bluuebunny/crossref_metadata_2025 huggingface dataset:
A pilot randomized controlled trial to improve geriatric frailty
Authors: Chan Ding-Cheng Derrick , Tsou Hsiao-Hui , Yang Rong-Sen , Tsauo Jau-Yih , Chen Ching-Yu , Hsiung Chao Agnes , Kuo Ken N
Published: September 2012

Background

Few randomized controlled trials (RCTs) report interventions targeting improvement of frailty status as an outcome.

Methods

This RCT enrolled 117 older adults (65-79 years of age) in Toufen, Taiwan who scored 3-6 on The Chinese Canadian Study of Health and Aging Clinical Frailty Scale Telephone Version and then score ≥1 on the Cardiovascular Health Study Phenotypic Classification of Frailty (CHS_PCF). With a two by two factorial design, subjects were randomly assigned to interventions (Exercise and nutrition, EN, n = 55 or problem solving therapy, PST, n = 57) or controls (non-EN, n = 62 or non-PST, n = 60). Educational booklets were provided to all. EN group subjects received nutrition consultation and a thrice-weekly exercise-training program while PST group subjects received 6 sessions in 3 month. Subjects were followed at 3, 6, and 12 months. Primary outcome was improvement of the CHS_PCF by at least one category (from pre-frail to robust, or from frail to pre-frail or robust) from baseline assessments. One hundred and one completed final assessments. Intention-to-treat analysis with the generalized estimating equation model was applied with adjustment for time and treatment-by-time interactions.

Results

Mean age was 71.4 ± 3.7 years, with 59% females. Baseline characteristic were generally comparable between groups. EN group subjects had a higher improvement rate on the primary outcome than non-EN group subjects (45% vs 27%, adjusted p = 0.008) at 3 months, but not 6 or 12 months. They also had more increase of serum 25(OH) vitamin D level (4.9 ± 7.7 vs 1.2 ± 5.4, p = 0.006) and lower percentage of osteopenia (74% vs 89% p = 0.042) at 12 months. PST group subjects had better improvement (2.7 ± 6.1 vs 0.2 ± 6.7, p = 0.035, 6-month) and less deterioration (−3.5 ± 9.7 vs −7.1 ± 8.7, p = 0.036, 12-month) of dominant leg extension power than non-PST subjects. Some secondary outcomes were also improved in control groups (non-EN or non-PST). No adverse effects were reported.

Conclusions

The three-month EN intervention resulted in short-term (3-month) frailty status improvement and long-term effect on bone mineral density and serum vitamin D (12-month) among Taiwanese community-dwelling elders. The effect of PST was less pronounce.

Trial registration

ClinicalTrials.gov: EC0970301
A new score predicting the survival of patients with spinal cord compression from myeloma
Authors: Douglas Sarah , Schild Steven E , Rades Dirk
Published: September 2012

Background

This study was performed to create and validate a scoring system for the survival of patients with malignant spinal cord compression (SCC) from myeloma.

Methods

Of the entire cohort (N = 216), 108 patients were assigned to a test group and 108 patients to a validation group. In the test group, nine pre-treatment factors including age, gender, Eastern Cooperative Oncology Group performance status (ECOG-PS), number of involved vertebrae, ambulatory status prior to radiotherapy, other bone lesions, extraosseous lesions, interval from first diagnosis of myeloma to radiotherapy of SCC, and the time developing motor deficits were retrospectively analyzed.

Results

On univariate analysis, improved survival was associated with ECOG-PS 1–2 (p = 0.006), being ambulatory (p = 0.005), and absence of other bone lesions (p = 0.019). On multivariate analysis, ECOG-PS (p = 0.036) and ambulatory status (p = 0.037) were significant; other bone lesions showed a strong trend (p = 0.06). These factors were included in the score. The score for each factor was determined by dividing the 12-month survival rate (in%) by 10. The total risk score was the sum of the three factor scores and ranged from 19 to 24 points. Three prognostic groups were designed with the following 12-month survival rates: 49% for 19–20 points, 74% for 21–23 points, and 93% for 24 points (p = 0.002). In the validation group, the 12-month survival rates were 51%, 80%, and 90%, respectively (p < 0.001).

Conclusions

This score appears reproducible, because the 12-month survival rates of both the test and the validation group were very similar. This new survival score can help personalize the treatment of patients with SCC from myeloma and can be of benefit when counseling patients.
The Beijing version of the montreal cognitive assessment as a brief screening tool for mild cognitive impairment: a community-based study
Authors: Yu Jing , Li Juan , Huang Xin
Published: September 2012

Background

A cross-sectional validation study was conducted in several urban and rural communities in Beijing, China, to evaluate the effectiveness of the Beijing version of the Montreal Cognitive Assessment (MoCA-BJ) as a screening tool to detect mild cognitive impairment (MCI) among Chinese older adults.

Methods

The MoCA-BJ and the Mini-Mental State Examination (MMSE) were administered to 1001 Chinese elderly community dwellers recruited from three different regions (i.e., newly developed, old down-town, and rural areas) in Beijing. Twenty-one of these participants were diagnosed by experienced psychiatrists as having dementia, 115 participants were diagnosed as MCI, and 865 participants were considered to be cognitively normal. To analyze the effectiveness of the MoCA-BJ, we examined its psychometric properties, conducted item analyses, evaluated the sensitivity and specificity of the scale, and compared the scale with the MMSE. Demographic and regional differences among our subjects were also taken into consideration.

