bluuebunny/crossref_metadata_2025_split huggingface dataset:
Important variations in the content of care pathway documents for total knee arthroplasty may lead to quality and patient safety problems
Authors: Segal Olivier , Bellemans Johan , Van Gerven Eva , Deneckere Svin , Panella Massimiliano , Sermeus Walter , Vanhaecht Kris 
Published: August 2011

AbstractAim  Reducing variations by standardizing the key interventions in clinical processes is an effective tool to minimize the probability of medical errors. Thus, we determined whether variations exist in the key interventions included in care pathway documents (CPDs) of different organizations and in the timing of these interventions during the care process.Methods  We invited members of the Belgian Dutch Clinical Pathway Network to send their CPDs for external review. We analysed 19 CPDs for total knee arthroplasty. International guidelines were consulted for definition of key interventions. Documentation of these interventions in the pathway documents was checked.Results  From the 19 CPDs analysed, we retrieved 18 key interventions. Nine of these key interventions appeared in at least 80% of the care pathways. Only two key interventions appeared in all pathway documents. Nine out of 12 interventions that appeared in at least 80% of the pathway documents showed a variation of 1 day in the timing of care from the median timing.Conclusion  We conclude that important variation exists in the included interventions and in their timing. The results of this study suggest that, before use in daily patient care, CPDs should be reviewed by peers and checked to ensure that all evidence‐based key interventions are included and properly planned. Only in this way can pathways documents be used interprofessionally during the entire perioperative period in the search for optimal quality and patient safety.
The experience of young people with depression: a qualitative study
Authors: MCCANN T. V. , LUBMAN D. I. , CLARK E. 
Published: August 2011

Accessible summary
Young people struggle to come to terms with depression.
They may withdraw from friends, fearful of stigma and to preserve friendships in the longer term, but withdrawing from friends can have paradoxical consequences.
They may respond in self‐protective, harmful and sometimes life‐threatening ways to their depression.
AbstractPeople who develop depression experience a maelstrom of emotions as they struggle to understand what is happening to them. While the experience has been comparatively well documented in older adults, much less is known about the depression experience and responses of young people. In this study, we aimed to explore the experience of young people diagnosed with depression. Twenty‐six young people were recruited from a youth mental health service. A qualitative interpretative design was used, incorporating semi‐structured, audio‐recorded interviews. Results provided four overlapping themes, reflecting the young people's difficulties in coming to terms with, and responding in self‐protective, harmful and at times life‐threatening ways to their depression: (1) struggling to make sense of their situation; (2) spiralling down; (3) withdrawing; and (4) contemplating self‐harm or suicide. Study conclusions are that young people faced considerable difficulties coming to terms with, and responding to, depression. Improving young people's understanding of depression and its treatment, reducing community stigma and providing accessible and youth‐focused services remain important targets for intervention. It is also important to improve mental health literacy in the community to increase awareness of depression and how mental health professionals, including nurses, respond effectively to the young person.
RepC protein of the octopine‐type Ti plasmid binds to the probable origin of replication within repC and functions only in cis
Authors: Pinto Uelinton M. , Flores‐Mireles Ana L. , Costa Esther D. , Winans Stephen C. 
Published: August 2011

SummaryVegetative replication and partitioning of many plasmids and some chromosomes of alphaproteobacteria are directed by their repABC operons. RepA and RepB proteins direct the partitioning of replicons to daughter cells, while RepC proteins are replication initiators, although they do not resemble any characterized replication initiation protein. Here we show that the replication origin of an Agrobacterium tumefaciens Ti plasmid resides fully within its repC gene. Purified RepC bound to a site within repC with moderate affinity, high specificity and with twofold cooperativity. The binding site was localized to an AT‐rich region that contains a large number of GANTC sites, which have been implicated in replication regulation in related organisms. A fragment of RepC containing residues 26–158 was sufficient to bind DNA, although with limited sequence specificity. This portion of RepC is predicted to have structural homology to members of the MarR family of transcription factors. Overexpression of RepC in A. tumefaciens caused large increases in copy number in cis but did not change the copy number of plasmids containing the same oriV sequence in trans, confirming other observations that RepC functions only in cis.
Echinococcus granulosus glycoconjugates induce peritoneal B cell differentiation into antibody‐secreting cells and cytokine production
Authors: MOURGLIA‐ETTLIN G. , AMEZCUA‐VESELY M. C. , FRAGA R. , BAZ A. , MERINO M. C. , GRUPPI A. , DEMATTEIS S. 
Published: August 2011

