bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of short‐term raloxifene therapy on fibrinolysis markers: TAFI, tPA, and PAI‐1
Authors: Ozeren Mehmet , Karahan S. Caner , Ozgur Mustafa , Eminagaoglu Selcuk , Unsal Mesut , Baytan Sukrucan , Bozkaya Hasan
Published: September 2005

Background.  Markers of fibrinolysis, thrombin‐activatable fibrinolysis inhibitor (TAFI), tissue‐type plasminogen activator (tPA), and plasminogen activator inhibitor‐1 (PAI‐1) levels were studied for the evaluation of short‐term effects of raloxifene administration in postmenopausal women.

Methods.  Thirty‐nine postmenopausal women with osteopenia or osteoporosis were included in this prospective, controlled clinical study. Twenty‐five women were given raloxifene hydrochloride (60 mg/day) plus calcium (500 mg/day). Age‐matched controls (n = 14) were given only calcium. Plasma TAFI, tPA, and PAI‐1 antigen levels were measured at baseline and after 3 months of treatment by commercially available ELISA kits. Variations of individuals were assessed by Wilcoxon's test. Relationship between those markers and demographic characteristics were investigated.

Results.  Three months of raloxifene treatment was associated with a significant decrease in the plasma TAFI antigen concentrations (16% change, P < 0.01), and a significant increase in tPA antigen concentrations (25% change, P < 0·05). A significant correlation was found between baseline TAFI antigen concentrations and the duration of amenorrhea (P < 0·05; r = 0·33).

Conclusion.  We suggest that the increased risk of venous thromboembolism due to raloxifene treatment may be related to increased tPA levels, but not TAFI levels.
The performance of a new scoring system for colposcopy in detecting high‐grade dysplasia in the uterine cervix
Authors: Strander Björn , Ellström‐Andersson Agneta , Franzén Stefan , Milsom Ian , Rådberg Thomas
Published: September 2005

Objective.  To construct a simple scoring system for colposcopic examination that can facilitate education of colposcopists and increase the accuracy of evaluation.

Design.  Prospective clinical study.

Setting and population.  Two hundred ninety‐seven examinations of women referred for colposcopy in western Sweden.

Methods.  Five variables were scored: acetowhiteness, margins and surface, vessels, lesion size, and iodine staining. Each variable could be assigned one of three ordered values. Multiple logistic regression was used in order to assess the ability of each single score to predict high‐grade lesions (HGL) in histology (cone or biopsy).

Main outcome measures.  Histopathology.

Results.  All five variables independently predicted for HGL. The analysis resulted in an ‘ideal’ weighted scoring system, which showed good sensitivity and specificity. Rounding off of each weight gave a more useful and simpler scoring system with values of 0, 1, or 2 without any significant change in performance. The possible total score was then 0–10. A score of ≥5 points identified all HGL and ≥8 points had a specificity of 90%.

Conclusions.  The scoring system safely identified a group of patients with low‐grade lesions or normal findings, thus allowing 17% to be followed only by colposcopy or cytology. Furthermore, it could select women for see‐and‐treat with only 10% of cases having less than HGL. With this strategy, only approximately 50% of the cases would have needed biopsy in the evaluation.
Morphological evidence for the role of suprabasal keratinocytes in wound reepithelialization
Authors: Usui Marcia L. , Underwood Robert A. , Mansbridge Jonathan N. , Muffley Lara A. , Carter William G. , Olerud John E.
Published: September 2005

The process by which wounds reepithelialize remains controversial. Two models have been proposed to describe reepithelialization: the “sliding” model and the “rolling” model. In the “sliding” model, basal keratinocytes are the principal cells responsible for migration and wound closure. In this model, basal and suprabasal keratinocytes remain strongly attached to leading edge basal keratinocytes and are then passively dragged along as a sheet. The “rolling” model postulates that basal keratinocytes remain strongly attached to the basement membrane zone while suprabasal keratinocytes at the wound margin are activated to roll into the wound site. The purpose of this study was to determine which populations of keratinocytes are actively involved in reepithelialization. We evaluated expression of keratins K14, K15, K10, K2e, and K16 as well as the proliferation marker Ki67 in the migrating tongue of normal human incisional 1‐hour to 28‐day wounds and normal human 3 mm diameter excisional 1‐ to 7‐day wounds. Our results show dramatic changes in phenotype and protein expression of keratins K10, K2e, K14, K15, and K16 in suprabasal keratinocytes in response to injury. We conclude that this large population of suprabasal keratinocytes actively participates in wound closure.
A second mutation in the methylenetetrahydrofolate reductase gene and the risk of venous thrombotic disease
Authors: Franco R. F. , Morelli V. , Lourenço D. , Maffei F. H. , Tavella M. H. , Piccinato C. E. , Thomazini I. A. , Zago M. A.
Published: September 2005

