bluuebunny/crossref_metadata_2025 huggingface dataset:
Low Hepatitis C Viral Load Predicts Better Long-Term Outcomes in Patients Undergoing Resection of Hepatocellular Carcinoma Irrespective of Serologic Eradication of Hepatitis C Virus
Authors: Shindoh Junichi , Hasegawa Kiyoshi , Matsuyama Yutaka , Inoue Yosuke , Ishizawa Takeaki , Aoki Taku , Sakamoto Yoshihiro , Sugawara Yasuhiko , Makuuchi Masatoshi , Kokudo Norihiro
Published: November 2012

Purpose

Hepatitis C virus (HCV) infection has been recognized as a potent risk factor for the postoperative recurrence of hepatocellular carcinoma (HCC). However, little is known about the impact of HCV viral load on surgical outcomes. The study objective was to investigate clinical significance of HCV viral load on long-term outcomes of HCC.

Patients and Methods

Three hundred seventy patients who were classified as Child-Pugh class A and underwent curative liver resections for HCV-related HCC were divided into low and high viral load groups (≤ or > 5.3 log10IU/mL) based on the results of a minimum P value approach to predict moderate to severe activity of hepatitis; the clinical outcomes were then compared.

Results

The 5-year recurrence-free survival rate was 36.1% in the low viral load group and 12.4% in the high viral load group (P < .001). The 5-year overall survival rate was 76.6% in the low viral load group and 57.7% in the high viral load group (P < .001). Multivariate analysis confirmed significant correlation between high viral load and tumor recurrence with a hazard ratio of 1.87 (95% CI, 1.41 to 2.48; P < .001). Subanalysis revealed that the favorable results in the low viral load group were not attributed to whether or not serologic eradication of HCV was obtained both in primary and recurrent lesions.

Conclusion

Low HCV viral load predicts better long-term surgical outcomes in patients with HCC regardless of the serologic eradication of HCV.
Bortezomib Added to Daunorubicin and Cytarabine During Induction Therapy and to Intermediate-Dose Cytarabine for Consolidation in Patients With Previously Untreated Acute Myeloid Leukemia Age 60 to 75 Years: CALGB (Alliance) Study 10502
Authors: Attar Eyal C. , Johnson Jeffrey L. , Amrein Philip C. , Lozanski Gerard , Wadleigh Martha , DeAngelo Daniel J. , Kolitz Jonathan E. , Powell Bayard L. , Voorhees Peter , Wang Eunice S. , Blum William , Stone Richard M. , Marcucci Guido , Bloomfield Clara D. , Moser Barry , Larson Richard A.
Published: November 2012

Purpose

The purpose of this study was to determine remission induction frequency when bortezomib was combined with daunorubicin and cytarabine in previously untreated older adults with acute myeloid leukemia (AML) and safety of bortezomib in combination with consolidation chemotherapy consisting of intermediate-dose cytarabine (Int-DAC).

Patients and Methods

Ninety-five adults (age 60 to 75 years; median, 67 years) with previously untreated AML (including therapy-related and previous myelodysplastic syndrome) received bortezomib 1.3 mg/m2 intravenously (IV) on days 1, 4, 8, and 11 with daunorubicin 60 mg/m2 on days 1 through 3 and cytarabine 100 mg/m2 by continuous IV infusion on days 1 through 7. Patients who achieved complete remission (CR) received up to two courses of consolidation chemotherapy with cytarabine 2 gm/m2 on days 1 through 5 with bortezomib. Three cohorts with escalating dose levels of bortezomib were tested (0.7, 1.0, and 1.3 mg/m2). Dose-limiting toxicities were assessed during the first cycle of consolidation. The relationship between cell surface expression of CD74 and clinical outcome was assessed.

Results

Frequency of CR was 65% (62 of 95), and 4% of patients (four of 95) achieved CR with incomplete platelet recovery (CRp). Eleven patients developed grade 3 sensory neuropathy. Bortezomib plus Int-DAC proved tolerable at the highest dose tested. Lower CD74 expression was associated with CR/CRp (P = .04) but not with disease-free or overall survival.

