bluuebunny/crossref_metadata_2025 huggingface dataset:
Tick bite anaphylaxis: Incidence and management in an Australian emergency department
Authors: Rappo Tristan B , Cottee Alice M , Ratchford Andrew M , Burns Brian J
Published: July 2013

Objectives

Ticks are endemic to the eastern coastline of Australia. The aim of the present study is to describe the incidence of tick bites in such an area, the seasonal and geographical distribution, the incidence of anaphylaxis due to tick bite and its management.

Methods

We retrospectively analysed emergency presentations of patients with tick bites to Mona Vale Hospital on Sydney's Northern Beaches over a 2 year period from 1 January 2007 to 1 January 2009. We recorded the geographical and seasonal distribution of tick bites as well as the symptoms from tick bite and its emergency management.

Results

We report over 500 cases of tick bites presenting to a single New South Wales hospital over a 2 year period, of which 34 resulted in anaphylaxis. Cutaneous symptoms were the most common feature associated with anaphylaxis (32/34, 94%). Forty per cent (13/34) of patients with tick bite anaphylaxis had a history of allergy or previous anaphylaxis. Seventy‐six per cent (26/34) of patients were administered adrenaline either prior to presenting or in the ED, while 97% (33/34) were treated with steroids. Fifty‐three per cent were referred to an immunologist and only one‐quarter were discharged with an adrenaline auto‐injector.

Conclusion

We report 34 cases of tick bite anaphylaxis over a 2 year period at a single hospital in a tick endemic area. The variation in the presenting symptoms and signs, as well as in management highlights the need for increased awareness for tick bite management in tick endemic areas.
Exploration of the perceptions of emergency physicians and interns regarding the medical documentation practices of interns
Authors: Isoardi Jonathon , Spencer Lyndall , Sinnott Michael , Nicholls Kim , O'Connor Angela , Jones Fleur
Published: July 2013

Objectives

The primary objective of the present study was to learn the factors that influence the documentation practices of ED interns. A second objective was to identify the expectations of emergency physicians (EPs) towards the medical record documentation of ED interns.

Methods

A qualitative design was adopted using semi‐structured interviews in convenience samples drawn from both groups.

Results

Eighteen interviews were conducted with intern volunteers and 10 with EP volunteers. One (5%) intern and two (20%) EPs had received medical documentation training. Factors that encouraged interns' documentation included: patient acuity (the more critical the condition, the more comprehensive the documentation) and the support of senior colleagues. Inhibiting factors included uncertainty about how much to write, and the shift being worked (interns indicated they wrote less at night). Factors of consequence to senior personnel included the apparent reluctance of interns to document management plans. They noted that interns frequently confine their notes to assessment, investigations and treatments, whereas EPs preferred records that demonstrated intern thought processes and included such matters as future actions to follow immediate treatment. A positive theme that emerged included the high level of support interns received from their senior colleagues. Another theme, the influence of patient acuity, held both positive and negative implications for intern writing practices.

Conclusion

The lack of formal training is an impediment to the production of useful medical records by ED interns. One solution proposed by both interns and senior personnel was the introduction of the subject into intern education programmes.
Effects of emergency department Care Coordination Team referrals in older people presenting with a fall
Authors: Harper Kristie J , Gibson Nicholas P , Barton Annette D , Petta Antonio C , Pearson Sara K , Celenza Antonio
Published: July 2013

Objectives

The study aims to describe the characteristics of patients presenting to an ED with a fall and evaluate multidisciplinary Care Coordination Team (CCT) referrals on patient outcomes.

Methods

A single‐centred retrospective analysis of electronic data at an adult tertiary hospital was performed using data from 2004 to 2009 of presentations for patients aged 65 years or over with a fall. The primary outcome measure was representation to hospital within 30 days, comparing patients referred to CCT and those not referred. Secondary outcomes were differences in demographic characteristics, mode of arrival, triage score and readmission.

Results

The proportion of ED patients presenting with a fall and their mean age is stable over time. From 2006 to 2009, 5162 fallers were referred to CCT in a decreasing trend, but with increased urgency. Statistically significant predictors for being referred to CCT were increasing age, being female, arriving by ambulance, being transferred from a nursing home and higher socioeconomic category. Arrival by ambulance and a history of previous falls were associated with representation and readmission. A decreasing trend from 2006 to 2009 was seen in rate ratios and odds ratios via regression modelling for both representation and readmission in patients referred to CCT.

Conclusion

Maturing of the CCT is associated with a decrease in representation and readmission rate. Over time, the CCT attended higher urgency patients associated with stable admission rates. These associations were not significant and the clinical effectiveness of ED CCTs requires further examination.
Nurse‐initiated analgesia pathway for paediatric patients in the emergency department: A clinical intervention trial
Authors: Taylor Simone E , McD Taylor David , Jao Kathy , Goh Shyan , Ward Meagan
Published: July 2013

Objective

The study aims to evaluate the impact of a nurse‐initiated analgesia pathway (NIAP) intervention for paediatric patients in the ED.

