bluuebunny/crossref_metadata_2025 huggingface dataset:
Usefulness of flow cytometry for differential diagnosis of precursor and peripheral T‐cell and NK‐cell lymphomas: Analysis of 490 cases
Authors: Karube Kennosuke , Aoki Ryosuke , Nomura Yuko , Yamamoto Kohei , Shimizu Kay , Yoshida Shirou , Komatani Hideki , Sugita Yasuo , Ohshima Koichi
Published: August 2010

Although various CD markers have been analyzed in T‐cell and natural killer (NK)‐cell lymphomas, the sensitivity and specificity of these phenotypic features have not been satisfactorily characterized. Flow cytometry (FCM) was used to determine the phenotypic pattern of 490 T/NK‐cell lymphomas with the aid of a set of surface antigens (CD2, CD3, CD4, CD5, CD7, CD8, CD10, CD11c, CD16, CD19, CD20, CD25, CD30, CD34, and CD56). In data obtained from 319 patients, CD10 expression was detected in 57% of angioimmunoblastic T‐cell lymphomas, CD30 in 93% of anaplastic large cell lymphomas, CD34 in 50% of lymphoblastic lymphomas, and CD56 in 100% of extranodal NK/T‐cell lymphomas nasal type. A total of 92% of adult T‐cell leukemia/lymphomas (ATLL) had expression of CD25 and downregulation of CD7. Of special interest is that 92 ATLL (50%) were CD4+CD7‐CD25+ phenotype while only four peripheral T‐cell lymphoma unspecified (9%) and one (9%) cutaneous T‐cell lymphoma had this phenotype. Phenotypic analysis using FCM was thus found to be useful for differential diagnosis of T‐cell and NK‐cell lymphomas.
Estimation of apoptosis and cell proliferation in histiocytic necrotizing lymphadenitis using immunohistochemical double staining
Authors: Nomura Yuko , Sugita Yasuo , Yoshida Shiro , Karube Kennosuke , Shimizu Kei , Aoki Ryosuke , Hirose Shinichi , Kikuchi Masahiro , Ohshima Koichi
Published: August 2010

The aim of the present study was to estimate the relationship between apoptosis and cell proliferation in histiocytic necrotizing lymphadenitis (HNL). Fifteen patients with HNL were retrospectively analyzed. The patients were divided into three groups according to the proportion of the necrotic area as follows: necrosis (+), necrotic area <25%; necrosis (++), necrotic area 25–50%; and necrosis (+++), necrotic area >50%. Immunohistochemical double staining was performed for CD3 plus caspase‐3 and for Ki‐67 plus caspase‐3 and positive cells were counted in two areas: one without and one with obvious apoptotic features. Most caspase‐3‐positive cells were also stained for CD3 (area exhibiting obvious apoptotic features: average, 92.3%). Furthermore, various proportions of both Ki‐67‐ and caspase‐3‐positive cells were detected in all the groups (range, 5–70%). In the area with obvious apoptotic changes, the average percentage of both Ki‐67‐ and caspase‐3‐positive cells (38.6%) was higher than that in the area without obvious apoptotic features (16.3%). A proportion of cells in HNL undergo proliferation and apoptosis simultaneously, such as neoplastic cells, thereby exhibiting rapid cell cycles.
Autoimmune pancreatitis‐associated prostatitis: Distinct clinicopathological entity
Authors: Uehara Takeshi , Hamano Hideaki , Kawakami Masako , Koyama Masamichi , Kawa Shigeyuki , Sano Kenji , Honda Takayuki , Oki Keiko , Ota Hiroyoshi
Published: August 2010

Autoimmune pancreatitis (AIP) has been recently proposed as a disease entity, and an elevated serum IgG4 level is a characteristic finding in it. This disease is sometimes associated with other inflammatory diseases, such as retroperitoneal fibrosis and sclerosing cholangitis. To elucidate the clinicopathological characteristics of AIP‐associated prostatitis (AIP‐P), the clinicopathological findings of AIP‐P patients were evaluated, and the immunohistochemical expression of the IgG subclasses (IgG1, IgG2, IgG3, and IgG4) in six AIP‐P patients was compared with that in 10 control patients who were clinically diagnosed as suspicious for carcinoma but who had focal inflammation without adenocarcinoma on histological examination of the prostate. All AIP‐P patients had the characteristic findings of AIP, and their lower urinary tract symptoms (LUTS) improved after steroid therapy. In four of five AIP‐P patients, digital rectal examination indicated prostate enlargement. Histologically, AIP‐P had lymphoplasmacytic and scattered eosinophilic infiltration and obliterative phlebitis accompanying gland atrophy with dense fibrosis. Immunohistochemically, the IgG4‐positive plasma cell/mononuclear cell ratio was significantly higher in the AIP‐P group than in the control group (P = 0.0011). AIP‐P is a distinct clinicopathological entity, and a mechanism similar to that implicated in AIP may be involved in it as well.
Histopathology of bone marrow reconstitution after umbilical cord blood transplantation for hematological diseases
Authors: Maeda Takashi , Shiozawa Eisuke , Mayumi Homma , Usui Takako , Nakashima Hidetoshi , Hattori Norimichi , Adachi Daisuke , Saito Bungo , Yanagisawa Kouji , Matsuda Isao , Nakamaki Tsuyoshi , Tomoyasu Shigeru , Yamochi‐Onizuka Toshiko , Takimoto Masafumi , Ota Hidekazu
Published: August 2010

