bluuebunny/crossref_metadata_2025 huggingface dataset:
Interaction of Carbamazepine with Herbs, Dietary Supplements, and Food: A Systematic Review
Authors: Fong Sophia Yui Kau , Gao Qiong , Zuo Zhong
Published: August 2013

Background. Carbamazepine (CBZ) is a first-line antiepileptic drug which may be prone to drug interactions. Systematic review of herb- and food-drug interactions on CBZ is warranted to provide guidance for medical professionals when prescribing CBZ.Method. A systematic review was conducted on six English databases and four Chinese databases.Results. 196 out of 3179 articles fulfilled inclusion criteria, of which 74 articles were reviewed and 33 herbal products/dietary supplement/food interacting with CBZ were identified. No fatal or severe interactions were documented. The majority of the interactions were pharmacokinetic-based (80%). Traditional Chinese medicine accounted for most of the interactions (n=17), followed by food (n=10), dietary supplements (n=3), and other herbs/botanicals (n=3). Coadministration of 11 and 12 of the studied herbal products/dietary supplement/food significantly decreased or increased the plasma concentrations of CBZ. Regarding pharmacodynamic interaction, Xiao-yao-san, melatonin, and alcohol increased the side effects of CBZ while caffeine lowered the antiepileptic efficacy of CBZ.Conclusion. This review provides a comprehensive summary of the documented interactions between CBZ and herbal products/food/dietary supplements which assists healthcare professionals to identify potential herb-drug and food-drug interactions, thereby preventing potential adverse events and improving patients’ therapeutic outcomes when prescribing CBZ.
Influence of Affordances in the Home Environment on Motor Development of Young Children in Japan
Authors: Mori Shiro , Nakamoto Hiroki , Mizuochi Hiroshi , Ikudome Sachi , Gabbard Carl
Published: August 2013

Previous research indicates that the home environment is a significant factor in early child development. The present study examined influence of the multidimensional home environment on young Japanese children’s motor development. A Japanese translation of the Affordances in the Home Environment for Motor Development-Self Report (AHEMD-SR) was used to assess home motor affordances in 262 families. Motor ability was assessed by parental report using the Enjoji Infant Analytic Developmental Test. We also asked parents to rate their own physical activity in terms of level and years of experience. As results, we found that the home environment in Japan was generally sufficient for children’s motor development and that children’s access to Fine Motor Toys (FMT) and Gross Motor Toys (GMT) had the strongest influence on their development. Analysis also indicated that AHEMD-SR scores were higher for children of parents who had some level of physical activity experience compared to children whose parents indicated no physical activity experience. Parents’ self-reported activity level was correlated with higher scores for the subscales FMT and GMT and for total AHEMD-SR score. These results indicate that both the physical and social-psychological environments (parental experience and views) of the home influenced children’s motor development.
Fundamental Spectral Theory of Fractional Singular Sturm-Liouville Operator
Authors: Bas Erdal
Published: August 2013

We give the theory of spectral properties for eigenvalues and eigenfunctions of Bessel type of fractional singular Sturm-Liouville problem. We show that the eigenvalues and eigenfunctions of the problem are real and orthogonal, respectively. Furthermore, we prove new approximations about the topic.
ShigellaBacteremia in a Patient with Visceral Leishmaniasis
Authors: Endris Mengistu , Mohammed Rezika , Takele Yegnasew , Woldeyohannes Desalegn , Tiruneh Moges , Diro Ermias
Published: August 2013

Bacteremia due toShigellais rare. A 26-year-old HIV-negative male presented with a persistent high-grade fever of two months duration to the Leishmaniasis Research and Treatment Center of University of Gondar Hospital. He was anorexic and had lost significant weight (from 76 to 57 kg in 4 months, BMI = 17.2 kg/m2). He also complained of headache, chills, and rigor. In the last one year, he was experiencing a few episodes of acute bloody diarrhea, the last episode being two months ago. Microscopy from splenic aspiration showed Leishman-Donovan bodies with parasite load of +3. The blood culture showedShigellaspecies, but the stool was culture negative. The isolate was sensitive to most tested antibiotic discs, sulfamethoxazole, ceftriaxone, gentamicin, tetracycline, and norfloxacilin, except ampicillin. Therefore, requesting blood culture for identifying unexpected type of organisms causing infections in patients with underlying diseases like visceral leishmaniasis should be encouraged.
Eicosanoids and Docosanoids in Plasma and Aorta of Healthy and Atherosclerotic Rabbits
Authors: Szklenar Monika , Kalkowski Janine , Stangl Verena , Lorenz Mario , Rühl Ralph
Published: August 2013

