bluuebunny/crossref_metadata_2025 huggingface dataset:
Enzian classification: does it correlate with clinical symptoms and the rASRM score?
Authors: Haas Dietmar , Oppelt Peter , Shebl Omar , Shamiyeh Andreas , Schimetta Wolfgang , Mayer Richard
Published: March 2013

Objective

To assess the extent to which the Enzian classification correlates with the revised American Society for Reproductive Medicine (rASRM) score and clinical symptoms in women with deeply infiltrating endometriosis.

Design

Retrospective cohort study (Canadian Task Force classification II‐2).

Setting

Endometriosis competence center specializing in minimally invasive surgery.

Patients

Between 1 January 2009 and 31 December 2011, a total of 194 women underwent surgery due to deeply infiltrating endometriosis. After histological confirmation, they were classified using the rASRM and Enzian systems. Clinical symptoms were recorded preoperatively.

Interventions

Operative laparoscopy to treat endometriosis.

Main outcome measures and Results

A clear correlation was seen between grades of severity in the rASRM score and the Enzian classification (p < 0.001). In addition, the rASRM severity grade and clinical symptoms correlated with the locations in the Enzian classification in relation to deeply infiltrating endometriosis. Pain and dysmenorrhea correlated strongly (p = 0.002, p < 0.001) with the severity grade in the Enzian classification.

Conclusions

Deeply infiltrating endometriosis is well characterized using the Enzian classification as a supplement to the rASRM score. There is also a clear correlation between the rASRM and Enzian classifications, because of the way in which the disease crosses morphological boundaries. The locations in the Enzian classification correlate partially with clinical symptoms, and the classification's severity grades correlate substantially with pain and dysmenorrhea. In view of these clinical results, use of the Enzian classification can be recommended as a supplement to the rASRM score for detailed description of endometriosis.
Biocompatibility Assessment of a Long‐Term Wearable Artificial Pump‐Lung in Sheep
Authors: Zhou Kang , Niu Shuqiong , Bianchi Giacomo , Wei Xufeng , Garimella Narayana , Griffith Bartley P. , Wu Zhongjun J.
Published: March 2013

The purpose of this study was to assess the biocompatibility of a newly developed long‐term wearable artificial pump‐lung (APL) in a clinically relevant ovine animal model. The wearable APL device was implanted in five sheep through left thoracotomy. The device was connected between the right atrium and pulmonary artery and evaluated for 30 days. Three sheep were used as the sham control. Platelet activation was assessed by measuring platelet surface P‐selectin (CD62P) expression with flow cytometry and plasma soluble P‐selectin with an enzyme‐linked immunosorbent assay. Thrombotic deposition on the device components and hollow fiber membranes were analyzed with digital imaging and scanning electron microscopy. Surface P‐selectin of the APL and sham groups changed significantly over the study period, but without significant differences between the two groups. Soluble P‐selectin for the two groups peaked in the first 24 h after the surgery. Soluble P‐selectin of the APL group remained slightly elevated over the study period compared to the presurgical baseline value and was slightly higher compared to that of the sham group. Plasma free hemoglobin remained in the normal ranges in all the animals. In spite of the surgery‐related alteration in laboratory tests and elevation of platelet activation status, the APL devices in all the animals functioned normally (oxygen transfer and blood pumping) during the 30‐day study period. The device flow path and membrane surface were free of gross thrombus. Electron microscopy images showed only scattered thrombi on the fibers (membrane surface and weft). In summary, the APL exhibited excellent biocompatibility. Two forms of platelet activation, surgery‐related and device‐induced, in the animals implanted with the wearable APL were observed. The limited device‐induced platelet activation did not cause gross thrombosis and impair the long‐term device performance.
Randomised clinical trial: the effects of daikenchuto, TU‐100, on gastrointestinal and colonic transit, anorectal and bowel function in female patients with functional constipation
Authors: Iturrino J. , Camilleri M. , Wong B. S. , Linker Nord S. J. , Burton D. , Zinsmeister A. R.
Published: March 2013

Background

Daikenchuto, a Japanese herbal medicine used for post‐operative ileus and constipation, dose dependently stimulates gastrointestinal (GI) motility and decreases rectal compliance and sensation. Effects of TU‐100 (commercial form of daikenchuto) in adults with constipation are unknown.

Aim

To compare the effects of oral TU‐100, 2.5 g t.d.s. or 5 g t.d.s. and placebo t.d.s. on GI and colonic transit (CT), rectal compliance (RC) and sensation thresholds (RST), anal sphincter pressures (ASP) and bowel function in female patients with functional constipation (FC).

Methods

We conducted a single‐centre, randomised, parallel‐group, double‐blind, pharmacodynamic study; 45 female patients with FC without evidence of rectal evacuation disorder were assigned to 28 days' treatment with oral placebo or TU‐100 (Tsumura USA, Princeton, NJ, USA). Demographic data and CT were measured at baseline and randomisation stratified by baseline CT (GC> or <1.9) and by BMI (<25 or ≥25 kg/m2). At the end of treatment period, we measured GI and CT by scintigraphy, RST and RC by barostat, ASP by manometry, psychosensory sensations, bowel function by daily diary and quality of life (QOL). The study had power to detect effect sizes of 33% (CT), 40% (RC) and 46% (RST). Statistical analysis included BMI as covariate.

Results

TU‐100 had no significant effects on GI or CT, RC, ASP, recto‐anal pressure difference, or RST. The 5 g t.d.s./day dose was associated with lower RST for first sensation and gas (unadjusted P: 0.045 and 0.024 respectively). There were no treatment effects on psychosensory symptoms, stool frequency, stool consistency or QOL.

