bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatitis B in Moroccan blood donors: a decade trend of the HBsAg prevalence in a resources limited country
Authors: Adouani B. , Alami R. , Laouina A. , Benahadi A. , Boulahdid S. , Mokhtari A. , Soulaymani A. , Abouyoub A. , Benajiba M.
Published: July 2013

Objectives

To calculate the hepatitis B surface antigen (HBsAg) reactive rate for 2011 blood donors (BD) across Morocco. In addition, to monitor the profile of donors bearing the HBsAg during 2000 and 2011, we calculated the percentage of the prevalence in both sexes, in different age groups and in first‐time replacement and regular BD from the Rabat Regional Blood Transfusion Centre.

Background

Hepatitis B is a viral infection that spreads through blood and other biological fluids. The hepatitis B virus remains one of the most common serious complications of transfusion. No information exists on the real prevalence of hepatitis B in Moroccan BD.

Methods

For the 2011 national HBsAg reactive rate, the percentage was calculated based on enzyme‐linked immunosorbent assay (ELISA) results of the 232 190 blood donations collected around the country. For the Rabat blood Centre, we calculated the hepatitis B sero‐prevalence from donations made at the donors' suite during 2000 and 2011.

Results

The national prevalence of HBsAg was 1·34%. The HBsAg variations among different regions was between 0·43 and 2·86%. The Rabat donors' suite hepatitis B prevalence decreased from 2·47% in 2000 to 0·91% in 2011 (P < 0·001). In both years, family/replacement donors were found as safe as first‐time BD and female donors were the safest.

Conclusions

These results, presented for the first time in the country, mapped the hepatitis B distribution across Morocco in a healthy population. The findings of this study could be of great importance in setting up strategies for the recruitment of the BD and keeping blood safety at the highest level.
A Hybrid Wavenumber Selection Scheme for Line-By-Line Photon Monte Carlo Simulations in High-Temperature Gases
Authors: Ren Tao , Modest Michael F.
Published: July 2013

Recently, it has become possible to conduct line-by-line (LBL) accurate radiative heat transfer calculations in spectrally highly nongray combustion systems using the Monte Carlo method. LBL accuracy, in principle, adds little to the computational load as compared to gray calculations. However, when employing the Monte Carlo method, the original scheme for choosing appropriate emission wavenumbers for statistical photon bundles is numerically expensive. An improved wavelength selection scheme has been applied to hypersonic plasmas for Monte Carlo solvers. However, directly applying this improved scheme to combustion gases may cause significant errors. In this paper, a hybrid scheme for wavenumber selection is proposed, significantly decreasing CPU requirements compared to previous work. The accuracy of the new method is established and its time requirements are compared against the previous method.
Twinkle, Twinkle, Little Plaque
Authors: Zidar David A.
Published: July 2013

At high resolution, atherosclerotic plaques in coronary arteries show their microcalcifications.
Draft Genome Sequence of
Ralstonia
sp. Strain GA3-3, Isolated from Australian Suburban Soil
Authors: Pearce Stephen L. , Pushiri Hafizah , Oakeshott John G. , Russell Robyn J. , Pandey Gunjan
Published: July 2013

Ralstonia
sp. strain GA3-3 is a hexachlorocyclohexane (HCH)-degrading bacterial strain isolated from suburban soil in Canberra, Australia. The genome of strain GA3-3 was sequenced to investigate its ability to degrade α-HCH. Here, we report the annotated genome sequence of this strain.
Complete Genome Sequence of Mycobacterium massiliense Clinical Strain Asan 50594, Belonging to the Type II Genotype
Authors: Kim Byoung-Jun , Kim Bo-Ram , Hong Seok-Hyun , Seok Seung-Hyeok , Kook Yoon-Hoh , Kim Bum-Joon
Published: July 2013

We report the complete genome sequence of the
Mycobacterium massiliense
clinical strain Asan 50594, which was grouped into the
M. massiliense
type II genotype, isolated from a Korean patient. This genome sequence will serve as a valuable reference for understanding the disparity in virulence and epidemiological traits between strains belonging to the
Mycobacterium abscessus
complex.
The Draft Genome Sequence of
Nocardioides
sp. Strain CF8 Reveals the Scope of Its Metabolic Capabilities
Authors: Kimbrel Jeffrey A. , Chang Jeff , Arp Daniel J. , Sayavedra-Soto Luis A.
Published: July 2013

Nocardioides
sp. strain CF8 was isolated from a soil sample collected at the Hanford Department of Energy site, Richland, WA. The strain was identified in microcosms based on its ability to grow on butane and has been characterized for its potential applications in the biodegradation of halogenated hydrocarbons. Here, the draft genome sequence is reported.
Novel Human Papillomavirus Type 174 from a Cutaneous Squamous Cell Carcinoma
Authors: Kocjan Boštjan J. , Steyer Andrej , Sagadin Martin , Hošnjak Lea , Poljak Mario
Published: July 2013

We report the cloning and characterization of a novel human papillomavirus (HPV), now officially recognized as HPV-174, isolated from a cutaneous squamous cell carcinoma. HPV-174 has a genome organization characteristic of cutaneous HPV types, clusters to the genus
Betapapillomavirus
, species β2, and is most closely related to HPV-145.
Genome Sequences for Three Denitrifying Bacterial Strains Isolated from a Uranium- and Nitrate-Contaminated Subsurface Environment
Authors: Venkatramanan Raghavee , Prakash Om , Woyke Tanja , Chain Patrick , Goodwin Lynne A. , Watson David , Brooks Scott , Kostka Joel E. , Green Stefan J.
Published: July 2013