Eicosanoids and docosanoids have been shown to be involved in atherosclerosis. Polyunsaturated fatty acids (PUFAs) are important nutrients that are metabolized by lipoxygenases and cyclooxygenases to various mono-hydroxy metabolites which can be further metabolized by specific enzymes to more complex eicosanoids and docosanoids. In this study a high-performance liquid chromatography methodology was established and rabbits were fed with a control or a high-cholesterol diet to induce atherosclerotic lesions to determine pro- or anti-inflammatory lipid mediators in atherosclerotic vessels. In aortic samples from atherosclerotic rabbits we determined for the first time various eicosanoids/docosanoids and observed an increased concentration of 12-lipoxygenase metabolites. Increased levels of 12-hydroxyeicosatetraenoic acid (12-HETE) in high-cholesterol versus control animals as well as increased ratios of 12-HETE/arachidonic acid ratios indicate that 12-lipoxygenase metabolites may have importance in atherosclerosis. In addition, decreased concentrations of the 5-lipoxygenase metabolite leukotriene B4 levels were detected in high-cholesterol animals. A positive correlation of total plaque area with plasma levels of 12-HETE and a negative correlation with aortic levels of endogenous PPARγ-ligand 13-oxo-octadecadienoic acid were found. This study let us conclude that the cholesterol content in the diet might influence atherosclerosis via increased 12-lipoxygenase- and cyclooxygenase-mediated pathways and reduced 5-lipoxygenase pathways.
Botulinum Toxin-A Injections for Idiopathic Overactive Bladder: A Systematic Review and Meta-Analysis
Authors: Cui Yu , Wang Long , Liu Longfei , Zeng Feng , Niu Jiping , Qi Lin , Chen Hequn
Published: August 2013

Objective: To review the current evidence on the efficacy and safety of botulinum toxin-A in the management of idiopathic overactive bladder (OAB). Methods: A systematic search of PubMed, Embase and the Cochrane Central Search Library was performed. All randomized controlled trials comparing botulinum toxin-A with placebo, different doses and injection techniques, in patients with idiopathic OAB was included. The analyzed outcomes were quantification of symptoms, urodynamic outcomes, quality of life and adverse events. Result: A total of 1,020 participants from 12 randomized controlled trials were included. Botulinum toxin-A was associated with less urinary frequency, less incontinence episodes, improvement in quality of life, higher post-void residual-related catheterization and higher urinary tract infection. Doses of 100-300 U were not consistently differentiated from each other in voiding diary, quality of life and urge urinary incontinence. No statistically significant difference was seen between bladder body and bladder base, bladder body and bladder body plus trigone in urinary retention and urinary tract infection. Conclusion: Botulinum toxin-A is associated with significant improvement in OAB symptoms in patients with idiopathic OAB. However, there is a higher incidence of postoperative urinary retention and urinary infection compared to placebo. Low-dose botulinum toxin-A seems to be the optimum dose that appropriately balances the benefits with adverse events. Trigone inclusion seems as safe and effective as trigone-sparing injection.
Prevalence of Sensitization to Cannabis sativa. Lipid-Transfer and Thaumatin-Like Proteins Are Relevant Allergens
Authors: Larramendi Carlos H. , López-Matas M. Ángeles , Ferrer Ángel , Huertas Ángel Julio , Pagán Juan Antonio , Navarro Luis Ángel , García-Abujeta José Luis , Andreu Carmen , Carnés Jerónimo
Published: August 2013

Background: Although allergy to Cannabis sativa was first reported over 40 years ago, the allergenicity has scarcely been studied. The objectives of this study were to investigate the frequency of sensitization to this plant, to analyze the clinical characteristics and allergenic profile of sensitized individuals and to identify the allergens involved. Methods: Five hundred and forty-five individuals in Spain attending allergy clinics with respiratory or cutaneous symptoms underwent a skin-prick test (SPT) with C. sativa leaf extract. The extract was characterized by SDS-PAGE and 2-dimensional electrophoresis. Specific IgE to C. sativa was measured in positive SPT individuals. The clinical and allergenic profiles of sensitized individuals were investigated and the most-recognized allergens sequenced and characterized by liquid chromatography-mass spectrometry/mass spectrometry. Results: Of this preselected population, 44 individuals had positive SPT to C. sativa (prevalence 8.1%). Prevalence was higher in individuals who were C. sativa smokers (14.6%). Two individuals reported mild symptoms with C. sativa. Twenty-one individuals from 32 available sera (65.6%) had positive specific IgE to C. sativa. Twelve sera recognized at least 6 different bands in a molecular-weight range of between 10 and 60 kDa. Six of them recognized a 10-kDa band, identified as a lipid transfer protein (LTP) and 8 recognized a 38-kDa band, identified as a thaumatin-like protein. Conclusions: There is a high prevalence of sensitization to C. sativa leaves. The clinical symptoms directly attributed to C. sativa were uncommon and mild. The sensitization profile observed suggests that C. sativa sensitization may be mediated by two mechanisms, i.e. cross-reactivity, mainly with LTP and thaumatin-like protein, and exposure-related ‘de novo' sensitization.
A Novel Prehospital Electrocardiogram Score Predicts Myocardial Salvage in Patients with ST-Segment Elevation Myocardial Infarction Evaluated by Cardiac Magnetic Resonance
Authors: Schoos Mikkel Malby , Lønborg Jacob , Vejlstrup Niels , Engstrøm Thomas , Bang Lia , Kelbæk Henning , Clemmensen Peter , Sejersten Maria
Published: August 2013