Conclusion

Mechanisms underlying the observed clinical benefit of TU‐100 remain unclear (ClinicalTrials.gov NCT01139216).
Randomised clinical trial: once‐ vs. twice‐daily prolonged‐release mesalazine for active ulcerative colitis
Authors: Flourié B. , Hagège H. , Tucat G. , Maetz D. , Hébuterne X. , Kuyvenhoven J. P. , Tan T. G. , Pierik M. J. , Masclee A. A. M. , Dewit O. , Probert C. S. , Aoucheta D. ,   the MOTUS study investigators
Published: March 2013

Background

Aminosalicylates are first‐choice treatment for mild‐to‐moderately active ulcerative colitis (UC); however, multi‐dosing regimens are inconvenient.

Aim

To compare the efficacy and safety of once‐ (OD) vs. twice‐ (BD) daily prolonged‐release mesalazine (Pentasa, Ferring, Saint‐Prex, Switzerland) for active mild‐to‐moderate UC in a non‐inferiority study.

Methods

Eligible patients (n = 206) were randomised to 8 weeks of mesalazine (4 g/day), either OD with two sachets of 2 g mesalazine granules in the morning (n = 102) or BD with one 2 g sachet in the morning and one in the evening (n = 104). Patients also received 4 weeks of mesalazine enema 1 g/day. Disease activity was assessed at randomisation, weeks 4, 8 and 12 using the UC Disease Activity Index (UC‐DAI). Clinical and endoscopic remission (primary endpoint) was assessed after 8 weeks. Patients recorded stool frequency and rectal bleeding in a daily diary.

Results

The primary endpoint, non‐inferiority in clinical and endoscopic remission with OD vs. BD mesalazine at 8 weeks, was met (intent‐to‐treat population: 52.1% vs. 41.8%, respectively, 95% confidence interval −3.4, 24.1; P = 0.14). Improvement of UC‐DAI score (92% vs. 79%; P = 0.01) and mucosal healing (87.5% vs. 71.1%; P = 0.007) were significantly better, time to remission significantly shorter (26 vs. 28 days; P = 0.04) and safety similar with OD vs. BD dosing.

Conclusions

When combined with mesalazine enema, prolonged‐release mesalazine once‐daily 4 g is as effective and well tolerated as 2 g twice‐daily for inducing remission in patients with mild‐to‐moderately active ulcerative colitis (Clinicaltrials.gov: NCT00737789).
Weekend hospitalisations and post‐operative complications following urgent surgery for ulcerative colitis and Crohn's disease
Authors: Ananthakrishnan A. N. , McGinley E. L.
Published: March 2013

Background

There is increasing complexity in the management of patients with acute severe exacerbation of inflammatory bowel disease [IBD; Crohn's disease (CD), ulcerative colitis (UC)] with frequent requirement for urgent surgery.

Aim

To determine whether a weekend effect exists for IBD care in the United States.

Methods

We used data from the Nationwide Inpatient Sample (NIS) 2007, the largest all‐payer hospitalisation database in the United States. Discharges with a diagnosis of CD or UC who underwent urgent intestinal surgery within 2 days of hospitalisation were identified using the appropriate ICD‐9 codes. The independent effect of admission on a weekend was examined using multivariate logistic regression adjusting for potential confounders.

Results

Our study included 7,112 urgent intestinal surgeries in IBD patients, 21% of which occurred following weekend admissions. There was no difference in disease severity between weekend and weekday admissions. Post‐operative complications were more common following weekend than weekday hospitalisations in UC [odds ratio (OR) 1.71, 95% confidence interval (CI) 1.01–2.90]. The most common post‐operative complication was post‐operative infections (Weekend 30% vs. weekday 20%, P = 0.04). The most striking difference between weekend and weekday hospitalisations was noted for needing repeat laparotomy (OR 11.5), mechanical wound complications (OR 10.03) and pulmonary complications (OR 2.22). In contrast, occurrence of any post‐operative complication in CD was similar between weekday and weekend admissions.

Conclusion

Patients with UC hospitalised on a weekend undergoing urgent surgery within 2 days have an increased risk for post‐operative complications, in particular mechanical wound complications, need for repeat laparotomy and post‐operative infections.
Impact of a single human leucocyte antigen (HLA) allele mismatch on the outcome of unrelated bone marrow transplantation over two time periods. A retrospective analysis of 3003 patients from the HLA Working Group of the Japan Society for Blood and Marrow Transplantation
Authors: Kanda Yoshinobu , Kanda Junya , Atsuta Yoshiko , Maeda Yoshinobu , Ichinohe Tatsuo , Ohashi Kazuteru , Fukuda Takahiro , Miyamura Koichi , Iida Hiroatsu , Mori Takehiko , Iwato Koji , Eto Tetsuya , Kawa Keisei , Morita Satoshi , Morishima Yasuo
Published: March 2013

