bluuebunny/crossref_metadata_2025 huggingface dataset:
Two cases of Zoon's balanitis treated with pimecrolimus 1% cream
Authors: Bardazzi F. , Antonucci Angela , Savoia F. , Balestri R.
Published: September 2009

Background  Plasma cell balanitis is a disorder of the middle‐aged and older uncircumcised male. Several treatments have been proposed to treat this disease, but plasma cell balanitis is often resistant to conventional therapy.

Methods  We decided to evaluate the efficacy and tolerability of pimecrolimus 1% cream in resistant Zoon's balanitis. We report two cases of resistant Zoon's balanitis treated with topical pimecrolimus 1% cream.

Results  One of the two patients had a complete regression of the lesion after 2 months of therapy. The other one had a great improvement of the lesion, but a hyperpigmented patch persisted on the glans.

Conclusion  Pimecrolimus 1% cream may be a valuable second‐line treatment for patients with steroid related side effects or with steroid and other conventional therapy resistant Zoon's balanitis, as well as for those rejecting circumcision.
Pyoderma gangrenosum – rebel without a cure?
Authors: Jacob Sharon E. , Weisman Robyn S. , Kerdel Francisco A.
Published: September 2009

Abst ract

Background  Pyoderma gangrenosum (PG) is a rare neutrophilic, ulcerating dermatosis that is frequently difficult to diagnose and often a diagnosis of exclusion. It is hypothesized that PG may be caused by an abnormal T‐cell and neutrophil response, which correlates with its common link to other disorders, such as inflammatory bowel disease, rheumatoid arthritis, and malignancies. Several treatments have been used successfully for PG, but none has proven to be universally effective.

Methods  We present three cases of PG treated with adalimumab after failed courses of steroids (orally and parenterally), thalidomide, cyclosporine, and mycophenolate mofetil.

Results  Patients 2 and 3, who had previously responded to infliximab, albeit with recurrence, were successfully treated with adalimumab at a dose of 40 mg once a week. Patient 1 initially responded to adalimumab, but after 7.5 months failed to show wound bed improvement at a dose of 80 mg/week subcutaneously. This patient had not previously been treated with infliximab.

Conclusion  We believe adalimumab to be a valuable alternative for the treatment of PG, with comparable efficacy to infliximab.
Effects of interferon‐α2b on keloid treatment with triamcinolone acetonide intralesional injection
Authors: Lee June Hyunkyung , Kim Seong Eon , Lee Ai‐Young
Published: September 2009

Background  Triamcinolone acetonide intralesional injection (TAIL) has been used for the treatment of keloids, but only with limited success. Interferon‐α (IFN‐α) is the most widely used IFN, and has mainly antiviral, antiproliferative, and antitumoral functions. A few studies have evaluated the efficacy of IFN‐α2b in controlled trials for the treatment of keloids.

Objective  To compare the efficacy and side‐effects of keloid treatment using IFN‐α2b and TAIL, and TAIL only.

Methods  Twenty lesions (combined TAIL + IFN‐α2b group) and 20 control lesions (TAIL‐only group) were studied in 19 patients (14 women and five men). The age range was 7–51 years (mean age, 24.6 years). Both groups were treated with TAIL every 2 weeks. The combined TAIL + IFN‐α2b group was treated with intralesional injection of IFN‐α2b, twice a week. Lesion measurements were made using thread, glue, and alginate.

Results  Statistically significant decreases in depth (81.6%, P = 0.005) and volume (86.6%, P = 0.002) were observed in lesions of the combined TAIL + IFN‐α2b group. In the TAIL‐only group, the decreases in depth (66.0%, P = 0.281) and volume (73.4%, P = 0.245) were less statistically significant. The main side‐effects were fever and flu‐like symptoms, mild pain, and inflammation at the injection site.

Conclusions  Intralesional IFN‐α2b is an effective and safe treatment for keloids. Although the recurrence rate is as yet unknown, more than 80% improvement was noted in the majority of cases. Hence, adjuvant intralesional IFN‐α2b should be considered, particularly for patients who have a history of failed corticosteroid injections.
“The Laundry Bag Project”– unequal distribution of dermatological healthcare resources for male and female psoriatic patients in Sweden
Authors: Nyberg Filippa , Osika Ingrid , Evengård Birgitta
Published: September 2009

Background  Psoriasis and eczema are common dermatological diseases that occur with approximately equal frequency in men and in women. The aim of this study was to determine whether men and women with dermatological diseases in need of ultra‐violet radiation (UV) treatment receive equal care.

Methods  We conducted a retrospective analysis of records of all patients referred to and seen at our clinic during 2003 with diagnoses of psoriasis or eczema. We performed a gender‐based analysis of the number, type, and estimated cost of the treatments given to each patient. We evaluated similar data from a Swedish Psoriasis Association (SPA) treatment center and from the state pharmacy monopoly (Apoteksstatistiken).

Results  Men with eczema or psoriasis received more help with emollients than did women and were given a greater number of UV treatments. At our clinic and at the SPA center, women constituted 37 and 42%, respectively, of the individuals who received UV treatment; yet, they received only 34 and 36% of the treatments, respectively. Women were prescribed self‐care more often than men, with 61% of prescriptions for emollients and 48% of specific topical treatments for psoriasis dispensed to women.

