bluuebunny/crossref_metadata_2025 huggingface dataset:
Telling the Patient's Story: using theatre training to improve case presentation skills
Authors: Hammer Rachel R , Rian Johanna D , Gregory Jeremy K , Bostwick J Michael , Barrett Birk Candace , Chalfant Louise , Scanlon Paul D , Hall-Flavin Daniel K
Published: February 2011

A medical student's ability to present a case history is a critical skill that is difficult to teach. Case histories presented without theatrical engagement may fail to catch the attention of their intended recipients. More engaging presentations incorporate ‘stage presence’, eye contact, vocal inflection, interesting detail and succinct, well organised performances. They convey stories effectively without wasting time. To address the didactic challenge for instructing future doctors in how to ‘act’, the Mayo Medical School and The Mayo Clinic Center for Humanities in Medicine partnered with the Guthrie Theater to pilot the programme ‘Telling the Patient's Story’. Guthrie teaching artists taught storytelling skills to medical students through improvisation, writing, movement and acting exercises. Mayo Clinic doctors participated and provided students with feedback on presentations and stories from their own experiences in patient care. The course's primary objective was to build students' confidence and expertise in storytelling. These skills were then applied to presenting cases and communicating with patients in a fresher, more engaging way. This paper outlines the instructional activities as aligned with course objectives. Progress was tracked by comparing pre-course and post-course surveys from the seven participating students. All agreed that the theatrical techniques were effective teaching methods. Moreover, this project can serve as an innovative model for how arts and humanities professionals can be incorporated for teaching and professional development initiatives at all levels of medical education.
Characterisation of multiresistant Brachyspira hyodysenteriae isolates from Czech pig farms
Authors: Šperling D. , Smola J. , Čížek A.
Published: February 2011

The aim of the present study was to evaluate the importance of clonal spread of Brachyspira hyodysenteriae resistant to pleuromutilins (tiamulin, valnemulin) on farms in the Czech Republic. Agar dilution method and macrorestriction fragment profile analysis by pulsed field gel electrophoresis were used to characterise 35 B hyodysenteriae isolates that were obtained from clinical cases of swine dysentery on 32 farms between 2000 and 2005. Most isolates showed multiple resistances to tiamulin, valnemulin, tylosin and lincomycin. A total of six pulsotypes were detected in these multiresistant isolates. An analysis of epidemiological data showed that multiresistant B hyodysenteriae isolates were more often detected on fattening farms (59 per cent), compared with farms with other types of production. Furthermore, it was found that multiresistant B hyodysenteriae clones were most frequently selected on farms with endemic incidence of swine dysentery. This finding was confirmed by the characterisation of 21 B hyodysenteriae isolates obtained from three large‐scale operations in seven consecutive years.
A Note on Field Vane Testing of Silty Soils
Authors: Blight G. E
Published: February 2011

The field vane test is usually used to measure the strength of clays, but it may also be applied to measurements in silty soils. Because of the relatively high permeability of silts, drainage of the soil surrounding the vane can take place even during a fairly rapid test.A method is proposed that enables the preselection of a test duration such that the strength measured is that of the fully drained soil. The procedure has been developed by both empirical and theoretical means.
STUDY OF VASCULAR SUPPLY OF LUNATE AND CONSIDERATION APPLIED TO KIENBÖCK DISEASE
Authors: Dubey P. P. , Chauhan Navneet Kumar , Siddiqui M. S. , Verma Anoop K.
Published: February 2011

The purpose of this study was to assess vascularity of the lunate by number of foramina and radiography of vessels of the wrist. The genesis of lunatomalacia requires some vascular risk and mechanical predisposition. The findings were correlated with the cause of Kienböck's disease. The vascular foramina were more than two in 91.33% of the lunate. The lunate had consistent dorsal and palmar branches from radial artery. The additional branches from anterior interosseous artery in 72.22% and a branch of palmar inter carpal arch in 69.44% cases contributed in arterial anastomosis on palmar aspect of lunate. The dorsal blood supply was found by anterior interosseous artery in 85.71% of specimens and dorsal branch from dorsal intercarpal arch in 50% of specimens. The blood supply of lunate comes along with various ligaments which may be disrupted due to trauma or strain leading to avascular necrosis. The present observations are suggestive of rich blood supply of lunate in comparison of other investigations. Therefore Kienböck's disease is less common in northern India.
TUBERCULAR OSTEOMYELITIS OF METACARPALS AND PHALANGES IN CHILDREN
Authors: Agarwal Anil , Qureshi Nadeem Akhtar , Kumar Pawan , Khan Shariq
Published: February 2011

The purpose of the series is to describe the management of tubercular osteomyelitis of metacarpals and phalanges in 11 children (range, 3–12 years) and to retrospectively analyse the relationship between radiological staging and clinical outcome following treatment. The available literature on the clinical and radiological manifestations of tubercular osteomyelitis of the hand (excluding wrist) was also reviewed. Follow-up averaged 17.7 months following completion of treatment. The different radiological descriptions of the condition could be grouped into three stages: Stage 1 (stage of soft tissue swelling and no bony changes), Stage 2 (stage of bony expansion) and Stage 3 (stage of destruction). The previously described different radiological entities of tubercular osteomyelitis of metacarpals and phalanges appear to be a sequential manifestation of the disease spectrum. Healing with non-operative treatment is excellent provided the diagnosis is made when tuberculosis presents with soft tissue swelling alone and before bony destruction occurs.
USE OF THE VOLAR FIXED ANGLE PLATE FOR COMMINUTED DISTAL RADIUS FRACTURES AND AUGMENTATION WITH A HYDROXYAPATITE BONE GRAFT SUBSTITUTE
Authors: Goto Akira , Murase Tsuyoshi , Oka Kunihiro , Yoshikawa Hideki
Published: February 2011

