bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Asian perspective on improving outcomes for nasal bone fractures by establishing specific treatment options
Authors: Yi J.S. , Kim M.J. , Jang Y.J. 
Published: April 2016

ObjectiveTo report treatment outcomes of patients with different types of nasal bone fracture, following a tailored treatment protocol.DesignThe patterns and the severity of the fractures were determined by a preoperative facial photo and nasal bone computed tomography (CT) retrospectively.SettingA tertiary referral centre.ParticipantsWe evaluated 129 patients who underwent surgery between March 2002 and January 2014. Patients were subjected to five different treatment methods depending on the severity of injury.Main outcome measuresMedical records were reviewed to assess rates of complications and revision surgery. Cosmetic and functional (the degree of nasal obstruction) outcomes were measured using the Likert scale from 1 (very dissatisfied, severe obstruction) to 5 (very satisfied, no obstruction).ResultsThe mean elapsed time from injury to surgery was 14.9 days. The overall treatment failure rate, defined as a deformity that required revision, was 6.2%. The patient satisfaction scores for aesthetic and functional outcomes were 3.9 and 4.6 respectively.ConclusionThe prudent selection of patients with indication for closed reduction, and further specification of variable treatment options for the various degrees of nasal bone fracture, may be helpful in achieving an improved treatment outcome.Level of evidence: level IV.
Management of pouch dysfunction in a tertiary centre
Authors: Ourô S. , Thava B. , Shaikh I. , Clark S. K. 
Published: April 2016

AbstractAimRestorative proctocolectomy (RPC) with ileal pouch–anal anastomosis is the operation of choice for ulcerative colitis (UC) and some cases of familial adenomatous polyposis (FAP). Although it offers improvement in quality of life and high patient satisfaction, pouch surgery is also associated with significant morbidity. The aim of this study was to describe the management of patients referred to a tertiary centre with pouch dysfunction.MethodAll patients referred with pouch dysfunction from other institutions between October 2006 and November 2014 were included in this retrospective study. Information regarding initial diagnosis before RPC, type of procedure, symptoms leading to referral, relation of the appearance of symptoms to the ileostomy closure, investigations, final diagnosis, treatment and follow‐up was reviewed.ResultsOne hundred and twenty‐one patients were included, having had RPC mostly for UC (94%), and with diverting ileostomy (83%). The most frequent reasons for referral were high frequency of defaecation in 83 (69%) patients, abdominal pain and incontinence in 45 (37%) each and perianal pain in 44 (36%). The principal investigations performed were pouchoscopy in 97 (80%) patients, examination under anaesthesia (EUA) in 62 (51%), pelvic magnetic resonance imaging (MRI) in 56 (46%) and contrast radiology of the pouch (pouchogram) in 45 (35%). The commonest diagnoses were pouchitis (primary and secondary) in 24 (21%) patients and anastomotic leakage in 26 (22%). After full investigation a cause for the symptoms could not be found in 24 (20%) patients, resulting in the diagnosis of exclusion of ‘irritable pouch syndrome’ or functional disorder. The treatments given were long‐term antibiotic therapy in 29 (25%) patients, ileostomy in 19 (16%), use of a Medena catheter to promote anal evacuation in 17 (15%) and dilatation of a stenosis under anaesthetic in 12 (10%). Six (5%) patients underwent major revision surgery of the pouch with a defunctioning ileostomy and the pouch was excised in another six (5%).ConclusionPatients with ileoanal pouch dysfunction often have multiple symptoms. This study shows that a wide range of investigations and treatment modalities need to be available to manage such patients, with a specialized approach in a multidisciplinary setting.
Development and reliability of the Functional Communication Classification System for children with cerebral palsy
Authors: Barty Elizabeth , Caynes Katy , Johnston Leanne M 
Published: April 2016

