bluuebunny/crossref_metadata_2025 huggingface dataset:
A randomized controlled pilot study of motivational interviewing for patients with psychotic and drug use disorders
Authors: Martino Steve , Carroll Kathleen M. , Nich Charla , Rounsaville Bruce J.
Published: August 2006

Aims  This pilot study examined the efficacy of a two‐session motivational interview adapted for dually diagnosed psychotic and drug‐related disordered patients (DDMI) in comparison to a two‐session standard psychiatric interview (SI).

Design  The study used a randomized controlled trial design. Participants received either DDMI or SI and were assessed at baseline, 4‐, 8‐ and 12‐week follow‐up points. The principal analysis for examination of treatment effects across time was a random effects regression model.

Setting  Both DDMI and SI interviews served as pre‐admission intake interventions to an ambulatory specialty dual diagnosis intensive out‐patient and partial hospital program.

Participants  Forty‐four treatment‐seeking participants (DDMI = 24; SI = 20) who had co‐occurring psychotic and drug‐related disorders were assigned randomly to the treatment conditions.

Measurements  Primary outcomes were days of primary drug use, secondary drug use, alcohol use and psychotropic medication adherence, proportion of participants admitted into the program and days of attendance.

Findings and conclusions  DDMI and SI resulted in improved treatment outcomes, but there were no main effects for the sample as a whole. Separate examination of primary cocaine and primary marijuana using subsamples, however, suggested that DDMI resulted in significantly better primary drug treatment outcomes for the cocaine‐using group, whereas SI resulted in significantly better primary drug treatment outcomes for the marijuana‐using group. These findings indicate that MI may not work equally well for all types of psychotic disordered dually diagnosed patients and that alternative approaches may be as effective in fostering improved substance use treatment outcomes for subgroups of these individuals.
Ablation of ovomucoid-induced allergic response by desensitization with recombinant ovomucoid third domain in a murine model
Authors: Rupa P , Mine Y
Published: August 2006

Attempts to modulate the allergenic response by hypoallergens aimed at eliminating IgE-binding epitopes have been established recently for allergen immunotherapy. Desensitization offers an alternative approach to mounting a protective immune response. We have shown previously that mutation of the decisive amino acids in the B cell epitope of the ovomucoid third domain suppresses IgE binding reactivity against human patient sera and we hypothesize that this hypoallergenic variant could be a potential candidate molecule for specific immunotherapy against an ovomucoid-induced IgE reaction. The aim of this study was to investigate whether hyposensitization with the ovomucoid-modified isoform could desensitize ovomucoid-sensitized mice. We mapped the immunodominant B cell epitopes of ovomucoid in Balb/c mice. A hypoallergenic ovomucoid mutant isoform, having ablated allergenicity against patient sera, was used to desensitize ovomucoid-sensitized Balb/c mice by intraperitoneal injection. Female Balb/c mice were sensitized with intact ovomucoid molecule (Fovm) and desensitized with the modified isoform of the third domain of ovomucoid (GMFA). Intact ovomucoid-sensitized mice desensitized with phosphate-buffered saline (PBS) served as positive controls to maintain hypersensitivity. To gain insight into the efficacy of the modified ovomucoid variant in desensitization, effects on hypersensitivity reactions and histamine levels, followed by its association with antibody levels and cytokine profiles, were measured. Abrogation of the allergic response with complete suppression of anaphylactic symptoms and lower serum histamine levels was observed in the desensitized group by GMFA, accompanied by significantly reduced ovomucoid-specific IgE and IgG1 levels and enhanced specific IgG and IgG2a levels. The sensitized group showed severe anaphylactic symptoms, enhanced serum histamine concentrations and increased levels of specific IgE and IgG1. The level of interleukin (IL)-4 was decreased dramatically in the desensitized group and higher levels of interferon (IFN)-γ were found, whereas mice sensitized with intact ovomucoid exhibited significantly higher levels of IL-4 favouring a Th2 skewed pathway. We demonstrate clearly that GMFA is able to ablate ovomucoid-induced allergic reactions in sensitized mice. This occurs via a suppression of specific IgE accompanied by an increase in suppressor T cell activity. This approach offers some promise for the development of treatment against ovomucoid-induced allergic response.
Increased susceptibility of cord blood B lymphocytes to undergo spontaneous apoptosis
Authors: Kessel A , Yehudai D , Peri R , Pavlotzky E , Bamberger E , Tov N , Toubi E
Published: August 2006

