bluuebunny/crossref_metadata_2025 huggingface dataset:
Epithelial–mesenchymal transition in cancer development and its clinical significance
Authors: Iwatsuki Masaaki , Mimori Koshi , Yokobori Takehiko , Ishi Hideshi , Beppu Toru , Nakamori Shoji , Baba Hideo , Mori Masaki
Published: October 2009

The epithelial–mesenchymal transition (EMT) plays a critical role in embryonic development. EMT is also involved in cancer progression and metastasis and it is probable that a common molecular mechanism is shared by these processes. Cancer cells undergoing EMT can acquire invasive properties and enter the surrounding stroma, resulting in the creation of a favorable microenvironment for cancer progression and metastasis. Furthermore, the acquisition of EMT features has been associated with chemoresistance which could give rise to recurrence and metastasis after standard chemotherapeutic treatment. Thus, EMT could be closely involved in carcinogenesis, invasion, metastasis, recurrence, and chemoresistance. Research into EMT and its role in cancer pathogenesis has progressed rapidly and it is now hypothesized that novel concepts such as cancer stem cells and microRNA could be involved in EMT. However, the involvement of EMT varies greatly among cancer types, and much remains to be learned. In this review, we present recent findings regarding the involvement of EMT in cancer progression and metastasis and provide a perspective from clinical and translational viewpoints. (Cancer Sci 2009)
Structure of exhumed mud volcano feeder complexes, Azerbaijan
Authors: Roberts K. S. , Davies R. J. , Stewart S. A.
Published: October 2009

We report the first structural field mapping of exhumed mud volcano feeder complexes. Three mud volcanoes outcropping onshore in Azerbaijan were selected on the basis of outcrop quality and scale. These examples are all located within 1 km of the axes of NW–SE‐trending folds associated with the southern margin of the Greater Caucasus mountain belt. The mapping shows that the intrusive complexes are 200–800 m wide and roughly circular. These feeder complexes consist of a megabreccia of country rock blocks at a scale of tens of metres, enclosed in a matrix of intrusive mud. Minor structures include grid like fractures sets, sinuous fractures, mud plugs and breccia pipes. The country rock blocks are deformed and rotated relative to surrounding sedimentary strata. Alternative mechanisms to explain the strain history of these large blocks in the feeder complexes are: a. stoping, b. flow rotation and c. caldera collapse. Our mapping indicates that the most likely mechanism involves stoping processes, similar to those identified in igneous systems. This study provides a basis for reservoir distribution in commercial geological models that contain the feeder complexes of mud volcano systems, and also constrains conduit geometry for modelling studies of evolution and flow dynamics.
Comprehensive analyses and characterization of haemophagocytic lymphohistiocytosis in Vietnamese children
Authors: My Lam T. , Lien Le B. , Hsieh Wen‐Chuan , Imamura Toshihiko , Anh Tran N. K. , Anh Phan N. L. , Hung Nguyen T. , Tseng Fan‐Chen , Chi Chia‐Yu , Dao Ngo T. H. , Le Duong T. M. , Thinh Le Q. , Tung Tran T. , Imashuku Shinsaku , Thuong Tang C. , Su Ih‐Jen
Published: October 2009

Haemophagocytic lymphohistiocytosis (HLH) is a fatal haematological disorder with diverse aetiology. This prospective study was undertaken to characterize HLH cases in Vietnamese children. Clinical and laboratory data, genetic analyses and outcome of the HLH patients were analysed. A total of 33 patients were enrolled from March 2007 to December 2008, with a median age of 3 years. Mutations of the SH2D1A (SAP) and PRF1 genes were detected in one patient, respectively. The virus association was high, up to 63·6% (21/33), including Epstein–Barr virus (19/33), cytomegalovirus (2/33) and dengue virus (2/33). Five patients had malignant lymphoma and two had autoimmune diseases. Twenty‐eight patients were treated according to the HLH‐2004 protocol. The first response rate was 64·3% (18/28), with an early death rate of 35·7% (10/28). High levels of interferon‐γ, interleukin‐10, MIG and interferon‐inducible protein‐10 (IP‐10) were associated with early mortality (P < 0·05). Reactivation among the responders was high (9/18) and the uneventful resolution was low (3/18) after a median follow‐up of 35 weeks. In conclusion, the majority of HLH cases are associated with virus infections in Vietnamese children. Familial HLH is rare. The frequent reactivation and high mortality demands a more appropriate therapeutic regimen in tropical areas like Vietnam.
‘What should I do with a 60‐year old man with a slightly low serum total testosterone concentration and normal levels of serum gonadotrophins’?
Authors: Hugh Jones T.
Published: October 2009

The fundamental question in assessing an older man with a slightly low total testosterone and normal gonadotrophin levels is to determine whether or not he has clinical hypogonadism. Hypogonadism is defined as a clinical syndrome complex, which comprises both symptoms as well as biochemical testosterone deficiency. As symptoms are nonspecific and there are no clear cut‐off values for testosterone levels this invariably leads to a clinical dilemma. International guidelines have been published which provide recommendations to aid the clinician in making a diagnosis. Late‐onset hypogonadism, the preferred terminology for age‐related hypogonadism, can only be made once other causes have been excluded. Evidence shows that low testosterone levels are associated with several common male conditions including erectile dysfunction, osteoporosis and diabetes. Short‐term studies have shown benefits of testosterone replacement therapy (TRT) on body composition, bone metabolism, insulin resistance, sexual function and quality of life. Recommendations give clear advice on safety monitoring, specifically in relation to prostate health. If a diagnosis of hypogonadism is made with borderline testosterone levels then a 3‐month trial of TRT can be considered. The diagnosis of hypogonadism associated with borderline testosterone levels and the decision to treat should only be made by an experienced clinician.
The role of TASK1 in aldosterone production and its expression in normal adrenal and aldosterone‐producing adenomas
Authors: Nogueira Edson F. , Gerry Daniel , Mantero Franco , Mariniello Barbara , Rainey William E.
Published: October 2009

