bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality of life
Authors: Watson Max , Lucas Caroline , Hoy Andrew , Wells Jo
Published: April 2011

This chapter covers quality of life assessment in healthcare, HRQoL measures, quality of life and palliative care, quality of life measures in palliative care, and individualised measures of quality of life.
Drug interactions in palliative care
Authors: Watson Max , Lucas Caroline , Hoy Andrew , Wells Jo
Published: April 2011

This chapter covers drug interventions in palliative care, including Cytochrome P450 isoenzymes. The chapter contains a large formulary of drugs including route, dose, frequency, and indications/ side-effects/ remarks.
Syringe drivers
Authors: Watson Max , Lucas Caroline , Hoy Andrew , Wells Jo
Published: April 2011

This chapter discusses syringe drives, including indications for use, general principles, and problems, and contains a table of common drugs, doses, and ranges for palliative care use with a 24h syringe driver.
Gastrointestinal symptoms
Authors: Watson Max , Lucas Caroline , Hoy Andrew , Wells Jo
Published: April 2011

This chapter covers gastrointestinal symptoms, including oral problems and how to manage them, nausea and vomiting, antiemetic drugs, constipation, diarrhoea, intestinal obstruction, hiccup, anorexia/ cachexia/ asthenia, ascites, tenesmus and temesmoid pain, dyspepsia, gastrointestinal bleeding, and bowel stoma care.
Endocrine and metabolic complications of advanced cancer
Authors: Watson Max , Lucas Caroline , Hoy Andrew , Wells Jo
Published: April 2011

This chapter covers paraneoplastic syndromes (Hypercalcaemia, Cushing’s syndrome, syndrome of inappropriate antidiuresis, hypoglycaemia (non-islet cell), carcinoid syndrome) before turning to non-paraneoplastic complications, including diabetes mellitus.
Sleep disorders
Authors: Watson Max , Lucas Caroline , Hoy Andrew , Wells Jo
Published: April 2011

This chapter on sleep disorders covers insomnia, disorders of the sleep-wake cycle, and excessive daytime sleepiness, before turning to causes and management.
Dietetics and nutrition
Authors: Watson Max , Lucas Caroline , Hoy Andrew , Wells Jo
Published: April 2011

This chapter provides a brief introduction to dietetics and nutrition, including the role of the dietician in palliative care, dietary management of common symptoms, nutritional supplements, and ethical issues.
Clinical and other applied psychology in palliative care
Authors: Watson Max , Lucas Caroline , Hoy Andrew , Wells Jo
Published: April 2011

This chapter provides a brief introduction to clinical and other applied psychology in palliative care, including roles for the applied psychologist, and the types of applied psychologist employed in healthcare.
Help and advice for patients
Authors: Watson Max , Lucas Caroline , Hoy Andrew , Wells Jo
Published: April 2011

This chapter lists resources available which offer help and advice to patients.
The ENT examination
Authors: Corbridge Rogan , Steventon Nicholas
Published: April 2011

Equipment 12

Examination of the ear 14

Otoneurological examination 21

Examination of the nose 22

Endoscopic examination 26

A fully equipped ENT department will have all the necessary instruments for performing a full ENT examination. However, if you are a GP, or if you are working in another specialty, you will need to obtain a basic equipment kit....
Common methods of presentation
Authors: Corbridge Rogan , Steventon Nicholas
Published: April 2011

Hoarse voice 32

Epistaxis (nosebleed) 33

Dysphagia (swallowing difficulty) 34

A feeling of a lump in the throat 35

A lump in the neck 36

Mouth or tongue ulcer 38

Stridor 40

Facial nerve palsy 42

Nasal obstruction 43

The discharging ear 44

Dizziness and vertigo ...
The external ear
Authors: Corbridge Rogan , Steventon Nicholas
Published: April 2011

Structure and function of the external ear 74

Congenital abnormalities 76

Infection of the pinna 78

Trauma to the pinna 80

Otitis externa 82

Necrotizing otitis externa 84

Malignancy of the pinna 86

Malignancy of the EAC 88

A working knowledge of the anatomy of the ear helps in documentation, correspondence, and in describing sites of lesions and trauma over the telephone. The main anatomical points are shown in ...
Skull base
Authors: Corbridge Rogan , Steventon Nicholas
Published: April 2011

Overview 150

Acoustic neuroma 152

Nasopharyngeal carcinoma 154

Juvenile nasal angiofibroma (JNA) 156

Sinonasal malignancy 157

The skull base is a specialized area of clinical work. The ENT surgeon is actively involved in this area, often as part of a team which includes a neurosurgeon or plastic surgeon....
The mouth, tonsils, and adenoids
Authors: Corbridge Rogan , Steventon Nicholas
Published: April 2011

Anatomy 186

Oral ulcers—benign 188

Oral ulcers—malignant 189

White patches in the mouth 190

Miscellaneous mouth conditions 192

Tonsillitis 194

Glandular fever 196

Tonsillectomy 197

Tonsillar tumours 198

Adenoidal enlargement 200

The nose and throat can be divided into the following anatomical areas (Fig. ...
The salivary glands
Authors: Corbridge Rogan , Steventon Nicholas
Published: April 2011

Structure and function of the salivary glands 202

Salivary gland tumours 204

Sialadenitis 206

Sialolithiasis 207

Other inflammatory conditions 208

Pseudosalivary swellings 209

Salivary gland surgery 210

There are three main pairs of salivary glands, the:

• parotid

• submandibular

• sublingual

In addition, a number of other tiny minor salivary glands are scattered throughout the mucosa of the mouth and throat. They produce the saliva needed for digestion and lubricating the food bolus....
The larynx
Authors: Corbridge Rogan , Steventon Nicholas
Published: April 2011

