bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic inflammation in asthma: a contest of persistence vs resolution
Authors: Van Hove C. L. , Maes T. , Joos G. F. , Tournoy K. G.
Published: July 2008

Recent investigations have highlighted that endogenous anti‐inflammatory mediators and immune regulating mechanisms are important for the resolution of inflammatory processes. A disruption of these mechanisms can be causally related not only to the initiation of unnecessary inflammation, but also to the persistence of several chronic inflammatory diseases. In asthma, chronic Th‐2 driven eosinophilic inflammation of the airways is one of the central abnormalities. To date, elucidating the role of the different pro‐inflammatory mediators involved in orchestrating the inflammatory processes in asthma has been the subject of intense research in both humans and animal models. However, the counter‐regulatory mechanisms that co‐determine the outcome in the contest of resolution vs persistence of the eosinophilic airway inflammation remain poorly understood. These are currently being investigated in animal models of chronic asthma. Elucidating these mechanisms is of relevance, since it can give rise to a new therapeutic approach in the treatment of chronic airway inflammation in asthmatics. This novel concept of treatment involves the stimulation of endogenous anti‐inflammatory pathways, rather than solely antagonising the various pro‐inflammatory mediators. Here, we review and discuss the current knowledge about these endogenous anti‐inflammatory mediators in clinical and experimental asthma.
A new biological mesh for cut surface hemostasis in liver transplantation using technical variants
Authors: Lacanna Francesco , Brunati Andrea , Reding Raymond
Published: July 2008

Abstract:  The use of a novel biological mesh for surface hemostasis is described in pediatric liver transplantation with alternative techniques. The putative benefits of TachoSil® are discussed, particularly in the context of children with impaired coagulation, including fulminant hepatic failure.
Collecting duct carcinoma arising in association with BK nephropathy post‐transplantation in a pediatric patient. A case report with immunohistochemical and in situ hybridization study
Authors: Emerson Lyska L. , Carney Heather M. , Layfield Lester J. , Sherbotie Joseph R.
Published: July 2008

Abstract:  The development of malignancy in a renal transplant graft is an uncommon phenomenon. A renal neoplasm developing in the adult donor kidney of a pediatric transplant recipient has only rarely been reported. We report a case of collecting duct carcinoma arising in association with BK virus nephropathy in an adult living‐related donor renal allograft to a pediatric recipient. Our case is the second report of neoplasia occurring in association with BK virus nephropathy post‐transplantation, suggesting that BK virus may play a role in oncogenesis. It has been proposed that the T‐Ag protein encoded by the polyomavirus family of viruses disrupts chromosomal integrity, creating oncogenes, and inactivating tumor suppressor genes. In our study, immunohistochemical staining with antibody directed against BK virus large T antigen showed nuclear staining within urothelium, tubular epithelium, tubular intraepithelial neoplasia, and invasive carcinoma. In situ hybridization did not identify BK virus DNA within neoplastic cells. T‐Ag protein expression has been shown to be tumor‐specific in bladder, gastric, and colorectal cancers. The finding of T‐Ag protein expression in both intraepithelial and invasive neoplastic tissues in our case raises the possibility of BK virus as a causative agent in oncogenesis.
Long‐term psychosocial outcome after renal transplantation during childhood
Authors: Kärrfelt Helena M. E. , Berg Ulla B.
Published: July 2008

Abstract:  The aim of this study was to describe long‐term psychosocial outcome after renal transplantation during childhood. Sixty‐eight patients, having reached adulthood (>20 yr of age), were selected for the study. An invitation letter was sent to the patients asking them to participate in an interview performed by telephone and 42 (24 females) agreed. The age at the time of the interview was median 25.7 yr. The age at the transplantation was 1.4–20.5 yr. A total of 9.5% considered themselves as ill (three of four on dialysis), 24% as both ill and well and 67% as well. The school performance did not differ to a great extent from the general population. Fourteen percent were unemployed compared with 5.3% of the general population. Fourteen percent, all under 25 yr, lived with their parents, 52% had independent lodging and 33% were married or lived with a partner. Twenty‐five patients stated that they had felt anxiety or depressed at some time. However, when asking them to score their quality of life on a scale from 1 to 10, they scored median 8.0. Thus, the long‐term psycho‐social outcome after kidney transplantation during childhood seems to be quite good. Most of the interviewed seemed to have a good life according to themselves.
Psychosocial functioning of pediatric renal and liver transplant recipients
Authors: Wu Yelena P. , Aylward Brandon S. , Steele Ric G. , Maikranz Julie M. , Dreyer Meredith L.
Published: July 2008

Abstract:  The current study examined child‐ and parent‐reported child psychosocial functioning in a large sample of children who received solid organ transplantation. Participants included 64 children who received kidney or liver transplantation and 64 parents who completed a standardized measure of children’s psychosocial functioning (BASC; Reynolds & Kamphaus, 1992). Although post‐transplant children reported significantly fewer psychosocial difficulties than the normative average, parents reported that children had some psychosocial difficulties, particularly internalizing problems. There were no differences in psychosocial functioning between deceased donor organ and living donor organ recipients. Given the discrepancy between parent and child report, the results suggest that children may underreport psychosocial difficulties following transplantation or parents may over‐report children’s difficulties. Clinicians and researchers are encouraged to obtain assessment information from multiple reporters when assessing psychosocial functioning in this population.
Successful unrelated cord blood transplantation for chronic granulomatous disease: A case report and review of the literature
Authors: Mochizuki Kazuhiro , Kikuta Atsushi , Ito Masaki , Akaihata Mitsuko , Sano Hideki , Ohto Hitoshi , Hosoya Mitsuaki
Published: July 2008

