Extreme Caution (extreme + caution)

Distribution by Scientific Domains


Selected Abstracts


Treatment of Striae Rubra and Striae Alba With the 585-nm Pulsed-Dye Laser

DERMATOLOGIC SURGERY, Issue 4 2003
Gloria P. Jimeénez MD
BACKGROUND The treatment of striae distensae has recently been reported with various lasers such as the 585-nm pulsed dye laser. At lower fluences (2.0 to 4.0 J/cm2), this laser has been purported to increase the amount of collagen in the extracellular matrix. OBJECTIVE To determine whether the 585-nm pulsed dye laser is effective in both striae rubra and striae alba after two treatments and, in addition, to determine whether there is a net effect on collagen density in treated samples. METHODS Twenty patients (skin types II to VI) with either striae rubra (9) or striae alba (11) were treated at baseline and at week 6. The total length of the study was 12 weeks. Untreated striae on the same patient were used as control subjects. Striae clinical parameters such as color and area were measured before the first and after the last treatment by an independent examiner using a visual analog scale. A hydroxyproline assay was used to measure collagen changes in two of the striae quantitatively. RESULTS The 585 nm had a moderate beneficial effect in reducing the degree of erythema in striae rubra. There was no apparent clinical change on striae alba. Total collagen per gram of dry weight of sampled tissue increased in striae treated with pulsed dye laser versus control subjects. CONCLUSION We recommend the use of the 585-nm pulsed dye laser for striae rubra in patients skin types II to IV. Extreme caution or avoidance should be observed in pulsed dye laser treatments for patients with phototypes V to VI even with the use of low fluences. Tissue collagen changes measured may be an early change, which precedes significant clinical improvement. [source]


Management of complications after implantation of fillers

JOURNAL OF COSMETIC DERMATOLOGY, Issue 1 2004
Koenraad De Boulle
Summary Soft tissue augmentation is widely practised by a variety of different practitioners. A new classification of filler substances and procedures, taking into account long-term safety and reversibility of side effects, is proposed: i non-permanent and biodegradable, ii,semi-permanent and biodegradable, iii,permanent and reversible, iv,permanent and non-reversible. Complications and adverse effects occur with all fillers and all filler procedures. Insufficient experience is an important contributory factor. Underreporting is probably common. Commonest are haematomas, ecchymoses, infections, papulopustular or acneiform lesions, non-hypersensitivity related swelling and oedema, erythema, changes in pigmentation, palpability of the implant and necrosis of overlying tissue. Specific therapeutic approaches for these complications and practical recommendations to minimize or avoid them are discussed. Hypersensitivity reactions and granuloma formation are the most distressing adverse effects. They can occur with most fillers. Mostly these hypersensitivity reactions are local granulomas but, rarely, generalized reactions also occur. Case reports of systemic reactions after injection of hyaluronic acid are documented. Treatments include steroids, minocycline and immunomodulatory agents, such as cyclosporin, tacrolimus and ascomycin. In selected cases, surgical procedures are necessary to elimirate granulomatous reactions. Implant migration and facial lipoatrophy are encountered with certain compounds. Extreme caution is therefore advocated before using permanent and non-reversible products for soft tissue augmentation. Those who use fillers need to be familiar with the complications of fillers and with the treatment of those complications. [source]


Coverage and accuracy of ethnicity data on three Asian ethnic groups in New Zealand

AUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 3 2010
Pauline Norris
Abstract Objective: Detecting and eliminating ethnic disparities in access to and outcomes of healthcare relies on accurate ethnicity recording. Studies have shown that there are inaccuracies in ethnicity data in New Zealand and elsewhere. This study examined coverage and accuracy of ethnicity data for three Asian ethnic groups. Methods: Student researchers from, or with links to, the ethnic groups concerned worked with communities to recruit participants. Names and dates of birth, length of residence in New Zealand and immigration status were recorded. Names and dates of birth were sent to the New Zealand Health Information Service, which attempted to link them with National Health Index ethnicity data. Results: Only 72% of participants could be linked to an NHI number, and only 48% of those had their ethnicity recorded accurately. Linkage odds were lower for older people, and accuracy was higher for Chinese people compared to the other ethnicities. Length of residence and immigration status did not affect either coverage or accuracy. Conclusion: Most participants who could be linked had their ethnicity recorded in the broader category of "Asian", but accuracy was poor at the sub-group level. Implications: Extreme caution should be applied when examining data about sub-groups within the ,Asian' category. [source]