SummaryHelminth parasite infections are associated with predominant Th2‐type cytokine responses, and parasite glycoconjugates have been recognized as partially responsible for such immune bias. It has been proved that Echinococcus granulosus evokes a Th2‐type cytokine pattern characterized by a high production of IL‐4, IL‐5, IL‐6 and IL‐10, and no or mild IFN‐γ levels in animal models and in patients with cystic echinococcosis, respectively. Here, we show that E4+ (a glycoconjugate‐enriched fraction from E. granulosus protoscolex) stimulated the secretion of a high concentration of IL‐6, followed by IL‐10 and TNF‐α by normal peritoneal B cells. We determined that E4+ bound to the surface of peritoneal B cells and induced their activation and, also, triggered the differentiation of peritoneal B cells into IgM‐, IgG2b‐ and IgG3‐secreting cells in a T‐independent way. Interestingly, the IgM released by E4+‐stimulated peritoneal B cells from normal mice recognized protoscolex antigens. Results showed that, after the encounter with antigens from E. granulosus protoscolex, peritonealB cells are a source of Th2‐type cytokines and polyclonal antibodies, some of which recognize parasite antigens, suggesting that peritoneal B cells can condition the outcome of the infection.
An Al‐inducible MATE gene is involved in external detoxification of Al in rice
Authors: Yokosho Kengo , Yamaji Naoki , Ma Jian Feng 
Published: August 2011

SummaryA number of plant species, including rice, secretes citrate from roots in response to Al stress. Here we characterized the functions of a gene, OsFRDL4 (Os01g0919100) that belongs to the multidrug and toxic compound extrusion (MATE) family in rice (Oryza sativa). Heterologous expression in Xenopus oocyte showed that the OsFRDL4 protein was able to transport citrate and was activated by Al. The expression level of the OsFRDL4 gene in roots was very low in the absence of Al, but was greatly enhanced by Al after short exposure. Furthermore, the OsFRDL4 expression was regulated by ART1, a C2H2‐type zinc finger transcription factor for Al tolerance. Transient expression of OsFRDL4 in onion epidermal cells showed that it localized to the plasma membrane. Immunostaining showed that OsFRDL4 was localized in all cells in the root tip. These expression patterns and cell specificity of localization of OsFRDL4 are different from other MATE members identified previously. Knockout of OsFRDL4 resulted in decreased Al tolerance and decreased citrate secretion compared with the wild‐type rice, but did not affect citrate concentration in the xylem sap. Furthermore, there is a positive correlation between OsFRDL4 expression level and the amount of citrate secretion in rice cultivars that are differing in Al tolerance. Taken together, our results show that OsFRDL4 is an Al‐induced citrate transporter localized at the plasma membrane of rice root cells and is one of the components of high Al tolerance in rice.
The fitness of drug‐resistant malaria parasites in a rodent model: multiplicity of infection
Authors: HUIJBEN S. , SIM D. G. , NELSON W. A. , READ A. F. 
Published: August 2011

AbstractMalaria infections normally consist of more than one clonally replicating lineage. Within‐host interactions between sensitive and resistant parasites can have profound effects on the evolution of drug resistance. Here, using thePlasmodium chabaudimouse malaria model, we ask whether the costs and benefits of resistance are affected by the number of co‐infecting strains competing with a resistant clone. We found strong competitive suppression of resistant parasites in untreated infections and marked competitive release following treatment. The magnitude of competitive suppression depended on competitor identity. However, there was no overall effect of the diversity of susceptible parasites on the extent of competitive suppression or release. If these findings generalize, then transmission intensity will impact on resistance evolution because of its effect on the frequency of mixed infections, not because of its effect on the distribution of clones per host. This would greatly simplify the computational problems of adequately capturing within‐host ecology in models of drug resistance evolution in malaria.
Chromosomal regions associated with dollar spot resistance in colonial bentgrass
Authors: Rotter David , Merewitz Emily , Huang Bingru , Belanger Faith C. 
Published: August 2011

