bluuebunny/crossref_metadata_2025 huggingface dataset:
Estrogen-Regulated Genes Predict Survival in Hormone Receptor–Positive Breast Cancers
Authors: Oh Daniel S. , Troester Melissa A. , Usary Jerry , Hu Zhiyuan , He Xiaping , Fan Cheng , Wu Junyuan , Carey Lisa A. , Perou Charles M.
Published: February 2006

Purpose

The prognosis of a patient with estrogen receptor (ER) and/or progesterone receptor (PR) –positive breast cancer can be highly variable. Therefore, we developed a gene expression–based outcome predictor for ER+ and/or PR+ (ie, luminal) breast cancer patients using biologic differences among these tumors.

Materials and Methods

The ER+ MCF-7 breast cancer cell line was treated with 17β-estradiol to identify estrogen-regulated genes. These genes were used to develop an outcome predictor on a training set of 65 luminal epithelial primary breast carcinomas. The outcome predictor was then validated on three independent published data sets.

Results

The estrogen-induced gene set identified in MCF-7 cells was used to hierarchically cluster a 65 tumor training set into two groups, which showed significant differences in survival (P = .0004). Supervised analyses identified 822 genes that optimally defined these two groups, with the poor-prognosis group IIE showing high expression of cell proliferation and antiapoptosis genes. The good prognosis group IE showed high expression of estrogen- and GATA3-regulated genes. Mean expression profiles (ie, centroids) created for each group were applied to ER+ and/or PR+ tumors from three published data sets. For all data sets, Kaplan-Meier survival analyses showed significant differences in relapse-free and overall survival between group IE and IIE tumors. Multivariate Cox analysis of the largest test data set showed that this predictor added significant prognostic information independent of standard clinical predictors and other gene expression–based predictors.

Conclusion

This study provides new biologic information concerning differences within hormone receptor–positive breast cancers and a means of predicting long-term outcomes in tamoxifen-treated patients.
Multicenter Phase I Study of Repeated Intratumoral Delivery of Adenoviral p53 in Patients With Advanced Non–Small-Cell Lung Cancer
Authors: Fujiwara Toshiyoshi , Tanaka Noriaki , Kanazawa Susumu , Ohtani Shoichiro , Saijo Yasuo , Nukiwa Toshihiro , Yoshimura Kunihiko , Sato Tetsuo , Eto Yoshikatsu , Chada Sunil , Nakamura Haruhiko , Kato Harubumi
Published: February 2006

Purpose

To determine the feasibility, safety, humoral immune response, and biologic activity of multiple intratumoral injections of Ad5CMV-p53, and to characterize the pharmacokinetics of Ad5CMV-p53 in patients with advanced non–small-cell lung cancer (NSCLC).

Patients and Methods

Fifteen patients with histologically confirmed NSCLC and p53 mutations were enrolled onto this phase I trial. Nine patients received escalating dose levels of Ad5CMV-p53 (1 × 109 to 1 × 1011 plaque-forming units) as monotherapy once every 4 weeks. Six patients were treated on a 28-day schedule with Ad5CMV-p53 in combination with intravenous administration of cisplatin (80 mg/m2). Patients were monitored for toxicity, vector distribution, antibody formation, and tumor response.

Results

Fifteen patients received a total of 63 intratumoral injections of Ad5CMV-p53 without dose-limiting toxicity. The most common treatment-related toxicity was a transient fever. Specific p53 transgene expression was detected using reverse-transcriptase polymerase chain reaction in biopsied tumor tissues throughout the period of treatment despite of the presence of neutralizing antiadenovirus antibody. Distribution studies revealed that the vector was detected in the gargle and plasma, but rarely in the urine. Thirteen of 15 patients were assessable for efficacy; one patient had a partial response (squamous cell carcinoma at the carina), 10 patients had stable disease, with three lasting at least 9 months, and two patients had progressive disease.

Conclusion

Multiple courses of intratumoral Ad5CMV-p53 injection alone or in combination with intravenous administration of cisplatin were feasible and well tolerated in advanced NSCLC patients, and appeared to provide clinical benefit.
Results of the Brazilian Osteosarcoma Treatment Group Studies III and IV: Prognostic Factors and Impact on Survival
Authors: Petrilli A. Sérgio , de Camargo Beatriz , Filho Vicente Odone , Bruniera Paula , Brunetto Algemir L. , Jesus-Garcia Reynaldo , Camargo Olavo P. , Pena Walter , Péricles Pedro , Davi Alexandre , Prospero José D. , Alves Maria Teresa S. , Oliveira Claudia R. , Macedo Carla R.D. , Mendes Wellington L. , Almeida Maria Teresa A. , Borsato Maria L. , dos Santos Telma M. , Ortega Jorge , Consentino Elio
Published: February 2006

Purpose

To evaluate the impact of chemotherapy and surgery on the outcome of osteosarcoma (OS) of the extremities and to identify prognostic factors in Brazilian patients.

Patients and Methods

A total of 225 patients with metastatic and nonmetastatic OS of the extremities were enrolled and assessed in two consecutive studies designed and implemented by the Brazilian Osteosarcoma Treatment Group.

Results

The 5-year survival and event-free survival rates for the 209 assessable patients were 50.1% and 39%, respectively; for the 178 patients with nonmetastatic disease at diagnosis, the rates were 60.5% and 45.5%, respectively. The multivariate analysis showed that the following variables were associated with a shorter survival: metastases at diagnosis (P < .001), necrosis grades 1 and 2 (P = .046), and tumor size (P = .0071).

