bluuebunny/crossref_metadata_2025 huggingface dataset:
Biomechanical Comparison of Coracoclavicular Reconstructive Techniques
Authors: Thomas Kristen , Litsky Alan , Jones Grant , Bishop Julie Y.
Published: January 2011

Background: Acromioclavicular joint dislocations are common orthopaedic injuries. Numerous operative techniques have been described, but the gold standard has yet to be defined. The goal of fixation is to create a stiff and strong reconstruction of the coracoclavicular ligaments to provide optimal stability. The modified Weaver-Dunn is the traditional surgical procedure. However, due to the high rate of recurrent instability with this technique, a shift toward a more anatomic repair has occurred.

Purpose: To evaluate the biomechanical performance of multiple types of coracoclavicular ligament reconstruction.

Study Design: Controlled laboratory study.

Methods: Thirty fresh-frozen human cadaveric shoulders were assigned to 1 of 5 reconstruction groups or a control group: modified Weaver-Dunn, nonanatomic allograft, anatomic allograft, anatomic suture, and GraftRope. A type III acromioclavicular joint dislocation was simulated in all specimens. The 5 techniques were completed, and a cyclic preload and a load-to-failure protocol were performed.

Results: The control had an average load to failure of 1330.6 ± 447.0 N. Compared with all techniques, the anatomic allograft had the highest load to failure, 948 ± 148 N. It had a significantly higher load to failure than the modified Weaver-Dunn (523.2 ± 98.6 N, P = .001), the anatomic suture (578.2 ± 195.3 N, P = .01), the nonanatomic allograft (591.2 ± 65.6 N, P = .003), and the GraftRope (646 ± 167.4, P = .016). No significant difference in load to failure was found between the remaining techniques.

Conclusion: The anatomic allograft reconstruction has superior initial biomechanical properties compared with the modified Weaver-Dunn, nonanatomic allograft, anatomic suture, and GraftRope techniques.

Clinical Relevance: Anatomic reconstruction of the coracoclavicular ligaments with allograft may provide a stronger biological solution for acromioclavicular joint dislocations. This reconstruction may minimize recurrent subluxation and pain and permit earlier rehabilitation when compared with current techniques.
Improving Injection Accuracy of the Elbow, Knee, and Shoulder
Authors: Daley Erika L. , Bajaj Sarvottam , Bisson Leslie J. , Cole Brian J.
Published: January 2011

Background: Joint injections and aspirations are used to reduce joint pain and decrease inflammation. The efficacy of these injections is diminished when they are placed inadvertently in the wrong location or compartment. The purpose of this study was to determine whether the use of varying sites or imaging techniques affects the rate of accurate needle placement in aspiration and injection in the shoulder, elbow, and knee.

Hypotheses: (1) Accuracy rates of different joint injection sites will demonstrate variability. (2) Injection accuracy rates will be improved when performed with concomitant imaging.

Study Design: Systematic review of the literature.

Methods: Studies reporting injection accuracy based on image verification were identified through a systematic search of the English literature. Accuracy rates were compared for currently accepted injection sites in the shoulder, elbow, and knee. In addition, accuracy rates with and without imaging of these joints were compared.

Results: In the glenohumeral joint, there is a statistically higher accuracy rate with the posterior approach when compared with the anterior approach (85% vs 45%). Injection site selection did not affect accuracy for the subacromial space, acromioclavicular joint, elbow, or knee. The use of imaging improved injection accuracy in the glenohumeral joint (95% vs 79%), subacromial space (100% vs 63%), acromioclavicular joint (100% vs 45%), and knee (99% vs 79%).

Conclusion: Injection accuracy rates are significantly higher for the posterior approach compared with the anterior approach for the glenohumeral joint. Similarly, the accuracy rates are also higher when imaging is used in conjunction with injection of the glenohumeral joint, subacromial space, acromioclavicular joint, and knee.
Arthroscopic Soft Tissue Tenodesis Versus Bony Fixation Anchor Tenodesis of the Long Head of the Biceps Tendon
Authors: Scheibel Markus , Schröder Ralf-Jürgen , Chen Jianhai , Bartsch Martin
Published: January 2011

Background: Currently there are no prospective data available that compare the different tenodesis techniques of the long head of the biceps tendon with regard to their clinical and structural results.

Hypothesis: Soft tissue tenodesis provides clinical and structural results equivalent to those of bony fixation anchor tenodesis.

Study Design: Cohort study; Level of evidence, 3.

Methods: Fifty-seven patients with arthroscopically proven lesions of the long head of the biceps tendon (LHB) were prospectively included in this study. Thirty patients (7 women, 23 men; mean age, 57.9 years) were treated with an arthroscopic soft tissue tenodesis (STT) and 27 patients (8 women, 19 men; mean age, 61 years) with an arthroscopic bony fixation anchor tenodesis (BFAT). The clinical evaluation included the Constant score as well as a newly developed LHB score (maximum 100 points) that includes evaluation of pain and cramps (maximum 50 points), the patient- and examiner-dependent grading of the cosmetic result (maximum 30 points), and the measurement of elbow flexion strength (maximum 20 points). The integrity of the tenodesis construct was evaluated indirectly by detecting the position of the LHB using magnetic resonance imaging. A proximal intertubercular location of the tendon was judged as an intact tenodesis construct (3 points), a distal intertubercular location as a failure of tenodesis followed by autotenodesis in the sulcus (2 points), and an extratubercular location as a complete failure (1 point).

