bluuebunny/crossref_metadata_2025 huggingface dataset:
Drug supply for psoriasis – results from a national pharmacy network
Authors: Franzke Nadine , Montenbruck Moritz , Langenbruch Anna Katharina , Beikert Florian C. , Kresken Joachim , Augustin Matthias
Published: March 2013

Background

In Germany, drugs are to a large extent provided by pharmacies. Thus, investigations in pharmacies permit drug usage studies both on patients receiving prescribable drugs and using self‐medication. The current study evaluated the quality of medical care, disease burden and spectrum of treatments for patients with psoriasis in a nationwide network of pharmacies.

Patients and methods

A nationwide cross‐sectional study was conducted in 61 pharmacies. Patients with psoriasis vulgaris who came to the pharmacy to obtain antipsoriatic drugs or basic ointments were consecutively recruited, interviewed and asked to complete a standardized questionnaire. The questionnaire focused on socio‐demographic characteristics and prior therapies for psoriasis. Furthermore, data on the patient's treatment satisfaction, disease‐related burden, and treatment adherence were evaluated. In addition, the proportion and significance of health care providers for psoriasis as well as the number of patients using self‐medication were assessed.

Results

The data on 241 patients show a high and long‐lasting disease‐related burden. A high utilization of resources was found. Dermatologists were the most frequently consulted providers (reported by 77.1 % of patients), followed by general practitioners (10.4 %). 3.5 % of patients were using self‐medication. Self‐reported adherence with treatment was moderate (71.6 %). Patient satisfaction varied considerably and demonstrated the need for improvement.

Conclusions

Psoriasis is a socio‐economically relevant disease. Health care is provided primarily by dermatologists. Surveying patients in a national network of pharmacies is a unique and effective way of collecting relevant “real world” data. Selection biases related to the health care setting are minimized.
Safety Evaluation of Excessive Ingestion of Mozuku Fucoidan in Human
Authors: Abe Sunao , Hiramatsu Kimiko , Ichikawa Osamu , Kawamoto Hitoshi , Kasagi Takeshi , Miki Yasunari , Kimura Takayuki , Ikeda Tadasu
Published: March 2013

Fucoidan is a sulfated polysaccharide in the brown sea algae. This study was conducted in 20 subjects taking excessive fucoidan up to 4.05 g daily for 2 wk. They recorded questionnaire sheets about their health. Blood and urine were collected before and after 2 wk of ingestion. We found that no disorder was apparent in the test period. Although total cholesterol (P value 0.017) and low‐density lipoprotein cholesterol (P value 0.017) showed statistically significant reduction and Cl (P value 0.002) showed significant increase, nothing deviated from the range of normal values. In conclusion, this study showed no abnormalities in the abdominal, fecal states, blood and urine at all.
Sensitivity of different assays for the serological diagnosis of epidermolysis bullosa acquisita: analysis of a cohort of 24 Italian patients
Authors: Calabresi V. , Sinistro A. , Cozzani E. , Cerasaro C. , Lolicato F. , Muscianese M. , Parodi A. , Didona B. , Zambruno G. , Di Zenzo G.
Published: March 2013

Background

Epidermolysis bullosa acquisita (EBA) is an autoimmune blistering disease characterized by tissue‐bound and circulating autoantibodies to the dermal‐epidermal junction. The autoantibody target is type VII collagen (Col VII) which is involved in dermal‐epidermal adhesion. Diagnosis is made by clinical and histopathological findings, linear deposition of autoantibodies at the dermal‐epidermal junction detected by direct immunofluorescence, and binding to the dermal side of salt‐split skin by indirect immunofluorescence (IIF). However, the detection of specific anti‐Col VII reactivity has an important confirmatory value.

Methods

The humoral immune response in EBA sera was analysed by (i) IIF on human skin, (ii) a commercial Col VII ELISA, and (iii) immunoblotting on Col VII produced by an epithelial cell line.

Objective

The aim of this study was to compare the sensitivity of different approaches for the serological diagnosis of EBA.

Results

The vast majority of EBA sera (79.2%) bound to the Col VII non‐collagenous domains by a commercial ELISA, while a small proportion of patients (12.5%) exclusively reacted to the collagenous domain by immunoblotting. Of note, the autoantibodies reactivity to Col VII was more frequently detected by IB (91.7%) than by IIF (83.3%) and ELISA (79.2%). Interestingly, 2 out of 24 sera recognized Col VII epitopes undetectable in the native secreted protein but present in the context of extracellular matrix proteins, as assessed by immunomapping on Col VII‐deficient skin.

