bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving outcomes for psychoses through the use of psycho‐education; preliminary findings
Authors: WALKER H. , CONNAUGHTON J. , WILSON I. , MARTIN C.R.
Published: March 2012

Accessible summary

This article explores the evidence to support an education programme for psychosis and introduces a new assessment tool designed to measure knowledge gain.

A description of the programme entitled ‘Coping With Mental Illness’ ‐ designed for people in forensic services – is offered.

Results of the measures taken to review the programme show an improvement in knowledge, mental health and self awareness.

A psycho‐education programme is provided for patients suffering from psychosis in Scotland's only high secure hospital. An 18‐month pilot study was carried out with consecutive case sample (treatment group) and ‘treatment as usual’ comparison group (control group). Pre, post and 6‐month follow‐up assessments were carried out. A range of outcome measures were used, including two measures of knowledge: a self‐report assessment tool – Forensic Assessment of Knowledge Tool and the Understanding Medication Questionnaire. Other measures were used to establish level of insight, Schedule for the Assessment of Insight and assess mental state [Positive and Negative Syndrome Scale (PANSS)]. Results from (n= 48) participants indicate no statistical difference between the treatment and control group scores on any assessment prior to commencement of the intervention, indicating a well‐matched sample group. However, all four assessments showed statistically significant changes post group. Treatment group showed an ability to improve knowledge and retain information about psychosis, which may account for their improved mental state and level of insight. Despite methodological limitations and a small sample group, this project has given an early indication of the positive value of this psycho‐education programme in a forensic setting.
Psychiatric clinical course strengthens the student–patient relationships of baccalaureate nursing students
Authors: KETOLA J. , STEIN J. V.
Published: March 2012

Accessible summary

It is stressful to be ill. People need nurses who help them emotionally while caring for their physical problems. The undergraduate psychiatric course is a good place to begin this learning. A pre and post survey asked 67 baccalaureate student nurses what they learned from their first clinical psychiatric nursing course. Specifically, the authors wanted to know whether working with people with mental illness would help students learn how to help people with emotional stress.

The students developed skills in listening and communication and progressed through steps essential to the development of empathy: breaking down stigma and prejudicial judgments, developing skills of self‐reflection, allowing people to impact them and feeling what it would be like if they were the patient, and recognizing what they had learned thereby making the learning conscious. With these new skills, students remarked on the life‐changing experiences they had with these patients. Many commented on their intention to integrate these skills and understandings into their nursing practice with all patients.

These study findings are important for three reasons: (1) recognition of the importance of the first psychiatric course in helping students develop empathy; (2) encouraging research to focus on faculty efforts to help students integrate these practices into other areas of nursing; and (3) recognition that empathy is a learned process.

Psychiatric nursing teaches students how to engage and communicate with patients who have severe emotional distress. Nurses need this knowledge as the majority of patients encountered in hospitals are distressed. This study explores the impact of a psychiatric clinical course in helping students learn to relate to distressed patients. The study used a mixed research methodology to survey 67 baccalaureate students about their experiences in the placement portion of the psychiatric nursing course. The pre‐clinical questions focused on students’ anticipation regarding individuals with mental illness and how the clinical experience would affect them as nurses and as individuals. The post‐clinical questions asked how the clinical experience affected them. The students stated that their time with patients had changed them. Ninety‐nine per cent were no longer frightened of the patients. Students realized the patients were distressed and were glad to help them. This work sensitized them to the individual rather than the generic patient. It initiated a process in self‐awareness, in sensitivity to the feelings of another person and in communication skills. These are steps in the development of an empathetic presence. The students recognized the need for these skills in all nursing. The authors recommend strategies to assist students in developing an empathetic presence.
Drug solubility classification in the bovine
Authors: MARTINEZ M. N. , APLEY M. D.
Published: March 2012

Martinez, M. N., Apley, M. D. Drug solubility classification in the bovine. J. vet. Pharmacol. Therap.35 (Suppl. 1), 93–97.

Currently, the basis for solubility test conditions and the corresponding solubility criteria is derived from the tremendous wealth of information developed to support human pharmaceutical product development and regulation. However, there are several critical differences between the gastrointestinal tract of ruminants and monogastric species that can affect the conditions and criteria to be applied to the classification of drug solubility in cattle. These include the pH of the stomach, the volume of the stomach, the types of oral formulations, and the definition of ‘highest dose’. These points are discussed below and alternative perspectives for consideration with regard to possible modification of solubility criteria for ruminants are presented.
Genotypic diversity enhances invasive ability of Spartina alterniflora
Authors: WANG X. Y. , SHEN D. W. , JIAO J. , XU N. N. , YU S. , ZHOU X. F. , SHI M. M. , CHEN X. Y.
Published: March 2012

Although genetic diversity is very important for alien species, which have to cope with new environments, little is known about the role that genetic diversity plays in their invasive success. In this study, we set up a manipulation experiment including three levels of genotypic diversity to test whether genotypic diversity can enhance the invasive ability of alien species, in our case the invasive Spartina alterniflora in China, and to infer the underlying mechanisms. There was no significant relationship between genotypic diversity and parameters of performance in the first year; however, from the summer of the second year onwards, genotypic diversity enhanced four of the six parameters of performance. After two growing seasons, there were significant positive relationships between genotypic diversity and maximum spread distance, patch size, shoot number per patch, and aboveground biomass. Moreover, abundance of the native dominant species Scirpus mariqueter was marginally significantly decreased with genotypic diversity of S. alterniflora, suggesting that enhanced invasive ability of S. alterniflora may have depressed the growth of the native species. There was no significant difference in most measures of performance among six genotypes, but we observed a transgressive over performance in four measures in multiple‐genotype patches. At the end of the experiment, there were significant nonadditive effects of genotypic diversity according to Monte Carlo permutations, in six‐genotype, but not three‐genotype plots. Our results indicated that both additive and nonadditive effects played roles in the positive relationship between genetic diversity and invasion success, and nonadditive effects were stronger as duration increased.
A promoter‐swap strategy between the AtALMT and AtMATE genes increased Arabidopsis aluminum resistance and improved carbon‐use efficiency for aluminum resistance
Authors: Liu Jiping , Luo Xiaoying , Shaff Jon , Liang Cuiyue , Jia Xiaomin , Li Ziyan , Magalhaes Jurandir , Kochian Leon V.
Published: March 2012