Structure and function of the larynx 214

The vocal cords 216

Congenital laryngeal lesions 218

Infections of the larynx 220

Cancer of the larynx 224

Treatment of laryngeal cancer 226

Benign lesions of the larynx 230

Differential diagnosis of a hoarse voice 234

Stridor 236...
The neck
Authors: Corbridge Rogan , Steventon Nicholas
Published: April 2011

Anatomy of the neck 260

Investigation of neck lumps 264

Congenital neck remnants 266

Neck infections 268

Lymph node enlargement 269

Neoplastic lymphadenopathy 270

Neck hernias 272

Many of the important structures in the neck can be seen or felt on examination. These are:

•...
Paediatric ENT problems
Authors: Corbridge Rogan , Steventon Nicholas
Published: April 2011

Assessing the paediatric patient 298

Neonatal problems 300

Airway problems 302

Feeding problems 304

Snoring and sleep apnoea 305

Speech development problems 306

• They are small and so is their anatomy

• They are usually unable to give an accurate history

• They have parents who may be very anxious...
Common Operations
Authors: Corbridge Rogan , Steventon Nicholas
Published: April 2011

The consent process 308

Giving the patient sufficient information 309

Presenting information to patients 310

Establishing capacity to make decisions 311

Children and consent 312

Complications of ear surgery 313

Complications of nasal surgery 314

Complications of head and neck surgery 315

Theatre equipment and its correct use ...
Allied health professionals
Authors: Corbridge Rogan , Steventon Nicholas
Published: April 2011

Who are allied health professionals? 340

The audiologist 341

The hearing therapist 342

Speech and language therapists (SALT) 343

The head and neck specialist nurse 344

Dietician 345

Aural care nurse 346

This term covers a number of different professional groups, including:

• Audiologists

•...
ENT manifestations of AIDS
Authors: Corbridge Rogan , Steventon Nicholas
Published: April 2011

Overview of AIDS 352

Specific ENT problems 354

• Virus transmitted by sexual contact (70%), needle sharing, and blood products

• Caused by a lentivirus—retrovirus subgroup

• Affinity for CD4 cells

• Enters cells by binding to CD4

• Replicates by using reverse transcriptase

•...
ENT emergencies
Authors: Corbridge Rogan , Steventon Nicholas
Published: April 2011

Epistaxis 374

Sudden onset hearing loss 376

Facial palsy or VIIth nerve palsy 378

Periorbital cellulitis 380

Fractured nose 382

Oesophageal foreign bodies 384

Secondary tonsillar haemorrhage 385

See Chapter 12 for details of:

The emergency airway

Stridor

Epiglottitis

Supraglottitis

Croup

Cricothyroidotomy

Tracheostomy

See Chapter ...
Integrating ecology into macroevolutionary research
Authors: McInnes Lynsey , Baker William J. , Barraclough Timothy G. , Dasmahapatra Kanchon K. , Goswami Anjali , Harmon Luke J. , Morlon Hélène , Purvis Andy , Rosindell James , Thomas Gavin H. , Turvey Samuel T. , Phillimore Albert B.
Published: April 2011

On 9 March, over 150 biologists gathered in London for the Centre for Ecology and Evolution spring symposium, ‘Integrating Ecology into Macroevolutionary Research’. The event brought together researchers from London-based institutions alongside others from across the UK, Europe and North America for a day of talks. The meeting highlighted methodological advances and recent analyses of exemplar datasets focusing on the exploration of the role of ecological processes in shaping macroevolutionary patterns.
Repression of N-glycosylation triggers the unfolded protein response (UPR) and overexpression of cell wall protein and chitin in Aspergillus fumigatus
Authors: Li Kai , Ouyang Haomiao , Lü Yang , Liang Jingnan , Wilson Iain B. H. , Jin Cheng
Published: April 2011

Aspergillus fumigatus is the most common airborne fungal pathogen, causing fatal invasive aspergillosis in immunocompromised patients. The crude mortality is 60–90 % and remains around 29–42 % even with treatment. The main reason for patient death is the low efficiency of the drug therapies. As protein N-glycosylation is involved in cell wall biogenesis in A. fumigatus, a deeper understanding of its role in cell wall biogenesis will help to develop new drug targets. The Afstt3 gene encodes the essential catalytic subunit of oligosaccharyltransferase, an enzyme complex responsible for the transfer of the N-glycan to nascent polypeptides. To evaluate the role of N-glycosylation in cell wall biosynthesis, we constructed the conditional mutant strain CPR-stt3 by replacing the endogenous promoter of Afstt3 with the nitrogen-dependent niiA promoter. Repression of the Afstt3 gene in the CPR-stt3 strain led to a severe retardation of growth and a slight defect in cell wall integrity (CWI). One of the most interesting findings was that upregulation of the cell wall-related genes was not accompanied by an activation of the MpkA kinase, which has been shown to be a central element in the CWI signalling pathway in both Saccharomyces cerevisiae and A. fumigatus. Considering that the unfolded protein response (UPR) was found to be activated, which might upregulate the expression of cell wall protein and chitin, our data suggest that the UPR, instead of the MpkA-dependent CWI signalling pathway, is the major compensatory mechanism induced by repression but not abolition of N-glycosylation in A. fumigatus. Our finding is a key to understanding the complex compensatory mechanisms of cell wall biosynthesis and may provide a new strategy for drug development.
Combinatorial binding of transcription factors in the pluripotency control regions of the genome
Authors: Ferraris Luciana , Stewart Allan P. , Kang Jinsuk , DeSimone Alec M. , Gemberling Matthew , Tantin Dean , Fairbrother William G.
Published: April 2011

