bluuebunny/crossref_metadata_2025 huggingface dataset:
An endless debate: the sense and nonsense of budgeting
Authors: Rickards Robert C.
Published: September 2008

Purpose

This article aims to summarize several studies about how businesses currently practice budgeting in Western and Central Europe. While analyzing these studies in the larger context of the ongoing debate about budgeting's importance, it provides conceptual linkages between them and additional insights into their findings.

Design/methodology/approach

The reported studies employ survey research, sometimes with panels of self‐selected interviewees within a single country and sometimes with samples of SMEs across multiple countries.

Findings

Recent survey results continue to show managers complaining about the wastefulness of preparing budgets, while steadfastly believing they are indispensable. Among others, Horváth and Partners accordingly advocate “advanced budgeting” concepts to modernize both planning and budgeting processes. CFO‐panel participants generally uphold the advocates' position except in the crucial area of available IT‐support. However, as explained next, connecting operational and strategic planning is primarily a conceptual rather than a hard‐ or software problem. In the European automobile suppliers' industry, controlling services therefore generally still rely on a small set of well‐understood standard tools.

Practical implications

Firms not using these standard tools in their operational controlling risk falling behind the competition. In order to close the gap between the perceived importance of and satisfaction with more complex instruments, however, several tools require improvement or simplification as well as conceptual clarity about how to employ them.

Originality/value

This article presents results from diverse studies on budgeting as currently practiced, reform concepts, and obstacles to their implementation. In doing so, it discusses how they relate to one another and what their significance is for both theory and practice.
The empowered customer and the digital myopia
Authors: Constantinides Efthymios
Published: September 2008

Purpose

Various developments in the marketing terrain in combination with the emergence of a new breed of information and communication technologies have been constantly transforming market dynamics and customer behavior over the last two decades. The purpose of this article is to explain the reasons behind one of these changes – the customer empowerment – and to discuss the implications of this development for the marketing practice.

Design/methodology/approach

The article analyses the background of customer empowerment on the basis of literature review, anecdotal evidence and underlines the role of the internet as a tool of customer empowerment. The paper attempts to identify the main issues around this new subject and often makes use of practical cases. The scope of the paper is to underline the need for marketing strategists to approach their customers and markets in new ways.

Findings

The old type push marketing approaches based on mass media and massively produced products become less and less effective.

Practical implications

Marketers must realize that the empowered consumer is now in control of the message and the communication process. He is able to ignore the marketer and make decisions based on high quality information, many alternatives and new forms of transactions. Reaching this consumer requires a trust‐based approach (customer advocacy) based on openness and a real effort to help the customer achieve his objectives.

Originality/value

The paper summarizes several ideas and demonstrates with many practical examples the new market realities. The paper argues that strategists and marketers failing to understand the impact of the internet and the consequences of customer empowerment on their markets suffer from “Digital Myopia” that could endanger the survival of their business in the future.
Positions and positioning: strategy simply stated
Authors: McKechnie Donelda S. , Grant Jim , Katsioloudes Marios
Published: September 2008

Purpose

The purpose of this paper is to focus on the four strategy tools of positions and positioning: leader, challenger, follower and niche. It suggests that it is important for managers to understand where their business fits in the market, vis‐à‐vis the competition. Without this knowledge, it is difficult to identify a differential advantage that will give the necessary competitive edge to attract the target customer.

Design/methodology/approach

This paper reviews positioning using a back to basics explanation. A simply constructed matrix – represented by variables: company‐focused or competition‐focused and pushes the boundaries or stays within boundaries – illustrates business philosophy in the marketplace.

Findings

Airlines positioned in the United Arab Emirates (UAE) aviation industry exemplify a market environment with companies holding distinctive positions. Emirates Airline is the leader, Etihad Airways is the challenger, Gulf Air is the follower and Air Arabia is successfully established in the niche position. A summary explanation of business operations for each airline supports the discussion.

Practical implications

Marketing practice aligned with textbook theory is identified in the growth‐oriented UAE aviation industry. In real‐world terms, four airlines distinctively hold each of the four positions while a fifth airline is making inroads into the regional market and appears to be challenging the current challenger.

Originality/value

The strategy simply stated in this paper suggests that the market environment is dynamic and constant assessment is necessary. Managers seeking to maximize differential advantage vis‐à‐vis the competition should consider using more than one strategy tool particularly if it contributes to a manager's ability to understand the market environment.
China branding: opportunities and challenges
Authors: Roll Martin
Published: September 2008

Purpose

The purpose of this article is to look at the challenges and opportunities in building Chinese brands.

Design/methodology/approach

The author provides an introduction to branding, describes its strategic importance and analyses the brand challenges for Chinese companies.

Findings

This rise of China has implications for branding and some of the new brands will arise from China over the next 10‐15 years.

Practical implications

The most important factor for building strong Asian brands is the mindset of the Asian CEO and boardroom. Branding is a boardroom discipline and successful brands can be built only when the boardroom, led by the chairman and the CEO, understands, appreciates and commits to treating branding as a strategic discipline and devotes the resources at the company's disposal to support the brands in a continuous manner.

Originality/value

Asian brands and the implications of these new brands are generally undervalued by most global businesses. This paper examines what is next from Asia.
Entering the South Korean market: a marketing‐planning process model for marketers based in overseas companies
Authors: Lee Yang‐Im , Trim Peter R.J.
Published: September 2008

Purpose

The purpose of this paper is to outline how a three phase marketing planning process model can assist marketing managers based in overseas companies to formulate a strategy for entering the South Korean market.

