bluuebunny/crossref_metadata_2025 huggingface dataset:
Lipidomic Profiling of Sinus Mucosa from Patients with Chronic Rhinosinusitis
Authors: Fazlollahi Farbod , Kongmanas Kessiri , Tanphaichitr Nongnuj , Clair Jon Mallen‐St. , Gopen Quinton , Faull Kym F. , Suh Jeffrey D.
Published: January 2015

Sinusitis is a cause of significant morbidity, substantial healthcare costs, and negative effects on quality of life. The primary objective of this study is to characterize the previously unknown lipid profile of sinonasal mucosa from patients with chronic rhinosinusitis (CRS) and from controls. Sinus mucosa samples were analyzed from 9 CRS patients with concomitant nasal polyps, 11 CRS patients without polyps, and 12 controls. Ten lone polyp samples were also analyzed. Samples were subjected to a modified Bligh/Dyer lipid extraction, then high performance thin layer chromatography (HPTLC), combined gas chromatography/electron impact‐mass spectrometry (GC/EI‐MS), and flow‐injection/electrospray ionization‐tandem mass spectrometry (FI/ESI‐MS/MS). Data was analyzed for identification and profiling of major components. HPTLC revealed an array of species reflecting the lipid complexity of the samples. GC/EI‐MS revealed cholesterol and several fatty acids. FI/ESI‐MSMS revealed numerous lipid species, namely a host of phosphatidylcholines, phosphatidylethanolamines, ceramides and cholesteryl esters, but no detectable amounts of phosphatidyinositols or sulfated lipids. These results are a first step to uncover unique molecular biomarkers in CRS.
Model for a Patient‐Centered Comparative Effectiveness Research Center
Authors: Costlow Monica R. , Landsittel Douglas P. , James A. Everette , Kahn Jeremy M. , Morton Sally C.
Published: January 2015

This special report describes the systematic approach the University of Pittsburgh and the University of Pittsburgh Medical Center (UPMC) undertook in creating an infrastructure for comparative effectiveness and patient‐centered outcomes research resources. We specifically highlight the administrative structure, communication and training opportunities, stakeholder engagement resources, and support services offered.
Day‐by‐day variation in affect, arousal and alcohol consumption in young adults
Authors: Peacock Amy , Cash Catherine , Bruno Raimondo , Ferguson Stuart G.
Published: January 2015

Introduction and Aims

Alcohol consumption has a well‐established relationship with mood, with higher positive and negative affect predicting alcohol use. More recently, researchers have explored whether alcohol consumption occurs as a response to affect variability as an attempt to self‐medicate and stabilise affect. Studies have revealed a positive association between alcohol use and intra‐ and inter‐individual affect variability in clinical and university student samples; however not much is known of this relationship among the general community.

Design and Methods

Ecological Momentary Assessment (EMA) methods were used to investigate the relationship between affect and arousal variability and alcohol use in 53 community volunteers. Participants self‐reported affect and arousal at three to five randomly timed moments throughout the day, as well as every time they drank.

Results

On a day‐to‐day basis, higher positive affect was associated with increased alcohol consumption. When analyses were restricted to self‐reported affect prior to alcohol consumption, only increased arousal and decreased variability in arousal predicted the likelihood of alcohol consumption. Mean level of arousal was associated with the extent of alcohol consumed.

Discussion and Conclusions

In this moderate drinking sample day‐to‐day affect and arousal, and arousal variability, were associated with alcohol consumption. Analyses restricted to pre‐drinking observations provide further evidence that self‐medication accounts of alcohol consumption may explain drinking initiation but that the relationship between affect factors and drinking behaviour may change around the point of first drink. [Peacock A, Cash C, Bruno R, Ferguson SG. Day‐by‐day variation in affect, arousal and alcohol consumption in young adults. Drug Alcohol Rev 2015;34:588–94]
Quantifying and interpreting nestedness in habitat islands: a synthetic analysis of multiple datasets
Authors: Matthews Thomas J. , Cottee‐Jones H. Eden W. , Whittaker Robert J.
Published: January 2015

Aim

The concept of nestedness is important in determining the relative contribution to overall system diversity of different habitat patches within a fragmented system. Much of the previous work on nestedness has focused on islands within oceans (islands sensu stricto). The largest analysis of habitat island systems to date found significant nestedness to be a near universal feature, but the methods used have since been criticized as inappropriate. Thus, there is a need for an updated, critical examination of the prevalence, underlying drivers and implications of nestedness in multiple habitat island systems.

Location

Global.

Methods

Here, we collate 97 datasets from published habitat island studies, comprising multiple taxa. We use the NODF metric (nestedness metric based on overlap and decreasing fill) to estimate nestedness and determine significance using the four‐step proportional–proportional algorithm to simulate presences/absence matrices. We investigate the role of habitat island area in driving observed nestedness. We use linear modelling to examine the impact of dataset characteristics on the degree of nestedness and assess the conservation biogeographic implications of nestedness in relation to strategic conservation planning.

Results

Significant nestedness occurred in only 9% of systems, whilst anti‐nestedness (i.e. datasets less nested than expected by chance) occurred in 16% of systems. For the majority of datasets found to be significantly nested, we observed a relationship with fragment area, suggesting that structured extinctions may be important in determining the composition of certain habitat island communities. We found that the degree of nestedness in an archipelago is an important consideration for systematic conservation planning.

