bluuebunny/crossref_metadata_2025 huggingface dataset:
Clines in Africa: does size vary in the same way among widespread sub‐Saharan monkeys?
Authors: Cardini Andrea , Dunn Jason , O'Higgins Paul , Elton Sarah
Published: September 2012

Aim

We characterize and compare patterns of clinal size variation among diverse widespread sub‐Saharan monkeys with the aim of identifying commonalities and differences in biogeographical variation. Thus, we accurately quantify nonlinear clines in representatives of the main lineages of widespread sub‐Saharan terrestrial and arboreal monkeys, and provide a crude numerical estimate of the strength of similarities across taxonomic groups.

Location

Sub‐Saharan Africa.

Methods

Variations of skull centroid size, as a proxy for body mass, were modelled over sub‐Saharan Africa within two terrestrial monkey species (Papio hamadryas and Chlorocebus aethiops) and two arboreal monkey taxa (Procolobus (Piliocolobus) sp., and the superspecies Cercopithecus nictitans–Cercopithecus mitis) using inverse distance weighting, thin‐plate splines and kriging. The model with the highest cross‐validated accuracy was used to produce contour plots that visualized clines and predicted size at equally spaced localities across overlapping areas of distribution ranges. Correlations among these predictions were used as a similarity measure among clines.

Results

Irrespective of phylogenetic distances and ecological differences, all groups showed similarities in clinal size over central Africa: large animals mostly live in and around the tropical forest of the Congo basin; size declines rapidly towards the Horn of Africa and the coasts of Kenya and Tanzania. Size also tends to decrease in western Africa but clinal patterns in this region vary, with vervets (Chlorocebus aethiops) exceptionally showing a size increase.

Main conclusions

Similarities in patterns of size across diverse monkey groups were found. Nonetheless, complexity in clines and a degree of heterogeneity across groups were evident, which is unlikely to be compatible with the exclusive effect on size of a single main environmental factor. Primary productivity may be most significant in relation to the consistent observation of large sizes in and adjacent to the central African tropical forest belt. Complex clines, such as those of African monkeys, are difficult to compare visually and data collection from evenly sampled sets of localities, where all species of interest may be found, is often impractical or simply not feasible for primates and other protected animals. The development of improved quantitative methods for the description and comparison of clines in mammals and other organisms is required.
Critical thinking in clinical medicine: what is it?
Authors: Gupta Mona , Upshur Ross
Published: September 2012

In this paper, we explore the recent emphasis, in various medical contexts, of the term ‘critical’ or the notion of ‘being critical’. We identify various definitions of being critical and note that they differ strikingly. What are these different uses of the term trying to capture that is important in clinical medicine and medical education? We have analysed these qualities as responsibilist, epistemic virtues. We believe that a virtues approach is best able to make sense of the non‐cognitive elements of ‘being critical’, such as the honesty and courage to question claims in the face of persuasion, authority or social pressure.

Medical educators and professional bodies seem to agree that being critical is important and desirable. Yet, it is unclear how this quality can be optimally fostered and balanced with the constraints that act upon individual practitioners in the context of institutional medicine including professional standards and the demands of the doctor–patient relationship. Other constraints such as authoritarianism, intimidation and financial pressures may act against the expression of being critical or even the cultivation of critical thinking. The issue of the constraints on critical thinking and the potential hazards it entails will require further consideration by those who encourage being critical in medicine.
What is knowledge and when should it be implemented?
Authors: O'Grady Laura
Published: September 2012

A primary purpose of research is to generate new knowledge. Scientific advances have progressively identified optimal ways to achieve this purpose. Included in this evolution are the notions of evidence‐based medicine, decision aids, shared decision making, measurement and evaluation as well as implementation. The importance of including qualitative and quantitative methods in our research is now understood. We have debated the meaning of evidence and how to implement it. However, we have yet to consider how to include in our study findings other types of information such as tacit and experiential knowledge. This key consideration needs to take place before we translate new findings or ‘knowledge’ into clinical practice. This article critiques assumptions regarding the nature of knowledge and suggests a framework for implementing research findings into practice.
Compellingness: assessing the practical relevance of clinical research results
Authors: Tonelli Mark R.
Published: September 2012

While the critical appraisal of clinical research has generally focused on aspects of study design and statistical analysis, other features of clinical studies appear to be more important to clinicians for assessing the value of a particular study in the care of particular patients. These features relate to the quality of the knowledge derived from the research, the value of the results to the care of individual patients, and the responsibility of clinicians to be stewards of limited resources. Twelve features of clinical research studies that affect how compelling individual clinicians find the results are proposed and examined here. By better understanding what makes clinical research compelling enough to alter or reinforce clinical practice, clinical researchers can design future studies to better serve the needs of clinicians and patients.
Many‐models medicine: diversity as the best medicine
Authors: Nunn Robin
Published: September 2012

Many medicines have been proposed to cure various ills of biomedicine including evidence‐based medicine, evolutionary medicine, narrative medicine, and complexity medicine, among others. To the extent that all models are idealizations or abstractions, all of these model medicines are imperfect in some respects. In the absence of a single unified model, if indeed unification is possible or even desirable, and despite the relative advantages of one model or another, in practice many models and methods are necessary in medicine. In this article, I consider the value of such diversity in models and methods. I briefly describe several models. Then I discuss simulations of agents who use diverse models. Advocates of models such as those discussed here typically claim that we should use their preferred model because it is the best. Evidence‐based medicine, for instance, has been promoted as the single best model of medicine while other models have been cast as lesser models or in opposition to it and each other. But isolated models and methods may never be as good as groups of models and methods. Debates about various individual models may result in better outcomes, but explicitly choosing to use many models is likely to produce even better outcomes.
How does a psychiatrist infer from an observed condition to a case of mental disorder?
Authors: Lemoine Maël
Published: September 2012