Objectives: We hypothesized that prehopsital ECG scores can identify ST-segment elevation myocardial infarction (STEMI) patients in whom time delay is particularly important for myocardial salvage. Methods: We evaluated the Anderson-Wilkins (AW) score (which designates the acuteness of ischemia) and grade 3 ischemia (GI3) (which identifies severe ischemia) in the prehospital ECG and compared them to the myocardial salvage index (MSI) assessed by cardiac magnetic resonance. Results: In 150 patients, system delay (alarm to balloon inflation) (β = -0.304, p < 0.001) and AW score (β = 0.364, p < 0.001) correlated with MSI. AW scores ≥3 (p < 0.001) and GI3 (p = 0.002) predicted the MSI. We formed 4 subgroups combining AW scores (<3 or ≥3) and grades of ischemia (<GI3 or =GI3), yielding a prehospital salvage score of 1-4, which predicted the MSI (p < 0.001), left ventricular ejection fraction at 3 months (p = 0.017), infarct size (p < 0.001), and troponin T (p < 0.001). MSI was only dependent on system delay in patients with acute ischemia (AW score = 3) with (β = -0.687, p = 0.005) or without (β = -0.454, p < 0.001) severe ischemia (GI3). Conclusion: In patients with STEMI, the novel prehospital salvage score identifies subgroups in which myocardial salvage is particularly time dependent.
Ectoine-Containing Cream in the Treatment of Mild to Moderate Atopic Dermatitis: A Randomised, Comparator-Controlled, Intra-Individual Double-Blind, Multi-Center Trial
Authors: Marini A. , Reinelt K. , Krutmann J. , Bilstein A.
Published: August 2013

Introduction: The natural cyclic tetrahydropyrimidine, ectoine, is a low-molecular, water-binding, organic osmolyte. Previously, topical application of ectoine to healthy human skin was shown to improve skin hydration as well as skin barrier function. Objectives: We therefore speculated that topical application of ectoine would be beneficial for patients with atopic dermatitis (AD), in which a genetically defined defect in skin barrier function is of major pathogenetic relevance. We assessed the efficacy of an ectoine-containing cream (EHK02-01) in the management of 65 patients with mild to moderate AD in a randomized, intra-individual, double-blind, multi-center trial, in which the efficacy of ectoine was compared to a nonsteroidal anti-inflammatory cream previously found to primarily act on skin barrier function and therefore with a comparable mode of action. Methods: Sixty-five patients with mild to moderate AD aged 18-65 years were enrolled. The patients applied EHK02-01 and the control cream on two symmetrical lesions twice daily for 28 days. At the beginning, after 7 and after 28 days, treated skin areas were assessed by modified, objective local SCORAD (Scoring Atopic Dermatitis) and IGA (Investigator's Global Assessment) as well as the patients' judgment of efficacy and their assessment of pruritus. Results: EHK02-01 was found to be very well tolerated. Even more important, efficacy of EHK02-01 treatment was equivalent to that achieved with the reference product. Conclusion: These results indicate that topical treatment with EHK02-01 may represent a novel option for the treatment of patients with AD.
Lessons from the Feeding Infants and Toddlers Study in North America: What Children Eat, and Implications for Obesity Prevention
Authors: Saavedra Jose M. , Deming Denise , Dattilo Anne , Reidy Kathleen
Published: August 2013

The latest exhaustive survey of dietary patterns in infants from the Feeding Infants and Toddlers Study (FITS) in North America documents and quantifies current trends in infant feeding. These include higher than generally recommended energy, protein, and saturated fat intakes. The majority of infants are bottle fed at some point in their first year of life, and their weaning diet often includes low intakes of fruits and vegetables, with high starchy, rather than green or yellow, vegetables. Early introduction of solids, use of cow's milk prior to 1 year of age, and high juice intake in the first 2 years - all less desirable diet practices - are improving, but are still prevalent. More preschoolers are likely to get sweets or sweetened beverages than a serving of fruit or a vegetable on a given day. These food intake patterns mimic the adult American diet and are associated with an increased risk of obesity in childhood and later life. But more importantly, these patterns appear to be set as early as 18 months of age, and by 20 months of age, they mimic the adult diet. Despite increase in total energy intake, and greater variety of foods, the basic characteristics of macronutrient intake distribution and food group contribution of energy to the diet before 2 years of age remain remarkably stable and similar to the family table. Obesity prevention needs to include specific targets in terms of breastfeeding and adequate formula feeding, as well as appropriate introduction of weaning foods with goals of changing the inadequate patterns documented in the FITS. These interventions will also require addressing parent and caregiver behaviors, including attending to hunger satiety cues (responsive feeding), and shaping early food preferences. This needs to be done starting at birth, in the first months of life. Early intervention offers a unique and potentially efficacious opportunity to shape the future dietary patterns of the next generation.
Influences on Children's Dietary Behavior, and Innovative Attempts to Change It
Authors: Baranowski Tom , Diep Cassandra , Baranowski Janice
Published: August 2013

Fruit and vegetable (FV) intake may protect against several chronic diseases, and the preferences and habits in relation to FV intake appear to form in early childhood. Child FV intake reflects many influences from multiple levels (e.g. internal to the child, family, school, and neighborhood). We have documented influences at each of these levels, but more definitive research in longitudinal samples remains to be conducted. Even though validated comprehensive models of influences on child FV intake in longitudinal studies are not available to guide intervention design for children of different ages, there has been an urgency to initiate chronic disease prevention interventions to mitigate the substantial health consequences. Effective interventions use known behavior change procedures to change the influences on FV intake enough to change the behavior, but few such interventions have demonstrated effectiveness at meaningful levels. Innovative methods need to be explored. Videogames for Health offer a medium that is attractive to children and shows promising results, especially for dietary behavior change. Exciting additional research is needed to clarify possible bidirectional influences between the environmental and individual influences on child intake with possible age-related differences in influence and in the optimal design of video games for dietary change.
Feeding Patterns during the First 2 Years and Health Outcome
Authors: Haschke Ferdinand , Haiden Nadja , Detzel Patrick , Yarnoff Benjamin , Allaire Benjamin , Haschke-Becher Elisabeth
Published: August 2013

