bluuebunny/crossref_metadata_2025 huggingface dataset:
Co‐inheritance of the Hb Sun Prairie mutation with a point mutation at 5′‐UTR in the eastern Indian population
Authors: Sarkar Anjali A. , Mukhopadhyay Chaitali , Chandra Sharmila , Banerjee Subrata , Das M. K. , Dasgupta Uma B
Published: April 2005

Haemoglobin (Hb) Sun Prairie (α2‐globin cd130, GCT→CCT, Ala→Pro) is detected in three unrelated chromosomes, in association with a C→T transition in the 5′‐untranslated region (UTR), two bases upstream from the translation start site. Reported inversion of α/β‐mRNA ratio observed in Hb Sun Prairie mutants might stem from the second mutation and should be investigated. Molecular modelling studies indicate that the 130th residue of α‐globin faces primarily the central cavity of the molecule and is not in contact with any β‐chain residue; further, no significant disruption of the Hb structure because of the Sun Prairie mutation is discernible. Depression of translation because of the second mutation of a conserved base in the 5′‐UTR might explain the observed clinical severity.
The immune response to primary EBV infection: a role for natural killer cells
Authors: Williams Hilary , McAulay Karen , Macsween Karen F. , Gallacher Neil J. , Higgins Craig D. , Harrison Nadine , Swerdlow Anthony J. , Crawford Dorothy H.
Published: April 2005

The role of antigen‐specific CD3+CD8+ cytotoxic T cells in the control of primary Epstein–Barr Virus (EBV) infection is well established. However, time is required for the antigen‐specific immune response to develop and expand. In contrast, innate immune responses, such as natural killer (NK) cells, are considered vital early in the infection process. We analysed the scale, phenotype and function of the NK cell response during symptomatic primary EBV infection, infectious mononucleosis (IM) and showed that NK cell numbers were significantly elevated both at diagnosis of IM and in the first month following diagnosis. There were also significant changes in cell phenotype and function, an increase in the proportion of CD56bright cells at diagnosis, and freshly isolated cells showing an enhanced ability to kill EBV‐infected cell lines. Moreover, in our cohort of IM patients higher NK cell counts were associated with significantly lower viral load in peripheral blood. Our results suggest NK cells have an important role in the control of primary EBV infection by eliminating infected B cells and augmenting the antigen‐specific T cell response via release of immunomodulatory cytokines. The magnitude of the NK cell response may ultimately determine whether primary EBV infection has a clinical outcome.
Group cognition in computer‐assisted collaborative learning
Authors: Stahl Gerry
Published: April 2005

Abstract
Recent research on instructional technology has focused increasingly on the potential of computer support to promote collaborative learning. Socio‐cultural theories have been imported from cognate fields to suggest that cognition and learning take place at the level of groups and communities as well as individuals. Various positions on this issue have been proposed and a number of theoretical perspectives have been recommended. In particular, the concept of common ground has been developed to explain how meanings and understandings can be shared by multiple individuals. This paper takes a critical look at the concept of shared meaning as it is generally used and proposes an empirical study of how group cognition is constituted in practice.
Interactive whiteboards: boon or bandwagon? A critical review of the literature
Authors: Smith Heather J. , Higgins Steve , Wall Kate , Miller Jen
Published: April 2005

Abstract
This article reviews the literature concerning the introduction of interactive whiteboards (IWBs) in educational settings. It identifies common themes to emerge from a burgeoning and diverse literature, which includes reports and summaries available on the Internet. Although the literature reviewed is overwhelmingly positive about the impact and the potential of IWBs, it is primarily based on the views of teachers and pupils. There is insufficient evidence to identify the actual impact of such technologies upon learning either in terms of classroom interaction or upon attainment and achievement. This article examines this issue in light of varying conceptions of interactivity and research into the effects of learning with verbal and visual information.
Student teachers' first reflections on information and communications technology and classroom learning: implications for initial teacher education
Authors: Sime Daniela , Priestley Mark
Published: April 2005

Abstract
This article explores student teachers' views of the use of information and communication technologies (ICT) in schools. There is limited research literature regarding the perceptions that such students develop in relation to the use of ICT in teaching while observing practice in schools. The paper offers an interpretive analysis of the opinions that a cohort of undergraduate student teachers at a Scottish University expressed in an online forum, following a period of school placement. As part of their initial teacher education (ITE), the students were asked to post messages on the forum in relation to the factors that they perceived as promoting or hindering the use of ICT in schools. Perceptions that students held were found to be complex and varied. Students associated the use of ICT with changes in the nature of classroom relations, as well as a reshaping of learning and teaching. While they welcomed the introduction of ICT as a tool for modernising teaching, students identified a variety of factors that hinder this process. The paper finishes by identifying some of the implications for those working with student teachers in encouraging their development of reflective practice with ICT and enhancing their positive attitudes in relation to the use of ICT in schools.
Double‐blind placebo‐controlled challenges for peanut allergy the efficiency of blinding procedures and the allergenic activity of peanut availability in the recipes
Authors: Van Odijk J. , Ahlstedt S. , Bengtsson U. , Borres M. P , Hulthén L.
Published: April 2005

Background:  A firm diagnosis of double‐blind placebo‐controlled food challenge (DBPCFC) would facilitate the diagnosis in patients with uncertain history of reaction. Guidelines are lacking for an upper provoking dose and how to hide high concentrations of peanuts.