The main thesis of this paper is that mental health practitioners can legitimately infer that a patient's given condition is a case of mental disorder without having diagnosed any specific mental disorder. The article shows how this is justifiable by relying either on psychopathological reasoning, on ‘intentional’ analysis or possibly on other modes of reasoning. In the end, it highlights the clinical and philosophical consequences of the plurality of modes of ‘inferences to mental disorder’.
Values‐based medicine and modest foundationalism
Authors: Little Miles , Lipworth Wendy , Gordon Jill , Markham Pippa , Kerridge Ian
Published: September 2012

Philosophically, values refer to the basic commitments that justify judgements, beliefs and practices, both at the community and personal levels. The study of these kinds of values is axiology. We suggest that all people subscribe to three foundational values – survival, security and flourishing – and that these foundational values are expressed by way of concepts, systems, principles and practices that may differ substantially from culture to culture. Values can stand on their own as foundational justifications for health care and medicine. Many ethical quandaries can be better understood, even though they may remain unsolved, by reference to the foundational values that people can agree upon. This version of values‐based health care has strong claims to prior logical status as a justification for the whole enterprise of health care, and values‐based medicine is a part of this larger domain.
Meaning and value in medical school curricula
Authors: Lipworth Wendy , Kerridge Ian , Little Miles , Gordon Jill , Markham Pippa
Published: September 2012

Rationale, aims and objectives

Bioethics and professionalism are standard subjects in medical training programmes, and these curricula reflect particular representations of meaning and practice. It is important that these curricula cohere with the actual concerns of practicing clinicians so that students are prepared for real‐world practice. We aimed to identify ethical and professional concerns that do not appear to be adequately addressed in standard curricula by comparing ethics curricula with themes that emerged from a qualitative study of medical practitioners.

Method

Curriculum analysis: Thirty‐two prominent ethics and professionalism curricula were identified through a database search and were analysed thematically. Qualitative study: In‐depth, semi‐structured interviews were conducted with 20 medical practitioners. Participants were invited to reflect upon their perceptions of the ways in which values matter in their practices and their educational experiences. The themes emerging from the two studies were compared and contrasted.

Results

While representations of meaning and value in ethics and professionalism curricula overlap with the preoccupations of practicing clinicians, there are significant aspects of ‘real‐world’ clinical practice that are largely ignored. These fell into two broad domains: (1) ‘sociological’ concerns about enculturation, bureaucracy, intra‐professional relationships, and public perceptions of medicine; and (2) epistemic concerns about making good decisions, balancing different kinds of knowledge, and practising within the bounds of professional protocols.

Conclusions

Our findings support the view that philosophy and sociology should be included in medical school and specialty training curricula. Curricula should be reframed to introduce students to habits of thought that recognize the need for critical reflection on the social processes in which they are embedded, and on the philosophical assumptions that underpin their practice.
Unreasonable reasons: normative judgements in the assessment of mental capacity
Authors: Banner Natalie F.
Published: September 2012

The recent Mental Capacity Act (2005) sets out a test for assessing a person's capacity to make treatment choices. In some cases, particularly in psychiatry, it is unclear how the criteria ought to be interpreted and applied by clinicians. In this paper, I argue that this uncertainty arises because the concept of capacity employed in the Act, and the diagnostic tools developed to assist its assessment, overlook the inherent normativity of judgements made about whether a person is using or weighing information in the decision‐making process. Patients may fail on this criterion to the extent that they do not appear to be handling the information given in an appropriate way, on account of a mental impairment disrupting the way the decision process ought to proceed. Using case law and clinical examples, I describe some of the normative dimensions along which judgements of incapacity can be made, namely epistemic, evaluative and affective dimensions. Such judgements are complex and the normative standards by which a clinician may determine capacity cannot be reduced to a set of criteria. Rather, in recognizing this normativity, clinicians may better understand how clinical judgements are structured and what kinds of assumption may inform their assessment.
Imperfection, practice and humility in clinical ethics
Authors: Garchar Kim
Published: September 2012

In this essay, I provide a description of the discipline of ethics using the philosophies of Aristotle and the American pragmatist John Dewey. Specifically, I argue that ethics is an active undertaking that is ambiguous and pluralistic. I then normatively prescribe the way in which clinical ethicists ought to approach their work in medicine. Rather than endeavouring to become, or behaving as if they are, experts, clinical ethicists must be humble. They must practise ethics. That is, they must admit ethics is the study and pursuit of the good life but that this study and pursuit occurs imperfectly in the face of problematic situations.
Different Critical Perinatal Periods and Hypothalamic Sites of Oestradiol Action in the Defeminisation of Luteinising Hormone Surge and Lordosis Capacity in the Rat
Authors: Sakakibara M. , Deura C. , Minabe S. , Iwata Y. , Uenoyama Y. , Maeda K.‐I. , Tsukamura H.
Published: September 2012