Conclusion

Our findings show that the use of multiple assays allows to improve diagnostic performance. An algorithm for efficient serological diagnosis of EBA is proposed.
Spatio‐temporal Variations in the Molecular Diversity of Microeukaryotes in Particular Ciliates in Soil of the Yellow River Delta, China
Authors: Zhao Feng , Xu Kuidong , Zhang Dechao
Published: March 2013

The Yellow River delta in China is one of the most active regions of land–ocean interaction. It has suffered serious salinization due to drying‐up of the Yellow River, rising sea level, and seashore erosion, and thus represents a special and extreme environment. We evaluated the microeukaryotic molecular diversity and its response to change of seasons and environmental variables, in particular salinity in the soil of the Yellow River delta, by denaturing gradient gel electrophoresis (DGGE) and gene sequencing. The sequencing of the microeukaryotic DGGE bands revealed the presence of diverse groups dominated by protists in particular ciliates. We further recovered a high diversity of marine and soil ciliates inhabiting in coastal soil using the ciliate‐specific DGGE. The neighbor‐joining tree indicated that the ciliate 18S rDNA sequences from high‐salinity soil were affiliated to Colpodea, Spirotrichea, Litostomatea, and Oligohymenophorea, while all the sequences unique to the low‐salinity soil were affiliated to Colpodea. Statistical analysis indicated that the microeukaryotic molecular diversity was significantly different among sites, while statistically indistinguishable among seasons. Soil salinity might be the main factor regulating the distribution of microeukaryotes in the soil from the Yellow River delta.
ENVIRONMENTAL MARKETS: WHAT DO WE LEARN FROM THE LAB?
Authors: Friesen Lana , Gangadharan Lata
Published: March 2013

In recent years, some of the most influential policies have been either tested or evaluated using experimental methods. Experiments have provided significant insights on the implications of different designs on market outcomes and the lessons learned have helped improve academic debate and the interaction between policy makers and researchers. In this paper, we provide an overview of experiments relating to environmental markets. Expenditure on environmental programs has been growing in importance yet it is controversial in current times due to the fiscal cuts around the world. Finding cost‐effective ways of reaching environmental goals is thus an objective of most governments. Research using experiments can help isolate how individuals and regulators would respond to incentives and therefore identify the most effective programs.
The adhesive and cohesive properties of a bacterial polysaccharide adhesin are modulated by a deacetylase
Authors: Wan Zhe , Brown Pamela J. B. , Elliott Ellen N. , Brun Yves V.
Published: March 2013

Bacterial exopolysaccharide synthesis is a prevalent and indispensible activity in many biological processes, including surface adhesion and biofilm formation. In Caulobacter crescentus, surface attachment and subsequent biofilm growth depend on the ability to synthesize an adhesive polar polysaccharide known as the holdfast. In this work, we show that polar polysaccharide synthesis is a conserved phenomenon among Alphaproteobacterial species closely related to C. crescentus. Among them, mutagenesis of Asticcacaulis biprosthecum showed that disruption of the hfsH gene, which encodes a putative polysaccharide deacetylase, leads to accumulation of holdfast in the culture supernatant. Examination of the hfsH deletion mutant in C. crescentus revealed that this strain synthesizes holdfast; however, like the A. biprosthecum hfsH mutant, the holdfasts are shed into the medium and have decreased adhesiveness and cohesiveness. Site‐directed mutagenesis at the predicted catalytic site of C. crescentus HfsH phenocopied the ΔhfsH mutant and abolished the esterase activity of HfsH. In contrast, overexpression of HfsH increased cell adherence without increasing holdfast synthesis. We conclude that the polysaccharide deacetylase activity of HfsH is required for the adhesive and cohesive properties of the holdfast, as well as for the anchoring of the holdfast to the cell envelope.
Associations between CD14 −159 C>T polymorphism and chronic/aggressive periodontitis susceptibility
Authors: Zhang H , Zhou l , Han Y , Cai Q , Li D , Pan Y , Wang L
Published: March 2013

Objectives

CD14 is a causative gene for periodontitis. However, conflicting results had been achieved when evaluating the associations between CD14 −159 C>T and periodontitis, which warranted us to conduct this meta‐analysis.

Material and Methods

A meta‐analysis based on eight relevant case–control studies was conducted to address this issue. Odds ratios (OR) with 95% confidence intervals (CIs) were applied to test the association. The statistical heterogeneity across studies was assessed by Chi‐square‐based Q‐test.

Results

Retrieved studies regarding CD14 −159 C>T and periodontitis susceptibility were put into the final analysis. Overall and subgroup analyses were performed. Finally, we did not find that this polymorphism could contribute to modified risk of periodontitis or in stratified analysis by ethnicity and type of disease. However, this polymorphism was associated with decreased risk of mild to moderate periodontitis (TT vs CC, OR = 0.42, 95% CI = 0.21–0.81, CT/CC vs TT, OR = 1.91, 95% CI = 1.09–3.35) but not severe periodontitis.

Conclusion

The present meta‐analysis provided confirmative evidence that CD14 −159 C>T was involved in the development of periodontitis.
Emergence delirium in children: a randomized trial to compare total intravenous anesthesia with propofol and remifentanil to inhalational sevoflurane anesthesia
Authors: Chandler John R. , Myers Dorothy , Mehta Disha , Whyte Emma , Groberman Michelle K. , Montgomery Carolyne J. , Ansermino J. Mark
Published: March 2013

Background

Emergence delirium (ED) refers to a variety of behavioral disturbances commonly seen in children following emergence from anesthesia. Vapor‐based anesthesia with sevoflurane, the most common pediatric anesthetic technique, is associated with the highest incidence of ED. Propofol has been shown to reduce ED, but these studies have been methodologically limited.

Objective

To conduct a randomized‐controlled trial comparing the incidence of ED in children following sevoflurane (SEVO) anesthesia and propofol–remifentanil total intravenous anesthesia (TIVA).