Aim:  To develop and evaluate a double‐blind recipe with minimum 10% of peanut. To compare the recipe with published recipes regarding blindness, taste, texture and immunoglobulin (Ig)E antibody binding to peanut.

Methods:  A recipe (I) with 10% of peanut was developed evaluated and used in DBPCFC. The challenges were followed by development of a concentrated recipe (II) (15% peanut, 25% fat). Recipe II was compared with the only published recipe (III) (11% peanut, 7% fat) regarding taste, texture and availability of peanut. Recipe IV (12% peanut, 10% fat) was developed using the same methods. The binding of IgE in the recipes was measured using an inhibition method.

Results:  During challenges, one patient reacted after 4 g, emphasizing the need for blinding recipes containing high doses of peanut. Evaluation between recipes II and III, only recipe II was regarded as blind by the taste panels. A tenfold lower availability of peanut protein in the recipe II was found at 50% of inhibition. Recipe IV had a better IgE binding that did not differ from the original peanut extract.

Conclusion:  The peanut taste and texture can be hidden in a challenge medium. The fat content was important for the availability of the allergenic protein in challenges. The availability of allergens must be taken into consideration when used for DBPCFC.
Early childhood environment related to microbial exposure and the occurrence of atopic disease at school age
Authors: de Meer G. , Janssen N. A. H. , Brunekreef B.
Published: April 2005

Background:  There is a growing body of evidence that the early childhood environment with respect to day care attendance, older siblings, pet ownership, and early life airway infections may protect from developing atopic disease. Few studies have distinguished between atopic sensitization and symptoms, and none have evaluated independent contributions for all of these different environmental conditions.

Objective:  Examine independent effects on atopic sensitization and symptoms of day care attendance, older siblings, pet ownership, and early infancy's airway disease.

Methods:  A cross‐sectional survey among 8–13‐year‐old school children with complete data for 1555 children.

Results:  After adjustment for confounders, atopic sensitization occurred less frequently in children that had attended a day care centre (OR: 0.73, 95% CI: 0.55–0.98) or had a cat or dog before 2 years of age (OR: 0.78, 95% CI: 0.61–0.99). Having older siblings yielded a nonsignificant trend towards protection (OR: 0.88, 95% CI: 0.70–1.11). For symptoms, there was no relation with having older sibs, day care attendance and pet ownership, although there was a trend towards protection for the combination of atopy and symptoms. In contrast, children with doctors’ treated airway disease before age 2, more frequently reported recent symptoms of wheeze, asthma, rhinitis, or dermatitis (all P < 0.05).

Conclusion:  Early life environmental exposure to day care, or pets may protect against atopic sensitization. Protection against symptoms only occurred if atopic sensitization was present as well.
Bacterial and fungal components in house dust of farm children, Rudolf Steiner school children and reference children – the PARSIFAL Study
Authors: Schram D. , Doekes G. , Boeve M. , Douwes J. , Riedler J. , Üblagger E. , von Mutius E. , Budde J. , Pershagen G. , Nyberg F. , Alm J. , Braun‐Fahrländer C. , Waser M. , Brunekreef B. ,   on behalf of the PARSIFAL Study Group
Published: April 2005

Background:  Growing up on a farm and an anthroposophic lifestyle are associated with a lower prevalence of allergic diseases in childhood. It has been suggested that the enhanced exposure to endotoxin is an important protective factor of farm environments. Little is known about exposure to other microbial components on farms and exposure in anthroposophic families.

Objective:  To assess the levels and determinants of bacterial endotoxin, mould β(1,3)‐glucans and fungal extracellular polysaccharides (EPS) in house dust of farm children, Steiner school children and reference children.

Methods:  Mattress and living room dust was collected in the homes of 229 farm children, 122 Steiner children and 60 and 67 of their respective reference children in five European countries. Stable dust was collected as well. All samples were analysed in one central laboratory. Determinants were assessed by questionnaire.

Results:  Levels of endotoxin, EPS and glucans per gram of house dust in farm homes were 1.2‐ to 3.2‐fold higher than levels in reference homes. For Steiner children, 1.1‐ to 1.6‐fold higher levels were observed compared with their reference children. These differences were consistently found across countries, although mean levels varied considerably. Differences between groups and between countries were also significant after adjustment for home and family characteristics.

Conclusion:  Farm children are not only consistently exposed to higher levels of endotoxin, but also to higher levels of mould components. Steiner school children may also be exposed to higher levels of microbial agents, but differences with reference children are much less pronounced than for farm children. Further analyses are, however, required to assess the association between exposure to these various microbial agents and allergic and airway diseases in the PARSIFAL population.
Association of stem cell factor expression in nasal polyp epithelial cells with aspirin sensitivity and asthma
Authors: Kowalski M. L. , Lewandowska‐Polak A. , Woźniak J. , Ptasińska A. , Jankowski A. , Wągrowska‐Danilewicz M. , Danilewicz M. , Pawliczak R.
Published: April 2005