Female rats show a gonadotrophin‐releasing hormone (GnRH)/luteinising hormone (LH) surge in the presence of a preovulatory level of oestrogen, whereas males do not because of brain defeminisation during the developmental period by perinatal oestrogen converted from androgen. The present study aimed to identify the site(s) of oestrogen action and the critical period for defeminising the mechanism regulating the GnRH/LH surge. Animals given perinatal treatments, such as steroidal manipulations, brain local implantation of oestradiol (E2) or administration of an NMDA antagonist, were examined for their ability to show an E2‐induced LH surge at adulthood. Lordosis behaviour was examined to compare the mechanisms defeminising the GnRH/LH surge and sexual behaviour. A single s.c. oestradiol‐benzoate administration on either the day before birth (E21), the day of birth (D0) or day 5 (D5) postpartum completely abolished the E2‐induced LH surge at adulthood in female rats, although the same treatment did not inhibit lordosis. Perinatal castration on E21 or D0 partially rescued the E2‐induced LH surge in genetically male rats, whereas castration from E21 to D5 totally rescued lordosis. Neonatal E2 implantation in the anterior hypothalamus including the anteroventral periventricular nucleus (AVPV)/preoptic area (POA) abolished the E2‐induced LH surge in female rats, whereas E2 implantation in the mid and posterior hypothalamic regions had no inhibitory effect on the LH surge. Lordosis was not affected by neonatal E2 implantation in any hypothalamic regions. In male rats, neonatal NMDA antagonist treatment rescued lordosis but not the LH surge. Taken together, these results suggest that an anterior hypothalamic region such as the AVPV/POA region is a perinatal site of oestrogen action where the GnRH/LH regulating system is defeminised to abolish the oestrogen‐induced surge. The mechanism for defeminisation of the GnRH/LH surge system might be different from that of sexual behaviour, in terms of the site(s) of oestrogen action and critical period, as well as the neurotransmitter system involved.
The history of blood transfusion prior to the 20th century – Part 1
Authors: Learoyd P.
Published: September 2012

Blood transfusion, that is the transference of blood from the circulation of one individual to that of another for practical therapeutic purposes, is of relatively recent origin. Although it only became a routine practical possibility during and shortly after the Second World War, the concept of the infusion of blood has a much longer history. Practical transfusion has to some degree paralleled and in many instances been the consequence of developments in other sciences. However, the early history of blood transfusion is to some extent one of mysticism, professional rivalries, disregard of published work and a desire to maintain the status quo with regard to ‘established medical procedure’. This article summarises some of the major aspects relating to the early history of blood transfusion.
Loss to programme between HIV diagnosis and initiation of antiretroviral therapy in sub‐Saharan Africa: systematic review and meta‐analysis
Authors: Mugglin Catrina , Estill Janne , Wandeler Gilles , Bender Nicole , Egger Matthias , Gsponer Thomas , Keiser Olivia ,   for IeDEA Southern Africa
Published: September 2012

Objectives  To assess the proportion of patients lost to programme (died, lost to follow‐up, transferred out) between HIV diagnosis and start of antiretroviral therapy (ART) in sub‐Saharan Africa, and determine factors associated with loss to programme.

Methods  Systematic review and meta‐analysis. We searched PubMed and EMBASE databases for studies in adults. Outcomes were the percentage of patients dying before starting ART, the percentage lost to follow‐up, the percentage with a CD4 cell count, the distribution of first CD4 counts and the percentage of eligible patients starting ART. Data were combined using random‐effects meta‐analysis.

Results  Twenty‐nine studies from sub‐Saharan Africa including 148 912 patients were analysed. Six studies covered the whole period from HIV diagnosis to ART start. Meta‐analysis of these studies showed that of the 100 patients with a positive HIV test, 72 (95% CI 60–84) had a CD4 cell count measured, 40 (95% CI 26–55) were eligible for ART and 25 (95% CI 13–37) started ART. There was substantial heterogeneity between studies (P < 0.0001). Median CD4 cell count at presentation ranged from 154 to 274 cells/μl. Patients eligible for ART were less likely to become lost to programme (25%vs. 54%, P < 0.0001), but eligible patients were more likely to die (11%vs. 5%, P < 0.0001) than ineligible patients. Loss to programme was higher in men, in patients with low CD4 cell counts and low socio‐economic status and in recent time periods.

Conclusions  Monitoring and care in the pre‐ART time period need improvement, with greater emphasis on patients not yet eligible for ART.
Diagnosis of treponemal co‐infection in HIV‐infected West Africans
Authors: Mamoojee Yaasir , Tan Grace , Gittins Sandra , Sarfo Stephen , Stephenson Lisa , Carrington David , Bedu‐Addo George , Phillips Richard , Appiah Lambert T. , Chadwick David
Published: September 2012

Objectives To evaluate the performance of two enzyme immunoassays (EIA), Murex and ICE, and the Determine TP point‐of‐care test (POCT) in diagnosing treponemal infection (syphilis or yaws) in patients attending a large HIV clinic in Ghana; to determine the prevalence of treponemal co‐infections; and to characterise demographic and clinical features of patients with infection.

Methods Samples were tested with EIAs and rapid plasma reagin (RPR), then POCT and reference assays forTreponema pallidumto determine prevalence of active and past infection. Sensitivity and specificity of each assay were calculated and demographic and clinical characteristics of patients compared. Data were collected from case notes of patients retrospectively.