Treatment of distal radius fractures with a volar fixed angle plate achieves sufficient stabilisation and permits early physical exercise. However, secondary displacement after surgery sometimes occurs in elderly patients with a metaphyseal comminution and/or cases in which the subchondral support pegs were not placed immediately below the subchondral zone.

We treated elderly patients suffering from distal radius fractures with metaphyseal comminution, using both volar fixed angle plate with or without augmentation with a hydroxyapatite bone graft substitute to investigate the benefit of augmentation for maintaining a fracture reduction. We evaluated the differences among radiographic parameters including palmar tilt, radial inclination, and ulnar variance on immediate postoperative and final follow-up radiographs to analyse the maintenance of the initial reduction.

There were no significant differences between the two groups in terms of palmar tilt (P = 0.80) and radial inclination (P = 0.17); however, ulnar variance increased significantly in the group treated with a volar fixed angle plate without augmentation (P < 0.05).

It might be useful to use a combination technique of a locking plate system and the hydroxyapatite bone graft substitute as augmentation to treat distal radius comminuted fractures in elderly patients.
RELIABILITY OF LICHTMAN'S CLASSIFICATION FOR KIENBÖCK'S DISEASE IN 99 SUBJECTS
Authors: Shin Masaki , Tatebe Masahiro , Hirata Hitoshi , Koh Shukuki , Shinohara Takaaki
Published: February 2011

Purpose: The objective of this research was to investigate the reliability of Lichtman's classification for Kienböck's disease.

Methods: Interobserver reliability and intraobserver reproducibility were investigated by interpreting both anteroposterior and lateral X-rays of the wrist joint twice in 99 patients with Kienböck's disease using the modified Lichtman's classification system. Observers comprised three orthopaedic surgeons, and no information was exchanged between observers either before or during the study.

Results: Intraobserver reliability was moderate (0.313–0.628), and interobserver reliability was fair (Siegel's kappa = 0.228).

Conclusion: Low values were obtained regarding interobserver reliability for the modified Lichtman's classification of Kienböck's disease. This classification is thus inadequate for use in clinical settings. A new classification should be established.
NON-UNION OF AN UNDISPLACED RADIAL STYLOID FRACTURE IN A HEAVY SMOKER: REVISITING THE ASSOCIATION OF SMOKING AND BONE HEALING
Authors: Sarraf Khaled M. , Tavare Aniket , Somashekar Naresh , Langstaff Ronald J.
Published: February 2011

Isolated radial styloid fractures occur relatively infrequently, with non-union of such fractures, especially when undisplaced, being highly unusual. Smoking of tobacco, a common habit which is decreasing in prevalence in the developed world, has been proven to exert many adverse effects on tissue healing including bone union. We present a case of non-union of an undisplaced radial styloid fracture in the dominant hand of a young and healthy heavy smoker, emphasising the negative impact of tobacco smoke and its association with bone repair. We suggest that heavy tobacco users should also be followed up more vigilantly with this complication in mind, with smoking cessation modalities being offered on presentation.
Automatic tag recommendation algorithms for social recommender systems
Authors: Song Yang , Zhang Lu , Giles C. Lee
Published: February 2011

The emergence of Web 2.0 and the consequent success of social network Web sites such as Del.icio.us and Flickr introduce us to a new concept called social bookmarking, or tagging. Tagging is the action of connecting a relevant user-defined keyword to a document, image, or video, which helps the user to better organize and share their collections of interesting stuff. With the rapid growth of Web 2.0, tagged data is becoming more and more abundant on the social network Web sites. An interesting problem is how to automate the process of making tag recommendations to users when a new resource becomes available.

In this article, we address the issue of tag recommendation from a machine learning perspective. From our empirical observation of two large-scale datasets, we first argue that the user-centered approach for tag recommendation is not very effective in practice. Consequently, we propose two novel document-centered approaches that are capable of making effective and efficient tag recommendations in real scenarios. The first, graph-based, method represents the tagged data in two bipartite graphs, (document, tag) and (document, word), then finds document topics by leveraging graph partitioning algorithms. The second, prototype-based, method aims at finding the most representative documents within the data collections and advocates a sparse multiclass Gaussian process classifier for efficient document classification. For both methods, tags are ranked within each topic cluster/class by a novel ranking method. Recommendations are performed by first classifying a new document into one or more topic clusters/classes, and then selecting the most relevant tags from those clusters/classes as machine-recommended tags.

