bluuebunny/crossref_metadata_2025 huggingface dataset:
New Vaccines for Developing Countries: Will it Be Feast or Famine?
Authors: Andrus Jon Kim , de Quadros Ciro , Matus Cuauhtemoc Ruiz , Luciani Silvana , Hotez Peter
Published: January 2017

The Revolving Fund of the Pan American Health Organization (PAHO) has an almost 30 year track record of providing access to essential vaccines for the entire population of Latin America and the Caribbean region. The activities of the PAHO Revolving Fund, coupled with the provision of high-quality technical assistance, were crucial to the successful control, elimination, or eradication of most of the region's great childhood killers, including measles and polio. Today, however, the Revolving Fund faces new challenges in the form of procuring a new generation of vaccines for human papillomavirus infection, rotavirus, and pneumococcal disease, which are priced orders of magnitude higher than the traditional childhood vaccines. The high cost of these essential new vaccines may require the PAHO Revolving Fund to establish innovative financial mechanisms for procuring these products at prices affordable for national immunization programs in Latin America and the Caribbean. The alternative, namely to bypass the Revolving Fund, could severely threaten the health of the region, especially Latin America's poorest people.
Clinical Preventive Services for Adolescents: Position Paper of the Society for Adolescent Medicine
Authors: English Abigail , Ford Carol A. , Santelli John S.
Published: January 2017

Over the past several years, new vaccines have become available to prevent serious illnesses and conditions in the adolescent population. Several have already been approved by the FDA for use in this age group; others are still in development. Recently, significant public attention has been focused on the availability of vaccines for several strains of HPV, to prevent both cervical cancer and genital warts. Prior to that, the vaccine for Hepatitis B was approved and recommended for the adolescent age group. Others currently available and recommended include vaccines for pertussis, meningitis, and influenza. In the future, additional vaccines are expected to become available for sexually transmitted and communicable diseases such as herpes simplex virus and HIV. Unfortunately, financial limitations and consent requirements can impede adolescents’ access to the vaccines that are recommended for their age group. However, a variety of policy options exist for overcoming the barriers and expanding access. These policy options are grounded both in international principles of human rights and in the existing framework of laws in the United States, and can be enhanced by attending to variations in age and developmental status among adolescents.
Confronting Conflict: Addressing Institutional Conflicts of Interest in Academic Medical Centers
Authors: Liang Bryan A. , MacKey Tim
Published: January 2017

Individual conflicts of interest are rife in healthcare, and substantial attention has been given to address them. Yet a more substantive concern-institutional conflicts of interest (“ICOIs”) in academic medical centers (“AMCs”) engaged in research and clinical care—have yet to garner sufficient attention, despite their higher stakes for patient safety and welfare. ICOIs are standard in AMCs, are virtually unregulated, and have led to patient deaths. Upon review of ICOIs, we find a clear absence of substantive efforts to confront these conflicts. We also assess the Jesse Gelsinger case, which resulted in the death of a study participant exemplifying a deep-seated culture of institutional indifference and complicity in unmanaged conflicts. Federal policy, particularly the Bayh-Dole Act, also creates and promotes ICOIs. Efforts to address ICOIs are narrow or abstract, and do not provide for a systemic infrastructure with effective enforcement mechanisms. Hence, in this paper, we provide a comprehensive proposal to address ICOIs utilizing a “Centralized System” model that would proactively review, manage, approve, and conduct assessments of conflicts, and would have independent power to evaluate and enforce any violations via sanctions. It would also manage any industry funds and pharmaceutical samples and be a condition of participation in public healthcare reimbursement and federal grant funding.

The ICOI policy itself would provide for disclosure requirements, separate management of commercial enterprise units from academic units, voluntary remediation of conflicts, and education on ICOIs. Finally, we propose a new model of medical education—academic detailing—in place of current marketing-focused “education.” Using such a system, AMCs can wean themselves from industry reliance and promote a culture of accountability and independence from industry influence. By doing so, clinical research and treatment can return to a focus on patient care, not profits.
Health Law 2010: It's Not All about the Money
Authors: Jacobson Peter D. , Mathur Soniya Keskar
Published: January 2017

It would be naïve to argue that money isn't the driving force motivating health care delivery in 2010. At nearly 17% of GDP, health care delivery is a large and growing industrial enterprise that is the largest employer in many communities. Save for free clinics, generating revenue is fundamental to every aspect of the delivery system. From insurance reimbursement rates to the cost of purchasing the latest technology, the surest explanation for understanding changes in the health care system and concomitant development of legal doctrine is, indeed, to “follow the money.”

Determining who controls the money flows usually explains who the dominant players are, and how they are able to organize and change the delivery system. Unquestionably, the most straightforward way to understand how the system functions, where its vulnerabilities lie, and why it is so difficult to institute significant reforms is to identify who controls the money.
Physical Test for Distant Metastases in Patients with Breast Cancer
Authors: Coombes R C , Powles T J , Abbott M , De Rivas L , Ford H T , McCready V R , Neville A M , Gazet J-C
Published: January 2017

Of 312 patients presenting with breast cancer to a single clinic, 297 were screened for metastases in skin and nodes, bone, marrow, liver and lungs, using standard clinical, radiological scanning and cytological techniques. Thirty-four patients were found to have overt metastatic disease using these tests. Metastases were demonstrable on chest X-ray in 6.1% of the entire group of patients, on the bone scan in 4.2%, liver scan in 1.5%, liver ultrasound in 1.2% and in the bone marrow in only a single patient; 3.8% had contralateral or supraclavicular lymph node metastases or skin metastases. Twenty-eight of these 34 patients (82%) with overt metastases would have been classed as metastatic had only chest X-ray and clinical examination been carried out.