Results Overall, 45/284 patient samples (14.8%, 95% CI, 11.1–19.4%) wereTreponema pallidumparticle agglutination (TPPA) positive, and of these, 27 (64.3%) were RPR positive and 4 (8.9%) were treponemal IgM positive. Both EIAs and Determine TP POCT showed high sensitivities and specificities for identifying infection although RPR was less reliable. Clinical features of syphilis or yaws were rarely identified in TPPA‐positive patients suggesting most had previous or late latent infection. Treatment of various intercurrent infections using short courses of antibiotics active againstT. pallidumwas common in the clinic.

Conclusions A high proportion of this HIV‐infected cohort showed evidence of treponemal infection. Both EIAs as well as the POCT were practical and effective at diagnosing treponemal co‐infection in this setting. RPR alone was unreliable at identifying active treponemal co‐infection, however might be useful in some settings where treponemal‐specific assays are unaffordable.
Maternal recall of birthweight and birth size in Entebbe, Uganda
Authors: Lule Swaib A. , Webb Emily L. , Ndibazza Juliet , Nampijja Margaret , Muhangi Lawrence , Akello Florence , Kakande Muhammed , Kizindo Robert , Elliott Alison M.
Published: September 2012

Objectives  To assess the reliability of maternally recalled birthweight and size in Entebbe, Uganda.

Methods  The study population comprised 404 mothers, who were participants in the Entebbe Mother and Baby Study (EMaBS). Mothers were recruited to EMaBS during antenatal care, maternal characteristics were recorded during pregnancy, and birthweight was recorded at delivery. Four to seven years after delivery, mothers were asked to recall the child’s birthweight and size. Their responses were compared with the birthweight recorded in the EMaBS database.

Results  Of 404 interviewed mothers, 303 (75%) were able to give an estimate of birthweight and for 265 of these EMaBS data on recorded birthweights were available. Women who were educated and whose children had low birth order were more likely to be able to give an estimate: 37 (14%) recalled the exact recorded birthweight; a further 52 (20%) were accurate to within 0.1 kg of the recorded weight. On average, mothers overestimated birthweight by 0.06 kg (95% CI: 0.00–0.13 kg, P = 0.04). Recalled and recorded birthweights showed moderate agreement with an intraclass correlation coefficient of 0.64. Four hundered mothers gave an estimate of birth size: the sensitivity and specificity of recalled birth size for classifying low birthweight were 76% (95% CI: 50–93%) and 70% (95% CI: 65–75%), respectively.

Conclusions  Mothers’ recall of birthweight was not precise but in absence of other data, recall of birthweight and size may have some value in epidemiological studies in these settings.
Effectiveness of an intervention on uptake of maternal care in four counties in Ningxia, China
Authors: Zhou Hong , Zhao Chun‐Xia , Wang Xiao‐Li , Xv Yi‐Chong , Shi Ling , Wang Yan
Published: September 2012

Objectives  To understand the utilisation of prenatal care and hospitalised delivery among pregnant Muslim women in Ningxia, China, and to explore the effectiveness of the integrated interventions to reduce maternal mortality.

Methods  Cross‐sectional surveys before and after the intervention were carried out. Using multistage sampling, 1215 mothers of children <5 years old were recruited: 583 in the pre‐intervention survey and 632 in the post‐intervention study. Data on prenatal care and delivery were collected from face‐to‐face interviews. Maternal mortality ratio (MMR) data were obtained from the local Maternal and Child Mortality Report System.

Results  After the intervention, the MMR significantly decreased (45.5 deaths per 100 000 live births to 32.7 deaths). Fewer children were born at home after the intervention than before the intervention (OR, 0.11; 95% CI, 0.08–0.15). The proportion of women who attended prenatal care at least once increased from 78.2% to 98.9% (OR, 24.55; 95% CI, 11.37–53.12). The proportion of women who had prenatal visit(s) in the first trimester of pregnancy increased from 35.1% to 82.6% (OR, 8.77; 95% CI, 6.58–11.69). The quality of prenatal care was greatly improved. Effects of the intervention on the utilisation of maternal care remained significant after adjusting for education level and household possessions.

Conclusions  The findings suggest that integrated strategies can effectively reduce maternal mortality.
Cutaneous leishmaniasis: cryosurgery using carbon dioxide slush in a resource‐poor country
Authors: Al‐Qubati Yasin , Janniger Edmund J. , Schwartz Robert A.
Published: September 2012

Leishmaniasis is a widespread parasitic disease seen most often in children and young adults, although it may occur at any age. In Yemen, up until now, specific treatment for cutaneous leishmaniasis (CL) has been challenging. Available chemotherapy is expensive and replete with significant side effects. Standard cryosurgery with liquid nitrogen is prohibitively expensive and often unavailable. The objective of this paper is to highlight the importance of cryosurgery with carbon dioxide slush in the treatment of CL in an economically underdeveloped region as a cost‐effective, simple, successful, and affordable option.
Prevalence and treatment of palmoplantar keratoderma and tinea pedis in patients with Sézary syndrome
Authors: Martin Stephanie J. , Duvic Madeleine
Published: September 2012

Background  Mycosis fungoides (MF) and the Sézary syndrome (SS) are non‐Hodgkin's lymphomas that present with cutaneous lesions. Sézary syndrome is characterized by blood involvement, exfoliative eryrthroderma, lymphadenopathy, pruritus, keratoderma, and immunosuppression. This study was to estimate the prevalence of palmoplantar keratoderma and tinea pedis in Sézary syndrome and to analyze the effectiveness of anti‐fungal treatment.

