bluuebunny/crossref_metadata_2025 huggingface dataset:
Photodynamic therapy with methyl aminolevulinate for primary nodular basal cell carcinoma: results of two randomized studies
Authors: Foley Peter , Freeman Michael , Menter Alan , Siller Gregory , El‐Azhary Rokea A. , Gebauer Kurt , Lowe Nicholas J. , Jarratt Michael T. , Murrell Dedee F. , Rich Phoebe , Pariser David M. , Oseroff Allan R. , Barnetson Ross , Anderson Christopher , Kossard Steven , Gibson Lawrence E. , Tope Whitney D.
Published: October 2009

Background  Data suggest that photodynamic therapy using topical methyl aminolevulinate (MAL PDT) may be a noninvasive alternative to excisional surgery for nodular basal cell carcinoma (BCC). In the studies described here, we investigated the histologic response, tolerability, and cosmetic outcome with MAL PDT for primary nodular BCC (≤ 5 mm in depth).

Methods  Two multicenter, randomized, double‐blind studies with similar design and procedures were conducted. After surface debridement and minor tumor debulking, MAL cream 160 mg/g (66 patients with 75 lesions) or placebo cream (65 patients with 75 lesions) was applied for 3 h, followed by illumination with broad‐spectrum red light (75 J/cm2, 570–670 nm). This was repeated 7 days later. Lesions with a partial response (≥ 50% reduction in greatest diameter) at 3 months were re‐treated (21%). Treatment sites were excised at 3 months (clinical nonresponders) or 6 months (clinical responders) after the last treatment.

Results  Histologically verified lesion complete response rates were higher with MAL PDT than with placebo [73% (55/75) vs. 27% (20/75)]. Treatment was most effective for facial lesions (89% complete response). Cosmetic outcome was good or excellent in 98% of evaluable, completely responding lesions treated with MAL PDT.

Conclusion  Although longer follow‐up studies are required, these promising data indicate the potential of topical MAL PDT as a noninvasive treatment alternative for nodular BCC.
Impact of ivermectin drug combinations on Pediculus humanus capitis infestation in primary schoolchildren of south Indian rural villages
Authors: Munirathinam Arumugam , Sunish Ittoop Pulikkottil , Rajendran Rathinasamy , Tyagi Brij Kishore
Published: October 2009

Background  Antifilarial drug combinations including ivermectin provide antifilarial activity with ancillary benefits on intestinal helminths and ectoparasites, such as chiggers and lice. The impact of single oral dose of antifilarial drugs, viz; (1) diethylcarbamazine (DEC) alone, (ii) DEC + albendazole (ALB), (iii) ivermectin (IVR) + DEC and (iv) IVR + ALB, was determined, on the head louse (Pediculus humanus capitis) in primary school children in a rural community in south India.

Methods  Primary school children (n = 534) of age 6–10 years from four villages of South India were examined for the presence of head lice before and after single dose of DEC + ivermectin drug combination. The effectiveness and the duration of cure sustained by these drugs were quantified. The head louse was examined by “combing method” during post‐treatment periods at 15, 45, 60 and 75 days interval.

Results  The antifilarial drug consumption rate was similar (96–98%) in all treatment arms. In pre‐treatment survey the prevalence of head lice in children administered with DEC, DEC + ALB, IVR + DEC and IVR + ALB arm was 86%, 80%, 87% and 80%, respectively, with the latter two arms demonstrating significant reduction in louse infestation (P < 0.05) for 60 days.

Conclusion  Single dose with IVR combination demonstrates a greater impact in reducing head louse infestation in the endemic rural communities for nearly 60 days. Therefore, in regions such as Africa where ivermectin is part of the antifilariasis campaign, this drug will have an additional benefit in reducing head lice infestation.
Upper gastrointestinal abnormalities and Helicobacter pylori in Behçet's disease
Authors: Çakmak Seray Külcü , Çakmak Atıl , Gül Ülker , Sulaimanov Marlen , Bingöl Pelin , Hazinedaroğlu M. Selçuk
Published: October 2009

Background  There are few published clinical trials concerning upper gastrointestinal (GI) involvement in Behçet's disease (BD), and most have been performed on patients with upper GI tract symptoms.

Aim  We sought to determine whether routine endoscopy is indicated in asymptomatic patients with BD and whether Helicobacter pylori plays a role in the pathogenesis of BD.

Methods  Forty consecutive patients with BD and 40 age‐ and gender‐matched controls with tinea pedis were studied. All patients underwent fiberoptic esophagogastroduodenoscopy. Urea breath test was used to identify H. pylori.

Results  Abnormalities were noted in 37 patients (93%): hiatal hernia (53%), antral gastritis (33%), pan‐gastritis (23%), gastric ulceration (8%), and duodenal ulceration (8%). Helicobacter pylori was found in 26 patients (65%) with BD and in 28 controls (70%) (no significant difference by chi‐squared test, P > 0.05). We found a high incidence of upper GI abnormalities in BD, but the abnormalities were not specific for the disorder.

