bluuebunny/crossref_metadata_2025 huggingface dataset:
DelPhi: a comprehensive suite for DelPhi software and associated resources
Authors: Li Lin , Li Chuan , Sarkar Subhra , Zhang Jie , Witham Shawn , Zhang Zhe , Wang Lin , Smith Nicholas , Petukh Marharyta , Alexov Emil
Published: May 2012

Background

Accurate modeling of electrostatic potential and corresponding energies becomes increasingly important for understanding properties of biological macromolecules and their complexes. However, this is not an easy task due to the irregular shape of biological entities and the presence of water and mobile ions.

Results

Here we report a comprehensive suite for the well-known Poisson-Boltzmann solver, DelPhi, enriched with additional features to facilitate DelPhi usage. The suite allows for easy download of both DelPhi executable files and source code along with a makefile for local installations. The users can obtain the DelPhi manual and parameter files required for the corresponding investigation. Non-experienced researchers can download examples containing all necessary data to carry out DelPhi runs on a set of selected examples illustrating various DelPhi features and demonstrating DelPhi’s accuracy against analytical solutions.

Conclusions

DelPhi suite offers not only the DelPhi executable and sources files, examples and parameter files, but also provides links to third party developed resources either utilizing DelPhi or providing plugins for DelPhi. In addition, the users and developers are offered a forum to share ideas, resolve issues, report bugs and seek help with respect to the DelPhi package. The resource is available free of charge for academic users from URL: http://compbio.clemson.edu/DelPhi.php
The simultaneous expression of both ephrin B3 receptor and E-cadherin in Barrett`s adenocarcinoma is associated with favorable clinical staging
Authors: Schauer Matthias C , Stoecklein Nikolas H , Theisen Joerg , Kröpil Feride , Baldus Stephan , Hoelscher Arnulf , Feith Markus , Bölke Edwin , Matuschek Christiane , Budach Wilfried , Knoefel Wolfram Trudo
Published: May 2012

Background

In intestinal epithelium, tyrosine kinase receptor Ephrin B3 (Eph B3) maintains the architecture of the crypt-villus axis by repulsive interaction with its ligand ephrin-B1. While loss of Eph B3 is linked to colorectal cancer initiation, overexpression of Eph B3 in cancer cell lines inhibits growth and induces functional changes with decreased mesenchymal and increased epithelial markers. In order to study this tumor suppressor activity of Eph B3 in esophageal adenocarcinoma we analyzed the simultaneous expression of Eph B3 and E-cadherin in both the healthy esophagus and in Barrett’s carcinoma.

Methods

Simultaneous expression of Eph B3 and E-cadherin was investigated in samples from 141 patients with Barrett’s carcinoma and from 20 healthy esophagi using immunhistology and quantitative PCR. Results from healthy squamous epithelium, Barrett’s metaplasia and staging-specific esophageal adenocarcinoma were correlated.

Results

A significantly reduced E-cadherin mRNA expression could be detected in adenocarcinoma compared to dysplasia. The immunhistological activity of E-cadherin and Eph B3 was reduced in adenocarcinoma compared to dysplasia or healthy esophageal mucosa. The intracellular E-cadherin distribution changed significantly from the cytoplasm to the membrane, when the Eph receptor was simultaneously expressed. Simultaneous expression of E-cadherin and Eph B3 showed a significant inverse correlation to tumor stage.

Conclusions

We present novel evidence of the tumor suppressor activity of Eph B3 in esophageal adenocarcinoma possibly due to the impact on redistribution of cellular E-cadherin to the membrane. Our results suggest that this effect might play a role in the dysplasia-adenocarcinoma sequence, the infiltrative growth pattern and the development of lymph node metastases.
Low-dose oral prednisone improves clinical and ultrasonographic remission rates in early rheumatoid arthritis: results of a 12-month open-label randomised study
Authors: Montecucco Carlomaurizio , Todoerti Monica , Sakellariou Garifallia , Scirè Carlo Alberto , Caporali Roberto
Published: May 2012

Introduction

In early rheumatoid arthritis (RA), low-dose oral prednisone (PDN) co-medication yields better clinical results than monotherapy with disease-modifying anti-rheumatic drugs (DMARDs). In addition, ultrasonography (US) evaluation reveals rapid and significant effects of glucocorticosteroids on subclinical synovitis. No data currently exist that examine the clinical and US results offered by glucocorticoid co-medication over DMARD monotherapy in early RA patients.

Methods

Two hundred and twenty patients with early RA (< 1 year from clinical onset) were treated according to a low disease activity (LDA) targeted step-up protocol including methotrexate (MTX) and, in the active treatment arm, low-dose (6.25 mg/day) oral PDN over 12 months. Clinical disease activity measures were collected at baseline, 2, 4, 6, 9 and 12 months, and US examination of hands was performed at baseline, 6 and 12 months. Grey-scale and power Doppler (PD) synovitis were scored (0 to 3) for each joint. At 12 months, clinical remission according to the disease activity score among 28 joints was defined as the clinical outcome, and a total joint PD score of 0 (PD negativity) as the imaging outcome.

