bluuebunny/crossref_metadata_2025_split huggingface dataset:
Combined low-dose mycophenolate mofetil and tacrolimus for lupus nephritis with suboptimal response to standard therapy: a 12-month prospective study
Authors: Mok CC , To CH , Yu KL , Ho LY 
Published: August 2013

Objective The objective of this paper is to evaluate the efficacy of combined mycophenolate mofetil (MMF) and tacrolimus (TAC) for lupus nephritis with suboptimal response to standard therapy. Methods Inclusion criteria for patients: (1) biopsy-confirmed active lupus nephritis; and (2) inadequate response to ≥2 immunosuppressive regimens. While prednisolone (≤10 mg/day) and angiotensin-converting enzyme inhibitors were continued, immunosuppressive agents were replaced by combined MMF (1 g/day) and TAC (4 mg/day). Patients were followed every 2 months for the clinical response and adverse events at 12 months. Results Twenty-one patients were recruited (20 women; age 35.8 ± 9.2 years; systemic lupus erythematosus (SLE) duration 111 ± 51 months). The histological classes of lupus nephritis were: IV/III (33%), V + III/IV (33%) and pure V (33%). The creatinine clearance (CrCl), urine protein-to-creatinine ratio (uP/Cr) and serum albumin was 82.4 ± 33 ml/min (<90 ml/min in 57%), 3.27 ± 1.5 and 30.1 ± 5.9 g/l, respectively. Thirteen (62%) patients had active urinary sediments and 17 (81%) patients had active lupus serology. At 12 months, eight (38%) patients had very good response, one (5%) patient had good response and five (24%) patients had partial response. Significant improvement in uP/Cr, albumin, complement C3 and anti-dsDNA titer, and stabilization of CrCl was observed in the responders. Thirty-three adverse events were reported in 18 patients: major infection requiring hospitalization (6%), infection not requiring hospitalization (27%), herpes infection (9%), diarrhea (12%), cramps (9%), dyspepsia (6%), transient increase in serum Cr (6%), alopecia (4%), facial twitching (3%), tremor (3%) and diabetes mellitus (3%). None of these had led to protocol withdrawal. Conclusions Combined low-dose MMF and TAC is an option for lupus nephritis that fails to respond adequately to standard regimens, with two-thirds of patients improving after 12 months. Longer-term observation is needed to confirm its efficacy and safety.
Drama as primary prevention: my life as a producer
Authors: Jurd Stephen 
Published: August 2013

Objective: This paper documents use of a historically accurate and psychiatrically relevant play written by a couple of visiting academics. Conclusion: The high recognisability of first author Samuel Shem’s name was used to attract interest from both within the medical profession and the media, which was intrigued by the curiosity of a psychiatrist turning producer. Far-reaching publicity was achieved at no financial cost.
Updating medical school psychiatry curricula to meet projected mental health needs
Authors: Thomas Susan , Pai Nagesh , Dawes Kerry , Wilson Coralie , Williams Virginia 
Published: August 2013

Objective: In view of the growing disease burden of mental disorders, we consider the pressing need to update medical school psychiatry education to better equip doctors to recognise and treat these conditions. Key challenges to the delivery of medical school mental health curricula, and possible directions for reform, are reviewed with the aims of stimulating collaboration and enhancing the efficiency across schools. Conclusions: In Australia, medical school expansion provides opportunities to prepare many training doctors to meet growing mental health care needs. Despite this, published reviews of practice and curriculum models are notably lacking. Australia, unlike other countries, has yet to agree on a core curriculum in medical school psychiatry, with practices varying widely between schools. Curricula should equip doctors to better recognise and treat common mental disorders during early stages, as well as preparing some for specialist psychiatry training. High-quality, multidisciplinary teaching in varied clinical settings may boost teaching resources. Additionally, medical education provides opportunities to better equip doctors to take care of their own mental health. Key challenges are to achieve a consensus on core curricula across Australian medical schools, and an appropriate proportion of medical school curriculum time for mental disorders, relative to their complexity and large disease burden.
The impact of mental state disorder and personality on social functioning in patients engaged in community mental health care
Authors: Newton-Howes Giles 
Published: August 2013