With 1 figure and 4 tablesAbstractInterspecific hybridization between colonial bentgrass and creeping bentgrasses may be a useful approach for introducing resistance to Sclerotinia homoeocarpa, the causal agent of dollar spot disease, into creeping bentgrass. An interspecific backcross population of 271 genotypes was evaluated for dollar spot in a 2‐year field study, and 11% of the genotypes were resistant to dollar spot. In the subset of the backcross population used for genetic linkage mapping, some resistant plants were identified, but no quantitative trait locus (QTL) was detected. A model of qualitative 3‐gene recessive epistasis for dollar spot resistance in colonial bentgrass was proposed, and the limitations of QTL analysis to detect genomic regions conferring multigenic qualitative traits were examined. In the simulations, monogenic traits and 2‐gene recessive epistatic traits were readily detectable by QTL analysis, whereas for 3‐gene recessive epistasis, a QTL was not detectable. As an alternative to QTL analysis, screening of resistant plants from the backcross population for genomic regions held in common suggests that linkage groups 2A1 and 3A1 are possibly genomic locations of dollar spot resistance in colonial bentgrass.
Protective role of uncoupling protein‐2 against dextran sodium sulfate‐induced colitis
Authors: Zhang Hongjie , Kuai Xiao‐yi , Yu Pengli , Lin Lin , Shi Ruihua 
Published: August 2011

AbstractBackground and Aims:  Uncoupling protein‐2 (UCP‐2) is a negative regulator of reactive oxygen species (ROS) production. We investigated the effect of UCP‐2 on disease progression in a murine dextran sodium sulfate (DSS)‐induced colitis model, and the expression and distribution of tight junction (TJ) proteins, such as occludin, zonula‐1 (ZO‐1), claudin‐4, and junctional adhesion molecule‐1 (JAM‐1).Methods:  Male UCP‐2−/− mice and wild‐type littermates were divided into four groups: groups I and II, which comprised each type of mouse, were administered 2.5% DSS dissolved in drinking water to create a colitis model. The control groups (groups III and IV, which comprised each type of mouse) were given normal drinking water. Disease progression was evaluated according to colon length and the disease activity index. The distribution of TJ proteins was detected by immunohistochemical analysis.Results:  Compared with wild‐type littermates, UCP‐2−/− mice treated with DSS developed more severe diarrhea, body weight loss (P < 0.01), significantly short colon length, and more inflammatory cell infiltration into the mucosa and submucosa. The level of malondialdehyde in colonic mucosa increased in UCP‐2−/− mice treated with DSS compared with the wild‐type littermates (P < 0.001). The distribution of the ZO‐1 and JAM‐1 proteins was significantly decreased in the colonic mucosa of UCP‐2−/− mice compared with the wild‐type littermates, whereas occludin and claudin‐4 distribution were not different between the UCP‐2−/− mice and wild‐type littermates.Conclusions:  UCP‐2 might reduce intestinal inflammatory response through the negative regulation of ROS, and affects the expression and distribution of TJ proteins.
Ribavirin downmodulates inducible costimulator on CD4+ T cells and their interleukin‐10 secretion to assist in hepatitis C virus clearance
Authors: Atsukawa Masanori , Nakatsuka Katsuhisa , Kobayashi Tamaki , Shimizu Masumi , Tamura Hideto , Harimoto Hirotomo , Takahashi Hidemi , Sakamoto Choitsu 
Published: August 2011

AbstractBackground and Aim:  The immunological mechanism by which ribavirin (RBV) polarizes the T‐helper (Th) 1/2 balance toward Th1 predominancy is not fully understood. We therefore examined whether RBV affects costimulatory signaling, which is known to be essential for regulating the Th1/2 balance.Methods:  The expression of costimulatory molecules and their ligands, and levels of various cytokines, released from CD4+ T cells obtained from healthy individuals or patients with chronic hepatitis C virus (HCV) infection were analyzed.Results:  In CD4+ T cells, RBV selectively downmodulates the expression of inducible costimulator (ICOS), a ligand for B7–H2 on dendritic cells, which mainly differentiates Th0 into Th2 cells. Moreover, the levels of interleukin‐10 (IL‐10) released from RBV‐stimulated CD4+ T cells also decreased, indicating that the downmodulation of ICOS induced by RBV might be correlated with the decrease in IL‐10 released from Th cells, leading to the inhibition of Th2 activity. An analysis of the association between ICOS kinetics and hepatitis C virus (HCV) elimination in hepatitis C patients receiving combined pegylated interferon and RBV indicated that HCV elimination tended to occur more frequently in patients showing ICOS downmodulation with RBV treatment. A decrease in IL‐10 production by CD4+ T cells was also observed in association with ICOS downregulation in patients who succeeded in HCV elimination.Conclusions:  The downmodulation of ICOS in correlation with a reduction in IL‐10 produced by CD4+ T cells is possibly the immunological mechanism of action of RBV, which polarizes the Th1/2 balance toward a Th1 cytokine profile, thus contributing to the elimination of cells chronically infected with HCV.
Colorectal cancer mouse models: Integrating inflammation and the stroma
Authors: Ernst Matthias , Ramsay Robert G 
Published: August 2011

