bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meta‐analysis: peri‐operative anti‐TNFα treatment and post‐operative complications in patients with inflammatory bowel disease
Authors: Narula N. , Charleton D. , Marshall J. K. 
Published: April 2013

SummaryBackgroundThe impact of peri‐operative use of TNFα antagonists on post‐operative complications such as infection and wound healing is controversial.AimTo conduct a systematic review and meta‐analysis to assess the impact of peri‐operative use of TNFα antagonists on post‐operative complications such as infection and wound healing in patients with inflammatory bowel disease (IBD).MethodsA literature search identified studies that investigated post‐operative outcomes in patients with IBD using TNFα antagonists. The primary outcome was the rate of post‐operative infectious complications. Secondary outcomes included the rates of non‐infectious complications and total complications. Odds ratios (OR) with 95% confidence intervals (CI) are reported.ResultsOverall, 18 studies with 4659 participants were eligible for inclusion. Patients with IBD using preoperative anti‐TNFα therapies had significant increases in post‐operative infectious [OR 1.56 (95% CI, 1.09–2.24)], non‐infectious [OR 1.57 (95% CI, 1.14–2.17)] and total complications [OR 1.73 (95% CI, 1.23–2.43)]. Studies limited to patients with Crohn's disease demonstrated a statistically significant increase in infectious (OR 1.93, 95% CI 1.28–2.89) and total (OR 2.19, 95% CI 1.69–2.84) complications, and a trend towards increase in non‐infectious complications (OR 1.73, 95% CI 0.94–3.17). Studies of patients with ulcerative colitis did not demonstrate significant increases in infectious (OR 1.39, 95% CI 0.56–3.45), non‐infectious (OR 1.40, 95% CI 0.68–2.85), or total complications (OR 1.10, 95% CI 0.81–1.47).ConclusionAnti‐TNFα therapies appear to increase the risk of post‐operative complications. The increase in risk is small, and may well reflect residual confounding rather than a true biological effect. Nevertheless, physicians should exercise caution when continuing biological therapies during the peri‐operative period.
Visual analogue scale in patients treated for allergic rhinitis: an observational prospective study in primary care
Authors: Demoly P. , Bousquet P. J. , Mesbah K. , Bousquet J. , Devillier P. 
Published: April 2013

SummaryBackgroundAllergic rhinitis (AR) severity is evaluated using scores such as Rhinoconjunctivitis Quality‐of‐Life Questionnaire (RQLQ) and total symptom score (TSS). However, a simple assessment is needed to enable physicians to evaluate the severity of the AR and the efficacy of the treatment.ObjectiveThe main objective was to validate visual analogue scale (VAS) as a simple quantitative tool to assess the burden of AR in primary care.MethodsThe study was multi‐centre prospective observational conducted in patients consulting general practitioners for symptomatic rhinitis. VAS, RQLQ and TSS6 were assessed at the consultation day and 14 days later, and changes were analysed using paired test. Correlations between VAS, RQLQ and TSS6 were assessed. Cut‐off levels for VAS, which discriminate significant from insignificant changes, were established using Receiver Operating Characteristic curves.ResultsA total of 990 patients were included in the study. According to allergic rhinitis and its impact on asthma classification, mild intermittent rhinitis was diagnosed in 20% patients, mild persistent in 17%, moderate/severe intermittent in 15% and moderate/severe persistent in 48%, at the consultation day. At day‐14, rhinitis symptoms and QoL improved significantly in almost all patients. Impairment incurred by AR and assessed with VAS improved also. The established cut‐off variation of 23 mm for VAS was associated with a cut‐off variation of 0.5 for RQLQ. Sensitivity analysis with RQLQ and TSS6 scales confirmed the aptitude of the cut‐off value (23 mm) to discriminate changes in symptoms and QoL.Conclusion and Clinical RelevanceThe VAS can detect with high sensitivity the variations of symptoms and QoL in patients with AR.
In vitro induction of functional allergen‐specific CD4+ CD25high Treg cells in horses affected with insect bite hypersensitivity
Authors: Hamza E. , Akdis C. A. , Wagner B. , Steinbach F. , Marti E. 
Published: April 2013

