Adolescents' interpretations of conditional confidentiality assurances.

PURPOSE: To improve physicians' discussions of confidentiality policies with adolescent patients. METHOD: Fifty-three students completed private semistructured interviews designed to explore adolescents' interpretations of a statement explaining both the protections and limitations of confidentiality. RESULTS: Results suggest strategies for explaining conditional confidentiality in a way adolescents' understand and trust.     

Is atopic dermatitis associated with obesity? A systematic review of observational studies

Obesity has been associated with atopic dermatitis (AD); however, the results have been conflicting. Our aim was to provide an update on current knowledge from observational studies addressing the possible association between obesity and AD. Systematic literature review was performed by identifying studies addressing a possible link between AD and overweight/obesity from PubMed, EMBASE and the Cochrane Library in accordance with the Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) guidelines. The quality of the included studies was assessed using the Newcastle–Ottawa Scale. A total of 45 studies (comprising more than 90 000 individuals with AD) fulfilled the criteria and were included in the present review. The available studies revealed inconsistencies, but the majority indicated that obesity is associated with AD. Studies addressing obesity in infancy or early childhood (age < 2 years) and AD reported a positive association. From childhood into adulthood, there is a discrepancy in the observations, as the more recent prospective studies found a positive association, whereas this was not observed in older cross‐sectional studies. The inconsistency might be explained by the difference in study design, the diagnostic criteria of AD, regional differences, and by the varied definitions of overweight and obesity used in the studies. In Conclusion, overweight/obesity is associated with an increased risk of AD. Large prospective cohort studies are required to confirm the association between AD and obesity and the possibility that weight control in childhood may help to mitigate or reverse AD symptoms.     

Isolation and characterisation of new microsatellite markers for the stonefly Brachyptera braueri comparing a traditional approach with high throughput 454 sequencing

We developed thirteen microsatellite markers for the stonefly Brachytpera braueri, a rare aquatic insect. We compared a “traditional” approach yielding an enriched library by cloning of positive host cells, hybridising and Sanger sequencing of target fragments with a 454 next generation sequencing approach. From a total of 881 fragments containing a repeat motif thirteen polymorphic loci were developed and tested for two populations. Number of alleles ranged from 4 to 20 and values of heterozygosity varied from 0.17 to 0.91 (H_O) and 0.26 to 0.91 (H_E). The markers are essential to investigate the colonisation potential of freshwater insects.     

Experimental testing of skin reactions to insulin detemir in diabetes patients naïve to insulin detemir

Background/aims: Sporadic reports on immediate and delayed cutaneous reactions to insulin detemir, a modern insulin analogue, have raised unsupported claims of allergy of type I, III and IV. The purpose of this experimental study using a provocative design was to elucidate the potential mechanisms behind such skin reactions. Material and methods: A total of 40 patients with type 1 diabetes or insulin‐requiring type 2 diabetes, all naïve to insulin detemir, were injected on the thigh with 0.l mL of insulin detemir (Levemir^®) administered with an 8 mm needle at three different depths, i.e. intradermal, subdermal and subcutaneously. Saline was injected as control. Any cutaneous reactions were assessed after 10 and 30 min, after 24 and 48 h and after 7 days. Histopathology of positive reactions on day 7 was obtained. The study was randomized, controlled, double‐blinded, and conducted in accordance with ICH‐GCP guidelines. Blood flow was recorded with the Periflux PF5010, and skin colour (a^*) with the DSMII colorimeter. Results: Clinical reading, flowmetry and colorimetry consistently showed delayed reactions after intradermal insulin injection (35 of 40 patients reacted with mainly weak reactions, P<0.05), peaking after 48 h, contrasting no special reaction immediately after injection, except for reactions attributed to needle trauma. A total of 22 patients reacted on subdermal injection and 21 on subcutaneous injection. Histopathology on day 7 from 22 reactions in 15 patients showed a consistent pattern of inflammation with eosinophilia as typically observed in adverse skin reactions to a variety of medicines. Reactions were interpreted as non‐specific biologic responses to the insulin different from direct toxic actions and classical allergic reaction patterns. Only one person registered itch/discomfort. A prick test vs. histamine reference excluded insulin detemir to be a pharmacological histamine releaser. Thus, provocative testing with insulin detemir produced delayed skin reaction but no immediate reaction. Measurement of circulating insulin detemir‐specific antibodies by RIA before and after 3 months showed no increase. Conclusion: Non‐allergic delayed skin reactions from intradermal and, to a minor degree, subdermal and subcutaneous injections of insulin detemir were frequent in this experimental study and showed a consistent histology pattern of inflammation with eosinophilia. Immediate reactions were not produced. The reactions are unlikely to be specific for insulin detemir, and other insulins should be studied in a similar provocative design.     

