 62% male) with severe chronic heart failure (CHF) consecutively screened for HT; (ii) 336 HT recipients (median age 56 yr, 82% male).

Results:  In CHF patients (screened for HT), prognosis was conditioned by the underlying severity of cardiac disease (i.e., New York Heart Association class III–IV, decreasing blood pressure, presence of atrial fibrillation and severe mitral regurgitation), whereas increasing age showed no sign of predicting all‐cause or cardiovascular mortality (both p ≥ 0.4). In HT recipients, age did not retain significance at multivariate analysis as an independent predictor (p ≥ 0.14 for both all‐cause and cardiovascular death), whereas ischemic etiology of pre‐existing CHF did (p ≤ 0.02).

Conclusions:  Age did not appear to be a primary determinant of all‐cause or cardiovascular mortality among potential HT candidates or eventual recipients (ischemic etiology of CHF turned out to be the major determinant of post‐transplant outcome). These results support the concept that HT may be considered a treatment option in patients with more advanced age strata, particularly when affected by non‐ischemic cardiomyopathy.
Generalized lymphedema in a sirolimus‐treated renal transplant patient
Authors: De Bartolomeis Carmine , Collini Andrea , Rumberger Brigitta , Barni Roberto , Ruggieri Giuliana , Bernini Marco , Carmellini Mario
Published: August 2010

Abstract:  Generalized lymphedema is an extremely rare effect of sirolimus therapy in renal transplant recipients. We describe the development of this complication in a 56‐yr‐old woman, who was given an experimental protocol with cyclosporine, sirolimus, steroids, and basiliximab. Following the protocol, after one month, the patient was randomized to the “sirolimus only” group, while cyclosporine was completely suspended and the oral steroids were continued. Three months later, the patient was admitted for severe lymphedema of the lower limbs, with significant weight increase, massive ascites and dyspnea, but excellent renal function. A chest radiography and an ultrasound study of the heart showed a moderate pleural and pericardial effusion. An abdominal ultrasound scan showed two small lymphoceles next to the transplanted kidney, confirmed with a CT scan. After sirolimus discontinuation the generalized lymphedema started to improve and three months later all the symptoms had disappeared.
Arteriovenous fistula reconstruction in patients with kidney allograft failure
Authors: Weyde Wacław , Letachowicz Waldemar , Krajewska Magdalena , Gołębiowski Tomasz , Letachowicz Krzysztof , Kusztal Mariusz , Porażko Tomasz , Wątorek Ewa , Madziarska Katarzyna , Klinger Marian
Published: August 2010

Abstract: Background:  Kidney recipients with failing allograft function face the vascular access problem again before returning to hemodialysis. An autologous arteriovenous fistula (AVF), according to the recent Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, is the optimal vascular access and the use of prosthetic grafts and catheters should be limited. The objective of this study was to assess the feasibility of AVF reconstruction in patients reentering hemodialysis after kidney allograft failure.

Materials and methods:  Two hundred and forty‐one transplant recipients reentered hemodialysis between 1990 and 2005. Before kidney transplantation, 221 patients had a functioning AVF on the forearm. Fistula reconstruction was attempted in 112 (51%) patients because of AVF thrombosis. Three strategies were applied according to forearm vein patency: a new radial‐cephalic fistula, a radial‐perforating vein fistula, or a radial‐basilic forearm transposition was created.

Results:  Forearm AVFs were successfully reconstructed in 85 of the 112 patients (73%). The primary patency of the reconstructed AVFs was 57.6% and 44% at 12 and 24 months. Secondary patency was 64.9% and 54.9% at 12 and 24 months, respectively.

Conclusions:  The reconstruction of an old, thrombosed AVF is possible in kidney recipients returning to dialysis, even if the time from thrombosis to fistula repair is a few years.
A single‐center experience with liver transplantation for Wilson’s disease
Authors: Martin Adrian P. , Bartels Michael , Redlich Jens , Hauss Johann , Fangmann Josef
Published: August 2010

Abstract:  Wilson’s disease is an inherited disorder of copper metabolism, presenting with prominent hepatic and neurologic manifestations. There is an established place for liver transplantation in the presence of liver disease, while the indication for neurologic manifestations is debated. Between 1993 and 2005, 11 patients were liver transplanted for Wilson’s disease at our institution. We retrospectively reviewed the medical records of the patients. The pathology of the explanted livers was analyzed. The patients were divided into three groups based on the evolution of the disease. Postoperative data gathered included patient and graft outcome, complications, neurologic status, and copper metabolism. Six males and five females were transplanted at a mean age of 29.7 yr (range 15–48 yr). Three patients had a fulminant presentation, two patients had decompensation of established disease, and six patients had chronic disease. Neurologic features were prominent in five patients. The pathologic analysis of the explanted graft showed cirrhosis in all patients. The five patients with fulminant and acute on chronic presentations also showed necrosis in the explant. The mean postoperative follow‐up was 56.8 months (range 10–129 months). Two patients were re‐transplanted. One patient died because of severe sepsis. Two patients with severe neurologic dysfunction showed significant remission of symptoms. Liver transplantation is a safe and effective treatment for both acute and chronic presentations of Wilson’s disease. Acute presentation correlates with the presence of necrosis in the explanted liver. In our series, there was a relevant improvement of the neurologic features after transplantation.
Cardiovascular risk, cardiovascular events, and metabolic syndrome in renal transplantation: comparison of early steroid withdrawal and chronic steroids
Authors: Rike Adele H. , Mogilishetty Gautham , Alloway Rita R. , Succop Paul , Roy‐Chaudhury Prabir , Cardi Michael , Kaiser Tiffany E. , Thomas Mark , Woodle E. Steve
Published: August 2010

Abstract: Background:  Cardiovascular disease (CVD) is the leading cause of death with a functioning graft in renal transplant recipients. The purpose of this study was to compare Framingham Risk Score (FRS), metabolic syndrome (MS), and cardiovascular events (CVE) in patients receiving early corticosteroid withdrawal (ECSWD), or chronic corticosteroid therapy (CCS).

Methods:  In all, 251 ECSWD and 146 CCS patients were evaluated. FRS and MS were identified at baseline, six, 12, and 24 months post‐transplant. A total of 124 patients with diabetes mellitus prior to transplantation were excluded from MS analysis. CVE were defined as sudden‐death, MI, angina, or CVA/TIA. Repeat‐measure logistic regression was used for statistical analysis.

Results:  Fifty‐four patients experienced 72 CVE. Mean follow‐up was 755 ± 312 d and time to CVE was 14.8 ± 8.3 months. Demographics were similar between groups. FRS was not different between groups. CVE were significantly greater in CCS patients then ECSWD (20% vs. 10%, p = 0.024). New‐onset MS occurred more frequently in patients receiving CCS then ECSWD (45% vs. 22%, p < 0.001) and was associated with more CVE (p < 0.015).

Conclusions:  Patients receiving ECSWD regimens have significantly decreased CVE and new onset MS compared with CCS. MS is associated with increased CV risk and CVE.