SummaryBackgroundInsect bite hypersensitivity (IBH) is a recurrent allergic dermatitis of horses with similarities to human atopic eczema, caused by bites of insects of the genus Culicoides. Previous studies suggested a dysregulated T cell tolerance to Culicoides allergen in IBH‐affected horses.ObjectiveWe have investigated whether the suppressive function of CD4+ CD25high cells is impaired in IBH‐affected horses and possible ways to restore it.MethodsCD4+ CD25− cells sorted from peripheral blood mononuclear cells (PBMC) were stimulated with irradiated autologous PBMC pulsed with Culicoides or tetanus toxoid as control antigen, in the presence of CD4+ CD25high cells. Furthermore, Culicoides‐specific CD4+ CD25high regulatory cells were expanded or induced from CD4+ CD25− cells in vitro in the presence of a combination of rIL‐2 and rTGF‐β1 (rIL‐2/rTGF‐β1) or of retinoic acid and rapamycin (RetA/Rapa). Proliferation was determined by [3H] thymidine incorporation and cytokine production measured by flow cytometry.ResultsThe ability of Culicoides‐ but not tetanus‐stimulated CD4+ CD25high cells to suppress proliferation of CD4+ CD25− cells was significantly lower in IBH‐affected horses (28%) than in healthy controls (86%). The decreased suppression in IBH‐affected horses was associated with a significantly higher proportion of IL‐4+ cells and a lower percentage of FoxP3+ IL‐10+ compared to controls. Addition of rIL‐2/rTGF‐β1 or of RetA/Rapa to Culicoides‐stimulated CD4+ CD25high cells from IBH‐affected horses significantly increased the proportion of FoxP3+ IL‐10+ cells. We also found that RetA/Rapa induced a more significant decrease in the frequency of IL‐4+ cells than rIL‐2/rTGF‐β1. Moreover, the suppressive activity of Culicoides‐stimulated CD4+ CD25high cells was significantly restored by both rIL‐2/rTGF‐β1and RetA/Rapa, albeit in an antigen‐unspecific manner. In contrast, in vitro induced Culicoides‐specific CD4+ CD25high cells suppressed proliferation of CD4+ CD25− cells in an antigen‐specific manner.Conclusion and Clinical RelevanceThe in vitro induction of functional allergen‐specific Treg cells in IBH‐affected horses suggests a potential therapeutic use of these cells in allergy.
Vascularized composite tissue allotransplantation – state of the art
Authors: Diaz‐Siso J. Rodrigo , Bueno Ericka M. , Sisk Geoffroy C. , Marty Francisco M. , Pomahac Bohdan , Tullius Stefan G. 
Published: April 2013

AbstractVascularized composite tissue allotransplantation is a viable treatment option for injuries and defects that involve multiple layers of functional tissue. In the past 15 yr, more than 150 vascularized composite allotransplantation (VCA) surgeries have been reported for various anatomic locations including – but not limited to – trachea, larynx, abdominal wall, face, and upper and lower extremities. VCA can achieve a level of esthetic and functional restoration that is currently unattainable using conventional reconstructive techniques.Although the risks of lifelong immunosuppression continue to be an important factor when evaluating the benefits of VCA, reported short‐ and long‐term outcomes have been excellent, thus far. Acute rejections are common in the early post‐operative period, and immunosuppression‐related side effects have been manageable. A multidisciplinary approach to the management of VCA has proven successful. Reports of long‐term graft losses have been rare, while several factors may play a role in the pathophysiology of chronic graft deterioration in VCA.Alternative approaches to immunosuppression such as cellular therapies and immunomodulation hold promise, although their role is so far not defined. Experimental protocols for VCA are currently being explored. Moving forward, it will be exciting to see whether VCA‐specific aspects of allorecognition and immune responses will be able to help facilitate tolerance induction.
Do endoscopic features suggesting eosinophilic esophagitis represent histological eosinophilia?
Authors: Hori Kazutoshi , Watari Jiro , Fukui Hirokazu , Tanaka Junji , Tomita Toshihiko , Sakurai Jun , Kondo Takashi , Oshima Tadayuki , Toyoshima Fumihiko , Yamasaki Takahisa , Okugawa Takuya , Miwa Hiroto 
Published: April 2013