Objectives: The aim of this study was to assess the degree to which mental state disorder and personality disorder impact on social functioning in patients engaged in secondary mental health care in New Zealand. Method: Patients were interviewed using peer-reviewed instruments able to provide an indication of severity to assess their social functioning, personality status and diagnosis. Univariate correlations and linear regression was used to identify the association between social functioning, mental state disorder and personality. Results: Using simple correlations all diagnostic categories associated with declines in social functioning. In the regression analysis depression and personality dysfunction accounted for 48% of the variance in social functioning. Conclusions: For patients engaged in secondary care, depression and personality dysfunction are significantly associated with poorer social functioning.
A history of insulin coma therapy in Australia
Authors: Kaplan Robert M 
Published: August 2013

Objective: To explore the history of insulin coma therapy (ICT) in Australia. Conclusions: The negative period between the wars came to an end with the discovery of the biological therapies, including ICT, a development of great interest to Australian psychiatrists. Melbourne psychiatrist Reg Ellery documented his use of ICT in 1937, but the evidence shows that he was beaten to it by Farran-Ridge and Reynolds at Mont Park. ICT was soon used at various centres, but phased out by the late fifties. A review follows of its use in Australia and a discussion of the issues involved. Doing ICT played a part in enhancing the professional status of Australian psychiatrists and was one of the factors that led to the establishment of the AAP in 1946.
Recovery, medication and shared responsibility in mental health care
Authors: Stratford Anthony , Brophy Lisa , Beaton Tracy , Castle David 
Published: August 2013

Objective: The recovery paradigm is significantly influencing contemporary mental health services. This paper explores using a recovery orientation when introducing, prescribing, administering and monitoring medication as part of treatment in psychiatry. Conclusions: Recovery is not ‘anti’ medication; however, a recovery-oriented position does require the adoption of an enabling and empowering approach to the use of medication. The cornerstone of this is shared decision-making that respects the person’s own lived experience and choice as well as the practitioner’s professional expertise. This paper suggests that by taking this path, relationships between psychiatrists, other clinicians and consumers will be enhanced.
The ACT Mental Health Service for People with Intellectual Disability, 10 years on
Authors: Wurth Peter , Brandon Shirley-Anne 
Published: August 2013

Objective: Our aim is to describe the establishment and first 10 years’ experience of a specialist team for providing psychiatric services to individuals with intellectual disability. Conclusion: This service is unique in Australia in providing a comprehensive mental health assessment and treatment service to this population in a defined catchment area. It can serve as a model for service development in this area of unmet need.
Stem cells of the lower limb: Their role and potential in management of critical limb ischemia
Authors: Hart Colin A , Tsui Janice , Khanna Achal , Abraham David J , Baker Daryll M 
Published: August 2013

Peripheral arterial occlusive disease (PAOD) contributes to decreased exercise tolerance, poor balance, impaired proprioception, muscle atrophy and weakness, with advanced cases resulting in critical limb ischemia (CLI) where the viability of the limb is threatened. Patients with a diagnosis of CLI have a poor life expectancy due to concomitant cardio and cerebrovascular diseases. The current treatment options to avoid major amputation by re-establishing a blood supply to the limb generally have poor outcomes. Human skeletal muscle contains both multipotent stem cells and progenitor cells and thus has a capacity for regeneration. Phase I and II studies involving transplantation of bone marrow-derived progenitor cells into CLI limbs show positive effects on wound healing and angiogenesis; the increase in quiescent satellite cell numbers observed in CLI muscle may also provide a sufficient in vivo source of resident stem cells. These indigenous cells have been shown to be capable of forming multiple mesodermal cell lineages aiding the repair and regeneration of chronically ischemic muscle. They may also serve as a repository for autologous transplantation. The behavior and responses of the stem cell population in CLI is poorly understood and this review tries to elucidate the potential of these cells and their future role in the management of CLI.
Internal Rotation Behind-the-Back Angle
Authors: Sraj Shafic A. 
Published: August 2013