In this study, we compared the rate of spontaneous apoptosis of B cells from umbilical cord blood with adult B cells and assessed the role of Bcl-2, CD5, interleukin (IL)-4 and B cell-activating factor in B cell spontaneous apoptosis. We found that spontaneous apoptosis of cultured B cells, as assessed by utilizing annexin-V binding, was significantly higher in cord blood than in healthy adult individuals (77·5; 95 CI, 73·5–81·5 versus 59·2; 95 CI, 54–64, respectively, P < 0·0001) and further confirmed by 4′ 6-diamidino-2-phenylindole, dihydrochloride (DAPI) staining. Whereas the expression of B cell-activating factor from the tumour necrosis factor family (BAFF) receptor mRNA was similar in B cells from adults and cord blood, we detected lower levels of circulating BAFF in the serum of cord blood (0·68 ± 0·13 ng versus 1·83 ± 0·54 ng, P = 0·01). The latter may explain, in part, our observation of lower levels of mean fluorescence intensity of Bcl-2 in cord B cells compared with adults (1·6 ± 0·9 versus 2·85 ± 1·3, P = 0·033). CD19+ CD5+ B cells from cord blood underwent a lower rate of apoptosis in comparison to CD19+ CD5– B cells (25·1 ± 9·3%versus 58·5 ± 12·5%, P < 0·0001). This pattern of sensitivity was comparable in adult blood (15 ± 5·5%versus 22·7 ± 9·3%, P = 0·01). Nevertheless, the rate of apoptosis was higher in CD19+ CD5+ from cord blood compared to CD19+ CD5+ from adults (25·1 ± 9·3%versus 15 ± 5·5%, P = 0·0013). The addition of rIL-4 (10 u/ml) to cultured cells decreased B cell apoptosis in a similar fashion in both cord and adults blood. This rescue was strengthened when BAFF (100 µg/ml) was further added. Thus, alterations in Bcl-2 or serum BAFF level may explain the increased rate of cord blood B cell apoptosis.
The role of CD4+CD25+ T cells in autoantibody production in murine lupus
Authors: Hsu W-T , Suen J-L , Chiang B-L
Published: August 2006

Systemic lupus erythematosus (SLE) is a chronic, systemic autoimmune disease characterized by the loss of tolerance to self-antigen. Because it is currently not known if regulatory T (Treg) cells are involved in the pathogenesis, we determined the frequency of CD4+CD25+ T cells and assayed the related gene expression levels in CD4+CD25+ T cells isolated from both lupus mice (NZB/NZW F1) and normal control mice (DBA2/NZW F1). The results showed that the frequency of CD4+CD25+ T cells in lupus mice was lower than that of normal mice. Except for the high expression level of interleukin (IL)-10 mRNA, CD4+CD25+ T cells from lupus mice expressed normal forkhead box P3 (Foxp3) and transforming growth factor (TGF)-β mRNA, and exerted suppressive functions. Furthermore, we depleted CD25+ Treg cells of non-autoimmune mice with anti-CD25 antibody and broke their tolerance with apoptotic cell-pulsed dendritic cells for the follow-up of autoantibody levels. The mice in the CD25+ cell-depleted group had higher titres of anti-double-strand/single-strand DNA antibodies than those of the isotype control antibody-treated group. These findings indicated that CD4+CD25+ T cells might be involved in the regulatory mechanism of autoantibody production.
Characterization of chicken epidermal dendritic cells
Authors: Igyártó Botond‐Zoltán , Lackó Erzsébet , Oláh Imre , Magyar Attila
Published: August 2006

It has been known for 15 years that the chicken epidermis contains ATPase+ and major histocompatibility complex class II‐positive (MHCII+) dendritic cells. These cells were designated as Langerhans cells but neither their detailed phenotype nor their function was further investigated. In the present paper we demonstrate a complete overlapping of ATPase, CD45 and vimentin staining in all dendritic cells of the chicken epidermis. The CD45+ ATPase+ vimentin+ dendritic cells could be divided into three subpopulations: an MHCII+ CD3– KUL01+ and 68.1+ (monocyte‐macrophage subpopulation markers) subpopulation, an MHCII– CD3– KUL01– and 68.1– subpopulation and an MHCII– CD3+ KUL01– and 68.1– subpopulation. The first population could be designated as chicken Langerhans cells. The last population represents CD4– CD8– T‐cell receptor‐αβ– and ‐γδ– natural killer cells with cytoplasmic CD3 positivity. The epidermal dendritic cells have a low proliferation rate as assessed by bromodeoxyuridine incorporation. Both in vivo and in vitro experiments showed that dendritic cells could be mobilized from the epidermis. Hapten treatment of epidermis resulted in the decrease of the frequency of epidermal dendritic cells and hapten‐loaded dendritic cells appeared in the dermis or in in vitro culture of isolated epidermis. Hapten‐positive cells were also found in the so‐called dermal lymphoid nodules. We suggest that these dermal nodules are responsible for some regional immunological functions similar to the mammalian lymph nodes.
Extravasation mucocele involving the ventral surface of the tongue (glands of Blandin–Nuhn)
Authors: GUIMARÃES M. S. , HEBLING J. , FILHO V. A. P. , SANTOS L. L. , VITA T. M. , COSTA C. A. S.
Published: August 2006

Summary.  Background.  Mucocele is a lesion that involves the salivary glands and respective current ducts caused mainly by traumas in the affected area. Two different histological forms can be found: extravasation phenomenon and mucus‐retention cyst where the former is the most frequently observed involving minor salivary glands such as the glands present in the anterior portion of the ventral surface of the tongue (glands of Blandin–Nuhn).

Case Report.  This report describes a large lesion involving the ventral surface of the tongue that was definitively diagnosed by histological examination as extravasation mucocele.