Low-birth-weight infants, in particular those with birth weights <1,500 g, benefit from fortified breast milk. Low protein intake is critical, because it is limiting growth. Long-term health outcomes in small-for-gestational-age infants from developing countries in relation to their early nutrition still need to be evaluated in controlled trials. Term infants both in developing and developed countries also benefit from exclusive breastfeeding: an analysis of a large dataset of surveys from 20 developing countries (168,000 infants and small children from the Demographic Health Survey, United States Agency for International Development) indicates that exclusive breastfeeding until 6 months is associated with significantly higher weight, length, and lower probability of stunting, wasting, and infections. Nine out of 10 infants still receive breast milk between 6 and 12 months and probability of infections tends to be lower if breastfeeding is continued during that age range. Between 12 and 24 months, when stunting and wasting rates are already high, 7 out of 10 infants still receive breast milk. No associations of feeding patterns with disease outcome can be found. Effectiveness trials of complementary feeding strategies in food-insecure countries are urgently needed. Follow-up until 10 years in a developed country now indicates that an infant population at risk for allergic diseases benefits both from breastfeeding and the use of hypoallergenic formula during the first 4 months of life, when compared to cow's milk-based formula: both the cumulative incidences of atopic disease and all allergic diseases are significantly lower.
Randomised in situ Study on the Efficacy of a Tin/Chitosan Toothpaste on Erosive-Abrasive Enamel Loss
Authors: Schlueter N. , Klimek J. , Ganss C.
Published: August 2013

Tin is a notable anti-erosive agent, and the biopolymer chitosan has also shown demineralisation-inhibiting properties. Therefore, the anti-erosive/anti-abrasive efficacy of the combination of both compounds was tested under in situ conditions. Twenty-seven volunteers were included in a randomised, double-blind, three-cell crossover in situ trial. Enamel specimens were recessed on the buccal aspects of mandibular appliances, extraorally demineralised (6 × 2 min/day) and intraorally treated with toothpaste slurries (2 × 2 min/day). Within the slurry treatment time, one-half of the specimens received additional intraoral brushing (5 s, 2.5 N). The tested toothpastes included a placebo toothpaste, an experimental NaF toothpaste (1,400 ppm F-) and an experimental F/Sn/chitosan toothpaste (1,400 ppm F-, 3,500 ppm Sn2+, 0.5% chitosan). The percentage reduction of tissue loss (slurry exposure/slurry exposure + brushing) compared to placebo was 19.0 ± 47.3/21.3 ± 22.4 after use of NaF and 52.5 ± 30.9/50.2 ± 34.3 after use of F/Sn/chitosan. F/Sn/chitosan was significantly more effective than NaF (p ≤ 0.001) and showed good efficacy against erosive and erosive-abrasive tissue loss. This study suggests that the F/Sn/chitosan toothpaste could provide good protection for patients who frequently consume acidic foodstuffs.
Pediatric Cervical Intraosseous Schwannoma
Authors: Mohanty Chandan B. , Rao K.V.L. Narasinga , Sampath S.
Published: August 2013

Intraosseous schwannoma of the spine is an extremely rare tumor, with only 18 cases reported so far in the literature. We describe the 1st case of intraosseous schwannoma in the pediatric age group, which was treated successfully, and we review the pertinent literature.
MPT0B169, a New Tubulin Inhibitor, Inhibits Cell Growth and Induces G2/M Arrest in Nonresistant and Paclitaxel-Resistant Cancer Cells
Authors: Lee Wei-Hwa , Liu Hsinjin Eugene , Chang Jang-Yang , Liou Jing-Ping , Huang Huei-Mei
Published: August 2013

The polymerization of tubulin molecules forms microtubules which are considered an attractive target for cancer treatment. Herein, we synthesized a new tubulin inhibitor, MPT0B169 (2-dimethylamino-N-[1-(4-methoxy-benzenesulfonyl)-2,​3-dihydro-1H-indol-7-yl]-acetamide) and demonstrated its action in leukemia cell lines HL60 and NB4 and lymphoma cell line U937. We found that MPT0B169 prevented tubulin assembly by binding the colchicine-binding site of tubulin in vitro. MPT0B169 also induced tubulin depolymerization in vivo. MPT0B169 inhibited the growth of HL60, NB4, and U937 cells in dose- and time-dependent manners. It also inhibited the growth of paclitaxel-resistant cancer cells. In addition, MPT0B169 caused G2/M cell cycle arrest in nonresistant and paclitaxel-resistant cancer cells, with a concomitant increase in cyclin B1 levels and cyclin-dependent kinase 1 (CDK1) phosphorylation. These results suggest that MPT0B169, a tubulin inhibitor, inhibits cell growth and induces G2/M cell cycle arrest of cancer cells through the disruption of tubulin polymerization.
Valproic Acid Attenuates Disease Symptoms and Increases Endogenous Myelin Repair by Recruiting Neural Stem Cells and Oligodendrocyte Progenitors in Experimental Autoimmune Encephalomyelitis
Authors: Pazhoohan Saeed , Satarian Leila , Asghari Ali-Akbar , Salimi Mehdi , Kiani Sahar , Mani Ali-Reza , Javan Mohammad
Published: August 2013