Background: The hand-behind-back method is the accepted technique to evaluate shoulder internal rotation, is highly popular, and is endorsed by the American Academy of Orthopaedic Surgeons. It remains, however, subject to intra- and interexaminer discrepancy and has been challenged by several recent publications. Hypothesis: Internal rotation behind the back can be evaluated with a measurable angle, which eliminates the need to estimate spinal level, decreases the effect of unrelated joints, and allows collection of numeric rather than categoric data. Study Design: Descriptive laboratory study. Methods: We defined the internal rotation behind-the-back (IRB) angle as that between the ulna and the line of gravity. A pendulum is attached to a standard goniometer. The patient is asked to reach the highest point along the midline of the back. The goniometer is centered over the pisiform, and the angle between the ulnar axis and the pendulum is measured. Two examiners assessed both shoulders of 60 volunteers with no shoulder pathology using this technique on 2 occasions. Both examiners were blinded to each other’s values. We applied the paired Student t test and calculated Pearson correlation coefficients and weighted Cohen kappa values. Results: The IRB angles ranged from 50° to 125°. The difference of the mean, as measured with the Student t test, was 0.6° (95% confidence interval: 0.1°, 1.3°) and 0.6° (95% confidence interval: −0.8°, 1.8°); the Pearson correlation coefficients were 0.98 and 0.92; and the weighted kappa values were 0.88 and 0.77 for interobserver and intraobserver analyses, respectively. Conclusion: The IRB angle is easy to measure, is reproducible, and does not rely on determination of spinal level. It provides numeric data and may eliminate some of the uncertainty associated with the estimation of spinal level. Clinical Relevance: The IRB angle may eliminate some of the uncertainty associated with the estimation of spinal level.
Muscle Changes in Aging
Authors: Siparsky Patrick N. , Kirkendall Donald T. , Garrett William E. 
Published: August 2013

Muscle physiology in the aging athlete is complex. Sarcopenia, the age-related decrease in lean muscle mass, can alter activity level and affect quality of life. This review addresses the microscopic and macroscopic changes in muscle with age, recognizes contributing factors including nutrition and changes in hormone levels, and identifies potential pharmacologic agents in clinical trial that may aid in the battle of this complex, costly, and disabling problem. Level of Evidence: Level 5.
High‐definition vs. standard‐definition endoscopy with indigo carmine for the in vivo diagnosis of colonic polyps
Authors: Longcroft‐Wheaton Gaius , Brown James , Cowlishaw David , Higgins Bernard , Bhandari Pradeep 
Published: August 2013

BackgroundThere is growing evidence that indigo carmine chromoendoscopy is effective for the in vivo diagnosis of colonic polyps. However, the impact of colonoscope resolution on diagnostic accuracy has not been investigated.ObjectiveWe aimed to compare the effectiveness of in vivo diagnosis of small colonic polyps using indigo carmine dye spray with standard‐definition and high‐definition colonoscopes.MethodsProcedures were performed using Fujinon colonoscopes and EPX 4400 processor. Fujinon standard‐definition (SD) and high‐definition (HD) colonoscopes were used, with the endoscopist blinded to colonoscope definition. Polyps <10 mm were assessed using 0.2% indigo carmine dye spray, with the predicted diagnosis recorded. In each case the kind of colonoscope (SD or HD) was recorded. Polyps were removed and sent for histological analysis, with the pathologist blinded to the diagnosis made by the endoscopist. The predicted diagnosis was compared with the true histology to calculate the accuracy, sensitivity and specificity of in vivo assessment using either SD or HD scopes.ResultsIn total 237 polyps <10 mm in size were examined. There was no statistically significant difference for any of the measured parameters between SD and HD assessments, with an accuracy, sensitivity and specificity of 89%, 91% and 87% with SD colonoscopes and 92%, 96% and 84% with HD colonoscopes.ConclusionsThe accuracy of in vivo assessment of small colonic polyps with indigo carmine dye spray is excellent with standard‐definition colonoscopes and is not improved with high‐definition colonoscopes.
Variation at 10p12.2 and 10p14 influences risk of childhood B-cell acute lymphoblastic leukemia and phenotype
Authors: Migliorini Gabriele , Fiege Bettina , Hosking Fay J. , Ma Yussanne , Kumar Rajiv , Sherborne Amy L. , da Silva Filho Miguel Inacio , Vijayakrishnan Jayaram , Koehler Rolf , Thomsen Hauke , Irving Julie A. , Allan James M. , Lightfoot Tracy , Roman Eve , Kinsey Sally E. , Sheridan Eamonn , Thompson Pamela , Hoffmann Per , Nöthen Markus M. , Mühleisen Thomas W. , Eisele Lewin , Zimmermann Martin , Bartram Claus R. , Schrappe Martin , Greaves Mel , Stanulla Martin , Hemminki Kari , Houlston Richard S. 
Published: August 2013