Results

Under the recommended cut-off score of 26, the MoCA-BJ demonstrated an excellent sensitivity of 90.4%, and a fair specificity (31.3%). The MoCA-BJ showed optimal sensitivity (68.7%) and specificity (63.9%) when the cut-off score was lowered to 22. Among all the seven cognitive sub-domains, delayed recall was shown to be the best index to differentiate MCI from the normal controls. Regional differences disappeared when the confounding demographic variables (i.e., age and education) were controlled. Item analysis showed that the internal consistency was relatively low in both naming and sentence repetition tasks, and the diagnostic accuracy was similar between the MoCA-BJ and the MMSE.

Conclusions

In general, the MoCA-BJ is an acceptable tool for MCI screening in both urban and rural regions of Beijing. However, presumably due to the linguistic and cultural differences between the original English version and the Chinese version of the scale, and the lower education level of Chinese older adults, the MoCA-BJ is not much better than the MMSE in detecting MCI, at least for this study sample. Further modifications to several test items of the MoCA-BJ are recommended in order to improve the applicability and effectiveness of the MoCA-BJ in MCI screening among the Chinese population.
No red cell alloimmunization or change of clinical outcome after using fresh frozen cancellous allograft bone for acetabular reconstruction in revision hip arthroplasty: a follow up study
Authors: Mittag Falk , Straub Matthias , Schäfer Richard , Kluba Torsten , Ipach Ingmar
Published: September 2012

Background

Possible immunization to blood group or other antigens and subsequent inhibition of remodeling or incorporation after use of untreated human bone allograft was described previously. This study presents the immunological, clinical and radiological results of 30 patients with acetabular revisions using fresh frozen non-irradiated bone allograft.

Methods

AB0-incompatible (donor-recipient) bone transplantation was performed in 22 cases, Rh(D) incompatible transplantation in 6 cases. The mean follow up of 23 months included measuring Harris hip score and radiological examination with evaluation of remodeling of the bone graft, implant migration and heterotopic ossification. In addition, all patients were screened for alloimmunization to Rh blood group antigens.

Results

Compared to the whole study group, there were no differences in clinical or radiological measurements for the groups with AB0- or Rh(D)-incompatible bone transplantation. The mean Harris Hip Score was 80.6. X-rays confirmed total remodeling of all allografts with no acetabular loosening. At follow up, blood tests revealed no alloimmunization to Rh blood group donor antigens.

Conclusions

The use of fresh frozen non-irradiated bone allograft in acetabular revision is a reliable supplement to reconstruction. The risk of alloimmunization to donor-blood group antigens after AB0- or Rh-incompatible allograft transplantation with a negative long-term influence on bone-remodeling or the clinical outcome is negligible.
Personal health records in the preclinical medical curriculum: modeling student responses in a simple educational environment utilizing Google Health
Authors: Karamanlis Dimokratis A , Tzitzis Panagiotis M , Bratsas Charalampos A , Bamidis Panagiotis D
Published: September 2012

Background

Various problems concerning the introduction of personal health records in everyday healthcare practice are reported to be associated with physicians’ unfamiliarity with systematic means of electronically collecting health information about their patients (e.g. electronic health records - EHRs). Such barriers may further prevent the role physicians have in their patient encounters and the influence they can have in accelerating and diffusing personal health records (PHRs) to the patient community. One way to address these problems is through medical education on PHRs in the context of EHR activities within the undergraduate medical curriculum and the medical informatics courses in specific. In this paper, the development of an educational PHR activity based on Google Health is reported. Moreover, student responses on PHR’s use and utility are collected and presented. The collected responses are then modelled to relate the satisfaction level of students in such a setting to the estimation about their attitude towards PHRs in the future.

Methods

The study was conducted by designing an educational scenario about PHRs, which consisted of student instruction on Google Health as a model PHR and followed the guidelines of a protocol that was constructed for this purpose. This scenario was applied to a sample of 338 first-year undergraduate medical students. A questionnaire was distributed to each one of them in order to obtain Likert-like scale data on the sample’s response with respect to the PHR that was used; the data were then further analysed descriptively and in terms of a regression analysis to model hypothesised correlations.

Results

Students displayed, in general, satisfaction about the core PHR functions they used and they were optimistic about using them in the future, as they evaluated quite high up the level of their utility. The aspect they valued most in the PHR was its main role as a record-keeping tool, while their main concern was related to the negative effect their own opinion might have on the use of PHRs by patients. Finally, the estimate of their future attitudes towards PHR integration was found positively dependent of the level of PHR satisfaction that they gained through their experience (rho = 0.524, p <0.001).

Conclusions

The results indicate that students support PHRs as medical record keeping helpers and perceive them as beneficial to healthcare. They also underline the importance of achieving good educational experiences in improving PHR perspectives inside such educational activities. Further research is obviously needed to establish the relative long-term effect of education to other methods of exposing future physicians to PHRs.
High density trans-admittance mammography development and preliminary phantom tests
Authors: Zhao Mingkang , Wi Hun , Mostofa Kamal Abu Hena , McEwan Alistair Lee , Woo Eung Je , Oh Tong In
Published: September 2012

Background

Malignant breast tumor tissue has a significantly different electrical impedance spectrum than surrounding normal tissues. This has led to the development of impedance imaging as a supplementary or alternative method to X-ray mammography for screening and assessment of breast cancers. However low spatial resolution and poor signal to noise ratio has limited the clinical application.

