bluuebunny/crossref_metadata_2025 huggingface dataset:
Pulmonary vascular dysfunction in end-stage cystic fibrosis: role of NF-κB and endothelin-1
Authors: Henno P. , Maurey C. , Danel C. , Bonnette P. , Souilamas R. , Stern M. , Delclaux C. , Lévy M. , Israël-Biet D.
Published: November 2009

Pulmonary hypertension is rare in chronic respiratory diseases but has a strong impact on the prognosis and is partly underlined by factors other than hypoxaemia. The aim of the present study was to assess the potential role of endothelin-1 (ET-1) and nuclear factor (NF)-κB vasoconstrictive pathways in pulmonary hypertension.

The effects of ET-1 receptors blockers (BQ 123 and 788) and of genistein were assessed on response to acetylcholine of pulmonary vascular rings from cystic fibrosis (CF) lung transplant recipients (n = 23). NF-κB and ET-1 receptor expression was immunodetected in pulmonary arteries and quantitated using Western blotting. ET-1 vascular content was quantitated using ELISA.

In total, 14 out of 23 subjects exhibited strongly impaired pulmonary vasodilation (p<0.01versusnine out of 23 subjects with a normal response) associated with an activation of ET-1 receptors A and NF-κB pathways. Genistein restored vasodilation in subjects with an abnormal response.

Pulmonary vascular dysfunction is frequent in end-stage CF, involving the NF-κB pathway and that of ET-1 through ET-1 receptor A (ETAR). These data leave a conceptual place for ETAR blockers and isoflavones in the management of the devastating vascular complication of chronic obstructive respiratory diseases such as CF.
Disseminated multiorgan MDR-TB resistant to virtually all first-line drugs
Authors: Sasse J. , Teichmann D.
Published: November 2009

The emergence of multidrug-resistant tuberculosis (MDR-TB) is a major global concern since, despite a complex treatment regime, it still remains a lethal threat.

A 21-yr-old male HIV-negative migrant from Burma presented with a disseminated tuberculosis affecting the lung, spleen, liver, mediastinal and abdominal lymph nodes. This particular strain ofMycobacterium tuberculosisproved to be resistant to all but one (pyrazinamide) of the first-line drugs,i.e.rifampicin, isoniazid and ethambutol, plus streptomycin, rifabutin and ofloxacin. On the mere account of its susceptibility concerning kanamycin it could not be labelled as extensively drug-resistant tuberculosis.

After 1 month of a standard first-line four-drug regimen and a subsequent 4 months of second-line treatment with amikacin, moxifloxacin, terizidone, protionamide, linezolid and pyrazinamide, sputum cultures eventually yielded constantly negative results. Likewise, the organ manifestations decreased significantly, so as to be virtually undetectable in computed tomography scans after 1 yr of continuous treatment. A moderate pancytopenia reversed completely after dose adjustment of linezolid.

Disseminated tuberculosis manifestations without typical pulmonary cavernous lesions are likely to represent primary infection rather than reactivation. Even a multiorgan disseminated MDR-TB with an extensive resistance pattern (including fluoroquinolones) can be successfully treated with an individual second-line treatment and result in considerably few adverse events.
Disseminated nontuberculous infections withMycobacterium genavenseduring sarcoidosis: FIGURE 1.
Authors: Dumouchel-Champagne H. , Charlier-Woerther C. , Boibieux A. , Ffrench M. , Carret G. , Chidiac C. , Peyramond D. , Ader F.
Published: November 2009

Sarcoidosis is a chronic disease characterised by the development and accumulation of granulomas in multiple organs. We report two observations of disseminatedMycobacterium genavenseinfection in patients with proven sarcoidosis. High fever and abdominal pain appeared at 8 and 18 months following the initiation of immunosuppressive therapy. Abdominal computed tomography scans of the patients showed diffuse mesenteric lymphadenitis and splenomegaly. The diagnosis was obtained on bone marrow specimens for both patients with numerous acid-fast bacteria at direct examination and positive specific mycobacterial identification by nucleic acid amplification test. Despite prompt antimycobacterial therapy, occurrence of complications (peritonitis post-splenectomy surgery and lung carcinoma) resulted in a fatal outcome for both patients. These cases highlight that opportunistic infections likeM. genavenseor other nontuberculous mycobacterial infections should be considered for long-standing immunocompromised patients with sarcoidosis.
Gastro-oesophageal reflux disease and non-asthma lung disease
Authors: Morehead R. S.
Published: November 2009

Gastro-oesophageal reflux disease (GERD) is a common disorder in Western countries, and its relationship to airways disorders (e.g.asthma) has been well established. Lung diseases other than asthma have also been associated with GERD, but the nature and scope of this relationship has not been fully defined. Diseases that have been associated with GERD include bronchiolitis syndromes, idiopathic pulmonary fibrosis, scleroderma and nontubercular mycobacterial infection.

Diagnostic evaluation centres upon proving both reflux and pulmonary aspiration, which may be accomplished in some cases by lung biopsy. However, in many cases a compatible clinical and radiographic picture coupled with proof of proximal reflux by combined oesophageal probe testing may suffice for a provisional diagnosis and allow institution of anti-reflux measures.