Experiments on real-world data from Del.icio.us, CiteULike, and BibSonomy examine the quality of tag recommendation as well as the efficiency of our recommendation algorithms. The results suggest that our document-centered models can substantially improve the performance of tag recommendations when compared to the user-centered methods, as well as topic models LDA and SVM classifiers.
Recommending friends and locations based on individual location history
Authors: Zheng Yu , Zhang Lizhu , Ma Zhengxin , Xie Xing , Ma Wei-Ying
Published: February 2011

The increasing availability of location-acquisition technologies (GPS, GSM networks, etc.) enables people to log the location histories with spatio-temporal data. Such real-world location histories imply, to some extent, users' interests in places, and bring us opportunities to understand the correlation between users and locations. In this article, we move towards this direction and report on a personalized friend and location recommender for the geographical information systems (GIS) on the Web. First, in this recommender system, a particular individual's visits to a geospatial region in the real world are used as their implicit ratings on that region. Second, we measure the similarity between users in terms of their location histories and recommend to each user a group of potential friends in a GIS community. Third, we estimate an individual's interests in a set of unvisited regions by involving his/her location history and those of other users. Some unvisited locations that might match their tastes can be recommended to the individual. A framework, referred to as a hierarchical-graph-based similarity measurement (HGSM), is proposed to uniformly model each individual's location history, and effectively measure the similarity among users. In this framework, we take into account three factors: 1) the sequence property of people's outdoor movements, 2) the visited popularity of a geospatial region, and 3) the hierarchical property of geographic spaces. Further, we incorporated a content-based method into a user-based collaborative filtering algorithm, which uses HGSM as the user similarity measure, to estimate the rating of a user on an item. We evaluated this recommender system based on the GPS data collected by 75 subjects over a period of 1 year in the real world. As a result, HGSM outperforms related similarity measures, namely similarity-by-count, cosine similarity, and Pearson similarity measures. Moreover, beyond the item-based CF method and random recommendations, our system provides users with more attractive locations and better user experiences of recommendation.
Design and Implementation of an Anycast Services Discovery in Mobile Ad Hoc Networks
Authors: Chen Shyr-Kuen , Wang Pi-Chung
Published: February 2011

Anycasting is a network service that selects the best one of service providers in an anycast group as a destination. While anycasting offers better service flexibility in mobile ad hoc networks (MANETs), it also incurs new problems. In MANETs, every node can move arbitrarily, and the routes from mobile nodes to their service providers would vary. Therefore, anycast service discovery in MANETs usually relies on network-layer message broadcasting, which leads to large traffic overhead for the scarce bandwidth of MANETs. In this work, we present a traffic-control scheme for anycast service discovery in MANETs. Our scheme can reduce the volume of query messages and the reply messages. In addition to basic anycasting, our scheme also supports k-anycast service that requests for k anycast service providers in each service instance. With k-anycast service, the fault tolerance and service flexibility of our scheme can be improved. Experimental results demonstrate that our scheme is efficient and feasible for MANETs.
A Decentralized Self-Organizing Service Composition for Autonomic Entities
Authors: Al-Oqily Ibrahim , Karmouch Ahmed
Published: February 2011

In service-oriented environments and distributed systems, service composition allows simple services to be dynamically combined into new, more complex services. Service composition techniques are usually designed as an extension to service discovery. Traditional techniques try to match a user’s requirements, often complex, with the available services. However, one-to-one matching is inefficient; it is preferable to meet the request from available services even when one of the basic services is not present. Separating composition and discovery has also led to inefficiency, especially in a highly dynamic environment. With the heterogeneity of networks, users, and applications having multiple sources, constructing service-specific overlays in large distributed networks is challenging. In this article, we propose a new service composition algorithm to deal with the problem of composing multiple autonomic elements to achieve system-wide goals. Using a self-organizing approach, autonomic entities are dynamically and seamlessly composed into service-specific overlay networks. The algorithm combines composition and service discovery into one step, thereby achieving more efficiency and less latency. The decentralized and self-organizing nature of the algorithm allows it to respond rapidly to system changes. Extensive simulation results validate the effectiveness of the approach when it is compared to other solutions.
The Completion of Real‐Asset Markets by Options
Authors: Kountzakis Christos E.
Published: February 2011

We combine the theory of finite‐dimensional lattice subspaces and the theory of regular values for maps between smooth manifolds in order to study the completion of real asset markets by options. The strike asset of the options is supposed to be a nominal asset. The main result of the paper is like in the case of the completion of a nominal asset market by options that if the strike asset of the options is the riskless asset, then the completion of a real asset market is generically equal to ℝS.
Unsteady Flow and Heat Transfer of a Dusty Fluid through a Rectangular Channel
Authors: Gireesha B. J. , Roopa G. S. , Bagewadi C. S.
Published: February 2011

The present discussion deals with the study of an unsteady flow and heat transfer
of a dusty fluid through a rectangular channel under the influence of pulsatile pressure
gradient along with the effect of a uniform magnetic field. The analytical solutions of the
problem are obtained using variable separable and Fourier transform techniques. The graphs are
drawn for the velocity fields of both fluid and dust phases under the effect of Reynolds number.
Further, changes in the Nusselt number are shown graphically, and, on the basis of these,
the conclusions and discussions are given.
Padé Approximants in Complex Points Revisited
Authors: Hebhoub Fahima , Yushchenko Lidiya
Published: February 2011

