bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective assessment of the effect on quality of life of anti‐tumour necrosis factor therapy for perineal Crohn’s fistulas
Authors: NG S. C. , PLAMONDON S. , GUPTA A. , BURLING D. , KAMM M. A.
Published: July 2009

Background  Anti‐tumour necrosis factor (TNF) therapy effectively treats Crohn’s perineal fistulas (CPF); the effect on health‐related quality of life (HRQoL) remains unknown.

Aims  To evaluate the effect of anti‐TNF therapy on the HRQoL of patients with CPF in daily clinical practice.

Methods  Prospective evaluation of clinical and magnetic resonance imaging (MRI) responses, disease activity (Perianal Disease Activity Index – PDAI), and HRQoL assessment [Inflammatory Bowel Disease Questionnaire (IBDQ)] in patients receiving anti‐TNF therapy for CPF treated up to 12 months.

Results  In all, 26 patients with CPF were treated (mean age 39 years; 19 infliximab, 7 adalimumab). At baseline, 85% patients had impaired IBDQ scores (mean 137; ‘normal’ >170). At 12 months, mean increases in IBDQ score for infliximab and adalimumab treated patients were 40 and 41 points respectively (P < 0.05). There were significant improvements in all IBDQ subscores (bowel, emotional, systemic, social) at 12 months (all P ≤ 0.003). Fourteen patients (74%) on infliximab and six on adalimumab (86%) achieved IBDQ score ≥170. Mean increase in IBDQ score was 50, 34 and 16 points in patients with clinical fistula closure (P < 0.001), clinical response (P = 0.002) and no response (n = 1) respectively. IBDQ score increased for patients with MRI healing (P < 0.001) and MRI improvement (P = 0.016), but not for those with no MRI change (n = 2). IBDQ correlated significantly with PDAI at baseline and at 12 months.

Conclusion  Anti‐TNF therapy improves HRQoL in patients with CPF at 12 months and this improvement is most pronounced in patients with clinical and MRI healing.
Young people's views of mental health education in secondary schools: a Scottish study
Authors: Woolfson R. , Woolfson L. , Mooney L. , Bryce D.
Published: July 2009

Background  This exploratory study used mixed methods to investigate young people's preferences in the delivery of mental health education and to investigate possible age and gender differences.

Method  Information was gathered about the delivery of mental health education in three secondary schools. Nine pupil focus groups were carried out to identify key themes which were then further developed and administered through questionnaires to a larger sample of 773 pupils.

Results  Gender and age differences were found in young people's preferences about who should deliver mental health education, and what, when, where and how this should be delivered.

Conclusion  Mental health education should reflect the needs of young people. Age and gender preferences should be considered when designing these programmes.
Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination
Authors: Guth S. , Theune U. , Aberle J. , Galach A. , Bamberger C. M.
Published: July 2009

Background  The prevalence of thyroid nodules in a healthy population is high: in the German Papillon study, nationwide ultrasound screening of more than 90 000 people using 7·5 MHz scanners revealed the presence of thyroid nodules in 33% of the normal population. A study employing more sensitive 13 MHz scanners has not been conducted so far.

Materials and methods  Six hundred and thirty‐five consecutive patients (33% female, 67% male, mean 56·7 years) presenting for a preventive health check up underwent ultrasound screening of the thyroid gland (Siemens Acuson Antares, 13 MHz‐linear scanner, B‐mode and Power mode) and measurement of the basal TSH (thyroid stimulating hormone) value. Size and degree of vascularization of the thyroid gland and of nodules were determined and analysed retrospectively.

Results  In 432 of 635 patients, thyroid nodules could be detected with an increasing incidence with age, in 338 without goiter. Mean thyroid size was 12·3 mL for women and 20·5 mL for men correlating strongly with body weight. Fifty‐three percentage of the nodules were smaller than 5 mm. Incidence of thyroid dysfunction was only 4%. No cancerous lesions could be found.

Conclusions  Using the 13 MHz technology, we found a substantially higher prevalence of thyroid nodules (68%) than the Papillon study (33%). Even if our population is older than in Papillon, the difference remains in comparable age groups. This is due to the higher sensitivity of 13 MHz scanning. Our study underlines the clinical significance of iodine deficiency and should renew the discussion on routine iodine supplementation.
Ecological assessment of an intermittent Mediterranean river using community structure and function: evaluating the role of different organism groups
Authors: HUGHES SAMANTHA JANE , SANTOS JOSÉ MARIA , FERREIRA MARIA TERESA , CARAÇA RUTE , MENDES ANA M.
Published: July 2009

1. Reliable lotic ecological monitoring requires knowledge of river typology, environmental factors, the effect of stressors known here as ‘pressures’ and appropriate indicators of anthropogenically induced change. We sampled benthic macroinvertebrate, fish, bird and macrophyte communities along an intermittent Mediterranean river and analysed community structure (relative abundance) and function (metrics) relative to environmental and pressure gradients in order to identify suitable indicator group(s) for future monitoring and mitigation programmes.

2. Principal components analysis revealed that scale‐dependent longitudinal differences in valley form separated narrower higher lying sites and tributaries with good quality habitats from more open degraded sites lower down the river continuum on a small floodplain and large scale pressures describing changes in land use related to agriculture with associated physical bankside and channel impacts.