Proton-pump inhibitors are the medications of choice for GERD; other interventions shown to reduce reflux are weight loss, elevation of the head of the bed and avoidance of recumbency after meals. However, acid suppression therapy does not address non-acid reflux that may be important in disease pathogenesis in select patients, and lifestyle modifications often fail.

Laparoscopic fundoplication is the procedure of choice for medically refractory GERD with excellent short-term results with respect to respiratory symptoms associated with GERD; however, long-term studies document a significant percentage of patients requiring ongoing acid suppression therapy.
Paradoxical reactions in non-HIV tuberculosis presenting as endobronchial obstruction
Authors: Bloch S. , Wickremasinghe M. , Wright A. , Rice A. , Thompson M. , Kon O. M.
Published: November 2009

Paradoxical reaction (PR) in tuberculosis (TB) is common and may affect up to 25% of patients. PR has the potential to cause significant morbidity and, on occasion, death. Although PR has been recognised for some time, the pathophysiology, especially in HIV-negative patients, is not well understood.

We present two cases of PR in HIV-negative patients with TB presenting as significant airway obstruction secondary to a florid endobronchial component.

These cases demonstrate that PR should be considered in all patients presenting with airway symptoms who have started TB treatment. The outcomes of the cases illustrate the need for wider recognition of this condition and more research to characterise patients who may be at risk, in order to gain a greater understanding of the mechanisms involved and to make or predict this diagnosis earlier.
iLAP: a workflow-driven software for experimental protocol development, data acquisition and analysis
Authors: Stocker Gernot , Fischer Maria , Rieder Dietmar , Bindea Gabriela , Kainz Simon , Oberstolz Michael , McNally James G , Trajanoski Zlatko
Published: November 2009

Background

In recent years, the genome biology community has expended considerable effort to confront the challenges of managing heterogeneous data in a structured and organized way and developed laboratory information management systems (LIMS) for both raw and processed data. On the other hand, electronic notebooks were developed to record and manage scientific data, and facilitate data-sharing. Software which enables both, management of large datasets and digital recording of laboratory procedures would serve a real need in laboratories using medium and high-throughput techniques.

Results

We have developed iLAP (Laboratory data management, Analysis, and Protocol development), a workflow-driven information management system specifically designed to create and manage experimental protocols, and to analyze and share laboratory data. The system combines experimental protocol development, wizard-based data acquisition, and high-throughput data analysis into a single, integrated system. We demonstrate the power and the flexibility of the platform using a microscopy case study based on a combinatorial multiple fluorescence in situ hybridization (m-FISH) protocol and 3D-image reconstruction. iLAP is freely available under the open source license AGPL fromhttp://genome.tugraz.at/iLAP/.

Conclusion

iLAP is a flexible and versatile information management system, which has the potential to close the gap between electronic notebooks and LIMS and can therefore be of great value for a broad scientific community.
Novel interactions of CLN5 support molecular networking between Neuronal Ceroid Lipofuscinosis proteins
Authors: Lyly Annina , von Schantz Carina , Heine Claudia , Schmiedt Mia-Lisa , Sipilä Tessa , Jalanko Anu , Kyttälä Aija
Published: November 2009

Background

Neuronal ceroid lipofuscinoses (NCLs) comprise at least eight genetically characterized neurodegenerative disorders of childhood. Despite of genetic heterogeneity, the high similarity of clinical symptoms and pathology of different NCL disorders suggest cooperation between different NCL proteins and common mechanisms of pathogenesis. Here, we have studied molecular interactions between NCL proteins, concentrating specifically on the interactions of CLN5, the protein underlying the Finnish variant late infantile form of NCL (vLINCLFin).

Results

We found that CLN5 interacts with several other NCL proteins namely, CLN1/PPT1, CLN2/TPP1, CLN3, CLN6 and CLN8. Furthermore, analysis of the intracellular targeting of CLN5 together with the interacting NCL proteins revealed that over-expression of PPT1 can facilitate the lysosomal transport of mutated CLN5FinMajor, normally residing in the ER and in the Golgi complex. The significance of the novel interaction between CLN5 and PPT1 was further supported by the finding that CLN5 was also able to bind the F1-ATPase, earlier shown to interact with PPT1.

Conclusion

We have described novel interactions between CLN5 and several NCL proteins, suggesting a modifying role for these proteins in the pathogenesis of individual NCL disorders. Among these novel interactions, binding of CLN5 to CLN1/PPT1 is suggested to be the most significant one, since over-expression of PPT1 was shown to influence on the intracellular trafficking of mutated CLN5, and they were shown to share a binding partner outside the NCL protein spectrum.
Prediction of clinical toxicity in localized cervical carcinoma by radio-induced apoptosis study in peripheral blood lymphocytes (PBLs)
Authors: Bordón Elisa , Henríquez Hernández Luis Alberto , Lara Pedro C , Pinar Beatriz , Fontes Fausto , Rodríguez Gallego Carlos , Lloret Marta
Published: November 2009

Background

Cervical cancer is treated mainly by surgery and radiotherapy. Toxicity due to radiation is a limiting factor for treatment success. Determination of lymphocyte radiosensitivity by radio-induced apoptosis arises as a possible method for predictive test development. The aim of this study was to analyze radio-induced apoptosis of peripheral blood lymphocytes.