The class of complexsymmetric functions contains the Stieltjes
functions. The aim of this work is to give some new results concerning
the location of zeros and poles of Padé approximants using the Taylor
series of functions developed in neighborhoods of complex points and
their conjugate points.
Defining Boundaries for Ecosystem-Based Management: A Multispecies Case Study of Marine Connectivity across the Hawaiian Archipelago
Authors: Toonen Robert J. , Andrews Kimberly R. , Baums Iliana B. , Bird Christopher E. , Concepcion Gregory T. , Daly-Engel Toby S. , Eble Jeff A. , Faucci Anuschka , Gaither Michelle R. , Iacchei Matthew , Puritz Jonathan B. , Schultz Jennifer K. , Skillings Derek J. , Timmers Molly A. , Bowen Brian W.
Published: February 2011

Determining the geographic scale at which to apply ecosystem-based management (EBM) has proven to be an obstacle for many marine conservation programs. Generalizations based on geographic proximity, taxonomy, or life history characteristics provide little predictive power in determining overall patterns of connectivity, and therefore offer little in terms of delineating boundaries for marine spatial management areas. Here, we provide a case study of 27 taxonomically and ecologically diverse species (including reef fishes, marine mammals, gastropods, echinoderms, cnidarians, crustaceans, and an elasmobranch) that reveal four concordant barriers to dispersal within the Hawaiian Archipelago which are not detected in single-species exemplar studies. We contend that this multispecies approach to determine concordant patterns of connectivity is an objective and logical way in which to define the minimum number of management units and that EBM in the Hawaiian Archipelago requires at least five spatially managed regions.
Methotrexate in Atherogenesis and Cholesterol Metabolism
Authors: Coomes Eric , Chan Edwin S. L. , Reiss Allison B.
Published: February 2011

Methotrexate is a disease-modifying antirheumatic drug commonly used to treat inflammatory conditions such as rheumatoid arthritis which itself is linked to increased cardiovascular risk. Treatments that target inflammation may also impact the cardiovascular system. While methotrexate improves cardiovascular risk, inhibition of the cyclooxygenase (COX)-2 enzyme promotes atherosclerosis. These opposing cardiovascular influences may arise from differing effects on the expression of proteins involved in cholesterol homeostasis. These proteins, ATP-binding cassette transporter (ABC) A1 and cholesterol 27-hydroxylase, facilitate cellular cholesterol efflux and defend against cholesterol overload. Methotrexate upregulates expression of cholesterol 27-hydroxylase and ABCA1 via adenosine release, while COX-2 inhibition downregulates these proteins. Adenosine, acting through the A2Aand A3receptors, may upregulate proteins involved in reverse cholesterol transport by cAMP-PKA-CREB activation and STAT inhibition, respectively. Elucidating underlying cardiovascular mechanisms of these drugs provides a framework for developing novel cardioprotective anti-inflammatory medications, such as selective A2Areceptor agonists.
Body Mass Index and Facial Cues in Sasang Typology for Young and Elderly Persons
Authors: Pham Duong Duc , Do Jun-Hyeong , Ku Boncho , Lee Hae Jung , Kim Honggie , Kim Jong Yeol
Published: February 2011

Facial characteristics may provide reliable information giving an insight into the inner nature of an individual. This study examines the differences in widely used facial metrics, including cheek‐to‐jaw width ratio (CJWR), width‐to‐height ratio (WHR), perimeter‐to‐area ratio (PAR), and facial masculinity indexes across Sasang constitutional types, to investigate the association between these facial cues and body mass index (BMI) and develop a predictive model for Sasang typing. 2D images of 911 participants were analyzed. The results indicated that TaeEum (TE) type generally has a squarer face, with the male TE type having a squarer and wider face than that of both SoYang (SY) and SoEum (SE) types. Male TE type has longer eyes than that of the SE type, and the lower face of the female TE type is longer than that of the SY type. PAR, WHR, CJWR, and eye size had associations with BMI, and the magnitude of correlation of CJWR in Korean men were twofold higher than that of the Caucasian and African men. BMI and facial metrics including PAR, WHR, CJWR, and eye size were good predictors for TE type, and the most parsimonious model for TE typing included BMI and CJWR with high predictive performances.
Blood-Brain Barrier Breakdown Following Traumatic Brain Injury: A Possible Role in Posttraumatic Epilepsy
Authors: Tomkins Oren , Feintuch Akiva , Benifla Moni , Cohen Avi , Friedman Alon , Shelef Ilan
Published: February 2011

Recent animal experiments indicate a critical role for opening of the blood-brain barrier (BBB) in the pathogenesis of post-traumatic epilepsy (PTE). This study aimed to investigate the frequency, extent, and functional correlates of BBB disruption in epileptic patients following mild traumatic brain injury (TBI). Thirty-seven TBI patients were included in this study, 19 of whom suffered from PTE. All underwent electroencephalographic (EEG) recordings and brain magnetic resonance imaging (bMRI). bMRIs were evaluated for BBB disruption using novel quantitative techniques. Cortical dysfunction was localized using standardized low-resolution brain electromagnetic tomography (sLORETA). TBI patients displayed significant EEG slowing compared to controls with no significant differences between PTE and nonepileptic patients. BBB disruption was found in 82.4% of PTE compared to 25% of non-epileptic patients (P=.001) and could be observed even years following the trauma. The volume of cerebral cortex with BBB disruption was significantly larger in PTE patients (P=.001). Slow wave EEG activity was localized to the same region of BBB disruption in 70% of patients and correlated to the volume of BBB disrupted cortex. We finally present a patient suffering from early cortical dysfunction and BBB breakdown with a gradual and parallel resolution of both pathologies. Our findings demonstrate that BBB pathology is frequently found following mild TBI. Lasting BBB breakdown is found with increased frequency and extent in PTE patients. Based on recent animal studies and the colocalization found between the region of disrupted BBB and abnormal EEG activity, we suggest a role for a vascular lesion in the pathogenesis of PTE.
A Procedure to Address the Fuel Rod Failures during LB‐LOCA Transient in Atucha‐2 NPP
Authors: Adorni Martina , Del Nevo Alessandro , D′Auria Francesco , Mazzantini Oscar
Published: February 2011