Methods  We conducted a retrospective review of 1562 prospectively collected patients at the MD Anderson Cancer Center Cutaneous Lymphoma Clinic over sixteen years. All patients’ palms and soles were evaluated for clinical evidence of keratoderma (hyperkeratosis) and for dermatophytosis (tinea pedis or unguum) by examining scales under 10% potassium hydroxide by light microscopy for hyphae.

Results  Of 138 Sézary syndrome patients (88 men, 50 women, median age at diagnosis 64 years), 85 (61.6%) had palmoplantar keratoderma; 45 of the 85 Sézary syndrome patients (52.9%) also had coexisting tinea pedis. Only 14 (10.1%) had tinea pedis without keratoderma. Treatment for tinea pedis resulted in microscopy cure of keratoderma in 12 of 45 (26.7%) patients and clinical improvement.

Conclusions  The prevalence of palmoplantar keratoderma in Sézary syndrome is 61.6%, with co‐existing tinea pedis found in 52.9%. Palmoplantar keratoderma with tinea pedis showed clinical improvement with fungicidal therapy suggesting that tinea often contributes to the pathogenesis and severity of Sézary syndrome‐related keratoderma.
Smashed skin grafting or smash grafting – a novel method of vitiligo surgery
Authors: Krishnan Ajay , Kar Sumit
Published: September 2012

Introduction Vitiligo is an acquired progressive disorder characterized by destruction of melanocytes in the lesion and the lesional hair follicles. A number of new therapeutic options for vitiligo have become available over the last decade or so both on the medical as well as surgical side. One among them is the smashed skin grafting or simply smash grafting, which is a modification of split‐thickness grafting. In this method, the graft undergoes “smashing” before being applied to the recipient site. Though a simple and effective procedure, very few people are doing the procedure either due to lack of awareness or due to lack of published data.

Materials and methods Smash skin grafting was performed in 26 patients with vitiligo in Mahatma Gandhi Institute of Medical Sciences, Sewagram, Maharashtra, India.

Results Smashed skin grafting helped to achieve more than 90% repigmentation of the vitiligo patches in our patients.

Conclusions Smashed skin grafting is a simple procedure with fewer side effects, better outcome, and high patient satisfaction or, in simple words, it can be considered as an alternative to various conventional surgical modalities like punch grafting and melanocyte cell culture methods. This article deals with the steps of the procedure, results of the surgery in a small group of patients, and the necessity of increasing the awareness of smash grafting.
Melanoma in South‐East Europe: epidemiological data from the central cancer registry and clinicopathological characteristics from the hospital‐based registry in Serbia
Authors: Kandolf‐Sekulović Lidija , Živković‐Perišić Snežana , Radević Tatjana , Rajović Milica , Dinić Miroslav , Zolotarevski Lidija , Mijušković Željko , Zečević Radoš D. , Novaković Marijan
Published: September 2012

Background  Melanoma in South‐East Europe shows varying incidence from 1.7 per 100,000 in Albania to 14.5 per 100,000 in Slovenia, but more detailed data from this region are scarce. In this study, we report epidemiological and clinicopathological characteristics of melanoma in central Serbia.

Materials and methods  Epidemiological data were retrieved from the Cancer Registry of Central Serbia and clinicopathological data from the hospital‐based registry.

Results  The ASR(W) incidence rate of melanoma was 4.2/100,000 (males) and 3.9/100,000 (females), and ASR(W) mortality rates were 1.9/100,000 (males) and 1.4/100,000 (females), with recorded rising trends in both of them. Data from the hospital‐based registry revealed a total of 266 patients treated from 2005 to 2010, with the median age at diagnosis of 57 (13–86) years. The most frequent histopathological subtype was superficial spreading melanoma (SSM; 63.53%), and ulceration was present in 40.6% of primary tumors. Median Breslow thickness was 3 mm (0.1–25 mm). Primary tumors with thickness of more than 4 mm were found in 31.95% of patients, and in this group statistically significant difference was found for younger age in patients with SSM (55 years vs. 61 years, P = 0.04).

Conclusion  Low incidence rates in central Serbia and probably other countries of South‐East Europe are accompanied by a large percentage of thick tumors and a significant proportion of younger patients with thick tumors. This points to the urgent need for more effective primary and secondary prevention of melanoma in these countries.
Efficacy of intradermal radiofrequency combined with autologous platelet‐rich plasma in striae distensae: a pilot study
Authors: Kim In Su , Park Kui Young , Kim Beom Joon , Kim Myeung Nam , Kim Chan Woong , Kim Sung Eun
Published: September 2012

Background  Different types of laser have recently been reported as effective tools of treatment in striae distensae. Although fractional photothermolysis is effective for striae distensae, post‐inflammatory hyperpigmentation is a major concern and common complication. There are no reports of the effects of using an intradermal radiofrequency (RF) device in striae distensae. Autologous platelet‐rich plasma (PRP) is an effective treatment known for its wound‐healing effects.

