bluuebunny/crossref_metadata_2025 huggingface dataset:
Potential CYP2C9‐mediated drug–drug interactions in hospitalized type 2 diabetes mellitus patients treated with the sulphonylureas glibenclamide, glimepiride or glipizide
Authors: Tirkkonen T. , Heikkilä P. , Huupponen R. , Laine K.
Published: July 2010

Abstract.  Tirkkonen T, Heikkilä P, Huupponen R, Laine K (University of Turku; Turku University Hospital; and StatFinn Ltd; Turku, Finland). Potential CYP2C9‐mediated drug–drug interactions in hospitalized type 2 diabetes mellitus patients treated with the sulphonylureas glibenclamide, glimepiride or glipizide. J Intern Med 2010; 268: 359–366.

Objectives.  Sulphonylureas are widely used in the treatment of type 2 diabetes mellitus (T2DM). Based on laboratory findings, we determined the clinical significance of potential CYP2C9‐mediated drug–drug interactions in hospitalized patients receiving glibenclamide, glimepiride or glipizide, all of which are metabolized by CYP2C9, together with a CYP2C9 inhibitor.

Design, setting and subjects.  An observational pharmaco‐epidemiological database study was performed in a university hospital setting with 3884 patients with T2DM.

Main outcome measures.  Efficacy and safety of sulphonylurea therapy during the potential interaction (sulphonylurea treatment with a CYP2C9 inhibitor) vs. control periods (sulphonylurea treatment without a CYP2C9 inhibitor) were estimated using laboratory parameters.

Results.  Almost 20% of patients were exposed to a potential drug–drug interaction with a CYP2C9 inhibitor during sulphonylurea treatment. More than 75% of the potential interactions occurred with trimethoprim, metronidazole and fluconazole. When all sulphonylureas were pooled and adjusted for age, gender, ward and sulphonylurea dose, mean and maximum fasting plasma glucose concentrations as well as maximum values of glycosylated haemoglobin were significantly lower during the interaction periods compared with control periods, whereas mean and minimum activities of alanine amino transferase and gamma‐glutamyl transferase were higher. The minimum fasting plasma glucose values were more often below the target range in patients with potential interactions. The sulphonylurea dose did not differ significantly between patients who were or were not concomitantly treated with a potentially interacting drug.

Conclusions.  Concomitant use of a CYP2C9 inhibitor results in exaggerated pharmacodynamic effects of sulphonylureas and increases the risk of hypoglycaemia in T2DM patients receiving glibenclamide, glimepiride or glipizide.
Corticotrophin‐Releasing Factor Gene Transcription is Directly Activated After Deprivation of Glucocorticoids in Hypothalamic Cells
Authors: Kageyama K. , Akimoto K. , Suda T.
Published: July 2010

Corticotrophin‐releasing factor (CRF) plays a central role in controlling the hypothalamic‐pituitary‐adrenal axis during stressful periods. CRF neurones are activated in the hypothalamic paraventricular nucleus (PVN) in response to stress, whereas the activated CRF neurones in the PVN are suppressed by glucocorticoids. Glucocorticoids may act directly on CRF neurones because glucocorticoid receptors are expressed highly on these neurones in the PVN. CRF expression levels in the PVN are also increased by adrenalectomy in vivo. The signalling pathways involved in the control of CRF gene transcription in the hypothalamus when negative feedback by glucocorticoids after adrenalectomy is lost remain undetermined. We investigated whether CRF gene transcription is regulated by both glucocorticoids and glucocorticoid withdrawal in hypothalamic cells. The present study demonstrates that CRF gene transcription activity and mRNA levels in the hypothalamic 4B cells were not modulated by incubation with dexamethasone for a short 2‐h period, although they were stimulated by incubation for longer than 5 h. CRF gene transcription activity and mRNA levels were increased after 2 h of dexamethasone deprivation. The cAMP‐response element (CRE) on the promoter was the main region that is regulated by both glucocorticoids and glucocorticoid withdrawal. We observed that the intracellular cAMP production levels were transiently increased 30 min after the removal of dexamethasone, whereas they were also increased 2.5 h after incubation with dexamethasone without the removal. Phosphorylated‐CRE‐binding protein (CREB)/CREB protein levels were also increased rapidly after the deprivation of glucocorticoids via an adenylate cyclase pathway. Therefore, the phosphorylation of CREB contributes to the activation of CRF gene transcription after the deprivation of glucocorticoids in hypothalamic cells.
Safety and tolerability of 0.1% tacrolimus solution applied to the external ear canals of atopic beagle dogs without otitis
Authors: Kelley Laura S. , Flynn‐Lurie Alison K. , House Rossi A. , Simpson Andrew C. , Marsella Rosanna
Published: July 2010