3. Forward selection of variables in redundancy analysis (RDA) showed that reach scale environmental variables were selected more frequently than pressure variables for each organism group. Altitude and pH were highly redundant within and between groups, indicating essentially longitudinal structural and functional distribution patterns. Redundancy was far lower between selected pressure variables, but single or no pressure variables were retained for some organism groups indicating poor association of functional data, in particular, with the identified pressures. All RDA results indicated a longitudinal pH gradient, highlighting the combined effect of multiple environmental and pressure based mechanisms on organism groups.

4. Large, mobile organisms such as fish and birds provided a reliable link between organism structure and function, environmental factors and physical disturbance of the channel, bankside and wider river corridor. Benthic macroinvertebrate and macrophyte structural data revealed distribution patterns in relation to water velocity, a key parameter for developing appropriate compensation measures.

5. Results clearly show the importance of assessing patterns of both functional and structural change across multiple organism groups in order to identify typologically appropriate links with complex environmental and pressure gradients and develop and implement appropriate monitoring systems.
Intraspecific variation in the consumption of exotic prey – a mechanism that increases biotic resistance against invasive species?
Authors: CARLSSON NILS O. L. , STRAYER DAVID L.
Published: July 2009

1. Hyper‐successful exotic species can both displace the native prey that formerly made up a native predator’s diet and represent an abundant potential prey resource for native predators. Little is known about how this drastic change affects native predators, or their short‐ and long term potential to regulate the exotic species.

2. We compared zebra mussel consumption by pumpkinseed sunfish (Lepomis gibbosus), redbreast sunfish (Lepomis auritus) and rock bass (Ambloplites rupestris) from populations that were either previously exposed to zebra mussels or naive to them.

3. Fish from populations with longer exposure to zebra mussels consumed many more zebra mussels than fish from populations with shorter or no previous exposure to zebra mussels.

4. Our experiment does not allow us to identify the mechanisms that underlie the patterns we found, but we discuss several plausible scenarios and their ecological implications.

5. Predator adaptation to exotic prey may be an important but overlooked factor in invasion biology. The initial response to exotic prey by a native predator may be a poor estimate of its ability to present biotic resistance to the invasion over the long term.
Low semen volume in 47 adolescents and adults with 47,XXY Klinefelter or 46,XX male syndrome
Authors: Aksglaede L. , Jørgensen N. , Skakkebæk N. E. , Juul A.
Published: July 2009

Klinefelter syndrome is characterized by progressive testicular failure causing androgen deficiency and azoospermia in most patients. The aim of this study was to evaluate semen quality in consecutive patients with an additional X chromosome as compared with healthy males. Forty‐seven males with non‐mosaic 47,XXY (n = 40) or SRY‐positive 46,XX male (n = 7) karyotypes aged 26.1 (range: 15.0–51.7) years participated. Semen quality was compared with 2136 (control group I) men from the general population aged 18.9 (17.9–28.6) years and with 349 fertile men (control group II) aged 30.9 (22.0–43.8) years. Semen volume adjusted for duration of abstinence was significantly smaller in the patients [2.0 (0.2–5.7) mL] when compared with control group I [3.1 (0.3–12.5) mL, p < 0.0001] and group II [3.6 (0.6–12.5) mL, p < 0.0001]. There was no difference in semen volume between 47,XXY and 46,XX males. All patients had azoospermia except two 47,XXY males aged 29 years who had sperm concentrations of 0.5 and 1.6 million/mL, respectively. We found significantly smaller semen volume in the patients when compared with controls, and the presence of motile spermatozoa in two out of 47 patients. The small semen volume supports the notion of 47,XXY patients being androgen insufficient despite serum testosterone levels within the normal range.
The relationship between varicoceles and obesity in a young adult population
Authors: Tsao Chih‐Wei , Hsu Chien‐Yeh , Chou Yu‐Ching , Wu Sheng‐Tang , Sun Guang‐Huan , Yu Dah‐Shyong , Fan Pao‐Luo , Chen Hong‐I , Chang Sun‐Yran , Cha Tai‐Lung
Published: July 2009

To determine whether a relationship between obesity and varicocele occurrence exists, the prevalence and severity of varicoceles related to obesity were investigated in a general population of young males. A total of 1050 young males attending the Navy Recruit Training Center were evaluated from their physical screening examinations. All subjects underwent history taking and physical examinations to evaluate for the presence and severity of varicocele. The anthropometric indexes including body mass index (BMI), waist circumference (WC) and waist‐to‐hip ratio (WHR) were recorded. All subjects were categorized by quartiles according to each anthropometric index. Means were compared with the Student’s t‐test. Severity was compared by analysis of variance testing and frequency was analysed using the chi‐square method. Statistical significance was considered at p <0.05. A total of 490 (46.67%) subjects had varicoceles. The means of BMI, WC and WHR of those without varicoceles was 23.99 ± 3.82 kg/m2, 83.20 ± 9.97 cm and 0.85 ± 0.05, respectively. These judged values were greater than those with varicoceles (22.02 ± 3.18 kg/m2, 79.19 ± 9.01 cm and 0.83 ± 0.05) (p < 0.001). In the univariate regression analysis, BMI, WC and WHR all had a significantly negative correlation with severity of varicocele (all p < 0.001). Analysis comparing varicocele frequency based on each grade per anthropometric index group was performed. The logistic regression revealed that the prevalence of grade II and III varicoceles showed a statistically inverse association with all three anthropometric indexes. The prevalence and severity of varicoceles inversely correlated with obesity. The present data support the explanation that obesity may result in a decreased nutcracker effect, which accounts for prevention of the renal vein compression by the adipose tissue.
Administration of noradrenaline in the autonomic ganglia modifies the testosterone release from the testis using an ex vivo system
Authors: Sosa Zulema Y. , Palmada Miguel N. , Fóscolo Mabel R. , Capani Francisco , Conill Alberto , Cavicchia Juan Carlos
Published: July 2009