The primary mechanism of Arabidopsis aluminum (Al) resistance is based on root Al exclusion, resulting from Al‐activated root exudation of the Al3+‐chelating organic acids, malate and citrate. Root malate exudation is the major contributor to Arabidopsis Al resistance, and is conferred by expression of AtALMT1, which encodes the root malate transporter. Root citrate exudation plays a smaller but still significant role in Arabidopsis Al resistance, and is conferred by expression of AtMATE, which encodes the root citrate transporter. In this study, we demonstrate that levels of Al‐activated root organic acid exudation are closely correlated with expression of the organic acid transporter genes AtALMT1 and AtMATE. We also found that the AtALMT1 promoter confers a significantly higher level of gene expression than the AtMATE promoter. Analysis of AtALMT1 and AtMATE tissue‐ and cell‐specific expression based on stable expression of promoter–reporter gene constructs showed that the two genes are expressed in complementary root regions: AtALMT1 is expressed in the root apices, while AtMATE is expressed in the mature portions of the roots. As citrate is a much more effective chelator of Al3+ than malate, we used a promoter‐swap strategy to test whether root tip‐localized expression of the AtMATE coding region driven by the stronger AtALMT1 promoter (AtALMT1P::AtMATE) resulted in increased Arabidopsis Al resistance. Our results indicate that expression of AtALMT1P::AtMATE not only significantly increased Al resistance of the transgenic plants, but also enhanced carbon‐use efficiency for Al resistance.
Portal Hypertension in Children: Expert Pediatric Opinion on the Report of the Baveno V Consensus Workshop on Methodology of Diagnosis and Therapy in Portal Hypertension
Authors: Shneider Benjamin L. , Bosch Jaime , de Franchis Roberto , Emre Sukru H. , Groszmann Roberto J. , Ling Simon C. , Lorenz Jonathan M. , Squires Robert H. , Superina Riccardo A. , Thompson Ann E. , Mazariegos George V.
Published: March 2012

Shneider BL, Bosch J, de Franchis R, Emre SH, Groszmann RJ, Ling SC, Lorenz JM, Squires RH, Superina RA, Thompson AE, Mazariegos GV. Portal Hypertension in Children: Expert Pediatric Opinion on the Report of the Baveno V Consensus Workshop on Methodology of Diagnosis and Therapy in Portal Hypertension.

Abstract:  Complications of portal hypertension in children lead to significant morbidity and are a leading indication for consideration of liver transplantation. Approaches to the management of sequelae of portal hypertension are well described for adults and evidence‐based approaches have been summarized in numerous meta‐analyses and conferences. In contrast, there is a paucity of data to guide the management of complications of portal hypertension in children. An international panel of experts was convened on April 8, 2011 at The Children’s Hospital of Pittsburgh of UPMC to review and adapt the recent report of the Baveno V Consensus Workshop on the Methodology of Diagnosis and Therapy in Portal Hypertension to the care of children. The opinions of that expert panel are reported.
Cardiac magnetic resonance imaging in children with chronic kidney disease and renal transplantation
Authors: Schaefer Betti , Rusai Krisztina , Toth Attila , Pasti Krisztina , Ujszaszi Akos , Kreko Marianna , Horvath Erzsebet , Sallay Peter , Reusz Gyorgy S. , Merkely Bela , Tulassay Tivadar , Szabo Attila J.
Published: March 2012

Schaefer B, Rusai K, Toth A, Pasti K, Ujszaszi A, Kreko M, Horvath E, Sallay P, Reusz GS, Merkely B, Tulassay T, Szabo AJ. Cardiac magnetic resonance imaging in children with chronic kidney disease and renal transplantation.

Abstract:  CV disease is the major cause of death in patients with CKD. Recently, CMR imaging emerges as a complementary method providing advantages in cardiac assessment; however, data on CMR in pediatric CKD are scarce. We performed CMR in 15 children: two with CKD, six on peritoneal dialysis, seven on hemodialysis, and in 18 children 5.1 (0.4–15.4) yr after kidney Tx. Eight children underwent CMR six months before and after Tx. Results are presented as mean z score ± SD. LV EF was higher and in the normal range in Tx patients compared with CKD (−0.3 ± 1 vs. −2.1 ± 1.6, respectively, p < 0.05), whereas RV EF was similar (−0.9 ± 1.4 vs. −0.9 ± 1.8, p = n.s.). End‐diastolic and end‐systolic LV volume index (0 ± 1.7 vs. 2.1 ± 3.1; 0.2 ± 1.2 vs. 3.1 ± 3.7, both p < 0.05) and LV mass index (1.4 ± 1.5 vs. 3.4 ± 2.9, p < 0.05) were lower in Tx children. All parameters improved in the eight children after Tx. In conclusion, our CMR analysis suggests marked improvement of cardiac function and morphology in children after kidney Tx. CMR might be an appropriate complementary method for measuring detailed cardiac status in children with CKD.
Cytotoxic T‐lymphocyte associated antigen‐4 gene polymorphisms and primary biliary cirrhosis: A systematic review
Authors: Li Man , Zheng Hao , Li Tao , Gao Ping , Zhang Xiao‐Lin , Liu Dian‐Wu
Published: March 2012

Background and Aim:  The cytotoxic T‐lymphocyte antigen 4 (CTLA4) is an inhibitory receptor expressed on activated and regulatory T lymphocytes. Polymorphisms could have remarkable effects on susceptibility to autoimmunity. However, the associations between CTLA‐4 polymorphisms and primary biliary cirrhosis (PBC) remain ambiguous. The aim of this meta‐analysis is to determine more precise estimations of the relationship.