A previous Japanese study revealed that a human leucocyte antigen (HLA)‐A or ‐B allele mismatch was associated with higher overall mortality, whereas an HLA‐C or ‐DRB1 allele mismatch did not affect mortality after serologically matched unrelated bone marrow transplantation (BMT). This study reanalysed 3003 adult patients who underwent unrelated BMT from a serologically HLA‐A, ‐B, or ‐DR matched unrelated donor between 1993 and 2009 using the latest database, that included 1966 HLA‐matched unrelated BMT and 187, 31, 524, and 295 unrelated BMT with a single HLA‐A, ‐B, ‐C, or ‐DRB1 allele mismatch, respectively. As opposed to our previous findings, HLA‐C and ‐DRB1 mismatches had a significant negative impact [hazard ratio (HR) 1·35, P < 0·001, and HR 1·45, P < 0·001] on survival in the period 2000–2009. The negative impact of each single HLA allele mismatch was not significantly different among the HLA‐A, ‐B, ‐C, and ‐DRB1 mismatches (P = 0·79). An interaction test revealed that the effects of single HLA‐C and ‐DRB1 allele mismatches significantly differed over the two time periods (P = 0·032 and P = 0·0072, respectively). In conclusion, the impact of a single HLA allele mismatch changed over time. In the recent cohort, the negative impact of HLA‐DRB1 and ‐C mismatches became apparent.
Distribution of phosphodiesterase type 5 (PDE5) in the lateral wall of the guinea pig urinary bladder
Authors: Rahnama'i Mohammad S. , van Koeveringe Gommert A. , Hohnen Ramona , Ona Samsya , van Kerrebroeck Philip E.V. , de Wachter Stefan G.G.
Published: March 2013

Objective

To study PDE5 localisation by visualising the product of phosphodiesterase type 5 (PDE5) inhibition, namely cGMP, to determine the site of action of inhibitors in the urinary bladder.

Materials and Methods

Bladders of nine male guinea pigs were dissected and treated in wells containing 2 mL Krebs' solution and 1 μM of the specific PDE5 inhibitor vardenafil at 36 °C for 30 min.

After stimulating tissues with 100 μM of the nitric oxide (NO) donor diethylamine‐NONOate for 10 min, the tissues were snap‐frozen and 9–10 μm sections were cut.

Sections were examined for cGMP immunoreactivity and also stained for vimentin, a marker for interstitial cells and the neuromarkers protein gene product 9.5 (PGP9.5), synaptic vesicle protein 2 (SV2), neurofilament (NF) and calcitonin gene‐related peptide (CGRP), using the two‐step indirect immunohistochemistry technique.

Results

After PDE5 inhibition, cGMP was found to be present in the urothelium, suburothelial interstitial cells and endothelium of blood vessels.

cGMP was not expressed in nerves positive for CGRP, NF and SV2, and was expressed only in very few efferent nerves positive for PGP9.5.

Conclusion

Our data show that the possible sites of action of PDE5 inhibition in the bladder are the urothelium, suburothelial interstitial cells and blood vessels, rather than the bladder nerve fibres.
A comparison of patient and tumour characteristics in two UK bladder cancer cohorts separated by 20 years
Authors: Bryan Richard T. , Zeegers Maurice P. , van Roekel Eline H. , Bird Deborah , Grant Margaret R. , Dunn Janet A. , Bathers Sarah , Iqbal Gulnaz , Khan Humera S. , Collins Stuart I. , Howman Andrew , Deshmukh Nayneeta S. , James Nicholas D. , Cheng Kar Keung , Wallace D. Michael A.
Published: March 2013

Objectives

To compare patient and tumour characteristics at presentation from two large bladder cancer cohorts, with recruitment separated by 15–20 years

To identify significant differences in the West Midlands' urothelial cancer of the bladder (UCB) population during this period.

Patients and Methods

Data were collected prospectively from 1478 patients newly diagnosed with UCB in the West Midlands from January 1991 to June 1992 (Cohort 1), and from 1168 patients newly diagnosed with UBC within the same region from December 2005 to April 2011 (Cohort 2).

Gender, age, smoking history, and tumour grade, stage, type, multiplicity and size at presentation were compared using a Pearson chi‐square test or Cochran–Armitage trend test, as appropriate.

Result

Cohort 2 had a higher proportion of male patients (P = 0.021), elderly patients (P < 0.001), grade 3 tumours (P < 0.001), Ta/T1 tumours (P = 0.008), multiple tumours (P < 0.001), and tumours of ≤2 cm in diameter (P < 0.001).

Conclusions

There were significant differences between the cohorts.

These differences are potentially explained by an ageing population, changes in grading practices, improved awareness of important symptoms, improved cystoscopic technology, and reductions in treatment delays.

Regional cohorts remain important for identifying changes in tumour and patient characteristics that may influence disease management in the UK and beyond.
A home‐based intervention using augmentative and alternative communication (AAC) techniques in rural Kenya: what are the caregivers' experiences?
Authors: Gona J. K. , Newton C. R. , Hartley S. , Bunning K.
Published: March 2013

Background

Caring for a child with complex communication needs associated with a developmental condition frequently adds stress to the caregiver. Furthermore, professional assistance is scarce in low‐income rural settings. For such children speech is frequently unachievable. Augmentative and alternative communication provides options for supplementing or replacing speech with other techniques. The current study aimed to examine the experiences of caregivers in Kenya before and after a home‐based intervention using augmentative and alternative communication techniques with children with complex communication needs.

Methods

Caregivers were interviewed pre‐ and post‐intervention. The interviews were digitally recorded, transcribed and translated into English. Content analysis was applied through the stages of text familiarization and topic organization. Emergent themes and their sub‐themes were identified and labelled. Connections between themes were established and interpretations made. The procedure was completed by a second researcher independently. Conflicting ideas were jointly discussed until consensus was achieved.

Results

Four themes emerged from the data: communication process; struggle; normality; and supernatural power. Before intervention, the caregivers acknowledged their expertise in communications with the child, while also revealing their sense of isolation, burden and pain. Normality was present as a source of comparison and also an aspirational goal. Post‐intervention more positive language was used to describe the child. There was an ‘opening up’ of communication that recognized the child's strengths and some social support systems were re‐established. The power of the supernatural was recognized before and after intervention.