Methods

We undertook a pre‐ and post‐intervention trial in a large, tertiary referral, mixed ED. The intervention comprised development and implementation of a comprehensive NIA Standing Order. In addition to paracetamol, which nurses could initiate pre‐intervention, they were authorised to administer ibuprofen, paracetamol/codeine combinations and topical local anaesthetics prior to a doctor assessing the patient. All nurses were trained and credentialed prior to administering the NIAP. Patients aged 5–17 years with a triage pain score of ≥4 (Wong–Baker or numerical rating scale) were eligible for enrolment. The primary outcome was time to analgesia. Secondary outcomes were the proportion of patients who received ‘adequate analgesia’ and parental satisfaction with ED pain management (measured 48 h post‐discharge).

Results

Fifty‐one children were enrolled in both the pre‐ and post‐intervention periods. Patient sex and mean age, weight and triage pain score did not differ between the groups (P > 0.05). At post‐intervention, significantly more patients received nurse‐initiated analgesia (3.0% vs 43.9%; P < 0.001) and the median time to analgesia was significantly reduced (58 min vs 23 min; P < 0.01). Also, significantly more patients received ‘adequate analgesia’ post‐intervention (41.2% vs 72.5%; P < 0.001). At follow up, the proportion of parents who were very satisfied with their child's overall pain management trended upwards in the post‐intervention period (47.1% vs 66.7%; P = 0.07). No adverse events were observed during either period.

Conclusion

The NIAP significantly reduced time to analgesia. It was associated with high levels of parental satisfaction.
Clinical applications for magnetic resonance guided high intensity focused ultrasound (MRgHIFU): Present and future
Authors: Ellis Samantha , Rieke Viola , Kohi Maureen , Westphalen Antonio C
Published: July 2013

It has been well known for decades that high intensity focused ultrasound (HIFU) generates heat in tissues resulting in coagulative necrosis. Implementation, however, has been slow, due to difficulties with finding an appropriate imaging modality that could not only guide treatment, but also provide real‐time thermal feedback. These problems have been overcome with the newest magnetic resonance‐guided high intensity focused ultrasound systems (MRgHIFU). With its superior spatial resolution enabling accurate image guidance coupled with its ability to provide real‐time thermography during treatments, MRI is moving further into the realm of therapeutics for oncologic patient care.

This article will discuss the implementation of an MR‐guided HIFU system, current clinical indications and touch on future directions.
Important impacts of tissue selection and lipid extraction on ecological parameters derived from stable isotope ratios
Authors: Perkins Matthew J. , McDonald Robbie A. , van Veen F. J. Frank , Kelly Simon D. , Rees Gareth , Bearhop Stuart
Published: July 2013

The nitrogen (δ15N) and carbon (δ13C) isotope ratios of animal tissues can help identify the composition of diets and open up a myriad of ecological applications. However, consumers do not ingest or assimilate all components of food items, and it is not well understood how sampling different tissues of sources and consumers may affect isotopic values ascribed, and thereby how such variation affects derived ecological measures.

Utilizing a simple prey–predator feeding relationship in insects, we examined isotopic differences in soft, exoskeleton and whole tissues using samples with and without lipid extraction. As a derived ecological measure, we calculated trophic discrimination factors, changes in δ15N or δ13C between source and consumer, for the different prey–predator tissue combinations.

Lipid extraction did not affect δ15N values, and we found significant tissue differences in δ15N that varied between prey and predator. Lipid extraction enriched δ13C values in most instances, and it was only after extraction of lipids that we observed consistent depletion of δ13C in exoskeleton relative to soft tissues in prey and predator.

Isotopic differences between tissue types propagated marked variation in derived ecological parameters. Common sampling practice using whole tissue for prey and predator (whole/whole) resulted in a trophic discrimination factor of 0·48‰ for δ15N, compared with correct factors of 0·97‰ (soft/whole) and 2·18‰ (soft/soft) using prey soft tissue actually ingested by the predator. For δ13C, variation across discrimination factors was less, with whole/whole tissue of −0·14‰, whilst correct factors were −0·55‰ (soft/whole) and −0·04‰ (soft/soft).

Our results indicate that tissue selection and preparation are important considerations for isotopic studies using arthropods. Lipid extraction is necessary to derive accurate δ13C values based on proteins, whilst consequences of tissue selection are likely context‐dependent: In poorly defined systems where sources are isotopically similar or have larger variance, our results indicate that tissue selection within sources is important to avoid significant error, whether estimating trophic positions or dietary proportions using mixing models. In such cases, we strongly recommend exclusion of source materials not assimilated in consumers.
BMI But Not Stage or Etiology of Nonalcoholic Liver Disease Affects the Diagnostic Utility of Carbohydrate‐Deficient Transferrin
Authors: Fagan Kevin J. , Irvine Katharine M. , McWhinney Brett C. , Fletcher Linda M. , Horsfall Leigh U. , Johnson Lambro A. , Clouston Andrew D. , Jonsson Julie R. , O'Rourke Peter , Martin Jennifer , Pretorius Carel J. , Ungerer Jacobus P. J. , Powell Elizabeth E.
Published: July 2013

Background

A reliable biomarker is required in hepatology clinics for detection and follow‐up of heavy alcohol consumption. Carbohydrate‐deficient transferrin (CDT) increases with sustained heavy alcohol consumption and is the most specific biomarker of ethanol (EtOH) consumption. Recent introduction of a standardized method for measuring CDT has improved its clinical application. This study was designed to determine whether alcohol‐independent factors influence CDT levels in patients with chronic liver disease (CLD).

Methods

The relationship between serum %CDT and self‐reported history of alcohol consumption was examined in 254 patients referred for evaluation of liver disease. CDT analysis was performed on serum collected at time of liver biopsy.