Methods:  From literature retrieval from PubMed, Web of Science, Science Direct, and the Chinese National Knowledge Infrastructure (CNKI) Database, the publications on the associations between rs231775, rs3087243, rs5742909, rs231725 and rs11571317 polymorphisms of CTLA4 and PBC through June 2011 were collected. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated in fixed or random model, I2 was calculated to examine heterogeneity, and funnel plots were plotted to examine small study effects with Revman 5.1 and Stata 11.

Results:  Overall, a significantly increased risk was found for G versus A allele for rs231775 (OR = 1.28, 95% CI = 1.17–1.41). For rs3087243, a significant association was found for AA versus GG genotype (OR = 0.66; 95% CI = 0.55–0.80). When subgroup analysis by ethnicity was performed, the same association was only found in Caucasians. For rs231725, the OR values (95% CI) for GG versus AA, GA versus AA and G versus A allele were 0.52 (0.40–0.68), 0.74 (0.60–0.92) and 0.73 (0.61–0.88). No significant associations were found for other polymorphisms.

Conclusion:  The G allele of rs231775 is a risk factor for PBC, while AA genotype of rs3087243 and GG, GA and G allele of rs231725 show negative associations with PBC.
Idiopathic thrombocytopenic purpura in childhood: Twenty years of experience in a single center
Authors: Stiakaki Eftichia , Perdikogianni Chryssoula , Thomou Christina , Markaki Erasmia‐Athina , Katzilakis Nikolaos , Tsirigotaki Maria , Kalmanti Maria
Published: March 2012

Background:  Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder with a variable clinical course.

Methods:  A retrospective analysis was carried out of ITP patients presenting to a pediatric hematology‐oncology department during a period of 20 years, with a focus on treatment and outcome.

Results:  One hundred and twenty‐four cases were recorded (mean patient age, 8.4 years). Forty‐nine children (39.5%) had platelet counts <10 000/µL at diagnosis. No episode of severe bleeding was observed. Peak incidence was observed during spring and summer. Respiratory infections proceeded in 58% of cases. Treatment consisted of i.v. immunoglobulin (IVIG) in 93 children at four dosing schedules. Sixteen children received corticosteroids, 10 children received anti‐D immunoglobulin and 14 received no treatment. Recovery was observed in 67% of children on IVIG and in 50% on anti‐D globulin. Eight patients did not respond initially and received corticosteroids. Three children with refractory thrombocytopenia received anti‐CD20 (rituximab). Fourteen children (11%) had persistent/chronic disease. In 10 of them recovery was observed in 13 months–8 years. Splenectomy was performed in six children with resistant/chronic disease.

Conclusion:  ITP has a benign course in the majority of cases. Anti‐D globulin can effectively be used as an alternative first‐line treatment. Rituximab can successfully be used in refractory cases, while splenectomy has currently limited indications.
Lack of an association between E‐selectin gene polymorphisms and risk of Kawasaki disease
Authors: Shirakawa Toshihiko , Ikeda Kazuyuki , Nishimura Shinji , Kuniba Hideo , Nakashima Kazuhisa , Motomura Hideki , Mizuno Yumi , Zaitsu Masafumi , Nakazato Mio , Maeda Takahiro , Hamasaki Yuhei , Hara Toshiro , Moriuchi Hiroyuki
Published: March 2012

Background:  Coronary artery lesions (CAL) are a serious complication of Kawasaki disease (KD). The increased serum E‐selectin level during the acute phase of KD and the association of E‐selectin gene (SELE) polymorphisms with the prevalence of coronary artery disease in adults suggest a possible association between SELE polymorphisms and the development of CAL in KD patients.

Methods:  The subjects consisted of 177 KD patients, including 59 with and 118 without CAL, and 305 healthy controls. Two single nucleotide polymorphisms (SNP) of SELE, 98G>T (rs1805193) and Ser128Arg (rs5361), were genotyped by direct sequencing and the high‐resolution melting curve method, respectively. The allele distributions were assessed using the chi‐squared test.

Results:  There were no significant differences in the T allele frequency at 98G>T between KD patients and controls (1.4% vs 1.0%, P= 0.55) or between KD patients with and without CAL (1.7% vs 1.3%, P= 0.77). Similarly, there were no differences in the distribution of the C allele (128Arg) at Ser128Arg between KD patients and controls (4.5% vs 3.4%, P= 0.40) or between KD patients with and without CAL (4.2% vs 4.7%, P= 0.86).

Conclusion:  Although no association was detected between these SELE polymorphisms and the prevalence of KD or the development of CAL, this may have been due to the study limitations, including a low frequency of the minor alleles and a small sample size. A larger‐scale association study is needed in order for a definitive conclusion to be made as to whether these SNP are associated with susceptibility to KD or not.
Value of amino‐terminal pro B‐natriuretic peptide in diagnosing Kawasaki disease
Authors: McNeal‐Davidson Ariane , Fournier Anne , Spigelblatt Linda , Saint‐Cyr Claire , Mir Thomas S , Nir Amiram , Dallaire Frédéric , Cousineau Jocelyne , Delvin Edgard , Dahdah Nagib
Published: March 2012

Background:  The aim of the present study was to investigate the diagnostic value of the N‐terminal B‐type natriuretic peptide (NT‐proBNP) in acute Kawasaki disease (KD) given that the clinical criteria and the current basic laboratory tests lack the necessary specificity for accurate diagnosis.