Objectives  Aldosterone production in the adrenal glomerulosa is mainly regulated by angiotensin II and K+. Adrenal glomerulosa cells are uniquely sensitive to extracellular K+. Genetic deletion of subunits of K+‐selective leak‐channels (KCNK), TASK1 and/or TASK3, in mice generates animals with hyperaldosteronism and histological changes in the adrenal cortex. Herein, we studied the expression of TASK1 in human adrenocortical cells, as well as its role in aldosterone production in H295R cells.

Design  TASK1 expression was investigated by comparative microarray analysis of aldosterone‐producing adenomas (APA) and normal adrenals (NAs). The effects of TASK1 knockdown by siRNA transfection were investigated in H295R cells. Fluo‐4 fluorescent measurements of intracellular Ca2 + and pharmacological inhibition of Ca2 + ‐dependent calmodulin kinases (CaMK) were performed to better define the effects of TASK1 on Ca2 + signalling pathways.

Results  Microarray analysis of APA and NA showed similar expression of TASK1 between these two groups. However, in APA, NA and H295R cells the expression of TASK1 was predominant when compared with other KCNK family members. Knockdown of TASK1 (with siRNA) induced the expression of steroidogenic acute regulatory (StAR) protein and aldosterone synthase (CYP11B2), and also stimulated pregnenolone and aldosterone production. Cells transfected with siTASK1 had increased intracellular Ca2 + , leading to activation of CaMK and increased expression of CYP11B2.

Conclusions  Our study reveals the predominant expression of TASK1 over other KCNK family genes in the human adrenal cortex. Herein, we also described the role of TASK1 in the regulation of human aldosterone production through regulation of intracellular Ca2 + and CaMK signalling pathways.
Transfer functions for solid‐solution partitioning of cadmium, copper, nickel, lead and zinc in soils: derivation of relationships for free metal ion activities and validation with independent data
Authors: Groenenberg J. E. , Römkens P. F. A. M. , Comans R. N. J. , Luster J. , Pampura T. , Shotbolt L. , Tipping E. , De Vries W.
Published: October 2009

Models to predict the solid‐solution partitioning of trace metals are important tools in risk assessment, providing information on the biological availability of metals and their leaching. Empirically based models, or transfer functions, published to date differ with respect to the mathematical model used, the optimization method, the methods used to determine metal concentrations in the solid and solution phases and the soil properties accounted for. Here we review these methodological aspects before deriving our own transfer functions that relate free metal ion activities to reactive metal contents in the solid phase. One single function was able to predict free‐metal ion activities estimated by a variety of soil solution extraction methods. Evaluation of the mathematical formulation showed that transfer functions derived to optimize the Freundlich adsorption constant (Kf), in contrast to functions derived to optimize either the solid or solution concentration, were most suitable for predicting concentrations in solution from solid phase concentrations and vice versa. The model was shown to be generally applicable on the basis of a large number of independent data, for which predicted free metal activities were within one order of magnitude of the observations. The model only over‐estimated free‐metal ion activities at alkaline pH (>7). The use of the reactive metal content measured by 0.43 m HNO3 rather than the total metal content resulted in a close correlation with measured data, particularly for nickel and zinc.
Perforin‐expressing cytotoxic cells contribute to chronic cardiomyopathy in Trypanosoma cruzi infection
Authors: Silverio Jaline Coutinho , De‐Oliveira‐Pinto Luzia Maria , Da Silva Andréa Alice , De Oliveira Gabriel Melo , Lannes‐Vieira Joseli
Published: October 2009

Understanding the dual participation of the immune response in controlling the invader and at the same time causing tissue damage might contribute to the design of effective new vaccines and therapies for Chagas disease. Perforin, a cytolytic protein product of killer cells, is involved in resistance to acute Trypanosoma cruzi infection. However, the contribution of perforin in parasite control and chronic chagasic cardiomyopathy is unclear. Perforin‐positive cells were detected in the heart tissue during the acute and chronic phases of infection of C57BL/6 mice inoculated with low dose (102 parasites) of the Colombian T. cruzi strain. This protocol led to acute phase survival in both wild‐type and perforin null (pfp−/−) mice lineages. During the chronic infection, parasitism and inducible nitric oxide synthase (iNOS) as well as interleukin (IL)‐4+ and, mainly, interferon (IFN)‐γ+ cells were more elevated in the heart tissue of pfp−/− mice. Higher levels of circulating NO and anti‐parasite immunoglobulin (Ig)G2c and IgG3, paralleled by a prominent frequency of IFN‐γ+ and IL‐10+ splenocytes, were present in pfp−/−‐infected mice. Therefore, although the perforin‐dependent pathway plays a role, it is not crucial for anti‐T. cruzi immunity and acute phase survival of mice infected with a low inoculum. Further, perforin deficiency resulted in lower activity of creatine kinase‐muscle brain isoform (CK‐MB) isoenzyme in serum and a more restricted connexin 43 loss, both of which are markers of the cardiomyocyte lesion. Moreover, perforin deficiency hampered the development of severe electrocardiographic abnormalities. Hence, our results corroborate that perforin‐bearing cytotoxic cells might contribute to cardiomyocyte lesion and heart dysfunction during chronic T. cruzi infection, shedding light on immunopathogenesis of chronic chagasic cardiomyopathy.
Can life‐history traits predict the response of forb populations to changes in climate variability?
Authors: Dalgleish Harmony J. , Koons David N. , Adler Peter B.
Published: October 2009