Methods

Ninety four consecutive patients suffering from cervical carcinoma, diagnosed and treated in our institution, and four healthy controls were included in the study. Toxicity was evaluated using the Lent-Soma scale. Peripheral blood lymphocytes were isolated and irradiated at 0, 1, 2 and 8 Gy during 24, 48 and 72 hours. Apoptosis was measured by flow cytometry using annexin V/propidium iodide to determine early and late apoptosis. Lymphocytes were marked with CD45 APC-conjugated monoclonal antibody.

Results

Radiation-induced apoptosis (RIA) increased with radiation dose and time of incubation. Data strongly fitted to a semi logarithmic model as follows: RIA = βln(Gy) + α. This mathematical model was defined by two constants: α, is the origin of the curve in the Y axis and determines the percentage of spontaneous cell death and β, is the slope of the curve and determines the percentage of cell death induced at a determined radiation dose (β = ΔRIA/Δln(Gy)). Higher β values (increased rate of RIA at given radiation doses) were observed in patients with low sexual toxicity (Exp(B) = 0.83, C.I. 95% (0.73-0.95), p = 0.007; Exp(B) = 0.88, C.I. 95% (0.82-0.94), p = 0.001; Exp(B) = 0.93, C.I. 95% (0.88-0.99), p = 0.026 for 24, 48 and 72 hours respectively). This relation was also found with rectal (Exp(B) = 0.89, C.I. 95% (0.81-0.98), p = 0.026; Exp(B) = 0.95, C.I. 95% (0.91-0.98), p = 0.013 for 48 and 72 hours respectively) and urinary (Exp(B) = 0.83, C.I. 95% (0.71-0.97), p = 0.021 for 24 hours) toxicity.

Conclusion

Radiation induced apoptosis at different time points and radiation doses fitted to a semi logarithmic model defined by a mathematical equation that gives an individual value of radiosensitivity and could predict late toxicity due to radiotherapy. Other prospective studies with higher number of patients are needed to validate these results.
Editorial: In-and-out blood vessels: new insights into T cell reverse transmigration
Authors: Raffaghello Lizzia , Pistoia Vito
Published: November 2009

Leukocytes move in the body along concentration gradients of chemoattractants under conditions of hemodynamic shear; these movements include exit from and re-entry into blood vessels.
Basophils preferentially express mouse mast cell protease 11 among the mast cell tryptase family in contrast to mast cells
Authors: Ugajin Tsukasa , Kojima Toshiyuki , Mukai Kaori , Obata Kazushige , Kawano Yohei , Minegishi Yoshiyuki , Eishi Yoshinobu , Yokozeki Hiroo , Karasuyama Hajime
Published: November 2009

mMCP-11 is the first mast cell tryptase whose expression is documented in mouse basophils.

Tryptases and chymases are the major proteins stored and secreted by mast cells, and they have various biological functions. However, the nature of proteases produced by basophils has been poorly characterized, particularly in mice. mMCP-11 is the most recently discovered mast cell tryptase in mice and was originally identified as Prss34, which is transcribed in some mast cell-like cell lines and at the early stage in the culture of BMMC with IL-3. Curiously, Prss34 is preferentially expressed in the BM and spleen among normal tissues in contrast to other mast cell tryptases. Therefore, it remains elusive what types of cells express mMCP-11 in vivo. Here, we show that mMCP-11 is highly expressed by primary basophils and to a much lesser extent, by some mast cells. Prss34 transcripts were detected abundantly in primary and cultured basophils and very weakly in peritoneal mast cells or cultured BMMC. Conversely, transcripts for mMCP-6 and mMCP-7 tryptases were preferentially expressed by cultured and peritoneal mast cells but not basophils. We established a mMCP-11-specific mAb and showed that mMCP-11 proteins are indeed expressed by primary basophils and those infiltrating the affected tissues during allergic inflammation and parasitic infections. Some primary mast cells also expressed mMCP-11 proteins, albeit at a much lower level. Thus, basophils rather than mast cells are the major source of mMCP-11. This is the first study to demonstrate that mouse basophils produce a trypsin-like protease.
Global warming
Authors: Moffic H. Steven
Published: November 2009

Much scientific consensus has developed that global warming is a major threat to the well-being of our planet and ourselves. This danger includes mental health. Violence, trauma and anxiety are all projected to increase. Psychology has also contributed to the genesis and delayed responsiveness to global warming, given the use of denial, narcissism, and fear of change on the part of politicians and citizens. Given the importance of psychiatry for this social problem, psychiatrists should be at the forefront of ‘going green’ in terms of advocacy, modelling and solutions. We are not yet, but our ethical duty requires more.
The Obama Presidency in Philosophical and Historical Context
Authors: Stavrou Nikolaos A.
Published: November 2009

The author places American politics in historical and philosophical context, reflecting on the significance of the election of the first African American as president of the United States. He raises fundamental questions about the dearth of historical change and the ability of the system to co-opt change, render it irrelevant in the long run, and maintain the status quo.
The Union for the Mediterranean: An Exercise in Region Building
Authors: Calleya Stephen C.
Published: November 2009

This article assesses early twenty-first-century dynamics in the Mediterranean area as indications of the limited success of countries in the region to integrate further into the emerging international system.

