bluuebunny/crossref_metadata_2025 huggingface dataset:
Tuberculous constrictive pericarditis with concurrent active pulmonary tuberculous infection: a case report
Authors: Liu Yen-Wen , Tsai Huey-Ru , Li Wen-Huang , Lin Li-Jen , Chen Jyh-Hong
Published: July 2009

Introduction

In some particular endemic area, it is not uncommon to see patients with tuberculosis pericarditis. However, it takes a period of time from tuberculous pericarditis to constrictive pericarditis. There is still no report of tuberculous constrictive pericarditis concurrent with active pulmonary TB infection in a patient without previous pulmonary TB infection history. Therefore, we reported a TB constrictive pericarditis with rare disease progress.

Case presentation

We report the case of a 63-year-old Taiwanese man with tuberculous constrictive pericarditis concurrent with active pulmonary tuberculous infection presenting with progressive extremities edema, puffy face, abdominal distension and dyspnea on exertion found to be caused by right heart failure. The patient was cured by pericardial stripping and anti-tuberculosis chemotherapy. We reviewed other cases of tuberculous constrictive pericarditis from the literature and described the peculiarities of this case.

Conclusions

Rapid diagnosis and treatment of constrictive pericarditis are crucial to reduce mortality. In some endemic areas, Mycobacterium tuberculosis infection should be taken into consideration during diagnostic evaluations for constrictive pericarditis. Surgical intervention is still the treatment of choice when the patient has the symptoms or signs of pericardial constriction and right heart failure. Our case is a constant reminder that active Mycobacterium tuberculosis infection does present itself with uncommon presentations.
Inflammatory fibroid polyp (Vanek's tumour), an unusual large polyp of the jejunum: a case report
Authors: Rehman Shafiq , Gamie Zakareya , Wilson Timothy R , Coup Andrew , Kaur Geetinder
Published: July 2009

We report the case of a 46-year-old man who presented with recurrent episodes of severe upper abdominal pain over a period of three months. A computerized tomography scan of his abdomen demonstrated a large non-obstructing jejunal mass. He underwent laparotomy and resection of a 13.5 cm tumour from the distal jejunum. Histopathological examination confirmed a large inflammatory fibroid polyp of the jejunum. The clinical presentation and microscopic features are discussed.
Central retinal vein occlusion: a case report and review of the literature
Authors: Alasil Tarek , Lee Nahyoung , Keane Pearse , Sadda Srinivas
Published: July 2009

Introduction

Central retinal vein occlusion is one of the major causes of severe vision impairment and blindness in adults.

Case presentation

We present a case of unilateral ischemic central retinal vein occlusion in a 54-year-old woman with history of uncontrolled hypertension and open angle glaucoma. Laboratory tests including complete hypercoagulability and thrombotic workup were completed.

Conclusion

Our case illustrates an interesting presentation of unilateral ischemic central retinal vein occlusion, where hypertension and glaucoma were thought to be the main risk factors. Close follow up, tight blood pressure and glaucoma control are crucial to prevent similar scenario in the fellow eye.
Spontaneous corneal melting during pregnancy: a case report
Authors: Oh Joo Youn , Kim Mee Kum , Park Joong Shin , Wee Won Ryang
Published: July 2009

Introduction

Biomechanical changes in the cornea during pregnancy might lead to pathological conditions such as corneal perforation or melting.

Case presentation

A 33-year-old Asian female who underwent penetrating keratoplasty in both eyes developed corneal melting in the right eye and marginal keratitis in the left eye in her fifth month of pregnancy. Marginal keratitis in the left eye immediately subsided with topical steroid therapy. However, spontaneous corneal melting progressed in the right eye, despite oral steroid therapy and amniotic membrane transplantation. We performed tectonic penetrating keratoplasty and corneoscleral grafting in the right eye.

Conclusion

We advise caution in the ophthalmologic care of pregnant patients who have preexisting corneal thinning disorders or who have undergone multiple corneal surgeries, because physiologic changes during pregnancy might contribute to corneal changes leading to spontaneous melting especially in patients with compromised cornea.
Mesothelioma in an HIV/AIDS patient without history of asbestos exposure: possible role for immunosuppression in mesothelioma: a case report
Authors: James Cleve Orian , Woods Ashanti W , Arya Payam , Abuelgasim Khadega Ahmed , Heath Lekidelu Taddesse , Sitapati Amy
Published: July 2009

We describe a 41-year-old African-American male who initially presented in respiratory distress. He had a positive history of asthma, cigarette smoking, and only recent possible asbestos exposure six months prior to onset of symptoms. Mesothelioma was suspected after chest radiography and PET-CT, and confirmed by immunohistochemical tissue analysis. We postulate that immunosuppression enhances susceptibility to mesothelioma, since weakened immune systems are present in both HIV/AIDS patients like this 41-year-old man, and elderly patients who compose the population that classically presents with mesothelioma. Furthermore, immunosuppression may be a prerequisite to the development of mesothelioma.
Gestational choriocarcinoma diagnosed with spontaneous splenic rupture after pregnancy induced by in vitro fertilization: a case report
Authors: Yürüyen Mehmet , Yildiz Ozcan , Papila Cigdem , Tuzuner Nukhet
Published: July 2009

