bluuebunny/crossref_metadata_2025_split huggingface dataset:
The incidence and aetiology of acute kidney injury in children in Norway between 1999 and 2008
Authors: Jenssen Gaute Reier , Hovland Eirik , Bangstad Hans‐Jacob , Nygård Karin , Vold Line , Bjerre Anna 
Published: July 2014

AbstractAimPrimary acute kidney injury (AKI) is a direct cause of hospitalisation in children, but can also result from other conditions. There is limited information on the epidemiology of this condition. Our aim was to describe the national incidence rate and aetiology of acute kidney injury in children under the age of 16 in Norway from 1999 to 2008.MethodsWe carried out a retrospective study of medical records provided by all 18 of the paediatric hospital departments that specialise in treating paediatric patients with AKI.ResultsWe identified 315 cases of AKI (53% male), with an estimated average annual incidence rate of 3.3 cases per 100 000 children and a median annual occurrence of 33 cases. Most cases (43%) were in children under five. We identified 53 aetiologies and classified these into 30 aetiological groups: 24% of the cases were prerenal (n = 75), 74% were intrinsic/renal (n = 234) and 2% were postrenal (n = 5). Nephritic syndromes was the major cause (44%) of AKI, followed by haemolytic‐uraemic syndrome (HUS) (15%).ConclusionNephritic syndromes and HUS are the most common aetiologies of AKI in Norway. Although our results could indicate a low incidence of paediatric AKI in Norway, the lack of other national studies makes comparisons difficult.
Clinical predictors of recurrent Clostridium difficile infection in out‐patients
Authors: Shivashankar R. , Khanna S. , Kammer P. P. , Scott Harmsen W. , Zinsmeister A. R. , Baddour L. M. , Pardi D. S. 
Published: July 2014

SummaryBackgroundClostridium difficile infection (CDI) recurs in 20–30% of patients.AimTo describe the predictors of recurrence in out‐patients with CDI.MethodsOut‐patient cases of CDI in Olmsted County, MN residents diagnosed between 28 June 2007 and 25 June 2010 were identified. Recurrent CDI was defined as recurrence of diarrhoea with a positive C. difficile PCR test from 15 to 56 days after the initial diagnosis with interim resolution of symptoms. Patients who had two positive tests within 14 days were excluded. Cox proportional hazard models were used to assess the association of clinical variables with time to recurrence of CDI.ResultsThe cohort included 520 out‐patients; 104 had recurrent CDI (cumulative incidence of 17.5% by 30 days). Univariate analysis identified increasing age and antibiotic use to be associated with recurrent CDI. Severe CDI, peripheral leucocyte count and change in serum creatinine >1.5‐fold were not. In a multiple variable model, concomitant antibiotic use was associated with risk of recurrent CDI (HR = 5.4, 95% CI 1.6–17.5, P = 0.005), while age (HR per 10 year increase = 1.1, 95% CI 0.9–1.3, P = 0.22); peripheral leucocyte count >15 × 109/L (HR = 1.0, 95% CI 0.5–2.1, P = 0.92); and change in serum creatinine greater than 1.5‐fold (HR = 0.8, 95% CI 0.4–1.5, P = 0.44) were not.ConclusionsAntibiotic use was independently associated with a dramatic risk of recurrent Clostridium difficile infection in an out‐patient cohort. It is important to avoid unnecessary systemic antibiotics in patients with Clostridium difficile infection, and patients with ongoing antibiotic use should be monitored closely for recurrent infection.
Adherence to UK national guidance for discharge information: an audit in primary care
Authors: Hammad Eman A. , Wright David John , Walton Christine , Nunney Ian , Bhattacharya Debi 
Published: July 2014

