bluuebunny/crossref_metadata_2025 huggingface dataset:
Tongue Color Analysis for Medical Application
Authors: Zhang Bob , Wang Xingzheng , You Jane , Zhang David
Published: April 2013

An in-depth systematic tongue color analysis system for medical applications is proposed. Using the tongue color gamut, tongue foreground pixels are first extracted and assigned to one of 12 colors representing this gamut. The ratio of each color for the entire image is calculated and forms a tongue color feature vector. Experimenting on a large dataset consisting of 143 Healthy and 902 Disease (13 groups of more than 10 samples and one miscellaneous group), a given tongue sample can be classified into one of these two classes with an average accuracy of 91.99%. Further testing showed that Disease samples can be split into three clusters, and within each cluster most if not all the illnesses are distinguished from one another. In total 11 illnesses have a classification rate greater than 70%. This demonstrates a relationship between the state of the human body and its tongue color.
Optical Coherence Tomography Imaging of Choroidal Abnormalities in Neurofibromatosis Type 1
Authors: Makino Shinji , Tampo Hironobu
Published: April 2013

We report a case of neurofibromatosis type 1 (NF1) examined by infrared fundus autofluorescence (IR-FAF) and optical coherence tomography (OCT) to characterize the associated choroidal abnormalities. The conventional ophthalmoscopic findings were unremarkable. However, IR-FAF revealed multiple bright patchy lesions in the choroid of the posterior pole, in both eyes. OCT demonstrated irregular hyperreflectivity at the sites of these lesions. Patients with NF1 may have typical choroidal lesions that are visible on IR-FAF, which can be confirmed through OCT.
Mutual Coupling in Phased Arrays: A Review
Authors: Singh Hema , Sneha H. L. , Jha R. M.
Published: April 2013

The mutual coupling between antenna elements affects the antenna parameters like terminal impedances, reflection coefficients and hence the antenna array performance in terms of radiation characteristics, output signal-to-interference noise ratio (SINR), and radar cross section (RCS). This coupling effect is also known to directly or indirectly influence the steady state and transient response, the resolution capability, interference rejection, and direction-of-arrival (DOA) estimation competence of the array. Researchers have proposed several techniques and designs for optimal performance of phased array in a given signal environment, counteracting the coupling effect. This paper presents a comprehensive review of the methods that model and mitigate the mutual coupling effect for different types of arrays. The parameters that get affected due to the presence of coupling thereby degrading the array performance are discussed. The techniques for optimization of the antenna characteristics in the presence of coupling are also included.
Wireless Sensing for the Respiratory Activity of Human Beings: Measurements and Wide-band Numerical Analysis
Authors: Scalise Lorenzo , Mariani Primiani Valter , Russo Paola , De Leo Alfredo , Shahu Desar , Cerri Graziano
Published: April 2013

An electromagnetic sensing system for the measurement of the respiratory activity is presented. The aims are to demonstrate the feasibility of the proposed approach and in particular to evaluate the effect on the measured signal of the distance between the subject and the sensing apparatus. Moreover, an electromagnetic model of the system, including the monitored subject, is proposed as a tool to solve the problem of selecting working parameters for system design. The sensing system is based on the measurement of the phase variation of the reflection coefficient caused by the respiratory activity. The phase signal compared with the thorax displacement measured by a reference instrument shows a high correlation () for different subject postures (sitting, standing, and lying) and a reduction of the signal amplitude with the distance  dB/cm is reported. The numerical simulations performed on a wide-band highlight the frequencies where the method exhibits the highest sensitivity to thorax movements. The sensitivity can be further improved by reducing the antenna beamwidth. Despite the signal amplitude reduction, the proposed system makes it possible to correctly operate at distances up to 2.5 m.
Serumβ-Catenin Levels Associated with the Ratio of RANKL/OPG in Patients with Postmenopausal Osteoporosis
Authors: Xu Xiao-Juan , Shen Lin , Yang Yan-Ping , Zhu Rui , Shuai Bo , Li Cheng-Gang , Wu Man-Xiang
Published: April 2013

Objective. To demonstrate the role of Wnt/β-catenin canonical pathway in postmenopausal osteoporosis by evaluating serumβ-catenin levels in patients with postmenopausal osteoporosis and analyzing their possible relationship with serum OPG, RANKL, the ratio of RANKL/OPG, sclerostin, and bone turnover markers.Methods. 480 patients with postmenopausal osteoporosis and 170 healthy postmenopausal women were enrolled in the study. Serumβ-catenin, OPG, RANKL, and sclerostin levels were measured by enzyme-linked immunosorbent assay. Bone status was assessed by measuring bone mineral density and bone turnover markers. Estradiol levels were also detected.Results. Serumβ-catenin levels were lower in postmenopausal osteoporotic women compared to nonosteoporotic postmenopausal women (26.26±14.81versus39.33±5.47 pg/mL,P<0.001). Serumβ-catenin was positively correlated with osteoprotegerin (r=0.232,P<0.001) and negatively correlated with the ratio of RANKL/OPG, body mass index, and sclerostin (r=-0.128,P=0.005;r=-0.117,P=0.010;r=-0.400,P<0.001, resp.) in patients with postmenopausal osteoporosis.Conclusion. The results indicate that lower serumβ-catenin and concomitantly higher ratio of RANKL/OPG may be involved in the pathogenesis of postmenopausal osteoporosis. Functional communication between RANKL/RANK/OPG system and Wnt pathways plays an important role in postmenopausal osteoporosis.
Viscosity Method for Hierarchical Fixed Point Problems with an Infinite Family of Nonexpansive Nonself-Mappings
Authors: Wang Yaqin
Published: April 2013

