bluuebunny/crossref_metadata_2025 huggingface dataset:
TEM image analysis and modelling: application to boehmite nanoparticles
Authors: MOREAUD M. , JEULIN D. , MORARD V. , REVEL R.
Published: November 2011

Boehmite occurs in the form of nanoparticles. Upon drying, it can form the alumina that is common in catalyst support used in refining and petrochemicals. The topotactic transformation of boehmite alumina led to an interest in the precise shape and size of these nanoparticles which is highly linked to the catalyst activity. Boehmite nanoparticles can be observed by transmission electron microscopy. Although they are highly aggregated, the analysis of transmission electron microscopy images with a specific random model approach, here a dilution model, can give an accurate estimate of their size. To use this approach, electronic noise and diffraction artefacts on the edges of the nanoparticles have to be removed. Covariance measurements on micrographs can be performed. They can be used to fit a model. The fitting uses a novel numerical method to estimate the covariogram of grains. The model can take into account the specific orientations of the nanoparticles. The influence of noise, image filters used to remove noise and diffraction artefacts, as well as all the parameters of the model are all studied in this paper. We propose nanoparticle size estimations procedures based on both single and mixture‐of‐two particle models.
Effects of Chronic and Acute Oestrogen Replacement Therapy in Aged Animals after Experimental Stroke
Authors: Liu F. , Benashski S. E. , Xu Y. , Siegel M. , McCullough L. D.
Published: November 2011

The effect of oestrogen replacement therapy (ERT) on stroke incidence and severity has been extensively debated. Clinical trials of ERT have demonstrated an increased risk of stroke in treated women, although the study participants were well past menopause when therapy was initiated. It has been suggested that detrimental effects of ERT may be unmasked after prolonged periods of hypoestrogenicity. To date, very few studies have examined the effect of ERT in aged animals, although the timing of replacement may be critical to the neuroprotective effects of ERT. We hypothesised that chronic ERT initiated in late middle age would decrease infarct size in the brain after an induced stroke, whereas acute ERT would have no beneficial effects in aged females. To test this hypothesis, two paradigms of ERT were administered to aged mice of both sexes aiming to determine the effects on stroke outcome and to explore the possible mechanisms by which ERT interacts with age. Female mice that received chronic ERT from 17–20 months of age showed improved stroke outcomes after experimental stroke, whereas females that had acute ERT initiated at 20 months of age did not. Chronic ERT females exhibited diminished levels of nuclear factor kappa B (NF‐κB) translocation compared to acute ERT females after stroke. Acute ERT females demonstrated both an increase in nuclear NF‐κB and enhanced expression of pro‐inflammatory cytokines. In addition, a sexual dimorphic effect of ERT was seen because males benefited from ERT, regardless of the timing of initiation. Aged males had significantly reduced expression of pro‐inflammatory markers after stroke compared to age‐matched females, suggesting a pro‐inflammatory milieu emerges with age in females. These results are consistent with the emerging clinical literature suggesting that ERT should be initiated at the time of menopause to achieve beneficial effects. The present study demonstrates the importance of using appropriate animal models in preclinical studies.
Why is Kikuchi–Fujimoto disease misleading?
Authors: Prignano Francesca , D’Erme Angelo Massimiliano , Zanieri Fabio , Bonciani Diletta , Lotti Torello
Published: November 2011

Background  Kikuchi–Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare, benign, autoimmune condition characterized by lymphadenopathy, fever, and neutropenia. KFD has also been frequently reported in association with systemic lupus erythematosus (SLE).

Report  We report a case of skin manifestations in KFD characterized by malar rash, photosensitivity, panniculitic lesions, positive antinuclear antibodies and nDNA, and negative extractable nuclear antigen. A biopsy performed on deep nodules on the arms revealed an infiltrate of monocytic cells. Electron microscopy showed no lymphocytic infiltrate at or below the basal membrane and no necrotic keratinocytes within the basal cells of the epidermis.

Conclusion  Histological and ultrastructural data showed that skin manifestations of KFD and SLE share some common features. Electron microscopy analysis can help discriminate between the two diagnoses.
Two novel frameshift mutations of the DSRAD gene in Chinese pedigrees with dyschromatosis symmetrica hereditaria
Authors: Liu Yan , Liu Feng , Wang Xiaopeng , Huo Jia , Xu Qingqiang , Li Xiaoli , Ren Jianwen , Wang Mei , Xiao Shengxiang , Peng Zhenhui
Published: November 2011

Background  Dyschromatosis symmetrica hereditaria (DSH) is an autosomal dominant disorder characterized by a mixture of hyperpigmented and hypopigmented macules localized on the back of the extremities and caused by the mutations in the DSRAD gene.

Methods  Two Chinese pedigrees of typical DSH were subjected to mutation detection in DSRAD. Direct sequencing of all PCR products of the whole coding regions of DSRAD was performed to identify the mutation.

Results  The c.1615delG (p.V539fs) mutation was found in the affected members but not in the healthy individuals in family 1 and the c.ins1372‐9 CCACAGAT (p.D458fs) mutation was found in patients but not in the healthy members of family 2.