Conclusions  We discovered previously unrecognized gender differences in standard dermatological treatment for common diagnoses at our hospital. To ensure optimal care for each patient, treatment disparity should be recognized and gender‐based analyzes be carried out when planning dermatological health care.
Immunohistochemistry and polymerase chain reaction on paraffin‐embedded material improve the diagnosis of cutaneous leishmaniasis in the Amazon region
Authors: Amato Valdir Sabbaga , Tuon Felipe Francisco , De Andrade, Jr Heitor Franco , Bacha Helio , Pagliari Carla , Fernandes Elaine Raniero , Duarte Maria Irma Seixas , Neto Vicente Amato , Zampieri Ricardo Andrade , Floeter‐Winter Lucile Maria , Celeste Beatriz J. , Oliveira Juliane , Quiroga Mariana Martinez , Mascheretti Melissa , Boulos Marcos
Published: September 2009

Background  Recently, there has been an increase in the incidence of cutaneous leishmaniasis (CL), which represents an important health problem. This increase may be related to the epidemiologic expansion of the infective agent and the increase in tourism in tropical areas. The difficulty in clinical diagnosis, mainly in areas in which CL is not the first consideration of local physicians, has intensified efforts to describe diagnostic tests, which should be specific, sensitive, and practical. Amongst the new tests described are those including nucleic acid amplification (polymerase chain reaction, PCR) and immunohistochemistry (IHC).

Methods  In this study, we evaluated the sensitivity of a PCR based on small subunit (SSU) ribosomal DNA, in comparison with IHC using Leishmania spp. antibodies, in biopsies embedded in paraffin.

Result  The results indicated a total sensitivity of 96% (90.9% with PCR and 68.8% with IHC), showing the possibility of using paraffin‐embedded biopsies to diagnose CL.

Conclusion  We propose the use of the two tests together as a routine protocol for diagnosis. This would require the provision of local medical services to perform molecular biology techniques and adequate Leishmania antibodies.
Necrolytic acral erythema seronegative for hepatitis C virus – two cases from India treated with oral zinc
Authors: Nikam Balkrishna Pralhad
Published: September 2009

Background  Necrolytic acral erythema (NAE) is a distinct skin entity and is strongly associated with chronic hepatitis C virus (HCV) infection. It is distinguished by its acral location, typical clinical and histopathologic features, and positive serum antibodies against HCV. Most cases have been treated with variable success using oral zinc, amino acids, and interferon with or without ribavirin therapy.

Methods  We report two patients with the clinical and histopathologic features of NAE; however, both tested seronegative for HCV. Both patients were treated with oral zinc acetate with good response, with one showing a partial relapse after stopping oral zinc. The clinical features, histopathologic findings, association of HCV, and treatment of NAE in different case reports were reviewed.

Conclusion  NAE has a strong association with HCV, particularly in prevalent countries such as Egypt. Nevertheless, it may occur independently without HCV association, and oral zinc may prove to be a less toxic therapeutic option for such cases.
Sweet's syndrome with neurologic manifestations in a patient with esophageal adenocarcinoma: case report and review of the literature
Authors: Sobol Urszula A. , Sherman Karen L. , Smith Jason , Nagda Suneel N. , Micetich Kenneth , Nickoloff Brian J. , Shoup Margo C.
Published: September 2009

Background  Sweet's syndrome, also known as febrile neutrophilic dermatosis, can occur in patients with an underlying malignancy and can present with extracutaneous manifestations, including neurologic symptoms.

Methods  This report describes a 62‐year‐old man with adenocarcinoma of the esophagus who developed Sweet's syndrome and whose postoperative course was complicated by encephalitis.

Results  A diagnosis of Sweet's syndrome with neurologic manifestations was made, and the patient was treated with oral corticosteroids. His symptoms improved markedly within 12 h.

Conclusion  Neurologic symptoms in Sweet's syndrome are infrequently reported and have not been described previously in a patient with adenocarcinoma of the esophagus.
Epidemiology of desquamative gingivitis: evaluation of 125 patients and review of the literature
Authors: Lo Russo Lucio , Fierro Gabriella , Guiglia Rosario , Compilato Domenico , Testa Nunzio Francesco , Lo Muzio Lorenzo , Campisi Giuseppina
Published: September 2009

Background  Desquamative gingivitis (DG) is a descriptive term used to indicate epithelial desquamation, erythema, erosions, and/or vesiculobullous lesions of the gingiva. DG is commonly associated with several mucocutaneous disorders and systemic conditions that may carry a poor prognosis and high morbidity; however, there are no clear data concerning the frequency of these disease associations.

Methods  We investigated the epidemiologic features of DG in 125 patients and compared our findings with information from a literature review.

Results  In our series, 88% of patients with DG had one of the following three disorders: oral lichen planus (OLP), mucous membrane pemphigoid (MMP), or pemphigus vulgaris. The most common cause of DG was OLP (75% of patients). 22% of patients had isolated gingival involvement, and there were diffuse gingival lesions in 57% of patients. Symptoms ranged from none (1%) to severe pain (10%). There was extra‐oral involvement of skin in 14% of patients, conjunctiva in 7%, genital mucosa in 26%, and internal organs in 3%. Our study showed MMP to be associated with DG in only a small percentage of patients (9%); this finding may be related to the patient population, epidemiology of the specific disease, and referral and/or past diagnostic bias.

Conclusion  Based on our series and recent reports, OLP seems to be the most common cause of DG.
Dermatitis cruris pustulosa et atrophicans revisited: our experience with 37 patients in south India
Authors: Kaimal Sowmya , D'Souza Mariette , Kumari Rashmi , Parija Subhash Chandra , Sistla Sujatha , Badhe Bhawana Ashok
Published: September 2009

Background  Dermatitis cruris pustulosa et atrophicans (DCPA) is a distinctive type of chronic superficial folliculitis, with a number of unique features such as its peculiar symmetric localization to legs, extreme chronicity, resistance to therapy, and inevitable alopecia and atrophy.

