bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diagnosis and management of anaemia of chronic disease: current status
Authors: Cullis Jonathan O. 
Published: May 2011

SummaryAnaemia of chronic disease is the second most common form of anaemia worldwide, and is seen in a variety of inflammatory, infective and malignant diseases. Functional iron deficiency is fundamental to the pathogenesis of the anaemia, and the polypeptide, hepcidin, plays a key role. Diagnosis may be difficult, but new automated red cell indices, algorithms for detection of functional iron deficiency, and assays for hepcidin levels are being developed. Management of the causative disease process will usually improve haemoglobin levels, but where this is not possible, erythropoietic stimulating agents are often used, although there are still concerns about potential adverse effects, especially thromboembolism. There is increasing evidence that supplemental iron given parenterally can safely overcome the functional iron deficiency. Inhibitors of hepcidin, and various inflammatory modulators show promise for the future.
Modulation of CD4+ T cell responses following splenectomy in hepatitis C virus-related liver cirrhosis
Authors: Hashimoto N , Shimoda S , Kawanaka H , Tsuneyama K , Uehara H , Akahoshi T , Kinjo N , Taketomi A , Shirabe K , Akashi K , Lleo A , Ansari A A , Gershwin M E , Maehara Y 
Published: May 2011

SummaryDysfunction of T cells is a common feature in chronic persistent viral infections, including hepatitis C virus (HCV), and although hepatic and peripheral T cells have been studied extensively in chronic HCV hepatitis, the role of splenic T cell responses in such patients is poorly defined. This is an important issue, as thrombocytopenia is a complication of HCV-related liver cirrhosis (LC), due to splenic platelet sequestration and bone marrow suppression; splenectomy has been proposed to treat such patients. Herein, we studied peripheral blood mononuclear cells (PBMC) and splenic lymphoid subpopulations from a total of 22 patients, including 15 with HCV-related LC with marked thrombocytopenia treated with splenectomy, and seven controls. CD4+ T cells from peripheral blood and spleen were isolated and phenotype and function evaluated. Splenic CD4+ T cells in patients with LC expressed molecules associated with inhibitory signalling, including increased frequency of negative markers such as cytotoxic T lymphocyte associated antigen-4 (CTLA-4) and programmed death 1 (PD-1) and decreased production of cytokines. Patients with LC manifest higher levels of splenic CD4+ regulatory T cells and PD-L1- and PD-L2-expressing cells than controls. Blocking of PD-1/PD-1 ligand interaction reconstituted proliferative and cytokine responses of splenic mononuclear cells (SMC) from patients with LC. Splenectomy was followed by an increase in the ratio of interferon (IFN)-γ to interleukin (IL)-10 and a reduction of PD-1-expressing CD4+ T cells in peripheral blood. Our data suggest that peripheral tolerance is promoted by the spleen in LC via the up-regulated expression of PD-1 ligands.
Determinants of plasma vitamin D levels in patients with acute coronary syndromes
Authors: Rodriguez Gabriella , Starr Aijing Z. , Czernuszewicz Grazyna Z. , Manhas Amit , Alhariri Ahmad , Willerson James T. , Reist Craig J. , Pieper Karen , Mahaffey Kenneth W. , Marian Ali J. , Kleiman Neal S. 
Published: May 2011

Eur J Clin Invest 2011; 41 (12): 1299–1309AbstractBackground  Vitamin D is implicated in various biological functions ranging from cellular proliferation to immunity. Vitamin D deficiency is associated with an increased risk of several diseases including coronary atherosclerosis.Materials and methods  We measured plasma 25(OH)D3 level in 224 patients with acute coronary syndromes (ACS) and 209 control individuals by ELISA. We genotyped the study populations for 11 single nucleotide polymorphisms (SNPs) in seven genes involved in vitamin D biosynthesis and metabolism by 5′ nuclease assays.Results  The mean and median plasma 25(OH)D3 levels were not significantly different between patients with ACS and controls (median: 22·06 vs. 22·24 ng mL−1, respectively, P = 0·618). Plasma 25(OH)D3 level was < 20 ng mL−1 in 175/433 (40%) and < 30 ng mL−1 in 333/433 (77%) participants. Only four individuals had plasma 25(OH)D3 levels of above 60 ng mL−1. African‐American and Hispanic populations, women and those with diabetes mellitus had significantly lower plasma 25(OH)D3 levels. In multivariable regression analysis, age, sex, diabetes mellitus, body weight, rs2762933 (CYP24A1) and rs6055987 (PLCB1) SNPs were independent predictors of plasma 25(OH)D3 level in the Caucasian population.Conclusions  We found no difference in mean plasma vitamin D levels between patients with ACS and controls. Differences in population characteristics between the two study groups including medications use and the lack of data on vitamin D, calcium and multivitamin supplements intake as well as the relatively small sample size of the populations could confound the results. Ethnic background, sex, age, body weight and SNPs in CYP24A1 and PLCB1 were independent determinants of plasma vitamin D levels.
In vitro responsiveness of human muscle cell peroxisome proliferator‐activated receptor δ reflects donors’ insulin sensitivity in vivo
Authors: Ordelheide Anna‐Maria , Heni Martin , Thamer Claus , Machicao Fausto , Fritsche Andreas , Stefan Norbert , Häring Hans‐Ulrich , Staiger Harald 
Published: May 2011