The pluripotency control regions (PluCRs) are defined as genomic regions that are bound by POU5F1, SOX2, and NANOG in vivo. We utilized a high-throughput binding assay to record more than 270,000 different DNA/protein binding measurements along incrementally tiled windows of DNA within these PluCRs. This high-resolution binding map is then used to systematically define the context of POU factor binding, and reveals patterns of cooperativity and competition in the pluripotency network. The most prominent pattern is a pervasive binding competition between POU5F1 and the forkhead transcription factors. Like many transcription factors, POU5F1 is co-expressed with a paralog, POU2F1, that shares an apparently identical binding specificity. By analyzing thousands of binding measurements, we discover context effects that discriminate POU2F1 from POU5F1 binding. Proximal NANOG binding promotes POU5F1 binding, whereas nearby SOX2 binding favors POU2F1. We demonstrate by cross-species comparison and by chromatin immunoprecipitation (ChIP) that the contextual sequence determinants learned in vitro are sufficient to predict POU2F1 binding in vivo.
Carbon and Nitrogen Metabolism in Mycorrhizal Networks and Mycoheterotrophic Plants of Tropical Forests: A Stable Isotope Analysis
Authors: Courty Pierre-Emmanuel , Walder Florian , Boller Thomas , Ineichen Kurt , Wiemken Andres , Rousteau Alain , Selosse Marc-André
Published: April 2011

Most achlorophyllous mycoheterotrophic (MH) plants obtain carbon (C) from mycorrhizal networks and indirectly exploit nearby autotrophic plants. We compared overlooked tropical rainforest MH plants associating with arbuscular mycorrhizal fungi (AMF) to well-reported temperate MH plants associating with ectomycorrhizal basidiomycetes. We investigated 13C and 15N abundances of MH plants, green plants, and AMF spores in Caribbean rainforests. Whereas temperate MH plants and fungi have higher δ13C than canopy trees, these organisms displayed similar δ13C values in rainforests, suggesting differences in C exchanges. Although temperate green and MH plants differ in δ15N, they display similar 15N abundances, and likely nitrogen (N) sources, in rainforests. Contrasting with the high N concentrations shared by temperate MH plants and their fungi, rainforest MH plants had lower N concentrations than AMF, suggesting differences in C/N of exchanged nutrients. We provide a framework for isotopic studies on AMF networks and suggest that MH plants in tropical and temperate regions evolved different physiologies to adapt in diverging environments.
In‐patient rehabilitation in haemophilic subjects with total knee arthroplasty
Authors: VILIANI T. , ZAMBELAN G. , PANDOLFI C. , MARTINI C. , MORFINI M. , PASQUETTI P. , INNOCENTI M.
Published: April 2011

Summary.  Total knee arthroplasty (TKA) is a major orthopaedic surgery intervention, indicated for severe haemophilic arthropathy. The aim of our study was to analyse rehabilitation outcome in haemophilic patients after TKA. A consecutive series of 21 patients (23 knees) was retrospectively evaluated. The mean age was 37 ± 8 years (range 22–55). Physiotherapy treatment was performed twice a day for 5 days week−1, for 3 h day−1. Assessment included knee range of motion (ROM), Visual Analogue Scale (VAS) for pain evaluation, Western Ontario and McMaster University (WOMAC) Score for functional outcome, Medical Research Council Scale (MRC) for quadriceps muscle strength evaluation, incidence of adverse events and a self‐reported questionnaire. The patients’data were recorded before surgery (t0), at Rehabilitation Unit admission (t1), before discharge (t2) and at follow‐up (t3), 11–48 months after rehabilitation. Western Ontario and McMaster University Score (ref. score: 0–96) was 56.7 ± 12 at t0 and 6.2 ± 6 at t3 (t3 vs. t0: P < 0.001). Visual Analogue Scale (ref. score: 0–10) decreased from 5.0 ± 2 at t1 to 2.1 ± 2 at t2 (t2 vs. t1: P < 0.05) and to 0.1 ± 0 at t3 (t3 vs. t2: P < 0.05). Flexion degrees increased from 43.4 ± 21° at t1 to 80.2 ± 15° at t2 (t2 vs. t1: P < 0.001) and to 95.0 ± 15° at t3 (t3 vs t2: P < 0.05). According to MRC (ref. score: 0–5), quadriceps muscle strength increased from 2.3 ± 0.6 at t1 to 3.6 ± 0.5 at t2 (t2 vs. t1: P < 0.05). Adverse events were found in four patients. Patients’ satisfaction on their outcome at follow‐up was referred as good by 72% of patients or excellent by 28% of patients. Postsurgical intensive rehabilitation in haemophilic patients resulted effective, safe and feasible.
Comparison of five malnutrition screening tools in one hospital inpatient sample
Authors: Neelemaat Floor , Meijers Judith , Kruizenga Hinke , van Ballegooijen Hanne , van Bokhorst‐de van der Schueren Marian
Published: April 2011

Aims and objectives.  The purpose of this study is to compare five commonly used malnutrition screening tools against an acknowledged definition of malnutrition in one hospital inpatient sample.

Background.  Early identification and intervention of malnutrition in hospital patients may prevent later complications. Several screening tools have reported their diagnostic accuracy, but the criterion validity of these tools is unknown.

Design.  A cross sectional study.

Methods.  We compared quick‐and easy screening tools [Malnutrition Screening Tool (MST), Short Nutritional Assessment Questionnaire (SNAQ) and Mini‐Nutritional Assessment Short Form (MNA‐SF)] and more comprehensive malnutrition screening tools [Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS‐2002)] to an acknowledged definition of malnutrition (including low Body Mass Index and unintentional weight loss) in one sample of 275 adult hospital inpatients. Sensitivity, specificity, positive predictive value and negative predictive value were determined. A sensitivity and specificity of ≥70% was set as a prerequisite for adequate performance of a screening tool.