We assessed the effect of a recently described mutation in the MTHFR gene (1298 A → C) on the risk of deep venous thrombosis (DVT) by determining its prevalence in 190 patients with verified DVT and in age‐, race‐ and gender‐matched controls. MTHFR 1298 A → C was found in 42.1% of patients and in 41.1% of controls. The OR for venous thrombosis was 1.07 (95% CI 0.70–1.65) for heterozygotes and 0.83 (95% CI 0.33–2.08) for homozygotes. The OR for the factor V Leiden (FVL) mutation was 3.40 (95% CI 1.22–9.48), for FII 20210 G → A was 5.22 (95% CI 1.12–24.2) and for MTHFR 677 C → T, 1.24 (95% CI 0.82–1.87). No significant increased risk for venous thrombosis was found when MTHFR 1298 A → C was coinherited with FVL (OR 2.85, 95% CI 0.88–9.23), FII 20210 G → A (OR 7.19, 95% CI 0.87–59.4) or MTHFR 677 C → T (OR 1.44, 95% CI 0.71–2.92). These data do not support a critical role of MTHFR 1298 A → C in the predisposition to DVT.
Two case studies of chronic idiopathic neutropenia preceding acute myeloid leukaemia
Authors: Auner Holger , Klintschar Michael , Crevenna Richard , Beham‐Schmid Christine , Hoefler Gerald , Mitterbauer Gerlinde , Linkesch Werner , Sill Heinz
Published: September 2005

Chronic idiopathic neutropenia is regarded as a benign disorder without risk of malignant transformation. We present two patients with chronic idiopathic neutropenia who showed disease progression to acute myeloid leukaemia. Sequence analysis of the granulocyte‐colony stimulating factor receptor (G‐CSFR) gene from leukaemic DNA did not reveal any mutations and microsatellite analysis provided no evidence of microsatellite instability or loss of constitutional heterozygosity. These case studies suggest that chronic idiopathic neutropenia may constitute a preleukaemic condition in some patients. Alterations of the G‐CSFR or defective DNA mismatch repair do not appear to be involved in malignant transformation.
Leukaemic blasts differ from normal bone marrow mononuclear cells and CD34+ haemopoietic stem cells in their metabolism of cytosine arabinoside
Authors: Braess J. , Wegendt C. , Feuring‐Buske M. , Riggert J. , Kern W. , Hiddemann W. , Schleyer E.
Published: September 2005

Different metabolites of cytosine arabinoside (AraC) contribute to its cytotoxicity including incorporation of AraCTP into DNA, the incorporation of AraUMP into RNA, inhibition of polymerase α and β (AraCMP/CTP), an impairment of repair mechanisms (AraCTP), alterations of phospholipid metabolism (AraCDP‐choline), a direct membrane interaction (AraC), the alteration of signal transduction pathways (AraCDP‐choline, AraCTP) and the induction of apoptosis. Since little is known about the potential differences in AraC metabolism between leukaemic blasts and normal haemopoietic progenitor cells, the formation of all known AraC metabolites was determined in bone marrow samples from patients with acute myeloid leukaemia (AML), healthy volunteers and specimens of cellsorted CD34+ haemopoietic stem cells. Highly significant differences were found for phosphorylated AraC metabolites (AraCMP, ‐CDP, ‐CTP, AraUMP) between AML and normal mononuclear bone marrow (ng/107 cells respectively 1.30 v 2.66; 2.65 v 7.50; 33.68 v 99.0; 1.18 v 5.70). The highest differences were found for formation of AraCDP‐choline (3.75 v 12.86) which might be relevant for the high efficacy of high‐dose AraC regimens. In contrast, no differences were found in the deamination product AraU (2.01 v 2.91). Only minute amounts of phosphorylated AraU derivatives were detected, providing an explanation for the lacking contribution of AraU to cytosine arabinoside cytotoxicity. Results in normal CD34+ haemopoietic stem cells did not differ significantly from normal bone marrow mononuclear cells and therefore justify their use as a surrogate in determining AraC‐induced haematotoxicity. These data suggest a metabolic basis for the relative selectivity of AraC cytotoxicity for AML blasts and provide a means to determine the role of different metabolites and their related mechanism of action for overall AraC cytotoxicity.
Serum thrombopoietin and erythropoietin levels in patients with acute promyelocytic leukaemia during all‐trans retinoic acid treatment
Authors: Kinjo Kentaro , Kizaki Masahiro , Takayama Nobuyuki , Michikawa Naohiko , Oda Atsushi , Okamoto Shin‐Ichiro , Tahara Tomoyuki , Kato Takashi , Miyazaki Hiroshi , Ikeda Yasuo
Published: September 2005

Endogenous serum thrombopoietin (TPO) and various cytokines including erythropoietin (EPO), interleukin (IL)‐3, IL‐6, IL‐11, granulocyte‐colony stimulating factor (G‐CSF), granulocyte‐macrophage‐colony stimulating factor (GM‐CSF) and stem cell factor (SCF) levels were measured in five patients with acute promyelocytic leukaemia (APL) during all‐trans retinoic acid (RA) treatment. During differentiation‐inducing therapy, platelet counts slowly increased and reached a peak between days 29 and 46 (median day 35). Serum TPO levels increased parallel to the increasing platelet counts and reached a maximum level during the first 10–20 d of all‐trans RA treatment. The circulating TPO levels then decreased in inverse correlation to the platelet counts. These unique changes in serum TPO levels revealed that TPO levels were not regulated by platelet or megakaryocyte mass in patients with APL during differentiation‐inducing therapy, and it would appear that TPO levels are directly regulated by all‐trans RA during the first 10–20 d of treatment. In addition, the change in circulating EPO levels and reticulocyte counts were similar to that of the TPO levels and platelet counts during all‐trans RA treatment, suggesting a close relationship between TPO and EPO signalling.
Relationship between megakaryocyte mass and serum thrombopoietin levels as revealed by a case of cyclic amegakaryocytic thrombocytopenic purpura
Authors: Zent Clive S. , Ratajczak Janina , Ratajczak Mariusz Z. , Anastasi John , Hoffman Philip C. , Gewirtz Alan M.
Published: September 2005