Eur J Clin Invest 2011; 41 (12): 1323–1329AbstractBackground  Peroxisome proliferator‐activated receptor δ (PPARδ) activation enhances muscular fatty acid oxidation and oxidative phosphorylation, and muscle’s oxidative capacity positively associates with whole‐body insulin sensitivity. Therefore, we asked here whether human muscle cell PPARD expression is a determinant of donors’ insulin sensitivity.Materials and methods  Skeletal muscle cells derived from 38 nondiabetic donors were differentiated in vitro to myotubes, and gene (mRNA) expression was quantified by real‐time RT–PCR. Donors’ insulin sensitivity was calculated from plasma insulin and glucose levels during oral glucose tolerance test (OGTT) and hyperinsulinemic‐euglycemic clamp.Results  Basal myotube PPARD expression was closely related to the expression of its target genes PDK4 and ANGPTL4 (P = 0·0312 and P = 0·0003, respectively). Basal PPARD, PDK4 and ANGPTL4 expression levels were not associated with donors’ insulin sensitivity (P > 0·2, all). Treatment of myotubes with a selective high‐affinity PPARδ agonist (GW501516) did not change mean PPARD, but enhanced mean PDK4 and ANGPTL4 expression 13‐ and 16‐fold, respectively (P < 0·0001, both). The individual PDK4 and ANGPTL4 expression levels reached upon GW501516 treatment were associated with donors’ insulin sensitivity neither (P > 0·2, both). However, GW501516‐mediated fold increments in PDK4 and ANGPTL4 expression, reflecting PPARδ responsiveness, were positively associated with donors’ insulin sensitivity derived from OGTT (P = 0·0182 and P = 0·0231, respectively) and hyperinsulinemic‐euglycemic clamp (P = 0·0046 and P = 0·0258, respectively).Conclusions  Using a highly selective pharmacological tool, we show here that the individual responsiveness of human muscle cell PPARδ, rather than the absolute PPARD expression level, represents a major determinant of insulin sensitivity.
Testicular germ cell tumours in dogs are predominantly of spermatocytic seminoma type and are frequently associated with somatic cell tumours
Authors: Bush J. M. , Gardiner D. W. , Palmer J. S. , Rajpert‐De Meyts E. , Veeramachaneni D. N. R. 
Published: May 2011

SummaryUnlike seminomas in humans, seminomas in animals are not typically sub‐classified as classical or spermatocytic types. To compare testicular germ cell tumours (TGCT) in dogs with those of men, archived tissues from 347 cases of canine testicular tumours were morphologically evaluated and characterized using human classification criteria. Histopathological and immunohistological analysis of PLAP, KIT, DAZ and DMRT1 expression revealed that canine seminomas closely resemble human spermatocytic seminomas. In addition, a relatively frequent concomitant presence of somatic cell tumours was noted in canine TGCT. None of the canine TGCT evaluated demonstrated the presence of carcinoma in situ cells, a standard feature of human classical seminomas, suggesting that classical seminomas either do not occur in dogs or are rare in occurrence. Canine spermatocytic seminomas may provide a useful model for this rare human neoplasm.
‘High‐tech’ home care: overview of professional care in patients on home parenteral nutrition and implications for nursing care
Authors: Huisman‐de Waal Getty , van Achterberg Theo , Jansen Jan , Wanten Geert , Schoonhoven Lisette 
Published: May 2011