Abstract:  CGD is a rare inherited immunodeficiency disorder that is caused by disability of oxidative killing. We presented a two‐yr‐old boy with CGD who was suffering from multiple systemic abscesses. He received the first BMT from his HLA‐haploidentical mother after conditioning with Flu, melphalan, and ATG. Although the maximum of 42% donor chimerism was achieved, it disappeared 73 days after the BMT. Then, we performed 5/6‐matched unrelated cord blood re‐transplantation after conditioning with Flu, Bu, and TBI (2 Gy). Engraftment and complete donor chimerism were achieved on days 18 and 19, respectively. The patient is now free from infection and maintains complete donor chimerism without GVHD 36 months after the cord blood re‐transplantation. We postulate that the unrelated CBT has a potential to be an alternative strategy and might be beneficial for patients with CGD who do not have an HLA‐identical donor.
Comparable outcomes of HLA‐matched unrelated and HLA‐identical sibling donor bone marrow transplantation for childhood acute myeloid leukemia in first remission
Authors: Lee Dae‐Hyoung , Kwon Young‐Joo , Lim Jihyang , Kim Yonggoo , Han Kyungja , Chung Nak‐Gyun , Jeong Dae‐Chul , Cho Bin , Kim Hack‐Ki
Published: July 2008

Abstract:  We retrospectively investigated the outcomes of HLA‐matched unrelated BMT (MU‐BMT, n = 13) and HLA‐identical sibling donor BMT (MS‐BMT, n = 17) for childhood AML in CR1 between June 2002 and August 2005. Engraftment of neutrophil and platelet did not differ between the two transplant groups. The cumulative incidence of grade II–IV acute GVHD and any chronic GVHD at three yr was not different between MS‐BMT and MU‐BMT. Of the 30 patients, four patients experienced relapses (three with MS‐BMT, one with MU‐BMT) and four patients died of transplant‐related complications (two with MS‐BMT, two with MU‐BMT). A total of 23 patients survived with a median follow‐up of 43.2 months. The Kaplan–Meier estimates for EFS rates at three yr were 71% and 77% for MS‐BMT and MU‐BMT, respectively, and the OS rates were 76% and 77% for MS‐BMT and MU‐BMT, respectively. The outcome of HLA‐matched unrelated BMT is comparable to that of HLA‐identical sibling BMT for childhood AML in CR1. HLA‐matched unrelated BMT may be recommended for patients who have AML in CR1 without an HLA‐matched sibling donor.
Primary cutaneous mucormycosis in a lung transplant recipient: case report and concise review of the literature
Authors: Page A.V. , Evans A.J. , Snell L. , Liles W.C.
Published: July 2008

Abstract: Mucormycosis (zygomycosis) is an invasive, opportunistic fungal infection caused by organisms of the class Zygomycetes. Immunocompromised individuals, including both solid organ and hematopoietic stem cell transplant recipients, are preferentially affected. Among solid organ transplant (SOT) recipients, the sinuses, with or without involvement of the orbits and cerebrum, are the most common sites of disease, although the pulmonary allograft appears to be targeted following lung transplantation. Here, we describe the unique case of a lung transplant recipient who developed multifocal cutaneous mucormycosis without involvement of the pulmonary allograft, and review the published literature regarding incidence, treatment, and prognosis of primary cutaneous mucormycosis following SOT.
Strengthening acceptance for xenotransplantation: the case of attraction effect
Authors: Rubaltelli Enrico , Burra Patrizia , Sartorato Valentina , Canova Daniele , Germani Giacomo , Tomat Silvia , Ancona Ermanno , Cozzi Emanuele , Rumiati Rino
Published: July 2008

Abstract:  Background:  Despite being still at the experimental level, xenotransplantation may become an effective strategy to overcome the scarcity of human organs. However, at the present time there is considerable resistance to this kind of biomedical technology. The aim of the present study was to identify novel strategies to reduce patients’ negative affective reactions towards xenotransplantation helping them to understand the advantages of xenotransplantation in a more analytical fashion and increase their acceptance for this approach.

Methods:  The study was conducted in a group of patients with liver cirrhosis waiting for liver transplantation. They were presented with hypothetical scenarios and asked to choose among either two or three alternative types of donor defined by their species (e.g., livers from humans vs. other species) and availability (low for human donors and high for livers from non‐human species).

Results:  Patients were unwilling to accept xenotransplantation if they were presented with livers from humans (chosen by 97.5% of participants) vs. livers from genetically modified pigs (2.5%). On the other hand, a different group of patients was significantly more willing to accept xenotransplantation if they were presented with three different types of donors: respectively, human beings (74.4%), genetically modified pigs (25.6%) and genetically modified dogs. In addition, human livers were judged significantly more attractive than genetically modified livers from pigs, monkeys, dogs, or sheep and pig livers were rated as significantly more attractive than livers from monkeys, dogs, or sheep (for all comparisons P < 0.01).