Gestational choriocarcinoma is a highly malignant tumor of trophoblastic cells with a propensity to metastasize to various sites including lungs, vagina, brain, liver, kidney, and gastrointestinal tract, in descending order of frequency. A 29-year-old Caucasian woman presented to the hospital as an emergency with abdominal pain, hypotension, nausea and vomiting at about 6th month of a twin delivery after in vitro fertilization. Our case probably represents the first case of metastatic choriocarcinoma developed after in vitro fertilization, whether associted with or not, which was cured successfully after chemotherapy.
Presence of HER4 associates with increased sensitivity to Herceptin™ in patients with metastatic breast cancer
Authors: Sassen Andrea , Diermeier-Daucher Simone , Sieben Manuela , Ortmann Olaf , Hofstaedter Ferdinand , Schwarz Stephan , Brockhoff Gero
Published: July 2009

Introduction

HER2 overexpression, or rather HER2 gene amplification, is indicative for Herceptin therapy in both metastatic and pre-metastatic breast cancer patients. Patient's individual sensitivity to Herceptin treatment, however, varies enormously and spans from effectual responsiveness over acquired insensitivity to complete resistance from the outset. Thus no predictive information can be deduced from HER2 determination so that molecular biomarkers indicative for Herceptin sensitivity or resistance need to be identified. Both ErbB receptor-dependent signalling molecules as well as HER2-related ErbB receptor tyrosine kinases, known to mutually interact and to cross-regulate each other are prime candidates to be involved in cellular susceptibility to Herceptin.

Methods

Using immunohistochemistry and fluorescence in situ hybridisation, we retrospectively investigated primary breast cancer tissues from 48 patients who were under Herceptin treatment. We quantified the gene copy numbers of all HER receptors and evaluated their coexpression profile. Moreover the HER2 phosphorylation state, the ratio of native to truncated HER2, p27(kip1) and PTEN expression were objects of this study.

Results

Above all markers investigated in this study Kaplan-Meier and Cox regression analysis revealed a significant positive impact of HER4 (co-)expression on overall survival from beginning of antibody therapy. Both HER4 expression and HER4 gene amplification emerged as independent prognostic markers in Herceptin-treated breast cancer patients and responsiveness to Herceptin turned out to be more efficient if tumour cells show HER4 expression.

Conclusions

Although HER4 is known to potentially exert a tumour cell killing activity and in turn to have a favourable impact in breast cancer patients we demonstrate here the first time that HER4 expression prolongs overall survival in Herceptin-treated patients. Elucidating HER4 receptor function in the context of Herceptin treatment will advance the design of highly efficient receptor targeting. By then we need to extend the analysis of breast cancer by allowing for HER2/HER4 coexpression by which valuable additional prognostic and predictive information might possibly be revealed.
S-100B and neuron-specific enolase as predictors of neurological outcome in patients after cardiac arrest and return of spontaneous circulation: a systematic review
Authors: Shinozaki Koichiro , Oda Shigeto , Sadahiro Tomohito , Nakamura Masataka , Hirayama Yo , Abe Ryuzo , Tateishi Yoshihisa , Hattori Noriyuki , Shimada Tadanaga , Hirasawa Hiroyuki
Published: July 2009

Introduction

Neurological prognostic factors after cardiopulmonary resuscitation (CPR) in patients with cardiac arrest (CA) as early and accurately as possible are urgently needed to determine therapeutic strategies after successful CPR. In particular, serum levels of protein neuron-specific enolase (NSE) and S-100B are considered promising candidates for neurological predictors, and many investigations on the clinical usefulness of these markers have been published. However, the design adopted varied from study to study, making a systematic literature review extremely difficult. The present review focuses on the following three respects for the study design: definitions of outcome, value of specificity and time points of blood sampling.

Methods

A Medline search of literature published before August 2008 was performed using the following search terms: "NSE vs CA or CPR", "S100 vs CA or CPR". Publications examining the clinical usefulness of NSE or S-100B as a prognostic predictor in two outcome groups were reviewed. All publications met with inclusion criteria were classified into three groups with respect to the definitions of outcome; "dead or alive", "regained consciousness or remained comatose", and "return to independent daily life or not". The significance of differences between two outcome groups, cutoff values and predictive accuracy on each time points of blood sampling were investigated.

Results

A total of 54 papers were retrieved by the initial text search, and 24 were finally selected. In the three classified groups, most of the studies showed the significance of differences and concluded these biomarkers were useful for neurological predictor. However, in view of blood sampling points, the significance was not always detected. Nevertheless, only five studies involved uniform application of a blood sampling schedule with sampling intervals specified based on a set starting point. Specificity was not always set to 100%, therefore it is difficult to indiscriminately assess the cut-off values and its predictive accuracy of these biomarkers in this meta analysis.

Conclusions

In such circumstances, the findings of the present study should aid future investigators in examining the clinical usefulness of these markers and determination of cut-off values.
Acanthosis Nigricans and Insulin Sensitivity in Patients with Achondroplasia and Hypochodroplasia due to FGFR3 Mutations
Authors: Alatzoglou Kyriaki S. , Hindmarsh Peter C. , Brain Caroline , Torpiano John , Dattani Mehul T.
Published: July 2009

Background and Aims: Acanthosis nigricans (AN) has been reported in association with severe skeletal dysplasias due to activating mutations in FGFR3, including thanatophoric dysplasia, severe achondroplasia (ACH) with developmental delay and AN (SADDAN syndrome), and Crouzon syndrome with AN. There are isolated reports of patients with ACH and AN. In this series, we report clinical and biochemical data on five male patients, four with ACH and one with hypochondroplasia (HCH), who developed AN without SADDAN.

