bluuebunny/crossref_metadata_2025 huggingface dataset:
Retroperitoneal Lymph Node Staging of Testicular Tumours
Authors: BUSSAR‐MAATZ R. , WEISSBACH L. ,   for TNM Study Group
Published: March 2014

Summary— A prospective multicentre study was carried out to determine the efficiency of various diagnostic methods in the assessment of the retroperitoneal space. The diagnostic findings were confirmed histologically after retroperitoneal lymph node dissection (RLND). The sensitivity was 71% for bipedal lymphography, 41% for computed tomography (CT), 31% for abdominal ultrasound and 37% for alpha‐fetoprotein/human chorionic gonadotrophin (AFP/HCG). Specificity was 60, 94, 87 and 93% respectively. When all diagnostic methods were combined, sensitivity was 88% and specificity 48%. The value of all methods depends on the metastatic enlargement of the lymph nodes. The predictive value of a negative diagnosis was 73% for lymphography, 67% for CT, 61% for ultrasound and 65% for AFP/HCG; the predictive value of a positive diagnosis was 58, 85, 69 and 81% respectively. Despite these results, lymphography is indicated only when a surveillance strategy is planned, since it detected 58% of the lymph node metastases that were overlooked by CT and tumour markers. Despite this, 17% of patients with clinical stage I tumours had metastases. False positive rates are detrimental to primary chemotherapy: between 24% (at least 2 methods positive) and 46% (1 or more methods positive) of patients with clinical stage II A/B tumours had a pathological stage I and for these patients primary chemotherapy meant overtreatment.
Childhood Urethral Injuries: Perspectives on Outcome and Treatment
Authors: BASKIN L. S. , McANINCH J. W.
Published: March 2014

Summary— To elucidate the history of childhood urethral injuries, we undertook a retrospective review of 19 male patients comprising 2 groups: those requiring surgical intervention in adulthood and those with complete disruption of the posterior urethra requiring acute intervention (cystostomy drainage).

Group 1 patients (n = 12) ranged in age from 17 to 63 years, had sustained urethral injury between the ages of 3 to 15 years and underwent initial surgery from 9 to 18 years after injury. In all 12 patients the strictures developed in the bulbar urethra. All now report continence and normal voiding and none is impotent.

Group 2 patients (n = 7) ranged in age from 4 to 16 years and underwent delayed primary reconstruction of the urethral rupture defect. Six patients are now continent with a good stream but the seventh has required repeat optical urethrotomy. One patient with erectile capability at the time of injury was rendered impotent and remains so.
Objective evaluation of the outcome of endopyelotomy using Whitaker's test and diuretic renography
Authors: AHLAWAT R. , BASARGE N.
Published: March 2014

Objectives To assess the role of Whitaker's test (WT) and 99mTc‐diethylene triamine penta‐acetic acid diuretic renography (DRG) in determining objectively the outcome of endopyelotomy, and to rationalize the frequency and timing of such evaluation after endopyelotomy.

Patients and methods Thirty‐one patients (age > 15 years) were prospectively evaluated after percutaneous endopyelotomy. WT was performed at 4–6 weeks via the nephrostomy maintained for external drainage, 24 h after removing the splint. DRG was performed at 3, 6 and 12 months, and then annually.

Results WT performed 24 h after removing the splint diagnosed pelvic pressures in the unobstructed range (< 15 cmH2O) in 21 of the 24 treated units (87% success); 21 of 24 patients were also evaluated with DRG at 3 months. An intra‐pelvic pressure of > 15 cmH2O was correlated with a pattern of obstruction on DRG in all three units. Despite an unobstructed WT in 18 patients, categorization of DRG drainage showed disparity in six cases. All six renal units had a large pelvic area (> 15.0 cm2 in two and > 20.0 cm2 in four) and/or a poor renal function (separate glomerular filtration rate [GFR] of ≤ 25 ml/min in four of the six units). The drainage pattern on DRG was unevaluable in two renal units as the function was poor (separate GFR < 15 ml/min). During the first year, the drainage pattern on DRG improved in four cases. When followed beyond one year, the drainage pattern deteriorated at 2 years in only one of 14 evaluated renal units with an initial unobstructed WT.

Conclusion Using objective methods of evaluation, endopyelotomy was successful in relieving obstruction in 87% of cases. If inaccuracies in the interpretation of DRG, i.e. a large pelvic capacity and poor renal function, are accounted for, the results of WT as early as 24 h after removal of the splint correlated with DRG. Drainage patterns on DRG did not deteriorate during the first year. An early post‐operative evaluation with WT or DRG, as appropriate, is thus sufficient evidence of the success of the procedure. Evaluations repeated during the first year after endopyelotomy may be unnecessary.
Effect of dietary intake on urinary oxalate excretion in calcium renal stone formers
Authors: MASAI M. , ITO H. , KOTAKE T.
Published: March 2014

Objective To investigate the influence of dietary intake on urinary oxalate excretion in calcium renal‐stone formers.

Patients and methods Dietary intake was monitored by using the dietary‐record method in 60 idiopathic stone formers. The patients collected their urine for 24 h at home and their urinary oxalate excretion rate was determined. The relationship between the daily intake of various nutrients and urinary oxalate excretion was examined by both monovariate and multivariate analyses.