Background: Inefficient remyelination of demyelinated plaques in multiple sclerosis (MS) leads to secondary axon degeneration and progressive disability. Therapies that potentiate remyelination would be of immense help for managing MS. Objective: Here, we report the effects of valproic acid (VPA) on focal experimental autoimmune encephalomyelitis (fEAE). Methods: fEAE was induced in Wistar rats by immunizing the animals with guinea pig spinal cord homogenate emulsified in complete Freund's adjuvant and with pertussis toxin (PT) injection into the spinal cord at the level of T8 vertebra on day 18 after immunization. VPA 300 mg/kg was applied for 4 days after or 8 days before PT administration. Behavioral evaluation, histological assessment and immunohistofluorescence assays were used to evaluate the outcomes. Results: VPA administration had no effect on the development of symptoms, but after discontinuing VPA, animals showed faster recovery. Eight days of pretreatment with VPA accelerated the recovery phase of EAE and increased the number of remyelinated axons in the lesion area. VPA pretreatment also increased the recruitment of neural stem cells and oligodendrocyte precursors within the lesion. Conclusions: Results suggest VPA as a potential therapy for remyelinating the lesions in MS and for faster recovery from disease relapses. The effect of VPA seems to be mediated by endogenous progenitors recruitment.
The Stable Microbubble Test for Determining Continuous Positive Airway Pressure (CPAP) Success in Very Preterm Infants Receiving Nasal CPAP from Birth
Authors: Bhatia Risha , Morley Colin J. , Argus Brenda , Tingay David G. , Donath Susan , Davis Peter G.
Published: August 2013

Background: Very preterm infants can be treated with nasal continuous positive airway pressure (CPAP) from birth, but some fail. A rapid test, such as the stable microbubble test (SMT) on gastric aspirate, may identify those who can be managed successfully using CPAP. Objective: To determine if SMT can identify soon after birth, very preterm infants who may be successfully managed on CPAP alone. Methods: Stable microbubbles (diameter <15 µm) were counted in gastric aspirates taken <1 h of age from infants <30 weeks' gestation, who received CPAP from birth. Infants failed CPAP if intubated at <72 h of age. Clinicians were masked to SMT results. A receiver operating characteristic curve was generated to determine the relationship between number of microbubbles/mm2 and subsequent intubation. Results: 68 infants of mean (SD) 28.1 (1.4) weeks' gestation received CPAP in the delivery room at a median (interquartile range) pressure 7 (6-8) cmH2O and FiO2 0.25 (0.21-0.3). Gastric aspirates were taken at a median (interquartile range) age of 0.5 (0.3-0.6) hours. The best cut-off point for predicting CPAP success or failure was a SMT count of 8 microbubbles/mm2. The area under the receiver operating characteristic curve was 0.8 (95% CI 0.7-0.9). A SMT count ≥8 microbubbles/mm2 had a sensitivity of 53%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 60% for predicting CPAP success. Conclusion: Infants treated with CPAP from birth, who had SMT counts ≥8 microbubbles/mm2 on their gastric aspirate, did not fail CPAP.
Screening for Co-Morbidity in 65,397 Obese Pediatric Patients from Germany, Austria and Switzerland: Adherence to Guidelines Improved from the Year 2000 to 2010
Authors: Flechtner-Mors Marion , Wiegand Susanna , Gellhaus Ines , Siefken-Kaletka Heidi , Widhalm Kurt , Reinehr Thomas , Roost Hans-Peter , Leipold Georg , Hoffmeister Ulrike , Holl Reinhard W. ,   for the BMBF Competence Network Obesity
Published: August 2013

Objective: The aim of the study was to analyze the adherence to current guidelines for co-morbidity screening in overweight and obese pediatric patients participating in the Adipositas-Patienten-Verlaufsdokumentation (APV) initiative in three German-speaking countries. Methods: APV database: 181 centers from Germany, Austria and Switzerland, specialized in obesity care, contributed standardized, anonymous data of medical examinations from 65,397 patients performed between 2000 and 2010. Completeness of screening for hypertension, dyslipidemia, and impaired glucose metabolism was analyzed using adjusted means. Results: Mean age of the cohort was 12.5 ± 2.9 years and 46.5% were male. 17.3% were overweight (>90th-97th percentile), 45.1% obese (>97th-99.5th percentile), and 37.7% extremely obese (>99.5th percentile). In 2000, blood pressure was documented for 55.1% of patients, increasing to 88.7% in 2010. The rate of lipid diagnostics also improved from 45.0 to 67.7%, and screening for diabetes rose from 32.7 to 62.3% in the same time period. Blood pressure measurements were performed more often during inpatient care (88.5%) compared to outpatient programs (77.5%). Screening was more complete with increasing age and increasing degree of obesity. In boys screening rate was higher than in girls. Conclusion: During the 11-year period, screening for co-morbidity improved significantly in overweight or obese children and adolescents. However, adherence to guidelines is still insufficient in some institutions. Quality control based on benchmarking may improve obesity care and outcome.
An Experimental Animal Model for Abdominal Fascia Healing after Surgery
Authors: Burcharth J. , Pommergaard H.-C. , Klein M. , Rosenberg J.
Published: August 2013