Methods:  Basic biological tests and serum NT‐proBNP levels obtained from acute KD patients were compared to that of febrile controls. NT‐proBNP was considered abnormal based on the following definitions: above a cut‐off determined on receiver operator characteristic (ROC) analysis, above the upper limit for age, or above 2 SD calculated from healthy children. Analyses were also performed for KD cases with complete or incomplete criteria combined and separately.

Results:  There were 81 patients and 49 controls aged 3.60 ± 2.77 versus 4.25 ± 3.88 years (P= 0.69). ROC analysis yielded significant area under the curve for NT‐proBNP. The sensitivity, specificity, positive and negative predictive values were 70.4–88.9%, 69.4–91.8%, 82.8–93.4%, and 65.2–79.1%. The odds ratios based on NT‐proBNP definitions varied between 18.13 (95% confidence interval [CI]: 7.21–45.57), 20.82 (95%CI: 8.18–53.0), and 26.71 (95%CI: 8.64–82.57; P < 0.001). Results were reproducible for cases with complete or incomplete criteria separately.

Conclusion:  NT‐proBNP is a reliable marker for the diagnosis of KD. Prospective clinical studies with emphasis on NT‐proBNP in a diagnostic algorithm are needed.
Tracheobronchial aspiration of foreign bodies and rigid bronchoscopy in children
Authors: Oncel Murat , Sunam Güven Sadi , Ceran Samı
Published: March 2012

Background: A significant proportion of cases of tracheobronchial foreign body aspiration due to life‐threatening condition is observed during childhood. The aim of the present study was to describe our experience with the diagnosis and treatment of foreign body aspirations during childhood and review published literature.

Methods: One hundred and eighty‐four patients under 16 years of age with a tentative diagnosis of foreign body aspiration were retrospectively evaluated according to age, sex, patient delay symptoms at presentation, foreign body type, localization and the diagnostic and therapeutic methods used.

Results: The most frequently aspirated objects were shelled nuts and seeds such as sunflower seeds, pistachio and hazelnuts. The chief symptom was cough. On physical examination, the most frequent findings were unilateral decrease of respiratory sound on the affected side with coarsening and bronchi. While 51% of cases presented a radiological finding, chest X‐ray was normal in the other. All patients underwent rigid bronchoscopy under general anesthesia and a foreign body was identified in 137 (74.3%). The rigid bronchoscopy intervention was used in some cases, especially in the presence of tracheal foreign bodies of organic origin.

Conclusions: Tracheobronchial foreign body aspiration is a significant cause of childhood morbidity and mortality. Early diagnosis and treatment is of utmost importance. Rigid bronchoscopy under general anesthesia should be performed in all patients suspected of foreign body aspiration, which could minimize mortality and morbidity if performed by experienced personnel with safe methods.
Factors affecting the diagnostic accuracy of endoscopic ultrasonography‐guided fine‐needle aspiration (EUS‐FNA) for upper gastrointestinal submucosal or extraluminal solid mass lesions
Authors: Rong Long , Kida Mitsuhiro , Yamauchi Hiroshi , Okuwaki Kousuke , Miyazawa Shiro , Iwai Tomohisa , Kikuchi Hidehiko , Watanabe Maya , Imaizumi Hiroshi , Koizumi Wasaburo
Published: March 2012

Aim:  A number of potential variables are associated with the diagnostic accuracy of endoscopic ultrasonography‐guided fine‐needle aspiration (EUS‐FNA). The aim of this study was to evaluate factors affecting the diagnostic accuracy of EUS‐FNA for upper gastrointestinal submucosal or extraluminal solid lesions.

Methods:  Patients with such lesions who underwent EUS‐FNA between January 2009 and December 2010 were studied retrospectively. Needles of 22, 25 and 19 gauge were used. The associations between the EUS‐FNA results and factors such as mass location, mass size, needle size, number of needle passes, combined histologic‐cytologic analysis and final diagnosis were analyzed.

Results:  A total of 170 EUS‐FNA procedures were performed in 158 patients with upper gastrointestinal submucosal or extraluminal solid lesions. The overall accuracy of EUS‐FNA was 86.5% (147/170). The diagnostic accuracy with three or more needle passes was higher than with less than 3.0 needle passes (90.0%, 108/120 vs 78.0%, 39/50; P < 0.05). Mass location, mass size, and final diagnosis were not associated with EUS‐FNA accuracy. Combined cytologic‐histologic analysis had significantly higher diagnostic accuracy than either cytologic or histologic analysis alone (P < 0.001). In a subgroup of 90 patients, both 22 and 25 gauge needles were used for EUS‐FNA. The overall diagnostic accuracy was similar for 25 gauge needles and 22 gauge needles (80.0% vs 78.9% P = 1.000) in this subgroup.

Conclusion:  Overall, 25 and 22 gauge needles have a similar diagnostic accuracy. Our results suggest that 3.0 or more needle passes and combined cytologic‐histologic analysis enhance the diagnostic accuracy of EUS‐FNA.
Study on sexual and reproductive health behaviors of unmarried female migrants in China
Authors: He Dian , Zhou You , Ji Ning , Wu Shizhong , Wang Zhijin , Decat Peter , Moyer Eileen , Minkauskiene Meile , Pang Cheng , Cheng Yimin
Published: March 2012

Aim:  The purpose of this study was to broadly assess the level of knowledge, attitude and behaviors related to sexual and reproductive health (SRH) among unmarried female migrants in China.