Tacrolimus is a nonsteroidal alternative to treat noninfectious otitis externa (OE) in people. This 21‐day study investigated whether twice daily application (0.2 mL/dose) of sterile olive oil based 0.1% tacrolimus suspension in ears of atopic beagle dogs without OE was associated with adverse local reactions, development of OE, change in otic cytology, vestibular dysfunction, or hearing loss detected by brainstem auditory evoked response (BAER). The study was randomized, double‐blinded, and placebo‐controlled. Twenty‐two dogs matched for age and sex were randomized to tacrolimus or vehicle control treatment groups. Two investigators independently evaluated dogs for signs of adverse effects including OE the first 4 days of treatment, then every 3 days. A logistic regression model was fit for each investigator’s clinical scores (SAS, 9.2, 2008). Time (P = 0.0032) and group (P = 0.0167) were always significant for OE. Inter‐observer reliability of clinical scores was strong, measured using Kappa coefficients and proportion of agreement. All nine exclusions (7/10 control‐ and 2/12 tacrolimus‐treated dogs) were excluded for yeast OE. Inter‐observer agreement to exclude was 100%. All dogs not excluded had normal BAER assessments before treatment, weekly during treatment, and after 21 days of treatment. None showed vestibular abnormalities at these times. Tacrolimus blood concentrations (Abbott IMx Tacrolimus II) were below detection limits (3 ng/mL) at baseline and after 21 days of treatment. Results suggest otic application of olive oil based tacrolimus suspension to canine ears with intact tympanic membranes is unlikely to result in hearing loss or vestibular dysfunction but yeast OE is a possible risk.
Registration trials for specific immunotherapy in Europe: advanced guidance from the new European Medical Agency guideline
Authors: Gödicke V. , Hundt F.
Published: July 2010

To cite this article: Gödicke V, Hundt F. Registration trials for specific immunotherapy in Europe: advanced guidance from the new European Medical Agency guideline. Allergy 2010; 65: 1499–1505.

Marketing authorization of medicinal products is granted based on results of registration trials. The European Medical Agency (EMA) has issued general and disease state‐specific guidelines for the conduct of such trials. In the area of allergic diseases, there are basically two general therapeutic approaches: Drugs that mitigate the symptoms and an approach that is targeted to the root cause of the disease, the allergen‐specific immunotherapy (SIT). While the ‘Guideline on the Clinical Development of Medicinal Products for the Treatment of Allergic Rhino‐Conjunctivitis’ (CHMP/EWP/2455/02) and the ‘Note for Guidance on the Clinical Investigation of Medicinal Products in the Treatment of Asthma’ (CPMP/EWP/2922/01) focuses exclusively on the development of medicinal products to treat allergic symptoms, there was no guideline for SIT in the past. In consequence, the conduct of clinical trials for SIT was widely lacking a standardized approach. This created difficulties when comparing drugs and outcomes and also uncertainty to predict marketing authorization. In 2009, the EMA has issued a new guideline on the clinical development of products for SIT. Despite some white spots in some areas, the new guideline constitutes a breakthrough with regard to guidance, harmonization and transparency in the conduct of clinical trials in SIT.
Seed viability in declining populations of Caladenia rigida (Orchidaceae): are small populations doomed?
Authors: Faast R. , Facelli J. M. , Austin A. D.
Published: July 2010

Despite comparatively good rates of pollination and seed production, some populations of the endangered terrestrial orchid Caladenia rigida continue to decline. To determine whether seed quality may be limiting reproductive potential, we assessed seed viability among declining populations of C. rigida (in the southern part of its distribution) and among populations that are regarded as stable (in the northern part of its distribution). We also compared differences in seed viability to plant traits, population size and habitat characteristics (soil properties, canopy cover, presence of proximate vegetation). Seed capsules from southern populations were significantly smaller, with only 9% of seeds being viable, compared to 36% in capsules from northern populations. Soil phosphorus concentrations differed between regions, but other habitat characteristics did not correlate with seed viability. Using calculations based on seedling recruitment data from other Caladenia species, we predict that seed output is insufficient to ensure the long‐term persistence of the smallest C. rigida populations.
Expression of Cytosolic Phospholipase A2 in Equine Endometrium during the Oestrous Cycle and Early Pregnancy
Authors: Ababneh MM , Ababneh H , Shidaifat F
Published: July 2010

Contents

Phospholipase A2 (PLA2) is a key enzyme for biosynthesis of PGF2α. Real‐time RT‐PCR and immunohistochemistry were used to determine transcription and cellular distribution of cytosolic PLA2 (cPLA2) in the equine endometrium during the oestrous cycle and early pregnancy. Endometrial biopsy and blood samples were collected from cycling mares on days (d) 8, 11, 15 and 18 (oestrus) (Day 0 = Day of ovulation; n = 5 for each day) and from pregnant mares (n = 4) on d15. Except for mares on d18 and some cyclic mares (n = 2) on d15 with low progesterone (P4) concentrations (<3.18 nm), P4 concentrations were high. Cytosolic PLA2 was mainly localized in the luminal epithelium and stroma was negative. Cytosolic PLA2 expression was negatively correlated with P4 concentration (r = −0.75, P < 0.001) and differed according to the stage of the oestrous cycle (P < 0.05). Cytosolic PLA2 expression was high during oestrus and declined to basal levels on d8 (P < 0.05). Thereafter, there was a trend for increased cPLA2 expression as luteal phase progressed. However, as P4 dropped below 3.18 nm on d15, cPLA2 expression increased (P < 0.05). In pregnant mares, cPLA2 expression was not different from cyclic mares on d15 with high P4 concentrations. However, it was lower than cyclic mares with low P4 concentrations (p < 0.05). In conclusion, cPLA2 isoform, a member of the PLA2 family that controls PGF2α secretion, is highly expressed in the endometrium at the expected time of luteolysis. Progesterone may be an inhibitor for cPLA2 expression. During pregnancy, cPLA2 expression may be sufficient to initiate the cascade for PGF2α secretion and does not play a direct role in maternal recognition of pregnancy.
Genistein Alters the Release of Oxytocin, Prostaglandins, Cortisol and LH during Insemination in Gilts
Authors: Norrby M , Madsen MT , Saravia F , Lundeheim N , Madej A
Published: July 2010