A survey was then carried out to determine when tests for bone and liver metastases became abnormal. Bone scan and skeletal survey results were reviewed in 58 patients, 22 of whom had developed skeletal metastases and all of whom had regular skeletal scintigraphy carried out. Sixteen of 20 (80%) scans carried out within six months of the development of skeletal deposits were abnormal compared with 4 of 19 (21%) scans at the same follow-up time in those who failed to develop metastases, but few patients showed definite evidence of bone metastases on scanning prior to radiological metastases. Fifty-one patients who were found to have liver metastases at post-mortem were reviewed and most showed progressively rising alkaline phosphatase before death but only 11 of 57 (19.2%) and 14 of 50 (28%) had positive liver scintiscans and liver ultrasound examinations respectively from 3–12 months before death.
Screening for Colorectal Carcinoma
Authors: Cappel J , Blum U , Ungeheuer E
Published: January 2017

Since the introduction in the Federal Republic of Germany of free routine screening for colorectal carcinoma (digital examination of the rectum in 1971; test for occult blood in the faeces in 1977), the number of Dukes' stage A cases diagnosed at one hospital has increased by 30%. The average interval between onset of symptoms and diagnosis has shortened from 5 to 3.8 months, and the proportion of inoperable carcinomas has decreased by 10%.
Minilaparotomy under Acupuncture Analgesia
Authors: Dias P L R , Subramanium S
Published: January 2017

Minilaparotomy was performed using acupuncture analgesia on 78 female patients seeking voluntary sterilization to determine whether this could be used as a substitute for standard analgesic sedation. In 48 women (62%) no intravenous drug medication was required, and sterilization was successfully performed using only the local anaesthetic and acupuncture electrostimulation. These patients could be discharged within one hour of operation. For a developing country with a shortage of trained anaesthetists, acupuncture analgesia could prove to be a simple, safe and economical method, especially in a rural setting.
Effects on Upper Gastrointestinal Mucosa of Three Delivery Systems of Potassium as Supplement to Frusemide Administration
Authors: McLoughlin J C
Published: January 2017

Thirty healthy volunteers were recruited into a study to determine the effects on the gastrointestinal mucosa of 3 different delivery systems of oral potassium supplementation associated with diuretic therapy (Diumide-K ContinusR tablets, Napp; Lasikal tablets, Hoechst; Lasix and Slow-KR tablets, Hoechst, Ciba). The volunteers were gastroscoped initially and after one week of treatment with one of the three therapies. There was a 60% incidence of erosions in the Lasix + Slow-K group, a 40% incidence in the Lasikal group, but no erosions in the group receiving Diumide-K Continus tablets. It is therefore concluded that Diumide-K Continus tablets incorporate the potassium in a delivery system which is unlikely to cause disruption to the gatrointestinal mucosa.
Adverse Reactions in Ten Years' General Practice, Computer Analysed
Authors: Johnson R A
Published: January 2017

A total of 167 264 symptoms were recorded in numerical shorthand during a ten years period in a general practice. Computer analysis yielded 1535 adverse reactions with the drug prescribed. Especially prominent were reactions from three antibiotics (13% of all reported reactions), most of which were alimentary symptoms. Ampicillin also induced rashes reported at a rate of 5.2 per thousand prescriptions. Reactions to an oral contraceptive (Minovlar) were the most frequent to a single named drug, being 25.9% of prescriptions for that drug. A worldwide total of around one trillion symptoms seems likely before AD 2000. Computers could be used to detect the unpredictable side effects, as with practolol. Various 'costs' involved are noted, together with wider questions.
Anaesthesia and Monitoring for Paediatric Radiotherapy
Authors: Casey W F , Price Vanessa , Smith H S
Published: January 2017

Four hundred and sixty-nine anaesthetics were given to 27 children between the ages of 18 months and 5 years so that they could receive radiotherapy. When ketamine was used as the sole anaesthetic agent, the induction of anaesthesia was frequently stressful and traumatic, with problems and difficulties being encountered during 24% of anaesthetics. A change to an entirely gaseous method of inducing and maintaining anaesthesia resulted in a much more acceptable service being offered to the children and the incidence of complications fell to only 4%. The problems of monitoring children whilst they receive radiotherapy under general anaesthesia are discussed, the merits of different methods are reviewed and the use of the capnograph is commended.
Intracellular Metabolites in Rat Muscle following Trauma: A 31P and 1H Nuclear Magnetic Resonance Study
Authors: Sprague D B , Gadian D G , Williams S R , Proctor E , Goode A W
Published: January 2017

Hind limb skeletal muscle was studied in vivo in a rat trauma model using nuclear magnetic resonance (NMR) spectroscopy. The model used was a 25% body surface area, full-thickness burn administered under anaesthesia. Two groups of six rats were studied. Weight loss was observed in the experimental group whilst the control group continued to gain weight. Concentration ratios involving intramyocellular phosphocreatine (PCr), creatine (Cr), adenosine triphosphate (ATP), inorganic phosphate (Pi), anserine (Ans) and taurine (Tau) were measured. No change in the ratios of PCr/Pi, PCr/ATP, Ans/PCr + Cr and Tau/PCr + Cr were seen between the two groups. Intracellular pH was the same in the two groups.