A viscosity method for hierarchical fixed point problems is presented to solve variational inequalities, where the involved mappings are nonexpansive nonself-mappings. Solutions are sought in the set of the common fixed points of an infinite family of nonexpansive nonself-mappings. The results generalize and improve the recent results announced by many other authors.
Effect of the Preheating Temperature on Process Time in Friction Stir Welding of Al 6061-T6
Authors: Jabbari Masoud
Published: April 2013

This paper presents the results obtained and the deductions made from an analytical modeling involving friction stir welding of Al 6061-T6. A new database was developed to simulate the contact temperature between the tool and the workpiece. A second-order equation is proposed for simulating the temperature in the contact boundary and the thermal history during the plunge phase. The effect of the preheating temperature on the process time was investigated with the proposed model. The results show that an increase of the preheating time leads to a decrease in the process time up to the plunge and the preheating stage. Results of modeling the thermal history showed acceptable agreement with corresponding experimental data from the literature.
Delayed Migration of a WallFlex Enteral Stent Resulting in Jejunal Perforation
Authors: Ge Phillip S. , Watson Rabindra R. , Chen David C. , Muthusamy V. Raman
Published: April 2013

Enteral stents are increasingly utilized to palliate malignant gastrointestinal obstruction; however, they can be associated with significant complications. We describe an unusual case of a 67-year-old male with gastric adenocarcinoma who underwent placement of a WallFlex metallic enteral stent to relieve a malignant gastric outlet obstruction. Four months later, while actively undergoing chemotherapy, he developed acute abdominal pain and was found to have delayed stent migration and jejunal perforation. He required emergent surgical resection of the perforated segment of jejunum. Delayed migration of the WallFlex enteral stent with subsequent visceral perforation has yet to be reported in the literature. Chemotherapy after stent placement has been associated with an increase in maintenance of stent patency; however, shrinkage of the local tumor by chemoradiation may increase the risk of stent migration. Care should be taken in placing enteral stents in patients undergoing continued treatment of their malignancy, as delayed migration of even uncovered stents may occur.
Complementary and Alternative Medicine and Cardiovascular Disease: An Evidence-Based Review
Authors: Rabito Matthew J. , Kaye Alan David
Published: April 2013

Complementary and alternative medicine (CAM) plays a significant role in many aspects of healthcare worldwide, including cardiovascular disease (CVD). This review describes some of the challenges of CAM in terms of scientific research. Biologically-based therapies, mind-body therapies, manipulative and body-based therapies, whole medical systems, and energy medicine are reviewed in detail with regard to cardiovascular risk factors and mediation or modulation of cardiovascular disease pathogenesis. CAM use among patients with CVD is prevalent and in many instances provides positive and significant effects, with biologically-based and mind-body therapies being the most commonly used treatment modalities. More rigorous research to determine the precise physiologic effects and long-term benefits on cardiovascular morbidity and mortality with CAM usage, as well as more open lines of communication between patients and physicians regarding CAM use, is essential when determining optimal treatment plans.
Gene Therapy of Multiple Sclerosis Using Interferonβ-Secreting Human Bone Marrow Mesenchymal Stem Cells
Authors: Ryu Chung Heon , Park Kwang Ywel , Hou Yun , Jeong Chang Hyun , Kim Seong Muk , Jeun Sin-Soo
Published: April 2013

Interferon-beta (IFN-β), a well-established standard treatment for multiple sclerosis (MS), has proved to exhibit clinical efficacy. In this study, we first evaluated the therapeutic effects for MS using human bone marrow-derived mesenchymal stem cells (hBM-MSCs) as delivery vehicles with lesion-targeting capability and IFN-βas therapeutic gene. We also engineered hBM-MSCs to secret IFN-β(MSCs-IFNβ) via adenoviral transduction and confirmed the secretory capacity of MSCs-IFNβby an ELISA assay. MSCs-IFNβ-treated mice showed inhibition of experimental autoimmune encephalomyelitis (EAE) onset, and the maximum and average score for all animals in each group was significantly lower in the MSCs-IFNβ-treated EAE mice when compared with the MSCs-GFP-treated EAE mice. Inflammatory infiltration and demyelination in the lumbar spinal cord also significantly decreased in the MSCs-IFNβ-treated EAE mice compared to PBS- or MSCs-GFP-treated EAE mice. Moreover, MSCs-IFNβtreatment enhanced the immunomodulatory effects, which suppressed proinflammatory cytokines (IFN- and TNF-) and conversely increased anti-inflammatory cytokines (IL-4 and IL-10). Importantly, injected MSCs-IFNβmigrated into inflamed CNS and significantly reduced further injury of blood-brain barrier (BBB) permeability in EAE mice. Thus, our results provide the rationale for designing novel experimental protocols to enhance the therapeutic effects for MS using hBM-MSCs as an effective gene vehicle to deliver the therapeutic cytokines.
Fournier's Gangrene Associated with Local Cutaneous HPV Lesions in a Previously Healthy Girl
Authors: Tsinti Maria , Tsekoura Theophani , Blevrakis Evangelos , Vlachakis Ioannis , Tsilimigaki-Christaki Amalia
Published: April 2013