Key Points
Variation at 10p12.2 (PIP4K2A) and 10p14 (GATA3) influences ALL risk and tumor subtype. GATA3 genotype is a determinant of event-free survivorship.
Prostaglandin-modulated umbilical cord blood hematopoietic stem cell transplantation
Authors: Cutler Corey , Multani Pratik , Robbins David , Kim Haesook T. , Le Thuy , Hoggatt Jonathan , Pelus Louis M. , Desponts Caroline , Chen Yi-Bin , Rezner Betsy , Armand Philippe , Koreth John , Glotzbecker Brett , Ho Vincent T. , Alyea Edwin , Isom Marlisa , Kao Grace , Armant Myriam , Silberstein Leslie , Hu Peirong , Soiffer Robert J. , Scadden David T. , Ritz Jerome , Goessling Wolfram , North Trista E. , Mendlein John , Ballen Karen , Zon Leonard I. , Antin Joseph H. , Shoemaker Daniel D. 
Published: August 2013

Key Points
Molecular profiling was used to optimize an ex vivo modulation protocol with dmPGE2 for UCB transplantation. Pulse treatment of UCB with dmPGE2 is safe and may lead to accelerated UCB engraftment and preferential cord chimerism.
Improvement of long-term outcomes in pancreatic cancer and its associated factors within the gemcitabine era: a collaborative retrospective multicenter clinical review of 1,082 patients
Authors: Kuroda Taira , Kumagi Teru , Yokota Tomoyuki , Seike Hirotaka , Nishiyama Mari , Imai Yusuke , Inada Nobu , Shibata Naozumi , Imamine Satoshi , Okada Shin-ichi , Koizumi Mitsuhito , Yamanishi Hirofumi , Azemoto Nobuaki , Miyaike Jiro , Tanaka Yoshinori , Tatsukawa Haruka , Utsunomiya Hiroki , Ohno Yoshinori , Miyake Teruki , Hirooka Masashi , Furukawa Shinya , Abe Masanori , Ikeda Yoshiou , Matsuura Bunzo , Hiasa Yoichi , Onji Morikazu 
Published: August 2013

Abstract

Background
Although the outcomes of pancreatic cancer have been improved by gemcitabine, the changes in its characteristics and long-term outcomes within the gemcitabine era remain unclear. This study was conducted to identify clinical characteristics of pancreatic cancer patients within the gemcitabine era.

Methods
A retrospective chart review was performed at 10 centers for 1,248 consecutive patients who were ever considered to have a diagnosis of pancreatic cancer between 2001 and 2010. Data collected included demographics, diagnosis date, clinical stage, treatment, and outcome; 1,082 patients met the inclusion criteria and were analyzed further. The chi-square test, Student’s t-test, and Mann–Whitney U-test were used for statistical analysis. Outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards regression. Differences in survival analyses were determined using the log-rank test.