Mast cells constitute a significant proportion of cells infiltrating nasal polyp tissue, and epithelial cells may release stem cell factor (SCF), a cytokine with chemotactic and survival activity for mast cells. We aimed to assess the expression of SCF in human nasal polyp epithelial cells (NPECs) as related to patients’ clinical phenotypes. Nasal polyp tissues were obtained from 29 patients [including nine with aspirin (ASA)‐hypersensitivity and 12 with bronchial asthma] undergoing polypectomy for nasal obstruction. Epithelial cells were obtained following 6‐week culture of nasal polyps explants. The SCF released into the culture supernatant was assessed by enzyme‐linked immunosorbent assay (ELISA) and total SCF mRNA in the polyp tissue was determined by semiquantitative reverse transcriptase polymerase chain reaction (RT‐PCR). For the whole group of patients, the number of polypectomies correlated with expression of SCF mRNA (r = 0.62; P < 0.005), SCF protein in the NPECs supernatants (r = 0.39; P < 0.05) and with density of mast cells in epithelial layer (r = 0.37; P < 0.05) and stromal layer (r = 0.5; P < 0.01) of nasal polyps. The SCF/β‐actin mRNA ratios were significantly higher in ASA‐hypersensitive (AH) asthmatics (median 0.97, range: 0.8–1.5) when compared with ASA‐tolerant (AT) patients (median 0.5, range: 0.1–0.7; P < 0.001). The SCF protein concentration in NPEC supernatants was also significantly higher in AH asthmatics (median 1.10 pg/μg DNA, range: 0.4–1.9) when compared with AT patients (median 0.1 pg/μg DNA, range: 0.02–1.2; P < 0.001). In the subpopulation of ASA‐sensitive asthmatics the number of poypectomies correlated also with the density of mast cells and eosinophils in the polyp tissue.
Comparison of nasal immunohistology in patients with seasonal rhinoconjunctivitis treated with topical steroids or specific allergen immunotherapy
Authors: Rak S. , Heinrich C. , Scheynius A.
Published: April 2005

Background:  Specific allergen immunotherapy (SIT) and nasal steroids (NS) are considered effective anti‐inflammatory treatments for allergic rhinitis, although their mechanism of action differs.

Objective:  The aim of this study was to examine the effect of treatment with NS and SIT on different populations of inflammatory cells in the nasal mucosa and to compare cell numbers before and during the birch pollen season in patients with seasonal allergic rhinitis.

Methods:  In a randomized, double‐blind, double dummy comparative study, 41 patients with seasonal rhinoconjunctivitis were treated with birch SIT or NS (budesonide 400 μg daily). Treatment with NS started before the birch pollen season and at the same time SIT‐treated patients reached the maintenance dose. Nasal biopsies for immunohistochemistry were obtained before the season and start of the treatments and at the peak of the pollen season during treatment.

Results:  Symptoms of rhinoconjunctivitis increased significantly in both groups during the pollen season but less in the NS‐treated group and the difference between the treatment groups was significant at the end of the season (P = 0.03). Immunohistochemistry of nasal biopsies from NS‐treated patients showed significantly fewer CD1a+, IgE+ and FcɛRI+ cells during the season compared with preseason (P = 0.02, P = 0.001 and P = 0.0004, respectively) and with seasonal values of the SIT‐treated group (P = 0.002, P = 0.002 and P = 0.0004 respectively).

Conclusion:  Treatment with NS but not SIT decreased the numbers of CD1a+, IgE+ and FcɛRI+ cells during the birch pollen season. Our data indicate that treatment with NS has a broader anti‐inflammatory range than SIT.
Low levels of CC16 in nasal fluid of children with birch pollen‐induced rhinitis
Authors: Johansson S. , Keen C. , Ståhl A. , Wennergren G. , Benson M.
Published: April 2005

Background:  Clara cell protein 16 (CC16; secretoglobin 1A1) is an anti‐inflammatory protein mainly expressed in the epithelial cells in the airways.

Objective:  To compare the levels of CC16 in nasal lavage (NAL) from children with intermittent allergic rhinitis and healthy controls and to study the effect of a local steroid.

Methods:  Thirty schoolchildren with birch pollen allergy and 30 healthy controls from the same schools were included in the study. The NAL fluid was collected before the season, during the birch pollen season and, for the patients, after 1 week of treatment with a local steroid. Symptom scores were obtained on every occasion. CC16 and eosinophil cationic protein (ECP) were analyzed with enzyme‐linked immunosorbent assay.

Results:  The nasal fluid levels of CC16 were significantly lower in patients than in controls, before and during pollen season. Before the season, the median CC16 concentrations were 9.1 (range 1.1–117) μg/l in patients and 25.7 (6.1–110.2) μg/l in controls. During the season, the median CC16 concentrations in nasal fluid were 12.9 (2.3–89.7) μg/l in the allergic children and 22.0 (9.5–90.1) μg/l in the healthy controls (P = 0.0005). Symptom scores, nasal fluid eosinophils and ECP were higher in patients during the season. Treatment with a local steroid did not change the CC16 levels.

Conclusions:  Nasal fluid CC16 levels were lower in children with birch pollen‐induced allergic rhinitis than in healthy controls both before and during the pollen season. We speculate that reduction in anti‐inflammatory activity by CC16 may contribute to the pathogenesis of allergic rhinitis.
Pulmonary sarcoidosis
Authors: Nunes H. , Soler P. , Valeyre D.
Published: April 2005