Conclusion.  Important concepts are reviewed to help clinicians correctly diagnose and treat this pathology.
Survival of Svalbard pink‐footed geeseAnser brachyrhynchusin relation to winter climate, density and land‐use
Authors: KÉRY MARC , MADSEN JESPER , LEBRETON JEAN‐DOMINIQUE
Published: August 2006

Global change may strongly affect population dynamics, but mechanisms remain elusive. Several Arctic goose species have increased considerably during the last decades. Climate, and land‐use changes outside the breeding area have been invoked as causes but have not been tested. We analysed the relationships between conditions on wintering and migration staging areas, and survival in Svalbard pink‐footed geeseAnser brachyrhynchus. Using mark–recapture data from 14 winters (1989–2002) we estimated survival rates and tested for time trends, and effects of climate, goose density and land‐use.

Resighting rates differed for males and females, were higher for birds recorded during the previous winter and changed smoothly over time. Survival rates did not differ between sexes, varied over time with a nonsignificant negative trend, and were higher for the first interval after marking (0·88–0·97) than afterwards (0·74–0·93). Average survival estimates were 0·967 (SE 0·026) for the first and 0·861 (SE 0·023) for all later survival intervals.

We combined 16 winter and spring climate covariates into two principal components axes. F1 was related to warm/wet winters and an early spring on the Norwegian staging areas and F2 to dry/cold winters. We expected that F1 would be positively related to survival and F2 negatively. F1 explained 23% of survival variation (F1,10 = 3·24; one‐sidedP = 0·051) when alone in a model and 28% (F1,9 = 4·50; one‐sidedP = 0·031) in a model that assumed a trend for survival. In contrast, neither F2 nor density, land‐use, or scaring practices on important Norwegian spring staging areas had discernible effects on survival.

Climate change may thus affect goose population dynamics, with warmer winters and earlier springs enhancing survival and fecundity. A possible mechanism is increased food availability on Danish wintering and Norwegian staging areas. As geese are among the main herbivores in Arctic ecosystems, climate change, by increasing goose populations, may have important indirect effects on Arctic vegetation. Our study also highlights the importance of events outside the breeding area for the population dynamics of migrant species.
Assessing grassland restoration success: relative roles of seed additions and native ungulate activities
Authors: MARTIN LEANNE M. , WILSEY BRIAN J.
Published: August 2006

Grassland restorations often lack rare forb and grass species that are found in intact grasslands. The possible reasons for low diversity include seed limitation, microsite limitation and a combination of both. Native ungulates may create microsites for seedling establishment in tallgrass prairie restorations by grazing dominant species or through trampling activities, but this has never been tested in developing prairies.

We experimentally tested for seed and microsite limitation in the largest tallgrass prairie restoration in the USA by adding rare forb and grass seeds in two trials inside and outside native ungulate exclosures. We measured seedling emergence because this stage is crucial in recruiting species into a community. We also measured light, water and standing crop biomass to test whether resource availability could help to explain seedling emergence rates.

Ungulates increased light availability for each sampling time and also increased above‐ground net primary productivity (ANPP) during summer.

Seedling emergence of rare prairie forbs and grasses was consistently greater when we added seeds.

Seedling emergence was conditionally greater with a combination of seed additions and grazing, but grazing alone was unable to increase emergence.

When ungulates increased seedling enhancement, the mechanism was partially associated with increased water and light availability.

Exotic and cosmopolitan weed seedling emergence was not affected by grazing.

Synthesis and applications. These results suggest that tallgrass prairie restorations are primarily seed limited and that grazing alone may not be able to increase seedling emergence of rare species without the addition of seeds. Therefore, adding seeds to grassland restorations may increase seedling emergence of rare species, and mimicking effects of grazing may increase emergence when seeds are added.
Ecologically justified charisma: preservation of top predators delivers biodiversity conservation
Authors: SERGIO FABRIZIO , NEWTON IAN , MARCHESI LUIGI , PEDRINI PAOLO
Published: August 2006

Because of their popular appeal, top vertebrate predators have frequently been used as flagship or umbrella species to acquire financial support, raise environmental awareness and plan systems of protected areas. However, some have claimed that the utilization of charismatic predators may divert a disproportionate amount of funding to a few glamorous species without delivering broader biodiversity benefits, an accusation aggravated by the fact that the conservation of top predators is often complex, difficult and expensive. Therefore, tests are needed of whether apex predators may be employed to achieve ecosystem‐level targets.

To test such a hypothesis, we compared the biodiversity values recorded at the breeding sites of six raptor species, differing widely in diet and habitat associations, with those observed at three types of control locations, (i) sites randomly chosen in comparable habitat, (ii) breeding sites of a randomly selected bird species of lower trophic level and (iii) breeding sites of a lower trophic level species with specialized ecological requirements. Biodiversity was measured as the richness and evenness of bird, butterfly and tree species.

Biodiversity levels were consistently higher at sites occupied by top predators than at any of the three types of control sites. Furthermore, sites occupied by top predators also held greater densities of individual birds and butterflies (all species combined) than control sites.

In a reserve‐selection simulation exercise, networks of protected sites constructed on the basis of top predators were more efficient than networks based on lower trophic level species, enabling higher biodiversity coverage to be achieved with a smaller number of reserves.