LEAKY PREZYGOTIC ISOLATION AND POROUS GENOMES: RAPID INTROGRESSION OF MATERNALLY INHERITED DNA

EVOLUTION, Issue 4 2005
Kai M. A. Chan
Abstract Accurate phylogenies are crucial for understanding evolutionary processes, especially species diversification. It is commonly assumed that "good" species are sufficiently isolated genetically that gene genealogies represent accurate phylogenies. However, it is increasingly clear that good species may continue to exchange genetic material through hybridization (introgression). Many studies of closely related species reveal introgression of some genes without others, often with more rapid introgression of maternally inherited chloroplast or mitochondrial DNA (cpDNA, mtDNA). We seek a general explanation for this biased introgression using simple models of common reproductive isolating barriers (RIBs). We compare empirically informed models of prezygotic isolation (for pre- and postinsemination mechanisms of both female choice and male competition) with postzygotic isolation and demonstrate that rate of introgression depends critically upon type of RIB and mode of genetic inheritance (maternal versus biparental versus paternal). Our frequency-dependent prezygotic RIBs allow much more rapid introgression of biparentally and maternally inherited genes than do commonly modeled postzygotic RIBs (especially maternally inherited DNA). After considering the specific predictions in the context of empirical observations, we conclude that our model of prezygotic RIBs is a general explanation for biased introgression of maternally inherited genomic components. These findings suggest that we should use extreme caution when interpreting single gene genealogies as species phylogenies, especially for cpDNA and mtDNA. [source]


Colonic sarcoidosis, infliximab, and tuberculosis: A cautionary tale

INFLAMMATORY BOWEL DISEASES, Issue 4 2004
Prof. Dario Sorrentino MD
Abstract The antitumor necrosis factor, infliximab, has been recently shown to be effective in refractory sarcoidosis including the intestinal form of this disease. We have tried this therapy in a 55-year-old woman under immunosuppressive therapy for longstanding sarcoidosis presenting with abdominal pain apparently caused by a colonic localization of the disease. The latter diagnosis was based, as recommended, on the presence of nonnecrotizing granulomas in mucosal biopsies, the presence of systemic disease, and the careful exclusion of other granulomatous diseases, including tuberculosis. After the first IV infusion (10 mg/kg BW), she quickly improved, but the wellbeing lasted approximately 4 weeks. She then received another dose of infliximab, but she soon developed low-grade fever and weakness and shortly succumbed of miliary tuberculosis. Likely, infliximab precipitated a pre-existing mycobacterial infection of the intestine. Given the likelihood of underdiagnosing intestinal tuberculosis,and the risks associated with infliximab treatment,this case suggests that this drug should be used with extreme caution, if at all, when a diagnosis of colonic sarcoidosis is suspected. [source]


ORIGINAL ARTICLE: Towards an understanding of the Holocene distribution of Fagus sylvatica L.

JOURNAL OF BIOGEOGRAPHY, Issue 1 2007
Thomas Giesecke
Abstract Aim, Understanding the driving forces and mechanisms of changes in past plant distribution and abundance will help assess the biological consequences of future climate change scenarios. The aim of this paper is to investigate whether modelled patterns of climate parameters 6000 years ago can account for the European distribution of Fagus sylvatica at that time. Consideration is also given to the role of non-climatic parameters as driving forces of the Holocene spread and population expansion of F. sylvatica. Location, Europe. Methods, European distributions were simulated using a physiologically-based bioclimatic model (STASH) driven by three different atmospheric general circulation model (AGCM) outputs for 6000 years ago. Results, The three simulations generally showed F. sylvatica to have potentially been as widespread 6000 years ago as it is today, which gives a profound mismatch with pollen-based reconstructions of the F. sylvatica distribution at that time. The results indicate that drier conditions during the growing season 6000 years ago could have caused a restriction of the range in the south. Poorer growth conditions with consequently reduced competitive ability were modelled for large parts of France. Main conclusions, Consideration of the entire European range of F. sylvatica showed that no single driving force could account for the observed distributional limits 6000 years ago, or the pattern of spread during the Holocene. Climatic factors, particularly drought during the growing season, are the likely major determinants of the potential range. Climatic factors are regionally moderated by competition, disturbance effects and the intrinsically slow rate of population increase of F. sylvatica. Dynamic vegetation modelling is needed to account for potentially important competitive interactions and their relationship with changing climate. We identify uncertainties in the climate and pollen data, as well as the bioclimatic model, which suggest that the current study does not identify whether or not climate determined the distribution of F. sylvatica 6000 years ago. Pollen data are better suited for comparison with relative abundance gradients rather than absolute distributional limits. These uncertainties from a study of the past, where we have information about plant distribution and abundance, argue for extreme caution in making forecasts for the future using equilibrium models. [source]


Comparing three different methods to detect selective loci using dominant markers

JOURNAL OF EVOLUTIONARY BIOLOGY, Issue 10 2010
A. PÉREZ-FIGUEROA
Abstract We carried out a simulation study to compare the efficiency of three alternative programs (dfdist, detseld and bayescan) to detect loci under directional selection from genome-wide scans using dominant markers. We also evaluated the efficiency of correcting for multiple testing those methods that use a classical probability approach. Under a wide range of scenarios, we conclude that bayescan appears to be more efficient than the other methods, detecting a usually high percentage of true selective loci as well as less than 1% of outliers (false positives) under a fully neutral model. In addition, the percentage of outliers detected by this software is always correlated with the true percentage of selective loci in the genome. Our results show, nevertheless, that false positives are common even with a combination of methods and multitest correction, suggesting that conclusions obtained from this approach should be taken with extreme caution. [source]


Discrepancies between isotope ratio infrared spectroscopy and isotope ratio mass spectrometry for the stable isotope analysis of plant and soil waters