Design/methodology/approach

A review of relevant literature and the development of a conceptual marketing planning process model.

Findings

South Korea has undergone rapid transformation in the past twenty years and South Korean electronics companies have established themselves as global companies. Overseas companies can operate in the South Korean market provided that they form partnership arrangements with domestic companies. Prior to attempting to enter the South Korean market, managers in overseas companies should study how South Korean companies implement their global marketing strategy(ies). This should provide them with an understanding of the Korean organizational value system and prepare them to enter into partnership arrangements based on mutuality.

Research limitations/implications

Managers based in overseas companies need to understand how facilitating technology such as the internet is helping to transform the retailing sector in South Korea.

Practical implications

There are a number of problems associated with the retail distribution system in South Korea and senior managers based in overseas companies need to have an appreciation of how South Korean companies compete and how they respond to government initiatives/pressure.

Originality/value

The model outlined in the paper should allow marketing managers in overseas companies to implement the strategic marketing approach and select the most appropriate partner organization to do business with.
Metaphors in strategy
Authors: Etzold Veit , Buswick Ted
Published: September 2008

Purpose

This article seeks to distinguish between rhetorical and cognitive metaphors and argues in favor of “pushing past the fault line.”.

Design/methodology/approach

Too much of strategy is locked in a toolbox approach that often makes solutions appear much easier than they are. One way of broadening the way one thinks about strategy is to bridge the gap between business and other disciplines. Ideas from the world outside business can be made useful for the strategist via metaphorical associations. This paper discusses William the Conqueror and Madonna as strong candidates for useful metaphors.

Findings

Metaphors are a powerful tool in business to understand partners, customers, and market participants.

Practical implications

The goal is to encourage metaphorical exploration, both in thought and practical use, by the readers.

Originality/value

It furthers the concept of interdisciplinary thinking by offering specific ways to use metaphors in business.
Efficiency of ellagic acid and arbutin in melasma: A randomized, prospective, open‐label study
Authors: ERTAM Ilgen , MUTLU Basak , UNAL Idil , ALPER Sibel , KIVÇAK Bijen , OZER Ozgen
Published: September 2008

The aim of this study was to compare the effectiveness of gel formulations containing arbutin, synthetic ellagic acid and plant extracts that contain ellagic acid, on patients with melasma. Thirty patients who applied to Ege University Medical Faculty, Department of Dermatology, were included in the study. A signed consent was obtained from each patient prior to study. Patients whose type of melasma was determined via Wood's lamp were randomized to groups of arbutin, synthetic ellagic acid and plant extract containing natural ellagic acid. The pigment density of patients was evaluated via Mexameter before and after the treatment. The approval of the Institutional Ethics Committee of Ege University was obtained before the study. Wilcoxon and Kruskal–Wallis tests were used in the statistical analysis. Nine of 10 patients, for whom synthetic ellagic acid was started, completed the study. A decrease in the level of melanin was determined in eight of these nine patients (P = 0.038). A significant decrease in the level of melanin was also determined in all 10 patients who used plant extract containing ellagic acid (P = 0.05). A significant response was obtained from all of 10 patients who used arbutin. The difference between pre‐ and post‐treatment levels of melanin was statistically significant (P = 0.05). Formulations prepared with plant extracts containing ellagic acid was found effective on melasma, similar to the formulations containing synthetic ellagic acid and arbutin. This material that is not yet being used widespread commercially on melasma could be an effective alternative for treatment of melasma.
Clinical analyses of atopic dermatitis in the aged
Authors: TANEI Ryoji , KATSUOKA Kensei
Published: September 2008

The aim of the present study was to analyze the characteristics of atopic dermatitis (AD) in the senile phase. Subjects were comprised of 16 patients investigated for clinical features, serum immunoglobulin (Ig)E levels and skin manifestations. Mean age was 76.9 ± 6.2 years (range, 68–87), with a man : woman ratio of 3:1. Mean age at onset was 67.7 ± 15.7 years. Eight patients (50%) had personal histories of chronic eczema until the young adult phase and three patients (18.8%) showed the classic course of child AD. Eczematous erythroderma in 10 patients (62.5%) and unclassified chronic eczema in five patients (31.3%) were the predominant clinical presentations. Mean total IgE level in sera of the 16 patients was 8810 ± 13 511 IU/mL (range, 5–53 605). Fourteen patients showed positive results for antigen‐specific IgE antibodies, and the mean total IgE level for these patients was 10 056 ± 14 044 IU/mL. Specific IgE to the main antigen, Dermatophagoides farinae, was observed in 12 patients (85.7%), representing the principal antibody in eight patients (57.1%). Eczematous dermatitis manifested predominantly in the face and neck, trunk and extensor and flexure sites of extremities, and less commonly in the antecubital and popliteal areas. Other stigmata of AD were observed as follows: red face in 10 patients (62.5%); Hertoghe's sign in six (37.5%); goose‐skin in four (25%); facial pallor in three (18.8%); and dirty neck in one (6.3%). These results indicate that senile‐type AD represents a characteristic subgroup of AD that appears in the last stage of life in AD patients.
Efficacy of infliximab for severe recalcitrant psoriasis after 6 weeks of treatment
Authors: DE OLIVEIRA Juliana Pedroso , LEVY Annabelle , MOREL Patrice , GUIBAL Fabien
Published: September 2008

