bluuebunny/crossref_metadata_2025 huggingface dataset:
Epigallocatechin‐3‐gallate induces cell death in acute myeloid leukaemia cells and supports all‐trans retinoic acid‐induced neutrophil differentiation via death‐associated protein kinase 2
Authors: Britschgi Adrian , Simon Hans‐Uwe , Tobler Andreas , Fey Martin F. , Tschan Mario P.
Published: January 2010

Acute promyelocytic leukaemia (APL) patients are successfully treated with all‐trans retinoic acid (ATRA). However, concurrent chemotherapy is still necessary and less toxic therapeutic approaches are needed. Earlier studies suggested that in haematopoietic neoplasms, the green tea polyphenol epigallocatechin‐3‐gallate (EGCG) induces cell death without adversely affecting healthy cells. We aimed at deciphering the molecular mechanism of EGCG‐induced cell death in acute myeloid leukaemia (AML). A significant increase of death‐associated protein kinase 2 (DAPK2) levels was found in AML cells upon EGCG treatment paralleled by increased cell death that was significantly reduced upon silencing of DAPK2. Moreover, combined ATRA and EGCG treatment resulted in cooperative DAPK2 induction and potentiated differentiation. EGCG toxicity of primary AML blasts correlated with 67 kDa laminin receptor (67LR) expression. Pretreatment of AML cells with ATRA, causing downregulation of 67LR, rendered these cells resistant to EGCG‐mediated cell death. In summary, it was found that (i) DAPK2 is essential for EGCG‐induced cell death in AML cells, (ii) ATRA and EGCG cotreatment significantly boosted neutrophil differentiation, and 67LR expression correlates with susceptibility of AML cells to EGCG. We thus suggest that EGCG, by selectively targeting leukaemic cells, may improve differentiation therapies for APL and chemotherapy for other AML subtypes.
Venous thrombosis of the upper extremity: effect of blood group and coagulation factor levels on risk
Authors: Flinterman Linda E. , Van Hylckama Vlieg Astrid , Rosendaal Frits R. , Doggen Carine J. M.
Published: January 2010

Venous thrombosis of the upper extremity is a rare form of thrombosis, accounting for around 4% of all venous thromboses, and for which only a few risk factors are known. This case‐control study investigated the effect of coagulation factors on risk of venous thrombosis of the upper extremity. Patients with venous thrombosis of the arm and partner controls were selected from the Multiple Environmental and Genetic Assessment study, a large population‐based case‐control study. Participants with a malignancy were excluded. Odds ratios (OR) were estimated for elevated levels of factor II, VII, VIII, IX, X, XI, von Willebrand Factor (VWF), and fibrinogen, low levels of protein C, protein S, and antithrombin, and for blood group non‐O. Substantially increased risks of venous thrombosis of the upper extremity were found for patients with high levels (above 90th percentile versus below) of factor VIII (OR: 4·2, 95% confidence interval (CI): 2·2–7·9), VWF (OR: 4·0, 95% CI: 2·1–7·8), fibrinogen (OR: 2·9, 95% CI, 1·5–5·7), and for blood group non‐O compared to O (OR: 2·1, 95% CI, 1·3–3·6). The other factors were not associated with an increased risk. Elevated levels of several procoagulant factors are associated with a strongly increased risk of venous thrombosis of the upper extremity.
Clinical efficacy and immunological mechanisms of sublingual and subcutaneous immunotherapy in asthmatic/rhinitis children sensitized to house dust mite: an open randomized controlled trial
Authors: Eifan A. O. , Akkoc T. , Yildiz A. , Keles S. , Ozdemir C. , Bahceciler N. N. , Barlan I. B.
Published: January 2010

Background
In children, the clinical efficacy and immunological mechanisms of sublingual immunotherapy (SLIT) compared with subcutaneous immunotherapy (SCIT) is still to be elucidated.

Objectives
To compare SLIT, SCIT and pharmacotherapy in relation to clinical efficacy and immunological mechanisms that govern its effect in asthmatic/rhinitis children who were sensitized to house dust mite (HDM).

Methods
In this single centre, prospective, randomized, controlled, open labelled, three parallel group trial, 48 patients mono‐sensitized to HDM were randomized to receive either SLIT (n=16), SCIT (n=16) or pharmacotherapy alone (n=16). Symptom, medication and visual analogue score (VAS) were collected and bronchial‐nasal hyper‐reactivity, skin prick tests, total‐specific IgE were performed at baseline and 12 months after treatment. In addition, peripheral blood mononuclear cells were cultured with recombinant Der p 1 and Bet v 1 extracts and allergen‐specific IL‐4, IL‐5, IL‐13, IFN‐γ, IL‐10, and TGF‐β secretions were measured.

Results
SLIT and SCIT demonstrated a significant reduction of total rhinitis and asthma symptom score, total medication score, VAS and skin reactivity to HDM (P<0.05) when compared with pharmacotherapy. A significant reduction of serum‐specific HDM‐IgE in SCIT and SLIT were observed. Moreover, titrated nasal provocative dose significantly increased in both immunotherapy groups when compared with the pharmacotherapy group. No adverse effects were reported in SLIT, while two patients demonstrated serious adverse events in SCIT. After 1 year of treatment, Der p 1‐driven IL‐10 significantly increased in SLIT compared with pharmacotherapy, whereas Bet v 1‐driven TGF‐β (negative control) increased significantly in SLIT only. No changes were observed for Th1–Th2 cytokines.