Methods  All patients with DCPA, attending the Dermatology Outpatient Department at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) Hospital, Pondicherry, from December 2006 to June 2008 were included. Parameters recorded were detailed history and examination, hemogram, erythrocyte sedimentation rate, random blood sugar, skin biopsy and cultures from pus and carrier sites (nares, axillae and gluteal fold).

Results  37 patients were studied (35 males and 2 females). Sixteen patients (43.24%) belonged to the 21–30 year‐old age group. The disease most commonly began on the legs (81.1%). Majority (78.38%) had a disease duration of less than 5 years. Itching was the most common symptom (89.19%), followed by bleeding and scaling, with no significant systemic symptoms. The lower limbs were involved in all patients. Eleven patients (29.73%) had involvement of other sites – beard, axillae, chest, moustache, abdomen, and eyebrows. Pustules, papules, and scaling were seen in all patients, followed by wiry roughness, atrophy, alopecia, and pigmentation. Aggravating factors included use of full‐length synthetic trousers, occupational exposure to potential irritants, and season (summer). Pus culture from the folliculitic lesions grew Staphylococcus aureus in 32 (86.49%) patients. Twenty one patients (56.75%) were carriers of S. aureus in one or more sites.

Conclusion  DCPA is a chronic folliculitis of the legs, with a multifactorial etiopathogenesis, in which staphylococcal carrier status may be a new potential pathogenetic factor.
Skin diseases in patients with β‐thalassemia major
Authors: Dogramaci Asena Cigdem , Savas Nazan , Ozer Burcin , Duran Nizami
Published: September 2009

Background  β‐Thalassemia major affects multiple organs and is associated with considerable morbidity and mortality. The goal of this analysis was to document the frequency of skin diseases among patients with β‐thalassemia major.

Methods  A sample of 78 patients with β‐thalassemia major was recruited and interviewed at the thalassemia clinic between April and June 2008. A dermatologist completed a skin examination of each patient and recorded any skin disease present. The patients’ laboratory results and treatment modalities were recorded from the charts.

Results  Sixty‐five (83.3%) of the 78 patients examined had a diagnosed skin disease: pruritus (37.2%), xerosis (34.6%), scars (24.4%), ephelides (23.1%), skin irritation/erythema caused by deferoxamine pump (12.8%), idiopathic guttate hypomelanosis (6.4%), pityriasis alba (6.4%), tinea infections (5.1%), verruca vulgaris (5.1%), urticaria (3.8%), hyperhidrosis, contact dermatitis, and acne (2.6%), necrobiosis lipoidica (1.3%), melasma (1.3%), and others (14.1%). Pruritus and xerosis increased in frequency with age. The mean serum ferritin level was higher in patients with xerosis than in those without (5607.7 ± 2997.5 ng/mL and 4285.2 ± 4732.4 ng/mL, respectively) (P = 0.005). Moreover, xerosis was observed significantly more frequently in patients using deferoxamine and deferiprone than in those using deferasirox (P = 0.047, P = 0.027, and P = 0.273, respectively).

Conclusion  Skin diseases, especially pruritus and xerosis, are observed highly frequently in patients with β‐thalassemia major. Treatment is needed for these patients who already have other significant morbidities.
Acute rejection in low‐toxicity regimens: clinical impact and risk factors in the Symphony study
Authors: Frei Ulrich , Daloze Pierre , Vítko Štefan , Klempnauer Jürgen , Reyes‐Acevedo Rafael , Titiz Izzet , Fricke Lutz , Bernasconi Corrado , Ekberg Henrik
Published: September 2009

Frei U, Daloze P, Vítko Š, Klempnauer J, Reyes‐Acevedo R, Titiz I, Fricke L, Bernasconi C, Ekberg H. Acute rejection in low‐toxicity regimens: clinical impact and risk factors in the Symphony study. Clin Transplant 2010: 24: 500–509. © 2009 John Wiley & Sons A/S.

Abstract:  The Symphony study assessed whether mycophenolate mofetil (MMF)‐based regimens containing reduced doses of adjunct immunosuppressants could reduce toxicity while maintaining efficacy. Here, we examined the impact of acute rejection and associated risk factors. The incidence of biopsy‐proven acute rejection in the low‐dose tacrolimus group was approximately half that of the standard‐dose cyclosporine and low‐dose cyclosporine groups, and a third of that in the low‐dose sirolimus group. The low‐dose cyclosporine group had more severe rejection episodes (≥grade II) compared with other groups. Acute rejection was associated with a 10 mL/min glomerular filtration rate (GFR) reduction and a 5.3% absolute increase in graft loss at 12 months. Overall, the highest GFR was found in both rejecters and non‐rejecters receiving low‐dose tacrolimus, both in an intent‐to‐treat analysis and in patients successfully treated according to the protocol. In Cox regression models, human leukocyte antigen (HLA) mismatches and expanded criteria donors increased the acute rejection risk, while recipient age, living related donor, and MMF dose were associated with a reduced risk. Acute rejection was associated with worse outcome but did not entirely explain the differences among the treatment groups. The 2 g MMF plus low‐dose tacrolimus combination appears to be the most efficient of all regimens examined regardless of acute rejection.
Patient HSP70‐hom TG haplotype is associated with decreased transplant‐related mortality and improved survival after sibling HLA‐matched hematopoietic stem cell transplantation
Authors: Kim Inho , Kim Jin Hee , Rhee Ji Young , Kim Jin Won , Cho Hyeon Jin , Cho Eun‐Young , Lee Jong‐Eun , Hong Yun‐Chul , Park Sung Sup , Yoon Sung‐Soo , Park Myoung Hee , Park Seonyang , Kim Byoung Kook
Published: September 2009

Kim I, Kim JH, Rhee JY, Kim JW, Cho HJ, Cho E‐Y, Lee J‐E, Hong Y‐C, Park SS, Yoon S‐S, Park MH, Park S, Kim BK. Patient HSP70‐hom TG haplotype is associated with decreased transplant‐related mortality and improved survival after sibling HLA‐matched hematopoietic stem cell transplantation. Clin Transplant 2010: 24: 459–466. © 2009 John Wiley & Sons A/S.