Conclusions  Routine endoscopy and screening for H. pylori infection may not be necessary in asymptomatic patients with BD.
Schnitzler syndrome: response to anakinra in two cases and a review of the literature
Authors: Schuster Christian , Kränke Birger , Aberer Elisabeth , Arbab Emad , Sturm Gunter , Aberer Werner
Published: October 2009

Background  Schnitzler syndrome is a rare disease characterized by a chronic urticarial eruption and monoclonal gammopathy, as well as clinical and laboratory signs of inflammation. The pathophysiology is still unknown, although various autoantibody‐mediated mechanisms have been described. Complete remission of symptoms has been reported recently in patients with Schnitzler syndrome treated with anakinra, an interleukin‐1 receptor antagonist.

Methods  Two patients with Schnitzler syndrome treated with anakinra therapy are presented.

Results  We report two cases of nearly complete remission of symptoms in Schnitzler syndrome after the initiation of anakinra therapy, and the first observation of a relapse under continuous daily anakinra therapy. A review of the published literature on the treatment of Schnitzler syndrome with anakinra is presented.

Conclusions  Based on published data, monotherapy with anakinra is currently the most promising treatment for Schnitzler syndrome, because it is able to induce complete remission of symptoms.
Demonstration of pemphigus‐specific immunofluorescence pattern by direct immunofluorescence of plucked hair
Authors: Rao Raghavendra , Dasari Kavitha , Shenoi Shrutakirthi , Balachandran Chandrashekaran
Published: October 2009

Background  Direct immunofluorescence (DIF) of perilesional skin is the gold standard in the diagnosis of pemphigus. Since the outer root sheath (ORS) of anagen hair is structurally analogous to epidermal keratinocytes, pemphigus specific immunofluorescence pattern may be present in the ORS.

Methods  Twenty consecutive patients of pemphigus were enrolled in the study, irrespective of any other inclusion or exclusion criteria. Hairs were plucked in a similar fashion to that of trichogram. Approximately 5 anagen hairs were selected processed and stained with fluorescein isothiocyanate (FITC) conjugates. DIF of perilesional skin and indirect immunofluorescence (IIF) were carried out simultaneously. DIF of hair was also done in equal numbers of controls with other dermatoses.

Results  Intercellular deposition of IgG was seen in the ORS of anagen hair in 85% of patients (n = 17). The test was positive in all patients who had scalp lesions (n = 10); however, it was also positive in 7 patients (77.7%) who did not have scalp lesions. The test was negative in 3 patients; two of whom were elderly and had sparse scalp hair. The other patient only had mucosal lesion. The test was negative in the control group.

Conclusion  DIF of hair is a simple, non‐invasive test. In future, it may alleviate the need for skin biopsies, in patients with pemphigus.
Does chloroquine therapy of porphyria cutanea tarda influence liver pathology?
Authors: Wollina U , Köstler E , Koch A , Riedel H , Stölzel U
Published: October 2009

Background  Porphyria cutanea tarda (PCT) is regularly associated with changes in liver tissue. On the other hand, systematic investigations are lacking on whether there is a correlation between the severity of liver damage and chloroquine treatment.

Patients and methods  During a 20‐year period, liver biopsies were obtained in 89 patients with PCT confirmed by biochemical analysis of urine and feces and low‐dose chloroquine therapy. Seventeen patients with alcohol‐induced liver disease were excluded. In 8 of 63 patients, only a single biopsy was available. Classification of liver damage was performed according to the Riedel score. Electron microscopy was available from 24 patients. In a second group of patients, the HFE status was investigated and Berlin blue stains of liver biopsies were performed.

Results  There was no correlation between the duration of cutaneous symptoms and liver pathology. After 12 months chloroquine treatment, 45 patients (81%) disclosed an improvement of liver pathology, nine (16%) had no change, and a worsening was observed in one patient (3%). All patients achieved a complete clinical and biochemical remission. In 13 of 16 patients with a relapse, there was again a deterioration of liver damage. Patients with HFE mutations had a significant higher risk (P < 0.05) for hepatic siderosis.

Conclusions  The severity of liver damage was not correlated with the disease duration. Chloroquine treatment resulted in PCT remission (clinical and biochemical) and in 81% to an improvement of liver morphology.
Lamellar ichthyosis with a novel homozygous C‐terminal mutation in the transglutaminase‐1 gene
Authors: Rodríguez‐Pazos Laura , Ginarte Manuel , Vega‐Gliemmo Ana , Toribio Jaime
Published: October 2009

Background  The majority of cases of Lamellar ichthyosis (LI) are caused by mutations in the transglutaminase‐1 (TGM1) gene. The mutations in the β‐barrel domains of the TGM1 gene are found very infrequently and several authors have suggested that these domains are not essential for the function of the enzyme. Other authors have postulated that mutations in these loci are pathogenic but they imply a less severe clinical picture of LI.

Case report  We report a patient with a severe phenotype of LI who had a homozygous mutation affecting the β‐barrel 2 domain of the TGM1.

Conclusions  This finding indicates that the integrity of β‐barrel domains is important for the correct function of the enzyme and that we are still far away from a consistent genotype‐phenotype correlation.
Gender differences in asthma prevalence: Variations with socioeconomic disadvantage
Authors: CHITTLEBOROUGH Catherine R. , TAYLOR Anne W. , DAL GRANDE Eleonora , GILL Tiffany K. , GRANT Janet F. , ADAMS Robert J. , WILSON David H. , RUFFIN Richard E. ,   On Behalf of The North West Adelaide Health Study Team
Published: October 2009

Background and objective:  Socioeconomic inequalities in health have been shown to vary for different diseases and by gender. This study aimed to examine gender differences in associations between asthma and socioeconomic disadvantage.