Conclusion
Both SLIT and SCIT demonstrated clinical improvement compared with pharmacotherapy in asthma/rhinitis children sensitized to HDM.
Which are the most important discriminatory items for subclassifying non‐specific low back pain? A Delphi study among Greek health professionals
Authors: Billis Evdokia , McCarthy Christopher J. , Gliatis John , Stathopoulos Ioannis , Papandreou Maria , Oldham Jacqueline A.
Published: January 2010

Rationale, aims and objectives  Developing homogenous low back pain (LBP) classification groups is recommended for enhancing clinical outcomes. However, an important step towards the development of specific subgroups is the selection and consensus agreement among health professionals on the discriminatory clinical items (sings and symptoms) that should be included in the classification process. Thus, this study's objective was to develop a list of clinical features for the assessment of LBP by health care providers within Greece, which are believed to be discriminatory in identifying LBP subgroups.

Methods  A random sample stratified by geographical region and work status of 150 Greek physiotherapists (PTs) participated in a two‐round Delphi study. PTs were asked to obtain consensus and hierarchy, the most important items out of a list of evaluating/diagnostic features believed to be discriminatory for LBP patients. These items included 80 clinical features and were generated in by PTs and doctors previous work.

Results  Second‐round questionnaires were returned by 112 PTs (74.6% response rate). A total of 66 clinical features were rated as important discriminatory items in LBP assessment. Clinical items included characteristics of present symptoms and the history's condition, general medical history, information regarding patient function, patients' attitudes regarding movement, diagnosis, expectations, fear‐avoidance beliefs as well as aspects of a physical examination including observation, active and passive movements, neurological and muscular examination.

Conclusions  This is the first study identifying important clinical items for LBP patients in Greece. It may be that these features are ‘discriminatory’ for different LBP subsets; however, further research is needed.
Reducing prescribing errors: can a well‐designed electronic system help?
Authors: Went Kathryn , Antoniewicz Patricia , Corner Deborah A. , Dailly Stella , Gregor Peter , Joss Judith , McIntyre Fiona B. , McLeod Shaun , Ricketts Ian W. , Shearer Alfred J.
Published: January 2010

Rationale, aims and objectives  In this study, the aim was to investigate if an electronic prescribing system designed specifically to reduce errors would lead to fewer errors in prescribing medicines in a secondary care setting.

Method  The electronic system was compared with paper prescription charts on 16 intensive care patients to assess any change in the number of prescribing errors.

Results  The overall level of compliance with nationally accepted standards was significantly higher with the electronic system (91.67%) compared with the paper system (46.73%). Electronically generated prescriptions were found to contain significantly fewer deviations (28 in 329 prescriptions, 8.5%) than the written prescriptions (208 in 408 prescriptions, 51%).

Conclusion  Taking an interdisciplinary approach to work on the creation of a system designed to minimize the risk of error has resulted in a favoured system that significantly reduces the number of errors made.
‘If it was osteoporosis, I would have really hurt myself.’ Ambiguity about osteoporosis and osteoporosis care despite a screening programme to educate fragility fracture patients
Authors: Sale Joanna E. M. , Beaton Dorcas E. , Sujic Rebeka , Bogoch Earl R.
Published: January 2010

Rationale, aims and objectives  Behaviour change models suggest that people need clear information about their susceptibility to disease and knowledge of treatment recommendations in order to change their behaviour. The purpose of this qualitative study was to examine fracture patients' understanding of osteoporosis (OP) and OP care after being screened for, and educated about, OP in a fracture clinic.

Methods  We conducted five focus groups with 24 patients (18 women, six men) aged 47–80 years old who were screened for OP through an urban fracture clinic. Participants were asked about their awareness of OP and their status of bone mineral density (BMD) testing and OP treatment.

Results  Twenty participants vocalized at least one expression of ambiguity regarding OP and/or treatment recommendations conveyed by the screening programme staff. Participants were ambiguous about the cause of their fracture, the BMD test process and results, and the presentation of OP. They were also ambiguous about the amount and type of medication and supplements recommended.

Conclusions  Despite a standardized screening programme in which OP was addressed in fragility fracture patients, ambiguity about diagnosis, testing and treatment were described. Efforts to clarify information relayed to fracture patients about their condition and recommended care need to extend beyond the fracture clinic so that health care providers can promote long‐term adherence to these recommendations.
Genetic signature of amphimixis allows for the detection and fine scale localization of sexual reproduction events in a mainly parthenogenetic nematode
Authors: VILLATE LAURE , ESMENJAUD DANIEL , VAN HELDEN MAARTEN , STOECKEL SOLENN , PLANTARD OLIVIER
Published: January 2010

Asexuality is an important mode of reproduction in eukaryotic taxa and has a theoretical advantage over sexual reproduction because of the increased ability to propagate genes. Despite this advantage, hidden signs of cryptic sex have been discovered in the genomes of asexual organisms. This has provided an interesting way to address the evolutionary impact of sex in plant and animal populations. However, the identification of rare sexual reproduction events in mainly asexual species has remained a challenging task. We examined the reproductive history in populations of the plant parasitic nematode Xiphinema index by genotyping individuals collected from six grapevine fields using seven microsatellite markers. A high level of linkage disequilibrium and heterozygous excess suggested a clonality rate of 95–100%. However, we also detected rare sexual reproduction events within these highly clonal populations. By combining highly polymorphic markers with an appropriate hierarchical sampling, and using both Bayesian and multivariate analysis with phylogenetic reconstructions, we were able to identify a small number of sexually produced individuals at the overlapping zones between different genetic clusters. This suggested that sexual reproduction was favoured when and where two nematode patches came into contact. Among fields, a high degree of genetic differentiation indicated a low level of gene flow between populations. Rare genotypes that were shared by several populations suggested passive dispersal by human activities, possibly through the introduction of infected plants from nurseries. We conclude that our method can be used to detect and locate sexual events in various predominantly asexual species.
Immunohistochemical evidence for macroautophagy in neurones and endothelial cells in Alzheimer's disease
Authors: Ma J.‐F. , Huang Y. , Chen S.‐D. , Halliday G.
Published: January 2010