Conclusion

The addition of bortezomib to standard 3 + 7 daunorubicin and cytarabine induction chemotherapy for AML resulted in an encouraging remission rate. The maximum tested dose of bortezomib administered in combination with Int-DAC for remission consolidation was 1.3 mg/m2 and proved tolerable. Further testing of this regimen is planned.
A dual function for canonical Wnt/β-catenin signaling in the developing mammalian cochlea
Authors: Jacques Bonnie E. , Puligilla Chandrakala , Weichert Rachel M. , Ferrer-Vaquer Anna , Hadjantonakis Anna-Katerina , Kelley Matthew W. , Dabdoub Alain
Published: November 2012

The canonical Wnt/β-catenin signaling pathway is known to play crucial roles in organogenesis by regulating both proliferation and differentiation. In the inner ear, this pathway has been shown to regulate the size of the otic placode from which the cochlea will arise; however, direct activity of canonical Wnt signaling as well as its function during cochlear mechanosensory hair cell development had yet to be identified. Using TCF/Lef:H2B-GFP reporter mice and transfection of an independent TCF/Lef reporter construct, we describe the pattern of canonical Wnt activity in the developing mouse cochlea. We show that prior to terminal mitosis, canonical Wnt activity is high in early prosensory cells from which hair cells and support cells will differentiate, and activity becomes reduced as development progresses. Using an in vitro model we demonstrate that Wnt/β-catenin signaling regulates both proliferation and hair cell differentiation within the developing cochlear duct. Inhibition of Wnt/β-catenin signaling blocks proliferation during early mitotic phases of development and inhibits hair cell formation in the differentiating organ of Corti. Conversely, activation increases the number of hair cells that differentiate and induces proliferation in prosensory cells, causing an expansion of the Sox2-positive prosensory domain. We further demonstrate that the induced proliferation of Sox2-positive cells may be mediated by the cell cycle regulator cyclin D1. Lastly, we provide evidence that the mitotic Sox2-positive cells are competent to differentiate into hair cells. Combined, our data suggest that Wnt/β-catenin signaling has a dual function in cochlear development, regulating both proliferation and hair cell differentiation.
miR-1 and miR-206 regulate angiogenesis by modulating VegfA expression in zebrafish
Authors: Stahlhut Carlos , Suárez Yajaira , Lu Jun , Mishima Yuichiro , Giraldez Antonio J.
Published: November 2012

Cellular communication across tissues is an essential process during embryonic development. Secreted factors with potent morphogenetic activity are key elements of this cross-talk, and precise regulation of their expression is required to elicit appropriate physiological responses. MicroRNAs (miRNAs) are versatile post-transcriptional modulators of gene expression. However, the large number of putative targets for each miRNA hinders the identification of physiologically relevant miRNA-target interactions. Here we show that miR-1 and miR-206 negatively regulate angiogenesis during zebrafish development. Using target protectors, our results indicate that miR-1/206 directly regulate the levels of Vascular endothelial growth factor A (VegfA) in muscle, controlling the strength of angiogenic signaling to the endothelium. Conversely, reducing the levels of VegfAa, but not VegfAb, rescued the increase in angiogenesis observed when miR-1/206 were knocked down. These findings uncover a novel function for miR-1/206 in the control of developmental angiogenesis through the regulation of VegfA, and identify a key role for miRNAs as regulators of cross-tissue signaling.
Aggregate Savings and External Imbalances in China
Authors: Yang Dennis Tao
Published: November 2012

Over the last decade, the internal and external macroeconomic imbalances in China have risen to unprecedented levels. In 2008, China's national savings rate soared to over 53 percent of its GDP, whereas its current account surplus exceeded 9 percent of GDP. This paper presents a unified framework for understanding the structural causes of these imbalances. I argue that the imbalances are attributable to a set of policies and institutions embedded in the economy. I propose a unified framework for understanding the joint causes of the high savings rate and external imbalances in China. My explanations first focus on an array of factors that encouraged saving across the corporate, government, and household sectors, such as policies that affected sectoral income distribution, along with factors like incomplete social welfare reforms, and population control policies. I then turn to policies that limited investment in China, thus preventing the high savings from being used domestically. Finally, I will examine how trade policies, such as export tax rebates, special economic zones, and exchange rate policies, strongly promote exports. Moreover, the accession of China to the World Trade Organization has dramatically amplified the effects of these structural distortions. In conclusion, I recommend some policy reforms for rebalancing the Chinese economy.
From Exxon to BP: Has Some Number Become Better than No Number?
Authors: Kling Catherine L , Phaneuf Daniel J , Zhao Jinhua
Published: November 2012