AimThis paper describes the development, validation, and reliability of the Functional Communication Classification System (FCCS), designed to classify expressive communication skills of children with cerebral palsy (CP) aged 4 years and 5 years (between their fourth and sixth birthdays).MethodThe Functional Communication Classification System (FCCS) was developed in 2006 using a literature review, client file audit, and expert consultative committee process in order to devise scale content, structure, and check clinical validity and utility. Interrater reliability was examined between speech–language pathologists (SLPs), other allied health professionals (AHPs), and parents of 48 children with CP. The scale was revised and a clinical reasoning prompt sheet added, then trialled again for 42 children. The result was a five‐level system with descriptors and decision‐making guides for classification of functional expressive communication for children with CP.ResultsOverall interrater reliability was excellent for the final FCCS, intraclass correlation coefficient=0.97 (95% confidence interval 0.95 to 0.98). Kappa values were 0.94 between SLPs and AHPs, 0.59 between SLPs and parents, and 0.60 between AHPs and parents.InterpretationThe FCCS is a reliable tool for describing functional communication in young children with CP, appropriate for use by SLPs, other AHPs, and parents of children with CP.
Examining factors associated with excess mortality in older people (age ≥ 70 years) with diabetes – a 10‐year cohort study of older people with and without diabetes
Authors: Forbes A. , Murrells T. , Sinclair A. J. 
Published: April 2016

AbstractAimsTo compare all‐cause mortality in older people with or without diabetes and consider the associated risk of comorbidity and polypharmacy.MethodsA 10‐year cohort study using data from the Health Innovation Network database (2003–2013) comparing mortality in people aged ≥ 70 years with diabetes (DM cohort) (n = 35 717) and without diabetes (No DM cohort) (n = 307 918).ResultsThe mean age of the DM cohort was 78.1 ± 5.8 years vs. 79.0 ± 6.3 years in the No DM cohort. Mean diabetes duration was 8.2 ± 8.1 years, and 30% had diabetes for > 10 years. The DM cohort had a greater comorbidity load and people in this cohort were prescribed more therapies than the No DM cohort. The 5‐ and 10‐year survival rates were lower in the DM cohort at 64% and 39%, respectively, compared with 72% and 50% in the No DM cohort. The excess mortality in the DM cohort was greatest in those aged < 75 years with longer duration diabetes, the relative hazard for mortality was higher in females. Although comorbidity and polypharmacy were associated with increased mortality risk in the DM cohort, this risk was lower compared with the No DM cohort. The hazard ratios (95% confidence interval) for comorbidities > 4 and medicines ≥ 7 were 1.29 (1.19 to 1.41) and 1.34 (1.25 to 1.43) in the DM cohort and 1.63 (1.57 to 1.70) and 1.48 (1.40 to 1.56) in the No DM cohort, respectively.ConclusionsThere is significant excess mortality in older people with diabetes, which is unexplained by comorbidity or polypharmacy. This excess is greatest in the younger old with longer disease duration, suggesting that it may be related to the effect of diabetes exposure.
Disclosure of Type 1 diabetes at work among Finnish workers
Authors: Hakkarainen P. , Moilanen L. , Hänninen V. , Räsänen K. , Munir F. 
Published: April 2016

AbstractAimsTo determine which self‐management factors and psychosocial work factors were associated with disclosing diabetes to colleagues, line managers and occupational health personnel among workers with Type 1 diabetes.MethodsA total of 767 working‐aged respondents with Type 1 diabetes completed a Finnish cross‐sectional survey named ‘People with Type 1 Diabetes in Worklife’. Factor analysis was carried out, followed by logistic regressions to estimate the associations between self‐management factors, psychosocial work factors and the likelihood of disclosure separately to colleagues, line managers and occupational health personnel. The models were adjusted for sociodemographic, diabetes‐related and work‐related variables.ResultsA total of 52% of the respondents had disclosed their diabetes to their colleagues, 45% to occupational health personnel and 28% to their line manager. Receiving social support and having good psychosocial work ability were significantly associated with disclosure to colleagues, line managers and occupational health personnel. Relations at work were associated with disclosure to colleagues and the line manager. Furthermore, opportunity to self‐manage diabetes at work was associated with disclosure to colleagues.ConclusionsLine managers and colleagues have a remarkable role to play in providing workplace support to workers with Type 1 diabetes. Disclosure of Type 1 diabetes should be encouraged as line managers can provide workers with the right support, implement work adaptations and facilitate job retention. As only half of respondents disclosed their Type 1 diabetes at work, further research is required into the reasons for and consequences of not disclosing a diagnosis.
Correlates of psychological outcomes among family members of people with diabetes in the second Diabetes Attitudes, Wishes and Needs (DAWN2™) study
Authors: Kovacs Burns K. , Holt R. I. G. , Nicolucci A. , Lucisano G. , Skovlund S. E. , Comaschi M. , Vallis M. , Peyrot M. 
Published: April 2016