Methods:  Socioeconomic variables were assessed among men and women in the North West Adelaide Health Study, a representative population cohort (n = 4060) aged 18 years and over in metropolitan South Australia. Asthma was determined from spirometry and self‐reported doctor diagnosis.

Results:  The prevalence of asthma was 12.0% (95% CI: 11.1–13.1), and was significantly higher among women (13.5%) than men (10.5%). For participants aged 18–64 years a higher prevalence of asthma was associated with an education level of secondary school or lower, or not being in the paid labour force among men, and with a gross annual household income of $20 000 or less among women. Among socioeconomically advantaged groups, the prevalence of asthma was significantly higher among women than men.

Conclusions:  Socioeconomic disadvantage was associated with higher asthma prevalence, although this varied by gender depending on the indicator of socioeconomic position used. Men with low education or those not employed in the paid labour force had higher asthma prevalence than more socioeconomically advantaged men. Women with low income had higher asthma prevalence than those with higher income. Among all socioeconomically advantaged groups, and also the low‐income group, women experienced a higher prevalence of asthma than men.
Chronic neck pain following car crashes: a population‐based study from Auckland, New Zealand
Authors: Ameratunga S. , Tin S. T. , Connor J. , Norton R.
Published: October 2009

Background:  In a setting with a ‘no fault’ universal government‐funded accident compensation system, we undertook a study to (i) estimate the prevalence and predictors of chronic neck pain in car occupants surviving serious injury‐producing crashes and (ii) compare the longer‐term health‐related quality of life of crash survivors with and without neck discomfort.

Methods:  A prospective cohort study recruited hospitalized survivors aged ≥16 years and non‐hospitalized drivers of cars involved in serious crashes in Auckland over a 10‐month period. Participants completed a structured questionnaire at recruitment and 5 and 18 months later.

Results:  Of the 268 participants, 50 (18.7%) reported neck pain or stiffness at 5 and 18 months following the crash. Of these, 70% noted the discomfort led to limitations in work and recreation. Depressive and post‐traumatic stress symptoms at 5 months were associated with an increased risk of moderate to severe neck discomfort at 18 months. Participants with and without neck discomfort had significantly reduced health‐related quality of life based on Short Form‐36 scores.

Conclusion:  Significant neck discomfort limiting usual function is relatively common up to 18 months following crashes. The reductions in health status among crash survivors with and without neck pain reveal the complexities in attributing longer‐term adverse outcomes to a particular condition in the absence of an appropriate comparison group. The findings indicate the need to manage judiciously comorbid conditions while prioritizing efforts to support crash survivors' return to their usual social roles and activities.
The utility of transoesophageal echocardiography to determine management in suspected embolic stroke
Authors: Galougahi K. K. , Stewart T. , Choong C. Y. P. , Storey C. E. , Yates M. , Tofler G. H.
Published: October 2009

Background:  Assessment for source of stroke is a common indication for transoesophageal echocardiography (TOE). Although an abnormality is frequently found, it remains uncertain how frequently the findings alter patient management. Also, the role of transthoracic echocardiography (TTE) prior to or instead of TOE is not well defined. We sought to determine the use of TTE prior to TOE, the outcome of the TOE and its impact on management.

Methods:  We retrospectively reviewed the records and echocardiography results of 100 consecutive patients who underwent TOE for any reason at a tertiary hospital. In 35 subjects (35%), the indication was evaluation for source of stroke. Among these, we determined clinical risk factors for stroke, if a TTE was performed prior to their TOE, the results of the TOE and its effect on management.

Results:  The mean age of the stroke patients was 64.6 years (17–90) and 49% were women. Eighty per cent had at least one risk factor for stroke and 17% had atrial fibrillation. A TTE, performed in 40% prior to the TOE, found an abnormality in 14% (2/14). The TOE showed an abnormality in 71% of patients; 54% had aortic atheroma; 17% PFO; 14% spontaneous echo contrast; 6% left atrial appendage thrombus, 3% left ventricular thrombus and 3% vegetation. In only one patient (3%) the management was altered based on the abnormal TOE findings.

Conclusion:  An abnormality on TOE, although common (71%) and more sensitive than TTE, altered management in only 3% of subjects referred for stroke assessment. Its role requires further consideration.
Prevalence and predictors of premature discontinuation of dual antiplatelet therapy after drug‐eluting stent implantation: importance of social factors in Asian patients
Authors: Poh C‐L. , Chan M. Y. , Lau C. , Teo S‐G. , Low A. F. , Tan H‐C. , Lee C‐H.
Published: October 2009

Aim:  Premature discontinuation of antiplatelet therapy is an independent predictor of late stent thrombosis. We sought to determine the prevalence and predictors of premature discontinuation of antiplatelet therapy after drug‐eluting stent implantation among patients in Asia.

Methods:  A total of 207 consecutive patients who underwent drug‐eluting stent implantation at our institution was followed up after 1 year. Premature discontinuation of antiplatelet therapy was defined as omission of aspirin and/or clopidogrel for 1 week or more.