Conclusion

Caring of a child with complex communication needs presents many challenges. A home‐based intervention using augmentative and alternative communication techniques appears to have been a catalyst for some positive transformations in the caregivers' experiences, although it is not possible to attribute this change to any one aspect. The potentials of the home‐based intervention would benefit from further investigation on a larger scale.
The prevalence of PFS and prevalence and characteristics of reported food allergy; a survey of UK adults aged 18–75 incorporating a validated PFS diagnostic questionnaire
Authors: Skypala I. J. , Bull S. , Deegan K. , Gruffydd‐Jones K. , Holmes S. , Small I. , Emery P. W. , Durham S. R.
Published: March 2013

Background

Pollen‐food syndrome (PFS), a food allergy affecting pollen‐sensitized individuals, is likely to be the most prevalent food allergy in adults, estimated to affect 50–90% of people allergic to birch tree pollen.

Objective

A validated PFS diagnostic questionnaire (PFSDQ2) was used to determine the prevalence of PFS and also to characterize those who report reactions to foods.

Methods

Five UK General practices each sent the PFSDQ2 by post to 2000 patients aged 18–75 years randomly selected from their practice database. The validated questionnaire was accompanied by an additional set of questions to ascertain the demographic of the population, the foods involved and the age of onset.

Results

There were 3590 subjects who returned completed questionnaires, with an average return rate from each practice of 36% (range 22–47%). Of these, 73 were diagnosed with PFS according to the questionnaire (PFS+ve) giving a population prevalence of 2%. A further 482 subjects reported reactions to foods but did not fulfil the diagnostic criteria for PFS. The greatest prevalence of PFS was in the Croydon (SE England) urban practice (4.1%) and the lowest in the Aberdeen (Scotland) urban practice (0.8%) (P < 0.001).The most frequently reported trigger foods were apples, hazelnuts and kiwifruit and the majority of those with PFS first experienced symptoms below the age of 20 years. PFS+ve subjects were also more likely to be female and have a higher socio‐economic status than those who did not report reactions to foods.

Conclusions

The UK prevalence of PFS was 2%, although this varied according to the location of the practice population. The majority of PFS+ve subjects first reported symptoms in their teens. The reported age of onset has important implications for the diagnosis of primary and cross‐reactive peanut and tree nut allergies in teenagers and young adults. The continuing rise in aeroallergen sensitization is likely to result in an increased frequency of PFS presenting in both primary and secondary care.
Standardizing skin biopsy sampling to assess rejection in vascularized composite allotransplantation
Authors: Hautz Theresa , Zelger Bettina G. , Weißenbacher Annemarie , Zelger Bernhard , Brandacher Gerald , Landin Luis , Morelon Emmanuel , Kanitakis Jean , Jablecki Jerzy , Lee W.P. Andrew , Pratschke Johann , Schneeberger Stefan
Published: March 2013

Over 70 hands and 20 faces have been transplanted during the past 13 yr, which have shown good to excellent functional and esthetic outcomes. However, (skin) rejection episodes complicate the post‐operative courses of hand and face transplant recipients and are still a major obstacle to overcome after reconstructive allotransplantation. This article summarizes all relevant information on the skin component and rejection of a vascularized composite allograft. As more and more centers plan to implement a vascularized composite allotransplantation (VCA) program, we further develop guidelines and recommendations on collection and processing of skin biopsies from hand and face allograft recipients. This will help to standardize post‐operative monitoring, avoid pitfalls for those new in the field and facilitate comparison of data on VCA between centers.
Origin matters: alien consumers inflict greater damage on prey populations than do native consumers
Authors: Paolucci Esteban M. , MacIsaac Hugh J. , Ricciardi Anthony
Published: March 2013

Aim

Introduced alien species are frequently implicated in ecosystem disruption and biodiversity loss, but some ecologists have recently argued that efforts to manage ecosystems should be refocused on known problematic species without regard to whether such species are native or alien. This argument rests on the premise that native and alien species in general do not differ in their impacts. Although there are numerous cases that suggest alien predators and herbivores can sometimes cause severe declines or even local extinctions of native species, very few studies have compared the impacts of native and alien consumers on native populations.

Location

World‐wide.

Methods

We have conducted a meta‐analysis on a global dataset to compare the effects of native and alien predators and herbivores on native populations occupying a broad range of terrestrial and aquatic environments.

Results

The distribution of positive, negative and neutral effects on native prey abundance differed significantly by consumer origin, with alien consumers associated with more negative and fewer positive effects than expected, opposite the finding for native consumers. The effect size of alien consumers was 2.4 times greater than that of native consumers and did not differ between predators and herbivores. The impact of alien consumers did not differ significantly in aquatic (lakes, rivers, oceans) versus terrestrial (continental, island) habitats. Similarly, there was no significant interaction between consumer origin and location, as consumers had similar effects in insular (freshwater, island) and open (continental, marine) systems – contrary to the notion that alien species impacts are mainly problematic for island biota.