1. Climate change will cause changes in average temperature and precipitation as well as increased fluctuations around the mean, yet few studies have considered the impacts of altered climate variability on plant populations. We tested whether life‐history traits (expected life span, generation time and seed size) can predict plant responses to increased environmental variability across similar plant species sharing the same habitat.

2. We combined long‐term demographic data on 10 prairie forb species with stochastic demography techniques to estimate the effects of potential changes in matrix element means and variances on the long‐term stochastic population growth rate.

3. For all 10 species, recruitment had higher contribution and elasticity values than survival, meaning that climate change is more likely to influence population growth through effects on recruitment than on survival for these relatively short‐lived forbs. Species with longer generation times had lower elasticities to increases in matrix element variability.

4. Synthesis. Our analysis of a unique, long‐term data set suggests that longer‐lived plant species will be less vulnerable to the effects of future increases in climate variability. While this relationship was previously reported for diverse taxa from many locations, our results show that it also applies within a guild of short‐lived species from a single community. The generality of the pattern demonstrates the potential for using life‐history traits to make predictions about which species may be the most vulnerable to climate change.
The Excurrent Ducts of the Testis of the Emu (Dromaius novaehollandiae) and Ostrich (Struthio camelus): Microstereology of the Epididymis and Immunohistochemistry of its Cytoskeletal Systems
Authors: Ozegbe P. C. , Kimaro W. , Madekurozwa M.‐C. , Soley J. T. , Aire T. A.
Published: October 2009

The volumetric proportion of the various ducts of the epididymis of the emu and ostrich and the immunohistochemistry of actin microfilaments, as well as cytokeratin, desmin and vimentin intermediate filaments, were studied in the various ducts of the epididymis of the emu and ostrich. The volumetric proportions of various ducts, which are remarkably different from those of members of the Galloanserae monophyly, are as follows: the rete testis, 5.2 ± 1.4% for the emu and 2.4 ± 1.8% for the ostrich; efferent ducts, 14.2 ± 2.3% (emu) and 11.8 ± 1.8% (ostrich); epididymal duct unit, 25.8 ± 5.8% (emu) and 26.1 ± 4.1% (ostrich) and connective tissue and its content, 54.7 ± 5.8% (emu) and 60.0 ± 4.9% (ostrich). Unlike in mammals and members of the Galloanserae monophyly, only vimentin was immunohistochemically demonstrated in the rete testis epithelium of the emu, and none of the cytoskeletal protein elements in the ostrich rete testis. The epithelium of the efferent ducts of the emu co‐expressed actin, cytokeratin and desmin in the non‐ciliated type I cells, and vimentin in the ciliated cell component. The ostrich demonstrated only cytokeratin in this epithelium. The ratite epididymal duct unit is different from that of mammals in lacking actin (only weaky expression in the ostrich), desmin and cytokeratin, and a moderate/strong immunoexpression of vimentin in the basal cells and basal parts of the NC type III cell in the epididymal duct unit. Immunoexpression of the microfilaments and intermediate filaments varied between the two ratite birds, as has been demonstrated previously in birds of the Galloanserae monophyly, and in mammals.
Morphometric Analysis of the Canal System of Cortical Bone: An Experimental Study in the Rabbit Femur Carried Out with Standard Histology and Micro‐CT
Authors: Pazzaglia U. E. , Zarattini G. , Giacomini D. , Rodella L. , Menti A. M. , Feltrin G.
Published: October 2009

The osteonal pattern of cortical bone is gradually built around the intracortical vessels by the progression of the cutting cones (secondary remodelling); therefore, the central canal size can be used as index of the remodelling activity. An experimental model in the rabbit femur was used to investigate, through central canal morphometry and frequency distribution analysis, the remodelling activity, comparing the middle of the diaphysis (mid‐shaft) with the extremity (distal‐shaft) and at the same level sectors and layers of the cortex in transversal sections. The study documented a higher density of canals in the mid‐shaft than in the distal‐shaft and a higher remodelling in the distal‐shaft. There were no significant differences between dorsal, ventral, medial and lateral sectors at both mid‐shaft and distal‐shaft levels, while the number of canals was higher in the sub‐periosteal layers than in the sub‐endosteal. A lower threshold of 40 μm2 was observed in the central canal area. Sealed osteons in the midshaft were 22.43% of the total number of osteons of the central canal area between 40 and 200 μm2 and 0.44% of those of the distal‐shaft. Micro‐CT allowed a 3D reconstruction of the vascular canal system, which confirmed the branched network pattern rather than the trim architecture of the traditional representation. Some aspects like the lower threshold of the central canal size and the sealed osteons documented the plasticity of the system and its capacity for adaptation to changes in the haemodynamic conditions.
Expression of ERCC1 and class IIIβ tubulin for predicting effect of carboplatin/paclitaxel in patients with advanced inoperable non‐small cell lung cancer
Authors: Ikeda Satoshi , Takabe Kazuhiko , Suzuki Keiko
Published: October 2009