Abstract:  Heat shock protein 70‐hom (HSP70‐hom) plays an important role in protein folding and immune responses. Therefore, HSP70‐hom gene polymorphisms may act as important factors in predicting the prognosis of patients receiving allogeneic hematopoietic stem cell transplantation (HSCT). To evaluate the role of HSP70‐hom gene polymorphisms in the prognosis of patients receiving sibling human leukocyte antigen (HLA)‐matched allogeneic HSCT, the HSP70‐hom polymorphisms, T2437C and G2763A, were genotyped in 147 patients receiving sibling HLA‐matched allogeneic HSCT. Individual diplotypes were estimated from genotype data of the two HSP70‐hom polymorphisms using the expectation maximization algorithm. Patients with the 2763GG or GA genotype showed longer overall survival compared with those with the 2763AA genotype, and patients with a TG haplotype (TG/TA, TG/TG or TG/CG) also showed longer overall survival compared with those with a non‐TG haplotype (TA/TA or TA/CG) (both G2763A genotype and diplotype, p < 0.01). Moreover, the 2437TT genotype was found to be protective for treatment‐related death compared with the 2437TC genotype, and a TG haplotype was found to be very protective for treatment‐related death compared with a non‐TG haplotype (T2437C genotype, p = 0.04; and diplotype, p = 0.02). Therefore, our results suggest that HSP70‐hom polymorphisms play an important role in the prognosis of patients receiving sibling HLA‐matched allogeneic HSCT.
DQB1 intron 3 sequences provide an insight into the evolution of DQB1 alleles and form the basis for intron‐based sequencing
Authors: Lebedeva T. , Harrison K. , Fresia B. , Ohashi M. , Yu N.
Published: September 2009

The goal of this project was to obtain sequences of intron 3 of DQB1 in order to develop a sequencing‐based typing protocol that provides a complete DQB1 exon 3 sequence. Current protocols do not provide complete sequences of exon 3, thus not allowing to differentiate common and well‐documented alleles DQB1*0301 and *0319 and resolve some common trans‐ambiguities with group‐specific sequencing primer (GSSP) sequencing using positions 641 and 650. Samples homozygous for the most common DQB1 alleles were used to obtain intron 3 sequences, which were used to design intron‐based primers for exon 3 amplification. The protocol was extensively validated; no allele dropouts were observed. The presented protocol allows differential typing of DQB1*0301 and *0319 and resolves some common trans‐ambiguities.
New CD3ζ allele showing a 9‐bp deletion in the 3′‐UT region of the gene
Authors: Aguinaga‐Barrilero A. , Rodríguez‐Pérez N. , Pérez‐Blas M. , Gutiérrez‐Calvo A. , Martín‐Villa J. M.
Published: September 2009

We report here a non‐previously described 9‐bp deletion in the 3′‐UT region of the CD3ζ gene, located in between two AREs.
A novel HLA‐DRB1 allele, DRB1*112802, was identified in a Chinese individual
Authors: Li Z. , Zhang L.‐H. , Zou H.‐Y. , Jin S.‐Z.
Published: September 2009

We report here a novel human leukocyte antigen‐DRB1 allele, DRB1*112802, which was identified from a Chinese individual during sequence‐based typing. The new allele is identical to DRB1*112801 except for one nucleotide change at nucleotide 189 (A → G ), codon 34 Q (CAA) → Q (CAG), no coding change.
HLA‐G polymorphism influences the susceptibility to HCV infection in sickle cell disease patients
Authors: Cordero E. A. A. , Veit T. D. , Da Silva M. A. L. , Jacques S. M. C. , Silla L. M. D. R. , Chies J. A. B.
Published: September 2009

Despite its well known monogenic etiopathogenesis, sickle cell disease (SCD) is characterized by a striking variability of clinical presentation. There is growing evidence that genetic factors may be involved in this variability. Human leukocyte antigen (HLA)‐G is a non‐classical HLA molecule which was shown to be expressed at sites of inflammation and in inflammatory diseases. Besides its large and highly polymorphic promoter region, the 3’ UTR region seems also to play an important role on regulating HLA‐G expression. We investigated the influence of the 14 pb (rs1704) and the +3142 (rs1063320) HLA‐G polymorphisms in 93 SCD patients in order to evaluate its potential role on clinical parameters. Twenty‐one patients presented an HCV infection. Among all SCD patients 16 (22.2%) were homozygous for the +3142C genotype, none of them hepatitis C (HCV) positive. Controlling for blood transfusions in the last year, the C allele represented a dose dependent protection effect for HCV infection (PR = 0.41; 95% CI: 0.24–0.71). The +3142C allele was also underrepresented among patients with history of respiratory‐tract infections. Our results support a role of the +3142 polymorphism in the susceptibility to infections, in particular to HCV infection, and suggest a possible interference of the HLA‐G molecule in the response to infections, among SCD patients.
Adoptive immunotherapy for cancer: the next generation of gene‐engineered immune cells
Authors: Berry L. J. , Moeller M. , Darcy P. K.
Published: September 2009