AbstractSequences of molecular events that initiate and advance the progression of human colorectal cancer (CRC) are becoming clearer. Accepting that these events, once they are in place, accumulate over time, rapid disease progression might be expected. Yet CRC usually develops slowly over decades. Emerging insights suggest that the tumor cell microenvironment encompassing fibroblasts and endothelial and immune cells dictate when, whether, and how malignancies progress. Signaling pathways that affect the microenvironment and the inflammatory response seem to play a central role in CRC. Indeed, some of these pathways directly regulate the stem/progenitor cell niche at the base of the crypt; it now appears that the survival and growth of neoplastic cells often relies upon their subverted engagement of these pathways. Spurned on by the use of gene manipulation technologies in the mouse, dissecting and recapitulating these complex molecular interactions between the tumor and its microenvironment in the gastrointestinal (GI) tract is a reality. In parallel, our ability to isolate and grow GI stem cells in vitro enables us, for the first time, to complement reductionist in vitro findings with complex in vivo observations. Surprisingly, data suggest that the large number of signaling pathways underpinning the reciprocal interaction between the neoplastic epithelium and its microenvironment converge on a small number of common transcription factors. Here, we review the separate and interactive roles of NFκB, Stat3, and Myb, transcription factors commonly overexpressed or excessively activated in CRC. They confer molecular links between inflammation, stroma, the stem cell niche, and neoplastic cell growth.
Current status on the diagnosis and management of pancreatic cysts in the Asia–Pacific region: Role of endoscopic ultrasound
Authors: Lim Lee Guan , Itoi Takao , Lim Wee Chian , Mesenas Steven Joseph , Seo Dong Wan , Tan Jonard , Wang Hsiu Po , Akaraviputh Thawatchai , Lakhtakia Sandeep , Omar Salem , Rantachu Thawee , Sachitanandan Sharmila , Yasuda Kenjiro , Varadarajulu Shyam , Wong Jennie , Dhir Vinay , Ho Khek Yu ,   the Asian Consortium of EUS
Published: August 2011

AbstractEndoscopic ultrasound (EUS) and EUS‐guided fine‐needle aspiration (EUS‐FNA) play increasingly prominent roles in the diagnosis and management of pancreatic cysts. The Asian Consortium of Endoscopic Ultrasound was recently formed to conduct collaborative research in this area. This is a review of literature on true pancreatic cysts. Due to the lack of systematic studies, there are no robust data on the true incidence of pancreatic cystic lesions in Asia and any change in over the recent decades. Certain EUS morphological features have been used to predict particular types of pancreatic cysts. Pancreatic cyst fluid viscosity, cytology, pancreatic enzymes, and tumor markers, in particular carcinoembryonic antigen, can aid in the diagnosis of pancreatic cysts. Hemorrhage and infection are the most common complications of EUS‐FNA of pancreatic cysts. Pancreatic cysts can either be observed or resected depending on the benign or malignant nature, or malignant potential of the lesions. Guidelines from an international consensus did not require positive cytological findings to be present in their recommendation for resection, which included all mucinous cystic neoplasms, all main‐duct intraductal papillary mucinous neoplasms (IPMN), all mixed IPMN, symptomatic side‐branch IPMN, and side‐branch IPMN larger than 3 cm. In patients with poor surgical risks, EUS‐guided cyst ablation of mucinous pancreatic cysts is an alternative. As long‐term prospective data on pancreatic cysts are still not available in Asia, management strategies are largely based on risk stratification by surgical risk and malignant potential. Gene expression profiling of pancreatic cyst fluid and confocal laser endomicroscopic examination of pancreatic cysts are novel techniques currently being studied.
Differential prognostic impact of renal insufficiency on patients with hepatocellular carcinoma: A propensity score analysis and staging strategy
Authors: Hsu Chia‐Yang , Hsia Cheng‐Yuan , Huang Yi‐Hsiang , Su Chien‐Wei , Lin Han‐Chieh , Chiou Yi‐You , Lee Rheun‐Chuan , Lee Fa‐Yauh , Huo Teh‐Ia , Lee Shou‐Dong 
Published: August 2011