J.‐F. Ma, Y. Huang, S.‐D. Chen and G. Halliday (2010) Neuropathology and Applied Neurobiology36, 312–319 Immunohistochemical evidence for macroautophagy in neurones and endothelial cells in Alzheimer's disease

Aim: To determine the pathological structures associated with macroautophagy in Alzheimer's disease (AD) and any relationship to disease progression. Methods: Immunohistochemistry using antibodies to beclin‐1, Atg5 and Atg12, early macroautophagy markers and LC3, the mammalian homologue of the later macroautophagy marker Atg8, were localized in formalin‐fixed, paraffin‐embedded medial temporal lobe sections of AD cases at variable neuritic disease stages. Double immunofluorescence labelling was used to co‐localize these macroautophagy markers with Aβ and phospho‐tau (AT8) and correlations performed using Spearman rank tests. Results: Atg12 immunoreactivity in AD was either dispersed in the soma and dendrites or concentrated in tau‐immunoreactive dystrophic neurites and some neurofibrillary tangles. Fewer Atg12‐immunopositive neurones were observed with longer disease durations. Atg12‐immunoreactive endothelial cells were found spatially associated with Aβ‐positive plaques, with more Atg12‐immunoreactive capillary endothelial cells with higher neuritic disease stage. These findings were confirmed by the other autophagy markers beclin‐1, Atg5 and LC3. Conclusion: The data confirm that macroautophagy occurs in neurones undergoing neuritic degeneration in AD, identified early macroautophagy markers in capillary endothelial cells in close proximity to Aβ plaques, and found that evidence for macroautophagy changes with disease progression.
Spread and interaction of Pepino mosaic virus (PepMV) and Pythium aphanidermatum in a closed nutrient solution recirculation system: effects on tomato growth and yield
Authors: Schwarz D. , Beuch U. , Bandte M. , Fakhro A. , Büttner C. , Obermeier C.
Published: January 2010

Pepino mosaic virus (PepMV) was shown to be efficiently transmitted between tomato plants grown in a closed recirculating hydroponic system. PepMV was detected in all plant parts after transmission via contaminated nutrient solution using ELISA, immunocapture RT‐PCR, RT‐PCR, electron microscopy, and by inoculation to indicator plants. Detection of PepMV in nutrient solution was only possible after concentration by ultracentrifugation followed by RT‐PCR. Roots tested positive for PepMV 1–3 weeks after inoculation, and subsequently a rapid spread from the roots into the young leaves and developing fruits was found within 1 week. PepMV was only occasionally detected in the older leaves. None of the infected plants showed any symptoms on fruits, leaves or other organs. Pre‐infection of roots of tomato cv. Hildares with Pythium aphanidermatum significantly delayed PepMV root infections. When mechanically inoculated with PepMV at the 2–4 leaf stage, yield loss was observed in all plants. However, only plants of cv. Castle Rock recorded significant yield losses when infected via contaminated nutrient solution. Yield losses induced by infection with PepMV and/or P. aphanidermatum ranged from 0·4 up to 40% depending on experimental conditions.
Adaptation to pyrrolnitrin in Botrytis cinerea and cost of resistance
Authors: Ajouz S. , Nicot P. C. , Bardin M.
Published: January 2010

The objective of this work was to estimate the risk of a decrease in the efficacy of biocontrol as a result of selection pressure exerted by biocontrol agents on Botrytis cinerea, focusing on pyrrolnitrin, an antibiotic identified in diverse biocontrol agents having an effect on B. cinerea. To evaluate a possible decrease in sensitivity to pyrrolnitrin, 10 successive generations of five isolates of B. cinerea were produced in vitro in the presence of a sublethal dose (10 μg L−1) of the antibiotic. For one isolate, a significant reduction in the sensitivity to pyrrolnitrin at the fifth generation was observed with a resistance factor of c. 11. The production of 10 additional generations for four of these isolates, with increasing doses of pyrrolnitrin (100–4000 μg L−1), resulted in the development of variants of B. cinerea with high levels of resistance to the antibiotic (RF > 1000) and a reduced sensitivity in vitro to a pyrrolnitrin‐producing bacterium. Reverse adaptation of resistant variants after 10 additional generations in the absence of selection pressure was not observed, suggesting stability of the resistance. Comparison of the pyrrolnitrin‐resistant generations and their sensitive parental isolates for mycelial growth, sporulation and aggressiveness on plant tissues revealed that the high level of resistance to pyrrolnitrin resulted in a high fitness cost. Mycelial growth was reduced between 1·7 to 3·6 times and sporulation reduced 3·8 to 6·6 times that of sensitive parental isolates. Similarly, aggressiveness was 7 to 10 and 3 to 10 times lower for resistant isolates on tomato and apple, respectively. This study provides evidence that a fungal plant pathogen is able to gradually build up resistance to an antibiotic produced by a biocontrol agent.
Committed differentiation of hair follicle bulge cells into sebocytes: an in vitro study
Authors: Fu Gang , Gao Qiang‐Guo , Lian Xiao‐Hua , Yu Jin , Xiang Ming‐Ming , Yang Tian
Published: January 2010

Background  Several studies have shown that hair follicle bugle cells can differentiate into hair follicles and contribute to the formation of the epidermis and sebaceous gland. Although many lines of evidence have suggested that the renewal and maintenance of the sebaceous gland depends on hair follicle bulge cells, direct evidence supporting the in vitro differentiation of follicle bulge cells into sebaceous gland cells has not been found.