The male gonad receives nerve fibres from the autonomic ganglionic system. These fibres converge on the testis along two pathways, the superior and the inferior spermatic nerves. The superior spermatic nerve runs from the superior mesenteric ganglion alongside the testicular artery, whereas the inferior spermatic nerve originates in inferior mesenteric ganglion, accompanies the vas deferens and penetrates the inferior pole of the testis. The aim of this work was to evaluate androgen release after the addition of noradrenaline or adrenoreceptor antagonists (propranolol or phentolamine) to the ganglionic compartment. An ex vivo system used in a previous work was incubated in two separate containers, one for the testis and the other for the ganglion. Both organs remain interconnected (as in vivo) by the respective spermatic nerve. When noradrenaline was added to the inferior mesenteric ganglion, testosterone release in the gonad container underwent a progressive and significant increment. Propranolol diminishes and phentolamine increases the androgen release. When using the superior mesenteric ganglion, no changes were observed. These results indicate that the ganglionic stimulation of the autonomic system clearly participates in testosterone release from the testis. This effect depends on the ganglion involved. These results make it evident that not only the classical and well‐known hypothalamus–hypophysial axis, but also the peripheral nervous system, via the autonomic ganglia, are directly involved in the endocrine control of the testis.
Post‐fertilization effects of chronic renal failure in male rats
Authors: Dimitriadis Fotios , Giannakis Dimitrios , Giotitsas Nikolaos , Parldalidis Nikolaos , Baltogiannis Dimitros , Saito Motoaki , Watanabe Takeshi , Gratsias Stavros , Zikopoulos Kostas , Pashopoulos Minas , Tsambalas Stavros , Kalaboki Valentina , Tsounapi Panagiota , Vlachopoulou Evlalia , Gekas Aristomenis , Melekos Michael , Makridimas George , Dalkalitsis Nikolaos , Georgiou Ioannis , Agapitos Emmanuel , Loutradis Dimitrios , Kanakas Nikolaos , Miyagawa Ikuo , Sofikitis Nikolaos
Published: July 2009

We evaluated the potential for growth and intrauterine development of embryos generated from the fertilization of oocytes with spermatozoa recovered from animals with chronic renal failure (CRF). Group A included sham‐operated rats (n = 28), group B1 involved CRF rats that had undergone erythropoietin plus bromocryptine treatment (n = 28), and group B2 included CRF rats that had received normal saline. Embryos derived from the in vitro fertilization of oocytes with spermatozoa recovered from rats of group A or group B1 or group B2 were transferred to female recipients. We induced CRF in a group of rats (group B; n = 56; the total kidney volume was reduced to one‐sixth with two operations). One week after the second operation, the rats of group B were randomly divided into group B1 (they subsequently received bromocryptine plus erythropoietin) and group B2 (they received injections of saline). Nine weeks after the second operation, the fertility of each male rat was assessed by mating tests and in vitro fertilization of oocytes. The mean litter size was significantly smaller in the subpopulation of fertile animals in group B2 than in the fertile rats of group B1 and in the fertile rats of group B1 than in the fertile rats of group A. Per cent of transferred blastocysts that developed into alive offspring were significantly lower in group B2 than in group B1 and in group B1 than in group A. Epididymal spermatozoa demonstrated a significantly larger DNA‐oxidative damage in group B2 than in group B1 and in group B1 than in group A. These findings demonstrate that sperm‐DNA damage because of CRF development is accompanied by a defect in the development of embryos generated in vitro. We may suggest that bromocryptine and erythropoietin protecting sperm DNA from oxidative damage improve reproductive potential in rats with CRF.
Inflammation and epithelial alterations in rat prostate: impact of the androgen to oestrogen ratio
Authors: Yatkin Emrah , Bernoulli Jenni , Talvitie Eva‐Maria , Santti Risto
Published: July 2009

Chronic non‐bacterial prostatitis may offer new insights into the pathogenesis of human benign prostatic hyperplasia and prostate cancer and the strategies for their treatment and prevention. The potential significance of androgen replacement therapy in terms of the reversal of oestradiol (E2)‐induced inflammatory reaction was studied in the dorsolateral prostate (DLP) of the Noble rat. Castrated Noble rats were treated with E2 and different doses of androgens [dihydrotestosterone (DHT) and testosterone (T)] to achieve an elevated concentration of E2 and a wide range of the androgen‐to‐oestradiol ratios in serum. After the 3‐week treatment, inflammatory changes in the DLP were classified and counted. Oestrogen receptor α (ERα), progesterone receptor (PR), fos‐related antigen‐2 (Fra2), Ki‐67 and P63 were immunocytochemically stained. T, E2 and prolactin concentrations in serum were measured and the relative weights of the seminal vesicles and pituitary glands and microscopic structures of the DLP and seminal vesicle ducts were determined. Hypoandrogenic doses of DHT (judged on the basis of seminal vesicle weight gain), dose‐dependently increased the number of perivascular and stromal inflammatory infiltrates. T and DHT were anti‐inflammatory at the doses which normalized or over stimulated the growth of the seminal vesicles. As signs of anti‐oestrogenicity, androgens dose‐dependently decreased the number and distribution of the ERα and PR‐positive cells at proinflammatory concentrations. Anti‐inflammatory concentrations were needed to reduce the expression of Fra2, E2‐increased prolactin concentration in serum and pituitary weight. The androgen concentrations required to prevent proinflammatory and epithelial responses to E2 in the presence of elevated E2 concentrations may subject the accessory sex glands to more intense androgenic stimulation than is normal for the male. The androgen‐resistant endpoints of oestrogen action (body weight reduction and hyperplasia of seminal vesicle ducts) further indicate limitations in the possible preventive effects of androgen‐replacement therapy.
First‐time mothers and changes in personality in relation to mode of delivery
Authors: Wiklund Ingela , Edman Gunnar , Larsson Christina , Andolf Ellika
Published: July 2009