Results: Twenty-four patients (5 women, 19 men; mean age, 58.6 years; mean follow-up, 19.6 months) in the STT group and 20 patients (5 women, 15 men; mean age, 59.1 years; mean follow-up, 22.4 months) in the BFAT group could be evaluated. The overall Constant score did not reveal any significant difference in the STT group (mean, 75.0 points) compared with the BFAT group (mean, 78.3 points) ( P > .05). However, the BFAT group showed significantly better results in the LHB score (BFAT mean, 91.8 points vs STT mean, 80.9 points), the examiner-dependent evaluation of the cosmetic result (BFAT mean, 11.3 points vs STT mean, 8.0 points), as well as in the evaluation of the structural integrity of the tenodesis construct (BFAT mean, 2.7 points vs STT mean, 2.2 points) ( P < .05).

Conclusion: When arthroscopic tenodesis of the LHB is indicated, the authors recommend a bony fixation over soft tissue fixation because anchor fixation provides significant advantages concerning the clinical and structural outcome.
Humeral Avulsion of the Inferior Glenohumeral Ligament in College Female Volleyball Players Caused by Repetitive Microtrauma
Authors: Taljanovic Mihra S. , Nisbet Jon K. , Hunter Tim B. , Cohen Randy P. , Rogers Lee F.
Published: January 2011

Background: Humeral avulsion of the inferior glenohumeral ligament is a rare injury resulting from hyperabduction and external rotation, and it is most commonly seen with sports-related injuries, including those from volleyball. The anterior band of the inferior glenohumeral ligament is most commonly injured (93%), whereas the posterior band is infrequently injured. The axillary pouch humeral avulsion of the inferior glenohumeral ligament as a result of repetitive microtrauma has not been yet described in the English literature.

Hypothesis: Humeral avulsions of the inferior glenohumeral ligaments are identifiable in volleyball players without acute injuries, and they have a unique pathologic pattern in these athletes.

Study Design: Case series; Level of evidence, 4.

Methods: Four female college volleyball players with pain in their dominant shoulder and with inferior capsular laxity and/or instability—without a known history of trauma or dislocation of the same shoulder—were referred by an experienced sports medicine orthopaedic surgeon for the magnetic resonance arthrogram procedure of the same shoulder. The imaging findings were retrospectively correlated with the initial interpretation and arthroscopic findings.

Results: All 4 patients had an axillary pouch humeral avulsion of the inferior glenohumeral ligament. Three had articular surface partial-thickness rotator cuff tear, and 3 had a labral tear. All were outside hitters or middle blockers who consequently performed multiple hitting maneuvers in practice and games.

Conclusion: Repetitive microtrauma from overhead hitting in volleyball generates forces on the inferior capsule of the shoulder joint that may cause inferior capsular laxity and subsequent failure of the humeral side of the axillary pouch portion of the inferior glenohumeral ligament.
Subacute Onset of Abnormal Gait and Head Drop in a 3-Year-Old With History of Extreme Prematurity
Authors: Brosch Jared R. , Sant Roma V. , Golomb Meredith R.
Published: January 2011

A 3-year-old boy who had been a 23-week premature infant had subacute onset of abnormal gait, which progressed to generalized weakness with severe weakness of neck extensors. He had U waves on electrocardiography. His serum potassium was 1.8 mmol/L. The patient had a gastrostomy tube due to chronic feeding issues and was treated with inhaled albuterol for chronic lung disease. When his oral intake regressed, his family administered one of his oral supplements through the gastrostomy tube; the supplement was low in potassium. This feeding regression continued for several months. He had no additional gastrointestinal or renal loss of potassium. He had frequent exacerbations of his bronchopulmonary dysplasia. His history suggested he had chronic potassium depletion and that albuterol may have led to further potassium redistribution, exacerbating his hypokalemia. As more extremely premature infants survive with chronic feeding and respiratory issues, this presentation may become more common.
Review of A Large Clinical Series: Once- Versus Twice-Daily Enoxaparin for Venous Thromboembolism Prophylaxis in High-Risk Trauma Patients
Authors: Bush Sarah , LeClaire Aimée , Hampp Christian , Lottenberg Lawrence
Published: January 2011

Background: Consensus guidelines support the use of low-molecular-weight heparin for venous thromboembolism (VTE) prophylaxis in high-risk trauma patients but do not recommend a specific regimen. The current study compared the effectiveness and safety of enoxaparin 40 mg once-daily versus enoxaparin 30 mg twice-daily for VTE prophylaxis in high-risk trauma patients. Methods: A retrospective chart review was conducted of all trauma patients older than 18 years of age admitted to Shands at the University of Florida between July 1, 2005 and June 30, 2007, who received either dosing regimen. Excluded were patients with Injury Severity Score <9, surviving <2 days, hospital length of stay <2 days, receipt of >1 agent, and/or dosing regimen for VTE prophylaxis during hospitalization, interruption in therapy, pregnancy, or diagnosis of a VTE within 24 hours of admission. Results: A total of 409 patients were treated with once-daily dosing and 278 patients were treated with twice-daily dosing. The overall rate of VTE was 2.9% (95% confidence interval, 1.52, 5.07) in the once-daily group and 1.1% in the twice-daily group (95% confidence interval, 0.22, 3.12; P = .118). Major bleeding occurred in 11 patients in the once-daily group and 5 patients in the twice-daily group (1.8% vs 2.7%; P = .608). Conclusion: Enoxaparin 30 mg twice-daily may be more effective than enoxaparin 40 mg once-daily for prevention of VTE in high-risk trauma patients; however, statistical significance was not achieved. There were no statistically significant differences observed in clinically significant bleeding. Further study is needed to clarify which dosing regimen of enoxaparin is superior with regard to safety and effectiveness.
Computerized Physician Order Entry in the Critical Care Environment: A Review of Current Literature
Authors: Maslove David M. , Rizk Norman , Lowe Henry J.
Published: January 2011