A case of an 11-year-old prepubertal girl with Fournier's gangrene is presented. The diagnosis was posed after the disease had progressed to the typical clinical picture of frank gangrene. A benign viral infection, common warts, possibly represents the initiating event of the development of this necrotizing soft tissue infection. The development of childhood Fournier's gangrene in association with viral infections has been reported in the past. An optimal outcome was achieved by aggressive antibiotic and surgical treatment despite the late diagnosis. In children, Fournier's gangrene develops in previously healthy individuals with benign diseases often representing the initiating events; thus, high index of suspicion is necessary for an early diagnosis that will lead to the optimal outcome.
Grade 1 Endometrioid Endometrial Carcinoma Presenting with Pelvic Bone Metastasis: A Case Report and Review of the Literature
Authors: Nguyen My-Linh T. , LaFargue Christopher J. , Pua Tarah L. , Tedjarati Sean S.
Published: April 2013

Most grade 1 endometrioid endometrial cancers are confined to the uterus at the time of diagnosis and confer a good prognosis. Rarely will a grade 1 endometrioid endometrial carcinoma present with distant metastasis, especially to the bone. We present the case of a 56-year-old woman with postmenopausal bleeding and right hip pain due to metastatic grade 1 endometrioid uterine cancer invading into the right ischium. We discuss treatment options as well as provide a review of prior published reports on bony metastasis in grade 1 endometrioid endometrial cancers. To date, this case is one of 10 others which demonstrates that even a well-differentiated, low-grade endometrioid endometrial carcinoma can progress in a highly aggressive manner.
On the Space of Functions with Growths Tempered by a Modulus of Continuity and Its Applications
Authors: Banaś Józef , Nalepa Rafał
Published: April 2013

We are going to study the space of real functions defined on a bounded metric space and having growths tempered by a modulus of continuity. We prove also a sufficient condition for the relative compactness in the mentioned function space. Using that condition and the classical Schauder fixed point theorem, we show the existence theorem for some quadratic integral equations of Fredholm type in the space of functions satisfying the Hölder condition. An example illustrating the mentioned existence result is also included.
Neural-Fuzzy Digital Strategy of Continuous-Time Nonlinear Systems Using Adaptive Prediction and Random-Local-Optimization Design
Authors: Tsai Zhi-Ren
Published: April 2013

A tracking problem, time-delay, uncertainty and stability analysis of a predictive control system are considered. The predictive control design is based on the input and output of neural plant model (NPM), and a recursive fuzzy predictive tracker has scaling factors which limit the value zone of measured data and cause the tuned parameters to converge to obtain a robust control performance. To improve the further control performance, the proposed random-local-optimization design (RLO) for a model/controller uses offline initialization to obtain a near global optimal model/controller. Other issues are the considerations of modeling error, input-delay, sampling distortion, cost, greater flexibility, and highly reliable digital products of the model-based controller for the continuous-time (CT) nonlinear system. They are solved by a recommended two-stage control design with the first-stage (offline) RLO and second-stage (online) adaptive steps. A theorizing method is then put forward to replace the sensitivity calculation, which reduces the calculation of Jacobin matrices of the back-propagation (BP) method. Finally, the feedforward input of reference signals helps the digital fuzzy controller improve the control performance, and the technique works to control the CT systems precisely.
Modified and Grafted Coronectomy: A New Technique and a Case Report with Two-Year Followup
Authors: Leizerovitz Michael , Leizerovitz Olga
Published: April 2013

Purpose. A standard coronectomy (intentional partial odontectomy) is recommended for mandibular third molar (MTM) extraction cases with a high risk of inferior alveolar nerve injury (IANI). However, complications such as inadvertent intraoperative root removal, post-op root migration, second molar (MSM) periodontal defects and others do exist. This report presents a new technique, the Modified and Grafted Coronectomy (MGC), describes the measures to prevent or minimize the known drawbacks of the standard coronectomy, and reviews the literature for comparison with three other IANI-prevention techniques.Materials and Methods. MGC was performed on two MTMs with nerve involvement and severe periodontal pockets on the distal of MSM. Modifications were: stabilizing the root stump to prevent intraoperative movement, creation of a large intrabony space for bone graft material, and grafting for periodontal healing while minimizing the possibility of post-op root migration.Results. Excellent overall periodontal improvement, with probing depths reduced to 3-4 mm. Panoramic radiograph displayed remarkable bone regeneration. No residual root migration was evident at the two year follow up.Conclusion. MGC may be a good alternative, especially in cases with periodontal defects on the distal of MSM. It may also help to minimize inadvertent intraoperative root removal and postoperative root migration.
Exploiting GPUs in Virtual Machine for BioCloud
Authors: Jo Heeseung , Jeong Jinkyu , Lee Myoungho , Choi Dong Hoon
Published: April 2013