Results:  Four (1.9%) patients died and the remaining 203 patients formed the study population. Prevalence of premature discontinuation of antiplatelet therapy was 12.8% (n= 26, aspirin, n= 12; clopidogrel, n= 9; both, n= 5). The median duration between stent implantation and discontinuation of antiplatelet therapy was 2.8 months. Reasons for discontinuation included cost (n= 1), gastric discomfort (n= 1), allergy (n= 3), bleeding (n= 3), advice from doctors (n= 7) and no reason (n= 11). Logistic regression showed that living alone was the only independent predictor of premature discontinuation of dual antiplatelet therapy (50.0% vs 11.3%, P= 0.001).

Conclusion:  Among Asian patients who have undergone drug‐eluting stent implantation, 12.8% discontinued dual antiplatelet therapy within 12 months. Living alone is associated with a fivefold increase in risk of premature drug discontinuation.
Continuity of care: when do patients visit community healthcare providers after leaving hospital?
Authors: Roughead E. E. , Kalisch L. M. , Ramsay E. N. , Ryan P. , Gilbert A. L.
Published: October 2009

Background/Aims:  Enhanced communication and transfer of information between healthcare providers and healthcare settings can reduce medication and healthcare errors post‐hospital discharge. The timeframes within which patients access community healthcare providers post‐hospital discharge are not well studied. This study aimed to determine length of time from hospital discharge until a general practice, pharmacy or specialist visit, or care planning service.

Methods:  We conducted a retrospective analysis of Department of Veterans' Affairs health claims data. All 109 860 veterans hospitalized in 2006 were included. Main outcome measures were time from first hospital discharge to first claim for a general practice, pharmacy, specialist visit and/or care planning service.

Results:  Within 30 days of hospital discharge 71% of subjects visited a general practitioner (GP), 86% had medicines dispensed from a community pharmacy and 44% saw a specialist. Median time to first pharmacy visit was 6 days (interquartile range 2–14) and 12 days for a GP visit (interquartile range 4–31). Less than 2% of the cohort received a discharge plan, case conference or medication review in the month after discharge.

Conclusions:  With 25% of patients having a claim for a GP service within 4 days of discharge, discharge summaries need to reach community‐based health professionals within this time. Most patients visited their community pharmacy within 2 weeks of hospital discharge and before they saw their GP. Pharmacists are not routinely advised of hospitalization or provided with discharge summaries. More active engagement of this professional group in the continuum of care might improve care after hospital discharge.
Clinical and biochemical characteristics of patients with thyroid‐stimulating hormone‐secreting pituitary adenomas from one New Zealand centre
Authors: Elston M. S. , Conaglen J. V.
Published: October 2009

Background:  Thyroid‐stimulating hormone (TSH)‐secreting pituitary adenomas (TSHoma) are a rare cause of thyrotoxicosis and need to be distinguished from the syndrome of resistance to thyroid hormone. Patients with TSHoma may also be misdiagnosed as having primary hyperthyroidism and receive inappropriate treatment directed towards the thyroid gland.

Methods:  We performed a retrospective review of patients with TSHoma who presented to one New Zealand endocrine service between 1989 and 2003.

Results:  Six patients with TSHoma were managed during this time period. All patients had elevated free thyroid hormone levels with elevated, or inappropriately normal, TSH levels. The median age at presentation was 43 years and the median time from symptom onset to correct diagnosis was 3 years (range 0.25–12 years). Five patients had a macroadenoma at the time of diagnosis. Three had been treated elsewhere for primary hyperthyroidism prior to referral. Three patients received octreotide as primary treatment with two of these patients later undergoing transsphenoidal resection of the pituitary adenoma.

Conclusion:  With increased awareness and earlier diagnosis of TSH‐secreting pituitary adenomas, management can be appropriately directed towards the pituitary.
Long‐term percutaneous endoscopic gastrostomy feeding in young adults with multiple disabilities
Authors: Lee L. , MacPherson M.
Published: October 2009

Aim: To study the outcomes from initiation of percutaneous endoscopic gastrostomy (PEG) feeding in young people with profound multiple disabilities.

Methods: Observations were made on 40 adults with lifelong intellectual disability (mental retardation) and quadriplegia, in whom PEG feeding was initiated during 1990–2008. There were 20 men and 20 women aged 15–40 years at the time of the audit, living in settings with 24 h registered nurse staffing.

Results: Undernutrition and recurrent aspiration with frequent infections were cited as reasons for PEG feeding. The positive outcomes were that some were said to be more alert for a time following the procedure; and these young adults lived with PEG feeding for an average of 8.5 years, some up to 18 years. In that time, however, they all experienced complications of the PEG insertion, and of the PEG feeding process. There were no measurable improvements in cognition. There were no reductions in prescription of medications. They all required frequent daily interventions by nurses to maintain medical stability. Ten people died during this review period, from continued deterioration in neurological status, with pneumonia cited as the terminal event.