It was recently reported that expression of excision repair cross‐complementation group 1 (ERCC1), a DNA repair protein, predicts sensitivity to platinum‐based chemotherapy drugs. Microtubule inhibitors such as paclitaxel demonstrate anticancer effects by inhibiting spindle fibers during mitosis; and class IIIβ tubulin (IIIβ tubulin), a microtubule component, is thought to be resistant to microtubule inhibitors. The purpose of the present study was to examine the correlation between prognosis and expression of these proteins using biopsy tissues obtained from 40 patients with advanced inoperable non‐small cell lung cancer who had been treated with carboplatin plus Taxol. On immunostaining 27 patients (68%) were positive for ERCC1 and 22 (55%) were positive for IIIβ tubulin. The prognosis of the ERCC1‐negative group was significantly better than that for the ERCC1‐positive group (P= 0.014). As for IIIβ tubulin, the prognosis for the negative group was also significantly better than that for the positive group (P= 0.025). Multivariate analysis showed that the expression of ERCC1 was an independent predictor of prognosis (hazard ratio: 3.485; 95% confidence interval: 1.123–10.818, P= 0.031). It was concluded that determination of the expression of these proteins is useful to predict the effects of platinum‐based anticancer drugs.
Area of residual tumor beyond the muscular layer is a useful predictor of outcome in rectal cancer patients who receive preoperative chemoradiotherapy
Authors: Kojima Motohiro , Ishii Genichiro , Yamane Yuki , Nishizawa Yuji , Saito Norio , Ochiai Atsushi
Published: October 2009

The purpose of the present study was to determine whether the amount and the location of residual tumor are associated with outcome in surgically treated rectal cancer patients who receive preoperative chemoradiation therapy. Forty‐three rectal cancer patients who underwent sphincter‐saving operations after preoperative chemoradiation therapy were enrolled in the study. The total area of residual tumors was measured using morphometry software, and then the area of the residual tumors located within and beyond the muscular layer was also determined. Associations between clinicopathological features were evaluated. The results showed that the total area of residual tumor and area of residual tumor within the muscular layer were associated with TNM stage, tumor regression, and microscopy features, but not with patient disease‐free survival. The area of the residual tumor located beyond the muscular layer was significantly associated with pathological ypT, ypN stage, tumor downstaging, perineural invasion, and the depth of tumor invasion beyond the muscular layer (P < 0.05). Further, large residual tumor area beyond the muscular layer was associated with shorter disease‐free survival (P < 0.05). Morphometry of residual tumor area beyond the muscular layer is a new pathological prognostic factor for rectal cancer patients receiving preoperative chemoradiation therapy.
Validation of the Cognitive Appraisal Health Scale with Jordanian patients
Authors: Ahmad Muayyad M.
Published: October 2009

The purpose of this study was to test the psychometric properties and the theoretical structure of the Cognitive Appraisal Health Scale for patients with acute and chronic diseases in medical and surgical wards. Previously, the Scale was validated with patients diagnosed with prostate cancer. However, in order to examine the psychometric properties of the scale with patients diagnosed with health problems other than prostate cancer, this study was conducted. The convenience sample of 140 male and 128 female patients was selected from an educational hospital and three private hospitals in Jordan. The factor structure for the Scale was examined by using confirmatory and exploratory factor analysis. The 13 item model with three factors yielded highly acceptable indices in all respects for patients with acute and chronic diseases and appears most useful for measuring their cognitive appraisal.
Adjuvant chemotherapy for stage C colonic cancer in a multidisciplinary setting
Authors: Chapuis Pierre H. , Bokey E. Leslie , Clarke Stephen , Beale Philip , Dent Owen F.
Published: October 2009

Background:  In this study of patients undergoing adjuvant chemotherapy for clinicopathological stage C colonic cancer after optimal surgery, the aims were: to describe their immediate experience of chemotherapy, to assess disease‐free survival, to compare overall survival with that of a matched untreated historical control group, and to evaluate the associations between previously identified adverse risk factors and survival.

Methods:  Data were drawn from a comprehensive, prospective hospital registry of resections for colorectal cancer between 1971 and 2004, with retrospective data on adjuvant chemotherapy. The main end point was overall survival. Statistical analysis employed the chi‐squared test, Kaplan–Meier estimation and proportional hazards regression.

Results:  From May 1992 to December 2004, there were 104 patients who received adjuvant chemotherapy. Duration of treatment, withdrawal from treatment, toxicity and other immediate treatment outcomes were similar to those in other equivalent studies. There were no toxicity‐associated deaths. Overall survival was significantly longer in the treated patients than in the control group (3‐year rates 81% and 66%, respectively, P = 0.009). A significant protective effect of adjuvant therapy was found (hazard ratio 0.5, 95% confidence interval 0.3–0.8, P = 0.001) after adjustment for histopathology features previously shown to be negatively associated with survival (high grade, venous invasion, apical node metastasis, free serosal surface involvement).