Title. First‐time mothers and changes in personality in relation to mode of delivery.

Aim. This paper is a report of a study conducted to examine changes in personality from late pregnancy to early motherhood in primiparas having vaginal or caesarean deliveries.

Background. Birth of the first child is a major life event, possibly influencing personality. The physiological and emotional processes that start in pregnant women have a major impact on the evolving mother–child relationship. Knowledge about changes in personality during pregnancy and motherhood is scarce.

Method. A prospective, group‐comparative cohort study including 314 healthy primiparas having either ‘caesarean section on maternal request’ (n = 74) or ‘spontaneous vaginal delivery group’ (n = 240). The self‐report inventory Karolinska Personality Scales was mailed to participants at 37–39 gestational weeks in pregnancy and 9 months after delivery. Data were collected from January 2003 to June 2006.

Results. All mean values of the personality variables were within the normal range. There was a statistically significant increase in Impulsivity (P = 0·046) and decrease in Socialization (P = 0·004). The scores developed differently depending on mode of delivery. Thus, women in the vaginal delivery group increased their scores on the Psychic anxiety and Guilt scales, while those in the caesarean delivery group decreased their scores. Although women in both groups became more impulsive and less socialized, personality remained comparatively stable in the transition from late pregnancy to motherhood.

Conclusion. As interactive therapeutic midwife/client relationships and maternal/social role preparation have been shown to have a great effect on progress in becoming a mother, knowledge about how personality may affect this process is important so that healthcare professionals can attempt to reduce women’s anxiety levels during pregnancy.
Towards a physical description of habitat: quantifying environmental adversity (abiotic stress) in temperate forest and woodland ecosystems
Authors: Ladd Brenton , Bonser Stephen P. , Peri Pablo L. , Larsen Joshua R. , Laffan Shawn W. , Pepper David A. , Cendón Dioni I.
Published: July 2009

1.
Our aim was to develop a quantitative proxy for environmental adversity (abiotic stress) in temperate Eucalyptus and Nothofagus forest and woodland ecosystems.

2. Samples and measurements were collected at 42 sites across a rainfall gradient in southern Australia, an elevation gradient in south‐eastern Australia, and a longitudinal transect (temperature gradient) in Patagonia, Argentina.

3.
We compared the ability of (a) abiotic variables (14 soil and 21 climatic variables) and (b) the stable carbon isotope (δ13C) values of soil organic matter (SOM), to predict variation in leaf area index (LAI; a forest productivity variable).

4.
The δ13C of SOM (soil aggregates) explained more variation (57%) in LAI than multivariate statistical models that integrated information on many abiotic variables. W* (a climatic water balance model) was also a powerful predictor variable, explaining 37% of the variability in LAI.

5

Synthesis. The stable carbon isotopic signature of soil aggregates is a powerful explanatory variable that may help us to quantify environmental adversity (abiotic stress) in temperate forest and woodland ecosystems.
Selective stimulation of intrinsic excitatory and inhibitory motor pathways in porcine lower oesophageal sphincter
Authors: Lecea B. , Martínez E. , Aulí M. , Opazo á. , Clavé P.
Published: July 2009

Abstract The mechanisms of stimulation of inhibitory and excitatory motor neurons (MNs) in the lower oesophageal sphincter (LOS) are not fully understood. The aim of this study was to assess the effect of selective stimulation of inhibitory and excitatory MNs in porcine LOS through nicotinic acetylcholine receptors (nAChRs), 5‐HT3and P2X receptors. Circular LOS strips from adult pigs were studied in organ baths. We compared the effects of stimulation of MNs by electrical field stimulation (26 V, 0.3–20 Hz); nicotine (1–300 μmol L−1); 5‐HT and 2‐Me‐5‐HT (1 nmol−1–30 μmol L−1); and α,β‐methylene ATP (α,β‐meATP 1–100 μmol L−1); in standard Krebs solution; a non‐adrenergic non‐nitrergic non‐purinergic (NANNNP) solution; and a non‐adrenergic non‐cholinergic (NANC) solution. Electrical stimulation of inhibitory MNs caused an intense LOS relaxation (−78.94 ± 4.50% of LOS tone); and of excitatory MNs, a strong contraction (17.89 ± 1.96 g). Nicotine 100 μmol L−1relaxed LOS (−84.67 ± 3.98%) in standard Krebs solution, an effect reduced by Tetrodotoxin (TTX) 1 μmol L−1. Nicotine induced a weak TTX‐sensitive contraction (1.64 ± 0.4 g) in NANNNP solution. 5‐HT 10 μmol L−1and 2‐Me‐5‐HT 30 μmol L−1contracted LOS in standard, NANC and NANNNP conditions, maximal responses (7.30 ± 1.52 g, 3.50 ± 0.18 g respectively) being reduced by TTX.α,β‐meATP 100 μmol L−1caused a LOS relaxation (−17.45 ± 6.62%) unaffected by TTX in NANC solution, and a contraction (6.7 ± 0.85 g) antagonized by TTX in NANNNP solution. Our results suggest selective mechanisms for stimulation of intrinsic excitatory and inhibitory motor pathways in porcine LOS. Inhibitory MNs are strongly stimulated by nAChRs and do not respond to stimulation of 5‐HT3and P2X receptors. By contrast, excitatory MNs are stimulated through 5‐HT3and P2X receptors, stimulation through nACRs being difficult and causing a weak response.
A systematic review and meta‐analysis of molecular epidemiological studies of tuberculosis: development of a new tool to aid interpretation
Authors: Houben Rein M. G. J. , Glynn Judith R.
Published: July 2009