Successive attempts to enhance regional and subregional dynamics across the Mediterranean have remained in an embryonic stage at best. A review of foreign policy priorities of the riparian states reveals a divergence in agenda setting, with either EU membership or subregional affairs dominating the foreign policy strategic planning. There is little to indicate that an intensification of trans-Mediterranean regional dynamics is taking place.

Until France officially took the initiative to promote the Union for the Mediterranean initiative in 2008, interest was waning in the Euro-Mediterranean Partnership that was launched in November 1995. The Union for the Mediterranean offers the blueprint to address the physical architectural deficit that has prevented the Mediterranean area from becoming a coherent, functional economic regional space.
Serbia's Foreign Policy Capacity
Authors: McConnell Melissa
Published: November 2009

Foreign policy capacity is defined as dynamic, information-based adaptation by nation-states in complex, ambiguous environments that involve their domestic systems as well as external variables. On questions of Bosnia and Kosovo, Serbia's policy capacity is weakened by lack of domestic consensus on whether Belgrade should embrace East or West on Balkan security issues. Nonalignment may be one way out of this dilemma; a second avenue might be a stronger role for the Contact Group comprising the United States, Russia, and key European Union countries. A continued policy of drift at the mercy of events seems risky for Serbia over the longer term.
Returning to Community and Praxis
Authors: Bickman Martin
Published: November 2009

Using autobiographical incidents, the author argues that to reform our pedagogy we need to change our professional lives, abandoning our habits of solitary research for more direct and communal action. We must go beyond our disciplinary fields and enlist students as allies in changing their own educations.
The Demands of the Day
Authors: Jager Colin
Published: November 2009

This article describes the current academic climate, among both faculty and students, as too harried and stressed for students to be really transformed by what they are learning. As a way to resist the neoliberalization of the university, it proposes that we rethink our relationship to enchantment.
Threat Level
Authors: Bérubé Michael
Published: November 2009

This article surveys the challenges college teachers in the United States will likely face in the near future and argues that overtly political attacks from the Right may be less important than the erosion of tenure entailed in universities' overuse of adjunct labor and the implications of the recent California district court case Hong v. Grant.
The Coming Apocalypse
Authors: Miller Richard E.
Published: November 2009

This article looks to a future where multimedia composing is the norm. While this paradigmatic shift in the cultural locus of literate activity will require the university to change, it also provides a rich opportunity for pedagogical innovation.
Performing Discussion
Authors: Linkin Harriet Kramer
Published: November 2009

This article argues that students still must be encouraged to participate in active, interpretive communities that build viable textual meanings in literature classes (and elsewhere). It questions how instructors in student-centered classrooms negotiate the balance between maintaining professorial authority and empowering students to test out interpretive arguments.
English Studies and Intellectual Property
Authors: DeVoss Dànielle Nicole
Published: November 2009

This article offers (1) scenarios showing why English studies scholars must pay attention to intellectual property issues; (2) a brief overview of copyright history in the United States; and (3) related research questions and pedagogical possibilities for English studies scholars to consider.
Teaching Narrative as Rhetoric
Authors: Phelan James
Published: November 2009

Teaching narrative as rhetoric is a powerful pedagogical approach, because it connects students' experiences as readers with their work in the classroom. As an analysis of Time's Arrow shows, the approach provides a valuable way to access—and assess—the cognitive, affective, and ethical dimensions of readerly experience.
Taking Stock
Authors: Brockman Elizabeth
Published: November 2009

This article characterizes the first ten volume years of From the Classroom (FTC), one of three featured columns in Pedagogy. FTC articles, like other Pedagogy articles, showcase the work of scholars representing different ranks, subdisciplines, and institutional levels; unlike regular articles, FTC articles tend to be just 500 to 3,000 words. FTC authors, then, are challenged to raise a specific question or phenomenon by placing it momentarily within a larger theoretical, historical, and conceptual framework. Brockman groups most FTC articles into nine categories: Minding the Margins; Honoring Creative Nonfiction; Understanding Class, Culture, Gender, and Race; Mentoring Preservice Teachers; Incorporating Technology; Constructing Academic Arguments; Teaching Non-English Majors; Highlighting Effective Methods; and Showcasing Subdisciplines.
Facile Fabrication of Superhydrophobic Cellulose Materials by a Nanocoating Approach
Authors: Li Sujing , Wei Yunqian , Huang Jianguo
Published: November 2009

Superhydrophobic cellulosic materials with remarkable self-cleaning ability and satisfactory long-term chemical stability were fabricated by depositing self-assembled silane monolayer onto ultrathin titania film precoated nanofibers of natural cellulosic substances without altering the initial material structures and morphologies.
Apparent declines in the global HIV transmission rate
Authors: Holtgrave D R
Published: November 2009