The implementation of health information technology (HIT) is accelerating, driven in part by a growing interest in computerized physician order entry (CPOE) as a tool for improving the quality and safety of patient care. Computerized physician order entry could have a substantial impact on patients in intensive care, where the potential for medical error is high, and the clinical workflow is complex. In 2009, only 17% of hospitals had functional CPOE systems in place. In intensive care unit (ICU) settings, CPOE has been shown to reduce the occurrence of some medication errors, but evidence of a beneficial effect on clinical outcomes remains limited. In some cases, new error types have arisen with the use of CPOE. Intensive care unit workflow and staff relationships have been affected by CPOE, often in unanticipated ways. The design of CPOE software has a strong impact on user acceptance. Intensive care unit-specific order sets lessen the cognitive workload associated with the use of CPOE and improve user acceptance. The diffusion of new technological innovations in the ICU can have unintended consequences, including changes in workflow, staff roles, and patient outcomes. When implementing CPOE in critical care areas, both organizational and technical factors should be considered. Further research is needed to inform the design and management of CPOE systems in the ICU and to better assess their impact on clinical end points, cost-effectiveness, and user satisfaction.
What Intensivists Need to Know About Hemophagocytic Syndrome
Authors: Okabe Toshimasa , Shah Gunjan , Mendoza Vinia , Hirani Amyn , Baram Michael , Marik Paul
Published: January 2011

Hemophagocytic syndrome, also known as hemophagocytic lymphohistiocytosis (HLH), is a rare and frequently fatal disorder caused by an uncontrollable and ineffective systemic immune response. Patients initially present with fever, cytopenia, and hepatosplenomegaly, and subsequently develop multiorgan failure (MOF). Hemophagocytosis can be found on biopsy specimen but is not required. Acquired forms of HLH can occur in apparently healthy adults, while children present more often with an inherited form of the disease. Since HLH often presents with sepsis-like symptoms and organ dysfunction, patients are usually treated for presumed sepsis, which inevitably leads to delayed diagnosis and treatment. Intensivists need to have a low threshold for suspecting this disorder when previously healthy individuals present with a fulminant sepsis-like syndrome, which are unresponsive to conventional treatment. We present 3 patients with HLH who were admitted to our adult medical intensive care unit (MICU) over a 2-year period with fatal outcomes and emphasize the diagnostic importance of markedly elevated serum ferritin levels and the need for tissue biopsy in making an accurate diagnosis in a timely manner.
Perspectives of Physicians and Nurses Regarding End-of-Life Care in the Intensive Care Unit
Authors: Festic Emir , Wilson Michael E. , Gajic Ognjen , Divertie Gavin D. , Rabatin Jeffrey T.
Published: January 2011

Context: The delivery of end-of-life care (EOLC) in the intensive care unit (ICU) varies widely among medical care providers. The differing opinions of nurses and physicians regarding EOLC may help identify areas of improvement. Objective: To explore the differences of physicians and nurses on EOLC in the ICU and how these differences vary according to self-reported proficiency level and primary work unit. Design: Cross-sectional survey of 69 ICU physicians and 629 ICU nurses. Setting: Single tertiary care academic medical institution. Results: A total of 50 physicians (72%) and 331 nurses (53%) participated in the survey. Significant differences between physicians and nurses were noted in the following areas: ability to safely raise concerns, do not resuscitate (DNR) decision making, discussion of health care directives, timely hospice referral, spiritual assessment documentation, utilization of social services, and the availability of EOLC education. In every domain of EOLC, physicians reported a more positive perception than nurses. Additional differences were noted among physicians based on experience, as well as among nurses based on their primary work unit and self-reported proficiency level. Conclusions: Even with an increased focus on improving EOLC, significant differences continue to exist between the perspectives of nurses and physicians, as well as physicians among themselves and nurses among themselves. These differences may represent significant barriers toward providing comprehensive, consistent, and coordinated EOLC in the ICU.
A 24-Year-Old Man With Cough, Rhabdomyolysis, and Pneumomediastinum
Authors: Sosa Andrés F. , Banauch Gisela
Published: January 2011

Background: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) frequently causes severe necrotizing pneumonia in young patients. Case: We present the case of a 24-year-old male, who was brought to the emergency department with persistent fevers, confusion, and severe cough. He was found to have necrotizing pneumonia, pneumomediastinum, and rhabdomyolysis with renal failure. Cultures were positive for influenza A and CA-MRSA. After a prolonged intensive care unit (ICU) stay, he made a complete recovery. Conclusion: Community-acquired MRSA pneumonia is a growing health threat that typically presents in young adults after, or in conjunction with, a flu-like illness. It is characterized by a rapidly progressive deteriorating clinical course.
Posterior Reversible Encephalopathy Syndrome
Authors: Staykov Dimitre , Schwab Stefan
Published: January 2011

Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, altered mental status, visual disturbances, and seizures. Radiological features typically include edema of the posterior cerebral regions, especially of the parietooccipital lobes. Atypical imaging features, such as involvement of anterior cerebral regions, deep white matter, and the brain stem are also frequently seen. Vasoconstriction is common in vascular imaging. Different conditions have been associated with PRES, but toxemia of pregnancy, solid organ or bone marrow transplantation, immunosuppressive treatment, cancer chemotherapy, autoimmune diseases, and hypertension are most commonly described. The pathophysiology of PRES is unclear and different hypotheses are being discussed. Posterior reversible encephalopathy syndrome is best managed by monitoring and treatment in the setting of a neurointensive care unit. The prognosis is usually benign with complete reversal of clinical symptoms within several days, when adequate treatment is immediately initiated. Treatment of severe hypertension, seizures, and withdrawal of causative agents represent the hallmarks of specific therapy in PRES. Delay in diagnosis and treatment may lead to permanent neurological sequelae. Therefore, awareness of PRES is of crucial importance for the intensivist.
Protestant ethics and the spirit of politics: Weber on conscience, conviction and conflict
Authors: Adair-Toteff Christopher
Published: January 2011

Readers of The Protestant Ethic and the Spirit of Capitalism recognize that Weber attempts to provide an ideal account of development of modern rational capitalism. What readers apparently do not realize is that Weber believes that there is a political development that is parallel to this economic development. Weber believed that Luther’s passive theology and doctrine of two kingdoms lead to quiet resignation in earthly matters. Luther advises shunning politics and avoiding political confrontation. In contrast, Weber held that Calvin’s theology of awe and his doctrine of predestination lead to active political stances and even imply a duty to resist tyranny. However, Weber rejects both Luther’s and Calvin’s political stances because both believed in a divinely ordered world and held that the consequences of their actions were ultimately left to God. Weber contends that only those people who have the proper understanding of the nature of power and have a real appreciation for the ‘diabolic’ nature of politics are suitable to be political actors. Thus, Weber insists that only those people who will take responsibility for their own political actions have the right to ‘stick their hands in the wheels of history’.
Correlation of testicular toxicity and oxidative stress induced by chlorpyrifos in rats
Authors: Mandal Tapas Kumar , Das Niladri Sekhar
Published: January 2011

Effect of chlorpyrifos pesticide on testicular oxidative damage was studied in Sprague-Dawley rats at varying doses. At lower doses (5 and 10 mg/kg body weight/30 days), reduction in plasma levels of testosterone and follicular stimulating hormone (FSH) and luteinizing hormone (LH) along with significant shrinkage of seminiferous tubules and drastic changes in germ cells were seen. But these adverse changes of testes were restored with the revival of serum testosterone and FSH and LH at higher doses (20 and 30 mg/kg body weight/30 days). Similarly, levels of testicular lipid peroxidation and diene conjugates were elevated whereas activities of antioxidant enzymes (superoxide dismutase, catalase and glutathione peroxidase), steroidogenic (Δ5, 3β-HSD and Δ5, 17β-HSD) enzymes and angiotensinogen-converting enzyme and glutathione content including lipid–protein content of testes were decreased at low doses. But at higher doses, reductions in level of lipid peroxidation (as revealed by malondialdehyde [MDA] value) and conjugated dienes were found and on the contrary, revivals of testicular antiperoxidative/antioxidant enzymes defense systems, angiotensinogen-converting enzyme (ACE), steroidogenic enzymes, lipid–protein and antioxidant glutathione content were observed. Therefore, the present study indicated from the results that chlorpyrifos had a dual effect at both doses on oxidative stress changes, but at higher doses, the cells were triggering its natural defense mechanism to combat the insult of lower doses of chlorpyrifos and became operative possibly through corrective measure of antioxidant enzymes defense system and pituitary gonadotropins hormones feedback mechanisms on testes.
Effect of progesterone on phosphamidon-induced impairment of memory and oxidative stress in rats
Authors: Sharma Amit K , Bhattacharya Swapan K , Khanna Naresh , Tripathi Ashok K , Arora Tarun , Mehta Ashish K , Mehta Kapil D , Joshi Vikas
Published: January 2011

Progesterone (a neurosteroid) is an important modulator of the nervous system functioning. Organophosphorus pesticides like phosphamidon have been shown to adversely affect memory and induce oxidative stress on both acute and chronic exposure. The present study was therefore designed to investigate the effects of progesterone (PROG) on phosphamidon-induced modulation of cognitive function and oxidative stress in rats. Cognitive function was assessed using step-down latency (SDL) on a passive avoidance apparatus and transfer latency (TL) on an elevated plus maze. Oxidative stress was assessed by examining the levels of thiobarbituric acid reactive species (TBARS) and non-protein thiols (NP-SH) in isolated homogenized whole brain samples. The results showed a significant reduction in SDL and prolongation of TL in the phosphamidon (1.74 mg/kg/d; p.o.) treated group at weeks 6 and 8 as compared to the control group. Two weeks treatment with PROG (15 mg/kg/d; i.p.) antagonized the effect of phosphamidon on SDL as well as TL. Phosphamidon alone produced a significant increase in the brain TBARS levels and decrease in the brain NP-SH levels. Treatment with PROG (15 mg/kg/d; i.p.) attenuated the effect of phosphamidon on oxidative stress. Together, the results showed that progesterone attenuated the cognitive dysfunction and increased oxidative stress induced by phosphamidon in the brain.
Schoolwide Positive Behavior Support in an Alternative School Setting
Authors: Farkas Melanie S. , Simonsen Brandi , Migdole Scott , Donovan Mary E. , Clemens Katharine , Cicchese Victor
Published: January 2011