To study hematopoietic reconstitution in umbilical cord blood transplantation (CBT), bone marrow (BM) histology was investigated in 35 biopsies after bone marrow transplantation (BMT) and in 40 biopsies after CBT. BM biopsies were obtained at different times after transplantation and were evaluated for cellularity, number of megakaryocytes and CD34‐positive cells, and fibrosis. In biopsies up to 29 days after BMT, cellularity was increased and megakaryocytes were observed, but at 29 days after CBT, biopsies showed severe cellular depletion and almost no megakaryocytes. In addition, fewer CD34‐positive cells were observed after CBT compared to after BMT. After day 30 after CBT, hematopoietic recovery of the BM was gradually observed and after day 100 after transplantation, no essential differences were observed between BMT and CBT. Hematopoietic recovery of the BM after CBT was delayed compared to that after BMT, but engraftment of donor cells after CBT was also observed in histopathologically. To the best of the authors' knowledge this is the first histopathological description of BM reconstitution after CBT.
Hypereosinophilic syndrome associated with occlusive coronary thrombosis and right ventricular thrombus
Authors: Sato Yuichiro , Fukunaga Takashi , Hayashi Tohru , Asada Yujiro
Published: August 2010

A 44‐year‐old man with HES who developed a large thrombus in the right ventricle as well as multiple occlusive coronary thrombi died of cardiac failure. Autopsy showed that a large thrombus in the right ventricle was associated with eosinophilic endocarditis. In addition, an occlusive thrombus formed in the circumflex and right coronary arteries with eosinophilic infiltrate in the walls. The findings suggest a causal relationship between coronary thrombosis and eosinophilia. To the authors' knowledge this is the first report to document the clinical and histological findings of coronary thrombosis in a patient with HES.
Kalinella bambusicola gen. et sp. nov. (Trebouxiophyceae, Chlorophyta), a novel coccoid Chlorella‐like subaerial alga from Southeast Asia
Authors: Neustupa Jiří , Němcová Yvonne , Eliáš Marek , Škaloud Pavel
Published: August 2010

The traditional green algal genus Chlorella, which comprised coccoid algae surrounded by a smooth cell wall and reproducing solely by autosporulation, has proved to be polyphyletic and extremely diverse in phylogenetic terms. We studied a new subaerial Chlorella‐like strain CAUP H7901 and morphological, ultrastructural, and molecular phylogenetic investigations indicated that it represents a new lineage of the trebouxiophycean Watanabea clade, dissimilar from other members of this group. The alga has globular coccoid cells with a single parietal pyrenoid‐bearing chloroplast. The pyrenoid is transected by multiple radial thylakoid bands. The alga reproduces exclusively by means of asexual autospores of unequal size. In 18S rDNA sequence phylogenies, it was nested within the Watanabea clade close to lineages containing Chlorella saccharophila, Chlorella luteoviridis, Heveochlorella hainangensis, and two uncharacterized strains, but alternative positions within the Watanabea clade could not be rejected by an approximately unbiased (AU) test. Here we describe this organism as a new genus and species Kalinella bambusicola gen. et sp. nov. Furthermore, we describe Heterochlorella gen. nov. to accommodate a species previously referred to as Chlorella luteoviridis.
Responses of Antarctic Iridaea cordata (Rhodophyta) tetraspores exposed to ultraviolet radiation
Authors: Zacher Katharina , Roleda Michael Y. , Wulff Angela , Hanelt Dieter , Wiencke Christian
Published: August 2010

In Antarctica ozone depletion is highest during spring, coinciding with the reproduction of many seaweed species. Propagules are the life‐stage of an alga most susceptible to environmental perturbations. Therefore, fertile thalli of Iridaea cordata (Turner) Bory (Rhodophyta) were collected in the eulittoral of King George Island (Antarctica) to examine spore susceptibility to ultraviolet radiation (UVR). In the laboratory, freshly released tetraspores were exposed to photosynthetically active radiation (PAR) (400–700 nm), PAR+UV‐A (320–700 nm) or PAR+UV‐A+UV‐B (280–700 nm). Photosynthetic efficiency was measured during 1–8 h of exposure and after 48 h of recovery. Additionally, mycosporine‐like amino acids (MAAs) and DNA damage were determined. Saturating irradiance of photosynthesis of freshly released tetraspores was 57 µmol photons m−2 s−1. Exposure to increasing fluence of PAR reduced photosynthetic efficiency. UVR further decreased the photosynthetic efficiencies of the tetraspores but spores were able to recover completely after UVR exposure and 2 days post‐cultivation under low PAR. DNA damage was minimal and lesions were effectively repaired under photoreactivating light. Concentrations of the MAAs shinorine and palythine were higher in tetraspores treated with UVR than in spores only exposed to PAR. Generally, the tetraspores show a good UV tolerance. This flexible response of the tetraspores of this species to changing radiation conditions enables the alga to grow along a considerable depth gradient from the sublittoral to the eulittoral where they can be exposed to enhanced UVBR under conditions of stratospheric ozone depletion.
Induction and isolation of pigmentation mutants of Porphyra yezoensis (Bangiales, Rhodophyta) by heavy‐ion beam irradiation
Authors: Niwa Kyosuke , Hayashi Yoriko , Abe Tomoko , Aruga Yusho
Published: August 2010