Methods

In order to improve spatial resolution we developed a trans-admittance mammography (TAM) system including an array of 60×60 current sensing electrodes. We adopted a similar setup to X-ray mammography where the breast is situated between two holding plates. The top plate is a large solid metal electrode for applying a sinusoidal voltage over a range of frequencies from 50 Hz to 500 kHz. The bottom plate has 3600 current sensing electrodes that are kept at the ground potential. Currents are generated from the top voltage-applying electrode and spread throughout the breast, entering the TAM system through the array of current sensing electrodes on the bottom plate. The TAM system measures the exit currents through 6 switching modules connected to 600 electrodes each. Each switching module is connected to 12 ammeter channels which are switched sequentially to 50 of the 600 electrodes each measurement time. Each ammeter channel is comprised of a current-to-voltage converter, a gain amplifier, filters, an analog to digital converter, and a digital phase sensitive demodulator.

Results

We found an average noise level of 38 nA, amplitude stability of less than 0.2%, crosstalk of better than -60 dB and 70 dB signal to noise ratio over all channels and operating frequencies. Images were obtained in time difference and frequency difference modes in a saline phantom.

Conclusion

We describe the design, construction, and calibration of a high density TAM system in detail. Successful high resolution time and frequency difference images showed regions of interest with the expected admittivity changes in the frequency spectrum.
Collaborative software for traditional and translational research
Authors: Berman Ari E , Barnett William K , Mooney Sean D
Published: September 2012

Biomedical research has entered a period of renewed vigor with the introduction and rapid development of genomic technologies and next-generation sequencing methods. This research paradigm produces extremely large datasets that are both difficult to store and challenging to mine for relevant data. Additionally, the thorough exploration of such datasets requires more resources, personnel, and multidisciplinary expertise to properly analyze and interpret the data. As a result, modern biomedical research practices are increasingly designed to include multi-laboratory collaborations that effectively distribute the scientific workload and expand the pool of expertise within a project. The scope of biomedical research is further complicated by increased efforts in translational research, which mandates the translation of basic laboratory research results into the human medical application space, adding to the complexity of potential collaborations. This increase in multidisciplinary, multi-laboratory, and biomedical translational research identifies a specific need for formalized collaboration practices and software applications that support such efforts. Here, we describe formal technological requirements for such efforts and we review several software solutions that can effectively improve the organization, communication, and formalization of collaborations in biomedical research today.
TCP’s dynamic adjustment of transmission rate to packet losses in wirelessnetworks
Authors: Park Mi-Young , Chung Sang-Hwa , Ahn Chang-Woo
Published: September 2012

Based on the assumption of transmission control protocol (TCP) that packetsare lost due to congestion, TCP’s congestion control algorithms suchas fast retransmit/recovery (FRR) and retransmission timeouts (RTO)unconditionally reduce the transmission rate for every packet loss. When TCPoperates in wireless networks, however, FRRs/RTOs are often triggeredregardless of congestion due to sudden delay and wireless transmissionerrors. The congestion irrelative FRRs/RTOs incur TCP’s misbehaviorsuch as blindly halving the transmission rate, unnecessarily retransmittingthe outstanding packets which may be in the bottleneck queue. Although manyprevious studies have been proposed to detect the congestion irrelativeFRRs/RTOs, they paid little attention on effectively adjusting thetransmission rate for the detected congestion irrelative FRRs/RTOs.

In this article, we propose an enhanced TCP to dynamically adjust itstransmission rate according to network conditions. Our scheme adjusts thetransmission rate in proportion to the available bandwidth in order toquickly utilize the available bandwidth, and also re-adjusts it in inverseproportion to the loss rate in order to avoid burst losses and longgo-back-N retransmissions. By doing so, our scheme hassignificant effects to avoid the performance degradation caused by thecongestion irrelative FRRs/RTOs. Throughout the extensive experiments, weevaluate our scheme and compare it with previous works in terms of goodput,fairness, and friendless under various network topologies. The results showthat our scheme significantly outperforms previous studies while itmaintains the fair and friendly behavior to other TCP connections.
Existence results for nonlinear fractional differential equations with closed boundary conditions and impulses
Authors: Wang Guotao , Ahmad Bashir , Zhang Lihong
Published: September 2012

This paper is concerned with the existence and uniqueness of solutions for impulsive nonlinear differential equations of fractional order

α
∈
(
1
,
2
]

with closed boundary conditions. By applying some standard fixed point theorems, we obtain the sufficient conditions for the existence and uniqueness of solutions of the problem at hand. An illustrative example is presented.