Methods and Results: We compared the results of a 1.75 g/kg oral glucose tolerance test performed in patients with ACH/HCH and AN with age-, sex-, and puberty-matched short children. Three of the patients were treated with recombinant human GH (dose range, 45–50 μg/kg/d), one patient had discontinued treatment 6 months before presentation, and one had never been treated. All patients had a fasting plasma glucose of less than 6 mmol/liter, and no patient had a plasma glucose greater than 7.8 mmol/liter at 2 h after ingestion of a glucose load. Although body mass index was higher in patients with skeletal dysplasia (28.9 ± 7.3 vs. 20 ± 0.6 kg/m2; P = 0.01), mean fasting plasma insulin concentration was greater in controls (14.4 ± 4.8 vs. 6.0 ± 4.5 mU/liter; P = 0.03), as was homeostasis assessment index for insulin resistance (2.5 ± 0.9 vs. 1.17 ± 0.8; P = 0.05).

Conclusion: Our findings suggest that the development of AN in patients with ACH/HCH is not due to insulin insensitivity either on its own or secondary to treatment with recombinant human GH. Whether the AN is due to altered melanocyte function in these individuals remains to be established.

The development of acanthosis nigricans in patients with achondroplasia/hypochondroplasia is not due to reduced insulin sensitivity.
Glucocorticoids Are Preferable to Thionamides as First-Line Treatment for Amiodarone-Induced Thyrotoxicosis due to Destructive Thyroiditis: A Matched Retrospective Cohort Study
Authors: Bogazzi Fausto , Tomisti Luca , Rossi Giuseppe , Dell'Unto Enrica , Pepe Pasquale , Bartalena Luigi , Martino Enio
Published: July 2009

Context: Type 2 amiodarone-induced thyrotoxicosis (AIT) is a destructive thyroiditis usually responsive to glucocorticoids; however, recent surveys showed that many expert thyroidologists worldwide use thionamides for type 2 AIT patients.

Objective: The objective of the study was to compare the effectiveness of methimazole (MMI) or prednisone (GLU) in type 2 AIT patients who had a short cure time according to a published predictive model.

Design: This was a matched retrospective cohort study.

Setting: The study was conducted at a university center.

Patients: Forty-two untreated type 2 AIT patients with a predicted cure time ≤40 d were divided into two groups (MMI and GLU groups). After matching for the predicted cure time, patients in the GLU group were selected in a 1:1 ratio to patients in the MMI group.

Intervention: Patients were treated with GLU or MMI for 40 d. Patients still thyrotoxic after 40 d continued glucocorticoids if in the GLU group or were switched to prednisone (MMI-GLU group) if in the MMI group.

Main Outcome Measure: Time and rate of cure (healing) at 40 d were measured.

Results: Patients still thyrotoxic after 40 d were 23.8 ± 9.3% in the GLU group and 85.7 ± 7.6% in the MMI group (P = 0.000). The GLU and MMI-GLU groups did not significantly differ in the nonhealing rate at 40 d (P = 0.730). When patients in the MMI group were treated with glucocorticoids, 94.1% patients achieved euthyroidism within 40 d. However, the global median cure time (MMI period + prednisone period) was longer (60 d, 95% confidence interval 53.5–66.5 d) in the MMI-GLU group than the GLU group (21 d, 95% confidence interval 15.1–26.9 d).

Conclusions: Glucocorticoids are the first-line treatment in type 2 AIT, whereas thionamides play no role in this destructive thyroiditis.

Glucocorticoids are the first-line treatment in type 2 amiodarone-induced thyrotoxicosis while thionamides play no role in this destructive thyroiditis.
Growth Hormone Excess Promotes Breast Cancer Chemoresistance
Authors: Zatelli Maria Chiara , Minoia Mariella , Molè Daniela , Cason Valentina , Tagliati Federico , Margutti Angelo , Bondanelli Marta , Ambrosio Maria Rosaria , degli Uberti Ettore
Published: July 2009

Context: GH and IGF-I are known to promote breast carcinogenesis. Even if breast cancer (BC) incidence is not increased in female acromegalic patients, mortality is greater as compared with general population.

Objective: The objective of the study was to evaluate whether GH/IGF-I excess might influence BC response to chemotherapy.

Design: We evaluated GH and IGF-I effects on cell proliferation of a BC cell line, MCF7 cells, in the presence of doxorubicin (Doxo), frequently used in BC chemotherapy, and the possible mechanisms involved.

Results: GH and IGF-I induce MCF7 cell growth in serum-free conditions and protect the cells from the cytotoxic effects of Doxo. GH effects are direct and not mediated by IGF-I because they are apparent also in the presence of an IGF-I receptor blocking antibody and disappear in the presence of the GH antagonist pegvisomant. The expression of the MDR1 gene, involved in resistance to chemotherapeutic drugs, was not induced by GH. In addition, c-fos transduction was reduced by Doxo, which prevented GH stimulatory effects. Pegvisomant inhibited basal and GH-induced c-fos promoter transcriptional activity. Autocrine GH action is ruled out by the lack of endogenous GH expression in this MCF7 cell strain.

Conclusions: These data indicate that GH can directly induce resistance to chemotherapeutic drugs with a mechanism that might involve GH-induced early gene transcription and support the hypothesis that GH excess can hamper BC treatment, possibly resulting in an increased mortality.