Infliximab treatment has been shown to be effective for moderate‐to‐severe psoriasis in several large clinical trials. Nonetheless, experience with this new treatment is still needed to evaluate its efficacy and tolerance in everyday practice. In this follow‐up study, we report our experience with infliximab for recalcitrant psoriasis. Nineteen patients with recalcitrant psoriasis were treated between July 2004 and December 2006 with 5 mg/kg infliximab i.v. at weeks 0, 2 and 6 followed by maintenance every 8 weeks. In three patients resistant to treatment, methotrexate was added at a 15–25 mg dose weekly after the sixth week of infliximab therapy. Pretreatment evaluations included chest X‐ray, tuberculin test (5 units), full blood count, kidney and liver function tests, antinuclear antibodies and patient weight. Response to treatment, using the Psoriasis Area and Severity Index (PASI) score, and adverse effects were prospectively assessed at weeks 0, 6 and 22. At week 6, after only two infusions, 78.9% (15/19) of patients showed at least 75% improvement in baseline PASI (PASI 75). At week 22, 73.6% (14/19) patients had reached PASI 75. Three patients had a relapse. Four developed adverse effects that required suspension of infliximab therapy. No tuberculosis or lymphoproliferative disease was observed. Four patients (21%) showed apparition of positive antinuclear antibody during the course of treatment and 57.8% (11/19) of patients showed an increase in weight at week 22. Our experience shows that infliximab is a very rapidly effective treatment of severe, treatment‐resistant psoriasis as soon as the sixth week of treatment.
Uncommon presentation of mycosis fungoides: Eyelid margin involvement
Authors: GÜL Ülker , SOYLU Seçil , ASLAN Erkan , YAZAR Zeliha , DEMİRİZ Murat
Published: September 2008

Mycosis fungoides is a cutaneous T‐cell lymphoma that has been rarely reported to involve ocular structures. A 33‐year‐old woman who had received therapy for mycosis fungoides on the trunk for 11 years, presented to our clinic with new plaques and tumors on her eyebrows and eyelid margin, and alopecia of her eyelashes and eyebrow. The histopathological examinations supported the diagnosis of mycosis fungoides. There was no intraocular involvement with tumor. The mycosis fungoides was of stage II B, and the patient was referred to medical oncology and radiation oncology clinics for treatment. She was placed on a radiotherapy schedule. The involvement of mycosis fungoides in the ocular area is rare in the published work. The importance of eye involvement is being seen in advanced cases, and there is a possible association between mycosis fungoides and poor prognosis by being an indicator of systemic involvement.
Ecthyma gangrenosum without pseudomonas septicemia in a kidney transplant recipient
Authors: NAKAI Noriaki , TAKENAKA Hideya , KISHIMOTO Saburo
Published: September 2008

We report a case of ecthyma gangrenosum (EG) without septicemia in a renal transplant recipient who presented with a 1‐month history of painful ulcers, vesicles and bullae on the face and extremities. Histopathological findings revealed subepidermal bullae covered by a necrotic epidermis containing an infiltrate of a moderate number of lymphocytes, neutrophils and necrotic collagen. Many dilated and congested capillaries were also present due to thrombi beneath the bullae, with alteration of collagen fibers through the superficial to middle dermis with some infiltrate. A culture from the ulcers revealed the presence of Pseudomonas aeruginosa and methicillin‐resistant Staphylococcus aureus, whereas the results of repeated blood cultures were negative. The ulcers were completely cured by early appropriate i.v. antibiotic therapy with granulocyte colony‐stimulating factor, without progression to EG with septicemia. An immunocompromised state due to immunosuppressive drugs, in addition to diabetes mellitus, hypogammaglobulinemia and hypoproteinemia, may have caused the EG and herpes zoster may have exacerbated the condition.
Tinea corporis with acute inflammation caused by Trichophyton tonsurans
Authors: OHNO Sayoko , TANABE Hiroshi , KAWASAKI Masako , HORIGUCHI Yuji
Published: September 2008

A 13‐year‐old Japanese boy presented with acute skin inflammation on the extremities. He belonged to a judo club of a junior high school in which club tinea capitis and tinea corporis seemed to be prevalent. Vesicles and pustules appeared on his right forearm and right leg. They increased in numbers and formed annular lesions. Pruritic erythema appeared surrounding these lesions. Direct microscopic examination of the lesions detected hyphae, and culture for the fungi yielded yellowish colonies. The result of culture from pustules revealed Staphylococcus aureus. At first, a topical antifungal drug and systemic antibiotics seemed to cure annular lesions, but pustules arose again. A large surrounding erythema was cured by topical treatment with a steroid agent. A biopsy specimen from a pustule showed hyphae of fungi within a hair shaft and in the bulb. The restriction fragment length polymorphism in the internal transcribed spacer regions of the ribosomal gene (polymerase chain reaction restriction fragment length polymorphism) revealed a banding pattern compatible with Trichophyton tonsurans. Treatment with systemic itraconazole was begun and lesions disappeared immediately. Systemic antifungal therapy was needed in our case. Tinea corporis with inflammation necessitates systemic antifungal therapy.
Gangrenous staphylococcal infections localized on the lesions of acquired reactive perforating collagenosis
Authors: KASHINO Kaori , SENOO Akemi , YAMASAKI Osamu , IWATSUKI Keiji
Published: September 2008

We report a 78‐year‐old man with diabetic nephropathy, who presented with acquired reactive perforating collagenosis, followed by gangrenous infections localized on the lesions. Histopathological findings revealed a feature of transepidermal elimination of degenerated collagen bundles associated with infiltrates of neutrophils. Staphylococcus aureus was isolated from the necrotic tissue. The infection was successfully treated with systemic antibiotics and debridement. We believe that the presence of necrotic plug in the lesions and microangiopathy due to diabetes mellitus may provide a susceptible milieu for bacterial inoculation.
Review article: the therapeutic and prognostic benefit of portal pressure reduction in cirrhosis
Authors: TRIANTOS C. K. , NIKOLOPOULOU V. , BURROUGHS A. K.
Published: September 2008

Background  Hepatic venous pressure gradient (HVPG) measurement is not a routinely used technique, despite its therapeutic and prognostic value.