Objectives  The proportion of tuberculosis cases in a population that are clustered (i.e. share identical strains of Mycobacterium tuberculosis) reflects ongoing M. tuberculosis transmission. It varies markedly, but it is unclear how much of this variation reflects measurable differences in study design, setting and the patient population. We aimed to assess the relative impact of these factors and develop a tool to improve interpretation of the proportion clustered from an individual study.

Methods  We systematically reviewed all population‐based TB clustering studies that used IS6110 RFLP as their main DNA fingerprinting technique. Meta‐regression was used to see how much of the variation in the proportion clustered between studies could be explained by variables describing study design, setting and population. We compared expected clustering, based on study design and setting, with that observed.

Results  Forty‐six studies were included. Just four factors related to study design and setting–study duration, sampling fraction, handling of low band strains and tuberculosis incidence–explained 28% of the variation in the proportion clustered. Additionally including average patient age and proportion foreign born explained 60% of the variation in clustering for industrialized countries. Comparison of expected and observed proportions showed that for some studies the expected proportion clustered differed strongly from that observed.

Conclusions  We were able to account for much of the variation in the proportion clustered. The comparison of expected and observed clustering allows for a more valid comparison of studies and provides a tool for identifying outliers that warrant further investigation.
High mortality risk among individuals assumed to be TB‐negative can be predicted using a simple test
Authors: Rabna Paulo , Andersen Andreas , Wejse Christian , Oliveira Ines , Gomes Victor Francisco , Haaland Maya Bonde , Aaby Peter , Eugen‐Olsen Jesper
Published: July 2009

Objectives  To determine mortality among assumed TB negative (aTBneg) individuals in Guinea‐Bissau and to investigate whether plasma levels of soluble urokinase receptor (suPAR) can be used to determine post‐consultation mortality risk.

Methods  This prospective West‐African cohort study included 1007 aTBneg individuals who were enrolled from 2004 to 2006; 4983 age‐matched controls were followed for comparison. Plasma suPAR levels were measured using the suPARnostic® ELISA. Survival was analysed using Cox regression, ROC curves and Kaplan–Meier analysis.

Results  After 3 months of follow‐up, mortality was 21 per 100 person‐year‐observation (PYO) among aTBneg individuals and three per 100 PYO among the control population [mortality rate ratio (MRR) = 6.92 (95% CI 4.48–10.7)]. SuPAR values ranged between 0.9 and 45 ng/ml in aTBneg individuals. A log‐linear relationship was found between suPAR levels <15 ng/ml and mortality. In the log‐linear range, a 1 ng/ml increase was associated with a 46% increase in the mortality rate: MRR = 1.46 (95% CI 1.34–1.59). The area under the ROC curves was 0.88 for HIV‐positive individuals and 0.79 for HIV‐negative individuals.

Conclusions  Our study showed a high mortality rate among aTBneg individuals and demonstrated that suPAR measurements can provide prognostic information on mortality among individuals without disease diagnosis. Measuring suPAR is a technically simple method for determining mortality risk in individuals that are assumed to be TB‐negative.
Molecular assessment of Plasmodium falciparum resistance to antimalarial drugs in China
Authors: Zhang G. Q. , Guan Y. Y. , Zheng B. , Wu S. , Tang L. H.
Published: July 2009

Objective  In China, Chloroquine (CQ) and sulfadoxine–pyrimethamine (SP) were abandoned for the treatment of falciparum malaria 20 years ago due to resistance. Subsequent field studies showed a trend of declining CQ and SP resistance in the country. The main purpose of this study was to analyse the molecular markers of antimalarial resistance and thereby to assess the possibility of reintroduction of CQ or SP for falciparum malaria treatment.

Methods  Plasmodium falciparum field isolates were collected in 2006–2007 from Hainan and Yunnan provinces, China. Nested PCR‐sequencing assays were applied to analyse the SNPs in four genes: P. falciparum chloroquine resistance transporter (pfcrt) gene, multi‐drug resistance 1 (pfmdr1) gene, dihydrofolate reductase (dhfr) gene and dihydropteroate synthetase (dhps) gene.

Results  We found the widespread presence of point mutations in the dhfr and dhps genes which are associated with SP treatment failure. The molecular analyses also showed the fairly high prevalence of point mutation in the pfcrt gene which is linked to CQ resistance.

