bluuebunny/crossref_metadata_2025 huggingface dataset:
Bilateral testicular metastases from prostatic carcinoma
Authors: MANIKANDAN RAMASWAMY , NATHANIEL CALVIN , REEVE NORMAN , BROUGH RICHARD J
Published: May 2006

Abstract  Testicular metastasis from carcinoma of the prostate is rare. We report a case of carcinoma of the prostate with bilateral testicular metastases 7 years after the initial diagnosis. The exact prognosis is not known but it usually indicates advanced disease. Although testicular metastasis is uncommon, it should be considered when a patient presents with a lump in the testis, particularly in a patient known to have another primary malignancy.
Primary retroperitoneal lymphocele in a pregnant woman: The first report
Authors: IKEDA TETSUHIRO , MIYAUCHI YUUKI , NISHIO SHUNJI , SHIMAMOTO KENJI , TANJI NOZOMU , YOKOYAMA MASAYOSHI
Published: May 2006

Abstract  In a 32‐year‐old pregnant woman, routine ultrasonography revealed right hydronephrosis and a huge retroperitoneal mass (20 × 7 cm) containing a fluid collection. Percutaneous drainage of the mass was performed and 2 L of clear, yellowish fluid was collected. Four months following the delivery, a recurrent retroperitoneal lymphocele was identified. Six months after the delivery, laparoscopic marsupialization was performed through a 10‐mm umbilical camera port and two 5‐mm ports on the right side of the abdomen. A posterior peritoneal window was established by creating a wide opening in the anterior wall of the lymphocele. Subsequent ultrasonography did not indicate a recurrence of the lymphocele or right hydronephrosis over a follow‐up period of 8 months.
Prolapse of a simple ureterocele presenting as a vulval mass in a woman
Authors: SEN ILKER , ONARAN METIN , TOKGOZ HUSNU , TAN MUSTAFA OZGUR , BIRI HASAN , BOZKIRLI IBRAHIM
Published: May 2006

Abstract  A 48‐year‐old woman presented with a large vulval mass after prolapse of a ureterocele. Her past excretory urogram showed a filling defect (cobra head appearance) in the bladder related to a single‐system ureterocele on the left. The mass was manually reduced back through to the urethra under sedation and a urethral catheter was inserted. The anterior wall of the ureterocele was resected transurethrally for definitive treatment.
Plasmacytoid urothelial carcinoma of the bladder
Authors: KOHNO TAKUROU , KITAMURA MASAYA , AKAI HIDEYUKI , TAKAHA MINATO , KAWAHARA KUNIMITSU , OKA TOSHITUGU
Published: May 2006

Abstract  We report the first case of a pathological complete response for plasmacytoid urothelial carcinoma of the bladder. A 76‐year‐old man was diagnosed with plasmacytoid urothelial carcinoma (T4, N0, M0) by the microscopically plasmacytoid appearance of the specimen from the transurethral resection. Immunohistochemical studies were positive for epithelial markers and negative for lymphoid markers. Two cycles of systemic chemotherapy were performed with methotrexate, etoposide, vinblastine, and cisplatin, followed by radical cystectomy. The pathological examination revealed no residual cancer cells in the resected specimen.
Early results of a new open surgical technique for treatment of uretero‐pelvic junction obstruction
Authors: SHAKERI SAEED , SALEHI‐POUR MEHDI , YARMOHAMMADI HOOMAN , PARVIZI ALI‐REZA
Published: May 2006

Objective:  Here we report our initial experience with a new open surgical technique for treating uretero‐pelvic junction obstruction (UPJO).

Methods:  One centimeter distal to the site of the uretero‐pelvic junction (UPJ) stenosis, a longitudinal incision of about 15 mm was made over the lateral side of the ureter. The renal pelvis was evacuated. Simultaneously, an oblique incision was made over the posterior and anterior walls of the renal pelvis. The most dependent point over the renal pelvis was sutured to the distal end of the ureterotomy incision. The anterior edge of the pyelotomy incision was anastomosed to the anterior edge of the ureterotomy incision and the posterior edge was anastomosed to the posterior edge of the ureterotomy incision. When the pyeloplasty was completed, the UPJ, accompanied by the proximal 1 cm of the ureter and excessive parts of the renal pelvis, was excised.

Results:  In 21 (92%) out of 23 patients, the surgical technique was successful.

Conclusions:  This technique results in predictably good outcomes and has the advantages of the dismembered method. It seems to be a valuable alternative treatment for UPJO.
Priming of indirect defences
Authors: Heil Martin , Kost Christian
Published: May 2006

Leaf damage induces in many plant species the secretion of extrafloral nectar (EFN) and/or the release of specific odours (volatile organic compounds, VOCs). Both traits attract carnivorous arthropods and function as indirect plant defences by increasing the predation pressure on attacking herbivores. We have conducted field experiments in Mexico and found that plants that had been exposed to VOCs thereafter responded to subsequent leaf damage with an increased EFN secretion. VOCs ‘primed’ the plants to respond more efficiently once they were attacked themselves. Such priming effects are well known for induced resistance to pathogens, yet this is the first description of VOCs priming EFN secretion, a taxonomically widespread anti‐herbivore defence. Plants can use chemical signals in their environment to assess the risk of herbivory and make use of this information to adjust their own defensive strategy accordingly.
Convalescence after colonic surgery with fast‐track vs conventional care
Authors: Jakobsen D. H. , Sonne E. , Andreasen J. , Kehlet H.
Published: May 2006

Objective  To compare convalescence after colonic surgery with a fast‐track rehabilitation programme vs conventional care.