Recently, biological applications start to be reimplemented into the applications which exploit many cores of GPUs for better computation performance. Therefore, by providing virtualized GPUs to VMs in cloud computing environment, many biological applications will willingly move into cloud environment to enhance their computation performance and utilize infinite cloud computing resource while reducing expenses for computations. In this paper, we propose a BioCloud system architecture that enables VMs to use GPUs in cloud environment. Because much of the previous research has focused on the sharing mechanism of GPUs among VMs, they cannot achieve enough performance for biological applications of which computation throughput is more crucial rather than sharing. The proposed system exploits the pass-through mode of PCI express (PCI-E) channel. By making each VM be able to access underlying GPUs directly, applications can show almost the same performance as when those are in native environment. In addition, our scheme multiplexes GPUs by using hot plug-in/out device features of PCI-E channel. By adding or removing GPUs in each VM in on-demand manner, VMs in the same physical host can time-share their GPUs. We implemented the proposed system using the Xen VMM and NVIDIA GPUs and showed that our prototype is highly effective for biological GPU applications in cloud environment.
IMM Iterated Extended Particle Filter Algorithm
Authors: Wan Yang , Wang Shouyong , Qin Xing
Published: April 2013

In order to solve the tracking problem of radar maneuvering target in nonlinear system model and non-Gaussian noise background, this paper puts forward one interacting multiple model (IMM) iterated extended particle filter algorithm (IMM-IEHPF). The algorithm makes use of multiple modes to model the target motion form to track any maneuvering target and each mode uses iterated extended particle filter (IEHPF) to deal with the state estimation problem of nonlinear non-Gaussian system. IEHPF is an improved particle filter algorithm, which utilizes iterated extended filter (IEHF) to obtain the mean value and covariance of each particle and describes importance density function as a combination of Gaussian distribution. Then according to the function, draw particles to approximate the state posteriori density of each mode. Due to the high filter accuracy of IEHF and the adaptation of system noise with arbitrary distribution as well as strong robustness, the importance density function generated by this method is more approximate to the true sate posteriori density. Finally, a numerical example is included to illustrate the effectiveness of the proposed methods.
Dissociation between Goal-directed and Discrete Response Localization in a Patient with Bilateral Cortical Blindness
Authors: Buetti Simona , Tamietto Marco , Hervais-Adelman Alexis , Kerzel Dirk , de Gelder Beatrice , Pegna Alan J.
Published: April 2013

We investigated localization performance of simple targets in patient TN, who suffered bilateral damage of his primary visual cortex and shows complete cortical blindness. Using a two-alternative forced-choice paradigm, TN was asked to guess the position of left–right targets with goal-directed and discrete manual responses. The results indicate a clear dissociation between goal-directed and discrete responses. TN pointed toward the correct target location in approximately 75% of the trials but was at chance level with discrete responses. This indicates that the residual ability to localize an unseen stimulus depends critically on the possibility to translate a visual signal into a goal-directed motor output at least in certain forms of blindsight.
Representation of Contextually Related Multiple Objects in the Human Ventral Visual Pathway
Authors: Song Yiying , Luo Yu L. L. , Li Xueting , Xu Miao , Liu Jia
Published: April 2013

Real-world scenes usually contain a set of cluttered and yet contextually related objects. Here we used fMRI to investigate where and how contextually related multiple objects were represented in the human ventral visual pathway. Specifically, we measured the responses in face-selective and body-selective regions along the ventral pathway when faces and bodies were presented either simultaneously or in isolation. We found that, in the posterior regions, the response for the face and body pair was the weighted average response for faces and bodies presented in isolation. In contrast, the anterior regions encoded the face and body pair in a mutually facilitative fashion, with the response for the pair significantly higher than that for its constituent objects. Furthermore, in the right fusiform face area, the face and body pair was represented as one inseparable object, possibly to reduce perceptual load and increase representation efficiency. Therefore, our study suggests that the visual system uses a hierarchical representation scheme to process multiple objects in natural scenes: the average mechanism in posterior regions helps retaining information of individual objects in clutter, whereas the nonaverage mechanism in the anterior regions uses the contextual information to optimize the representation for multiple objects.
Decreased levels of serum omentin-1 in patients with obstructive sleep apnoea syndrome
Authors: Wang Qiuyan , Feng Xuewei , Zhou Chuming , Li Peng , Kang Jian
Published: April 2013

Background

Inflammation is involved in the mechanism of obstructive sleep apnoea syndrome (OSAS). Omentin, a newly discovered adipokine, is implicated to play an anti-inflammatory role. This study aims to determine whether serum levels of omentin-1 are associated with the presence and severity of OSAS.

Methods

This study consisted of 192 patients with OSAS and 144 healthy subjects. Serum levels of omentin-1 were measured using enzyme-linked immunosorbent assay.

Results

Serum omentin-1 levels were significantly decreased in OSAS patients compared with healthy controls. Multivariable logistic regression analysis revealed that serum omentin-1 levels were inversely associated with the presence of OSAS (odds ratio 0.520, 95% confidence interval 0.433 to 0.623; P < 0.001). Severe OSAS patients had significantly lower serum omentin-1 levels compared with mild and moderate OSAS patients. Spearman correlation analysis showed that serum omentin-1 levels were correlated with the severity of OSAS. Simple linear regression analysis showed that the serum levels of omentin-1 were negatively correlated with waist circumference, body mass index, systolic blood pressure, homeostasis model assessment of insulin resistance (HOMA-IR), C-reactive protein (CRP), and apnoea-hypopnoea index in patients with OSAS. Furthermore, only HOMA-IR and CRP remained inversely associated with serum omentin-1 after multiple stepwise regression analysis.