Estimates of global and regional HIV incidence and prevalence are helpful for gauging the state of the epidemic. However, they do not contain as much information as the HIV transmission rate for judging the potential speed of HIV spread. The HIV transmission rate can be defined as follows: for every 100 persons living with HIV, the number of HIV infections transmitted to seronegative partners in one year. Here, we estimate the transmission rate for the global epidemic for the years 2001 and 2007, and for 10 major international regions for the year 2007. The transmission rate is calculated as incidence divided by prevalence, and the quotient then multiplied by 100. Previously published and publicly available, the Joint United Nations Programme on HIV/AIDS estimates of HIV incidence and prevalence at the global and regional levels were utilized. Between 2001 and 2007, the global HIV transmission rate dropped from 10.2 to 8.2, a decrease of 19.6% in six years time. The regional estimates for 2007 ranged from 3.7 in Western and Central Europe, to 10.5 in the Middle East and Northern Africa, to 17.6 in Oceania. The global transmission rate for 2007 of 8.2 indicates that 91.8% or more of persons living with HIV are not transmitting to other persons in a given year. The 19.6% decrease in HIV transmission rate between 2001 and 2007 appears to indicate some success in global HIV prevention efforts. The range of regional estimates helps to identify areas with the potential for rapidly growing epidemics, even if the raw numbers of new infections and prevalence are low. I believe the transmission rate to be a useful statistic and recommend its further adoption.
Non-vertical HIV transmission to children in sub-Saharan Africa
Authors: Reid S
Published: November 2009

This review considers whether HIV prevalence data on children in sub-Saharan Africa support the hypothesis that blood exposures account for a large proportion of HIV infections in Africa. Data from a systematic search on HIV-infected children support two analyses. In 25 studies where the mothers' HIV status was not matched with data on each child (excluding non-representative samples of children), the observed prevalence in children in 20 studies was greater than expected from vertical transmission. The population-weighted difference – 1.3% – was approximately one-third of observed prevalence in children. In 32 studies that match HIV-positive children with HIV-negative mothers, 406 discordant mother–child pairs were identified, and in studies identifying at least five non-vertical infections in children, 17.5% of HIV-positive children had HIV-negative mothers. In discussing an important role for unsafe health care in exceptionally rapid HIV transmission in Africa, leading AIDS researchers cite low HIV prevalence in children not yet sexually active. The assumption that childhood HIV prevalence would increase with age in children, if injections transmitted HIV is shown to be erroneous; it fails to account for early mortality in HIV-positive children. Evidence of child-to-child HIV transmission supports the theory that nosocomial infections are important to the AIDS pandemic, and procedures more prevalent than blood transfusions, such as injections, are likely involved.
Injection risks and HIV transmission in the Republic of South Africa
Authors: Reid S , Van Niekerk A A
Published: November 2009

The sexualization of the HIV epidemic in South Africa has been used as evidence that unsafe medical injections are of minimal importance to transmission in Africa, because the country was thought to be free of unsafe injection risks. More recent observation reveals routine failures in infection control in South African maternity and paediatric wards and in public dental clinics. In one province at least one medical injection in five is administered with a used needle or syringe. Over 25% of new HIV infections identified in South African adults using the BED IgG capture enzyme immunoassay in 2005 were in individuals reporting they had not been sexually active in the past 12 months. Immunization injections received at public health facilities are associated with HIV infections in children, many of whom may have passed HIV to their mothers during breastfeeding. South Africa is one of few countries in sub-Saharan Africa not using auto-disable (non-reusable) syringes for all immunizations. Using resource scarcity as justification for needle reuse is ethically indefensible, as injection safety is a readily achievable goal.
Diverse blood exposures associated with incident HIV infection in Calabar, Nigeria
Authors: Peters E J , Brewer D D , Udonwa N E , Jombo G T A , Essien O E , Umoh V A , Otu A A , Eduwem D U , Potterat J J
Published: November 2009

Few types of blood exposures have been assessed in relation to incident HIV infection in sub-Saharan Africa, despite evidence that penile–vaginal sex cannot account for the epidemic in the region. To investigate correlates of incident HIV infection in Calabar, Nigeria, we surveyed clients at voluntary HIV counselling and testing centres. Participating clients who tested multiple times were generally similar to those testing only once in terms of demographic characteristics, sexual and blood exposures and HIV prevalence. Blood exposures were common. Serial testers had a 10% annual incidence of HIV infection. Seroconverters and seronegative serial testers were similar on most demographic characteristics and sexual exposures. However, seroconverters were more likely than seronegatives to report blood exposures during the test interval, both for most specific exposures as well as summary measures of blood exposures. In particular, seroconverters were substantially more likely to report one of a set of blood exposures that cannot be explained as a consequence of unprotected vaginal sex or of health care for symptoms of HIV infection (adjusted odds ratio = 6.6, 95% confidence interval = 1.2–38). The study design we used is an inexpensive approach for describing the local epidemiology of HIV transmission and can also serve as the foundation for more definitive investigations that employ contact tracing and sequencing of HIV DNA.
Minimum infective dose of HIV for parenteral dosimetry
Authors: Reid S , Juma O A
Published: November 2009

The probability of HIV-1 transmission in a small blood exposure such as a needlestick injury or an unsafe medical injection has been estimated indirectly. Now that several comparable laboratory simulations have provided data on inoculum volumes for such exposures, the epidemiological evidence supporting these estimates can be validated and qualified using dosimetry. This review of data on infective titre, viral load and injection inoculum volume compares three approaches to HIV dosimetry. Agreement across the three approaches indicates that unsafe medical injections are several times more likely to transmit HIV-1 than needlestick accidents, and that the risk remains substantial if injection equipment is wiped, rinsed or flushed prior to re-use. The 50% infective dose of HIV in blood exposures ranges from one virion (two copies RNA) in primary infection with CCR5 co-receptor using strains of HIV-1 to 65,000 copies HIV-1 RNA in blood from an asymptomatic source patient. The median transmission risks for unsafe intravenous or intramuscular injections using equipment cleaned but not sterilized after use on a symptomatic pre-AIDS patient are 1.8% (95% confidence interval [CI] 0.1–3.2%) and 0.8% (95% CI 0.1–1.4%), respectively.
A multi-institutional mobility model for regional deployment of Telesynergy telemedicine systems
Authors: Schenken Larry L , Heron Dwight E , Saw Cheng B , Proctor Julian W
Published: November 2009