Results

CDT levels were not affected by severity or etiology of nonalcoholic liver disease. Thirteen of 254 subjects had a %CDT >1.7, predictive of heavy alcohol intake, 6 of whom did not acknowledge heavy drinking. Twelve of these 13 subjects were suspected heavy drinkers on review of their medical records and clinical results. Conversely, not all acknowledged heavy drinkers had %CDT >1.7. Heavy drinkers with a body mass index (BMI) in the overweight or obese range had significantly lower %CDT than lean heavy drinkers. This persisted even when lean body weight was used as an approximation of the EtOH volume of distribution.

Conclusions

An elevated BMI reduces the diagnostic utility of CDT at higher alcohol intake in subjects with CLD using the standardized method. In a hepatology outpatient setting, this assay is likely to be useful to confirm suspicion of heavy drinking in subjects who are not overweight, but cannot reliably identify moderate drinkers or heavy drinkers who are overweight.
Methylation differences of the neuronatin gene promoter region in liver between normal and cloned pigs
Authors: Gu Ting , Su Xi , Zhao Shuhong , Li Changchun
Published: July 2013

Abnormal phenotypes in cloned pigs can be partly due to changes in epigenetic modifications such as methylation levels of promoter CpG islands. Neuronatin is an imprinted gene, conserved in human, pig, cattle and mouse, which is expressed exclusively from the paternal allele. Three CpG islands located in the promoter region of the porcine neuronatin gene have the potential to regulate the gene expression by cytosine methylation. To illustrate whether neuronatin was differentially expressed among nuclear transfer macroglossia–positive and nuclear transfer macroglossia–negative pigs and in vitro‐fertilized pigs, we detected its expression level by qRT‐PCR and further quantified methylation levels by pyrosequencing DNA from the liver. The results showed that neuronatin was expressed at a significantly higher level in livers of nuclear transfer macroglossia‐positive pigs compared with normal cloned and in vitro‐fertilized pigs. Livers of nuclear transfer macroglossia‐positive pigs also had a significantly lower methylation level at CpG island 2 and CpG island 3 in the promoter region.
Has fertility declined from mid‐1990s to mid‐2000s?
Authors: Rostad Berit , Schmidt Lone , Sundby Johanne , Schei Berit
Published: July 2013

Objective

To assess changes in self‐reported fertility from the mid‐1990s to the mid‐2000s.

Design

The study is a retrospective population‐based study.

Setting

The study applied a dataset from two cross‐sectional surveys conducted in the mid‐1990s and some 10 years later, inviting all women in a county in Norway.

Population

Women aged 50–59 years enrolled in either survey constituted two cohorts. Data on 4468 women in the first survey (Cohort 1940) and 4951 women in the latter survey (Cohort 1950) were collected by structured questionnaires.

Main outcome measures

Prevalence of fertility, infertility with subcategories subfertility and involuntary childlessness, as well as childlessness was estimated and compared between the surveys. Possible sociodemographic and lifestyle predictors of fertility were assessed at different points in time.

Results

Fertility declined over the two successive surveys; 87.8% of the women in Cohort 1940 were fertile compared with 84.2% of the women in Cohort 1950 (p = 0.000). The prevalence of infertility increased over time due to an increase in subfertility from 7.8 to 10.6% (p = 0.000). The level of education increased with time, as did at‐risk alcohol consumption and smoking, and these factors were adversely associated with fertility. The proportion of childless women increased across surveys (p = 0.004) but relatively fewer women were involuntarily childless in Cohort 1950 than in Cohort 1940 (p = 0.543).

Conclusion

Fertility, measured at 10‐year intervals, declined significantly. The decline in fertility was related to changes in subfertility. Adjustments for sociodemographic and lifestyle factors did not fully explain the decline in fertility.
Gender Differences in Attitudes Toward Police Use of Tasers Following the Dziekanski Case
Authors: Mandel David R.
Published: July 2013

Prior research has shown that men and women respond differently on a variety of behavioral, attitudinal, and affective measures related to agentic and communal interpersonal orientation, yet research on such measures seldom disaggregates findings by gender. The present study examined how gender moderated a range of affective and cognitive responses to an important social and policy issue—police use of Tasers. The study followed the Dziekanski case in which an émigré to Canada died after being repeatedly stunned with a Taser by police officers. Compared to men, women were significantly more opposed to police Taser use, they were likelier to blame police for Dziekanski's death, and they reported stronger emotional responses to the case. The findings extend support for the view that men and women exhibit different patterns of response to situations that evoke communal values, and they highlight the importance of theoretical guidance in disaggregating responses in opinion research.
Trends and inequalities in the surgical management of ureteric calculi in the USA
Authors: Seklehner Stephan , Laudano Melissa A. , Jamzadeh Asha , Del Pizzo Joseph J. , Chughtai Bilal , Lee Richard K.
Published: July 2013

Objective

To assess trends in the surgical management of ureteric calculi over a 10‐year period.

Materials and Methods

An analysis of the 5% Medicare Public Use Files, from 2001, 2004, 2007 and 2010, was performed to assess the use of ureteroscopy (URS), extracorporal shockwave lithotripsy (ESWL) and ureterolithotomy (UL) in treating ureteric calculi.

Patients were identified using International Classification of Diseases 9th edition (Clinical Modification) and Current Procedure Terminology codes.