Aim  To review the role of HVPG from published literature.

Methods  Systematic literature review.

Results  In acute variceal bleeding, HVPG is prognostic identifying ‘difficult to treat’ group, which now has defined clinical correlations. In secondary prevention of portal hypertensive bleeding, a reduction to ≤12 mmHg confers near complete protection against rebleeding. The target of ≥20% HVPG reduction from baseline needs prospective assessment to test a change of therapy, if no reduction occurs. The acute HVPG response to beta‐blockade needs further assessment. In primary prevention, the cost‐effectiveness of HVPG measurement is not favourable given the efficacy of medical therapy. In chronic liver disease, wedge hepatic venous pressure (WHVP) is prognostic for survival. Pharmacological reduction in portal pressure decreases complications and improves survival, possibly independent of a concomitant improvement in liver function. This latter requires urgent confirmation as it is clinically very relevant. HVPG monitoring can be used to assess anti‐viral therapy particularly in cirrhosis, ergonomically combined with transjugular biopsy.

Conclusions  The prognostic and therapeutic value of HVPG is established beyond portal hypertensive bleeding for which there are some clinical surrogates. HVPG measurement should now be part of everyday clinical practice.
Long‐term outcome of adalimumab therapy for ulcerative colitis with intolerance or lost response to infliximab: a single‐centre experience
Authors: OUSSALAH A. , LACLOTTE C. , CHEVAUX J.‐B. , BENSENANE M. , BABOURI A. , SERRE A.‐A. , BOUCEKKINE T. , ROBLIN X. , BIGARD M.‐A. , PEYRIN‐BIROULET L.
Published: September 2008

Background  Adalimumab may be effective in inducing remission in patients with mild‐to‐moderate ulcerative colitis who had secondary failure to infliximab.

Aim  To evaluate long‐term efficacy and safety of adalimumab in patients with ulcerative colitis who previously responded to infliximab, and then lost response or became intolerant.

Methods  We report our single‐centre experience in 13 patients. The patients received a loading dose of 160 mg of adalimumab subcutaneously in week 0, followed by 80 mg at week 2 and then 40 mg every other week starting at week 4. The primary efficacy measure was the proportion of patients on adalimumab therapy during the study.

Results  Median duration of follow‐up was 42 weeks (range, 10–100). The mean number of adalimumab infusions was 21 (range, 5–50). The probability of maintaining adalimumab was 92.3%, 84.6%, 60.6% and 32.5% at 1, 3, 6 and 23 months respectively. Six of 13 patients (46.2%) underwent colectomy during the study. No serious toxicities occurred in the study.

Conclusion Adalimumab is well‐tolerated and may be effective in maintaining clinical remission in a subgroup of patients with ulcerative colitis and lost response or intolerance to infliximab, potentially avoiding colectomy in about half of the patients.
Interaction of ribavirin with azathioprine metabolism potentially induces myelosuppression
Authors: PEYRIN‐BIROULET L. , CADRANEL J.‐F. , NOUSBAUM J.‐B. , OUSSALAH A. , SEDDIK M. , CANVA V. , CORTOT A. , SOGNI P. , GUEANT J.‐L , BIGARD M.‐A. , ROBLIN X. , BRONOWICKI J.‐P.
Published: September 2008

Background  The interaction of ribavirin, an inosine monophosphate dehydrogenase inhibitor, with azathioprine metabolism, potentially leading to myelotoxicity, remains unexplored.

Aim  To underline the interaction of ribavirin, an inosine monophosphate dehydrogenase inhibitor, with azathioprine metabolism, potentially leading to myelotoxicity.

Methods  The medical records of eight patients who developed severe pancytopenia following concomitant use of azathioprine and ribavirin were retrospectively reviewed.

Results  Bone marrow suppression reached nadir after a mean interval of 4.6 ± 1.6 weeks following HCV therapy initiation in seven patients. At the time of pancytopenia, the mean platelet count was 69.75 ± 82.8 × 10−3/mm3, mean haemoglobin level 7.75 ± 1.3 g/dL and mean neutrophil count 0.45 ± 0.26 × 10−3/mm3. All patients had normal thiopurine methyltransferase genotype. In two patients, a prospective monitoring of azathioprine metabolites was available. Myelotoxicity was accompanied by elevated total methylated metabolite levels (16 500 and 15 000 pmol/8 × 108 erythrocytes) with a concomitant decrease in 6‐tioguanine nucleotide levels; 1 month after azathioprine, pegylated interferon alfa and ribavirin were discontinued and full blood count returned to normal in both patients. No haematological toxicity occurred after the reintroduction of peginterferon plus ribarivin or azathioprine alone in eight patients.