Conclusion

The overall 5- and 10-year survival rates were lower than the rates reported in North American and European trials. A pattern of advanced disease at diagnosis was often present, with a high proportion of patients having metastases (20.8%) and large tumor size (42.9%). However, these features were not necessarily associated with longer duration of prediagnostic symptoms. These findings were considered in the strategic planning of the current Brazilian cooperative study, with the aim of improving survival and quality of life of a large number of patients with OS.
Diagnostic Performance of Whole Body Dual Modality 18F-FDG PET/CT Imaging for N- and M-Staging of Malignant Melanoma: Experience With 250 Consecutive Patients
Authors: Reinhardt Michael J. , Joe Alexius Y. , Jaeger Ursula , Huber Andrea , Matthies Alexander , Bucerius Jan , Roedel Roland , Strunk Holger , Bieber Thomas , Biersack Hans-Juergen , Tüting Thomas
Published: February 2006

Purpose

To assess the diagnostic performance of positron emission tomography/computed tomography (PET/CT) using 18F-fluorodeoxyglucose (FDG) for N- and M-staging of cutaneous melanoma.

Patients and Methods

This is a retrospective and blinded study of 250 consecutive patients (105 women, 145 men; age 58 ± 16 years) who underwent FDG-PET/CT for staging of cutaneous melanoma at different time points in the course of disease. Whole-body FDG-PET/CT was performed 101 ± 21 minutes postinjection of 371 ± 41 MBq FDG. Diagnostic accuracy for N- and M-staging was determined for CT alone, PET alone, and PET/CT.

Results

PET/CT detected significantly more visceral and nonvisceral metastases than PET alone and CT alone (98.7%, 88.8%, and 69.7%, respectively). PET/CT imaging thus provided significantly more accurate interpretations regarding overall N- and M-staging than PET alone and CT alone. Overall N- and M-stage was correctly determined by PET/CT in 243 of 250 patients (97.2%; 95% CI, 95.2% to 99.4%) compared with 232 patients (92.8%; 95% CI, 89.6% to 96.0%) by PET, and 197 patients (78.8%; 95% CI, 73.7% to 83.9%) by CT. All differences were significant. Accuracy of PET/CT was significantly higher than that of PET and CT for M-staging (0.98 v 0.93 and 0.84) and significantly higher than that of CT for N-Staging (0.98 v 0.86). Change of treatment according to PET/CT findings occurred in 121 patients (48.4%).

Conclusion

The diagnostic performance of FDG-PET/CT for N- and M-staging of melanoma patients suggests its use for whole-body tumor staging, especially for detection or exclusion of distant metastases.
Phase I Trial Evaluating the Safety of Bevacizumab With Concurrent Radiotherapy and Capecitabine in Locally Advanced Pancreatic Cancer
Authors: Crane Christopher H. , Ellis Lee M. , Abbruzzese James L. , Amos Christina , Xiong Henry Q. , Ho Linus , Evans Douglas B. , Tamm Eric P. , Ng Chaan , Pisters Peter W.T. , Charnsangavej Chusilp , Delclos Marc E. , O'Reilly Michael , Lee Jeffrey E. , Wolff Robert A.
Published: February 2006

Purpose

To study the safety of bevacizumab with capecitabine-based chemoradiotherapy.

Patients and Methods

Patients with inoperable pancreatic adenocarcinoma received bevacizumab 2 weeks before radiotherapy (50.4 Gy treating the primary tumor and gross adenopathy), every 2 weeks during radiotherapy (12 patients each at 2.5, 5.0, 7.5, and 10 mg/kg), and after radiotherapy until disease progression. Capecitabine was administered on days 14 through 52 (650 mg/m2 orally twice daily for the first six patients; 825 mg/m2 for the remaining patients).

Results

Significant acute gastrointestinal (43% grade 2; 4% grade 3), hand and foot syndrome (21% grade 2), and transient hematologic (8% grade 3 or greater) events were uncommon with protocol mandated dose reductions of capecitabine grade 2 toxicity (43% of patients). Among the first 30 patients treated, three patients had tumor-associated bleeding duodenal ulcers, and one had a contained duodenal perforation. No additional bleeding events occurred among the final 18 patients after patients with duodenal involvement by tumor were excluded. Nine (20%) of 46 assessable patients had confirmed partial responses until distant progression for a median of 6.2 months. Four patients have undergone pancreaticoduodenectomy without perioperative complication. The median survival was 11.6 months (95% CI, 9.6 to 13.6), from the start of protocol therapy.

Conclusion

Concurrent bevacizumab did not significantly increase the acute toxicity of a relatively well-tolerated chemoradiotherapy regimen. However, ulceration and bleeding in the radiation field possibly related to bevacizumab occurred when tumor involved the duodenal mucosa. The encouraging efficacy end points suggest that the further study of bevacizumab with chemoradiotherapy is warranted.
Characterization of CD4+CD25+ Regulatory T Cells in Patients Treated With High-Dose Interleukin-2 for Metastatic Melanoma or Renal Cell Carcinoma
Authors: Cesana Giovanni C. , DeRaffele Gail , Cohen Seth , Moroziewicz Dorota , Mitcham Josephine , Stoutenburg John , Cheung Ken , Hesdorffer Charles , Kim-Schulze Seunghee , Kaufman Howard L.
Published: February 2006

Purpose

To characterize the number and functional status of CD4+CD25+ regulatory T cells (Tregs) in patients with metastatic melanoma (MM) and renal cell carcinoma (RCC) treated with high-dose bolus interleukin-2 (IL-2).