Conclusion  Our study found two novel frameshift mutations in the DSRAD gene. We add new variants to the knowledge of DSRAD mutations in DSH.
Experience of an information aid for newly diagnosed multiple sclerosis patients: a qualitative study on the SIMS‐Trial
Authors: Borreani Claudia , Giordano Andrea , Falautano Monica , Lugaresi Alessandra , Martinelli Vittorio , Granella Franco , Tortorella Carla , Plasmati Imma , Radaelli Marta , Farina Deborah , Dalla Bella Eleonora , Bianchi Elisabetta , Acquarone Nicola , Miccinesi Guido , Solari Alessandra ,   on behalf of the SIMS‐Trial group
Published: November 2011

Background The SIMS‐Trial (ISRCTN81072971) proved the effectiveness, in terms of patient’s knowledge and care satisfaction, of an add‐on information aid (personal interview with a physician using a navigable CD and take‐home booklet) in 120 newly diagnosed patients with multiple sclerosis (MS) from five Italian centres.

Objective To scrutinize the experience of SIMS‐Trial participants in order to gain better understanding of the effectiveness of the information aid and its components.

Design We performed (i) nine individual semi‐structured interviews with a purposeful sample of SIMS‐Trial patients who received the information aid, (ii) focus group meeting (FGM) with the physicians who conducted the personal interview, and (iii) FGM with patients’ caring neurologists.

Results Patients’ experience with the information aid was positive as it enhanced their understanding of their disease, being viewed as a guided tour of their medical condition. The physicians who conducted the personal interviews were also positive in their overall evaluation but noted an initial difficulty in using the CD. The caring neurologists had limited direct experience of the aid, and their views were confined to utility of the information aid in general. All participants considered the combination of personal interview, CD navigation and take‐home booklet essential, but urged a more flexible scheduling of the personal interview. It also emerged that some content required revision and that the aid was unsuitable for patients with primary progressive MS.

Conclusions The results of the study further support the value of the aid and also provide important indications for improving it and refining indications for use.
Increased risk for post‐operative corneal injuries in patients who undergo laparoscopic gynecologic surgery
Authors: KIM K. , KIM H. J. , NO J. H. , KIM T. W. , KIM Y. B. , SUH C. S.
Published: November 2011

Background

The objective of this study was to verify whether or not the incidence of post‐operative corneal injuries (PCIs) in patients who undergo laparoscopic gynecologic surgery is higher than patients who undergo non‐laparoscopic gynecologic surgery.

Methods

 The peri‐operative variables were extracted from the medical records of patients who underwent gynecologic surgery under general anesthesia at our institute between January 2004 and June 2010. The extracted variables were age, day of week of surgery, type of surgery (laparoscopy vs. non‐laparoscopy), surgical scheduling (elective vs. emergent), pre‐operative hemoglobin, surgery time, peri‐operative transfusions, and PCIs. The association of peri‐operative variables with PCIs was examined using univariate and multivariate analyses.

Results

 A total of 6992 consecutive patients were included in this study. PCIs occurred in 23 patients (0.3%). Based on univariate analysis, the type of surgery and surgery times were associated with PCIs. Based on multivariate analysis, laparoscopy and lengthy surgery times significantly increased the risk for PCIs. The median duration of PCI symptoms was 3 days (range, 1–11 days); no patient had long‐term sequalae.

Conclusion

 Laparoscopic gynecologic surgery increases the incidence of PCI compared with non‐laparoscopic gynecologic surgery.
A Single Administration of the GnRH Antagonist Acyline Inhibits Basal and GnRH‐Stimulated Serum Testosterone Concentrations in Male Dogs
Authors: García Romero G , Mattioli G , Rosa D , Diaz JD , Abeyá M , Gobello C
Published: November 2011

Contents

The objective of this study was to describe testosterone (T) response to GnRH challenge in antagonist‐treated dogs over a 30‐day period. Eight mongrel dogs were randomly assigned to either the GnRH antagonist acyline 330 μg/kg sc (ACY; n = 4) or a placebo group (PLA; n = 4). The dogs were serially challenged with the GnRH agonist, buserelin 0.2 μg/kg sc on days −1, 1, 3, 7, 10, 14, 21 and 30. On these days, blood samples for T determinations were collected before (−30 min) and 60, 120 and 180 min after the agonist injection. Basal (−30 min) and post‐GnRH agonist stimulation T values were compared by anova for repeated measures. Before treatments (day −1), there were no differences in basal T serum concentrations between groups (p > 0.1). After treatments, basal T showed a significant interaction between treatment and day (p < 0.05). Furthermore, when both groups were analysed independently, basal T varied in the ACY (p < 0.01) but not in the PLA group (p > 0.1). On day −1, before treatments, the stimulation tests had only a time effect (p = 0.05) although on days 1 (p < 0.01), 3 (p < 0.01), 7 (p < 0.01), 10 (p < 0.01) and 14 (p < 0.05), the response to the agonist differed between groups, becoming similar on days 21 (p > 0.05) and 30 (p > 0.05). It was concluded that, in dogs, a single administration of the GnRH antagonist prevented canine gonadal axis to physiologically respond to agonistic challenge during 14 days.
Reexamining the boundaries of the ‘normal’ in ageing
Authors: O’Rourke Hannah M. , Ceci Christine
Published: November 2011

O’ROURKE HM and CECI C. Nursing Inquiry 2013; 20: 51–59  Reexamining the boundaries of the ‘normal’ in ageing