NMR spectroscopy in vivo gives values of Pi and PCr that differ from those obtained by conventional techniques. NMR values are probably more accurate as no degradation occurs during measurement, the measurements being repeatable and noninvasive.
Gemfibrozil in the Treatment of Resistant Familial Hypercholesterolemia and Type III Hyperlipoproteinaemia
Authors: Houlston R , Quiney J , Watts G F , Lewis B
Published: January 2017

The efficacy of gemfibrozil in the treatment of resistant familial hypercholesterolaemia and type III hyperlipoproteinaemia was evaluated in 26 individuals over a mean period of 16 months. In the untreated state both disorders are associated with a high frequency of coronary heart disease. In the former, gemfibrozil with a bile acid sequestrant reduced plasma cholesterol by 32%, an incremental decrease of 17% compared with sequestrant therapy alone. In type III, plasma cholesterol was reduced by 40% and plasma triglyceride by 70%, while high-density lipoprotein cholesterol increased by 45%. In none of the patients studied did clinical or biochemical side effects occur.
Coxsackie B Viruses and Myalgic Encephalomyelitis
Authors: Bell E J , McCartney R A , Riding M H
Published: January 2017

Data collected over the past 6 years suggest that Coxsackie B viruses (CBV) play an important role in myalgic encephalomyelitis (ME). Since psychological upset is a feature of this illness, 247 patients, recently admitted to a psychiatric hospital, were tested for neutralizing antibodies to CBV. A total of 12.5% had significantly raised CBV titres compared with 4–5% of ‘well’ control groups; the percentage positive was greatest (21%) in those aged 30–39 years.

During 1985 and 1986 sera from 290 adults with ME were tested using the newly developed CBV IgM ELISA test; 37% were CBV IgM positive compared with 9% of 500 ‘well’ adult controls. Forty-seven children, with ME were similarly tested during this period; 38% were positive, implying recent or active CBV infection. The combined use of this ELISA test and the virus probe techniques now available should further help to elucidate the exact role of CBV in this disabling illness.
Psychiatric Response to the Clapham Rail Crash
Authors: Burns T P , Hollins S C
Published: January 2017

The psychiatric response to the Clapham rail crash is described. The psychiatric input was short term, dealing with the 38 inpatients and over 200 hospital staff involved in the response. The need to evolve a compact, responsive team structure is noted. The value of a proactive approach and provision of psychological debriefing is defended. Incorporation of components of the psychiatric response into the Hospital's major incident plan is reported.
The Clinimetric Properties of Instruments Measuring Home Hazards for Older People at Risk of Falling: A Systematic Review
Authors: Romli Muhammad Hibatullah , Mackenzie Lynette , Lovarini Meryl , Tan Maw Pin , Clemson Lindy
Published: January 2017

Home hazards are associated with falls among older people living in the community. However, evaluating home hazards is a complex process as environmental factors vary according to geography, culture, and architectural design. As a result, many health practitioners commonly use nonstandardized assessment methods that may lead to inaccurate findings. Thus, the aim of this systematic review was to identify standardized instruments for evaluating home hazards related to falls and evaluate the clinimetric properties of these instruments for use by health practitioners. A systematic search was conducted in the Medline, CINAHL, AgeLine, Web of Science databases, and the University of Sydney Library CrossSearch Engine. Study screening, assessment, and quality ratings were conducted independently. Thirty-six studies were identified describing 19 instruments and three assessment techniques. The clinimetric properties varied between instruments. The Home Falls and Accidents Screening Tool, Home Safety Self-Assessment Tool, In-Home Occupational Performance Evaluation, and Westmead Home Safety Assessment were the instruments with high potential for evaluating home hazards associated with falls. Health practitioners can choose the most appropriate instruments for their practice, as a range of standardized instruments with established clinimetric properties are available.
In Vitro Construction of Totally Autogenous Venous Valve: Early Experience
Authors: Hasaniya N. W.
Published: January 2017

Objective:

To construct in vitro and test a venous valve from bovine external jugular vein.

Materials and methods:

Sections of bovine jugular vein were trimmed and venous valves fashioned using the author's design.

Outcome measures:

The competence of the valves was tested by inflating them using saline on a test rig whilst assessing their competence using duplex ultrasonography.

Results:

Ten valves were constructed and all were patent; eight were completely competent at pressures up to 260 mmHg. Two valves required additional external sutures to be placed in order to achieve complete competence.

Conclusions:

The author's design allows construction of a venous valve in any straight segment of vein. In vivo studies will be required to assess the durability of this design.
Varicose Veins in Pregnancy: A Health Professional's Questionnaire
Authors: Coughlin L. B. , Gandy R. , Rosser S. , de Cossart L.
Published: January 2017

Objective:

To acertain the knowledge of varicose vein disease amongst health professionals dealing with pregnant women.

Method:

Postal questionnaire survey.