Conclusion  Collectively, the benefit/risk ratio favours avoidance of inosine monophosphate dehydrogenase inhibitors in purine analogue‐treated patients with normal thiopurine methyltransferase activity, a situation frequently encountered in clinical practice.
Fluctuation of gastrointestinal symptoms in the community: a 10‐year longitudinal follow‐up study
Authors: FORD A. C. , FORMAN D. , BAILEY A. G. , AXON A. T. R. , MOAYYEDI P.
Published: September 2008

Background  There are few studies examining the stability of gastrointestinal symptoms during prolonged periods of follow‐up.

Aim  To examine this issue in individuals previously recruited into a community screening programme for Helicobacter pylori providing symptom data at study entry.

Methods  All traceable participants were sent dyspepsia and IBS questionnaires by post at 10 years. Symptom subgroups were assigned at baseline and 10‐year follow‐up. Individuals symptomatic at both time points who changed subgroup were compared with those symptomatic and remaining in the same subgroup.

Results  Three‐thousand eight hundred and nineteen individuals provided data. At baseline, 2417 (63%) were asymptomatic or did not meet diagnostic criteria for a subgroup. Of these, 1648 (68%) remained asymptomatic at 10 years, whilst 769 (32%) reported symptoms. Of the 1402 individuals symptomatic at baseline, 404 (29%) remained in the same subgroup at 10 years, 603 (43%) changed subgroup and symptoms resolved or did not meet criteria for a subgroup in 395 (28%). Symptom stability was more likely in males [odds ratio (OR): 1.50; 99% confidence interval (CI): 0.97–2.31] and older subjects (OR per year: 1.09; 99% CI: 1.01–1.17).

Conclusion  Of those subjects symptomatic at baseline, almost three‐quarters remained symptomatic at 10 years, but over 40% changed symptom subgroup.
Low‐dose lactose in drugs neither increases breath hydrogen excretion nor causes gastrointestinal symptoms
Authors: MONTALTO M. , GALLO A. , SANTORO L. , D’ONOFRIO F. , CURIGLIANO V. , COVINO M. , CAMMAROTA G. , GRIECO A. , GASBARRINI A. , GASBARRINI G.
Published: September 2008

Background Despite the reported tolerance to a low dose of lactose, many lactose malabsorbers follow a rigorous lactose‐free diet also avoiding lactose‐containing drugs. Up to now, only a few case reports have described the onset of gastrointestinal symptoms in lactose malabsorbers following the ingestion of these drugs. It has been suggested that capsules/tablets contain no more than 400 mg of lactose.

Aim To evaluate breath H2 excretion and intolerance symptoms after ingestion of a capsule containing 400 mg of lactose or placebo through a randomized, cross‐over, double‐blind, controlled study.

Methods Seventy‐seven lactose maldigesters with intolerance underwent two H2 breath tests with both 400 mg of lactose and 400 mg of placebo. Gastrointestinal symptoms occurring in the 8 h following the ingestion of different substrates were evaluated by a visual‐analogue scale.

Results Ingestion of 400 mg of lactose did not cause a significant difference in breath H2 excretion or in the severity of gastrointestinal symptoms compared to placebo.

Conclusion In patients with lactase deficiency, drugs containing 400 mg of lactose or less can be used safely.
Clinical trial: effect of active lactic acid bacteria on mucosal barrier function in patients with diarrhoea‐predominant irritable bowel syndrome
Authors: ZENG J. , LI Y.‐Q. , ZUO X.‐L. , ZHEN Y.‐B. , YANG J. , LIU C.‐H.
Published: September 2008

Background  The intestinal permeability is increased in patients with diarrhoea‐predominant irritable bowel syndrome (D‐IBS).

Aim  To determine the possible efficacy of lactic acid bacteria on the increased intestinal permeability in D‐IBS.

Methods  Treatment was employed for 4 weeks in a randomized single blind placebo controlled study with 30 D‐IBS patients. Patients were given either probiotic fermented milk (Streptococcus thermophilus, Lactobacillus bulgaricus, Lactobacillus acidophilus and Bifidobacterium Longum) or milk beverage containing no bacteria. The clinical symptoms were scored and intestinal permeability was measured by a triple sugar test before and after treatment.

Results  Small bowel permeability was measured as the ratio of lactulose and mannitol recovery and colonic permeability was measured as the total mass of sucralose excretion (mg). After probiotics treatment, small bowel permeability decreased significantly from 0.038 (0.024) at baseline to 0.023 (0.020) (P = 0.004), the proportion of patients with increased small bowel permeability was lower than baseline (28.6% vs. 64.3%, P = 0.023). However, colonic permeability improved neither in the probiotics group nor in the placebo group at week 4. Treatment with probiotics significantly decreased the mean global IBS scores compared with the baseline scores (9.62 ± 1.05 vs. 7.64 ± 1.24, P < 0.001).

Conclusion  Short‐term active lactic acid bacteria treatment for D‐IBS improved mucosal barrier function.
The cost‐utility of high dose oral mesalazine for moderately active ulcerative colitis
Authors: BUCKLAND A. , BODGER K.
Published: September 2008

Background  Mesalazine (mesalamine) is standard first line treatment for moderately active ulcerative colitis (UC). Recently, doubling the mesalazine dose (Asacol 4.8 g/day) was shown to improve efficacy with no increase in adverse events. The cost‐effectiveness of this strategy remains unknown.

Aim  To assess the cost‐utility of high dose (HD) mesalazine (Asacol 4.8 g/day) compared with standard dose (SD) mesalazine (Asacol 2.4 g/day) as first line treatment for moderately active UC.

Methods  The costs and benefits associated with a treatment pathway beginning with HD or SD mesalazine were determined over 12 weeks using a decision tree analytical model.