Textbooks and policy documents tend to present the boundary between normal and abnormal ageing as natural and clearly demarcated. In this study, we trouble the notion of natural and clearly demarcated boundaries between normal and abnormal ageing by considering how these boundaries have been established and maintained in present‐day Western contexts. We draw on both Canguilhem’s discussion of the normal and the abnormal and Foucault’s emphasis on the role of the sociohistorical context in the social practice of boundary generation. In doing so, we critically examine common conceptualizations of normal and abnormal ageing, including those found in antiageing science, successful ageing and healthy ageing policy discourses and in health education textbooks. We argue that the growing emphasis on ‘healthy’ ageing both reflects and shapes the societal views of those individuals who are not able to remain disease‐free and represents a kind of mystification of ageing where ageing without functional or cognitive decline is instituted as the norm. Awareness of the role that the social context plays in shaping definitions of normal and abnormal ageing encourages critical consideration of the effects that Western conceptualizations of normal ageing may have for older adults who continue to age with cognitive or functional decline.
Clinicopathological significance of invasive micropapillary carcinoma component in invasive breast carcinoma
Authors: Ide Yoshimi , Horii Rie , Osako Tomo , Ogura Kaoru , Yoshida Reiko , Iwase Takuji , Akiyama Futoshi
Published: November 2011

Invasive micropapillary carcinoma (IMP) of the breast is a rare variant of invasive breast carcinoma and most cases of IMP are associated with nodal metastasis and lymphatic invasion. Lesions composed of an IMP component alone are rare and almost always coexist with other pathological components. However, few reports have documented IMP along with its proportion and the coexistent pathological type. We analyzed the total 486 breast cancer lesions operated in our hospital in 1998. We classified the lesions into five groups by the proportion of the IMP component in each lesion. Then we evaluated the incidence of nodal metastasis and lymphatic invasion in each group. The incidence of the invasive carcinoma containing any IMP components was 8.4%. The incidence of nodal metastasis and lymphatic invasion in lesions with an IMP component were significantly higher than that in those with no IMP. No correlation was seen between the incidence of nodal metastasis and the coexistent pathological type, shape of tumor clusters, nuclear grade and the expression of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 and gross cystic disease fluid protein‐15 in IMP components. The presence of IMP components was a significant predictive factor for nodal metastasis, even if it is detected in only a small proportion of the tumor.
B‐type natriuretic peptide levels at birth predict cardiac dysfunction in neonates
Authors: Moriichi Akinori , Cho Kazutoshi , Mizushima Masato , Furuse Yuta , Akimoto Takuma , Yamada Takashi , Minakami Hisanori
Published: November 2011

Background:  Although the B‐type natriuretic peptide (BNP) levels in the umbilical cord blood (UCB‐BNP) and amniotic fluid (AF‐BNP) of neonates may be clinically useful for identifying newborns with cardiac dysfunction, the effects of various clinical factors, such as gestational age at birth, small for gestational age (SGA), and neonatal asphyxia, on the UCB‐BNP and AF‐BNP levels have not been studied extensively.

Methods:  The present study sought to determine whether the UCB‐BNP and AF‐BNP levels can predict cardiac dysfunction and hypotension in preterm infants soon after birth and to evaluate the association between BNP and various clinical factors. The UCB‐BNP and AF‐BNP levels at birth were determined in 320 and 195 neonates, respectively, born to mothers with singleton pregnancies.

Results:  The UCB‐BNP and AF‐BNP levels in infants treated with dopamine were significantly higher than those in infants without dopamine administration (230.1 vs 33.1 pg/mL and 74.4 vs 18.1 pg/mL, respectively). Stepwise multiple regression analyses indicated that gestational age, SGA, asphyxia, and chorioamnionitis were significant independent determinants of the UCB‐BNP level. Cut‐off values of >90 pg/mL for UCB‐BNP and >36 pg/mL for AF‐BNP yielded sensitivities of 68% and 93%, respectively, and specificities of 84% and 81%, respectively, for detecting neonates who required dopamine administration after birth.

Conclusion:  High UCB‐BNP and AF‐BNP levels predict neonatal cardiac dysfunction soon after birth.
Maternal periodontitis as a risk factor for prematurity
Authors: Piscoya Maria Dilma B. V. , Ximenes Ricardo A. A. , Silva Genivaldo M. , Jamelli Sílvia R. , Coutinho Sônia B.
Published: November 2011

Background:  The aim of this study was to investigate maternal periodontitis associated with prematurity.

Methods:  We carried out a case–control study including 718 puerperae who experienced a spontaneous delivery: 360 cases (premature) and 358 controls (full‐term). Sociodemographic, obstetric, prenatal, perinatal and periodontal data were obtained within 48 h after delivery. Periodontitis was defined as probing depth ≥4 mm and attachment loss ≥3 mm at same site, for ≥4 teeth.

Results:  Periodontitis was associated with prematurity (odds ratio 6.95; confidence interval 3.69–13.09). Prematurity was associated with maternal age < 20 years, family income < one minimum salary, maternal schooling < 8 years, premature birth history, premature membrane rupture, ruptured membranes > 24 h, smoking, urinary tract infection, leukorrhea, pre‐eclampsia, prenatal consultations < 3 and precarious housing. After multivariate confounder adjustments, periodontitis remained independently associated with prematurity (odds ratio 6.05; confidence interval 3.01–12.16).

Conclusions:  Periodontitis is strongly associated with prematurity, indicating necessity for regular periodontal investigation and treatment during pregnancy.
Fluctuations in relative humidity provided to extremely low‐birthweight infants (R1)
Authors: Kaczmarek Jennifer , Tarawneh Amjad , Martins Bianca , Mendes Sant' Anna Guilherme
Published: November 2011

Background:  In extremely low‐birthweight infants, the addition of relative humidity (RH) improves thermal stability, fluid and electrolyte balance. However, during routine care this microenvironment is frequently disturbed. The objective of this study was to determine the frequency, magnitude and direction of fluctuations in RH provided to extremely low‐birthweight infants.