Background: Incisional hernia (IH) is a well-known complication after abdominal surgical procedures. The exact etiology of IH is still unknown even though many risk factors have been suggested. The aim of this study was to create an animal model of a weakly healed abdominal fascia that could be used to evaluate the actively healing fascia. Such an animal model may promote future research in the prevention of IH. Methods: 86 male Sprague-Dawley rats were used to establish a model involving six experiments (experiments A-F). Mechanical testing of the breaking strength of the healed fascia was performed by testing tissue strips from the healed fascia versus the unincised control fascia 7 and 28 days postoperatively. Results: During the six experiments a healing model was created that produced significantly weaker coherent fascia when compared with the control tissue measured in terms of mechanical breaking strength. This new animal model employed myofascial closing after a full thickness abdominal incision using a running suture with fast-absorbable suture material. This technique produced a weak myofascial layer compared with the control tissue measured in terms of breaking strength after both 7 and 28 days. Conclusion: It was possible to create a healed but weak abdominal fascia in rats with a minimum of defects after incision using a running suture technique in the fascia. In contrast to other models, regular tissue defects were absent, and the model can therefore be used to evaluate the changes, both histological and mechanical, in the actively healing fascia, which may lead to incisional herniation. Furthermore, the model may also be used to study interventions performed to promote healing. This contrasts with existing models with regular fascia defects, which are not well suited for this purpose.
Subacute Cutaneous Lupus Erythematosus Triggered by Radiotherapy
Authors: Kolm I. , Pawlik E. , Eggmann N. , Kamarachev J. , Kerl K. , French L.E. , Hofbauer G.F.L.
Published: August 2013

Background: The origin of collagen autoimmune diseases is not fully understood. Some studies postulate a mechanism of molecular mimicry or heterologous immunity following viral infections triggering autoimmunity. Apart from infections, other exogenous factors such as visible light or X-rays have been reported to incite autoimmunity. Case Report: We report a case of histologically and serologically confirmed subacute lupus erythematosus (SCLE) following radiotherapy for breast cancer. Discussion: The close temporal and spatial correlation between radiotherapy and onset of SCLE in this patient suggests that an autoimmune reaction may have been triggered locally by functionally altering the immune system and breaking self-tolerance.
Morphology and taxonomy of Psammodiscus Round & Mann (Bacillariophyceae: Rhaphoneidales) with a description of the new species Psammodiscus calceatus
Authors: WATANABE TSUYOSHI , NAGUMO TAMOTSU , SUN ZHONGMIN , HASEGAWA KAZUKIYO , MIYAGAWA TOMOFUMI , KUMADA MISATO , TANAKA JIRO
Published: August 2013

Part of the definition of Psammodiscus is that there is always a small pore and sometimes a rimoportula present on the valve centre. A new species Psammodiscus calceatus Tsuy.Watanabe, Nagumo & J. Tanaka is described, which lacks a central small pore. And the valves of P. nitidus were found that have two marginal rimoportulae. Living cell of P. nitidus attached on sand grain solitary and it has many discoid plastids. The structures of rotae with fin-like projections in Psammodiscus differ from those of Rhaphoneidaceae genera. The epicingulum of Psammodiscus consists of three or four open bands with the valvocopula and second band opening at 180° to one another alternately at one apex.
A new cauliflorous species of Aristolochia (Aristolochiaceae) from Espírito Santo, Brazil
Authors: Freitas Joelcio , De Lírio Elton John , González Favio
Published: August 2013

We describe and illustrate Aristolochia subglobosa, a new species assigned to subseries Anthocaulicae. The subseries is characterized by the presence of extremely short and cauliflorous racemes in which each flower is subtended by a small bract. The new species is related to A. bahiensis, A. daemoninoxia and A. guentheri. So far, A. subglobosa is the second species of this subseries known to occur in the Atlantic Forest of Brazil.
Preservation of internal pleurites in a new palaeocorystid crab (Crustacea, Brachyura, Raninoidia) from the Cenomanian (Upper Cretaceous) of Poitou-Charentes, France
Authors: BAKEL BARRY W. M. VAN
Published: August 2013

A new palaeocorystid crab, Joeranina houssineaui n. sp., is described from upper Cenomanian strata in southwest France. Being apparently derived from J. broderipii, the new species inhabited a sandier substrate environment than its predecessor. The incomplete holotype reveals portions of the internal pleurites, which are rarely seen in extinct crabs.
Analysis and Characterization of Probability Distribution and Small-Scale Spatial Variability of Rainfall in Singapore Using a Dense Gauge Network
Authors: Mandapaka Pradeep V. , Qin Xiaosheng
Published: August 2013

Hourly rainfall measurements from a network of 49 rain gauges on the tropical island of Singapore are analyzed to characterize variability of rainfall for temporal and spatial scales ranging from 1 to 24 h and from 1 to 45 km, respectively. First, the probability distributions of rain rates are characterized using the method ofLmoments. The analysis showed that the Pearson type-3 (PE3) distribution best fitted the rain rates for all time scales of concern. The parameters of the PE3 distribution are found to be related to the time scale through simple power laws. Second, the spatial structure of rainfall is characterized using spatial correlations. The decay of correlations with intergauge distance is parameterized using a powered-exponential function. In general, thee-folding correlation distance (distance at which the correlation drops to 1/e) varied from 10 km at hourly scales to 33 km at daily scales. The study also examined diurnal, seasonal, and anisotropic patterns in the spatial correlation structure of rainfall. The rainfall patterns are smoothest in December and January and are most variable in February, April, and October. Diurnal analysis of spatial correlations showed that the rainfall patterns are smoothest in the early hours between 0100 and 0600 local time and are most variable during the afternoon between 1500 and 1900 local time. The results also showed complex anisotropic patterns in spatial correlations, with considerable dependence of rainfall orientation on spatial scale and the time of the year.
Downscaling of GCM-Simulated Precipitation Using Model Output Statistics
Authors: Eden Jonathan M. , Widmann Martin
Published: August 2013