Cyclic amegakaryocytic thrombocytopenic purpura is a rare syndrome characterized by periodic failure of megakaryocytopoiesis. In this report we describe a patient with cyclic amegakaryocytic thrombocytopenic purpura associated with a megakaryocyte specific serum IgG antibody, who responded to cyclosporin A therapy. Serial serum thrombopoietin assays during an episode of platelet cycling demonstrated a reciprocal relationship between serum thrombopoietin level and megakaryocyte mass, suggesting that megakaryocytes have an important role in the regulation of thrombopoietin metabolism.
Identification and characterization of a novel mutation in von Willebrand factor causing type 2B von Willebrand's disease
Authors: Facey David A. , Favaloro Emmanuel J. , Koutts Jerry , Berndt Michael C. , Hertzberg Mark S.
Published: September 2005

Type 2B von Willebrand's disease (VWD) is a variant in which the structurally abnormal von Willebrand factor (VWF) has an increased affinity for the platelet glycoprotein Ib–IX–V complex. Spontaneous binding of type 2B VWF to platelets and their subsequent clearance from the plasma appear to account for the characteristic phenotype of type 2B VWD. Several type 2B mutations have been described and shown to be grouped along the amino edge of the beta sheet of the VWF A1 domain. In this report we describe a novel missense mutation, Arg543Leu, in the VWF A1 domain in three members of a family with type 2B VWD. We have expressed and characterized the corresponding recombinant mutant VWF in transiently transfected COS‐7 cells. Relative to wild‐type VWF, recombinant Arg543Leu VWF showed a similar multimer composition but exhibited binding to fixed platelets both in the presence and absence of ristocetin, confirming the ability of this mutation to permit spontaneous interaction of VWF with platelets. These studies are consistent with a recently proposed model in which the VWF‐A1 domain exists in either ‘on’ or ‘off’ states, with type 2B mutations switching VWF to an ‘on’ state to facilitate GPIb binding.
The physiological response of thrombopoietin (c‐Mpl ligand) to thrombocytopenia in the rat
Authors: Yang Chun , Chun Li Yan , Kuter David J.
Published: September 2005

It has been suggested that circulating levels of thrombopoietin (TPO) are determined primarily by platelet and megakaryocyte clearance of TPO and not by changes in hepatic TPO production. The experimental evidence accumulated so far to support this hypothesis is incomplete. We have therefore developed a new model of non‐immune thrombocytopenia in the rat and used it to assess the relationship of TPO (c‐mpl ligand) to the platelet mass. 14 d following the administration of busulphan, the platelet count reached a nadir of <2% of its initial value and remained at this level for up to 6 d. Circulating TPO was measured by two different bioassays which were sensitive enough to measure normal levels of TPO and levels rose from 106 ± 29 pg/ml in animals with a normal platelet count to 2015 ± 544 pg/ml in those with thrombocytopenia. These elevated levels of TPO were solely a response to the low platelet count since transfusion of a normal mass of platelets into the thrombocytopenic animals returned the TPO levels exactly to normal. The increase in TPO levels in thrombocytopenic animals was not due to increased TPO production since the thrombocytopenic animals did not show any increase in TPO mRNA in total or polysome‐associated hepatic RNA. Rather, rat platelets were able to bind and stoichiometrically remove TPO from thrombocytopenic plasma via high‐affinity receptors (Kd = 38 ± 10 pm; 233 ± 32 receptors/platelet). These results serve as a proof that the circulating level of TPO is determined not by alterations in TPO transcription or translation but by the ability of the platelet mass to bind and remove TPO from the circulation.
Born to clot: the European burden
Authors: Rees David C. , Chapman Nicola H. , Webster Matthew T. , Guerreiro Joao F. , Rochette Jacques , Clegg John B.
Published: September 2005

Venous thrombosis is a common problem, predominantly afflicting people of European origin. This European predisposition has been explained to some extent by the recent characterization of factor V Leiden, and the G20210A prothrombin variant. Although it is clear that factor V Leiden is largely confined to Europeans, the world distribution of the prothrombin variant is not known. We have analysed samples from 22 different non‐European countries and shown that this prothrombin variant is very rare outside Europe: one case occurring in India. The reason for the confined distribution of these two mutations is unclear.
Clinical and analytical relevance of the combination of prothrombin 20210A/A and factor V Leiden: results from a large family
Authors: Corral J. , Zuazu‐Jausoro I. , Rivera J. , González‐Conejero R. , Ferrer F. , Vicente V.
Published: September 2005

We analysed the clinical and analytical features of 18 subjects from a Spanish family who bear several combinations of two prothrombotic mutations, factor V Leiden (FVL) and prothrombin 20210A. We identified three subjects homozygous for the 20210A prothrombin mutation which additionally were heterozygous for FVL. The combination of both mutations increases the risk of developing venous thrombotic episodes at the earlier age. However, even in association with FVL, the homozygous condition of the prothrombin 20210A mutation requires additional risk factors to induce a thrombotic event. Finally, the plasma level of factor II showed a significant relationship with the prothrombin genotype.
Disentangling above‐ and below‐ground competition between lianas and trees in a tropical forest
Authors: SCHNITZER STEFAN A. , KUZEE MIRJAM E. , BONGERS FRANS
Published: September 2005

Light is thought to be the most limiting resource in tropical forests, and thus above‐ground competition is commonly accepted as the mechanism that structures these communities. In many tropical forests, trees compete not only with other trees, but also with lianas, which compete aggressively for below‐ground resources and thus may limit tree growth and regeneration.