Results:

General practitioners (GPs) and midwives estimated an incidence of varicose veins in pregnancy of 20-50%. Factors associated with varicose veins included second and subsequent pregnancies, thrombophlebitis, family history and obesity, although obesity was thought to be less of an association by the vascular surgeons (57%). Half the respondents linked varicose veins to deep venous thrombosis. Support hosiery is the main management, with 10% of obstetricians asking for a vascular surgeon's opinion, but never vice versa. Surgical treatment was recommended on family completion but 38% of vascular surgeons will consider surgery between pregnancies. Eighty per cent of GPs and 91% of midwives would welcome guidelines. Fifty-seven per cent of vascular surgeons stated that they already have guidelines although these are the professionals least likely to deal with pregnant women.

Conclusion:

Knowledge amongst health professionals of varicose vein disease in pregnancy is generally good. However, guidelines would be welcomed.
Transvenous Interruption of the Inferior Vena Cava. New Model of Vena Cava Filter. Preliminary Results in 143 Cases
Authors: Castellani L. , Pietri J. , Nicaise H. , Quilliet L. , Lermusiaux P. , Alison D. , Benhamou A.C. , Guillou L.
Published: January 2017

A new device for transvenous interruption of the inferior vena cava is described. Based upon the Greenfield filter, upward- and downward-facing hooks prevent movement of the filter within the vein. Results of the use of the device in 143 patients after 3 months are presented and compared to other filters.
Chronic Venous Insufficiency of the Upper Limb Due to Outflow Obstruction of Venous Access
Authors: Halevy A. , Zelikovski A. , Modai D. , Swissgarten Y. , Orda R.
Published: January 2017

Two patients with angio-access for haemodialysis in whom the main venous outflow tract was thrombosed, developed severe chronic venous insufficiency (CVI) of the upper limb after a short period; one case developing a stasis ulcer of the cubital fossa. The angio-accesses were still functioning when the diagnosis was made. Treatment by surgery resulted in a dramatic regression of clinical signs of chronic venous insufficiency. CVI of the upper limb has not previously been described.

CVI is a frequent and known complication after deep vein thrombosis (DVT) of the lower limbs, but never appears after DVT of the upper limbs. We describe two cases of upper limb CVI which developed as a complication of angio-access for haemodialysis treatment, and their successful treatment by surgery.
Functional Meaning of Different Injection Levels in the Course of Sclerotherapy
Authors: Kerner Jutta , Schultz-Ehrenburg Ulrich
Published: January 2017

The successive changes of vein function in the course of sclerotherapy were studied by non-invasive photoplethysmography. The effect of injection at different levels was analysed in 30 patients, 22 with long saphenous varicosis, four with short saphenous varicosis and four with long saphenous varicosis and leg ulcers. The first two groups were treated by injections descending from the *crosse (saphenofemoral or saphenopo-pliteal junction) according to the method of Tournay. The third group (with leg ulcers) were treated by ascending injections, beginning adjacent to the ulcer and ending with crosse injection. Three case-reports are given, of one in each group, to show the typical changes of vein function in the different sclerosing methods.

Crosse obliteration proved to be the most important step in improving vein function. It was followed by sclerosing of perforators of the lower leg, which influenced vein function in varying ways. Sclerosing remaining varicose dilations only optimized the cosmetic results without any measurable effect on vein function. According to our observations, failure to correct sapheno-femoral respectively sapheno-popliteal incompetence is inadequate treatment.
The Treatment of Varicose Veins Using the Venous Valve Cuff
Authors: Lane R. J. , McMahon C. , Cuzzilla M.
Published: January 2017

Objective:

To assess the safety and efficacy of venous valve cuffing for the treatment of varicose veins.

Design:

Three prospective studies were performed. The first study was the subjective and objective evaluation of venous valve cuffing in a series of unselected patients with varicose veins. Indications for use of the technique were defined in the first study, and applied in the second study, which focused on an evaluation of objective outcome criteria. The third study was an evaluation of the long-term effect of venous valve cuffing.

Setting:

Royal North Shore Public Hospital, Mater Private Hospital and Peninsula Private Hospital (Sydney, Australia).

Patients:

In the first series there were 93 limbs in 72 unselected patients with varicose veins. The second series consisted of 78 limbs in 62 patients who were selected based on the indications established in the first study. A third series of 100 limbs in 75 patients, selected at random, was reviewed to assess the long-term subjective and objective outcome.

Measurements:

All clinical outcome variables were observed subjectively. Photoplethysmographic recovery times and reflux at the sapheno-femoral junction (SFJ), at the knee, and below the knee were measured. Vein diameters at the groin and at the knee were measured pre- and postoperatively.

Results:

Unselected patients have a good clinical outcome, but approximatley one-third have residual venous reflux at the SFJ. Selected patients with mild to moderate varicose veins have an excellent result in all criteria investigated.