Statistical analyses using the Fisher and chi‐squared tests, and multivariate logistic regression analysis (dependent variables: URS, ESWL, UL, treatment, no treatment; independent variables: age, gender, ethnicity, geography and year of treatment) were performed.

Results

A total of 299 920 patients with ureteric calculi were identified. Of these, 115 200 underwent surgery.

Men (odds ratio [OR] = 1.15, P < 0.001) were more likely, while patients from ethnic minorities (OR = 0.84, P = 0.004) were less likely to be treated. Patients in the West of the USA were also less likely to be treated (OR = 0.76, P < 0.001) as were patients aged <65 or >84 years old (P = 0.29).

The predominant surgical approach was URS (65.2%), followed by ESWL (33.6%) and UL (1.2%).

The use of URS increased over time, while the use of ESWL and UL declined.

Women (OR = 1.25, P < 0.001) were more likely to undergo URS. Patients in the South of the USA (OR = 1.51, P < 0.001) and patients from ethnic minorities were more likely to undergo ESWL (OR = 1.23, P = 0.03).

Conclusions

The surgical treatment of ureteric calculi changed significantly between 2001 and 2010.

The use of URS expanded at the expense of ESWL and UL.

Multiple inequalities existed in overall surgical treatment rates and in the choice of treatment; age, gender, ethnicity and geography influenced both whether patients underwent surgical intervention and the type of surgical approach used.
Comparison of early postoperative morbidity after robot‐assisted and open radical cystectomy: results of a prospective observational study
Authors: Musch Michael , Janowski Maxim , Steves Antonia , Roggenbuck Ulla , Boergers Andre , Davoudi Yadollah , Loewen Heinrich , Groeben Harold , Kroepfl Darko
Published: July 2013

Objective

To evaluate early postoperative morbidity in patients undergoing either robot‐assisted (RARC) or open radical cystectomy (ORC) for bladder cancer.

Patients and Methods

A total of 100 patients underwent RARC (between August 2009 and August 2012) and 42 underwent ORC (between October 2007 and July 2009) as treatment for bladder cancer.

Data on the patients' peri‐operative course were collected prospectively up to the 90th postoperative day for the RARC group and up to the 60th postoperative day for the ORC group.

Postoperative complications were recorded based on the Clavien–Dindo classification system.

Both groups were compared with regard to patient and tumour characteristics, surgical and peri‐operative outcomes.

Results

The RARC and ORC groups were well matched with regard to age, body mass index, gender distribution, type of urinary diversion and pathological tumour characteristics (all P > 0.1), but patients in the RARC group had more serious comorbidities according to the Charlson comorbidity index (P = 0.034).

Although surgical duration was longer in the RARC group (P < 0.001) the estimated blood loss was lower (P < 0.001) and transfusion requirement was less (P < 0.001).

Overall 59 patients (59%) in the RARC group and 39 patients (93%) in the ORC group experienced postoperative complications of any Clavien–Dindo grade <90 days and <60 days after surgery, respectively (P < 0.001; relative risk reduction 0.36).

Major complications (grades 3a–5) were also less frequent after RARC (24 [24%] vs 18 patients [43%]; P = 0.029) with a relative risk reduction of 0.44.

In the subgroup of patients with an ileum conduit as a urinary diversion (RARC, n = 76 vs ORC, n = 31) the overall rate of complications (43 [57%] vs 28 [90%] patients; P < 0.001) and the rate of major complications (17 [22%] vs 15 [48%] patients; P = 0.011) were lower in the RARC group with relative risk reductions of 0.37 and 0.54, respectively.

Conclusions

A significant reduction in early postoperative morbidity was associated with the robotic approach.

Despite more serious comorbidities and a 30‐day longer follow‐up in the RARC group, patients in the RARC group experienced fewer postoperative complications than those in the ORC group. Major complications, in particular, were less frequent after RARC.
Assessing the cultural competence of oral health research conducted with migrant children
Authors: Riggs Elisha , Gussy Mark , Gibbs Lisa , van Gemert Caroline , Waters Elizabeth , Priest Naomi , Watt Richard , Renzaho Andre M. N. , Kilpatrick Nicky
Published: July 2013

Objectives

Traditional assessment of research quality addresses aspects of scientific rigor, however, ensuring barriers to participation by people of different cultural backgrounds are addressed requires cultural competence. The aim of this research was to assess the cultural competence of oral health research conducted with migrant children.

Methods

A protocol was developed with explicit inclusion and exclusion criteria. Electronic databases were searched from 1995 to 2009. Each study was assessed for cultural competence using the assessment criteria and a template developed as a proof‐of‐concept approach.

Results

Of the 2059 articles identified, 58 met inclusion criteria (n = 48 studies). There were four (8.3%) cohort studies, five (10.4%) intervention studies, 37 (77.1%) quantitative cross‐sectional studies, and two (4.2%) were qualitative studies. Overall, migrant children had worse oral health outcomes in all studies compared with their host‐country counterparts. All studies rated poorly in the cultural competence assessment.

Conclusions

Appropriate inclusion of all potentially vulnerable groups in research will result in better estimates and understandings of oral health, and more reliable recommendations for prevention and management.
The different roles of neighbourhood and individual social capital on oral health–related quality of life during pregnancy and postpartum: a multilevel analysis
Authors: Lamarca Gabriela A. , Leal Maria do C. , Leao Anna T. T. , Sheiham Aubrey , Vettore Mario V.
Published: July 2013

Objective

Social capital incorporates neighbourhood and individual levels of interactions and influences health. The objective of this was to assess the association of neighbourhood and individual social capital with oral health–related quality of life (OHRQoL) in pregnant and postpartum women.