Depending on the specific event scenario and on the purpose of the analysis, the availability of calculation methods that are not implemented in the standard system thermal hydraulic codes might be required. This may imply the use of a dedicated fuel rod thermomechanical computer code. This paper provides an outline of the methodology for the analysis of the 2A LB‐LOCA accident in Atucha‐2 NPP and describes the procedure adopted for the use of the fuel rod thermomechanical code. The methodology implies the application of best estimate thermalhydraulics, neutron physics, and fuel pin performance computer codes, with the objective to verify the compliance with the specific acceptance criteria. The fuel pin performance code is applied with the main objective to evaluate the extent of cladding failures during the transient.
The procedure consists of a deterministic calculation by the fuel performance code of each individual fuel rod during its lifetime and in the subsequent LB‐LOCA transient calculations. The boundary and initial conditions are provided by core physics and three‐dimensional neutron kinetic coupled thermal‐hydraulic system codes calculations.
The procedure is completed by the sensitivity calculations and the application of the probabilistic method, which are outside the scope of the current paper.
Estrogen-Related Receptor Gamma Promotes Mesenchymal-to-Epithelial Transition and Suppresses Breast Tumor Growth
Authors: Tiraby Claire , Hazen Bethany C. , Gantner Marin L. , Kralli Anastasia
Published: February 2011

Estrogen-related receptors (ERR), ERR alpha (ERRα) and ERR gamma (ERRγ), are orphan nuclear receptors implicated in breast cancer that function similarly in the regulation of oxidative metabolism genes. Paradoxically, in clinical studies, high levels of ERRα are associated with poor outcomes whereas high levels of ERRγ are associated with a favorable course. Recent studies suggest that ERRα may indeed promote breast tumor growth. The roles of ERRγ in breast cancer progression and how ERRα and ERRγ may differentially affect cancer growth are unclear. In mammary carcinoma cells that do not express endogenous ERRγ, we found that ectopic expression of ERRγ enhanced oxidative metabolism in vitro and inhibited the growth of tumor xenografts in vivo. In contrast, ectopic expression of the ERRα coactivator PGC-1α enhanced oxidative metabolism but did not affect tumor growth. Notably, ERRγ activated expression of a genetic program characteristic of mesenchymal-to-epithelial transition (MET). This program was apparent by changes in cellular morphology, upregulation of epithelial cell markers, downregulation of mesenchymal markers, and decreased cellular invasiveness. We determined that this program was also associated with upregulation of E-cadherin, which is activated directly by ERRγ. In contrast, PGC-1α activated only a subset of genes characteristic of the MET program and, unlike ERRγ, did not upregulate E-cadherin. In conclusion, these results show that ERRγ induces E-cadherin, promotes MET, and suppresses breast cancer growth. Our findings suggest that ERRγ agonists may have applications in the treatment of breast cancer. Cancer Res; 71(7); 2518–28. ©2011 AACR.
The Biphasic Role of NF-κB in Progression and Chemoresistance of Ovarian Cancer
Authors: Yang Gong , Xiao Xue , Rosen Daniel G. , Cheng Xi , Wu Xiaohua , Chang Bin , Liu Guangzhi , Xue Fengxia , Mercado-Uribe Imelda , Chiao Paul , Du Xiang , Liu Jinsong
Published: February 2011

Purpose: NF-κB is a transcription factor known to promote tumorigenesis. However, NF-κB is also known to be proapoptotic and may potentially function as a tumor suppressor, although such a functional role has not been extensively investigated in human cancer.

Experimental Design: A dominant-negative mutant of IκBα with mutations at S32A and S36A was used to inhibit the function of NF-κB in ovarian cancer cell lines. The transcription ability, tumorigenesis, apoptosis, and drug sensitivity were examined in derivative cell lines in comparison with parental cells. We also analyzed the association of nuclear expression of NF-κB p65 with patient survival in an ovarian cancer tissue array.

Results: We show that NF-κB functions as a tumor suppressor in four ovarian cancer cell lines, but it functions as an oncogene in their aggressive chemoresistant isogenic variants. NF-κB can exert its proapoptotic or antiapoptotic effect by activating or repressing mitogen-activated protein kinase (MAPK) phosphorylation in parental or aggressive chemoresistant variant cell lines. We also show that the nuclear accumulation of p65 in epithelial cancer tissue is associated with a good response to chemotherapy and can predict longer overall survival for patients with ovarian cancer.