Methods

One hundred and twelve children, ASA I‐II, aged ≥2 and ≤6 years, undergoing strabismus repair, were assigned to receive TIVA (intravenous induction and maintenance of anesthesia with propofol and remifentanil) or SEVO (inhalational induction and maintenance of anesthesia with sevoflurane). Parent–child induction behavior was scored using the Perioperative Adult Child Behavior Interaction Scale (PACBIS). Postoperatively, ED was assessed by a masked investigator using the Pediatric Anesthesia Emergence Delirium (PAED) Scale and pain using the Face, Legs, Activity, Cry, Consolability (FLACC) Scale every 5 min.

Results

Data are reported for 94 subjects. Incidence of ED was higher with SEVO (38.3% vs 14.9%, P = 0.018). There was no difference in the median PACBIS score. A higher FLACC score was seen with SEVO (median 3 vs 1, P = 0.033). Subjects experiencing ED had higher FLACC scores vs those unaffected by ED (median 7 vs 1, P < 0.0001).

Conclusion

There was a lower incidence of ED after TIVA. Both intravenous and inhalational inductions were similarly well‐tolerated. The use of TIVA was associated with reduced postoperative pain as measured using FLACC scores.
Pregabalin Vs. Opioids for the Treatment of Neuropathic Cancer Pain: A Prospective, Head‐to‐Head, Randomized, Open‐Label Study
Authors: Raptis Efklidis , Vadalouca Athina , Stavropoulou Evmorfia , Argyra Eriphili , Melemeni Aikaterini , Siafaka Ioanna
Published: March 2013

Objectives

Neuropathic cancer pain (NCP) is a common manifestation of cancer and/or its treatment. Treatment following the WHO analgesic ladder provides relief for the majority of cancer pain patients; however, concern remains that opioids may be less efficacious for neuropathic pain (NP) compared with nociceptive pain, often necessitating the use of higher doses. Adjuvants, such as pregabalin, have shown to be efficacious for the treatment of NP, although data come mostly from noncancer studies. The comparative efficacy and safety of opioids versus adjuvants has not been studied for NCP. The aim of this study was to directly compare pregabalin versus a strong opioid for the treatment of NCP.

Methods

A total of 120 patients, diagnosed with “definite” NCP, were randomized into two groups and received increasing doses of either oral pregabalin or transdermal fentanyl for 28 days. VAS score, patient satisfaction, need for opioid rescue, and adverse events (AEs) were recorded.

Results

In the pregabalin group, a significantly higher proportion of patients achieved at least 30% reduction in VAS compared with the fentanyl group (73.3%, 95% CI: 60.3%–83.93 vs. 36.7%, 95% CI: 24.5%–50.1%, P < 0.0001, respectively), while the percentage mean change from baseline was also significantly different [46% (95% CI: 39.5%–52.8%) for pregabalin and 22% (95% CI: 14.9%–29.5%) for fentanyl (P < 0.0001)]. Patient‐reported satisfaction was more frequent with pregabalin, while AEs and treatment discontinuations were more frequent in the fentanyl group.

Discussion

Prompt use of a neuropathic pain‐specific adjuvant, such as pregabalin, in NCP may lead to better control of the neuropathic component, with opioid‐sparing effects.
Perineural Hematoma Following Lumbar Transforaminal Steroid Injection Causing Acute‐on‐Chronic Lumbar Radiculopathy: A Case Report
Authors: Desai Mehul J , Dua Shivani
Published: March 2013

Introduction

Transforaminal epidural steroid injections (TFESI) are commonly performed for the treatment of lumbar herniated nucleus pulposus and lumbosacral radiculopathy. Although rare, documented complications including spinal cord infarction, paraparesis, epidural abscess, paraplegia, and epidural hematoma have been reported. Here, we present a case of perineural hematoma affecting the L4 nerve root resulting in progressive acute‐on‐chronic lumbar radiculopathy following TFESI.

Case Report

A 72‐year‐old female presented with 3 months of low back and right anterior thigh pain. She subsequently underwent right L3 and L4 TFESI for physical examination findings concordant with radiographic right foraminal stenosis at L3‐4 and L4‐5 with L3‐4 spondylolisthesis. Over the following week, the patient reported progressive right lower extremity weakness, worsening sensory loss, and ambulatory dysfunction. Examination revealed mild L3/4 myotomal weakness, sensory changes, and areflexia at the right patella. A gadolinium‐enhanced MRI was ordered, which showed focal abnormal signal with involvement of the right L4‐L5 neuroforamina and extending slightly far laterally, consistent with a small hematoma, affecting the L4 nerve root. Within 2 months, her strength and reflexes normalized and sensory loss diminished following medical management.