Growth hormone (GH) can directly induce chemoresistance, likely involving GH-induced early gene transcription. GH excess can hamper breast cancer treatment, possibly resulting in an increased mortality.
Role of cleavage by separase of the Rec8 kleisin subunit of cohesin during mammalian meiosis I
Authors: Kudo Nobuaki R. , Anger Martin , Peters Antoine H. F. M. , Stemmann Olaf , Theussl Hans-Christian , Helmhart Wolfgang , Kudo Hiromi , Heyting Christa , Nasmyth Kim
Published: July 2009

Proteolytic activity of separase is required for chiasma resolution during meiosis I in mouse oocytes. Rec8, the meiosis-specific α-kleisin subunit of cohesin, is a key target of separase in yeast. Is the equivalent protein also a target in mammals? We show here that separase cleaves mouse Rec8 at three positions in vitro but only when the latter is hyper-phosphorylated. Expression of a Rec8 variant (Rec8-N) that cannot be cleaved in vitro at these sites causes sterility in male mice. Their seminiferous tubules lack a normal complement of 2 C secondary spermatocytes and 1 C spermatids and contain instead a high proportion of cells with enlarged nuclei. Chromosome spreads reveal that Rec8-N expression has no effect in primary spermatocytes but produces secondary spermatocytes and spermatids with a 4 C DNA content, suggesting that the first and possibly also the second meiotic division is abolished. Expression of Rec8-N in oocytes causes chromosome segregation to be asynchronous and delays its completion by 2-3 hours during anaphase I, probably due to inefficient proteolysis of Rec8-N by separase. Despite this effect, chromosome segregation must be quite accurate as Rec8-N does not greatly reduce female fertility. Our data is consistent with the notion that Rec8 cleavage is important and probably crucial for the resolution of chiasmata in males and females.
How do anti-mitotic drugs kill cancer cells?
Authors: Gascoigne Karen E. , Taylor Stephen S.
Published: July 2009

In 2007, over 12-million people were diagnosed with cancer. According to the American Cancer Society, at least one third of these individuals are not expected to survive the disease, making cancer the second most prevalent cause of death worldwide. Systemic chemotherapy forms the mainstay of cancer treatment, and agents that disrupt mitotic spindle assembly – so called `anti-mitotics' – are commonly used to treat a wide variety of cancers. Traditional anti-mitotic agents include the microtubule toxins such as taxol, other taxanes and the vinca alkaloids, all of which have proven successful in the clinic. However, patient response remains highly unpredictable, and drug resistance is common. In addition, toxicity is a problem. To address these limitations, a new generation of anti-mitotic drugs is being developed. As the first wave of these new agents enters clinical trails, much hope rests on their outcome. Meanwhile, significant attention is being focused on trying to predict which tumour types are likely to respond. In this Commentary, we outline recent advances in our understanding of how cancer cells respond to anti-mitotic drugs, and discuss the relevance of these studies to their use in the clinic.
Unconventional splicing ofXBP1mRNA occurs in the cytoplasm during the mammalian unfolded protein response
Authors: Uemura Aya , Oku Masaya , Mori Kazutoshi , Yoshida Hiderou
Published: July 2009

XBP1 is a key transcription factor that regulates the mammalian unfolded protein response. Its expression is regulated by unconventional mRNA splicing that is carried out by endonuclease IRE1 and a specific, as yet unknown, RNA ligase in response to the accumulation of unfolded proteins in the ER. Conventional mRNA splicing occurs only in the nucleus, but it has remained unclear whether unconventional splicing of XBP1 mRNA takes place in the nucleus, cytoplasm or both. Here, we show that the catalytic domain of IRE1 contains a nuclear exclusion signal to prevent IRE1 from mislocalizing to the nucleus. In addition, RNA ligase, which joins XBP1 exons cleaved by IRE1 was detected in the cytoplasm but not in the nucleus. Moreover, the cytoplasm contained large amounts of unspliced XBP1 mRNA compared with the nucleus. Most unspliced XBP1 mRNA was converted to spliced mRNA by unconventional splicing even if de novo transcription was blocked, suggesting that cytoplasmic XBP1 mRNA, not nuclear XBP1 mRNA, is a major substrate for unconventional splicing. From these observations, we concluded that unconventional splicing of XBP1 mRNA occurs predominantly in the cytoplasm.
Neogenesis and maturation of transient Golgi-like cisternae in a simple eukaryote
Authors: Štefanić Saša , Morf Laura , Kulangara Caroline , Regös Attila , Sonda Sabrina , Schraner Elisabeth , Spycher Cornelia , Wild Peter , Hehl Adrian B.
Published: July 2009

The highly reduced protozoan parasite Giardia lamblia has minimal machinery for cellular processes such as protein trafficking. Giardia trophozoites maintain diverse and regulated secretory pathways but lack an identifiable Golgi complex. During differentiation to cysts, however, they produce specialized compartments termed encystation-specific vesicles (ESVs). ESVs are hypothesized to be unique developmentally regulated Golgi-like organelles dedicated to maturation and export of pre-sorted cyst wall proteins. Here we present a functional analysis of this unusual compartment by direct interference with the functions of the small GTPases Sar1, Rab1 and Arf1. Conditional expression of dominant-negative variants revealed an essential role of Sar1 in early events of organelle neogenesis, whilst inhibition of Arf1 uncoupled morphological changes and cell cycle progression from extracellular matrix export. The latter led to development of `naked cysts', which lacked water resistance and thus infectivity. Time-lapse microscopy and photobleaching experiments showed that putative Golgi-like cisternae in Giardia develop into a network capable of exchanging soluble cargo at a high rate via dynamic, tubular connections, presumably to synchronize maturation. The minimized and naturally pulsed trafficking machinery for export of the cyst wall biopolymer in Giardia is a simple model for investigating basic principles of neogenesis and maturation of Golgi compartments.
Regulation of VDR by ΔNp63α is associated with inhibition of cell invasion
Authors: Kommagani Ramakrishna , Leonard Mary K. , Lewis Stefanie , Romano Rose-Anne , Sinha Satrajit , Kadakia Madhavi P.
Published: July 2009