Results.  According to the acknowledged definition of malnutrition 5% of patients were at moderate risk of malnutrition and 25% were at severe risk. The comprehensive malnutrition screening tools (MUST, NRS‐2002) and the quick‐and‐easy malnutrition screening tools (MST and SNAQ) showed sensitivities and specificities of ≥70%. However, 47% of data were missing on the MUST questionnaire and 41% were missing on MNA‐SF. The MNA‐SF showed excellent sensitivity, but poor specificity for the older subpopulation.

Conclusions.  The quick‐and‐easy malnutrition screening tools (MST and SNAQ) are suitable for use in an hospital inpatient setting. They performed as well as the comprehensive malnutrition screening tools (MUST and NRS‐2002) on criterion validity. However, MUST was found to be less applicable due to the high rate of missing values. The MNA‐SF appeared to be not useful because of it low specificity.

Relevance to clinical practice.  Insight in what is the most valid and practical nutritional screening tool to use in hospital practice will increase effective recognition and treatment of malnutrition.
Clinical and molecular findings of 13 families from Saudi Arabia and a family from Sudan with homocystinuria
Authors: Zaidi SHE , Faiyaz‐Ul‐Haque M , Shuaib T , Balobaid A , Rahbeeni Z , Abalkhail H , Al‐Abdullatif A , Al‐Hassnan Z , Peltekova I , Al‐Owain M
Published: April 2011

Zaidi SHE, Faiyaz‐Ul‐Haque M, Shuaib T, Balobaid A, Rahbeeni Z, Abalkhail H, Al‐Abdullatif A, Al‐Hassnan Z, Peltekova I and Al‐Owain M. Clinical and molecular findings of 13 families from Saudi Arabia and a family from Sudan with homocystinuria.

Homocystinuria due to cystathionine beta synthase (CBS) deficiency results in elevated plasma homocysteine and methionine levels, which are associated with multiple organ pathologies, including vascular, respiratory, musculoskeletal, nervous, and ocular tissues. This autosomal recessive disorder is caused by homozygous or compound heterozygous mutations in the CBS gene encoding for the CBS. Although homocystinuria is observed in Arab and North African patients, their clinical presentations have not been described and molecular causes remained largely uninvestigated. In this study, we describe the clinical presentations of 22 homocystinuria patients from 13 Saudi Arabian families and 1 North African Sudanese family. Cardinal biochemical features of homocystinuria manifested in all patients, but heterogeneity of expression was observed for other associated phenotypes. One patient developed Legg–Calvé–Perthes disease that has not been previously described in homocystinuria. In the Saudi families, a novel nonsense mutation, p.Trp323X, and recurrent p.Arg336Cys and p.Gly153Arg mutations were identified in the CBS gene. The p.Trp323X mutation was found in 10 of the 13 unrelated Saudi families. In the Sudanese family, the p.Thr257Met mutation in the CBS gene, previously described in Italian and Spanish patients, was found. This study shows that the spectrum of CBS gene mutations in Saudi homocystinuria patients is quite different than the Arab patients from Qatar and Israel. This study is the only detailed phenotypic and genetic depiction of homocystinuria patients from Saudi Arabia and Sudan. The data are useful for diagnosis and management of Saudi patients.
Novel TMPRSS3 variants in Pakistani families with autosomal recessive non‐syndromic hearing impairment
Authors: Lee K , Khan S , Islam A , Ansar M , Andrade P B , Kim S , Santos‐Cortez R L P , Ahmad W , Leal S M
Published: April 2011

Lee K, Khan S, Islam A, Ansar M, Andrade PB, Kim S, Santos‐Cortez RLP, Ahmad W, Leal SM. Novel TMPRSS3 variants in Pakistani families with autosomal recessive non‐syndromic hearing impairment.

Mutations in the TMPRSS3 gene are known to cause autosomal recessive non‐syndromic hearing impairment (ARNSHI). After undergoing a genome scan, 10 consanguineous Pakistani families with ARNSHI were found to have significant or suggestive evidence of linkage to the TMPRSS3 region. In order to elucidate if the TMPRSS3 gene is responsible for ARNSHI in these families, the gene was sequenced using DNA samples from these families. Six TMPRSS3 variants were found to cosegregate in 10 families. None of these variants were detected in 500 control chromosomes. Four novel variants, three of which are missense [c.310G>A (p.Glu104Lys), c.767C>T (p.Ala256Val) and c.1273T>C (p.Cys425Arg)] and one nonsense [c.310G>T (p.Glu104Stop)], were identified. The pathogenicity of novel missense variants was investigated through bioinformatics analyses. Additionally, the previously reported deletion c.208delC (p.His70ThrfsX19) was identified in one family and the known mutation c.1219T>C (p.Cys407Arg) was found in five families, which makes c.1219T>C (p.Cys407Arg) as the most common TMPRSS3 mutation within the Pakistani population. Identification of these novel variants lends support to the importance of elements within the low‐density lipoprotein receptor A (LDLRA) and serine protease domains in structural stability, ligand binding and proteolytic activity for proper TMPRSS3 function within the inner ear.
Current issues in the clinical management of invasive aspergillosis – the AGIHO, DMykG, ÖGMM and PEG web‐based survey and expert consensus conference 2009
Authors: Rüping M. J. G. T. , Vehreschild J. J. , Groll A. , Lass‐Flörl C. , Ostermann H. , Ruhnke M. , Cornely O. A.
Published: April 2011