The paucity of research investigating the effectiveness of universal behavioral strategies for supporting students in alternative educational settings is of great concern. However, a growing literature base supporting schoolwide positive behavioral support interventions (SWPBS) has been encouraging. This program evaluation provides additional support for this literature, indicating a positive impact of SWPBS Tier 1 implementation on key student outcome measures in a school serving students in Grades 5–12 identified with emotional disturbance or as otherwise health impaired. In addition, this program evaluation includes measures and positive findings for both (a) implementation fidelity and (b) social validity in this alternative school setting.
Prospects of Statins in Parkinson Disease
Authors: Roy Avik , Pahan Kalipada
Published: January 2011

Parkinson disease (PD) is second only to Alzheimer disease as the most common neurodegenerative disorder in humans. Despite intense investigations, no effective therapy is available to halt the progression of PD. Although statins are widely used cholesterol-lowering drugs throughout the world, recent studies suggest that these drugs modulate neurodegeneration-related signaling processes and may be beneficial for PD. Simvastatin is the most potent statin in crossing the blood-brain barrier, and this particular statin drug negatively correlates with the incidence of PD and shows efficacy in animal models of PD. However, PD mainly occurs in the aging population, who are more vulnerable to cholesterol or lipid-related disorders, raising questions whether this possible beneficial effect of statins in PD patients is cholesterol dependent or cholesterol independent. This article presents data on the therapeutic efficacy of simvastatin in a chronic MPTP model of PD, reviews recent literature, and discusses the pros and cons of statin therapy in PD.
Social Marketing, Stages of Change, and Public Health Smoking Interventions
Authors: Diehr Paula , Hannon Peggy , Pizacani Barbara , Forehand Mark , Meischke Hendrika , Curry Susan , Martin Diane P. , Weaver Marcia R. , Harris Jeffrey
Published: January 2011

As a “thought experiment,” the authors used a modified stages of change model for smoking to define homogeneous segments within various hypothetical populations. The authors then estimated the population effect of public health interventions that targeted the different segments. Under most assumptions, interventions that emphasized primary and secondary prevention, by targeting the Never Smoker, Maintenance, or Action segments, resulted in the highest nonsmoking life expectancy. This result is consistent with both social marketing and public health principles. Although the best thing for an individual smoker is to stop smoking, the greatest public health benefit is achieved by interventions that target nonsmokers.
Do guidelines recommending pharmacogenetic testing of psychiatric patients affect treatment costs and the use of healthcare services?
Authors: Herbild Louise , Bech Mickael , Gyrd-Hansen Dorte , Christensen Mona , Werge Thomas , Nielsen Kirsten Annette
Published: January 2011

Aim: To identify the effects of local recommendations of pharmacogenetic testing in psychiatry with respect to treatment costs. Methods: Based on Danish patient registers, individual treatment costs within a 365-day period at three psychiatric hospitals recommending and using pharmacogenetic testing is compared retrospectively with treatment costs at other Danish psychiatric hospitals using alternate treatment strategies. Primary outcome of interest is total direct costs analyzed by multilevel modelling. Secondary outcome measures are healthcare consumption within specific sectors analyzed by Tobitregressions. Results: Costs among patients treated at hospitals recommending and using pharmacogenetic testing were not found to be statistically significantly different from costs among patients treated at sites using alternate treatment strategies. In spite of recommendations to test all patients the uptake of the test was, however, low (26—31 %). Treatment practice using routine therapeutic drug monitoring (in Ãrhus) shows a trend towards lower costs. Conclusions: Based on this natural experiment we were not able to document statistically significant differences in total costs between treatment sites that had guidelines recommending pharmacogenetic testing, relative to sites without such guidelines, over a period of one year. However, guidelines of pharmacogenetic testing and possibly also therapeutic drug monitoring seem to lead to reductions in costs for primary care services. In the case of the former, reductions do, however, seem to be outweighed by increases in costs for psychiatric and non-psychiatric inpatient stays. In conclusion, no statistically significant differences in total direct costs across sites with different treatment strategies were found.
Use of medical resources and indirect costs of otitis media in Sweden
Authors: Speets Anouk M. , Wolleswinkel Judith H. , Forsgren Arne , Sobocki Patrik A.
Published: January 2011

Aims: To estimate the use of medical resources and the societal impact of otitis media (OM) in children less than five years of age in Sweden. Methods: An internet survey questionnaire was administered to a sample of parents with children <5 years of age. The survey covered socio-demographic data, characteristics of the OM episode, use of medical resources, productivity loss by the caregivers, and travel-related costs. Medical doctor confirmed OM (MD-OM) was defined as symptoms of earache or ‘‘running’’ ear, and/or a diagnosis of OM provided by a medical doctor. Results: Of all MD-OM episodes (n = 91), in 47% a general practitioner had been consulted, in 21% a paediatrician, and in 23% an emergency department had been visited. Hospital admission occurred in one case. The MD prescribed antibiotics in 85% and over the counter drugs were bought in 69% of the episodes. In 57% of the MD-OM episodes the caregivers lost days from a paid job (mean 30.3 hours per episode, SD 19.6). In 30% of the episodes, parents reported productivity loss at work during their child’s illness (mean 9.0 hours per episode, SD 12.4). The mean costs were estimated to be 6,385 SEK (575) per episode of MD-OM resulting in an economic burden to Sweden of 743,570,000 SEK (66,920,866). Fifty eight per cent of the costs were indirect non-medical costs. Conclusions: The medical and economic burden of OM is considerable to individual families as well as to society in Sweden. This study has filled a gap in the knowledge base on the impact of OM on society.
The Danish Health Examination Survey 2007-2008 (DANHES 2007-2008)
Authors: Eriksen Louise , Grønbæk Morten , Helge Jørn Wulff , Tolstrup Janne Schurmann , Curtis Tine
Published: January 2011