Conclusions: Our data provide strong evidence that NF-κB can function as a biphasic regulator, either suppressing or enhancing ovarian cancer growth through the regulation of MAPK and cellular apoptosis. Clin Cancer Res; 17(8); 2181–94. ©2011 AACR.
Management of Patients with Known Drug Hypersensitivity in an Emergency Department in Israel
Authors: Reisfeld Sharon , Goldberg Arnon , Confino-Cohen Ronit
Published: February 2011

Background: Drug hypersensitivity (DH) is potentially life threatening. Its management in the emergency department (ED) is not always satisfactory. Previous studies have evaluated the management of allergic reactions in the ED, but none has specifically addressed patients with known DH. In this study we aimed to analyze the treatment offered to patients with DH presenting to the ED in a hospital in Israel for any reason. Methods: Records of patients discharged from the ED on 19 randomly chosen dates between February 2004 and September 2005 were retrospectively reviewed. Data included demographics, diagnosis, previous drug allergies, training of the ED physician, time and day of the week, management, and discharge instructions. Results: Of 3,996 admissions to the ED, 436 (11%) patients reported 531 hypersensitivities, 45 (10%) of which were treated incorrectly. Trainees in internal medicine made significantly fewer errors than did trainees in surgery (p < 0.0005). Most errors involved NSAID hypersensitivity. Conclusion: A known DH was overlooked in 45 patients admitted to the ED. The specialty of the treating physician was the only significant factor found to affect patient management. Physicians, especially surgeons, should receive guidance concerning the correct management of patients with DH. All physicians should be aware of the optimal management of these patients.
The Impact of Diagnosed and Undiagnosed Current Asthma in the General Adult Population
Authors: Accordini Simone , Cappa Veronica , Braggion Marco , Corsico Angelo G. , Bugiani Massimiliano , Pirina Pietro , Verlato Giuseppe , Villani Simona , de Marco Roberto ,   for the ISAYA Study Group
Published: February 2011

Background: Restrictive definitions of current asthma are used in epidemiological studies to achieve a highly specific classification of subjects. However, undiagnosed asthmatics should be taken into account to correctly evaluate the impact of the disease in the general population. Methods: In an Italian multi-centre cross-sectional survey carried out in 1998–2000, 18,647 responders (20–44 years old) to a screening questionnaire were classified as having physician-diagnosed current asthma or current respiratory symptoms. Similarities in the risk factor profile and in the socioeconomic burden were considered suggestive of undiagnosed current asthma. Results: In Italy, the prevalence of physician-diagnosed current asthma was 4.9% (95% CI 4.4–5.4), while that of ‘asthma attacks and/or use of anti-asthmatic drugs in the past 12 months without a diagnosis of asthma’ (ADWD) was 1.5% (95% CI 1.3–1.7). Allergic rhinitis was highly associated with diagnosed current asthma [relative risk ratio (RRR) 12.48; 95% CI 9.12–17.07; reference category: neither asthma during lifetime nor current respiratory symptoms] and with ADWD (RRR 8.42; 95% CI 6.33–11.19). Chronic cough/phlegm was homogeneously associated with all the respiratory conditions, and the strongest relationship was with ADWD (RRR 7.79; 95% CI 4.95–12.25). Subjects with ADWD and diagnosed current asthmatics were characterised by high and homogeneous percentages of individuals who reported productivity losses (19.0 and 15.1%) and hospitalisations (9.2 and 6.2%) because of respiratory problems in the past year. Conclusions: The impact of current asthma seems to be largely underestimated among Italian adults, since the individuals with ADWD may be undiagnosed current asthmatics.
Evidence for Clinical Safety, Efficacy, and Parent and Physician Perceptions of Levocetirizine for the Treatment of Children with Allergic Disease
Authors: Pampura A.N. , Papadopoulos N.G. , Špičák V. , Kurzawa R.
Published: February 2011

Allergic rhinitis (AR) and chronic idiopathic urticaria (CIU) are highly burdensome diseases, which are increasing in prevalence, especially in the paediatric population. Despite the availability of a large number of medications for treatment of AR and CIU, their use in children has primarily been based on data obtained from a limited number of clinical trials in children and/or testing in adults. The H1-antihistamines have traditionally been used as first-line treatment for the relief of both AR and CIU symptoms in children. The first-generation H1-antihistamines are associated with marked adverse effects such as sedation, sleepiness/drowsiness as well as difficulties in learning and cognitive processing; thus, they are recommended for limited or discontinued use in children with AR or CIU. In contrast, second-generation H1-antihistamines are more adapted for the use in children with AR and CIU due to better safety profiles. However, only a limited number of trials with these agents have been conducted and generally, data from well-designed trials in children are lacking. Levocetirizine is one of the most extensively investigated H1-antihistamines for its pharmacologic properties, safety, efficacy as well as overall global satisfaction in children aged 2–12 years. Levocetirizine is the only H1-antihistamine launched in the 21st century shown to lack clinically relevant adverse effects on physical and psychomotor development or routine laboratory tests over a long-term period of 18 months in 1- to 3-year-old children predisposed to development of allergic disease. Available data suggest that levocetirizine is a suitable treatment option for AR and CIU in children aged 6 months to 12 years.
Leptin Has a Priming Effect on Eotaxin-Induced Human Eosinophil Chemotaxis
Authors: Kato Hikari , Ueki Shigeharu , Kamada Rie , Kihara Junko , Yamauchi Yumiko , Suzuki Tomomi , Takeda Masahide , Itoga Masamichi , Chihara Mami , Ito Wataru , Kayaba Hiroyuki , Chihara Junichi
Published: February 2011