The objectives of this study were to identify unsolved issues in the management of invasive aspergillosis, identify controversies and achieve consensus. The German Speaking Mycological Society (Deutschsprachige Mykologische Gesellschaft, DMykG) invited other German infectious diseases (ID) and mycological societies to submit unsolved issues concerning the diagnosis and treatment of invasive aspergillosis. Based on these contributions, a digital web‐based questionnaire of 12 questions on Aspergillus spp. was designed to be completed by experts of the participating societies. Controversial results were identified by a mathematical model and were discussed at a consensus conference during the 43rd Annual Meeting of the DMykG in Cologne, Germany. Forty‐two individuals completed the questionnaire. Analysis showed a strong consensus on effective preventive measures, choice of antifungal agents for pre‐emptive, empiric and targeted treatment, as well as the evaluation of early chest CT control scans as a measure of treatment response assessment. Opinions on the indication for a pulmonary biopsy of a halo sign in high‐risk neutropenic patients and on the role of Aspergillus spp. PCR as well as galactomannan from serum in the assessment of treatment duration diverged in spite of discussion such that a consensus could not be reached. Using a recently published two‐step approach – web‐based survey plus classical panel discussion – expert consensus was achieved on 10 of 12 questions concerning the diagnosis and treatment of invasive aspergillosis.
Sources of resistance to Fusarium head blight within Syrian durum wheat landraces
Authors: Talas Firas , Longin Friedrich , Miedaner Thomas
Published: April 2011

With 1 figure and 1 table

Fusarium head blight (FHB) is a destructive disease of wheat all over the world. FHB causes high economic losses for durum wheat because of the lack of resistance sources. Initially, sixty‐eight Syrian landraces were tested in field conditions after inoculation to discriminate the most resistant and environmentally stable landraces. Further tests across a total of four environments revealed four landraces with a low mean FHB rating (19–25%) compared to common German durum varieties (56–60%) and an environmentally stable resistance. They are considered as promising resistance sources to FHB for introgression in the adapted durum wheat gene pool.
Snoring is not associated with adverse effects on blood pressure, arterial structure or function in 8‐year‐old children: The Childhood Asthma Prevention Study (CAPS)
Authors: Marshall Nathaniel S , Ayer Julian G , Toelle Brett G , Harmer Jason A , Phillips Craig L , Grunstein Ronald R , Celermajer David S , Marks Guy B
Published: April 2011

Aims:  To study the association between childhood snoring and cardiovascular risk factors.

Methods:  Cross‐sectional analyses of a population‐based birth cohort, who had been participants in a randomised controlled trial of interventions to prevent asthma and who were assessed at age 8 years. The presence and frequency of snoring were assessed by parent‐completed questionnaire. We measured a wide range of cardiovascular function markers including non‐fasting serum lipoproteins, blood pressure, high‐sensitivity C‐reactive protein, carotid artery intima media thickness (by ultrasound), brachial pulse wave velocity and augmentation index (by applanation tonometry).

Results:  Of 409 children whose snoring status was assessed at age 8 years, 321 had lipid and 386 had arterial structure and function measurements. Snoring was not independently associated with blood pressure, carotid artery intima media thickness or measures of arterial stiffness (all P > 0.05). Increasing snoring frequency was independently associated with lower high‐density lipoprotein cholesterol (−0.032 g/dL per step, 95% confidence interval −0.060 to −0.003), although the difference in high‐density lipoprotein between snorers and non‐snorers was not significant (P = 0.052). An association of snoring frequency with brachial pulse wave velocity differed according to body mass index (P = 0.03) and was the reverse of that expected.

Conclusions:  Parentally reported snoring was not independently associated with adverse measurements of metabolic markers, vascular structure or function in 8‐year‐old children. Parental reports of snoring may be below the treatment threshold without additional diagnosis via sleep studies.
Respiratory problems in children with Down syndrome
Authors: Pandit Chetan , Fitzgerald Dominic A
Published: April 2011

Down syndrome is associated with a significant health burden, which is particularly apparent in young children who will frequently present with cardiac and respiratory problems. Respiratory presentations include problems related to structural abnormalities of the airways and lungs, glue ears, recurrent lower respiratory tract infections and obstructive sleep apnoea. These conditions are readily identifiable and able to be treated. An awareness of the breadth of respiratory problems and a plan to monitor patients with Down syndrome for their development has the potential to improve outcomes.
Teenage toxins: Recreational poisoning in the adolescent
Authors: Gunja Naren
Published: April 2011

Adolescents are experimenting with recreational drugs on a regular basis, particularly at social gatherings such as parties, raves and mass events. A combination of reduced fluid intake, physical activity and drug‐induced hyperthermia leads to complications such as heat stroke, delirium and potentially death. The clinician needs to be aware of the variety of pharmacologically active substances available in the recreational marketplace in order to diagnose and manage these patients. Recreational misadventure, because of incorrect dosage or mixing multiple substances, is a common reason for teenagers presenting to hospital with toxidromes. Death from club drug overdose is more likely to be associated with suicidal intent, related risky behaviour and trauma, as well as the inherent toxicity of the drug itself. Although many teenagers are concerned about ‘drink spiking’ with club drugs, the most common agent causing drink spiking incidents is ethanol.
Hypoplastic left heart syndrome in context
Authors: Winlaw David S , Badawi Nadia , Jacobe Stephen , Kasparian Nadine A , Cooper Stephen G , Murphy David N , Sherwood Megan C , Roberts Philip , Leclair Karen , Scarfe Gabbie , Sholler Gary F
Published: April 2011