Contents

Soya products containing phytooestrogens are widely used as feed for pigs. However, limited data are available on the effects of phytooestrogen on the endocrine status of pigs. The aim of this work was to study the impact of the phytooestrogen genistein added to a soya‐free diet on the hormonal pattern in gilts during oestrus and artificial insemination (AI). Ten gilts were fed a soya‐free diet and fitted with jugular vein catheter through vena auricularis. The gilts were randomly divided into two groups (G‐ and C‐group) where the G‐group was given pure genistein, 1 mg/kg body weight (BW) twice daily, per os. Blood samples were collected before, during and after AI. Oxytocin, prostaglandin E2, prostaglandin F2α, 13,14‐dihydro‐15‐keto‐prostaglandin F2α (PGFM), cortisol and LH concentrations in blood plasma were analysed. Oxytocin concentrations were almost twice as high in the G‐group as in C‐group after the AI. Prostaglandin E2 concentrations were higher in G‐group than in C‐group during the entire sampling period. After AI, the concentrations of prostaglandin E2 increased in G‐group but not in C‐group. Prostaglandin F2α concentration had a pulsatile pattern, with increasing pulses after AI in G‐group. Plasma PGFM concentrations increased after AI with a small variation between the groups. Plasma cortisol concentration increased after AI in C‐group. LH decreased after AI in G‐group. Genistein stimulated elevations of plasma oxytocin and prostaglandin E2 concentrations and a pulsative pattern in prostaglandin F2α concentration. The possible involvement of genistein in plasma cortisol and basal LH concentrations in gilts given genistein may also be suggested.
Pseudofrenelopsis fossils from Cretaceous gypsum beds in Guixi, Jiangxi Province, China and their geological significance
Authors: Sun Bainian , Dai Jing , Wang Yongdong , Jia Hui , Yan Defei , Jiang Zikun
Published: July 2010

Compressed fossil plants were found in the gypsum beds of the Zhoujiadian Formation in Guixi City, Jiangxi Province, China. The cuticular features of two species of Pseudofrenelopsis (Cheirolepidiaceae) were examined by scanning electron microscopy in this study: Pseudofrenelopsis papillosa Cao ex Zhou and Pseudofrenelopsis guixiensis Bainian Sun et Dai, sp. nov. A detailed analysis of the internode epidermis, and the adaxial and abaxial leaf cuticles of the two species, was performed, extending our knowledge of the morphological and anatomical characteristics of the extinct Pseudofrenelopsis. A new species, Pseudofrenelopsis guixiensis sp. nov., is proposed based upon comparison of its cuticular features. It differs from previously published species in that it has hairs on the abaxial surfaces of its leaves, sometimes shares subsidiary cells on the surfaces of internodes, lacks a hypodermis, and has no papillae on its epidermal cells. Because the distribution of fossil Pseudofrenelopsis is restricted to the Lower Cretaceous, the Early Cretaceous age of the Zhoujiadian Formation is affirmed. The fossils of Pseudofrenelopsis show obvious xeromorphic characteristics, such as apparent thickening of the cuticles, subsidiary cells with obvious papillae, and anticlinal walls with strong cutinization, and they are found associated with gypsum beds and close to red beds. All of these features indicate an arid climate.
One year experience of nocturnal home haemodialysis with an alternate night schedule in Hong Kong
Authors: TANG HON‐LOK , WONG JOSEPH H‐S , POON CLARA K‐Y , TANG CANDIC M‐K , CHU KWOK‐HONG , LEE WILLIAM , FUNG SAMUEL K‐S , CHAU KA‐FOON , LI CHUN‐SANG , TONG KWOK‐LUNG
Published: July 2010

Aim:  Nocturnal home haemodialysis (NHHD) was started in Hong Kong in 2006. The experience of 1 year of NHHD with an alternate night schedule in two local centres is reported.

Methods:  The clinical parameters of 14 patients who had completed 1 year of NHHD were retrospectively analyzed. All patients were receiving an alternate night schedule (3.5 sessions/week) for 6–8 h/session.

Results:  After 1 year of NHHD, haemoglobin levels increased from 9.6 ± 1.6 g/dL before NHHD to 11.4 ± 2.2 g/dL (P < 0.05) despite a reduction in erythropoietin dose requirement from 120.6 ± 44.3 to 59.4 ± 74.6 U/kg/week (P < 0.05). Four patients (29%) were able to stop taking erythropoietin after NHHD. Serum phosphate levels reduced from 2.33 ± 0.41 to 1.59 ± 0.29 mmol/L (P < 0.01) and calcium phosphate product decreased from 5.29 ± 0.96 to 3.74 ± 0.90 mmol2/L2 (P < 0.01). Phosphate binder dose was greatly reduced and eight patients (67%) were able to stop taking phosphate binders. The number of antihypertensive medications tended to reduced from 2.5 ± 1.3 to 1.6 ± 1.5 (P = 0.067) with four patients (29%) able to stop antihypertensives. Left ventricular mass index decreased from 186 ± 62 to 168 ± 60 g/m2 (P = 0.463) although this was not statistically significant. Weekly spKt/V during conventional haemodialysis was 3.63 ± 0.95 while that during NHHD was three times higher at 11.09 ± 6.44 (P < 0.01). The quality of life indexes also showed improvement.