Conclusions:  These results demonstrate that paradigms from other fields, like decision‐making, might help to communicate more effectively the potential of xenotransplantation, modulating patients’ affective reactions and allowing them to understand the potential strengths of this biomedical technology.
Toward evolutionary graphs with two sexes: a kin selection analysis of a sex allocation problem
Authors: WILD GEOFF
Published: July 2008

Evolutionary graphs are used to model the effects of spatial and social structure in social evolutionary problems (e.g. evolutionary games). Recent work has highlighted the fact that evolution on graphs can be understood using kin selection theory. This paper shows how one can use kin selection to study evolutionary graphs inhabited by a diploid sexual organism by means of a simple example. Specifically, we study the well‐known sex allocation problem of how best to divide a fixed amount of effort between the production of sons on the one hand and the production of daughters on the other. Like many previous studies, we identify equal investment in sons and daughters as the only phenotype favoured by selection. Our analysis also highlights the advantages and disadvantages of applying kin selection to the study of evolutionary graphs.
Multiple parasites mediate balancing selection at two MHC class II genes in the fossorial water vole: insights from multivariate analyses and population genetics
Authors: TOLLENAERE C. , BRYJA J. , GALAN M. , CADET P. , DETER J. , CHAVAL Y. , BERTHIER K. , RIBAS SALVADOR A. , VOUTILAINEN L. , LAAKKONEN J. , HENTTONEN H. , COSSON J.‐F. , CHARBONNEL N.
Published: July 2008

We investigated the factors mediating selection acting on two MHC class II genes (DQA and DRB) in water vole (Arvicola scherman) natural populations in the French Jura Mountains. Population genetics showed significant homogeneity in allelic frequencies at the DQA1 locus as opposed to neutral markers (nine microsatellites), indicating balancing selection acting on this gene. Moreover, almost exhaustive screening for parasites, including gastrointestinal helminths, brain coccidia and antibodies against viruses responsible for zoonoses, was carried out. We applied a co‐inertia approach to the genetic and parasitological data sets to avoid statistical problems related to multiple testing. Two alleles, Arte‐DRB‐11 and Arte‐DRB‐15, displayed antagonistic associations with the nematode Trichuris arvicolae, revealing the potential parasite‐mediated selection acting on DRB locus. Selection mechanisms acting on the two MHC class II genes thus appeared different. Moreover, overdominance as balancing selection mechanism was showed highly unlikely in this system.
QTL mapping of inbreeding‐related cold sensitivity and conditional lethality in Drosophila melanogaster
Authors: VERMEULEN C. J. , BIJLSMA R. , LOESCHCKE V.
Published: July 2008

Inbreeding depression is a central theme within genetics, and is of specific interest for researchers within evolutionary and conservation genetics and animal and plant breeding. Inbreeding effects are thought to be caused by the joint expression of conditional and unconditional deleterious alleles. Whenever the expression of deleterious alleles is conditional, this can result in extreme environmental sensitivity in certain inbred lineages. Analysis of conditional lethal effects can reveal some of the loci that are sensitive to inbreeding. We performed a QTL (quantitative trait locus) mapping study of inbreeding‐related and conditionally expressed lethality in Drosophila melanogaster. The lethal effect was triggered by exposure to a cold shock. We used a North Carolina crossing Design 3 to establish the mapping population, as well as to estimate the average dominance ratio and heritability. We found two QTL on the major autosomes carrying recessive lethals that caused male mortality, one of which also affected female mortality. More detailed study of these loci will provide information on the mechanistic basis and environmental sensitivity of inbreeding depression.
The impact of parasite dispersal on antagonistic host–parasite coevolution
Authors: VOGWILL T. , FENTON A. , BROCKHURST M. A.
Published: July 2008

Coevolving populations of hosts and parasites are often subdivided into a set of patches connected by dispersal. Higher relative rates of parasite compared with host dispersal are expected to lead to parasite local adaptation. However, we know of no studies that have considered the implications of higher relative rates of parasite dispersal for other aspects of the coevolutionary process, such as the rate of coevolution and extent of evolutionary escalation of resistance and infectivity traits. We investigated the effect of phage dispersal on coevolution in experimental metapopulations of the bacterium Pseudomonas fluorescens SBW25 and its viral parasite, phage SBW25Φ2. Both the rate of coevolution and the breadth of evolved infectivity and resistance ranges peaked at intermediate rates of parasite dispersal. These results suggest that parasite dispersal can enhance the evolutionary potential of parasites through provision of novel genetic variation, but that high rates of parasite dispersal can impede the evolution of parasites by homogenizing genetic variation between patches, thereby constraining coevolution.
Synergistic effect of drought and chestnut blight (Cryphonectria parasitica) on growth decline of European chestnut (Castanea sativa)
Authors: Waldboth M. , Oberhuber W.
Published: July 2008