Methods:  All infants in our study had ambient temperature and RH continuously recorded for 48 h using a datalogger device (RH32S‐C2). A clinically acceptable range for RH was defined as the set point ±10%. A secondary analysis was performed to compare outcomes between infants that spent > 50% of the time out‐of‐range (OOR) or inside the range (IR). A P‐value < 0.05 was significant.

Results:  A total of 20 infants were included. Important fluctuations were detected by the device with infants spending 40% and 14% of the time above and below the range, respectively. However, the RH set point did not differ from the mean levels measured over 48 h by the RH32S‐C2 or the incubator. Infants in the OOR group spent significantly more time at values higher than the planned range when compared to IR infants.

Conclusion:  Although significant fluctuations in RH above the desired range were detected in more than half of the infants, the average values were similar to the set points. Nevertheless, knowledge of these dynamic changes may help to optimize individualized care.
Immune response to Haemophilus influenzae type b conjugate vaccine in preterm infants
Authors: Tsuda Kennosuke , Iwasaki Shiho , Horiguchi Haruko , Mori Masaaki , Nishimaki Shigeru , Seki Kazuo , Taguri Masataka , Yokota Shumpei , Ishiwada Naruhiko
Published: November 2011

Background:  Haemophilus influenzae type b (Hib) vaccine became available for use in Japan in December 2008. The aim of the present study was to evaluate the immunogenicity of Hib vaccine in Japanese preterm infants.

Methods:  Serum samples were obtained from 54 preterm infants before the first vaccination and 1 month after the third. Anti‐polyribosylribitol phosphate (PRP) antibodies were measured using an enzyme‐linked immunosorbent assay method. Antibody positivity was defined as levels >1 µg/mL.

Results:  Of the 54 preterm infants, 46 (85.2%) achieved antibody levels >1 µg/mL. This compares with the 92.4% reported in full‐term infants. The antibody seroconversion rate of infants starting vaccination at 2 months of age was close to being significantly lower than when vaccination was started at 3 months of age (P= 0.060). In addition, the percentage of infants achieving a positive response in the group with a history of antenatal steroid exposure was significantly higher than in those not exposed (P= 0.046). Thus, risk factors for lower Hib antibody concentrations after three doses of vaccine were age at first vaccination and lack of use of antenatal steroids.

Conclusions:  There is a possibility that perinatal factors and the environment unique to preterm infants are related to their lower antibody positivity rates compared to full‐term infants. It may therefore be preferable to modify the proposed immunization schedule.
Outline of JUA clinical guidelines for benign prostatic hyperplasia
Authors: Homma Yukio , Gotoh Momokazu , Yokoyama Osamu , Masumori Naoya , Kawauchi Akihiro , Yamanishi Tomonori , Ishizuka Osamu , Seki Narihito , Kamoto Toshiyuki , Nagai Atsushi , Ozono Seiichiro
Published: November 2011

The Japanese Urological Association has developed Clinical Guidelines for Benign Prostatic Hyperplasia (BPH) for men with suspected BPH, which have been abridged and translated into English. This article is a shortened version of the English translation. The Guidelines were formulated on the basis of evidence retrieved from the PubMed database between 1995 and 2009, as well as other relevant sources. The target patients of these Guidelines are men with suspected BPH, and the target users are urologists. A mandatory assessment should include a medical history, a physical examination, the completion of symptom and quality of life questionnaires, urinalysis, prostate ultrasonography, measurement of serum prostate specific antigen and postvoid residual urine, and an uroflowmetry. Optional tests include a bladder diary, the measurement of serum creatinine, and upper urinary tract ultrasonography. Care should be taken to not overlook coexisting diseases such as an infection or malignancy that may obscure the diagnosis. Treatment should consist of conservative therapy or the use of medications such as α1‐adrenoceptor antagonists, or both. The use of 5α‐reductase inhibitors or anticholinergic agents should be considered in patients with an enlarged prostate (>30 mL) or overactive bladder symptoms (overactive bladder symptom score ≥6), respectively. Surgical intervention is indicated when non‐surgical treatments fail to provide sufficient symptomatic relief and bladder outlet obstruction is highly suspected.
Why are some patients admitted to psychiatric hospital while others are not? A study assessing risk during the admission interview and relationship to outcome
Authors: Hunt Glenn E. , O'Hara‐Aarons Maureen , O'Connor Nick , Cleary Michelle
Published: November 2011

The aim of this study was to determine what patient characteristics are used to decide whether a patient is or is not admitted to a psychiatric hospital, and what happens to those not admitted. A further aim was to determine if high levels of risk on admission predict seclusions, length of stay, or readmission within 28 days. Data were collected prospectively on consecutive presentations to an admission office via case notes and electronic databases. Eighty percent (100/127) of the adults presenting to the admission office over a typical month were admitted to hospital. Patients were more likely to be admitted if they were experiencing psychosis or exacerbation of schizophrenia, referred by other doctors or mental health teams, had a legal reason for referral, or if they were homeless. There was no association between risk for violence or suicide and seclusion rates, length of stay, or being readmitted within 28 days. It was reassuring to find that 85% of those not admitted were referred to other mental health providers, and none required admission over the following month. This study found high rates of seclusion and readmissions within 1 year, which requires further study to find strategies to reduce these rates.
Methanogenic toluene metabolism: community structure and intermediates
Authors: Fowler S. Jane , Dong Xiaoli , Sensen Christoph W. , Suflita Joseph M. , Gieg Lisa M.
Published: November 2011