Conclusion

Decreased serum omentin-1 levels could be considered as an independent predictive marker of the presence and severity of OSAS.
Role of genetic testing in the management of patients with inherited porphyria and their families
Authors: Whatley S D , Badminton M N
Published: April 2013

The porphyrias are a group of mainly inherited metabolic conditions that result from partial deficiency of individual enzymes in the haem biosynthesis pathway. Clinical presentation is either with acute neurovisceral attacks, skin photosensitivity or both, and is due to overproduction of pathway intermediates. The primary diagnosis in the proband is based on biochemical testing of appropriate samples, preferably during or soon after onset of symptoms. The role of genetic testing in the autosomal dominant acute porphyrias (acute intermittent porphyria, hereditary coproporphyria and variegate porphyria) is to identify presymptomatic carriers of the family specific pathogenic mutation so that they can be counselled on how to minimize their risk of suffering an acute attack. At present the additional genetic factors that influence penetrance are not known, and all patients are treated as equally at risk. Genetic testing in the erythropoietic porphyrias (erythropoietic protoporphyria, congenital erythropoietic porphyria and X-linked dominant protoporphyria) is focused on predictive and preconceptual counselling, prenatal testing and genotype–phenotype correlation. Recent advances in analytical technology have resulted in increased sensitivity of mutation detection with success rates of greater than 90% for most of the genes. The ethical and consent issues are discussed. Current research into genetic factors that affect penetrance is likely to lead to a more refined approach to counselling for presymptomatic gene carriers.
A multicentre study comparing two methods for serum free light chain analysis
Authors: Lock RJ , Saleem R , Roberts EG , Wallage MJ , Pesce TJ , Rowbottom A , Cooper SJ , McEvoy ED , Taylor JL , Basu S
Published: April 2013

Background

Serum free light chain analysis is now well established in the investigation of monoclonal gammopathies. In the UK there has, until recently, been a single supplier of kits for such analysis. Recently, a second method using monoclonal antisera was introduced. We have compared the performance of these two kits in four routine laboratories.

Method

Samples submitted for routine analysis (327 samples, 258 [79%] from patients with B-cell lymphoproliferative disease) for serum free light chains were tested by both technologies (Freelite, Binding Site and N Latex FLC, Siemens), according to the manufacturers’ instructions.

Results

Qualitative data were available by both methods on 313 samples for serum free kappa chains and 324 samples for lambda free light chains. We found poor correspondence of 81% for kappa and 74% for lambda. Five percent of samples were significantly discordant in these assays.

Conclusions

These assays perform very differently in clinical practice. They cannot be used interchangeably, especially if monitoring patient responses to therapy.
Best practice guidelines on clinical management of acute attacks of porphyria and their complications
Authors: Stein Penelope , Badminton Mike , Barth Julian , Rees David , Stewart M Felicity
Published: April 2013

The British and Irish Porphyria Network guidelines describe best practice in the clinical assessment, investigation and management of acute porphyria attacks and their complications, including severe attacks with neuropathy. Acute attacks of porphyria may occur in acute intermittent porphyria (AIP), variegate porphyria (VP) and hereditary coproporphyria (HCP). Aminolaevulinic acid dehydratase deficiency porphyria (ADP) is a very rare autosomal recessive porphyria; only six cases substantiated by mutation analysis have yet been described in the literature.

Urinary porphobilinogen (PBG) is always raised in an acute attack due to AIP, VP or HCP and this analysis is essential to confirm the diagnosis. A positive result in a qualitative or semi-quantitative screening test must be followed by PBG quantitation at the earliest opportunity. However in a severely ill patient, treatment should not be delayed.

Removal of precipitating factors, effective analgesia and control of symptoms with safe medication, attention to nutrition and fluid balance are essential. The indications for use of intravenous haem arginate are set out, together with advice on its administration. A small proportion of acute porphyria patients develop recurrent attacks and management options that may be considered include gonadotrophin-releasing hormone analogues, ‘prophylactic’ regular haem arginate infusion or ultimately, liver transplantation.
Artifactually elevated serum bicarbonate results caused by elevated serum lactate dehydrogenase concentrations
Authors: Saleem Mohamed , Dimeski Goce , Bourne Les , Coates Penelope
Published: April 2013

Background

An accurate estimation of serum bicarbonate concentration (HCO[Formula: see text]) is essential to the diagnosis and treatment of acid-base disorders and electrolyte disturbances. We noted significant discrepancies between HCO[Formula: see text] concentration measured by the Olympus AU2700 analyser and total serum carbon dioxide (TCO2) concentration derived from a Radiometer blood gas analyser on several patient samples. This was reported to the manufacturer which led to a recall of certain reagent lot numbers. We hypothesised the mechanism for this interference to be elevated levels of lactate dehyrogenase (LD).

Methods

We investigated the effect of increasing LD concentration on HCO[Formula: see text] with the reagent lot that was recalled and compared this with a subsequent reagent lot that was known to be unaffected on an Olympus AU2700.

Results

The experimental data confirmed a positive interference in the Olympus AU2700 HCO[Formula: see text] assay using older reagent lot numbers. The false positive HCO[Formula: see text] interference was significant (>10% change) when the LD concentration exceeded 845 U/L.