Conclusions:  For patients who have had a curative resection for lymph node positive colonic cancer in a specialist colorectal surgical unit and been managed by a multidisciplinary team, post‐operative adjuvant chemotherapy is safe and provides the same survival advantage as seen in randomized trials.
Colorectal cancer stem cells
Authors: Salama Paul , Platell Cameron
Published: October 2009

Somatic stem cells reside at the base of the crypts throughout the colonic mucosa. These cells are essential for the normal regeneration of the colonic epithelium. The stem cells reside within a special ‘niche’ comprised of intestinal sub‐epithlial myofibroblasts that tightly control their function. It has been postulated that mutations within these adult colonic stem cells may induce neoplastic changes. Such cells can then dissociate from the epithelium and travel into the mesenchyme and thus form invasive cancers. This theory is based on the observation that within a colon cancer, less than 1% of the neoplastic cells have the ability to regenerate the tumour. It is this group of cells that exhibits characteristics of colonic stem cells. Although anti‐neoplastic agents can induce remissions by inhibiting cell division, the stem cells appear to be remarkably resistant to both standard chemotherapy and radiotherapy. These stem cells may therefore persist after treatment and form the nucleus for cancer recurrence. Hence, future treatment modalities should focus specifically on controlling the cancer stem cells. In this review, we discuss the biology of normal and malignant colonic stem cells.
Prostate‐specific antigen velocity (PSAV): a practical role for PSA?
Authors: Thanigasalam Ruban , Mancuso Pascal , Tsao Kim , Rashid Prem
Published: October 2009

Background:  Prostate cancer is a leading cause of morbidity and mortality in Australian men. Early detection and treatment are critical to patient outcome, but detection is often difficult because of the limited accuracy of available tests. This paper assesses whether the use of prostate specific antigen kinetics has a practical use in the contemporary urological setting.

Methods:  A Medline literature review was performed examining related articles on the commonly available tests for prostate cancer, what they mean, their limited accuracy in cancer detection, and how this accuracy can be improved.

Discussion:  Detection of significant organ‐confined prostate cancer should be the goal of general practitioners and urologists alike. Prostate‐specific antigen and digital rectal examination are commonly used but lack specificity and sensitivity, especially for small organ‐confined cancers. The additional use of prostate‐specific antigen velocity may enhance the specificity and sensitivity of detection.
Elective gastrostomy, nutritional status and quality of life in advanced head and neck cancer patients receiving chemoradiotherapy
Authors: Morton Randall P. , Crowder Victoria L. , Mawdsley Robert , Ong Esther , Izzard Mark
Published: October 2009

Background:  Chemoradiotherapy for treatment of advanced head and neck cancer (HNC) is used to achieve organ preservation without compromising survival. Because chemoradiotherapy usually impacts adversely on nutritional and functional status, feeding by percutaneous endoscopic gastrostomy (PEG) is often part of the management regimen for these patients, but the presence of a PEG tube can also be associated with reduced quality of life (QOL). This study aimed to examine the factors associated with PEG insertion and the effects of PEG use on QOL and functional outcomes in HNC patients receiving chemoradiotherapy.

Method:  Survey of 36 consecutive patients treated by primary chemoradiotherapy for HNC. Patient weight, age, tumour type, details of PEG insertion, feeding regimens and treatment were noted. The survey comprised the Performance Status Scale, the Functional Measure for Swallowing, Nutritional Mode and a self‐assessment of QOL.

Results:  PEG insertion within 1 month of treatment was associated with smaller fall in body mass index at 12 months than PEG insertion 1 month or more after the start of the treatment (P < 0.05). Body mass index change was inversely correlated with health‐related quality of life and significantly related to lower speech and swallowing function scores. Longer PEG duration correlated with poorer performance status and swallowing function (P < 0.01). Longer PEG duration also predicted poorer overall QOL (P < 0.01) and poorer swallowing (P < 0.01) and speech (P < 0.05). Nutritional mode was related to overall QOL (P < 0.01).

Conclusions:  Nutritional support for HNC patients undergoing chemoradiotherapy is an essential component of patient care. Early PEG insertion and shorter PEG duration are associated with more favourable QOL‐related outcomes.
Outcome following surgery for squamous cell carcinoma of the oesophagus
Authors: Yong En Loon C. , Han Xing Peng , Watson David I. , Devitt Peter G. , Jamieson Glyn G. , Thompson Sarah K.
Published: October 2009

Introduction:  This study was undertaken to determine the outcomes of patients treated for squamous cell carcinoma (SCC) of the oesophagus.

Methods:  The study group consisted of 61 patients (median age: 64 years) with invasive SCC of the oesophagus who underwent resection between 1987 and 2007 in Adelaide, South Australia. Thirty‐two (52%) were female. Survival data were available for all patients. The log rank test was performed to identify prognostic factors for survival.

Results:  The 5‐year overall survival rate was 33% (median: 24 months). Of 61 patients, 42 (69%) received neoadjuvant therapy prior to surgery. The overall resection rate was 95%. Significant post‐operative morbidity occurred in 47%, and the in‐hospital mortality was 5% (30‐day mortality: 3%). No overall survival benefit was seen in patients undergoing neoadjuvant therapy prior to surgical resection. However, patients who had a complete pathological response to neoadjuvant therapy had a better 5‐year survival than patients who did not receive neoadjuvant therapy: 47% versus 30%, respectively.