Using a replicated experiment, we tested the relative strengths of above‐ and below‐ground competition from lianas on tree saplings in a disturbed forest in Côte d’Ivoire with a heterogeneous canopy and relatively high light penetration. We planted seedlings of three tree species and subjected them to below‐ground competition with lianas (BGC), above‐ and below‐ground competition with lianas (ABGC), or a liana‐free control treatment. After 2 years, we harvested the saplings and compared the amount of above‐ground biomass and its relative allocation among the three experimental treatments and different tree species.

Lianas competed intensely with saplings in this tropical forest, substantially limiting sapling growth. Saplings grown in the ABGC and BGC treatments had only 18.5% and 16.8% of the above‐ground dry biomass of those grown in the liana‐free control treatment.

Sapling biomass did not differ significantly among the ABGC and BGC treatments, suggesting that below‐ground competition was the driving force behind liana vs. tree competition in this forest. Above‐ground competition with lianas, however, did affect the allocation of biomass in saplings, resulting in shorter, thicker stems and a poorly developed crown.

Collectively, our findings suggest that below‐ground competition with lianas plays a substantial role in limiting the growth of saplings in disturbed and secondary tropical forests, and above‐ground effects may be due to a combination of above‐ground competition and mechanical stress.

Disentangling above‐ and below‐ground competition between lianas and trees is critical for a comprehensive understanding of the dynamics of naturally regenerating tropical forests, as well as formulating successful management plans for sustainable timber harvest.
The tidal model as experienced by patients and nurses in a regional forensic unit
Authors: COOK N. R. , PHILLIPS B. N. , SADLER D.
Published: September 2005

The Tidal Model has been implemented in Rangipapa, a regional secure mental health forensic unit in New Zealand. A phenomenological study was undertaken to obtain reflective description of the nursing care experience from the perspective's of four Registered Nurses and four Special Patients. Five major themes were identified that appeared to capture the experiences of the participants. The themes show changes to the unit's unique culture and values following implementation of the model. These changes engendered a sense of hope, where nurses felt they were making a difference and patients were able to communicate in their own words their feelings of hope and optimism. Levelling was experienced as an effect emerging from individual and group processes whereby a shift in power enhanced a sense of self and connectedness in their relationships. These interpersonal transactions were noted by the special patients as being positive for their recovery. This enabled effective nurse–patient collaboration expressed simply as working together. The participants reported a feeling of humanity, so that there was a human face to a potentially objectifying forensic setting. Implications arising from this study are that the use of the model enables a synergistic interpersonal process wherein nurses are professionally satisfied and patients are validated in their experience supporting their recovery.
Therapeutic relationships: from psychiatric hospital to community
Authors: FORCHUK C. , MARTIN M.‐L. , CHAN Y. L. , JENSEN E.
Published: September 2005

The objective of this study was to determine the cost and effectiveness of a transitional discharge model (TDM) of care with clients who have a chronic mental illness. The model was tested in a randomized clinical trial using a cluster design. This model consisted of: (1) Peer support for 1 year and (2) Ongoing support from hospital staff until a therapeutic relationship was established with the community care provider. Participants (n = 390) were interviewed at discharge, 1 month post‐discharge, 6 months post‐discharge and 1 year post‐discharge. Data collected included demographics, quality of life, health care utilization, levels of functioning and the degree of intervention received. The intervention group post‐discharge costs and quality of life were not significantly improved compared with the control group. Although not predicted a priori, intervention subjects were discharged an average of 116 days earlier per person. Based on the hospital per diem rate this would be equivalent to $12M CDN hospital costs. Both under‐implementation among implementation wards and contamination in control wards were found. This study demonstrates some of the multiple challenges in health system research.
Observation: the original sin of mental health nursing?
Authors: BUCHANAN‐BARKER P. , BARKER P.
Published: September 2005

The assessment and management of ‘risk’ has become a focal aspect of contemporary mental health practice. Given their proximal relationship with service users, nurses most often represent the ‘front line’ of risk management, typically expressed in hospital settings through the bureaucratic process of ‘observation’. Much of the available ‘evidence’ is highly critical of this practice and service user researchers, in particular, have repeatedly called for alternatives. This paper reviews the historical and inter‐professional dimensions of the practice of observation, contrasting this with mental health nursing's search over the past two decades, at least within the UK, for professional autonomy. Contemporary mental health nursing is trapped in an anachronistic relationship with psychiatric medicine. If nursing is to prosper, nurses must address the complex issues underlying this inter‐professional relationship. The authors describe the development of ‘bridging’– a radical alternative to observation practice, which represents a means of managing ‘risk’ and a way that nurses might develop their interpersonal relationships with people deemed to be at risk, thereby asserting the power of ‘caring’.
Interprofessional supervision from the perspectives of both mental health nurses and other professionals in the field of cognitive behavioural psychotherapy
Authors: TOWNEND M.
Published: September 2005

This study reports on an open‐ended qualitative survey to describe interprofessional supervision within a sample of 170 randomly recruited accredited cognitive behavioural psychotherapists, the majority of whom are mental health nurses. Interdisciplinary supervision was found to be very common and creating some rich opportunities for learning and practice development. A number of interprofessional difficulties were also found to be occurring for a variety of reasons, which are described. Recommendations are made as to how these problems can be overcome.
Developing a service to monitor and improve physical health in people with serious mental illness
Authors: OHLSEN R. I. , PEACOCK G. , SMITH S.
Published: September 2005