Material and Methods:  This cross‐sectional study was conducted and a self‐administered questionnaire was designed for collecting information on SRH including 15 items for knowledge, 8 items for attitude and some items for contraception and abortion related behaviors.

Results:  A total of 1690 unmarried female migrants were interviewed. Most of the respondents had less knowledge of SRH. Only one‐third of respondents was aware of emergency contraceptives and could freely talk about SRH with their friends. Over one‐third of respondents were not willing to come into contact with someone with AIDS or STDs. In this study, 10.4% participants had an unwanted pregnancy and 95% of them had an abortion. Multivariate analysis showed that having a boyfriend, duration of employment in city, knowledge on SRH and freely discussing SRH with peer were associated with having premarital sex among these unmarried female migrants.

Conclusion:  This study revealed that the unmarried female migrant was one of the most vulnerable groups concerning SRH. In some policy reforms, appropriate and cost‐effective SRH services should be provided for these migrants.
Hysteroscopy after uterine fibroid embolization: Evaluation of intrauterine findings in 127 patients
Authors: Mara Michal , Horak Petr , Kubinova Kristyna , Dundr Pavel , Belsan Tomas , Kuzel David
Published: March 2012

Aim:  Several atypical hysteroscopy findings have been described in association with uterine artery embolization (UAE). The purpose of this study was to evaluate the types and frequency of these findings in the largest published series of patients.

Material and Methods:  Premenopausal patients after bilateral UAE for symptomatic intramural fibroid underwent subsequent hysteroscopic examination 3–9 months following UAE. The uterine cavity was examined with focus on specific post‐embolization changes. Biopsy of endometrium was obtained and evaluated together with a biopsy of abnormal foci if present.

Results:  UAE was performed in a total of 127 women with an average size of dominant fibroid 63.1 mm in diameter and an average patient age of 35.1 years. Even though the majority of patients were asymptomatic at the time of hysteroscopy (78.0%), the post‐embolization hysteroscopic examination was normal in only 51 patients (40.2%). The most frequent abnormalities included tissue necrosis (52 women, 40.9%), intracavitary myoma protrusion (45 women, 35.4%), endometrium ‘spots’ (22.1%), intrauterine synechiae (10.2%) and ‘fistula’ between the uterine cavity and intramural fibroid (6.3%). Histopathological examination showed normal, secretory or proliferative endometrium in 83.5% patients. Necrosis and/or hyalinization prevailed in the results of biopsy of abnormal loci (45 cases, 35.4%).

Conclusion:  Frequency of abnormal hysteroscopic findings several months after UAE for primary intramural myomas is high. Alarmingly high is the percentage of patients with a histopathologically verified necrosis. Performing hysteroscopy in selected patients after UAE is necessary before eventual surgical re‐intervention, especially in women with reproductive plans.
Uterine cervical malignant granular cell tumor
Authors: Guo Na , Peng Zhilan , Yang Kaixuan , Lou Jiangyan
Published: March 2012

Malignant granular cell tumor is relatively uncommon, constituting only 1–2% of all granular cell tumors. It is a rare and unusual tumor, especially in non‐typical sites, such as the uterine cervix, and grows more rapidly than benign granular cell tumor. It can be treated with surgical excision, but recurrence is possible and prognosis can be poor. A malignant granular cell tumor in the uterine cervix of a 37‐year‐old woman was incidentally diagnosed. The patient has a history of irregular vaginal bleeding. Uterine cervical biopsy under colposcope revealed a malignant granular cell tumor. After isophosphamide, etoposide, and cisplatin neoadjuvant chemotherapy, surgery was performed on the lesion, which approximately involved half the depth of cervical stroma. Computed tomography examination showed no local recurrence or distant metastasis during the 26‐month follow‐up period.
Role of blunt suture needle in episiotomy repair at uncomplicated vaginal deliveries in reducing glove perforation rate: A randomized controlled trial
Authors: El‐Refaie Tamer A. , Sayed Khalid K. , El‐Shourbagy Mahmoud A. A. , Arafat Ebtesam A.
Published: March 2012

Aim:  The aim of this study was to evaluate the role of blunt suture needles for episiotomy repair at uncomplicated vaginal deliveries in reducing glove perforation rate.

Methods:  This was a prospective randomized controlled trial wherein 300 nulliparous women with uncomplicated vaginal deliveries were randomized to episiotomy repair with either blunt or sharp suture needles. Patient demographics and clinical variables were collected. Postoperatively, the surgeons were surveyed regarding ease of using the needle, and glove perforation was determined by three tests: air insufflation, water filling and water load.

Results:  A total of 41 perforations occurred in the 39 episiotomy repairs with glove perforations (13%). There was a significantly higher number of glove perforations using the sharp suture needles (28/150; 18.7%) than with the blunt suture needles (11/150; 7.3%) (P = 0.005). Glove perforation of the non‐dominant hand occurred in 90% of the cases. Using a blunt suture needle took significantly more time (P < 0.001) to complete the repair than using a sharp needle. Surgeons reported that blunt needles were more difficult to use than sharp needles (P < 0.001).

Conclusion:  Blunt suture needles for episiotomy repair were shown to have a significantly lower instance of glove perforation but required more time and are perceived to be more difficult to complete the repair as compared to sharp needles.
Conservative and radiological management of simple renal cysts: a comprehensive review
Authors: Skolarikos Andreas , Laguna M. Pilar , de la Rosette Jean J.M.C.H.
Published: March 2012

What's known on the subject? and What does the study add?