Discussion

Although extremely rare, perineural or foraminal hematomas may occur as a serious complication of TFESI, even in the setting of a standardized procedure. Hematoma may cause worsening of symptoms in the acute and subacute phase following TFESI. Further investigation into the etiologies of such injuries is warranted and must be added to the considerations of pain physicians performing these procedures.
Efficient application of in vitro anther culture for different European winter wheat (Triticum aestivum L.) breeding programmes
Authors: Lantos Csaba , Weyen Jens , Orsini José M. , Gnad Heike , Schlieter Bernd , Lein Volker , Kontowski Stefan , Jacobi Andreas , MihÁly Róbert , Broughton Sue , Pauk János
Published: March 2013

The efficiency of our anther culture protocol was tested with high‐ and low‐responding genotypes, ‘Svilena’ and ‘Berengar’, and 93 F1 winter wheat crosses in 2010 and 2011. Based on data for these genotypes, the effect of genotype influenced the number of embryo‐like structures, regenerated plantlets and green plantlets, while the number of albino plantlets was affected by genotype, year and environmental factors. Although genotype also influenced the production of green plantlets from breeding crosses, with green plantlets per 100 anthers ranging from 0.04 to 28.67, the average regeneration rate over all crosses was 5.3 green plantlets/100 anthers, which resulted in a total of 11 416 well‐rooted green plantlets. The survival rate of green plantlets following acclimatization was 97.21% in 2010 and 96.34% in 2011. In this study, the phenomenon of albinism and genotype dependency did not hinder the production of more than five thousand green plantlets each year. In our experiments, anther culture proved to be an efficient method in winter wheat breeding programmes with lower costs than alternative technologies.
The Pitfalls of Skin Biopsies to Diagnose Epidermolysis Bullosa
Authors: Murrell Dedee F.
Published: March 2013

See related article on page 226
Resuscitation skills of pediatric residents and effects of Neonatal Resuscitation Program training
Authors: Gunay Ilker , Agin Hasan , Devrim Ilker , Apa Hursit , Tezel Basak , Ozbas Sema
Published: March 2013

Background

The Neonatal Resuscitation Program (NRP) is an effective tool in decreasing mortality and morbidity due to birth asphyxia. The aim of the study was to assess the skill and knowledge level of pediatric residents in a teaching hospital and the effects of NRP training.

Methods

Subjects consisted of pediatric residents of Dr Behcet Uz Hospital, Izmir, Turkey. They were assessed on practice exam scenarios and NRP provider course flow charts. Teams with two members were formed randomly. Each resident was evaluated on a 100 point scale covering all resuscitation steps and interventions. Exam scores were analyzed for two major parameters: resident participation in NRP training (never, within the last 6 months, and ≥6 months previously) and being a senior (>18 months residency).

Results

A total of 49 residents enrolled in the study (94.2% of the target group). Twenty‐one residents had NRP training (42.9%). Junior residents comprised 46.9% of the study group. The mean skill score was 72.1, and it was significantly higher for senior residents and residents who attended the NRP course (P < 0.05). Although there was no difference between the members within a team, residents who had not attended the NRP course performed better when paired with a resident with NRP certification.

Conclusions

NRP training significantly increases the resuscitation knowledge and skill of pediatric residents, although this can be achieved by being a senior. Residents should undergo training as soon as possible to achieve a higher level of quality in resuscitating babies.
Quality of life in children treated with restrictive diet for inherited metabolic disease
Authors: Eminoglu Tuba F. , Soysal Sebnem A. , Tumer Leyla , Okur Ilyas , Hasanoglu Alev
Published: March 2013

Background

The aim of this study was to investigate the quality of life (QoL) of a group of patients with inherited metabolic diseases (IMD) who were treated with restrictive diet.

Method

A total of 68 patients (35 boys, 51.5%; 33 girls, 48.5%) with IMD (organic acidemia [OA], n = 14; disorder of carbohydrate metabolism [CMD], n = 33; and disorder of amino acid metabolism [AMD], n = 21) and their parents were inteviewed. Both parents completed a QoL Scale for Metabolic Diseases–Parent Form, a KINDL parent questionnaire, and a depression form. All patients aged ≥4 years completed a questionnaire themselves, including the KINDL‐Kid and KINDL‐Kiddo self‐reports. The semi‐standardized interviews were carried out with patients and their parents in a clinical setting.

Results

The patients with bad diet compliance had lower scores for school labeling and perception of disease on both the parent and child questionnaire forms (P < 0.05). The patients were then divided into three groups (OA, CMD, AMD) for further analysis. Differences were seen between groups with regard to scores of physical function and school performance according to QoL Scale for Metabolic Diseases–Parent Form (P < 0.01). According to parent perceptions, the CMD patients had better QoL with regard to emotional wellbeing.

Conclusion

As negative effects of the disease increased, the QoL of IMD patients and their parents decreased in terms of emotional, physical, and cognitive function. Application of expanded newborn scanning programs, early diagnosis, regular follow up, and family education would lessen the effects of the disease and improve the QoL of both families and children.
Breath holding spells: Point prevalence and associated factors among Turkish children
Authors: Carman Kursat Bora , Ekici Arzu , Yimenicioglu Sevgi , Arslantas Didem , Yakut Ayten
Published: March 2013

Background

Breath holding spells (BHS) are known as paroxysmal non‐epileptic disorder. There are two subtypes of BHS: cyanotic and the pallid. BHS have been reported to occur in 0.1–4.6% of children in Western countries. Although it is easy to diagnose in its typical form, the data on prevalence of BHS are insufficient in developing countries.

Methods

This study was performed in Turkey's Eskisehir province. A total of 1000 randomly selected 0–6‐year‐old children were invited to family health centers. A specific questionnaire was given to parents. Children who had a history BHS were referred to the hospital to for investigation of medical history and neurological examinations.