Developing effective models of identifying and managing physical health problems amongst mentally ill populations has become a more pressing issue in recent years as the prescription of Second Generation Antipsychotics (SGAs) has burgeoned. Some of the side effects commonly associated with SGAs such as weight gain and metabolic disorders have potentially devastating effects on health and well‐being, increasing cardiovascular risk and the incidence of diabetes. The Well‐Being Support Programme (WSP), a nurse‐led service, was designed to provide a care delivery system whereby physical problems could be identified and appropriate treatment and monitoring initiated by prompt referral to suitable specialist services or general practitioners, forging strong links between primary and secondary care and ensuring that mentally ill patients with physical health problems were receiving holistic care packages. Other problems such as unhealthy lifestyles and obesity were managed by the Nurse Advisor running the programme. Interventions such as weight counselling and groups, and structured exercise programmes were beneficial in terms of encouraging healthier lifestyles, managing obesity and improving self‐esteem. This paper describes the manner in which the service was set up and implemented, demonstrating an effective model for identifying and managing physical health problems in the mentally ill.
Mental health nurses’ and psychiatrists’ views on the prognosis of schizophrenia and depression: an exploratory, qualitative investigation
Authors: CHUR‐HANSEN A. , TAVERNER R. , BARRETT R. J. , HUGO M.
Published: September 2005

This study uses a qualitative methodology to explore mental health literacy, specifically perceptions of prognosis, which is typically investigated with a quantitative, questionnaire‐based approach. Two vignettes – one of a person with schizophrenia and one with depression – were shown to three mental health nurses and three psychiatrists. During semi‐structured, open‐ended interviews, they were asked to discuss their thoughts about the prognosis for the patient presented in each vignette. Participants tended to use the terms ‘prognosis’ and ‘outcome’ interchangeably. Psychiatrists tended to be more guarded in determining a prognosis than nurses. Both groups emphasized the importance of clinical experience in formulating views. However, nurses also discussed the role of the multidisciplinary team, whilst psychiatrists emphasized their reliance upon the scientific literature in shaping opinions. Participants identified information relevant for incorporating into future vignettes, to allow more informed research into literacy. The results of quantitative mental health literacy research should be interpreted with caution. Simplifying responses to allow comparative analysis is necessary, but masks more complex and important interpretations. Further qualitative research is recommended, the results of which can inform more comprehensive quantitative studies in the area.
A double‐blind, placebo‐controlled study of house dust mite immunotherapy in Chinese asthmatic patients
Authors: Wang H. , Lin X. , Hao C. , Zhang C. , Sun B. , Zheng J. , Chen P. , Sheng J. , Wu A. , Zhong N.
Published: September 2005

Background:  The purpose of this study was to determine if house dust mite immunotherapy with Alutard SQ is effective in improving symptom control and reducing rescue medication use in Chinese patients with mild to moderate allergic asthma.

Methods:  This is a double‐blind, placebo‐controlled study involving 132 asthmatic subjects aged 6–45 years recruited from three different regions of Mainland China. Subjects were given a 52‐week course of immunotherapy with Dermatophagoides pteronyssinus extract (Alutard Der p, ALK‐Abelló, Hørsholm, Denmark) or placebo while their dose of inhaled corticosteroids (ICS) was maintained.

Results:  129 subjects (64 in active group) completed the study. The symptom scores began to diverge at week 29 with the immunotherapy group showing a significantly lower score until week 48 (P = 0.018). Immunotherapy resulted in a significant decline in symptom (P = 0.002) and medication (P = 0.007) scores during the second half of the treatment period. Both groups showed significant improvement in peak flow rate and bronchial hyperresponsiveness. Serum eosinophil cationic protein (ECP) also decreased in both groups of subjects, but peripheral blood eosinophil count remained unchanged. Skin test response decreased in actively treated subjects only, but Der p‐specific immunoglobulin E (IgE) remained unchanged. Immunotherapy resulted in a significantly greater improvement in self‐evaluation scores (P < 0.01).

Conclusions:  One year treatment with Alutard SQ house dust mite immunotherapy significantly reduced symptoms and medication use in asthmatic subjects. This was associated with a greater subjective improvement in asthma control.
Variation of T‐cell activation in allergic subjects during natural pollen exposure
Authors: Koscher V. , Milhe F. , El Biaze M. , Vervloet D. , Magnan A.
Published: September 2005

Background.  Allergic inflammation is characterized by a Th2 activation. However, little is known about dynamics of T‐cell cytokine production during natural allergen exposure.

The aim of this study was to assess the Th1/Th2 balance in cypress allergic patients compared with controls, and variations of this balance over the pollen season.

Methods.  Twenty cypress allergic patients and 10 controls were studied, distributed during two consecutive pollen seasons. Cytokine production was assessed by flow cytometry and ELISA. The variation of cytokine production during the pollen season was analyzed among patients in four occasions, and the preseason values were compared with controls. IL‐13 and IFN‐γ‐containing T cells were assessed among whole blood cells and PBMC. In addition the effect of specific stimulation by Juniperus ashei pollen extract was studied.

Results.  Compared with controls, IL‐13‐producing T cells were increased in allergics in any case. By contrast, compared with controls, allergic IFN‐γ‐producing T cells were decreased in whole blood, but not in PBMC, and were increased after specific stimulation. During the season, an increase in IFN‐γ‐ and a decrease in IL‐13‐producing T cells occurred in patients, whatever the culture conditions.