Producing reliable estimates of changes in precipitation at local and regional scales remains an important challenge in climate science. Statistical downscaling methods are often utilized to bridge the gap between the coarse resolution of general circulation models (GCMs) and the higher resolutions at which information is required by end users. As the skill of GCM precipitation, particularly in simulating temporal variability, is not fully understood, statistical downscaling typically adopts a perfect prognosis (PP) approach in which high-resolution precipitation projections are based on real-world statistical relationships between large-scale atmospheric predictors and local-scale precipitation. Using a nudged simulation of the ECHAM5 GCM, in which the large-scale weather states are forced toward observations of large-scale circulation and temperature for the period 1958–2001, previous work has shown ECHAM5 skill in simulating temporal variability of precipitation to be high in many parts of the world. Here, the same nudged simulation is used in an alternative downscaling approach, based on model output statistics (MOS), in which statistical corrections are derived for simulated precipitation. Cross-validated MOS corrections based on maximum covariance analysis (MCA) and principal component regression (PCR), in addition to a simple local scaling, are shown to perform strongly throughout much of the extratropics. Correlation between downscaled and observed monthly-mean precipitation is as high as 0.8–0.9 in many parts of Europe, North America, and Australia. For these regions, MOS clearly outperforms PP methods that use temperature and circulation as predictors. The strong performance of MOS makes such an approach to downscaling attractive and potentially applicable to climate change simulations.
Two isolated giant gastric duplication cysts in thorax in a newborn
Authors: Turkyilmaz C , Onal E , Atalay Y , Sonmez K , Turkyilmaz Z , Koc E , Ergenekon E , Konus O
Published: August 2013

We report a case of a newborn with severe respiratory distress since birth with two giant intrathoracic and separate eneteric duplication cysts in right hemithorax. On day 19, the intrathoracic cysts were removed, and the baby was discharged on his 22nd day of life. Histologic findings confirmed the diagnosis of a gastric duplication cyst. This report is the first case of two isolated, separated and giant right intrathoracic gastric duplication cysts in literature. The diagnostic values of radiological evaluation and surgical and pathological management for precise diagnosis are discussed.
Conservative management of laryngeal dog bite*
Authors: Oozeer NB , Fairgrieve R , Clement WA
Published: August 2013

Background and aims

Dog bites represent an important public health issue, causing injuries from trivial to fatal. The true incidence is unknown due to the lack of national and local reporting system. School children, mostly male, are more commonly affected with the majority of injuries occurring in the head and neck area, followed by the limbs and trunk.

Methods

The conservative management of a 6-year-old girl who sustained a fracture of her laryngeal structure from an attack by her neighbours’ dog is described. Only a 1 cm visible puncture wound in the midline of her neck with air escaping through the wound was seen at presentation.

Results

Ten days were spent in hospital including the first four in intubated Paediatric Intensive Care Unit. Initial microlaryngoscopy and bronchoscopy (MLB) showed a swelling in the right anterior subglottis not reducible by manipulation. She was re-intubated with progressively larger naso-tracheal tube until the fracture was fully reduced on her 3rd MLB. Three months post-injury, there is no evidence of airway narrowing.

Conclusion

The literature advocates early surgical management of laryngeal trauma including dog bites. Conservative management of laryngeal fracture from a dog bite is feasible and associated with a good outcome and no long-term sequela.
Bilateral Morgagni hernia: operative discovery of appendix lying on superior pulmonary vein
Authors: Lammy S , Stewart M , Carnochan FM , Walker WS
Published: August 2013

A patient presented having an acute abdomen on a background of a twelve-month history of worsening asthma. Computed tomography showed giant bilateral intrathoracic hernias extending to both thoracic apices. Our case was unusual as the defect was bilateral and left-sided. Surgical repair revealed each hernia sac measuring >20 cm and to contain the entirety of the small bowel and colon (including retroperitoneal bowel). The appendix was discovered adjacent to right superior pulmonary vein. Both sacs were excised and the defects dissected and transfixed in a single stage operation. In the post-operative stage, he developed a 6.3 cm fluid collection anterior to the right atrium and a left-sided pleural effusion. Morgagni hernias can escape detection and be attributed to other diagnoses courtesy of false localising signs on clinical examination and symptoms in the history.
Cozen’s phenomenon: a remindera
Authors: Dorman S , Jariwala A , Campbell D
Published: August 2013

A four-year-old child attended Accident and Emergency following a fall from a slide with a displaced and angulated proximal tibial metaphyseal fracture. Treatment included closed manipulation under anaesthesia and an above knee cast for seven weeks. Serial radiographs over the following few months were satisfactory demonstrating good alignment and evidence of healing. However, at four-months review new-onset genu valgum with mechanical axis deviation was noted. No evidence of spontaneous resolution was noted over the following 12 months and hence a corrective hemi-epiphysiodesis was performed. At 12-months post-operatively, there was marked clinical and radiographical improvement in alignment. Classically Cozen’s phenomenon is described as the late-onset post-traumatic valgus deformity associated with proximal tibial metaphyseal fractures in children. We want to reemphasise the early recognition of children at risk of this unique complication. In addition, we wish to highlight the progression of the late-onset valgus and its subsequent management.
Dipyridamole and paracetamol overdose resulting in multi-organ failure
Authors: Cullis PS , Watson D , Cameron A , McKee RF
Published: August 2013