Toluene is a model compound used to study the anaerobic biotransformation of aromatic hydrocarbons. Reports indicate that toluene is transformed via fumarate addition to form benzylsuccinate or by unknown mechanisms to form hydroxylated intermediates under methanogenic conditions. We investigated the mechanism(s) of syntrophic toluene metabolism by a newly described methanogenic enrichment from a gas condensate‐contaminated aquifer. Pyrosequencing of 16S rDNA revealed that the culture was comprised mainly of Clostridiales. The predominant methanogens affiliated with the Methanomicrobiales. Methane production from toluene ranged from 72% to 79% of that stoichiometrically predicted. Isotope studies using 13C7 toluene showed that benzylsuccinate and benzoate transiently accumulated revealing that members of this consortium can catalyse fumarate addition and subsequent reactions. Detection of a BssA gene fragment in this culture further supported fumarate addition as a mechanism of toluene activation. Transient formation of cresols, benzylalcohol, hydroquinone and methylhydroquinone suggested alternative mechanism(s) for toluene metabolism. However, incubations of the consortium with 18O‐H2O showed that the hydroxyl group in these metabolites did not originate from water and abiotic control experiments revealed abiotic formation of hydroxylated species due to reactions of toluene with sulfide and oxygen. Our results suggest that toluene is activated by fumarate addition, presumably by the dominant Clostridiales.
Unveiling microbial life in the new deep‐sea hypersaline Lake Thetis. Part II: a metagenomic study
Authors: Ferrer Manuel , Werner Johannes , Chernikova Tatyana N. , Bargiela Rafael , Fernández Lucía , La Cono Violetta , Waldmann Jost , Teeling Hanno , Golyshina Olga V. , Glöckner Frank Oliver , Yakimov Michail M. , Golyshin Peter N. ,   The MAMBA Scientific Consortium
Published: November 2011

So far only little is known about the microbial ecology of Mediterranean deep‐sea hypersaline anoxic lakes (DHALs). These brine lakes were formed by evaporite dissolution/brine seeps and are important model environments to provide insights into possible metabolisms and distributions of microorganisms on the early Earth. Our study on the Lake Thetis, a new thalassohaline DHAL located South‐East of the Medriff Corridor, has revealed microbial communities of contrasting compositions with a high number of novel prokaryotic candidate divisions. The major finding of our present work is co‐occurrence of at least three autotrophic carbon dioxide fixation pathways in the brine–seawater interface that are likely fuelled by an active ramified sulphur cycle. Genes for the reductive acetyl‐CoA and reductive TCA pathways were also found in the brine suggesting that these pathways are operational even at extremely elevated salinities and that autotrophy is more important in hypersaline environments than previously assumed. Surprisingly, genes coding for RuBisCo were found in the highly reduced brine. Three types of sulphide oxidation pathways were found in the interface. The first involves a multienzyme Sox complex catalysing the complete oxidation of reduced sulphur compounds to sulphate, the second type recruits SQR sulphide:quinone reductase for oxidation of sulphide to elemental sulphur, which, in the presence of sulphide, could further be reduced by polysulphide reductases in the third pathway. The presence of the latter two allows a maximal energy yield from the oxidation of sulphide and at the same time prevents the acidification and the accumulation of S0 deposits. Amino acid composition analysis of deduced proteins revealed a significant overrepresentation of acidic residues in the brine compared with the interface. This trait is typical for halophilic organisms as an adaptation to the brine's extreme hypersalinity. This work presents the first metagenomic survey of the microbial communities of the recently discovered Lake Thetis whose brine constitutes one of saltiest water bodies ever reported.
Good quality white‐light transurethral resection of bladder tumours (GQ‐WLTURBT) with experienced surgeons performing complete resections and obtaining detrusor muscle reduces early recurrence in new non‐muscle‐invasive bladder cancer: validation across time and place and recommendation for benchmarking
Authors: Mariappan Paramananthan , Finney Steven M. , Head Elizabeth , Somani Bhaskar K. , Zachou Alexandra , Smith Gordon , Mishriki Said F. , N'Dow James , Grigor Kenneth M. ,   for members of the Edinburgh Urological Cancer Group
Published: November 2011

Study Type – Therapy (cohort)

Level of Evidence 2b

What's known on the subject? and What does the study add?

Apart from bladder tumour multiplicity, size, stage, grade and presence of cis, early recurrence following white light TURBT for new bladder tumours is also determined by surgeon experience, completeness of resection and presence or absence of detrusor muscle in the specimen.

This study aims to validate surgeon experience and detrusor muscle as independent predictors of early recurrence following apparently complete white light TURBT in new bladder tumours.

OBJECTIVE

To validate in patients undergoing first transurethral resection of bladder tumour (TURBT) for non‐muscle‐invasive bladder cancer (NMIBC), the presence/absence of detrusor muscle (DM) in the specimen and surgeon experience as independent predictors of the quality of TURBT.

PATIENTS AND METHODS

Patients with new NMIBC, who had undergone complete first resections were recruited from a prospectively maintained cohort from the 1980s at the Western General Hospital, Edinburgh, UK and a contemporary cohort from the Aberdeen Royal Infirmary, UK.