Results

Each group included 110 patients with comparable demographic, clinical, laboratory and US characteristics. At 12 months, the LDA rate was similar in the two groups, whilst the clinical remission rate (risk ratio = 1.61 (95% confidence interval = 1.08, 2.04)) and PD negativity rate (risk ratio = 1.31 (95% confidence interval = 1.04, 1.64)) were significantly higher in the MTX+PDN group.

Conclusion

In early RA, despite a similar response rate in terms of LDA, low-dose oral PDN co-medication led to a higher proportion of clinical remission and PD negativity compared with MTX monotherapy, thus ensuring a better disease activity control.

Trial registration number

Current Controlled Trials ISRCTN2486111
Morbidity and cost burden of methicillin-resistant Staphylococcus aureus in early onset ventilator-associated pneumonia
Authors: Shorr Andrew F , Tabak Ying P , Gupta Vikas , Johannes RS , Liu Larry Z , Kollef Marin H
Published: May 2012

Introduction

To gain a better understanding of the clinical and economic outcomes associated with methicillin-resistant Staphylococcus aureus (MRSA) infection in patients with early onset ventilator-associated pneumonia (VAP), we retrospectively analyzed a multihospital US database to identify patients with VAP over a 24 month period (2002–2003).

Method

Data recorded included physiologic, laboratory, culture, and other clinical variables from 59 institutions. VAP was defined as new positive respiratory culture after at least 24 hours of mechanical ventilation (MV) and the presence of primary or secondary ICD-9-CM diagnosis codes of pneumonia. Outcomes measures included in-hospital morbidity and mortality for the population overall and after onset of VAP (duration of MV, intensive care unit [ICU] stay, in-hospital stay, and case mix and severity-adjusted operating cost). The overall cost was calculated at the hospital level using the Center for Medicare and Medicaid Services Cost/Charge Index for each calendar year.

Results

A total of 499 patients were identified as having VAP. S. aureus was the leading organism (31% of isolates). Patients with MRSA were significantly older than patients with methicillin-sensitive Staphylococcus aureus (MSSA; median age 74 versus 67 years, P < 0.05) and more likely to be medical patients. Compared with MSSA patients, MRSA patients on average consumed excess resources of 4.4 (95% confidence interval 0.6–8.2) overall MV days, 3.8 (-0.5 to +8.0) days of inpatient length of stay (LOS), 5.3 (1.0–9.7) ICU days, and US$7731 (-US$8393 to +US$23,856) total cost after controlling for case mix and other factors. Furthermore, MRSA patients needed excess resources after the onset of VAP (4.5 [95% confidence interval 1.0–8.1] MV days, 3.7 [-0.5 to +8.0] inpatient days, and 4.4 [0.4–8.4] ICU days) after controlling for the same case mix and admission severity covariates.

Conclusion

S. aureus remains a common cause of VAP. VAP due to MRSA was associated with increased overall LOS, ICU LOS, and attributable ICU LOS compared with MSSA-related VAP. Although not statistically significant because of small sample size and large variation, the attributable excess costs of MRSA amounted to approximately US$8000 per case after controlling for case mix and severity.
A multivariate Bayesian model for assessing morbidity after coronary artery surgery
Authors: Biagioli Bonizella , Scolletta Sabino , Cevenini Gabriele , Barbini Emanuela , Giomarelli Pierpaolo , Barbini Paolo
Published: May 2012

Introduction

Although most risk-stratification scores are derived from preoperative patient variables, there are several intraoperative and postoperative variables that can influence prognosis. Higgins and colleagues previously evaluated the contribution of preoperative, intraoperative and postoperative predictors to the outcome. We developed a Bayes linear model to discriminate morbidity risk after coronary artery bypass grafting and compared it with three different score models: the Higgins' original scoring system, derived from the patient's status on admission to the intensive care unit (ICU), and two models designed and customized to our patient population.

Methods

We analyzed 88 operative risk factors; 1,090 consecutive adult patients who underwent coronary artery bypass grafting were studied. Training and testing data sets of 740 patients and 350 patients, respectively, were used. A stepwise approach enabled selection of an optimal subset of predictor variables. Model discrimination was assessed by receiver operating characteristic (ROC) curves, whereas calibration was measured using the Hosmer-Lemeshow goodness-of-fit test.

Results

A set of 12 preoperative, intraoperative and postoperative predictor variables was identified for the Bayes linear model. Bayes and locally customized score models fitted according to the Hosmer-Lemeshow test. However, the comparison between the areas under the ROC curve proved that the Bayes linear classifier had a significantly higher discrimination capacity than the score models. Calibration and discrimination were both much worse with Higgins' original scoring system.