Synthesis and applications. Our results provide evidence of a link between the strategic utilization of top predatory species and ecosystem‐level conservation. We suggest that, at least in some biological systems, conservation plans based on apex predators could be implemented to deliver broader biodiversity benefits.
Photon flux partitioning among species along a productivity gradient of an herbaceous plant community
Authors: AAN ANNE , HALLIK LEA , KULL OLEVI
Published: August 2006

We studied light partitioning among species along the natural productivity gradient of herbaceous vegetation with an above‐ground dry mass of 150–490 g m−2. The aim was to investigate how the light capturing ability per above‐ground biomass and leaf nitrogen changes in an entire community and to reveal whether different species respond similarly to changes in soil conditions and competition.

Species becoming dominant at high soil resources have intrinsically low leaf area ratios (LAR) and lower tissue nitrogen concentration, and hence relatively high nitrogen use efficiency. These traits lead to dominance when soil resources allow rapid growth so that benefits arising from the ability to locate leaves above neighbours and thereby increasing asymmetry of competition, become more crucial.

In contrast to our expectations, above‐ground efficiency of nitrogen use on the community level (aNUE) increased along the productivity gradient. Species level nitrogen use efficiency was unaffected by variation in site productivity; the increase in community aNUE was solely as a consequence of changes in species composition.

Light absorption per unit of above‐ground mass, ΦM, declined significantly at the community level and also in most species, indicating that light use efficiency increased with increased site productivity and LAI.

Light absorption per unit of leaf nitrogen, ΦN, as an indicator of the ratio NUE/LUE showed no clear pattern on the community level because both NUE and LUE tend to increase with increased productivity. At the species level, ΦN tends to decrease because NUE did not change with stand productivity.

Some subordinate species responded by enlarging their LAR to increased competition. Additionally, these species were the most responsive in their leaf chlorophyll/nitrogen ratio to changes in light conditions, which shows that physiological plasticity is important for species that are unable to compete for light with the ability to position their leaves above those of other species.

This study shows how plasticity in above‐ground growth pattern and nitrogen allocation differs between species with respect to increased soil fertility and competition, leading to distinctive strategies of survival. Light partitioning analysis reveals that increased competition for light, resulting in changes in species composition, is the key factor that leads to decoupling of species and community level acclimation.
The rough edges of the conservation genetics paradigm for plants
Authors: OUBORG N. J. , VERGEER P. , MIX C.
Published: August 2006

Small and isolated populations of species are susceptible to loss of genetic diversity, owing to random genetic drift and inbreeding. This loss of diversity may reduce the evolutionary potential to adapt to changing environments, and may cause immediate loss of fitness (cf. inbreeding depression). Together with other population size‐dependent stochastic processes, this may lead to increased probabilities of population extinction.

This set of processes and theories forms the core of conservation genetics and has developed into the conservation genetics paradigm. Many empirical studies have concentrated on the relationship between population size and genetic diversity, and in many cases evidence was found that small populations of plants do indeed have lower levels of genetic diversity and increased homozygosity. Although less empirical attention has been given to the relationship between low genetic diversity, fitness and, in particular, evolutionary potential, the paradigm is now widely accepted.

Here we present five areas of the paradigm which could be refined, i.e. the ‘rough’ edges of the conservation genetics paradigm.

Treating population size and isolation not as interchangeable parameters but as separate parameters affecting population genetics in different ways could allow more accurate predictions of the effects of landscape fragmentation on the genetic diversity and viability of populations.

There is evidence that inbreeding depression may be a genotype‐specific phenomenon, rather than a population parameter. This sheds new light on the link between population inbreeding depression and the expected increased probability of extinction.

Modern eco‐genomics offers the opportunity to study the population genetics of functional genes, to the extent that the role of selection can be distinguished from the effects of drift, and allowing improved insights into the effects of loss of genetic diversity on evolutionary potential.

Incorporating multispecies considerations may result in the generally accepted notion that small populations are at peril being called into question. For instance, small populations may be less capable of sustaining parasites or herbivores.

Comparative studies of endangered, common and invasive species may be a valuable approach to developing conservation biology from a phenomenological case study discipline into one investigating the general principles of what sustains biodiversity.

The issues discussed set an agenda for further research within conservation genetics and may lead to a further refinement of our understanding and prediction of the genetic effects of habitat fragmentation. They also underline the need to integrate ecological and genetic approaches to the conservation of biodiversity, rather than regarding them as opposites.
Molecular characterization of fungal endophytic morphospecies isolated from stems and pods of Theobroma cacao
Authors: Crozier J. , Thomas S. E. , Aime M. C. , Evans H. C. , Holmes K. A.
Published: August 2006