Background  Introduction of a multimodal rehabilitation programme (fast‐track) with focus on epidural anaesthesia, minimal invasive surgical techniques, optimal pain control, and early nutrition and mobilization together with detailed patient information have led to a shorter hospital stay after colonic surgery. There are not much data on convalescence after discharge.

Methods  A prospective, controlled, non‐randomized interview‐based assessment in 160 patients undergoing an elective, uncomplicated, open colonic resection or the Hartmann reversal procedure with a fast‐track or a conventional care programme in two university hospitals. A structured interview‐based assessment was performed preoperatively, and day 14 and 30 postoperatively.

Results  Patients undergoing colonic surgery with a fast‐track programme regained functional capabilities earlier with less fatigue and need for sleep compared with patients having conventional care. Despite early discharge of the fast‐track patients (mean 3.4 days vs 7.5 days), no differences were found according to the need for home care, social care and visit to general practitioners, although the fast‐track group had an increased number of visits at the outpatient clinic for wound care. More patients in the fast‐track group were re‐admitted, but the overall mean total hospital stay was 4.2 days vs 8.3 days in the conventional group.

Conclusion  A fast‐track rehabillitation programme led to a shorter hospital stay, less fatigue and earlier resumption of normal activities, without the increased need for support after discharge compared with conventionally treated patients after uncomplicated colonic resection.
Reported symptoms, diagnostic delay and stage of colorectal cancer: a population‐based study in Denmark
Authors: Korsgaard M. , Pedersen L. , Sørensen H. T. , Laurberg S.
Published: May 2006

Objective  The primary prognostic factor for colorectal cancer (CRC) is stage. Any association between symptoms, diagnostic delay and stage may have implications for the clinical course of the disease. We examined the association between symptoms and diagnostic delay and between symptoms and stage, and assessed whether the associations differed for colon cancer (CC) and rectal cancer (RC).

Patients and methods  Population‐based prospective observational study based on 733 Danish CRC patients. Diagnostic delay and patients’ reported symptoms were determined through questionnaire–interviews. Dukes’ stage was obtained from medical records and pathology forms. Diagnostic delay was categorized into three delay groups: ≤ 60, 61–150 and > 150 days. Stage was classified into nonadvanced (Dukes’ A and B) or advanced (Dukes’ C and D) cancers. We calculated the frequency of the most frequently reported initial symptom or symptom complex for CC and RC patients, and evaluated the frequency of patients with different initial symptoms/symptom complexes in the three delay groups. For the most frequent initial symptoms/symptom complexes, we calculated the frequencies according to stage, and estimated the relative risk of having an advanced stage, with 95% confidence intervals.

Results  The most frequent initial symptoms/symptom complexes were very vague symptoms for CC and rectal bleeding for RC. For both CC and RC, rectal bleeding was significantly associated with nonadvanced stage. The relative risk of having an advanced cancer was 0.6 for monosymptomatic rectal bleeding and 0.7 for rectal bleeding combined with other symptoms.

Conclusions  Initial symptoms of CC were often very vague, making it difficult to identify a precise start date. The most frequent initial symptom/symptom complex for RC – rectal bleeding – was better defined. Rectal bleeding was significantly associated with nonadvanced CC and RC and a significantly decreased relative risk of having an advanced cancer.
Investigation of stimulus position in the production of the strength duration curve of the external anal sphincter muscle in women with anorectal dysfunction
Authors: Telford K. J. , Grey B. R. , MacKenzie N. , Hosker G. L. , Kiff E. S.
Published: May 2006

Objective  The strength duration test (SDT) is a minimally invasive test of the innervation of a muscle and has been successfully adapted for use on the external anal sphincter (EAS). The SDT has previously been performed on the EAS placing a stimulating probe in the 3 o'clock position. The aim of this study was to determine whether there was any variation in the strength duration curves (SDC) produced at different positions around the EAS.

Patients and methods  Thirty‐one patients with anorectal dysfunction attended our Institution for Anorectal Physiology Studies and were recruited to the study. After undergoing anal manometry, pudendal nerve terminal motor latency measurement and endoanal ultrasonography, the SDT was performed in four stimulus positions (3, 6, 9 and 12 o'clock). The sequence of positions was randomly selected.

Results  Four SDCs were obtained successfully in 25 patients. There was no significant difference seen between the four positions at the longer current durations (1–100 ms). Significant differences occurred at the shortest current durations (0.3 and 0.1 ms) when comparing adjacent stimulus positions except between the 6 and 9 o'clock positions, which were comparable. When opposing positions were compared (3–9 and 6–12 o'clock) at these short durations no significant difference was found.

Conclusion  There was no significant difference between the SDC produced at 3 and 9 o'clock. These positions closely correspond to where the pudendal nerves enter the EAS. It therefore appears acceptable to perform the SDT in either of these positions, though 3 o'clock remains our preferred position.
Diagnostic utility of brain‐natriuretic peptide for left ventricular diastolic dysfunction in asymptomatic type 2 diabetic patients
Authors: Shimabukuro M. , Higa N. , Oshiro Y. , Asahi T. , Takasu N.
Published: May 2006

Aim:  Left ventricular (LV) diastolic dysfunction has been reported to be prevalent in diabetic subjects, but this recognition could often be missed. We evaluated prevalence of LV diastolic dysfunction and diagnostic utility of brain‐natriuretic peptide (BNP) in asymptomatic patients with type 2 diabetes mellitus.