Conclusion

Most prediction rules use sequential numerical risk scoring to quantify prognosis and are an advanced form of audit. Score models are very attractive tools because their application in routine clinical practice is simple. If locally customized, they also predict patient morbidity in an acceptable manner. The Bayesian model seems to be a feasible alternative. It has better discrimination and can be tailored more easily to individual institutions.
Collecting a “Lost City” For Science: Huaquero Vision and the Yale Peruvian Expeditions to Machu Picchu, 1911, 1912, and 1914–15
Authors: Hall Amy Cox
Published: May 2012

In 1911 Hiram Bingham and the Yale Peruvian Expedition team first sighted Machu Picchu. The expedition would return to Peru two more times (1912 and 1914–15), mapping, excavating, and photographing the Andean region around Cuzco. Part of the legacy of the three expeditions is its set of collections that include exotic animals, books and antiquities, and skeletal remains. This article examines the practices and collecting technologies of the expedition to suggest that the objects collected as well as the technologies and practices used in collecting helped fashion Machu Picchu into a “lost city” that was “scientifically discovered” by Bingham. The expedition combined a reliance on prospecting by local huaqueros with the notion that science had a sovereign claim on those objects that might contribute to the accumulation of its knowledge. Ultimately, the re-visioning of Machu Picchu as a vestige of the glorious Inca race and a “scientific discovery” was materialized and evidenced through collected objects.
Death and the Maiden
Authors: Bennett Judith M.
Published: May 2012

The partnership of death and maidenhood—found in many cultures, present as well as past, east as well as west—is examined here in the particular context of late medieval England, when mortality was exceptionally high and maidens unusually numerous. Drawing on a wide range of materials (including saints’ lives, poetry, monumental brasses, and wills), the essay shows how the English imagined maidens who were untamed by manly authority, endowed with a menacing sexuality, and superhumanly powerful in relation to death. It concludes by considering the global reach of this curious coupling and the ways in which its specific meanings at the end of the Middle Ages might have contributed to the fears that drove witch-hunting in the sixteenth and seventeenth centuries.
Utopia, Ireland, and the Tudor Shock Doctrine: Spenser’s Vision of Capitalist Imperialism
Authors: Hogan Sarah
Published: May 2012

Edmund Spenser’s A View of the Present State of Ireland is one of the most notorious works in the imperial archive, yet its fantasy of annihilating reform, or what might now be called “creative destruction,” schemes a highly specific kind of colonial project driven by novel kinds of economic motive. This essay considers how A View redeploys utopian literary forms in the colonial setting so as to envision unimpeded, accelerated “primitive accumulation,” that violent process of dispossession that defines the agrarian and imperial origins of capitalism. While The Faerie Queene adopts a more residual, backward-glancing form, its allegories of Spanish greed and Irish theft likewise attempt to morally differentiate emergent English methods of expropriation from competing methods of conquest and customary economies.
An observational study into the management of arteriomegaly: a call for a revised classification system
Authors: Barandiaran JV , Hall TC , Glaves I , El-Barghouti N , Perry EP
Published: May 2012

INTRODUCTION

Arteriomegaly is the diffuse ectasia of arteries with or without aneurysmal disease. Patients with arteriomegaly have a higher incidence of morbidity including limb loss compared to patients with other arteriopathies. The aim of this observational study was to review the management of these patients in our institution.

METHODS

Radiologists and surgeons prospectively reviewed aortofemoral angiography. Patients with arteriomegaly were identified. Data relating to demographics, mode of presentation, risk factors, type of arteriomegaly, management and progression of disease were analysed.

RESULTS

Arteriomegaly was identified in 1.3% of patients (n=69) undergoing lower limb angiography in the study period. Of these, the majority (n=67) were men. The mean age was 74 years (range: 60–89 years) and 76% were smokers. Co-morbidities included coronary artery disease (55%), diabetes mellitus (20%), hypertension (45%) and cerebrovascular events (6%). Fortynine patients presented with critical limb ischaemia and eighteen patients were seen electively in the outpatients department with symptoms of intermittent claudication. Data were incomplete for two male patients and were therefore not included. At presentation, 22 patients were classified as Hoi lier type I, 5 were type II and 9 were type III. Thirty-one patients had arteriomegalic vessels but no aneurysmal disease. After a median follow-up duration of 76 months (range: 6–146 months), 34 patients progressed to type I, 2 to type II and 18 to type III. Thirteen remained without aneurysmal disease. Twenty-nine patients required angioplasty and twenty-eight required bypass surgery during this time. In total, 102 procedures were required for complicated disease. The limb salvage rate was 92%. Although 8 patients in our series died, the remaining 59 are under regular follow up.

CONCLUSIONS

This study illustrates the progressive nature of arteriomegaly. Results of the management of these patients in our institution are similar to those in the literature. We suggest an additional fourth category to Hollier’s classification that describes arteriomegalic disease without aneurysmal degeneration as this, too, deserves special management. Regular follow-up visits and early intervention for patients with arteriomegaly is advocated to reduce the high incidence of morbidity.
Pathophysiology and management aspects of adrenal angiomyolipomas
Authors: Hussain T , Al-Hamali S
Published: May 2012

Angiomyolipomas are benign mesenchymal tumours originating from the kidney and adrenals. They are rare tumours that can be sporadic and isolated or occur as a part of tuberous sclerosis. These tumours have a high content in the cells, which is pathognomonic for diagnosis using ultrasonography, computed tomography and magnetic resonance imaging. Atypical angiomyolipomas occur with excessive smooth muscle cells and less adipose tissue, and are sensitive to immunohistochemistry studies. Most of these lesions are detected incidentally but some can cause back and abdominal pains if large in size. Larger lesions are also vulnerable to spontaneous or traumatic rupture, causing large retropertitoneal bleeds. Surgery should be considered as the definitive management for larger lesions to avoid associated complications. There have been no reports of any malignant change being reported in any of the lesions but a long follow-up period is still required, given the unknown clinical progression of these rare tumours.
Caliper measurement to improve clinical assessment of palpable neck lumps
Authors: Wasson J , Amonoo-Kuofi K , Scrivens J , Pfleiderer A
Published: May 2012