Aim.  The aim of this study is to describe the quality, quantity and content of care given to home parenteral nutrition‐dependent patients by various professionals in the Netherlands and to detect potential shortcomings.Background.  Home parenteral nutrition is a lifesaving treatment for patients who cannot eat or cannot eat sufficiently. Very little is known about follow‐up care after hospital stay. Yet this is an important aspect of care as patients must cope with high‐tech skills at home. Also, complications and psychosocial complaints can occur.Design.  Survey.Methods.  A patient questionnaire was used to assess contacts with professionals and possible shortcomings in care. Nursing files from home parenteral nutrition nurses were reviewed for information from all contact moments. Home parenteral nutrition nurses and home care teams were interviewed to assess nursing care and to detect bottlenecks.Results.  The nutrition support team was primarily responsible for the home parenteral nutrition care. Physical complaints like abdominal pain or nausea and venous access problems like fever were discussed most often. Patients were satisfied about the nutrition support team, but both the patients and the home parenteral nutrition nurses reported that relatively little attention was paid to psychosocial problems. Furthermore, the included patients visited their General Practitioner 11 times per year on average (range 1–104). Patients experienced a bottleneck with respect to the general practitioner’s knowledge of home parenteral nutrition‐related matters.Conclusion.  Home parenteral nutrition patients visit the nutrition support team and their general practitioner most frequently and much attention is paid to medical and physical problems. Psychosocial problems, however, were only discussed in a minority of patients, and this was experienced as a shortcoming.Relevance to clinical practice.  Both the patients and the home parenteral nutrition nurses reported that relatively little attention was paid to psychosocial problems. Patients’ concerns must be integrated in contact moments to enhance Quality of Life.
Nurses’ knowledge of heart failure education principles survey: a psychometric study
Authors: Hart Patricia L , Spiva LeeAnna , Kimble Laura P 
Published: May 2011

Aims.  To compare the psychometric properties of the original dichotomously scored Nurses’ Knowledge of Heart Failure Self‐Management Education Principles Survey with a Likert scored version.Background.  Nurses must be knowledgeable of HF self‐management principles to provide optimal education to patients. Psychometrically strong instruments to measure nurses’ knowledge of HF self‐management provide important insight into gaps of nurses’ knowledge.Design.  This psychometric study had a two phase non‐experimental design comparing the psychometric characteristics of two versions of an existing survey in addition to test–retest reliability of the revised survey.Methods.  A convenience sample of 122 nurses was recruited from a healthcare system located in the Southeastern USA. Data were collected from August 2006 through December 2006. Nurses completed the two versions of the survey.Results.  The sample was predominantly Caucasian (76%), female (95%) with a mean age of 42 years (SD 11·4). Internal consistency reliability was 0·27 for the dichotomously scored version of the survey and 0·70 for the Likert scored version. The test–retest reliability of the Likert scored survey was r = 0·66. Data from individual Likert scored items indicated nurses were most knowledgeable about the need to continue daily weights even after HF symptoms are gone (mean = 4·43, SD 0·51) and least knowledgeable about how to advise asymptomatic patients to manage a low BP reading (mean = 2·11, SD 0·98).Conclusion.  The Likert scored version of the Nurses’ Knowledge of Heart Failure Self‐Management Principles Survey was stronger psychometrically than the dichotomously scored version.Relevance to clinical practice.  Teaching HF self‐management skills to patients is challenging and it is important to identify nurses’ gaps in knowledge of self‐management principles. The psychometrically sound Likert scored version of the survey potentially may be used to identify nurses’ knowledge gaps and inform staff development in‐services.
Quality circles for pharmacotherapy to modify general practitioners' prescribing behaviour for generic drugs
Authors: Spiegel Wolfgang , Mlczoch‐Czerny Marie‐Theres , Jens Rolf , Dowrick Christopher 
Published: May 2011