On March 23, 1989, the Exxon Valdez ran aground in Alaska's Prince William Sound and released over 250,000 barrels of crude oil, resulting in 1300 miles of oiled shoreline. The Exxon spill ignited a debate about the appropriate compensation for damages suffered, and among economists, a debate concerning the adequacy of methods to value public goods, particularly when the good in question has limited direct use, such as the pristine natural environment of the spill region. The efficacy of stated preference methods generally, and contingent valuation in particular, is no mere academic debate. Billions of dollars are at stake. An influential symposium appearing in this journal in 1994 provided arguments for and against the credibility of these methods, and an extensive research program published in academic journals has continued to this day. This paper assesses what occurred in this academic literature between the Exxon spill and the BP disaster. We will rely on theoretical developments, neoclassical and behavioral paradigms, empirical and experimental evidence, and a clearer elucidation of validity criteria to provide a framework for readers to ponder the question of the validity of contingent valuation and, more generally, stated preference methods.
The relative effects of fat versus muscle mass on cystatin C and estimates of renal function in healthy young men
Authors: Chew-Harris Janice S C , Florkowski Christopher M , George Peter M , Elmslie Jane L , Endre Zoltan H
Published: November 2012

Background

It is well known that plasma creatinine concentration is affected by muscle mass, while some studies have suggested cystatin C is affected by body mass index (BMI). Our aim was to assess the effects of lean versus fat mass on cystatin C and creatinine derivative equations in estimating glomerular filtration rate (GFR) in healthy young men.

Methods

Three groups of participants were studied: those classified as normal (BMI 18-25 kg/m 2 with body fat, 30%); muscular subjects (BMI .30 kg/m 2 and body fat, 20%); and obese subjects (BMI .30 kg/m 2 and body fat .30%). All underwent diethylenetriamine pentaacetic acid GFR, bio-electrical impedance and dual-energy X-ray absorptiometry body composition analysis, measurement of plasma cystatin C, creatinine and high-sensitivity C-reactive protein and completed a diet record.

Results

Cystatin C was highest in the obese group (0.77 mg/L; 95% confidence intervals [CI] 0.69-0.77) and creatinine was highest in the muscular group (90.1 μmol/L; 95% CI 84.3-96.0). On multivariate analysis, body fat and GFR (P = 0.003) were significant determinants of cystatin C; muscle mass and age affected creatinine significantly (P = 0.02). Using cystatin C equations, Le Bricon and Hoek showed significantly lower estimated GFR in the obese group but performed reasonably well within 50%, 30% and 20% of GFR. Creatinine equations showed significant underestimations of GFR for the muscular group.

Conclusions

Body fat is a significant determinant of cystatin C while creatinine concentration is highly affected by muscle mass and age. Body composition plays an important role in the interpretation of renal function. Cystatin C equations are still accurate in predicting GFR in our healthy male group without chronic kidney disease.
Between-assay variability of faecal calprotectin enzyme-linked immunosorbent assay kits
Authors: Whitehead S J , French J , Brookes M J , Ford C , Gama R
Published: November 2012

Background

Faecal calprotectin (f-Cp), a marker of intestinal inflammation, can be used to distinguish between functional and organic bowel disease. F-Cp, following extraction, is commonly quantified using enzyme-linked immunosorbent assays (ELISAs) but there are no data comparing the different f-Cp assays or sample extraction devices. We, therefore, evaluated and compared the performance of the Immunodiagnostik, Bühlmann and Eurospital f-Cp ELISA assays as well as the Roche, Immunodiagnostik and ScheBo Biotech commercial faecal extraction devices. We also briefly report results from a pilot f-Cp external quality assurance (EQA) scheme.

Methods

Imprecision, linearity, recovery, drift and limit of quantitation of the f-Cp assays were evaluated and between-assay variability assessed. The three commercial sample extraction devices were compared with the manual weighing method. Four faecal samples were distributed as part of a pilot EQA scheme to 15 laboratories using quantitative ELISA f-Cp assays.

Results

The three f-Cp assays demonstrated adequate intra-/interbatch imprecision, linearity and recovery. The crosscomparison study and EQA data demonstrated that, for the same sample, the Bühlmann assay reports up to 3.8 times higher f-Cp concentrations than the Immunodiagnostik and Eurospital assays. On average, the commercial extraction devices led to a 7.8-28.1% under-recovery of f-Cp in comparison to the manual weighing method.