The p63 transcription factor has a pivotal role in epithelial morphogenesis. Multiple transcripts of the TP63 gene are generated because of alternative promoter usage and splicing. ΔNp63α is the predominant isoform of p63 observed during epithelial morphogenesis and in human cancers. Loss of ΔNp63α expression has been shown to promote invasiveness in a subset of human cancer cell lines. Here, we studied whether the regulation of VDR by ΔNp63α controls the invasiveness of an epidermoid cancer cell line. We demonstrate that VDR expression is induced by all p63 isoforms, including ΔNp63α. Endogenous ΔNp63α protein was observed to bind to the VDR promoter, and silencing of endogenous ΔNp63α resulted in diminished VDR expression. Although silencing of p63 inhibits VDR expression leading to an increase in cell migration, overexpression of p63 or VDR results in reduced cell migration as a result of increased VDR expression. Therefore, it is conceivable that p63 inhibits cell invasion by regulating VDR expression. Finally, we observed that expression of p63 and VDR overlaps in the wild-type mouse skin, but a reduced or complete absence of VDR expression was observed in skin from p63-null mice and in p63-null mouse embryonic fibroblasts. In conclusion, we demonstrate a direct transcriptional regulation of VDR by ΔNp63α. Our results highlight a crucial role for VDR in p63-mediated biological functions.
Carrier Multiplication in CdTe Quantum Dots by Single-photon Timing Spectroscopy
Authors: Kobayashi Yoichi , Udagawa Takeshi , Tamai Naoto
Published: July 2009

Carrier multiplication (CM) was observed in CdTe quantum dots (QDs) capped with tetradecylphosphonic acid (TDPA) at hν⁄Eg>2.5 by picosecond single-photon timing spectroscopy, where hν and Eg are the excitation and the band gap energies, and the CM efficiency increased rapidly with the increase of hν⁄Eg. No CM was observed less than the threshold value of hν⁄Eg≈2.5, which is close to that of CdSe QDs. As compared to a previous report by Nair and Bawendi, our result suggests that CM is sensitive to the QD surface conditions.
Enhanced Adsorption of Protein Fused with Polymeric Material-binding Peptide
Authors: Matsuno Hisao , Date Takaaki , Kubo Yohei , Yoshino Yuta , Tanaka Naoki , Sogabe Atsushi , Kuroita Toshihiro , Serizawa Takeshi
Published: July 2009

A model protein was fused with the ELWRPTR peptide, which binds specifically to the isotactic poly(methyl methacrylate) (it-PMMA) film surface, and its adsorption on PMMA film surfaces was then investigated by surface plasmon resonance measurements. We found that the adsorption constant of the fusion protein for the it-PMMA film surface was 75-fold greater than that of native protein.
An in-depth analysis of complaints in an orthopaedic department in the NHS
Authors: Giles Sally J , Morris Michael , Cook Gary A
Published: July 2009

Objective

To undertake an in-depth analysis of all complaints over a 12-month period in an orthopaedic department in the NHS.

Setting

Department of Orthopaedics in a UK NHS Trust.

Methods

Sixteen complaints files and associated patient case-notes were retrospectively reviewed by an independent consultant orthopaedic surgeon and members of the research team.

Results

There were some common themes in the adverse events reported. For example, failure to obtain adequately informed consent and lack of information given to patients were the most common adverse events that were identified by the review process. There were 36 adverse events/complications in the sample, 30 were adverse events and six were complications. Half of the complaints reviewed (18/36) related directly to adverse events. The majority of the adverse events that were identified by this study and review of complaints (27/36) were covered by the adverse event list and should have triggered an incident report.

Conclusion

Adverse events are not being acknowledged and there is a need for more openness with patients. As such, a larger study is needed to explore the extent of these issues.
Laryngeal cancer in acquired immunodeficiency syndrome
Authors: Shushan S , Cinamon U , Levy D , Sokolov M , Roth Y
Published: July 2009

With improved survival, more AIDS patients, especially heavy smokers and alcohol abusers, may be confronted with laryngeal squamous cell carcinoma. Since curative treatment may require aggressive combined therapy, these patients, often suffering from immunosupression and poor general condition, present unique therapeutic challenges. The objective of the study was to describe treatment dilemmas. This case report presents a detailed description of an AIDS patient with carcinoma of the larynx. A patient with T3N0M0 laryngeal carcinoma and AIDS underwent tracheotomy and biopsy, followed by severe neck and pulmonary infection. After convalescence, radiotherapy was administered, with no evidence of a disease during a 3.5-year follow-up. During his remaining life, the patient developed severe psychoaffective disorder, his immune state deteriorated until he demised from sepsis. In conclusion, patients with HIV infection, especially having a history of tobacco or alcohol abuse, should be carefully examined for head and neck carcinoma that is likely to be more aggressive. Following surgery, AIDS patients may have worse wound healing and a greater tendency to contract infections. Radiotherapy and especially chemotherapy may cause life-threatening complications. Although early detection may increase survival, curative treatment should involve many disciplines and extra caution.
Increasing incidence of Kaposi's sarcoma in black South Africans in KwaZulu-Natal, South Africa (1983–2006)
Authors: Mosam A , Carrara H , Shaik F , Uldrick T , Berkman A , Aboobaker J , Coovadia H M
Published: July 2009