Main conclusions

We hypothesize that the ecological naïveté of native biota facilitates their enhanced suppression by alien predators and herbivores relative to native enemies. Our results counter the assertion that the biogeographical origin of species has no bearing on their ecological impact.
β‐adrenergic signaling promotes posteriorization in Xenopus early development
Authors: Mori Shoko , Moriyama Yuki , Yoshikawa Kumiko , Furukawa Tomoyo , Kuroda Hiroki
Published: March 2013

Adrenaline (also known as Epinephrine) is a hormone, which works as major regulator of various biological events such stages of vertebrate, the role of adrenaline for early embryogenesis has been as heart rate, blood vessel and air passage diameters, and metabolic shifts. Although its specific receptors are expressing at the early developmental stage those functions are poorly understood. Here, we show that loss‐of‐functional effects of adrenergic receptor β‐2 (Adrβ2), which was known as the major receptor for adrenaline and highly expressed in embryonic stages, led posterior defects at the tadpole stage of Xenopus embryos, while embryos injected with Adrβ2 mRNA or treated with adrenaline hormone adversely lost anterior structures. This posteriorization effect by adrenaline hormone was dose‐dependently increased but effectively rescued by microinjection of antisense morpholino oligomer for Adrβ2 (Adrβ2‐MO). Combination of adrenaline treatments and microinjection of Adrβ2 mRNA maximized efficiency in its posteriorizing activity. Interestingly, both gain‐ and loss‐of‐functional treatment for β‐adrenergic signaling could not influence anterior neural fate induced by overexpression of Chordin mRNA in presumptive ectodermal region, meaning that it worked via mesoderm. Taken together with these results, we conclude that adrenaline is a novel regulator of anteroposterior axis formation in vertebrates.
Adipose‐derived mesenchymal stem cells and regenerative medicine
Authors: Konno Masamitsu , Hamabe Atsushi , Hasegawa Shinichiro , Ogawa Hisataka , Fukusumi Takahito , Nishikawa Shimpei , Ohta Katsuya , Kano Yoshihiro , Ozaki Miyuki , Noguchi Yuko , Sakai Daisuke , Kudoh Toshihiro , Kawamoto Koichi , Eguchi Hidetoshi , Satoh Taroh , Tanemura Masahiro , Nagano Hiroaki , Doki Yuichiro , Mori Masaki , Ishii Hideshi
Published: March 2013

Adipose tissue‐derived mesenchymal stem cells (ADSCs) are multipotent and can differentiate into various cell types, including osteocytes, adipocytes, neural cells, vascular endothelial cells, cardiomyocytes, pancreatic β‐cells, and hepatocytes. Compared with the extraction of other stem cells such as bone marrow‐derived mesenchymal stem cells (BMSCs), that of ADSCs requires minimally invasive techniques. In the field of regenerative medicine, the use of autologous cells is preferable to embryonic stem cells or induced pluripotent stem cells. Therefore, ADSCs are a useful resource for drug screening and regenerative medicine. Here we present the methods and mechanisms underlying the induction of multilineage cells from ADSCs.
Pathogenic polypores in Argentina
Authors: Rajchenberg M. , Robledo G.
Published: March 2013

We surveyed the polypore species associated with living hosts in Argentina. We reviewed the literature on polypores found in Argentina and, in addition with the study of unpublished herbarium material, present a list of 87 species decaying living trees in native forests and introduced plantations. The rot type, host(s), distribution and remarks are presented for each species. Among 87 species found, 71 produce a white rot and 16 a brown rot in wood; 61 species were exclusively found on native hosts and 7 on exotic, cultivated hosts, while 18 were found on both types of substrates; one species, Amylosporus campbellii, was exclusively found associated with grasses. For most cases, there are no pathological studies based on rot measurement and culture isolation to determine incidence and severity of the decay.
Mitigating amphibian chytridiomycosis with bioaugmentation: characteristics of effective probiotics and strategies for their selection and use
Authors: Bletz Molly C. , Loudon Andrew H. , Becker Matthew H. , Bell Sara C. , Woodhams Douglas C. , Minbiole Kevin P. C. , Harris Reid N.
Published: March 2013

Probiotic therapy through bioaugmentation is a feasible disease mitigation strategy based on growing evidence that microbes contribute to host defences of plants and animals. Amphibians are currently threatened by the rapid global spread of the pathogen, Batrachochytrium dendrobatidis (Bd), which causes the disease chytridiomycosis. Bioaugmentation of locally occurring protective bacteria on amphibians has mitigated this disease effectively in laboratory trials and one recent field trial. Areas still naïve to Bd provide an opportunity for conservationists to proactively implement probiotic strategies to prevent further amphibian declines. In areas where Bd is endemic, bioaugmentation can facilitate repatriation of susceptible amphibians currently maintained in assurance colonies. Here, we synthesise the current research in amphibian microbial ecology and bioaugmentation to identify characteristics of effective probiotics in relation to their interactions with Bd, their host, other resident microbes and the environment. To target at‐risk species and amphibian communities, we develop sampling strategies and filtering protocols that result in probiotics that inhibit Bd under ecologically relevant conditions and persist on susceptible amphibians. This filtering tool can be used proactively to guide amphibian disease mitigation and can be extended to other taxa threatened by emerging infectious diseases.
Changes in expression of growth‐associated protein‐43 in trigeminal ganglion neurons and of the jaw opening reflex following inferior alveolar nerve transection in rats
Authors: Teramoto Kohei , Tsuboi Yoshiyuki , Shinoda Masamichi , Hitomi Suzuro , Abe Kimiko , Kaji Kaori , Tamagawa Takaaki , Suzuki Azumi , Noma Noboru , Kobayashi Masayuki , Komiyama Osamu , Urata Kentaro , Iwata Koichi
Published: March 2013