Tumour size, multiplicity, surgeon category, presence or absence of DM in the specimen, grade, stage, findings at first check cystoscopy and early re‐TURBT were evaluated.

Surgeons were stratified into a senior group (consultant and trainees in year five or six) and a junior group (trainees below year five).

Early recurrence, or recurrence rate at the first follow up cystoscopy (RRFFC), was used to measure quality and was defined as finding pathologically confirmed tumour at early re‐TURBT or the first check cystoscopy.

RESULTS

From a total of 566 patients evaluated from both cohorts, 473 NMIBC specimens were suitable for analysis.

Logistic regression multivariate analysis revealed that the absence of DM was associated with a higher RRFFC (odds ratio [OR]= 3.6, 95% CI = 1.7–7.5, P < 0.001).

Senior surgeons were more likely to resect DM (OR = 4.9, 95% CI = 2.3–10.7, P < 0.001)

Senior surgeons were independently associated with a lower RRFFC (OR = 5.3, 95% CI = 2.1–12.9, P < 0.001).

CONCLUSIONS

Detrusor muscle status at the first, apparently complete, TURBT and surgeon's experience independently predict the quality of TURBT.

Documented complete resection by experienced surgeons with DM presence (good quality white‐light TURBT) should be considered a benchmark for white‐light TURBT in NMIBC.
Type of transrectal ultrasonography probe influences prostate cancer detection rates on repeat prostate biopsy
Authors: Ching Christina B. , Zaytoun Osama , Moussa Ayman S. , Li Jianbo , Avallone Anthony , Jones J. Stephen
Published: November 2011

Study Type – Diagnostic (case series)

Level of Evidence 4

What's known on the subject? and What does the study add?

It is known that the end‐fire probe detects more prostate cancer on initial prostate biopsy, but there is no literature looking at the influence of type of probe on repeat biopsy.

Given that the literature on the influence of ultrasonography probe on repeat prostate biopsy is non‐existent, the present study adds information which may help urologists improve their chances of detecting prostate cancer on prostate biopsy. Determining which type of probe to use on a prostate biopsy is a simple external factor that may help improve patient management.

OBJECTIVE

To determine if the type of transrectal ultrasonography (TRUS) probe used during repeat prostate biopsy influences prostate cancer detection rates.

PATIENTS AND METHODS

We conducted a retrospective chart review of 680 men undergoing repeat prostate biopsy at our institution between 2000 and 2010.

Patient mean (range) age was 64.2 (39–95) years.

The median (range) prostate‐specific antigen (PSA) level was 5.5 (0.37–33.8) ng/mL and median (range) free PSA was 17 (5–45) %.

Patient age, PSA, prostate volume, number of biopsy cores, time interval between initial and repeat biopsy, digital rectal examination and pathological findings were all included in a multivariate logistic regression analysis.

RESULTS

The use of an end‐fire probe on repeat biopsy significantly increased prostate cancer detection (odds ratio [OR] 1.59, 95% confidence interval [CI]: 1.03–2.46).

The time interval between 1st and 2nd biopsy was also significant (OR 1.46, 95% CI: 1.11–1.09).

On univariate analysis, white race (OR 0.66, 95% CI: 0.44–0.99), increasing prostate volume (OR 0.70, 95% CI: 0.55–0.89), and higher free PSA (OR 0.54, 95% CI: 0.34–0.84) were associated with a decreased risk of cancer.

When evaluating the different permutations of using an end‐fire or side‐fire probe on initial or repeat biopsy, there was no difference in prostate cancer detection regardless of order of use of an end‐fire or side‐fire probe.

CONCLUSIONS

An end‐fire probe is associated with improved prostate cancer detection rates on both initial and repeat biopsy.

The order of probe use does not appear to matter.
Global robotic experience and the type of surgical system impact the types of robotic malfunctions and their clinical consequences: an FDA MAUDE review
Authors: Lucas Steven M. , Pattison Erik A. , Sundaram Chandru P.
Published: November 2011

Study Type – Therapy (case series)

Level of Evidence 4

What's known on the subject? and What does the study add?

Malfunctions of the robotic surgical system have been reported, and the critical failure rate leading to converting or aborting the case occurs in less than 1% of cases. However, little is known about how global robotic experience with time and the advent of newer robotic surgical systems impact robot malfunctions. In this study, we characterize the changes in type and consequences of robot malfunctions over time and by type of robotic system used (da Vinci or da Vinci S).

OBJECTIVES

To assess annual rates of robotic system malfunctions and compare the da Vinci S® system (dVS) and da Vinci® surgical system (dV).

To assess the types of malfunctions and associated outcomes for robotic cases and determine the extent to which experience and technological improvements impact these.

PATIENTS AND METHODS

This study is a retrospective review of the US Food and Drug Administration (FDA) MAUDE (Manufacturer and User Facility Device Experience) database, a publicly available, voluntary reporting system (http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfmaude/search.cfm).

The database was searched using the two phrases ‘da Vinci’ and ‘Intuitive Surgical’ from 2003 to 2009.

Malfunctions of the instruments, console, patient‐side cart, camera and cannula were recorded.

Data on intraoperative injuries, case delays and conversions were also collected.

RESULTS

In all, 1914 reports were reviewed (991 dVS and 878 dV, 45 unclassified) with peak years for reports of 2008 for dVS (571) and 2007 for dV (211), P < 0.001.