INTRODUCTION

One-stop neck lump clinics with ultrasonography and cytopathology support are an expensive and finite resource. Consequently, many neck lump patients are assessed in general ear, nose and throat or head and neck clinics. Optimal clinical assessment of neck lump size is important to guide investigation, monitor change and provisionally stage nodal disease. The aims of this study were to investigate whether caliper measurement is more accurate than clinical palpation in assessing neck lump size and whether caliper measurement of neck lump size correlates closely with accurate ultrasonography measurement.

METHODS

A prospective study was carried out involving 50 patients with clinically palpable neck lumps presenting to the one-stop neck lump clinic. Long and short axis neck lump dimensions were estimated first by clinical palpation and second by caliper measurement. Estimations were compared with accurate ultrasonography measurement.

RESULTS

The mean combined long and short axis measurement deviation from accurate ultrasonography measurement was smaller for caliper measurement (7.80mm) than for clinical palpation (12.38mm) (p<0.01). There was no significant difference observed between combined axis ultrasonography and combined axis caliper measurement of neck lumps (p=0.462).

CONCLUSIONS

Caliper measurement is more accurate than clinical palpation in estimating the size of clinically palpable neck lumps. The use of calipers to measure the skin surface dimensions of palpable neck lumps is statistically comparable to accurate ultrasonography measurement.
The STAR score: a method for auditing clinical records
Authors: Tuffaha H , Amer T , Jayia P , Bicknell C , Rajaretnam N , Ziprin P
Published: May 2012

INTRODUCTION

Adequate medical note keeping is critical in delivering high quality healthcare. However, there are few robust tools available for the auditing of notes. The aim of this paper was to describe the design, validation and implementation of a novel scoring tool to objectively assess surgical notes.

METHODS

An initial ‘path finding’ study was performed to evaluate the quality of note keeping using the CRABEL scoring tool. The findings prompted the development of the Surgical Tool for Auditing Records (STAR) as an alternative. STAR was validated using inter-rater reliability analysis. An audit cycle of surgical notes using STAR was performed. The results were analysed and a structured form for the completion of surgical notes was introduced to see if the quality improved in the next audit cycle using STAR. An education exercise was conducted and all participants said the exercise would change their practice, with 25% implementing major changes.

RESULTS

Statistical analysis of STAR showed that it is reliable (Cronbach’s a = 0.959). On completing the audit cycle, there was an overall increase in the STAR score from 83.344% to 97.675% (p<0.001) with significant improvements in the documentation of the initial clerking from 59.0% to 96.5% (p<0.001) and subsequent entries from 78.4% to 96.1% (p<0.001).

CONCLUSIONS

The authors believe in the value of STAR as an effective, reliable and reproducible tool. Coupled with the application of structured forms to note keeping, it can significantly improve the quality of surgical documentation and can be implemented universally.
Primary extraskeletal Ewing sarcoma involving the carotid artery: a case report and review of the current literature
Authors: Kallala R , Nikkhah D , Nix P , Woodhead C
Published: May 2012

Extraskeletal Ewing sarcoma (EES) is a rare soft tissue neoplasm of primitive mesenchymal cells. There is a scarcity of data on EES involving the head and neck, with studies being over years or even decades. We are the first to report a case of EES involving the carotid artery and its subsequent surgical excision and reconstruction.
Urinary tract transitional cell carcinoma and melanosis of the bladder: a case report and review of the literature
Authors: Harikrishnan JA , Chilka S , Jain S
Published: May 2012

Melanosis vesica is a rare condition and thought to be benign. We report the case of a 50-year-old man who presented with haematuria and was found to have a diffusely pigmented bladder on cystoscopy and high grade transitional cell carcinoma of his upper and lower renal tract. This required a laparoscopic nephroureterectomy and pathology confirmed a diagnosis of melanosis vesica. Melanosis vesica has only been associated with high grade transitional cell carcinoma in one previous case. We recommend that any patient presenting with bladder melanosis is monitored for the development of upper or lower urinary tract transitional cell carcinoma.
Bilateral lower limb compartment syndrome: a potentially destructive complication of breast reduction
Authors: Malahias M , Ghorbanian S , Lemonas P
Published: May 2012

Compartment syndrome is a serious condition in which the pressure in the limb increases and potentially compromises capillary circulation with subsequent ischaemic complications. This case report presents a case of bilateral lower limb compartment syndrome after bilateral breast reduction for back pain. The patient was an otherwise healthy 24-year-old Afro-Caribbean woman. This report aims to highlight the need for an increased index of suspicion for compartment syndrome in any postoperative patient complaining of lower limb pain.
The oldest reported mirror hand? The curse of the coal-house frog!
Authors: Marsden NJ , Whitaker IS , Boyce DE
Published: May 2012