AimsPoor communication of clinical information between healthcare settings is associated with patient harm. In 2008, the UK National Prescribing Centre (NPC) issued guidance regarding the minimum information to be communicated upon hospital discharge. This study evaluates the extent of adherence to this guidance and identifies predictors of adherence.MethodsThis was an audit of discharge summaries received by medical practices in one UK primary care trust of patients hospitalized for 24 h or longer. Each discharge summary was scored against the applicable NPC criteria which were organized into: ‘patient, admission and discharge’, ‘medicine’ and ‘therapy change’ information.ResultsOf 3444 discharge summaries audited, 2421 (70.3%) were from two teaching hospitals and 906 (26.3%) from three district hospitals. Unplanned admissions accounted for 2168 (63.0%) of the audit sample and 74.6% (2570) of discharge summaries were electronic. Mean (95% CI) adherence to the total NPC minimum dataset was 71.7% [70.2, 73.2]. Adherence to patient, admission and discharge information was 77.3% (95% CI 77.0, 77.7), 67.2% (95% CI 66.3, 68.2) for medicine information and 48.9% (95% CI 47.5, 50.3) for therapy change information. Allergy status, co‐morbidities, medication history and rationale for therapy change were the most frequent omissions. Predictors of adherence included quality of the discharge template, electronic discharge summaries and smaller numbers of prescribed medicines.ConclusionsDespite clear guidance regarding the content of discharge information, omissions are frequent. Adherence to the NPC minimum dataset might be improved by using comprehensive electronic discharge templates and implementation of effective medicines reconciliation at both sides of the health interface.
Safety, local tolerability and pharmacokinetics of ceftaroline fosamil administered in a reduced infusion volume
Authors: Edeki Timi , Kujacic Mirjana , Broadhurst Helen , Li Jianguo , Sunzel Maria 
Published: July 2014

AimsThe standard dose of ceftaroline fosamil for patients with normal renal function is 600 mg diluted in 250 ml by 60 min intravenous infusion every 12 h. This two part phase I trial (NCT01577589) assessed safety and local tolerability of multiple ceftaroline fosamil 50 ml and 250 ml infusions, and pharmacokinetics following single administrations of each infusion volume.MethodsPart A was a placebo‐controlled, double‐blind, multiple dose crossover study. Twenty‐four healthy subjects were randomized to simultaneous, bilateral ceftaroline fosamil 600 mg and placebo infusions in each arm (50 ml then 250 ml or vice versa) every 12 h for 72 h, with a ≥ 4.5 day washout. Local tolerability was evaluated by the Visual Infusion Phlebitis scale, with scores ≥2 considered infusion site reactions (ISRs). Part B was an open label crossover study. Ten subjects were randomized to single 50 ml and 250 ml ceftaroline fosamil 600 mg infusions on days 1 and 3 (washout on day 2). Blood samples for pharmacokinetic analysis were taken over 24 h.ResultsIn part A, four subjects (16.7%) experienced ISRs, all of which were associated with placebo infusions. No ISRs were reported for either ceftaroline fosamil 50 ml or 250 ml. Plasma pharmacokinetics (ceftaroline fosamil, active ceftaroline and an inactive metabolite) were similar following single 50 ml and 250 ml infusions in part B.ConclusionsNo new safety concerns were identified for ceftaroline fosamil 600 mg 50 ml compared with 250 ml. These findings suggest infusion volumes down to 50 ml may be used in patients with fluid intake restrictions.
The presence of mast cell clonality in patients with unexplained anaphylaxis
Authors: Gülen T. , Hägglund H. , Sander B. , Dahlén B. , Nilsson G. 
Published: July 2014

SummaryBackgroundThe mechanisms by which mast cells in patients with unexplained anaphylaxis (UEA) are triggered remain elusive. Onset of episodes is unpredictable and often recurrent. The substantial overlap between the clinical manifestations ofUEAand clonal mast cell disorders (CMD) suggests an association between these rare disorders. The two forms ofCMDcharacterized to date are systemic mastocytosis (SM) and monoclonal mast cell activation syndrome (MMAS).ObjectiveTo examine the hypothesis that the pathogenesis ofUEAreflects the presence of aberrant subpopulations of mast cells.MethodsThirty (14 men, 16 women) patients (≥ 18 years) suffering from UEA and with no signs of cutaneous mastocytosis were recruited. Patients underwent an initial complete allergy work‐up to confirm the diagnosis of UEA. Level of baseline serum tryptase (sBT) and total IgE were determined. In addition, a bone marrow examination was performed on all 30 patients to investigate possible underlying CMD.ResultsFourteen (47%) of our cases (nine men, five women) were diagnosed with CMD: 10 with SM and four with MMAS. Four of the 10 patients with SM had mast cell aggregates in their bone marrow. All patients with SM exhibited a sBT level > 11.4 ng/mL, whereas this level was elevated in only two of those with MMAS and four with UAE but not diagnosed with CMD. Total IgE levels were lower in the group of patients with CMD (P < 0.03).Conclusion and Clinical RelevanceThe pathogenic mechanism underlying UEA could be explained by the presence of immunophenotypically aberrant mast cells with clonal markers in 47% of our subjects, indicating that clonal mast cell disorders are present in a substantial subset of these patients. Thus, the presence of CMD should be considered in patients with UEA if they have an elevated level of sBT (≥ 11.4 ng/mL) and cardiovascular symptoms such as syncope.
Successful immunotherapy of autoimmune cholangitis by adoptive transfer of forkhead box protein 3+ regulatory T cells
Authors: Tanaka H , Zhang W , Yang G-X , Ando Y , Tomiyama T , Tsuneyama K , Leung P , Coppel R L , Ansari A A , Lian Z X , Ridgway W M , Joh T , Gershwin M E 
Published: July 2014