RAPID COMMUNICATIONS IN MASS SPECTROMETRY, Issue 14 2010
Adam G. West
The use of isotope ratio infrared spectroscopy (IRIS) for the stable hydrogen and oxygen isotope analysis of water is increasing. While IRIS has many advantages over traditional isotope ratio mass spectrometry (IRMS), it may also be prone to errors that do not impact upon IRMS analyses. Of particular concern is the potential for contaminants in the water sample to interfere with the spectroscopy, thus leading to erroneous stable isotope data. Water extracted from plant and soil samples may often contain organic contaminants. The extent to which contaminants may interfere with IRIS and thus impact upon data quality is presently unknown. We tested the performance of IRIS relative to IRMS for water extracted from 11 plant species and one organic soil horizon. IRIS deviated considerably from IRMS for over half of the samples tested, with deviations as large as 46, (,2H) and 15.4, (,18O) being measured. This effect was reduced somewhat by using activated charcoal to remove organics from the water; however, deviations as large as 35, (,2H) and 11.8, (,18O) were still measured for these cleaned samples. Interestingly, the use of activated charcoal to clean water samples had less effect than previously thought for IRMS analyses. Our data show that extreme caution is required when using IRIS to analyse water samples that may contain organic contaminants. We suggest that the development of new cleaning techniques for removing organic contaminants together with instrument-based software to flag potentially problematic samples are necessary to ensure accurate plant and soil water analyses using IRIS. Copyright © 2010 John Wiley & Sons, Ltd. [source]


Neuroendocrine transdifferentiation induced by VPA is mediated by PPAR, activation and confers resistance to antiblastic therapy in prostate carcinoma

THE PROSTATE, Issue 6 2008
Adriano Angelucci
Abstract BACKGROUND Prostate cancer (PCa) is the most commonly diagnosed cancer in men in the Western Countries. When prostatectomy fails to eradicate the primary tumor, PCa is generally refractory to all therapeutic approaches. Valproic acid (VPA) is a promising anticancer agent recently assigned to the class of histone deacetylase (HDAC) inhibitors. However molecular mechanisms underlying VPA action in PCa cells are largely unknown and further experimental validation to prove its potential application in clinic practice is needed. RESULTS In our study we show that VPA is a potent inducer of neuro-endocrine transdifferentiation (NET) in androgen receptor null PCa cells, both in vitro and in vivo. NET was an early event detectable through the expression of neuro-endocrine (NE) markers within 72 hr after VPA treatment and it was associated to a reduction in the overall cell proliferation. When we interrupted VPA treatment we observed the recovery in residual cells of the basal proliferation rate both in vitro and in a xenograft model. The NET process was related to Bcl-2 over-expression in non-NE PCa cells and to the activation of PPAR, in NE cells. The use of specific PPAR, antagonist was able to reduce significantly the expression of NE markers induced by VPA. CONCLUSIONS Our data indicate that the use of VPA as monotherapy in PCa has to be considered with extreme caution, since it may induce an unfavorable NET. In order to counteract the VPA-induced NET, the inhibition of PPAR, may represent a suitable adjuvant treatment strategy and awaits further experimental validation. Prostate 68: 588,598, 2008. © 2008 Wiley-Liss, Inc. [source]


Lower limb ulceration: a detailed study of aetiology in 555 patients

BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2000
J. Naik
Background: The purpose of the study was to investigate the aetiology of lower limb ulceration. Methods: The aetiology of lower limb ulceration was reviewed in 555 patients with 689 ulcerated limbs referred to a single-visit leg ulcer clinic. Results: The mean age of the patients was 70 (range 27,95) years and 335 (60 per cent) were women. The aetiology of the ulceration in 689 limbs was venous in 496 (72 per cent), arterial in 14 (2 per cent), mixed venous and arterial in 101 (15 per cent), with other causes in 78 (11 per cent). Of the 496 venous ulcers, 261 (53 per cent) had isolated superficial reflux, 233 (47 per cent) had deep venous reflux, of which 165 (71 per cent) had full-length and 68 (29 per cent) segmental reflux, and two patients had isolated perforator reflux. Deep venous obstruction was present in 16 limbs (3 per cent) with venous ulcers and 14 of these demonstrated continuous flow in the long saphenous vein (LSV). Of the 261 ulcerated legs with isolated superficial reflux, 197 (75 per cent) had LSV reflux only, 22 (8 per cent) had short saphenous vein (SSV) reflux only and 41 (16 per cent) had combined LSV and SSV reflux. Of those with LSV reflux, 65 per cent had a medial malleolar ulcer and 20 per cent had a lateral malleolar lesion. Of those with SSV reflux, 62 per cent had a lateral malleolar ulcer and 38 per cent had a medial malleolar ulcer. Conclusion: Half of the ulcerated legs have superficial venous reflux; these combined with the superficial and segmental deep venous reflux group comprise the 65 per cent of patients who may benefit from superficial venous surgery. Continuous flow in the LSV should alert the clinician to deep venous obstruction, in which circumstance compression therapy should be used with extreme caution. Duplex is central to the investigation of the ulcerated leg. © 2000 British Journal of Surgery Society Ltd [source]