AbstractAimsTo conduct a second Diabetes Attitudes, Wishes and Needs (DAWN2™) study, examining the experiences of family members caring for adults with diabetes in order to identify correlates of family member psychological outcomes (generic psychological well‐being, perceived quality of life, and diabetes‐related burden, impact and distress).MethodsA total of 2057 family members living with a person with diabetes and involved in their care participated in an online, telephone or in‐person survey. Samples of 120 respondents were recruited in each of 17 countries. Significant (P < 0.05) correlates of psychological outcomes were identified by multi‐level multiple regression.ResultsOutcomes were worse for family members not working because of diabetes or those who had other competing obligations. Outcomes were worse if the person with diabetes was not a partner or parent, used injected diabetes medication, or had more frequent hypoglycaemia. Outcomes were worse for family members who believed that diabetes was more severe, were more involved in diabetes care, had more conflict over diabetes care or were frustrated about not knowing how to help the person with diabetes. Outcomes were better for those who had greater support from others and felt they found good ways to help the person with diabetes. There were significant differences in outcomes among countries before and after adjustment for individual characteristics, and correlates of outcomes varied by country.ConclusionsSeveral modifiable risk and protective factors for family member psychological outcomes were identified in this study. Diabetes education and social support were associated with improved outcomes, especially if they were helpful in supporting people with diabetes.
Localized insulin amyloidosis with use of concentrated insulin: a potential complication
Authors: Mangla A. , Kim G. J. , Agarwal N. , Khurana S. , Catchatourian R. , Jiang J. J. 
Published: April 2016

AbstractBackgroundInsulin‐derived amyloidosis is a rare form of amyloidosis composed of insulin fibrils. The pH and concentration of insulin are known to influence the conformational state of the insulin hormone, with an increasing concentration favouring a more complex conformation. Concentrated insulin delivers a large amount of insulin to a localized area, raising the possibility of inducing conformational changes, forming insulin fibrils and leading to localized insulin amyloidosis.Case reportA middle‐aged woman with long history of Type 2 diabetes mellitus, treated with concentrated human insulin (U‐500 insulin) presented with nodular lesions at the site of her daily insulin injections. A punch biopsy of the nodules showed skin with dermal amyloidosis staining favourably with Congo Red stain. The amyloid tumours were resected and areas positive for Congo Red stain were sent for liquid chromatography tandem mass spectrometry, which showed a peptide profile consistent with amyloid insulin.ConclusionConcentrated insulin was first introduced in 1952, however, it is only over the last two decades that it has been used increasingly, in congruence with the increasing incidence of obesity and diabetes mellitus seen in the USA. Only a few cases of insulin amyloidosis at the site of injection have been described in literature. With the increase in the use of insulin, this complication seems to be occurring more frequently. This is the first case report of a person with diabetes mellitus who developed localized insulin amyloidosis with the use of concentrated insulin, and points towards a potential complication of developing insulin amyloidosis with the use of concentrated insulin.
Patient involvement in the development of a handbook for moderate rheumatoid arthritis
Authors: Prothero Louise , Georgopoulou Sofia , de Souza Savia , Bosworth Ailsa , Bearne Lindsay , Lempp Heidi 
Published: April 2016