Conclusions:

After competence is restored to the SFJ, the saphenous vein decreases in size and achieves physiological one-way flow. Venous valve cuffing demonstrates a low incidence of symptoms and recurrence in both the short and long term.
A Trial of Phyllocontin (Slow Aminophylline) Tablets in Patients with Bronchospasm
Authors: Dhatariya R C
Published: January 2017

Fifteen adult patients were treated with Phyllocontin tablets 225 mg in a dosage of 1-2 tablets twice daily for a period of eight weeks. Side-effects were minimal and the patients all improved markedly clinically and as shown by PEF measurements using a Peak Flow Gauge. Two children aged 8 also showed clinical improvement.
Experience with High Doses of Ibuprofen in the Long-Term Treatment of Rheumatoid Arthritis
Authors: Pavelka K , Vojtisek O , Susta A , Kankova D , Bremova A , Kralova M
Published: January 2017

Ibuprofen (Brufen) is a non-steroidal anti-inflammatory drug well-established in the symptomatic treatment of rheumatoid arthritis. In view of its exceptionally good tolerance it has become fashionable to prescribe increasingly large doses for severe cases or in those patients unable to tolerate other anti-rheumatic compounds. This study illustrates the sustained therapeutic benefit and almost complete lack of toxicity in fifty-nine rheumatoid patients treated with up to 1,600 mg ibuprofen daily over six months. Significant improvement occurred in all clinical parameters and gastro-intestinal upset leading to discontinuance of therapy was reported in just two patients. There were no abnormalities in any of the biochemical tests performed.
Piracetam and Chlormethiazole in Acute Alcohol Withdrawal: A Controlled Clinical Trial
Authors: Dencker S J , Wilhelmson G , Carlsson E , Bereen F J
Published: January 2017

Sixty in-patient alcoholics, presenting with an alcohol withdrawal syndrome after at least one week's drinking bout, were randomly allocated to fixed dose regimens of either piracetam or chlormethiazole in a one-week double-blind trial.

The patients were studied in respect to physical and biochemical parameters as well as symptom reduction and side-effects.

The battery of rating scales demonstrated a good symptom reduction in both drug groups. On the whole a small tendency to more symptom items being reduced on piracetam in comparison with chlormethiazole was found. But the three items, sleep disturbances, decreased libido at the initial phase, and the staffs assessment showed statistically significant differences in favour of chlormethiazole.

This study demonstrated that piracetam was just as efficient as chlormethiazole in patients not requiring sedation.
Response of Some Haemocoagulatory and Haemorheological Variables to Maximal Exercise in Sedentary and Active Subjects
Authors: De Scalzi M. , Cinelli P. , de Leonardis V. , Becucci A. , Mariani R. , Fattirolli F. , Ciapini A.
Published: January 2017

The purpose of this study was to evaluate how physical conditioning is associated with haemostatic and rheological responses to strenuous exercise. A total of 25 males, divided into two groups differing in exercise fitness (14 sedentary and 11 active), underwent exercise testing on a bicycle ergometer with an initial 25 W workload increasing by the same amount every 3 min. The following variables were evaluated before and after the test: platelet count and aggregability, plasma fibrinogen, fibrinolytic degradation products, viscometry and micro-haematocrit. Significant differences in baseline values between the two groups were found only for blood viscosity. Irrespective of the group, significantly increased values were demonstrated for all the variables, except platelet aggregability and fibrinogen levels, in response to strenuous exercise. It is concluded that the possible protective effect of exercise against cardiovascular disease does not seem to be related to changes in the haemorheological and haemostatic measures evaluated.
Spontaneous Pathology of the Thymus in Aging Wistar (Cpb:WU) Rats
Authors: Kuper C. F. , Beems R. B. , Hollanders V. M. H.
Published: January 2017

Spontaneous thymic lesions were investigated in Wistar (Cpb:WU) rats. Thymic tumors were not uncommon and most showed medullary differentiation. Thymic involution was investigated in a limited group of animals in which the survival rate for males and females was similar. The histological pattern of thymic involution differed between sexes. Severe thymic involution occurred more frequently in males than in females and at an earlier age.
An empty horizon
Authors: Deas Malcolm
Published: January 2017

Riven by rebels and now drugs, South America's longest-running democracy appears to teeter on the edge of fragmentation.
The man with the Most money
Authors: Gusinsky Vladimir
Published: January 2017

One of Russia's richest, but by no means most favoured, sons talks of storm-troops and future shock in an interview with Index's Irena Maryniak
Let's talk about the Cuban economy
Authors: Beatriz Marta , Cabello Roque
Published: January 2017

With the economy squeezed between the loss of Soviet cash and ever-tighter US sanctions, the government has to find another way
Purification and Characterisation of Two GST'S Forms from Rhizobium Leguminosarum with a High Affinity to Herbicides
Authors: Faraone A. , Petrucci M. , Paludi D. , Aceto A. , Dainelli B.
Published: January 2017

Cytosolic glutathione transferase are a family of multifunctional proteins that catalyse the conjugation of GSH to a large variety of endogenous and exogenous compounds. These enzymes have been widely studied in mammals and, to a lesser extent, in plants. In plants, GSTs can detoxify herbicides; they are also induced by pathogenic infection and are likely to be involved in defence responses. GSTs are found in pathogenic and not pathogenic prokaryotes but the functional role played by these enzymes in the cell still remains to be clarified. Here, we report the purification and characterisation of two GST's forms from Rhizobium leguminosarum that play a very important role in agriculture by inducing nitrogen-fixing nodules on the roots of legumes. These bacterial GSTs from R. leguminosarum have immunological characteristics that are different among them and they are characterised both by a high affinity to herbicides.
Expression of the T Cell Receptor Vβ Repertoire in a Human T Cell Resistant to Asbestos-Induced Apoptosis and Peripheral Blood T Cells from Patients with Silica and Asbestos-Related Diseases
Authors: Nishimura Y. , Miura Y. , Maeda M. , Hayashi H. , Dong M. , Katsuyama H. , Tomita M. , Hyodoh F. , Kusaka M. , Uesaka A. , Kuribayashi K. , Fukuoka K. , Nakano T. , Kishimoto T. , Otsuki T.
Published: January 2017