The chestnut blight fungus [Cryphonectria parasitica (Murill) Barr] has threatened European chestnut stands (Castanea sativa Mill.) in the 20th century, but infected trees recovered because of the appearance of hypovirulent strains. However, within a dry inner Alpine valley (Italy), blight‐infected C. sativa showing various degrees of crown dieback and dead trees were found. We conducted a dendroecological analysis to retrospectively evaluate a possible synergistic effect of blight infection in the early 1970s and climate stress on the growth decline of C. sativa. In the Eisack Valley (Italy), where annual precipitation is <700 mm, increment cores were taken from blight‐infected C. sativa (n = 103) showing different levels of decline symptoms, i.e. extent of crown dieback (healthy, moderate, severe), and from dead trees. Ring width and basal area increment (BAI) chronologies were developed based on dendroecological methods. Growth–climate relationships were explored using response function analysis and Pearson correlation coefficients. Major findings of our study were: (i) C. sativa growth is limited by low precipitation from December to February and high temperatures in June, (ii) BAI of all vitality classes except healthy trees shows a decreasing trend since 1980; and (iii) a severe drought in 1996 accelerated growth decline and caused death of infected C. sativa individuals. Because of the strong influence of climate on radial tree growth within the study area and observed divergent growth trends in selected vitality classes after infestation by hypovirulent C. parasitica strains in the early 1970s, we conclude that although blight infection is a prerequisite for observed growth declines, soil water availability in the years of drought strongly affects susceptibility to tree death.
Effects of Saccharomyces boulardii on cytokine secretion from intraepithelial lymphocytes infected by Escherichia coli and Candida albicans
Authors: Fidan Isil , Kalkanci Ayse , Yesilyurt Emine , Yalcin Burce , Erdal Berna , Kustimur Semra , Imir Turgut
Published: July 2008

Saccharomyces boulardii (S. boulardii) is a probiotic and used in the prevention or treatment of diarrhoea. Saccharomyces boulardii has many mechanisms to protect the host against diarrhoeal pathogens. It might modulate the immune system. In this study, the influence of S. boulardii on the secretion of cytokines from intraepithelial lymphocytes (IELs) infected with Escherichia coli (E. coli) and Candida albicans (C. albicans) was investigated in vitro. Cytokine levels were determined by enzyme‐linked immunosorbent assay. The secretion of proinflammatory cytokines such as interleukin (IL)‐1β was decreased in the infected IELs incubated with S. boulardii, but different from it, anti‐inflammatory cytokine levels such as IL‐4 and IL‐10, however, were found to be higher. These findings demonstrated that S. boulardii may have protective effects against diarrhoeal pathogens by reducing the proinflammatory response.
Isolation of Acremonium strictum from pleural fluid of a patient with colon adenocarcinoma
Authors: Nedret Koç Ayşe , Mutlu Sarigüzel Fatma , Artiş Tarık
Published: July 2008

Although Acremonium strictum is environmentally widespread as opportunistic fungus, it may cause infection in patients who have immunodeficiency. In this study, A. strictum were isolated from the pleural fluid of a patient with colon adenocarcinoma. The patient did not receive antifungal therapy because the patient died on the same day after the isolation of the mould from the pleural fluid. Major risk factors for the fungal infection are surgery because of cancer, administration of parenteral hyperalimentation and broad‐spectrum antibiotics, attaching chest tube and ventilation tube and hospitalization in intensive care unit. The minimal inhibitory concentrations (MICs) of amphotericin B, fluconazole, ketoconazole, itraconazole, voriconazole for the A. strictum strain isolated from pleural fluid were 0.125, 256, 2, 1.5 and 0.25 μg ml−1, respectively. In conclusion, bacteria and fungi, especially opportunistic fungi should be taken into consideration in the developing pleuritis in the patients with predisposing risks for the fungal infection.
Systemic therapy of paediatric atopic dermatitis: An update
Authors: Borchard Kate LA , Orchard David
Published: July 2008

Topical therapies are the mainstay in the treatment of atopic dermatitis, and are effective in the majority of patients with mild and localized disease. In patients with widespread or recalcitrant moderate to severe dermatitis, systemic therapies may be required. The frequently used systemic therapies are immunosuppressants, immune response modifiers, anti‐inflammatories, antihistamines, and antibiotics. In this article, the indications and scientific support for the use of these medications is reviewed.
Black heel, talon noir or calcaneal petechiae?
Authors: Urbina Francisco , León Lorena , Sudy Emilio
Published: July 2008

We describe a series of six patients with superficial cutaneous haemorrhages of the feet, including a classical case of black heel (talon noir) and other similar cases with diverse clinical presentations that do not match the typical description of that process. The main differences lay in production mechanism, morphology and location. The causes of these ‘atypical’ lesions were: burns with hot sand, friction against the rough edge of a swimming pool, wearing new shoes, jogging, or pricking a blister with a needle. Clinically, they consisted of isolated or multiple, small, large or linear, brown or black lesions located in areas that did not include the convex part of the heel, in which talon noir usually appears; on the contrary, the lesions affected the back third of the soles, the toes, periungual fold and plantar arch. As the presence of blood in the horny layer was a common final factor in all these cases, a better name for this process would be ‘post‐traumatic cutaneous intracorneal blood’ to describe black heel and its diverse clinical presentations.
Erythema induratum in a Kenyan child
Authors: Thoo Caroline HF , Graf Nicole , Hogan Peter
Published: July 2008