Genome sequences for three strains of denitrifying bacteria (
Alphaproteobacteria
—
Afipia
sp. strain 1NLS2 and
Hyphomicrobium denitrificans
strain 1NES1;
Firmicutes
—
Bacillus
sp. strain 1NLA3E) isolated from the nitrate- and uranium-contaminated subsurface of the Oak Ridge Integrated Field Research Challenge (ORIFRC) site, Oak Ridge Reservation, TN, are reported.
Human Innate Immunity to Toxoplasma gondii Is Mediated by Host Caspase-1 and ASC and Parasite GRA15
Authors: Gov Lanny , Karimzadeh Alborz , Ueno Norikiyo , Lodoen Melissa B.
Published: July 2013

Interleukin-1β (IL-1β) functions as a key regulator of inflammation and innate immunity. The protozoan parasiteToxoplasma gondiiactively infects human blood monocytes and induces the production of IL-1β; however, the host and parasite factors that mediate IL-1β production duringT. gondiiinfection are poorly understood. We report thatT. gondiiinduces IL-1β transcript, processing/cleavage, and release from infected primary human monocytes and THP-1 cells. Treating monocytes with the caspase-1 inhibitor Ac-YVAD-CMK reduced IL-1β release, suggesting a role for the inflammasome inT. gondii-induced IL-1β production. This was confirmed by performing short hairpin RNA (shRNA) knockdown of caspase-1 and of the inflammasome adaptor protein ASC. IL-1β induction required active parasite invasion of monocytes, since heat-killed or mycalolide B-treated parasites did not induce IL-1β. Among the type I, II, and III strains ofT. gondii, the type II strain induced substantially more IL-1β mRNA and protein release than did the type I and III strains. Since IL-1β transcript is known to be induced downstream of NF-κB signaling, we investigated a role for the GRA15 protein, which induces sustained NF-κB signaling in a parasite strain-specific manner. By infecting human monocytes with aGRA15-knockout type II strain and a type I strain stably expressing type IIGRA15, we determined thatGRA15is responsible for IL-1β induction duringT. gondiiinfection of human monocytes. This research defines a pathway driving human innate immunity by describing a role for the classical inflammasome components caspase-1 and ASC and the parasite GRA15 protein inT. gondii-induced IL-1β production.

IMPORTANCEMonocytes are immune cells that protect against infection by increasing inflammation and antimicrobial activities in the body. Upon infection with the parasitic pathogenToxoplasma gondii, human monocytes release interleukin-1β (IL-1β), a “master regulator” of inflammation, which amplifies immune responses. Although inflammatory responses are critical for host defense against infection, excessive inflammation can result in tissue damage and pathology. This delicate balance underscores the importance of understanding the mechanisms that regulate IL-1β during infection. We have investigated the molecular pathway by whichT. gondiiinduces the synthesis and release of IL-1β in human monocytes. We found that specific proteins in the parasite and the host cell coordinate to induce IL-1β production. This research is significant because it contributes to a greater understanding of human innate immunity to infection and IL-1β regulation, thereby enhancing our potential to modulate inflammation in the body.
Radicular cyst of primary tooth associated with maxillary sinus
Authors: Bahadure Rakesh N , Khubchandani Monika , Thosar Nilima R , Singh Rajeev Kumar
Published: July 2013

Radicular cyst is one of the most common odontogenic cystic lesions found in the jaws. It is inflammatory in nature and found mostly in relation to a non-vital tooth. It usually presents at a later stage in life because the formation of the cyst is the last step in the progression of inflammatory events after a periapical infection. The cyst usually goes unnoticed because of its painless nature and small size. We present the clinical, radiographic and histological characteristics of a radicular cyst along with its management. Cystic sac was removed surgically under general anaesthesia after the elevation of the mucoperiosteal flap. Histopathologically, the cystic sac was consistent with the features of a radicular cyst. Follow-up period of 21 months showed improved radiographical appearance on Coned Beam CT. Vestibular deepening was planned as a future treatment in the same region.
Cerebral venous thrombosis due to cryptogenic organising pneumopathy with antiphospholipid syndrome worsened by heparin-induced thrombocytopenia
Authors: Hsieh J , Kuzmanovic I , Vargas M I , Momjian-Mayor I
Published: July 2013

Cerebral venous thrombosis (CVT) has usually been ascribed to prothrombotic conditions, oral contraceptives, pregnancy, malignancy, infection, head injury or mechanical precipitants. The case reported here illustrates two rare causes of CVT observed in the same patient: the presence of antiphospholipid antibodies associated with an asymptomatic cryptogenic organising pneumopathy (COP) which were considered the origin of the venous cerebral thrombosis and heparin-induced thrombocytopenia (HIT) which was responsible for the worsening of the thrombosis observed a few days after the introduction of treatment. Moreover, we provide here additional positive experience in the treatment of both, CVT and HIT, by fondaparinux with bridging to warfarin given their successful evolution under this anticoagulant option.
An unusual cause of a haemorrhagic stroke: acquired haemophilia A
Authors: Araf Shamzah , Aleem Sobia , Liu Boyang , Balikai Girish
Published: July 2013