Methods

This was a follow‐up prevalence multilevel study on a representative sample of 1248 women grouped into 55 neighbourhoods.OHRQoLwas assessed in the postpartum period using the Oral Health Impact Profile questionnaire (OHIP‐14). Exploratory variables were gathered during the first trimester of pregnancy and included neighbourhood social capital (neighbourhood‐level measure), individual social capital (social support and social networks), demographic and socio‐economic variables, oral health measures, and health‐related behaviours.

Results

The multilevel ordered multinomial logistic regression showed that neighbourhood social capital did not significantly affect women'sOHRQoLduring pregnancy and postpartum period. Individual social capital measures were independently associated with highOHRQoL. Lack of family social network increased the odds for highOHRQoL (OR = 1.44, 95%CI: 1.08–1.92). Individuals with high levels of positive social interaction were less likely to report high scores ofOHRQoL (OR = 0.90, 95%CI: 0.82–0.98).

Conclusion

Individual social capital was of greater relevance to women'sOHRQoLin and after pregnancy than neighbourhood social capital. These findings suggest that quality of personal and social resources of pregnant women are more important forOHRQoLthan the neighbourhoods where the women live.
Upregulation of Glutamate–Aspartate Transporter by Glial Cell Line–Derived Neurotrophic Factor Ameliorates Cell Apoptosis in Neural Retina in Streptozotocin‐Induced Diabetic Rats
Authors: Wang Lu , Deng Qin‐Qin , Wu Xiao‐Hua , Yu Jun , Yang Xiong‐Li , Zhong Yong‐Mei
Published: July 2013

Aims

Dysfunction of glutamate uptake, largely mediated by the glutamate–aspartate transporter (GLAST), may lead to retinal cell apoptosis in diabetic retinopathy. The aim of this study is to examine how cell apoptosis and the expression level of GLAST in neural retina of a diabetic rat model are changed and whether the neuroretinal apoptosis could be ameliorated by the administration of glial cell line–derived neurotrophic factor (GDNF).

Methods

Diabetes was induced by intraperitoneal injection of streptozotocin (STZ) in Sprague–Dawley rats. GLAST protein expression levels were determined by Western blotting, whereas apoptosis of retinal neurons was evaluated by TUNEL staining. To assess the role of GDNF in ameliorating the STZ‐induced retinal changes, GDNF/GDNF with siRNA directed against GLAST was injected into the vitreous after STZ injection.

Results

In rat retinas 4 weeks after the onset of STZ‐induced diabetes, TUNEL‐positive cells were significantly increased, whereas GLAST levels were significantly reduced. Intraocular administration of GDNF at the early stage of diabetes remarkably increased the GLAST levels and decreased TUNEL‐positive signals in the retinas. These effects of GDNF were largely abolished by coadministration of GLAST siRNA.

Conclusions

GDNF, administrated at the early stage of diabetes, could rescue retinal cells from neurodegeneration by upregulating the expression of GLAST.
Cost of illness from occupational hand eczema in Germany
Authors: Diepgen Thomas L. , Scheidt Reginald , Weisshaar Elke , John Swen M. , Hieke Klaus
Published: July 2013

Background

There is little knowledge about the costs of occupational hand eczema.

Objectives

To estimate the societal costs of patients with occupational hand eczema in Germany.

Methods

Resource use during the past year, disease severity and quality of life [Dermatology Life Quality Index (DLQI)] were gathered for patients with occupational hand eczema before they entered a special rehabilitation programme. Costs were calculated from the societal perspective. The analysis focused on all patients and the severity groups no signs/mild (group A) and moderate to severe (group B).

Results

One hundred and fifty‐one patients were analysed, with a mean age of 44.9~years and a mean DLQI score of 10.9; 64.9% were male. Sickness absence was recorded for 62.9% of all patients (76.4~days on average in the last 12~months). Annual societal costs were €8799 per patient. Indirect costs represented 70% of total costs. Quality of life (DLQI) was statistically different across both severity groups (group A, 7.9; group B, 12.9), but direct treatment costs were not (€2705 versus €2610, respectively). There was a trend towards higher indirect costs in patients in severity group B (group A, €5120; group B, €6796).

Conclusion

The annual societal costs of patients with occupational hand eczema in this study are high, and similar to those for severe psoriasis and atopic dermatitis.
Comparison of four methods for assessment of severity of hand eczema
Authors: Agner Tove , Jungersted Jacob Mutanu , Coenraads Pieter‐Jan , Diepgen Thomas
Published: July 2013

Background

Several instruments for the assessment of the severity of hand eczema and health‐related quality of life (HR‐QoL) related to hand eczema have been developed.

Objectives

The aim of the present study was to evaluate the correlation between frequently used methods.

Methods

Consecutive patients with current hand eczema from three different centres participated in the study. Severity of hand eczema was assessed with the Hand Eczema Severity Index (HECSI), the Physician Global Assessment (PGA), the Clinical Photo Guide, and the Dermatology Life Quality Index (DLQI).