The present study describes the isolation of pigmentation mutants of Porphyra yezoensis Ueda induced by heavy‐ion beam irradiation for the first time. The gametophytic blades were irradiated with 12C+6 ion beams within a dose range of 25–400 Gy. From the survival rate and cell growth of the irradiated blades, it is suggested that a dose of 150 Gy or less is suitable to induce mutation for the isolation of mutants of P. yezoensis. After irradiation, red, green and deep reddish brown‐colored gametophytic blades developed from archeospores that were released from each of the mutated cell clusters of the respective different colors, and the red mutant strain (IBY‐R1) and green mutant strain (IBY‐G1) were established as a conchocelis colony in culture. Blades of the mutants were characterized by their growth and photosynthetic pigment contents compared with those of the wild‐type. From these results, it is clear that heavy‐ion beam mutagenesis will be an effective tool for genetic and breeding studies of Porphyra, and also for other algal research.
Research note: First report of the Japanese species Grateloupia lanceolata (Halymeniaceae, Rhodophyta) from California, USA
Authors: Miller Kathy Ann , Hughey Jeffery R. , Gabrielson Paul W.
Published: August 2010

The Japanese red alga Grateloupia lanceolata (Okamura) Kawaguchi was discovered in southern California at Santa Catalina Island in spring 2003 and April 2008 and in central California at the mouth of the Elkhorn Slough in Moss Landing in May, June and July of 2008. The morphology of thalli from both localities agrees with published figures. Sequences from the rbcL gene and the nuclear marker, internal transcribed spacer‐1 from Californian G. lanceolata were identical to those from two specimens of G. lanceolata introduced to the Thau Lagoon, Mediterranean France and a specimen from Japan. It is likely that the import of oysters for mariculture played a role in its introduction into California.
Sequence repeats enlarge the internal transcribed spacer 1 region of the brown alga Colpomenia sinuosa (Scytosiphonaceae, Phaeophyceae)
Authors: Cho Ga Youn , Choi Dong Woog , Kim Myung Sook , Boo Sung Min
Published: August 2010

Colpomenia sinuosa is an annual brown algal species that occurs in temperate to tropical waters of the world. In order to examine the genetic diversity among populations of the species and to discuss its current distribution, we analyzed the nuclear ribosomal DNA internal transcribed spacer (ITS) region from 18 specimens of C. sinuosa, and, for comparison, plastid rbcL from the same specimens. The C. sinuosa ITS region (2141–2534 base pairs) is approximately 2.2 times the length of most other brown algae. We found a long repeated sequence of approximately 190 base pairs in the first half of the ITS1 region; five repeats in Northern Hemisphere collections and three in those from the Southern Hemisphere, which result in ITS length variation. The unequal occurrence of tandem repeats of C. sinuosa corresponds to the geographical distribution of the species. The rbcL sequences from all the specimens of C. sinuosa, except the Canary Island samples, were identical, indicating that they indeed belong to the same species.
Antimicrobial susceptibility of Staphylococcus aureus in children with atopic dermatitis
Authors: Tang Ching‐Shen , Wang Chih‐Chien , Huang Ching‐Feng , Chen Shyi‐Jou , Tseng Min‐Hua , Lo Wen‐Tsung
Published: August 2010

Background:  Skin infection and/or nasal carriage of Staphylococcus aureus in children with atopic dermatitis (AD) is a risk factor for exacerbating disease or subsequent recurrent S. aureus infection. The purpose of the study is to evaluate the antibiotic susceptibilities of S. aureus strains from AD children and determine the most appropriate choice of antibiotics.

Methods:  Nasal swabs from 168 healthy children with AD and 20 AD children with concurrent skin and soft‐tissue infections (SSTI) were collected in 2005–2008. S. aureus strains were further analyzed for and compared with antibiotic susceptibilities.

Results:  There were 78 (46.4%) healthy children with AD colonized with S. aureus, and 24 (30.8%) were methicillin‐resistant S. aureus (MRSA). Among the 20 SSTI‐infecting strains, 12 (60%) were MRSA. Antimicrobial susceptibility testing showed that, after penicillin, colonizing and SSTI‐infecting strains had the highest rates of resistance to erythromycin (50% and 70%, respectively). All isolated strains were susceptible to vancomycin, rifampin, and mupirocin. Multi‐drug resistance was found in 70% of the colonizing and 50% of the SSTI‐infecting strains. D‐test assay revealed inducible clindamycin resistance in 75% of the colonizing strains. The most prevalent resistance gene was ermB which was present in 94.9% and 92.9% of colonizing and SSTI‐infecting strains, respectively.

Conclusions:  This study found that colonizing and SSTI‐infecting strains of S. aureus from AD children had a high prevalence of MRSA and multi‐drug resistance. Trimethoprim‐sulfamethoxazole, rifampin, fusidic acid and mupirocin appear to be more suitable for treatment and decolonization of S. aureus in AD children.
Two types of orthostatic dysregulation assessed by diameter of inferior vena cava
Authors: Fujii Yuri , Ishizaki Yuko , Kino Minoru , Taniuchi Shoichiro , Kobayashi Yohnosuke , Kaneko Kazunari
Published: August 2010

Aims:  Orthostatic dysregulation (OD) is common in adolescents. This study was conducted to evaluate the usefulness of the measurement of the diameter of the inferior vena cava (IVC) for objective assessment of patients with OD.