An elderly woman presented with extensive bruising and a haemorrhagic stroke. Initial investigations revealed an abnormal clotting screen with a prolonged activated partial thromboplastin time. Further investigations revealed this to be due to antibodies that the patient had developed against clotting factor VIII also known as acquired haemophilia A.
A misdiagnosed burn: necrotising fasciitis in an elderly patient
Authors: Vijayan Roshan , Magdum Ashish , Critchley Paul
Published: July 2013

A 91-year-old man was admitted having been found unresponsive in his bed. He was previously well, but had sustained a laceration over the dorsum of his forearm after a recent fall. Initial appearances were innocuous, and suggestive of a superficial wound infection. A review of the wound by the plastic surgeons led to the diagnosis of a full-thickness burn, despite a lack of supporting evidence in the history. No clinician who had initially assessed the patient was involved in his ongoing care. Rapid clinical deterioration ensued, with sepsis and deteriorating mental state. Necrosis spread rapidly up his arm, and the diagnosis of necrotising fasciitis was made. The patient was urgently taken to theatre for circumferential excision of the necrotic tissue. He was subsequently managed on the intensive care unit where he made a promising initial recovery, but later died from pneumonia in the ward.
A traumatic case of fat embolism
Authors: Telford Lucy , Harris Joanna
Published: July 2013

A fit and healthy 47-year-old woman developed type I respiratory failure 2 days following surgical fixation for a left intertrochanteric neck of femur fracture. She presented to the acute trauma unit following a fall off a horse and had a long dynamic hip screw fixation in theatre. Postoperatively, she became confused and hypoxic. Her chest X-ray was inconclusive and her CT pulmonary angiogram showed diffuse patchy ground glass shadowing in keeping with acute respiratory distress syndrome. Following review by intensive care and respiratory physicians, a diagnosis of acute lung injury secondary to fat embolism was reached. The patient made a good recovery on the orthopaedic ward with supportive treatment.
Treatment of maxillary central incisor with external root resorption using mineral trioxide aggregate: 18 months follow-up
Authors: Gandi Padma , Disha Saraswathi
Published: July 2013

External cervical resorption is the loss of dental hard tissue as a result of odontoclastic action; it usually begins on the cervical region of the root surface of the teeth. This case report demonstrates an external cervical resorption in a maxillary central incisor of a 24-year-old male patient. After surgical intervention and root canal treatment, the resorption was subsequently sealed with mineral trioxide aggregate. The 18 months follow-up demonstrates no pathological changes on clinical and radiographic examination. This case report presents a treatment strategy that might improve the healing outcomes for patients with external cervical resorption.
Mechanical properties of the patellar tendon in elite volleyball players with and without patellar tendinopathy
Authors: Helland Christian , Bojsen-Møller Jens , Raastad Truls , Seynnes Olivier R , Moltubakk Marie M , Jakobsen Vidar , Visnes Håvard , Bahr Roald
Published: July 2013

Background

Although differences in mechanical properties between symptomatic and healthy tendons have been observed for the Achilles tendon, the impact of tendinopathy on patellar tendon mechanics is not fully documented. The aim of the present case–control study was to assess the mechanical properties of the tendon and jump performance in elite athletes with and without patellar tendinopathy.

Methods

We identified 17 male volleyball players with patellar tendinopathy and 18 healthy matched controls from a 5-year prospective cohort study on junior elite volleyball players. Outcome variables included three measures of maximal vertical jump performance and ultrasound-based assessments of patellar tendon cross-sectional area, stiffness and Young's modulus.

Results

The proximal cross-sectional area of the patellar tendon was significantly larger in the tendinopathic group (133±11 vs 112±9 mm2, respectively; p<0.001). Pathological tendons presented lower stiffness (2254±280 vs 2826±603 N/mm, respectively; p=0.006) and Young's modulus (0.99±0.16 vs 1.17±0.25 GPa, respectively; p=0.04) than healthy tendons. However, the difference between the countermovement jump height and the squat jump height (3.4±2.2 vs 1.2±1.5 cm, p=0.005) was significantly higher in the tendinopathic group compared with the control group.

Conclusions

Patellar tendinopathy is associated with a decrease  in the mechanical and material properties of the tendon in elite athletes subjected to a high volume of jumping activity. However, compared with their healthy counterparts, tendinopathic volleyball players have a better ability to utilise the stretch-shortening cycle when jumping.
ACTIVEDEP: a randomised, controlled trial of a home-based exercise intervention to alleviate depression in middle-aged and older adults
Authors: Pfaff Jon J , Alfonso Helman , Newton Robert U , Sim Moira , Flicker Leon , Almeida Osvaldo P
Published: July 2013

Objective

To evaluate the efficacy of a home-based exercise programme added to usual medical care for the treatment of depression.

Design

Prospective, two group parallel, randomised controlled study.

Setting

Community-based.

Patients

200 adults aged 50 years or older deemed to be currently suffering from a clinical depressive illness and under the care of a general practitioner.

Interventions

Participants were randomly allocated to either usual medical care alone (control) or usual medical care plus physical activity (intervention). The intervention consisted of a 12-week home-based programme to promote physical activity at a level that meets recently published guidelines for exercise in people aged 65 years or over.

Main outcome measurements

Severity of depression was measured with the structured interview guide for the Montgomery-Asberg Depression Rating Scale (SIGMA), and depression status was assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I).

Results

Remission of depressive illness was similar in both the usual care (59%) and exercise groups (63%; OR = 1.18, 95% CI 0.61 to 2.30) at the end of the 12-week intervention, and again at the 52-week follow-up (67% vs 68%) (OR=1.07, 95% CI 0.56 to 2.02). There was no change in objective measures of fitness over the 12-week intervention among the exercise group.