Results

One hundred and nineteen patients with hand eczema were included in the study. All six pairwise correlation coefficients between the tested methods were highly statistically significant. Correlation was highest between the HECSI and the PGA (r = 0.82), and weakest, although still statistically significant, between the DLQI and the other three severity scores (r between 0.30 and 0.45). Age and frequency of eruptions did not influence the correlations. With respect to sex, there was a tendency for correlation between methods to be higher for men than for women.

Conclusion

We found an overall positive correlation between the four severity assessments applied. As the weakest correlation was found between the DLQI and the other methods, it is suggested that measurement of HR‐QoL should be included for assessment of the severity and consequences of hand eczema, but the finding also indicates that a disease‐specific tool for evaluation of HR‐QoL in hand eczema patients is needed.
A simple tool with which to study the course of chronic hand eczema in clinical practice: a reduced‐item score
Authors: van der Valk Pieter G. M. , van Gils Robin F. , Boot Cécile R. L. , Evers Andrea W. M. , Donders Rogier , Alkemade Hans A. C. , Coenraads Pieter Jan , Rustemeyer Thomas , van Mechelen Willem , Anema Johannes R.
Published: July 2013

Background

Physicians need a simple, disease‐specific tool with which to assess disease severity and the effect of therapeutic intervention in patients with chronic hand eczema. The currently available clinical scoring systems include numerous items, which makes them laborious to complete and limit their use in daily practice.

Objective

To develop a simple tool with which to assess disease severity of patients with chronic hand eczema.

Methods

We evaluated two tools, the Hand Eczema Severity Index (HECSI) and the Hand Eczema Area and Severity score, to determine their ability to predict the Investigator's Global Assessment (IGA) of disease severity in patients with moderate to severe hand eczema. We used a stepwise reduction analysis to determine a minimal set of significantly contributing items for predicting IGA.

Results

A three‐item score, based on the highest observed value of induration, fissuring, and scaling, predicted IGA with a correlation of 0.667. The HECSI predicted the IGA with a correlation of 0.675.

Conclusion

On the basis of this analysis, we propose a simple tool for clinical decision‐making and evaluation of therapeutic intervention in daily practice.
What do patients with occupational hand eczema know about skin care?
Authors: Fisker Maja H. , Ebbehøj Niels E. , Jungersted Jakob M. , Agner Tove
Published: July 2013

Background

The aim of the present study was to examine the knowledge of skin care and treatment of hand eczema (HE) in a sample of patients with newly reported occupational HE.

Materials and methods

A questionnaire consisting of 13 questions about knowledge of skin care and treatment of HE was sent to all patients with occupational HE reported to the National Board of Industrial Injuries in the period 1 January 2010 to 31 March 2010.

Results

Three hundred and seventy individuals, 269 females and 101 males, with a mean age of 39.9 years, responded to the questionnaire (response rate of 73%). The overall percentage of correct answers was 73%. Variables significantly influencing the level of knowledge were sex and age, with a need for more information in males and in patients above the age of 50 years. No significant influence of level of education, eczema activity, previous information about HE, previous or current atopic eczema or dermatology life quality index (DLQI) was found.

Conclusion

There is still potential for improvement of the level of knowledge among patients with occupational HE. Special attention should be paid to males and patients above the age of 50 years.
Risk factors associated with sensitization to hydroxyisohexyl 3‐cyclohexene carboxaldehyde
Authors: Uter Wolfgang , Geier Johannes , Schnuch Axel , Gefeller Olaf
Published: July 2013

Background

Hydroxyisohexyl 3‐cyclohexene carboxaldehyde (HICC) is a synthetic fragrance chemical and an important contact allergen, at least in Europe. Despite this importance, little is known about risk factors associated with this allergen.

Objective

To examine factors from the history and clinical presentation of patch tested patients associated with HICC sensitization.

Methods

Contact allergy surveillance data of 95 637 patients collected by the Information Network of Departments of Dermatology (IVDK,
www.ivkd.org) in 2002–2011 were analysed. Point and interval estimates of the relative risk were derived from multifactorial logistic regression modelling.

Results

The overall prevalence of HICC sensitization was 2.24%. The strongest risk factors were polysensitization and dermatitis of the axillae, followed by dermatitis at other sites. No consistent and significant time trend was observed in this analysis. As compared with the youngest patients, the odds of HICC sensitization increased approximately three‐fold in the 52–67‐year age group, and strongly declined with further increasing age.

Conclusions

The risk pattern with regard to age and affected anatomical site differed from that observed with other fragrance screening allergens. Cosmetic exposure, as broadly defined here, was a stronger and more prevalent individual risk factor than occupational exposure.
Eczema and ceramides: an update
Authors: Jungersted Jakob Mutanu , Agner Tove
Published: July 2013

Although normal epidermal barrier function depends on numerous factors, including corneocytes, lipids, enzymes, pH, and calcium gradient, the key players are lipids and proteins in the stratum corneum. Atopic dermatitis is characterized by barrier abnormalities, such as the presence of filaggrin mutations in almost 50% of patients with moderate/severe atopic dermatitis, and lipid disturbances, mainly expressed as insufficient ceramides. In this review, with an emphasis on human studies, we consider the latest research on ceramides, on ceramides in different types of eczema and following various types of treatment. We also consider the genetic influence on stratum corneum lipids. The review is an update on research indexed in PubMed following the discovery of the filaggrin mutations in atopic dermatitis in 2006, but when newer publications cannot stand alone, we include publications from before 2006.
Fragrant finishing of cotton with microcapsules: comparison between printing and impregnation
Authors: Golja Barbara , Šumiga Boštjan , Forte Tavčer Petra
Published: July 2013