Despite being one of the rarest congenital upper limb abnormalities, a wide spectrum of the typical mirror hand has been described in the literature. We report a very interesting case of a new variant of mirror hand presenting in a 78-year-old man. The unique features of the case include the age at diagnosis, the anatomical features present and the acquired function despite no form of reconstructive surgery.
Changing incidence and management of penetrating neck injuries in the South East London trauma centre
Authors: Harris R , Olding C , Lacey C , Bentley R , Schulte KM , Lewis D , Kandasamy N , Oakley R
Published: May 2012

INTRODUCTION

A total of 17 cases of penetrating neck injury were managed by the otolaryngology team at King’s College Hospital over a 3-year period in the 1980s. In April 2010 King’s College Hospital became the major trauma centre for South East London. This prospective cohort study compares the incidence, changing demographic features and treatment outcomes of penetrating neck trauma in South East London over the previous 23 years.

METHODS

Data were collected over a 12-month period (April 2010 to March 2011) and a selective management protocol was introduced to standardise initial investigations and further treatment.

RESULTS

The past 23 years have seen a 550% increase in the incidence of penetrating neck injuries in South East London, with a marked increase in gun crime. Only 38% of cases underwent negative neck exploration in 2011 compared with 65% in 1987. Selective conservative management based on the absence of haemodynamic instability or radiological findings reduces length of hospital stay, lightens surgical workload and cuts costs without affecting morbidity or mortality.

CONCLUSIONS

The increased incidence of penetrating neck injury is a reflection of more interpersonal violence rather than a consequence of the larger South East London trauma centre catchment area. Tackling this problem requires focus on wider issues of community prevention. Sharing of data between the four London trauma centres and the police is needed to help prevent interpersonal violence and develop a universal treatment algorithm for other institutions to follow.
Effectiveness of a gentamicin impregnated collagen sponge on reducing sternal wound infections following cardiac surgery: a meta-analysis of randomised controlled trials
Authors: Creanor S , Barton A , Marchbank A
Published: May 2012

INTRODUCTION

Gentamicin impregnated collagen sponges are licensed for use after cardiac surgery in over 50 countries but their effectiveness at preventing sternal wound infections (SWIs) remains uncertain. The aim of this meta-analysis was to assess the current evidence for effectiveness of such sponges at preventing SWIs in patients after cardiac surgery.

METHODS

A systematic search of the literature was undertaken and meta-analyses were performed on the results of the identified, eligible studies. Using random effects models, odds ratios (OR) and corresponding 95% confidence intervals (Cl) were calculated for all SWIs and deep SWIs for: a) all participants, and b) participants deemed as high risk.

RESULTS

Three unique randomised controlled trials (published between 2005 and 2010) involving 3,994 participants met the inclusion criteria. There was insufficient evidence of a significant difference between intervention and control groups for all SWIs (all participants: OR: 0.66, 95% Cl: 0.39–1.14; high risk participants: OR: 0.60, 95% Cl: 0.24–1.52). There was insufficient evidence of a significant benefit of the sponge in deep SWIs across all participants (OR: 0.72, 95% Cl: 0.47–1.10) but some evidence of benefit in terms of reducing the incidence of deep SWIs in high risk participants (OR: 0.62, 95% Cl: 0.39–0.98).

CONCLUSIONS

There is insufficient evidence of the effectiveness (or otherwise) of gentamicin impregnated sponges in preventing SWIs following cardiac surgery. However, some evidence does exist that such sponges can reduce the incidence of deep infections in high risk patients.
Case-based review: conservative management of appendicitis – are we delaying the inevitable?
Authors: Davies S , Peckham-Cooper A , Sverrisdottir A
Published: May 2012

Acute appendicitis is a common surgical presentation for which surgical intervention, an appendicectomy, has remained a largely unchallenged primary treatment modality. Traditionally, it has been felt that the pathophysiological progressive nature of appendicitis ultimately leads to perforation. A number of recent studies, however, suggest that the process of appendiceal inflammation may follow a more remitting nature with evidence indicating spontaneous resolution. It is hypothesised that the treatment of uncomplicated appendicitis may therefore be amenable to conservative management with antibiotics. This article aims to highlight some of the issues and challenges relating to the conservative management of acute appendicitis and further demonstrates potential diagnostic and treatment difficulties involved in managing the more unfamiliar condition of recurrent appendicitis.
Subacute reaction to endoscopic mucosal resection mimicking perforation
Authors: Williamson JML , Dunkley P , Hewin D
Published: May 2012

A 25-year-old woman underwent routine day-case endoscopic mucosal resection (EMR) of two ascending colonic polyps. Six hours later she re-presented with severe abdominal pain. On examination she was tachycardic with tenderness and peritonism in the right lower quadrant. Urgent abdominal computed tomography (CT) did not reveal any signs of free intra-abdominal gas or fluid but did detect transmural thickening and oedema in the ascending colon and caecum. As there was no radiological evidence of perforation, the patient was managed conservatively and made a full recovery.

The exact aetiology of this patient’s symptoms is not known. She may have developed post-polypectomy electrocoagulation (a transmural diathermy injury), localised ischaemia of the colonic wall (secondary to the adrenaline used during EMR) or an allergic reaction to the dye used during EMR.