A 10‐year‐old Kenyan girl presented with a 9‐month history of a persistent, painful eruption of multiple, tender, non‐ulcerated, pigmented nodules involving the calves, shins and soles of the feet. She had recurring fevers particularly at night, lethargy, weight loss and a persistent non‐productive cough. The Mantoux test was positive. Chest X‐ray revealed mild peribronchial thickening in the hilar region but no evidence of hilar lymphadenopathy, consolidation and/or cavitation suggestive of tuberculosis. Sputum and gastric washings were negative for acid‐fast bacilli. Histology on a skin biopsy showed a granulomatous panniculitis with no histological evidence of Mycobacterium tuberculosis, consistent with erythema induratum. In view of her constitutional symptoms, chronic non‐productive cough and positive Mantoux test, she was diagnosed with pulmonary tuberculosis despite the non‐specific chest X‐ray and negative bacteriology. Anti‐tuberculous therapy was initiated with pyrazinamide, isoniazid and rifampicin for 2 months followed by dual therapy with isoniazid and rifampicin for a further 4 months. Her constitutional and respiratory symptoms and skin eruption cleared within 6 months with treatment.
Spontaneous resolution of facial papular mucinosis in a transplant patient
Authors: Braue Anna , Dolianitis Con , Varigos George
Published: July 2008

A 37‐year‐old male developed facial papules 6 months post renal–pancreatic transplant. Histological findings were consistent with localized papular mucinosis; electrophoresis showed no paraprotein. A trial of erbium and aura lasers, at ablative doses, produced no improvement. Independent treatments with oral doxycycline, itraconazole, acitretin, and isotretinoin also had no effect. The facial papules improved spontaneously, 2 years after first presentation and 8 months after treatment ceased. The patient remains clear of lesions.
Integrated Community Policy Uptake Model: Responding to select Manitoba and Saskatchewan rural women's experiences of health reform/renewal
Authors: Petrucka Pammla , Smith Donna Lynn
Published: July 2008

Objective:  To explore the impacts and implications of health reform/renewal for rural women in Saskatchewan and Manitoba, Canada.

Design:  The study was a multiple case study approach using mixed methods of focus groups, individual interviews, and trends/utilization analysis.

Setting:  Three rural communities – two in Saskatchewan; one in Manitoba.

Participants:  Rural women; non‐health providers.

Interventions:  None.

Outcome Measures:  None.

Results:  This paper presents a four phase Integrated Community Policy Uptake Model which is derived from the experiences of rural women during the operationalizing of health reform policy. The model depicts a four phase integration of the health reform or renewal policy; specifically, ‘Taking In’, ‘Taking On’, ‘Taking Over’, and ‘Taking Beyond’. The Integrated Community Policy Uptake Model is firmly rooted in the perceptions and opinions of rural women, and is informed by their understanding of health policy.

Conclusion:  The involvement of rural women in the policy process is necessary. The model proposed potentially encourages women to become more directly engaged in future health policy making and planning. There is also significant potential for this model to inform decision makers of the perceptions, needs, and solutions offered by stakeholders such as rural women.
Learning and being a first‐time student supervisor: Challenges and triumphs
Authors: Pereira Robert B.
Published: July 2008

The transitions made from a student to a practitioner can be daunting for recent graduates when they enter the ‘real world’ and apply theory, frames of reference and idealistic goal setting to achieve the best outcome for their clients experiencing dysfunction, disruption or disability. The exponential rate of learning that the recent graduate experiences is phenomenal and can either promote their development as innovative and prepared practitioners or lead towards an early career change or feelings of incompetence. Retention in the allied health professions is of upmost importance for the ongoing development of professional scholarship, reputation and continued responsibility to the community. This is especially true for those working, or considering to work in regional, rural and remote areas where there is an ever‐growing need for flexible, resourceful and culturally sensitive health professionals.
Long‐term outcome of endoscopic semiconductive diode laser irradiation therapy with injection of indocyanine green for early gastric cancer
Authors: Kawaguchi Atsushi , Nagao Shigeaki , Takebayashi Koichi , Higashiyama Masaaki , Komoto Shunsuke , Hokari Ryota , Miura Soichiro
Published: July 2008

Background and Aim:  Semiconductive laser irradiation has been used to treat early gastric cancer. However, the long‐term follow up results have not been reported. The objective of the present study was to assess retrospectively the clinical usefulness of diode laser irradiation for early gastric cancer.

Methods:  The subjects of this study were 13 patients (14 lesions) selected from 125 patients with early gastric cancer who were treated by endoscopy during the period from September 1995 to February 2003. The macroscopic tumor type was superficial type, including eight lesions of 0′–IIc and six lesions of 0′–IIa. Histological diagnoses were eight cases (nine lesions) of well‐differentiated adenocarcinoma, three cases of moderately differentiated adenocarcinoma and two cases of poorly differentiated adenocarcinoma. After injection with indocyanine green solution (1 mg/mL) into the submucosal layer, a semiconductive diode laser (30–40 W/s) was irradiated by the non‐contacting method.

Results:  The total amount of laser irradiation for 14 lesions was 9568.80 ± 7197.01 J on average. There was no major complication. In the period up to December 2007, six patients survived and seven patients died. However, no‐one died of progression of gastric cancer. The mean survival times of all patients, survivors and patients who died were 5 years 2.8 months; 6 years 4.5 months; and 4 years 11.7 months, respectively.