The aim of the study was to describe the temporal trends in the incidence of Kaposi's sarcoma (KS) in black South Africans in KwaZulu-Natal (KZN). The study was designed as a retrospective record review. The incidence of Kaposi's sarcoma was estimated using administrative records for patients receiving care for KS through public sector oncology clinics in KZN, 1983–2006. Annual age-standardized incidence rates were calculated using provincial census data for the denominator. Age-specific rates were calculated for the pre-AIDS (1983–1989) and for the generalized AIDS epidemic eras (2006). Age-standardized incidence of KS increased in KZN from <1:100,000 in 1990 to at least 15:100,000 in 2006; this increase was observed in both men and women. There was a shift in the peak age-specific incidence rates from the sixth decade of life in the pre-AIDS era to the fourth and fifth decades in the AIDS era. In conclusion, KS is a growing public health problem in KZN, South Africa. These data reinforce the need for comprehensive national access to and roll-out of antiretroviral drugs, given their success in prevention and treatment of KS in first-world settings.
Adequacy of testing, empiric treatment, and referral for adult male emergency department patients with possible chlamydia and/or gonorrhoea urethritis
Authors: Merchant R C , DePalo D M , Stein M D , Rich J D
Published: July 2009

This study evaluated the adequacy of testing, empiric treatment and referral for further evaluation of adult male emergency department (ED) patients with possible chlamydia and/or gonorrhoea urethritis. Of 968 adult male ED patients, 84% were tested for chlamydia and gonorrhoea, 16% for HIV and 27% for syphilis; 92% received empiric treatment for chlamydia and gonorrhoea and 71% were referred for further evaluation; of those tested, 29% were infected with chlamydia, gonorrhoea or both; and 3% of those tested had a positive syphilis test. The results of logistic regression modelling indicated that testing, treatment and referral were not related to a history of sexual contact with someone known to have a sexually transmitted disease or to the patient's ultimate diagnosis of a laboratory-confirmed infection. Compliance with Centers for Disease Control and Prevention (CDC) recommendations for chlamydia and gonorrhoea testing and treatment regimens was high, but was poor for HIV testing. More explicit guidance from CDC regarding syphilis testing and referral for further evaluation is needed.
The frequency of HIV-I drug resistance mutations among treatment-naïve individuals at a tertiary care centre in south India
Authors: Kandathil A J , Kannangai R , Abraham O C , Rupali P , Pulimood S A , Verghese V P , Grant P , Pillay D , Sridharan G
Published: July 2009

Antiretroviral treatment (ART) use in India requires information on baseline drug resistance mutations and polymorphisms in the protease (Pr) and reverse transcriptase (RT) genes of HIV-1 strains from treatment-naïve individuals. We report resistance predictor mutations and polymorphisms in the Pr and the RT sequence of non-clade B HIV-1 strains from ART naïve individuals. The genotypic resistance assay was done on 93 treatment-naïve individuals. The sequences were analysed by Stanford HIV drug resistance data for genotypic drug resistance analysis and REGA HIV-1 subtyping tool. Phylogenetic tree was generated with MEGA 4 for quality control. Ninety-two strains belonged to clade C and one to clade A (A1). Amino acid substitutions were seen at positions associated with drug resistance in Pr gene – 10, 24, 74 (each 3%) and position 82 (11%). Substitutions were seen at positions 41 (1%), 100 (1%), 101 (6%), 103 (2%), 179 (6%) and 181 (1%) of the RT sequence known to confer drug resistance in clade B.

Polymorphisms in HIV-1 pol gene among treatment-naïve individuals were similar when compared with previous data. One strain each had Y181C substitution, T74S and E35G substitutions in the Pr and one had A98G, K101R and L210FL substitutions in RT.
Contraceptive use among women attending an open access genitourinary medicine department
Authors: Trewinnard K , Foley E
Published: July 2009

Termination of pregnancy rates among young women are rising in the UK and are associated with poor use of reliable contraceptive methods. Many women attending the genitourinary (GU) department for sexually transmitted infection screening do so because of poor or no condom use and are at ongoing risk of unwanted pregnancy. Few of these women attend a contraception clinic, where a full range of contraceptive methods, including long-acting reversible contraception, are available. In this study of 152 women of reproductive age, half stated that they needed further contraceptive advice. In total four-fifths of the women without a reliable method of contraception wanted contraceptive advice and/or future contraceptive provision in the GU medicine clinic.
A randomized trial of computer-based reminders and audit and feedback to improve HIV screening in a primary care setting
Authors: Sundaram V , Lazzeroni L C , Douglass L R , Sanders G D , Tempio P , Owens D K
Published: July 2009