Research design and methods:  Plasma BNP levels and LV geometry and diastolic filling indices, including the ratio of peak early transmitral Doppler flow (E) over flow propagation velocity (Vp) measured by colour M‐mode Doppler echocardiography, were analysed in 98 consecutive asymptomatic patients with type 2 diabetes mellitus and 51 age‐matched controls.

Results:  The LV mass index and relative wall thickness were higher in diabetic groups than controls without any differences in LV systolic function. The frequency of diastolic dysfunction defined as E/Vp ≥ 1.5 were 31% in diabetic groups and 15% in controls (χ2 = 4.364, p = 0.037). By receiver‐operating characteristic (ROC) curve analysis, a BNP cutoff value of 19.2 pg/ml in controls had a 53.1% positive predictive value (53.1%) and a high negative predictive value (94.4%) for E/Vp ≥ 1.5, whereas a BNP cutoff value of 18.1 pg/ml in diabetic groups had a 61.8% positive and 97.3% negative predictive values.

Conclusions:  The frequency of E/Vp ≥ 1.5 was higher in asymptomatic diabetic patients, suggesting that LV diastolic dysfunction was prevalent. The plasma concentration of BNP could be used to depict LV diastolic dysfunction in such population.
Thermogenic and metabolic antiobesity drugs: rationale and opportunities
Authors: Clapham J. C. , Arch J. R. S.
Published: May 2006

Antiobesity drugs that target peripheral metabolism may avoid some of the problems that have been encountered with centrally acting anorectic drugs. Moreover, if they cause weight loss by increasing fat oxidation, they not only address a cause of obesity but also should promote loss of fat rather than lean tissue and improve insulin sensitivity. Weight loss may be slow but more sustained than with anorectic drugs, and thermogenesis may be insufficient to cause any discomfort. Some thermogenic approaches are the activation of adrenergic, thyroid hormone or growth hormone receptors and the inhibition of glucocorticoid receptors; the modulation of transcription factors [e.g. peroxisome proliferator‐activated receptor δ (PPARδ) activators] or enzymes [e.g. glutamine fructose‐6‐phosphate amidotransferase (GFAT) inhibitors] that promote mitochondrial biogenesis, and the modulation of transcription factors (PPAR α activators) or enzymes (AMP‐activated protein kinase) that promote fatty acid oxidation. More surprisingly, studies on genetically modified animals and with enzyme inhibitors suggest that inhibitors of fatty acid synthesis [e.g. ATP citrate lyase, fatty acid synthase, acetyl‐CoA carboxylase (ACC)], fatty acid interconversion [stearoyl‐CoA desaturase (SCD)] and triglyceride synthesis (e.g. acyl‐CoA : diacylglycerol acyltransferase) may all be thermogenic. Some targets have been validated only by deleting genes in the whole animal. In these cases, it is possible that deletion of the protein in the brain is responsible for the effect on adiposity, and therefore a centrally penetrant drug would be required. Moreover, whilst a genetically modified mouse may display resistance to obesity in response to a high fat diet, it requires a tool compound to demonstrate that a drug might actually cause weight loss. Even then, it is possible that differences between rodents and humans, such as the greater thermogenic capacity of rodents, may give a misleading impression of the potential of a drug.
Adiponectin receptors gene expression in lymphocytes of obese and anorexic patients
Authors: Alberti L. , Gilardini L. , Girola A. , Moro M. , Cavagnini F. , Invitti C.
Published: May 2006

Aim:  Two adiponectin receptors (ADIPORs), ADIPOR1 and ADIPOR2, are widely expressed in tissues. Whether changes in the expression of ADIPORs are associated with obesity and insulin resistance in humans is still unclear. The aim of this study was to explore whether lymphocyte ADIPOR1 and ADIPOR2 mRNA expression is associated with obesity, insulin resistance, first‐phase insulin secretion and serum adiponectin levels.

Methods:  Using reverse transcription‐polymerase chain reaction, we measured ADIPOR1 and ADIPOR2 mRNA levels in the lymphocytes of 59 obese patients, of whom 39 had normal glucose tolerance, 8 had impaired glucose tolerance or impaired fasting glucose, and 12 had type 2 diabetes, and of 21 women with restrictive anorexia nervosa.

Results:  In all subjects, ADIPOR1 expression was 2.2‐fold higher than that of ADIPOR2 (p < 0.0001). The mRNA expression level of both receptors correlated with each other (p < 0.0001). After adjustment for age and sex, lymphocyte ADIPORs mRNA expression (ADIPOR1, p < 0.005; ADIPOR2, p < 0.05) and serum adiponectin (p < 0.0001) were significantly lower in obese patients than in anorexic subjects. In a multivariate analysis with ADIPOR1 as the dependent variable and body mass index (BMI), blood pressure and adiponectin as the independent variables, only serum adiponectin remained positively and independently correlated with ADIPOR1 (p < 0.05). Adiponectin was independently and negatively related to BMI and sex.