Sarcoidosis is a multisystemic disease of unknown aetiology characterized by the formation of immune granulomas in involved organs. It is a worldwide disease that mainly affects 25–40 years old people with a lifetime incidence rate of 0.85–2.4%. Multiple clinical phenotypes are observed according to presentation, involved organs, disease duration and severity. Sarcoidosis primarily affects the lungs and the lymphatic system. The prevailing pathogenic hypothesis is that various antigens could promote sarcoidosis in genetically susceptible hosts, both these factors modulating the incidence and the clinical phenotype of sarcoidosis. So far, environmental agents have been suspected, including possible mycobacteria and propionibacteria. Interferon‐γ, tumour necrosis factor (TNF)‐α, interleukin (IL)‐12 and IL‐18 play a critical role in driving the Th1 commitment in the course of granulomatous process. Evolution of sarcoidosis is often marked by spontaneous resolution within 12–36 months, but can be severe because of chronic cases with pulmonary fibrosis or involving other organs, including heart, central nervous system and eyes. Mortality, ranging between 0.5 and 5%, is most often related to pulmonary fibrosis. Corticosteroids can reverse the granulomatous process, but are only suspensive, and their long‐term benefit remains under question. Corticosteroids are recommended when sarcoidosis shows unfavourable clinical tolerance and evolution. Alternative and corticosteroid‐sparing therapies are of increased interest in difficult cases, while targeted new drugs such as anti‐TNF‐αare still under investigation.
In search of a new paradigm: mechanisms of sensitization and elicitation of food allergy*
Authors: Poulsen L. K.
Published: April 2005

In this review of research priorities, presented for the European Commission, food allergy is established as a disease with a considerable impact on modern society. Research paradigms have changed from establishing basic symptomatology and diagnostic methods over allergen characterization to a risk‐identification approach looking at which patients are at risk of developing reactions to a certain dose of allergenic food. In order to solve some of the apparent paradoxes of regional, temporal, and species‐related differences in sensitization and food allergic reactions, it is suggested to study the basic underlying mechanisms in the cross‐field between immunology and gastroenterology. Research priorities should include the molecular basis of cross‐reactivity, the digestion and maintenance of antigenicity, the genetics of food allergy, and the immune response to food antigens and effects on the gastrointestinal immune system by food matrices and the microbial gut‐flora. Necessary methods with be spanning from molecular biology to large‐scale clinical and epidemiological studies.
Reporting of adverse events following immunization in Australia
Authors: Isaacs David , Lawrence Glenda , Boyd Ian , Ronaldson Kathlyn , McEwen John
Published: April 2005

Abstract:  It is an important component of any immunization programme that vaccine safety is monitored by carrying out surveillance for adverse events following immunization (AEFI). Such surveillance can be active or passive. Active surveillance will detect more AEFI, but the vast majority will be minor events. Passive surveillance is probably more appropriate for routine AEFI surveillance, while active surveillance can be used to monitor a new vaccine or to test whether a specific severe event is significantly associated with immunization. Australia has a predominantly passive surveillance system. The system has recently been centralized, providing useful national data on vaccine safety.
Epidemiology of necrotizing enterocolitis – Part I: Changing regional trends in extremely preterm infants over 14 years
Authors: Luig Melissa , Lui Kei ,   NSW & ACT NICUS Group
Published: April 2005

Objectives:  Advances in perinatal care include exogenous surfactant, unequivocal acceptance of antenatal steroids and in utero and ex utero transfers to tertiary centres. Increased survival of extremely premature infants may change the incidence and outcome of necrotizing enterocolitis (NEC). Our aim was to examine the trends in the incidence of NEC, surgery and mortality in infants of 24–28 weeks gestation in a retrospective regional review of three epochs over a span of 14 years.

Methods:  Radiologically or surgically proven NEC cases were determined from the New South Wales Neonatal Intensive Care Unit Study database. Three epochs were examined. A total of 360 infants were admitted in 1986–87 (Epoch 1), 622 in 1992–93 (Epoch 2) and 673 in 1998–99 (Epoch 3).

Results:  There was an increase in neonatal intensive care unit admissions and a decrease in early and overall mortality of these very premature infants across the epochs. None of the early deaths was due to NEC. The incidence of NEC decreased in post day 5 survivors: 33 cases in Epoch 1 (12%), 60 cases in Epoch 2 (12%) and 34 cases in Epoch 3 (6%, P < 0.001). There was no change in surgical intervention (45%, 57% and 41%, respectively) or mortality due to NEC (37%, 27% and 32%). The reduced incidence of NEC was not singularly influenced by antenatal steroids, exogenous surfactant or outborn delivery. In a multivariate analysis, only later epoch of birth was independently associated with reduced NEC risk.

Conclusions:  With improved care and survival of extremely premature infants, the incidence of NEC has decreased, but it remains a disease of high mortality and morbidity.
Epidemiology of necrotizing enterocolitis – Part II: Risks and susceptibility of premature infants during the surfactant era: A regional study
Authors: Luig Melissa , Lui Kei ,   NSW & ACT NICUS Group
Published: April 2005

Objectives:  We observed a reduced incidence of necrotizing enterocolitis (NEC) despite increased survival of extremely premature infants over the last two decades. A different susceptibility pattern to NEC according to gestation has been proposed. We aim to examine the influence of perinatal risk factors for NEC in infants less than 32 weeks gestation, in our region, in the post‐surfactant era.

Methods:  NEC incidence, perinatal risk factors and neonatal outcomes were examined in a cohort of 4649 infants of 24–31 weeks gestation from the Neonatal Intensive Care Unit Study (NICUS) database, admitted during 1994–99.

Results:  A total of 178 (3.8%) infants developed NEC. More 24–27 weeks infants than 28–31 weeks infants had NEC (6.6% vs 2.6%, P < 0.001). Although low gestation infants had higher mortality and surgery need, post‐operative survival (60%) was comparable to the higher gestation infants. NEC in the higher gestation group tended to be associated with perinatal risk factors, while risk factors were equally common in low gestation infants who developed NEC or not. Overall, gestation (P < 0.001), small for gestational age (P= 0.008), hyaline membrane disease (P < 0.001), placental abruption (P= 0.002) and earlier year of birth (P= 0.03) were independently associated with increased odds of NEC. Maternal hypertensive disease of pregnancy was associated with reduced NEC risk (P= 0.02).