Conclusion.  These results show that the allergic T‐cell activation is not limited to a Th2 profile: allergen‐stimulated T cells are able to produce IFN‐γ at baseline, and the Th1/Th2 ratio increases during the pollen season.
Pholcodine stimulates a dramatic increase of IgE in IgE‐sensitized individuals. A pilot study
Authors: Florvaag E. , Johansson S. G. O. , Öman H. , Harboe T. , Nopp A.
Published: September 2005

Background:  A previous study showed a relation between pholcodine (PHO) consumption, prevalence of IgE‐sensitization to PHO, morphine (MOR) and suxamethonium (SUX) and anaphylaxis to neuromuscular blocking agents (NMBA). The purpose of this pilot study was to explore the effect on IgE production, in IgE‐sensitized and nonsensitized individuals, of exposure to cough syrup and environmental chemicals containing PHO, MOR and SUX related allergenic structures.

Methods:  Serum concentrations of IgE and IgE antibodies to PHO, MOR and SUX allergens measured by ImmunoCAPTM (Pharmacia Diagnostics, Uppsala, Sweden) were followed after intake of cough syrup, or exposure to confectionary and other household chemicals containing various amounts of substances cross‐reacting with PHO, MOR and SUX.

Results:  Cough syrup containing PHO gave, in sensitized individuals, within 1–2 weeks, an increase of IgE of 60–105 times and of IgE antibodies to PHO, MOR and SUX in the order of 30–80 times. The tested confectionary did not have any similar stimulating effect but seemed to counteract the expected decrease of IgE. No effect was seen in nonsensitized individuals. The PHO stimulated IgE showed a nonspecific binding to ImmunoCAP with common allergens and glycine background ImmunoCAP that was up to 10‐fold higher than that of monomeric myeloma‐IgE at twice the concentration.

Conclusions:  It seems as cough syrups containing PHO have a most remarkable IgE boostering effect in persons IgE‐sensitized to PHO, MOR and SUX related allergens. Household chemicals containing such allergenic epitopes seem capable of some, minor, stimulation.
Asthma in every fifth child in Oslo, Norway: a 10‐year follow up of a birth cohort study*
Authors: Carlsen K. C. L. , Håland G. , Devulapalli C. S. , Munthe‐Kaas M. , Pettersen M. , Granum B. , Løvik M. , Carlsen K.‐H.
Published: September 2005

Background:  The western world's increase in childhood asthma is suggested to level off. We aimed to investigate asthma prevalence in 10‐year‐old children within the prospective birth cohort Environment and Childhood Asthma (ECA) Study in Oslo established in 1992/1993.

Subjects and methods:  Six hundred and sixteen (77%) of 803 children (mean age 10.9 ± 0.9 (SD) years) with lung function measurements at birth were reinvestigated at age 10 years. At birth they corresponded to the entire birth cohort (n = 3754) regarding gender, socio‐demographic factors, parental allergic diseases, pet keeping and maternal smoking. Results from structured parental interview, spirometry, and skin prick test for inhalant and food allergens are presented. Asthma definition required minimum two positive criteria, (i) doctor's diagnosis of asthma, (ii) wheeze and/or chest tightness, (iii) use of anti‐asthmatic treatment. Current asthma required asthma definition plus either (ii) and/or (iii) in the last 12 months, and/or ≥10% fall in forced expired volume in 1 s after treadmill running.

Results:  Lifetime prevalence of asthma was 20.2%; current asthma 11.1%, doctor diagnosis of asthma 16.1% and wheezes ever 30.3%. Allergic sensitization (29.3% overall) was more common among children with current (56.3%) compared to asymptomatic (last 12 months) (26.0%) or no asthma (27.6%) (P < 0.001). Boys more often than girls had current asthma (14.4 vs 7.1%, P = 0.004), wheeze ever (36.9 vs 22.5%, P = 0.002) and allergic sensitization (36.2 vs 22.1%, respectively, P < 0.001).

Conclusion:  Childhood asthma apparently continues to increase in Oslo, having affected every fifth 10‐year‐old child.
Allergic diseases and atopic sensitization in children related to farming and anthroposophic lifestyle – the PARSIFAL study
Authors: Alfvén T. , Braun‐Fahrländer C. , Brunekreef B. , von Mutius E. , Riedler J. , Scheynius A. , van Hage M. , Wickman M. , Benz M. R. , Budde J. , Michels K. B. , Schram D. , Üblagger E. , Waser M. , Pershagen G. ,   the PARSIFAL study group
Published: September 2005

Background:  The prevalence of allergic diseases has increased rapidly in recent decades, particularly in children. For adequate prevention it is important not only to identify risk factors, but also possible protective factors. The aim of this study was to compare the prevalence of allergic diseases and sensitization between farm children, children in anthroposophic families, and reference children, with the aim to identify factors that may protect against allergic disease.

Methods:  The study was of cross‐sectional design and included 14 893 children, aged 5–13 years, from farm families, anthroposophic families (recruited from Steiner schools) and reference children in Austria, Germany, the Netherlands, Sweden and Switzerland. A detailed questionnaire was completed and allergen‐specific IgE was measured in blood.

Results:  Growing up on a farm was found to have a protective effect against all outcomes studied, both self‐reported, such as rhinoconjunctivitis, wheezing, atopic eczema and asthma and sensitization (allergen specific IgE ≥0.35 kU/l). The adjusted odds ratio (OR) for current rhinoconjunctivitis symptoms was 0.50 (95% confidence interval (CI) 0.38–0.65) and for atopic sensitization 0.53 (95% CI 0.42–0.67) for the farm children compared to their references. The prevalence of allergic symptoms and sensitization was also lower among Steiner school children compared to reference children, but the difference was less pronounced and not as consistent between countries, adjusted OR for current rhinoconjunctivitis symptoms was 0.69 (95% CI 0.56–0.86) and for atopic sensitization 0.73 (95% CI 0.58–0.92).