Methods  Rat vibrissa follicle bulge cells were isolated, cultured, and transfected with green fluorescent protein (GFPC1) plasmids carrying the peroxisome proliferator‐activated receptor γ2 (PPARγ2 ) gene. The transfected cells were cultured in modified medium, and the morphologic changes of the cells were observed. Moreover, the expression of epithelial membrane antigens (EMAs) by the cells was detected by immunocytochemistry, and adipogenesis of the cells was evaluated.

Results  After induction culture, the cell body enlarged gradually and contained abundant cytoplasm; lipid droplets appeared in the cytoplasm of some cells, and the cells resembled sebocytes of the sebaceous gland. The cells were positive on oil red O and EMA staining. The expression of PPARγ2 mRNA and protein was significantly upregulated in PPARγ2‐transfected cells. The rate of oil red O‐stained and EMA‐positive cells was higher in PPARγ2‐transfected cells after induction than in bulge‐PPARγ2 cells and non‐transfected bulge cells.

Conclusions  Rat vibrissa hair follicle bulge cells may differentiate into sebocytes in vitro, and the PPARγ2 gene plays a crucial role.
Acral pseudolymphomatous angiokeratoma of children in an elderly man: report of a case and review of the literature
Authors: Chedraoui Adele , Malek Joelle , Tamraz Hussam , Zaynoun Shukrallah , Kibbi Abdul Ghani , Ghosn Samer
Published: January 2010

Acral pseudolymphomatous angiokeratoma of children (APACHE) is clinically characterized by angiomatous papules that preferentially affect acral areas of children. It is currently believed to be a variant of pseudolymphoma rather than angiokeratoma. Histopathologically, a mixed inflammatory cell infiltrate comprising B‐ and T‐lymphocytes and a proliferation of thick‐walled blood vessels are the hallmark. In the literature, although more adult cases are being described, the clinical, epidemiologic and histopathologic data of this presentation is scant. We report a 76‐year‐old man who presented with a 5‐year history of progressively increasing asymptomatic dusky dome‐shaped papules and plaques on his upper and lower extremities. Histology was consistent with APACHE. After reviewing all the adult cases in the literature and comparing them to the classical variant in children, we found no significant difference warranting separating these two variants. We prefer the designation “papular angiolymphoid hyperplasia” to APACHE as it encompasses all the childhood and adult cases involving acral and nonacral sites and highlights the histological and sometimes clinical similarities this entity shares with angiolymphoid hyperplasia with eosinophilia.
Some unusual type 2 reactions in leprosy
Authors: Ramesh V. , Pahwa Manish
Published: January 2010

Background  Type 2 reactions with lepromatous leprosy (LL) not occurring during multi‐drug therapy (MDT) have been reported.

Methods  Three patients have been described, each representing a prototype, the first presenting as bullous erythema nodosum leprosum (ENL), second with ENL erupting after treatment for co‐existing pulmonary tuberculosis and resembling immune reconstitution inflammatory syndrome, and a third patient with recurrent Sweets‐syndrome like presentation who had taken incomplete MDT in the past for leprosy. In all, the diagnosis was established by demonstration of acid‐fast bacilli (AFB) on slit‐skin smears (SSS) and histopathology.

Results & Conclusion  The fact that reactions can occur in patients with clinically inapparent LL, who are more likely to present in general hospitals, has been reemphasized to enhance awareness among physicians. First presentation of leprosy as ENL is probably precipitated by common antibiotics taken for other illnesses. Since reactional episodes can occur before, during and after MDT for leprosy and the clinical picture is not specific to any of them, it is important to ascertain the status of anti‐leprosy therapy during these episodes and treat them accordingly.
Nickel hypersensitivity: a clinical review and call to action
Authors: Schram Sarah E. , Warshaw Erin M. , Laumann Anne
Published: January 2010

Nickel sensitivity is common and increasing in prevalence. This review discusses nickel sensitivity and its association with body piercing and other environmental factors, occupational relevance, and potential implications for implantable metal medical devices. In addition, current European legislation that limits the release of nickel from jewelry is highlighted and an argument for similar legislation elsewhere is presented.
Resistant pityriasis lichenoides et varioliformis acuta in a 3‐year‐old boy
Authors: Lazaridou Elizabeth , Fotiadou Christina , Tsorova Christina , Trachana Maria , Trigoni Anastasia , Patsatsi Aikaterini , Ioannides Demetris
Published: January 2010