Conclusions:  Early gastric cancer can be successfully treated by laser therapy with few complications and good prognosis. This method is expected to be most suitable and effective for elderly patients with serious underlying disease.
Tendon sheath abscess and severe carbamazepine hypersensitivity
Authors: Khatami Ameneh , Singh‐Grewal Davinder , Kilham Henry
Published: July 2008

Abstract:  We report a 10‐year‐old girl with enthesitis and Staphylococcus aureus tendon sheath abscess as complications of severe carbamazepine hypersensitivity. Our patient had an adverse reaction to intravenous immunoglobulin and this, as well as the use of corticosteroids, may have contributed to her condition.
Anterior spinal cord infarction caused by fibrocartilaginous embolism
Authors: Piao Yue‐Shan , Lu De‐Hong , Su Ying‐Ying , Yang Xiao‐Ping
Published: July 2008

Fibrocartilaginous embolism is a rare cause of anterior spinal cord infarction. We report a case of anterior spinal cord infarction caused by a fibrocartilaginous embolism of 3 months duration in a 23‐year‐old man. Ten days after a trivial strike to the neck and back, he had sudden back pain, weakness of the upper and lower extremities, developed dyspnea and became unconscious. Cervical MRI showed an enlargement of the lower medulla and cervical cord with abnormal signals in the ventral portion. The follow‐up MRI performed 2 months later showed atrophy of the above lesion. On histopathological examination, there was a recent, extensive infarct in the cervical cord and lower medulla. The lesion was symmetrical, and predominantly involved the anterior part of the spinal cord. Moreover, many basophilic, alcian blue‐positive emboli in the arteries and veins of the lesion were detected. This is the first autopsy case of anterior spinal cord infarction caused by a fibrocartilaginous embolism that has been confirmed in China. The clinicopathological features of this case are reviewed in this paper.
Peripheral nervous system pathology in fragile X tremor/ataxia syndrome (FXTAS)
Authors: Gokden Murat , Al‐Hinti Jomana T. , Harik Sami I.
Published: July 2008

Fragile X tremor/ataxia syndrome (FXTAS) occurs in individuals with moderate CGG expansion of the fragile X mental retardation 1 (FMR1) gene and is associated with intranuclear inclusions in neurons and astrocytes. Although the neuropathologic findings in the brain and spinal cord were described, pathological features in the peripheral nervous system were not reported. Here, we report on novel neuropathological findings in the peripheral nervous system and especially in autonomic ganglia at autopsy in a man with FXTAS. In addition to the characteristic brain and spinal cord findings, typical intranuclear inclusions were identified in the ganglion cells of adrenal medulla, dorsal root ganglia, paraspinal sympathetic ganglia, myenteric ganglia of the stomach and subepicardial autonomic ganglion of the heart. Our findings indicate that FXTAS diffusely involves the central and peripheral nervous systems, which explains the protean neurological symptoms ranging from dementia to dysautonomia.
Psychological status of patients with mucopolysaccharidosis type II and their parents
Authors: Kuratsubo Izumi , Suzuki Yasuyuki , Orii Koji O. , Kato Tomomi , Orii Tadao , Kondo Naomi
Published: July 2008

Background:  The aim of the present study was to delineate the psychological status of 10 patients with the attenuated phenotype of mucopolysaccharidosis type II (MPS‐II) and their parents (six fathers and five mothers) for the improvement of clinical management.

Methods:  Intellectual ability was evaluated using the Wechsler Intelligence Scale. Activities of daily living (ADL) was assessed using the Functional Independence Measure. The personality and psychiatric aspects were analyzed using the Yatabe–Guilford Personality test (Y‐G test) and the Tree‐Drawing Test. Mental health was assessed using the General Health Questionnaire 60 (GHQ‐60) and State–Trait Anxiety Inventory (STAI).

Results:  Intellectual background, measured with full‐scale, verbal and performance IQ, were 72.8, 76.1 and 79.3, respectively. Nine of 10 patients were not judged as having neurosis and a psychotic tendency with the Y‐G test. In the tree‐drawing test, many patients drew a tree without ground, suggesting that they have difficulties in making relationships with surrounding people and the community. The child patient with a psychosis pattern on the Y‐G test, drew a bizarre tree, suggesting psychological problems. GHQ‐60 and STAI survey indicated that the patients and their parents had higher levels of anxiety. A significant negative correlation between GHQ‐60 score and ADL (R = −0.77) was identified, suggesting that the psychological status may worsen as ADL decreases.

Conclusions:  Patients with MPS‐II and their parents had higher risks for mental problems. Understanding psychological status is essential when providing genetic counseling or therapeutic intervention.
Cardiac output and blood volume parameters using femoral arterial thermodilution
Authors: López‐Herce Jesús , Bustinza Amaya , Sancho Luis , Mencía Santiago , Carrillo Angel , Moral Ramón , Bellón Jose María
Published: July 2008

Background:  The pulse‐induced continuous cardiac output (PiCCO) system is a less invasive method than pulmonary thermodilution for the measurement of cardiac output and estimating blood volume parameters. The normal values in children have not been defined. The purpose of the present paper was therefore to evaluate cardiac output and parameters of blood volume using femoral arterial thermodilution in critically ill children.

Methods:  A prospective study was performed in 17 critically ill children aged between 2 months and 14 years. Two measurements were taken for each determination of cardiac output, global end diastolic volume (GEDVI), intrathoracic blood volume index (ITBI), extravascular lung water index (ELWI), systolic volume index (SVI), stroke volume variation (SVV), cardiac function index (CFI), left ventricular contractility (dp/dt max), and the systemic vascular resistance index (SVRI).