Microencapsulated fragrance was used to produce a fragrant textile product. Melamine–formaldehyde polymer wall microcapsules with a lavender, rosemary and sage essential oil core were applied to a cotton fabric in two ways, i.e. byscreen printing and impregnation. The samples were dried and cured, and then the differences between them were analysed. The condition and distribution of applied microcapsules were observed by scanning electron microscopy, fragrance evaluation was performed on printed and impregnated samples after they had been washed several times, and their handle properties were investigated. Moreover, the influence of artificial light on the wall of microcapsules was examined, and possible antibacterial activity against Staphylococcus aureus and Escherichia coli was evaluated. The change in colour of all samples as a consequence of the addition of microcapsules to the paste or bath was checked. The results show that both application techniques are appropriate for the effective fragrant but on the other hand ineffective antibacterial finishing of cotton fabrics. Artificial light did not affect the microcapsules. There is an impact on colour only when the capsules are printed to fabric. Both of the techniques used, printing and impregnation, have advantages as well as drawbacks.
A century of indicator dilution technique
Authors: Henriksen Jens H. , Jensen Gorm B. , Larsson Henrik B. W.
Published: July 2013

This review imparts the history and the present status of the indicator dilution technique with quantitative bolus injection. The first report on flow measurement with this technique appeared 100 years ago. In 1928, the use of intravascular dyes made possible a widespread application in animals and human during the next decades. Multiple indicators, radioactive tracers, inlet–outlet detection and residue detection were introduced in the 1950s and 1960s, and refined along with the development of indicator kinetics. From the 1970s, a wide clinical use in the study of heart, brain, lungs, liver and kidneys developed, and powerful computers in the 1980s and 1990s accorded the technique a new dimension. Today, the indicator dilution technique, on one hand, is applied in the same way as 100 years ago, on the other hand it forms the basis of quantitative SPECT, positron emission tomography, and dynamic MR scans. The technique still undergoes refinement and elaboration as a lasting concept with a high potential for further development.
5‐aminolaevulinic acid/photo‐dynamic therapy and gefitinib in non‐small cell lung cancer cell lines: a potential strategy to improve gefitinib therapeutic efficacy
Authors: Postiglione I. , Chiaviello A. , Aloj S. M. , Palumbo G.
Published: July 2013

Objectives

Often, non‐small cell lung cancers (NSCLC) respond only poorly to the tyrosine kinase inhibitor (TKI) gefitinib, which targets the epidermal growth factor receptor (EGFR), these poor responders EGFRs lacking activating mutations. In this study, we have attempted to improve TKI response of NSCLC cell lines (A549 and H1299) devoid of EGFR mutations, by combination of gefitinib and 5‐ALA/photodynamic therapy (PDT).

Materials and methods

Cells of the two lines were incubated with gefitinib (from 0.5 to 50 mm, for 48 h) then irradiated at doses ranging from 4 to 20 J/cm2; 5‐ALA concentration and incubation time were kept constant (1 mm for 3 h). We analysed cell viability, colony‐forming efficiency, cell cycle parameters, proteasome and NF‐κB activity and expression patterns of specific proteins, after individual or combined treatments.

Results

Effects (antagonistic, additive or synergistic) of combination treatment were evaluated using a predictive model (combination index) for expected interactive effects and results are consistent with mutual potentiation exceeding simple additivity. Investigation of molecular mechanisms underlying cytotoxic effects indicated that combination treatment impaired proteasome function, inhibited NF‐κB transcriptional activity and hampered AKT pro‐survival signalling.

Conclusions

The results of this study show that poor response of cells devoid of EGFR activating mutations to TKIs, can be overcome by combining gefitinib with 5‐ALA/photodynamic therapy (PDT).
Oxygen consumption in T‐47D cells immobilized in alginate
Authors: Larsen B. E. , Sandvik J. A. , Karlsen J. , Pettersen E. O. , Melvik J. E.
Published: July 2013

Objectives

Encapsulation or entrapment of cells is increasingly being used in a wide variety of scientific studies for tissue engineering and development of novel medical devices. The effect on cell metabolism of such systems is, in general, not well characterized. In this work, a simple system for monitoring respiration of cells embedded in 3‐D alginate cultures was characterized.

Materials and methods

T‐47D cells were cultured in alginate gels. Oxygen concentration curves were recorded within cell‐gel constructs using two different sensor systems, and cell viability and metabolic state were characterized using confocal microscopy and commercially available stains.

Results

At sufficient depth within constructs, recorded oxygen concentration curves were not significantly influenced by influx of oxygen through cell‐gel layers and oxygen consumption rate could be calculated simply by dividing oxygen loss in the system per time, by the number of cells. This conclusion was supported by a 3‐D numeric simulation. For the T‐47D cells, the oxygen consumption rate was found to be 61 ± 6 fmol/cell/h, 3–4 times less than has previously been found for these cells, when grown exponentially in monolayer culture.