Pityriasis lichenoides et varioliformis acuta (PLEVA) represents the acute clinical subtype of pityriasis lichenoides (PL) and its occurrence is relatively common during childhood. Diagnosis and treatment may sometimes pose certain difficulties. We present the recalcitrant case of a 3‐year‐old boy with an asymptomatic polymorphic eruption consisting of multiple, scattered, 0.5 cm, round to ovoid, erythematous papules covered in places with a fine scale, vesicles and superficial erosions with thick hemorrhagic crusts. The correlation of the clinical features with the lesional histopathology favored the diagnosis of PLEVA. No first‐line treatment scheme succeeded in controlling the eruption of new lesions. The only therapeutic approach that eventually managed to cease the disease evolution was the combination of prednisolone and methotrexate.
Effects of vitamin C vs. multivitamin on melanogenesis: comparative study in vitro and in vivo
Authors: Choi Yang Kyu , Rho Yong Kwan , Yoo Kwang Ho , Lim Yun Young , Li Kapsok , Kim Beom Joon , Seo Seong Jun , Kim Myeung Nam , Hong Chang Kwun , Kim Dong‐Seok
Published: January 2010

Background  Vitamin C has been used for the treatment of hyperpigmented diseases. However, there is no study available on hypopigmenting effect of multivitamin.

Objectives  To investigate the inhibitory effects of multivitamin and vitamin C on melanogenesis.

Methods  We assessed the effect of multivitamin and vitamin C on cell viability, melanogenesis, and mushroom tyrosinase. The antioxidant activity of multivitamin and vitamin C was measured. We performed the Western blot analysis to study the effect of multivitamin and vitamin C on the expression of tyrosinase, microphthalmia‐associated transcription factor (MITF), extracellular signal‐regulated kinase (ERK), and Akt/protein kinase B. In a clinical trial, 20 melasma patients were treated with split face iontophoresis using either multivitamin or vitamin C. We evaluated the hypopigmenting effects of multivitamin and vitamin C through colorimetric measurement.

Results  Both vitamin C and multivitamin inhibited melanogenesis with low cytotoxicity. Multivitamin reduced melanin contents greater than vitamin C. However, the effects of vitamin C are greater than those of multivitamin on mushroom tyrosinase inhibition and antioxidation. In the Western blot, the reduced tyrosinase expression and MITF level were observed only in multivitamin‐treated group, and not in vitamin C‐treated group. No changes of ERK and Akt activation were observed in both multivitamin and vitamin C‐treated groups. After 12 weeks of treatment with iontophoresis, both multivitamin and vitamin C were effective for melasma.

Conclusions  Multivitamin has shown more anti‐melanogenic effect than vitamin C via the downregulation of MITF.
Clinical characteristics of basal cell carcinoma in a tertiary hospital in Sarawak, Malaysia
Authors: Bin Yap Felix Boon
Published: January 2010

Background  Basal cell carcinoma (BCC) is the most common skin cancer among Orientals. Data on this malignancy is lacking in Malaysia, prompting a retrospective study to determine the clinical characteristics in the skin clinic, Sarawak General Hospital between 2000 and 2008.

Methods  Demographic data and clinical features of 64 histopathologically proven BCC from 43 patients were retrieved. Statistical analysis was performed comparing the clinical characteristics based on the region of involvement and gender.

Results  The mean age of presentation was 60.9 years. Male to female ratio was 1.05. Majority of the patients were Chinese (44.2%) followed by Malays (32.6%), Bidayuhs (14.0%) and Ibans (6.9%). Nodular BCC accounted for 95.3% of cases while 4.7% were superficial BCC. All the nodular BCC were pigmented. Ulceration was noted in 18%. There were 82.8% of BCC on the head and neck region and 17.2% on the trunk and limb region. BCC on the latter region were larger (mean 35.0 cf. 14.4 mm, p < 0.001) and ulcerated (45.5% cf. 11.3%, p = 0.01). Superficial BCC were also more frequently encountered in this region (18.2% cf. 1.9%, p = 0.02). Compared to women, men had larger BCC (mean 21.1 cf. 13.3 mm, p = 0.03) and kept them for a longer duration (mean 21.6 cf. 13.3 months, p = 0.04).

Conclusion  Clinical characteristics of BCC in Sarawak were similar to other Asian studies. Additionally, BCC on the trunk and limbs and in men were larger, ulcerative and long standing warranting better efforts for earlier detection.
Sustained seroconversion of chronic hepatitis B infection after stem cell transplantation
Authors: Serap Aksoylar , Funda Ozgenc , Bengu Kadioglu , Mehmet Kantar , Nazan Cetingul , Rasit Yagci , Savas Kansoy
Published: January 2010

Serap A, Funda O, Bengu K, Mehmet K, Nazan C, Rasit Y, Savas K. Sustained seroconversion of chronic hepatitis B infection after stem cell transplantation. Pediatr Transplantation 2011: 15: E92–E95. © 2010 John Wiley & Sons A/S.

Abstract:  We present an 18‐yr‐old adolescent with acute lymphocytic leukemia, who underwent peripheral blood SCT with serologically and histologically documented chronic hepatitis B infection. Prior and during the transplant process, lamivudine was administered orally and he underwent SCT with a twofold decrease in viral load at the time of transplant from his HLA full matched, HBV natural immune (anti‐HBs and anti‐HBc positive) donor. Successful engraftment was achieved and three months after SCT, HBV seroconversion was documented accompanied with an ALT flare. Chronic graft‐versus‐host disease coincided after the transplantation, and he has been on immunosuppressive treatment for 25 months with sustained HBV seroconversion. We assume that adoptive immunity transfer combined with antiviral treatment might also constitute sustained seroconversion in chronic HBV, besides the reported risk of reactivation.
Electron microscopy evaluation of block needle‐related trauma to the tibial nerve
Authors: MACDONALD K. S. , SITES B. D.
Published: January 2010

Background: Direct puncture by a needle is a risk factor for nerve damage. This investigation used scanning electron microscopy (SEM) to attempt to visualize the damage caused by different needles.