Conclusions:  We have demonstrated in this study that lymphocytes express ADIPORs and that, similar to serum adiponectin, ADIPORs expression is markedly reduced in obese subjects. ADIPORs expression is not independently related to BMI, insulin resistance and β‐cell function.
PPARγ agonists: safety issues in heart failure
Authors: Tang W. H. Wilson , Maroo Anjli
Published: May 2006

PPARγ agonists (or thiazolidinediones, TZD) are popular oral drugs for glycaemic control in patients with diabetes mellitus. However, side‐effects of fluid retention, oedema and congestive heart failure have been reported in the literature as well as observed in clinical registries and trials. Concerns regarding the safety of TZD use in patients with underlying heart failure have been implicated by its propensity to cause fluid retention. There is relatively good documentation in the literature that TZDs do not produce adverse haemodynamic consequences. TZD‐induced fluid retention is often sub‐acute in nature, developed over weeks to months following initiation, and primarily located in the periphery. Drug withdrawal may lead to complete resolution of fluid retention. Current approval of TZD use in patients with mild (NYHA class I – II) and stable heart failure is supported by existing literature and clinical experience. There have been few reports of severe adverse consequences following drug withdrawal, and emerging data are suggesting potential benefits of TZDs in the diabetic population with or without underlying heart failure. Future research should therefore be directed at better understanding PPARγ‐related mechanisms of renal sodium retention and endothelial vascular permeability of the periphery, as well as development of newer compounds without this side‐effect.
Insulin detemir lowers the risk of hypoglycaemia and provides more consistent plasma glucose levels compared with NPH insulin in Type 1 diabetes
Authors: Kølendorf K. , Ross G. P. , Pavlic‐Renar I. , Perriello G. , Philotheou A. , Jendle J. , Gall M‐A. , Heller S. R.
Published: May 2006

Aims  Hypoglycaemia remains a major barrier preventing optimal glycaemic control in Type 1 diabetes due to the limitations of conventional insulin preparations. We investigated whether basal‐bolus therapy with insulin detemir (detemir), a new soluble basal insulin analogue, was more effective in reducing the risk of hypoglycaemia compared with NPH insulin (NPH).

Methods  In this multinational, open‐label, cross‐over trial, 130 individuals with Type 1 diabetes received detemir and NPH twice daily in a randomized order in combination with premeal insulin aspart (IAsp) during two 16‐week treatment periods. Risk of hypoglycaemia was based on self‐measured plasma glucose (SMPG) and self‐reported episodes during the last 10 weeks of each period.

Results  Risk of nocturnal and overall hypoglycaemia was, respectively, 50% and 18% lower with detemir than with NPH (P < 0.001). A total of 19 severe hypoglycaemic episodes occurred during treatment with detemir compared with 33 with NPH (NS). HbA1c decreased by 0.3% point with both treatments and was comparable at 7.6% (± sem 0.06%, 95% confidence interval −0.106, 0.108) after 16 weeks with similar doses of basal insulin. Within‐person variation in mean plasma glucose was lower with detemir than with NPH (sd 3.00 vs. 3.33, P < 0.001), as was prebreakfast SMPG (P < 0.0001).

Conclusions  Detemir was associated with a significantly lower risk of hypoglycaemia compared with NPH at similar HbA1c when used in combination with mealtime IAsp. The more consistent plasma glucose levels observed with detemir may allow people to aim for tighter glycaemic control without an increased risk of hypoglycaemia.
Aldosterone synthase (CYP11B2) −344T/C polymorphism is not associated with the initiation and progression of diabetic nephropathy in Caucasian Type 1 diabetic patients
Authors: Lajer M. , Schjoedt K. J. , Jacobsen P. , Tarnow L. , Parving H.‐H.
Published: May 2006

Aims  Aldosterone is one of the main effectors of the renin–angiotensin–aldosterone system regulating blood pressure. Previous studies have shown that the aldosterone synthase promoter polymorphism −344T/C influences aldosterone levels and is associated with hypertension, a risk factor for the initiation and progression of diabetic nephropathy. Therefore, we investigated whether the −344T/C polymorphism is associated with the development and progression of diabetic nephropathy in Type 1 diabetes mellitus.

Methods  The −344T/C polymorphism was determined using standard PCR techniques in 422 Type 1 diabetic patients with overt diabetic nephropathy [mean age 43 years (sd 11)], and in 479 patients with persistent normoalbuminuria and long‐standing Type 1 diabetes [age 47 years (sd 12), duration of diabetes 27 years (sd 10)]. Furthermore, we genotyped 163 Type 1 diabetic patients with overt diabetic nephropathy treated with angiotensis‐converting enzyme inhibitors (ACE‐I). These patients were followed for a median of 6 years (range 3–14), with nine measurements (range 3–29) of glomerular filtration rate (GFR), and had a decline in GFR of 3.1 (−3.2; 23.7) ml/min per year.

Results  There was no significant difference between cases and controls in either genotype distributions (cases TT 0.33, TC 0.48, CC 0.19; controls TT 0.32, TC 0.48, CC 0.20) or allele frequencies (cases T/C 0.57/0.43; controls T/C 0.56/0.44). Furthermore, a genotype–phenotype interaction analysis in the normoalbuminuric patients revealed no differences in sex distribution, age, duration of diabetes, blood pressure, HbA1c, or urinary albumin excretion rate across genotypes. In the observational follow‐up study, the rate of decline in GFR did not differ between groups of patients with different −344T/C genotype (P = 0.41). However, the T‐allele made a statistically significant contribution to both systolic and diastolic pressure during follow‐up (P = 0.006 and 0.032, respectively).

Conclusions  The −344T/C polymorphism of the aldosterone synthase gene is not associated with initiation or progression of diabetic nephropathy in Caucasian Type 1 diabetic patients, but modulates blood pressure variation.
Assessment of diabetes screening by general practitioners in France: the EPIDIA Study
Authors: Cogneau J. , Balkau B. , Weill A. , Liard F. , Simon D.
Published: May 2006

Aims  To audit Type 2 diabetes screening in general practice in France and to determine the frequency of undiagnosed diabetes in patients at high risk, after systematic screening and diagnosis.