Simple renal cysts are a common entity, which may need observation and follow‐up or treatment.

The study, for the first time, systematically reviews the indications for follow‐up or radiological treatment of simple renal cysts.

To review the conservative and radiological management of simple renal cysts a systematic literature review was performed. Simple renal cysts are commonly found in the adult population. Increasing age is highly associated with its incidence. When they remain asymptomatic they require neither treatment nor follow‐up. When the shape of the cyst is slightly irregular follow‐up is mandatory to exclude malignant progression. Symptomatic cysts require intervention. Ultrasound or computed tomography guidance have been effectively used for cyst puncture. However, simple fluid aspiration is ineffective leading to cyst recurrence. Aspiration should be accompanied with the injection of a sclerosing agent to destroy renal cyst epithelium. Several issues such as the ultimate technique and agent remain to be clarified. High rates of cyst disappearance and long‐lasting cyst volume reduction have been reported with the use of various sclerosants. Ethanol in high concentrations and multiple injections is more commonly used with new agents showing similar efficacy and better complication profile. Studies comparing radiological intervention to surgical excision are lacking. Simple renal cysts may not require treatment when asymptomatic. Radiological intervention with the use of sclerosants needs further evaluation and comparison with other treatment methods.
Vitamin supplementation and blood pressure in Type 2 diabetes
Authors: Jarvandi S. , Joseph L. , Gougeon R. , Dasgupta K.
Published: March 2012

Diabet. Med. 29, 1253–1259 (2012)

Aims  Vitamin D levels are inversely related to blood pressure. Given that low sun exposure can create a greater reliance on dietary sources of vitamin D, we aimed to determine whether dietary vitamin D and blood pressure associations differ between periods of low and high sun exposure.

Methods  Dietary intake, vitamin supplementation, blood pressure, and anthropometric parameters were assessed each season for 1 year (174 adults with Type 2 diabetes). Separate linear regression models were constructed for high and low sun exposure periods to examine associations of systolic blood pressure with dietary vitamin D intake and vitamin supplement use (adjusted for age, gender, BMI, ethnicity, smoking, alcohol, physical activity, antihypertensive medication and nutrient intake). Robustness of findings was confirmed with within‐subject repeated measures analysis, including an interaction term for sun exposure period.

Results  Vitamin D intake from food sources was low year‐round and no conclusive association with blood pressure was identified during either period. Systolic blood pressure was 5.1 mmHg lower during the low sun exposure period (95% CI 0.5–9.7) in daily supplement users compared with non‐users. The interaction term between supplement use and sun exposure period was significant (low sun exposure* no supplement, P = 0.02). Systolic blood pressure was relatively stable in users (low and high sun exposure periods, respectively, mean ± SE: 135.2 ± 2.6 mmHg and 134.2 ± 2.5 mmHg), but not in non‐users (140.2 ± 2.7 mmHg and 130.5 ± 2.5 mmHg).

Conclusions  Vitamin supplementation may stabilize systolic blood pressure in adults with Type 2 diabetes across seasons.
Comparison of cystatin C‐ and creatinine‐based estimation of glomerular filtration rate according to glycaemic status in Type 2 diabetes
Authors: Oh S. J. , Lee J. I. , Ha W. C. , Jeong S. H. , Yim H. W. , Son H. S. , Sohn T. S.
Published: March 2012

Diabet. Med. 29, e121–e125 (2012)

Aims  The influence of hyperglycaemia on the performance of glomerular filtration rate (GFR) estimating equations remains to be determined. We compared the performance of creatinine‐based GFR with cystatin C‐based GFR in patients with Type 2 diabetes according to glycaemic status.

Methods  In a cross‐sectional study of 210 patients with Type 2 diabetes, we staged glycaemic status by HbA1c tertiles [HbA1c≤ 75 mmol/mol (9.0%) (n = 70), HbA1c 76–95 mmol/mol (9.1–10.8%) (n = 70), HbA1c >95 mmol/mol (10.8%) (n = 70)] and measured GFR. Isotopic GFR was measured using renal dynamic imaging with 99mTc‐diethylene‐triamine‐penta‐acetic acid. Estimated GFR (eGFR) was measured using creatinine‐based formulae (Cockcroft–Gault‐eGFR, the Modification of Diet in Renal Disease equation‐eGFR and the Chronic Kidney Disease Epidemiology Collaboration formula‐eGFR) and a cystatin C‐based formula (cystatin C‐eGFR).

Results  The isotopic GFR of all patients was 93.1 ± 34.1 ml min−1 1.73 m−2. All methods for estimating GFR underestimated isotopic GFR [Cockcroft–Gault‐eGFR (68.8 ± 38.6 ml min−1 1.73 m−2) (P < 0.05), Modification of Diet in Renal Disease‐eGFR (74.8 ± 31.3 ml min−1 1.73 m−2) (P < 0.05), Chronic Kidney Disease Epidemiology Collaboration‐eGFR (72.9 ± 26.6 ml min−1 1.73 m−2) (P < 0.05) and cystatin C‐eGFR (83.5 ± 33.2 ml min−1 1.73 m−2) (P < 0.05)]. In all patient groups, cystatin C‐eGFR was less biased and more accurate than the creatinine‐based formulae, especially in the group with HbA1c > 95 mmol/mol (10.8%) where there was no difference between cystatin C‐eGFR and isotopic GFR.