Main conclusions

Significant nestedness is considerably less common in habitat islands than previously reported. Strategic guidance for conservation planning should proceed on a case by case basis, and previous conservation recommendations based on the assumption of significant nestedness in most fragmented landscapes may need to be re‐evaluated.
Climate‐driven changes in winter abundance of a migratory waterbird in relation to EU protected areas
Authors: Pavón‐Jordán Diego , Fox Anthony D. , Clausen Preben , Dagys Mindaugas , Deceuninck Bernard , Devos Koen , Hearn Richard D. , Holt Chas A. , Hornman Menno , Keller Verena , Langendoen Tom , Ławicki Łukasz , Lorentsen Svein H. , Luigujõe Leho , Meissner Włodzimierz , Musil Petr , Nilsson Leif , Paquet Jean‐Yves , Stipniece Antra , Stroud David A. , Wahl Johannes , Zenatello Marco , Lehikoinen Aleksi
Published: January 2015

Aim

Species are responding to climate change by changing their distributions, creating debate about the effectiveness of existing networks of protected areas. As a contribution to this debate, we assess whether regional winter abundances and distribution of the SmewMergellus albellus, a migratory waterbird species listed on Annex I (EUBirds Directive) that overwinters exclusively in European wetlands, changed during 1990–2011, the role of global warming in driving distributional changes and the effectiveness of the network of Special Protection Areas (SPAs,EUBirds Directive) in the context of climate change.

Location

Europe.

Methods

We used site‐specific counts (6,883 sites) from 16 countries covering the entire flyway to estimate annual abundance indices and trends at country, region (north‐eastern, central and south‐western) and flyway scales, inside and outsideSPAs. We fitted autoregressive models to assess the effect of winter temperature on the annual abundance indices whilst accounting for autocorrelation.

Results

The Smew wintering distribution shifted north‐eastwards in Europe in accordance with the predictions of global warming, with increasing numbers in the north‐eastern region and declines in the central region. Trends in wintering numbers were more positive inSPAs on the north‐eastern and south‐western part of the flyway. However, a large proportion of the wintering population remains unprotected in north‐eastern areas outside of the existingSPAnetwork.

Main conclusions

SPAs accommodated climate‐driven abundance changes in the north‐eastern region of the wintering distribution by supporting increasing numbers of Smew in traditional and newly colonized areas. However, we highlight gaps in the current network, suggesting that urgent policy responses are needed. Given rapid changes in species distributions, we urge regular national and international assessments of the adequacy of theEUNatura 2000 network to ensure coherence in site‐safeguard networks for this and other species.
Current roles of endoscopy in the management of intraductal papillary mucinous neoplasm of the pancreas
Authors: Tanaka Masao
Published: January 2015

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is characterized by intraductal papillary proliferation of mucin‐producing epithelial cells that exhibit various degrees of dysplasia. IPMN is classified into four histological subtypes (gastric, intestinal, pancreatobiliary, and oncocytic) according to its histomorphological and immunohistochemical characteristics. Endoscopic retrograde cholangiopancreatography plays a crucial role in the evaluation of these features of IPMN. Endoscopic ultrasonography (EUS) has proven to be more sensitive than computed tomography or magnetic resonance imaging for early detection of malignancy. The present review addresses the current roles of endoscopy and related techniques in the management of IPMN. The particular focus is on diagnosing IPMN and malignancy within IPMN, detecting pancreatic cancer concomitant with IPMN, differentiating the epithelial subtypes of IPMN, determining the optimal strategy for the management of branch duct IPMN, and discussing innovative endoscopic technology related to IPMN. The disadvantages of endoscopic examinations of IPMN and different attitudes toward EUS‐guided fine‐needle aspiration for IPMN between Japan (negative) and other countries (active) are also discussed.
Use of medication algorithms in first episode psychosis: a naturalistic observational study
Authors: Yeisen Rafal A.H. , Joa Inge , Johannessen Jan Olav , Opjordsmoen Stein
Published: January 2015

Aims

Medical algorithms are evidence‐based guidelines which help physicians to make their decisions regarding treatment. Non‐adherence to medical algorithms is a matter of concern. The aims of this study were to investigate physicians' adherence to an algorithm for antipsychotics, patients' adherence to the physicians' recommendations and whether these factors influence one year outcome.

Method

An extensive file audit survey was conducted among 55 consecutively first admitted inpatients and outpatients from three units of a university hospital; looking at the prescription of antipsychotics to patients (15–65 years) experiencing first episode psychosis (F19.5, F20.0–F29.0 according to ICD‐10). Inclusion period was 2 years. Data on clinical condition and use of drugs were collected from the electronic patient administrative record system and from each patient's medical record for 12 months.

Results

Only 62% of the physicians adhered to the medical algorithm, although all first choices of drugs were made according to international standards. Fifty‐six percent of patients used their medicine more than 75% of the time, 22% had between 26% and 74% adherence and 22% adhered less than 25%. Patient adherence was significantly associated with good outcome. Older patients and inpatients had more favourable outcomes than younger patients and outpatients. Physicians at inpatient wards initiated pharmacological treatment significantly earlier than physicians in outpatient departments. The most common first antipsychotic drug to prescribe was olanzapine followed by risperidone.