Patients and Methods

Patients with MM or RCC treated with high-dose bolus IL-2 (600,000 IU/kg every 8 hours) at a single center provided pre- and post-treatment whole blood specimens. Peripheral blood mononuclear cells were isolated by Ficoll density gradient centrifugation, separated into cellular subsets, and analyzed by flow cytometry or used for in vitro proliferation assays.

Results

Between September 2003 and July 2005 57 patients were enrolled in the study with 48 patients available for analysis (45 MM, 12 RCC). Tregs were defined as CD4+CD25hi T cells, and this subset was significantly elevated in the cancer patients compared with normal donors (7.75% v 2.24%). The CD4+CD25hi T-cell pool in the patients constitutively expressed intracellular FoxP3, CTLA-4, and produced high amounts of IL-10. The Tregs were CCR7+ with 50% representing naïve and 50% central-memory T cells. The cells were functionally suppressive in mixed in vitro proliferation assays. Following IL-2 administration, the number and frequency of Tregs increased in patients with progressive disease but returned to normal levels in patients with objective clinical responses.

Conclusion

The number of Tregs, defined as CD4+CD25hi T cells is increased in patients with MM and RCC. High-dose IL-2 resulted in a significant decrease of Tregs in those patients achieving an objective clinical response to IL-2 therapy.
Multicenter Validation of a Gene Expression–Based Prognostic Signature in Lymph Node–Negative Primary Breast Cancer
Authors: Foekens John A. , Atkins David , Zhang Yi , Sweep Fred C.G.J. , Harbeck Nadia , Paradiso Angelo , Cufer Tanja , Sieuwerts Anieta M. , Talantov Dmitri , Span Paul N. , Tjan-Heijnen Vivianne C.G. , Zito Alfredo F. , Specht Katja , Hoefler Heinz , Golouh Rastko , Schittulli Francesco , Schmitt Manfred , Beex Louk V.A.M. , Klijn Jan G.M. , Wang Yixin
Published: February 2006

Purpose

We previously identified in a single-center study a 76-gene prognostic signature for lymph node-negative (LNN) breast cancer patients. The aim of this study was to validate this gene signature in an independent more diverse population of LNN patients from multiple institutions.

Patients and Methods

Using custom-designed DNA chips we analyzed the expression of the 76 genes in RNA of frozen tumor samples from 180 LNN patients who did not receive adjuvant systemic treatment.

Results

In this independent validation, the 76-gene signature was highly informative in identifying patients with distant metastasis within 5 years (hazard ratio, [HR], 7.41; 95% CI, 2.63 to 20.9), even when corrected for traditional prognostic factors in multivariate analysis (HR, 11.36; 95% CI, 2.67 to 48.4). The actuarial 5- and 10-year distant metastasis-free survival were 96% (95% CI, 89% to 99%) and 94% (95% CI, 83% to 98%), respectively, for the good profile group and 74% (95% CI, 64% to 81%) and 65% (53% to 74%), respectively for the poor profile group. The sensitivity for 5-yr distant metastasis-free survival was 90%, and the specificity was 50%. The positive and negative predictive values were 38% (95% CI, 29% to 47%) and 94% (95% CI, 86% to 97%), respectively. The 76-gene signature was confirmed as a strong prognostic factor in subgroups of estrogen receptor-positive patients, pre- and postmenopausal patients, and patients with tumor sizes 20 mm or smaller. The subgroup of patients with estrogen receptor-negative tumors was considered too small to perform a separate analysis.

Conclusion

Our data provide a strong methodologic and clinical multicenter validation of the predefined prognostic 76-gene signature in LNN breast cancer patients.
The Intraductal Approach to Breast Cancer Biomarker Discovery
Authors: Dua R. Sascha , Isacke Clare M. , Gui Gerald P.H.
Published: February 2006

Established methods of breast cancer detection have well-described limitations, and new diagnostic techniques are evolving continually to improve diagnostic accuracy. The intraductal approach encompasses the modalities of nipple aspiration, ductal lavage, and duct endoscopy, and is a means of directly accessing the microenvironment of the breast and either sampling or visualizing this intraductal milieu. The aim of sampling this mammary microenvironment is to obtain samples from the physical surroundings of cells that are undergoing malignant transformation, thereby providing a new method of detection before the development of a clinically or radiologically discernible mass. A literature review was conducted to investigate the evolution of the intraductal approach and its particular application in the field of biomarker discovery, primarily using the intraductal technique of nipple aspiration, in combination with emerging protein profiling techniques.
Social Networks, Social Support, and Survival After Breast Cancer Diagnosis
Authors: Kroenke Candyce H. , Kubzansky Laura D. , Schernhammer Eva S. , Holmes Michelle D. , Kawachi Ichiro
Published: February 2006

Purpose

We prospectively examined social ties and survival after breast cancer diagnosis.

Patients and Methods

Participants included 2,835 women from the Nurses' Health Study who were diagnosed with stages 1 to 4 breast cancer between 1992 and 2002. Of these women, 224 deaths (107 of these related to breast cancer) accrued to the year 2004. Social networks were assessed in 1992, 1996, and 2000 with the Berkman-Syme Social Networks Index. Social support was assessed in 1992 and 2000 as the presence and availability of a confidant. Cox proportional hazards models were used in prospective analyses of social networks and support, both before and following diagnosis, and subsequent survival.

Results

In multivariate-adjusted analyses, women who were socially isolated before diagnosis had a subsequent 66% increased risk of all-cause mortality (HR = 1.66; 95% CI, 1.04 to 2.65) and a two-fold increased risk of breast cancer mortality (HR = 2.14; 95% CI, 1.11 to 4.12) compared with women who were socially integrated. Women without close relatives (HR = 2.65; 95% CI, 1.03 to 6.82), friends (HR = 4.06; 95% CI, 1.40 to 11.75), or living children (HR = 5.62; 95% CI, 1.20 to 26.46) had elevated risks of breast cancer mortality and of all-cause mortality compared with those with the most social ties. Neither participation in religious or community activities nor having a confidant was related to outcomes. Effect estimates were similar in analyses of postdiagnosis networks.