The aim of the present study was to clarify an involvement of growth‐associated protein‐43 (GAP‐43) in the regeneration of primary afferent trigeminal ganglion (TG) neurons following inferior alveolar nerve transection (IANX). A larger number of GAP‐43 immunoreactive (GAP‐43 IR) TG neurons was observed in rats 3 d after IANX compared with sham rats. Growth‐associated protein‐43 IR TG neurons were also detected for 30 d after IANX, and the number of GAP‐43 IR TG neurons was significantly higher in the IANX model until day 30. The relative number of large (>600 μm2) GAP‐43 IR TG neurons was significantly lower, whereas the relative number of small (<400 μm2) GAP‐43 IR TG neurons was significantly higher than that at day 0 until 30 d after IANX. To evaluate the functional recovery of damaged IAN, the jaw opening reflex (JOR), elicited by the electrical stimulation of the IAN, was measured before and after IANX. Jaw opening reflex occurrence was gradually increased and the relative threshold of electrical stimulation eliciting JOR was gradually decreased over the 30‐d duration of the study. On day 30 after IANX, the JOR occurrence and relative JOR threshold were similar to those in sham rats. The present findings suggest that changes in the expression of GAP‐43 in TG neurons after IANX are involved in regeneration and functional recovery of the transected IAN.
Interleukin‐17/T‐helper 17 cells in an atopic dermatitis mouse model aggravate orthodontic root resorption in dental pulp
Authors: Shimizu Mami , Yamaguchi Masaru , Fujita Shoji , Utsunomiya Tadahiko , Yamamoto Hirotsugu , Kasai Kazutaka
Published: March 2013

Interleukin (IL)‐17 is an important mediator of orthodontically induced inflammatory root resorption (OIIRR). However, its role in the dental pulp (DP) has not been studied. The aim of this study was to investigate, using an atopic dermatitis (AD) model, how IL‐17 contributes to OIIRR in DP. Atopic dermatitis is the most common IL‐17‐associated allergic disease. Atopic dermatitis model mice (AD group) and wild‐type mice (control group) were subjected to an excessive orthodontic force. The localization of T‐helper (Th)17 cells, IL‐17, IL‐6, and keratinocyte chemoattractant (KC; an IL‐8‐related protein in rodents) were determined in DP. In addition, CD4+ T cells, including IL‐17 production cells, were obtained from patients with AD and from healthy donors, and the effects of IL‐17 on the production of IL‐6 and IL‐8 were investigated using a co‐culture of CD4+ T cells with human dental pulp (hDP) cells stimulated with substance P (SP). Immunoreactivity for Th17 cells, IL‐17, IL‐6, and KC was increased in DP tissue subjected to orthodontic force in the AD group compared with DP tissue subjected to orthodontic force in the control group. The cells obtained from the AD patients displayed increased IL‐6 and IL‐8 production. These results suggest that IL‐17 may aggravate OIIRR in DP.
Characterization of the oral fungal microbiota in smokers and non‐smokers
Authors: Monteiro‐da‐Silva Filipa , Sampaio‐Maia Benedita , Pereira Maria de Lurdes , Araujo Ricardo
Published: March 2013

This study aimed to assess the effect of smoking on the biodiversity of the oral fungal microbiota of healthy young subjects, using an improved culture method that assesses both total and pathogenic viable fungi. Forty individuals (20 smokers and 20 non‐smokers) were selected. All individuals presented fungal growth (100% for molds and 92.5% for yeasts), a prevalence higher than previously reported. The most commonly occurring molds were Penicillium sp., Aspergillus sp., and Cladosporium sp. Smokers presented significantly higher levels of yeasts and pathogenic molds than did non‐smokers. No differences in fungal prevalence and diversity were observed in smokers and non‐smokers following a 30‐wk observation period. In conclusion, tobacco smoking may alter the oral mycobiota and facilitate colonization of the oral cavity with yeasts and pathogenic molds. The effect of chronic fungal colonization on the oral health of tobacco smokers cannot be neglected.
Effects of retention site on breakdown of organic matter in a mountain stream
Authors: Flores Lorea , Díez Jose Ramón , Larrañaga Aitor , Pascoal Cláudia , Elosegi Arturo
Published: March 2013

Organic matter inputs to streams can be retained in contrasting sites, from small leaf packs on top of cobbles to thick organic deposits trapped by wood jams. Differences in environmental conditions and in stability among sites can affect the biological communities, the quality of organic matter and its use by consumers.

We measured the accumulation and composition of coarse organic matter and the breakdown of alder leaves on the surface of the streambed, inside gravel bars and in thick litter deposits trapped by log jams. We also monitored fungal sporulation rates and macroinvertebrate diversity and density in these retention sites.

The amount of organic matter in these locations differed significantly among sites and ranged from 118 g m−2 in gravel to 11 562 g m−2 in jams. The biomass of shredders also differed significantly among retention sites, being highest in jams (1440 mg m−2) and lowest in gravel (86 mg m−2).

Breakdown of alder leaves in fine‐mesh bags did not differ among retention sites. In coarse‐mesh bags, leaf breakdown rate was significantly lower in gravel bars than in surface sites or jams. Despite large differences in amount and quality of organic matter between surface sites and jams, alder leaves broke down at the same rate.

Density of invertebrates in bags and fungal sporulation rates tended to be highest in surface sites and lowest in gravel bars. The contribution of microbes to breakdown was 67% in gravel, 52% in surface and only 28% in jams. Overall, the differences among sites in leaf breakdown were correlated with invertebrate density.