Conclusions:  The incidence of NEC continues to decrease in the surfactant era and the pattern of susceptibility to NEC is based on gestational age grouping and risk factors. The reduced risk associated with hypertensive disease of pregnancy is unexplained.
Prone or supine for infants with chronic lung disease at neonatal discharge?
Authors: Elder Dawn E , Campbell Angela J , Doherty Dorota A
Published: April 2005

Objective:  To determine whether infants with chronic lung disease (CLD), ready for neonatal unit discharge, maintain cardiorespiratory stability while sleeping supine.

Methods:  Subjects were 15 infants born <32 weeks gestational age (GA) and ready for discharge from the regional tertiary neonatal intensive care unit. Polysomnography recordings of sleep state, heart rate, arterial oxygen saturation, respiratory effort and nasal/oral airflow were taken prone and supine for up to 3 h post feed with the first position randomly allocated. The main outcome measures were oxygen saturation and apnoea hypopnoea index (AHI).

Results:  Seven infants (median GA 27 weeks, birthweight 945 g) had CLD and eight infants (median GA 29 weeks, birthweight 1160 g) did not. CLD infants were more mature at study than non‐CLD infants (median 39 vs 36 weeks, P = 0.019). Neither oxygen saturation nor AHI were position dependent and no group differences were noted with respect to CLD status. There was a significant interaction of GA and sleep position with less‐mature infants spending less time in quiet sleep (QS) in supine position (P = 0.006). These less‐mature infants also had a higher AHI (P = 0.033). As expected, the AHI and arousal index (AI) were higher in active sleep (P ≤ 0.001, P = 0.013, respectively) and mean oxygen saturation was lower (P = 0.001).

Conclusions:  The supine position appears appropriate for very preterm infants with CLD going home from the neonatal unit. Respiratory instability on neonatal discharge is more likely to be associated with immaturity than CLD.
The distraction test: The last word?
Authors: Russ Shirley A , Poulakis Zeffie , Wake Melissa , Barker Melinda , Rickards Field , Jarman Frederick C , Saunders Kerryn , Edwards Gwynne , Symons Lindsay , Oberklaid Frank
Published: April 2005

Objective: Universal Newborn Hearing Screening (UNHS) programmes have been widely implemented, but their costs, benefits and long‐term logistics remain to be clearly defined. There are few rigorous evaluations of alternative strategies. In this paper, we evaluate the performance of the distraction test component of the two‐tiered Victorian Infant Hearing Screening Program (VIHSP).

Methods: All babies born in the State of Victoria, Australia in 1993 who survived the neonatal period were screened for the presence of risk factors for hearing loss. Those at‐risk were referred for Auditory Brainstem Evoked Response (ABR) screening by a professional audiologist. All others were screened by modified distraction test at age 7–9 months. This birth cohort was followed through age 6 for diagnoses of congenital hearing loss resulting in fitting of hearing aids. Estimates of false‐positives, false‐negatives, sensitivity, specificity and positive predictive values were determined for the distraction test as a population screen. Ages at diagnosis and aid fitting for screen failures with hearing loss were compared with current goals.

Results: For targeted (moderate or greater‐aided) losses, the distraction test yielded eight (0.02%) documented false‐negatives (one severe and seven moderate) and an estimated 4265 (99%) false‐positives. Distraction test sensitivity was 65%, specificity 91% and PPV 0.3%. Mean age at diagnosis for distraction test failures across all severities, including mild losses, was 23 (SD 18) months with a mean age at aid fitting of 26 (SD 20) months.

Conclusions: The distraction test screen generated large numbers of false‐positives and a significant number of false‐negatives, performing particularly poorly with moderate losses. Ages at diagnosis and aid fitting for screen failures were far older than currently accepted goals. There is little evidence that the distraction test can be made to work acceptably as a population‐based screen.
Physician counselling practices and decision‐making for extremely preterm infants in the Pacific Rim
Authors: Martinez Alma M , Partridge J Colin , Yu Victor , Wee Tan Keng , Yeung Chap‐Yung , Lu Jen‐Her , Nishida Hiroshi , Boo Nem‐Yun
Published: April 2005

Objectives:  This study was undertaken to evaluate physician counselling practices and resuscitation decisions for extremely preterm infants in countries of the Pacific Rim. We sought to determine the degree to which physician beliefs, parents' opinion and medical resources influence decision‐making for infants at the margin of viability.

Methods:  A survey was administered to neonatologists and paediatricians who attend deliveries of preterm infants in Australia, Hong Kong, Japan, Malaysia, Taiwan and Singapore. Questions were asked regarding physician counselling practices, decision‐making for extremely preterm infants and demographic information.

Results:  Physicians counsel parents antenatally with increasing frequency as gestational age increases. Most physicians discuss infant mortality and morbidity with parents prior to delivery. Physicians less frequently discuss the option of no resuscitation of an extremely preterm infant, withdrawal of support at a later time, or financial costs to parents. Severe congenital malformations, perception of a poor future quality of life, parental wishes and a high probability of death for the infant are influential in limiting resuscitation in very preterm infants for a majority of physicians. Less influential factors are parent socioeconomic status, language barriers, financial costs for the family, allocation of national resources, moral or religious considerations, or fear of litigation. Physician thresholds for resuscitation of infants ranged between 22 and 25 weeks gestation and between 400 and 700 g birthweight.