As EMR is an increasingly used treatment modality in the management of colonic polyps, clinicians should have an awareness of the complications of treatment. We would advocate a low threshold for prompt CT investigation in any patient presenting with abdominal pain after EMR to detect any evidence of free intraperitoneal air. Patients without signs of perforation may be managed conservatively, as in this case.
Prolonged survival after surgical management of metastases in malignant melanoma: three case reports
Authors: Whitaker SR , Houston SJ
Published: May 2012

The incidence of malignant melanoma is increasing and the management of metastatic disease remains a challenge to clinicians. We describe three cases where surgical management of metastases has resulted in prolonged survival.
Transnasal K-wire to stabilise a complex zygomatic fracture: a forgotten method of fixation
Authors: Singh MK , Shekar K , Flood T , Greenstein A
Published: May 2012

Zygomatic complex fractures make up approximately 60% of facial fractures. The vast majority treated surgically use titanium miniplates. These require longer operating times and facial incisions to access the fracture. The use of a K-wire was first described 60 years ago. As a new generation of surgeons emerges, it is important to be aware of the various techniques available to increase their surgical armamentarium. One of its benefits is that it has a significantly reduced operative time and does not require any incisions.
Small bowel obstruction induced by spontaneous partial deflation of an intragastric balloon
Authors: Hegade VS , Sood R , Douds AC
Published: May 2012

The intragastric balloon (IGB) has been used for decades as a temporary measure for weight reduction in the morbidly obese. Serious complications related to the device remain rare. We present the case of a 23-year-old Caucasian man who developed signs of bowel obstruction following spontaneous partial deflation of an air filled IGB with subsequent migration and impaction in the jejunum. We discuss the role of the IGB in the treatment of obesity, side effects and the serious complications that can occur.
Gastric schwannoma: a benign tumour often mistaken clinically, radiologically and histopathologically for a gastrointestinal stromal tumour – a case series
Authors: Williamson JML , Wadley MS , Shepherd NA , Dwerryhouse S
Published: May 2012

INTRODUCTION

Gastric schwannomas are rare mesenchymal tumours that arise from the nerve plexus of the gut wall. They present with non-specific symptoms and are often detected incidentally. Pre-operative investigation is not pathognomonic and many are therefore diagnosed as gastrointestinal stromal tumours (GISTs). Operative resection is usually curative as they are almost always benign, underpinning the importance of differentiating them from GISTs.

METHODS

Three cases of gastric schwannomas were identified over a seven-year period. The clinical details and management were reviewed retrospectively.

RESULTS

There were two women and one man with a mean age of 62 years (range: 51–69 years). Two patients presented with bleeding and one with abdominal pain. The mean tumour size was 5.2cm (range: 2–10cm) and the tumours were resected completely following total or wedge gastrectomies. Histology in all cases showed spindle cells with a cuff of lymphoid tissue. Immunohistochemistry confirmed positive S100 staining and negative CD117 and DOG-1 staining in all cases.

CONCLUSIONS

We report our experience with these unusual primary stromal tumours of the gut and their presentations, preoperative investigations, operative findings and pathological findings are discussed. Operative resection in all cases has been considered curative, which is supported by previous series confirming the excellent prognosis of gastric schwannomas.
Incorporating the dental specialties into the ISCP
Authors: Mochrie Anne
Published: May 2012

The Intercollegiate Surgical Curriculum Programme (ISCP) is an online management tool for use in training. It was conceived in 2003, piloted in 2005 and launched in 2007. Its initial development was funded by the department of Health and the joint surgical colleges and it houses the nine surgical curricula. for the surgical specialties the ISCP supports educational supervision, e-portfolios, e-logbooks, workplace-based learning and assessment and the annual review of competence progression.
Taking Definitive Surgical Trauma Skills to the Needy
Authors: Nott David M
Published: May 2012

For the past ten years or so I have been involved with the Definitive SurgicalTrauma Skills (DSTS) course at the Royal College of Surgeons. The course was set up by Professors Jim Ryan and Peter Roberts and continued by NigelTai. I now convene the course and have also been involved in the faculty of the Military Operational SurgicalTraining (MOST) course also run at the College. MOST teaches military surgeons, anaesthetists and ancillary surgical staff before going to war, convened and orchestrated by Mark Midwinter, defence Professor of Surgery.
Moving on
Authors: Williams Norman
Published: May 2012

The last few months have been potentially divisive for the medical profession with some people adopting polarised views on the Health and Social Care Bill, sometimes on the basis of misinformation. debate has been passionate and, at times, heated. Colleges have held extraordinary general meetings and conducted polls of members. The results have often been contradictory: calls for withdrawal yet a desire to continue dialogue. Your Council has attempted to distance our College from the political polemic and has consistently signified its wish to 'critically engage'. I outlined in my last email how this policy had improved the bill.
Importing Genre, Exporting Cult: The Japanese Zom-Com
Authors: Wing-Fai Leung
Published: May 2012