Conclusion

Initial medical intervention followed international standards, but the physicians failed to adhere to algorithms in their follow‐up of medication regimes. Adherence was associated with outcome.
Attention‐deficit/hyperactivity disorder symptoms in adults with self‐reported epilepsy: Results from a national epidemiologic survey of epilepsy
Authors: Ettinger Alan B. , Ottman Ruth , Lipton Richard B. , Cramer Joyce A. , Fanning Kristina M. , Reed Michael L.
Published: January 2015

Objective

To assess symptoms of attention‐deficit/hyperactivity disorder (ADHD) and their impact among adults with epilepsy from a large community‐based survey.

Methods

Adults who self‐reported epilepsy were sent a postal survey including the Adult ADHD Self‐Report Scale version 6 (ASRS‐6), Physicians Health Questionnaire (PHQ‐9), Generalized Anxiety Disorder Assessment 7 (GAD‐7), and questions about seizure frequency and number of antiepileptic drugs (AEDs) during the preceding 3 months. Individuals with ASRS‐6 scores >14 were classified as ASRS+, and those with lower scores as ASRS−. Outcome measures included the Quality of Life in Epilepsy Inventory 10 (QOLIE‐10), Quality of Life and Enjoyment and Satisfaction Questionnaire (Q‐LES‐Q), and the Sheehan Disability Scale (SDS). The relationship of ADHD symptoms to quality of life outcomes was modeled hierarchically, with linear regression controlling for sociodemographic covariates, comorbid depression and anxiety, seizure frequency, and number of AEDs.

Results

Among 1,361 of respondents with active epilepsy, 18.4% (n = 251) were classified as ASRS+ and at risk for ADHD. Compared to ASRS− cases, ASRS+ individuals were more likely to have elevated depression and anxiety scores as well as greater seizure frequency and more AED use (p < 0.05 for all). Modeling results comparing ASRS+ and ASRS− cases, controlling for all covariates, indicated that ASRS+ cases had lower quality of life (Beta [β] = −3.07, 95% confidence interval [CI] −4.19 to −1.96) and worse physical (β = −0.048 95% CI −0.076 to −0.020) and social functioning (β = −0.058, 95% CI −0.081 to −0.035) on the Q‐LES‐Q, and increases in family (β = 1.57, 95% CI 1.09–2.05), social (β = 1.68, 95% CI 1.20–2.16), and work‐related disability (β‐1.86, 95% CI 1.27–2.46).

Significance

ADHD symptoms occur in nearly one of five adults with epilepsy, and are associated with increased psychosocial morbidity and lowered QOL. Future studies should clarify the nature and causes of ADHD symptoms in adults with epilepsy.
Metabolic dependence of phytoplankton species richness
Authors: Segura A. M. , Calliari D. , Kruk C. , Fort H. , Izaguirre I. , Saad J. F. , Arim M.
Published: January 2015

Aim

To analyse the dependence of phytoplankton species richness on temperature within the framework of the metabolic theory of ecology (MTE) with explicit consideration of its assumptions and predictions.

Location

Lakes from the Southern Hemisphere – South America (Argentinean Pampa to Tierra del Fuego) and Antarctica – and Northern Hemisphere – North America (USA) and Europe (Denmark to Spain).

Methods

The MTE proposes that natural logarithm of species richness and the inverse of temperature are linearly related, with a slope equal to the activation energy. The MTE assumes that the total community abundance, average body size and per species average community productivity are independent of the temperature. These predictions and assumptions are here evaluated using c. 660 phytoplankton lake communities and a literature review of 281 experimental measures of growth rate. Linear, curvilinear and segmented models were contrasted with empirical trends.

Results

Temperature–richness relationships showed a three‐phase segmented form in two of the three continents. Generally, at temperatures above 17 °C and below 11 °C there was a weak relationship or none. Intermediate temperatures showed the expected positive association with richness, but with steeper slopes (c. 1) than MTE expectations (c. 0.3). Statistical models including total community abundance and average body size explained up to 64% of the variance in richness.

Main conclusions

In its original formulation the MTE is not a satisfactory model for large‐scale richness patterns in phytoplankton. However, the MTE is able to better explain richness patterns when the temperature dependence of abundances and body size are explicitly accounted for in the model. These temperature dependences improve the performance of MTE predictions but question the interpretation of the richness–temperature slope as a measure of activation energy. The balance among activation energy, abundance and body size produced the observed segmented pattern in temperature–richness relationships for lake phytoplankton.
“Unredressed” Grievances under RTE: Navigating the State Labyrinth
Authors: Bhattacharjee Malini , Mysoor Dolashree
Published: January 2015

Despite the refrain that India's statutory rights suffer from weak enforcement, little academic attention has been paid toward the role of grievance redress mechanisms that are crucial to rights enforcement. This article undertakes a systematic policy analysis of the grievance redress system under the Right to Education (RTE) Act at the level of both design and performance by illustrating it through the Karnataka example. Our findings show that the redress procedures under RTE in Karnataka are perplexing and poorly designed and have not led to enforcement of the right. With faltering administrative accountability, many complainants find themselves with unresolved grievances leading to unenforced or improperly enforced rights. Significant changes in the law and a substantial redesign of institutions are vital for effectively enforcing the RTE.
Exit from the high street: an exploratory study of sustainable fashion consumption pioneers
Authors: Bly Sarah , Gwozdz Wencke , Reisch Lucia A.
Published: January 2015