Conclusions

Very high levels of LD concentrations were the cause of interference in the Olympus AU2700 HCO[Formula: see text] enzymatic assay. Laboratorians should be aware that very high levels of LD may be a potential interference in some enzymatic HCO[Formula: see text] assays.
Difficult airway communication between anaesthetists and general practitioners
Authors: Wilkes M , Beattie C , Gardner C , McNarry AF
Published: April 2013

Background and aims

Advance warning of patients who are difficult to intubate may prevent an airway catastrophe but relies on effective communication between specialties. Anaesthetists aim to inform general practitioners whenever a difficult airway is encountered and expect general practitioners to include this information in subsequent referrals. We investigated how anaesthetists communicated with general practitioners, their knowledge of the Read Code (used by general practitioner computer systems) for difficult tracheal intubation, and how likely general practitioners were to pass the information on.

Methods and results

We surveyed 631 consultant anaesthetists and 217 general practitioners. We found only 125 (20%) anaesthetists consistently wrote difficult airway letters to general practitioners. Only 20 (3%) knew the Read Code for difficult intubation (SP2y3), although 454 (72%) thought it to be useful. Most general practitioners (212, 98%) thought airway information to be important, but only half receiving a difficult airway communication forwarded it on. General practitioners recommended including the Read Code SP2y3 and labelling it ‘high priority’, ensuring that ‘Difficult Tracheal Intubation’ would be listed in the Emergency Care Summary generated for hospital referrals.

Conclusion

Communication between anaesthetists and general practitioners is currently poor, but could be improved by simplifying difficult airway letters and including the SP2y3 code and a statement of priority.
Patient outcomes using revised guidance NHS Continuing Care Eligibility Criteria, Scotland (CEL 2008)
Authors: Martin BJ , Valiyaparambath N , Gray J
Published: April 2013

Aim

To determine the efficacy of selection of patients for NHS (Scotland) continuing care using revised guidance eligibility criteria, CEL (2008).

Methods

On September 2009, a census was conducted of 632 patients, distributed over 10 hospital sites in NHS Lanarkshire Older People's Directorate, to identify those patients who had future care needs assessed using revised NHSS CEL (2008) eligibility criteria during the previous 3 months. These patients were then assigned to one of four categories: (1) eligible for NHS continuing care; (2) likely destination care home; (3) likely discharge home with complex care package; and (4) outcome uncertain. ‘Frailty’ was recorded in a sub-group of patients using Rockwood’s frailty index. The index records frailty on a scale 0–1, a higher score indicating greater frailty. Outcomes were recorded at 2-monthly intervals for 1 year. Patients undergoing acute assessment and/or specialist rehabilitation, those admitted before 1 April 2009 and already accepted for NHS continuing care and those with a planned discharge date were excluded.

Results

Two hundred and eleven patients were identified as meeting the criteria for allocation to one of the four categories. Mortality at 1 year was as follows: NHS continuing care 40/45 (89%), likely Care Home destination 39/81 (48%), likely home discharge 22/61 (35%), outcome uncertain 13/24 (54%). Mean frailty scores were: NHS continuing care 0.4, likely care home 0.34, likely discharge home 0.29; p=0.0002 (ANOVA). Re-admission rates were high, 60% once and 40% twice or more, in patients discharged from hospital.

Conclusion

The revised guidance on Eligibility for NHS Continuing Care in Scotland, CEL (2008), is useful in identifying the frailest patients with complex needs and limited survival. However, hospital re-admission rates and mortality are high in all patients considered for eligibility to NHS continuing care in whom the guidance is applied.
Validation of the Global Rating Scale for endoscopy
Authors: Williams T , Ross A , Stirling C , Palmer K , Phull PS
Published: April 2013

The Global Rating Scale for endoscopy is a web-based tool that can be used to assess and improve the quality of an endoscopy service. It was developed by asking endoscopy health professionals what they would want from the service for themselves or their relatives if they were undergoing an endoscopic procedure. To date, the Global Rating Scale has not been validated by patients themselves. We used focus groups in order to access the views and opinions of patients who had recently had experience of endoscopy services. Six focus groups were undertaken in five different Health Board areas across Scotland; in total 26 people participated. The results indicated that from the patients’ perspective the 12 items of the GRS covered all areas of the endoscopy experience. There were no specific concerns identified that were not already covered within the Global Rating Scale. We conclude that the Global Rating Scale does address quality issues that matter to patients undergoing endoscopy, and validates the use of the GRS as a quality assessment tool for endoscopy services.
Variation in practice: an analysis of Scottish Surgical Profiles ENT data
Authors: Yeo JCL , Ah-See KW , MacKenzie K
Published: April 2013

Background

Variation in otolaryngology intervention rates is reported in the Scottish Surgical Profiles Project. Tonsillectomy is one of the selected key indicator procedures. The variation in practice was discussed nationally at the Scottish Otolaryngology Society summer meetings in 2009 and 2010. NHS Grampian had a significantly higher tonsillectomy rate compared with other Scottish NHS boards.

Aims

To determine the accuracy of NHS Grampian data reported by the Information Service Division (ISD) and to record the appropriateness of listing of patients for tonsillectomy with reference to the Scottish Intercollegiate Guidelines Network (SIGN).