Conclusions:  We report physician beliefs and practices regarding resuscitation and the counselling of parents of extremely preterm infants in Pacific Rim countries. While we find variation among countries, physician practices appear to be determined by ethical decision‐making and medical factors rather than social or economic factors in each country.
Autoimmune hepatitis/primary sclerosing cholangitis overlap syndrome in a child: Diagnostic usefulness of magnetic resonance cholangiopancreatography
Authors: Lee Way Seah , Saw Chong Beng , Sarji Sazilah Ahmad
Published: April 2005

Abstract:  A 5‐year‐old Chinese girl with 1‐year history of progressive jaundice, steatorrhoea and pruritus was referred. Physical examination showed failure to thrive, marked jaundice, finger clubbing and hepatomegaly. There was laboratory evidence of cholestatic jaundice and autoimmunity, with marked elevation of alkaline phosphatase (ALP) and γ‐glutamyl transferase (γGT). Histology of percutaneous liver biopsy revealed hepatitis around the portal triad, as well as features of liver cirrhosis. Primary sclerosing cholangitis (PSC) overlapping with autoimmune hepatitis (AIH) was suspected. Endoscopic retrograde cholangiopancreatography (ERCP) was not feasible as there was no weight‐appropriate ERCP scope available. Magnetic resonance cholangiopancreatography (MRCP) was performed and revealed areas of irregularity and slight attenuation of the right and left hepatic ducts, representing stricturing, in keeping with PSC. PSC/AIH overlap syndrome was diagnosed in this child in which MRCP has contributed to its diagnosis.
Cooperative partnerships or conflict‐of‐interest? A national survey of interaction between the pharmaceutical industry and medical organizations
Authors: Kerridge I. , Maguire J. , Newby D. , McNeill P. M. , Henry D. , Hill S. , Day R. , Macdonald G. , Stokes B. , Henderson K.
Published: April 2005

Abstract

Background:  There is extensive and varied interaction between the pharmaceutical industry and the medical profession. Most empirical research concerns contact between individual physicians and industry, and reflects North American experience. We sought to clarify the extent and nature of relationships between the pharmaceutical industry and Australian medical organizations.

Methods:  We administered questionnaires to 63 medical organizations concerned with clinical practice, continuing medical education or professional accreditation, or the political representation of medical professionals.

Results:  Survey instruments were received from 29 organi­zations, giving a response rate of 46%. Seventeen of these organizations (59%) had received support from one or more pharmaceutical company in the past financial year. Support was predominantly for annual conferences, with some support for continuing medical education, research, travel and library purchases. The majority of organizations had an academic journal or newsletter, and 10 (34%) accepted revenue from pharmaceutical advertising. Twenty organizations (72%) had policies or guidelines covering their relationship with industry. Few organizations indicated that they would be unable to continue their activities without pharmaceutical industry support.

Conclusion:  These data indicate a high level of inter­action between the pharmaceutical industry and medical organizations in Australia. While most organizations have policies for guiding their relationship with industry, it is unclear whether these are effective in preventing conflicts of interest and maintaining public trust. (Intern Med J 2005; 35: 206–210)
Prospective study of treatment with selective internal radiation therapy spheres in patients with unresectable primary or secondary hepatic malignancies
Authors: Lim L. , Gibbs P. , Yip D. , Shapiro J. D. , Dowling R. , Smith D. , Little A. , Bailey W. , Liechtenstein M.
Published: April 2005

Abstract

Aim:  To prospectively evaluate the efficacy and safety of Selective Internal Radiation (SIR) Spheres (Sirtex Medical, Sydney, NSW, Australia) in patients with unresectable primary or secondary hepatic malignancies.

Methods:  We report our experience of SIR sphere therapy at three Australian centres. Patients with previously untreated colorectal cancer (CRC) received concurrent 5FU, other patients with CRC received 5‐FU at investigator discretion and all other patients received SIR spheres alone.

Results:  Forty‐six patients were enrolled between January 2002 and June 2003. The majority (32 patients) had metastatic colorectal cancer and five patients had hepatocellular carcinoma. The median age of patients was 64 years (range 46–78 years). Forty‐three patients were evaluable for response. There were 12 partial responses, of which 10 were in patients with CRC. The median duration of response for all patients was 8.6 months (range 2–21 months). Overall treatment related toxicity was acceptable. Significant late toxicity included four cases of severe gastric ulceration, despite standard work‐up and treatment by experienced interventional radiologists.

Conclusion:  In this series of patients, treatment with SIR‐spheres has demonstrated modest activity, mostly observed in patients with CRC. Toxicity was substantial in a small number of patients. (Intern Med J 2005; 35: 222–227)
Radiotherapy in the management of solitary extramedullary plasmacytoma
Authors: Chao M. W. , Gibbs P. , Wirth A. , Quong G. , Guiney M. J. , Liew K. H.
Published: April 2005

Abstract

Background:  Solitary extramedullary plasmacytoma (SEP) is a rare tumour for which the standard treatment remains local radiotherapy (RT). We present a study of a multi‐institutional experience, between 1980 and 1999, in an attempt to better understand the natural history of SEP and to identify possible prognostic factors.