Results By monovariate analysis, the intake of carbohydrate, total protein and fat were significantly correlated with urinary oxalate excretion, but the intake of calcium and body surface area were not. In addition, the intake of total protein was highly correlated with that of fat. By multivariate analysis, the intake of carbohydrate and fat were significantly related to urinary oxalate excretion, and the intake of calcium was inversely correlated with urinary oxalate excretion, but the intake of total protein showed no significant correlation.

Conclusion The intake of carbohydrate and fat was positively and the intake of calcium was inversely correlated with urinary oxalate excretion in stone formers and, taken together, these findings suggested that fat plays an important role in urinary oxalate excretion and that protein has a minimal effect.
A controlled study of intravesical epirubicin with or without alpha2b‐interferon as prophylaxis for recurrent superficial transitional cell carcinoma of the bladder
Authors: RAITANEN M‐P. , LUKKARINEN O. ,   on behalf of Finnish Multicentre Study Group
Published: March 2014

Objectives To evaluate the efficacy of intravesical epirubicin with or without alpha2b‐interferon (alpha2b‐IFN) as a prophylactic treatment for recurrent superficial transitional cell carcinoma (TCC) of the urinary bladder.

Patients and methods A total of 81 patients with superficial (stage Ta and T1), well or moderately differentiated (grades 1 and 2) TCC were treated between June 1988 and December 1993. The patients were randomized into three groups: Group 1 was treated by transurethral resection (TUR) alone; Group 2 received 50 mg epirubicin and Group 3 received 50 mg epirubicin combined with 10 MU alpha2b‐IFN, intravesically in 50 mL sterile buffer solution. The instillations were started 1 week after TUR and were performed weekly during the first month and then once a month for one year. The patients were followed for a total of 2 years. Recurrence rate and tumour rate were calculated to assess the behaviour of the disease.

Results The patients were followed for a mean of 20 months. Patients receiving intravesical chemoimmunotherapy (Group 3) had the most favourable outcome; they had comparatively lower recurrence and tumour rates, fewer patients with recurrences and, most importantly, the longest disease‐free interval. Side‐effects were mostly mild and transient, and no differences were found among the groups.

Conclusions In reducing the number of patients having recurrences and extending the recurrence‐free interval, intravesical chemoimmunotherapy with epirubicin and alpha2b‐IFN had a promising effect on the natural course of superficial bladder cancer, particularly in patients with a history of prior recurrences.
Comparison of relaxation responses of detrusor strips from neuropathic and control patients
Authors: WILLIAMS P. , DATTA S. , GERMAN K. , STEPHENSON T.P. , BEDWANI J.R.
Published: March 2014

Objectives To confirm the existence of relaxation responses to electrical‐field stimulation in strips of human detrusor, and to compare these responses in strips from control subjects with those in strips from a group of neuropathic patients exhibiting hyper‐reflexia.

Patients and methods Detrusor specimens were obtained at operation from a group of control patients, and from a group of patients with neuropathy (mainly spina bifida) and a history of hyper‐reflexia. Muscle strips were prepared from these, mounted in organ baths, and contracted by exposure to a modified Krebs' solution containing 26 mm KCl and atropine. Relaxation responses were induced by an electrical‐field stimulation (50 V, 90 μs pulses at 2–16 Hz for 10 s).

Results Of 29 strips, 20 (69%) from control patients showed relaxations, compared with 17 of 28 strips (61 %) from neuropathic patients (P > 0.1). The maximum relaxation response in the control strips was 49 ± 5.6% (mean ± sem) of the maximum relaxation induced by isobutyl methylxanthine, compared with 43 ± 4.8% in the strips from neuropathic patients (P > 0.1). The maximum response occurred at similar frequencies (4 or 8 Hz) in the two groups. The relaxations were reduced by the inhibitor of nitric oxide synthase, N‐nitro L‐arginine methyl ester (0.1 mm, P < 0.05), but were not affected by guanethidine (50 μm) or tetrodotoxin (0.5 μm).

Conclusion These results confirm the existence of field stimulation‐induced relaxation in human detrusor, but suggest that hyper‐reflexia in the neuropathic bladder cannot be accounted for by any deficiency in this response.
Urethral sphincter volumes in women with obstructed voiding and abnormal sphincter electromyographic activity
Authors: NOBLE J.G. , DIXON P.J. , RICKARDS D. , FOWLER C.J.
Published: March 2014

Objective To investigate the role of transrectal ultrasonography (TRUS) of the female urethral sphincter and to compare sphincter volumes in controls and women with obstructed voiding associated with abnormal myotonic‐like electromyographic (EMG) activity in the urethral sphincter.

Patients and methods Fourteen women patients (mean age 29 ± 3.2 years) with symptoms of urinary outlet obstruction underwent videocystometrography (VCMG), urethral sphincter EMG and TRUS. Their sphincter volumes were compared with those obtained from 20 age‐matched control patients with other urodynamic diagnoses or normal urodynamics.

Results In every patient the urethral sphincter was identified as an ovoid, hypoechoic structure distal to the bladder outlet. The mean volume of the sphincter in those patients with abnormal EMG activity (3.05 ± 0.23 cm3) was significantly greater than that in the control group (1.30 ± 0.09 cm3; P < 0.001).

Conclusion TRUS provided a useful method of imaging the urethral sphincter in women. The results suggest that there was an increase in the volume of the urethral sphincter in females with obstructed voiding, providing collateral evidence that the abnormal EMG activity is a significant factor in the pathophysiology of the disorder.
Tethered spinal cord: the effect of neurosurgery on the lower urinary tract and male sexual function
Authors: BOEMERS T.M.L. , VAN GOOL J.D. , DE JONG T.P.V.M.
Published: March 2014

Objective To determine the effect of neurosurgical untethering on the lower urinary tract and male sexual function, in patients with tethered spinal cord.