Conclusions

Laboratories should be aware of the lack of the assay standardization, as demonstrated by the between-assay variability. A comparison between f-Cp concentrations reported by these assays and clinical markers of disease severity is required in order to determine their diagnostic accuracy. The EQA scheme represents the first available programme for f-Cp.
Identification of a rare variant haemoglobin (Hb Sinai-Baltimore) causing spuriously low haemoglobin A1c values on ion exchange chromatography
Authors: Smith Geoff , Murray Heather , Brennan Stephen O
Published: November 2012

Commonly used methods for assay of haemoglobin A1c (HbA1c) are susceptible to interference from the presence of haemoglobin variants. In many systems, the common variants can be identified but scientists and pathologists must remain vigilant for more subtle variants that may result in spuriously high or low HbA1c values. It is clearly important to recognize these events whether HbA1c is being used as a monitoring tool or, as is increasingly the case, for diagnostic purposes. We report a patient with a rare haemoglobin variant (Hb Sinai-Baltimore) that resulted in spuriously low values of HbA1c when assayed using ion exchange chromatography, and the steps taken to elucidate the nature of the variant.
Crowdsourcing New Product Ideas over Time: An Analysis of the Dell IdeaStorm Community
Authors: Bayus Barry L.
Published: November 2012

Several organizations have developed ongoing crowdsourcing communities that repeatedly collect ideas for new products and services from a large, dispersed “crowd” of nonexperts (consumers) over time. Despite its promises, little is known about the nature of an individual's ideation efforts in such an online community. Studying Dell's IdeaStorm community, serial ideators are found to be more likely than consumers with only one idea to generate an idea the organization finds valuable enough to implement, but they are unlikely to repeat their early success once their ideas are implemented. As ideators with past success attempt to again come up with ideas that will excite the organization, they instead end up proposing ideas similar to their ideas that were already implemented (i.e., they generate less diverse ideas). The negative effects of past success are somewhat mitigated for ideators with diverse commenting activity on others' ideas. These findings highlight some of the challenges in maintaining an ongoing supply of quality ideas from the crowd over time.

This paper was accepted by Kamalini Ramdas, entrepreneurship and innovation.
Tiers in One-Sided Matching Markets: Theory and Experimental Investigation
Authors: Wang Yu , Haruvy Ernan
Published: November 2012

The design of a matching market may affect behavior in prematch stages. In some settings, forward-looking agents might purchase low-priced properties with the intention of trading up. From a design standpoint, such behavior is undesirable. We investigate a tiered structure as a potential solution. Using a model that endogenizes prematch acquisition decisions, we show that tiers promote exchange while protecting the primary market. In the laboratory, we find that both firm revenue and total social surplus are improved by tiered matching, and the amount of improvement depends on the exchange mechanism the firm uses. We focus on two popular mechanisms—deposit first and request first. We find that subjects are less likely to take advantage of the match under tier-free deposit first mechanism, possibly because of risk aversion. Thus, a tiered approach is more critical under the request first mechanism. We confirm that risk aversion partly explains deviations from theory.

This paper was accepted by Uri Gneezy, behavioral economics.
Dancing with the Enemy? Relational Hazards and the Contingent Value of Repeat Exchanges in M&A Markets
Authors: Lee Jeongsik ”Jay”
Published: November 2012

I examine the problem of relational hazards between repeat exchange partners and the contingent roles of trade uncertainty and future exchange prospects in moderating the potentially conflicting effects of past exchanges on these hazards, thereby facilitating or restraining the formation of relational embeddedness. On the data of advisory relationships in U.S. mergers and acquisitions from 1981 to 2004, I find that firms that repeatedly hire the same investment banks as financial advisors tend to overpay for acquisition targets, as reflected by negative investor reactions measured in the cumulative abnormal return. In addition, the degree of overpayment increases with the frequency of prior exchanges. This adverse effect of exchange history grows if the uncertainty regarding the target firm rises. However, better prospects for future business with acquiring firms help mitigate this negative effect, although this moderating effect varies across the types of exchange experience. The findings suggest that a potentially complex and nuanced process underlies repeat exchanges, which are an oft-claimed precursor of relational embeddedness, to deliver tangible economic benefits. This study contributes to the emerging literature on the “dark side” of embeddedness and, more broadly, to the sociology of markets and organizations by substantiating the contingency mechanisms that shape the value of a repeat relationship in market exchanges.
Guilt by Design: Structuring Organizations to Elicit Guilt as an Affective Reaction to Failure
Authors: Bohns Vanessa K. , Flynn Francis J.
Published: November 2012