Results  A 12‐week treatment pathway starting with HD mesalazine cost an average of £2382 per patient compared with £2474 for SD mesalazine and generated 0.0016 more quality adjusted life years (QALYs). HD mesalazine dominated SD mesalazine, being both more effective and less costly. HD mesalazine treatment resulted in fewer patients requiring surgery or hospitalization for intensive pharmacological treatment. Probabilistic sensitivity analysis indicated a 72% chance that HD mesalazine was cost effective, based on a cost/QALY threshold of £30 000.

Conclusions  This study suggests that HD mesalazine represents a cost‐effective alternative to SD mesalazine for moderately active UC, while potentially reducing the need for hospitalization.
Review article: pharmacological therapy for hepatocellular carcinoma with sorafenib and other oral agents
Authors: CHAPARRO M. , GONZÁLEZ MORENO L. , TRAPERO‐MARUGÁN M. , MEDINA J. , MORENO‐OTERO R.
Published: September 2008

Background  Hepatocellular carcinoma (HCC) is the fifth most common malignancy worldwide. Unresectable disease patients have median survival of few months. There is a substantial need for novel treatments for patients with advanced HCC.

Aim  To provide an update review of mechanism of hepatocarcinigenesis and systemic therapies for HCC and the relevant role of Sorafenib in patients with advanced disease.

Methods  A Medline search was performed to identify pertinent original research and review articles. Selected references in these articles were also evaluated.

Results  Systemic chemotherapy for HCC has been quite ineffective. Preclinical studies demonstrated that Raf/MAPK‐ERK kinase (MEK)/Extracellular signal regulated kinase (ERK) pathway has a role in HCC. HCC tumours are highly vascularized and vascular endothelial growth factor (VEGF) augments HCC development and metastasis. Sorafenib blocks tumour cell proliferation by targeting Raf/MEK/ERK signalling and exerts an antiangiogenic effect by targeting VEGF receptors‐2/3 and platelet derived growth factor receptor β tyrosine kinases.

Conclusions  Currently available therapies are not effective for patients with advanced HCC. Sorafenib has demonstrated for the first time to prolong survival in patients with advanced HCC, and it is the new reference standard for systemic treatment in these patients.
Severe obstructive sleep apnoea exacerbates the microvascular impairment in very mild hypertensives
Authors: Nazzaro P. , Schirosi G. , Clemente R. , Battista L. , Serio G. , Boniello E. , Carratù P. L. , Lacedonia D. , Federico F. , Resta O.
Published: September 2008

Background  Different studies have shown that obstructive sleep apnoea syndrome (OSAS), frequently associated with hypertension, represents a harmful and independent risk for cardiovascular diseases. The aim of our study was to ascertain whether the occurrence of OSAS could worsen microcirculatory impairment in very mild hypertensives.

Materials and methods  One hundred untreated very mild hypertensives underwent polysomnography and subdivided into 32 non‐OSAS, 33 mild OSAS and 35 severe OSAS patients on standardized criteria. They underwent routine blood chemistry, ambulatory blood pressure monitoring and anthropometric analysis. Skin capillary density (n mm−2) of forearm (FAC) and periungueal (PUC) fields was obtained through videocapillaroscopy. By a venous congestion manoeuvre, PUC was maximized (CVC) and secondary capillary recruitment (GAIN) was calculated. These measurements served as indices of structural and functional capillary rarefaction, respectively.

Results  Severe OSAS hypertensives showed reduced FAC (P < 0·001) and PUC (P < 0·001) as compared to those with mild OSAS and non‐OSAS, but a greater CVC (P < 0·01) and GAIN (P < 0·001). Multiple regression analysis showed that PUC was inversely related to total sleep time with oxyhaemoglobin saturation at < 90% (TST90) (P < 0·001) and FAC to the apnoea‐hypopnoea index (AHI) (P < 0·001) and to the sleep propensity (P < 0·01). CVC was positively associated to AHI (P < 0·001) and GAIN to TST90 (P < 0·05).

Conclusions  The findings suggest that OSAS, by means of reduced basal and functional capillarity rarefaction, might pose an additional risk of impaired peripheral perfusion in very mild hypertensives. A microcirculation studytherefore should be a part of the clinical approach in patients at high cerebro‐cardiovascular risk such as hypertensives and patients with OSAS.
Apoptotic effect of Helicobacter pylori on oesophageal squamous‐cell carcinoma cells in vitro
Authors: Wu I.‐C. , Wu M.‐T. , Chen Y.‐K. , Hsu M.‐C. , Chou S.‐H. , Lee C.‐H. , Shiea J.‐T. , Wu I.‐L. , Huang C.‐T. , Wu D.‐C.
Published: September 2008

Backbround  The relationship between Helicobacter pylori (Hp) infection and oesophageal squamous‐cell carcinoma (ESCC) risk is still inconclusive. Our previous study found an inverse association between the two, but its mechanism is still unknown. Thus, we conducted in vitro studies to clarify the issue.

Materials and methods  One ESCC (CE 81T/VGH) cell line was co‐cultured with Hp, using one gastric adenocarcinoma (AGS) cell line as the control. Hp–induced cell apoptosis was determined by flow cytometry, terminal transferase‐mediated dUTP nick end labelling (TUNEL) assay and staining; caspase‐3 protein expressions in cell lysates were detected by Western immunoblot.