Methods:  Twenty children with OD (median 14 years, range 9–15 years) and 23 age‐matched healthy children (median 12 years, range 10–15 years) were enrolled. A diameter of IVC was measured by an abdominal echogram before and after a head‐up tilt table testing (HUT). Changes in IVC was assessed by an arbitrary parameter, collapse index (CI) as the following equation: [(maximal IVC diameter in the supine position − maximal IVC diameter in the standing position)/(maximal IVC diameter in the supine position)]× 100. CI was evaluated 4 weeks after treatment with an adrenergic agent.

Results:  Children with OD demonstrated either higher CI or lower CI compared to that in control children: CI was more than 50 (range 50–71) in 12 patients with OD while that was equal to or less than 0 (range −225 to 0) in eight out of 20 patients. In contrast, CI was between 0 and 50 (range 1–26) in 23 healthy children. Pharmacological treatment induced the normalization in the CI in both higher and lower CI group.

Conclusion:  OD can be classified into two subtypes: by HUT, one is characterized by an increase of IVC diameter while another is characterized by its decrease. Measurement of IVC diameter by HUT is useful to understand the pathophysiology and to assess the efficacy of treatment.
The impact on the emergency department of integrating psychiatric services into a general hospital
Authors: MACLEAN ANDREW , ANDREW‐STARKEY SYLVIA
Published: August 2010

Objectives: To compare Emergency Department presentations before and after the integration of a 23 bed psychiatric unit with a general hospital.

Design: Retrospective analysis of Emergency Department register over a six year period.

Subjects: Patients included were those who presented to the Emergency Department with either a primary psychiatric complaint or an intentional toxic ingestion.

Results: Total Emergency Department presentations have remained relatively stable during the study period (27,693 ± 699). Intentional ingestion numbers have shown only a slight increase since the opening of the Psychiatric Unit from 198 in 1987 to 308 in 1992.

The number of patients with primary psychiatric complaints has however increased greatly from an average of 47 annually prior to the opening of the Psychiatric Unit to an average of 550 per year after the opening with a trend of increasing numbers each year.

Emergency departments of hospitals considering inpatient psychiatric services must carefully plan to meet the needs of an increased emergency psychiatric population.
Panspinal epidural abscess secondary to vertebral osteomyelitis
Authors: Tall Gary D , Rowe Dominic
Published: August 2010

Spinal epidural abscess is an unusual but potentially devastating condition that constitutes a neurosurgical emergency. Early diagnosis is imperative as delays in therapy commonly result in irreversible neurologic impairment, or death. We present the case of a 52 year old man with a panspinal epidural abscess secondary to lumbar vertebral osteomyelitis. This is only the third case of panspinal epidural abscess reported in the literature. Urgent decompression and prolonged intravenous antibiotics resulted in full recovery.
Adenosine is safe and effective in the emergency management of tachyarrhythmias
Authors: Dilley Stuart J , Rogers Ian , Sprivulis Peter , Jelinek George A
Published: August 2010

Objective:

To describe three Australasian emergency departments' experience with the use of intravenous adenosine for the treatment of tachyarrhythmias.

Design:

Prospective uncontrolled study of the indications, efficacy and adverse effects encountered during the use of adenosine for the treatment of regular tachyarrhythmias presenting to the emergency departments of Fremantle, Box Hill and Maroondah Hospitals during a twelve month period.

Results:

One hundred and two episodes of regular tachyarrhythmia were treated in 87 patients. Of 92 cases of narrow complex tachycardia (NCT), 75 were A‐V nodal in origin. All but four patients (96%) reverted to sinus rhythm although nine subsequently relapsed. Dosages used ranged from 5 to 20mg. Of 10 cases of wide complex tachycardia (WCT), five were subsequently shown to be ventricular tachycardia (VT). No cases of decompensation requiring cardioversion were seen following adenosine. A total of 17 cases were due to atrial flutter. Flutter waves were exposed by adenosine in 14 cases. Mild transient adverse effects were common.

Conclusions:

Intravenous adenosine is useful in the treatment of supraventricular tachycardia and is of diagnostic value in other NCTs. The agent may be safely administered to patients with WCT where a diagnosis other than VT is considered. Adverse effects are common, though generally well tolerated and transient.
Removal of nasal foreign bodies using the Fogarty catheter
Authors: Ryan Nicholas J
Published: August 2010

Patients with nasal foreign bodies frequently present to emergency departments. Nasal foreign bodies are often difficult to remove and may require referral to an ENT surgeon or admission to hospital for removal under general anaesthetic. This study reviews patients with nasal foreign bodies who presented to the Gosford District Hospital Emergency Department over a three and a half year period. The results indicate that a technique for the removal of nasal foreign bodies in the emergency department using a Fogarty catheter may be successful.
Effects of bariatric surgery on urinary and sexual function
Authors: Ranasinghe Weranja K.B. , Wright Timothy , Attia John , McElduff Patrick , Doyle Terrence , Bartholomew Meegan , Hurley Katrina , Persad Rajendra A.
Published: August 2010

Study Type – Symptom prevalence (non‐consecutive cohort) Level of Evidence 4

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

Obesity is a known risk factor for Urinary Incontinence. Non surgical weight loss has been shown to reduce Urinary Incontinence, but there is only limited evidence for surgically induced weight loss. This study aims to clarify the effects of surgically induced weight loss on urinary and erectile function.

OBJECTIVE

To investigate the effects of weight loss and time post laparoscopic gastric banding surgery (LGB) on urinary and sexual function.