Conclusion  The results of the present study indicate that CQ and SP should not be reintroduced for falciparum malaria treatment in the near future in China.
Disseminated Geotrichum candidum infection in a patient with relapsed acute myelogenous leukemia following allogeneic stem cell transplantation and review of the literature
Authors: Henrich T.J. , Marty F.M. , Milner Jr D.A. , Thorner A.R.
Published: July 2009

Abstract: We describe a woman with relapsed acute myelogenous leukemia after allogeneic stem cell transplantation who developed disseminated Geotrichum candidum infection during chemotherapy‐induced neutropenia. The isolate was susceptible to voriconazole, amphotericin B, and micafungin in vitro. We review the literature regarding invasive infections with G. candidum, which predominantly affect immunocompromised hosts, and discuss potential therapies for this rare pathogen.
Ritual fights and male reproductive success in a human population
Authors: LLAURENS V. , RAYMOND M. , FAURIE C.
Published: July 2009

Ritual fights are widespread across human populations. However, the evolutionary advantage associated with this behaviour is unclear because these fights rarely provide direct benefits such as territory, resources or mates. Here, the reproductive success of men competing in a traditional ritual fight, Sereer wrestling, was investigated for the first time. Involvement in wrestling had a significant positive effect on men’s number of offspring and a marginally significant effect on polygyny, controlling for age, body condition and socio‐economic status. These positive effects suggest that being involved in wrestling competition provides prestige, facilitating access to mates and thereby increasing fecundity. However, when women were interviewed on their preference concerning qualities of potential mates, the quality ‘being involved in wrestling competition’ was poorly ranked. This discrepancy may arise either from deceptive reports or from discordance between parents and daughters in the choice of a husband.
Genetic divergence is more tightly related to call variation than landscape features in the Amazonian frogsPhysalaemus petersiandP. freibergi
Authors: FUNK W. C. , CANNATELLA D. C. , RYAN M. J.
Published: July 2009

Behavioural isolation from divergence in male advertisement calls and female preferences is hypothesized to cause genetic divergence and speciation in the Amazonian frogsPhysalaemus petersiandP. freibergi, yet the importance of call variation and landscape features in genetic divergence is unresolved. We tested for correlations between genetic divergence at microsatellite loci and (1) call variables; and (2) landscape variables among 10 populations of these frogs. Genetic divergence was not correlated with geographical distance, rivers or elevation. There was a strong positive relationship, however, between genetic divergence and inter‐population differences in one call variable, whine dominant frequency. Effective population sizes varied among sites (range = 15–846) and were often small, suggesting that genetic drift could influence call evolution. Evidence for fine‐scale genetic structure within sites was also found. Our results support the hypothesis that behavioural isolation from divergence in male calls and female preferences causes genetic divergence and speciation.
Primary cutaneous aspergillosis in a patient with cutaneous T‐cell lymphoma
Authors: Yuanjie Zhu , Jingxia Du , Hai Wen , Jianghan Chen , Julin Gu
Published: July 2009

We present a case of primary cutaneous aspergillosis caused by Aspergillus terreus in a patient with cutaneous T‐cell lymphoma. A 41‐year‐old woman bruised her left shin and presented with a 1 × 2 cm ecchymosis on the upper third of the left shin for over 6 months. Before mycological examination and sequential biopsies, the patient was erroneously treated with antibiotics and local debridement. After final diagnosis of cutaneous aspergillosis caused by A. terreus cutaneous T‐cell lymphoma on the basis of mycological, histopathological and immunohistochemical findings, the patient responded well to oral itraconazole and chemotherapy for over 1 month.
In vitro interaction between suramin and fluvastatin against clinically important Zygomycetes
Authors: Galgóczy László , Papp Tamás , Vágvölgyi Csaba
Published: July 2009

The in vitro antifungal activity of suramin and its combinations with fluvastatin was investigated in this study. Several species belonging to the class Zygomycetes are considered agents of opportunistic human or animal infections. In the present work, 15 fungal isolates representing eight clinically important genera (Absidia, Micromucor, Mortierella, Mucor, Rhizomucor, Rhizopus, Saksenaea and Syncephalastrum) were investigated. The efficiency with which fluvastatin inhibited growth in the presence of suramin (100 μg ml−1) was studied. The investigated compounds acted synergistically and additively on the growth when a strain was resistant to suramin and sensitive to fluvastatin; at the same time, antagonistic interactions were detected when strains were sensitive to both agents. In these cases, the growth inhibition effect of suramin was dominant.
Neonatal candidaemia in Kuwait: a 12‐year study of risk factors, species spectrum and antifungal susceptibility
Authors: Al‐Sweih Noura , Khan Ziauddin , Khan Seema , Devarajan L. V.
Published: July 2009