BackgroundEsophageal linear furrows, corrugated rings, and/or white exudates are often seen in patients with eosinophilic esophagitis (EoE); however, whether these are specific to EoE remains unclear. Endoscopic surveillance of these features was conducted to determine whether these represent esophageal eosinophilia, which is essential for the diagnosis of EoE.Patients and MethodsTwo thousand seven hundred and sixty‐three patients were enrolled consecutively. Target biopsy was carried out when the above features were seen. Histological eosinophilia was defined as 24 or more eosinophils per high‐power field (HPF). Associations between features and eosinophilia were analyzed statistically.ResultsTwo thousand five hundred and forty‐five patients completed the study. Linear furrows, corrugated rings and white exudates were seen in 24, 15 and 45 patients, respectively. These findings somewhat overlapped. Among 58 biopsied patients withany of the above features, these features represented eosinophilia in 14% (3/21), 23% (3/13), and 5% (2/43), respectively. None of the 199 patients who received biopsy for other features had eosinophilia. Two of five eosinophilia patients were diagnosed with EoE. Multiple comparisons revealed that eosinophil counts in linear furrows and corrugated rings but not white exudates were significantly greater than those in other features (12, 9, 1, and <1 eosinophils/HPF on average, respectively).ConclusionsAn endoscopic feature suggesting EoE does not always represent esophageal eosinophilia and is non‐specific for EoE, although it reminds endoscopists of the presence of EoE. The diagnostic utility of linear furrows or corrugated rings for esophageal eosinophilia is superior to that of white exudates.
Endoscopic papillary large balloon dilation for the management of recurrent difficult bile duct stones after previous endoscopic sphincterotomy
Authors: Yoon Hyung Geun , Moon Jong Ho , Choi Hyun Jong , Kim Dong Choon , Kang Myung Soo , Lee Tae Hoon , Cha Sang‐Woo , Cho Young Deok , Park Sang‐Heum , Kim Sun‐Joo 
Published: April 2013

BackgroundEndoscopic management of recurrent bile duct stones after endoscopic sphincterotomy (EST) is effective and safe. However, repeat EST for extension of a previous EST for recurrent bile duct stones may involve substantial risk. The aim of the present study was to evaluate the safety and efficacy of endoscopic papillary large balloon dilation (EPLBD) without repeat EST for recurrent difficult bile duct stones after previous EST.Patients and MethodsFrom January 2006 to October 2010, a total of 52 patients were enrolled; all had undergone EPLBD (balloon diameter: 12–20 mm) to remove recurrent difficult bile duct stones after previous EST. In all patients, stone removal had failed with conventional methods using a basket and/or balloon. The size of the balloon for EPLBD was selected to fit the diameter of the common bile duct or the largest stone.ResultsThe median interval between initial EST and stone recurrence was 2.2 years (range 1–10). Median diameters of thelargest stone and balloon were 20.1 mm (range 12–40) and 14.7 mm (range 12–20), respectively. Complete stone removal was achieved in all patients (100%). The median number of endoscopic retrograde cholangiopancreatography sessions needed for complete stone removal was 1.6 (range 1–3). Additional lithotripsy was required in 16 patients (30.7%). No procedure‐related complications were documented, with the exception of four cases of asymptomatic hyperamylasemia. The recurrence rate of CBD stones after bile duct clearance was 17.3% (9/52) during the follow‐up period (mean 27.0 ± 14.1 months).ConclusionsEPLBD without repeat EST is effective and relatively safe for the extraction of recurrent difficult bile duct stones after previous EST.
Ventilatory function in children with severe motor disorders using night‐time postural equipment
Authors: Dawson Nicola C , Padoa Kathryn A , Bucks Romola S , Allen Penny , Evans Hazel , McCaughey Elizabeth , Hill Catherine M 
Published: April 2013