Conclusions

This home-based physical activity intervention failed to enhance fitness and did not ameliorate depressive symptoms in older adults, possibly due to a lack of ongoing supervision to ensure compliance and optimal engagement.
A retrospective analysis of long-term outcomes following a single episode of transscleral cyclodiode laser treatment in patients with glaucoma
Authors: Zhekov Ivailo , Janjua Razia , Shahid Humma , Sarkies Nicholas , Martin Keith R , White Andrew J R
Published: July 2013

Objectives

To investigate the efficacy of a single cyclodiode laser photocoagulation treatment for refractory glaucoma and its effect on visual outcome in patients with good visual potential as well as to evaluate possible predictive factors in establishing optimal treatment parameters.

Design

Retrospective observational study.

Setting

Tertiary referral centre.

Participants

The notes of 87 patients with refractory glaucoma who underwent cyclodiode photocoagulation as a first surgical intervention over a 7-year period.

Main outcome measures

Maintenance of intraocular pressure (IOP) reduction, number of medications and visual acuity outcomes post-treatment.

Results

The mean IOP after a single treatment decreased from 39.5±1.3 to 17.8±1.5 mm Hg after a 6-week follow-up period (p<0.0001). This reduction in IOP was maintained over a 3-year period. Here, 61.5% of patients were able to reduce the number of medications used, with mean reduction from 2.6 to 1.5 medications (p<0.05). The mean initial visual field loss prior to treatment was 8.74 dB and at 6 months post-treatment was measured at 9.06 dB (p>0.05), suggesting no significant overall change. Visual acuity remained unchanged or improved for 83.6% of patients (p>0.05) with relatively good visual potential (average vision preoperatively was 0.57 logMAR). Hypotony occurred in 5.3% of patients. No patients required enucleation or evisceration.

Conclusions

A single session of cyclodiode laser therapy was associated with significant IOP reduction in a majority of patients with refractory glaucoma. The majority were able to maintain the IOP reduction over a 3-year period without the need for a further surgical intervention. Additionally, over 80% of the patients in our study were able to maintain their baseline visual acuity. These results support the view that a single cyclodiode treatment can be sufficient in achieving long-term IOP control and may be considered in eyes with relatively good visual potential.
Improving life expectancy: how many years behind has the USA fallen? A cross-national comparison among high-income countries from 1958 to 2007
Authors: Verguet Stéphane , Jamison Dean T
Published: July 2013

Objective

Many studies have documented higher mortality levels in the USA compared to other high-income nations. We add to this discussion by quantifying how many years behind comparison countries the USA has fallen and by identifying when US mortality rates began to diverge.

Design

We use full life tables, for men and women, for 17 high-income countries including the USA. We extract the life expectancy at birth and compute the mortality rates for each 5-year age group from birth up to age 80. Using the metric of how many ‘years behind’ a country has fallen, we compare US mortality levels with those in other high-income countries (‘comparators’).

Results

We report life expectancy for 17 high-income countries, for the period 1958–2007. Up to the late 1970s, US men and especially women closely tracked comparators in life expectancy. In the late 1970s in the USA, most strikingly women began to diverge from comparators so that the US female life expectancy in 2007 corresponded to that of the comparators’ average 10 years earlier. Mortality rates also began to diverge from the late 1970s, and the largest mortality gap was in the 15–49 age group, for both men and women, where the USA had fallen about 40 years behind the comparators by 2007.

Conclusions

Some causes proposed for the relatively high US mortality today—racial differences, lack of universal health insurance, US exceptionalism—changed little while the mortality gap emerged and grew. This suggests that explanations for the growing gap lie elsewhere. Quantification of how many years behind the USA has fallen can help provide clues about where to look for potential causes and remedies.
Thirty years of HIV in Israel: current epidemiology and future challenges
Authors: Mor Zohar , Weinstein Ruth , Grotto Itamar , Levin Yana , Chemtob Daniel
Published: July 2013

Objective

The HIV/AIDS burden in Israel is increasing. This study aims to describe the nationwide-HIV epidemiology in the last 30 years and highlight areas of concern in HIV/AIDS control.

Design

Descriptive study.

Setting

The National HIV/AIDS Registry in Israel.

Participants

All individuals who were reported with HIV/AIDS in Israel.

Primary outcome measures

Classification of HIV/AIDS cases by risk groups, calculation of annual trend analysis and estimation of HIV transmission rates by dividing the annual HIV/AIDS-incidence by the prevalence, while the number of newly diagnosed HIV/AIDS cases reported was a proxy of the incidence.

Results

From 1981 to 2010, 6579 HIV/AIDS cases were reported in an upward trend from 3.6 new HIV diagnoses/100 000 population in 1986 to 5.6 in 2010. Immigrants from countries of generalised epidemic (ICGE) comprised 2717 (41.3%) of all cases: 2089 (76.9%) were Israeli citizens and 628 (23%) were non-Israeli citizens, mostly migrant workers. The majority (N=2040) of ICGE Israeli citizens were born in Ethiopia. Only 796 (12.1%) of all HIV/AIDS cases were heterosexuals who were non-ICGE and not injecting drug users (IDUs). IDU comprised 13.4% (N=882) of all cases. Men who have sex with men (MSM) accounted for 33.2% (N=1403) of all men reported, while the annual number of MSM reported with HIV/AIDS has quadrupled between 2000 and 2010. It is estimated that the HIV point prevalences in 2010 for Ethiopian-born Israeli citizens, IDU and MSM aged 16–45 were 1805, 1492 and 3150, respectively. The crude estimated transmission rates among Israeli citizens, excluding the Ethiopian-born, was 10.5, while among Ethiopian-born Israeli citizens, IDU and MSM the rates were 3.6, 6.3 and 13.2, respectively.