MATERIALS AND METHODS

653 females and 145 males who underwent LGB over the last 10 years at a single centre in Australia were contacted by post and asked to complete validated questionnaires.

RESULTS

The pre‐surgery body‐mass index (BMI) was higher in males than females (47.3 vs 43.5); 65% of the females and 24% of males previously had some degree of urinary incontinence (UI). There were significant weight and BMI losses in males and females (23.2 kg and 7.51 vs 22.7 kg and 8.28; P < 0.0001). In females there were significant improvements in the ICIQ‐SF (P= 0.0008) and Quality of Life (P < 0.0001) scores. For each kilogram lost there was a 0.05 improvement in the ICIQ score (P= 0.03) in females. There were also postoperative improvements in all symptoms of UI and stress incontinence in females but urge incontinence worsened, when adjusted for weight loss. In males there was no improvement in UI with weight loss after LGB. There was no relationship with time and UI in either gender; 83.3% of males reported a degree of ED before LGB. There was improvement in the IIEF score in males post LGB but there was worsening of erectile index (P= 0.005) and orgasmic function (P= 0.002) when adjusted for time. More males had started using phosphodiesterase type 5 inhibitors, post‐LGB.

CONCLUSIONS

Surgically induced weight loss by LGB improved overall UI, quality of life and stress incontinence in females but urge incontinence worsened. There was no improvement in UI with weight‐loss or overall sexual function after LGB in males. However, erectile index and orgasmic function worsened when adjusted for time. Further evaluation is required by means of larger prospective studies involving urodynamic testing.
Predictors of prolonged operative time during robot‐assisted laparoscopic radical prostatectomy
Authors: Yong Daniel Z. , Tsivian Matvey , Zilberman Dorit E. , Ferrandino Michael N. , Mouraviev Vladimir , Albala David M.
Published: August 2010

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

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

Robotic prostatectomy has now become the most common surgical approach in the United States for patients with prostate cancer. There is a significant learning curve for this procedure and this paper attempts to help understand what factors will make the operative times longer. Very little to date has been written on this topic.

OBJECTIVE

To determine risk factors for prolonged operative time (OT) during robot‐assisted laparoscopic radical prostatectomy (RALP). Being able to predict prolonged OT is of pivotal importance both to the physician for patient counseling and to the hospital management.

PATIENTS AND METHODS

Retrospective review of patient records undergoing RALP between 2003 and 2009 at a tertiary academic center with a structured teaching program. The following variables were recorded: age, race, body‐mass index (BMI), previous abdominal surgery (yes/no), nerve‐sparing technique (yes/no), lymph nodes dissection (yes/no), pathological stage (organ‐confined versus non), cumulative surgical experience with RALP (expressed as number of years since introduction of RALP at our center), prostate weight and OT calculated skin‐to‐skin by the anesthesiologists. Prolonged OT was defined as the upper quintile (20%) according to the distribution. Multivariate regression model was generated to assess potential predictors of prolonged OT.

RESULTS

A total of 523 records were retrieved. Caucasians accounted for 77.8% of the cohort. Median age was 60.3 years (interquartile range, IQR, 55.0–64.6 years), median BMI 28.1 (25.8–30.7 kg/m2), prostate weight 46.0 g (37.0–57.8 g). Eighty‐six (16.4%) patients had previous abdominal surgery, lymph nodes dissection was performed in 341 (65.2%) and nerve‐sparing technique was done in 310 (59.3%) cases. Median OT was 175 min (IQR 146–220 min). Prolonged OT was set at >230 min, thereby 105 (20.1%) records were classified as such. On multivariate analysis, cumulative surgical experience with RALP (P < 0.001), nerve sparing (P= 0.023) and prostate weight (P < 0.001) were independent predictors of prolonged OT.

CONCLUSIONS

Larger prostates are associated with longer OT and this effect is maintained independently of cumulative robotic experience that represents another independent factor in determining OT.
Trospium chloride once‐daily extended release is efficacious and tolerated in elderly subjects (aged ≥75 years) with overactive bladder syndrome
Authors: Sand Peter K. , Johnson II Theodore M. , Rovner Eric S. , Ellsworth Pamela I. , Oefelein Michael G. , Staskin David R.
Published: August 2010

Study Type – Therapy (data synthesis from RCTs) Level of Evidence 1c

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

Treatment of overactive bladder syndrome (OAB) in elderly individuals presents several potential clinical challenges, which include alterations in sleep and cognition, multiple co‐morbidities, polypharmacy, and frailty syndrome. A broad consensus of clinical opinion exists that the addition of an overactive bladder medication may amplify these clinical challenges via the antimuscarinic effects on cognition and the potential for drug‐drug interactions.

The quaternary amine structure of trospium chloride provides protection against penetration of the blood‐brain barrier, and minimizes the potential for metabolic drug‐drug interactions. This study globally supports the efficacy and safety of Sanctura XR (extended release trospium chloride) in a population of elderly patients (75 years or older) with overactive bladder syndrome and multiple co‐morbidities at risk for drug‐drug interactions, impaired cognition and frailty syndrome.

OBJECTIVE

To evaluate the safety and efficacy of once‐daily trospium chloride extended release (ER) in overactive bladder syndrome (OAB) in subjects aged ≥75 years.

SUBJECTS AND METHODS

The analysis included subjects ≥75 years of age with OAB.