Conclusions:  This study indicates that growing up on a farm, and to a lesser extent leading an anthroposophic life style may confer protection from both sensitization and allergic diseases in childhood.
The −675 4G/5G plasminogen activator inhibitor‐1 promoter polymorphism in house dust mite‐sensitive allergic asthma patients
Authors: Pampuch A. , Kowal K. , Bodzenta‐Lukaszyk A. , Castelnuovo A. Di , Chyczewski L. , Donati M. B. , Iacoviello L.
Published: September 2005

Background:  Plasminogen activator inhibitor (PAI)‐1 plays an important role in inflammation and tissue remodeling. Recently, the −675 4G/5G PAI‐1 polymorphism has been linked with asthma.

Objective:  This study was undertaken to evaluate associations of the −675 4G/5G PAI‐1 polymorphism with functional and immunologic parameters of newly diagnosed house dust mite‐sensitive allergic asthmatics (HDM‐AAs).

Methods:  This study was performed in 127 HDM‐AAs, who responded with at least 20% fall of forced expiratory volume during the first second (FEV1) to a bronchial challenge with Dermatophagoides pteronyssinus allergen and during the follow up observation fulfilled GINA criteria for mild–moderate asthma. About 89 healthy control nonatopic subjects (HCs) were used as controls.

Results:  The frequency of 4G allele was greater in HDM‐AAs (0.69; 95% CI: 0.62–0.76) than in HCs (0.55; 95% CI: 0.48–0.62; P = 0.0034). The PAI‐1 polymorphism was associated with an increased risk of HDM‐AA; adjusted for sex and age odds ratio was 2.62; (95% CI: 1.16–5.92) for 4G/5G genotype and 3.48 (95% CI: 1.54–7.89) for 4G/4G genotype compared with 5G/5G genotype. Total serum immunoglobulin E (tsIgE) level in 4G/4G homozygotes (557 ± 343 kU/l) was significantly greater than in 5G/5G homozygotes (241 ± 288 kU/l; P < 0.001). Both nonspecific and allergen‐specific bronchial reactivities were greater in 4G/4G homozygotes than in 5G/5G homozygotes. 4G/4G genotype was associated with significantly higher morning plasma PAI‐1 concentration in HDM‐AAs and HCs. Morning plasma PAI‐1 concentration correlated significantly with logPC20 (r = −0.39; P = 0.0001) and with logtsIgE (r = 0.247; P = 0.0117).

Conclusion:  These results support the hypothesis linking the 4G/4G PAI‐1 genotype with an increased risk of allergic asthma, bronchial hyperreactivity, and increased tsIgE levels.
The spatial and temporal distribution of avian foraging guilds at the sewerage works at Chepkoilel campus, Moi University, Kenya
Authors: Waweru C. W. , Wahungu G. M. , Mugendi E. M.
Published: September 2005

In a study conducted between January–March 2001, the spatial and temporal distribution of bird species in four sewage ponds at Chepkoilel campus, Moi University, Kenya, were determined. The total bird counts were conducted thrice daily for 10 days in each pond, yielding a total of 120 observations for all four ponds. Observations were made on three distinct foraging guilds: divers, surface feeders and birds that fished from the shore. Twenty‐four species of birds belonging to 10 families were observed in the ponds. The pond number had a significant effect on the distribution of the mean number of birds for all species. The highest mean number of birds was recorded in the first sedimentation pond receiving raw sewage (Pond I), with the number of birds decreasing linearly to Pond IV. The highest mean number of bird species also was observed for Pond I, with the lowest number being observed for Pond III. Even when the results were adjusted for area, the pond number was still significant, although the order changed significantly. Under these conditions, the highest density of birds was observed for Pond II. This was significantly higher than for Ponds I or III, which exhibited non‐significantly different densities. Pond IV exhibited a significantly lower density that all the other ponds. The total number of birds increased with the number of species. The density of avian foraging guilds was found to be significantly higher in Ponds I and II than in Ponds III and IV, supporting our hypothesis that bird abundance and distribution is influenced by the treatment status of the influent sewage.
Placebo‐controlled randomized comparison of vaginal with rectal misoprostol in the prevention of postpartum hemorrhage
Authors: Ozkaya Okan , Sezik Mekin , Kaya Hakan , Desdicioglu Raziye , Dittrich Ralf
Published: September 2005

Aim: To compare vaginally administered misoprostol to rectally administered misoprostol and placebo in a prospective randomized placebo‐controlled study.

Methods: One hundred and fifty women with singleton vaginal deliveries were randomized (50 women in each arm) to receive 400‐µg misoprostol tablets (crushed and suspended in a microenema) intravaginally, or 400‐µg misoprostol tablets rectally, or two placebo lactose tablets rectally. The medication was administered immediately after delivery of the placenta. Women with profuse hemorrhage and delayed placental separation (>30 min) were excluded. Our outcome measures were postpartum blood loss 1 h after administration, and change in hemoglobin and hematocrit values from baseline to postpartum day 1. Analysis of variance and chi‐squared tests were used to compare the outcome variables between groups.