Results:  One hundred and seventeen measurements were performed. The mean cardiac index (CI) was 3.5 ± 1.3 L/min per m2. The GEDVI (399.7 ± 349.1 mL/m2), ITBI (574.5 ± 212.2 mL/m2) and dp/dt max (804.6 ± 372.1 mmHg/s) were lower than reported in adults, whereas ELWI (18.9 ± 9.3 mL/m2) and CFI (8 ± 2.5 L/min) where higher. The GEDVI, SVI, dp/dt max and CI increased with the weight of the patients whereas the ELWI values decreased.

Conclusions:  Femoral arterial thermodilution is a suitable technique for the measurement of cardiac output in critically ill children. The intrathoracic and intracardiac volumes are lower than in adults, whereas extrapulmonary water is higher; these values are related to the weight of the patient.
Nitric oxide synthase gene polymorphisms in children with minimal change nephrotic syndrome
Authors: Alasehirli Belgin , Balat Ayse , Barlas Omer , Kont Aylin
Published: July 2008

Aims:  Nitric oxide (NO) attenuates many functions within the kidney, and all NO synthase (NOS) isoforms are constitutively expressed in the kidney. But the exact role of NO in renal diseases is still debatable. The aim of the present study was to investigate endothelial (eNOS), and neuronal (nNOS) NOS gene polymorphisms in children with minimal change nephrotic syndrome (MCNS).

Materials and methods:  Eighty‐six Turkish children with clinical MCNS, ranging in age from 2 to 10 years, were compared with 114 healthy age‐ and sex‐matched controls. The glu 298 Asp (G/T) polymorphism of the eNOS, and C276T (C/T) polymorphism of nNOS genes were genotyped using polymerase chain reaction.

Results:  The distribution of GG, TG, and TT genotypes for eNOS was 52%, 33% and 15% in MCNS compared with 61%, 26% and 13% in the controls (P > 0.05). The distribution of CC, TC, and TT genotypes for nNOS was 16%, 66% and 18% in MCNS compared with 10%, 43% and 47% in the controls. TT genotype distribution of nNOS was found to be lower in patients (P = 0.003). The eNOS and nNOS gene polymorphisms were not associated with gender, positive family history, frequency of relapses, or response to steroid.

Conclusions:  The present study is the first to investigate eNOS and nNOS gene polymorphisms in children with MCNS. The nNOS gene polymorphism may be associated with MCNS in children, but further studies in a larger population with different glomerular diseases are needed to confirm the results.
Autonomic function in patients with Duchenne muscular dystrophy
Authors: Inoue Miki , Mori Kazuhiro , Hayabuchi Yasunobu , Tatara Katsunori , Kagami Shoji
Published: July 2008

Background:  Assessing autonomic function is important for patients with chronic heart failure, but the way that autonomic function changes in patients with Duchenne muscular dystrophy (DMD) and correlates with other clinical parameters during their young age is not clearly known.

Methods:  Heart rate variability (HRV) during ambulatory electrocardiogram (ECG) was performed in 57 DMD patients (130 recordings) who were not receiving medication (mean age 15.3 ± 4.5 years). The data were compared with the serum levels of brain natriuretic peptide (BNP), the shortening fraction (SF) of the left ventricle on echocardiography, and simple parameters of heart rate from 24 h ambulatory ECG.

Results:  Among four parameters of HRV measurements (high frequency [HF]; percentage of adjacent normal R‐R intervals that were >50 ms different for the entire 24 h recording [%RR50]; ratio of low to high frequency [LF/HF]; and standard deviation for all normal R‐R intervals for the entire 24 h recording [SDNN]), SDNN was most frequently abnormal. Even when SF was normal, a significant percentage of patients exhibited, abnormal parasympathetic activity (HF, %RR50: 74%, 78%, respectively), sympathetic activity (LF/HF, 43%), and SDNN (96%). Similarly, even if serum BNP levels were normal, 86%, 89%, 59%, and 97% of the patients displayed abnormal autonomic function on these measurements, respectively. Mean heart rate at night most accurately predicted abnormality of SDNN. When the cut‐off point for mean heart rate at night was 71 beats/min, the sensitivity and specificity of this parameter for predicting abnormal SDNN was 94% and 85%, respectively (P < 0.0001).

Conclusion:  In DMD, autonomic function, especially SDNN, was frequently abnormal, although conventional clinical examinations of cardiac function (BNP levels and SF) were normal. It is proposed that mean heart rate during night could be used as a simple measurement for evaluation of autonomic function.
Association between white blood cell count and components of metabolic syndrome
Authors: Wu Chung‐Ze , Lin Jiunn D. , Li Jer‐Chuan , Kuo Shi‐Wen , Hsieh Chang‐Hsun , Lian Wei‐Chen , Lee Chien‐Hsing , Wan Hsiang‐Lin , Hung Yi‐Jen , Pei Dee
Published: July 2008

Background:  Components of metabolic syndrome (MetS) were found to be associated with several inflammatory factors including white blood cell count (WBCC), which is an easily available test in clinical practice. In the present study, the relationships between WBCC and MetS components were investigated in children.

Methods:  A total of 288 Taiwanese children, under 10 years old, with normal WBCC, were enrolled in the study. They were divided into quartiles according to WBCC (lowest, WBCC1; highest, WBCC4). The mean values of each MetS component for every group were compared in boys and girls separately. Multivariate linear regression between the WBCC and the MetS components after adjusting for age and body mass index (BMI) were also evaluated.