Endophytic fungi were isolated from healthy stems and pods of cacao (Theobroma cacao) trees in natural forest ecosystems and agroecosystems in Latin America and West Africa. These fungi were collected for screening as a potential source of biocontrol agents for the basidiomycetous pathogens of cacao in South and Central America, Moniliophthora roreri (frosty pod rot) and Moniliophthora perniciosa (witches’ broom). Many of these isolates were morphologically unidentifiable as they failed to form fruiting structures in culture, or only produced arthrosporic stages. Affinities with basidiomycetes were suspected for many of these based on colony morphology. Fifty‐nine of these morphologically unidentifiable isolates were selected for molecular identification by DNA extraction and sequence analysis of nuclear ribosomal DNA (rDNA). The large subunit (LSU) was chosen for initial sequencing because this region has been used most often for molecular systematics of basidiomycete fungi, and comprehensive LSU datasets were already available for sequence analyses. Results confirmed that the majority of the isolates tested belonged to the Basidiomycota, particularly to corticoid and polyporoid taxa. With LSU data alone, identification of the isolates was resolved at varying taxonomic levels (all to order, most to family, and many to genus). Some of the isolates came from rarely isolated genera, such as Byssomerulius, whilst the most commonly isolated basidiomycetous endophyte was a member of the cosmopolitan genus Coprinellus (Agaricales). The role of these fungi within the host and their potential as biological control agents are discussed.
Pattern of growth after pediatric living‐donor small bowel transplantation
Authors: Porubsky Marian , Testa Giuliano , John Eunice , Holterman Mark , Tsou Marc , Benedetti Enrico
Published: August 2006

Abstract:  The aim of our study was to analyze growth in children who underwent LDSB. The question was whether these children obtain linear growth and improvement of the Z‐score for height and weight after the transplant. Three children with a mean age of 24 months underwent living‐donor intestinal transplantation with 150 cm of terminal ileum. At a mean follow‐up of 27 months height increased from 82.5 to 97.5 cm although Z‐score for height did not improve, −2.679 to −2.675. Mean weight increased from 11.4 to 14.2 kg while Z‐score for weight went from −1.916 to −2.409. Although these data are pertinent to only three children and the follow‐up is slightly longer than two yr, it appears that while long‐term survival and independency from TPN is achieved, only linear growth might be expected and catch‐up growth does not occur.
Elevated serum alkaline phosphatase levels in a renal transplant patient precede colitis
Authors: Korzets A. , Zevin D. , Ori Y. , Herman M. , Chagnac A. , Gafter U.
Published: August 2006

Abstract: An asymptomatic, but highly significant, rise in serum alkaline phosphatase (AP) levels developed in a renal transplant recipient. Investigations ruled out bony or hepatobiliary disease. Subsequent diarrhea and weight loss led to a diagnosis of cytomegalovirus (CMV) colitis, which was confirmed with a positive CMV pp65 antigenemia test and an endoscopic finding of multiple colonic erosions. Intravenous ganciclovir led to complete patient recovery and a swift reduction of serum AP levels to normal.

Normally, intestinal AP isoenzymes are cleared quickly from the circulation. However, acute bowel diseases, especially when inflammatory in origin, can produce high serum AP levels. In this presented patient, the rise in serum AP levels preceded symptomatic manifestations of CMV colitis, and fell with successful therapy.

Acute CMV disease in solid organ transplant recipients is common, can take many shapes, and needs to be diagnosed quickly. An unexplained rise in serum AP levels should lead to a search for inflammatory bowel disease, specifically CMV colitis, in transplanted patients.
Intracranial Nocardia recurrence during fluorinated quinolones therapy
Authors: Dahan K. , Kabbaj D. El , Venditto M. , Pastural M. , Delahousse M.
Published: August 2006

Abstract: Nocardia infection is a well‐recognized complication in renal transplant recipients and other immunocompromised hosts. It is mostly a primary pulmonary infection, which can disseminate to other organs in half of the cases. Nocardiosis is a life‐threatening infection. Therefore, an efficient long‐lasting treatment must be rapidly administered. We report 1 case of disseminated nocardiosis with pulmonary involvement, brain lesions, and bone lesions in a renal transplant patient, who was treated with stereotactic aspiration in association with high dose of trimethoprim/sulfamethoxazole (TMP/SMX) and imipenem, changed, after 3 weeks to moxifloxacin. First, clinical manifestations decreased after surgical drainage and combination therapy with the 2 antimicrobial agents, but later the patient developed a recurrence of brain lesions during treatment with quinolones. Consequently, the patient was again treated with TMP/SMX and imipenem, after which the patient recovered. It is surprising that moxifloxacin was efficient in vitro and the antimicrobial concentration in the central nervous system was high, yet the nocardial abscess recurred under this therapy.
Herpes simplex virus hepatitis: expanding the spectrum of disease
Authors: Duckro A.N. , Sha B.E. , Jakate S. , Hayden M.K. , Simon D.M. , Saltzberg S.N. , Arai S. , Kessler H.A.
Published: August 2006

Abstract: We describe 2 transplant patients with herpes simplex virus (HSV) hepatitis who were minimally symptomatic throughout their illness. The spectrum of disease caused by HSV hepatitis is more variable than previously reported in this population. HSV hepatitis should be considered in immunocompromised hosts with elevated transaminases without evidence of fulminant hepatic necrosis.
Aspergillus infection limited to renal allograft: case report and review of literature
Authors: Linden E. , Restrepo D. , Dikman S. , Murphy B. , Huprikar S.
Published: August 2006

Abstract: We report a case of a 28‐year‐old recipient of a cadaveric renal transplant who developed Aspergillus infection in the allograft without having disseminated disease. We review the previously reported cases of isolated Aspergillus in kidney transplant recipients and discuss the possible route of transmission in our patient. We also discuss the alternate but successful treatment that our patient received.
Favorable outcome of liver transplantation despite a high hepatitis B virus replication: beyond the limits?
Authors: Dumortier J. , Le Derf Y. , Guillem P. , Chevallier P. , Boillot O.
Published: August 2006