MSC:26A33, 34B15, 34B37.
Optimal SP frame selection and bit budget allocation for mobile H.264 video streaming
Authors: Colonnese Stefania , Rinauro Stefano , Rossi Lorenzo , Scarano Gaetano
Published: September 2012

Mobile video streaming services are challenging, as they obey several system constraints, such as random access facilities, efficient server storage, and flexible rate adaptation. Rate adaptation can be performed by means of seamless switching among different encoded bitstreams. The H.264 video coding standard explicitly supports bitstream switching using specific frame coding modes, namely switching pictures (SP). Locations of SP frames affect the overall bit rate and quality of streamed video. In this study, we address the issue of optimal joint selection of the SP frames locations and bit budget allocation at frame layer. The optimization is carried out via a game theoretic approach under assigned system constraints on the overall streaming rate and the maximum random access delay. Numerical simulations show that our frame layer optimal encoding procedure brings advantages in terms of several characteristics of the streamed video, encompassing enhanced rate-distortion, reduced transmission buffer occupancy, equalization of the transmission delays, and more efficient switching.
Diagnostic issues and capabilities in 48 isolation facilities in 16 European countries: data from EuroNHID surveys
Authors: Thiberville Simon-Djamel , Schilling Stefan , De Iaco Giuseppina , Fusco Francesco Maria , Thomson Gail , Maltezou Helen C , Gottschalk Rene , Brodt Reinhard H , Bannister Barbara , Puro Vincenzo , Ippolito Giuseppe , Brouqui Philippe
Published: September 2012

Background

Highly infectious diseases (HIDs) are defined as being transmissible from person to person, causing life-threatening illnesses and presenting a serious public health hazard. The sampling, handling and transport of specimens from patients with HIDs present specific bio-safety concerns.

Findings

The European Network for HID project aimed to record, in a cross-sectional study, the infection control capabilities of referral centers for HIDs across Europe and assesses the level of achievement to previously published guidelines. In this paper, we report the current diagnostic capabilities and bio-safety measures applied to diagnostic procedures in these referral centers. Overall, 48 isolation facilities in 16 European countries were evaluated. Although 81% of these referral centers are located near a biosafety level 3 laboratory, 11% and 31% of them still performed their microbiological and routine diagnostic analyses, respectively, without bio-safety measures.

Conclusions

The discrepancies among the referral centers surveyed between the level of practices and the European Network of Infectious Diseases (EUNID) recommendations have multiple reasons of which the interest of the individuals in charge and the investment they put in preparedness to emerging outbreaks. Despite the fact that the less prepared centers can improve by just updating their practice and policies any support to help them to achieve an acceptable level of biosecurity is welcome.
Early data from project engage: a program to identify and transition medically hospitalized patients into addictions treatment
Authors: Pecoraro Anna , Horton Terry , Ewen Edward , Becher Julie , Wright Patricia A , Silverman Basha , McGraw Patty , Woody George E
Published: September 2012

Background

Patients with untreated substance use disorders (SUDs) are at risk for frequent emergency department visits and repeated hospitalizations. Project Engage, a US pilot program at Wilmington Hospital in Delaware, was conducted to facilitate entry of these patients to SUD treatment after discharge. Patients identified as having hazardous or harmful alcohol consumption based on results of the Alcohol Use Disorders Identification Test-Primary Care (AUDIT-PC), administered to all patients at admission, received bedside assessment with motivational interviewing and facilitated referral to treatment by a patient engagement specialist (PES). This program evaluation provides descriptive information on self-reported rates of SUD treatment initiation of all patients and health-care utilization and costs for a subset of patients.

Methods

Program-level data on treatment entry after discharge were examined retrospectively. Insurance claims data for two small cohorts who entered treatment after discharge (2009, n = 18, and 2010, n = 25) were reviewed over a six-month period in 2009 (three months pre- and post-Project Engage), or over a 12-month period in 2010 (six months pre- and post-Project Engage). These data provided descriptive information on health-care utilization and costs. (Data on those who participated in Project Engage but did not enter treatment were unavailable).

Results

Between September 1, 2008, and December 30, 2010, 415 patients participated in Project Engage, and 180 (43%) were admitted for SUD treatment. For a small cohort who participated between June 1, 2009, and November 30, 2009 (n = 18), insurance claims demonstrated a 33% ($35,938) decrease in inpatient medical admissions, a 38% ($4,248) decrease in emergency department visits, a 42% ($1,579) increase in behavioral health/substance abuse (BH/SA) inpatient admissions, and a 33% ($847) increase in outpatient BH/SA admissions, for an overall decrease of $37,760. For a small cohort who participated between June 1, 2010, and November 30, 2010 (n = 25), claims demonstrated a 58% ($68,422) decrease in inpatient medical admissions; a 13% ($3,308) decrease in emergency department visits; a 32% ($18,119) decrease in BH/SA inpatient admissions, and a 32% ($963) increase in outpatient BH/SA admissions, for an overall decrease of $88,886.

Conclusions

These findings demonstrate that a large percentage of patients entered SUD treatment after participating in Project Engage, a novel intervention with facilitated referral to treatment. Although the findings are limited by the retrospective nature of the data and the small sample sizes, they do suggest a potentially cost-effective addition to existing hospital services if replicated in prospective studies with larger samples and controls.
Positive effect of septimeb™ on mortality rate in severe sepsis: a novel non antibiotic strategy
Authors: Eslami Kaveh , Mahmoodpoor Ata , Ahmadi Arezoo , Abdollahi Mohammad , Kamali Koorosh , Mousavi Sarah , Najafi Atabak , Baeeri Maryam , Hamishehkar Hadi , Kouti Leila , Javadi Mohammad Reza , Mojtahedzadeh Mojtaba
Published: September 2012

Background

Septimeb is a new herbal-derived remedy, recently approved for its potential immunomodulatory effects. Regarding the key role of immune system in the pathogenesis of severe sepsis and lack of any standard treatment for improving survival of these patients; we evaluated the effect of Septimeb -as an adjutant to standard treatment-on inflammatory biomarkers and mortality rates in patients with severe sepsis.