With respect to time, the proportion of console and patient‐side cart malfunctions declined from 2007 onward compared with the proportions prior to 2007 (5.1% vs 9.4% and 6.6% vs 10.9%).

Patient injury did not change with year of surgery (0.5–5.4% of malfunctions, P= 0.358), open conversions declined (21.3% of malfunctions before 2007 vs 9.9% from 2007 onward, P < 0.001) and patient deaths increased (0.0013% of cases before 2007 vs 0.0061% of cases from 2007 onward, P < 0.001).

With regard to robotic system, console and patient‐side cart malfunctions were more frequent with the dV than the dVS: 82/878 vs 39/991 and 100/878 vs 48/991, P < 0.001.

Open conversion was more frequent with dV than dVS (19.3% vs 7.7% of reported malfunctions, P < 0.001), while patient injury was less with dV than dVS (3.5% vs 5.9%, P= 0.021).

CONCLUSIONS

The dVS decreased console and patient‐side cart errors relative to total malfunctions, which were also influenced by surgical year.

Open conversions were reduced by increased robotic experience and newer surgical system.

Differences in patient injury may reflect changes in reporting or case complexity.
Which patients are at the highest risk of dying from competing causes ≤10 years after radical prostatectomy?
Authors: Froehner Michael , Koch Rainer , Litz Rainer J. , Hakenberg Oliver W. , Wirth Manfred P.
Published: November 2011

Study Type – Outcomes (cohort)

Level of Evidence 2b

What's known on the subject? and What does the study add?

Several comorbidity classifications have been investigated for their suitability to assist treatment decision‐making in men with early prostate cancer. In unselected patients, some serious comorbidities have been shown to be associated with a 10‐year competing mortality rate clearly superseding the 50% level.

The present study shows that it is hardly possible to discern meaningful subsets of patients with a 10‐year risk of competing mortality of >50% by using comorbidity classifications. This finding suggests that the selecting clinicians did well in estimating the medium‐term survival probability in men referred for radical prostatectomy.

OBJECTIVE

To identify subsets of patients who are most likely to die from competing causes ≤10 years after radical prostatectomy (RP).

PATIENTS AND METHODS

In all, 2205 consecutive patients who underwent RP for clinically localized prostate cancer between 1992 and 2005 were studied. The 10‐year cumulative competing mortality rates were determined in several worst‐case scenarios formed by using comorbidity classifications and combinations of them.

RESULTS

In this sample of men selected for RP, even those with the most severe comorbidity level had a competing mortality risk of <50% ≤10 years after RP.

Depending on the comorbidity classification used, the 10‐year cumulative competing mortality rates differed between 16 and 39% in the whole sample and between 18 and 48% in men aged ≥65 years.

CONCLUSION

Clinicians do well in estimating the further life span in candidates for RP. Comorbidity classifications may assist treatment choice in this population but are not able to discern meaningful subsets to be excluded from curative treatment because of a life expectancy falling below a limit of 10 years.
Survival after treatment for carcinoma invading bladder muscle: a Dutch population‐based study on the impact of hospital volume
Authors: Goossens‐Laan Catharina A. , Visser Otto , Hulshof Maarten C.C.M. , Wouters Michel W. , Bosch J. L. H. Ruud , Coebergh Jan‐Willem W. , Kil Paul J.M.
Published: November 2011

Study Type – Prognosis (cohort)

Level of Evidence 2a

What's known on the subject? and What does the study add?

The subject of mortality and survival rates after radical cystectomies in high‐volume hospitals in comparison to low‐volume hospitals has been extensively studied. Postoperative mortality is known to be significantly lower with high‐volume providers, but for survival rates there was only a trend forwards this finding. For this reason, we performed this Dutch population‐based study on survival rates, to see if we had enough power to support this trend with significant findings. To our knowledge, this is the first study of good quality showing a significant beneficial effect for survival in high‐volume hospitals.

OBJECTIVE

To examine the volume–outcome relationship for carcinoma invading bladder muscle (MIBC) with respect to differences in survival rates among all hospitals in the Netherlands as a guide for regionalization initiatives.

MATERIALS AND METHODS

This population‐based retrospective study included all patients (n= 13 033) newly diagnosed with MIBC during the period 1999–2008 in the Netherlands, selected from the Netherlands Cancer Registry.

Data were collected on demographics, morphology, stage at diagnosis and after surgery, primary treatment, vital status and date of follow‐up or death.

The relative survival rate (RSR) per treatment was analysed for age, stage and hospital surgical volume.

RESULTS

Overall 5 and 10‐year RSR for all treatments of MIBC was 32% and 25%, respectively.

Although 71.7% of the patients featured stages II and III, radical cystectomy was only performed in only 42% and 44% of these patients, respectively.

Relative survival for MIBC remained unchanged in the two consecutive time periods (1999–2003 and 2004–2008).

In all, 34% of patients diagnosed in low‐volume hospitals (<10 cystectomies/year) underwent cystectomy vs 42% of those diagnosed in high‐volume hospitals (P= 0.000).

In a multivariate analysis long‐term survival (>30 days after surgery) was significantly lower in patients after cystectomy for stage II/III in low‐volume hospitals (hazard ratio [HR] 1.17, P= 0.036). A high lymph node count (>20) was associated with a lower risk of death (HR 0.52, P= 0.000).

CONCLUSIONS

The 10‐year RSR for patients with MIBC in the Netherlands was modest (25%) and has remained unchanged in the last decade.

The chance of undergoing cystectomy is significantly higher in high‐volume hospitals. Long‐term survival after cystectomy is higher in high‐volume hospitals.