AimNight‐time postural equipment (NTPE) can prevent hip subluxation in children with severe motor disorders (SMDs). However, it is unclear how it affects ventilatory function. The aims of the study were to determine how NTPE use affects ventilatory function and to compare night‐to‐night variability of ventilatory function in children with SMDs and typically developing healthy children.MethodFifteen NTPE users (six males, nine females), aged 1 to 19 years (mean age 8y 7mo) alternated sleep condition between NTPE and sleeping unsupported for 14 nights. In all but two participants, gross motor function was classified as Gross Motor Function Classification System (GMFCS) level V; in the other two it was level IV. Oxyhaemoglobin saturation (SpO2) was monitored each night and transcutaneous CO2 (PtcCO2) for one night in each sleep condition. In 17 healthy children of similar age, home SpO2 only was monitored for seven nights.ResultsIn 13 of 15 NTPE users and 12 of the 17 typically developing children, SpO2 monitoring was satisfactorily completed. Of the children with SMDs, two had mean SpO2 levels below the treatment threshold for supplemental oxygen, which was uniquely associated with use of NTPE in only one participant, and three had nocturnal hypoventilation, which was uniquely associated with NTPE use in only one case. Night‐to‐night SpO2 variability was higher in children with SMDs than in typically developing children.InterpretationNTPE may impair or enhance ventilatory function in a minority of children. Owing to night‐to‐night variability in SpO2, at least three nights of monitoring are recommended to determine optimal positioning for effective ventilation before and after NTPE introduction.
Guidelines for the organisation of continuing professional development activities for the European dentist
Authors: Suomalainen K. , Karaharju‐Suvanto T. , Bailey S. , Bullock A. , Cowpe J. , Barnes E. , Thomas H. , Thomas R. , Kavadella A. , Kossioni A. , Kersten H. , Povel E. , Giles M. , Walmsley D. , Soboleva U. , Liepa A. , Akota I. 
Published: April 2013

AbstractAimFree movement of dental professionals across the European Union calls for more uniform continuing education in dentistry to ensure up‐to‐date, high‐quality patient care and patient safety. This article provides guidelines for the management and delivery of high‐quality continuing professional development (CPD) by European dental schools and other CPD providers.MethodThe guidelines are based on an extensive literature inventory, a survey of existing practices (both available as separate publications), discussions during meetings of the Association for Dental Education in Europe in 2011 and 2012 and debate amongst the members of the DentCPD project team representing six dental schools.ResultsOn the basis of the literature review, survey and discussions, we recommend that (i) every dentist should be given the opportunity for CPD, (ii) providers should be quality‐approved and impartial, (iii) educators should be approved, impartial, suitably trained, and with educational expertise, (iv) the mode of CPD delivery should suit the educational activity, with clear learning objectives or outcomes, (v) effort should be made to assess the learning, (vi) participant feedback should be collected and analysed to inform future developments and (vii) uniform use of the pan‐European system of learning credit points (ECTS) should be implemented.ConclusionImplementation of these guidelines should make dental CPD more transparent to all relevant parties and facilitate the transferability of earned credits across the European Union. It will also enable better quality control within dentistry, resulting in enhanced dental care and ultimately the improvement in patient safety.
Core continuing professional development (CPD) topics for the European dentist
Authors: Bailey S. , Bullock A. , Cowpe J. , Barnes E. , Thomas H. , Thomas R. , Kavadella A. , Kossioni A. , Karaharju‐Suvanto T. , Suomalainen K. , Kersten H. , Povel E. , Giles M. , Walmsley A. D. , Soboleva U. , Liepa A. , Akota I. 
Published: April 2013

AbstractIntroductionIn the context of free movement, EU‐citizens need assurance that dental practitioners providing their care have a degree/license to practice that meets EU‐standards and that they maintain their knowledge and skills through ongoing education.AimOne aim of the ‘DentCPD’ project (HYPERLINK ‘http://www.dentcpd.org’ www.dentcpd.org) was to identify and agree essential CPD requirements for EU dentists. This paper reports the consensus process and outcomes.MethodsAgreement on core components of CPD was achieved through a three stage process: an online survey of dental educators' (n = 143) views on compulsory topics; a paper‐based questionnaire to practitioners (n = 411); leading to a proposal discussed at the Association for Dental Education (ADEE) 2011 Lifelong Learning special interest group (SIG).ResultsFrom the online survey and practitioner questionnaire, high levels of agreement were achieved for medical emergencies (89%), infection control (79%) and the medically compromised patient (71%). The SIG (34 attendees from 16 countries) concluded that these three CPD topics plus radiation protection should be core‐compulsory and three CPD topics should be core‐recommended (health and safety, pain management, and safeguarding children & vulnerable adults). They also agreed that the teaching of all topics should be underpinned by evidence‐based dentistry.ConclusionBuilding four core topics into CPD requirements and making quality‐approved education and training available will ensure that all dentists have up‐to‐date knowledge and skills in topic areas of direct relevance to patient safety. In turn, this will contribute to patients having access to comparably high standards of oral health care across Europe.
Realism and Representation: The Case of Rembrandt's Hat
Authors: Morris Michael 
Published: April 2013