Methods

In this multicenter, randomized, single-blind trial, we assigned patients with severe sepsis and Acute Physiology and Chronic Health Evaluation (APACHE II) score of more than 20 to receive standard treatment of severe sepsis (control group) or standard treatment plus Septimeb. This group was treated with Septimeb for 14 days then followed up for another14 days. APACHE score, Sequential Organ Failure Assessment (SOFA) and Simplified Acute Physiology Score (SAPS) were calculated daily. Blood samples were analyzed for interleukin 2 tumor necrosis factor-α, total antioxidant power, platelet growth factor and matrix metalloproteinase 2.

Results

A total of 29 patients underwent randomization (13 in control group and 16 in Septimeb group). There was significant difference between the Septimeb and control group in the 14 days mortality rate (18.8% vs. 53.85 respectively, P=0.048). Compared to control group, Septimeb was significantly effective in improving SAPS (P= 0.029), SOFA (P=0.003) and APACHE II (P=0.008) scores. Inflammatory biomarkers didn’t change significantly between the two groups (P>0.05).

Conclusion

Septimeb reduces mortality rates among patients with severe sepsis and it could be added as a safe adjutant to standard treatment of sepsis.
A novel method to quantify IRDye800CW fluorescent antibody probes ex vivo in tissue distribution studies
Authors: Oliveira Sabrina , Cohen Ruth , Walsum Marijke Stigter-van , van Dongen Guus AMS , Elias Sjoerd G , van Diest Paul J , Mali Willem , van Bergen en Henegouwen Paul MP
Published: September 2012

Background

We describe a new method for biodistribution studies with IRDye800CW fluorescent antibody probes. This method allows the quantification of the IRDye800CW fluorescent tracer in percentage of injected dose per gram of tissue (% ID/g), and it is herein compared to the generally used reference method that makes use of radioactivity.

Methods

Cetuximab was conjugated to both the near-infrared fluorophore IRDye800CW and/or the positron emitter 89-zirconium, which was injected in nude mice bearing A431 human tumor xenografts. Positron emission tomography (PET) and optical imaging were performed 24 h post-injection (p.i.). For the biodistribution study, organs and tumors were collected 24 h p.i., and each of these was halved. One half was used for the determination of probe uptake by radioactivity measurement. The other half was homogenized, and the content of the fluorescent probe was determined by extrapolation from a calibration curve made with the injected probe.

Results

Tumors were clearly visualized with both modalities, and the calculated tumor-to-normal tissue ratios were very similar for optical and PET imaging: 3.31 ± 1.09 and 3.15 ± 0.99, respectively. Although some variations were observed in ex vivo analyses, tumor uptake was within the same range for IRDye800CW and gamma ray quantification: 15.07 ± 3.66% ID/g and 13.92 ± 2.59% ID/g, respectively.

Conclusions

The novel method for quantification of the optical tracer IRDye800CW gives similar results as the reference method of gamma ray quantification. This new method is considered very useful in the context of the preclinical development of IRDye800CW fluorescent probes for optical molecular imaging, likely contributing to the selection of lead compounds that are the most promising for clinical translation.
Recycling endosome-dependent and -independent mechanisms for IL-10 secretion in LPS-activated macrophages
Authors: Stanley A C , Lieu Z Z , Wall A A , Venturato J , Khromykh T , Hamilton N A , Gleeson P A , Stow J L
Published: September 2012

Two post-Golgi pathways where IL-10 is trafficked, ensures its secretion from activated macrophages under different physiological conditions.

IL-10 is a key anti-inflammatory cytokine secreted by activated macrophages as a feedback control mechanism to prevent excessive inflammatory responses. Here, we define multiple intracellular trafficking pathways involved in the secretion of newly synthesized IL-10 from macrophages following TLR4 activation with LPS, and show how this relates to the previously defined trafficking pathways for IL-6 and TNF in macrophages simultaneously producing these proinflammatory cytokines. IL-10 exits the Golgi in multiple tubular carriers, including those dependent on p230GRIP. Some of the IL-10 is then delivered to recycling endosomes, where cytokine sorting may occur prior to its release. Another portion of the IL-10 is delivered to the cell surface in distinct vesicles colabeled for apoE. Thus, we show at least two post-Golgi pathways via which IL-10 is trafficked, ensuring its secretion from activated macrophages under different physiological conditions.
Fertility (male and female) and Menopause
Authors: Ruddy Kathryn J. , Partridge Ann H.
Published: September 2012

The impact of oncologic treatments on fertility and menopausal symptoms is often significant for patients with cancer. Surgery, radiation, and chemotherapy can all damage the reproductive organs or the hypothalamic pituitary axis that controls them, impairing fertility and causing hormonally mediated symptoms such as hot flashes.