Conclusions: Unlike other people with neurological deterioration, young adults with lifelong multiple disabilities may live for many years with PEG feeding. There is little gain in quality of life.
Cardiovascular mortality and morbidity in chronic obstructive pulmonary disease: the impact of bronchodilator treatment
Authors: Wood‐Baker R. , Cochrane B. , Naughton M. T.
Published: October 2009

Chronic obstructive pulmonary disease (COPD) is a substantial health burden. Cardiovascular disease (CVD), the leading cause of death, frequently coexists with COPD, an effect attributed to high individual disease prevalences and shared risk factors. It has long been recognized that COPD, whether stable or during acute exacerbations, is associated with an excess of cardiac arrhythmias. Bronchodilator medications have been implicated in the excess CVD seen in COPD, either as an intrinsic medication effect or related to side‐effects. Despite the theory behind increased pro‐arrhythmic effects in COPD, the reported results of trials investigating this for inhaled formulations at therapeutic doses are few. Methodological flaws, retrospective analysis and inadequate adjustment for concomitant medications, including short‐acting ‘relief’ bronchodilators and non‐respiratory medications with known arrhythmia propensity, mar many of these studies. For most bronchodilators at therapeutic levels in stable COPD, we can be reassured of their safety from current studies. The exception to this is ipratropium bromide, where the current data indicate an association with increased cardiovascular adverse effects. Moreover, there is no proven benefit from combining short‐acting beta‐agonists with short‐acting anticholinergics at high doses in the acute setting, and although this practice is widespread, it is associated with increased cardiovascular risk.
Intraperitoneal distribution imaging in ovarian cancer patients
Authors: Dawson S. J. , Hicks R. J. , Johnston V. , Allen D. , Jobling T. , Quinn M. , Rischin D.
Published: October 2009

Background/Aims: Optimal delivery of intraperitoneal (IP) chemotherapy is dependent on adequate drug distribution. An accurate understanding of the limitations of IP distribution is critical if we are to improve cytotoxic delivery through this route.

Methods: Using repeated scintigraphic peritoneography we investigated peritoneal fluid distribution in patients receiving IP therapy. Both early (1–6 h) and late (24–48 h) images were performed. The peritoneal cavity was divided into six regions; pouch of Douglas, left and right paracolic gutters, left and right subphrenic spaces and the right subhepatic space. The distribution in each region was classified as absent (0), faint (1) or intense (2). A total distribution score was calculated from the summation of distribution values for each of the six regions. Distribution was then graded according to the total distribution score as follows: Grade 0 = 0–3; Grade 1 = 4–6; Grade 2 = 7–9; and Grade 3 = 10–12.

Results: Twenty‐six participants were included in the study: all 26 patients had early imaging performed and 21 of these also had late imaging. Thirteen (50%) and 15 (71%) patients had grade 1 or 2 IP distribution on early and late imaging respectively. The most common abdominal regions to show maldistribution were the subphrenic spaces.

Conclusions: This study highlights the deficiencies of distribution following IP drug delivery, with the majority of patients demonstrating multiple regions of faint or absent uptake on scintigraphic peritoneography imaging. Future large clinical studies investigating IP chemotherapy should include analyses of IP distribution to improve our understanding of optimal drug delivery through this route.
Managing obstruction of the central airways
Authors: Williamson J. P. , Phillips M. J. , Hillman D. R. , Eastwood P. R.
Published: October 2009

Lung cancer is the most common cause of cancer death in Australia, Europe and the USA. Up to 20–30% of these cancers eventually affect the central airways and result in reduced quality of life, dyspnoea, haemoptysis, post‐obstructive pneumonia and ultimately death. Non‐malignant processes may also lead to central airway obstruction and can have similar symptoms. With the development of newer technologies, the last 20 years have seen the emergence of the field of interventional pulmonology to deal specifically with the diagnosis and management of thoracic malignancy, including obstruction of the central airways. This review discusses the pathology, pre‐procedure work‐up and management options for obstructing central airway lesions. Several treatment modalities exist for dealing with endobronchial pathology with local availability and expertise guiding choice of treatment. While the literature lacks large, multicentre, randomized studies defining the optimal management strategy for a given problem, there is growing evidence from numerous case studies of improved physiology, of quality of life and possibly of survival with modern interventional techniques.
Vaccination and screening for infections in patients with inflammatory bowel disease: a survey of Australian gastroenterologists
Authors: Gupta A. , Macrae F. A. , Gibson P. R.
Published: October 2009

Aims: To survey the practice among gastroenterologists in Australia relating to screening for latent infections and vaccination of patients with inflammatory bowel disease prior to treatment with tumour necrosis factor alpha (TNF‐α) inhibitors.

Methods: A structured 15 question electronic survey was advertised to gastroenterologists in Australia through an email mailing list and through a hardcopy newsletter.

Results: Forty‐four clinicians responded to the survey. Screening practice relating to latent tuberculosis infection and hepatitis B virus (HBV) was performed variably, with significant differences in screening methodology. Vaccination for HBV, influenza and pneumococcus was performed infrequently, and the timing of when vaccination should be offered varied considerably.

Conclusions: Despite published guidelines advocating screening for latent infections and vaccination of patients treated with TNF‐α inhibitors, compliance with recommendations was poor. Recommendations for screening and vaccination of these patients are provided based on these findings.
Weak population regulation in ecological time series
Authors: Ziebarth Nicolas L. , Abbott Karen C. , Ives Anthony R.
Published: October 2009

How strongly natural populations are regulated has a long history of debate in ecology. Here, we discuss concepts of population regulation appropriate for stochastic population dynamics. We then analyse two large collections of data sets with autoregressive‐moving average (ARMA) models, using model selection techniques to find best‐fitting models. We estimated two metrics of population regulation: the characteristic return rate of populations to stationarity and the variability of the stationary distribution (the long‐term distribution of population abundance). Empirically, longer time series were more likely to show weakly regulated population dynamics. For data sets of length ≥ 20, more than 35% had characteristic return times > 6 years, and more than 29% had stationary distributions whose coefficients of variation were more than two times greater than would be the case if they were maximally regulated. These results suggest that many natural populations are weakly regulated.