Conclusion:  This 1 year experience of alternate night NHHD demonstrates benefits in terms of anaemia control, erythropoietin requirement, serum phosphate and calcium phosphate product reduction, blood pressure control, haemodialysis adequacy and quality of life. NHHD with an alternate night schedule is a promising dialytic therapy for patients receiving chronic haemodialysis in this locality.
Relationship between the course of depression symptoms and the left ventricular mass index and left ventricular filling pressure in chronic haemodialysis patients
Authors: KIM YONG KYUN , PARK CHAN S , IHM SANG‐HYUN , KIM HEE‐YEOL , HONG TAI Y , KIM DAI J , PAE CHI‐UN , SONG HO C , KIM YONG‐SOO , CHOI EUY J
Published: July 2010

Aim:  Multiple measurements of depression symptoms over time were more predictive of cardiovascular mortality than a single time measurement performed at baseline. The aim of this study is to evaluate the association of the course of depression symptoms, based on repeated assessments of depression symptoms over time, with left ventricular mass index (LVMI) and left ventricular filling pressure (LVFP) in patients on haemodialysis (HD).

Methods:  The level of depression symptoms in 61 patients on HD were prospectively assessed using the Beck Depression Inventory (BDI) at baseline and at three intervals (5, 10, 15 months). Doppler echocardiographic examinations were performed at the end of follow up.

Results:  At the end of follow up, the patients were divided into three groups according to their course of depression symptoms: non‐depression (n = 21), intermittent depression (n = 23) and persistent depression (n = 17). LVMI and LVFP were significantly increased in the persistent depression symptoms group compared to those of the non‐depression symptoms group and the intermittent depression symptoms group. Persistent depression symptoms were independently associated with LVMI (β‐coefficient = 0.347, P = 0.017) and LVFP (β‐coefficient = 0.274, P = 0.048) after adjustment for age, sex, systolic blood pressure, diastolic blood pressure, diabetes and interdialytic weight gain.

Conclusion:  In our study, persistent depression symptoms were associated with left ventricular hypertrophy and diastolic dysfunction. Our data may provide a more complete understanding of cardiovascular risk associated with depression symptoms in patients on HD.
Macrosomia, top of the iceberg: The charm of underlying factors
Authors: Donma Mustafa Metın
Published: July 2010

Background:  Macrosomia is associated with childhood obesity. Gestational diabetes mellitus (GDM) is a risk factor for macrosomia. The aim of this large‐scale investigation was to determine the incidence, risk factors, characteristic features, and perinatal outcome of macrosomic infants.

Methods:  This prospective study was carried out on 6385 newborns. Demographic data included maternal age, paternal age, type of delivery, sex, parity and gestational age at delivery. Anthropometric measurements were recorded. ABO/Rh typing was performed and GDM was diagnosed.

Results:  Out of 6385 term deliveries, 477 infants (7.47%) were macrosomic. Incidence of GDM was 0.6% and 4.8% in the control group and in macrosomic births, respectively. Incidence of GDM(+) cases was 4% among macrosomic infants weighing 4000–4500 g. GDM(+) cases were densely populated (11%) in macrosomic infants weighing ≥ 4500 g (P≤ 0.05). Male/female ratio was significantly higher in macrosomic infants weighing ≥ 4500 g than those weighing 4000–4500 g (P≤ 0.05). High parental age was the risk factor for GDM. Blood group A was the most frequently observed type among mothers with macrosomic infants, however, blood group O was dominant in cases with GDM. In multivariate logistic regression analysis, the male infant was the most striking infant characteristic and GDM was the most striking maternal characteristic that were significantly associated with increased odds of macrosomic birth.

Conclusions:  This research reports the association between blood group system and macrosomia as well as parental age and GDM simultaneously. Our study reports a prevalence of GDM in both infants with normal birth weight and macrosomic newborns at the same time.
Laparoscopic restorative proctectomy – hybrid approach or totally laparoscopic?
Authors: Ellis‐Clark Jodie Michelle , Lumley John W , Stevenson Andrew R. L. , Stitz Russell W.
Published: July 2010

Background:  Laparoscopic rectal resection is now a technique that is emerging from experience with laparoscopic colonic resection. We review and present our experience with restorative proctectomy for cancer and compare those performed with a hybrid technique with those performed totally laparoscopically.

Methods:  A total of 177 patients have undergone laparoscopic restorative proctectomy. All of the patients were planned to have the abdominal portion of their surgery performed laparoscopically and to convert to open for the rectal dissection as required. They were then stratified into those that had their surgery performed completely laparoscopically (laparoscopic group – LG), and to those who had their rectal dissection and or transection performed with an open incision (hybrid group – HG).

Results:  Short‐term outcomes were compared between the LG (n = 103) and the HG (n = 74). The overall complication rate was higher in the HG (12% versus 35% P < 0.001), mainly with a significantly higher pelvic abscess rate and higher rate of post‐operative ileus. There were no intraoperative or post‐operative deaths. Length of stay was equivalent in both groups (five days). To date, distal recurrence has occurred in 7.7% of the patients, eight in the LG and four in the HG (NS). Two patients, one in each group, have had local recurrence only.

Conclusions:  Laparoscopic open or laparoscopic hybrid approaches are techniques that can be used in suitable patients. Both have acceptable morbidity and mortality.
Pancreatic fistula after distal pancreatectomy: incidence, risk factors and management
Authors: Kah Heng Chiow Adrian , Salleh Ibrahim , San Tan Siong , Ying Feng , Su‐Ming Tan
Published: July 2010

Background:  Pancreatic fistulae post distal pancreatectomy still leads to significant morbidity and if not properly managed, may lead to mortality. The identification of risk factors and effective management of patients with pancreatic fistulae is important in the prevention of these complications.