Results
The distribution of clinical stages was: I, 2.2%; II, 3.4%; III, 13%; IVa, 27%; and IVb, 55%. Chemotherapy alone was administered to 42% of patients and 17% underwent resection. The 1-, 3-, and 5-year survival rates were 39%, 13%, and 6.9%, respectively. The median survival time was 257 days, but differed considerably among treatments and clinical stages. Demographics, distribution of clinical stage, and cause of death did not differ between groups A (2001–2005, n = 406) and B (2006–2010, n = 676). However, group B included more patients who underwent chemotherapy (P < 0.0001) and fewer treated with best supportive care (P = 0.0004), mirroring improvements in this group’s long-term outcomes (P = 0.0063). Finally, factors associated with long-term outcomes derived from multivariate analysis were clinical stage (P < 0.0001), location of the tumor (P = 0.0294) and treatments (surgery, chemotherapy) (P < 0.0001).

Conclusions
Long-term outcomes in pancreatic cancer has improved even within the gemcitabine era, suggesting the importance of offering chemotherapy to patients previously only considered for best supportive care. Most patients are still diagnosed at an advanced stage, making clinical strategy development for diagnosing pancreatic cancer at earlier stages essential.
Influence of pre- and post-usage flushing frequencies on bacterial water quality of non-touch water fittings
Authors: Suchomel Miranda , Diab-Elschahawi Magda , Kundi Michael , Assadian Ojan 
Published: August 2013

Abstract

Background
Non-touch fittings have been reported to be susceptible for Pseudomonas aeruginosa accumulation. A number of factors may contribute to this, including the frequency of usage, duration of water stagnation, or presence of plastic materials. Programmable non-touch fittings are appearing which allow regular automated post-flushing with cold water to prevent water stagnation. However, the ideal duration of post-flushing is unknown as well as the effect of pre-rinsing with cold water before use.

Methods
Eight non-touch fittings with brass valve blocks were mounted on a mobile test sink and connected to the same central water pipe source, differing only in presence or absence of water connection pipes, length of connection pipe, frequency of usage, and time intervals for pre- and post-usage water flush. The total bacteria colony-forming unit (cfu) counts were obtained by the spread plate technique.

Results
Low frequency of water use in combination with a long stagnating water column resulted in high bacterial cfu counts. Post-usage flushing for 2 seconds did not differ from no flushing. Flushing for 10 seconds with cold water after use or 30 seconds flush before use were both the most effective measures to prevent non-touch fittings from biofilm formation over a period of 20 weeks.

Conclusion
Further improvements in water fitting technology could possibly solve the problem of bacterial water contamination in health care settings.
Extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome in severe malaria
Authors: Alves Carlos , Chen Jen-Ting , Patel Nina , Abrams Darryl , Figueiredo Paulo , Santos Lurdes , Sarmento António , Paiva José Artur , Bacchetta Matthew , Wilgus May-Lin , Roncon-Albuquerque Roberto , Brodie Daniel 
Published: August 2013

AbstractBackgroundSevere malaria may be complicated by the acute respiratory distress syndrome (ARDS), which is associated with a high mortality. In the present report, a series of three cases of imported malaria complicated by refractory severe ARDS supported with extracorporeal membrane oxygenation (ECMO) is presented.MethodsOne female and two male adult patients (ages 39 to 53) were included. Two patients hadPlasmodium falciparuminfection and one patient hadPlasmodium vivaxandPlasmodium ovaleco-infection. Anti-malarial therapy consisted in intravenous quinine (in two patients) and intravenous quinidine (in one patient), plus clindamycin or doxycycline.ResultsDespite lung protective ventilation, a conservative strategy of fluid management, corticosteroids (two patients), prone position (two patients) and inhaled nitric oxide (one patient), refractory severe ARDS supervened (PaO2to FiO2ratio 68) and venovenous ECMO was then initiated. In one patient, a bicaval dual-lumen cannula was inserted; in the two other patients, a two-site configuration was used. Two patients survived to hospital-discharge (duration of ECMO support: 8.5 days) and one patient died from nosocomial sepsis and multi-organ failure after 40 days of ECMO support.ConclusionsECMO support allowed adequate oxygenation and correction of hypercapnia under lung protective ventilation, therefore reducing ventilator-induced lung injury. ECMO referral should be considered early in malaria complicated by severe ARDS refractory to conventional treatment.