Methods

Retrospective review of case notes and surgical records of patients who had undergone tonsillectomy between March 2007 and March 2008 in NHS Grampian.

Results

Between March 2007 and March 2008, 509 tonsillectomy cases were performed in NHS Grampian. This corresponded to the data received from ISD. 87% of tonsillectomies performed were compliant with SIGN guidelines.

Conclusion

The Scottish otolaryngology clinicians have found the reporting of the intervention rates stimulating and challenging. Discussion of the surgical profile project regularly at national specialty meetings resulted in a preliminary detailed targeted audit of those who were persistent outliers for tonsillectomy. This refuted the presumed reasons for this variation, namely inaccurate figures from ISD and inappropriate listings by clinicians.
Primary headache disorders in children under 7 years of age
Authors: Ramdas S , Prasad M , Abu-Arafeh I
Published: April 2013

Background and aim

Research on headache disorders in young children is limited. This study aims to determine causes and clinical presentations of headache in young children attending a specialist clinic.

Methods and results

All children attending the headache clinic over 9-year period were included. Data were collected prospectively on demography and clinical presentations of headache at every attendance. The diagnosis of headache disorders was based on the International Classification of Headache Disorders-II (2004). Of the 921 children (491 male) who attended the clinic, 73 children (8%) were under 7 years of age at presentation; 34 children had migraine, 11 had tension-type headache (4 chronic), 4 had mixed types of headache and 16 children had unclassified headaches. Anorexia, nausea, vomiting, light intolerance and noise intolerance were common during migraine attacks and forehead was the most common site of maximal pain.

Conclusions

Migraine is the most common headache disorder in young children attending a specialist clinic. Headache presentation is often atypical and in 20% of young children headache disorders are unclassified. Chronic tension-type headache, often considered a disease of adolescents and adults, is shown to present in early age.
A survey of principal researchers who lead research into Adults with Incapacity in Scotland
Authors: Cameron AC , Lees KR , Booth MG , Bailey A , Hunter W
Published: April 2013

Background

Scotland’s ‘A’ Research Ethics Committee (SAREC, previously MREC A) has exclusive authority to consider research involving Adults with Incapacity in Scotland. No appeal facility exists although resubmissions are accepted. Legislation covering research in England and Wales has created anomalies. RECs ‘recognised’ by the UK Ethics Committee (3 in Scotland, several in England) can approve drug studies involving Adults with Incapacity in Scotland. Several English RECs can approve studies led from outside Scotland.

Methods

We conducted an anonymous online survey of researchers experienced in studies involving Adults with Incapacity to establish their opinions on the role of SAREC. The survey had 5 multiple-choice questions. Two questions invited a free-text comment.

Results

Seventy-seven researchers (45% response) completed the survey. The majority (61/76, 80%) received a favourable opinion from SAREC immediately/after minor revision. The consensus was a single, experienced committee is advantageous to researchers (69/77 (90%)) and research participants (65/75 (87%)). There was no association between application outcome and opinion on whether a single committee is advantageous for researchers ( p = 0.39 (Fisher’s exact test)) or research participants ( p = 0.49). Most (42/76, 55%) favoured the current system for reviewing decisions.

Conclusions

The research establishment favours retaining expertise in one committee. Most are content not having an external appeal facility.
The acute abdomen in the older person
Authors: McCarthy K , Hardy K , Ackermann C , Hewitt J
Published: April 2013

The acute abdomen is a common condition in older people. Half of all presentations to hospital require admission, with a third requiring immediate surgery. The Royal College of Surgeons of England have reported a worryingly high mortality rate in the over 80s undergoing emergency surgery, with a 3-fold difference in mortality throughout the England, Wales and Northern Ireland. The aim of this article is to highlight the issues that older people face in relation to acute abdominal pathology.
‘Real men wear kilts’.. The anecdotal evidence that wearing a Scottish kilt has influence on reproductive potential: how much is true?
Authors: Kompanje EJO
Published: April 2013

Background and aims

There are anecdotal reports that men who wear (Scottish) kilts have better sperm quality and better fertility. But how much is true? Total sperm count and sperm concentration reflect semen quality and male reproductive potential. It has been proven that changes in the scrotal temperature affect spermatogenesis. We can at least affirm that clothing increases the scrotal temperature to an abnormal level that may have a negative effect on spermatogenesis. Thus, it seems plausible that men should wear skirts and avoid trousers, at least during the period during which they plan to conceive children.

Methods and results

Analysis of literature concerning scrotal temperature and spermatogenesis and fertility. Wearing a Scottish kilt in a traditional (‘regimental’) way may have clear health-related benefits. Kilt wearing likely produces an ideal physiological scrotal environment, which in turn helps maintain normal scrotal temperature, which is known to be beneficial for robust spermatogenesis and good sperm quality.

Conclusion

Based on literature on scrotal temperature, spermatogenesis and fertility, the hypothesis that men who regularly wear a kilt during the years in which they wish to procreate will, as a group, have significantly better rates of sperm quality and higher fertility.
Experience of practitioners and delivery outcome
Authors: Indraccolo U , Nicchi S , Indraccolo SR
Published: April 2013

Background

It is commonly believed that the experience of practitioners (time spent in delivery ward) may be helpful in aiding the spontaneous vaginal birth.