A subgroup analysis of pooled data was performed for subjects aged ≥75 years from two randomized, double‐blind, multicenter studies of subjects with OAB receiving once‐daily trospium 60 mg extended release (ER) or placebo for 12 weeks, followed by 9‐month open‐label extension periods during which all subjects received trospium ER. A total of 143 of the 1165 subjects from two phase III registration trials who were aged ≥75 years (85 trospium ER, 58 placebo; mean age 79 years and ranging up to 90 years; 73% female) were evaluated.

Dual primary efficacy variables were the changes from baseline in the average number of toilet voids per day and urge urinary incontinence episodes per day.

RESULTS

At week 12 of the double‐blind period, trospium ER produced greater improvements from baseline than placebo in voiding diary parameters, OAB Patient Global Assessment, and quality of life.

Efficacy and tolerability persisted among subjects receiving open‐label trospium ER for up to 1 year.

CONCLUSIONS

Once‐daily trospium chloride 60 mg ER demonstrated efficacy vs placebo and was tolerated in subjects aged ≥75 years with OAB.

For subjects who continued into the open‐label treatment period, efficacy and tolerability were observed for up to 1 year.
Reduced bladder tumour recurrence rate associated with narrow‐band imaging surveillance cystoscopy
Authors: Herr Harry W. , Donat Sherri M.
Published: August 2010

Study Type – Diagnostic (exploratory cohort)  Level of Evidence 2b

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

Narrow‐band imaging cystoscopy is a new imaging modality developed to enhance conventional standard white‐light cystoscopy to evaluate bladder tumors. The current paper suggests that fulguration of low‐risk papillary bladder tumours using NBI cystoscopy results in fewer subsequent tumour recurrences than fulguration using standard cystoscopy. How, or if, NBI cystoscopy will become integrated into routine management of non‐invasive bladder tumours remains for further study.

OBJECTIVE

To evaluate frequency of recurrences among patients with papillary bladder tumours followed sequentially with conventional white‐light (WLI) cystoscopy and narrow‐band imaging (NBI) cystoscopy.

PATIENTS AND METHODS

A cohort of 126 patients with recurrent low‐grade papillary bladder tumours were followed every 6 months for 3 years by conventional WLI cystoscopy, and then over the next 3 consecutive years by NBI cystoscopy.

Recurrent tumours detected were treated by outpatient fulguration or transurethral resection.

We compared the tumour recurrence rate during follow‐up with WLI and NBI cystoscopy, using patients as their own controls.

RESULTS

Of the 126 patients, 94% had tumour recurrences during WLI cystoscopy vs 62% during NBI cystoscopy.

The mean number of recurrent tumours was 5.2 with WLI cystoscopy vs 2.8 with NBI cystoscopy, and the median recurrence‐free survival time was 13 vs 29 months (P= 0.001).

CONCLUSION

Compared with follow‐up with WLI cystoscopy, NBI cystoscopy was associated with fewer patients having tumour recurrences, fewer numbers of recurrent tumours, and a longer recurrence‐free survival time.
Regression to normoglycaemia by fenofibrate in pre‐diabetic subjects complicated with hypertriglyceridaemia: a prospective randomized controlled trial
Authors: Wan Q. , Wang F. , Wang F. , Guan Q. , Liu Y. , Wang C. , Feng L. , Gao G. , Gao L. , Zhao J.
Published: August 2010

Diabet. Med. 27, 1312–1317 (2010)

Aims  Lipotoxicity has recently been shown to be an important risk factor underlying the pathogenesis of pre‐diabetes. However, clinical evidence supporting the treatment of pre‐diabetes by improving lipotoxicity is lacking. Here, we conducted an open‐label, randomized, controlled trial to investigate whether fenofibrate, the widely used hypolipidaemic agent, might benefit pre‐diabetes, with metfomin and diet control, the recommended intervention methods, as positive controls.

Methods  Newly diagnosed pre‐diabetes patients (n = 120) with hypertriglyceridaemia (plasma triglyceride levels between 1.8 and 4.5 mmol/l) were randomly assigned by computer‐generated randomization sequence to either control group (no intervention), fenofibrate group (200 mg once a day), metformin group (500 mg three times a day) or diet‐controlled group (diet recommendation). Plasma biochemistry examination was performed every 2 months. The primary endpoint was the outcome of the natural course of pre‐diabetes, evaluated by oral glucose tolerance test after 6‐month follow‐up.

Results  Twenty subjects in the fenofibrate group, 24 subjects in the metformin group and 25 subjects in both the diet‐controlled group and the control group finished the trial. Fenofibrate, metformin and diet control had protective effects on hypertriglyceridaemic pre‐diabetes, evidenced by 53.3, 70 and 30% participants regressed to normoglycaemia, respectively. The effects of fenofibrate and metformin were comparable (P > 0.05), while diet control was less effective (P < 0.05). Liver damage occurred in six subjects in the fenofibrate group and gastrointestinal symptoms occurred in four subjects in the metformin group. No serious adverse events occurred.

Conclusion  Controlling lipotoxicity by fenofibrate could effectively ameliorate the natural course of hypertriglyceridaemic pre‐diabetes.
Improvement in pregnancy‐related outcomes in the offspring of diabetic mothers in Bavaria, Germany, during 1987–2007
Authors: Beyerlein A. , Von Kries R. , Hummel M. , Lack N. , Schiessl B. , Giani G. , Icks A.
Published: August 2010

Diabet. Med. 27, 1379–1384 (2010)

Aims  Reducing the risk of adverse outcomes in diabetic pregnancies to the level of risk in non‐diabetic pregnancies is a major goal in diabetes care. So far there have not been any data to show whether progress is being made towards this goal.