In today's fashion system, dominated by business models predicated on continual consumption and globalized production systems that have major environmental and social impacts, the consumption of ‘sustainable fashion’ takes on an almost paradoxical quality. This paper explores this paradox by focusing on a previously under‐researched group of consumers – ‘sustainable fashion consumption pioneers’ who actively engage and shape their own discourse around the notion of sustainable fashion consumption. These pioneers actively create and communicate strategies for sustainable fashion behaviour that can overcome the nebulous and somewhat paradoxical reality that sustainable development in the fashion industry presents. Specifically, we use passive netnography and semi‐structured interviews to illuminate the role of motivational and contextual factors that help shape these consumers' definitions of sustainable fashion including such key behaviours as purchasing fewer garments of higher quality, exiting the retail market, purchasing only second‐hand fashion goods and sewing or upgrading their own clothing. Central to much of these behaviours is the notion that personal style, rather than fashion, can bridge the potential disconnect between sustainability and fashion while also facilitating a sense of well‐being not found in traditional fashion consumption. As such, our research suggests that for these consumers sustainability is as much about reducing measurable environmental or social impacts as it is about incorporating broader concepts through which to achieve goals beyond the pro‐environmental or ethical.
Multi‐institutional survey of social, management, husbandry and environmental factors for the SSP African lion Panthera leo population: examining the effects of a breeding moratorium in relation to reproductive success
Authors: Daigle C. L. , Brown J. L. , Carlstead K. , Pukazhenthi B. , Freeman E. W. , Snider R. J.
Published: January 2015

A breeding moratorium enacted in the early 1980s for African lions Panthera leo in North American zoos was lifted in 1998. However, post‐moratorium reproduction was poorer than expected from 1999 to 2005. In 2007, therefore, a multi‐institutional survey was conducted to provide a general overview of the Species Survival Plan® (SSP) African lion population ♀♀, and assess relationships between social, management, husbandry and environmental conditions, and reproductive activity. Females (n = 40) were divided into reproductive categories: contracepted, non‐reproductive, nulliparous and reproductive. Several factors were associated with reproductive success, one of which suggests that larger pride sizes and lion temperament may play roles in reproduction. In addition, compared with reproductive ♀♀, non‐reproductive ♀♀ were housed with fewer ♀♀, were fed less food per day, spent less time per day on display and tended to be trained fewer times per week. The biological significance of some of these relationships with reproduction is not clear, and cause‐and‐effect relationships were not established. However, this information will be valuable in directing future studies to determine how lion management affects reproduction. One possible explanation for the reproductive decline could have been a loss of breeding‐management knowledge during the moratorium, a situation that has since been resolved.
Non‐compliance with India's Factories Act: Magnitude and patterns
Authors: CHATTERJEE Urmila , KANBUR Ravi
Published: January 2015

While non‐compliance with legislation and regulations is said to be rife in developing countries, there is limited systematic evidence of the magnitude of non‐compliance. The authors quantify non‐compliance with India's Factories Act in 2010 and find that the number of non‐compliant firms is nearly twice that of compliant firms, and much larger than the number of firms “adjusting out” of the legislation. Thus, non‐compliance with the Factories Act is a key feature of India's “missing middle”. The main trends and patterns of non‐compliance are explored, and a number of key issues highlighted for further analytical and policy research.
A Novel Marker to Predict Early Recurrence After Atrial Fibrillation Ablation: The Ablation Effectiveness Quotient
Authors: WYNN GARETH J. , DAS MOLOY , BONNETT LAURA J. , HALL MARK C.S. , SNOWDON RICHARD L. , WAKTARE JOHAN E.P. , MODI SIMON , TODD DERICK M. , GUPTA DHIRAJ
Published: January 2015

Ablation Effectiveness Quotient

Introduction

Inability to predict clinical outcome despite acutely successful pulmonary vein isolation (PVI) remains the Achilles’ heel of atrial fibrillation ablation (AFA). Arrhythmia recurrence is frequently due to recovery of radiofrequency (RF) ablation lesions believed to be complete at the original procedure.

Objectives

We hypothesized that a high ratio between post‐AFA levels of serum high sensitivity cardiac troponin T (HScTnT), a highly specific marker of acute myocardial injury, and duration of RF application (the ablation effectiveness quotient, AEQ) would indicate effective ablation and correlate with early clinical success.

Methods

We prospectively measured HScTnT levels in 60 patients (42 [70%] male, 22 [37%] with paroxysmal AF [PAF], mean age 62.5 ± 10.6 years) 12–18 hours after AFA and calculated the AEQ for each. Patients were followed‐up with ECGs and Holter monitors for recurrence of atrial tachyarrhythmia (AT).

Results

Early recurrence of AT within 6 months occurred in 22 (37%). AT recurrence was not significantly related to left atrial size or comorbidities, nor to RF time or HScTnT level. Mean AEQ was significantly lower in those with recurrence than those without (0.35 ± 0.14 ng/L/s vs. 0.45 ± 0.18 ng/L/s), P = 0.02. Subgroup analysis showed this finding was due to patients with PAF in whom early significance was maintained to one year, with an AEQ >0.4 ng/L/s having 75% sensitivity and 90% specificity in predicting freedom from AT.