Background: Tissue eosinophilia is one of the hallmarks of allergic diseases and Th2-type immune responses including asthma. Systemic inflammation caused by adipose tissue in obesity via production of adipokines such as leptin has been attracting attention recently as a contributor to exacerbation of allergic immune reactions. In this study, we examined whether leptin might affect eosinophil chemotactic responses. Methods: Peripheral blood eosinophils were purified, and the effect of leptin on eosinophil migration was investigated using in vitro systems. Results: High concentrations of leptin induced eosinophil chemotaxis and rapid phosphorylation of ERK1/2 and p38 mitogen-activated protein kinase but not calcium mobilization. We also found that pretreatment of eosinophils with physiological concentrations of leptin amplified the chemotactic responses to eotaxin. This leptin-primed chemotaxis appears to be associated with increased calcium mobilization but not with ERK1/2 and p38 pathways. Conclusions: These results indicate that leptin has both direct and indirect effects on eosinophil chemotaxis and intracellular signaling. In physiological settings, leptin may maintain eosinophil accumulation at allergic inflammatory foci.
Occurrence of Nonceliac Gluten Sensitivity in Patients with Allergic Disease
Authors: Massari S. , Liso M. , De Santis L. , Mazzei F. , Carlone A. , Mauro S. , Musca F. , Bozzetti M.P. , Minelli M.
Published: February 2011

Background: The aim of this study was to determine the occurrence of gluten sensitivity (GS) in a group of allergic patients and to assess the efficacy of a gluten-free diet (GFD) on the improvement of the symptomatology in those who were diagnosed with GS. Methods: 262 unrelated allergic patients with gastrointestinal symptoms of obscure origin were tested for GS condition by biopsy. All patients were also genotyped for the typical celiac DQ2 and DQ8 molecules and investigated for several hematological parameters such as antigliadin and antiendomysial antibodies. Patients displaying mucosal lesions were invited to follow a GFD. Results: Seventy-seven of the 262 allergic patients were positive to mucosal lesions, but negative to the antiAGA, antiEMA and to DQ2 and DQ8 molecules. We found, instead, a prevalence of the DQA1*05 allele, whereas anemia of inflammatory origin represented the predominant complaint in our subjects. The positive patients, who, after the GS diagnosis, followed a GFD, exhibited control of symptoms as well as stabilization of the hematological parameters even if allergic manifestations were not abated. Conclusions: A nonceliac gluten-sensitive enteropathy (NCGSE) commonly occurs in allergic patients. Based on the high prevalence of NCGSE in allergy, it is recommended that biopsy should be part of the routine investigation of allergic disease to offer the benefits of treatment with a GFD to the patients.
Possible Association of SLC22A2 Polymorphisms with Aspirin-Intolerant Asthma
Authors: Park Tae-Joon , Kim Jeong-Hyun , Bae Joon-Seol , Park Byung-Lae , Cheong Hyun Sub , Chun Ji-Yong , Lee Jin-Sol , Kim Jason Yongha , Pasaje Charisse Flerida , Cho Sang Heon , Uh Soo-Taek , Kim Mi-Kyeong , Choi Inseon S. , Koh In Song , Park Choon-Sik , Shin Hyoung Doo
Published: February 2011

Background: Aspirin-intolerant asthma (AIA) is a clinical syndrome characterized by acute bronchoconstriction following the ingestion of aspirin. Solute carrier family 22, member 2 (SLC22A2), also known as organic cation transporter 2 (OCT2), is predominantly expressed in the luminal membrane of airway epithelial cells and has been shown to mediate the transport of prostaglandins on the cyclooxygenase pathway which is regulated by aspirin blockage. Recently, SLC22A2-mediated uptake inhibition by several nonsteroidal anti-inflammatory drugs and decreased SLC22A2 transport activity by its genetic variants have been elucidated in asthma. Methods: To investigate the associations between AIA and genetic polymorphisms of the SLC22A2 gene, 18 variants were genotyped in 163 AIA subjects and 429 aspirin-tolerant asthma (ATA) controls. Logistic analyses were used to evaluate p values for the associations of SLC22A2 polymorphisms with AIA. Results: One common polymorphism in intron 5, i.e. rs316021, was significantly associated with susceptibility to AIA (p = 0.004, Pcorr = 0.05, OR = 0.60, 95% CI = 0.43–0.85 in a codominant model). The minor allele frequency of rs316021 in the AIA group was significantly lower than that in the ATA controls. In addition, a polymorphism in intron 4 (rs3912161) and a haplotype (SLC22A2-ht3) showed significantly stronger association signals with the FEV1 fall rate induced by aspirin provocation in AIA subjects compared with ATA controls (p = 0.004, Pcorr = 0.05). Conclusion: Our findings suggest that SLC22A2 could be a susceptibility gene for aspirin intolerance in asthmatics.
Evidence-Based Management of Nasal Polyposis by Intranasal Corticosteroids: From the Cause to the Clinic
Authors: Bachert Claus
Published: February 2011