Conclusions:  Oesophagectomy following neoadjuvant therapy for SCC of the oesophagus can be performed with low perioperative mortality. A complete response to neoadjuvant therapy was followed by an improved survival outcome.
Bilateral thoracoscopy, mediastinoscopy and laparoscopy, in addition to CT, MRI and PET imaging, are essential to correctly stage and treat patients with mesothelioma prior to trimodality therapy*
Authors: Alvarez John M. , Hasani Arman , Segal Amanda , Sterret Greg , Millward Michael , Nowak Ana , Musk William , Bydder Sean
Published: October 2009

Background:  Trimodality therapy (TMT; extrapleural pneumonectomy (EPP), chemotherapy and radiation therapy) offers the potential of optimal survival in selected patients with Brigham stage I–II epitheliod mesothelioma based on CT, MRI and PET scanning. We hypothesized that these scanning modalities were inadequate to accurately stage these patients.

Methods:  Patients suitable for TMT, in addition to CT, MRI and PET scanning, prior to EPP, underwent bilateral thoracoscopy, mediastinoscopy and laparoscopy (surgical staging). Follow‐up CT scans were performed, six monthly, quality of life assessments yearly.

Results:  From 1 June 2004 to 28 February 2007, 34 patients were referred; mean age was 66 years (range: 44–69). Surgical staging was performed in 30 patients; 24 patients were confirmed as Brigham Stage I–II. However, six were upstaged, five as stage IV disease (one contralateral chest, two contralateral chest and abdomen, two abdomen) and one as mediastinal node positive; two further patients were reclassified histologically (one sarcomatoid, one biphasic). These eight patients fared poorly, 50% dying within 1 year from mesothelioma. Following surgical staging, 3 patients declined further surgery; thus, 19 patients proceeded to surgery, 3 were unresectable and 16 received EPP. Follow‐up of all 34 patients is complete.

Conclusion:  Surgical staging identified 26% of patients who would have received no benefit from TMT.
Mandibular ameloblastoma: clinical experience and literature review
Authors: Sham Eric , Leong James , Maher Rory , Schenberg Michael , Leung Michael , Mansour Alan K.
Published: October 2009

Background:  Ameloblastoma is a locally aggressive odontogenic tumour of the mandible and maxilla that, if neglected, can cause severe facial disfigurement and functional impairment. A thorough understanding of its clinicopathological behaviour is essential to avoid recurrence associated with inadequately treated disease. Currently, wide resection and immediate reconstruction is the treatment of choice in most cases of mandibular ameloblastoma. We present our experience in the management of this disease and review the current status of the literature.

Method:  Retrospective review of all patients between 1996 and 2006 with histologically confirmed ameloblastoma. A literature review on the current understanding of this disease and its management is then presented.

Results:  Six patients were identified, ranging between 23 and 54 years old. All were females. Two tumours involved the angle and posterior body of the mandible, one the angle and ramus, one the body and two the anterior mandibular. Four patients underwent mandibular reconstruction with free tissue transfer and two by non‐vascularized bone grafts. All procedures were successful. One patient developed deep vein thrombosis requiring anticoagulation. Another developed a collection at the mandibular surgical site requiring drainage. Satisfactory union was achieved in all cases with no evidence of recurrence. All patients had adequate cosmesis, masticatory efforts and speech.

Conclusion:  Management of ameloblastoma remains a challenge and requires a thorough understanding of the behaviour of its different clinicopathological variants. We have found segmental mandibulectomy and immediate reconstruction to be an excellent treatment option in our series of patients.
The rise of research on futures in ecology: rebalancing scenarios and predictions
Authors: Coreau Audrey , Pinay Gilles , Thompson John D. , Cheptou Pierre‐Olivier , Mermet Laurent
Published: October 2009

Ecology Letters (2009) 12: 1277–1286

Concern about the ecological consequences of global change has increasingly stimulated ecologists to examine the futures of ecological systems. Studying futures is not only a crucial element of the interaction between science, management and decision making, but also a critical research challenge per se, especially because futures cannot be observed or experimented on. In addition, researchers can encounter methodological and theoretical difficulties, which make interpretations and predictions problematic. In the literature which deals with futures of ecological systems two main lines of research can be distinguished: a predictive approach, which dominates the literature, can be contrasted with a rarer number of studies that elaborate potential scenarios for ecological systems. Scenario approaches currently concern mainly contacts with stakeholders or decision makers, or the use of climate scenarios to derive projections about ecological futures. We argue that a new direction for ecological futures research could be explored by using ecological scenarios in combination with predictive models to further fundamental ecological research, in addition to enhancing its applied value.
The costs and benefits of fast living
Authors: Rose Karen E. , Atkinson Rebecca L. , Turnbull Lindsay A. , Rees Mark
Published: October 2009