The Telesynergy workstation is a remote medical consultation system that provides medical staff with the means to collaborate with one another on cancer research and treatment. There are about 25 systems in use around the world. In order to share the equipment with five community hospital partners in Western Pennsylvania, we designed and implemented a transport system for the workstation. Small groups can be accommodated within the trailer and larger groups can participate inside a building when the system is offloaded at a suitable site. We designed special transport cases for the main components and chose a trailer suitable to move them by road. The transport cases were secured by inexpensive, ratchet style tiedown devices made of woven nylon webbing with steel end hooks. Calculations suggest that these restraints are sufficient to protect the equipment in a 48 km/h vehicle collision. During the first 12 months, we moved the trailer more than 700 km without system damage. Mobile videoconferencing seems to be successful on both environmental and cost grounds.
Reliability of an external loop recorder for automatic recognition and transtelephonic ECG transmission of atrial fibrillation
Authors: Müller Axel , Scharner Wilfried , Borchardt Tilo , Och Wolfgang , Korb Harald
Published: November 2009

In order to test a newly developed algorithm for detecting atrial fibrillation in clinical practice, we carried out parallel recordings using a conventional 24-h electrocardiogram (ECG) monitor and telemonitoring with an external loop recorder. Recordings were made in 24 patients with persistent atrial fibrillation and in another 24 patients with sinus rhythm. Atrial fibrillation was detected immediately in 23 of 24 patients with persistent atrial fibrillation and 20 min after fitting the single-channel loop recorder in the 24th patient (sensitivity 100%). On average, 3.1 false positives (i.e. detection of an episode, including the end or beginning of atrial fibrillation) were transmitted per patient. The sensitivity of the algorithms for automatically detecting bradycardiac and tachycardiac atrial fibrillation was also high. In 12 of 24 patients with sinus rhythm, false-positive tele-ECGs were transmitted. These were caused by supraventricular or ventricular extrasystoles and by sinus arrhythmias or sinoatrial (SA) blocks. The external loop recorder was very effective at detecting paroxysmal atrial fibrillation. Possible indications for the clinical use of this recorder include, in addition to diagnosis, monitoring patients for atrial fibrillation recurrence after cardioversion or catheter ablation.
Telemedical assistance for in-flight emergencies on intercontinental commercial aircraft
Authors: Weinlich Michael , Nieuwkamp Nadine , Stueben Uwe , Marzi Ingo , Walcher Felix
Published: November 2009

We have conducted a three-year prospective study of medical incidents on a commercial airline. A telemedicine service was available via an on-board satellite phone. During the study period there were 3364 medical incidents. The most common incident was collapse ( n = 2310, 57%). Telemedicine was used in 323 of the cases (9%). Neurological patients, mostly stroke and seizures, excluding psychiatric diseases, were seen in 27% of the telemedicine cases ( n = 83). Most of the cases involved middle-aged people, not the elderly. The group of patients that needed diversion ( n = 27) was compared to the cases staying on board ( n = 275). None of the patients in the non-diversion group deteriorated. All unstable patients forced a diversion. Doctors on board used the service in more severe cases, whereas laymen used the service in less severe cases. The results of the present study demonstrate the advantage of using simple teleconsultation in cases of medical emergency on board an aircraft.
Real-time medical control using a wireless audio-video transmission device in a pre-hospital emergency service in Korea
Authors: Kwak Min Ji , Kim Ji Man , Shin Il Hyung , Shin Sang Do , Song Kyoung Jun , Suh Gil Joon , Kim Hee Chan
Published: November 2009

We developed a hands-free portable device which can provide two-way, real-time audio and video communication between hospital doctors and emergency medical technicians (EMTs) providing pre-hospital care. The device was based on an ultra mobile PC with a camera, a microphone/earphone set and a WIBRO modem for wireless Internet connection at an average data transmission rate of 1 Mbit/s. Feasibility tests were conducted in 55 real emergency situations over a period of three months at five different Rescue Centres in Seoul. Successful communication between an EMT and a doctor was achieved in 46 cases (84%). The device showed acceptable performance in terms of audio/video transmission time delays and maximum transmitted video frame rates, both outdoors, inside a building and in a moving vehicle at 70 km/h. Eight control centre staff and 11 EMTs who used the device completed a questionnaire. Despite acceptable basic performance, the device was found to be limited in terms of the contribution it made to the medical control of EMTs. However, improvements in device performance should produce higher quality pre-hospital emergency medical care in the future.
Cerebellar haemangioblastoma presenting with dizziness in pregnancy: case report and review of the literature
Authors: Kenyon Anna P , Haider Salman , Ashkan Keyoumars , Nelson-Piercy Catherine
Published: November 2009