Aims: The Danish Health Examination Survey (DANHES 2007—2008) was carried out by the National Institute of Public Health, University of Southern Denmark, in 13 Danish municipalities in 2007—2008. The focus of the survey was diet, smoking, alcohol, and physical activity. The aim of the survey was to establish a research database for future cross-sectional and follow-up studies. Methods: DANHES 2007—2008 included internet-based questionnaires and a health examination. There were two different questionnaires: a basic questionnaire on socio-demography, health behaviour, self-reported health status, and living conditions, and a supplementary food frequency questionnaire. The health examination contained measurements of blood pressure, resting heart rate, height, weight, fat percentage, waist and hip circumference, blood and hair samples, spirometry, bone mineral density, physical performance, muscle strength, and aerobic fitness. Results: A total of 76,484 people completed the basic questionnaire, and 18,065 adult individuals participated in the health examination, corresponding to a response rate of 14% and a participation rate of 10%, respectively. Conclusions: The database from DANHES 2007—2008 is unique in its size and diversity of measurements and questionnaire contents. Data can be linked to various registers through the Danish civil registration system, and blood samples are stored in a biobank allowing for genetic analyses. Hence, DANHES 2007—2008 forms the basis for future research projects with a focus on health behaviour and prevention of lifestyle-related diseases.
SKARP - A population-based cohort study of childhood food-associated symptoms perceived by parents and food allergies diagnosed by physicians: Design, methods and participation
Authors: Pyrhönen Kaisa , Läärä Esa , Kaila Minna , Hiltunen Liisa , Näyhä Simo
Published: January 2011

Background: Few epidemiological studies exist on food-associated symptoms and allergies in large unselected child populations. Aims: To describe the design, methods and participation rate of the South Karelian Allergy Research Project (SKARP), a population-based epidemiological study on food-associated symptoms and physician-diagnosed food allergies. Methods: The study population of 5,973 children born between 2001 and 2006 and resident in the province of South Karelia, Finland, was identified from the nationwide population register. The parents received a questionnaire to be returned at their child’s annual visit to the child health clinic, where supplementary interviews were performed. Results of allergy tests (skin prick tests, immunoglobulin E antibodies and open food challenges) performed on participants and non-participants were collected from the relevant health care units in the area. Results: Participation rates in the questionnaire study were 54% (644/1,194) among the parents of neonates and 69% (3308/4,779) among those of the children aged 1 to 4 years. Cooperation with the child health clinics and mailing of a reminder questionnaire improved participation by 8 and 10 percentage points, respectively. The final participation rate seemed to be unaffected by whether the child had or had not been tested for suspected allergy. Conclusions: A reasonably good participation rate and almost complete coverage of allergy tests were achieved thanks to successful cooperation with the child health clinics and test laboratories. This baseline study forms a representative database to estimate the occurrence of food-associated symptoms, physician-diagnosed food allergies and allergy testing in the general population.
Health-related quality of life in Chinese people: A population-based survey of five cities in China
Authors: Rui Wang  , Cheng Wu  , Ma Xiu-Qiang , Zhao Yan-Fang , Yan Xiao-Yan , Jia He
Published: January 2011

Aims: The current study aimed at undertaking an investigation to describe health-related quality of life (HRQL) in Chinese people, with a Mandarin version of the 36-item short-form health survey (SF-36) validated. Methods: A total of 3,219 respondents were successfully interviewed under a randomized stratified multi-stage sampling design from April 2007 to January 2008 in five cities of mainland China. Self-finished interview method was applied and the Mandarin version of SF-36 was used for assessing HRQL. Results: As a result, the reliability and validity of SF-36 were acceptable, although some deviations from the hypothesized model still existed. The Chinese population scored higher than other populations in five of the eight SF-36 scales and Chinese men scored higher than women in six of the eight SF-36 scales. Conclusions: Basically, the Mandarin version of SF-36 is a reliable instrument, although minor modifications are needed. The health-related quality of life in Chinese people were quite high based on the sample of five cities in China; further research is needed to establish the countrywide norm of health-related quality of life in mainland China.
Multidisciplinary Team Meetings About a Patient in Primary Care
Authors: Van Houdt Sabine , De Lepeleire Jan , Driessche Kristel Vanden , Thijs Gabie , Buntinx Frank
Published: January 2011