AbstractRationale, aims and objectives  In Austria, the participation of general practitioners (GPs) in so‐called ‘quality circles for pharmacotherapy’ (QCPs) was taken as a special approach to increase the use of generics and possibly, to improve the quality and efficiency of prescribing patterns in primary care. This study aimes at exploring GPs' perception of QCPs whether they think that taking part has helped to change their prescribing habits, their opinions on generics in general and the issues that arise for them in attempting to promote their use.Methods  Qualitative analysis was used to evaluate QCP protocols for their potential to evoke discussion in the group and for their relevance to our study questions.Results  Of the 821 self‐employed GPs in Vienna under contract with the Vienna District Health Insurance Fund 445 took part at least once in the study period. Seven main topics, which provide insight into various aspects of patient care in primary care, were identified: QCPs work, generic drug prescription, problems related to the sale of generics, patient counselling and education, therapy adherence, coordination of care, competence and medical education. From all prescribed drugs for which generics were available in the fourth quarter of the year 2003 GPs prescribed 33.91% generics, in the fourth quarter of 2004 43.97%, in the fourth quarter of 2005 46.31%, and in the fourth quarter of 2006 49.88%.Conclusions  Peer review groups can be an important method of quality improvement in GPs' prescribing behaviour in favour of generics. QCPs also facilitate the exchange between GPs on problems encountered and provide feedback to policy makers.
The applicability of grading systems for guidelines
Authors: Baker Adrian , Potter Jonathan , Young Katharine , Madan Ira 
Published: May 2011

AbstractRationale  This study focused on factors that most concern specialist societies when choosing an evidence grading system, such as methodological strengths and weaknesses, applicability and ease of use. The grading systems chosen were the Scottish Intercollegiate Guidelines Network (SIGN), the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the National Service Framework for long‐term neurological conditions critical appraisal tool (NSF‐LTC).Methodology  Twelve assessors, representing typical members of society‐based guideline development groups, graded papers and a recommendation using a key question as a guide. Key questions and recommendations were extracted from existing clinical guidelines representing a variety of research fields. Assessors were given 3 months to grade the papers using the grading systems and to complete a semi‐structured qualitative questionnaire. The results were independently assessed for emerging themes.Results  Assessors felt all three systems had strengths and weaknesses depending on the type of evidence being graded. GRADE was seen as the most complex but rigorous system, while SIGN and NSF were seen as easier and more flexible to use, but less methodologically rigorous. In grading the evidence, 10% of assessors used GRADE incorrectly, 33% used SIGN incorrectly and 75% used NSF‐LTC incorrectly. In grading the recommendations, 60% used GRADE incorrectly, 50% used SIGN incorrectly and 50% used NSF‐LTC incorrectly.Implications  It is recommended that specialist societies consider the type of evidence they will be evaluating and the research experience of the appraisers before selecting a grading system. Additionally, appraisers should have training in appraising and grading evidence using the system to be employed.
Managing risk: a qualitative study of community‐based professionals working with learning‐disabled sex offenders
Authors: HUTCHINSON J. , LOVELL A. , MASON T. 
Published: May 2011

Accessible summary
Practitioners within learning disability services rarely use organized actuarial assessments, preferring intuitive ones based on observation.
There is little difference in risk assessment according to professional discipline.
Sex offenders with learning disabilities require more systematic assessment to differentiate them from non‐learning‐disabled sex offenders.
AbstractThis study reports on research conducted to examine how community practitioners manage the difficulties of risk assessment in relation to people with a learning disability and a history of sexually offensive or abusive behaviour. Semi‐structured interviews were conducted with a number of key professionals from various disciplines, all currently involved in the assessment process with the aim of determining potential referral to community settings. Data analysis revolved around a thematic exposition of factors influencing the relationship between the objective science of psychiatric investigation and the subjective interpretation of real‐world practicalities in working with this group. Findings surrounded three major themes, frame conflict, relating to the difficulties of decision making in this area, therapeutic performance, whereby professionals were expected to engage in some form of active intervention, and safety outcomes, involving consideration of the problematic nature of judging the likelihood of re‐offending.
Intraperitoneal murine Echinococcus multilocularis infection induces differentiation of TGF‐β‐expressing DCs that remain immature
Authors: MEJRI N. , MÜLLER J. , GOTTSTEIN B. 
Published: May 2011