Dipyridamole intoxication is rare and few reports exist amongst the current literature. A case of dipyridamole and paracetamol overdose is described in a previously healthy 58-year-old woman, which resulted in multi-organ failure requiring dialysis, inotropic support, ventilation and extensive surgical intervention for small bowel ischaemia. This case highlights the dangers of an unusually large overdose of a commonly prescribed drug, and reviews current knowledge of dipyridamole intoxication.
Neonatal hip septic arthritis: ultrasound should not influence decision to aspirate
Authors: Lee SWJ , Irwin GJ , Huntley JS
Published: August 2013

An 18-week-old boy presented to the emergency department with 24-h history of fever and irritability with a painful left hip held in flexion. Blood tests showed an elevated ESR of 65 mm/h, but white cell count and C-reactive protein were in the reference range. Admission hip ultrasound identified a small effusion (<2 mm at the recess), not large enough to determine turbidity. Joint aspiration under general anaesthesia yielded frank pus and mandated open arthrotomy. Physicians must maintain a high index of suspicion of hip septic arthritis irrespective of ultrasound findings and have a low threshold for joint aspiration. Aspiration ‘to dryness’ would have left substantial pus within the joint and is consistent with advocating arthrotomy and washout in this age group, when the diagnosis of septic arthritis has been made.
Intravitreal bevacizumab for the treatment of retinopathy of prematurity: a case report
Authors: Flavahan PW , Lavy TE , Wykes W
Published: August 2013

Objective

We report the first case in Scotland of a premature infant treated for retinopathy of prematurity with bevacizumab.

Method

A case report and a review of the literature are presented.

Results

Retinopathy of prematurity is a leading worldwide cause of childhood blindness. Conventional laser treatment results in destruction of the peripheral retina and does not prevent all cases of vision loss, particularly in Zone I disease. We present the case of a baby born at 26+3 weeks who developed stage 3+ disease located in Zone I of the retina. The patient was treated with bilateral bevacizumab injections and achieved complete resolution of his retinopathy.

Conclusion

Bevacizumab therapy for the treatment of retinopathy of prematurity is an effective and inexpensive treatment that can readily and quickly be administered by a competent ophthalmologist without the need for specialist equipment.
The effect of magnesium administration on erythrocyte transketolase activity in alcoholic patients treated with thiamine
Authors: Peake RWA , Godber IM , Maguire D
Published: August 2013

Background and aims

Chronic alcoholic patients are at increased risk of developing deficiencies of thiamine and magnesium. Thiamine is an essential co-factor for a number of enzymes involved in carbohydrate metabolism and requires optimal levels of magnesium for biological function. However, whilst thiamine supplementation is well established for the treatment of alcoholic patients, the importance of magnesium is often overlooked. We describe the effect of concurrent thiamine and magnesium administration on the activity of the thiamine-dependent enzyme erythrocyte transketolase in a cohort of chronic alcoholic patients.

Methods

Baseline erythrocyte transketolase activities were measured on blood samples collected from 36 chronic alcoholic patients presenting acutely to the Accident and Emergency department. Patients received either intravenous Pabrinex (thiamine) supplemented with magnesium sulphate ( n = 18) or Pabrinex only ( n = 18). Post-treatment bloods were collected for re-assessment of erythrocyte transketolase activity. The change in transketolase activities (pre-vs. post-treatment) between the two patient groups were compared by Mann-Whitney U test.

Results

The increase in transketolase activity following treatment in the cohort receiving Pabrinex supplemented with magnesium sulphate was significantly greater ( p = 0.018) than that produced in the cohort receiving Pabrinex alone.

Conclusion

In the acute management of a sample of chronic alcoholic patients, those receiving magnesium sulphate with Pabrinex have higher increases in erythrocyte transketolase activity compared with those receiving Pabrinex alone. We conclude that concurrent magnesium administration with Pabrinex may be required for enabling full efficacy of Pabrinex treatment, as demonstrated by its positive effect on erythrocyte transketolase activity.
The suspected scaphoid injury: resource implications in the absence of magnetic resonance imaging
Authors: Burns MJ , Aitken SA , McRae D , Duckworth AD , Gray A
Published: August 2013

Introduction

Undiagnosed and untreated scaphoid fractures have poorer outcomes and many patients are unnecessarily immobilised for prolonged periods of time to avoid missing occult injuries. Magnetic resonance imaging has a high sensitivity and specificity in detecting occult scaphoid fractures, but many units do not routinely use this imaging modality in the diagnostic pathway. We aimed to determine the patterns of suspected scaphoid injuries, report the process of care, and calculate the costs involved in their management.

Methods

We prospectively identified all adult patients referred to fracture clinic at the Royal Infirmary of Edinburgh with a scaphoid-related injury, between October 2007 and September 2008. Clinical notes were examined retrospectively. We defined three injury groups: true fractures, occult fractures, and suspected scaphoid injuries. We analysed patient demographics, treatment timelines, and the treatment costs involved.

Results

Fracture clinic received 537 scaphoid-related referrals. There were 87 true fractures, 43 occult fractures, and 407 suspected injuries, incurring average treatment costs of £1,173, £773, and £384 respectively. Occult fractures accounted for 33% of all confirmed scaphoid fractures. The majority of scaphoid-related referrals (76%) were never proven to have a scaphoid fracture, and many were unnecessarily immobilised. The costs involved in the treatment of suspected scaphoid injuries were found to be higher than the cost of magnetic resonance imaging (£97).

Conclusion

In this group of suspected scaphoid injury, we believe the introduction of an early magnetic resonance imaging protocol would lead to an earlier definitive diagnosis and potentially a more cost-effective service.