Conclusion

A high AEQ correlates well with freedom from AT in patients with PAF in both the short and medium term. If confirmed in further studies, AEQ may become a useful marker of risk of AT post‐AFA.
Use of antihypertensive drugs and risk of skin cancer
Authors: Schmidt S.A.J. , Schmidt M. , Mehnert F. , Lemeshow S. , Sørensen H.T.
Published: January 2015

Background

Several antihypertensive drugs are photosensitizing and may therefore act as cocarcinogens with ultraviolet radiation.

Objective

To examine whether antihypertensive drug use is associated with squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and malignant melanoma (MM).

Methods

We used population‐based databases to conduct a case–control study including all first‐time cases of SCC (n = 2282), BCC (n = 17 242), and MM (n = 3660) in northern Denmark, 1991–2010. We matched approximately 10 controls (n = 231 743) to each case by age, sex and county using risk‐set sampling. We used conditional logistic regression to compute odds ratios (ORs) for skin cancer with 95% confidence intervals comparing ever users of antihypertensives (>2 previous prescriptions) with non‐users (≤2 previous prescriptions). We adjusted for comorbidity and comedications. We further analysed use by duration (short term: <5 years; long term: ≥5 years) and intensity (low intensity or high intensity: <50% or ≥50% prescription coverage during total duration of use, respectively).

Results

Ever users of diuretics were at increased risk of SCC (OR 1.19; 1.06–1.33), driven by potassium‐sparing agents alone (OR 1.40; 1.09–1.80) or with low‐ceiling diuretics (OR 2.68; 2.24–3.21) and by long‐term use (OR 1.41; 1.16–1.72 at low intensity; OR 1.44; 0.98–2.14 at high intensity). Ever users of sulphonamides (OR 1.49; 1.04–2.12) and non‐aldosterone antagonist potassium‐sparing agents (OR 2.26; 0.85–6.01) were at increased MM risk. The latter was also associated with BCC (OR 1.47; 1.00–2.17), as was low‐ceiling diuretics combined with potassium‐sparing agents (OR 1.23; 1.12–1.35). Long‐term, low‐intensity (OR 1.53; 1.05–2.23) and high‐intensity (OR 1.44; 0.56–3.69) angiotensin receptor blocker use was associated with MM. Estimates for angiotensin‐converting enzyme inhibitors, β‐blockers, and calcium channel blockers were inconsistent or weak (<20% increased).

Conclusion

Long‐term angiotensin receptor blocker use was associated with risk of MM. Moreover, long‐term diuretic use was associated with SCC risk, driven by potassium‐sparing agents alone or in combination with low‐ceiling diuretics.
An update on photodynamic therapies in the treatment of onychomycosis
Authors: Simmons B.J. , Griffith R.D. , Falto‐Aizpurua L.A. , Nouri K.
Published: January 2015

Onychomycosis is a common fungal infection of the nails that is increasing in prevalence in the old, diabetics and immunocompromised. Onychomycosis presents a therapeutic challenge that can lead to significant reductions in quality of life leading to both physical and psychological consequences. Current treatment modalities are difficult to implement due to the poor penetration of topical treatments to the nail bed, the slow growing nature of nails and the need for prolonged use of topical and/or oral medications. Standard of care medications have cure rates of 63–76% that leads to a high propensity of treatment failures and recurrences. Photodynamic therapy (PDT) offers an alternative treatment for onychomycosis. Methylene blue dye, methyl‐aminolevulinate (MAL) and aminolevulinic acid (ALA) have been used as photosensitizers with approximately 630 nm light. These modalities are combined with pre‐treatment of urea and/or microabrasion for better penetration. PDT treatments are well tolerated with only mild transient pain, burning and erythema. In addition, significant cure rates for patients who have contraindications to oral medications or failed standard medications can be obtained. With further enhancements in photosensitizer permeability, decreased pre‐treatment and photosensitizer incubation times, PDT can be a more efficient and cost‐effective in office based treatment for onychomycosis. However, more large‐scale randomized control clinical trials are needed to access the efficacy of PDT treatments.
Surgery under general anaesthesia in severe hidradenitis suppurativa: a study of 363 primary operations in 113 patients
Authors: Blok J.L. , Boersma M. , Terra J.B. , Spoo J.R. , Leeman F.W.J. , van den Heuvel E.R. , Huizinga J. , Jonkman M.F. , Horváth B.
Published: January 2015

Background

Treatment of hidradenitis suppurativa (HS) is a difficult undertaking, especially as there is no consensus on what surgical technique is preferred. At our centre severe HS (Hurley II/III) is operated under general anaesthesia, mostly with the STEEP procedure.

Objectives

To investigate characteristics, surgical outcomes and patient satisfaction of HS patients who underwent deroofing or STEEP under general anaesthesia.

Methods

A clinical records‐based retrospective analysis was conducted of all patients who had surgery under general anaesthesia between 1999 and 2013. Patient satisfaction was retrospectively investigated with questionnaires.

Results

A total of 482 operations (363 primary operations and 119 re‐operations) were performed during the study period. The proportion of women in the included population was 68%. The median diagnostic delay (patient's and doctor's delay) was 6.5 years. Relapses occurred after 29.2% of primary operations. Women had higher relapse rates than men [odds ratio 2.85 (1.07;7.61)]. Hypergranulation of the wound was the most common complication and occurred in 7% of all operations. The median score patients attributed to the medical effect of surgery was eight of 10 (zero corresponding to very dissatisfied and 10 to very satisfied).