Patients and methods Thirty‐six children with tethered spinal cord due to neurospinal dysraphism were assessed clinically and urodynamically before and after surgical untethering. Sexual function was evaluated in 14 boys before and after neurosurgery. In young boys, the assessment was by parental observation and was considered normal if erections had been observed regularly, or if the child had mentioned having an erection at any time. Older patients were asked if they had achieved voluntary erections and whether or not they were able to ejaculate.

Results The mean follow‐up was 91 months and the mean follow‐up after neurosurgery was 34 months. A lasting improvement of urinary tract function occurred in only one patient, while another became worse. Seven children had temporary changes of bladder/sphincter function; two developed detrusor overactivity with sphincter dyssynergia and five had signs of bladder denervation. Long‐term follow‐up showed no permanent changes of lower urinary tract function in 94% of 34 patients. Sexual function was considered normal in 13 boys. One boy apparently gradually lost erectile ability before untethering and regained it after surgery, while another boy had erectile dysfunction post‐operatively for almost 6 months.

Conclusion Changes in bladder‐sphincter function after untethering are usually transient and often the result of partial denervation. Although a small group of children seem to benefit from untethering, others can become worse and the individual outcome cannot be predicted. Erectile dysfunction can occur and parents and patients have to be informed of this possible complication. As pre‐operative progression of neurological symptoms and post‐operative denervation were observed only in patients with myelomeningocele and lipomyelomeningocele, this group may be distinct from patients with occult forms of spinal dysraphism. The natural history in the latter group of patients is unclear and a beneficial effect of prophylactic untethering remains to be proven by controlled prospective studies.
Treating erectile dysfunction with a vacuum tumescence device: a retrospective analysis of acceptance and satisfaction
Authors: BALTACI S. , AYDOS K. , KOSAR A. , ANAFARTA K.
Published: March 2014

Objectives To evaluate the quality of erections, ability to perform sexual intercourse, incidence of complications and satisfaction of patients using an external vacuum erection device in the treatment of erectile failure.

Patients and methods Of the 61 impotent men who participated in this clinical trial, 49 used the device and were surveyed. The mean follow‐up period was 12.8 months. A subjective rating scale from 1 to 10 was used to assess the patients' satisfaction with the device, where 1 indicated ‘dissatisfied’ and 10 indicated ‘very satisfied’.

Results The ease of using the device, satisfaction with the quality of erections and ability to perform intercourse were given scores >5 by 88, 84 and 82% of the patients, respectively. Sixteen (33%) of the men withdrew from the trial, primarily because they were unable to achieve and maintain a full erection, or suffered conflicts in their relationship, or for reasons not related to the device. Overall, the effectiveness rate was 67%. Of 32 patients with arteriogenic impotence, 28 (88%) had satisfactory results and had an improvement in their capacity for spontaneous erections with the device. The most frequent adverse effects were blocked ejaculation, bruising or the development of ecchymosis, discomfort during pumping and discomfort from using the constriction bands.

Conclusion These results suggest that the vacuum device is an effective and safe treatment for impotence of various aetiologies, especially for those patients with arteriogenic impotence.
Simplified sperm retrieval and intracytoplasmic sperm injection in patients with azoospermia
Authors: TSIRIGOTIS M. , PELEKANOS M. , YAZDANI N. , BOULOS A. , FOSTER C. , CRAFT I.L.
Published: March 2014

Objective To evaluate the rate of recovery of spermatozoa from the epididymis using a percutaneous aspiration technique and to assess the fertilization rate following intracytoplasmic sperm injection (ICSI).

Patients and methods Forty‐two patients with azoospermia underwent a total of 46 treatment cycles of in vitro fertilization (IVF) and ICSI. The sperm used for ICSI was retrieved percutaneously by fine‐needle aspiration and syringe suction (percutaneous epididymal sperm aspiration, PESA) from the epididymis in 28 patients (mean age 34.9 years), over 32 cycles. Six patients underwent microsurgical sperm aspiration (MESA) and in the remaining eight patients, neither percutaneous aspiration nor MESA yielded suitable sperm and spermatozoa extracted from testicular biopsy were used.

Results A total of 362 oocytes were collected and of those, 286 (79%) were subjected to ICSI. Of the injected oocytes, 49 (17.2%) were damaged, 138 (48.3%) achieved normal fertilization and, of those, 112 (81.2%) cleaved. A total of 67 embryos were transferred and 18 more were suitable for cryopreservation. Of the 25 cycles with embryo transfer, eight resulted in a pregnancy and of these, one miscarried. The pregnancy rate was 25% per cycle and 32% per embryo transfer. The implantation rate was 12%.

Conclusions This extensive series of PESA/ICSI cycles indicates that PESA can be used successfully to retrieve spermatozoa in patients with azoospermia. The technique is simple, cost‐effective and is associated with fewer complications compared to an open microsurgical procedure.
Measuring the fetal kidney with ultrasonography
Authors: SCOTT J.E.S. , WRIGHT B. , WILSON G. , PEARSON I.A. , MATTHEWS J.N. S. , ROSE P.G.
Published: March 2014

Objectives To establish a normal range of measurements for the external and internal dimensions of the fetal kidney and, if possible, to correlate these measurements with gestational age.