Methods:  There were 75 open consecutive distal pancreatectomies in the Department of Surgery, Changi General Hospital from May 2001 to May 2007.

Results:  The indications for operation were neuroendocrine tumours (n= 15), adenocarcinoma (n= 20), Intraductal papillary mucinous tumour (IPMT) (n= 20), serous cysts (n= 15) and trauma (n= 5). There were 20 patients (27%) who developed pancreatic fistulae in the whole series. On univariate analysis, the patients with pancreatic fistulae had significantly more pre‐morbidities, softer pancreas and use of staplers as a method of closure of the pancreatic remnant. On multivariate analysis, the use of staplers and soft pancreas were significant independent risk factors for the development of pancreatic fistulae in our patient population. All of the patients with pancreatic fistulae were successfully treated non‐surgically with no mortality in the whole series.

Conclusions:  The use of stapler on soft pancreas leads to a higher risk for pancreatic fistulae after distal pancreatectomies. Most pancreatic fistulae can be managed non‐surgically with good outcome.
Open incisional biopsy is a safe and accurate technique for soft tissue tumours
Authors: Clayer Mark
Published: July 2010

Background:  Accurate diagnosis of musculoskeletal tumours is important for successful treatment. Studies have reported a high risk of complications following open biopsy and have advocated core biopsy as a safer alternative; however, accuracy may be reduced with the smaller sample. The aims of this study were to determine the accuracy of open incisional biopsy, the complications (overall and those that affected subsequent management) including local recurrence and the need for further surgery.

Methods:  This study was a retrospective audit of 135 consecutive open incisional biopsies of soft tissue tumours. The complications, including changes to surgical management as a direct result of complications of the biopsy, were recorded for all 135 cases. The accuracy of the open biopsy was determined by comparing the histology of the biopsy with the final histology of the 88 cases that proceeded to definitive surgical resection.

Results:  There were two complications attributable to the biopsy (complication rate 1.5%). No complication affected the definitive management. There were three cases where the biopsy incorrectly reported a benign condition when it was malignant (benign versus malignant accuracy 96%). There were no cases of benign initially being reported as malignant. The tissue diagnosis was correct in 72 of the excised specimens (accuracy 82%). The false positive rate for malignant versus benign was 0%, sensitivity 93%, specificity 100% and positive predictor value 100%.

Discussion:  Open incisional biopsy remains a safe and accurate method of obtaining a tissue diagnosis when the principles of biopsy are adhered to.
Survival from breast cancers managed by surgeons participating in the National Breast Cancer Audit of the Royal Australasian College of Surgeons
Authors: Roder David , Wang Jim X. , Zorbas Helen , Kollias James , Maddern Guy
Published: July 2010

Background:  The National Breast Cancer Audit (NBCA) of the Royal Australasian College of Surgeons has collected data on early breast cancer since 1998. In this project, deaths were traced by linkage of NBCA patient identifiers (first three digits of surname and date of birth) with the National Death Index that covers all deaths in Australia.

Methods:  Death data were traced to 31 December 2007. Invasive cancers diagnosed in 1998–2005 were included in survival analyses to allow enough follow‐up for assessment. Survivals were compared with survivals for similar stages recorded by the New South Wales (NSW) Cancer Registry and USA Surveillance Epidemiology and End Results (SEER) programme. Survivals were analysed by conventional clinical risk factors to see if expected differences presented.

Results:  The 5‐year survival from breast cancer of 93% for NBCA cases was the same as the SEER figure for local and regional cases combined in 1996–2004. The NBCA figure for localized cases was 97%, which was the same as for NSW. Node‐positive NBCA cancers had a 5‐year survival of 89%, which was slightly higher than the corresponding 86% for NSW, which may reflect exclusion from the NBCA of some cases with a poorer prognosis, including those with positive fixed nodes. As expected, lower survivals presented for older cases and those with conventional clinical risk factors.

Conclusions:  These survivals are credible both overall and by clinical risk factor. Opportunities present to use these data for survival monitoring and to investigate survival by socio‐demographic characteristic, treatment protocol, case volume and provider characteristics.
Extending boundaries: Clinical communication with culturally and linguistically diverse mental health clients and carers
Authors: Cross Wendy M. , Bloomer Melissa J.
Published: July 2010

We are often confronted with the dilemmas of interacting with people from different cultural backgrounds. How do we ensure that we meet their needs, if they have some barriers to communicating those needs? This project explores the communication mechanisms used by mental health clinicians, to explore how they modify their communication to reconcile cultural differences and promote self‐disclosure. It also identifies the practical experiences that have enlightened clinicians' practice when interacting with culturally and linguistically diverse (CALD) groups. Through focus groups, mental health clinicians were probed about their experiences with CALD groups and the methods used to facilitate communication. Clinicians were working in either acute adult inpatient or community settings in a large metropolitan health service. Fifty‐three clinicians formed 7 focus groups. In the focus groups, clinicians were asked about their perceptions of communication with CALD clients. Guided questions were used. All focus groups were audio‐taped and transcribed. Two distinct themes emerged. They were ‘respect’ and ‘cultural understanding’. The clinicians recognized that showing and maintaining respect for the CALD client, and their families significantly impacted on the development of a therapeutic relationship. Showing cultural understanding and acceptance for difference also enhanced communication.
Evaluation of the effect of extra‐amniotic normal saline infusion alone or in combination with dexamethasone for the induction of labor
Authors: Kashanian Maryam , Fekrat Mohsen , Naghghash Salvasadat , Ansari Narges Sheikh
Published: July 2010

Aim:  To compare the effect of extra‐amniotic normal saline solution infusion on its own, and in combination with dexamethasone on the ripening of the cervix and induction of labor.