Conclusions

The HIV/AIDS burden in Israel is low among heterosexuals and higher in risk-groups. Among these risk groups, the highest HIV transmission rate was in MSM, followed by IDU and ICGE. Culturally sensitive and focused prevention interventions should be tailored exclusively for each of the vulnerable risk groups.
Children, smoking households and exposure to second-hand smoke in the home in rural Australia: analysis of a national cross-sectional survey
Authors: Longman Jo M , Passey Megan E
Published: July 2013

Objectives

This paper aimed to explore the association between rurality and (1) household smoking status and (2) home second-hand smoke exposure, in households with children aged 0–14 years.

Design

Cross-sectional study.

Setting

Households across Australia.

Participants

Households across the country were randomly selected to provide a nationally representative sample. Respondents were persons aged 12 years or older in each household who were next going to celebrate their birthday.

Primary outcome measures

Household smoking status and smoking inside the home.

Methodology

The 2010 Australian National Drug Strategy Household survey data were analysed to explore the prevalence of household smoking and home second-hand smoke exposure in rural and urban households with children. Multivariable logistic regression was used to explore the association of rurality with household smoking and with home second-hand smoke exposure, controlling for potential confounders.

Results

Households with children were more likely to be smoking households (35.4%, 95% CI 34.2% to 36.5%) than households without children (32.1%, 95% CI 31.3% to 32.8%). Both household smoking (43.6% (95% CI 41.5% to 45.7%) vs 31.4% (95% CI 30.0% to 32.8%)) and home second-hand smoke exposure (8.0% (95% CI 6.8% to 9.1%) vs 5.2% (95% CI 4.5% to 5.8%)) were significantly more common for rural children. In multivariate analyses controlling for confounding factors, rurality remained associated with smoking households (OR 1.21, 95% CI 1.07 to 1.37), whereas it did not remain associated with children's home second-hand smoke exposure (OR 1.07, 95% CI 0.85 to 1.35). Larger household size, low socioeconomic status and being a single-parent household were the main drivers of home second-hand smoke exposure.

Conclusions

The proportion of smoking households with children, and the number of children regularly exposed to second-hand smoke in their homes remain important public health concerns. Smoking cessation support and tobacco control policies might benefit from targeting larger and/or socioeconomically disadvantaged households including single-parent households.
Evidence for non-communicable diseases: analysis of Cochrane reviews and randomised trials by World Bank classification
Authors: Heneghan C , Blacklock C , Perera R , Davis R , Banerjee A , Gill P , Liew S , Chamas L , Hernandez J , Mahtani K , Hayward G , Harrison S , Lasserson D , Mickan S , Sellers C , Carnes D , Homer K , Steed L , Ross J , Denny N , Goyder C , Thompson M , Ward A
Published: July 2013

Introduction

Prevalence of non-communicable diseases (NCDs) is increasing globally, with the greatest projected increases in low-income and middle-income countries. We sought to quantify the proportion of Cochrane evidence relating to NCDs derived from such countries.

Methods

We searched the Cochrane database of systematic reviews for reviews relating to NCDs highlighted in the WHO NCD action plan (cardiovascular, cancers, diabetes and chronic respiratory diseases). We excluded reviews at the protocol stage and those that were repeated or had been withdrawn. For each review, two independent researchers extracted data relating to the country of the corresponding author and the number of trials and participants from countries, using the World Bank classification of gross national income per capita.

Results

797 reviews were analysed, with a reported total number of 12 340 trials and 10 937 306 participants. Of the corresponding authors 90% were from high-income countries (41% from the UK). Of the 746 reviews in which at least one trial had met the inclusion criteria, only 55% provided a summary of the country of included trials. Analysis of the 633 reviews in which country of trials could be established revealed that almost 90% of trials and over 80% of participants were from high-income countries. 438 (5%) trials including 1 145 013 (11.7%) participants were undertaken in low-middle income countries. We found that only 13 (0.15%) trials with 982 (0.01%) participants were undertaken in low-income countries. Other than the five Cochrane NCD corresponding authors from South Africa, only one other corresponding author was from Africa (Gambia).

Discussion

The overwhelming body of evidence for NCDs pertains to high-income countries, with only a small number of review authors based in low-income settings. As a consequence, there is an urgent need for research infrastructure and funding for the undertaking of high-quality trials in this area.
Variations in surgical management from a national bowel cancer screening programme
Authors: Codd R J , Thomas R , Heard H , Radcliffe A G , Williams G L , Evans M D
Published: July 2013

Objective

Population screening for colorectal cancer (CRC) was introduced to Wales in October 2008. The aim of this study was to evaluate the early impact of screening on CRC services.

Design

Prospectively collected data from the Bowel Screening Wales (BSW) programme and the Welsh Bowel Cancer Audit (WBCA) were used to identify all screen-detected (SD) CRC diagnoses in Wales between April 2009 and March 2011. Data from the WBCA were used to calculate surgical outcomes.