AbstractBackgroundSelf‐management is a key recommendation for people with rheumatoid arthritis (RA). Educational materials may support self‐management, and increasingly patients are becoming involved with the development of these materials. The TITRATE trial compares the effectiveness of intensive management to standard care in patients with moderate RA across England. As part of the intensive management intervention, participants are given a handbook.Aim and objectivesThe aim of this study was to develop a handbook to support the intensive management. The objectives were to: (i) involve patients in the identification of relevant information for inclusion in the TITRATE handbook; (ii) ensure the content of the handbook is acceptable and accessible.DesignWe held an audio‐taped workshop with RA patients. The transcript of the workshop was analysed using thematic content analysis.ResultsFive main themes were identified as follows: ‘rheumatoid arthritis treatment, perceptions of rheumatoid arthritis, the importance of individualized goals, benefits of self‐management and the patient handbook’. Feedback from the workshop was incorporated into the handbook, and patients’ anonymous testimonies were added.ConclusionThis study demonstrates that patient contribution to the development of educational material to support intensive management of RA is both feasible and valuable. A qualitative evaluation of the use and impact of the handbook with patients and practitioners is planned on completion of the TITRATE trial.
Lymph node – an organ for T‐cell activation and pathogen defense
Authors: Gasteiger Georg , Ataide Marco , Kastenmüller Wolfgang 
Published: April 2016

SummaryThe immune system is a multicentered organ that is characterized by intimate interactions between its cellular components to efficiently ward off invading pathogens. A key constituent of this organ system is the distinct migratory activity of its cellular elements. The lymph node represents a pivotal meeting point of immune cells where adaptive immunity is induced and regulated. Additionally, besides barrier tissues, the lymph node is a critical organ where invading pathogens need to be eliminated in order to prevent systemic distribution of virulent microbes. Here, we explain how the lymph node is structurally and functionally organized to fulfill these two critical functions – pathogen defense and orchestration of adaptive immunity. We will discuss spatio‐temporal aspects of cellular immune responses focusing on CD8 T cells and review how and where these cells are activated in the context of viral infections, as well as how viral antigen expression kinetics and different antigen presentation pathways are involved. Finally, we will describe how such responses are regulated and ‘helped’, and discuss how this relates to intranodal positioning and cellular migration of the various cellular components that are involved in these processes.
Tertiary lymphoid structures, drivers of the anti‐tumor responses in human cancers
Authors: Dieu‐Nosjean Marie‐Caroline , Giraldo Nicolas A. , Kaplon Hélène , Germain Claire , Fridman Wolf Herman , Sautès‐Fridman Catherine 
Published: April 2016

SummaryThe characterization of the microenvironment of human tumors led to the description of tertiary lymphoid structures (TLS) characterized by mature dendritic cells in a T‐cell zone adjacent to B‐cell follicle including a germinal center. TLS represent sites of lymphoid neogenesis that develop in most solid cancers. Analysis of the current literature shows that the TLS presence is associated with a favorable clinical outcome for cancer patients, regardless of the approach used to quantify TLS and the stage of the disease. Using several approaches that combine immunohistochemistry, gene expression assays, and flow cytometry on large series of lung tumors, our work demonstrated that TLS are important sites for the initiation and/or maintenance of the local and systemic T‐ and B‐cell responses against tumors. Surrounded by high endothelial venules, they represent a privileged area for the recruitment of lymphocytes into tumors and generation of central‐memory T and B cells that circulate and limit cancer progression. TLS can be considered as a novel biomarker to stratify the overall survival risk of untreated cancer patients and as a marker of efficient immunotherapies. The induction and manipulation of cancer‐associated TLS using drug agonists and/or biotherapies should open new avenues to treat cancer patients.
Control of the thymic medulla and its influence on αβT‐cell development
Authors: Lucas Beth , McCarthy Nicholas I. , Baik Song , Cosway Emilie , James Kieran D. , Parnell Sonia M. , White Andrea J. , Jenkinson William E. , Anderson Graham 
Published: April 2016

SummaryThe thymus is a primary lymphoid tissue that supports the generation of αβT cells. In this review, we describe the processes that give rise to the thymus medulla, a site that nurtures self‐tolerant T‐cell generation following positive selection events that take place in the cortex. To summarize the developmental pathways that generate medullary thymic epithelial cells (mTEC) from their immature progenitors, we describe work on both the initial emergence of the medulla during embryogenesis, and the maintenance of the medulla during postnatal stages. We also investigate the varying roles that receptors belonging to the tumor necrosis factor receptor superfamily have on thymus medulla development and formation, and highlight the impact that T‐cell development has on thymus medulla formation. Finally, we examine the evidence that the thymic medulla plays an important role during the intrathymic generation of distinct αβT‐cell subtypes. Collectively, these studies provide new insight into the development and functional importance of medullary microenvironments during self‐tolerant T‐cell production in the thymus.
Thymocytes self‐renewal: a major hope or a major threat?
Authors: Peaudecerf Laetitia , Krenn Gerald , Gonçalves Pedro , Vasseur Florence , Rocha Benedita 
Published: April 2016