Adoptive cellular immunotherapy involving transfer of tumor‐reactive T cells has shown some notable antitumor responses in a minority of cancer patients. In particular, transfer of tumor‐infiltrating lymphocytes has resulted in long‐term objective responses in patients with advanced melanoma. However, the inability to isolate sufficient numbers of tumor‐specific T cells from most malignancies has restricted the broad utility of this approach. An emerging approach to circumvent this limitation involves the genetic modification of effector cells with T cell receptor (TCR) transgenes or chimeric single‐chain variable fragment (scFv) receptors that can specifically redirect T cells to tumor. There has been much progress in the design of TCR and scFv receptors to enhance the antigen‐specific activation of effector cells and their trafficking and persistence in vivo. Considerable effort has been directed toward improving the safety of this approach and reducing the immunogenicity of the receptor. This review discusses the latest developments in the field of adoptive immunotherapy using genetically modified immune cells that have been transduced with either TCR or scFv receptor transgenes and used in preclinical and clinical settings as anticancer agents.
Regional anaesthesia for a Caesarean section in women with cardiac disease: a prospective study
Authors: LANGESÆTER E. , DRAGSUND M. , ROSSELAND L. A.
Published: September 2009

Background
We conducted a prospective observational survey of pregnant women with cardiac disease. The aim was to analyse and present the mode of delivery, outcome, and haemodynamic changes during a caesarean section under regional anaesthesia in women with cardiac disease.

Methods
All pregnant women with a cardiovascular diagnosis, except hypertension, were included in the registry. Based on the cardiac diagnoses, and on the New York Heart Association classification, a multidisciplinary group made recommendations for each patient and decided on the mode of delivery. The data from continuous, invasive haemodynamic monitoring in intermediate‐ and high‐risk patients under regional anaesthesia for a caesarean section were analysed and presented.

Results
The hospital had approximately 9000 deliveries in the period from November 2003 to April 2008. A total of 113 pregnancies in 107 women were included. Thirty‐two (28.3%) pregnancies were classified into the high‐risk category. Of 103 deliveries, caesarean sections were performed in 59 (52.2%) cases, with regional anaesthesia in 51 patients (18 emergencies), general anaesthesia in eight patients (five emergencies), and a planned vaginal delivery in 44 patients. There was no mortality among the mothers or the babies during the hospital stay or 6 months postpartum. Pre‐operative cardiovascular stability during the caesarean section was maintained by volume and phenylephrine infusion guided by invasive monitoring of haemodynamic variables.

Conclusion
Our study suggests that pregnant women with cardiac disease may safely deliver the baby by a caesarean section under regional anaesthesia. According to our findings, haemodynamic stability can be obtained by titrated regional anaesthesia, intravenous (i.v.) volume, phenylephrine infusion, and small repeated doses of i.v. oxytocin guided by invasive monitoring.
Depth of anaesthesia and post‐operative cognitive dysfunction
Authors: STEINMETZ J. , FUNDER K. S. , DAHL B. T. , RASMUSSEN L. S.
Published: September 2009

Background: A deep level of anaesthesia measured by the bispectral index has been found to improve processing speed as one aspect of cognitive function after surgery. The purpose of the present study was to assess the possible effect of the level of anaesthesia on post‐operative cognitive dysfunction (POCD) 1 week after surgery, as assessed by a neuropsychological test battery.

Methods: We included 70 patients >60 years of age scheduled for elective non‐cardiac surgery with general anaesthesia. The depth of anaesthesia was monitored using the cerebral state monitor, which provided a cerebral state index (CSI) value. Cognitive function was assessed by the ISPOCD neuropsychological test battery before and at 1 week (or hospital discharge) after surgery and POCD was defined as a Z score above 1.96.

Results: Five patients were not assessed after surgery. The mean CSI was 40 and 43 in patients with (N=9) and without POCD (N=56), respectively (P=0.41). The cumulated time of both deep anaesthesia (CSI<40) and light anaesthesia (CSI>60) did not differ significantly, and no significant correlation was found between the mean CSI and the Z score.

Conclusion: We were unable to detect a significant association between the depth of anaesthesia and the presence of POCD 1 week after the surgery.
Evaluation of the Video Intubation Unit in morbid obese patients
Authors: BATHORY I. , GRANGES J.‐C. , FRASCAROLO P. , MAGNUSSON L.
Published: September 2009

Background: Tracheal intubation may be more difficult in morbidly obese (MO) patients than in the non‐obese. The aim of this study was to evaluate clinically if the use of the Video Intubation Unit (VIU), a video‐optical intubation stylet, could improve the laryngoscopic view compared with the standard Macintosh laryngoscope in this specific population.

Methods: We studied 40 MO patients (body mass index >35 kg/m2) scheduled for bariatric surgery. Each patient had a conventional laryngoscopy and a VIU inspection. The laryngoscopic grades (LG) using the Cormack and Lehane scoring system were noted and compared. Thereafter, the patients were randomised to be intubated with one of the two techniques. In one group, the patients were intubated with the help of the VIU and in the control group, tracheal intubation was performed conventionally. The duration of intubation, as well as the minimal SpO2 achieved during the procedure, were measured.

Results: Patient characteristics were similar in both groups. Seventeen patients had a direct LG of 2 or 3 (no patient had a grade of 4). Out of these 17 patients, the LG systematically improved with the VIU and always attained grade 1 (P<0.0001). The intubation time was shorter within the VIU group, but did not attain significance. There was no difference in the SpO2 post‐intubation.