Methods  We used population‐based data on 2 292 053 deliveries between 1987 and 2007 in Bavaria, Germany, to assess temporal trends for stillbirths, early neonatal mortality, preterm delivery, macrosomia and malformations in consecutive 7 year intervals. We estimated prevalences and prevalence odds ratios for these outcomes. For stillbirth, as the most severe adverse outcome, we assessed the contributions of several predictors using multiple regression models.

Results  With the exception of early neonatal deaths, the risks for all outcomes were significantly increased in the offspring of mothers with pregestational diabetes in all three time periods (e.g. odds ratio for stillbirths in diabetic compared with non‐diabetic mothers in 2001–2007, 1.89; 95% confidence interval 1.24, 2.87). However, the prevalence of stillbirths, premature delivery and macrosomia decreased over time in diabetic mothers (e.g. 1.71% for stillbirths in 1987–1993 and 0.66% in 2001–2007), as did the respective odds ratios. Maternal smoking, hypertension and substandard utilization of antenatal care were significantly associated with stillbirths in diabetic women.

Conclusions  Although the risk of adverse pregnancy outcomes is still increased in diabetic mothers, considerable improvement has been achieved. We hypothesize that this improvement is possibly due to improved diabetes care.
Long‐term effects of a home‐visiting intervention for depressed mothers and their infants
Authors: Kersten‐Alvarez Laura E. , Hosman Clemens M.H. , Riksen‐Walraven J. Marianne , Van Doesum Karin T.M. , Hoefnagels Cees
Published: August 2010

Background:  Whereas preventive interventions for depressed mothers and their infants have yielded positive short‐term outcomes, few studies have examined their long‐term effectiveness. The present follow‐up of a randomised controlled trial (RCT) is one of the first to examine the longer‐term effects of an intervention for mothers with postpartum depression and their infants at school‐age. In early infancy, the intervention was found effective in improving mother–infant interaction and the child’s attachment to its mother.

Methods:  Twenty‐nine mother–child pairs who completed the intervention are compared with 29 untreated mother–child dyads as to the quality of maternal interactive behaviour and the child outcomes of attachment security to the mother, self‐esteem, ego‐resiliency, verbal intelligence, prosocial behaviour, school adjustment, and behaviour problems at age 5 (M = 68 months).

Results:  In the total sample no lasting treatment benefits were found, but in families reporting a higher number of stressful life events, children in the intervention group had fewer externalising behaviour problems as rated by their mothers than children in the control group.

Conclusions:  In the context of multiple stressful life events the intervention served as a buffer by preventing the development of externalising problems in the child. The results warrant cautious interpretation because of the relatively small sample size and differential attrition revealing the mothers that completed the follow‐up assessment to have improved less on maternal sensitivity following the intervention than the mothers who did not participate in the follow‐up.
Report on accreditation learning sets in the West Midlands Region of the NHS
Authors: Giles Gwen
Published: August 2010

This article reports on the evaluation of the first year of a project, which utilized learning sets to support librarians undergoing the accreditation process, in the health libraries in the West Midlands region of the NHS.

The West Midlands Health region is divided up into education consortia patches. Each group of patch librarians was allocated a local accreditation facilitator. The groups met regularly to discuss problems and progress relating to their library’s accreditation.

The results of the evaluation suggest that this is a valuable approach to use. The recommendations state that regular, frequent meetings are needed. Extra training and guidance would help the facilitators to be more effective in their role.
Improving the provision of traditional health knowledge for rural communities in Ghana*
Authors: Yeboah Theophilus
Published: August 2010

In Ghana many rural illiterate people practise traditional medicine and spread their knowledge through oral communication among themselves. This paper observes that traditional health information which freely circulates, and is actively disseminated by healers in rural communities greatly contributes to the knowledge for preparing home remedies and other traditional interventions. Oral communication can give rise to inaccurate and even dangerous information where charlatans can penetrate and operate within the health system. The Danfa project, which involved verbal teaching of modern health techniques to illiterate herbalists, and educating villagers about improved traditional medical practices, is described as a success story of information provision for illiterates. The experience is applied to propose the modification of some training programmes under the Ministry of Health to produce traditional health care information providers. Repackaged information and the public media are recommended as the most effective method of transferring knowledge to those unable to read.
Creating books for the National electronic Library for Health: expected barriers and useful lessons
Authors: O’Brien Claire
Published: August 2010

The National electronic Library for Health (NeLH) is now taking shape, as the virtual branch libraries begin to accumulate ‘books’, among their resources. In the Primary Care branch (http://www.nelh‐pc.nhs.uk), one of the first available books was the Statement of Fees and Allowances (otherwise known as the Red Book). While being held up as an example of what the NeLH can offer, this book and the story of its transformation from paper to Internet format is a powerful example of how much further the National Health Service (NHS) must go before it can claim to be fully exploiting the benefits of information technology (IT).