Conclusions

The experimental set‐up presented here may be varied in multiple ways by changing the cell‐gel construct 3‐D microenvironment, easily allowing investigation of a variety of factors on cell respiration.
Effects of human epidermal growth factor gene‐transfected mesenchymal stem cells on fibroblast migration and proliferation
Authors: You D. H. , Nam M. J.
Published: July 2013

Objectives

We were interested in determining whether epidermal growth factor gene‐transfected mesenchymal stem cells (EGF‐MSC) would accelerate fibroblast migration and proliferation.

Materials and methods

Fibroblasts were cultured in serum‐free conditioned media from EGF‐MSC; RT‐PCR was performed to detect expression of EGF gene in EGF‐MSCs. EGF protein levels in cell culture supernatants from EGF‐MSC were assayed by ELISA and proliferation of EGF‐MSC‐treated fibroblasts was performed using MTT assay. Effects of EGF‐MSC on fibroblast migration were evaluated using scratch wound and transmigration assays. Cell adhesion molecules, cell dynamics molecules and phospho‐(Ser) kinase substrate expressions of EGF‐MSC‐treated fibroblasts were evaluated by western blotting.

Results

EGF gene expression increased in EGF‐MSCs and viability of EGF‐MSC‐treated fibroblasts was elevated. EGF‐MSC‐treated fibroblasts showed increased migration compared to controls. Expressions of cell adhesion molecules (β‐catenin, N‐cadherin), cell dynamics molecules (cofilin, ezrin) and phospho‐(Ser) kinase substrates (phospho‐MAPK/CDK substrate, phospho‐Arg‐(Ser)‐X‐Tyr/Phe‐X‐pSer motif) increased in EGF‐MSC‐treated fibroblasts. These results imply that EGF‐MSCs contributed to enhancing the wound healing process by increased cell adhesion, dynamic effects, fibroblast migration, and proliferation.

Conclusions

This study indicates that EGF‐MSCs had a positive influence on fibroblast migration and proliferation and EGF‐MSC may provide a useful strategy for wound healing.
Effects of bone morphogenetic protein‐4 (BMP‐4) on adipocyte differentiation from mouse adipose‐derived stem cells
Authors: Wei X. , Li G. , Yang X. , Ba K. , Fu Y. , Fu N. , Cai X. , Li G. , Chen Q. , Wang M. , Lin Y.
Published: July 2013

Objectives

As mesenchymal stem cells (MSCs) can be isolated easily from adipose tissues while retaining their self‐renewal and multi‐potential differentiation capacities, they hold promising possibilities for being applied extensively in tissue engineering. Bone morphogenetic protein (BMP) family members have been reported to provide instructive signals to MSCs for them to differentiate into several different cell lineages. The study described here aims to investigate whether BMP‐4 could promote adipose‐derived stem cell (ASC) differentiation into adipocytes under various concentrations.

Materials and methods

ASCs were isolated from mouse inguinal adipose pads and cultured in vitro. 10 ng/ml and 50 ng/ml BMP‐4 were added to adipogenic media for 8 days. Oil red‐O staining, reverse transcription/polymerase chain reaction and immunocytofluorescence staining were performed to examine differentiation of the ASCs.

Results

As indicated by increased expression of adipogenic and lipogenic genes (PPAR‐γ, APN and LPL) and proteins, 50 ng/ml BMP‐4 seemed to induce mASCs to differentiate into the adipo‐lineage compared to 10 ng/ml BMP‐4, and control groups. In addition, lipid droplets accumulated within the adipocytes under 50 ng/ml BMP‐4 stimulation, as shown by oil red‐O staining.

Conclusions

Our present study suggests that BMP‐4, as an adipo‐inducing factor, promoted adipogenesis of ASCs at higher concentrations (50 ng/ml) and can perhaps be considered as a candidate for use in adipose tissue engineering.
Interleukin‐6‐induced satellite cell proliferation is regulated by induction of theJAK2/STAT3 signalling pathway through cyclin D1 targeting
Authors: Kurosaka M. , Machida S.
Published: July 2013

Objectives

To determine whether interleukin‐6 (IL‐6) stimulates rat muscle satellite cell proliferation in culture, and if so, to clarify the signalling mechanisms.

Materials and methods

Primary satellite cells were isolated from thirty male F344 rats, 11 weeks of age.IL‐6 at concentrations of 0.01, 0.1, 1, 10 or 100 ng/ml was added to culture media.

Results

IL‐6 at 0.01–1 ng/ml induced dose‐dependent increase in cell proliferation. After treatment with 1 ng/ml IL‐6, cell proliferation increased by 31%, and p‐STAT3+/MyoD+cells increased in number compared to those in control media (P < 0.05). Inhibitors of JAK2 (AG 490) and STAT3 (STAT3 peptide) blocked the increase in BrdUrd+cell numbers at 6 h post stimulation with 1 ng/ml IL‐6 (P < 0.05). Furthermore, cyclin D1mRNAexpression and cyclin D1+/MyoD+cell numbers significantly increased in cultures treated with 1 ng/ml IL‐6 compared to those in control media (P < 0.05). In contrast, treatment with 10 and 100 ng/ml IL‐6 did not stimulate cell proliferation. Treatment with 10 ng/ml IL‐6 induced greater SOCS3mRNAexpression than with 1 ng/ml IL‐6 and control media. Moreover, co‐localization of SOCS3 and myogenin was observed after treatment with 10 ng/ml IL‐6.

Conclusions

IL‐6 induced dose‐dependent increase in satellite cell proliferation by activating theJAK2/STAT3/cyclin D1 pathway.