Conclusion

Socially isolated women had an elevated risk of mortality after a diagnosis of breast cancer, likely because of a lack of access to care, specifically beneficial caregiving from friends, relatives, and adult children.
Pax6-dependent boundary defines alignment of migrating olfactory cortex neurons via the repulsive activity of ephrin A5
Authors: Nomura Tadashi , Holmberg Johan , Frisen Jonas , Osumi Noriko
Published: March 2006

Neuronal migration is a prerequisite event for the establishment of highly ordered neuronal circuits in the developing brain. Here, we report Pax6-dependent alignment of the olfactory cortex neurons in the developing telencephalon. These neurons were generated in the dorsal part of telencephalon, migrated ventrally and stopped at the pallium-subpallium boundary (PSB). In Pax6 mutant rat embryos, however, these neurons invaded the ventral part of the telencephalon by crossing the PSB. Ephrin A5,one of the ligands for EphA receptors, was specifically expressed in the ventral part of the telencephalon, and its expression level was markedly reduced in the Pax6 mutant. Gain- and loss-of-function studies of ephrin A5 indicated that ephrin A5 plays an important role in the alignment of olfactory cortex neurons at the PSB. Our results suggest that Pax6-regulated ephrin A5 acts as a repulsive molecule for olfactory cortex neurons in the developing telencephalon.
Air breathing of aquatic burrow-dwelling eel goby,Odontamblyopus lacepedii(Gobiidae: Amblyopinae)
Authors: Gonzales Tomas T. , Katoh Masaya , Ishimatsu Atsushi
Published: March 2006

Odontamblyopus lacepedii is an eel goby that inhabits both coastal waters and intertidal zones in East Asia, including Japan. The fish excavates burrows in mudflats but, unlike the sympatric amphibious mudskippers, it does not emerge but stays in the burrows filled with hypoxic water during low tide. Endoscopic observations of the field burrows demonstrated that the fish breathed air in the burrow opening; air breathing commenced 1.3 h following burrow emersion, when water PO2 was ∼2.8 kPa, with an air-breathing frequency (fAB) of 7.3±2.9 breaths h–1 (mean ± s.d., N=5). Laboratory experiments revealed that the fish is a facultative air breather. It never breathed air in normoxic water (PO2=20.7 kPa) but started bimodal respiration when water PO2 was reduced to 1.0–3.1 kPa. The fish held air inside the mouth and probably used the gills as gas-exchange surfaces since no rich vascularization occurred in the mouth linings. As is known for other air-breathing fishes, fAB increased with decreasing water PO2. Both buccal gas volume (VB) and inspired volume (VI) were significantly correlated with body mass (Mb). At a given Mb, VI was nearly always equal to VB,implying almost complete buccal gas renewal in every breathing cycle. A temporal reduction in expired volume (VE) was probably due to a low aerial gas exchange ratio (CO2 elimination/O2uptake). Air breathing appears to have evolved in O. lacepedii as an adaptation to aquatic hypoxia in the burrows. The acquisition of the novel respiratory capacity enables this species to stay in the burrows during low tide and extends the resident time in the mudflat, thereby increasing its chances of tapping the rich resources of the area.
The ventilatory, cardiac and behavioural responses of resting cuttlefish(Sepia officinalisL.) to sudden visual stimuli
Authors: King Alison J. , Adamo Shelley A.
Published: March 2006

When startled, some animals reduce ventilation rate and heart rate, and become motionless. The function of this response, if any, remains unknown. We used non-invasive ultrasound imaging to monitor the ventilatory, cardiac and postural responses of cuttlefish exposed to sudden visual stimuli. Simultaneously, we recorded cuttlefish behaviour using an overhead video camera. Upon presentation of the sudden visual stimulus (rapidly approaching bird cut-out), cuttlefish rapidly changed the colour and the texture of their skin, taking on characteristics of the Deimatic Display. Cuttlefish also became motionless (behavioural freezing), hyperinflated their mantles, and decreased their ventilation rate and heart rate. We found no evidence of a relationship between the intensity of the Deimatic Display and the intensity of any other measured parameter. Ventilation rate decreased during behavioural freezing. Hyperinflation of the mantle was most intense in preparation for and during behavioural freezing. Heart rate decreases occurred during mantle hyperinflation and were greatest in animals showing the most hyperinflation. Decreased heart rate may not be adaptive per se. Instead, it might be a product of the unusual arrangement of the cuttlefish peripheral vasculature,which could be compressed during mantle hyperinflation. By filling the mantle with water (hyperinflation), this response to sudden stimuli may help cuttlefish prepare for possible flight by jet propulsion, which often follows the Deimatic Display.
Sex differences in food intake and digestive constraints in a nectarivorous bird
Authors: Markman Shai , Tadmor-Melamed Hagar , Arieli Amichai , Izhaki Ido
Published: March 2006

Sex-specific foraging behaviour might be influenced by digestive constraints. However, evidence for sex differences in digestive performance is limited. Various physiological traits are known to be body size dependent. Therefore, we hypothesized that body size differences between male and female birds may lead to differences in their digestive characteristics. We predicted that if food intake and digestive functions are only governed by body mass,then males that are heavier than females would have higher food intake, food assimilation efficiency and gut transit time, but not after controlling for the effect of body mass.