Regionalization of bladder cancer treatments could improve overall outcomes.
Motion Retrieval Using Low‐Rank Subspace Decomposition of Motion Volume
Authors: Sun Chuan , Junejo Imran , Foroosh Hassan
Published: November 2011

This paper proposes a novel framework that allows for a flexible and an efficient retrieval of motion capture data in huge databases. The method first converts an action sequence into a novel representation, i.e. the Self‐Similarity Matrix (SSM), which is based on the notion of self‐similarity. This conversion of the motion sequences into compact and low‐rank subspace representations greatly reduces the spatiotemporal dimensionality of the sequences. The SSMs are then used to construct order‐3 tensors, and we propose a low‐rank decomposition scheme that allows for converting the motion sequence volumes into compact lower dimensional representations, without losing the nonlinear dynamics of the motion manifold. Thus, unlike existing linear dimensionality reduction methods that distort the motion manifold and lose very critical and discriminative components, the proposed method performs well even when inter‐class differences are small or intra‐class differences are large. In addition, the method allows for an efficient retrieval and does not require the time‐alignment of the motion sequences. We evaluate the performance of our retrieval framework on the CMU mocap dataset under two experimental settings, both demonstrating promising retrieval rates.
EVALUATING THE BREADTH OF POLICY ENGAGEMENT BY ORGANIZED INTERESTS
Authors: HALPIN DARREN R. , THOMAS H.F.
Published: November 2011

This article probes the variation in the breadth of policy engagement among organized interests. The literature, heavily shaped by large‐n US studies of Washington and its lobbying system, suggests many reasons for organized interests to focus policy engagement relatively narrowly. This claim of policy specialization has been long repeated in the British public policy literature. The aim of this article is to empirically test the extent to which expectations of narrowed engagement hold in a UK context. This article uses a new Scottish dataset that tracks actual engagement by any organized interest on executive policy consultations over a 25‐year period. It tracks over 90,000 ‘mobilization events' by over 18,000 organizations in 1,690 distinct consultation issues across the entire Scottish policy system. In analysing these data, we concern ourselves with establishing: (1) the extent of generalized engagement; (2) the type of organized interests that are more or less general in their engagement; and (3) the extent to which a specialized style of policy engagement is on the increase over time. In the process, we develop measures that are appropriate for assessing breadth of engagement using issue‐based policy data.
‘…I TAKE POLITICAL RESPONSIBILITY!’: THE THEORETICAL AND EMPIRICAL RELATION BETWEEN MINISTERIAL RESPONSIBILITY AND MINISTERIAL RESIGNATIONS IN GERMANY
Authors: FISCHER JÖRN
Published: November 2011

How is the doctrine of ministerial responsibility applied in the decisions of German ministers (not) to resign? This question arises from an empirical puzzle as well as from a theoretical contradiction. Despite the prominent principle of ministerial responsibility, empirically, the ‘personal consequences' of ministerial scandals in their area of responsibility, display a large variance. Some ministers resign because of rather trifling affairs, others stay in office in spite of serious scandals. Taking into consideration the delegation relationship between the executive and the parliament, in view of the principal‐agent theory, a minister's resignation due to major political or personal misconduct is to be expected. On the other hand, the actual constitutional configuration of ministerial responsibility casts theoretical doubts on the ministerial loss of office. The quantitative analysis of 133 resignation issues in the years 1949 to 2009 reveals that ministerial responsibility bears no relevance to the decision whether to resign or not. Indeed, when the cause of the resignation issue is directly connected to ministerial responsibility, the probability of a resignation even decreases.
Risk‐Averse Mitigation Decisions in an Unpredictable Climate System*
Authors: Lontzek Thomas S. , Narita Daiju
Published: November 2011

Risk aversion plays a central role in the decisions made in the face of uncertainties, and climate‐change mitigation should be no exception. However, the interlinkage of risk aversion and climate‐change uncertainties has hardly been investigated numerically, in part because of the computational difficulties of stochastic optimization. In this paper, we apply the numerical techniques of stochastic optimization to the economic modeling of climate change, with the aim of modeling the decision preferences of a risk‐conscious agent in the face of unpredictable climate change. The model underlines the critical role played by the risk‐aversion parameter in determining the effects of uncertainties on mitigation, not only in level but also in sign.
Money Management and Views of Civil Partnership in Same-Sex Couples: Results from a UK Survey of Non-Heterosexuals
Authors: Burgoyne Carole , Clarke Victoria , Burns Maree
Published: November 2011

Recent legislation in the UK has extended many of the legal and financial rights and responsibilities of heterosexual marriage to same-sex couples who register their partnerships. Prior to the Civil Partnership Act (2004) however, little was known about financial arrangements in same-sex couples, nor the extent to which these mirrored those of married or cohabiting heterosexuals. This paper reports the findings from the first large-scale survey in the UK to investigate finances and civil partnership beliefs in a convenience sample of non-heterosexuals: 510 individuals, of whom 386 were currently in a same-sex relationship, participated in the survey. Our findings showed less merging of finances (such as in pooling, allowance, and whole wage systems) than is typical in heterosexual married couples. The results of a series of multinomial logistic regression analyses showed that rating CP as more important, and having both names on the mortgage, significantly reduced the odds of independent (ie, separate) management of finances. Participants were almost unanimous in their endorsement of CP as a form of legal recognition, with a large majority saying that they would also consider it for themselves.