Ecology Letters (2010) 13: 21–31
The role of surveillance in the treatment of patients with muscle‐invasive bladder cancer after chemotherapy
Authors: Hellenthal Nicholas J. , Ramirez Michelle L. , Evans Christopher P. , DeVere White Ralph W.
Published: October 2009

Study Type – Prognosis (case series) Level of Evidence 4

OBJECTIVE

To determine the survival of patients at our institution who were clinically tumour‐free (cT0) on re‐staging transurethral resection (TUR) after treatment with chemotherapy for muscle‐invasive bladder cancer.

PATIENTS AND METHODS

In all, 55 patients with muscle‐invasive, organ‐confined transitional cell carcinoma of the bladder were treated with TUR followed by systemic chemotherapy, over a 10‐year period. Patients were separated into two groups, those who were clinically T0 and those who showed persistent disease (>cT0) on re‐biopsy after chemotherapy. Overall and disease‐specific survival rates were calculated for the two groups. The cT0 group was further followed for tumour recurrence and clinical outcomes.

RESULTS

Thirty‐one patients (56%) were clinically T0 on TUR after chemotherapy; of these patients, 22 (71%) either died from other causes (with no disease recurrence) or are alive and with no evidence of disease at a mean follow‐up of 53 months. Twenty of the 31 patients (65%) have retained their bladder with no evidence of cancer recurrence at a mean follow‐up of 46 months. Disease‐free status (cT0) at the time of TUR after chemotherapy was associated with significantly higher overall and cancer‐specific survival (hazard ratio 3.40, P = 0.003; and 8.63, P = 0.001, respectively).

CONCLUSION

Previous studies suggest that surveillance can be a reasonable option for patients with muscle‐invasive transitional cell carcinoma of the bladder who show no evidence of disease on TUR after chemotherapy. Patients with persistent bladder cancer on re‐biopsy after chemotherapy tend to fare poorly even with immediate cystectomy.
Is surveillance of small renal masses safe in the elderly?
Authors: O’Malley Rebecca L. , Godoy Guilherme , Phillips Courtney K. , Taneja Samir S.
Published: October 2009

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

To determine if preoperative variables, including gender, age and tumour size, influence the decision for active surveillance of renal masses, as due to the increasing detection of incidental renal masses within the ageing population there is a need to identify reliable means of selecting patients who require therapy.

PATIENTS AND METHODS

We retrospectively identified all renal masses resected at our institution between 1 December 1999, and 1 October 2005. The size of tumour, patient age and gender were compared between those with and without malignancy on final pathology. The influence of these variables in predicting malignancy, high grade, and high stage were assessed by univariate and multivariate analysis using logistic regression models, with a significance level of P < 0.05. Subsets were analysed for the groups of patients with tumours of ≤3 or >3 cm and those aged ≤75 or >75 years.

RESULTS

Among 466 of 501 patients with evaluable data, univariate analysis showed that both male gender and increasing size positively predicted malignancy (odds ratio 1.13 and 1.40, respectively), but age, treated as a continuous variable, did not. On multivariate analysis both remained independent predictors of malignancy (odds ratio 1.13 and 1.40, respectively). Size was the only independent predictor of high‐stage and high‐grade disease on both univariate and multivariate analysis. Among 156 patients with tumours of ≤3 cm, on multivariate analysis, male gender was only weakly associated with the risk of malignancy, whereas size remained strongly predictive (odds ratio 1.98, P = 0.076; and 2.16, P = 0.015, respectively). Neither male gender, size nor age increased the risk of high‐stage or high‐grade disease in this cohort. Patients who were aged >75 years had a greater risk of high‐stage disease than those aged <75 years (odds ratio 2.64, P = 0.008). On multivariate analysis, age >75 years remained an independent predictor of malignancy and high‐stage, along with size (odds ratio 2.75, P = 0.014; and 1.35, P < 0.001).

CONCLUSIONS

Increased size of tumour increases the risk of malignancy and the likelihood of high‐stage and high‐grade disease. Among patients aged >75 years there was a higher risk of malignancy and high‐stage disease than in those aged ≤75 years. As such, the decision for observation should not be based upon age alone, and should be approached with caution in patients aged >75 years, particularly for larger lesions.
Haemostatic role and histopathological effects of a new haemostatic agent in a rat bladder haemorrhage model: an experimental trial
Authors: Kilic Ozcan , Gonen Murat , Acar Kadir , Yurdakul Talat , Avunduk Mustafa Cihat , Esen Haci Hasan , Oz Mehmet
Published: October 2009

OBJECTIVE

To investigate the haemostatic efficacy and histopathological effects of a new haemostatic agent, Ankaferd BloodStopper® (ABS; Ankaferd Drug Cosmetic Co., Istanbul, Turkey) in a rat bladder haemorrhage model. ABS is a unique combination of five plant extracts that has been used in Turkish traditional medicine as a haemostatic agent for external traumatic bleeds.