SummaryIntraperitoneal larval infection (alveolar echinococcosis, AE) with Echinococcus multilocularis in mice impairs host immunity. Metacestode metabolites may modulate immunity putatively via dendritic cells. During murine AE, a relative increase of peritoneal DCs (pe‐DCs) in infected mice (AE‐pe‐DCs; 4% of total peritoneal cells) as compared to control mice (naïve pe‐DCs; 2%) became apparent in our study. The differentiation of AE‐pe‐DCs into TGF‐β‐expressing cells and the higher level of IL‐4 than IFN‐γ/IL‐2 mRNA expression in AE‐CD4+pe‐T cells indicated a Th2 orientation. Analysis of major accessory molecule expression on pe‐DCs from AE‐infected mice revealed that CD80 and CD86 were down‐regulated on AE‐pe‐DCs, while ICAM‐1(CD54) remained practically unchanged. Moreover, AE‐pe‐DCs had a weaker surface expression of MHC class II (Ia) molecules as compared to naïve pe‐DCs. The gene expression level of molecules involved in MHC class II (Ia) synthesis and formation of MHC class II (Ia)–peptide complexes were down‐regulated. In addition, metacestodes excreted/secreted (E/S) or vesicle‐fluid (V/F) antigens were found to alter MHC class II molecule expression on the surface of BMDCs. Finally, conversely to naïve pe‐DCs, an increasing number of AE‐pe‐DCs down‐regulated Con A‐induced proliferation of naïve CD4+pe‐T cells. These findings altogether suggested that TGF‐β‐expressing immature AE‐pe‐DCs might play a significant role in the generation of a regulatory immune response within the peritoneal cavity of AE‐infected mice.
Glatiramer Acetate‐Specific Antibody Titres in Patients with Relapsing / Remitting Multiple Sclerosis and in Experimental Autoimmune Encephalomyelitis
Authors: Bomprezzi R. , Schaefer R. , Reese V. , Misra A. , Vollmer T. L. , Kala M. 
Published: May 2011

AbstractGlatiramer acetate (GA) is an immunomodulatory drug approved for the treatment of clinically isolated syndrome (CIS) and relapsing/remitting multiple sclerosis (RRMS). As an antigen‐based therapy, GA induces GA‐specific antibodies in treated patients and animals. GA‐specific antibodies do not neutralize therapeutic effects on relapses and disability. Rather, it has been suggested that GA‐specific antibodies may be associated with improved clinical outcomes. We evaluated antibody responses in eight patients with RRMS treated with GA for 15 months and antibody responses in GA‐treated C57BL/6 mice before and after induction of experimental autoimmune encephalomyelitis (EAE). There were no significant differences from pretreatment levels of total IgE or GA‐specific IgE in patients with RRMS. Total IgG1, IgG3 and GA‐specific IgG4 were significantly increased at 15 months of GA treatment. Antibody type and titre were not associated with clinical outcomes, i.e. expanded disability status scale (EDSS) score, disease burden on magnetic resonance images (MRI) or clinical relapses. In contrast, mice with EAE showed a marked increase in GA‐specific IgE and GA‐specific IgG1 antibody responses. GA‐treated mice demonstrated improved clinical symptoms and lower mortality than untreated controls. Our results suggest that antibody responses to GA are heterogeneous among patients with RRMS, with no apparent association between antibody response and clinical outcomes. Clinical improvements in EAE‐induced GA‐treated mice suggest that GA‐specific IgE and IgG1 may contribute to GA treatment effects in EAE.
Engagement: an indicator of difference in the perceptions of antenatal care for pregnant women from diverse socioeconomic backgrounds
Authors: Docherty Angie , Bugge Carol , Watterson Andrew 
Published: May 2011

AbstractBackground  Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. Research tends to focus on access of services. Yet access may not equate with the equity of services for women from different socioeconomic backgrounds.Objectives  To determine whether pregnant women’s perceptions of antenatal provision differed in relation to their socioeconomic deprivation ranking (determined by the Scottish Index of Multiple Deprivation 2006).Design  A longitudinal, qualitative study with comparative antenatal case studies between January 2007 and April 2009.Setting/Participants  Cases were primigravida women from ‘least deprived’ (n = 9) and ‘most deprived’ (n = 12) geographical areas within one local authority in Scotland.Analysis  Data were analysed using case study replication analysis.Results  There was little difference in access to antenatal services between the ‘least’ and ‘most’ deprived groups. Perception of care differed in relation to the level of ‘engagement’ (defined using constructs of: language and personalization of care; power and relationships; and health literacy). Engagement was evidenced in most of the ‘least deprived’ cases and almost none of the ‘most deprived’ cases. Specifically, socioeconomically deprived women described less evidence of personal connection to their own care, effective communication and the opportunity for shared decision making.Conclusion  In women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing antenatal service quality. As engagement levels may be one method by which to predict and improve health outcomes, a more equitable antenatal service may need to be developed through the early identification of those women at risk of non‐engagement.