Methods:  The records at Radiation Oncology Victoria and Peter MacCallum Cancer Centre, Melbourne, were used for the identification of patients. The inclusion criteria were as follows: (i) histological confirmation of clonal plasma cells involving a single extramedullary site with or without lymph node involvement; (ii) no histological evidence of bone marrow involvement; (iii) no evidence of distant bone lesion on radiographic skeletal survey (bone erosions adjacent to the primary thought to be due to contiguous involvement were permitted) and (iv) no anaemia, hypercalcaemia or renal impairment due to plasma cell dyscrasia.

Results:  A total of 16 patients was identified, with a median follow up of 66 months (range 12–211 months). The head and neck region accounted for the majority of presentations (88%). Among all patients, a serum mono­clonal paraprotein was found in three patients and bone erosion was identified in seven patients. All patients received local RT, although two patients also received elective nodal irradiation (ENI). The median RT dose was 45 Gy (range 40–50.4 Gy). Local control was achieved in all patients (100%), however, regional recurrence outside the RT fields occurred in 2/16. Multiple myeloma (MM) developed in five patients, all within 5 years. The predicted 10‐year myeloma free survival is 75% and 10‐year overall survival is 54%.

Conclusion:  RT can achieve excellent local control of SEP. The rate of conversion to MM is 31%. Moderate dose RT of at least 40 Gy using limited radiation fields is recommended, although ENI should be considered if toxicity is not increased. (Intern Med J 2005; 35: 211–215)
Lymphocytic hypophysitis: a rare cause of hypoglycaemia in a man with type 2 diabetes mellitus
Authors: Lee P. , Chrysostomou A. , Tress B. , Ebeling P. R.
Published: April 2005

Abstract

Lymphocytic hypophysitis is a primary inflammatory disorder of the pituitary gland, which may cause panhypopituitarism. The majority of cases occur in women during the peripartum period and it is rare in men. We present a case, initially presenting with recurrent hypoglycaemic episodes, in a man with previously well‐controlled type 2 diabetes mellitus. (Intern Med J 2005; 35: 254–257)
Capsule endoscopy: current indications and future prospects
Authors: Remedios M. L. , Appleyard M.
Published: April 2005

Abstract

Capsule endoscopy represents a significant advance in the investigation of small bowel diseases and the beginning of wireless endoscopic imaging. Capsule endoscopy involves swallowing a video capsule endoscope, which is painless and relatively safe. Its use has been established for suspected small bowel bleeding, and the role of capsule endoscopy in the investigation of inflammatory bowel disease, iatrogenic disease, polyposis syndromes and coeliac disease is evolving. It is likely that in many instances it will become the next test after standard endoscopic evaluation. Early data suggest that capsule endoscopy improves outcome in patients with suspected small bowel bleeding, but more data are required on outcomes for the other indications. (Intern Med J 2005; 35: 234–239)
Biomineralization of endolithic microbes in rocks from the McMurdo Dry Valleys of Antarctica: implications for microbial fossil formation and their detection
Authors: Wierzchos Jacek , Sancho Leopoldo García , Ascaso Carmen
Published: April 2005

In some zones of Antarctica's cold and dry desert, the extinction of cryptoendolithic microorganisms leaves behind inorganic traces of microbial life. In this paper, we examine the transition from live microorganisms, through their decay, to microbial fossils using in situ microscopy (transmission electron microscopy, scanning electron microscopy in back‐scattered electron mode) and microanalytical (energy dispersive X‐ray spectroscopy) techniques. Our results demonstrate that, after their death, endolithic microorganisms inhabiting Commonwealth Glacier sandstone from the Antarctica McMurdo Dry Valleys become mineralized. In some cases, epicellular deposition of minerals and/or simply filling up of empty moulds by minerals leads to the formation of cell‐shaped structures that may be considered biomarkers. The continuous deposition of allochthonous clay minerals and sulfate‐rich salts fills the sandstone pores. This process can give rise to microbial fossils with distinguishable cell wall structures. Often, fossilized cell interiors were of a different chemical composition to the mineralized cell walls. We propose that the microbial fossil formation observed was induced by mineral precipitation resulting from inorganic processes occurring after the death of cryptoendolithic microorganisms. Nevertheless, it must have been the organic template that provoked the diffusion of mineral elements and gave rise to their characteristic distribution pattern inside the fossilized cells.
Viruses, prokaryotes and DNA in the sediments of a deep‐hypersaline anoxic basin (DHAB) of the Mediterranean Sea
Authors: Danovaro R. , Corinaldesi C. , Dell’Anno A. , Fabiano M. , Corselli C.
Published: April 2005

Viral and prokaryote abundance were investigated in a deep‐hypersaline anoxic basin of the Eastern Mediterranean Sea (DHAB Atalante basin at c. 3000 m depth). This system was compared with two nearby deep‐sea sites characterized by oxic conditions. Viral abundance and virus to prokaryote abundance ratio in hypersaline anoxic sediments displayed values close to those reported in oxic sites. The analysis of vertical profiles of viral abundance in the Atalante basin revealed the lack of significant changes with depth in the sediment, suggesting that benthic viruses in these anoxic and hypersaline conditions are preserved or resistant to decay. The anoxic basin displayed also very high concentrations of labile organic components (proteins and lipids) and extracellular DNA. These findings suggest that the DHAB sediments represent a reservoir for long‐term preservation of benthic viruses and nucleic acids.
Polynucleobacter Bacteria in the Brackish‐Water Species Euplotes harpa (Ciliata Hypotrichia)
Authors: VANNINI CLAUDIA , PETRONI GIULIO , VERNI FRANCO , ROSATI GIOVANNA
Published: April 2005