Methods  For this study, 288 general practitioners volunteered to include all consecutive non‐diabetic patients aged < 65 years who had at least two risk factors for diabetes, whatever the reason for consultation. If a plasma glucose had not been recorded in the previous 12 months, a fasting plasma glucose (FPG) was performed, with a second test if FPG ≥ 7.0 mmol/l.

Results  There were 5950 patients included. The most frequent diabetes risk factors were: age ≥ 40 years, 92%; overweight [body mass index (BMI) ≥ 27 kg/m2], 59%; treated hypertension, 48%; treated dyslipidaemia, 37%; family history of diabetes, 24%. Of these subjects at high risk for diabetes, 88% had a FPG measurement in their medical record (75% measured during the preceding 12 months). In the 1499 patients in whom FPG was measured, diabetes was diagnosed in 40 patients (2.7% 95% CI 1.9–3.5) and 22% had impaired fasting glucose (IFG). Thus, the frequency of undiagnosed diabetes in the 5950 high‐risk patients was 0.67% (0.46–0.88).

Conclusion  Screening for diabetes by general practitioners in France appears to be adequate and undiagnosed diabetes is rare in patients with risk factors for diabetes, at least in those consulting the general practitioners studied.
A randomized trial of adding insulin glargine vs. avoidance of insulin in people with Type 2 diabetes on either no oral glucose‐lowering agents or submaximal doses of metformin and/or sulphonylureas. The Canadian INSIGHT (Implementing New Strategies with Insulin Glargine for Hyperglycaemia Treatment) Study
Authors: Gerstein H. C. , Yale J.‐F. , Harris S. B. , Issa M. , Stewart J. A. , Dempsey E.
Published: May 2006

Aims  Insulin is generally withheld until people with Type 2 diabetes are unresponsive to other therapies. However, its potential advantages suggest that it could be added earlier to achieve glycaemic goals; this possibility was tested in a clinical trial.

Methods  Consenting adults aged 18–80 years with Type 2 diabetes for at least 6 months, HbA1c of 7.5–11%, and on 0, 1 or 2 oral agents, were randomized to one of two therapeutic approaches for 24 weeks: evening insulin glargine plus self‐titration by 1 unit/day if the fasting plasma glucose (FPG) was > 5.5 mmol/l; or conventional therapy with physician adjustment of oral glucose‐lowering agents if capillary FPG levels were > 5.5 mmol/l. The primary outcome was the first achievement of two consecutive HbA1c levels ≤ 6.5%.

Results  Two hundred and six participants were allocated to glargine and 199 to oral agents. Compared with control subjects, participants receiving glargine: (i) were 1.68 times more likely to achieve two consecutive HbA1c levels ≤ 6.5% (95% CI 1.00–2.83; P = 0.049); (ii) reduced their HbA1c by 1.55 vs. 1.25% (P = 0.005), achieving adjusted means of 7.0 vs. 7.2% (P = 0.0007); (iii) had lower FPG (P = 0.0001), non‐high‐density lipoprotein (HDL) cholesterol (P = 0.02) and triglycerides (P = 0.02); (iv) had greater increases in treatment satisfaction (P = 0.045); and (v) had a 1.9‐kg greater increase in weight (P < 0.0001). No differences in hypoglycaemia were noted.

Conclusions  Adding insulin glargine is more likely to achieve a lower HbA1c level than conventional therapy with oral agents.
Putative association of peroxisome proliferator‐activated receptor γ co‐activator 1β (PPARGC1B) polymorphism with Type 2 diabetes mellitus
Authors: Park K. S. , Shin H. D. , Park B. L. , Cheong H. S. , Cho Y. M. , Lee H. K. , Lee J.‐Y. , Lee J.‐K. , Kim H. Tae , Park C.‐S. , Han B. G. , Kimm K. , Oh B.
Published: May 2006

Aims  Peroxisome proliferator‐activated receptor γ co‐activator 1β (PPARGC1B) may play an important role in obesity and Type 2 diabetes mellitus (T2DM). In an effort to identify genetic polymorphisms in potential candidate genes for T2DM, genetic associations of PPARGC1B were examined in a Korean T2DM study.

Methods  We have sequenced the PPARGC1B, and examined its association with T2DM and diabetic phenotypes in a Korean T2DM study (775 T2DM patients and 316 control subjects) using the TaqMan method. Logistic and multiple regression models were employed to analyse the genetic contributions of polymorphisms. Nineteen polymorphisms were identified in PPARGC1B.

Results  By logistic regression analysis controlling for age and sex as covariates, one non‐synonymous single‐nucleotide polymorphism (SNP; +102605C>A; Arg292Ser) in exon 5 showed marginal significant associations with the risk of T2DM. The allele frequency of the minor allele [‘A (= Ser)’ allele of +102605C>A] was lower among T2DM patients (frequency = 0.101) than among control subjects (frequency = 0.135) [P = 0.03, OR = 0.71 (95% CI: 0.51–0.94)]. Furthermore, serum triglyceride level was also associated with this non‐synonymous SNP (+102605C>A; Arg292Ser) in exon 5 among controls (P = 0.03 in the dominant analysing model). Serum triglyceride levels [1.46 ± 0.70 (log‐transformed value; 0.12 ± 0.18)] were lower in individuals who carry one or two copies of minor alleles than among others [1.60 ± 0.85 (log‐transformed value; 0.16 ± 0.21)].