Background: Nasal polyposis is an inflammatory disorder involving the mucosa of the nose and paranasal sinuses and affecting approximately 2–4% of the general population. Methods: A literature search of Medline and Embase was conducted to obtain an overview of the epidemiology, pathophysiology, and current treatment of nasal polyposis, focusing on evidence-based efficacy of intranasal corticosteroids (INSs) as primary and postoperative therapy. Recent research on INSs in nasal polyp treatment, along with notable historic findings, was reviewed. Results: Nasal polyps are mostly characterized by eosinophil infiltration, a complex inflammation of nasal mucosa, and possibly production of polyclonal IgE. Current treatment modalities include INSs, oral corticosteroids, and surgery; surgery is generally limited to those with an insufficient response to medical treatment. Because of their effects on eosinophil-dominated inflammation, INSs and oral corticosteroids are the primary medical treatment strategies. The very low (≤1%) systemic bioavailability of newer INSs minimizes the systemic adverse effects seen with oral corticosteroids. Conclusion:Based on randomized, controlled trials, guidelines recommend INSs as first-line therapy for nasal polyps and for care after polypectomy. Clinical data suggest INSs are effective in reducing polyp size and relieving nasal symptoms. INS treatment has also reduced nasal polyp recurrence in patients undergoing functional endoscopic sinus surgery. Treatment with these mainstay options has been found to improve quality of life, which, along with symptom improvement, is a key factor in disease treatment.
Sensitization to Horse Allergens in Italy: A Multicentre Study in Urban Atopic Subjects without Occupational Exposure
Authors: Liccardi G. , D’Amato G. , Antonicelli L. , Berra A. , Billeri L. , Canonica G.W. , Casino G. , Cecchi L. , Folletti I. , Gani F. , Lombardi C. , Lo Schiavo M. , Meriggi A. , Milanese M. , Passalacqua G. , Pio R. , Rolla G. , Russo M. , Scaccianoce S. , Senna G.E. , Scavalli P. , Scichilone N. , Sposato B. , Siracusa A. , Ventura M.T. ,   Allergy Study Group of the Italian Society of Respiratory Medicine (SIMeR)
Published: February 2011

Background: Horses play a significant role in people’s leisure time in Italy and other countries, but few data are available on IgE-mediated sensitization to horse allergens in patients without occupational exposure. We assessed, in a multicentric survey, the prevalence of horse sensitization in atopic subjects and its clinical characteristics. Methods: Allergists from the whole Italian territory were required to collect the results of skin prick tests from at least 100 consecutive subjects. Those patients with a positive skin test to horse dander underwent a detailed interview concerning clinical history, pet ownership and possible exposure. Results: Data from 3,235 outpatients were collected and 2,097 had at least 1 skin positivity. Among them, 113 (5.38%) were sensitized to horse dander (9 monosensitized). Thirty patients reported direct horse contact (4 owners and 26 for riding or occasional contact), 23 patients were sometimes in contact with horse owners and 60 subjects denied any direct or indirect exposure. Among 9 horse monosensitized patients, 6 had intermittent and mild rhinitis and 3 persistent moderate/severe rhinitis plus asthma. Three of them were horse owners or riders and the remaining had no contact with the animal. Conclusions: Our data evidence that the rate of sensitization to horse dander is not negligible and probably underestimated. In susceptible, not occupationally exposed individuals, horse contact, but also indirect or no apparent exposure, may induce sensitization. We recommend inclusion of horse allergen in the routine panel for the diagnosis of respiratory allergy.
Sensitization to Airborne Ascospores, Basidiospores, and Fungal Fragments in Allergic Rhinitis and Asthmatic Subjects in San Juan, Puerto Rico
Authors: Rivera-Mariani Félix E. , Nazario-Jiménez Sylvette , López-Malpica Fernando , Bolaños-Rosero Benjamín
Published: February 2011

Background: Fungal spores are the predominant biological particulate in the atmosphere of Puerto Rico, yet their potential as allergens has not been studied in subjects with respiratory allergies. The purpose of this study was to determine the level of sensitization of subjects with respiratory allergies to these particles. Methods: Serum samples were drawn from 33 subjects with asthma, allergic rhinitis, or nonallergic rhinitis and 2 controls with different skin prick test reactivity. An MK-3 sampler was used to collect air samples and the reactivity of the sera to fungal particles was detected with a halogen immunoassay. Results: All subjects reacted to at least 1 fungal particle. Thirty-one subjects reacted to ascospores, 29 to basidiospores, 19 to hyphae/fungal fragments, and 12 to mitospores. The median percentage of haloes in allergic rhinitis subjects was 4.82% while asthma or nonallergic rhinitis subjects had values of 1.09 and 0.39%, respectively. Subjects with skin prick tests positive to 3, 2, 1, or no extract had 5.24, 1.09, 1.61, and, 0.57% of haloed particles, respectively. If skin prick tests were positive to basidiomycetes, pollen, animals, or deuteromycetes, the percentages of haloes were 4.72, 4.15, 3.63, and 3.31%, respectively. Of all haloed particles, 46% were unidentified, 25% ascospores, 20% basidiospores, 7% hyphae/fungal fragments, and 2% mitospores. IgE levels and the number of positive skin prick test extracts correlated with the percentage of haloes. Conclusion: In tropical environments, sensitization to airborne basidiomycetes, ascomycetes, and fungal fragments seems to be more prevalent than sensitization to mitospores in subjects with active allergies, suggesting a possible role in exacerbations of respiratory allergies.