Conclusions  Performance of cystatin C‐eGFR was superior to creatinine‐based GFR in patients with Type 2 diabetes with HbA1c > 95 mmol/mol (10.8%).
Low glycaemic variability in subjects with Type 2 diabetes following pre‐Ramadan assessment and adjustments for fasting
Authors: Hui E. , Oliver N.
Published: March 2012

Diabet. Med. 29, 828–829 (2012)
Arterial stiffness and endothelial dysfunction independently and synergistically predict cardiovascular and renal outcome in patients with type 1 diabetes
Authors: Theilade S. , Lajer M. , Jorsal A. , Tarnow L. , Parving H.‐H. , Rossing P.
Published: March 2012

Diabet. Med. 29, 990–994 (2012)

Aims  To evaluate whether pulse pressure alone or with placental growth factor as estimates of arterial stiffness and endothelial dysfunction, predicts mortality, cardiovascular disease and progression to end‐stage renal disease in patients with Type 1 diabetes.

Methods  Prospective, observational study, median (range) follow‐up 8 (0–13) years, 900 patients with Type 1 diabetes, 458 with diabetic nephropathy, mean ± SD age 44 ± 11 years.

Results  During follow‐up, we recorded 178 (20%) all‐cause deaths, 109 (12%) cardiovascular deaths, 213 (24%) cardiovascular events and 73 (16%) progressed to end‐stage renal disease. Elevated pulse pressure predicted all‐cause and cardiovascular mortality and cardiovascular events [Hazard Ratio (HR) (95% CI) per 10 mmHg increase]: HR 1.2 (1.1–1.3), 1.3 (1.2–1.5) and 1.2 (1.1–1.3), P < 0.001 (adjusted for sex, age, HbA1c, cholesterol, diastolic blood pressure, creatinine, smoking, previous cardiovascular disease and nephropathy status). Furthermore, pulse pressure predicted the development of end‐stage renal disease in patients with diabetic nephropathy: HR 1.2 (1.1–1.4), P = 0.011 (adjusted for sex, age, HbA1c, cholesterol, diastolic blood pressure, previous cardiovascular disease and glomerular filtration rate). In a two‐hit model, patients with pulse pressure and placental growth factor levels above the median vs. below the median had increased risk of all‐cause and cardiovascular mortality, cardiovascular events and progression to end‐stage renal disease: adjusted HRs 2.3 (1.2–4.2), 4.2 (1.6–11.0), 2.3 (1.3–4.1) and 3.5 (1.0–11.8),P < 0.05.

Conclusions  Elevated pulse pressure independently predicts mortality, cardiovascular events and progression to end‐stage renal disease in patients with Type 1 diabetes. Placental growth factor adds to the predictive value of pulse pressure on cardiovascular and renal outcome.
Accuracy of glycated haemoglobin in screening for pre‐diabetes in Asian Indians—a community survey: the Chandigarh Urban Diabetes Study (CUDS)
Authors: Bhansali A. , Walia R. , Ravi Kumar P. , Ravi Kiran M. , Shanmugasundar G.
Published: March 2012

Aim  To compare American Diabetes Association and International Expert Committee recommended cut‐off values of HbA1c for detecting the presence of pre‐diabetes against plasma glucose values obtained from oral glucose tolerance tests in Asian Indians.

Methods  A cross‐sectional randomly sampled population survey involving 2368 adults, aged ≥ 20 years. HbA1c was measured on a Bio‐Rad 10 system in 1972 subjects.

Results  Of the 1972 subjects studied, 329 were detected to have pre‐diabetes based on isolated impaired fasting glucose in 125 subjects (6.3%), isolated impaired glucose tolerance in 141 subjects (7.1%) and the presence of both in 63 subjects (3.2%). The HbA1c cut‐off of 34 mmol/mol (5.7%), as recommended by the American Diabetes Association for detecting the presence of pre‐diabetes, showed sensitivity of 62%, specificity 77%, with a positive predictive value of 34.7%, a negative predictive value of 89.5% and accuracy of 67.8%; whereas the HbA1c cut‐off recommended by the International Expert Committee of 42 mmol/mol (6%) had a sensitivity of 36%, specificity of 90%, positive predictive value of 42.7%, negative predictive of 85.4% and an accuracy of 77%. However, both these HbA1c cut‐offs underdiagnosed the presence of pre‐diabetes in 38 and 64% of these subjects, respectively.

Conclusions  The American Diabetes Association and the International Expert Committee recommended HbA1c cut‐off values and oral glucose tolerance tests identify different pre‐diabetes cohorts. Long‐term prospective studies are required to define the usefulness of one over the other.
Preferences of people with diabetes for diabetic retinopathy screening: a discrete choice experiment
Authors: Yeo S. T. , Edwards R. T. , Fargher E. A. , Luzio S. D. , Thomas R. L. , Owens D. R.
Published: March 2012

Diabet. Med. 29, 869–877 (2012)

Aims  The ever‐increasing prevalence of diabetes places pressure on the provision of diabetic retinopathy screening services. As the first study of its kind, we aimed to determine preferences for diabetic retinopathy screening in people with diabetes and to examine the trade‐offs between frequency of screening and other service attributes.

Methods  A questionnaire including a discrete choice experiment was administered to people (n = 198) attending diabetic retinopathy screening at eight clinics across Wales, United Kingdom. The discrete choice experiment contained eight pairwise choices in which screening provision was described by five attributes: frequency of screening; travel time; results time; ability of screening to detect other changes; and explanation of results. Data were analysed using logistic regression techniques.

Results  We gained a response rate of 86.4% from the 198 questionnaires administered at clinics; 160 complete responses were analysed. Respondents valued four out of the five attributes [ability of screening to detect other changes (P = 0.000), explanation of results (P = 0.024), frequency of screening (P = 0.000) and travel time (P = 0.007)]. Results time was insignificant (P = 0.122). Respondents were willing to wait an additional 12, 2 and 1 month between screening tests to have a test that was able to detect additional changes, to have their results explained in person rather than by letter and to have a 15‐min reduction in travel time, respectively.