Results  Increased apoptosis was found in CE 81T/VGH, but not in AGS cells, by flow cytometry and TUNEL assay after being co‐cultured with Hp at the multiplicity of infection of 1/100 (but not at 1/400) for 36 h. The amount of activated caspase‐3 (17/19 kDa) also increased in CE 81T/VGH, but not in AGS cells, after co‐culturing with Hp at MOI of 1/100 for 36 h. The results were confirmed by triplicate experiments in which the different apoptotic assays remained consistent.

Conclusions  Our study provides indirect evidence of the inverse association between Hp infection and ESCC risk, which is possibly due to Hp‐induced apoptosis in ESCC cells. A further in vivo study is necessary to confirm our findings.
Effect of weight loss on markers of triglyceride‐rich lipoprotein metabolism in the metabolic syndrome
Authors: Chan D. C. , Watts G. F. , Ng T. W. K. , Yamashita S. , Barrett P. H. R.
Published: September 2008

Backgroud  Hypertriglyceridaemia, a consistent feature of dyslipidaemia in the metabolic syndrome (MetS), is related to the extent of abdominal fat mass and altered adipocytokine secretion. We determined the effect of weight loss by dietary restriction on markers of triglyceride‐rich lipoprotein (TRL) metabolism and plasma adipocytokines.

Design  Thirty‐five men with MetS participated in a 16 week randomized controlled dietary intervention study. Apolipoprotein (apo) C‐III, apoB‐48, remnant‐like particle (RLP)‐cholesterol, total adiponectin, high‐molecular weight (HMW) adiponectin, and retinol‐binding protein‐4 (RBP‐4) concentrations were measured using immunoassays.

Results  Compared with weight maintenance (n = 15), weight loss (n = 20) significantly decreased body weight, plasma insulin, triglycerides, total cholesterol, low‐density lipoprotein (LDL)‐cholesterol and lathosterol (P < 0·05). Weight loss also decreased plasma concentrations of apoC‐III (–33%), apoB‐48 (–37%), very low‐density lipoprotein (VLDL)‐apoB (–43%), RLP‐cholesterol (–48%), and RBP‐4 (–20%), and significantly increased plasma total (+20%) and HMW‐adiponectin (+19%) concentrations. In the weight loss group, reduction in plasma apoC‐III was associated (P < 0·05) with reduction in plasma apoB‐48, VLDL‐apoB, RLP‐cholesterol and triglycerides. Increase in total adiponectin was associated (P < 0·05) with the reduction in plasma VLDL‐apoB and triglycerides. The changes in HMW‐adiponectin and RBP‐4 were not associated with changes in plasma apoB‐48, apoC‐III, VLDL‐apoB, RLP‐cholesterol or triglycerides. In multiple regression analysis including changes in visceral fat, insulin and total adiponectin concentrations, the fall in plasma apoC‐III concentration was an independent predictor of the reductions in plasma apoB‐48, VLDL‐apoB, RLP‐cholesterol and triglycerides concentrations.

Conclusions  In men with MetS, weight loss decreases the plasma concentrations of apoB‐48, VLDL‐apoB, RLP‐cholesterol and triglycerides. This effect could partly relate to concomitant changes in plasma apoC‐III and adiponectin concentrations that accelerate the catabolism of TRLs.
A clinically relevant major cross‐reactive allergen from mesquite tree pollen
Authors: Dhyani A. , Singh B. P. , Arora N. , Jain V. K. , Sridhara S.
Published: September 2008

Background  Prosopis juliflora (mesquite) is one of the major sources of pollinosis in tropical and semi‐arid countries of the world. The present study was undertaken to purify and characterize a major cross‐reactive allergen from this tree species.

Materials and methods  Mesquite pollen extract was purified using reverse‐phase chromatography. Allergen characterization was done by electrophoresis, enzyme‐linked immunosorbent assay (ELISA) and Western blotting. Clinical relevance of the purified protein was analyzed by in vivo (skin tests) and in vitro experiments such as ELISA, histamine release, peripheral blood mononuclear cells (PBMC) proliferation and cytokine assays. Cross‐reactivity of purified protein with allergenic tree species and lima bean (food) was assessed by inhibition assays.

Results  A 66‐kDa protein was purified from mesquite pollen extract using octadecyl silica resin. Purified protein recognized 90% of mesquite‐sensitized patients in skin test and ELISA. It induced significant histamine release in allergic patients’ blood and interleukin‐4 secretion in the PBMC culture supernatants. Inhibition assays suggested close allergenic relationship of this protein with Ailanthus excelsa, Cassia siamea, Salvadora persica pollen and Phaseolus lunatus (lima bean – an edible legume).

Conclusions  A 66‐kDa major cross‐reactive allergen was isolated from mesquite pollen using single‐step purification procedure. The protein seems relevant for clinical applications in allergic disorders.
Nuclear receptors, transcription factors linking lipid metabolism and immunity: the case of peroxisome proliferator‐activated receptor gamma
Authors: Varga T. , Nagy L.
Published: September 2008