Despite recommendations for voluntary HIV screening, few medical centres have implemented screening programmes. The objective of the study was to determine whether an intervention with computer-based reminders and feedback would increase screening for HIV in a Department of Veterans Affairs (VA) health-care system. The design of the study was a randomized controlled trial at five primary care clinics at the VA Palo Alto Health Care System. All primary care providers were eligible to participate in the study. The study intervention was computer-based reminders to either assess HIV risk behaviours or to offer HIV testing; feedback on adherence to reminders was provided. The main outcome measure was the difference in HIV testing rates between intervention and control group providers. The control group providers tested 1.0% ( n = 67) and 1.4% ( n = 106) of patients in the preintervention and intervention period, respectively; intervention providers tested 1.8% ( n = 98) and 1.9% ( n = 114), respectively ( P = 0.75). In our random sample of 753 untested patients, 204 (27%) had documented risk behaviours. Providers were more likely to adhere to reminders to test rather than with reminders to perform risk assessment (11% versus 5%, P < 0.01). Sixty-one percent of providers felt that lack of time prevented risk assessment. In conclusion, in primary care clinics in our setting, HIV testing rates were low. Providers were unaware of the high rates of risky behaviour in their patient population and perceived important barriers to testing. Low-intensity clinical reminders and feedback did not increase rates of screening.
HIV/AIDS-related knowledge, sources and perceived need among senior high school students: a cross-sectional study in China
Authors: Li S , Huang H , Xu G , Cai Y , Shi R , Shen X
Published: July 2009

This study aimed to assess HIV/AIDS-related knowledge, sources and perceived need among senior high school students in China. A total of 2668 senior high school students aged 15.17–23.42 years participated in the survey. A self-administered questionnaire was used to collect information on HIV/sexually transmitted infection-related knowledge, sources and perceived information need. The results showed that levels of HIV/AIDS knowledge were distributed as follows: low for 6.8%, moderate for 29.6% and high for 63.7%. The most important information sources were, in rank order, TV/photographic recording (72.1%), school heath education curriculum (51.8%) and reading materials (45.7%). About half of the students, 46.3%, confirmed a need for more information and 87.8% of the sampled senior high school students communicated with others if he/she had problems related to HIV/AIDS. Strengthening and improving information sources, particularly its accuracy and comprehensiveness, would help in ensuring that adolescents obtained the HIV/AIDS health information they needed.
Anthropometric indices of infants born to HIV-1-infected mothers: a prospective cohort study in Lagos, Nigeria
Authors: Ezeaka V C , Iroha E O , Akinsulie A O , Temiye E O , Adetifa I M O
Published: July 2009

Numerous studies have reported that HIV-infected pregnant women are at increased risk of delivery of low birth weight (LBW) infants, of preterm deliveries and of intrauterine growth restriction. The objective of the study was to determine the effect of maternal HIV infection on the anthropometric characteristics of the babies at birth. A prospective study was carried out at the Lagos University Teaching Hospital, Nigeria. There were three times more LBW babies in the HIV-positive group than in the uninfected mothers (odds ratio = 3.47, 95% confidence interval = 1.69, 7.27; χ2 = 12.99, P = 0.0003).The maternal weight ( t = 15.85; P = 0.0001), maternal body mass index (BMI) ( t = 15.07; P = 0.0003), birth weight of infants ( t = 27.17; P = 0.0001) and birth length ( t = 31.20; P = 0.001) were significantly less in HIV-positive mothers than in controls. In conclusion, poor maternal bodyweight and low BMI are significant contributors to LBW in HIV-infected women. Nutritional counselling, dietary intake and weight monitoring during pregnancy should be emphasized to improve pregnancy outcome in HIV-infected women.
Screening for asymptomatic chlamydia in women – how often would gonorrhoea be missed?
Authors: Rosenvinge M M , Lau R
Published: July 2009

Resistance of Neisseria gonorrhoeae (GC) to azithromycin is increasing. The dose of azithromycin used for treating uncomplicated genital chlamydia may be subtherapeutic for GC and contribute to gonococcal resistance. The National Chlamydia Screening Programme (NCSP) does not routinely screen for GC but advises further testing of clients with symptoms. This will miss asymptomatic cases. We conducted a case-note review of 100 women aged 16–24 years diagnosed with chlamydia and women aged 16–24 years co-infected with GC and chlamydia, who attended a London genitourinary clinic from 1 October 2004 to 30 September 2005. There were 559 chlamydia diagnoses; 38 (7%) were co-infected with GC. Those co-infected were younger: mean age 18.9 versus 20.3 ( P = 0.005). They were also more likely to have symptoms: 28/38 (74%) versus 50/94 (53%) ( P = 0.03). Two of 10 women with asymptomatic GC were contacts; meaning that eight cases of asymptomatic GC would have received subtherapeutic treatment. In conclusion, additional testing for GC should be considered in local NCSP protocols where there is a high prevalence of both infections.
The first case of criminalization of transmission of hepatitis B in the UK: defendant sentenced to two years’ imprisonment on the grounds of hepatitis B deoxyribonucleic acid sequencing
Authors: Mohanty K
Published: July 2009

A 29-year-old Turkish man Ercan Yasar, who worked as a restaurant worker in Cheltenham, infected a Cheltenham woman 27 years of age with hepatitis B and chlamydia between 14 and 17 September 2007. He was charged with biological grievous bodily harm, which carries a maximum of five years’ imprisonment if found guilty following a trial. The defendant, Ercan Yasar, pleaded guilty to the charge and was given appropriate credit for entering an early guilty plea and was sentenced to two years’ imprisonment before the Gloucester Crown Court on 14 November 2008.
Report of spontaneous and persistent genital arousal in women attending a sexual health clinic
Authors: Garvey L J , West C , Latch N , Leiblum S , Goldmeier D
Published: July 2009