Conclusions  Respondents were willing to accept a longer screening interval, as long as preferences for other attributes of service provision (ability of screening to detect other changes, explanation of results and travel time) were made available.
Impaired fasting glucose in combination with silent myocardial ischaemia is associated with poor prognosis in healthy individuals
Authors: Intzilakis T. , Mouridsen M. R. , Almdal T. P. , Haugaard S. B. , Sajadieh A.
Published: March 2012

Diabet. Med. 29, e163–e169 (2012)

Aim  As both impaired fasting glucose and silent myocardial ischaemia are risk factors for cardiovascular disease and death, we hypothesized that these risk factors in combination would identify those subjects at the highest risk of adverse events.

Methods  Healthy individuals without diabetes (n = 596, 55–75 years) were examined for silent myocardial infarction (≥ 1 mm ST‐interval during ≥ 1 min) by ambulant 48‐h continuous electrocardiogram monitoring and impaired fasting glucose (fasting plasma glucose 5.6–6.9 mmol/l).

Results  After 6.3 years, 77 subjects met the endpoint of myocardial infarction and/or death. The prevalence of silent myocardial ischaemia at inclusion was 12.3% in subjects with impaired fasting glucose and 11.7% in subjects with normal fasting glucose, P = 0.69. Subjects with impaired fasting glucose/silent myocardial ischaemia more often met the endpoint (36%) than subjects with impaired fasting glucose/no silent myocardial ischaemia (15%), subjects with normal fasting glucose/silent myocardial ischaemia (12%), and subjects with normal fasting glucose/no silent myocardial ischaemia (10%), respectively, (P < 0.001). In a Cox model including these four study groups of interest, gender, age, smoking habits, blood pressure and total cholesterol, only subjects with impaired fasting glucose/silent myocardial ischaemia exhibited an increased risk of death or myocardial infarction (hazard ratio 2.5, P = 0.016).

Conclusion  The combination of impaired fasting glucose and silent myocardial ischaemia was associated with the poorest prognosis in middle‐aged and older subjects without previously known glucose metabolic aberration and heart disease.
Haemoglobin A1c, acute hyperglycaemia and short‐term prognosis in patients without diabetes following acute ST‐segment elevation myocardial infarction
Authors: Liu Y. , Yang Y.‐M. , Zhu J. , Tan H.‐Q. , Liang Y. , Li J.‐D.
Published: March 2012

Diabet. Med. 29, 1493–1500 (2012)

Aims  To assess the prognostic impact of HbA1c and blood glucose level in patients with acute ST‐segment elevation myocardial infarction and without diabetes. The relationship between HbA1c and acute hyperglycaemia was also explored.

Methods and results  We evaluated 4793 ST‐segment elevation myocardial infarction patients with baseline HbA1c and three glucose measurements in the first 24 h. First, patients were stratified into quintiles by HbA1c and mean/admission glucose level. A total of 373 deaths (7.8%) occurred at 7 days, and 486 deaths (10.1%) occurred at 30 days. There were no significant differences in 7‐ and 30‐day mortality, and major adverse cardiovascular event rates across HbA1c quintiles (< 34.4 mmol/mol (5.3% ), 34.4 to < 37.7 mmol/mol (5.6%), 37.7 to < 41.0 mmol/mol (5.9% ), 41.0 to < 47.5 mmol/mol (6.5%), and ≥ 47.5 mmol/mol; P for trend > 0.05). The risks of mortality and major adverse cardiovascular events were significantly increased in patients with higher glucose quintiles and lower quintile compared with the middle quintile after multivariable adjustment (P < 0.001). Patients were then reclassified into four groups according to mean/admission glucose and HbA1c levels. The group with elevated glucose and non‐elevated HbA1c was associated with the highest mortality and major adverse cardiovascular event risk (P < 0.001).

Conclusions  Unlike acute hyperglycaemia, an elevated HbA1c level was not a risk factor for short‐term outcomes in ST‐segment elevation myocardial infarction patients without diabetes. Patients with acute hyperglycaemia and non‐elevated HbA1c were associated with the worst prognosis. That suggests chronic glycaemic control/HbA1c level may help to recognize stress‐induced hyperglycaemia and identify high‐risk patients.
On‐Market Share Buy‐Backs: ASX Disclosure Requirements and Compliance
Authors: HOLUB MARK , MITCHELL JASON
Published: March 2012

Our paper investigates the compliance of Australian listed firms with the ASX disclosure rules for on‐market share buy‐backs. We find that firm compliance is reasonable for initial buy‐back announcements, but poor for final buy‐back notices. In the latter instance, the disclosure in the appropriate ASX notice is provided in only 53% of cases. Of significant concern is the even lower degree of final notice compliance (42%) for buy‐backs tagged as having ‘unlimited’ duration. Across our total sample of 807 buy‐backs, an alternative form of disclosure of buy‐back completion is provided in 25% of cases, and no proper notification of either the initial announcement or the completion of the buy‐back is provided in 12% of cases. In order to improve buy‐back transparency, some legislative reform of the ASX rules is suggested including: discontinuing ‘unlimited duration’ buy‐backs, restricting buy‐back periods to a maximum of twelve months (after which a new buy‐back process must be initiated), avoiding multiple simultaneous buy‐backs, removing the requirement of daily buy‐back notices in favour of more meaningful quarterly or monthly reports, and requiring greater disclosure in relation to foreign buy‐backs.