Subjects and methods The external and internal dimensions of the fetal kidney were measured in 810 women selected on the grounds of obstetric, fetal or technical risk factors from a consecutive series of 1136 women attending the ante‐natal ultrasonography clinic of a district general hospital. Post‐natal data were obtained from medical records on 1122 newborns. The maximum of pairs of renal measurements was used for analysis. Measurements were cross‐sectional in 347 cases and longitudinal in 463. The total number of measurement episodes was 2294.

Results External renal dimension and gestational age were closely related, enabling accurate growth centile charts to be constructed. The correlation between renal pelvic dimension and gestational age was weak. The maximum dimension of the renal pelvis at any gestational age in 92.7% of fetuses was < 5 mm. Using longitudinal measurements, 6.5% of cases with a renal pelvic dimension of < 5 mm at the first scan measured ≥ 5 mm at a subsequent scan, but 53.3% with a dimension of ≥ 5 mm at the first scan also measured ≥ 5 mm at the subsequent scan.

Conclusion It is possible to assess the growth and size of the fetal kidney according to gestational age but this does not apply to the renal pelvis. A renal pelvic dimension of > 5 mm at any gestational age is unusual and dilatation beyond this level should prompt a detailed post‐natal urological investigation.
Treatment of enuresis risoria in children by self‐administered electric and imaginary shock
Authors: ELZINGA‐PLOMP A. , BOEMERS T.M.L. , MESSER A.P. , VIJVERBERG M.A.W. , DE JONG T.P.V.M. , VAN GOOL J.D.
Published: March 2014

Objective To treat enuresis risoria (giggle micturition) by a self‐administered electric and imaginary shock and to evaluate the outcome after behavioural therapy.

Patients and methods Six boys and three girls with enuresis risoria were evaluated and treated. The mean age at referral was 10.4 years (range 5.7–14.2). All children had episodes of involuntary complete bladder emptying triggered by hearty laughter or giggling. The frequency ranged from four times per day to twice a week. No other voiding problems were noted. Five patients (four boys and one girl, mean age 10.2 years, range 5.7–14.2) received conditioning training which consisted largely of the self‐administration of a harmless, painless electric shock to the back of one hand, at the moment when micturition was induced by laughter, leading to inhibition of the voiding reflex. Later, the electric shock was replaced by an imaginary shock. Training was undertaken on an outpatient basis. A mean of eight sessions, each of 45 min duration, was necessary to train the children. The mean follow‐up was 26 months (range 12–51).

Results The frequency of wetting was reduced by a mean of 89% in all children 1 year after the successful completion of the training. In three children, followed for 2 years, this result stabilized at that proportion. One of these children, followed for > 3 years, gradually reverted to the original pattern of daily wetting and another patient, with a follow‐up of > 4 years, maintained an 86% reduction of wetting incidents.

Conclusion Until now, there was no specific treatment for enuresis risoria and not all patients outgrow the problem; this experimental conditioning programme shows promise in diminishing wetting incidents. However, the programme needs further testing in a prospective study.
Modification of therapy based on videourodynamics in neurologically normal children: Southampton 1988–1993
Authors: PORTER T. , WEERASINGHE N. , MALONE P.S.
Published: March 2014

Objective To follow up a previously investigated group of enuretic children to assess their current situation and to determine if their previous treatment was appropriate.

Patients and methods A group of 57 neurologically normal, enuretic children (mean age 10 years) were followed for a mean of 19 months (range 3–54) after the establishment of a working diagnosis with videourodynamics. Many of these children had previously been under medical follow‐up for long periods with no change in their enuresis. Depending on the urodynamic diagnosis, a therapeutic strategy was instigated and continued for an appropriate duration. Normal children were simply reassured.

Results Currently, 44 patients (77%) are completely or very nearly dry.

Conclusion Videourodynamics, although a traumatic procedure, provides information unobtainable from other sources. Treatment based on this information gives good results and may prevent years of unnecessary or inappropriate therapy, and psychological problems. Ambulatory studies may yield more useful information.
The use of the hCG stimulation test in the endocrine evaluation of cryptorchidism
Authors: DAVENPORT M. , BRAIN C. , VANDENBERG C. , ZAPPALA S. , DUFFY P. , RANSLEY P.G. , GRANT D.
Published: March 2014

Objective To review retrospectively the value of the human chorionic gonadotrophin (hCG) test in the evaluation of prepubertal boys with bilateral impalpable testes.

Subjects and methods The study comprised 31 boys investigated between 1974 and 1990 at the Hospital for Sick Children, London. All boys had an hCG test consisting of three intramuscular injections of hCG on successive days at a daily dose dependent on their age (< 1 year old, 500 units; 1–10 years, 1000 units; > 10 years, 1500 units). Blood samples were taken before the first dose and 24 h after the last dose and the level of plasma testosterone assessed and expressed as a pre/post ratio.

Results Eight boys had no response to hCG, due to anorchia. One boy had no response to hCG but had bilateral atrophic intra‐abdominal testes. Twenty‐two boys responded to hCG and had testes whose size was related to the degree of testosterone elevation after this stimulatory test. The hCG test therefore had a positive predictive value of 89% and a negative predictive value of 100%. There was a quantitative difference in testosterone response between 14 boys who had bilateral intra‐abdominal testes of ‘normal’ volume (median pre/post ratio, 11.4) and nine boys who had an otherwise reduced volume of testes (dysplastic or unilateral intra‐abdominal) (median pre/post ratio of 4; P = 0.02).