Understanding these risks and strategies to mitigate them may substantially improve cancer survivorship care. For both female and male patients who desire a future biologic child, there are a variety of fertility preservation techniques that should be considered. For cancer survivors who experience menopausal symptoms, lifestyle changes may be beneficial, and hormonal and nonhormonal pharmacologic agents are well proven to reduce symptom burden.
Bone Health in Adult Cancer Survivorship
Authors: Lustberg Maryam B. , Reinbolt Raquel E. , Shapiro Charles L.
Published: September 2012

Optimizing health outcomes, including prevention of osteoporotic fractures, is essential for promoting the well-being of the growing number of cancer survivors. Medical providers who participate in the care of cancer survivors should be aware that various cancer treatments may cause bone loss, which can increase the risk of subsequent of osteoporosis. Healthy bone remodeling is a balanced and dynamic equation between new bone formation and bone resorption. Aging, natural menopause, and cancer treatments such as surgical oophorectomy, gonadotropin-releasing hormone agonists, chemotherapy-induced ovarian failure, androgen deprivation therapy, and aromatase inhibitors can all promote bone loss. The WHO Fracture Assessment Tool can be used as a clinical aid to assess an individual's osteoporotic fracture risk, with or without bone mineral density measurements obtained from dual-energy x-ray absorptiometry. Preventative strategies include adequate calcium and vitamin D supplementation and modifying risk factors such as alcohol intake, tobacco use, and lack of exercise. Bisphosphonate therapy and rank-ligand monoclonal antibody therapy are the most commonly used agents for management of bone loss resulting from cancer treatment. This review will summarize the mechanisms by which cancer treatments cause bone loss as well provide screening and treatment recommendations for the management of bone loss.
Estrogen Plus Progestin and Colorectal Cancer Incidence and Mortality
Authors: Simon Michael S. , Chlebowski Rowan T. , Wactawski-Wende Jean , Johnson Karen C. , Muskovitz Andrew , Kato Ikuko , Young Alicia , Hubbell F. Allan , Prentice Ross L.
Published: September 2012

Purpose

During the intervention phase in the Women's Health Initiative (WHI) clinical trial, use of estrogen plus progestin reduced the colorectal cancer diagnosis rate, but the cancers were found at a substantially higher stage. To assess the clinical relevance of the findings, analyses of the influence of combined hormone therapy on colorectal cancer incidence and colorectal cancer mortality were conducted after extended follow-up.

Patients and Methods

The WHI study was a randomized, double-blind, placebo-controlled clinical trial involving 16,608 postmenopausal women with an intact uterus who were randomly assigned to daily 0.625 mg conjugated equine estrogen plus 2.5 mg medroxyprogesterone acetate (n = 8,506) or matching placebo (n = 8,102). Colorectal cancer diagnosis rates and colorectal cancer mortality were assessed.

Results

After a mean of 5.6 years (standard deviation [SD], 1.03 years) of intervention and 11.6 years (SD, 3.1 years) of total follow-up, fewer colorectal cancers were diagnosed in the combined hormone therapy group compared with the placebo group (diagnoses/year, 0.12% v 0.16%; hazard ratio [HR], 0.72; 95% CI, 0.56 to 0.94; P = .014). Bowel screening examinations were comparable between groups throughout. Cancers in the combined hormone therapy group more commonly had positive lymph nodes (50.5% v 28.6%; P < .001) and were at higher stage (regional or distant, 68.8% v 51.4%; P = .003). Although not statistically significant, there was a higher number of colorectal cancer deaths in the combined hormone therapy group (37 v 27 deaths; 0.04% v 0.03%; HR, 1.29; 95% CI, 0.78 to 2.11; P = .320).

Conclusion

The findings, suggestive of diagnostic delay, do not support a clinically meaningful benefit for combined hormone therapy on colorectal cancer.
Visitor behaviour and public health implications associated with exotic pet markets: an observational study
Authors: Warwick Clifford , Arena Phillip C , Steedman Catrina
Published: September 2012

Objectives

To conduct on-site assessments of public health implications at key European pet markets.

Design

Observational study of visitor behaviour at stalls that displayed and sold animals, mainly amphibians and reptiles, to assess potential contamination risk from zoonotic pathogens. We noted initial modes of contact as ‘direct’ (handling animals) as well as ‘indirect’ (touching presumed contaminated animal-related sources) and observed whether these visitors subsequently touched their own head or mouth (H1), body (H2) or another person (H3).

Setting

Publicly accessible exotic animal markets in the UK, Germany and Spain.

Participants

Anonymous members of the public in a public place.

Main outcome measures

Occurrence and frequency of public contact (direct, indirect or no contact) with a presumed contaminated source.

Results

A total of 813 public visitors were observed as they attended vendors. Of these, 29 (3.6%) made direct contact with an animal and 222 (27.3%) made indirect contact with a presumed contaminated source, with subsequent modes of contact being H1 18.7%, H2 52.2% and H3 9.9%.