Cerebral neoplasms are uncommon in pregnancy but should be considered in any pregnant woman with new onset neurological symptoms and signs. We report a case of cerebellar haemangioblastoma presenting in pregnancy and discuss the clinical presentation, diagnosis, surgical management and medical literature surrounding the condition.
Arthritis in pregnancy: the role and safety of biological agents
Authors: Youssef Peter , Kennedy Debra
Published: November 2009

As the average age of mothers is increasing there is a greater likelihood that they will have intercurrent medical problems at the time of their pregnancy. As a group, autoimmune diseases are relatively common with an estimated population prevalence of 5–8%. At least 75% of autoimmune diseases occur in women, most frequently during the child-bearing years. Rheumatoid arthritis (RA) is the most common chronic inflammatory disease of joints and occurs in approximately 1% of the population with women being affected two or three times more than men and many of the women being of child-bearing age. The pathogenesis of RA is multifactorial with a role for T-lymphocytes, B-lymphocytes, macrophages and other pro-inflammatory cells producing a plethora of cytokines including interleukin-1 and tumour necrosis factor- α in the synovial cavity resulting in irreversible damage to cartilage, soft tissues and bone.1 The drug treatment of RA involves the use of disease-modifying agents to reduce or prevent permanent tissue damage. There is a new class of drugs that can be used to target specific cells and cytokines that have been called ‘biological agents’. These drugs have been shown to significantly reduce inflammation and to retard the progression of joint damage in RA thereby reducing symptoms and improving function.2
Diabetes insipidus in pregnancy
Authors: Hague William M
Published: November 2009

Diabetes insipidus is an uncommon condition with various aetiologies. Recent research has uncovered new mechanisms underlying the syndrome. Careful attention to management is essential in pregnant women to avoid serious complications. Diabetes insipidus in pregnancy may be due to relative reduction in secretion of AVP from the posterior pituitary (cranial DI), increase in breakdown of AVP by placental cystine aminopeptidase with vasopressinase activity, or resistance of the rental tubules to AVP (nephrogenic DI).
Effect of thyroid peroxidase antibodies on thyroid-stimulating hormone reference limits in a primarily Latina population
Authors: Lee Richard H , Spencer Carole A , Montoro Martin N , Aghajanian Paola , Goodwin T Murphy , Miller Erin A , Petrovic Ivana , Braverman Lewis E , Mestman Jorge H
Published: November 2009

The aim of the paper is to determine the prevalence of thyroid peroxidase antibodies (TPOAb) and assess its effect on the thyroid-stimulating hormone (TSH) reference range during pregnancy in a primarily Latina population. Serum samples were collected from healthy pregnant women and non-pregnant controls. TSH reference ranges were calculated when TPOAb-positive patients were either included or excluded. A total of 134 pregnant women and 107 non-pregnant controls were recruited. Positive TPOAb titres were found in 23 (17.2%) of the 134 pregnant women, and in 14 (13.1%) of the 107 non-pregnant controls. When the TPOAb-positive women were included in the TSH analysis, the upper reference limit using two different methods was consistently higher: 0–2.2 fold in the non-pregnant women, 2.01–2.78 fold in the first trimester, 3.18–4.7 fold in the second and 1.05–1.42 fold in the third. The lower TSH reference limit was not affected by the inclusion of TPOAb-positive subjects. In conclusion, inclusion of TPOAb-positive patients results in higher upper reference limits during pregnancy.
Clinical and radiological follow-up of the Aequalis third-generation cemented total shoulder replacement
Authors: Khan A. , Bunker T. D. , Kitson J. B.
Published: November 2009

There are no long-term published results on the survival of a third-generation cemented total shoulder replacement. We describe a clinical and radiological study of the Aequalis total shoulder replacement for a minimum of ten years. Between September 1996 and May 1998, 39 consecutive patients underwent a primary cemented total shoulder replacement using this prosthesis. Data were collected prospectively on all patients each year, for a minimum of ten years, or until death or failure of the prosthesis. At a follow-up of at least ten years, 12 patients had died with the prosthesis intact and two had emigrated, leaving 25 available for clinical review. Of these, 13 had rheumatoid arthritis and 12 osteoarthritis. One refused radiological review leaving 24 with fresh radiographs.

Survivorship at ten years was 100% for the humeral component and 92% for the glenoid component. The incidence of lucent lines was low. No humeral component was thought to be at risk and only two glenoid components. The osteoarthritic group gained a mean 65° in forward flexion and their Constant score improved by a mean 41.4 points (13 to 55). The rheumatoid group gained a mean of 24° in flexion and their Constant score improved by 29.4 points. This difference may have been due to failure of the rotator cuff in 75% of the patients with rheumatoid arthritis.

Thus a third-generation total shoulder replacement gives an excellent result in patients with osteoarthritis and an intact rotator cuff. Patients with rheumatoid arthritis have a 75% risk of failure of the rotator cuff at ten years.
Femoral lengthening in achondroplasia
Authors: Venkatesh K. P. , Modi H. N. , Devmurari K. , Yoon J. Y. , Anupama B. R. , Song H. R.
Published: November 2009

Extensive limb lengthening may be indicated in achondroplastic patients who wish to achieve a height within the normal range for their population. However, increasing the magnitude of lengthening is associated with further complications particularly adjacent joint stiffness and fractures. We studied the relationship between the magnitude of femoral lengthening and callus pattern, adjacent joint stiffness and fracture of the regenerate bone in 40 femoral lengthenings in 20 achondroplastic patients. They were divided into two groups; group A had lengthening of less than 50% and group B of more than 50% of their initial femoral length. The patterns of radiological callus formation were classified according to shape, type and features. The incidence of callus features, knee stiffness and regenerate bone fracture were analysed in the two groups. Group B was associated with an increased incidence of concave, lateral and central callus shapes, adjacent joint and stiffness and fracture. Statistically, the incidence of stiffness in adjacent joints and regenerate bone fracture was significantly associated with the magnitude of lengthening.