Conclusion The hCG test is a valid indicator of the presence of functioning testicular tissue. It is predictive of anorchia and a good response to hCG suggests the presence of testes sufficiently large for orchidopexy.
A peer support programme for enhancing adherence to oral antipsychotic medication in consumers with schizophrenia
Authors: Boardman Gayelene , McCann Terence , Kerr Debra
Published: March 2014

Aims

To assess if consumers with schizophrenia who were non‐adherent to their oral antipsychotic medication had improved adherence and mental state, after participating in a problem‐solving based peer support programme.

Background

Many people with schizophrenia are reluctant to take their antipsychotic medications. Peer support, combined with a problem‐solving approach, could be used as a strategy to improve adherence outcomes. A peer is an individual with mental illness who offers support to others.

Design

A quasi‐experimental time‐series design was used to measure the effect of the problem‐solving based peer support programme on adherence and mental state.

Method

Consumers who were non‐adherent to oral antipsychotic medication were recruited from February 2009–June 2010. Peers contacted consumers by a weekly 20‐minute telephone call for 8 weeks. Mental state was measured using the Brief Psychiatric Rating Scale‐E and medication adherence was measured by self‐report at baseline, postintervention (week 8) and follow‐up (week 14). Data were analysed using the Friedman's test and Wilcoxon Signed Rank test for pair‐wise comparisons.

Results

The study included 22 consumers and six peers: 19 males, mean age 35·1 years. Improvements were identified in medication adherence, negative symptoms and overall mental state between baseline and week 8. These improvements were maintained at week 14.

Conclusion

Medication adherence may be enhanced with the addition of a peer support intervention. A problem‐solving based peer support programme could be implemented in the community setting for patients who are non‐adherent with oral antipsychotic medication.
Promotoras as facilitators of change: Latinas' perspectives after participating in a lifestyle behaviour intervention program
Authors: Albarran Cynthia R. , Heilemann MarySue V. , Koniak‐Griffin Deborah
Published: March 2014

Aim

To describe immigrant Latinas' perspectives of a lifestyle behaviour intervention, focusing on their interactions with and perceptions of the promotoras who delivered the program in the USA.

Background

Immigrant Latinas in the USA have high obesity rates, which contribute to increased risk for cardiovascular disease and other long‐term diseases. Interventions using the promotora model appear to be effective in reducing cardiovascular disease risk by improving dietary habits, physical activity and selected clinical variables among Latinas. However, there has been very limited enquiry into what it is about these interventions and promotoras that facilitates behaviour change, from the perspective of participants.

Design

Grounded theory methodology guided the data collection and analysis.

Methods

This qualitative study was completed in 2012 in California, after the end of a lifestyle behaviour intervention. Four focus groups and seven one‐on‐one interviews were conducted with a total of 18 immigrant Latina intervention participants.

Results

Women described promotoras as helping them change by motivating them through three interconnected elements: tools, support and knowledge. Latinas viewed their ability to make lifestyle changes as connected with their emotional and psychological health and saw promotoras as counsellors who gave emotional and social support. In this respect, the intervention was emotionally therapeutic for this sample of Latinas, although this was not the original intention of the program.

Conclusion

Promotoras gave the backbone of the intervention and were crucial in motivating Latinas to implement lifestyle changes. Future lifestyle behaviour interventions should include a strong component of mental and emotional well‐being.
Pupillary reactivity to emotional stimuli in children of depressed and anxious mothers
Authors: Burkhouse Katie L. , Siegle Greg J. , Gibb Brandon E.
Published: March 2014

Background

The primary aim of this study was to examine differences in physiological reactivity (measured via pupillometry) to emotional stimuli between children of depressed versus nondepressed mothers. A second goal was to examine differences in pupil dilation to emotional stimuli between children of anxious versus nonanxious mothers.

Method

Participants included 117 mother–child pairs drawn from the community. Children were between the ages of 8 and 14. Pupil dilation was assessed using an eye‐tracker while participants viewed angry, happy, or sad faces.

Results

Children of mothers with a history of major depression (MDD) exhibited increased pupil dilation to sad, but not happy or angry, faces compared with children of nondepressed mothers. Second, we found that children of anxious mothers exhibited increased pupil dilation to angry, but not happy or sad, faces compared to youth of nonanxious mothers.

Conclusions

The current findings add to the growing body of research suggesting that differences in physiological reactivity to depression‐ and anxiety‐relevant cues may represent an important mechanism in the intergenerational transmission of MDD and anxiety.
Respiratory Impairment and Dyspnea and Their Associations with Physical Inactivity and Mobility in Sedentary Community‐Dwelling Older Persons
Authors: Vaz Fragoso Carlos A. , Beavers Daniel P. , Hankinson John L. , Flynn Gail , Berra Kathy , Kritchevsky Stephen B. , Liu Christine K. , McDermott Mary M. , Manini Todd M. , Jack Rejeski W. , Gill Thomas M. ,   Lifestyle Interventions Independence for Elders Study Investigators
Published: March 2014

Objectives

To evaluate the prevalence of respiratory impairment and dyspnea and their associations with objectively measured physical inactivity and performance‐based mobility in sedentary older persons.

Design

Cross‐sectional.

Setting

Lifestyle Interventions and Independence for Elders Study.

Participants

Community‐dwelling older persons (n = 1,635, mean age 78.9) who reported being sedentary (<20 min/wk of regular physical activity and <125 min/wk of moderate physical activity in past month).