Multidisciplinary team meetings (MTM) about a patient are a way to coordinate fragmented care. The Minimal Data Set/Resident Assessment Instrument (MDS/RAI) is a tool to prepare and support these meetings. Methods: An exploratory, qualitative study was used to examine the factors that influence the need for an MTM and to determine the value of MDS/RAI supporting the MTM. Results: Key elements are awareness of the health care professionals that “something is wrong” and the presence of sufficient family caregivers with enough capacity. The MDS/RAI is an aid because registration provides all health care professionals with the same type of preparation, allows possible blind spots to be discovered, and provides structure to the multidisciplinary meeting. Multidisciplinary meetings were found to contribute to sharing of information, knowledge, goals, and mutual respect. Conclusion: The evaluation of the patient’s care needs by MDS/RAI registration, performed by health care professionals involved in the care, and discussion of the results leads to more efficient MTMs.
IL-7R–dependent survival and differentiation of early T-lineage progenitors is regulated by the BTB/POZ domain transcription factor Miz-1
Authors: Saba Ingrid , Kosan Christian , Vassen Lothar , Möröy Tarik
Published: January 2011

T cells originate from early T lineage precursors that have entered the thymus and differentiate through well-defined steps. Mice deficient for the BTB/POZ domain of zinc finger protein-1 (Miz-1) almost entirely lack early T lineage precursors and have a CD4−CD8− to CD4+CD8+ block causing a strong reduction in thymic cellularity. Miz-1ΔPOZ pro-T cells cannot differentiate in vitro and are unable to relay signals from the interleukin-7R (IL-7R). Both STAT5 phosphorylation and Bcl-2 up-regulation are perturbed. The high expression levels of SOCS1 found in Miz-1ΔPOZ cells probably cause these alterations. Moreover, Miz-1 can bind to the SOCS1 promoter, suggesting that Miz-1 deficiency causes a deregulation of SOCS1. Transgenic overexpression of Bcl-2 or inhibition of SOCS1 restored pro-T cell numbers and their ability to differentiate, supporting the hypothesis that Miz-1 is required for the regulation of the IL-7/IL-7R/STAT5/Bcl-2 signaling pathway by monitoring the expression levels of SOCS1.
The importance of neovascularization and its inhibition for allogeneic hematopoietic stem cell transplantation
Authors: Penack Olaf , Socié Gerard , van den Brink Marcel R. M.
Published: January 2011

GVHD and tumor relapse are fundamental problems in allogeneic HSCT. Recent research has linked neovascularization to GVHD, tumor growth, and graft-versus-tumor (GVT) activity. Damage of the endothelium by the conditioning regimen provides the initiation stimulus for recruitment of donor-derived endothelial cells and their progenitors. During the early inflammatory phase of GVHD there is considerable neovascularization facilitating migration of inflammatory cells to target organs. In the course of GVHD, however, the vasculature itself becomes a target of alloreactive donor T cells. As a consequence, later stages of GVHD are characterized by fibrosis and rarefaction of blood vessels. Importantly, the inhibition of tumor-neovascularization by activated donor T cells that release antiangiogenic substances contributes to GVT and may be enhanced by pharmacologic inhibition of neovascularization. Furthermore, the therapeutic inhibition of neovascularization may improve immunotherapy for cancer by enhancing leukocyte infiltration in tumor tissue because of normalization of tumor vessels and stimulation of leukocyte–vessel wall interactions. These insights identify important mechanisms underlining the importance of neovascularization for allogeneic immune responses and move therapeutic approaches targeting neovascularization into the spotlight. This perspective covers current knowledge of the role of neovascularization during GVHD as well as GVT and its implications for HSCT.
Association between serum high-molecular-weight adiponectin level and the severity of chronic graft-versus-host disease in allogeneic stem cell transplantation recipients
Authors: Nakasone Hideki , Binh Phan Nguyen Thanh , Yamazaki Rie , Tanaka Yukie , Sakamoto Kana , Ashizawa Masahiro , Sato Miki , Terasako Kiriko , Kimura Shun-ichi , Kikuchi Misato , Kako Shinichi , Okuda Shinya , Oshima Kumi , Tanihara Aki , Nishida Junji , Abe Yasunori , Kanda Yoshinobu
Published: January 2011

Recently, a growing body of evidence has suggested that adiponectin, which is secreted by adipose tissues, plays a critical role in obesity-related and autoimmune diseases. We compared the concentrations of adiponectin among 26 normal subjects and 34 allogeneic stem cell transplantation recipients. The concentrations of adiponectin were significantly higher in recipients with chronic graft-versus-host disease (cGVHD) than those in subjects without cGVHD (21.7 ± 11.0 vs 9.1 ± 6.1 μg/mL in females, P < .001; and 10.1 ± 6.8 vs 4.3 ± 2.9 μg/mL in males, P = .003). Multivariate analysis revealed that a higher concentration of adiponectin was associated with female sex (β-coefficient 8.2, P < .0001) and the severity of cGVHD (β-coefficient 6.6, 12.7, and 15.6, P < .01, each for mild, moderate, and severe cGVHD, respectively). In addition, adiponectin levels increased as cGVHD progressed, decreased as cGVHD improved, and did not change with stable cGVHD. In conclusion, adiponectin was associated with the severity of cGVHD and might play a role in the pathophysiology of cGVHD.
Discovery pipeline for epigenetically deregulated miRNAs in cancer: integration of primary miRNA transcription
Authors: Hulf Toby , Sibbritt Tennille , Wiklund Erik D , Bert Saul , Strbenac Dario , Statham Aaron L , Robinson Mark D , Clark Susan J
Published: January 2011

Background

Cancer is commonly associated with widespread disruption of DNA methylation, chromatin modification and miRNA expression. In this study, we established a robust discovery pipeline to identify epigenetically deregulated miRNAs in cancer.