Results:  In group comparison, only the high‐density lipoprotein‐cholesterol (HDL‐C) was found to be significantly lower in WBCC4 in boys. Other components were not different. After multivariate linear regression, WBCC was negatively correlated to HDL‐C and positively to BMI in boys. Although not significant, similar relationships were also observed in girls. Interestingly, borderline positive correlation was noted between triglyceride (TG) and WBCC in girls.

Conclusion:  BMI was positively and HDL‐C was negatively related to WBCC in boys. A similar trend could also be observed in girls but without significance. Borderline significant correlation between TG and WBCC was noted in girls. These findings suggest that cardiovascular risks might commence even in childhood. Early detection of children with these abnormalities may help to prevent cardiovascular disease and diabetes in adolescence or even adulthood.
Test performance of two‐question screening for postpartum depressive symptoms
Authors: Mishina Hiroki , Hayashino Yasuaki , Fukuhara Shunichi
Published: July 2008

Background:  The Edinburgh Postnatal Depression Scale (EPDS) is commonly used to screen for postpartum depression, but it is difficult to consistently administer it to all mothers during busy well‐child visits owing to the fact that it is time‐consuming. The purpose of the present paper was to evaluate the performance of a concise, two‐question screening tool in the detection of mothers with postpartum depressive symptoms who had a high EPDS score.

Methods:  The study involved 103 mothers attending a single hospital for 1 month well‐child visits. The primary outcome measure was the detection of mothers with postpartum depressive symptoms, using the EPDS score as the reference standard. Visiting mothers were asked to complete both the EPDS questionnaire and a two‐question questionnaire covering depressive mood and anhedonia while in the hospital waiting room. The sensitivity, specificity, predictive value, and likelihood ratio of the two‐question instrument was evaluated using the EPDS as standard.

Results:  Taking EPDS as standard, sensitivity of the two‐question instrument was 88% (95% confidence interval [CI]: 64−99%), specificity was 76% (95%CI: 65−84%), positive predictive value was 42% (95%CI: 26−59%), and negative predictive value was 97% (95%CI: 90−100%). The stratified likelihood ratios of each of the two‐question instrument test scores 0, 1, and 2 were 0.2 (95%CI: 0.04−0.6), 3.4 (95%CI: 1.8−6.2) and 4.2 (95%CI: 1.5−12.3), respectively.

Conclusions:  With the cut‐off point set at 1, the two‐question instrument had high sensitivity in detecting postpartum depressive symptoms at 1 month well‐child visits. In primary care setting, negative result with the two‐question instrument may be a good indicator of no need for further evaluation for postpartum depression.
Introduction to the updated Australian and New Zealand consensus guidelines for the use of antifungal agents in the haematology/oncology setting, 2008
Authors: Slavin M. A.
Published: July 2008

The process for development of these consensus Australasian antifungal guidelines for use in adult patients with haematological malignancy is described. New features included, how the guidelines should be applied, the risk assessment tool used and the grading system for evidence and strength of recommendation are discussed.
Continuing medical education in pediatric anesthesia – a theoretical overview
Authors: TURNER NIGEL MCBETH
Published: July 2008

The importance of continuing medical education (CME) as a method of improving the quality of care of children undergoing anesthesia is universally recognized. This article, which is based on a presentation at the FEAPA European Conference on Paediatric Anaesthesia in September 2007 in Amsterdam, gives a theoretical overview of continuing education and introduces some generic educational concepts, such as the CRISIS‐criteria and Kirkpatrick’s evaluation model, which are as relevant to pediatric anesthesia as to other areas of medical practice. The terms CME and continuing professional develop are described. Some consideration is given to how anesthesiologists can assess the potential worth of an educational activity for their practice. No attempt will be made to judge particular educational activities, as the choice of the most appropriate activity rests primarily with the individual.
Do patients require outpatient follow‐up after rapid referral double contrast barium enema?
Authors: Odofin O. , Alexander R. , Bowers H. , Chave H. , Branagan G.
Published: July 2008

Introduction  In our hospital, patients above the age of 40 years referred with a change in bowel habit without rectal bleeding undergo a double contrast barium enema (DCBE) ideally within 2 weeks. Results of benign studies are sent to a consultant colorectal surgeon and a routine clinic visit arranged. The aim of this study was to identify whether, following DCBE, patients (i) presented at a later date with colorectal cancer and (ii) needed assessment in clinic.

Method  This is a review looking at all patients who underwent DCBE prior to routine clinic visit between January 2004 and December 2005. Hospital databases were cross‐referenced to identify any patients presenting with a new diagnosis of colorectal malignancy between DCBE and April 2007. Clinic letters were reviewed to identify the number of outpatient visits prior to discharge and reasons for continued follow‐up.

Results  During the study period, 521 patients (age range 31–93 years, 316 female) had DCBE prior to assessment in clinic. Diagnoses: cancer 48 (9.2%), polyps 13 (2.5%), colitis 3 (0.6%), no significant pathology 457 (87.7%). Of this latter cohort, 387 (84.7%) were discharged after one clinic visit; 54 (11.9%) attended twice and 11 (2.4%) were seen more than twice. Reasons for multiple attendances were management of haemorrhoids/anal fissure or investigations of unrelated symptoms. No new cancers were identified in this cohort between January 2004 and April 2007.

Conclusion  Double contrast barium enema is a safe screening tool following a ‘2‐week rule’ referral with CIBH. Following a report of no significant pathology, there is no need to arrange routine follow‐up.