To explore the effects of asbestos and silica on the human immune system, an experimental model of low-dose and long-term exposure was established using a human HTLV-1-immortalized polyclonal T cell line, MT-2 (MT-2Org). MT-2 cells were continuously exposed to asbestos at a concentration (10 μg/ml) which does not induce complete cell death during short-term exposure. After acquiring resistance to CB-induced apoptosis (designated MT-2Rst), an immunological comparison was made between the MT-2Org and MT-2Rst lines in terms of T cell receptor-Vβ (TcR-Vβ) expression. MT-2Rst cells showed excess expression of various TcR-Vβ, although TcR-Vβ-overpresenting cells were characterized as undergoing apoptosis due to first contact with CB. Patients with asbestos-related diseases (ARD), such as asbestosis and malignant mesothelioma, were compared with silicosis (SIL) patients as a disease control and with healthy donors (HD). SIL and ARD not only differed in their causative materials, silica and asbestos as mineral silicates, but also in terms of complications; autoimmune disorders in SIL and tumors in ARD. ARD patients showed a restricted overpresentation of TcR-Vβ without clonal expansion, whereas SIL patients revealed significant overpresentation of TcR-Vβ 7.2. These experimental and clinical analyses indicate the superantigenic and dysregulation of autoimmunity-inducing effects of asbestos and silica, respectively.
Successful “Salvage” Therapy of Intravenous Cyclophosphamide for Refractory Polymyositis in an Elderly Patient: Case Report
Authors: Pinto A. , Tuttolomondo A. , Di Raimondo D. , Di Gati M. , Di Sciacca R. , Fernandez P. , Licata G.
Published: January 2017

Dermatomyositis and polymyositis may affect children and adults and are now widely recognized as major causes of disability which, thanks to the introduction of immunosuppressive drugs, is often treatable, at least to some extent. Few data exist regarding polymyositis in elderly patients. We describe a case of refractory life-threatening polymyositis in an elderly patient, successfully treated with intravenous cyclophosphamide.
Dendritic Cell Differentiation Blocked by Primary Effusion Lymphoma-Released Factors is Partially Restored by Inhibition of P38 MAPK
Authors: Cirone M. , Di Renzo L. , Trivedi P. , Lucania G. , Borgia G. , Frati L. , Faggioni A.
Published: January 2017

To better understand the molecular mechanisms underlying the dendritic cell (DC) defects in cancer, we analyzed which signaling pathway is implicated in the abnormal monocyte differentiation into DC determined by the presence of Primary effusion lymphoma (PEL) released factors. Our results indicate that the DC, obtained in this condition, together with phenotypic abnormalities and reduced allostimulatory function, showed hyperphosphorylation of signal transducer and activator of transcription 3 (STAT3) and p38 mitogen-activated protein kinase (MAPK) molecules, in comparison to the DC differentiated in the absence of PEL-released factors. The inhibition of p38 MAPK but not of STAT3 phosphorylation, with specific inhibitors, was able to revert the effect of the PEL-released factors on the DC phenotype. This study suggests that p38 MAPK signaling pathway is an important contributor to the abnormal differentiation of DC in PEL.
Response of Crypt Paneth Cells in the Small Intestine following Total-Body γ-Irradiation
Authors: Gorbunov N.V. , Garrison B.R. , Kiang J.G.
Published: January 2017

Ionizing irradiation causes damage and functional failure of irradiation-sensitive systems and tissues such as small intestine. The molecular mechanisms underlying inflammatory and adaptive responses to acute irradiation damage are poorly understood. Using a mouse model of total-body γ-irradiation, we assessed the irradiation response of crypt host-defense Paneth cells by measuring α-defensin 4 (AD4) expression and correlated the gathered data with activation of the caspase-1/IL-1β inflammatory signaling cascade. The irradiation injury was produced in CD2F1 mice exposed to 9.25 Gy γ-radiation. This dose resulted in 85–100% mortality at the 15th day post-irradiation. Small intestine tissue samples were collected at the 7th day post-irradiation. Assessment of irradiation-associated pro-inflammatory alterations in small intestine tissue and expression of AD4 in Paneth cells was conducted using confocal immunofluorescence imaging, transmission electron microscopy (TEM), light microscopy, and immunoblotting techniques. The small intestine analysis revealed an increase in the precursor form of IL-1β, the activated form of IL-1β, and the activated form of caspase-1 (p10 CASP-1) at the 7th day post-irradiation. Immunoprecipitation analysis showed increased interaction between IL-1β and p10 CASP-1 after irradiation. This effect was observed in the irradiated small intestine and CD15-positive Paneth cells using confocal imaging techniques. The pro-inflammatory alterations in Paneth cells were accompanied by increases in AD4 mRNA and its 8 kD peptide product. Paneth cell secretory activity was observed at the sites of bacterial translocation in the crypt lumens. These data suggest that Paneth cells can contribute to small intestine inflammatory remodeling during the post-irradiation period.
Development and Preliminary Validation of a Diagnostic Score for Identifying Patients Affected with Adult-Onset Autoinflammatory Disorders
Authors: Cantarini L. , Lucherini O.M. , Iacoponi F. , Cimaz R. , Simonini G. , Rigante D. , Pasini F. Laghi , Baldari C.T. , Capecchi P.L. , Brizi M.G. , Galeazzi M.
Published: January 2017