Results

Using an integrative approach that combines primary transcription, genome-wide DNA methylation and H3K9Ac marks with microRNA (miRNA) expression, we identified miRNA genes that were epigenetically modified in cancer. We find miR-205, miR-21, and miR-196b to be epigenetically repressed, and miR-615 epigenetically activated in prostate cancer cells.

Conclusions

We show that detecting changes in primary miRNA transcription levels is a valuable method for detection of local epigenetic modifications that are associated with changes in mature miRNA expression.
Optimization of glutathione production in batch and fed-batch cultures by the wild-type and recombinant strains of the methylotrophic yeast Hansenula polymorphaDL-1
Authors: Ubiyvovk Vira M , Ananin Vladimir M , Malyshev Alexander Y , Kang Hyun Ah , Sibirny Andriy A
Published: January 2011

Background

Tripeptide glutathione (gamma-glutamyl-L-cysteinyl-glycine) is the most abundant non-protein thiol that protects cells from metabolic and oxidative stresses and is widely used as medicine, food additives and in cosmetic industry. The methylotrophic yeast Hansenula polymorpha is regarded as a rich source of glutathione due to the role of this thiol in detoxifications of key intermediates of methanol metabolism. Cellular and extracellular glutathione production of H. polymorpha DL-1 in the wild type and recombinant strains which overexpress genes of glutathione biosynthesis (GSH2) and its precursor cysteine (MET4) was studied.

Results

Glutathione producing capacity of H. polymorpha DL-1 depending on parameters of cultivation (dissolved oxygen tension, pH, stirrer speed), carbon substrate (glucose, methanol) and type of overexpressed genes of glutathione and its precursor biosynthesis during batch and fed-batch fermentations were studied. Under optimized conditions of glucose fed-batch cultivation, the glutathione productivity of the engineered strains was increased from ~900 up to ~ 2300 mg of Total Intracellular Glutathione (TIG) or GSH+GSSGin, per liter of culture medium. Meantime, methanol fed-batch cultivation of one of the recombinant strains allowed achieving the extracellular glutathione productivity up to 250 mg of Total Extracellular Glutathione (TEG) or GSH+GSSGex, per liter of the culture medium.

Conclusions

H. polymorpha is an competitive glutathione producer as compared to other known yeast and bacteria strains (Saccharomyces cerevisiae, Candida utilis, Escherichia coli, Lactococcus lactis etc.) with good perspectives for further improvement especially for production of extracellular form of glutathione.
Plasmodium falciparum liver stage antigen-1 is cross-linked by tissue transglutaminase
Authors: Nicoll William S , Sacci John B , Rodolfo Carlo , Di Giacomo Giuseppina , Piacentini Mauro , Holland Zoe JM , Doerig Christian , Hollingdale Michael R , Lanar David E
Published: January 2011

Background

Plasmodium falciparumsporozoites injected by mosquitoes into the blood rapidly enter liver hepatocytes and undergo pre-erythrocytic developmental schizogony forming tens of thousands of merozoites per hepatocyte. Shortly after hepatocyte invasion, the parasite starts to produce Liver Stage Antigen-1 (LSA-1), which accumulates within the parasitophorous vacuole surrounding the mass of developing merozoites. The LSA-1 protein has been described as a flocculent mass, but its role in parasite development has not been determined.

Methods

Recombinant N-terminal, C-terminal or a construct containing both the N- and C- terminal regions flanking two 17 amino acid residue central repeat sequences (LSA-NRC) were subjected to in vitro modification by tissue transglutaminase-2 (TG2) to determine if cross-linking occurred. In addition, tissue sections ofP. falciparum-infected human hepatocytes were probed with monoclonal antibodies to the isopeptide ε-(γ-glutamyl)lysine cross-bridge formed by TG2 enzymatic activity to determine if these antibodies co-localized with antibodies to LSA-1 in the growing liver schizonts.

Results

This study identified a substrate motif for (TG2) and a putative casein kinase 2 phosphorylation site within the central repeat region of LSA-1. The function of TG2 is the post-translational modification of proteins by the formation of a unique isopeptide ε-(γ-glutamyl)lysine cross-bridge between glutamine and lysine residues. When recombinant LSA-1 protein was crosslinkedin vitroby purified TG2 in a calcium dependent reaction, a flocculent mass of protein was formed that was highly resistant to degradation. The cross-linking was not detectably affected by phosphorylation with plasmodial CK2in vitro. Monoclonal antibodies specific to the very unique TG2 catalyzed ε- lysine cross-bridge co-localized with antibodies to LSA-1 in infected human hepatocytes providing visual evidence that LSA-1 was cross-linkedin vivo.

Conclusions

While the role of LSA-1 is still unknown these results suggest that it becomes highly cross-linked which may aid in the protection of the parasite as it develops.
Variant Plasmodium ovale isolated from a patient infected in Ghana
Authors: Tordrup David , Virenfeldt Jakob , Andersen Felicie F , Petersen Eskild
Published: January 2011

Recent data have found that Plasmodium ovale can be separated in two distinct species: classic and variant P. ovale based on multilocus typing of different genes. This study presents a P. ovale isolate from a patient infected in Ghana together with an analysis of the small subunit RNA, cytochrome b, cytochrome c oxidase I, cysteine protease and lactate dehydrogenase genes, which show that the sample is a variant P. ovale and identical or highly similar to variant P. ovale isolated from humans in South-East Asia and Africa, and from a chimpanzee in Cameroon. The split between the variant and classic P. ovale is estimated to have occurred 1.7 million years ago.