Measurements

Respiratory impairment was defined as low ventilatory capacity (forced expiratory volume in 1 second less than lower limit of normal (LLN)) and respiratory muscle weakness (maximal inspiratory pressure <LLN). Dyspnea was defined as moderate to severe ratings on the modified Borg index, immediately after a 400‐m walk test (400‐MWT). Physical inactivity was defined according to high sedentary time as the highest quartile of participants with accelerometry‐measured activity of <100 counts/min. Performance‐based mobility was evaluated using the Short Physical Performance Battery (≤7 defined as moderate to severe mobility impairment) and 400‐MWT gait speed (<0.8 m/s defined as slow).

Results

Prevalence rates were 17.7% for low ventilatory capacity, 14.7% for respiratory muscle weakness, 31.6% for dyspnea, 44.7% for moderate to severe mobility impairment and 43.6% for slow gait speed. Significant associations were found between low ventilatory capacity and slow gait speed (adjusted odds ratio (aOR) = 1.41, 95% confidence interval (CI) = 1.03–1.92), between respiratory muscle weakness and moderate to severe mobility impairment (aOR = 1.42, 95% CI = 1.03–1.95), and between dyspnea and high sedentary time (aOR = 1.98, 95% CI = 1.28–3.06) and slow gait speed (aOR = 1.70, 95% CI = 1.22–2.38).

Conclusion

Respiratory impairment and dyspnea are prevalent in sedentary older persons and are associated with objectively measured physical inactivity and poor performance‐based mobility. Because they are modifiable, respiratory impairment and dyspnea should be considered in the evaluation of sedentary older persons.
Effectiveness of a National Transitional Care Program in Reducing Acute Care Use
Authors: Wee Shiou‐Liang , Loke Chok‐Kang , Liang Chun , Ganesan Ganga , Wong Loong‐Mun , Cheah Jason
Published: March 2014

This study evaluated the effectiveness of a national transitional care program for elderly adults with complex care needs and limited social support. The Aged Care Transition (ACTION) Program was designed to improve coordination and continuity of care and reduce rehospitalizations and visits to emergency departments (EDs). Dedicated care coordinators provided coaching to help individuals and families understand the individuals' conditions, effectively articulate their preferences, and enable self‐management and care planning. Participants were individuals aged 65 and older hospitalized and enrolled from five public general hospitals in Singapore between February 2009 and July 2010 (N = 4,132). The coordinators worked with participants during hospitalization and followed up with telephone calls and home visits for 1 to 2 months after discharge and coordinated placements with appropriate community service providers. Unplanned rehospitalization and ED visit (up to 6 months after discharge) rates were compared with those of a comparator group of individuals who did not receive care coordination using propensity score‐based weighting. Participant and caregiver surveys on quality of life and self‐rated health were also administered. Recipients of the ACTION program had fewer unplanned rehospitalizations and ED visits after discharge. Propensity score–adjusted odds ratios of participants versus control for number of unplanned rehospitalization and ED visits were 0.5 (95% confidence interval (CI) = 0.5–0.6) and 0.81 (95% CI = 0.72–0.90) 30 days after discharge and 0.6 (95% CI = 0.6–0.7) and 0.90 (95% CI = 0.82–0.99) 180 days after discharge. Quality of life and self‐rated health were better 4 to 6 weeks after discharge than 1 week after discharge. These findings confirm the effectiveness of the ACTION program in improving the transition of vulnerable older adults from hospital to community. Such transitional care should be considered as an integral part of care integration.
Relationship Between 25‐Hydroxyvitamin D and Cognitive Function in Older Adults: The Health, Aging and Body Composition Study
Authors: Wilson Valerie K. , Houston Denise K. , Kilpatrick Laurel , Lovato James , Yaffe Kristine , Cauley Jane A. , Harris Tamara B. , Simonsick Eleanor M. , Ayonayon Hilsa N. , Kritchevsky Stephen B. , Sink Kaycee M. ,   the Health, Aging and Body Composition Study
Published: March 2014

Objectives

To examine the relationship between 25‐hydroxyvitamin D (25(OH)D) levels and cognitive performance over time in older adults in the Health, Aging and Body Composition (Health ABC) Study.

Design

Prospective cohort study.

Setting

Community‐dwelling participants in Pittsburgh, Pennsylvania, and Memphis, Tennessee.

Participants

Well‐functioning adults aged 70 to 79 at baseline with serum 25(OH)D measured at the 12‐month follow‐up visit and cognitive function measured at baseline and 4‐year follow‐up visit (N = 2,777).

Measurements

Vitamin D status was categorized as 25(OH)D levels of less than 20.0 ng/mL, 20.0 to 29.9 ng/mL, or 30.0 ng/mL or greater. Cognition was measured using the modified Mini‐Mental State Examination (3MS) and Digit Symbol Substitution Test (DSST). Linear regression models adjusting for multiple covariates, including age, education, sex, race, site, season, physical activity, and comorbidities, were used in the analysis.