MATERIALS AND METHODS

In all, 20 male Sprague–Dawley rats were divided into two equal groups. In both groups, the mucosa was damaged on the posterior wall (PW) of the bladder. The liquid form of ABS was applied to the bleeding area of one group (group 1) and 0.9% NaCl to the bleeding area of the other group (group 2, controls). The solutions were applied drop by drop with a 2 mL injector until the bleeding stopped and the bleeding times recorded. For histopathological examination, two tissue samples were taken from all rats in each group; one from the damaged mucosa in the PW and one from undamaged mucosa in the lateral wall (LW). Two sections were prepared from all samples. One section was stained with haematoxylin and eosin (H&E), and the rest was used for immunohistochemical staining for fibronectin.

RESULTS

The mean bleeding times were 65 s and 147 s for groups 1 and 2, respectively (P < 0.001). In the pathological specimens stained with H&E, fibrosis and other studied pathological features were similar in the LW samples in groups 1 and 2. Similarly, there were no differences between the PW samples of groups 1 and 2. In the pathological specimens stained for fibronectin, the number of attenuated cells was similar in the LWs of group 1 and 2 (P = 0.21) as well as in the PWs of each group (P = 0.066).

CONCLUSIONS

ABS decreased bleeding time and did not increase fibrotic reactions in rat bladder tissue.
DDT and urogenital malformations in newborn boys in a malarial area
Authors: Bornman Riana , De Jager Christiaan , Worku Zeleke , Farias Paulina , Reif Simon
Published: October 2009

Study Type – Symptom prevalence (retrospective cohort) Level of Evidence 2b

OBJECTIVE

To determine the risk of external urogenital birth defects (UGBDs) in newborn boys from a malarial area currently sprayed with technical 1,1,1‐trichloro‐2,2‐bis(4‐chlorophenyl) ethane (DDT), as increased fetal oestrogenic or anti‐androgenic exposure might be involved in the pathogenesis of increased prevalence of human male reproductive tract anomalies, and DDT and metabolites interact with both these receptors.

SUBJECTS AND METHODS

We examined 3310 newborn baby boys and recorded external UGBDs.

RESULTS

Of the newborn boys 10.8% (357) had UGBDs; a multivariate logistic model showed that mothers who lived in villages sprayed with DDT between 1995 and 2003 had a significantly greater chance (33%) of having a baby with a UGBD than mothers whose homes were not sprayed (odds ratio 1.33, 95% confidence interval 1.04–1.72). Being a homemaker instead of being employed further significantly increased the risk of having a baby with a UGBD by 41% (odds ratio 1.41, 1.13–1.77).

CONCLUSIONS

Maternal exposure to DDT by living in a DDT‐sprayed village was associated to having male offspring with one or more UGBDs. Monitoring the impact of indoor residual spraying on human and environmental health is imperative if DDT is being used, especially as climate change raises concerns about the global spread of malaria. Integrating adequate indoor residual spraying measures by malarial vector control programmes, and increased public awareness to limit personal exposure, are crucial components that need to be addressed.
Education, Aspirations and Life Satisfaction
Authors: Ferrante Francesco
Published: October 2009

The idea that expanding work and consumption opportunitiesalwaysincreases people's wellbeing is well established in economics but finds no support in psychology. Instead, there is evidence in both economics and psychology that people's life satisfaction depends on howexperienced utilitycompares with expectations of life satisfaction ordecision utility.

In this paper I suggest that expanding work and consumption opportunities is a good thing for decision utility but may not be so for experienced utility. On this premise, I argue that people may overrate their socioeconomic prospects relative to real life chances and I discuss how systematic frustration over unfulfilled expectations can be connected to people's educational achievement.

I test the model's predictions on Italian data and find preliminary support for the idea that education and access to stimulating environments may have a perverse impact on life satisfaction. I also find evidence that the latter effect is mediated by factors such as gender and age.

Indeed, the model seeks to go beyond the Italian case and provide more general insights into how age/life satisfaction relationships can be modelled and explained.
The Impact of EU Structural Funds on FDI
Authors: Katsaitis Odysseas , Doulos Dimitris
Published: October 2009

The effectiveness of EU Structural Funds on the economic performance of the receiving countries has been extensively investigated in the last twenty years. The results indicate that the impact of these funds on economic growth is conditional on the quality of the institutions of the receiving countries. In the case of countries with poor institutional quality, the effect of Structural Funds on economic growth will be negative. The reason being, that Structural Funds do affect the allocation of recourses and in countries with poor institutional quality the misallocation of resources might worsen. For example, corruption might divert funds from productive activities; increased opportunities for rent seeking might absorb resources and so on.