Abstract:  Hypoplastic left heart syndrome is a rare condition requiring major cardiac surgery during the neonatal period to sustain life, with subsequent procedures culminating in completion of the Fontan circulation – the common pathway for all ‘single ventricle’ conditions. Algorithms for care of these children are now well defined with predictable medium‐term outcomes with the majority achieving a Fontan circulation. Hypoplastic left heart syndrome is one of a group of conditions that require complex surgery as a neonate and require a similar perioperative approach. Antenatal diagnosis is common in this patient subgroup, and there is a significant body of work that can be drawn on to inform parental choice.
CLINICAL USEFULNESS OF NARROW BAND IMAGING MAGNIFYING CLASSIFICATION FOR COLORECTAL TUMORS BASED ON BOTH SURFACE PATTERN AND MICROVESSEL FEATURES
Authors: OKA SHIRO , TANAKA SHINJI , TAKATA SAYAKA , KANAO HIROYUKI , CHAYAMA KAZUAKI
Published: April 2011

We use the narrow band imaging (NBI) magnifying classification (Hiroshima Classification) on the basis of both their surface pattern and microvascular architecture to characterize colorectal tumors. Herein, we describe the Hiroshima Classification in detail and provide statistical data supporting its usefulness in diagnosing histologic type, whether a hyperplastic lesion, tubular adenoma, carcinoma with intramucosal to submucosal scanty invasion or carcinoma with submucosal massive invasion, and thus in selecting the appropriate treatment strategy. We also discuss the circumstances in which the Hiroshima Classification must be augmented by conventional pit pattern diagnosis. NBI magnification is easily carried out. We strongly recommend application of NBI magnification to the differential diagnosis of colorectal lesions as well as treatment decision making.
A CASE OF EARLY GASTRIC CANCER IN WHICH THE DEGREE OF HISTOLOGICAL ATYPIA WAS CORRECTLY PREDICTED BY MAGNIFYING ENDOSCOPY COMBINED WITH NARROW BAND IMAGING
Authors: HIRASAWA DAI , FUJITA NAOTAKA , YAMAGATA TAKU , SUZUKI TAKASHI , NODA YUTAKA
Published: April 2011

We herein report a case of early gastric cancer with mixed components having different grades of atypia, which was correctly predicted by magnifying endoscopy combined with narrow band imaging. A 67‐year‐old man had a flat elevated lesion (0‐IIa) in the anterior wall of the gastric antrum. With narrow band imaging, a flat lateral extension (0‐IIb), not recognized with white light imaging was seen in the anal side of the main tumor. Magnifying endoscopy combined with narrow band imaging saw a relatively regular fine network pattern of micro‐vessels in the surface of the 0‐IIa area. However, in the surface of the 0‐IIb area, a villous structure with villi of various size and heterogeneity, micro‐vessels showing tortuousity were observed. We judged the grade of atypia to be higher in the 0‐IIb area than in the 0‐IIa area. Histological examination of the resected specimen verified the 0‐IIa area and 0‐IIb area as adenoma and adenocarcinoma, respectively.
ENDOSCOPIC DIFFERENTIAL DIAGNOSIS BETWEEN ULCERATIVE COLITIS‐ASSOCIATED NEOPLASIA AND SPORADIC NEOPLASIA IN SURVEILLANCE COLONOSCOPY USING NARROW BAND IMAGING
Authors: WATANABE KENJI , SOGAWA MITSUE , YAMAGAMI HIROKAZU , WATANABE JUN , AJIOKA YOICHI , ARAKAWA TETSUO
Published: April 2011

We investigated the efficacy of narrow band imaging, magnifying chromoendoscopy, autofluorescence imaging and photodynamic diagnosis for surveillance colonoscopy or work‐up in patients with ulcerative colitis. Endoscopic differential diagnosis between sporadic neoplasia and colitis‐associated dysplasia or cancer, however, is still an important issue in practice. Optimization of surveillance colonoscopy, including development of novel methods, should be addressed in the near future.
RESPONSIVE INSERTION TECHNOLOGY
Authors: SAITO YUTAKA , KIMURA HIDENOBU
Published: April 2011

The colonoscopic insertion technique is still one of the most difficult endoscopic procedures to master and development of a new colonoscope that is easier to insert is much awaited especially into the cecum without patient discomfort. We focused on reducing patient pain and boosting the success rate of colonoscope insertion into the cecum in complicated cases. As a result, we have successfully developed two mechanisms: “Passive Bending” and use of a “High Force Transmission insertion tube.”

We believe these two mechanisms when combined together will contribute to a reduction in patient discomfort and an increase in the cecal intubation rate during many difficult colonoscopies, but further evaluation is required with respect to therapeutic endoscopy effectiveness and insertion for patients with long colons.
A CONVEX EUS IS USEFUL TO DIAGNOSE VASCULAR INVASION OF CANCER, ESPECIALLY HEPATIC HILUS CANCER
Authors: HARA KAZUO , BHATIA VIKRAM , HIJIOKA SUSUMU , MIZUNO NOBUMASA , YAMAO KENJI
Published: April 2011

Endoscopic ultrasonography (EUS) has become an indispensable diagnostic procedure pairing endoscopy with transluminal high frequency ultrasonography. EUS provides images with a high resolution such that the depth of tumor invasion can be accurately determined. It also sees lesions outside of gastrointestinal tract, particularly those in pancreas, biliary system and periluminal lymph nodes. The most important limitation of EUS was lack of specificity, that is, the differentiation between benign and malignant lesions. In 1992, EUS‐guided fine needle aspiration (EUS‐FNA) was introduced with the sampling of a lesion in the pancreatic head using a convex EUS. Since then the indications of EUS‐FNA have been expanded to include a variety of therapeutic uses. In addition, a convex EUS probe can also be used for detailed evaluation of the pancreatobiliary system, in lieu of a radial EUS. The vascular structures surrounding liver, biliary system and pancreas can be showed by a convex EUS system very clearly and easily compared with the more familiar radial EUS images. So we think a convex EUS is very useful for not only EUS‐FNA but also screening and close examination for cancer with vascular invasion.
THE ROLE OF LINEAR ARRAY EUS FOR DIAGNOSIS OF PANCREATIC MALIGNANCIES IN THE CURRENT SITUATION
Authors: ASHIDA REIKO , ARISAKA YOSHIFUMI , MASUDA DAISUKE , TAKII MICHIAKI , HIGUCHI KAZUHIDE
Published: April 2011