Conclusion: In MO patients, the use of the VIU significantly improves the visualisation of the larynx, thereby improving the intubation conditions.
Sex differences in cerebral injury after severe haemorrhage and ventricular fibrillation in pigs
Authors: SEMENAS E. , NOZARI A. , SHARMA H. S. , BASU S. , RUBERTSSON S. , WIKLUND L.
Published: September 2009

Background: Experimental studies of haemorrhagic shock have documented a superior haemodynamic response and a better outcome in female animals as compared with male controls. Such sexual dimorphism has, nevertheless, not been reported after circulatory arrest that follows exsanguination and shock. We aimed to study differences in cerebral injury markers after exsanguination cardiac arrest in pre‐pubertal piglets. The hypothesis was that cerebral injury is less extensive in female animals, and that this difference is independent of sexual hormones or choice of resuscitative fluid.

Methods: Thirty‐two sexually immature piglets (14 males and 18 females) were subjected to 5 min of haemorrhagic shock followed by 2 min of ventricular fibrillation and 8 min of cardiopulmonary resuscitation, using three resuscitation fluid regimens (whole blood, hypertonic saline and dextran, or acetated Ringers' solution plus whole blood and methylene blue). Haemodynamic values, cellular markers of brain injury and brain histology were studied.

Results: After successful resuscitation, female piglets had significantly greater cerebral cortical blood flow, tended to have lower S‐100β values and a lower cerebral oxygen extraction ratio. Besides, in female animals, systemic and cerebral venous acidosis were mitigated. Female piglets exhibited a significantly smaller increase in neuronal nitric oxide synthase (nNOS) and inducible nitric oxide synthase (iNOS) expression in their cerebral cortex, smaller blood–brain‐barrier (BBB) disruption and significantly smaller neuronal injury.

Conclusion: After resuscitation from haemorrhagic circulatory arrest, cerebral reperfusion is greater, and BBB permeability and neuronal injury is smaller in female piglets. An increased cerebral cortical iNOS and nNOS expression in males implies a mechanistic relationship with post‐resuscitation neuronal injury and warrants further investigation.
Confocal Scanning Laser Microscopy Examination of Bovine Vaginal Fluid at Oestrus
Authors: Rutllant J. , López‐Béjar M. , Camón J. , Martí M. , López‐Gatius F.
Published: September 2009

This article reports the study of the structural elements of bovine vaginal fluid at oestrus using a confocal scanning laser microscope (CSLM) to examine samples collected from 10 lactating cows at the time of insemination. The filamentous glycoproteins, which form the structural component of vaginal fluid, were stained with fluorophore acridine orange for 10 min. This microscopy technique permits visualization of a network of non‐oriented filaments of different thickness in a three‐dimensional array. This arrangement was repeated throughout the sample and was common to all samples. Interfilament spaces varied in width between cows and ranged from 1 to 20 μm. The present results provide a new, non‐aggressive technique for the study of biological samples that show hydrogel‐like behaviour. Due to its simplicity, the CSLM technique proposed offers the advantages of (1) providing realistic images of vaginal fluid structure, free from artifacts arising from sample preparation, and (2) the possibility of observing specimens shortly after collection. CSLM proved to be a useful tool for the examination of vaginal fluid and may also serve as a good control for artifacts associated with scanning electron microscopy procedures.
Proliferation in the Gastric Epithelium of Bovine Abomasum during Foetal Development as Revealed by Ki‐67 Immunocytochemistry
Authors: Sommer U. , Kressin M.
Published: September 2009

For the first time, proliferative cells in the abomasal mucosa of 30 bovine foetuses with a crown–rump length of 34 to 1000 mm (approximately 45–250 days of gestation) were detected using the antibody MIB‐1 against the (human) nuclear‐associated protein Ki‐67. At the beginning of mucosal development, the epithelium is stratified and MIB‐1 positive cells are scattered all over the epithelium. With the formation of gastric pit/gland invaginations, the proliferative cells are mostly confined to the basal half or third of the gastric pit/gland unit, both in the regio glandulae propriae and in the regio glandulae pyloricae. From the 27th week in the regio glandulae propriae and the 30th week in the pyloric gland region, respectively, the proliferative cells move upwards and are situated in the bottom of the pit and the upper part of the gland, whereas the base of the gland is free of labelling.
Ultrastructure of Spermatogonia and Primary Spermatocytes of C57BL6J Mice
Authors: Martins M. R. F. B. , Silva J. R. C. P.
Published: September 2009

The three types of spermatogonia were confirmed. Type A spermatogonia have a large nucleus and loose chromatin and are poor in endoplasmic reticulum. The second type, B spermatogonia, have rounded and smaller nuclei filled with more electron‐dense nucleoplasmic material. The endoplasmic reticulum has the aspect of round or elongated cisterns that are free in the cytoplasm or close to the basement membrane. In contrast, intermediate spermatogonia present chromatin material with intermediate condensation compared with the two previous cell types. Primary spermatocytes are characterized by the presence of intercellular bridges and a synaptonemal complex. In the late pachytene stages, the synaptonemal complex was found to be enveloped by chromatin material.
Contribution to the Development of the Stapedius Muscle Structure in Human Fetuses
Authors: Whyte  , Cisneros  , Yus  , Blasco  , Torres  , Sarrat
Published: September 2009