Conclusion  The present study provides, for the first time, information about genetic polymorphisms in PPARGC1B and putative associations of one non‐synonymous SNP with the risk of T2DM and serum triglyceride (TG) levels in the Korean population, although this result was not significant after correction for multiple testing.
The diagnosis of osteomyelitis of the foot in diabetes: microbiological examination vs. magnetic resonance imaging and labelled leucocyte scanning
Authors: Ertugrul M. B. , Baktiroglu S. , Salman S. , Unal S. , Aksoy M. , Berberoglu K. , Calangu S.
Published: May 2006

Aims  Foot infections and their sequelae are among the most common and severe complications of diabetes mellitus. As diabetic patients with foot infections develop osteomyelitis and may progress to amputation, early diagnosis of osteomyelitis is critical.

Methods  We compared the diagnostic values of labelled leucocyte scanning with Tc99m, magnetic resonance imaging (MRI) and microbiological examination of bone tissue specimens with histopathology, the definitive diagnostic procedure. Thirty‐one diabetic patients with foot lesions were enrolled in the study and histopathological examination was performed in all. Patients had clinically suspected foot lesions of ≥ grade 3 according to the classification of Wagner.

Results  Bone specimens were obtained for histopathological examination. Microbiology had a sensitivity of 92% and specificity of 60%. Labelled leucocyte scanning had a sensitivity of 91%, specificity of 67%, and MRI a sensitivity of 78%, specificity of 60%.

Conclusions  Microbiological examination may be as useful as and less costly than other diagnostic procedures and is the only method which can guide the choice of antibiotic therapy.
Twice‐daily compared with once‐daily insulin glargine in people with Type 1 diabetes using meal‐time insulin aspart
Authors: Ashwell S. G. , Gebbie J. , Home P. D.
Published: May 2006

Aims  To compare blood glucose control when using insulin glargine twice daily at breakfast‐ and dinner‐times with insulin glargine once daily at dinner time, in unselected people with Type 1 diabetes using insulin aspart at meal‐times.

Methods  In this 8‐week, two‐way, cross‐over study, 20 people with Type 1 diabetes were randomized to insulin glargine injection once daily at dinner‐time or twice daily at breakfast‐ and dinner‐times, both plus meal‐time insulin aspart. Each 4‐week treatment period concluded with a 24‐h inpatient metabolic profile.

Results  Insulin doses, HbA1c, fructosamine concentration and pre‐breakfast self‐monitored blood glucose (SMBG) concentration did not differ between treatment periods. SMBG concentrations after breakfast, after lunch and before dinner were lower with twice‐daily compared with once‐daily dinner‐time glargine [9.3 ± 0.5 (± se) vs. 6.7 ± 0.5 mmol/l, P = 0.003; 10.2 ± 0.9 vs. 7.0 ± 0.9 mmol/l, P = 0.024; 9.6 ± 0.5 vs. 6.6 ± 0.5 mmol/l, P = 0.001]. Mean 24‐h SMBG concentration was lower with twice‐daily glargine (7.1 ± 0.5 vs. 8.8 ± 0.5 mmol/l, P = 0.031). Within‐day variability of SMBG concentration was lower with twice‐daily glargine (sd 3.2 ± 0.2 vs. 4.0 ± 0.3 mmol/l, P = 0.044). Plasma free insulin concentration was higher in the afternoon with twice‐daily glargine (21.9 ± 1.4 vs. 16.1 ± 1.3 mU/l, P = 0.009), but lower overnight (12.1 ± 1.7 vs. 17.8 ± 1.7 mU/l, P = 0.030), compared with once‐daily injection. Plasma glucose concentration overnight was higher with twice‐daily compared with once‐daily glargine (mean 9.0 ± 0.4 vs. 6.6 ± 0.4 mmol/l, P = 0.001).

Conclusions  Blood glucose concentration rises in the late afternoon in association with falling plasma insulin levels towards the end of the 24‐h period after insulin glargine injection in some people with Type 1 diabetes using once‐daily glargine at dinner‐time plus a rapid‐acting insulin analogue at meal‐times. This is prevented by twice‐daily injection of insulin glargine.
Searching for diabetes decision aids and related background information
Authors: Lenz M. , Kasper J. , Mühlhauser I.
Published: May 2006

Aims  Patient decision aids (DAs) are interventions designed to help patients making informed decisions. DAs are complex interventions comprising a number of active components each essential to the proper functioning of the aid. Critical appraisal of DAs therefore requires access to information describing the incremental assessment of each stage in their development, including information about the theoretical funding, development processes, efficacy trials and long‐term implementation. We explored the feasibility of identifying such information with conventional database search strategies. Our study was conducted only in the field of diabetes care.

Methods  The ‘Inventory of Existing Patient Decision Aids’, medline (PubMed) and the World Wide Web were used to identify DAs relevant for diabetes care. For tracking information concerning each developmental stage, the reference lists of the DAs, home pages of the authors, medline, embase, PsycINFO, cinahl, and the Cochrane database were searched systematically.

Results  A total of 13 DAs relevant for diabetes care were identified. The search for publications concerning their development yielded more than 3000 results, only 10 of which referred to at least one of the 13 DAs. No additional background information was found on the home pages of the authors.