Results

444 SD cancers were registered during the study period representing 11% of all CRC diagnoses. There was a 9.9% increase in CRC incidence following the introduction of the BSW. SD patients presented with earlier stage disease; SD Dukes’ A 35.1% vs 13.9% symptomatic patients (p<0.001) and SD Dukes’ D 7.4% vs 21.8% symptomatic, (p<0.001). There were more colonic cancers among the SD population (p<0.001). The resection rate for SD cancers was 89%, significantly higher than symptomatic cancers (67.7%; p<0.0001). There was variability in the use of polypectomy as a definitive procedure to treat CRC between units. Overall laparoscopic resection was used in 52% of cases but with considerable interunit variability (0–92%).

Conclusions

The introduction of screening has increased the workload of the colorectal multidisciplinary teams in Wales. This has occurred through both an increase in case volume and the identification of more patients with early stage disease. There is considerable interunit variability in the use of techniques of local excision and rates of laparoscopic resection that need to be addressed.
Maintaining clinical governance when giving telephone advice
Authors: Alazawi William , Agarwal Kosh , Suddle Abid , Aluvihare Varuna , Heneghan Michael A
Published: July 2013

Objective

Delivering excellent healthcare depends on accurate communication between professionals who may be in different locations. Frequently, the first point of contact with the liver unit at King's College Hospital (KCH) is through a telephone call to a specialist registrar or liver fellow, for whom no case notes are available in which to record information. The aim of this study was to improve the clinical governance of telephone referrals and to generate contemporaneous records that could be easily retrieved and audited.

Design

An electronic database for telephone referrals and advice was designed and made securely available to registrars in our unit.

Setting

Service development in a tertiary liver centre that receives referrals from across the UK and Europe.

Main outcome measures

Demographic and clinical data were recorded prospectively and analysed retrospectively.

Results

Data from 350 calls were entered during 5 months. The information included the nature and origin of the call (200 from 75 different institutions), disease burden and severity of disease among the patients discussed with KCH, and outcome of the call. The majority of cases were discussed with consultants or arrangements were made for formal review at KCH.

Conclusions

A telephone referrals and advice database provides clinical governance, serves as a quality indicator and forms a contemporaneous record at the referral centre. Activity data and knowledge of disease burden help to tailor services to the needs of referrers and commissioners. We recommend implementation of similar models in other centres that give extramural verbal advice.
Fibrosing organising pneumonia
Authors: Beardsley Brooke , Rassl Doris
Published: July 2013

Organising pneumonia (otherwise referred to as bronchiolitis obliterans organising pneumonia) is characterised histologically by plugs of granulation tissue, which are present predominantly within small airways, alveolar ducts and peri-bronchiolar alveoli. This pattern is not specific for any disorder or cause, but is one type of inflammatory response to pulmonary injury, which may be seen in a wide variety of clinical conditions. Typically, organising pneumonia responds very well to corticosteroid treatment; however, a small percentage of patients appear to develop progressive fibrosis.
Circulating cell-free DNA in serum as a biomarker of colorectal cancer
Authors: da Silva Filho Benisio Ferreira , Gurgel Ana Pavla Almeida Diniz , Neto Manoel Álvaro de Freitas Lins , de Azevedo Dalmo Almeida , de Freitas Antonio Carlos , Silva Neto Jacinto da Costa , Silva Luiz Antonio Ferreira
Published: July 2013

Aims

The aim of this study was to report circulating cell-free DNA using ALU247 and ALU247/ALU115 biomarkers in serum of operated and non-operated patients with colorectal cancer (CRC).

Methods

To undertake this, 90 blood samples were collected, including 30 samples from healthy volunteers; 27 samples from CRC non-operated patients and 33 samples from CRC-operated patients. Circulating cell-free DNA was verified through quantitative real-time PCR (qPCR) using ALU115 and ALU247 primers.

Results

With regard to the ALU115-qPCR biomarker, the increased levels of circulating cell-free DNA in serum of non-operated patients were significant when compared with control (p<0.05). Moreover, levels of ALU247-qPCR biomarker were statistically significant between non-operated versus operated and non-operated versus control groups (p=0.000). With regard to the ALU247/115-qPCR biomarker, significant differences were observed between control versus non-operated patients (p=0.019), operated versus non-operated patients (p=0.005) and control versus operated patients (p=0.043).

Conclusions

Thus, the ALU247 and ALU247/ALU115-qPCR biomarkers may be important in detecting and monitoring CRC patients in both early and late stages.
Challenges and controversies in the diagnosis of malignant mesothelioma: Part 2. Malignant mesothelioma subtypes, pleural synovial sarcoma, molecular and prognostic aspects of mesothelioma, BAP1, aquaporin-1 and microRNA
Authors: Henderson Douglas W , Reid Glen , Kao Steven C , van Zandwijk Nico , Klebe Sonja
Published: July 2013