AbstractBackground and Aim:  Renal insufficiency (RI) can coexist in patients with hepatocellular carcinoma (HCC). This study analyzed the prognostic impact of RI on patients with HCC and determined the optimal staging strategy for these patients.Methods:  RI was defined as an estimated glomerular filtration rate <60 mL/min/1.73 m2. A total of 502 and 1701 HCC patients with and without RI, respectively, were enrolled. One‐to‐one matched patient cohorts according to treatments were built by using the propensity model. The prognostic ability of the Cancer of the Liver Italian Program, Barcelona Clinic Liver Cancer, Japan Integrated Scoring, and Taipei Integrated Scoring (TIS) systems in HCC patients with RI was compared by using the Akaike information criterion (AIC).Results:  For patients undergoing percutaneous ablation and transarterial chemoembolization (TACE), RI was significantly associated with decreased long‐term survival (P = 0.001 and 0.004, respectively). In patients receiving resection and other treatments, there were no significant survival differences between patients with and without RI. With similar demographics generated in the propensity model, significantly decreased survival was found in patients with RI in the TACE group (P = 0.018), but not in the resection, percutaneous ablation, and other treatment groups. Among HCC patients with RI, the TIS system had the lowest AIC value.Conclusions:  RI is often present in patients with HCC and predicts a poor outcome in patients undergoing TACE. The survival of HCC patients receiving resection, percutaneous ablation, and other treatments is not affected by RI. The TIS staging system is a more feasible prognostic model for HCC patients with RI.
Is transient elastography valuable for high‐risk esophageal varices prediction in patients with hepatitis‐B‐related cirrhosis?
Authors: Chen Yong Peng , Zhang Qi , Dai Lin , Liang Xie Er , Peng Jie , Hou Jin Lin 
Published: August 2011

AbstractBackground and Aim:  The aim of this study was to evaluate the clinical value of transient elastography (TE) for high‐risk esophageal varices (HREV) prediction in hepatitis‐B‐related cirrhosis patients.Methods:  A total of 238 patients with hepatitis B cirrhosis were prospectively enrolled. All patients had undergone TE and upper gastrointestinal endoscopy. Diagnostic value was assessed by the area under ROC curve (AUROC), predictive value and likelihood ratio.Results:  The size of esophageal varices correlated with liver stiffness with Kendall's tau_b 0.236 overall and 0.425 in patients with ALT ≥ 5 × upper limit of normal (ULN). The AUROC of TE predicting HREV was 0.73 (95% confidence interval 0.66–0.80) overall and 0.92 (0.82–1.01) for patients with ALT ≥ 5 × ULN. In patients with ALT ≥ 5 × ULN, cut‐off 36.1 kPa predicted HREV with a 100% negative predictive value (NPV), an indefinite negative likelihood ratio (NLR), a 72.7% positive predictive value (PPV) and a positive likelihood ratio (PLR) of 9.3. The AUROC of HREV‐predicting model, constructed by ultrasonography and TE (USLS), was 0.84 (0.77–0.90) in the training set and 0.85 (0.76–0.94) in the validating set. Cut‐off 3.30 excluded HREV with NPV 0.946 and NLR 0.10, and cut‐off 5.98 determined HREV with PPV 0.870 and PLR 10.24. Using USLS, nearly 50% of patients could avoid endoscopic screening. The model's predictive values were maintained at similar accuracy in the validation set. Differences of AUROC in USLS, liver stiffness/spleen diameter to platelet ratio score and ultrasonic score were not significant.Conclusions:  TE may predict HREV in patients with ALT ≥ 5 × ULN. Overall, the clinical values of TE and USLS for HREV prediction should be evaluated by further studies.