Methods:  A double‐blind randomized clinical trial study was performed at Akbar Abadi Teaching Hospital in Tehran, Iran, between March 2002 and March 2003 on 84 pregnant women at a gestational age of 40 weeks or more, and with a Bishop score ≤5 with cephalic presentation, singleton pregnancy and intact membranes who had been admitted in the labor ward for the induction of labor. The women were randomly assigned into the two groups. In 41 cases, dexamethasone 20 mg extra‐ovulary, plus extra‐amniotic saline solution infusion (EASI) was prescribed, and in 43 patients EASI alone was prescribed. After 6 h of these protocols, oxytocin was started. Following this the process of labor up to delivery was followed in the two groups and a comparison was made.

Results:  There were no statistically significant differences between the two groups according to age, parity, gravidity and primary Bishop score. Of the 84 women, 75 entered the active phase of labor (38 [88.37%] in the EASI group and 37 [90.25%] in combined group) without a significant difference. The duration between oxytocin infusion until delivery were 7.25 ± 2.86 h and 9.76 ± 3.91 h in the dexamethasone and EASI groups, respectively, which showed a statistically significant difference (P = 0.002). There were no significant differences between the two groups according to cesarean section rate, meconium passage by fetus, neonatal Apgar score, birthweight, and need for the neonatal intensive care unit. There was a statistically significant negative correlation between gravidity and interval between oxytocin induction and delivery (P = 0.001, r = −474).

Conclusion:  Extra‐amniotic saline solution infusion is a suitable and cheaper method for the ripening of the cervix and induction of labor, and adding the dexamethasone to it can shorten the duration of labor without any significant risk to the mother or her fetus.
Liraglutide improves treatment satisfaction in people with Type 2 diabetes compared with sitagliptin, each as an add on to metformin
Authors: Davies M. , Pratley R. , Hammer M. , Thomsen A. B. , Cuddihy R.
Published: July 2010

Diabet. Med. 28, 333–337 (2011)

Aims  Patient‐reported outcomes from clinical trials offer insight into the impact of disease on health‐related quality of life, including treatment satisfaction. This patient‐reported outcomes evaluation was a substudy of a 26‐week randomized, open‐label trial comparing the once‐daily injectable human GLP‐1 analogue liraglutide with once‐daily oral sitagliptin, both added to metformin. The patient reported outcomes substudy aimed to evaluate treatment satisfaction using the Diabetes Treatment Satisfaction Questionnaire (DTSQ) at baseline and 26 weeks.

Methods  In the main 26‐week randomized, open‐label study (n = 658), liraglutide, 1.2 or 1.8 mg, injected with a pen, led to greater HbA1c reduction than oral sitagliptin, 100 mg once daily, both added to metformin = 1500 mg daily: mean HbA1c reduction was 1.5, 1.2 and 0.9% (7, 10 and 14 mmol/mol) for liraglutide 1.8 mg, 1.2 mg and sitagliptin, respectively (P < 0.0001 for both liraglutide doses vs. sitagliptin) and liraglutide patients lost more weight (3 vs.1 kg; P < 0.0001). In this patient‐reported outcomes substudy (liraglutide 1.8 mg, n = 171; 1.2 mg, n = 164; sitagliptin, n = 170) DTSQ scores were analyzed by ANCOVA with treatment and country as fixed effects and baseline value as covariate.

Results  Overall treatment satisfaction, calculated by adding satisfaction scores for `current treatment’, `convenience’, `flexibility’, `understanding’, `recommend’, and `continue’, improved in all groups at 26 weeks; greater improvement with liraglutide (4.35 and 3.51 vs. 2.96; P = 0.03 for liraglutide 1.8 mg vs. sitagliptin) may reflect greater HbA1c reduction and weight loss. Patients perceived themselves to be hyperglycaemic significantly less frequently with liraglutide 1.8 mg (difference = −0.88; P < 0.0001) and 1.2 mg (difference = −0.49; P = 0.01). Perceived frequency of hypoglycaemia was similar across all groups.

Conclusions  Injectable liraglutide may lead to greater treatment satisfaction than oral sitagliptin, potentially by facilitating greater improvement in glycaemic control, weight loss and/ or perception of greater treatment efficacy.
Minimum Wages and Employment: Reconsidering the Use of a Time Series Approach as an Evaluation Tool
Authors: Lee Wang‐Sheng , Suardi Sandy
Published: July 2010

The time series approach used in the minimum wage literature essentially aims to estimate a treatment effect of increasing the minimum wage. In this article, we employ a novel approach based on aggregate time series data that allows us to determine if minimum wage changes have significant effects on employment. This involves the use of tests for structural breaks as a device for identifying discontinuities in the data, which potentially represent treatment effects. In an application based on Australian data, the tentative conclusion is that the introduction of minimum wage legislation in Australia in 1997 and subsequent minimum wage increases appear not to have had any significant negative employment effects for teenagers.
A Good Time to Stay Out? Strikes and the Business Cycle
Authors: Devereux Paul J. , Hart Robert A.
Published: July 2010