Results

Sixty‐eight percent of participants had 25(OH)D levels of less than 30.0 ng/mL. Lower 25(OH)D levels were associated with lower baseline cognitive scores on the 3MS (adjusted mean 89.9, 95% confidence interval (CI) = 89.4–90.4 for <20.0 ng/mL; adjusted mean 90.8, 95% CI = 90.4–91.3 for 20.0–29.9 ng/mL; adjusted mean 90.6, 95% CI = 90.2–91.1 for ≥30.0 ng/mL; P trend = .02) and the DSST (adjusted mean 35.2, 95% CI = 34.5–36.0 for <20.0 ng/mL; adjusted mean 35.9, 95% CI = 35.2–36.6 for 20.0–29.9 ng/mL; adjusted mean 37.0, 95% CI = 36.3–37.8 for ≥30.0 ng/mL; P trend = .01). Participants with low 25(OH)D levels had greater declines in 3MS scores over 4 years than those with higher levels (least square mean change −1.0, 95% CI = −1.5 to −0.6 for <20.0 ng/mL; least square mean change −0.8, 95% CI = −1.2 to −0.3 for 20.0–29.9 ng/mL; least square mean change −0.2, 95% CI = −0.7 to 0.2 for ≥30.0 ng/mL; P = .05). There was no significant difference in DSST decline according to 25(OH)D level.

Conclusion

Low 25(OH)D levels were associated with worse global cognitive function and greater decline over time according to the 3MS. Intervention trials are needed to determine whether vitamin D supplementation can reduce cognitive decline.
Memory for between‐list and within‐list information in amnesic patients with temporal lobe and diencephalic lesions
Authors: Hunkin Nicola M. , Awad Mohammed , Mayes Andrew R.
Published: March 2014

Patients with medial temporal lobe damage and diencephalic damage were compared on two tests of verbal temporal order memory: between‐list discrimination and within‐list discrimination. Both patient groups were impaired relative to a group of healthy control participants. In addition, despite comparable levels of item recognition, the diencephalic group was impaired relative to the medial temporal lobe group on both within‐list and between‐list discrimination. Temporal order memory for between‐list information showed a significant correlation with a composite measure of recognition memory, and the results are discussed in terms of the patients' reliance on familiarity and distance‐based processes to make temporal order judgments.
Combining multiple healthcare databases for postmarketing drug and vaccine safety surveillance: why and how?
Authors: Trifirò G. , Coloma P. M. , Rijnbeek P. R. , Romio S. , Mosseveld B. , Weibel D. , Bonhoeffer J. , Schuemie M. , van der Lei J. , Sturkenboom M.
Published: March 2014

A growing number of international initiatives (e.g. EU‐ADR, Sentinel, OMOP, PROTECT and VAESCO) are based on the combined use of multiple healthcare databases for the conduct of active surveillance studies in the area of drug and vaccine safety. The motivation behind combining multiple healthcare databases is the earlier detection and validation, and hence earlier management, of potential safety issues. Overall, the combination of multiple healthcare databases increases statistical sample size and heterogeneity of exposure for postmarketing drug and vaccine safety surveillance, despite posing several technical challenges. Healthcare databases generally differ by underlying healthcare systems, type of information collected, drug/vaccine and medical event coding systems and language. Therefore, harmonization of medical data extraction through homogeneous coding algorithms across highly different databases is necessary. Although no standard procedure is currently available to achieve this, several approaches have been developed in recent projects. Another main challenge involves choosing the work models for data management and analyses whilst respecting country‐specific regulations in terms of data privacy and anonymization. Dedicated software (e.g. Jerboa) has been produced to deal with privacy issues by sharing only anonymized and aggregated data using a common data model. Finally, storage and safe access to the data from different databases requires the development of a proper remote research environment. The aim of this review is to provide a summary of the potential, disadvantages, methodological issues and possible solutions concerning the conduct of postmarketing multidatabase drug and vaccine safety studies, as demonstrated by several international initiatives.
A new regulatory framework for extra-judicial consumer redress: where we are and how to move forward
Authors: Cortés Pablo
Published: March 2014

This paper examines the new legal framework on consumer Alternative Dispute Resolution (ADR) in the EU. Its primary contribution lies in identifying that harmonising the complaint submission in a pan-European Online Dispute Resolution (ODR) platform, and directing parties to nationally approved ADR entities that comply with minimum standards, will not fulfil the potential of an extra-judicial consumer redress system. This paper proposes key functions that the ODR platform should incorporate if it is to provide effective redress. This paper also argues that a successful ODR platform should include built-in incentives that encourage parties to: (i) participate in approved ADR processes; (ii) settle complaints with little or no intervention from neutral third parties; and (iii) ensure voluntary compliance with final outcomes.
Extracellular environment modulates the formation and propagation of particular amyloid structures
Authors: Westergard Laura , True Heather L.
Published: March 2014

Amyloidogenic proteins, including prions, assemble into multiple forms of structurally distinct fibres. The [PSI+] prion, endogenous to the yeast Saccharomyces cerevisiae, is a dominantly inherited, epigenetic modifier of phenotypes. [PSI+] formation relies on the coexistence of another prion, [RNQ+]. Here, in order to better define the role of amyloid diversity on cellular phenotypes, we investigated how physiological and environmental changes impact the generation and propagation of diverse protein conformations from a single polypeptide. Utilizing the yeast model system, we defined extracellular factors that influence the formation of a spectrum of alternative self‐propagating amyloid structures of the Sup35 protein, called [PSI+] variants. Strikingly, exposure to specific stressful environments dramatically altered the variants of [PSI+] that formed de novo. Additionally, we found that stress also influenced the association between the [PSI+] and [RNQ+] prions in a way that it superceded their typical relationship. Furthermore, changing the growth environment modified both the biochemical properties and [PSI+]‐inducing capabilities of the [RNQ+] template. These data suggest that the cellular environment contributes to both the generation and the selective propagation of specific amyloid structures, providing insight into a key feature that impacts phenotypic diversity in yeast and the cross‐species transmission barriers characteristic of prion diseases.
Proper functioning of the GINS complex is important for the fidelity of DNA replication in yeast
Authors: Grabowska Ewa , Wronska Urszula , Denkiewicz Milena , Jaszczur Malgorzata , Respondek Aleksandra , Alabrudzinska Malgorzata , Suski Catherine , Makiela‐Dzbenska Karolina , Jonczyk Piotr , Fijalkowska Iwona J.
Published: March 2014