Results

A total of 933 children participated and were included in analysis. Thirty‐four children (3.6%) had had BHS. Children's birthweight, parent consanguinity and mothers' education status significantly affected the frequency of BHS. Increase in birth sequence decreases the risk of BHS 0.65‐fold. Fathers' education status also affected the prevalence of BHS, with the risk of BHS being 0.39‐fold less if the father had completed high school or some higher education. And, as the age of the fathers increased, the risk that their children would have BHS was 1.14‐fold higher.

Conclusions

Although the calculated prevalence rate was compatible with previous studies, positive family history for BHS, birth sequence, parents' education status and fathers' age were identified as risk factors associated with BHS.
Interhemispheric transfer of spatial and semantic information: Electrophysiological evidence
Authors: Dal Molin Anna , Marzi Carlo Alberto , Banich Marie T. , Girelli Massimo
Published: March 2013

The goal of this study was to cast light on the existence of functional callosal channels for the interhemispheric transfer (IHT) of spatial and semantic information. To do so, we recorded event‐related potentials in healthy humans while performing a primed odd‐even discrimination task. Targets were visually presented numbers preceded by single‐letter primes signaling the probable presentation of an odd or an even number. Primes and targets could appear either in the same or in different visual fields, thus requiring an IHT in the latter case. The P1 and N2 components were influenced by IHT of spatial information only, whereas the later N400 was influenced by IHT of both spatial and semantic information. This was not the case for the P3b, which was modulated by semantic validity only. These results provide novel evidence of the existence of a temporally separated interhemispheric exchange of spatial and semantic information.
Nurse–patient interaction is a resource for hope, meaning in life and self‐transcendence in nursing home patients
Authors: Haugan Gørill
Published: March 2013

Background

Spiritual dimensions such as hope, meaning in life and self‐transcendence have been found to be predictors of successful ageing, life satisfaction and well‐being in older individuals. Connectedness and communicating with others have been seen to facilitate hope, meaning in life and self‐transcendence among nursing home patients.

Aims

This study aimed to investigate the associations between hope, meaning in life, self‐transcendence and nurse–patient interaction in a nursing home population.

Design and methods

A cross‐sectional design was employed, collecting data in 44 different Norwegian nursing homes (NHs) from 250 patients who met the inclusion criteria. Approval by all regulatory institutions dealing with research issues in Norway and the Management Unit at the 44 NHs was obtained. A sample of 202 cognitively intact nursing home patients responded to the Herth Hope Index, the Purpose in Life test, the Self‐Transcendence Scale and the Nurse–Patient Interaction Scale. A structural equation model (SEM) of the hypothesized relationships between the constructs was tested.

Results

The SEM model fit well with the present data. Significant direct relationships of nurse–patient interaction on hope, meaning in life and self‐transcendence were displayed. Meaning and the interconnectedness dimension of hope appeared to be particularly dynamic resources, revealing significant influences on all the constructs in the SEM model tested.

Conclusion

Nurse–patient interaction influences hope, meaning in life and self‐transcendence in cognitively intact nursing home patients and might be an important resource in relation to patients' health and global well‐being. Thus, care providers are above all fundamental for nursing home patients. Advancing caregivers' interacting and communicating skills might facilitate patients' health and global well‐being and inspire professional caregivers as they perform their daily care practices. More research of the effectiveness of such strategies is greatly needed.

Limitations

The SEM model tested comprised 20 variables, indicating a desirable sample size of n = 200, while the present effective sample was n = 187. Also, cross‐sectional data do not allow making conclusion on the causality.
Asymmetric Explanations of Group Differences: Experimental Evidence of Foucault’s Disciplinary Power
Authors: Hegarty Peter , Bruckmüller Susanne
Published: March 2013

Whilst the same group differences can be explained in many ways, explanations of group differences tend to spontaneously figure the distinctive attributes of lower‐status groups against a background norm of high‐status groups’ attributes. We suggest that this asymmetry occurs in the explanations of scientists and laypeople who have been influenced by the history of ‘disciplinary power’ which works to disempower lower‐status people by making them visible to the human sciences. We argue that social groups who are habitually studied first in research programs, more commonly encountered social groups, and prototypical social groups are all less likely than their counterparts to be marked in spontaneous explanations of empirical group differences. We present evidence that groups who are explicitly mentioned in such explanations are assumed to be lower in power. We describe some limitations to current knowledge about such asymmetric explanations and suggest some directions for further research, including our thoughts about how to integrate existing findings with the possibility of formulating cognitive alternatives to the status quo among minority groups.
Post‐exposure prophylaxis in resource‐poor settings: review and recommendations for pre‐departure risk assessment and planning for expatriate healthcare workers
Authors: Vaid Nidhi , Langan Katherine M. , Maude Richard J.
Published: March 2013