Method: A 15 cm section of the tibial nerve was removed from the ankle of a patient undergoing below‐the‐knee amputation. The nerve specimen was punctured perpendicular to the fibers once by each of four needles: an insulated 22 G short‐beveled (30°), a 25 G long‐beveled Quincke spinal needle, an 18 G Tuohy, and a 25 G Whitacre pencil point. The distal and proximal ends on either side of the needles were marked and the nerve was sectioned into 0.5 cm pieces. Each sample was preserved and then prepared for SEM. The needle tract was observed for evidence of mechanical damage at magnifications between × 47 and × 102 using SEM.

Results: The epineurium, perineurium, fascicles, endoneurium, and vessels were identified in each sample. In both the short‐beveled and the Whitacre samples, all fascicles along with the surrounding perineurium were intact. In both the Tuohy and the Quincke samples, obvious transection of fascicles and disruption of the perineurium were observed.

Conclusions: This investigation suggests that both the Tuohy and the Quincke needles may be more likely to cause trauma to the tibial nerve than either the short‐beveled or the Whitacre needles.
A case of fatal caffeine poisoning
Authors: RUDOLPH T. , KNUDSEN K.
Published: January 2010

Caffeine is a natural alkaloid methylxanthine that is found in various plants such as coffee or tea. Symptoms of a severe overdose may present with hypokalemia, hyponatremia, ventricular arrhythmias, hypertension followed by hypotension, respiratory failure, seizures, rhabdomyolysis, ventricular fibrillation and finally circulatory collapse. A 21‐year‐old woman called for the ambulance herself soon after the ingestion of about 10,000 mg of caffeine. At the arrival of the ambulance, the patient went into cardiac arrest almost immediately. After a total resuscitation period of 34 min including seven counter‐shocks and 2 mg epinephrine, the patient was stable enough to be transferred to the hospital. The patient soon went into VF again and received two more counter‐shocks and 1 mg epinephrine and finally an intravenous bolus dose of 300 mg amiodarone. The initial arterial blood gas showed pH at 6.47, lactate at 33 mmol/l and potassium level at 2.3 mmol/l. Unfortunately, no blood samples for caffeine analysis were taken. Three days after hospital admission, the patient developed myoclonus, which did not respond to medical treatment. Excessive intake of caffeine may produce arrhythmias and pronounced hypokalemia and ensuing ventricular fibrillation. In case of counter‐shock‐resistant VF, it can be necessary to give an early loading dose of amiodarone. Furthermore, it may be beneficial to replace the potassium as early as possible. Epinephrine and buffer solutions used during resuscitation may further decrease blood potassium levels and should be administrated cautiously. Epinephrine can be replaced by other vasopressor drugs, such as vasopressin without effects on β‐receptors.
LiFE Pilot Study: A randomised trial of balance and strength training embedded in daily life activity to reduce falls in older adults
Authors: Clemson Lindy , Singh Maria Fiatarone , Bundy Anita , Cumming Robert G. , Weissel Elvina , Munro Jo , Manollaras Kate , Black Deborah
Published: January 2010

Background:  Exercise as a falls prevention strategy is more complex with people at risk than with the general population. The Lifestyle approach to reducing Falls through Exercise (LiFE) involves embedding balance and lower limb strength training in habitual daily routines.

Methods:  A total of 34 community‐residing people aged ≥70 years were randomised either into the LiFE programme or into a no‐intervention control group and followed up for six months. Inclusion criteria were two or more falls or an injurious fall in the past year.

Results:  There were 12 falls in the intervention group and 35 in the control group. The
relative risk (RR) analysis demonstrated a significant reduction in falls (RR = 0.23; 0.07–0.83). There were indications that dynamic balance (
P
 = 0.04 at three months) and efficacy beliefs (
P
 = 0.04 at six months) improved for the LiFE programme participants. In general, secondary physical and health status outcomes, which were hypothesised as potential mediators of fall risk, improved minimally and inconsistently.

Conclusions:  LiFE was effective in reducing recurrent falls in this at‐risk sample. However, there were minimal changes in secondary measures. The study was feasible in terms of recruitment, randomisation, blinding and data collection. A larger randomised trial is needed to investigate long‐term efficacy, mechanisms of benefit and clinical significance of this new intervention.
Trial of aripiprazole in the treatment of first‐episode schizophrenia
Authors: Lee Hwa‐Young , Ham Byung‐Joo , Kang Rhee‐Hun , Paik Jong‐Woo , Hahn Sang‐Woo , Lee Moon‐Soo , Lee Min‐Soo
Published: January 2010

Aims:  Aripiprazole is an atypical antipsychotic indicated for the treatment of adult patients with schizophrenia. It is effective and well tolerated in patients with schizophrenia or schizoaffective disorder. The aim of the present study was to investigate therapeutic efficacy and tolerability of aripiprazole in patients with first‐episode schizophrenia.

Methods:  Twenty‐one patients meeting the DSM‐IV criteria for schizophrenia were recruited. The Positive and Negative Symptom Scale (PANSS) and the Clinical Global Impressions Scale (CGI) were completed at the beginning of the study and again after 1, 2, 4, and 8 weeks of aripiprazole treatment. Side‐effects were analyzed using the Udvalg for Kliniske Undersøgelser Side‐Effect Rating Scale. Weight was checked at each testing session, and prolactin levels were measured at baseline and after 8 weeks of aripiprazole treatment.