Abstract: Patients with end‐stage liver disease due to chronic hepatitis B virus (HBV) infection with a persistent viral replication are generally denied liver transplantation (LT). We report the case of a patient who presented with the emergence of a YMDD escape mutant virus under lamivudine treatment, and developed terminal liver failure requiring LT. Pre‐LT introduction of adefovir led to only a mild decrease in replication. The patient was treated with a combination of intravenous hepatitis B immune globulin (HBIG) that was started perioperatively, and also continued lamivudine and adefovir after LT. One year after LT, there was no evidence of HBV infection recurrence. This observation suggests that persistent high HBV replication might not be a contra‐indication to LT, providing adequate and effective prophylaxis is given, using HBIG and antiviral drug combination therapy.
Mycobacterium tuberculosis infection following renal transplantation in Taiwan
Authors: Chen C.‐H. , Lian J.‐D. , Cheng C.‐H. , Wu M.‐J. , Lee W.‐C. , Shu K.‐H.
Published: August 2006

Abstract: Background. Tuberculosis (TB) is one of the major causes of morbidity and mortality worldwide. Post‐transplant (post‐Tx) TB is a problem in successful long‐term outcome of renal transplantation recipients. It is a life‐threatening opportunistic infection that is frequently encountered, but the diagnosis is often delayed. With the emergence of newer potent immunosuppressive regimens and an increased incidence of TB in the general population, post‐Tx TB among transplant recipients can be anticipated. Our objective was to describe the pattern and risk factors of TB infection, and the prognosis in an endemic area.

Methods. This study was a retrospective review of the records of 756 renal transplant recipients in our hospital during the period from January 1983 to December 2003. The demographic data, transplant characteristics, clinical manifestations, diagnostic criteria, treatment protocol, and long‐term outcome of this cohort of patients were analyzed.

Results. Thirty‐one episodes developed into TB in 29 patients (3.8%) with a mean age of 45.5 (range: 24.2–66.2) years and a mean post‐Tx period of 57.9 (range: 1.2–145.2) months. The forms of the diseases were pulmonary in 22/31 (71%), disseminated in 1/31 (3%), miliary in 1/31 (3%), and extrapulmonary in 7/31 (23%). All patients initially received 4‐drug combination therapy, and then dosage was adjusted based on clinical condition. Because of drug interaction, a mean 2‐fold increase in the dose of calcineurium inhibitor, but no change in steroid, was required. Twenty‐two patients (71%) had an elevated creatinine (Cr) level, and 6 (19%) patients did not recover owing to tissue‐proof acute rejection (3 cases) and chronic allograft nephropathy (3 cases), respectively, after treatment. The serum Cr level on diagnosis of TB was 1.9±0.7 mg/dL; it then deteriorated to 2.4±1.5 mg/dL (P=0.134). Hepatotoxicity developed in 11 patients (35.5%) during treatment. Twenty‐five patients were successfully treated, 2 patients remain under treatment, and 4 (12.9%) died. Based on univariate analysis, we found the post‐Tx TB risk factors were diabetes and more than 3 episodes of rejection, modalities for acute rejection (high‐dose steroid and anti‐lymphocyte globulin), and maintenance therapy with steroid.

Conclusion. Post‐Tx TB is a serious problem worldwide, and a high index of suspicion is warranted to ensure early diagnosis and prompt initiation of treatment for TB among renal transplant patients. The use of optimal immunosuppressive agents to minimize acute rejection seems reasonable to prevent TB infection in endemic areas like Taiwan. More than 9 months of treatment may be necessary to prevent recurrence.
Acute graft pyelonephritis following renal transplantation
Authors: Kamath N.S. , John G.T. , Neelakantan N. , Kirubakaran M.G. , Jacob C.K.
Published: August 2006

Abstract: Background.Urinary tract infection is the most common form of bacterial infection encountered in a renal transplant recipient. Studies explaining the long‐term consequences of acute graft pyelonephritis (AGPN) are few.

Methods.A total of 1022 consecutive renal allograft recipients were studied retrospectively over a period of 10 years for evidence of AGPN. These patients were classified into two groups according to the presence or absence of at least one AGPN episode. Only culture‐proven infections were included in the study.

Result.Of the 1022 renal transplant recipients, 169 patients (16.5%) developed AGPN. In the multivariate analysis with stepwise logistic regression, significant associations were observed between AGPN and placement of ureteric stent (odds ratio [OR]=4.6), urological malformations of native kidney (OR=2.1), cytomegalovirus (CMV) disease (OR=2.0), mycophenolate mofetil (MMF)‐based regimen (OR=1.9), and acute rejection episodes (OR=1.5). However, age>40 years, female gender, induction therapy, anti‐CD3 treatment, and hyperglycemia did not show such an association. In comparison with the non‐AGPN group, these patients had a lower graft and patient survival (though it did not attain statistical significance). In the multivariate analysis using the Cox model for the entire study population, AGPN did not independently contribute to poor graft or patient survival.