A study of candidaemia in neonatal intensive care unit (NICU) over a 12‐year period (1995–2006) taking into consideration demographic variables, risk factors, aetiological Candida species and therapeutic outcomes is presented. The yeast isolates were identified by VITEK2 yeast identification system and antifungal susceptibility was determined by E‐test. Of 4815 neonates admitted in NICU, 182 cases of candidaemia were detected with an overall prevalence of 4.0% and crude mortality of 27.7%. The annual rate of candidaemia per 1000 admissions was the highest in 1997 (84 cases) and the lowest in 2004 (10 cases). Of the 112 assessable candidaemia cases, 78 (70%) occurred in very low birth weight neonates (≤1500 g), 65 (58%) were born with gestational age of ≤30 weeks. The main identifiable risk factors were use of ≥2 antibiotics (87%), total parenteral nutrition for >5 days (82%), placement of central venous catheter (78%) and prior colonisation with Candida species (54%). Candida albicans and non‐albicans Candida species accounted for 43% and 57% of candidaemia cases, respectively, and C. parapsilosis emerged as a predominant species. No fluconazole resistance was observed in C. albicans and C. parapsilosis isolates. This is the first comprehensive study on the epidemiology of neonatal candidiasis in Kuwait.
Effect of nicotine on the pelvic afferent nerve activity and bladder pressure in rats
Authors: Kontani Hitoshi , Okamura Takashi , Kimura Satoko , Ishida Kazuumi , Takeno Satoshi
Published: July 2009

Objectives:  To record afferent nerve activity and bladder pressure in anesthetized male rats and to investigate whether increased afferent nerve activity induced by nicotine is able to evoke reflex bladder contractions.

Methods:  Using continuous infusion cystometrography, bladder pressure was measured via a bladder cannula. Afferent activity was recorded in the uncut L6 dorsal root. Nicotine was injected intra‐arterially through a cannula placed near the bifurcation of the internal iliac artery a few minutes after micturition.

Results:  Nicotine (0.15–1.5 µmol) evoked a marked elevation of afferent discharge without a simultaneous increase in bladder pressure. Bladder contractions appeared about 43 and 19 s after bolus injection of nicotine at 0.45 and 1.5 µmol, respectively. Firing rates of afferent nerves were reduced when the contraction appeared. Continuous infusion of nicotine at 0.75 µmol/min for 20 min evoked marked elevation of afferent discharge, which was maintained during infusion of nicotine and after it had been withdrawn. Repetitive contractions were observed thereafter and disappeared when the L6 dorsal roots were bilaterally resected.

Conclusions:  A transient increase in afferent discharges induced by bolus injection of nicotine was unable to evoke reflex bladder contraction. Repetitive bladder contractions after withdrawal of continuous nicotine infusion were induced in a reflex manner by the increased afferent activity.
Lateral view dissection of the prostato‐urethral junction to reduce positive apical margin in laparoscopic radical prostatectomy
Authors: Sasaki Hiroshi , Miki Jun , Kimura Takahiro , Sanuki Kunitaro , Miki Kenta , Takahashi Hiroyuki , Egawa Shin
Published: July 2009

Objective:  To assess the impact of lateral view apical dissection in laparoscopic radical prostatectomy (LRP) on the reduction of positive surgical margin rates and recovery of postoperative continence.

Methods:  One hundred and forty‐four consecutive patients underwent LRP from October 2004 to March 2008. Lateral view dissection of the prostato‐urethral junction was conducted in 76 of them (Group 2). Standard dissection was used in the remaining patients (Group 1). The effect of this technical modification on the reduction of positive surgical margin rates and postoperative recovery of urinary continence was assessed in the two groups.

Results:  Overall, the incidence of positive margins decreased from 23 (35.9%) in Group 1 to 16 cases (21.9%) in Group 2 (P = 0.07). Positive margin rates in pT2 decreased from 30.6% to 6.5% (P = 0.006). Apical and dorso‐apical margins were reduced from 26.5% to 4.3% (P = 0.009) and from 10.2% to 0% (P < 0.001), respectively. Postoperative recovery of urinary continence improved significantly, with a pad‐free rate over the first 3 months of 55.9% in Group 1 vs 71.7% in Group 2 (P = 0.01). Multivariate logistic regression analysis showed this modified surgical technique to predict a lower rate of positive margins.

Conclusion:  Lateral view dissection of the prostato‐urethral junction is an easily applicable technical modification. It provides better visualization of apical anatomy substantially contributing to the reduction of positive surgical margin rates, especially at the level of prostatic apex.
What are the most effective strategies for improving quality and safety of health care?
Authors: Scott I.
Published: July 2009

There is now a plethora of different quality improvement strategies (QIS) for optimizing health care, some clinician/patient driven, others manager/policy‐maker driven. Which of these are most effective remains unclear despite expressed concerns about potential for QIS‐related patient harm and wasting of resources. The objective of this study was to review published literature assessing the relative effectiveness of different QIS. Data sources comprising PubMed Clinical Queries, Cochrane Library and its Effective Practice and Organization of Care database, and HealthStar were searched for studies of QIS between January 1985 and February 2008 using search terms based on an a priori QIS classification suggested by experts. Systematic reviews of controlled trials were selected in determining effect sizes for specific QIS, which were compared as a narrative meta‐review. Clinician/patient driven QIS were associated with stronger evidence of efficacy and larger effect sizes than manager/policy‐maker driven QIS. The most effective strategies (>10% absolute increase in appropriate care or equivalent measure) included clinician‐directed audit and feedback cycles, clinical decision support systems, specialty outreach programmes, chronic disease management programmes, continuing professional education based on interactive small‐group case discussions, and patient‐mediated clinician reminders. Pay‐for‐performance schemes directed to clinician groups and organizational process redesign were modestly effective. Other manager/policy‐maker driven QIS including continuous quality improvement programmes, risk and safety management systems, public scorecards and performance reports, external accreditation, and clinical governance arrangements have not been adequately evaluated with regard to effectiveness. QIS are heterogeneous and methodological flaws in much of the evaluative literature limit validity and generalizability of results. Based on current best available evidence, clinician/patient driven QIS appear to be more effective than manager/policy‐maker driven QIS although the latter have, in many instances, attracted insufficient robust evaluations to accurately determine their comparative effectiveness.
Aspirin for primary prevention: do potential benefits outweigh the risks?
Authors: Shakib S.
Published: July 2009