This article argues that the Japanese zom-com, with Wild Zero (2001, dir. Takeuchi Tetsuro) and Tokyo Zombie (Tokyo Zonbi 2005, dir. Sato Sakichi) as examples, is the result of cultural borrowing from American popular culture and an eclectic mix of generic influences. The zom-com films
from Japan rarely reference traditional folklore that has been a central source in the history of Japanese horror cinema. Instead, the current discussion considers the two films alongside the zombie canon, and explores how they exist as transnational cult that can be understood through the
academic discourse on taste and distinction. In the age of global production and consumption, differences are minimized in these films’ “imageries of Japan” and the producers’ marketing, rendering them familiar trash and engendering their cult status. The article concludes
that it is the trans-cultural quality of these Japanese films rather than “the dead that walk” which underpins them as cult movies.
Displaced in the Simulacrum: Migrant Workers and Urban Space in The World
Authors: Wang Yanjie
Published: May 2012

The article examines the construction of the World Expo Garden in Shanghai in 2010, in relation to Jia Zhangke’s 2004 film The World. It argues that during the process of large-scale demolition and reconstruction involved in the creation of the World Expo Garden, one cannot ignore
the numerous migrant workers who swarmed into the city and contributed tremendously to the completion of one project after another. This article argues that in spite of their pivotal role in providing cheap labor to rebuild the city, migrant workers have not been afforded any space in the
spectacular tapestry of Shanghai. This article examines how Jia Zhangke’s film is of particular interest to the investigation of the crisscross of migrant workers and the cityscape, and argues that The World is not so much a showcase of the cosmopolitan city of Beijing than an internal
perspective of the city beneath the veneer of its prosperity.
Disavowing The Isle : Masochism and New Extremity
Authors: Johnson Beth
Published: May 2012

This article undertakes a thematic and aesthetic analysis of The Isle (Seom 2002, dir. Kim Ki-duk) and conceptualizes the theme of disavowal in association with UK audience expectations of popular and “extreme” Asian cinema. In addition, this work also seeks to reframe Kim
beyond Asia extreme in a framework around intimacy and pain more akin to European extreme cinema. Via close reading, the complex representations of brutal intimacy found in this film can, I argue, be understood in-line with the Korean concept of “han,” marginality, and masochism.
Considering formal and stylistic ellipses within the text, I argue that The Isle opens up a space for audiences to consider what is disavowed, unseen, and unsaid in Kim’s work.
The challenges and opportunities of community celebrations that value diversity and foster unity: Beyond ‘spaghetti and polka’
Authors: Hilbers Julieanne
Published: May 2012

There is an interplay between celebrations that value the individual, foster connection with others like oneself, those that seek to value diversity across communities and those that identify with the whole-of-community in ways that respect individual diversity. This article explores the contribution of celebrations towards valuing diversity and the importance of celebrations that are responsive to the dynamic, multidimensional nature of communities. It draws on doctoral research reviewing contemporary festivals held around Australia. Arguments are made for the consideration of celebrations that enable a shared experience and celebrate each individual’s uniqueness.
Enacting change: Disability and the arts in Northern Ireland
Authors: Goddard Jennifer
Published: May 2012

Disability Arts (arts created by people with disabilities as a political act), which grew out of the Disability Rights movement in the United States and in England in the 1970s–1980s, is not widely practised or recognized in Northern Ireland. Most arts practice in the region involving people with disabilities is based on an Arts and Disability approach (arts for people with disabilities by non-disabled people). This approach tends to attract criticism from the Disability Arts movement, as it relies on non-disabled facilitators and practitioners, who may not challenge the ownership and power dynamics of the dominant over the marginal group. This suggests that there is need for cultural and attitudinal change. However, history has repeatedly shown that it is neither appropriate nor acceptable to ‘cut and paste’ the British model into the Northern Irish context. Furthermore, the social model of disability embedded in UK legislation has recently been challenged by certain voices from within disability studies. The latter half of this article focuses on the initial stages of a participatory action research study with the theatre company Kids in Control, Belfast, in August 2011. The first in a series of three workshop cycles, this practice research had a focus on developing working relationships with young adults with learning disabilities, and observing the way in which they work individually and as a group using drama. Subsequent research will be used to investigate the development of an independent professional theatre company to be led by the young people themselves, given that this is their preferred outcome. Throughout the research process, some of the following questions will be investigated:

Given that contextually appropriate transformative cultural and attitudinal change needs to take place in Northern Ireland with regard to disability, how exactly should this happen?

What should these changes look like, and what should be the result?