Ecology Letters(2009) 12: 1379–1384

Growth rates play a fundamental role in many areas of biology (Q. Rev. Biol., 67, 1992, 283; Life History Invariants. Some Explorations of Symmetry in Evolutionary Biology, 1993; Philos. Trans. R. Soc. Lond. B Biol. Sci., 351, 1996, 1341; Plant Strategies, Vegetation Processes, and Ecosystem Properties, 2002; Trends Ecol. Evol., 18, 2003, 471; Q. Rev. Biol., 78, 2003, 23; J. Ecol., 95, 2007, 926.) but the cost and benefits of different growth rates are notoriously difficult to quantify (Q. Rev. Biol., 72, 1997, 149; Funct. Ecol., 17, 2003, 328). This is because (1) growth rate typically declines with size and yet the most widely used growth measure – relative growth rate or RGR (conventionally measured as the log of the ratio of successive sizes divided by the time interval) – is not size‐corrected and so confounds growth and size, (2) organisms have access to different amounts of resource and (3) it is essential to allow for the long‐term benefits of larger size. Here we experimentally demonstrate delayed costs and benefits of rapid growth in seven plant species using a novel method to calculate size‐corrected RGR. In control treatments, fast‐growing plants benefited from increased reproduction the following year; however, fast‐growing plants subjected to an experimental stress treatment (defoliation) showed strongly reduced survival and reproduction the following year. Importantly, when growth was estimated using the classical RGR measure, no costs or benefits were found. These results support the idea that life‐history trade‐offs have a dominant role in life‐history and ecological theory and that the widespread failure to detect them is partly due to methodological shortcomings.
Dorsal onlay lingual mucosal graft urethroplasty for urethral strictures in women
Authors: Sharma Girish K. , Pandey Ashwani , Bansal Harbans , Swain Sameer , Das Suren K. , Trivedi Sameer , Dwivedi Udai S. , Singh Pratap B.
Published: October 2009

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

To describe the technique and results of dorsal onlay lingual mucosal graft (LMG) urethroplasty for the definitive management of urethral strictures in women.

PATIENTS AND METHODS

In all, 15 women (mean age 42 years) with a history suggestive of urethral stricture who had undergone multiple urethral dilatations and/or urethrotomy were selected for dorsal onlay LMG urethroplasty after thorough evaluation, from October 2006 to March 2008. After a suprameatal inverted‐U incision, the dorsal aspect of the urethra was dissected and urethrotomy was done at the 12 o’clock position across the strictured segment. Tailored LMG harvested from the ventrolateral aspect of the tongue was then sutured to the urethrotomy wound over an 18 F silicone catheter.

RESULTS

The preoperative mean maximum urinary flow rate of 7.2 mL/s increased to 29.87 mL/s, 26.95 mL/s and 26.86 mL/s with a ‘normal’ flow rate curve at 3, 6 and 12 months follow‐up, respectively. One patient at the 3‐month follow‐up had submeatal stenosis and required urethral dilatation thrice at monthly intervals. At the 1‐year follow‐up, none of the present patients had any neurosensory complications, urinary incontinence, or long‐term functional/aesthetic complication at the donor site.

CONCLUSION

LMG urethroplasty using the dorsal onlay technique should be offered for correction of persistent female urethral stricture as it provides a simple, safe and effective approach with durable results.
Treatment of long ureteric strictures with buccal mucosal grafts
Authors: Kroepfl Darko , Loewen Heinrich , Klevecka Virgilijus , Musch Michael
Published: October 2009

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

To describe the reconstruction of long ureteric strictures using buccal mucosal patch grafts and to report the intermediate‐term functional outcome.

PATIENTS AND METHODS

Between November 2000 and October 2006 reconstruction of seven long ureteric strictures using buccal mucosal patch grafts and omental wrapping was performed in five women (one with bilateral strictures) and one man. The surgical steps of stricture reconstruction and wrapping with omentum are described in detail. Stricture recurrence was defined as persistent impaired ureteric drainage as displayed by imaging techniques or the necessity to prolong JJ stenting. Patency rates and stricture recurrence‐free survival rates are provided.

RESULTS

With a median follow up of 18 months five of the seven strictures were recurrence‐free. Graft take was good in all patients. In one asymptomatic patient, there was impaired ureteric drainage on the reconstructed side, and in one patient with reconstruction of both ureters prolonged JJ stenting of one side was necessary. In both patients, the impaired drainage was caused by persistent stricture below the reconstructed ureteric segments.

CONCLUSIONS

At intermediate‐term follow‐up in a small group of patients with long ureteric strictures, treatment with buccal mucosal patch grafts and omental wrapping showed good functional outcome.
The effect of the approach to radical prostatectomy on the profitability of hospitals and surgeons
Authors: Lotan Yair , Bolenz Christian , Gupta Amit , Hotze Timothy , Ho Richard , Cadeddu Jeffrey A. , Roehrborn Claus G.
Published: October 2009

Study Type – Therapy (economics analysis) Level of Evidence 2b

OBJECTIVE

To evaluate the profit margins for radical retropubic prostatectomy (RRP), laparoscopic radical prostatectomy (LRP) and robot‐assisted laparoscopic prostatectomy (RALP), and the effect on the reimbursement to the urologist, as there has been a dramatic increase in use of RALP, with the cost of the robot borne by hospitals.

METHODS

Data on costs and payments to hospital and surgeon from 2003 to 2008 for RRP, LRP and RALP were obtained from the hospital and urology department. We determined the profit based on the difference between payments received and total cost.

RESULTS

Between 2000 and 2008, 1279 RPs were performed at our private hospital. The introduction of RALP increased total number of RPs and replaced most RRPs. RRP represents the only procedure where payments exceed total costs. For RRP there was a significantly higher profit for patients with comorbidities. The type of payer had a large effect on profit. Medicare provides a small profit for RRP but a significant loss of >US$4000 for RALP. While all insurance companies resulted in losses for LRP and RALP, there was variability of almost $600/case for LRP and >$1400/case for RALP. RALP provided the highest reimbursement for the surgeon due to additional reimbursement for the S2900 code (use of robot).