It is estimated that more than 3 million healthcare workers worldwide suffer needlestick and splash injuries whilst at work resulting in the potential transmission of blood‐borne pathogens via exposure to bodily fluids. Under‐reporting and the subsequent management of occupational injuries is a problem both in the United Kingdom and abroad. Many expatriate health care workers will work in low resource settings where the risk of transmission is greatest but in contrast to wealthier countries such as the United Kingdom, there is often a lack of effective systems for its safe management. This article provides important information about this risk and how to minimise it. The reasons for an increased risk in transmission, its subsequent management and pre‐departure planning are discussed, together with the evidence for initiation of post‐exposure prophylaxis; current National and International guidelines as well as the urgent need for International standardisation of these is also discussed.
Trends in transfusion‐transmissible infections among Australian blood donors from 2005 to 2010
Authors: Lucky Tarana T.A. , Seed Clive R. , Keller Anthony , Lee June , McDonald Ann , Ismay Susan , Wand Handan , Wilson David P.
Published: March 2013

Background

Routine monitoring of trends in transfusion‐transmissible infections (TTIs) is essential to maintaining and improving transfusion safety. Although periodic studies have been published there is no comprehensive trend analysis for TTIs in Australian donors. This study determined recent trends in TTIs for which testing is conducted in Australia and described key attributes of infected blood donors.

Study Design and Methods

This is a retrospective analysis using data on donation testing for TTIs (2005‐2010) from the national blood service donor database and data on postdonation interviews with TTI‐positive donors (2008‐2010) from a risk factor database incorporating responses to standardized interview questions. The study measured the prevalence and incidence of TTIs in Australia and assessed their time trends. Multivariate analysis of time trends was conducted using Poisson regression models.

Results

Overall, the prevalence and incidence of TTIs in 2005 to 2010 remained low and steady. The prevalence of hepatitis C virus decreased (rate ratio [RR], 0.93; 95% confidence interval [CI], 0.89‐0.97) and the prevalence of active syphilis increased (RR, 1.51; 95% CI, 1.15‐1.99) significantly during the study period. Prevalence of TTIs among Australian blood donors was substantially lower than that in the general population and no unique risk factors were identified in test‐positive blood donors when compared with the general population.

Conclusion

Both the prevalence and the incidence of TTIs in Australian blood donors remained low, with a steady or declining trend for most infections except active syphilis. The lower prevalence of TTIs in blood donors compared with the general population reflects the effectiveness of donor education and donor selection measures in Australia.
Microbial contamination of hematopoietic progenitor and other regenerative cells used in transplantation and regenerative medicine
Authors: Jacobs Michael R. , Good Caryn E. , Fox Robert M. , Roman Katharine P. , Lazarus Hillard M.
Published: March 2013

Background

Microbial contamination of hematopoietic progenitor cells (HPCs) and other regenerative cells used in transplantation and regenerative medicine can occur during collection and after in vitro manipulation, including purging, cryopreservation, thawing, and infusion.

Study Design And Methods

Microbiologic culture findings on consecutive HPCs and other cell preparations at a single institution derived from peripheral blood, marrow, cord blood, and mesenchymal stromal cells during all phases of manipulation were retrospectively examined from 2005 through 2011. Results were classified as confirmed positive, false positive, and indeterminate.

Results

During the 6‐year surveillance period, 365 patients underwent 912 procedures involving HPC or other cell‐based transfusion. True positive microbial contamination was found in five of 663 (0.8%) peripheral blood and two of 34 (5.9%) marrow preparations (p = 0.04), while no contamination was found in 118 preparations from other sources. True‐positive microbial contaminants included coagulase‐negative staphylococci in autologous HPC products derived from peripheral blood from two patients with asymptomatic central venous catheter infections at time of apheresis and Propionibacterium acnes in one apheresis and two marrow products. Organism loads were low in all cases (≤500 colony‐forming units/mL), and no adverse sequelae occurred in four patients that received contaminated products.

Conclusion

The incidence of microbial contamination of progenitor cell products in our institution over a 6‐year period was low (0.8% overall), with contaminants originating from infected central venous catheters or from skin flora. All contaminants were bacterial species of low virulence, present in low titers and, if transfused, did not result in adverse reactions.
Sterilisation and Monetary Control by the GCC Member Countries
Authors: Hassan M. Kabir , Nakibullah Ashraf , Hassan Abul
Published: March 2013

The prevailing dollar peg of the Gulf Cooperation Council (GCC) countries and the absence of any significant current and capital account restrictions led some to believe that these countries have lost monetary independence. However, the paper presents evidence that interest rates of the GCC countries did not converge to the interest rates of the US implying that the assets of the GCC countries are not perfect substitutes to the US assets. This imperfect asset substitutability has allowed the GCC countries to manoeuvre their monetary policies and the central banks of the GCC countries have had some control over their money growth rates by sterilising the changes in international reserves. Results indicate that the monetary authorities of these countries used domestic credit policy to attain some domestic policy objective while engaging in sterilised foreign exchange intervention. This result implies that the proposed GCC central bank should be able to maintain the monetary independence as a group and can reap the benefit of monetary efficiency of the proposed Gulf Monetary Union.
The role of phosphorus in the pathophysiology of chronic kidney disease
Authors: Geddes Rebecca F. , Finch Natalie C. , Syme Harriet M. , Elliott Jonathan
Published: March 2013

Objective

To review the human and veterinary literature on the role of phosphorus in the pathophysiology of chronic kidney disease (CKD) and to explore why control of plasma phosphorus concentration is an important goal in the management of patients with this disease.