Conclusion.AGPN in the renal transplant setting is an ominous event, as these patients are also more prone to develop bacteremia, acute rejection, and CMV disease, which could then lead to poor graft and patient survival. Its association with MMF needs further clarification.
Antigen detection, serology, and molecular diagnosis of invasive mycoses in the immunocompromised host
Authors: Wheat L.J.
Published: August 2006

Abstract: Understanding the uses and limitations of methods for rapid diagnosis of fungal disease is essential in order to diagnose and treat these infections early in their course. Antigen detection methods are useful for diagnosis of aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, paracoccidioidomycosis, and penicilliosis marneffei. The accuracy of the β‐glucan assay for diagnosis of aspergillosis and candidiasis and its role in fungal diagnosis remains unclear, in part because the few published studies report widely varying specificity. Serologic tests for antibodies are also useful for diagnosis of histoplasmosis and coccidioidomycosis, but their sensitivity may be reduced by immunosuppression. While molecular diagnostic methods have been described and are available at some reference and university laboratories, their role in patient care remains uncertain, largely because of the lack of well‐characterized assays and studies establishing their accuracy. Culture methods, although essential for establishing the diagnosis in some cases, have limitations for rapid diagnosis, namely insensitivity, need for invasive procedures, and delayed growth.
Experimental adaptation to high and low quality environments under different scales of temporal variation
Authors: BUCKLING A. , BROCKHURST M. A. , TRAVISANO M. , RAINEY P. B.
Published: August 2006

We investigated the role of the scale of temporal variation in the evolution of generalism in populations of the bacterium Pseudomonas fluorescens. Replicate populations were propagated as batch cultures for approximately 1400 generations (192 days), in either high quality media only, low quality media only, or were alternated between the two at a range of temporal scales (between 1 and 48 days). Populations evolved in alternating media showed fitness increases in both media and the rate of alternation during selection had no effect on average fitness in either media. Moreover, the fitness of these populations in high quality media was the same as for populations evolved only in high quality media and likewise for low quality media. Populations evolved only in high or low quality media did not show fitness improvements in their nonselective media. These results indicate that cost‐free generalists can evolve under a wide range of temporal variation.
Direct fitness or inclusive fitness: how shall we model kin selection?
Authors: TAYLOR P. D. , WILD G. , GARDNER A.
Published: August 2006

Two standard mathematical formulations of kin‐selection models can be found. Inclusive fitness is an actor‐centred approach, which calculates the fitness effect on a number of recipients of the behaviour of a single actor. Direct fitness is a recipient‐centred approach, which calculates the fitness effect on the recipient of the behaviour of a number of actors. Inclusive fitness offers us a powerful heuristic, of choosing behaviour to maximize fitness, but direct fitness can be mathematically easier to work with and has recently emerged as the preferred approach of theoreticians. In this paper, we explore the fundamental connection between these two approaches in both homogeneous and class‐structured populations, and we show that under simple assumptions (mainly fair meiosis and weak selection) they provide equivalent formulations, which correspond to the predictions of Price's equation for allele frequency change. We use a couple of examples to highlight differences in their conception and formulation, and we briefly discuss a two‐species example in which we have a class of ‘actor’ that is never a ‘recipient’, which the standard direct fitness method can handle but the usual inclusive fitness cannot.
Dynamics of the evolution of Batesian mimicry: molecular phylogenetic analysis of ant‐mimicking Myrmarachne (Araneae: Salticidae) species and their ant models
Authors: CECCARELLI F. S. , CROZIER R. H.
Published: August 2006

Batesian mimicry is seen as an example of evolution by natural selection, with predation as the main driving force. The mimic is under selective pressure to resemble its model, whereas it is disadvantageous for the model to be associated with the palatable mimic. In consequence one might expect there to be an evolutionary arms race, similar to the one involving host–parasite coevolution. In this study, the evolutionary dynamics of a Batesian mimicry system of model ants and ant‐mimicking salticids is investigated by comparing the phylogenies of the two groups. Although Batesian mimics are expected to coevolve with their models, we found the phylogenetic patterns of the models and the mimics to be indicative of adaptive radiation by the mimic rather than co‐speciation between the mimic and the model. This shows that there is strong selection pressure on Myrmarachne, leading to a high degree of polymorphism. There is also evidence of sympatric speciation in Myrmarachne, the reproductive isolation possibly driven by female mate choice in polymorphic species.
The mental health nurse practitioner in the emergency department: An Australian experience
Authors: Wand Timothy , Fisher Jacklin
Published: August 2006

ABSTRACT:  This paper describes the establishment of a mental health nurse practitioner (MHNP) position in New South Wales, Australia. The authors report on a MHNP role that functions collaboratively within a large inner city emergency department. Attention is centred on what constitutes advanced mental health nursing practice in the emergency department setting. Three areas associated with the work of MHNPs – therapeutic techniques, prescribing and care coordination and referral – are highlighted to explore the scope of the MHNP role. The authors propose that the success of this position is based on a process of consultation and evaluation, partnership between disciplines and clinical services and the role maintaining a truly nursing focus rather than attempting to replace or replicate psychiatric medicine.
A selective review of mental health nursing in New South Wales, Australia, in relation to clinical supervision
Authors: White Edward , Roche Michael
Published: August 2006