Results:  Significant benefits were observed after the first week of treatment. After 1 week of aripiprazole treatment, subscale and total scores on the PANSS had decreased significantly. This significant decrease was maintained throughout the study period. The mean score of CGI severity was also significantly different after 2 weeks of aripiprazole administration when compared to baseline score, and the significance was maintained thereafter. Weight did not significantly change after aripiprazole administration. Although mean prolactin level was decreased at 8 weeks, the difference was not significant.

Conclusions:  Aripiprazole is an effective and well‐tolerated antipsychotic agent in patients with first‐episode schizophrenia. Further investigations with larger samples are needed.
Development of a clinical pathway for long‐term inpatients with schizophrenia
Authors: Nakanishi Miharu , Sawamura Kanae , Sato Sayaka , Setoya Yutaro , Anzai Nobuo
Published: January 2010

Clinical pathways have been defined as an optimal sequencing and timing of interventions by staff for a particular diagnosis or procedure, designed to better utilize resources, maximize quality of care and minimize delays. The aim of the present study was to develop a clinical pathway for long‐term inpatients with schizophrenia. A review of clinical records was conducted for 17 patients with schizophrenia who had stayed in one psychiatric hospital for >1 year, and who remained in the community >3 months after hospital discharge. A review of clinical routine records was conducted. The discharge process of each patient was expressed in a clinical pathway around phases and care components. They were integrated into one clinical pathway. The discharge process was divided into assessment and goalsetting, preparation, and discharge phases. Care components included discharge planning, daily activity, living environment, health management, and basic life skills. Discharge planning was an important care component that was combined with all three phases. A clinical pathway was developed from reviewing past patient records, and discharge planning was found to be an important care component, which was combined with all three phases: assessment and goalsetting, preparation, and discharge. Further study is needed to examine the validity of the pathway for use in other hospitals.
Higher incidence of hysterectomy and oophorectomy in women suffering from clinical depression: Retrospective chart review
Authors: Mantani Akio , Yamashita Hidehisa , Fujikawa Tokumi , Yamawaki Shigeto
Published: January 2010

The aim of the present study was to retrospectively evaluate women who were admitted to Hiroshima University Hospital, Department of Psychiatry and Neurosciences, from 1979 to 2008. The women were classified as ‘depressed women’ (n = 159; mean age, 52.3 ± 5.7 years) or ‘non‐depressed women’ (n = 182; mean age, 51.5 ± 4.5 years). A total of 14.5% of the depressed women and 3.3% of the non‐depressed women had a hysterectomy and/or oophorectomy; this difference was statistically significant (P = 0.0003). This is consistent with previous reported information as well as clinical experience that depressed women had a higher incidence of hysterectomy and/or oophorectomy.
Open wards versus locked wards of general hospitals in the treatment of psychiatric patients with medical comorbidities: A cross‐sectional study in Tokyo
Authors: Hatta Kotaro , Usui Chie , Nakamura Hiroyuki , Kurosawa Hisashi , Arai Heii
Published: January 2010

Aim:  Treatment of medical comorbidities among psychiatric patients is an expected role of general hospital psychiatric wards. The purpose of this study was to clarify whether locked wards of general hospitals are necessary in the treatment of psychiatric patients with severe medical comorbidities.

Methods:  A cross‐sectional study concerning patients who required admission due to both somatic and psychiatric diseases was performed all over Tokyo during a 2‐month period. Demographic and clinical characteristics of patients who were admitted to locked wards of general hospitals were compared with those of patients admitted to open wards of general hospitals.

Results:  In locked wards, the rate of organic mental disorders, median Lack of Judgment and Insight from the Positive and Negative Syndrome Scale, and rate of diseases requiring surgery were significantly higher than those in open wards. The rate of patients with medical comorbidities who could not be admitted was significantly higher for open wards than for locked wards. Furthermore, the rate of patients with both medical comorbidities and attempted suicide who could not be admitted was significantly higher for open wards than for locked wards.

Conclusion:  Locked wards may be necessary to treat severe psychiatric patients with severe medical comorbidities.
Does daily Naikan therapy maintain the efficacy of intensive Naikan therapy against depression?
Authors: Sengoku Mari , Murata Hiroaki , Kawahara Takanobu , Imamura Kaori , Nakagome Kazuyuki
Published: January 2010

Aim:  Naikan Therapy, which has been applied to treating patients with various mental difficulties, can be classified into two major categories: intensive Naikan therapy, which lasts for seven days in a Naikan center or a clinical institute secluded from the outside world for the purpose of deep introspection, and daily Naikan therapy, which can be integrated into regular daily activities. The aim of this research is to evaluate daily Naikan therapy as a maintenance treatment for depression.

Methods:  Forty‐seven patients, who were diagnosed as having major depressive disorder using DSM‐IV criteria and who practiced intensive Naikan therapy participated in the present study. Two groups of patients were compared: 24 patients who conducted daily Naikan therapy and 23 patients who did not, after practicing intensive Naikan therapy. To evaluate efficacy, the Beck Depression Inventory was used as a primary outcome measure for the assessment of depression. The State–Trait Anxiety Inventory and the Cornell Medical Index were also used as secondary outcome measures to evaluate anxiety and psychosomatic conditions before, immediately after and three months after intensive Naikan therapy.

Results:  Significant between‐group differences were obtained in the time course change of depression, anxiety and psychosomatic scores within three months following the completion of intensive Naikan therapy.