Results: One hundred and twenty‐six women were available for analysis. Baseline characteristics were similar across the groups. The number of excluded subjects, the estimated blood loss, and the drop in hemoglobin and hematocrit values did not differ between the three groups (P > 0.05).

Conclusions: Misoprostol administered vaginally or rectally at a dosage of 400 µg following placental separation was not effective for decreasing postpartum bleeding in women without excessive hemorrhage.
Tuberculous peritonitis in pregnancy
Authors: Lee Gui Se Ra , Kim Sa Jin , Park In Yang , Shin Jong Chul , Kim Soo Pyung
Published: September 2005

Tuberculous peritonitis in pregnancy is one of the least common forms of extrapulmonary tuberculosis in pregnancy. The case is described herein of a 23‐year‐old primigravida woman with primary tuberculous peritonitis in pregnancy at 24 weeks’ gestation. Excisional biopsy taken from the peritoneum during laparotomy resulted in the histopathologic diagnosis of tuberculous peritonitis. The patient made a good physical recovery after being placed on antituberculous chemotherapy and gave birth to a healthy male neonate of 2.5 kg at 37 weeks’ gestation by vaginal delivery.
Clinicopathologic manifestations of early‐onset endometrial cancer in Japanese women with a familial predisposition to cancer
Authors: Yamagami Wataru , Susumu Nobuyuki , Banno Kouji , Hirao Takeshi , Kataoka Fumio , Hirasawa Akira , Suzuki Nao , Aoki Daisuke , Nozawa Shiro
Published: September 2005

Aim: The number of patients under 40 years of age with early‐onset endometrial cancer is on the rise in Japan. Preservation of fertility in younger patients is a critical issue. In order to examine the clinical and pathological characteristics of these patients, cases of early‐onset endometrial cancer at a single hospital were analyzed.

Methods: Seventy‐four patients were diagnosed with endometrial cancer before age 40 and included in this study after obtaining informed consent.

Results: The clinical characteristics included a significantly higher prevalence of complications such as nulligravidity and nulliparity (P < 0.001). Pathologically, well‐differentiated endometrial carcinoma was significantly more frequent (P = 0.011). The 5‐year survival rate was high (98.7%). In regards to the relationship between clinicopathological features and grade of differentiation, the prevalence of G2 and G3 carcinoma was not significantly lower (P = 0.24) in patients with obesity. Although the frequency of G2 and G3 carcinoma was significantly higher in patients with a family history of cancer (P = 0.02), their 5‐year survival rate was not significantly lower (100%).

Conclusion: This study found that these two types of early‐onset endometrial cancer are clinicopathologically different. In patients with a family history of cancer, their body mass index was lower, and the frequency of G2 and G3 carcinoma was significantly higher, but their 5‐year disease‐free survival rate was not significantly lower.
Diagnostic evaluation of Karman endometrial aspiration in patients with abnormal uterine bleeding
Authors: Tansathit Thitinan , Chichareon Saibua , Tocharoenvanich Sathana , Dechsukhum Chavaboon
Published: September 2005

Aim: To assess sensitivity and specificity of Karman aspiration in the diagnosis of abnormal endometrium compared with the final diagnosis and evaluate tissue adequacy obtained by Karman aspiration.

Methods: The study group were women who presented with abnormal uterine bleeding to Songklanagarind Hospital between August 2003 and July 2004 and who underwent Karman aspiration prior to conventional curettage. The final diagnosis was defined as the most severe histopathology from either Karman aspiration or conventional curettage. Abnormal endometrium included inflammation, polyp, hyperplasia and malignant changes.

Results: Two hundred and twenty‐six women were assessed. Endometrial aspiration showed a sensitivity of 89.6% and specificity 100.0% in diagnosis of abnormal endometrium. Abnormal endometrium was detected in 58 women. Of 11 women diagnosed with endometrial cancer, only one case was undetected by Karman aspiration due to a failure to create negative pressure in the uterus. Endometrial aspiration yielded adequate tissue in 86.7%.

Conclusion: Karman endometrial aspiration is an accurate and easy procedure, and should be considered in the initial evaluation of abnormal uterine bleeding.
Cohesive‐zone modelling of the deformation and fracture of spot‐welded joints
Authors: CAVALLI M. N. , THOULESS M. D. , YANG Q. D.
Published: September 2005

The deformation and failure of spot‐welded joints have been successfully modelled using a cohesive‐zone model for fracture. This has been accomplished by implementing a user‐defined, three‐dimensional, cohesive‐zone element within a commercial finite‐element package. The model requires two material parameters for each mode of deformation. Results show that the material parameters from this type of approach are transferable for identical spot welds in different geometries where a single parameter (such as maximum stress) is not. The approach has been demonstrated using a model system consisting of spot‐welded joints made from 5754 aluminium sheets. The techniques for determining the cohesive fracture parameters for both nugget fracture and nugget pullout are described in this paper. It has been demonstrated that once the appropriate cohesive parameters for a weld are determined, quantitative predictions can be developed for the strengths, deformations and failure mechanisms of different geometries with nominally identical welds.
Neonatal pneumothorax – an unexpected perioperative complication
Authors: GLAISYER HILARY , WAY CAROLYN
Published: September 2005

We report our experience of three cases of intraoperative pneumothorax in neonatal surgical patients. Following a review of the literature, we discuss possible causes for each case and methods of treatment. We emphasize the need for inclusion of pneumothorax as a cause for cardiorespiratory instability even when no predisposition is identifiable and highlight the need for prompt treatment to prevent serious morbidity and mortality.