To the extent that EU Structural Funds have a negative impact on the allocation of resources and growth this might affect the attractiveness of the country as a location for FDI. In this research we investigate the impact of EU Structural Funds on the volume of FDI inflows in EU‐15 countries. The econometric analysis is based on a panel analysis of EU‐15 countries for the period 1970 – 2005. We utilize a variety of econometric techniques appropriate for this kind of panel data (fixed effects, random effects, OLS and GMM estimators). The results are extremely robust to these alternative specifications. The empirical findings are consistent with the findings of previous studies regarding the determinants of FDI and indicate that the impact of EU Structural Funds on FDI inflows critically depends on the institutional quality of the receiving countries. For countries with high quality institutions the EU Structural Funds have a positive impact on FDI, for countries with low quality institutions the impact will be negative.
What Is the Value of (My and My Family's) Good Health?
Authors: De Mello Luiz , Tiongson Erwin R.
Published: October 2009

This paper uses several waves of the General Social Survey (GSS) including data for up to about 32,000 individuals to estimate the effect of a variety of health conditions on happiness. We show that healthy people are in general happier than individuals with poor health, controlling for a number of personal and household characteristics. On the basis of the regression results, we computed the monetary value of good health, suggesting that relatively large sums of money would be required to compensate individuals for the loss in happiness associated with poor health. Finally, we show that people become unhappy when the health status of their loved ones deteriorates. In particular, the compensating value associated with a spouse's poor health can be very large, thus pointing to some altruism in the relationship between health status and happiness.
Epidemiological evidence for the links between sleep, circadian rhythms and metabolism
Authors: Gangwisch J. E.
Published: October 2009

Epidemiological data reveal parallel trends of decreasing sleep duration and increases in metabolic disorders such as obesity, diabetes and hypertension. There is growing evidence that these trends are mechanistically related. The seasonal expression of the thrifty genotype provides a conceptual framework to connect circadian and circannual rhythms, sleep and metabolism. Experimental studies have shown sleep deprivation to decrease leptin, increase ghrelin, increase appetite, compromise insulin sensitivity and raise blood pressure. Habitually short sleep durations could lead to insulin resistance by increasing sympathetic nervous system activity, raising evening cortisol levels and decreasing cerebral glucose utilization that over time could compromise β‐cell function and lead to diabetes. Prolonged short sleep durations could lead to hypertension through raised 24‐h blood pressure and increased salt retention resulting in structural adaptations and the entrainment of the cardiovascular system to operate at an elevated pressure equilibrium. Cross‐sectional and longitudinal epidemiological studies have shown associations between short sleep duration and obesity, diabetes and hypertension. If metabolic changes resulting from sleep restriction function to increase body weight, insulin resistance and blood pressure then interventions designed to increase the amount and improve the quality of sleep could serve as treatments and as primary preventative measures for metabolic disorders.
Adipose tissue, adipocytes and the circadian timing system
Authors: Johnston J. D. , Frost G. , Otway D. T.
Published: October 2009

Circadian clocks time the daily occurrence of multiple aspects of behaviour and physiology. Through studies of chronic misalignment between our internal clocks and the environment (e.g. during shift work), it has long been postulated that disruption of circadian rhythms is detrimental to human health. Recent advances in understanding of the cellular and molecular basis of mammalian circadian timing mechanisms have identified many key genes involved in circadian rhythm generation and demonstrated the presence of clocks throughout the body. Furthermore, clear links between sleep, circadian rhythms and metabolic function have been revealed, and much current research is studying these links in more detail. Here, we review the evidence linking circadian rhythms, clock genes and adipose biology. We also highlight gaps in our understanding and finally suggest avenues for future research.
A biobehavioural model of the night eating syndrome
Authors: Stunkard A. J. , Allison K. C. , Lundgren J. D. , O'Reardon J. P.
Published: October 2009

This paper will propose a biobehavioral mechanism for the Night Eating Syndrome (NES), a disorder characterized by a delayed circadian rhythm of food intake and neuroendocrine function. Food intake consists of at least 25% of daily caloric intake after the evening meal and/or at least two nighttime awakenings with ingestions per week. This will be explored by reviewing neuroimaging of brain serotonin transporters (SERT) and treatment with selective serotonin reuptake inhibitors (SSRIs). SERT binding is elevated in the midbrain of night eaters, causing dysregulation of the circadian rhythm of both food intake and neuroendocrine function. The administration of SSRIs blocks the reuptake of serotonin and restores the circadian rhythm of both food intake and neuroendocrine function. This hypothesis implies that reduction of SERT activity should increase postsynaptic serotonin transmission and relieve NES. This is precisely the effect of SSRIs. NES is a function of elevated SERT, and blocking of SERT with an SSRI resolves NES. This model of NES attests to the validity of the diagnosis of NES and the criteria by which it is identified, and it provides an explanation of the mechanism.
The role of cell‐specific circadian clocks in metabolism and disease
Authors: Bray M. S. , Young M. E.
Published: October 2009

Biological rhythms are an integral component of essentially all aspects of life. These rhythms are controlled in part by circadian clocks, transcriptionally based mechanisms that synchronize the organism to its changing environment. The central circadian clock is located within the suprachiasmatic nucleus of the brain, while peripheral clocks are located within virtually all cells outside of the suprachiasmatic nucleus. Although our understanding of central clock structure and function is well advanced, the role of peripheral clocks in whole body energy metabolism is just beginning to be elucidated. Both central and peripheral circadian clocks likely regulate many physiological functions, including insulin sensitivity, endocrine regulation, energy homeostasis, satiety signalling, cellular proliferation and cardiovascular function. Widely varying phenotypes have been reported following global genetic disruption of the clock mechanism in mice, with phenotype dependent on both the clock component targeted and genetic background. The inconsistency in phenotypes associated with clock disruption may be due, in part, to cell‐specific effects of the circadian clocks. To address this question, many laboratories have begun generating animal models of cell type‐specific clock disruption. In this review, we summarize the existing literature on tissue‐specific models of circadian clock disruption and provide a focus for future research in this area.