In this article, we compile a unique historical dataset that records strike activity in the British engineering industry from 1920 to 1970. These data have the advantage of containing a fairly homogeneous set of companies and blue‐collar workers. They cover a long period with varying labour market conditions, include information that enables the addition of union and company fixed effects, and provide geographical detail that allows a district‐level analysis that controls for year and seasonal effects. We study the cyclicality of strike durations, strike incidence and strike outcomes, and distinguish between pay and non‐pay strikes. We find evidence that strikes over pay have countercyclical durations. However, in the post‐war period, the magnitude of this effect for pay‐related strikes is much reduced when union and firm fixed effects are included. These findings suggest that it is important when studying strike durations to take account of differences in the types of companies and unions that are involved in strikes at different points of the business cycle. We also find that strike outcomes tend to be more favourable to unions when the national unemployment rate is lower.
Transnational Labour Solidarity and Social Movement Unionism: Insights from and beyond a Women Workers' Strike in Turkey
Authors: Fougner Tore , Kurtoğlu Ayça
Published: July 2010

Through an analysis of solidarity across borders and social groups in connection with and beyond a strike on the part primarily of women workers at a foreign‐owned factory in Turkey's Antalya Free Zone, this article contributes to the debate on the two union renewal strategies of transnational labour solidarity and coalition building with social movements. In the case at hand, the extensive strike‐related support on the part of external unions and the women's movement illustrates the positive difference that solidarity practices can make. However, looking beyond the strike itself, the case points to significant challenges related to the development of deeper and more proactive solidarity across borders and social groups.
The Involvement of Civil Society Organizations in British Industrial Relations: Extent, Origins and Significance
Authors: Heery Edmund , Abbott Brian , Williams Stephen
Published: July 2010

This article examines the involvement of civil society organizations (CSOs) in UK industrial relations. Organizations of this type, including advocacy, campaigning, identity and community organizations have attracted increasing attention from employment relations scholars in recent years. The study reported in this article demonstrates that CSOs have become increasingly active in the sphere of work and employment, partly in response to trade union decline but also owing to political opportunities, afforded by the labour market policy of the New Labour government. It is claimed that CSOs operate at multiple levels of the industrial relations system and interact with the state, employers and trade unions. They generate significant effects within UK industrial relations and can rightly be judged significant ‘new actors’ on the UK employment scene.
Clearing and Settlement of Derivatives: Is a Code of Conduct Advisable?
Authors: Nielsson Ulf
Published: July 2010

This article is a first step to assess whether a self‐regulatory ‘Code of Conduct’, which has been in effect for European equities, should also be extended to derivatives. The aim of the code is to increase competition and customer choice in the European transaction process (trading, clearing and settlement). The article examines whether such a code is advisable for derivatives by evaluating potential market failures and inefficiencies in European derivatives markets. More specifically, the article: a) highlights the main differences in the clearing and settlement procedures of derivatives versus equities; b) outlines current and alternative market infrastructures in derivatives post‐trade markets; and c) evaluates the current level of competition among derivatives exchanges and also between the on‐ and off‐exchange trading segments.

The article concludes that if imminent initiatives taken to increase the competitiveness of over‐the‐counter (OTC) derivatives markets vis‐à‐vis the incumbent derivatives exchanges—such as increased clearing house usage and new entry of multilateral trading facilities—are not effective in the near future, a code of conduct could be envisaged. This should entail promoting faster automation of OTC post‐trade processes and ensuring price comparability is maintained between derivatives exchanges.
Determinants of Investor Demand for Cross‐Listed Firms
Authors: Athanassakos George , Ackert Lucy F. , Naydenova Budina , Tafkov Ivo
Published: July 2010

By focusing on the decisions of investors to invest in cross‐listed stocks, this paper presents new evidence on why we observe striking differences in the percentage of trade in foreign markets for cross‐listed stocks. With a large sample of Toronto Stock Exchange (TSX) stocks cross‐listed in the U.S. and Canada, we document the effect of investor recognition and risk characteristics on the distribution of trading volume. Firms that are more visible to American investors are traded more heavily in the U.S. At the same time, firms that offer diverse risk characteristics are attractive to Americans. While investors understand the benefits of international diversification, as they are attracted to stocks that are different (e.g., the stock of small firms with few assets in the U.S.), they also seek stocks that provide them with high returns.
Towards Culturally Appropriate Assessment? A Contribution to the Debates
Authors: Johnston Patricia Maringi G.
Published: July 2010

Culturally appropriate assessment in higher educational is premised on factors that do not benefit minority groups, because they have no control over the processes governing such factors. Significantly, practices to account for students from different ethnic/minority/indigenous backgrounds are the inclusion of elements like their language, knowledge and culture into the curriculum. However, assessment procedures are often seen to be ‘a‐cultural’, but are political activities that benefit the interests of some groups over others, as ‘a‐cultural’ approaches tend to be bound within the cultural capital of the dominant group. This article examines the international discussions relating to culturally appropriate assessment through generic themes, assessment practices, cultural inclusions and cultural appropriateness. It argues that there are two distinct approaches to addressing inclusion: ‘centric’ and ‘friendly’, respectively, that result in different priorities and outcomes. Assessment however, is a political struggle between dominant and minority interests, which this article also recognises and explores.
Optoacoustics–its application in photodermatology
Authors: Meinhardt‐Wollweber M. , Krebs R. , Heinrich U. , Tronnier H. , Anders‐von Ahlften A.
Published: July 2010

IFSCC Magazine, 12 (4) 365–370 (2009)