We fed a diet of equicaloric solutions of sucrose and a 1:1 mixture of glucose and fructose (hexose mixture) solutions to Palestine sunbirds(Nectarinia osea). When fed sucrose solutions, males had longer transit times but similar absorption efficiencies as females. Transit times,corrected for differences in body mass and food intake, were still longer in males than in females when fed on sucrose solutions. The sex-specific differences in transit time disappeared when the birds were fed the hexose mixture.

Our results suggest that males take longer to digest than females when fed on sucrose-rich nectars as opposed to hexose-rich nectars, and therefore can allow themselves a relatively lower digestive capacity. This may suggest sex-specific co-evolution of sunbirds within mixed plant communities, which have both sucrose- and hexose-rich nectar-producing plants. Furthermore,future studies on digestion in birds may pay attention to sex-specific differences.
A New Efficient Method for Stereoselective Synthesis of 2-Deoxy-C-ribofuranosides
Authors: Mukaiyama Teruaki , Uchiro Hiromi , Hirano Noriyuki , Ishikawa Tatsuya
Published: March 2006

Stereoselective C-glycosylation of 2-deoxyribose derivatives having 3-O-thiocarbamoyl directing group with carbon nucleophiles was successfully carried out by using SiCl(OTf)3 as an activator. Several 2-deoxy-β-C-ribofuranosides which can be easily converted to 2′-deoxy-C-nucleosides were obtained in good yields with high stereoselectivities.
Photochemical Rearrangement of Chlorinated Dibenzo-p-dioxins. Regioselective Carbon–Oxygen Bond Homolysis from the Singlet Excited State, and Carbon–Chlorine Bond Homolysis from the Triplet Excited State
Authors: Kobayashi Takanori , Shimada Jun-ichi , Kitahara Chieko , Haga Naoki
Published: February 2006

UV light irradiation of 1-chloro-, 2-chloro-, 1,2-dichloro-, 2,3-dichloro-, and 2,7-dichlorodibenzo-p-dioxin in methanol leads to regioselective homolysis of carbon–oxygen bond from the singlet excited state to undergo rearrangement into chlorinated 2,2′-biphenols. On the contrary, reaction from the triplet excited state of chlorinated dioxins results in selective formation of dechlorinated congeners without altering the dioxin skeleton.
Framework for Canadian telehealth guidelines: summary of the environmental scan
Authors: Hogenbirk John C , Brockway Pam D , Finley John , Jennett Penny , Yeo Maryann , Parker-Taillon Dianne , Pong Raymond W , Szpilfogel Claudine C , Reid Dan , MacDonald-Rencz Sandra , Cradduck Trevor
Published: March 2006

A Canadian project (the National Initiative for Telehealth Guidelines) was established to develop telehealth guidelines that would be used by health professionals, by telehealth providers as benchmarks for standards of service and by accrediting agencies for accreditation criteria. An environmental scan was conducted, which focused on organizational, human resource, clinical and technological issues. A literature review, a stakeholder survey (245 mail-outs, 84 complete responses) and 48 key informant interviews were conducted. A framework of guidelines was developed and published as a preliminary step towards pan-Canadian policies. Interim recommendations were that organizations and jurisdictions might consider formal agreements to specify: (1) organizational interoperability; (2) technical interoperability; (3) personnel requirements; (4) quality and continuity-of-care responsibilities; (5) telehealth services; (6) remuneration; and (7) quality assurance processes. An additional recommendation was that flexible mechanisms were needed to ensure that accreditation criteria will be realistic and achievable in the context of rapid changes in technology, service integration and delivery, as well as in the context of operating telehealth services in remote or underserved areas.
Tele-electrocardiography in the epidemiological 'Study of Health in Pomerania' (SHIP)
Authors: Alte Dietrich , Völzke Henry , Robinson Daniel M , Kleine Volker , Grabe Hans Jörgen , John Ulrich , Felix Stephan B
Published: March 2006

We have evaluated a portable electrocardiogram (ECG) card in the large population-based epidemiological 'Study of Health in Pomerania' (SHIP). In all, 7008 men and women (20–79 years) were randomly selected from population registries and 4310 subjects participated. Participants used an ECG card for four weeks and recorded two ECGs daily. The participants were also encouraged to record additional ECGs in the case of symptomatic arrhythmias, chest pain or dizziness. The ECGs were sent via telephone. Acrobat (.pdf) files arrived at the study centre via email. Arrhythmias were analysed by visual ECG inspection. Seventy-one per cent of the participants sent at least 80% of the requested ECGs for four weeks. There were few problems (about 70) in the total of 38,162 ECGs transmitted. Overall, 94% of all ECGs were rated as 'good'. Physicians required about 1.5 h to read approximately 100 ECGs daily. The functionality and ergonomics of ECG cards appear to be sufficiently developed for large-scale use in epidemiological studies.
Understanding Store-Brand Purchase Behavior Across Categories
Authors: Hansen Karsten , Singh Vishal , Chintagunta Pradeep
Published: March 2006

This paper investigates whether the tendency to buy store brand is category specific, or an enduring consumer trait. We develop a multicategory brand-choice model with a factor-analytic structure on the covariance matrix of the coefficients. The methodology allows us to elicit the basic latent tendency for a household to buy store brands, while controlling for other causes such as price sensitivity. The model is applied to a set of ten food and nonfood product categories. We find strong evidence of correlations in household preferences for store brands across categories. Using a two-dimensional factor structure, we find that one of the factors explains a substantial amount of variation in store-brand preference, while the other factor explains price sensitivity—consistently across categories. The presence of these factors in all categories indicates that there are unobservable household-level traits that are non-category specific, i.e., stable across product categories. Using data from five holdout categories, we find that household estimates of these latent factors are very useful in predicting demand for store brands in new categories. Other potential applications for store managers are discussed.
MRSA – ‘Bug-Bear’ of a Surgical Practice: Reducing the Incidence of MRSA Surgical Site Infections
Authors: Guyot Andrea , Layer Graham
Published: March 2006