Conclusion

The diagnostic delay in HS is long due to a lack of knowledge in both patients and health care professionals, indicating that there is a need for education. Deroofing and the STEEP are effective surgical procedures in severe cases of HS and lead to a relatively high patient satisfaction. The postoperative relapse risk is higher in women. Prospective studies are required for the development of clear guidelines on the appropriate choice of surgery.
Splenic lipidosis in intensively cultured perch, Perca fluviatilis L.
Authors: Stejskal V , Kouřil J , Policar T , Svobodová Z
Published: January 2015

Macroscopically visible lipid deposition varying in size from pinpoint to 8‐mm diameter was found in spleens of a population of intensively farmed perch, Perca fluviatilis L. over a 24‐month rearing period. Large agglomerates of adipocytes distinguishable from surrounding normal tissue occurred in all individuals with spleen lipidosis. Several affected fish presented total dystrophy of large clusters of hepatocytes. Prevalence of lipidosis was 5.0% at 12 months and 16.6% at 24 months. There was no significant difference between fatty acid profiles of liver or perivisceral fat of perch with and without lipidosis except for linoleic, myristic, γ‐linoleic, cis‐eicosatrienic, palmitooleic acid. Body weight and hepatosomatic, perivisceral fat and splenosomatic indices were not associated with lipidosis. There was no significant effect of lipidosis on mortality or growth.
Maintenance and Expansion: Modeling Material Stocks and Flows for Residential Buildings and Transportation Networks in the EU25
Authors: Wiedenhofer Dominik , Steinberger Julia K. , Eisenmenger Nina , Haas Willi
Published: January 2015

Material stocks are an important part of the social metabolism. Owing to long service lifetimes of stocks, they not only shape resource flows during construction, but also during use, maintenance, and at the end of their useful lifetime. This makes them an important topic for sustainable development.

In this work, a model of stocks and flows for nonmetallic minerals in residential buildings, roads, and railways in the EU25, from 2004 to 2009 is presented. The changing material composition of the stock is modeled using a typology of 72 residential buildings, four road and two railway types, throughout the EU25. This allows for estimating the amounts of materials in in‐use stocks of residential buildings and transportation networks, as well as input and output flows. We compare the magnitude of material demands for expansion versus those for maintenance of existing stock. Then, recycling potentials are quantitatively explored by comparing the magnitude of estimated input, waste, and recycling flows from 2004 to 2009 and in a business‐as‐usual scenario for 2020. Thereby, we assess the potential impacts of the European Waste Framework Directive, which strives for a significant increase in recycling.

We find that in the EU25, consisting of highly industrialized countries, a large share of material inputs are directed at maintaining existing stocks. Proper management of existing transportation networks and residential buildings is therefore crucial for the future size of flows of nonmetallic minerals.
Topographic sleep EEG changes in the acute and chronic stage of hemispheric stroke
Authors: Poryazova Rositsa , Huber Reto , Khatami Ramin , Werth Esther , Brugger Peter , Barath Krizstina , Baumann Christian R. , Bassetti Claudio L.
Published: January 2015

After stroke, the injured brain undergoes extensive reorganization and reconnection. Sleep may play a role in synaptic plasticity underlying stroke recovery. To test this hypothesis, we investigated topographic sleep electroencephalographic characteristics, as a measure of brain reorganization, in the acute and chronic stages after hemispheric stroke. We studied eight patients with unilateral stroke in the supply territory of the middle cerebral artery and eight matched controls. All subjects underwent a detailed clinical examination including assessment of stroke severity, sleep habits and disturbances, anxiety and depression, and high‐density electroencephalogram examination with 128 electrodes during sleep. The recordings were performed within 10 days after stroke in all patients, and in six patients also 3 months later. During sleep, we found higher slow‐wave and theta activity over the affected hemisphere in the infarct area in the acute and chronic stage of stroke. Slow‐wave, theta activity and spindle frequency range power over the affected hemisphere were lower in comparison to the non‐affected side in a peri‐infarct area in the patients’ group, which persisted over time. Conversely, in wakefulness, only an increase of delta, theta activity and a slowing of alpha activity over the infarct area were found. Sleep slow‐wave activity correlated with stroke severity and outcome. Stroke might have differential effects on the generation of delta activity in wakefulness and sleep slow waves (1–8 Hz). Sleep electroencephalogram changes over both the affected and non‐affected hemispheres reflect the acute dysfunction caused by stroke and the plastic changes underlying its recovery. Moreover, these changes correlate with stroke severity and outcome.
An accurate and portable eye movement detector for studying sleep in small animals
Authors: Sánchez‐López Álvaro , Escudero Miguel
Published: January 2015

Although eye movements are a highly valuable variable in attempts to precisely identify different periods of the sleep–wake cycle, their indirect measurement by electrooculography is not good enough. The present article describes an accurate and portable scleral search coil that allows the detection of tonic and phasic characteristics of eye movements in free‐moving animals. Six adult Wistar rats were prepared for chronic recording of electroencephalography, electromyography and eye movements using the scleral search coil technique. We developed a miniature magnetic field generator made with two coils, consisting of 35 turns and 15 mm diameter of insulated 0.2 mm cooper wire, mounted in a frame of carbon fibre. This portable scleral search coil was fixed on the head of the animal, with each magnetic coil parallel to the eye coil and at 5 mm from each eye. Eye movements detected by the portable scleral search coil were compared with those measured by a commercial scleral search coil requiring immobilizing the head of the animal. No qualitative differences were found between the two scleral search coil systems in their capabilities to detect eye movements. This innovative portable scleral search coil system is an essential tool to detect slow changes in eye position and miniature rapid eye movements during sleep. The portable scleral search coil is much more suitable for detecting eye movements than any previously available system because of its precision and simplicity, and because it does not require immobilization of the animal's head.
Empirical caspofungin therapy in clinical practice for suspected invasive fungal disease in adults with acute lymphoblastic leukaemia
Authors: Kiehl Michael G. , Egerer Gerlinde , Engelhardt Monika , Gross Barbara
Published: January 2015