Conclusions  Conventional database search strategies do not allow the extraction of information about the stages in development of a DA. To facilitate critical appraisal of DAs, we propose the creation of an electronic database which provides information about available DAs, together with the relevant background literature, or to incorporate such a system into existing databases.
Global Guideline for Type 2 Diabetes: recommendations for standard, comprehensive, and minimal care
Authors:   IDF Clinical Guidelines Task Force
Published: May 2006

The Clinical Guidelines Task Force of the International Diabetes Federation has created an evidence‐based Global Guideline for the care of people with Type 2 diabetes around the world. The recommendations developed for three levels of care (standard, comprehensive, and minimal), which can be applied in settings with different resources, are presented here. The source document is published elsewhere.
Improving health by exploiting bioactivity of European grains: HEALTHGRAIN
Authors: Richardson D. P.
Published: May 2006

Summary  In July 2005, researchers from 15 European countries and 43 partners began to work on a 5‐year project called HEALTHGRAIN. This work is an EU Integrated Project funded by the European Commission within the Sixth Framework Programme, FOOD‐CT‐2005‐514008 under the topic ‘Improving and enhancing the nutritional value and health benefits of cereals’ (http://www.healthgrain.org).
How university students evaluate the grammatical style of nutrition messages?
Authors: Unusan N.
Published: May 2006

Summary  This study was designed to investigate the response of university students to eight different types of nutritional messages, which encouraged consuming the recommended daily servings of fruit and vegetables to help reduce the risk of heart disease, cancer and obesity. The formats used included offers, obligations, rhetorical questions using ‘how about’ or ‘why not’, a suggestive statement, a positive command and a positive command followed by a negative command and vice versa. The aim of the study was to determine if various grammatical styles of the same message could affect respondents’ views of their persuasiveness. A total of 1319 university students rated each message for persuasiveness. Positive commands using ‘could’, instructions which incorporated ‘should’ and rhetorical question using ‘how about’ were considered to be more persuasive than the other styles of nutrition messages (P < 0.01).
Obesity and type 2 diabetes
Authors: Waine C.
Published: May 2006

Summary  The rise in obesity – and specifically abdominal obesity – is driving the global increase in type 2 diabetes. Excess visceral fat, the causative factor behind abdominal obesity, is closely linked with β‐cell dysfunction and insulin resistance, two of the key components of type 2 diabetes pathogenesis. Attempts to curb the current abdominal obesity and type 2 diabetes epidemics will require a government‐led public health approach, in tandem with a personal approach aimed at helping abdominally obese individuals reduce their cardiovascular and metabolic (cardiometabolic) risk profile.
Proposing and Testing an Intellectual Capital‐Based View of the Firm
Authors: Reed Kira Kristal , Lubatkin Michael , Srinivasan Narasimhan
Published: May 2006

abstract This study examines one specific aspect of the resource‐based view, intellectual capital, and its three knowledge components – human, organizational, and social capital. We hypothesize that the impact of each component on financial performance is contingent upon the values of the other components, and that these leveraging effects are themselves contingent upon the industry conditions in which a business operates. Our hypotheses are supported using line‐of‐business survey and FDIC data (within‐industry/within‐geographic region) from two non‐competing resource niches of the banking industry (personal and commercial banking).
Stakeholder Influences in Organizational Survival*
Authors: Pajunen Kalle
Published: May 2006

abstract  Although much has been written on declines and turnarounds, virtually no research has examined stakeholders' influence in an existence threatening crisis of an organization. This paper provides a theory and a historical case study that show how the most influential stakeholders can be identified and managed during an organizational survival. The proposed model demonstrates how stakeholders' influence in organizational survival consists of both direct resource dependence‐ and structure‐based forms of power. The case analysis then describes an examination of actual stakeholder influences and changes in them during the decline and turnaround process. Finally, based on the findings of the case analysis and the influence identification, propositions are developed. They relate specific types of behaviours of influential stakeholders to the probability of organizational survival, showing how stakeholder management can be operationalized in an organizational turnaround.
Winning – Jack Welch
Authors: Abetti Pier A.
Published: May 2006

Book reviewed:

Jack Welch (with Suzy Welch), Winning. New York, NY: Harper Business, 2005: Pages 372; Price US$27.95.
Progressive Pioneer: Alexander James Inglis (1879–1924) and American Secondary Education
Authors: Wraga William G.
Published: May 2006

Alexander James Inglis's transformation from an academic traditionalist devoted to Latin pedagogy to an influential progressive-experimentalist and advocate of the comprehensive high school during the early twentieth century has received insufficient attention from educational and curriculum historians. A reconstruction of Inglis's career leads to an exploration of the explanatory power of four accepted historical interpretations when applied to his work. Recognizing the limitations of these interpretations for explaining anomalous aspects of Inglis's career, the possibility of educational biography for revealing nuances obscured by high-level generalizations is broached.
The politics of diaspora and the morality of secularism: Muslim identities and Islamic authority in Mauritius
Authors: Eisenlohr Patrick
Published: May 2006

Previous work on inter‐ethnic coexistence in Mauritius has portrayed secularism as the only possible site of the national, which is at the same time described as clearly separated from religious traditions. In contrast, focusing on understandings of secularism among Mauritian Muslims in the context of a politics of diasporic ‘ancestral cultures’, this article analyses secularism as a field of morality which is inseparable from questions of religious reform and authenticity. The discussion of ethnographic material from Mauritius suggests that the opposition between secularity and religiosity should be treated as a productive tension rather than a liberal antinomy.
‘Remembering to forget’: public secrecy and memory of sexual violence in the Bangladesh war of 1971
Authors: Mookherjee Nayanika
Published: May 2006