To date, the rate of detection of autoinflammatory gene mutations in patients suspected of having an autoinflammatory disorder is very low. However, most of these data refer to pediatric populations. The relative rarity and lack of information on adult-onset autoinflammatory diseases make it likely that mutations will be found in an even smaller percentage of cases. Our aim was to develop and validate a set of variables for predicting the risk that a given adult patient presenting with recurrent fever episodes carries mutations in the MEFV or TNFRSF1A genes, in order to increase the probability of obtaining positive results on genetic testing. One hundred and ten consecutive patients with a clinical history of periodic fever attacks were screened for mutations in the TNFRSF1A and the MEFV genes. The mean age at disease onset was 27.85 years. Detailed information about each patient's family history, personal history, and clinical manifestations were retrospectively collected. A diagnostic score was constructed based on univariate and multivariate analysis in a randomly-selected dataset (training set; n=40). The score was validated on an independent set of the remaining patients (validation set; n=70). Age at onset (odds ratio [OR] 0.958, P = 0.050), positive family history of recurrent fever episodes (OR 5.738, P = 0.006), thoracic pain (OR 7.390, P = 0.002), abdominal pain (OR 2.853, P = 0.038) and skin involvement (OR 8.241, P = 0.003) were independently correlated with a positive genetic test result. A diagnostic score was calculated using the linear combination of the estimated coefficients of the logistic model (cut off equal to 0.24) revealing high sensitivity (0.94), high specificity (0.94) and high accuracy (0.94). We have identified variables that appear to be strongly related to the probability of detecting gene mutations in MEF and TNFRSF1A in adults, thus improving the evaluation of patients with suspected autoinflammatory disorders.
Crowding and Violence on Psychiatric Wards: Explanatory Models
Authors: Kumar Shailesh , Ng Bradley
Published: January 2017

Objective:

Violence is widely prevalent on acute-care psychiatric wards, and crowding has been identified as a major risk factor. This paper explores why patients may respond to crowding with violence.

Method:

We carried out a literature review on Medline, using the key words “violence” and “crowding.” We conducted an additional hand search of the references collected from the reviewed papers.

Results:

Factors specific to the relation between crowding on acute-care inpatient psychiatric wards and violence can be divided under the following headings: 1) patient density, privacy, and control; 2) ward architecture; 3) the social organization of psychiatric wards; 4) interpersonal space; 5) phylogenic theories; and 6) anthropological theories of human behaviour.

Conclusions:

We offer explanatory models for this relation and suggest strategies to counter the effects of crowding. Recommendations are made for future studies.

Objectif:

La violence dans les unités de soins psychiatriques aigus est très répandue et l'on a reconnu que le surpeuplement est un important facteur de risque. Le présent article cherche à savoir pourquoi les patients peuvent répondre au surpeuplement par la violence.

Méthode:

Une revue de la documentation a été menée dans Medline à l'aide des mots clés violence et surpeuplement. Une recherche manuelle additionnelle des références recueillies dans les articles examinés a aussi été menée.

Résultats:

Les facteurs spécifiques de la relation entre le surpeuplement des unités de soins psychiatriques aigus et la violence peuvent se diviser selon les catégories suivantes: 1) la densité, l'intimité et le contrôle des patients, 2) l'architecture de l'unité, 3) l'organisation sociale des unités psychiatriques, 4) l'espace interpersonnel, 5) les théories phylogéniques et 6) les théories anthropologiques du comportement humain.

Conclusions:

Les modèles explicatifs de cette relation sont offerts et des stratégies sont suggérées pour contrer les effets du surpeuplement. Des recommandations sont faites pour de futures études.
An Open-Label Study of Nefazodone Treatment of Major Depression in Patients with Congestive Heart Failure
Authors: Lespérance François , Frasure-Smith Nancy , Laliberté Marc-André , White Michel , Lafontaine Sylvain , Calderone Angelino , Talajic Mario , Rouleau Jean-L
Published: January 2017

Objectives:

To evaluate the feasibility of screening and recruiting patients with major depression and congestive heart failure (CHF) in a tertiary care cardiology hospital and to obtain preliminary efficacy, tolerability, and safety data for nefazodone treatment of a major depressive episode in CHF patients.

Method:

We conducted a 12-week, open-label trial of nefazodone given in dosages up to 600 mg daily. We assessed patients at baseline, 1, 2, 4, 8, and 12 weeks. Measures used were the 17-item Hamilton Depression Rating Scale (HDRS), the Clinical Global Impression Scale, the Beck Depression Inventory, Spielberger's State-Trait Anxiety Inventory, and the Minnesota Living with Heart Failure Questionnaire. We also obtained pre- and poststudy ECGs, 24-hour Holter monitor recordings, and plasma levels of norepinephrine.