Our results showed large differences in the amount and quality of organic matter accumulated, in biological communities and in the use of organic matter among retention sites of a single stream reach. This spatial variability should be taken into account in studies of ecosystem functioning related to organic matter.
Short‐term clinical outcomes in delirious older patients: A study at general medical wards in a university hospital in Thailand
Authors: Praditsuwan Rungnirand , Sirisuwat Achara , Assanasen Jintana , Eiamjinnasuwat Waricha , Pakdeewongse Sorapop , Limmathuroskul Duangsawang , Srinonprasert Varalak
Published: March 2013

Aim

Delirium, a common disorder in hospitalized older patients, frequently results in unfavorable consequences. Previous studies in different settings have provided conflicting results regarding clinical outcomes and mortality. We aimed to study three clinical outcomes – length of stay (LOS), in‐hospital mortality and 3‐month mortality – among delirious Thai older patients.

Methods

A prospective observational study was carried out in a university hospital in Thailand. All patients aged older than 70 years admitted to general medical wards were included. Delirium assessments were undertaken within the first 24 h of admission and serially until discharge. Subsequent assessments were carried out at 3 months after discharge. Delirium was diagnosed based on the Diagnostic and Statistical Manual of Mental Disorders fourth edition criteria. Factors associated with mortality were determined by using logistic regression models.

Results

LOS was significantly longer in the delirium group (10 and 8 days, P = 0.001). Furthermore, the delirium group had higher in‐hospital and 3‐month mortality (P < 0.001). Factors significantly associated with in‐hospital mortality in multivariate analysis were age more than 80 years (AOR 2.74, 95% CI 1.05–7.15), malignancy (AOR 3.11, 95% CI 1.16–8.33), severe illness (AOR 3.75, 95% CI 1.38–10.20) and delirium (AOR 7.34, 95% CI 1.51–35.69). Delirium remained a strong predictor for 3‐month mortality in multivariate analysis with AOR of 3.33 (95% CI 1.45–7.62)

Conclusions

Delirium was associated with prolonged hospital‐stay and was the strongest predictor for mortality among older hospitalized patients. It requires serious attention from physicians, healthcare administrators and policy makers to implement an appropriate management plan for this high‐burden issue. Geriatr Gerontol Int 2013; 13: 972–977.
Medication adherence: Is it a hidden drug‐related problem in hidden elderly?
Authors: Lee Vivian WY , Pang Kathy KW , Hui Ka Chun , Kwok Jennifer CK , Leung Siu Ling , Yu Doris Sau Fung , Lee Diana Tze Fan
Published: March 2013

Aim

The present study aimed to identify the health needs of the hidden elderly in Hong Kong, and to investigate the impacts of pharmacist and nursing interventions on medication management and well‐being in hidden elderly.

Methods

Participants were recruited by social workers if they were aged 65 years or older; did not have normal social life and network; did not have family support; and were not linked to the existing network of community support. Pharmacists identified drug‐related problems. The health needs of participants were assessed by observations and interviews. Outcome measurements were scores of Morisky 8‐item Medication Adherence Scale and EuroQoL (Quality of Life) 5‐D Questionnaire.

Results

A total of 93 participants were recruited and 86 participants completed the study. The mean age was 81.46 ± 5.70 years, the mean number of chronic disease was 3.29 ± 1.45 and the mean number of chronic medications was 6.36 ± 2.96. The most commonly observed chronic diseases were hypertension, cardiac problems, diabetes, hyperlipidemia and arthritis. Drug non‐adherence and storage problems were found in 61.63% and 69.77% of participants. The mean total EuroQoL score increased by 1.05 (P ≤ 0.001). The mean Morisky score decreased by 0.61, signifying improvement of medication adherence (P < 0.001). Female sex (P = 0.045), polypharmacy with more than nine concurrent medications (P = 0.013), arthritis (P = 0.006) and drug storage problems (P = 0.002) were identified as factors associated with poor medication adherence.

Conclusions

The majority of hidden elderly suffered from multiple chronic diseases, and the prevalence of drug‐related problems was high. Pharmacist and nursing interventions improved drug‐related problems, drug compliance and quality of life in hidden elderly. Geriatr Gerontol Int 2013; 13: 978–985.
What Is Governance?
Authors: Fukuyama Francis
Published: March 2013

This commentary points to the poor state of empirical measures of the quality of states, that is, executive branches and their bureaucracies. Much of the problem is conceptual, as there is very little agreement on what constitutes high‐quality government. The commentary suggests four approaches: (1) procedural measures, such as theWeberian criteria of bureaucratic modernity; (2) capacity measures, which include both resources and degree of professionalization; (3) output measures; and (4) measures of bureaucratic autonomy. It rejects output measures and suggests a two‐dimensional framework of using capacity and autonomy as a measure of executive branch quality. This framework explains the conundrum of why low‐income countries are advised to reduce bureaucratic autonomy while high‐income ones seek to increase it.
Assessments of the extent to which health‐care providers involve patients in decision making: a systematic review of studies using the OPTION instrument
Authors: Couët Nicolas , Desroches Sophie , Robitaille Hubert , Vaillancourt Hugues , Leblanc Annie , Turcotte Stéphane , Elwyn Glyn , Légaré France
Published: March 2013

Background

We have no clear overview of the extent to which health‐care providers involve patients in the decision‐making process during consultations. The Observing Patient Involvement in Decision Making instrument (OPTION) was designed to assess this.

Objective

To systematically review studies that used the OPTION instrument to observe the extent to which health‐care providers involve patients in decision making across a range of clinical contexts, including different health professions and lengths of consultation.

Search strategy

We conducted online literature searches in multiple databases (2001–12) and gathered further data through networking.

Inclusion criteria

(i) OPTION scores as reported outcomes and (ii) health‐care providers and patients as study participants. For analysis, we only included studies using the revised scale.