Methods  Nineteen Asian female patients with striae distensae were enrolled in this study. Three sessions of intradermal RF (1134‐kHz frequency, 12‐W power, 26‐G electrode size) combined with autologous PRP were performed in each patient at intervals of four weeks. Patients were evaluated subjectively by the investigators and by themselves.

Results  Evaluation of clinical results at four weeks after treatment showed that only one (5.3%) of the 19 patients achieved excellent improvement, whereas seven (36.8%) demonstrated marked improvement, six (31.6%) showed moderate improvement, and five (26.3%) showed mild improvement. None of the patients showed worsening of striae distensae. A total of 63.2% of patients reported they were “satisfied” or “very satisfied” with the degree of overall improvement.

Conclusions  Intradermal RF combined with autologous PRP appears to be an effective treatment for striae distensae.
Elderly patients' experiences using adaptive conjoint analysis software as a decision aid for osteoarthritis of the knee
Authors: Rochon Donna , Eberth Jan M. , Fraenkel Liana , Volk Robert J. , Whitney Simon N.
Published: September 2012

Background

Decision making in knee osteoarthritis, with many treatment options, challenges patients and physicians alike. Unfortunately, physicians cannot describe in detail each treatment's benefits and risks. One promising adjunct to decision making in osteoarthritis is adaptive conjoint analysis (ACA).

Objective

To obtain insight into the experiences of elderly patients who use adaptive conjoint analysis to explore treatment options for their osteoarthritis.

Design

Participants, all 65 and older, completed an ACA decision aid exploring their preferences with regard to the underlying attributes of osteoarthritis interventions. We used focus groups to obtain insight into their experiences using this software.

Results

Content analysis distributed our participants' concerns into five areas. The predicted preferred treatment usually agreed with the individual's preference, but our participants experienced difficulty in four other domains: the choices presented by the software were sometimes confusing, the treatments presented were not the treatments of most interest, the researchers' claims about treatment characteristics were unpersuasive and cumulative overload sometimes developed.

Conclusion

Adaptive conjoint analysis presented special challenges to our elderly participants; we believe that their relatively low level of computer comfort was a significant contributor to these problems. We suggest that other researchers choose the software's treatments and present the treatment attributes with care. The next and equally vital step is to educate participants about what to expect, including the limitations in choice and apparent arbitrariness of the trade‐offs presented by the software. Providing participants with a sample ACA task before undertaking the study task may further improve participant understanding and engagement.
Brassinosteroids accelerate recovery of photosynthetic apparatus from cold stress by balancing the electron partitioning, carboxylation and redox homeostasis in cucumber
Authors: Jiang Yu‐Ping , Huang Li‐Feng , Cheng Fei , Zhou Yan‐Hong , Xia Xiao‐Jian , Mao Wei‐Hua , Shi Kai , Yu Jing‐Quan
Published: September 2012

The aim of this study was to examine the role of brassinosteroids (BRs) in protecting the photosynthetic apparatus from cold‐induced damage in cucumber (Cucumis sativus) plants. Recovery at both high light (HL) and low light (LL) after a cooling at 10/7°C induced irreversible inhibition of CO2 assimilation, photoinhibition at photosystem I (PSI) and inhibition of enzyme activities of Calvin cycle and ascorbate (AsA)‐reduced glutathione (GSH) cycle, followed by accumulation of H2O2 and malondialdehyde. However, cold‐induced photoinhibition at PSII was fully recovered at LL but not at HL. Meanwhile, recovery at HL increased electron flux to O2‐dependent alternative pathway [Ja(O2‐dependent)]. Foliar application of 24‐epibrassinolide (EBR) accelerated recovery from photoinhibition of PSII but not of PSI. EBR also significantly increased CO2 assimilation, activity of Calvin cycle enzymes and electron flux to carbon reduction [Je(PCR)], with a concomitant decrease in Ja(O2‐dependent); meanwhile EBR increased the activity of enzymes in AsA‐GSH cycle and cellular redox states. However, the positive effect of EBR on plant recovery was observed only at HL, but not LL. These results indicate that BR accelerates the recovery of photosynthetic apparatus at HL by activation of enzymes in Calvin cycle and increasing the antioxidant capacity, which in turn mitigate the photooxidative stress and the inhibition of plant growth during the recovery.
Small body size increases the regional differentiation of populations of tropical mantellid frogs (Anura: Mantellidae)
Authors: Pabijan M. , Wollenberg K. C. , Vences M.
Published: September 2012

The processes affecting species diversification may also exert an influence on patterns of genetic variability within species. We evaluated the contributions of five variables potentially influencing clade diversification (body size, reproductive mode, range size, microhabitat and skin texture) on mtDNA divergence and polymorphism among populations of 40 species of frogs (Mantellidae) from two rainforest communities in Madagascar. We report an inverse association between body size and nucleotide divergence between populations but find no influence of other variables on genetic variation. Body size explained ca. 11% of the variation in nucleotide divergence between populations and was coupled with high FST levels and an absence of haplotype sharing in small‐bodied and medium‐sized frogs. Low dispersal ability is likely the proximate mechanism producing higher population differentiation in small mantellids. The lack of genetic cohesion among populations establishes regional genetic fragmentation which in turn has the potential to accelerate rates of allopatric speciation in small frogs relative to large species. However, there is little evidence of increased speciation rates in these or other small‐bodied organisms. We reconcile these contradictory observations by suggesting that lower dispersal ability also curbs colonization of new areas, decelerating diversification in weak dispersers. Our results imply that the intermediate dispersal model also applies to amphibians and may explain inconsistent previous results on the correlation of body size and speciation rate.
High cell‐autonomy of the anterior endomesoderm viewed in blastomere fate shift during regulative development in the isolated right halves of four‐cell stage Xenopus embryos
Authors: Koga Masaaki , Nakashima Takuro , Matsuo Shintaro , Takeya Ryu , Sumimoto Hideki , Sakai Masao , Kageura Hiroshi
Published: September 2012