AbstractSome artistic representations—the painting of a hat in a famous picture by Rembrandt is an example—are able to present vividly the character of what they represent precisely by calling attention to their medium of representation. There is a puzzle about this whose structure, I argue, is analogous to that of a familiar Kantian problem for traditional realism. I offer a precise characterization of the puzzle, before arguing that an analogue for the case of representation to the Kantian solution to the problem for traditional realism is implausible. I offer an alternative solution to the puzzle about representation which also explains why we should be interested in artistic representation in the first place. I close with the outline of a possible realist response to the traditional Kantian problem.
Comparison of soil carbon stocks in Scottish soils between 1978 and 2009
Authors: Chapman S. J. , Bell J. S. , Campbell C. D. , Hudson G. , Lilly A. , Nolan A. J. , Robertson A. H. J. , Potts J. M. , Towers W. 
Published: April 2013

SummaryThe change in soil carbon (C) stock over a 19–31‐year period (mean 25 years) has been measured at 179 sites on a 20‐km grid across Scotland. Sampling was by horizon from a profile pit. Although soil bulk density determinations were absent at the first sampling time, we used bulk density values from the second sampling time calibrated against NIR spectra to predict the missing values. There was no detectable change in overall total soil C stock (mean ± standard error, to a depth of 100 cm), which was 266 ± 15 and 270 ± 15 t C ha−1 for the first and second sampling times, respectively, or generally in C stock within specific vegetation or soil types. The exception was for soils under woodland, excluding those on deep peat, which exhibited a significant (P = 0.05) gain of 1.0 t C ha−1 year−1. Soils under woodland (mainly coniferous plantation) also showed a significant (P = 0.04) increase in C content (g kg−1), a significant decrease in bulk density (P = 0.006) and an increase in the thickness of the Litter‐Fermentation‐Humus (LFH) layer (P = 0.06). Recalculating the C stock to a depth of 15 cm showed a significant increase in overall C stock (when deep peat sites were excluded) as well as specifically in moorland and woodland soils, suggesting that had we sampled only to 15 cm, we would have reached a different conclusion. Both improved grassland soils and those initially under arable cultivation showed a significant decrease in C content. However, the mean thickness of Ap horizons increased from 29 to 32 cm, with a concomitant decrease in C content and a slight increase in bulk density; this we ascribe to deeper ploughing between the sample periods. In the context of possible soil C losses, we can be 95% confident that the mean loss does not exceed 0.2% year−1 and 99% confident that it does not exceed 0.4% year−1.
The tail wagging the dog – regulation of lipid metabolism by protein kinase C
Authors: Schmitz‐Peiffer Carsten 
Published: April 2013

Upon their discovery almost 40 years ago, isoforms of the lipid‐activated protein kinase C (PKC) family were initially regarded only as downstream effectors of the second messengers calcium and diacylglycerol, undergoing activation upon phospholipid hydrolysis in response to acute stimuli. Subsequently, several isoforms were found to be associated with the inhibitory effects of lipid over‐supply on glucose homeostasis, especially the negative cross‐talk with insulin signal transduction, observed upon accumulation of diacylglycerol in insulin target tissues. The PKC family has therefore attracted much attention in diabetes and obesity research, because intracellular lipid accumulation is strongly correlated with defective insulin action and the development of type 2 diabetes. Causal roles for various isoforms in the generation of insulin resistance have more recently been confirmed using PKC‐deficient mice. However, during characterization of these animals, it became increasingly evident that the enzymes play key roles in the modulation of lipid metabolism itself, and may control the supply of lipids between tissues such as adipose and liver. Molecular studies have also demonstrated roles for PKC isoforms in several aspects of lipid metabolism, such as adipocyte differentiation and hepatic lipogenesis. While the precise mechanisms involved, especially the identities of protein substrates, are still unclear, the emerging picture suggests that the currently held view of the contribution of PKC isoforms to metabolism is an over‐simplification. Although PKCs may inhibit insulin signal transduction, these enzymes are not merely downstream effectors of lipid accumulation, but in fact control the fate of fatty acids, thus the tail wags the dog.