The purpose of this report is to contribute to the knowledge of the morphogenesis of the human stapedius muscle. We have studied the stapedius structure development in 17 temporal bones from human fetuses. Chronological ages were from 48 days (21 mm) to 29 weeks (270 mm). Samples were fixed in 10% formol, decalcified with 2% nitric acid, embedded in Paraplast, sectioned in sequence of 7 μm and were stained with haematoxylin & eosin and Martins’ trichrome. Four maturation stages were observed in the development of the stapedius muscle structure. First, the formation of the ‘primordium muscularis’ in the mesenchyme of the tympanic cavity (promyoblasts) was observed in a 36‐mm embryo. Second, its differentiation into myoblasts, and its next cellular fusion to form muscle tubes, was seen in a 99‐mm foetus. In the third stage, myofibrogenesis phenomena were developed, to synthesize, the myotube myoblasts, myofilaments, phenomena we observed that took place during the 14th to 17th weeks of development. The last stage was characterized by the presence of striated muscle fibres, at first intermingled with myotubes (18th to 26th weeks), until in the 29th week fetuses (270 mm) the skeletal muscle fibre was completely differentiated. We conclude that in the 29th week of development (270 mm) the stapedius muscle structure is completely differentiated, although the functional development is not complete until birth.
Trichoderma harzianum and its Metabolite 6‐Pentyl‐alpha‐pyrone Suppress Fusaric Acid Produced by Fusarium moniliforme
Authors: El‐Hasan A. , Walker F. , Buchenauer H.
Published: September 2009

The interaction of the pathogen Fusarium moniliforme and two antagonistic Trichoderma harzianum isolates was studied especially with respect to their secondary metabolites fusaric acid (FA) and 6‐pentyl‐alpha‐pyrone (6PAP). Among 10 isolates of F. moniliforme screened for FA production on maize kernels, the isolate 8 accumulated the highest amount of FA (678 μg/g). Mycelial growth and production of FA by isolate 8, determined in different liquid media revealed that the highest biomass and FA were produced in Czapek Dox Broth (CDB) followed by Richard’s solution. The amount of FA per gram mycelial dry weight reached its maximum in CDB and Richard’s solution after 14 days of incubation. Mycelial growth and conidia production of both Trichoderma isolates (T16 and T23) were retarded by increasing concentrations of FA in agar medium. At FA concentration of 300 mg/ml the radial mycelial growth of the isolates T16 and T23 were retarded by 32.5% and 45%, respectively. Conidia production was diminished in a similar extent as mycelial growth. Both T. harzianum isolates were capable to degrade FA in potato dextrose broth medium, particularly when lower doses of FA were present. In the presence of 50 mg/ml FA in the culture medium, the isolates T23 and T16 reduced FA by 51.4% and 88.4%, respectively, 9 days post‐inoculation. The antifungal metabolite 6PAP, isolated from T. harzianum T23 cultures, was introduced at different concentrations into 2‐day‐old cultures of F. moniliforme. After further 5 days of incubation of F. moniliforme in the presence of 6PAP, the FA contents per gram mycelial dry weight were significantly decreased compared to control cultures where 6PAP was absent. Dosages of 300 and 400 mg/l of 6PAP in the cultures retarded FA accumulations by 62.5% and 77.2%, respectively. The current results, however, provided the first evidence for activity of 6PAP, as a Trichoderma secondary metabolite, on degrading/synthesis suppression of the Fusarium toxin FA.
A Novel Gene Involved in Lesion Formation in Magnaporthe grisea
Authors: Yang J. , Li H. , Liu L. , Su Y. , Li J. B. , Chang Q. , Qu L. J. , Wang Y. Y. , Zhu Y. Y. , Li C. Y.
Published: September 2009

To date, a number of genes that are expressed in the early stages of infection have been reported, while few genes that are expressed during the course of colonization, after the initiation of plant infection, have been studied. Plant inoculations, real‐time polymerase chain reaction (PCR), gene cloning, protein expression and bioinformatics analysis were combined to identify a novel gene, MgNIP04, in the rice blast fungus, Magnaporthe grisea. Bioinformatics analysis showed that the amino acid sequence contained a signal peptide. The wounded inoculation resulted in necrosis specks when the total expressed proteins including MBP‐MgNIP04 was inoculated on the wounded rice leaves, which demonstrated the protein directly interacted with rice. The real‐time PCR result of infected leaves showed that it is upregulated during late stages of infection of rice. Additionally, the copies of the gene expression absolute quantity of the gene were 7.61 × 102, 1.06 × 103, 1.31 × 103, 4.13 × 103, and 4.00 × 103, at 24, 48, 72, 96 and 168 h postinoculation (HPI), respectively. The higher copies of MgNIP04 were found at 96 and 168 HPI. The copies of MgNIP04 in mycelia of Y98‐63C, Y99‐16, 94‐64‐1b and 95‐23‐4a were significantly lower than those of infected leaves. Through the above bioinformatics and experimental analysis, our result suggested that the MgNIP04 was novel pathogenicity‐related protein in rice blast fungus.
Detection of ‘Candidatus Phytoplasma pini’ in Pinus sylvestris trees in Poland
Authors: ŚLiwa H. , Kaminska M. , Korszun S. , Adler P.
Published: September 2009

Abnormal shoot branching was observed in Pinus sylvestris trees in Poland. These abnormalities resulted in the formation of dense, ball‐like structures with dwarfed needles. The presence of phytoplasma in the needles of branched and surrounding symptomless shoots was demonstrated using nested‐polymerase chain reaction (PCR) with universal primer pairs that amplified phytoplasma 16S rDNA, as well as using restriction fragment length polymorphic analysis of PCR products. Comparison of nucleotide sequences of DNA samples from three P. sylvestris trees with ball‐like structures revealed that their fragments of 16S rDNA were identical. The nucleotide sequence showed more than 99% similarity with the corresponding fragments of sequence of ‘Candidatus phytoplasma pini’.
Effects of pioglitazone and rosiglitazone combined with metformin on body weight in people with diabetes
Authors: Derosa G. , Tinelli C. , Maffioli P.
Published: September 2009