The isolated right half (RH) or left half (LH) of Xenopus embryos can undergo regulation so as to form well‐proportioned larvae. To assess how the combined actions of maternal determinants and cell–cell interactions contribute to form the well‐proportioned larvae, we quantitatively compared four‐cell stage blastomere fate between normal larvae and regulated larvae from RH embryos. In normal larvae, the clones of the right dorsal blastomere (RD) and right ventral blastomere (RV) were located unilaterally. In contrast, in regulated larvae: (i) the RD clone exclusively occupied the anterior endomesoderm (AE) derivatives, coinciding no RV progeny in those derivatives of normal larvae. The clone bilaterally populated tissues along the dorsal midline, which characteristically included the medial regions of both somites adjoining the notochord, with higher percentages on the right and anterior sides. (ii) The RV clone extensively compensated for the missing left side at the expense of its right side contribution, and bilaterally occupied the ventroposterior and also dorsal regions excluding the AE derivatives. This clone considerably populated, with altered orientations, the derivatives of the left half gastrocoel roof plate (GRP), the left half GRP being essential for laterality determination. These results show that the high cell‐autonomy in the AE constitutes a mechanism common to both normal and regulative development. In regulated larvae, cell–cell interactions shifted the midlines on the dorsal side slightly and the ventral side to a greater extent. The cell lineage difference in the left half GRP could result in a different utilization of maternal determinants in that area.
Geochemistry of Devonian–Carboniferous clastic sediments of the Tsetserleg terrane, Hangay Basin, Central Mongolia: Provenance, source weathering, and tectonic setting
Authors: Purevjav Narantuya , Roser Barry
Published: September 2012

The Devonian–Carboniferous Tsetserleg terrane of Mongolia forms part of the complex Central Asian Orogenic Belt (CAOB). The Tsetserleg terrane consists mainly of clastic sediments, and is situated in the southern Hangay–Hentey Basin. Internally the terrane is divided into the Erdenetsogt (Middle Devonian), Tsetserleg (Middle‐Upper Devonian) and Jargalant (Lower Carboniferous) Formations. Provenance and tectonic setting of the Hangay–Hentey Basin remains controversial, with proposals ranging from passive margin through to island‐arc. A suite of 94 Tsetserleg sandstones and mudrocks was collected with the aim of constraining provenance, source weathering, and depositional setting, using established petrographic and whole‐rock geochemical parameters. Petrographically the sandstones are immature, with average compositions of Q22F14L64, Q14F17L69, and Q18F12L70 in the Erdenetsogt, Tsetserleg, and Jargalant Formations, respectively. Lv/L ratios range from 0.81 to 1.00 (average 0.95), and P/F from 0.68 to 0.93 (average 0.83). Framework compositions indicate deposition in an undissected or transitional arc. Geochemically, the sandstones are classified as greywackes. Geochemical contrasts between sandstone and mudrock averages in each formation are small, with lithotype means for SiO2 ranging only from 65.54 to 68.62 wt.%. These features and weak trends on variation diagrams reflect the immaturity of the sediments. Comparison of elemental abundances with average upper continental crust, major element discriminant scores, and immobile element ratios indicate a uniform average source composition between dacite and rhyolite. The maximum value for the Chemical Index of Alteration in the Erdenetsogt Formation is about 78 after correction for K‐metasomatism, indicating moderate source weathering. Lower maximum values (61 and 63, respectively) in the Tsetserleg and Jargalant Formations indicate they were derived from a virtually unweathered and tectonically active source. Tectonic setting discrimination parameters indicate a continental island‐arc environment, similar to several other CAOB suites of similar age. This arc source may have been built on a continental fragment situated within the Mongol–Okhotsk Ocean during Middle Devonian‐Lower Carboniferous time.
Contiguous ABCD1 DXS1357E deletion syndrome: Report of an autopsy case
Authors: Iwasa Mitsuaki , Yamagata Takanori , Mizuguchi Masashi , Itoh Masayuki , Matsumoto Ayumi , Hironaka Mitsugu , Honda Ayako , Momoi Mariko Y. , Shimozawa Nobuyuki
Published: September 2012