The frequency of spontaneous genital arousal (GA) and persistent genital arousal disorder (PGAD) in women is unknown. The aim of this study was to conduct an anonymous survey to assess the frequency and nature of spontaneous GA and PGAD in women attending a walk-in sexual health clinic in London. Female patients completed a questionnaire, which included demographic information, medical, psychiatric and gynaecology history, the hospital anxiety and depression scale, and a somatization scale. Patients were then asked to complete three questions regarding spontaneous and persistent GA. Any patient with one or more symptoms then answered questions about the distress, intensity and duration of sensations. Ninety-six subjects participated. The mean age was 28.97 years. Thirty-two women (33.3%) answered ‘yes’ to at least one question regarding spontaneous or persistent GA and six women (6.3%) women answered ‘yes’ to all three questions. Only one subject fulfilled all five diagnostic criteria for PGAD. In conclusion, women report a high rate of spontaneous GA in the absence of desire or excitement. This has not been well described previously. A small proportion of women report multiple features of spontaneous and persistent GA, with chronicity over years, but without distress in most cases. Larger studies are needed.
The Successful Intelligence of High-Growth Entrepreneurs: Links to New Venture Growth
Authors: Baum J. Robert , Bird Barbara J.
Published: July 2009

We develop a model of successful intelligence in entrepreneurship. The model was tested through interviews with 22 printing industry CEOs and responses from 143 founders of early-stage, high-growth printing and graphics businesses. Successful intelligence combined with entrepreneurial self-efficacy to predict swift action and multiple improvement actions (repeated goal-driven changes). Swift action and multiple improvement actions predicted higher subsequent venture growth across four years. This field study confirmed that successful intelligence consists of practical, analytical, and creative intelligence and that, together with entrepreneurial self-efficacy, it enables and motivates successful entrepreneurial behavior. Intelligence has received little entrepreneurship research attention; however, this empirical study suggests that specific intelligences should be included as predictors in studies of venture outcomes. The two entrepreneurial behaviors developed here are useful concepts beyond the entrepreneurship domain.
The Effects of Competition on Referral Alliances of Professional Service Firms
Authors: Nam Inwoo , Gruca Thomas S. , Tracy Roger
Published: July 2009

The supply side of many professional service markets consists of two different pools of providers: generalists and specialists. Specialists usually gain access to new clients through referrals from generalists. To ensure a continuing stream of engagements, specialists often form referral alliances with multiple generalists. Engaging the right generalist partners and allocating resources to the resulting referral relationships are among the most important challenges facing these specialist firms. In this study, we examine how competition affects the management of referral alliances over time. Because of the high level of inseparability of the professional service engagement, the nature of competition among specialists is complex. Building on the ecological view of competition, we model the degree of niche overlap in the specialist's home markets and the generalists' markets as well as the potential overlap due to the proximity of rivals vis-à-vis generalists. Using data on visiting consultant clinics involving cardiology specialty practices and rural hospitals from a Midwestern state over a 13-year period, we find that the various aspects of niche overlap influence the involvement of these specialist professional service firms in referral alliances as well as resources they allocate to these relationships. In addition to expanding our understanding of vertical, bilateral alliances between professional service firms, this study enhances our general understanding of strategic alliances by demonstrating how partner attractiveness and the actions of rivals affect the resource allocation decisions of firms managing multiple strategic alliances over time.
Superstitious Learning with Rare Strategic Decisions: Theory and Evidence from Corporate Acquisitions
Authors: Zollo Maurizio
Published: July 2009

In this paper, the notion of superstitious learning is applied to the context of rare and complex strategic decisions. I argue that superstitious learning is a particularly relevant problem for these types of decisions not only because causal linkages between actions and outcomes might be poorly inferred, but also, more basically, because their performance outcomes are often very difficult to assess in objective ways. I test these arguments with a sample of U.S. bank mergers and find evidence that managers' perceptions of success in previous acquisitions is negatively related to the actual performance of the focal merger, and that this effect increases, rather than decreases, as managers accumulate experience. Consistent with the theoretical arguments developed, the effect is significantly attenuated as the knowledge is systematically articulated and codified and the stock of experience becomes more heterogeneous.
Cognitive Processes of Opportunity Recognition: The Role of Structural Alignment
Authors: Grégoire Denis A. , Barr Pamela S. , Shepherd Dean A.
Published: July 2009

Substantial gains can be made by individuals and organizations adept at detecting new opportunities. But how do business leaders do that concretely? Organization research shows that managers are more inclined to identify threats than opportunities, but it is still not clear why this is the case. Likewise, research points to several factors that may facilitate the recognition of opportunities. Yet empirical observations have been limited by retrospective biases and other conceptual challenges. As a result, key questions remain not only about what factors facilitate the recognition of opportunities, but also about why these factors play such a role. To further understanding of these issues, we study the reasoning strategies that individuals mobilize for recognizing opportunities. We develop a model of opportunity recognition as a cognitive process of structural alignment, and analyze the think-aloud verbalizations of executive entrepreneurs as they try to recognize opportunities for new technologies. In contrast to prior research, the qualitative and quantitative data do not provide evidence that individuals use prototypes to recognize opportunities. Instead, we find that different kinds of mental connections play different roles in the process of recognizing opportunities, with different consequences. We also document why and how prior knowledge may facilitate this process. By drawing attention to the cognitive underpinnings of opportunity recognition, we cast light on why it constitutes such a challenging task for individuals and organizations. In turn, this provides a useful basis for exploring the factors that explain why some individuals/organizations are able to recognize opportunities that others simply fail to see.