The role of aspirin for primary prevention in healthy individuals has been the subject of clinical trials for more than a quarter of a century. Because of this evidence, or sometimes despite it, many individuals self‐administer aspirin to prevent cardiovascular events. This article reviews the published work for aspirin in primary prevention of cardiovascular and malignant diseases and considers whether aspirin would be approved by regulatory authorities for this use if it were to be marketed for this indication today.
Hypercalcaemia caused by a carcinoid tumour
Authors: Brzozowska M. M. , Wolmarans L. , Conaglen J. V.
Published: July 2009

Humoral hypercalcaemia resulting from carcinoid tumours is uncommon. We report a case of hypercalcaemia because of excessive secretion of parathyroid hormone‐related protein (PTHrP) in a 77‐year‐old woman with an advanced carcinoid tumour. Fibroblast growth factor 23 levels were also elevated. The hypercalcaemia responded to adjunctive therapy with long‐acting octreotide analogue therapy, bisphosphonates and steroids. The role of PTHrP in humoral hypercalcaemia of malignancy, its association with neuroendocrine tumours, as well as the therapeutic use of somatostatin analogues are reviewed.
Transition to psychiatric/mental health nursing programs: Expectations and practical considerations
Authors: Cleary Michelle , Horsfall Jan , Happell Brenda
Published: July 2009

Mental health services have developed transition programs to attract staff, including new graduates, staff with mental health nursing experience without formal qualifications, experienced nurses wishing to move into mental health, and nurses returning to the workforce. Transition to psychiatric/mental health programs are considered to be particularly significant in the mental health field because of the relative under‐representation of mental health content in undergraduate curricula. Unfortunately, transition programs have received only minor attention in the literature and there is a paucity of published evaluations to determine their effectiveness. The aim of this paper is to examine transition programs and consider how they meet the expectations of stakeholders, such as consumers of mental health services, and program participants' expectations. It is concluded that published systematic evaluations are lacking, particularly those considered from the perspective of stakeholders. Consideration of these expectations should be reflected in the design and delivery of mental health nursing transition programs.
Negotiating complexities: An ethnographic study of intellectual disability and mental health nursing in New Zealand
Authors: Taua Chris , Farrow Tony
Published: July 2009

This paper presents the findings from a study undertaken to describe nursing practice in one dual diagnosis (DD; coexisting mental illness and intellectual disability) inpatient unit in New Zealand. A focused ethnographic approach (using fieldwork observations, a review of documents, and five semistructured interviews) was used to gather data. A model of culture was used to analyze data to allow a description of DD nursing practice. Additionally, this framework allowed for an exploration of the artefacts, values, and assumptions that underpin these practices. Three key themes emerged from the data: keeping everyone safe, managing the complexities in assessment, and narrating their work. Together, these themes indicate that in the absence of a defined model of DD nursing, practice is based on an institutional psychiatric model. We argue that DD nursing models need to be made explicit in order to advance nursing in this area.
Cochrane Reviews of non‐medication‐based psychotherapeutic and other interventions for schizophrenia, psychosis, and bipolar disorder: A systematic literature review
Authors: Jung Xenia Tricia , Newton Richard
Published: July 2009

Mental health‐care professionals are striving to keep up to date with health interventions that are effective and beneficial to patients. The Cochrane Reviews make available a systematic and up‐to‐date review of a comprehensive range of health interventions. We identified a total of 28 interventions from a systematic search and review of the Cochrane Reviews for either schizophrenia, psychosis, schizoaffective, or bipolar disorder. These interventions have been graded into tables of: strong support that merits application, moderate support that warrants consideration of application, not supported, and data that is deemed inconclusive. The tables provide a comprehensive summary and classification of evidence‐based practices. This information is presented in a way to enable nurses and other health‐care professionals to analyze their own practices to improve mental health services and outcomes for patients. Of the 28 interventions identified in this review, four had strong support and five had moderate support meriting application. Limitations of this review are discussed.
Duly Authorized Officers' practices under mental health law in New Zealand: Are nurses meeting the requirements of the law?
Authors: McKenna Brian , Thom Katey , O'Brien Anthony , Crene Sally , Simpson Alexander
Published: July 2009

The Mental Health (Compulsory Assessment and Treatment) Act (1992) introduced a number of statutory roles that are undertaken by mental health nurses. One of these roles is that of Duly Authorized Officer (DAO). The DAO is responsible for the procedural requirements necessary to facilitate compulsory assessment. Under Section 9(2)(d), the DAO is required to ensure that the purpose of the assessment and the requirements of the notice of assessment are explained to the person in the presence of a member of their family, a caregiver, or other person concerned with the welfare of the person. Three recent High Court decisions under the Habeas Corpus Act 2001 have challenged existing DAO practices in arranging the presence of a third party. This paper presents research, which focuses on unravelling some of the complexities associated with meeting this procedural requirement. It illustrates these complexities through a discussion of the results of an audit of files and three focus groups with mental health nurses who practise as DAO. The paper concludes that national guidelines for practice need to be developed for DAO to assist mental health nurses in meeting this statutory requirement.