Data extraction

Extracted data included: (i) study and participant characteristics and (ii) OPTION outcomes (scores, statistical associations and reported psychometric results). We also assessed the quality of OPTION outcomes reporting.

Main results

We found 33 eligible studies, 29 of which used the revised scale. Overall, we found low levels of patient‐involving behaviours: in cases where no intervention was used to implement shared decision making (SDM), the mean OPTION score was 23 ± 14 (0–100 scale). When assessed, the variables most consistently associated with higher OPTION scores were interventions to implement SDM (n = 8/9) and duration of consultations (n = 8/15).

Conclusions

Whatever the clinical context, few health‐care providers consistently attempt to facilitate patient involvement, and even fewer adjust care to patient preferences. However, both SDM interventions and longer consultations could improve this.
The Concept of International Opportunity in International Entrepreneurship: A Review and a Research Agenda
Authors: Mainela Tuija , Puhakka Vesa , Servais Per
Published: March 2013

Recent research in the field of international entrepreneurship (IE) has emphasized the concept of international opportunity. The entrepreneurial behaviors focused on international opportunities have been found to be critical in IE. International opportunities, however, are often depicted in rather abstract and unspecified ways, and the research suffers from narrow theoretical discussion in relation to the concept of opportunity. To address these issues, the authors draw from entrepreneurship research and present alternative conceptualizations of opportunities as a basis for more in‐depth study of international opportunities in IE. To further articulate a future research agenda, the authors review the state of knowledge on opportunities in the IE field by content‐analyzing articles published between 1989 and 2012. All the analyzed articles incorporate the concept of opportunity into their studies. It is found that, although the IE research has investigated many relevant elements, it is rather limited in the articulation of the conceptual features of international opportunities and opportunity‐focused behaviors. Building on these observations, the authors propose a definition of international opportunity and research questions and strategies to advance IE research on international opportunities.
A case of leukemia cutis presenting as histiocytoid Sweet’s syndrome
Authors: Zhenying Zhang , Xiaoming Liu , Yongjun Piao , Shixin Han
Published: March 2013

Background  Leukemia cutis (LC) represents a skin infiltration by leukemic cells. Clinically, it can mimic a wide variety of dermatoses.

Methods  We report a case of LC presenting with a Sweet’s syndrome‐like eruption and a histiocytoid Sweet’s syndrome histologic manifestation.

Results  This case may represent distinct and important cutaneous and histopathologic manifestations of LC.

Conclusions  We believe that peripheral blood or bone marrow cytologic analysis is necessary in cases of LC to rule out the possibility of histiocytoid Sweet’s syndrome. Additional study is needed to further elucidate the relationship between LC and histiocytoid Sweet’s syndrome.
Spontaneous appearance of multiple asymptomatic papules and/or nodules over an apparently normal skin of the trunk
Authors: Sehgal Virendra N. , Singh Navjeevan , Prasad Pullabatla V. S. , Lal Jangid B. , Kaviarasan Pitchai K.
Published: March 2013

What is your diagnosis?
Generalized erythematous–violaceous plaques in a patient with a history of dyslipidemia
Authors: Hernández Noelia , Peñate Yeray , Borrego Leopoldo
Published: March 2013

What is your diagnosis?
How does robot‐assisted radical prostatectomy (RARP) compare with open surgery in men with high‐risk prostate cancer?
Authors: Punnen Sanoj , Meng Maxwell V. , Cooperberg Matthew R. , Greene Kirsten L. , Cowan Janet E. , Carroll Peter R.
Published: March 2013

What's known on the subject? and What does the study add?

Previous studies have shown that robot‐assisted radical prostatectomy (RARP) can be performed in men with high‐risk prostate cancer with similar outcomes to that of open surgery. However, most of the literature consists of small case series and compares RARP outcomes to open outcomes from the literature.

This study compared a cohort of high‐risk patients undergoing open RP and RARP at a single institution with good follow up. We found no difference in positive margin rates or likelihood of prostate cancer recurrence. This adds to the growing evidence that RARP is a safe option for men with high‐risk disease.

Objective

To compare oncological outcomes in high‐risk patients who underwent open retropubic radical prostatectomy (RRP) and robot‐assisted RP (RARP) at a single institution. Despite equivalent oncological outcomes between open RRP and RARP, the use of RARP in men with high‐risk tumours has been debated.

Patients and Methods

A retrospective analysis of high‐risk patients treated with open RRP or RARP at UCSF from 2002 to 2011 was conducted.

The relationship between surgical approach and positive margin rate was assessed by multivariate logistic regression

Cox proportional hazards regression assessed the effect of surgical approach on time to tumour recurrence.

Results

In all, 177 open RRP and 233 RARP patients made up the final cohort for analyses. The mean (SD) age was 61.6 (6.6) years and the median (range) follow‐up was 27 (2–112) months.

RARP patients had less blood loss (median 200 vs 400 mL, P < 0.01) and underwent complete bilateral nerve sparing more often (54% vs 34%, P < 0.01) than those undergoing open RRP.

There were no differences by approach in pathological grade, stage, or positive margin rates. However, there was a trend towards higher positive margin rates with RARP early on.

Recurrence‐free survival was similar at 2 years (84% and 79%) and 4 years (68% and 66%) after open RRP and RARP, respectively (log‐rank P = 0.53).

Conclusions

This study is novel in that it assesses outcomes of open RRP vs RARP in a cohort of high‐risk men at a single institution.

RARP appears to be a feasible option for men with high‐risk prostate cancer and displayed equivalent oncological outcomes compared with open RRP.