Conclusions

Our observations indicate that opportunities for direct and indirect contact at pet markets with presumed contaminated animals and inanimate items constitute a significant and major concern, and that public attendees are exposed to rapid contamination on their person, whether or not these contaminations become associated with any episode of disease involving themselves or others. These public health risks appear unresolvable given the format of the market environment.
Oral bacteria: masters of disguise and distant site invaders
Authors: Petersen Helen
Published: September 2012

Oral bacteria have long been recognised as pathogens in distant site infections, most notably infective endocarditis (IE). Current changes in guidelines from the National Institute for Health and Clinical Excellence have highlighted the fact that these bacteria do not rely on a single surgical event to gain access to the vasculature and travel to the heart valves. Low grade, repetitive transient bacteraemia caused by everyday activities such as tooth brushing are thought to be more important in initiating IE. This article tells the story of the mechanisms by which oral commensal bacteria gain access to the vascular system to invade distant sites, including the heart valves.
A dental perspective of facial palsy
Authors: Klobucar Robert , Kingsmill Virginia , Venables Vanessa , Bisase Brian , Nduka Charles
Published: September 2012

Facial palsy affects patients in more ways than one would at first think. The aesthetic signs are obvious for all to see, the psychological problems less so. Then there are the functional problems that blight many patients’ lives. Eating, drinking and speaking are everyday tasks that become difficult to do. Adequate oral hygiene is hard for patients to sustain when they have difficulty opening their mouth, and suffer from a dry mouth and food trapping. To understand and increase awareness of these issues, it is valuable to look initially at the aetiology of facial palsy. This informs the specific symptoms and subsequent management of the condition.
The Use of Galactogogues in the Breastfeeding Mother
Authors: Forinash Alicia B , Yancey Abigail M , Barnes Kylie N , Myles Thomas D
Published: September 2012

Objective:

To review data regarding the efficacy of galactogogues available in the US to increase breast milk production in postpartum mothers.

Data Sources:

Literature was sought using PubMed (1966-June 2012) and EMBASE (1973-June 2012). Search terms included breastfeeding, breast milk, Lactation, galactogogue, motoctopramide, oxytocin, fenugreek, milk thistle, Silymarin, growth hormone, thyroid releasing hormone, medroxyprogesterone, domperidono. goat's rue, beer, Asparagus racemosus, shatavari, Medicago sativa, alfalfa. Onicus bonedictus. blessed thistle, Galoga officinalis, brewer's yeast, and herbals.

Study Selection and Data Extraction:

All studies including humans and published in English with data assessing the efficacy of galactogogues for increasing breast milk production were evaluated.

Data Synthesis:

Breast milk is considered the optimal food source for newborns through 1 year of age. Many factors influence overall maternal production, including maternal pain, illness, balance of time when returning to work, anxiety, or emotional stress. Although a variety of herbal and pharmaceutical options have anecdotal evidence of their ability to improve breast milk production, peer-reviewed studies proving their efficacy are lacking. Metoclopramide, oxytocin, fenugreek, and milk thistle have shown mixed results in improving milk production; however, the trials were small and had a variety of limitations.

Conclusions:

Nonpharmacologic recommendations should be exhausted before adding therapy. Although anecdotal evidence encourages the use of metoclopramide, fenugreek, asparagus, and milk thistle for their galactogogue properties, efficacy and safety data in the literature are lacking. Oxytocin and domperidono are potentially available for compounding purposes, but safety data are limited. More studies are needed to evaluate the effects of available galactogogues on breast milk production.
Financial Liberalization, Banking Crises and Economic Growth: The Case of South Mediterranean Countries
Authors: Ben Salha Ousama , Bouazizi Tarek , Aloui Chaker
Published: September 2012

The central aim of this paper is to empirically assess the effects of financial liberalization on economic growth in the presence of banking crises. Our empirical investigation is based on a dynamic panel model for a sample of 10 South Mediterranean countries during the period 1980-2005. Results suggest that equity market liberalization positively affects economic growth in these countries, especially in the period of fragility and banking crises. Capital account liberalization, however, has no significant effects. As expected, banking crises exert negative effects on economic growth. When we control for the presence of macroeconomic stability and appropriate openness sequencing, the anticipated effects of capital account liberalization become significant. We conclude that macroeconomic reforms and trade opening are both crucial prerequisites for the success of the capital account liberalization process.
Do Immigrant Students Succeed? Evidence from Italy and France
Authors: Murat Marina
Published: September 2012

This paper uses data from PISA 2006 on science, mathematics and reading to analyze immigrant school gaps – negative difference between immigrants’ and natives’ scores - and the structural features of educational systems in two adjacent countries, Italy and France, with similar migration inflows and with similar schooling institutions, based on tracking. Our results show that tracking and school specific programs matter; in both countries, the school system upholds a separation between students with different backgrounds and ethnicities. Residential segregation or discrimination seem also to be at work, especially in France. Given the existing school model, a teaching support in mathematics and science in France and in reading in Italy would help immigrant students to converge to natives’ standards.
Does China Still Have a Labor Cost Advantage?
Authors: Ceglowski Janet , Golub Stephen S.
Published: September 2012

In recent years wages in China have been rising and the yuan has appreciated, potentially eroding China’s cost advantage in manufactures. This paper explores the evolution of China’s relative unit labor costs in manufacturing over 1998-2009. Between 1998 and 2003 China’s unit labor costs fell, but since 2003 they have increased both absolutely and relative to US unit labor costs. Much of the rise in China’s relative unit labor costs can be traced to a real appreciation of the yuan against the dollar. Despite the recent rise, China’s unit labor costs remain low relative to those in most other countries.
A history of HbA1c through Clinical Chemistry and Laboratory Medicine
Authors: Gillery Philippe
Published: September 2012