Exposure to lipids has a major effect on mammalian cells. Naturally, it has a profound impact on their metabolism, but it can also significantly alter their cellular and molecular phenotypes and responses. This latter is via specific signalling pathways leading to alterations in the expression of genes and gene networks. Multicellular organisms utilize a specialized group of proteins to detect and transduce lipid signals to the level of the expression of the genome. These proteins, termed nuclear hormone receptors, are lipid‐activated transcription factors regulating gene expression upon binding of small fatty ligands. In this review, we discuss the role and contribution of peroxisome proliferator‐activated receptor gamma (PPARγ) to macrophage and dendritic cell biology and also to gut epithelial cell function. We discuss how using different experimental systems and approaches the pathways activating the receptor and its target genes can be identified and complex biological processes unravelled. It appears that PPARγ is part of the macrophage's response to pathogenic lipoproteins and it coordinately regulates lipid uptake and efflux. Intriguingly, in another cell type of the immune system, dendritic cells, the receptor has overlapping, but distinct functions. In these cells, activation of PPARγ leads to altered immune phenotype characterized by increased phagocytic capacity, antigen processing and lipid antigen presenting capacity. This nuclear hormone receptor links lipid metabolism and immune cell function and these links provide unique insights into the regulatory logic of normal physiological responses and certain pathologies, such as atherosclerosis, chronic inflammatory diseases and autoimmunity.
Matrix metalloproteinase 2 improves the transplanted adipocyte survival in mice
Authors: Kuramochi D. , Unoki H. , Bujo H. , Kubota Y. , Jiang M. , Rikihisa N. , Udagawa A. , Yoshimoto S. , Ichinose M. , Saito Y.
Published: September 2008

Background  Fat tissue is a common material for autologous transplantation in plastic and reconstructive surgery. Basic fibroblast growth factor (bFGF) ameliorates the fat graft survival. A transplantation model has shown the gene expression of matrix metalloproteinases (MMPs) to increase in adipocytes. The aim of this study is to investigate the role of MMPs in the amelioration of survival by bFGF.

Materials and methods  3T3‐L1 adipocytes were incubated with or without 10 µg mL−1 bFGF for 8 h in the presence or absence of the MMP inhibitor GM6001, vascular endothelial growth factor (VEGF), MMP‐2 or anti‐bFGF antibody to study the effect of bFGF on MMP‐2 mRNA expression, MMP‐2 activity, fat accumulation or 2‐deoxyglucose uptake. Collagen sheets containing l × l07 adipocytes with or without bFGF in the presence or absence of GM6001 were subcutaneously transplanted into mice, and the appearance, histology, mRNA expression and fat accumulation of the grafts were analysed 4 weeks after transplantation.

Results  The MMP‐2 expression was drastically induced by bFGF among MMPs in 3T3‐L1 adipocytes. MMP‐2 accelerated fat accumulation, peroxisome proliferator‐activated receptor gamma (PPARγ) mRNA expression, and glucose uptake to an extent similar to those induced by bFGF, respectively. The bFGF‐induced increases were inhibited by the blocking of MMP‐2. The transplantation of adipocytes into mice showed that bFGF ameliorates the appearance and fat accumulation, as well as mRNA expression in grafts. These effects were almost or partly inhibited by a MMP blockade.

Conclusions  MMP‐2 may be involved in the mechanism by which bFGF ameliorates the survival of fat grafts.
Self‐reported competence of home nursing staff in Finland
Authors: Grönroos Eija , Perälä Marja‐Leena
Published: September 2008

Title.  Self‐reported competence of home nursing staff in Finland.

Aim.  This paper is a report of a study to investigate the self‐reported competence of home nursing staff and whether this is associated with their education, job descriptions, access to help and support and with factors in their psychosocial work environment, such as opportunities for personal growth and development at work.

Background.  Home nursing staff face increasing demands on their competence. Advances in information technology and working methods have increased the need for education. Thus, information on the factors associated with the competence of home nursing staff help us to support them in a way that improves the quality of care.

Method.  The data were gathered via a questionnaire completed in 2003 by the home nursing staff of 24 municipalities in different regions of Finland. A total of 2366 home care staff (response rate 63%), of whom 790 were home nursing staff (response rate 65%), were sent questionnaires. Univariate and multivariate logistic regression were used as main statistical methods.

Findings.  The best predictors for self‐reported competence of home nursing staff were their reading scientific or professional journals, opportunities for skill development, decision‐making latitude and work demands.

Conclusion.  Simple and practical ways for updating the competence of home nursing staff should be created. These staff are a very important source of information for home care clients. Supporting the knowledge of home nursing staff is also an efficient way of keeping clients and their informal caregivers informed about care guidelines, health and social services and social benefits.
Education for new role development: the Community Matron in England
Authors: Girot Elizabeth A. , Rickaby Caroline E.
Published: September 2008

Title.  Education for new role development: the Community Matron in England.

Aim.  This paper is a report of an evaluation of the English national pilot education programme preparing Community Matrons to fulfil their role.

Background.  Investment in community services has been important in introducing new ways of working in the United Kingdom National Health Service, particularly for patients with complex long‐term conditions. Development of the Community Matron role in England is an exemplar in the creation of modern nursing careers that are fit for purpose.

Method.  A mixed methods approach to data collection was adopted. This included documentary analysis of a range of sources used in the development and evaluation of the programme. In addition, during 2006, a self‐administered questionnaire was sent to all Community Matrons undertaking the programme (n = 70), with a response rate of 67% (n = 47). Individual telephone interviews were conducted with 17 students and six mentors. A focus group was also undertaken with the education programme Development Team (n = 5). Quantitative data were analysed using SPSS and qualitative data analysed using content and thematic analyses.

Findings.  The majority of students (n = 25) believed that the programme had met their expectations and had helped them to achieve the functions of the Community Matron role as defined in national competence statements. However, 17 students experienced difficulties in the level of organisational readiness to support them in their role, including, for example, lack of facilitation of their work‐based learning.

Conclusion.  In spite of the successful programme design, there is a need for organisations to develop their infrastructure to support new roles as well as offering protected time to learn in practice.