An implantable tumor-window chamber model for the study of photodynamic therapy.

In order to study both the anti-tumor effects and early vascular events in photodynamic therapy, a useful animal model has been developed. A window chamber is surgically placed on the dorsum of the Fischer-344 rat, and 500-microns fragments of the rat mammary adenocarcinoma 13672 are placed under direct vision into the subcutaneous tissue. Implantation of the chamber has been successfully completed in more than 50 rats. The operative procedure is straightforward and is accomplished in less than 1 hour. Using tumor fragments, tumor viability has been 60%. We have demonstrated obvious and reproducible neovascularization occurring as soon as 1 day after implantation. The application of this system to an experimental protocol comparing the photosensitizers dihematoporphyrin ether (DHE) and chloraluminum sulfonated phthalocyanine (CASP) has yielded important information on early vascular events resulting from photodynamic therapy.     

Negative ion chemical ionization gas chromatography-mass spectrometry and atmospheric pressure chemical ionization liquid chromatography-mass spectrometry of low-dosed and/or polar drugs in plasma.

In clinical and forensic toxicology, doping control, and therapeutic drug monitoring, specific and sensitive detection and precise quantification of xenobiotics in biosamples are great challenges. Today, mass spectrometry techniques, coupled with gas chromatography or liquid chromatography, are the most powerful methods in analytic toxicology. The pros and cons of electron ionization (EI) and negative ion chemical ionization (NICI) gas chromatography-mass spectrometry (GC-MS) and of atmospheric pressure chemical ionization liquid chromatography-mass spectrometry (APCI-LC-MS) are described for determination of the low-dosed benzodiazepine flunitrazepam and its 7-amino and its nor-metabolite in plasma. In addition, application of NICI-GC-MS is described for sensitive chiral determination of amphetamine derivatives in plasma and application of APCI-LC-MS for screening, library-assisted identification, and validated quantification of oral antidiabetics and for validated quantification of the neuroleptic risperidone and its 9-hydroxy metabolite. These examples show that NICI-GC-MS and LC-MS are powerful tools for determination of low-dosed and/or rather polar drugs or poisons, thus becoming indispensable supplements to classic EI-GC-MS in clinical and forensic toxicology as well as in doping control.     

The Use of Vital Dyes in Ocular Surgery

Vital dyes have advanced diagnosis and surgical technique in various specialties, including oncology, gastroenterology, and ophthalmology. In ocular surgery vital dyes are widely used in cataract and vitreoretinal surgery. Worldwide, intra-operative use of trypan blue during cataract surgery has enhanced visualization of the anterior capsule during capsulorrhexis, and patent blue has been recently licensed in Europe for cataract surgery. For chromovitrectomy, the vital dyes indocyanine green, infracyanine green, and brilliant blue stain the internal limiting membrane, and trypan blue and triamcinolone acetonide help visualize epiretinal membranes and vitreous, respectively. Intra-operative vital dyes are finding uses in corneal, glaucoma, orbit, strabismus, and conjunctival surgery. We provide a summary of current knowledge of the use of vital dyes in ocular surgery. We review the properties of dyes, techniques of application, indications, and complications in ocular surgery. Vital dyes represent an expanding area of research, and novel dyes deserve further investigation.