Adverse publicity (the ‘superbug') has demonstrated that the problem of MRSA (methicillin-resistant Staphylococcus aureus) is prevalent in many of the country's most prestigious hospitals. The results of the mandatory UK Department of Health (DH) surveillance for early surgical site infections in orthopaedic surgery (SSIS) have been published recently for the period April 2004 to March 2005 when 41,242 operations were studied (< http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsStatistic > 28 October 2005). Infection rates were generally and gratifyingly low but 48% of surgical site infections were caused by Staph. aureus and of those 68% were MRSA. The following article will discuss the aetiology and prevention of MRSA surgical site infection.
Lost ‘Swab’ at Inguinal Hernioplasty Under Local Anaesthesia
Authors: Gostling Julie , McKain E Steve , Dumont Steve , Stephenson Brian M
Published: March 2006

Small surgical swabs should not be placed adjacent to polypropylene mesh prosthetics
Identifying High-Risk Patients Undergoing Urgent and Emergency Surgery
Authors: Neary WD , Foy C , Heather BP , Earnshaw JJ
Published: March 2006

INTRODUCTION

The aim was to identify high-risk patients undergoing non-elective orthopaedic and general surgery.

PATIENTS AND METHODS

This was a retrospective cohort study of all non-elective general and orthopaedic surgical procedures performed in a 1-year interval in a district general hospital. A total of 1869 patients underwent urgent or emergency surgery in the calendar year 2000. Outcomes were identified from various related hospital databases. Case notes of those who died were reviewed. Risk factors for mortality were examined using univariate and multivariate analysis.

RESULTS

The mortality rates were 89/1869 (5%) at 30 days and 216 (12%) after 1 year. The high initial death rate continued for about 100 days after surgery. Increasing age (P < 0.0001), size of operation (P = 0.004) and American Society of Anesthesiologists (ASA) fitness grade (P < 0.0001) were associated with significantly higher risk of death at 1 year on multivariate analysis. A high risk group was identified of 273 patients aged over 50 years, of ASA Grade III or above who needed major surgery; they had a 30-day mortality rate of 18%.

CONCLUSIONS

A simple scoring system could be used to identify high-risk patients who require non-elective surgery that could be a target for interventions to try and reduce their risk of death.
Registry of Shoulder Arthroplasty – The Scottish Experience
Authors: Sharma S , Dreghorn CR
Published: March 2006

INTRODUCTION

Recognising that timely dissemination of information in the orthopaedic community was important and in the absence of any national guidelines for shoulder arthroplasty, the Scottish shoulder arthroplasty registry, a voluntary registry, was started in 1996. The goals of the registry were to assess contemporary practice, provide a benchmark against which surgeons could compare their practice, identify risk factors for a poor outcome, and to improve outcomes through continuous feedback to the participating surgeons.

PATIENTS AND METHODS

A standardised proforma was used to collect information on the diagnostic and demographic data, type of procedure performed, type of implant used, any associated procedures performed in conjunction with the arthroplasty, and peri-operative complications. Postoperative pain, activity and patient satisfaction were assessed annually using another standardised proforma.

RESULTS

Twenty surgeons have contributed to the register and 451 shoulder arthroplasties were registered over a 5-year period. Of patients, 23.2% were male and 76.8% female. The mean age was 65 years (range, 37–90 years). Shoulder arthroplasty was commonly performed for rheumatoid arthritis followed by trauma, osteoarthritis and avascular necrosis of the humeral head. Overall, 397 (88%) patients had a hemi-arthroplasty and 54 (12%) had a total shoulder replacement. Of the 54 cases that had a glenoid replacement, 28 were performed for inflammatory arthritis, 21 for osteoarthritis and 5 were for revisions. The humeral component was cemented in 204 (45%) cases, 160 of whom had a shoulder replacement for trauma. The glenoid component was cemented in 48 (89%) cases. Cross referencing our data with the figures of the actual number of shoulder arthroplasties performed, however, indicated that our registry at best collected only 53% of all the shoulder arthroplasties performed in Scotland annually.

CONCLUSIONS

The value of a joint registry is dependent on the accuracy and completeness of the data entered. Our registry, therefore, fails as an implant registry. We believe that compliance for data registration can only be ensured if dedicated data collection staff are employed to co-ordinate the data collection and collation process.
Femoral Cementing Techniques: Current Trends in the UK
Authors: Nedungayil SK , Mehendele S , Gheduzzi S , Learmonth ID
Published: March 2006

INTRODUCTION

The results of a survey conducted amongst hip surgeons in Great Britain on the use of bone cement and femoral cementing techniques are reported.

MATERIALS AND METHODS

A postal questionnaire was sent out to the members of the British Orthopaedic Association for their opinion on cement usage and femoral cementing techniques in primary hip arthroplasty.

RESULTS

A majority of surgeons use high viscosity cement (82%) and cement containing antibiotics (77%). Almost a fifth of the respondents were unaware of the place of storage of the cement and of the ambient theatre temperature. Over two-thirds experienced inconsistencies in the handling of cement and attributed this to inconsistent theatre temperature (40%) and storage temperature (14%). A majority of the surgeons followed the ‘modern’ femoral cementing technique of vacuum mixing (94%), plugging the femoral canal (98%), pulsed lavage (87%), retrograde cement introduction (95%), use of stem centralisers (62%) and cement pressurisation. Four-fifths of the surgeons used time as a guide for cement and stem insertion rather than consistency of the cement.