Over the last few decades, the role of endoscopic ultrasound (EUS) in the diagnosis of pancreatic malignancies has greatly increased by allowing earlier diagnosis and appropriate staging. The development of linear array EUS also allows fine needle aspiration (FNA) to be carried out under real‐time EUS guidance and offers definitive diagnosis, which has fundamentally changed the diagnostic approach to pancreatic malignancies. Moreover, linear array EUS with the EUS‐FNA technique has a therapeutic application that has expanded the role of this procedure in the management of pancreatic malignancies. This review will focus on the features of linear array EUS and discuss the current role of linear array EUS in the diagnosis of pancreatic malignancies.
AN ESOPHAGEAL SCC CASE WHICH COULD BE DISTINGUISHED FROM NON‐NEOPLASIA USING MAGNIFYING ENDOSCOPY WITH NBI IMAGING
Authors: MIYAHARA RYOJI , HIROOKA YOSHIKI , OHMIYA NAOKI , NAKAMURA MASANAO , GOTO HIDEMI
Published: April 2011

In this case, narrow‐band imaging helped to distinguish esophagitis. The case involved an 81‐year‐old female was being seen as an outpatient because of Gastroesophageal Reflux Disease (GERD) symptoms associated with an esophageal hiatal hernia. Endoscopy showed long reddish lesions on the posterior wall of the lower thoracic esophagus. Non‐magnifying endoscopic images with white light initially suggested reflux esophagitis. Magnifying endoscopy with narrow‐band imaging showed proliferation of intraepithelial papillary capillary loop‐like vessels as well as irregular widening and narrowing of vessels, so the patient's condition was diagnosed as superficial esophageal cancer. Endoscopic submucosal dissection was carried out.
ON GOOD AND BAD FORMS OF MEDICALIZATION
Authors: PARENS ERIK
Published: April 2011

The ongoing ‘enhancement’ debate pits critics of new self‐shaping technologies against enthusiasts. One important thread of that debate concerns medicalization, the process whereby ‘non‐medical’ problems become framed as ‘medical’ problems.

In this paper I consider the charge of medicalization, which critics often level at new forms of technological self‐shaping, and explain how that charge can illuminate – and obfuscate. Then, more briefly, I examine the charge of pharmacological Calvinism, which enthusiasts, in their support of technological self‐shaping, often level at critics. And I suggest how that charge, too, can illuminate and obfuscate.

Exploring the broad charge of medicalization and the narrower counter charge of pharmacological Calvinism leads me to conclude that, as satisfying as it can be to level one of those charges at our intellectual opponents, and as tempting as it is to lie down and rest with our favorite insight, we need to gather the energy to have a conversation about the difference between good and bad forms of medicalization. Specifically, I suggest that if we consider the ‘medicalization of love,’ we can see why critics of and enthusiasts about technological self‐shaping should want (and in some cases have already begun) to distinguish between good and bad forms of such medicalization.
ETHICAL CONCERNS REGARDING COMMERCIALIZATION OF DEEP BRAIN STIMULATION FOR OBSESSIVE COMPULSIVE DISORDER
Authors: ERICKSON‐DAVIS CORDELIA
Published: April 2011

The United States Food and Drug Administration's recent approval of the commercial use of Deep Brain Stimulation (DBS) as a treatment for Obsessive Compulsive Disorder (OCD) will be discussed within the context of the existing USA regulatory framework. The purpose will be to illustrate the current lack of regulation and oversight of the DBS market, which has resulted in the violation of basic ethical norms. The discussion will focus on: 1) the lack of available evidence on procedural safety and efficacy, 2) the numerous conflicts of interest held by research investigators, and 3) the ambiguity of both aforementioned categories due to an inherent lack of transparency in the research. It is argued that in order to address these issues, ethical analyses of DBS for psychiatric disorders must include the role of the industry forces that have become the primary impetus for this research. As such, DBS for OCD serves as an important case example in studies of neurotechnology and innovative surgery.
THE PLACE OF GOD IN SYNTHETIC BIOLOGY: HOW WILL THE CATHOLIC CHURCH RESPOND?
Authors: HEAVEY PATRICK
Published: April 2011

Some religious believers may see synthetic biology as usurping God's creative role. The Catholic Church has yet to issue a formal teaching on the field (though it has issued some informal statements in response to Craig Venter's development of a ‘synthetic’ cell). In this paper I examine the likely reaction of the Catholic Magisterium to synthetic biology in its entirety. I begin by examining the Church's teaching role, from its own viewpoint, to set the necessary backround and context for the discussion that follows. I then describe the Church's attitude to science, and particularly to biotechnology. From this I derive a likely Catholic theology of synthetic biology.