Patients with acute lymphoblastic leukaemia (ALL) after cytotoxic chemotherapy or haematopoietic stem cell transplantation (HSCT) are at risk for life‐threatening invasive fungal disease (IFD). The aim was to evaluate the characteristics, antifungal therapy and outcome of adult patients with ALL after chemotherapy or HSCT receiving caspofungin empirically in a clinical setting. Retrospective chart reviews were conducted at nine large tertiary care centres in Germany. Adult patients with ALL treated empirically with caspofungin according to the product label between 2006 and 2012 were eligible. Data were extracted as case reports. In total, 25 patients (12 males, 13 females; median age 37 years; 19 with B‐ALL, 6 with T‐ALL) with 28 treatment episodes because of suspected IFD (18 episodes after chemotherapy, 10 episodes after allogeneic HSCT) were included in the analysis. Empirical caspofungin therapy (median duration: 19 days, range 1–105 days) was given as first‐line monotherapy in 20 (71.4%), second‐line monotherapy in five (17.9%) and combination therapy in three (10.7%) episodes respectively. Therapy rated successful according to the physician's overall assessment (inflammatory parameters, clinical symptoms): 20 (95%) of 21 evaluable episodes with therapy duration of at least 8 days. Empirical caspofungin appears to be an effective therapeutic option in critically ill adult ALL patients with suspected IFD in clinical practice.
Evaluation of 28 cases of mucormycosis
Authors: Kursun Ebru , Turunc Tuba , Demiroglu Yusuf Ziya , Alışkan Hikmet Eda , Arslan Ayşe Hande
Published: January 2015

Mucormycosis is a rare but invasive fungal disease with high mortality. The present study aimed to retrospectively investigate the demographic characteristics, as well as the clinical, radiological and laboratory features and the results of treatment, in the patients followed in our hospital because of mucormycosis. The present study retrospectively evaluated 28 cases, which were followed in our hospital because of mucormycosis between January 2002 and July 2013. The clinical form was rhinocerebral in 27 cases (rhinoorbital in 12, nasal in 8 and rhinoorbitocerebral in 7) and disseminated in one case. With regard to predisposing factors, diabetes mellitus (n = 20), haematological malignancy (n = 6) and chronic renal insufficiency (n = 5) were the leading concomitant diseases. Seventeen (61%) of 28 cases showed atypical clinical picture. With regard to the therapeutic outcomes; it was found that 14 (50%) cases died and six cases recovered with sequel. Today, when particularly the prevalence of immunosuppressive diseases and conditions are gradually increasing, the incidence of mucormycosis is also increased. Considering that the majority of our cases had atypical clinical involvement and complications, being familiar with the characteristics of this disease could be life‐saving together with early diagnosis and treatment.
Onychomycosis caused by Onychocola canadensis: the first report in Estonia and lessons to learn
Authors: Järv Helle
Published: January 2015

We report the first case of onychomycosis caused by Onychocola canadensis in Estonia. We believe that the number of nail infections caused by this fungus is underestimated due to the current diagnostic algorithm of non‐dermatophytic onychomycosis. The need to define categories and criteria for ‘proven’ and ‘probable’ non‐dermatophyte mold infections to promote more extensive studies in the future is also discussed.
Comparison of nephrotoxicity associated to different lipid formulations of amphotericin B: a real‐life study
Authors: Falci Diego R. , da Rosa Franciane B. , Pasqualotto Alessandro C.
Published: January 2015

Amphotericin B (AmB) use is limited by the occurrence of kidney toxicity. Here, we evaluated the incidence and impact of nephrotoxicity in a large series of patients receiving therapy with amphotericin B deoxycholate (d‐AmB), liposomal AmB (L‐AmB), or AmB lipid complex (ABLC), in a clinical practice scenario. In a retrospective cohort study, patients treated with different AmB formulations between 2003 and 2012 were evaluated. Medical records and laboratory data were reviewed. Nephrotoxicity was determined according to modified RIFLE criteria. Predictors of nephrotoxicity and mortality were determined and treatment groups were compared. About 431 patients were studied (d‐AmB, n = 236; L‐AmB, n = 105; ABLC, n = 90). Frequency of severe nephrotoxicity (RIFLE ‘Failure’) was 11.5%, 2.4% and 7.2% for d‐AmB, L‐AmB and ABLC, respectively (P = 0.046). Use of L‐AmB was found to be an independent protective factor (OR: 0.18; 95% CI: 0.03–0.64; P = 0.006) for severe nephrotoxicity, considering d‐AmB as a reference. L‐AmB was also a protective factor for mortality (OR: 0.56; 95% CI: 0.32–0.99; P = 0.046). In addition, in‐hospital overall mortality was associated with cancer, previous dialysis, evolution to dialysis, and stay in the intensive care unit. Patients treated with ABLC showed similar frequency of severe kidney toxicity than those treated with d‐AmB. L‐AmB was associated with better outcomes than other formulations, including severe nephrotoxicity and overall mortality.
Successful long‐term management of invasive cerebral fungal infection following liver transplantation
Authors: Patel Madhukar S. , Wright Alissa J. , Kohn Rachel , Markmann James F. , Kotton Camille N. , Vagefi Parsia A.
Published: January 2015