CONCLUSIONS

Though most of the surgeons follow contemporary cementing techniques, it appears that inconsistency of the working properties of the cement is a major impediment. Many surgeons are also unaware of the variables that can influence polymerisation and working time of the cement.
Perceptions of the Application of Fast-Track Surgical Principles by General Surgeons
Authors: Walter Catherine Jane , Smith Adrian , Guillou Pierre
Published: March 2006

INTRODUCTION

Fast-track surgery is a novel approach which uses a multimodal package of changes to traditional surgical care to reduce the stress response evoked by surgery allowing for enhanced recovery times. The depth of understanding and application of fast-track principles to general surgical practice by consultant surgeons is unknown.

MATERIALS AND METHODS

‘Core management features’ central to published fast-track general surgical studies were identified following a comprehensive Medline literature search. The knowledge and application of these features were examined in a postal questionnaire sent to 116 general surgeons in a single region.

RESULTS

Of respondents, 31% indicated they were currently using fast-track surgery (the ‘fast-trackers'). The number of fast-track compliant responses was calculated for each consultant (range, 1–12 of 14). Mean scores for ‘fast-trackers’ of 8.45 (± 2.188) and ‘non-fast-trackers’ of 6.16 (± 2.352) showed no significant differences (P > 0.6). The ‘fast-trackers’ median estimated length of stay (LOS) was 5 days (inter-quartile range [IQR], 4–7) which was significantly lower than the 7 day (IQR 6–8) LOS estimates given by the ‘non-fast-trackers’ (P < 0.01).

CONCLUSIONS

Despite estimating reduced LOS, no significant difference in total fast-track compliant responses was found between the ‘fast-tracker’ and ‘non-fast-tracker’ groups. The ‘fast-trackers’ estimated LOS of 5 days is 2.5 times the 2 day LOS reported in the published fast-track studies. A significant gap exists between the perception and realisation of fast-track methodology amongst general surgeons.
Proton Pump Inhibition is a Feasible Primary Alternative to Surgery and Balloon Dilatation in Adult Peptic Pyloric Stenosis (APS): Report of Six Consecutive Cases
Authors: Shabbir J , Durrani S , Ridgway PF , Mealy K
Published: March 2006

INTRODUCTION

Surgery has been the gold standard in the treatment of adult pyloric stenosis (APS). The introduction of proton pump inhibitors (PPIs) in 1989 revolutionised the treatment of peptic ulcer disease and its complications.

PATIENTS AND METHODS

We carried out a prospective study to evaluate the effectiveness of PPIs as an alternative to surgery for treatment of APS. Six consecutive patients admitted with a diagnosis of adult peptic pyloric stenosis between November 1999 and August 2002 were studied. The diagnosis was confirmed with endoscopy. All patients were commenced on a twice-daily dose of intravenous PPI. This was changed to oral treatment after 2 days. Main outcome measures evaluated were resolution of symptoms on PPIs and failure of medical therapy.

RESULTS

There were five females and one male. Median age at diagnosis was 72 years (range, 30–90 years). Median duration of symptoms was 2 weeks (range, 1–5 weeks). Of the patients, five had a history of peptic ulcer disease. Complete resolution was achieved in 5 patients (83%). Median duration for resolution of symptoms was 9 days (range, 5–14 days). All patients were changed to oral PPIs after 2 days. One patient did not respond to oral therapy and required surgical intervention (pyloroplasty). Median follow-up was 26 months (range, 6–48 months). There was no recurrence of symptoms. All patients were discharged on low-dose PPI.

CONCLUSIONS

This study supports the view that proton pump inhibitors are a safe and feasible alternative to surgery in adult pyloric stenosis secondary to peptic ulcer disease.
Dead Men and Radiologists Don't Lie: A Review of Cadaveric and Radiological Studies of Rotator Cuff Tear Prevalence
Authors: Reilly P , Macleod I , Macfarlane R , Windley J , Emery RJH
Published: March 2006

INTRODUCTION

Rotator cuff tears are a common pathology, with a varied prevalence reported.

PATIENTS AND METHODS

A literature review was undertaken to determine the cadaveric and radiological (ultrasonography and magnetic resonance imaging [MRI]) prevalence of rotator cuff tear. The radiological studies were subdivided into symptomatic and asymptomatic subjects.

RESULTS

Cadaveric rotator cuff tears were found in 4629 shoulders of which only 2553 met the inclusion criteria. The prevalence of full-thickness tears was 11.75% and partial thickness 18.49% (total tears 30.24%). The total tear rate in ultrasound asymptomatic was 38.9% and ultrasound symptomatic 41.4%. The total rate in MRI asymptomatic was 26.2% whilst MRI symptomatic was 49.4%.

DISCUSSION

The unselected cadaveric population should contain both symptomatic and asymptomatic subjects. A prevalence of tears between the symptomatic and asymptomatic radiological groups would be expected. However, apart from the MRI asymptomatic group, the radiological prevalence of rotator cuff tears exceeds the cadaveric.

CONCLUSIONS

Rotator cuff tears are frequently asymptomatic. Tears demonstrated during radiological investigation of the shoulder may be asymptomatic. It is important to correlate radiological and clinical findings in the shoulder.
How Well Equipped are ENT Wards for Airway Emergencies?
Authors: Banga Rupan , Thirlwall Andrea , Corbridge Rogan
Published: March 2006

INTRODUCTION

With increased cross cover of specialities at night and more direct triaging of casualty patients to ENT wards, there is an increased need to ensure that there is adequate provision of emergency airway management. There are currently no national guidelines on what equipment should be available on ENT wards, and the authors have devised a portable airway box with all equipment deemed necessary to manage an acute airway. We believe that all junior doctors covering ENT should have airway training and access to an airway box. The aim of this study was to determine the provision of on-ward airway equipment and training on ENT wards in England.