HbA1c was discovered in the late 1960s and its use as marker of glycemic control has gradually increased over the course of the last four decades. Recognized as the gold standard of diabetic survey, this parameter was successfully implemented in clinical practice in the 1970s and 1980s and internationally standardized in the 1990s and 2000s. The use of standardized and well-controlled methods, with well-defined performance criteria, has recently opened new directions for HbA1c use in patient care, e.g., for diabetes diagnosis. Many reports devoted to HbA1c have been published in Clinical Chemistry and Laboratory Medicine (CCLM) journal. This review reminds the major steps of HbA1c history, with a special emphasis on the contribution of CCLM in this field.
An Optimization Algorithm for SDR Multi-Standard Systems Using Directed Hypergraphs
Authors: Kaiser Patricia , Sahili Amine El , Louët Yves
Published: September 2012

Software-Defined radio (SDR) is a future-proof solution for designing flexible and adaptable wireless networks and equipments. It replaces conventional radio hardware with reconfigurable, reprogrammable radios. A graphical approach for designing flexible SDR multi-standard systems is proposed, which provides all the possible alternatives of implementation capable of realizing the multi-standard design. However, a cost function which evaluates the cost of any one of these options is proposed in previous work. All these ideas are briefly mentioned in this paper but however, our goal is to help finding the option of implementation which has the minimum cost. Graph theory is adopted and particularly the study of directed hypergraphs, to present a new idea algorithm capable of solving this optimization problem. This algorithm provides an exact-optimal solution, unlike the previously applied heuristic methods which give a near-optimal solution. Furthermore in this work, we analyze the computational complexity of our algorithm.
The role of functionally defective rare germline variants of sialic acid acetylesterase in autoimmune Addison's disease
Authors: Gan Earn H , MacArthur Katie , Mitchell Anna L , Pearce Simon H S
Published: September 2012

Background

Autoimmune Addison's disease (AAD) is a rare condition with a complex genetic basis. A panel of rare and functionally defective genetic variants in the sialic acid acetylesterase (SIAE) gene has recently been implicated in several common autoimmune conditions. We performed a case–control study to determine whether these rare variants are associated with a rarer condition, AAD.

Method

We analysed nine SIAE gene variants (W48X, M89V, C196F, C226G, R230W, T312M, Y349C, F404S and R479C) in a United Kingdom cohort of 378 AAD subjects and 387 healthy controls. All samples were genotyped using Sequenom iPlex chemistry to characterise primer extension products.

Results

A heterozygous rare allele at codon 312 (312*M) was found in one AAD patient (0.13%) but was not detected in the healthy controls. The commoner, functionally recessive variant at codon 89 (89*V) was found to be homozygous in two AAD patients but was only found in the heterozygous state in controls. Taking into account all nine alleles examined, 4/378 (1.06%) AAD patients and 1/387 (0.25%) healthy controls carried the defective SIAE alleles, with a calculated odds ratio of 4.13 (95% CI 0.44–97.45, two-tailed P value 0.212, NS).

Conclusion

We demonstrated the presence of 89*V homozygotes and the 312*M rare allele in the AAD cohort, but overall, our analysis does not support a role for rare variants in SIAE in the pathogenesis of AAD. However, the relatively small collection of AAD patients limits the power to exclude a small effect.
Severe Poisoning After Accidental Pediatric Ingestion of Glycol Ethers
Authors: Wang George S. , Yin Shan , Shear Brian , Heard Kennon
Published: September 2012

Human glycol ether poisonings are sparsely reported in the medical literature. We describe a healthy 22-month-old boy who accidentally drank up to 330 mL of brake fluid containing a 75% bleed of various glycol ethers (5%–50% polyethylene glycol monomethyl ether, 15%–40% triethylene glycol monoethyl ether, 1%–30% triethylene glycol monomethyl ether, 1%–25% triethylene glycol monobutyl ether, 1%–20% polyethylene glycol, monobutyl ether, 1%–20% triethylene glycol, and <10% of other glycol ethers). Within 4 hours, he became somnolent and developed a persistent metabolic acidosis. Thirty minutes later, he received 1 dose of fomepizole. Neither progression nor improvement in clinical or metabolic status was noted after the fomepizole. He received hemodialysis for 3 hours ∼8 hours after ingestion, and his symptoms resolved resulting in an uneventfully recovery.
Desconfortos físicos decorrentes dos tratamentos do câncer de mama influenciam a sexualidade da mulher mastectomizada?
Authors: Cesnik Vanessa Monteiro , Santos Manoel Antônio dos
Published: September 2012

Este trabalho é uma revisão integrativa, que objetiva analisar a produção científica dedicada à sexualidade da mulher com câncer de mama após a mastectomia, com foco na interferência dos desconfortos físicos decorrentes dos tratamentos sobre sua vida sexual. O estudo abrangeu trabalhos publicados no período de 2000 a 2009, utilizando as bases MEDLINE, LILACS e PsycINFO, por meio dos descritores mastectomy, breast neoplasms, sexuality, sexual behavior, amputation, psychossexual development, marital relations. Foram selecionados nove artigos, que abordavam as repercussões dos desconfortos físicos provenientes dos tratamentos oncológicos na vivência da sexualidade. Os achados evidenciaram que, mesmo quando existe intensa e satisfatória vida sexual no período prévio à doença, fatores como estresse, dor, fadiga, insulto à imagem corporal e baixa autoestima, decorrentes dos tratamentos, podem desorganizar o funcionamento sexual da mulher acometida. É necessário sensibilizar os profissionais para acolherem o tema em políticas e estratégias preventivas, diagnósticas e terapêuticas.