The Church's teachings on scientific and biotech research show that it is likely to have a generally positive disposition to synbio, if it and its products can be acceptably safe. Proper evaluation of, and protection against, risk will be a significant factor in determining the morality of the research. If the risks can be minimized through regulation or other means, then the Church is likely to be supportive. The Church will also critique the social and legal environment in which the research is done, evaluating issues such as the patenting of scientific discoveries and of life.
EVALUATING INTERVENTIONS IN HEALTH: A RECONCILIATORY APPROACH
Authors: WOLFF JONATHAN , EDWARDS SARAH , RICHMOND SARAH , ORR SHEPLEY , REES GERAINT
Published: April 2011

Health‐related Quality of Life measures have recently been attacked from two directions, both of which criticize the preference‐based method of evaluating health states they typically incorporate. One attack, based on work by Daniel Kahneman and others, argues that ‘experience’ is a better basis for evaluation. The other, inspired by Amartya Sen, argues that ‘capability’ should be the guiding concept. In addition, opinion differs as to whether health evaluation measures are best derived from consultations with the general public, with patients, or with health professionals. And there is disagreement about whether these opinions should be solicited individually and aggregated, or derived instead from a process of collective deliberation. These distinctions yield a wide variety of possible approaches, with potentially differing policy implications. We consider some areas of disagreement between some of these approaches. We show that many of the perspectives seem to capture something important, such that it may be a mistake to reject any of them. Instead we suggest that some of the existing ‘instruments’ designed to measure HR QoLs may in fact successfully already combine these attributes, and with further refinement such instruments may be able to provide a reasonable reconciliation between the perspectives.
Cash transfers, social protection and poverty reduction
Authors: Slater Rachel
Published: April 2011

Slater R. Cash transfers, social protection and poverty reduction

Int J Soc Welfare 2011: 20: 250–259 © 2011 United Nations Research Institute for Social Development (UNRISD), International Journal of Social Welfare © 2011 Blackwell Publishing Ltd and the International Journal of Social Welfare.

Cash transfers form an important and growing part of social protection programming in many developing countries. This article evaluates the use of different types of cash transfers in different regional contexts as a tool for reducing poverty and inequality in developing countries. Particular attention is paid to knowledge about the appropriateness and cost‐effectiveness of targeted versus universal cash transfers and about conditional versus unconditional transfers. The article finds that a fine balance is required. On the one hand, overambitious procedures for targeting or conditionality should be avoided where administrative capacity is low. On the other hand, to rule out any possibility of conditionality or targeting on the grounds of weak administrative capacity leaves only the option of universal transfers.
Gamma‐glutamylcysteine ethyl ester protects cerebral endothelial cells during injury and decreases blood–brain barrier permeability after experimental brain trauma
Authors: Lok Josephine , Leung Wendy , Zhao Song , Pallast Stefanie , van Leyen Klaus , Guo Shuzhen , Wang Xiaoying , Yalcin Ayfer , Lo Eng H.
Published: April 2011

J. Neurochem. (2011) 118, 248–255.

Oxidative stress is a pathway of injury that is common to almost all neurological conditions. Hence, methods to scavenge radicals have been extensively tested for neuroprotection. However, saving neurons alone may not be sufficient in treating CNS disease. In this study, we tested the cytoprotective actions of the glutathione precursor gamma‐glutamylcysteine ethyl ester (GCEE) in brain endothelium. First, oxidative stress was induced in a human brain microvascular endothelial cell line by exposure to H2O2. Addition of GCEE significantly reduced formation of reactive oxygen species, restored glutathione levels which were reduced in the presence of H2O2, and decreased cell death during H2O2‐mediated injury. Next, we asked whether GCEE can also protect brain endothelial cells against oxygen–glucose deprivation (OGD). As expected, OGD disrupted mitochondrial membrane potentials. GCEE was able to ameliorate these mitochondrial effects. Concomitantly, GCEE significantly decreased endothelial cell death after OGD. Lastly, our in vivo experiments using a mouse model of brain trauma show that post‐trauma (10 min after controlled cortical impact) administration of GCEE by intraperitoneal injection results in a decrease in acute blood–brain barrier permeability. These data suggest that the beneficial effects of GCEE on brain endothelial cells and microvessels may contribute to its potential efficacy as a neuroprotective agent in traumatic brain injury.
A NON‐PARAMETRIC MEASURE OF POVERTY ELASTICITY
Authors: CHAMBERS DUSTIN , DHONGDE SHATAKSHEE
Published: April 2011

We estimate the growth elasticity of poverty (GEP) using recently developed non‐parametric panel methods and the most up‐to‐date and extensive poverty data from the World Bank, which exceeds 500 observations in size and represents more than 96 percent of the developing world's population. Unlike previous studies which rely on parametric models, we employ a non‐parametric approach which captures the non‐linearity in the relationship between growth, inequality, and poverty. We find that the growth elasticity of poverty is higher for countries with fairly equal income distributions, and declines in nations with greater income disparities. Moreover, when controlling for differences in estimation technique, we find that the reported values of the GEP in the literature (based on the World Bank's now‐defunct 1993‐PPP based poverty data) are systematically larger in magnitude than estimates based on the latest 2005‐PPP based data.
4‐Methylpyrazole as a treatment in naturally occurring ethylene glycol intoxication in cats
Authors: Tart Kelly M. , Powell Lisa L.
Published: April 2011

Objective –To describe the clinical experience and therapeutic use of fomepizole (4‐methylpyrazole [4‐MP]) in 3 cats with naturally occurring ethylene glycol (EG) toxicity.

Case or Series Summary –All cats were documented to be EG positive by an ethylene glycol test kit. This report describes the dose of 4‐MP used, available clinicopathological data, and clinical progression during hospitalization. All patients survived to discharge.

New or Unique Information Provided –IV use of 4‐MP at 125 mg/kg as an initial dose and 31.25 mg/kg at 12, 24, and 36 hours is safe and effective for treatment of naturally occurring EG toxicity in cats. Increased HCO3concentrations were noted after IV use of 4‐MP. This is the first report documenting the successful treatment of naturally occurring EG intoxication in cats with 4‐MP.
It Is a G‐Zero, Not a G‐20, World
Authors: ROUBINI NOURIEL
Published: April 2011

The G‐20 supplanted the G‐8 as the executive committee of globalization as the emerging and advanced economies came together in the wake of the Wall Street crash to stave off depression. Now, each country is going its own way.

In this section we examine whether the G‐20 can be saved, and what the countries within it must do to bring the global economy into balance.