Data Sources

Human and veterinary studies, reviews, clinical reports, textbooks, and recent research findings focused on phosphate homeostasis andCKDpatient management.

Human Data Synthesis

Recent studies using rodent models and human patients withCKDhave focused on trying to elucidate the role of the phosphatonins, predominantly fibroblast growth factor‐23, in phosphate homeostasis and the pathophysiology of secondary renal hyperparathyroidism (SRHP). Fibroblast growth factor‐23 is now considered to be a key regulator of plasma phosphorus concentration in people but has only recently been investigated in companion animal species.

Veterinary Data Synthesis

Cross‐sectional studies of naturally occurringCKDin dogs and cats have shown hyperphosphatemia andSRHPto be highly prevalent and associated with increased morbidity and mortality in these patients. Experimental studies of surgically induced renal impairment in the dog and cat, and cases of naturally occurringCKDhave emphasized the ability of renal care diets to modify plasma phosphorus and parathyroid hormone concentrations. Evidence from these studies indicates that maintaining plasma phosphorus concentrations to within the International Renal Interest Society targets forCKDpatients improves survival time and reduces clinical manifestations of hyperphosphatemia andSRHP.

Conclusions

The maintenance of plasma phosphorus concentrations in to within the International Renal Interest Society targets is recommended in management ofCKDpatients. The discovery of the phosphatonins has improved understanding of the mechanisms involved in phosphorus homeostasis andSRHPand may lead to improved ability to monitor and manage these patients.
Chemical control of weedy rice in precise hill‐direct‐seeded rice in South China
Authors: Shen Xuefeng , Gao Xuhua , Eneji A. Egrinya , Chen Yong
Published: March 2013

Precise hill‐direct‐seeded rice, which is both cost‐ and labor‐saving, is based on the direct seeding of rice by using a precision rice hill‐drop drilling machine. Weedy rice (Oryza sativa f. spontanea), also known as “red rice”, is a major weed in precise hill‐direct‐seeded rice, causing an ≤80% yield loss and a reduction in grain quality. The aim of this study was to evaluate the control efficiency of weedy rice by pretilachlor (a pre‐emergence herbicide) and fenclorim (a safener) and their safety for precise hill‐direct‐seeded rice in two consecutive years. The amount of rice seed germination was accelerated by soaking the seeds in the safener at 0.67 g ai L−1 for 1 h before sowing. The pre‐emergence pretilachlor treatments were applied 2 days after sowing cultured rice. The inhibition of the shoot fresh weight of the cultured rice was reduced by 3.3, 6.4 and 7.4% with 450, 900 and 1350 g ai ha−1 of pretilachlor at 32 days after sowing (DAS) and that of the root fresh weight was reduced by 2.6, 4.9 and 8.1%, respectively. With fenclorim and pretilachlor in a precise hill‐direct‐seeded rice field in 2010 and 2011, the weedy rice control efficiency at 32 DAS was reduced by 100 and 98.0%, respectively. The pre‐emergence pretilachlor treatments that were applied at 2 DAS were much more efficient in the weedy rice control and less inhibitory to the cultured rice growth. The rice yield was increased by 26.1–26.7% in the mechanical precise hill‐direct‐seeded rice, relative to the manual‐seeding rice, with the application of fenclorim and pretilachlor.
Addressing the Growing International Challenge of Cancer: A Multinational Perspective
Authors: Varmus Harold , Kumar Harpal S.
Published: March 2013

Leaders of cancer research organizations propose measures to address the growing international challenge of cancer.
Mast Cells Help Bacteria Hang Out After the Party
Authors: Polage Christopher R.
Published: March 2013

Mast cell-derived IL-10 shifts the bladder towards immune tolerance and limits adaptive immunity to pathogens.
Vertical Transmission of a
Drosophila
Endosymbiont Via Cooption of the Yolk Transport and Internalization Machinery
Authors: Herren Jeremy K. , Paredes Juan C. , Schüpfer Fanny , Lemaitre Bruno
Published: March 2013

Spiroplasma
is a diverse bacterial clade that includes many vertically transmitted insect endosymbionts, including
Spiroplasma poulsonii
, a natural endosymbiont of
Drosophila melanogaster
. These bacteria persist in the hemolymph of their adult host and exhibit efficient vertical transmission from mother to offspring. In this study, we analyzed the mechanism that underlies their vertical transmission, and here we provide strong evidence that these bacteria use the yolk uptake machinery to colonize the germ line. We show that
Spiroplasma
reaches the oocyte by passing through the intercellular space surrounding the ovarian follicle cells and is then endocytosed into oocytes within yolk granules during the vitellogenic stages of oogenesis. Mutations that disrupt yolk uptake by oocytes inhibit vertical
Spiroplasma
transmission and lead to an accumulation of these bacteria outside the oocyte. Impairment of yolk secretion by the fat body results in
Spiroplasma
not reaching the oocyte and a severe reduction of vertical transmission. We propose a model in which
Spiroplasma
first interacts with yolk in the hemolymph to gain access to the oocyte and then uses the yolk receptor, Yolkless, to be endocytosed into the oocyte. Cooption of the yolk uptake machinery is a powerful strategy for endosymbionts to target the germ line and achieve vertical transmission. This mechanism may apply to other endosymbionts and provides a possible explanation for endosymbiont host specificity.