This article explores the processes through which the ‘public secrecy’ of rape during the Bangladesh war of 1971 operates within the present‐day ethnographic context. It examines contemporary commemorations of the war and of women who have achieved local and national fame as rape victims (euphemistically referred to as ‘war heroines’). The article analyses the discrepancy between raped women’s national position as icons of ‘honour’ and their local reception through sanctions and constant khota (sarcastic/censorious remarks expressing scorn and evoking the unpleasant events). By exploring the relationship between scorn, honour, rape, sexuality, narratives of remembrance, and the emergence of ‘public secrets’– and how these are interwoven by the subjectivity of the raped – the article argues that memories of rape are simultaneously located within the ambiguities of revelation and of concealment which are indispensable to the operations of power. In the process the article establishes the relationship between secrecy and memory. Further, a focus on the intersubjective domain of memory provides methodological and ethical tools with which to engage with narratives of the past relating to wartime violence.
Severity of cerebral white matter lesions and infarcts in patients with transient or moderately disabling cerebral ischaemia: reproducibility of grading by neurologists
Authors: De Schryver E. L. L. M. , Van Gijn J. , Kappelle L. J. , Koudstaal P. J. , Algra A. ,   on behalf of the ESPRIT Study Group
Published: May 2006

Diffuse or multifocal ischaemic white matter lesions increase the risk of intracranial haemorrhage in patients using oral anticoagulants for secondary prevention after cerebral ischaemia of arterial origin. We studied whether neurologists could reliably assess the presence of these white matter abnormalities. As part of the European/Australian Stroke Prevention in Reversible Ischaemia Trial (ESPRIT), the severity of white matter lesions and presence of ischaemic lesions were twice assessed in a consensus meeting of three neurologists (from a pool of nine) as absent, moderate or severe, in a sample of 126 randomly selected CT or MRI scans. The neurologists were not aware of the duplicate grading. The degree of agreement between the first and second observation was calculated with kappa statistics. The kappa value for agreement between the first and second assessment of white matter lesions was 0.58 (95% CI 0.40–0.76). The kappa value for the presence of clinically relevant and/or irrelevant ischaemic lesions was 0.68 (95% CI 0.58–0.78). Clinicians can assess the presence of white matter lesions with sufficient reliability. Such assessment may prevent unnecessary risk with oral anticoagulation in secondary prevention after cerebral ischaemia of arterial origin, of which the efficacy is currently being assessed in ESPRIT.
Side‐effects of subthalamic stimulation in Parkinson's disease: clinical evolution and predictive factors
Authors: Guehl D. , Cuny E. , Benazzouz A. , Rougier A. , Tison F. , Machado S. , Grabot D. , Gross C. , Bioulac B. , Burbaud P.
Published: May 2006

Chronic bilateral high‐frequency stimulation of the subthalamic nucleus (STN) is an alternative treatment for disabling forms of Parkinson's disease when on–off fluctuations and levodopa‐induced dyskinesias compromise patients’ quality of life. The aim of this study was to assess the evolution of side‐effects during the first year of follow‐up and search for clinical predictive factors accounting for their occurrence. We compared the frequency of side‐effects at 3 and 12 months after surgery in a cohort of 44 patients. The off‐medication scores of Unified Parkinson's Disease Rating Scale (UPDRS) II, III, axial symptoms, disease duration and age at surgery were retained for correlation analysis. Dysarthria/hypophonia, weight gain and postural instability were the most frequent chronic side‐effects. Whereas dysarthria/hypophonia remained stable over time, weight gain and postural instability increased during the first year post‐op. High axial and UPDRS II scores at surgery were predictive of dysarthria/hypophonia. Age and axial score at surgery were positively correlated with postural instability. Despite the occurrence of side‐effects, the benefit/side‐effects ratio of STN stimulation was largely positive during the first year of follow‐up. Age, intensity of axial symptoms and UDPRS II off‐medication score before surgery are predictive factors of dysarthria/hypophonia and postural instability after surgery.
Cluster-Like Headache Secondary to Idiopathic Intracranial Hypertension
Authors: Volcy M , Tepper SJ
Published: May 2006

Few cluster-like headaches have been described. Idiopathic intracranial hypertension (IIH) presents with headaches in more than 90± of patients. We describe a male patient with new onset cluster-like headache secondary or related to IIH.
Postnatal transitions in myosin heavy chain isoforms of the rabbit superficial masseter and digastric muscle
Authors: Korfage J. A. M. , Van Wessel T. , Langenbach G. E. J. , Ay F. , Van Eijden T. M. G. J.
Published: May 2006

We investigated the early (< 8 weeks) and late (> 8 weeks) postnatal development of the fibre type composition and fibre cross‐sectional area in the superficial masseter and digastric muscle of male rabbits. It was hypothesized, first, that due to the transition between suckling and chewing, during early postnatal development the increase in the proportion of slow fibre types and in fibre cross‐sectional areas would be larger in the masseter than in the digastric; and second, that due to the supposed influence of testosterone during late postnatal development, the proportion of slow fibre types in both muscles would decrease. Fibre types were classified by immunostaining according to their myosin heavy chain (MyHC) content. The proportion of slow fibre types significantly increased in the masseter, from 7% at week 1 to 47% at week 8, and then decreased to 21% at week 20, while in the digastric it increased from 5% in week 1 to 19% at week 8 and remained the same thereafter. The changes in the proportion of fast fibre types were the opposite. The remarkable increase and decrease in the proportion of slow fibre types in the masseter was attributed predominantly to MyHC‐cardiac α fibres. During early development, the cross‐sectional area of all fibres in both muscles increased. However, only the fast fibre types in the masseter continued to grow further after week 8. Before weaning, the fast fibre types in the digastric were larger than those in the masseter, but after week 8, they became larger in the masseter than in the digastric. In adult animals, masseter and digastric had the same percentage of fast fibre types, but these fibres were almost twice as large in masseter as in digastric.