MATERIALS AND METHODS

A telephone survey of all English hospitals with in-patient ENT services.

RESULTS

A total of 103 departments were contacted with 98% response rate. Most wards were covered by a combination of ENT and other specialties. Results indicated that only 18% of departments had an airway box and 28% had some training in airway management.

CONCLUSIONS

Results suggest poor provision of emergency airway equipment and training on wards. We recommend the use of an airway box, and list of minimal equipment required.
The Surgical Risk of Suprapubic Catheter Insertion and Long-Term Sequelae
Authors: Ahluwalia RS , Johal N , Kouriefs C , Kooiman G , Montgomery Bruce SI , Plail RO
Published: March 2006

INTRODUCTION

Suprapubic catheter (SPC) insertion is a common urological procedure, which is often referred to as safe and simple even in inexperienced hands. There is, however, very little published evidence on the safety of this procedure. Our study aimed to provide evidence on the associated morbidity and mortality and provide guidance for practising clinicians.

PATIENTS AND METHODS

A total of 219 patients who underwent SPC insertion under cystoscopic guidance at two urology institutions between 1994 and 2002 were identified and their case notes reviewed.

RESULTS

The intra-operative complication rate was 10% and the 30-day complications rate was 19%. Mortality rate was 1.8%. Long-term complications included recurrent UTIs (21%), catheter blockage (25%) resulting in multiple accident and emergency attendance (43%). Despite this, the satisfaction rate was high (72%) and most patients (89%) prefer the SPC over the urethral catheter.

CONCLUSIONS

SPC bladder drainage results in a high patient satisfaction rate. Patients and clinicians should be aware of the potential complications associated with SPC insertion.
The Effect of Total Hip Replacement on the Employment Status of Patients Under the Age of 60 Years
Authors: Mobasheri R , Gidwani S , Rosson JW
Published: March 2006

INTRODUCTION

A retrospective study was undertaken of a consecutive cohort of 86 patients (101 hips) under the age of 60 years operated on by a single orthopaedic team between 1993 and 2003 at a district general hospital.

PATIENTS AND METHODS

Demographic and diagnostic data were collected from patients’ hospital records, and a detailed questionnaire regarding occupational status was used at follow-up.

RESULTS

Nearly all of the patients working prior to surgery returned to employment following surgery. Nearly half of those not working pre-operatively regained employment postoperatively; among those that did not return to work, this was for reasons unrelated to their hip. Those patients who had been out of work prior to their surgery took significantly longer to return to work.

CONCLUSIONS

Our study demonstrates that total hip replacement is effective in keeping patients under the age of 60 years employed. It is also effective in allowing those already off work due to hip pain to return to work, although there is a much greater delay.
On Improving the Conceptual Foundations of International Marketing Research
Authors: Douglas Susan P. , Craig C. Samuel
Published: February 2006

International marketing research plays a vital role as firms expand globally. Yet limited attention has been paid to the conceptual underpinnings of research needed to guide expansion. This article focuses on these issues and specifically examines the conceptual framework that guides research, the geographic units of analysis, and the constructs. The authors suggest two alternative approaches to organizing cross-cultural research: the adapted etic and the linked emic.
Cultural Distance and Psychic Distance: Two Peas in a Pod?
Authors: Sousa Carlos M.P. , Bradley Frank
Published: February 2006

Cultural distance and psychic distance are two concepts that are widely used in the international business literature. A large number of studies use both concepts interchangeably with no clear distinction between them. The authors propose a new model to assess cultural distance and psychic distance separately. Through the use of survey data of more than 300 managers, this article shows that both concepts are conceptually different and that psychic distance is determined by cultural distance and the individual values of the managers.
An Exploratory Study of the Functional Forms of Export Market Identification Variables
Authors: Williamson Nicholas C. , Kshetri Nir , Heijwegen Tim , Schiopu Andreea Fortuna
Published: February 2006

Exploratory research demonstrates that the import market potential, import market competitiveness, and “barriers-to-imports” variables can be successfully integrated into a shift-share framework for identifying export markets. The authors present managerial implications for global competitive strategy in exporting.
Who Standardizes Advertising more Frequently, and Why Do They Do So? A Comparison of U.S. and Japanese Subsidiaries’ Advertising Practices in the European Union
Authors: Taylor Charles R. , Okazaki Shintaro
Published: February 2006

This study reports the results of a survey of executives of subsidiaries of Japanese and U.S. firms operating in the European Union (EU). The fundamental issues addressed are the degree to which firms perceive EU national markets as similar, the degree to which firms use standardized advertising across the EU, and firms’ reasons for standardizing advertising. Global marketing strategy theory contends that firms are more likely to follow a strategy if the environment is conducive to that strategy, suggesting that greater convergence of EU markets would lead to greater standardization of advertising. The findings of this study indicate that both Japanese and U.S. managers still note obstacles to the standardization of advertising in the EU. Consistent with global marketing strategy theory, overall levels of standardization of advertising are somewhat moderate. Firms in the United States are slightly more likely than Japanese firms to use a standardized advertising strategy in the EU. In addition, U.S. firms tend to put greater emphasis on the creation of a uniform brand image, whereas managers from both countries value cost savings. Japanese firms value the higher level of central control that can emanate from standardization.