Pleural malignant mesothelioma (MM) includes several unusual and even rare but distinctive histological subtypes, in addition to the usual subdivision into epithelioid, biphasic and sarcomatoid MM. Criteria for discrimination between fibrous pleuritis versus desmoplastic mesothelioma include evidence of neoplastic invasion for diagnosis of desmoplastic MM, but this histological assessment is complicated by the recently-described ‘fake fat phenomenon’ in cases of fibrous pleuritis. The distinction between biphasic and monophasic synovial sarcoma of the pleura versus biphasic and sarcomatoid MM can be problematical and is most cogently based upon molecular detection of the t(X;18) translocation, whereas a clear diagnosis of MM for a pleural tumour histologically resembling synovial sarcoma is favoured by a negative result for this translocation and, probably, microRNA evidence supportive of a diagnosis of MM. Aquaporin-1 (AQP1) is a molecule involved in the growth of MM cells, and yet is a factor reported to correlate with improved survival rates for MM with an epithelioid component, in comparison to AQP1-poor MM, as assessed from AQP1 expression by epithelioid MM cells only (apart from co-expression by stromal endothelial cells in addition to the tumour cells). Recent reports have also focused upon germline mutations in the BRCA1-associated protein 1 (BAP1), not only in cases of familial mesothelioma, but also BAP1 deletion in sporadic MM. Prognostic factors for MM include not only the histological subtypes, but other independent variables that include (among others), AQP1 expression by mesothelioma cells, the clinical status of the patient, the serum neutrophil:lymphocyte ratio and blood thrombocytosis.
Corpora amylacea in gastrointestinal leiomyomas: a clinical, light microscopic, ultrastructural and immunohistochemical study with comparison to hyaline globules
Authors: Hechtman Jaclyn Frances , Gordon Ronald E , McBride Russell B , Harpaz Noam
Published: July 2013

Context

Corpora amylacea (CA) are inclusions with starch-like composition that occur in various conditions. We have observed CA in gastrointestinal leiomyomas (GILM) and hypothesised that they differ from intracytoplasmic hyaline globules (HG) of GILM. We aimed to investigate the anatomical distribution, prevalence, staining characteristics and ultrastructural features of CA and compare them with HG of GILM.

Design

Slides from a consecutive series of resected GILM and bland spindle cell tumours were examined for CA and HG. Special stains, electron microscopy and elemental analysis were performed on select leiomyomas.

Results

CA occurred in 13/35 GILM (37%) from the following sites: oesophagus (4/8), stomach (5/7) including one frozen section, small intestine (1/2) and large intestine (3/18), but were not identified in 19 gastrointestinal stromal tumours (12 gastric, 7 small intestinal; p=0.0019), five schwannomas (three gastric, two small intestinal; p=0.154) and 35 non-GILM (p=0.0001). The densities of CA ranged from one per 4–200 mm2. CA stained intensely with periodic acid Schiff after diastase predigestion (PASD), Alcian blue and ubiquitin, and faintly in peripheral zones for desmin and smooth muscle actin. Ultrastructurally, CA consisted of an electron-dense outer layer and a fibrillar core with scattered particle matter. HG were present in all leiomyomas, but showed variable staining for PASD, negative staining for Alcian blue and ubiquitin, and positive staining for smooth muscle markers.

Conclusions

CA are a distinctive histological feature of approximately one third of GILM with different composition to HG. These differences may represent divergent degenerative processes or different stages of a single degenerative process over time.
A brief history of British military experiences with infectious and tropical diseases
Authors: Bailey Mark S
Published: July 2013

Infectious and tropical diseases have been a problem for British expeditionary forces ever since the Crusades. Outbreaks were especially common on Navy ships from the 16th to 18th centuries due to poor living conditions and travel to the tropics. However, since these occurred in small, isolated and controlled environments it meant that naval medical practitioners were able to keep detailed records and develop empirical approaches for their prevention. The first Royal Naval Hospitals were established in response to these diseases and Royal Navy doctors made valuable early contributions towards understanding them. Even larger outbreaks of infectious and tropical diseases occurred in the Army during the Napoleonic, Crimean and Boer Wars and throughout the colonial era, which strongly influenced the formation of the Army Medical Services including provision for teaching and research. The establishment of germ theory led to a golden era of discovery regarding these diseases and British Army doctors made numerous important contributions. Subsequent improvements in prevention, diagnosis and treatment reduced the mortality from infectious and tropical diseases during the World Wars, but they remained a significant problem in the non-European campaigns and also the numerous ‘small wars’ that followed. Even in the 21st century some of these diseases still cause outbreaks with significant morbidity and impact on deployments, but the military clinical and academic resources to deal with them are now much reduced. Preventive measures such as hygiene, sanitation, infection control, vaccination and chemoprophylaxis are invaluable, but history shows that these can become neglected over time and disrupted or overwhelmed during the early or most intense stages of military operations. This is why military specialists in infectious diseases, tropical medicine, sexual health, medical microbiology and communicable diseases control are still required.
Age-adjusted infarct volume threshold for good outcome after endovascular treatment
Authors: Ribo Marc , Flores Alan , Mansilla Eloy , Rubiera Marta , Tomasello Alejandro , Coscojuela Pilar , Pagola Jorge , Rodriguez-Luna David , Muchada Marian , Alvarez-Sabín José , Molina Carlos A
Published: July 2013

Background and purpose

Infarct volume and age are strong predictors of outcome in patients with stroke. We aimed to determine the impact of infarct volume on outcome according to age.

Methods

Consecutive patients with acute stroke with documented internal carotid artery/middle cerebral artery occlusion who underwent endovascular procedures were studied. Patients were categorized in three age groups: <70 years (G1), 70–79 years (G2), ≥80 years (G3). The Alberta Stroke Program Early CT score (ASPECTS) was graded on initial CT. Time of successful recanalization (Thrombolysis In Cerebral Infarct (TICI) ≥2b )and good outcome at 3 months (modified Rankin Scale score ≤2) were recorded. Infarct volume was measured on the 24 h control CT.