IMPORTANCE
Most insect species, including important disease vectors and crop pests, harbor vertically transmitted endosymbiotic bacteria. Studies have shown that many facultative endosymbionts, including
Spiroplasma
, confer protection against different classes of parasites on their hosts and therefore are attractive tools for the control of vector-borne diseases. The ability to be efficiently transmitted from females to their offspring is the key feature shaping associations between insects and their inherited endosymbionts, but to date, little is known about the mechanisms involved. In oviparous animals, yolk accumulates in developing eggs and serves to meet the nutritional demands of embryonic development. Here we show that
Spiroplasma
 coopts the yolk transport and uptake machinery to colonize the germ line and ensure efficient vertical transmission. The uptake of yolk is a female germ line-specific feature and therefore an attractive target for cooption by endosymbionts that need to maintain high-fidelity maternal transmission.
EvolutionaryGenomics of Salmonellaenterica Subspecies
Authors: Desai Prerak T. , Porwollik Steffen , Long Fred , Cheng Pui , Wollam Aye , Clifton Sandra W. , Weinstock George M. , McClelland Michael
Published: March 2013

Six subspecies are currently recognized in
Salmonella
enterica
. Subspecies I (subspecies
enterica
) is responsible for nearly
all infections in humans and warm-blooded animals, while five other
subspecies are isolated principally from cold-blooded animals. We
sequenced 21 phylogenetically diverse strains, including two
representatives from each of the previously unsequenced five
subspecies and 11 diverse new strains from
S. enterica
subspecies
enterica
, to put this species into an
evolutionary perspective. The phylogeny of the subspecies was partly
obscured by abundant recombination events between lineages and a
relatively short period of time within which subspeciation took place.
Nevertheless, a variety of different tree-building methods gave
congruent evolutionary tree topologies for subspeciation. A total of
285 gene families were identified that were recruited into subspecies
enterica
, and most of these are of
unknown function. At least 2,807 gene families were identified in one
or more of the other subspecies that are not found in subspecies I or
Salmonella
bongori
. Among these gene families were 13 new
candidate effectors and 7 new candidate fimbrial clusters. A third
complete type III secretion system not present in subspecies
enterica
(I) isolates was found in
both strains of subspecies
salamae
(II). Some gene
families had complex taxonomies, such as the type VI secretion
systems, which were recruited from four different lineages in five of
six subspecies. Analysis of nonsynonymous-to-synonymous substitution
rates indicated that the more-recently acquired regions in
S.
enterica
are undergoing faster fixation rates than the
rest of the genome. Recently acquired AT-rich regions, which often
encode virulence functions, are under ongoing selection to maintain
their high AT content.

IMPORTANCE
We have
sequenced 21 new genomes which encompass the phylogenetic diversity of
Salmonella
, including strains of the previously
unsequenced subspecies
arizonae
,
diarizonae
,
houtenae
,
salamae
, and
indica
as well as new
diverse strains of subspecies
enterica
. We have deduced possible
evolutionary paths traversed by this very important zoonotic pathogen
and identified novel putative virulence factors that are not found in
subspecies I. Gene families gained at the time of the evolution of
subspecies
enterica
are of particular
interest because they include mechanisms by which this subspecies
adapted to warm-blooded hosts.
Colo-colic intussusception secondary to lipomatous polyp in an adult
Authors: Rutherford Claire Louise , Alkhaffaf Bilal , Massa Edward , Turner Paul
Published: March 2013

A woman in her early 50s presented with a 2-week history of gradually worsening colicky abdominal pain with associated vomiting, loose stools and reduced appetite. There was no malaena or perrectal bleeding. On examination, there was tenderness in the epigastric region with an associated palpable fullness. Subsequent imaging revealed a substantial colo-colic intussusception with the lead point being a lipoma of the ascending colon. Subsequent colonic resection was undertaken with histology confirming a lipomatous polyp.
The somatic affairs ofBRAF: tailored therapies for advanced malignant melanoma and orphan non-V600E (V600R-M) mutations
Authors: Ponti Giovanni , Pellacani Giovanni , Tomasi Aldo , Gelsomino Fabio , Spallanzani Andrea , Depenni Roberta , Al Jalbout Samer , Simi Lisa , Garagnani Lorella , Borsari Stefania , Conti Andrea , Ruini Cristel , Fontana Annalisa , Luppi Gabriele
Published: March 2013

BRAF V600R-M-D are uncommon mutations, not included in the experimental protocols of BRAF selective inhibitors. We report the evaluation of correlations among different types of BRAF somatic mutations in melanoma and their management with BRAF inhibitors. 21 patients with BRAF mutated metastatic melanoma were enrolled in the protocol with BRAF inhibitors for compassionate use at the University of Modena. Hot spot V600E mutations were found in 19 patients. V600R mutation and double (V600E -V600M) mutation were identified in two melanomas. In one case, V600K mutation was found. Two screening failures were noted. Mean progression free survival at follow-up of to 8 weeks, was 7.6 months. Five patients had a very short follow-up and the experimental protocol is still ongoing, so we cannot provide complete follow-up data. However, all of them are still under treatment and disease progression free. An objective response with few side effects was observed in all patients. in vitro studies with the aim of testing drug sensitivity.