ABSTRACT:  Recent reports have suggested that mental health staff have added stress, which arose from poor working conditions, heavy workloads, and lack of resources, within a culture in which there was a large degree of burnout, low morale, lack of job satisfaction, poor status, insensitivity and indifference. This is particularly so for mental health nurses, who create the ambience in clinical settings. Previous research has shown that the introduction of clinical supervision, as a central plank of clinical governance arrangements, has a positive effect in some of these respects, but remains underdeveloped in Australia. The present scoping study examined the extent to which this was so in mental health nursing services in the state of New South Wales. Individual mental health nurses (n =  601) and Area Health Services (n =  17) provided data about their local circumstances. Findings revealed that mental health nursing in New South Wales was a committed, late middle‐aged workforce, working in services about which there was a width of opinion with the prevailing management arrangements, yet to fully exploit their therapeutic potential, or engage the educational opportunities that would assist them in their endeavour. More specifically, it remained a workforce that has yet to engage clinical supervision in a systematically coherent manner. The study concluded, therefore, that clinical supervision offered a possible practical remedy to address the causes and the effects of suboptimal service provision and that the ready availability of dedicated funding and the immediate access to service development and research expertise was a rare and timely confluence.
Topiramate in the treatment of obese subjects with drug‐naive type 2 diabetes
Authors: Stenlöf K. , Rössner S. , Vercruysse F. , Kumar A. , Fitchet M. , Sjöström L. ,   Study Group
Published: August 2006

Aim: The aim of this study was to examine the efficacy and safety of topiramate as an adjunct to diet and exercise in drug‐naive, obese subjects with type 2 diabetes.

Methods: Drug‐naive individuals with type 2 diabetes, body mass index (BMI) of ≥27 and <50 kg/m2and haemoglobin A1c(HbA1c) of <10.5% were enrolled into the study. All the individuals participated in a non‐pharmacologic weight loss program (Pathways to Change®; Johnson & Johnson Healthcare Systems, Piscataway, NJ, USA) throughout the trial. After a 6‐week placebo run‐in, the subjects were randomized to placebo, topiramate 96 mg/day or topiramate 192 mg/day. Subjects were scheduled for 8‐week titration and 52‐week maintenance phases. The study was ended early; efficacy data were reported for a predefined modified intent‐to‐treat (MITT) population (n = 229), with 40 weeks of treatment. All the subjects who provided any safety data were included in the safety population (n = 535).

Results: Baseline mean weight was 103.7 kg, BMI 36 kg/m2and HbA1c6.7% across all treatment groups. By the end of week 40, the placebo, the topiramate 96 mg/day and topiramate 192 mg/day groups lost 2.5, 6.6 and 9.1% of their baseline body weight respectively (p < 0.001 vs. placebo, MITT population using last observation carried forward). The decrease in HbA1cwas 0.2, 0.6 and 0.7% respectively (p < 0.001 vs. placebo, MITT). Topiramate significantly reduced blood pressure and urinary albumin excretion; a weight‐loss‐independent HbA1cimproving effect of topiramate was demonstrated. Adverse events were predominantly related to central nervous system (CNS).

Conclusions: Topiramate as an add‐on treatment to lifestyle improvements produced significant weight loss and improved glucose homeostasis in obese, drug‐naive subjects with type 2 diabetes. These treatment advantages should be balanced against the occurrence of adverse events in the CNS.
Short‐term effects of metformin in type 2 diabetes
Authors: Eriksson A. , Attvall S. , Bonnier M. , Eriksson J. W. , Rosander B. , Karlsson F. A.
Published: August 2006

Background:  Although metformin is widely used in the management of type 2 diabetes, its mechanism(s) of action is not fully known, and there have been remarkably few reports on short‐term effects of the drug. Here, we examined the early effects on glucose and lipid metabolism and on certain adipose tissue and inflammatory markers during treatment for 28 days.

Methods:  Twenty‐one patients were randomized to metformin (n = 16) or placebo (n = 5) and studied at baseline, 1, 2 and 4 weeks with blood sampling and oral glucose tolerance tests (OGTT). The active group received 500 mg metformin daily in the first week, 500 mg twice daily during week 2 and 1000 mg twice daily during weeks 3 and 4.

Results:  After 7 days of treatment, a reduced area under curve (AUC) for glucose at OGTT with no change in AUC for insulin levels was observed compared to baseline. Insulin sensitivity, as derived from the OGTT by Gutt’s index, was increased. Reductions in fasting plasma glucose, total cholesterol and low‐density lipoprotein cholesterol appeared after 14 days, and reductions in triglycerides, plasminogen activator inhibitor‐1 (PAI‐1) and leptin after 28 days of treatment. There were no changes in body weight, adiponectin or C‐reactive protein. Compared with placebo, the changes between day 0 and day 28 differed significantly with regard to AUC for glucose at OGTT and Gutt’s index, and showed strong trends for PAI‐1 and leptin.

Conclusions:  The data demonstrate that in type 2 diabetes, metformin rapidly affects glucose handling without changing the concentrations of insulin. Reductions in PAI‐1 and leptin levels indicate that the early effects of metformin involve also the adipose tissue.