The role of replicative DNA polymerases in ensuring genome stability is intensively studied, but the role of other components of the replisome is still not fully understood. One of such component is the GINS complex (comprising the Psf1, Psf2, Psf3 and Sld5 subunits), which participates in both initiation and elongation of DNA replication. Until now, the understanding of the physiological role of GINS mostly originated from biochemical studies. In this article, we present genetic evidence for an essential role of GINS in the maintenance of replication fidelity in Saccharomyces cerevisiae. In our studies we employed the psf1‐1 allele (Takayama et al., 2003) and a novel psf1‐100 allele isolated in our laboratory. Analysis of the levels and specificity of mutations in the psf1 strains indicates that the destabilization of the GINS complex or its impaired interaction with DNA polymerase epsilon increases the level of spontaneous mutagenesis and the participation of the error‐prone DNA polymerase zeta. Additionally, a synergistic mutator effect was found for the defects in Psf1p and in the proofreading activity of Pol epsilon, suggesting that proper functioning of GINS is crucial for facilitating error‐free processing of terminal mismatches created by Pol epsilon.
Repressor element‐1 silencing transcription factor (REST) is present in human control and Huntington's disease neurones
Authors: Schiffer Davide , Caldera Valentina , Mellai Marta , Conforti Paola , Cattaneo Elena , Zuccato Chiara
Published: March 2014

Aims

The repressor element‐1 silencing transcription factor/neurone‐restrictive silencer factor (REST/NRSF) is a master regulator of neuronal gene expression. REST/NRSF functions by recruiting other cofactors to genomic loci that contain the repressor element 1/neurone restrictive silencer element (RE1/NRSE) binding motif. In brain, demonstration of REST protein presence in neurones has remained controversial. However, RE1/NRSE containing neuronal genes are actively modulated and REST dysregulation is implicated in Huntington's disease (HD). We aimed to investigate REST distribution in autopsy brain from control and HD patients.

Methods

Brain tissues from six controls and six HD cases (Vonsattel grade 3 and 4) were investigated using immunohistochemical analysis.

Results

REST was present in neurones and glial cells of the cortex, caudate nucleus, hippocampus and cerebellum. REST labelling was mainly cytoplasmic in neurones while preferential nuclear staining of REST was found in glial cells. We also found that REST and huntingtin (HTT) colocalize in human neurones. Low levels of cytoplasmic REST were detected in neurones of the HD cortex and caudate but no direct relationship between decreased neuronal REST expression and disease grade was observed.

Conclusions

These data support the notion of REST presence in human brain neurones and glial cells and indicate the importance of developing compounds able to restore REST‐regulated transcription of neuronal genes in HD.
Survey of chronic haemodialysis in children between 2007 and 2012 in China
Authors: Jiang Yeping , Shen Ying , Lau Keith Kwong Hung
Published: March 2014

Aim

The prevalence of chronic kidney disease (CKD) in children has been on the rise in China and more and more paediatric patients are now relying on chronic renal replacement therapies to sustain their lives. However, there is still a lack of literature in China about their outcomes, thus making it difficult, if not impossible for the paediatric nephrology community to develop strategies to guide future developments and to better serve this group of sick children.

Methods

Our institution has recently conducted a nation‐wide survey to obtain data of children with end‐stage renal disease (ESRD) between the years 2007 to 2012. Questionnaires were distributed to 39 member hospitals of the Chinese Paediatric Nephrology Association. Only 28 of our member hospitals were actively providing dialysis services to children and their responses were included in this study.

Results

There were a total of 1033 children with ESRD and within this cohort, 474 patients (45.9%) received chronic dialysis and 380 patients (80.2%) preferred haemodialysis.

Conclusion

Haemodialysis is far more commonly used than peritoneal dialysis in China and the outcomes were similar to the experiences in North America. The data we gained through this survey provides the foundation for future planning and development of the paediatric dialysis services in China.
Framework for controlling infection through isolation precautions inJapan
Authors: Kawakami Kazumi , Misao Hanako
Published: March 2014

InJapan, nurses certified in infection control face organizational and structural challenges to the implementation of the recommended isolation precautions. In this study, we developed a conceptual framework for the problem‐solving process of certified nurses in infection control when implementing appropriate isolation‐precaution measures. We conducted a qualitative, descriptive study using directed content analysis. Semistructured interviews were conducted with 40 nurses who had over five years' experience in infection control. Factors assessing the risk of infection in patients were identified, including microorganism characteristics, patient characteristics, and risk of infection to the entire unit. The nurses also assessed the risk of infection in institutions from the following perspectives: organizational culture, infection control system, human resources, environment surrounding the facility, ethical issues, and external factors. Individual characteristics, such as attributes, knowledge, expertise, and job function, were identified as major influencing factors in the problem‐solving process. These findings could be useful for newly‐certified nurses in infection control and provide recommendations on implementing isolation‐precaution measures.