We suggest that careful radiological assessment of the patterns of callus formation is a useful method for the evaluation and monitoring of regenerate bone.
The level of vitamin D in the serum correlates with fatty degeneration of the muscles of the rotator cuff
Authors: Oh J. H. , Kim S. H. , Kim J. H. , Shin Y. H. , Yoon J. P. , Oh C. H.
Published: November 2009

This study examined the role of vitamin D as a factor accounting for fatty degeneration and muscle function in the rotator cuff. There were 366 patients with disorders of the shoulder. A total of 228 patients had a full-thickness tear (group 1) and 138 patients had no tear (group 2). All underwent magnetic resonance arthrography and an isokinetic muscle performance test. The serum concentrations of vitamin D (25(OH)D3) were measured.

In general, a lower serum level of vitamin D was related to higher fatty degeneration in the muscles of the cuff. Spearman’s correlation coefficients were 0.173 (p = 0.001), −0.181 (p = 0.001), and −0.117 (p = 0.026) for supraspinatus, infraspinatus and subscapularis, respectively. In group 1, multivariate linear regression analysis revealed that the serum level of vitamin D was an independent variable for fatty degeneration of the supraspinatus and infraspinatus.

The serum vitamin D level has a significant negative correlation with the fatty degeneration of the cuff muscle and a positive correlation with isokinetic muscle torque.
The management of severe acetabular bone defects in revision hip arthroplasty using modular porous metal components
Authors: Lingaraj K. , Teo Y. H. , Bergman N.
Published: November 2009

We investigated the early results of modular porous metal components used in 23 acetabular reconstructions associated with major bone loss. The series included seven men and 15 women with a mean age of 67 years (38 to 81), who had undergone a mean of two previous revisions (1 to 7).

Based on Paprosky’s classification, there were 17 type 3A and six type 3B defects. Pelvic discontinuity was noted in one case. Augments were used in 21 hips to support the shell and an acetabular component-cage construct was implanted in one case. At a mean follow-up of 41 months (24 to 62), 22 components remained well fixed. Two patients required rerevision of the liners for prosthetic joint instability. Clinically, the mean Harris Hip Score improved from 43.0 pre-operatively (14 to 86) to 75.7 post-operatively (53 to 100). The mean pre-operative Merle d’Aubigné score was 8.2 (3 to 15) and improved to a mean of 13.7 (11 to 18) post-operatively.

These short-term results suggest that modular porous metal components are a viable option in the reconstruction of Paprosky type 3 acetabular defects. More data are needed to determine whether the system yields greater long-term success than more traditional methods, such as reconstruction cages and structural allografts.
Long-term outcome after supination-external rotation type-4 fractures of the ankle
Authors: Stufkens S. A. S. , Knupp M. , Lampert C. , van Dijk C. N. , Hintermann B.
Published: November 2009

We have compared the results at a mean follow-up of 13 years (11 to 14) of two groups of supination-external rotation type-4 fractures of the ankle, in one of which there was a fracture of the medial malleolus and in the other the medial deltoid ligament had been partially or completely ruptured.

Of 66 patients treated operatively between 1993 and 1997, 36 were available for follow-up. Arthroscopy had been performed in all patients pre-operatively to assess the extent of the intra-articular lesions. The American Orthopaedic Foot and Ankle Society hind-foot score was used for clinical evaluation and showed a significant difference in both the total and the functional scores (p < 0.05), but not in those for pain or alignment, in favour of the group with a damaged deltoid ligament (p < 0.05). The only significant difference between the groups on the short-form 36 quality-of-life score was for bodily pain, again in favour of the group with a damaged deltoid ligament. There was no significant difference between the groups in the subjective visual analogue scores or in the modified Kannus radiological score.

Arthroscopically, there was a significant difference with an increased risk of loose bodies in the group with an intact deltoid ligament (p < 0.005), although there was no significant increased risk of deep cartilage lesions in the two groups.

At a mean follow-up of 13 years after operative treatment of a supination-external rotation type-4 ankle fracture patients with partial or complete rupture of the medial deltoid ligament tended to have a better result than those with a medial malleolar fracture.
Chronic lumbar paraspinal compartment syndrome
Authors: Xu Y. M. , Bai Y. H. , Li Q. T. , Yu H. , Cao M. L.
Published: November 2009

A 25-year-old male weightlifter felt increasing intractable low back pain during training but denied any acute injury. The physical examination, blood parameters, radiographs and MRI were unremarkable. He had been treated non-operatively by various means, with only temporary relief. The pressures in the lumbar paraspinal compartment were abnormally high and he was treated by surgical decompression. This gave rapid relief, he returned to training, and one year later the pain had not recurred.