Summary
Treatment of primary biliary cirrhosis (PBC) has lagged behind that of other autoimmune diseases. In this study we have addressed the potential utility of immunotherapy using regulatory T cells (Treg) to treat murine autoimmune cholangitis. In particular, we have taken advantage of our ability to produce portal inflammation and bile duct cell loss by transfer of CD8+T cells from the dominant negative form of transforming growth factor beta receptor type II (dnTGF-βRII) mice to recombination-activating gene (Rag)1–/– recipients. We then used this robust established adoptive transfer system and co-transferred CD8+T cells from dnTGF-βRII mice with either C57BL/6 or dnTGF-βRII forkhead box protein 3 (FoxP3+) T cells. Recipient mice were monitored for histology, including portal inflammation and intralobular biliary cell damage, and also included a study of the phenotypical changes in recipient lymphoid populations and local and systemic cytokine production. Importantly, we report herein that adoptive transfer of Treg from C57BL/6 but not dnTGF-βRII mice significantly reduced the pathology of autoimmune cholangitis, including decreased portal inflammation and bile duct damage as well as down-regulation of the secondary inflammatory response. Further, to define the mechanism of action that explains the differential ability of C57BL/6 Tregversus dnTGF-βRII Treg on the ability to down-regulate autoimmune cholangitis, we noted significant differential expression of glycoprotein A repetitions predominant (GARP), CD73, CD101 and CD103 and a functionally significant increase in interleukin (IL)-10 in Treg from C57BL/6 compared to dnTGF-βRII mice. Our data reflect the therapeutic potential of wild-type CD4+FoxP3+Treg in reducing the excessive T cell responses of autoimmune cholangitis, which has significance for the potential immunotherapy of PBC.
Defending plasma T3 is a biological priority
Authors: Abdalla Sherine M. , Bianco Antonio C. 
Published: July 2014

SummaryTriiodothyronine (T3), the active form of thyroid hormone is produced predominantly outside the thyroid parenchyma secondary to peripheral tissue deiodination of thyroxine (T4), with <20% being secreted directly from the thyroid. In healthy individuals, plasma T3 is regulated by the negative feedback loop of the hypothalamus–pituitary–thyroid axis and by homoeostatic changes in deiodinase expression. Therefore, with the exception of a minimal circadian rhythmicity, serum T3 levels are stable over long periods of time. Studies in rodents indicate that different levels of genetic disruption of the feedback mechanism and deiodinase system are met with increase in serum T4 and thyroid‐stimulating hormone (TSH) levels, while serum T3 levels remain stable. These findings have focused attention on serum T3 levels in patients with thyroid disease, with important clinical implications affecting therapeutic goals and choice of therapy for patients with hypothyroidism. Although monotherapy with levothyroxine is the standard of care for hypothyroidism, not all patients normalize serum T3 levels with many advocating for combination therapy with levothyroxine and liothyronine. The latter could be relevant for a significant number of patients that remain symptomatic on monotherapy with levothyroxine, despite normalization of serum TSH levels.
Cross‐sectional associations of acylation stimulating protein (ASP) and adipose tissue gene expression with estradiol and progesterone in pre‐ and postmenopausal women
Authors: Rezvani Reza , Gupta Abhishek , Smith Jessica , Poursharifi Pegah , Marceau Picard , Pérusse Louis , Bouchard Claude , Tchernof André , Cianflone Katherine 
Published: July 2014