How can models of good practice be developed and disseminated?
Negotiating cultural identity through the arts: Fitting in, third space and cultural memory
Authors: Wakholi Peter Mbago , Wright Peter
Published: May 2012

The article examines ways in which arts-based educational approaches were applied to a group of African descendant youth in Western Australia, as a way of understanding challenges to their bicultural socialization and means to developing their bicultural competence. Drawing on African cultural memory as a cultural resource enabled participants to discover the relevance of African cultural memory and embodied knowledge to their bicultural socialization and bicultural competence. The article challenges the argument that successful integration into dominant culture is only possible when migrants remain focused on acquisition of dominant cultural values – ‘Fitting in’. The African Cultural Memory Youth Arts Festival (ACMYAF) offered an alternative conception of successive integration as a process inclusive of creative appropriation and revaluation of ancestral culture through cultural memory. The festival became a third space through which the participants explored embodied knowledge and African cultural memory towards a positive self-concept and bicultural competence.
Self-Diffusion of Lithium in Amorphous Lithium Niobate Layers
Authors: Rahn Johanna , Hüger Erwin , Dörrer Lars , Ruprecht Benjamin , Heitjans Paul , Schmidt Harald
Published: May 2012

We investigated lithium self-diffusion in amorphous lithium niobate layers between 298 and 423 K. For the experiments, amorphous 6LiNbO3/ 7LiNbO3 isotope hetero-structures were deposited by ion beam sputtering and analysed after diffusion annealing by secondary ion mass spectrometry (SIMS). This arrangement allows one to study pure isotope interdiffusion. The results show that the diffusivities obey the Arrhenius law with an activation enthalpy of 0.7 eV, which is considerably lower than the activation enthalpy found for LiNbO3 single crystals in literature. Consequently, the Li diffusivities are higher by at least eight orders of magnitude in the amorphous samples in the temperature range studied.
Living with Difference: Experiences of Adolescent Girls with Cleft Lip and Palate
Authors: Tiemens Kim , Nicholas David , Forrest Christopher R.
Published: May 2012

Objective

This study explored the experiences of adolescent girls with cleft lip and palate who were preparing for orthognathic surgery.

Design

A qualitative study, based on a phenomenological approach, explored adolescents’ experiences. Two 1-hour semistructured interviews were conducted before surgery, and member checking was employed to verify findings with each participant.

Setting

A tertiary care pediatric hospital in central Canada.

Participants

A criterion sampling technique was used to recruit a sample of seven participants with cleft lip and palate ranging in age from 15 to 20 years who were scheduled for cleft orthognathic surgery.

Results

Participants described experiencing teasing, bullying, and stares. In many cases, participants sought to resist and dismiss negative social attitudes about their visible difference while working to combat this with a positive view of who they really are. To varying degrees, participants felt constricted in engaging in the community as they were worried what others thought of their visible difference. They worked at finding ways to reduce the impact of social stigma through coping strategies, social supports, and reconstructive surgery.

Conclusions

Adolescent girls can experience strain associated with living with a facial difference; however, they find strategies to cope with the perception of difference. Reconstructive surgery is viewed as a means to increase confidence. Further intervention is needed in understanding and addressing stigma and fostering resiliency related to female adolescents living with a facial difference.
Evolutionary modifications of ontogeny of threeDechenellaspecies (Proetidae), from the Middle Devonian of the Ardenne Massif (France)
Authors: Bignon Arnaud , Crônier Catherine
Published: May 2012

Numerous exuviae of threeDechenellaspecies (D. givetensis,D. ziegleriandD. calxensis) from the Middle Devonian (Givetian) of NE France (Ardenne Massif) provide the opportunity to identify the evolutionary modifications of ontogeny of the threeDechenellaspecies and to elaborate a conceptual framework of developmental shape changes. First we used biometric and morphometric approaches to characterize shape modifications. Then we computed ontogenetic trajectories by multivariate regression of geometric shape variables on centroid size in order to compare them. Finally, we compared parallelism between trajectories and rates of development relative to size. These analyses demonstrate a significant difference in the cranidial developmental trajectories ofD. givetensisandD. ziegleriindicating an allometric repatterning. However, pygidia of these species share the same allometric pattern with a distinct developmental rate suggesting that heterochrony could be a partial explanation for the body shape evolution. Pygidial ontogeny ofD. calxensiscorresponds to an allometric repatterning with respect to both other species. This work illustrates the complexity of evolutionary modifications of ontogeny constituting an important process in morphological novelties.
Phylogenetic implications of the oldest crinoids
Authors: Guensburg Thomas E.
Published: May 2012

For many years the earliest record of the class Crinoidea was a single late Tremadocian genus. In the past decade, five crinoid genera were described from the early and middle Tremadocian, near the base of the Ordovician. Together these six genera represent a diverse assemblage with all but one expressing existing subclass apomorphies. Two of the recently described genera were initially assigned to their own order (plesion) Protocrinoida but not to a subclass. Here they are placed in the camerates based on apomorphies of the tegmen complex. Protocrinoids exhibit plesiomorphies unlike typical camerates. Two genera group with cladids, one expressing dendrocrinine apomorphies and the other cyathocrinine. One genus is placed within disparids, with iocrinid apomorphies.

Based on its ancient age and trait mosaic, the protocrinoidTitanocrinusis designated as outgroup in a phylogenetic analysis using all other Early Ordovician and select Middle Ordovician taxa as an ingroup. Character compilation and phylogenetic analysis posit early class-level plesiomorphies inherited from an unknown ancestry but lost during subsequent crinoid evolution. Class-level apomorphies also emerge, some of which were subsequently lost and others retained. Results are generally robust and consistent with earlier subdivisions of the class, but supporting lower rank reorganizations. Strong support for the camerate branch low in the crinoid tree mirrors findings of earlier workers. Cladids branch from a series of intermediate nodes and disparids nest highest. Branching of disparids from cladids could be homoplastic.