Results:

After screening 443 CHF patients, 28 patients with major depression met study eligibility criteria. The 23 patients who completed 4 or more weeks of medication showed significant improvement on all depression scales and in quality of life. Of 19 subjects who completed the full 12-week trial, 74% experienced a decline of 50% or more on HDRS scores. The completers also showed a significant reduction in heart rate, an increase in QT intervals (but not in the QTc), and a marginally significant decrease in plasma norepinephrine. There were no changes in heart rate variability.

Conclusions:

It is feasible to screen and recruit CHF patients with major depression for an antidepressant trial. Nefazodone seems sufficiently safe, tolerable, and efficacious to justify a larger, placebo-controlled trial.
EEG Abnormalities and Outcome in First-Episode Psychosis
Authors: Manchanda Rahul , Malla Ashok , Harricharan Rajendra , Cortese Leonardo , Takhar Jatinder
Published: January 2017

Objective:

There is widespread consensus that the EEG is not useful for the detection of clinically relevant abnormalities in patients with psychosis. Given that the EEG records brain dysfunction, this study examines whether an abnormal EEG in first-episode psychosis patients is associated with poorer prognosis, compared with a normal EEG.

Method:

At their initial assessment, 61 patients with first-episode psychosis had an EEG classified according to the following modified Mayo Clinic system: normal, essentially normal (that is, one or more elements of questionable normality), or dysrhythmia (grade I to V). We assessed psychiatric symptoms using the Scale for Assessment of Negative Symptoms (SANS) and the Scale for Assessment of Positive Symptoms (SAPS) on entry and after 1 year of treatment. Psychosis is considered to have remitted if there are no, or minimal, psychotic symptoms (that is, a rating of 2 or less on every SAPS global rating), maintained for 1 month.

Results:

At the end of 1 year, 19/21 (90.5%) patients with a normal EEG had a remission of their positive symptoms, compared with 18/28 (64.3%) of those with an essentially normal EEG and only 7/12 (58.3%) of those with dysrhythmia. Negative symptoms were reduced by more than 50% in 11/18 (61.1%) patients with a normal EEG, compared with 10/28 (35.7%) patients with an essentially normal EEG. None of the 8 patients with dysrhythmia on their EEG experienced reduced negative symptoms.

Conclusion:

The above findings suggest that an abnormal EEG in patients with first-episode psychosis is associated with a poorer prognosis.
Processes of In-Hospital Psychiatric Care and Subsequent Criminal Behaviour among Patients with Schizophrenia: A National Population-Based, Follow-up Study
Authors: Pedersen Charlotte Gjørup , Jensen Signe Olrik Wallenstein , Johnsen Søren Paaske , Nordentoft Merete , Mainz Jan
Published: January 2017

Objectives:

It is unknown whether evidence-based, in-hospital processes of care may influence the risk of criminal behaviour among patients with schizophrenia. Our study aimed to examine the association between guideline recommended in-hospital psychiatric care and criminal behaviour among patients with schizophrenia.

Methods:

Danish patients with schizophrenia (18 years or older) discharged from a psychiatric ward between January 2004 and March 2009 were identified using a national population-based schizophrenia registry ( n = 10 757). Data for in-hospital care and patient characteristics were linked with data on criminal charges obtained from the Danish Crime Registry until November 2010.

Results:

Twenty per cent ( n = 2175) of patients were charged with a crime during follow-up (median = 428 days). Violent crimes accounted for 59% ( n = 1282) of the criminal offences. The lowest risk of crime was found among patients receiving the most processes of in-hospital care (top quartile of received recommended care, compared with bottom quartiles, adjusted hazard ratio = 0.86, 95% CI 0.75 to 0.99). The individual processes of care associated with the lowest risk of criminal behaviour were antipsychotic treatment and staff contact with relatives.

Conclusions:

High-quality, in-hospital psychiatric care was associated with a lower risk of criminal behaviour after discharge among patients with schizophrenia. Processus des soins psychiatriques à l'hôpital et du comportement criminel subséquent chez des patients souffrant de schizophrénie: une étude populationnelle nationale de suivi
Cognitive-Behavioural Therapy for Psychosis: A Status Report
Authors: Norman Ross MG , Townsend Laurel A
Published: January 2017

Objective:

To review the nature of cognitive-behavioural interventions for psychosis and to evaluate evidence of their effectiveness.

Method:

Electronic (Medline and Psychinfo) and bibliography-based searches were carried out to locate descriptions and evaluations of cognitive-behavioural interventions for psychosis.

Results:

Various cognitive-behavioural interventions have been used for reducing psychosis. These have usually been applied to auditory hallucinations and/or delusions in otherwise treatment-resistant patients. Most evaluations comprise case studies or simple pre-post designs. Controlled trial evaluations are few, and although the results are promising, methodological problems limit the conclusions that can be drawn concerning the clinical utility of such approaches.

Conclusions:

More and better controlled trial evaluations of cognitive-behavioural interventions are needed in this area. If further research supports the efficacy of these techniques, issues related to clinical effectiveness, mediators of treatment effects, risks, and cost-effectiveness will also need to be addressed.