Aim

To check if this opinion is true.

Methods

In 995 low-risk, full-term, pregnancies resulting in spontaneous labour, multivariate logistic regression analysis was performed, which considered the age, the years of service of the obstetrician and of the midwife, and of both as independent variables.

Results

The longer the obstetrician (odds ratio 0.779, C.I. 95% 0.653–0.930, p = 0.006) or the midwife has been practising (odds ratio 0.609, C.I. 95% 0.408–0.909, p = 0.015) the less likely is the occurrence of a spontaneous vaginal birth. The combined years of service of the caring doctor/midwife pair appears to have no influence on the outcome of delivery. The chances of an operative vaginal birth increase with the age of the caring obstetrician (odds ratio 1.362, C.I. 95% 1.138–1.630, p = 0.001).

Conclusion

The experience of the staff assisting women in labour definitely does not determine the success of deliveries. The skills of each professional category are based on theoretical knowledge that is possibly not being put to use during routine duties, especially by the ‘more experienced’ practitioners. Additionally, it appears that there is no team work, and decisions are not taken together.
‘Broken Heart’ syndrome in Scotland: a case of Takotsubo cardiomyopathy in a recently widowed lady
Authors: Mukherjee A , Sünkel-Laing B , Dewhurst N
Published: April 2013

Takotsubo cardiomyopathy (TCM), first described in Japan in the early 1990s, is a reversible non-ischaemic cardiomyopathy of unclear aetiology characterised by transient left ventricular dysfunction. It mimics acute myocardial infarction with ST segment changes (STEMI), although evidence of occlusive coronary artery disease is absent. TCM is typically triggered by an intense physical or emotional stress event. We report a case of TCM diagnosed in a recently widowed lady in whom a myocardial infarction was initially suspected. This case illustrates the importance of an awareness of this unique clinical entity. Without appreciation of differentiating features, TCM can easily be misdiagnosed as an acute coronary syndrome. Misdiagnosis and the subsequent inappropriate and potentially harmful use of fibrinolytic therapy can be avoided through careful history-taking, clinical examination and appropriate investigations. Although well reported in the medical literature, this case of TCM provides the basis of a timely summary and update on current understanding of this perplexing condition.
A case report of Lemierre’s Syndrome associated with dental sepsis
Authors: Boyd D , Paterson P , Dunphy L , Carton A , Hammersley N
Published: April 2013

Introduction

Lemierre’s syndrome is a potentially fatal condition characterised by spread of an oropharyngeal infection, resulting in thrombosis of the internal jugular vein. This leads to septicaemia and possible metastatic abscesses.

Case presentation

We discuss the case of a previously healthy 17-year-old male who developed Lemierre’s syndrome following dental sepsis. He presented with bilateral submandibular and submental swelling extending into the neck and chest. His management included a tracheostomy; incision and drainage of the abscesses; drainage of a pleural effusion and prolonged anticoagulant therapy.

Conclusion

The incidence of Lemierre’s disease appears to be increasing and early diagnosis is essential. A high index of suspicion is needed in cases of oropharyngeal infection followed by fever, tender swelling of the neck and dysphagia – especially in young patients.
Unusual cause of small intestine obstruction in a child
Authors: Jurić I , Pogorelić Z , Despot R , Mrklić I
Published: April 2013

Introduction

Anisakiasis is caused by human infection by the anisakis larvae, a marine nematode found in undercooked or raw fish. Infection with the parasite Anisakis simplex is common in Japan and northern European countries. With the increased popularity of eating sushi and raw fish infection with anisakis is expected to rise.

Case presentation

We present the case of a 14-year-old boy who had eaten sushi 3 days before the onset of symptoms and had small bowel obstruction caused by enteric anisakiasis. To the best of our knowledge this is the first reported case of intestinal anisakiasis presenting as a bowel obstruction in a child.

Conclusion

Enteric anisakiasis is very rare, and its diagnosis is usually made after laparotomy. Nevertheless, when signs of acute abdomen develop after the ingestion of raw fish, such as sushi or sashimi, the possibility of enteric anisakiasis should be considered.
Neurofibromatosis type-1 with retroperitoneal stromal tumour: one case report
Authors: Zong G-q , Fei Y , Wang F , Liu R-m
Published: April 2013

Background

Neurofibromatosis with gastrointestinal stromal tumours have been reported several times, while neurofibromatosis with retroperitoneal stromal tumours are very rare.

Case description

We report the case of a 44-year-old man with a long history of neurofibromatosis. He complained of severe constipation and left leg pain. The patient’s examination showed prominent peripheral cutaneous neurofibromas mainly in the belly and limbs, especially a huge mass in his abdomen, no less than ten café-au-lait spots, four Lisch nodules of the iris. Computed tomography and magnetic resonance imaging revealed a round and lobular mass in the retroperitoneal space. It was a well-circumscribed, hypervascular mass with cystic necrosis. A surgical resection was performed, and pathology and immunohistochemistry findings were consistent with stromal tumour. The c-kit gene and platelet-derived growth factor receptor-α gene mutations are not observed in the specimen.

Conclusions

Neurofibromatosis with retroperitoneal stromal tumour is very rare, and radiological, pathological and immunohistochemical examination may identify it. Surgical resection may be the unique method of cure for it.