Results

A total of 214 patients were studied (G1: 68; G2: 74; G3: 72). For all patients the mean infarct volume was 94.7±127 mL; 35.6% had a good outcome. We observed larger infarct volumes in patients with a bad outcome in each age group (G1: 22 vs 182 mL, p<0.01/G2: 22 vs 164 mL, p<0.01/G3: 7.6 vs 132 mL, p<0.01). However, the target cut-off infarct volume that better predicted a good outcome decreased as age increased: G1: 49 mL (sensitivity 80%, specificity 92.6%); G2: 32.5 mL (sensitivity 80%, specificity 81%); G3: 15.2 mL (sensitivity 81.3%, specificity 86.7%). Overall, after adjusting for age, occlusion location, baseline NIH Stroke Scale score and infarct volume, the only predictor of a good outcome was achieving a final infarct volume less than the age-adjusted target (OR 5.5, 95% CI 1.6 to 18.8; p<0.01). The probability of achieving an infarct volume less than the age-adjusted target decreased according to baseline ASPECTS, time and degree of recanalization.

Conclusions

Age-adjusted infarct size might represent a powerful surrogate marker of stroke outcome and further refine the predictive accuracy of infarct volume on prognosis in patients with stroke undergoing endovascular treatment. This information may be used in the design of new trials to individualize selection criteria for different age groups.
Novel application of a balloon-anchoring technique for the realignment of a prolapsed Pipeline Embolization Device: a technical report
Authors: Crowley R Webster , Abla Adib A , Ducruet Andrew F , McDougall Cameron G , Albuquerque Felipe C
Published: July 2013

Background

Flow-diverting stents represent a substantial advancement in the treatment of cerebral aneurysms. They can, however, be associated with unique complications that may require management through adjunctive techniques.

Objective

To present a technical report of a salvage technique used to realign a prolapsed Pipeline Embolization Device (PED) during the treatment of a giant internal carotid artery (ICA) aneurysm.

Methods

A patient in his late 70s with an incidental giant supraclinoid ICA aneurysm presented for endovascular consideration. Treatment was planned using the PED. Following placement of the device there were two focal areas of incomplete expansion and balloon angioplasty was performed. This manipulation resulted in foreshortening of the distal aspect of the PED which caused the device to prolapse into the aneurysm. After multiple unsuccessful attempts to regain distal access, a salvage technique was attempted in which a balloon was inflated in the middle cerebral artery and, by applying traction, the PED was realigned with the parent artery.

Results

After the PED was realigned, direct distal catheter access was achieved and a second Pipeline device was deployed, successfully covering the aneurysm neck with resultant flow stasis. The patient had no postoperative issues and was discharged 2 days later without deficit.

Conclusions

The balloon-anchoring technique was successfully used to realign a PED that had prolapsed into a giant ICA aneurysm. This maneuver prevented potentially disastrous complications and allowed the satisfactory completion of the aneurysm embolization. This represents a useful salvage technique that should be considered when encountering a prolapsed stent.
Trends in junior doctors' certainty about their career choice of eventual clinical specialty: UK surveys
Authors: Surman Geraldine , Lambert Trevor W , Goldacre Michael J
Published: July 2013

Introduction

The paper explores whether UK qualified junior doctors' certainty about their choice of eventual clinical specialty has changed in recent years following structural changes to postgraduate training.

Materials and methods

We analysed data from questionnaire surveys of all doctors who qualified in the UK in 11 ‘year of qualification’ cohorts between 1974 and 2009. We report on responses to questions at years 1, 3 and 5 after qualifying.

Results

Overall, 1 year after qualification, 28.6% (6576/23018) of doctors specified that they were certain about their choice of future specialty, 47.7% specified that their choice was probable and 23.7% were uncertain about it. By year 3 after qualification, 88% of doctors specified that their current specialty choice was definitely or probably their final choice, as did 95% in year 5. Levels of certainty in year 1 showed little change across the cohorts who qualified between 1974 and 2002 (average 28% ‘definite’), dropped in the 2005 cohort and then increased to 38% in the qualifiers of 2008 and 2009. Similar changes occurred in years 3 and 5 among doctors surveyed after 2005. There was large variation in certainty of choice by specialty chosen but no important difference between men and women.

Conclusions

Levels of confidence about early choice of specialty are now higher than they were prior to the 2005 changes to postgraduate training.
Evaluation of aqueous tear production in dogs after general anaesthesia with medetomidine‐propofol‐carprofen‐halothane
Authors: Komnenou A. T. H. , Kazakos G. M. , Savvas I. , Thomas A. L. N.
Published: July 2013

The influence of an anaesthetic protocol, which included medetomidine, propofol, carprofen and halothane on tear production in the dog. There are no previous studies on the effects of this combination on tear production in dogs or in any other species. The present study included 39 dogs, which underwent non‐ophthalmic surgery in our clinic. Preanaesthetically, all dogs had normal tear production (18.62±3.65 mm/minute) as this was recorded with Schirmer tear test I (STT I) and the ophthalmologic examination did not reveal anything abnormal. Tear production readings were recorded before the administration of premedication, at the end of anaesthesia, one hour and two hours postanaesthesia. No reverse agent was administrated. At the end of anaesthesia (right eye (oculus dexter, OD) P<0.0005, left eye (oculus sinister, OS) P<0.0005), as well as one hour postanaesthesia (OD P=0.020, OS P=0.001) there was a statistically significant reduction in tear production, which returned to normal values two hours postanaesthesia, regardless of the duration of the operation. This anaesthetic combination resulted in a decrease in tear production and, therefore, the use of tear substitute treatment in dogs undergoing anaesthesia with this protocol (combination) from the time the sedative is given until at least two hours after the end of anaesthesia is highly recommended.