Conclusion:  The current study indicates that conducting daily Naikan therapy is effective for maintaining the psychological and psychosomatic state at 3 months following the intensive Naikan therapy, while a lack of therapy may allow the patients to exacerbate their conditions to the level they held before practicing intensive Naikan therapy.
S‐phase fraction and DNA ploidy in oral leukoplakia
Authors: Khanna Rahul , Agarwal Anshu , Khanna Seema , Basu Somprakas , Khanna Ajay Kumar
Published: January 2010

Background:  The risk of malignant conversion in oral leukoplakia is well documented. Histological findings are often unreliable and it is difficult to predict on the basis of clinical and histopathological changes which leukoplakic lesion will turn malignant.

Methods:  We used the technique of flow cytometry to evaluate the ploidy status, DNA index and S‐phase fraction in leukoplakia, oral cancer and normal oral mucosal biopsies and compared it with histological findings. The study was carried out on 30 patients with oral cancer, 60 with leukoplakia and 30 with normal oral mucosal biopsies.

Results:  The aneuploidy rate in oral cancers was 64%, for leukoplakia 20%, while all normal mucosal biopsies were diploid. Aneuploid lesions also had a greater S‐phase fraction (SPF). The DNA Index (DI) of aneuploid oral cancers was 1.72 and aneuploid leukoplakias was 1.24. Leukoplakia specimens which showed histological evidence of dysplasia had aneuploidy rate of 38%, DI of 1.19 and SPF of 6.2%. The corresponding values for leukoplakia specimens without dysplasia were 14%, 1.09 and 4.1%, respectively.

Conclusion:  The method of flow cytometry can be used to identify the subset of leukoplakia patients who are at a higher risk of malignant conversion. These patients could undergo more rigid surveillance or undergo excision biopsy of their lesions.
Use of face masks by non‐scrubbed operating room staff: a randomized controlled trial
Authors: Webster Joan , Croger Sarah , Lister Carolyn , Doidge Michelle , Terry Michael J. , Jones Ian
Published: January 2010

Background:  Ambiguity remains about the effectiveness of wearing surgical face masks. The purpose of this study was to assess the impact on surgical site infections (SSIs) when non‐scrubbed operating room staff did not wear surgical face masks.

Methods:  Eight hundred twenty‐seven participants undergoing elective or emergency obstetric, gynecological, general, orthopaedic, breast or urological surgery in an Australian tertiary hospital were enrolled. Complete follow‐up data were available for 811 patients (98.1%). Operating room lists were randomly allocated to a ‘Mask group’ (all non‐scrubbed staff wore a mask) or ‘No Mask group’ (none of the non‐scrubbed staff wore masks). The primary end point, SSI was identified using in‐patient surveillance; post discharge follow‐up and chart reviews. The patient was followed for up to six weeks.

Results:  Overall, 83 (10.2%) surgical site infections were recorded; 46/401 (11.5%) in the Masked group and 37/410 (9.0%) in the No Mask group; odds ratio (OR) 0.77 (95% confidence interval (CI) 0.49 to 1.21), p = 0.151. Independent risk factors for surgical site infection included: any pre‐operative stay (adjusted odds ratio [aOR], 0.43 (95% CI, 0.20; 0.95), high BMI aOR, 0.38 (95% CI, 0.17; 0.87), and any previous surgical site infection aOR, 0.40 (95% CI, 0.17; 0.89).

Conclusion:  Surgical site infection rates did not increase when non‐scrubbed operating room personnel did not wear a face mask.
Boundary element prediction of TBC fracture resistance
Authors: KEPPAS L. K. , ANIFANTIS N. K.
Published: January 2010

The present study investigates the transient behaviour of interfacial cracks in thermal barrier coatings. It is assumed that a TBC withstands a thermal shock in the presence of external mechanical load acting on its surface. Crack closure takes place while the thermal contact resistance as well the friction between the crack faces is considered. The dependence of the thermal resistance on the contact pressure invokes coupling between the temperature and displacement fields. An appropriate boundary element procedure based on two‐dimensional time‐dependent thermoelasticity, is utilized for the numerical solution. A series of parametric analyses examines the impact of the coefficient of friction, thermal contact resistance and coefficient of heat convection on the crack severity.
Variable amplitude cyclic deformation and fatigue behaviour of stainless steel 304L including step, periodic, and random loadings
Authors: COLIN J. , FATEMI A.
Published: January 2010

This paper discusses cyclic deformation and fatigue behaviours of stainless steel 304L and aluminium 7075‐T6 under variable amplitude loading using strain‐controlled as well as load‐controlled tests. Load sequence effects were investigated in step tests with high‐low and low‐high sequences. For stainless steel 304L, strong hardening induced by the first step of the H‐L sequence significantly affects the fatigue behaviour, depending on the test control mode used. For periodic overload tests of stainless steel 304L, hardening due to the overloads was progressive throughout life and more significant than in H‐L step tests. For aluminium 7075‐T6, no effect on deformation behaviour was observed due to periodic overloads. However, the direction of the overloads was found to affect fatigue life, as tensile overloads led to longer lives, while compressive overloads led to shorter lives. Deformation and fatigue behaviours under random loading were also studied for the two materials. To correlate a broad range of fatigue life data for a material with strong deformation history effect, such as stainless steel, it is shown that a damage parameter with both stress and strain is required. The Smith‐Watson‐Topper parameter as such a parameter is shown to correlate the data reasonably well under different control modes and loading conditions.