SummaryThymus transplants were never used to correct T‐cell intrinsic deficiencies, as it is generally believed that thymocytes have short intrinsic lifespans. This notion is based on multiple thymus transplantation experiments, where it was shown that thymus‐resident cells were rapidly replaced by progenitors migrating from the bone marrow (BM). This substitution occurs even when bone marrow precursors are unable to generate T cells, as in Rag1/2− or severe combined immunodeficiency (SCID)‐deficient mice. In contrast, two groups reported that neonatal thymi transplanted into mice that cannot respond to IL‐7 harbor populations with extensive capacity to self‐renew, which maintain continuous thymocyte generation for several months after surgery. The consequences of this self‐renewal capacity differed in these two laboratories. We found that these thymus transplants rapidly reconstitute the full diversity of peripheral T‐cell repertoires 1 month after surgery, the earliest time point studied. Moreover, transplantation experiments performed across major histocompatibility barriers show that allogeneic‐transplanted thymi are not rejected, and allogeneic cells do not induce graft‐versus‐host disease, both syngeneic and allogeneic transplants inducing rapid protection from infection. These results indicate a potential use of neonatal thymus transplants to correct T‐cell intrinsic deficiencies. The other group observed that continuous thymocyte renewal from BM precursors was fundamental to prevent tumor development. In the absence of this input, thymocytes from the transplanted thymus generated tumors with all the characteristics of T‐cell acute lymphoblastic leukemia (T‐ALL). Moreover, they suggested that the absence of BM competition was responsible for the T‐ALLs developing in X‐linked severe combined immunodeficiency (SCID)‐X1 patients, deficient in the expression of IL2‐Rγc. These patients were treated with autologous CD34+ cells transfected with virus vectors expressing γc in the absence of myeloablation. We here review the potential therapeutic impact of thymus transplantation and compare the results of these two laboratories aiming to find an answer to the ‘Dr Jekill versus Mr. Hyde’ status of thymus transplantation experiments.
Dendritic cells in remodeling of lymph nodes during immune responses
Authors: Acton Sophie E. , Reis e Sousa Caetano 
Published: April 2016

SummaryA critical hallmark of adaptive immune responses is the rapid and extensive expansion of lymph nodes. During this process, the complex internal structure of the organs is maintained revealing the existence of mechanisms able to balance lymph node integrity with structural flexibility. This article reviews the extensive architectural remodeling that occurs within lymph nodes during adaptive immune responses and how it is regulated by dendritic cells (DCs). In particular we focus on previously unappreciated functions of DCs in coordinating remodeling of lymph node vasculature, expansion of the fibroblastic reticular network and maintenance of lymphoid stromal phenotypes. Our increased understanding of these processes indicates that DCs need to be viewed not only as key antigen‐presenting cells for lymphocytes but also as broad‐acting immune sentinels that convey signals to lymphoid organ stroma and thereby facilitate immune response initiation at multiple levels.
Autoimmune regulator and self‐tolerance – molecular and clinical aspects
Authors: Abramson Jakub , Husebye Eystein S. 
Published: April 2016

SummaryThe establishment of central tolerance in the thymus is critical for avoiding deleterious autoimmune diseases. Autoimmune regulator (AIRE), the causative gene in autoimmune polyendocrine syndrome type‐1 (APS‐1), is crucial for the establishment of self‐tolerance in the thymus by promoting promiscuous expression of a wide array of tissue‐restricted self‐antigens. This step is critical for elimination of high‐affinity self‐reactive T cells from the immunological repertoire, and for the induction of a specific subset of Foxp3+ T‐regulatory (Treg) cells. In this review, we discuss the most recent advances in our understanding of how AIRE operates on molecular and cellular levels, as well as of how its loss of function results in breakdown of self‐tolerance mechanisms characterized by a broad and heterogeneous repertoire of autoimmune phenotypes.