Contiguous ABCD1 DXS1357E deletion syndrome (CADDS) is a contiguous deletion syndrome involving the ABCD1 and DXS1357E/BAP31 genes on Xq28. Although ABCD1 is responsible for X‐linked adrenoleukodystrophy (X‐ALD), its phenotype differs from that of CADDS, which manifests with many features of Zellweger syndrome (ZS), including severe growth and developmental retardation, liver dysfunction, cholestasis and early infantile death. We report here the fourth case of CADDS, in which a boy had dysmorphic features, including a flat orbital edge, hypoplastic nose, micrognathia, inguinal hernia, micropenis, cryptorchidism and club feet, all of which are shared by ZS. The patient achieved no developmental milestones and died of pneumonia at 8 months. Biochemical studies demonstrated abnormal metabolism of very long chain fatty acids, which was higher than that seen in X‐ALD. Immunocytochemistry and Western blot showed the absence of ALD protein (ALDP) despite the presence of other peroxisomal proteins. Pathological studies disclosed a small brain with hypomyelination and secondary hypoxic‐ischemic changes. Neuronal heterotopia in the white matter and leptomeningeal glioneuronal heterotopia indicated a neuronal migration disorder. The liver showed fibrosis and cholestasis. The thymus and adrenal glands were hypoplastic. Array comparative genomic hybridization (CGH) analysis suggested that the deletion was a genomic rearrangement in the 90‐kb span starting in DXS1357E/BACP31 exon 4 and included ABCD1, PLXNB3, SRPK3, IDH3G and SSR4, ending in PDZD4 exon 8. Thus, the absence of ALDP, when combined with defects in the B‐cell antigen receptor associated protein 31 (BAP31) and other factors, severely affects VLCFA metabolism on peroxisomal functions and produces ZS‐like pathology.
Central nervous system marginal zone B‐cell lymphoma of mucosa‐associated lymphoid tissue type involving the brain and spinal cord parenchyma
Authors: Ueba Tetsuya , Okawa Masakazu , Abe Hiroshi , Inoue Tooru , Takano Koichi , Hayashi Hiroyuki , Nabeshima Kazuki , Oshima Koichi
Published: September 2012

We present a case of a 53‐year‐old HIV negative man with a 2‐month history of progressive recent memory disturbance, gait disturbance and urinary incontinence. On MRI, an infiltrative tumor in the brain and spinal cord was noted. Subsequent positron emission tomography studies along with bone marrow biopsy and serum protein electrophoresis showed no evidence of systemic disease. Open brain biopsy results revealed a small lymphocytic infiltrate with scattered plasma cells in a predominantly perivascular growth pattern. The morphology was consistent with involvement by a low‐grade B‐cell lymphoma. Immunohistochemical findings showed CD20+, CD10–, CD5–, TdT–, EBV–encoded RNA in situ– and IgM–. The above findings were consistent with involvement by a non‐dural extranodal marginal zone B‐cell lymphoma (MZBCL) primary to the brain and spinal cord. This is a case report of a CNS MZBCL of mucosa‐associated lymphoid tissue type involving the brain and spinal cord parenchyma.
Cerebral astroblastoma in an adult: An immunohistochemical, ultrastructural and genetic study
Authors: Fu Yong‐Juan , Taniguchi Yoshinori , Takeuchi Shigekazu , Shiga Atsushi , Okamoto Kouichirou , Hirato Junko , Nobusawa Sumihito , Nakazato Yoichi , Kakita Akiyoshi , Takahashi Hitoshi
Published: September 2012

Astroblastoma is a rare glial tumor of unknown origin, usually affecting the cerebral hemispheres of children and young adults. Here we report an unusual cerebral tumor in a 60‐year‐old woman. On MRI, the tumor appeared as a well circumscribed lesion in the left frontal lobe. Histopathologically, it was composed of rounded eosinophilic cells, and was divisible into two areas. One area was characterized by a collection of GFAP‐positive cells around sclerotic blood vessels (astroblastic pseudorosettes and perivascular hyalinization), and had a Ki‐67 labeling index of 2.8%. However, the other area was highly cellular, showing many GFAP‐negative cells often with a rhabdoid appearance, mitoses and a Ki‐67 index of 15.7%. Thus, a final diagnosis of malignant astroblastoma was made. In both areas of the tumor, nearly all the cells were positive for epithelial membrane antigen, and many were positive for oligodendrocyte transcription factor 2 (Olig2). Focal expression of cytokeratin was also evident. With regard to genetic markers, the tumor cells were positive for INI1 and negative for mutant IDH1. The p53 labeling index was <1%. Ultrastructurally, the presence of intra‐ and intercellular lumina with microvilli was a feature. DNA examination of IDH1/2 and TP53 showed no mutations. In conclusion, although ependymal features were evident ultrastructurally in the present tumor, the immunohistochemical expression pattern of Olig2 was that of diffuse astrocytoma. On the other hand, the absence of mutations in both IDH1/2 and TP53 suggested that the present tumor was not a purely astrocytic neoplasm. Further studies, including molecular and genetic analyses, will provide insight into the histogenesis of astroblastoma.
Qualitative study of humanization‐based nursing education focused on role modeling by instructors
Authors: Nouri Jamileh Mokhtari , Ebadi Abbas , Alhani Fatemeh , Rejeh Nahid , Ahmadizadeh Mohammad Javad
Published: September 2012

This study explored the perspectives and experiences of Iranian nursing students and nursing instructors about role modeling. Using a purposeful sampling strategy, 22 nursing students and seven nursing instructors were recruited from five nursing schools in Tehran. Three focus‐group discussions and two individual semi‐structured interviews with nursing students, and seven semi‐structured interviews with nursing instructors, were conducted to gather data. A qualitative content analysis approach was utilized and three main themes emerged during data analysis: “attempt to promote emotional development,”“attempt to promote spiritual development,” and “attempt to promote intellectual development.” It was concluded that understanding the factors influencing role modeling will be helpful for developing strategies to integrate role modeling into nursing education so as to promote the quality of nursing education in Iran.