CONCLUSIONS

The introduction of RALP has increased the case volume at our hospital and improved profits for the surgeon. The hospital loses money on each LRP and RALP case compared with RRP, which provides a small profit.
Open renal biopsy: comorbidities and complications in a contemporary series
Authors: Stec Andrew A. , Stratton Kelly L. , Kaufman Melissa R. , Chang Sam S. , Milam Douglas F. , Herrell S. Duke , Dmochowski Roger R. , Smith Jr Joseph A. , Clark Peter E. , Cookson Michael S.
Published: October 2009

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

To report the indications and outcomes of a contemporary series of patients with contraindications to percutaneous renal biopsies (PRBs) who had an operative RB (ORB), as although ORB is a relatively infrequent procedure, it remains an important and underreported operation.

PATIENTS AND METHODS

In a retrospective review of patients who had an ORB we examined comorbidities, indications, and 30‐day morbidity and mortality. Preoperative comorbidities were stratified according to the Charlson comorbidity index.

RESULTS

In all, 115 patients had ORB between 1991 and 2006 (mean age 48 years, range 18–83); 60% of the patients were American Society of Anesthesiologists class ≥3. The median Charlson comorbidity index score was 3, with a score of 0 in 20.9%, 1–2 in 27.8%, 3–4 in 30.4% and ≥5 in 20.9% of patients. Indications for an ORB included morbid obesity, failed PRB, coagulopathy, and solitary kidney. In all, 47.8% of patients had a serum creatinine level of <3.0 mg/dL, 34.8% of >3.0 mg/dL and 17.4% were dialysis‐dependent. There were 43 complications in 36 patients. The mortality rate after surgery was 0.8%. There were eight major complications in seven patients (6.1%) including cardiac arrest, stroke, sepsis, reoperation and re‐intubation. There were minor complications 34 times in 31 patients (27%), the most common being wound infection, pneumonia, intraoperative transfusion of >2 units, arrhythmia, postoperative retroperitoneal bleed, and seep vein thrombosis.

CONCLUSIONS

This study shows that there are significant comorbidities in patients referred to urologists for an ORB. With a mortality rate of 0.8% and major and minor complication rates of 6.1% and 27%, respectively, the ORB, while infrequent, carries a significant risk in this population that should be included in preoperative decision making and used for patient counselling.
Real‐time polymerase chain‐reaction detection of pathogens is feasible to supplement the diagnostic sequence for urinary tract infections
Authors: Lehmann Lutz E. , Hauser Stefan , Malinka Thomas , Klaschik Sven , Stüber Frank , Book Malte
Published: October 2009

OBJECTIVE

To evaluate, in a prospective pilot study, the feasibility of identifying pathogens in urine using real‐time polymerase chain reaction (PCR), and to compare the results with the conventional urine culture‐based procedures.

PATIENTS AND METHODS

Severe urinary tract infections (UTIs) are frequent in critically ill patients in the intensive‐care unit (ICU) and in outpatients, and thus the reliable and fast identification of the bacteria is mandatory, but routine urine culture is time‐consuming and the therapeutic regimen is often calculated and not culture‐based. The study included 301 prospectively collected urine samples from 189 patients with suspected UTI, based in a university hospital in 2005, and included outpatients and those in the ICU. Urine culture with Cled‐, MacConkey‐ and malt extract agar of all samples was followed by microbiological identification of the pathogens in 98 samples with visible growth. In parallel, all samples were assessed using qualitative real‐time PCR‐based DNA detection and identification by labelled hybridization probes.

RESULTS

In all, 15 dipstick culture‐negative samples showed positive pathogen DNA identification by PCR. By contrast, 17 PCR‐negative samples showed detectable pathogens by culture, of which 10 were not detectable on PCR because the identified pathogens were not represented in the probe panel. The sensitivity and specificity for detecting contaminated samples was 0.90 and 0.87, respectively. Overall, 95% of the mono‐infection pathogens and 57% of the multiple‐infection pathogens were detected concordantly with both methods.

CONCLUSION

In this prospective pilot study PCR‐based identification of pathogens was feasible for supplementing conventional culture methods for the diagnosis of UTI. The main advantage is the time saved in identifying the pathogens. The limited pathogen detection in multiple‐infection‐samples by PCR might be explained by competitive PCR amplification conditions.
Critical appraisal of technical problems with robotic urological surgery
Authors: Nayyar Rishi , Gupta Narmada P.
Published: October 2009

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

To record the technical problems and complications associated with the use of da Vinci S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) and to review previous reports.

METHODS

We analysed our records for all machine‐ or instrument‐related errors during the course of 340 consecutive robot‐assisted urological operations at our centre from July 2006 to March 2009, using one robotic machine. The cause of the error (machine or human), troubleshooting methods and consequences of the errors were evaluated.

RESULTS

The overall device failure rate was 10.9% (37/340). The most frequent technical problems were related to robotic instruments (23/37). Other failures included colour/hue changes in the console image, intermittent double vision, fused illuminator bulb and problems with the master tool‐manipulator device (hand‐piece unit), patient cart circuitry, patient‐side manipulator arm, closed‐circuit camera unit or camera cable. Of 37 problems, 28 (76%) were surmountable during the course of surgery. The overall conversions to standard open/laparoscopic procedure attributable to mechanical failures of the robot were 0.6% (2/340). There were no complications or direct harm to the patient in any case. Most faults could be corrected or bypassed with some addition to operating room time.

CONCLUSIONS

Despite an association of various types of new technical problems with robotic surgery, it provides a safe mode of minimally invasive surgery with very low conversion rates attributable to it, and no direct patient injury.