Synopsis

Optoacoustics is a new method to study the optical properties of human skin in vivo. We measured the absorption spectra of human skin in a study in twenty subjects belonging to skin phototypes I‐IV. Absorption coefficients were determined in the range from 290 nm to 341 nm (3 nm steps) on the inner and outer side of the forearm and the ball of the thumb. Comparison of these new data with known action spectra of photobiologic effects and natural solar irradiation spectra indicates that the small wavelength range from ca. 300 nm to 320 nm may be responsible for significant detrimental and beneficial effects. Consequently, the skin is very sensitive to changes in irradiation in this spectral region.
A Liberal Defence of (Some) Duties to Compatriots
Authors: LAZAR SETH
Published: July 2010

abstract

This paper asks whether we can defend associative duties to our compatriots that are grounded solely in the relationship of liberal co‐citizenship. The sort of duties that are especially salient to this relationship are duties of justice, duties to protect and improve the institutions that constitute that relationship, and a duty to favour the interests of compatriots over those of foreigners. Critics have argued that the liberal conception of citizenship is too insubstantial to sustain these duties — indeed, that it gives us little reason to treat compatriots any differently from how we treat foreigners, with all the practical consequences that this would entail. I suggest that on a specific conception of liberal citizenship we can, in fact, defend associative duties, but that these extend only to the duty to protect and improve the institutions that constitute that relationship. Duties of justice and favouritism, I maintain, cannot be particularised to one's compatriots.
Comparison of the contractile properties, oxidative capacities and fibre type profiles of the voluntary sphincters of continence in the rat
Authors: Buffini Maria , O’Halloran Ken D. , O’Herlihy Colm , O’Connell Ronan , Jones James F. X.
Published: July 2010

The external urethral sphincter (EUS) and external anal sphincter (EAS) are the principal voluntary striated muscles that sustain continence of urine and faeces. In light of their common embryological origin, shared tonic sphincteric action and synchronized electrical activity in vivo, it was expected that they would exhibit similar physiological and structural properties. However, the findings of this study using paired observations of both sphincters isolated from the rat show clearly that this is not the case. The anal sphincter is much more fatigable than the urethral sphincter. On completion of a fatigue protocol, the amplitude of the last twitch of the EAS had declined to 42 ± 3% of the first twitch, whereas the last twitch of the EUS was almost identical to that of the first (95 ± 3%). Immunocytochemical detection of myosin heavy‐chain isoforms showed that this difference was not due to the presence of more slow‐twitch oxidative type 1 fibres in the EUS compared with the EAS (areal densities 4 ± 1% and 5 ± 1%, respectively; P = 0.35). In addition, the fatigue difference was not explained by a greater contribution to force production by fast oxidative type 2A fibres in the urethral sphincter. In fact, the anal sphincter contained a higher areal density of type 2A fibres (56 ± 5% vs. 37 ± 4% in the EUS, P = 0.017). The higher oxidative capacity of the EUS, measured histochemically, explained its fatigue resistance. These results were surprising because the fatigue‐resistant urethral muscle exhibited faster single‐twitch contraction times compared with the anal sphincter (56 ± 0.87 ms vs. 72.5 ± 1.16 ms, P < 0.001). Neither sphincter expressed the type 2X myosin isoform but the fast‐twitch isoform type 2B was found exclusively in the EUS (areal density 16 ± 2%). The type 2B fibres of the EUS were small (diameter 19.5 ± 0.4 μm) in comparison to typical type 2B fibres of other muscles. As a whole the EUS is a more oxidative than glycolytic muscle. In conclusion, analysis of the twitch mechanics and fatigue of two sphincters showed that the EUS contained more fatigue‐resistant muscle fibres compared with the EAS.
The climatic sensitivity of the forest, savanna and forest–savanna transition in tropical South America
Authors: Hirota Marina , Nobre Carlos , Oyama Marcos Daisuke , Bustamante Mercedes MC
Published: July 2010

Featured paper: See Editorial p553
Unintentional injuries among older adults in northern Sweden – a one‐year population‐based study
Authors: Saveman Britt‐Inger , Björnstig Ulf
Published: July 2010

Scand J Caring Sci; 2011; 25; 185–193 Unintentional injuries among older adults in northern Sweden – a one‐year population‐based study

Aim: To study the epidemiology of unintentional injuries in a population of 21 000 Swedish older adults (65+) and to compare the injury incidence with similar data collected two decades earlier.

Method: This is a retrospective epidemiologic cross‐sectional study based on a 1‐year data set of all the 1753 registered injury events from a well‐defined population.

Result: The injury rate per 1000 individuals was three times higher in the 85+ age group than in the 65–74 age group. The rate was also higher in women than in men aged 75 and older. Fractures, especially on lower and upper extremities, were the most common injuries. Falls in residential care facilities caused the most serious injuries. In transport areas, pedestrian falls and bicyclist crashes were much more common than car crashes. Of the 1753 people injured, 42% were treated as inpatients for a total of 11 569 days; 86% of these days were caused by injury events in the home (57%) or in residential care facilities (29%). Our 65+ age group occupied 69% of all hospital bed‐days for trauma in all ages (0–102 years).

Conclusion: Over the last two decades, the injury and fracture rate per 1000 individuals has increased by 40–50%, especially in the older age groups. During this time, the nursing strategy for older adults has changed in Sweden. As a result, more people live in their homes nowadays. This increase is distressing especially when we consider the current knowledge of preventive measures. The high number and proportion (>2/3) of inpatient trauma days for these age groups are a heavy burden for the medical sector. These facts call for more effective preventive measures, especially in the home and in residential care facilities, to minimize the negative health effects and the rising health costs.