Currently, pioglitazone and rosiglitazone are the thiazolidinediones available for clinical use. In the literature, there are different studies concerning the efficacy, safety and tolerability of thiazolidinediones as add‐on therapy to metformin in patients with type 2 diabetes inadequately controlled with metformin alone. Metformin and thiazolidinediones are both antihyperglycaemic drugs, both lower blood glucose concentrations in type 2 diabetes without causing overt hypoglycaemia and both require the presence of insulin to generate their therapeutic effects, but act without stimulating insulin secretion. Some authors reported that the improved glycaemic control obtained with thiazolidinediones is associated with an increase in body weight with an estimated 2–3 kg weight gain for every 1% decrease in HbA1c which could negate some of the benefits of the improved metabolic control. Some other authors, instead, reported that thiazolidinediones give a better improvement in the glycaemic control compared with metformin alone without giving weight gain. The emerging discrepancies from these studies could be because of the study design, the patient selection, the degree of glycaemic control and/or the methods to measure body weight. We have undertaken a thorough literature search on Medline and Embase to evaluate the effects of thiazolidinediones plus metformin combination in people with diabetes on the body weight.
The European Exenatide study of long‐term exenatide vs. glimepiride for type 2 diabetes: rationale and patient characteristics
Authors: Kazda C. , Gallwitz B. , Simó R. , Guzmán J. R. , Kraus P. , Nicolay C. , Rose L. , Schernthaner G.
Published: September 2009

Aim: To describe the rationale for the European Exenatide (EUREXA) clinical study and describe the characteristics of the patient cohort.

Methods: EUREXA is a multinational study of long‐term effects of add‐on exenatide vs. glimepiride in patients with type 2 diabetes and failure of diet/lifestyle plus metformin monotherapy. Metformin failure was defined as hemoglobin A1c (HbA1c) ≥ 6.5% and patients were overweight/obese (BMI ≥ 25 to < 40 kg/m2). The primary end point is time to failure of combination treatment, defined from HbA1c concentration according to current criteria. At baseline, an oral glucose tolerance test (OGTT) was performed, fasting blood was taken for lipid profile and patients were randomized to add‐on exenatide (5 μg b.i.d. for 4 weeks then 10 μg b.i.d.) or glimepiride (1 mg/day titrated to maximum dose).

Results: A total of 1039 patients were entered in the study, with mean (± s.d.) age 57.2 ± 9.6 years, body mass index (BMI) 32.4 ± 4.1 kg/m2, duration of diabetes 5.6 ± 4.5 years and HbA1c 7.4 ± 0.7%. A history of cardiovascular disease (CVD) was present for 64.8% of patients overall and duration of diabetes was statistically significantly longer for patients with CVD than without (p = 0.010). Lipid abnormalities were reported for 48.9% of patients and 40.9% were taking at least one lipid‐lowering medication.

Conclusion: Patients included in the EUREXA study had early failure of glucose control with metformin and presented typical features of type 2 diabetes: overweight/obesity and high prevalence of lipid abnormalities and CVD. In this population, the effects of exenatide vs. glimepiride will be evaluated over at least 2.5 years.
Sterol regulatory element‐binding protein‐1c knockdown protected INS‐1E cells from lipotoxicity
Authors: Li J. , Liu X. , Ran X. , Chen J. , Li X. , Wu W. , Huang H. , Huang H. , Long Y. , Liang J. , Cheng J. , Tian H.
Published: September 2009

Objective: The reduction in insulin secretory capacity and β‐cell mass has been attributed, at least partially, to lipotoxicity, which may contribute to the development of type 2 diabetes. Chronic free fatty acids (FFA) exposure impairs pancreatic β‐cell function and induces β‐cell apoptosis. This study is to elucidate the underlying molecular mechanisms.

Research design and methods: We exposed INS‐1E pancreatic β‐cell line to palmitate or oleate, and measured the glucose stimulated insulin secretion (GSIS). The effect of FFA on sterol regulatory element‐binding protein (SREBP)‐1c lipogenic pathway, and expression of genes involved in β‐cell functions, including AMPK (AMP‐activated protein kinase), UCP‐2 (uncoupling protein‐2), IRS‐2 (insulin receptor substrate‐2), PDX‐1 (pancreatic duodenal homeobox‐1), GLUT‐2 (glucose transporter‐2) and B cell lymphoma/leukaemia‐2 (Bcl‐2) were investigated. Apoptosis of these exposed cells was determined by MitoCapture, Annexin V‐Cy3 or terminal deoxynucleotidyl transferase‐mediated dUTP nick‐end labeling assay. Cell lipid accumulation was measured by oil red O staining or TG extraction. Also SREBP‐1c expression knockdown were used.

Results: FFA treatment resulted in SREBP‐1c overexpression, impaired GSIS, lipid accumulation, apoptosis of INS‐1E cells. In addition, the expression of lipogenic genes and UCP‐2 were upregulated, but AMPK, IRS‐2, PDX‐1, GLUT‐2 and Bcl‐2 were downregulated in the exposed cells. However, these lipotoxic effects of FFA were largely prevented by induction of a SREBP‐1c small interfering RNA.

Conclusions: These data suggest a strong correlation between FFA treatment and SREBP‐1c activation in INS‐1E cells. SREBP‐1c might be a major factor responsible for β‐cell lipotoxicity, and SREBP‐1c knockdown could protect INS‐1E cells from lipotoxicity, which is implicating a therapeutic potential for treating diabetes related to lipotoxicity.