Abstract. We have found a Polynucleobacter bacterium in the cytoplasm of Euplotes harpa, a species living in a brackish‐water habitat, with a cirral pattern not corresponding to that of the freshwater Euplotes species known to harbor this type of bacteria. The symbiont has been found in three strains of the species, obtained by clonal cultures from ciliates collected in different geographic regions. The 16S rRNA gene sequence of this bacterium identifies it as a member of the β‐proteobacterial genus Polynucleobacter. This sequence shares a high similarity value (98.4–98.5%) with P. necessarius, the type species of the genus, and is associated with 16S rRNA gene sequences of environmental clones and bacterial strains included in the Polynucleobacter cluster (>95%). An oligonucleotide probe was designed to corroborate the assignment of the retrieved sequence to the symbiont and to detect similar bacteria rapidly. Antibiotic experiments showed that the elimination of the bacteria stops the reproductive cycle in E. harpa, as has been shown for the freshwater Euplotes species.
Microgemma vivaresi n. sp. (Microsporidia, Tetramicridae), Infecting Liver and Skeletal Muscle of Sea Scorpions, Taurulus bubalis (Euphrasen 1786) (Osteichthyes, Cottidae), an Inshore, Littoral Fish
Authors: CANNING ELIZABETH U. , FEIST STEPHEN W. , LONGSHAW MATTHEW , OKAMURA BETH , ANDERSON CORT L. , TSE MAN TSUEY , CURRY ALAN
Published: April 2005

Abstract. The ultrastructure of a new microsporidian species Microgemma vivaresi n. sp. causing liver cell xenoma formation in sea scorpions, Taurulus bubalis, is described. Stages of merogony, sporogony, and sporogenesis are mixed in the central cytoplasm of developing xenomas. All stages have unpaired nuclei. Uninucleate and multinucleate meronts lie within vacuoles formed from host endoplasmic reticulum and divide by binary or multiple fission. Sporonts, no longer in vacuoles, deposit plaques of surface coat on the plasma membrane that cause the surface to pucker. Division occurs at the puckered stage into sporoblast mother cells, on which plaques join up to complete the surface coat. A final binary fission gives rise to sporoblasts. A dense globule, thought to be involved in polar tube synthesis, is gradually dispersed during spore maturation. Spores are broadly ovoid, have a large posterior vacuole, and measure 3.6 μm × 2.1 μm (fresh). The polar tube has a short wide anterior section that constricts abruptly, then runs posteriad to coil about eight times around the posterior vacuole with granular contents. The polaroplast has up to 40 membranes arranged in pairs mostly attached to the wide region of the polar tube and directed posteriorly around a cytoplasm of a coarsely granular appearance. The species is placed alongside the type species Microgemma hepaticusRalphs and Matthews 1986 within the family Tetramicridae, which is transferred from the class Dihaplophasea to the class Haplophasea, as there is no evidence for the occurrence of a diplokaryotic phase.
Frontiers in Genomics: Insights into Protist Evolutionary Biology, University of Iowa, May 19–21, 2004
Authors: BHATTACHARYA DEBASHISH , KATZ LAURA A.
Published: April 2005

Abstract. Protists constitute the bulk of eukaryotic diversity yet their genomes remain relatively unexplored. To address this issue, a workshop entitled, “Frontiers in Genomics: Insights into Protist Evolutionary Biology”, was convened at the University of Iowa on June 19–21, 2004. The specific aims of the workshop were to define the role of genomics in the eukaryotic tree of life, to identify challenges in characterizing protist (i.e. microbial eukaryote) genomes, and in proposing specific solutions to these challenges. The findings of the workshop are presented here and in a white paper that provide a set of guidelines for organizing the protist community and for planning and executing a protist genome project.
How many novel eukaryotic “kingdoms”? Pitfalls and limitations of environmental DNA surveys
Authors: BERNEY CÉDRIC , FAHRNI JOSÉ , PAWLOWSKI JAN
Published: April 2005

Over the past few years, the use of cultivation‐independent techniques to detect eukaryotic diversity has proven to be a powerful approach. Based on small‐subunit ribosomal RNA (SSU rRNA) gene analyses, these studies have revealed the existence of an unexpected variety of new phylotypes. Some of them do not seem to be related to any molecularly described lineage, and have been proposed to represent novel eukaryotic kingdoms. In order to critically review the evolutionary importance of this novel high‐level eukaryotic diversity and to test the potential technical and analytical pitfalls and limitations of eukaryotic environmental DNA surveys (EES), we analysed 484 environmental SSU rRNA gene sequences, including 81 new sequences from sediments of the river Seymaz (Geneva, Switzerland). Based on a detailed screening of an exhaustive alignment of SSU rRNA gene sequences and the phylogenetic re‐analysis of previously published sequences using Bayesian methods, our results suggest that the number of novel higher‐level taxa revealed by previous EES was over‐estimated. Three main sources of errors are responsible for this situation, namely (1) the presence of undetected chimeric sequences; (2) the misplacement of several fast evolving sequences; and (3) the incomplete sampling of described, but yet unsequenced eukaryotes. EES undoubtedly contribute to unravel many novel eukaryotic lineages, but there is no clear evidence for a spectacular increase of the diversity at a megaevolutionary level. After our re‐analysis, we found only five candidate lineages of possible novel high‐level eukaryotic taxa. To ascertain their taxonomic status, however, the organisms themselves have to be identified now.