This article refers to the author’s experience in producing electronic books for primary care using WaX software, and an example of a process change from paper to screen that was managed within a university administrative office. The author suggests that to reap optimal benefits from IT, the NeLH and its collaborators must address the fundamental issues of people and the paper‐based processes used by information providers. The NeLH must work with both NHS IT trainers and information providers in a three‐way collaboration involving key people and processes, to achieve the efficient production of an updateable and user‐friendly library of electronic books.
Chronic exposure to nicotine and saquinavir decreases endothelial Notch‐4 expression and disrupts blood‐brain barrier integrity
Authors: Manda Vamshi K. , Mittapalli Rajendar K. , Geldenhuys Werner J. , Lockman Paul R.
Published: August 2010

J. Neurochem. (2010) 115, 515–525.

Since the advent of HAART, there have been substantial improvements in HIV patient survival; however, the prevalence of HIV associated dementia has increased. Importantly, HIV positive individuals who smoke progress to HIV associated neurological conditions faster than those who do not. Recent in vitro data have shown that pharmacological levels of saquinavir causes endothelial oxidative stress and significantly decreases Notch‐4 expression, a primary protein involved in maintaining stability of blood‐brain barrier (BBB) endothelium. This is concerning as nicotine can also generate reactive oxygen species in endothelium. It is largely unknown if pharmacological doses of these drugs can cause a similar in vivo down‐regulation of Notch‐4 and if there is a concurrent destabilization of the integrity of the BBB. The data herein show: (i) nicotine and protease inhibitors cause an additive oxidative stress burden in endothelium; (ii) that the integrity of the BBB is disrupted after concurrent chronic nicotine and protease inhibitor administration; and (iii) that BBB endothelial dysfunction is correlated with a decrease in Notch‐4 and ZO‐1 expression. Considering the high prevalence of smoking in the HIV infected population (3‐ to 4‐fold higher than in the general population) this data must be followed up to determine if all protease inhibitors cause a similar BBB disruption or if there is a safer alternative. In addition, this data may suggest that the induced BBB disruption may allow foreign molecules to gain access to brain and be a contributing factor to the slow progression of HIV associated dementia.
Care managers’ view of family influence on needs assessment of older people
Authors: Janlöv Ann‐Christin , Hallberg Ingalill Rahm , Petersson Kerstin
Published: August 2010

Scand J Caring Sci; 2011; 25; 243–252 Care managers’ view of family influence on needs assessment of older people

Research has shown that families experience poor involvement in needs assessment of older people while little is known about municipal care managers’ views of family participation. The aim was to explore how municipal care managers view families’ participation in and influence on needs assessment of older people receiving public home help. Individual interviews (n = 26) were conducted with care managers (n = 5) about their previously conducted needs assessments (n = 5–6). As a complement, a focus group interview with care managers (n = 9) from nine different municipalities was conducted. All interviews were analysed using a qualitative content analysis. The results revealed the overarching category, ‘Having to establish boundaries towards family influence and at the same time use them as a resource’, which encompassed five principal categories. How family participation was viewed and handled during the needs assessment process seemed determined by the way care managers set boundaries for their professional responsibility. Their views revealed both distancing and strengthening attitudes. The distancing attitude dominated, in particular towards family members who were not perceived as having any legal rights to be considered, even though their participation was an important resource. To follow legislation and municipal guidelines of allocation of public home help to avoid reprimands caused a need for self‐protection. The care managers seemed pressed by demands from organizations and families, and in this competition, the family lost out. Adherence to organizational developed patterns of handling legislation and guidelines were prioritized. Because family members often are older and assist in providing care, family participation in the needs assessment of older help recipients needs further societal support.
Relationships among oxidative status, breeding conditions and life‐history traits in free‐living Great Tits Parus major and Common Starlings Sturnus vulgaris
Authors: COSTANTINI DAVID , CARELLO LIVIA , FANFANI ALBERTO
Published: August 2010

The interest shown by ecologists in antioxidants and oxidative stress as potential modulators of life‐history trade‐offs has expanded greatly in recent years. However, we still know very little about natural variation in oxidative damage and antioxidant capacity in free‐living animals. In this study, we describe the natural variation in three components of oxidative balance in nestlings and breeding females in free‐living Great Tits Parus major and Common Starlings Sturnus vulgaris in central Italy, and relate these to breeding conditions and life‐history traits. Our results suggest that there are associations among oxidative physiology, reproductive activity, growth pattern and season in wild birds, but that the nature of these associations might be species‐specific rather than general across species.
Health‐Led Interventions in the Early Years to Enhance Infant and Maternal Mental Health: A Review of Reviews
Authors: Barlow Jane , McMillan Anita Schrader , Kirkpatrick Sue , Ghate Deborah , Barnes Jacqueline , Smith Marjorie
Published: August 2010

Background:  Increasing recognition of the importance of maternal mental health and early parenting in optimising the later mental health of the child has given rise to new ways of working during the perinatal period.

Aims:  The objective of this review is to identify effective health‐led interventions to support parents, parenting and the parent‐infant relationship during the perinatal period,1 and beyond.

Method:  A systematic search of key electronic databases was undertaken to identify secondary and primary sources of data addressing the research question. Twenty‐four reviews addressed the effectiveness of interventions delivered during the postnatal period in promoting closeness and sensitive parenting, infant sensory and perceptual capabilities, and positive parenting, and in addressing infant regulatory problems, maternal mental health problems, and parent‐infant relationship problems.

Conclusions:  A number of methods of working are recommended as part of a model of progressive‐universalism beginning ante‐natally and continuing through the first two post‐natal years, and beyond. The implications for universal, targeted and specialist healthcare services are explored, alongside the role and contribution of CAMHS practitioners.