Central nervous system (CNS) infections after liver transplantation may be fungal in aetiology, with involvement from either common organisms such as Cryptococcus neoformans and Aspergillus spp. as well as less common organisms, such as the Mucorales and Scedosporium spp. Although the mortality of CNS fungal infections was nearly 100% in early series, more recent data has suggested that good outcomes can be achieved. This may be due to both improved diagnostic capabilities, such as the ability to obtain fungal susceptibilities and therapeutic drug levels, and improved therapeutic options, such as the newer triazoles‐ voriconazole and posaconazole. Due to improved outcomes, issues have now arisen around the long‐term tolerability of these agents. The following two cases of invasive cerebral fungal infections following liver transplantation, one with Aspergillus flavus, and the other with Scedosporium boydii/apiospermum highlight the success that can be seen with the modern management of a previously fatal diagnosis. In particular, we highlight the issues around therapeutic monitoring and discontinuation of therapy.
A case of cerebral phaeohyphomycosis caused by Fonsecaea monophora, a neurotropic dematiaceous fungus, and a review of the literature
Authors: Doymaz Mehmet Z. , Seyithanoglu Mehmet F. , Hakyemez İsmail , Gultepe Bilge S. , Cevik Serdar , Aslan Turan
Published: January 2015

The Fonsecaea species, which are the leading causes of chromoblastomycosis, are not considered neurotropic fungal agents. Fonsecaea pedrosoi is the primary species in the genus and is usually isolated from chromoblastomycosis cases. However, the recently distinguished species F. monophora has been reported in a few cerebral phaeohyphomycosis cases. Here, a case of cerebral phaeohyphomycosis caused by Fonsecaea monophora is presented in a 71‐year‐old female subject with chronic diabetes mellitus and hypertension. The identification of F. monophora was made through mycological and molecular analysis, and an isolate was differentiated from the closely related F. pedrosoi by sequence data on key bases on the ribosomal internal transcribed spacer region. The case was successfully treated with surgical and medical approaches, and the patient has remained healthy and stable after a ten‐month follow up. Given the increasing incidence of this type of infection of the central nervous system (CNS), this case provides further support for the consideration that F. monophora might represent a neurotropic agent.
Application of the DiversiLab system for tracing the source of the mixed infections caused by Cryptococcus neoformans var. grubii from a patient with systemic lupus erythematosus
Authors: Dou Hongtao , Xu Yingchun , Li Taisheng
Published: January 2015

Two strains of Cryptococcus neoformans (PU 66 and PU112) were simultaneously isolated from a patient with systemic lupus erythematosus. We aimed to trace the source of the mixed infections. Multi‐locus sequence typing (MLST) and the DiversiLab system analyses were performed on the 2 clinical and 23 environmental C. neoformans from pigeon droppings, 11 from the home (H1) the patient visited, 12 from another home (H2) as control. All the strains were uniformly genotyped as C. neoformans var. grubii VNI. Clinical strain PU66 and all the H1 isolates had the same sequence type (ST) – ST5, while for PU112 a new ST was observed – ST265. However, there was only one single base of 7 MLST loci difference between PU66 and PU112. Sequence types of the H2 strains were ST31 and ST297. DiversiLab analysis showed that strain similarity between the two clinical strains was 96.7%. In relation to environmental samples, the highest strain similarity (99.3%) was observed for PU66 and PU70 (H1). However, none of the environmental isolates had similarity over 98.6% comparing to PU112. One source of the mixed infections has been detected, but another needs further investigation.
HIV‐associated disseminated histoplasmosis in western French Guiana, 2002–2012
Authors: Putot A. , Perrin S. , Jolivet A. , Vantilcke V.
Published: January 2015

Disseminated histoplasmosis (DH) is the most current revelation mode of AIDS in French Guiana. We describe the clinical and paraclinical presentation of DH, diagnostic tools, evolution and factors associated with 1‐year mortality in HIV‐infected patients from western French Guiana. Microbiologically proven AIDS‐related DH in Saint Laurent du Maroni's hospital between May 2002 and May 2012 were retrospectively included. Among the 82 patients included, 58 (71%) were male, 44 (53%) presented concurrent histoplasmosis and HIV diagnosis and 63 (80%) had a CD4 cell count under 50 cells μL−1. Almost all patients had weight loss (97%) and fever (95%), while 84% had digestive symptoms (63% diarrhoea), 55% lymphadenopathy, and 49% respiratory symptoms. Documented and presumed locations of H. capsulatum var capsulatum (Hcc) concerned almost all organs, with a particular affinity for the bone marrow and the digestive system. Co‐infections were associated in 65%. Following treatment initiation, 10 patients (13%) died within 1 month and 17 patients (25%) died within a year. DH is a polymorphous systemic mycosis with haematological and digestive tropism. Co‐infections are frequent and mortality rate is high.