SummaryObjectiveSex steroid hormones play an important regulatory role in fat metabolism and obesity. We hypothesized involvement of interactions between ovarian hormones with acylation stimulating protein (ASP).Design, patients and measurementsIn 392 women with wide age (18–69 years) and body size (BMI: 17 to 90 kg/m2) ranges, fasting plasma levels of ASP, ovarian hormones, glucose, adiponectin and lipids/apolipoproteins were assessed, along with determination of metabolic syndrome (MS) features. Gene expression of C3 (ASP precursor) and related receptors C5L2, C3aR and C5aR in subcutaneous and omental adipose tissues was measured in a subset.ResultsAcylation stimulating protein correlated negatively with concentrations of estradiol (P < 0·0001), adiponectin (P < 0·001) and apolipoprotein A1 (P < 0·001) and positively with apolipoprotein B levels (P < 0·001), systolic blood pressure (P < 0·001), waist circumference (P < 0·001), and triglyceride concentrations (P < 0·01). In age‐matched groups of lean, overweight, metabolically healthy obese (MHO) and obese with metabolic syndrome (MSO), there was a stepwise increase in ASP levels (P < 0·001) while concentrations of adiponectin (P < 0·0001) and estradiol (P < 0·001) but not those of progesterone decreased. Progesterone but not estradiol levels correlated positively with C3 gene expression in omental adipose tissue (P < 0·05) and negatively with C5L2 expression in both omental (P < 0·01) and subcutaneous (P < 0·05) adipose tissues.ConclusionOur results are consistent with the concept that sex hormones differentially influence circulating ASP and adipose tissue gene expression of its related proteins in a depot‐specific manner. ASP may play a role in the regulation of regional fat metabolism through interactions with sex hormones in women.
The spectrum of clinical, hormonal and molecular findings in 280 individuals with nonclassical congenital adrenal hyperplasia caused by mutations of the CYP21A2 gene
Authors: Livadas S. , Dracopoulou M. , Dastamani A. , Sertedaki A. , Maniati‐Christidi M. , Magiakou A.‐M. , Kanaka‐Gantenbein C. , Chrousos G.P. , Dacou‐Voutetakis C. 
Published: July 2014

SummaryBackgroundNonclassical congenital adrenal hyperplasia (NC‐CAH) is caused by mutations of the CYP21A2 gene. The clinical manifestations and hormonal derangements of NC‐CAH are quite variable.Objectives(i) To define the phenotype and its relation to genotype according to gender and age and (ii) to evaluate the validity of currently applied hormonal criteria for establishing the diagnosis of NC‐CAH.Patients and MethodsThe clinical, hormonal and molecular data of 280 subjects (235 female) with NC‐CAH and a median age of 17·6 years were analysed. CYP21A2 genotyping was performed in all subjects.ResultsThe majority of females aged less than 8 years presented with premature pubarche (88·3%), while those older than 8 presented with a polycystic ovary‐like phenotype (63·2%). A total of 7·7% of the females and 51·1% of the males were asymptomatic at the time of diagnosis. In the total group, 50·4% of the subjects were compound heterozygotes for one classical (C) and one nonclassical (NC) mutation, while 46% of the alleles studied carried the p.V281L mutation. Basal 17OHP values were below 6 nm (2 ng/ml) in 2·1% of the subjects with NC‐CAH, but none had peak 17OHP values post‐ACTH lower than 30 nm (10 ng/ml).ConclusionsNC‐CAH has a variable phenotype depending on the age, gender and the presence of a classical mutation. A peak cut‐off value of 17OHP post‐ACTH lower than 30 nm excludes the diagnosis of NC‐CAH, whereas basal 17OHP <6 nm may represent a false‐negative result. A significant number of patients harboured a classical mutation, a finding which requires genotyping of the partner for genetic counselling.
The Effect of Age on Right Ventricular Diastolic Function in Healthy Subjects Undergoing Treadmill Exercise Test
Authors: Celik Murat , Yalcinkaya Emre , Yuksel Uygar Cagdas , Gokoglan Yalcin , Bugan Baris , Kabul Hasan Kutsi , Barcin Cem 
Published: July 2014

ObjectiveThere is an increasing interest for the value of right ventricle (RV) in predicting exercise tolerance and prognosis in cardiovascular disease. However, there is relatively few data evaluating the effect of age on RV diastolic filling velocities during rest or exercise in healthy subjects.MethodsA total of 54 healthy subjects were enrolled in this study. Patients were divided into 2 groups according to their age: Group 1 (≤45‐years‐old) and Group 2 (>45‐years‐old). A treadmill exercise test was performed using modified Bruce protocol. Conventional pulsed‐wave Doppler and tissue Doppler velocities were obtained both at rest and immediately after the end of exercise, respectively.ResultsIn the overall analysis, tricuspid flow Doppler analysis showed a significant increase in A‐wave velocity, less marked rise in E‐wave velocity, decreased E/A ratio and decreased E‐wave deceleration time (EDT) with exercise. Tissue Doppler analysis revealed increased Aa velocity, decreased in Ea/Aa ratio and IVRT. No significant change was observed in Ea velocity and E/Ea ratio with exercise. Although diastolic velocities changed significantly with exercise, systolic velocities did not. Cardiac response to exercise differed slightly in the older subjects compared to younger ones. The older subjects were more likely to have a reduced mean rate of RV filling for the second half of diastole from baseline to peak exercise.ConclusionTo distinguish normal physiological changes due to aging from those of pathologic conditions may provide benefits while evaluating patients with known or suspected cardiovascular disease.
Effect of Remote Ischemic Postconditioning on Left Ventricular Mechanics
Authors: Nacar Alper Bugra , Topcu Selim , Kurt Mustafa , Tanboga Ibrahim Halil , Karakaş Mehmet Fatih , Buyukkaya Eyup , Aksakal Enbiya , Sen Nihat , Akcay Adnan Burak , Bilen Emine 
Published: July 2014

BackgroundRemote ischemic postconditioning (RIPC) decreases infarct size and prevents left ventricular (LV) remodeling in patients with myocardial infarction. However, there is no study that evaluates the effect of RIPC on LV mechanics assessed by speckle tracking echocardiography. Therefore, we aimed to test the effects of RIPC on LV deformation parameters such as strain, strain rate, rotation, and twist in healthy subjects.MethodsThe study group consisted of 22 healthy subjects. To test the effects of RIPC, 3 cycles of reperfusion followed by ischemia (each lasting 10 or 30 seconds) were applied immediately after 20 minutes of nondominant arm ischemia. Transthoracic echocardiography (TTE) was obtained at baseline and repeated 30 minutes after the completion of these cycles. In TTE images, apical 4‐3‐2 chamber longitudinal strain (LS)/strain rate, basal and apical circumferential strain/strain rate, and rotational parameters, such as basal rotation, apical rotation, and LV twist, were recorded.ResultsApical 4‐3‐2 chamber LS and apical circumferential strain/strain rate measurements were comparable before and after RIPC, whereas basal circumferential strain was significantly decreased after RIPC (−23 ± 3.4 vs. −18.9 ± 6.9, P = 0.017). After RIPC, apical rotation was significantly increased (11.6 ± 3.7 vs. 16.7 ± 4.0, P < 0.001) and basal rotation was significantly decreased (−6.1 ± 2.1 vs. −4.7 ± 2.4, P = 0.03).Consequently, net LV twist was significantly increased (17.4 ± 4.5 vs. 21.7 ± 4.7).ConclusionsWe proposed that RIPC affects the rotational mechanics of the heart rather than longitudinal mechanics. These results might give new insights into understanding the favorable effects of the post‐ conditioning.
Host preference and suitability of grasses for Oebalus pugnax
Authors: Awuni G.A. , Gore J. , Cook D. , Bond J.A. , Musser F.R. , Adams C.A. 
Published: July 2014

AbstractThe rice stink bug, Oebalus pugnax (Fabricius) (Hemiptera: Pentatomidae: Carpocorini), though graminaceous, discriminates among its numerous host grass species. This could represent a feeding preference, it could be related to host suitability for growth and development. To clarify the role of host grass discrimination, two laboratory studies were conducted: (1) free‐choice tests to evaluate preferences of O. pugnax among 11 wild host grass species found in three rice‐producing counties of the central Mississippi Delta (MS, USA), and (2) no‐choice tests to evaluate the impact of rice (Oryza sativa L.), junglerice [Echinochloa colona (L.) Link], and dallisgrass (Paspalum dilatatum Poir.) (all Poaceae), on the development of O. pugnax from second instar to adult. In the free‐choice test, four experiments were conducted, each with four sets of host grass species and observed 1, 2, 4, 8, and 16 h after release in cages. Approximately 4 h was necessary for O. pugnax to settle on preferred host grasses. Oebalus pugnax showed a feeding preference for junglerice over all 10 other grass species. Bahiagrass, Paspalum notatum Flueggé, was the least preferred. The no‐choice tests showed significant effect of host grass species on O. pugnax mean development time of nymphal survival to adults. Survival of nymphs was lower and mean development time was longer on dallisgrass compared to rice and junglerice. Knowledge of O. pugnax rate of growth and development on host grasses could be useful in the future development of rice integrated pest management strategies.