In this article, we outline a model of how organizations can effectively shape employees’ affective reactions to failure. We do not suggest that organizations eliminate the experience of negative affect following performance failures—instead, we propose that they encourage a more constructive form of negative affect (guilt) instead of a destructive one (shame). We argue that guilt responses prompt employees to take corrective action in response to mistakes, whereas shame responses are likely to elicit more detrimental effects of negative affect. Furthermore, we suggest that organizations can play a role in influencing employees’ discrete emotional reactions to the benefit of both employees and the organization. We describe the necessary antecedents for encouraging guilt responses without simultaneously eliciting shame. In essence, employees are more likely to experience guilt (but not shame) if they feel they had control over a specific negative event and the event resulted in a negative outcome for others. Given these necessary preconditions, we identify a set of organizational characteristics—autonomy, specificity of performance feedback, and outcome interdependence—that can be modified to make the experience of guilt more likely than that of shame in the workplace. The ethical and practical limits of shaping employees’ emotional experiences within a negative affective domain are also addressed.
Dynamism, Capital Structure, and Performance in a Sub-Saharan Economy: Extending the Institutional Difference Hypothesis
Authors: Ofori-Dankwa Joseph , Julian Scott D.
Published: November 2012

Extant research examining the capital structure–performance relationship has been undertaken primarily in developed economies. These studies integrate agency theory considerations with the contingency perspective and suggest a positive interaction between sector dynamism, equity, and performance. Our study extends this research stream by examining the capital structure–performance link in a sub-Saharan economy, an underresearched but economically emerging region. Using logic undergirding a substantial stream of institutional theory-based studies that we term the institutional difference hypothesis, we argue that the implications of the capital structure–performance relationship are contingent on the extent of national-level institutional underdevelopment. Taking into account institutional differences between developed economies and those in the sub-Saharan region, we hypothesize a negative interaction between sector dynamism, equity, and firm performance in sub-Sahara. Using longitudinal data from Ghanaian corporations for 1996–1999, we find substantial support for our hypothesis. Contrary to findings from developed economies, sector dynamism negatively moderates the firm equity–performance relationship: a strongly positive effect of equity on performance in stable sectors becomes slightly negative in highly dynamic ones. We unpack the implications of these results for theory and research.
A Concept Generation Support System for Product-Service System Development
Authors: Kim Kwang-Jae , Lim Chie-Hyeon , Lee Dong-Hee , Lee Jin , Hong Yoo-Suk , Park Kwangtae
Published: November 2012

A product-service system (PSS) is a novel type of business model that integrates products and services in a single system. It provides a strategic alternative to product-oriented economic growth and price-based competition in the global market. This research proposes a methodology to support the generation of innovative PSS concepts, called the PSS concept generation support system. The models and strategies of 118 existing PSS cases were analyzed, and the insights extracted were used to develop the methodology. The methodology consists of various tools and a systematic procedure to support the generation process. It is generic enough to be applied to a variety of PSS contexts. The methodology is demonstrated and verified via case studies on the washing machine and refrigerator industries. The proposed PSS concept generation support system can serve as an efficient and effective aid to PSS designers for new PSS development.
Questionable safety of thyroid surgery with same day discharge
Authors: Doran HE , England J , Palazzo F
Published: November 2012

INTRODUCTION

Over the last two decades increasing numbers of surgical procedures have been performed on an outpatient basis. In 2000 the National Health Service in England set the target of performing 75% or more of all elective surgical procedures as day cases and in 2001 the British Association of Day Surgery added thyroidectomy to the list of day case procedures. However, same day discharge following thyroidectomies has been adopted by only a very small number of UK centres. The aim of this review was to establish the evidence base surrounding same day discharge thyroid surgery.

METHODS

The British Association of Endocrine and Thyroid Surgeons commissioned the authors to perform a review of the best available evidence regarding day case thyroid surgery as a part of a consensus position to be adopted by the organisation. A MEDLINE® review of the English medical literature was performed and the relevant articles were collated and reviewed.

RESULTS

There are limited comparative data on day case thyroid surgery. It is feasible and may save individual hospitals the cost of inpatient stay. However, the risk of airway compromising and life threatening post-operative bleeding remains a major concern since it is not possible to positively identify those patients most and least at risk of bleeding after thyroidectomy. It is estimated that half of all post-thyroidectomy bleeds would occur outside of the hospital environment if patients were discharged six hours after surgery.

CONCLUSIONS

Same day discharge in a UK setting cannot be endorsed. Any financial benefits may be outweighed by the exposure of patients to an increased risk of an adverse outcome. Consequently, 23-hour surgery is recommended.
Safe percutaneous suprapubic catheterisation
Authors: Goyal NK , Goel A , Sankhwar SN
Published: November 2012

INTRODUCTION

We describe our technique of percutaneous suprapubic catheter insertion with special reference to steps that help to avoid common complications of haematuria and catheter misplacement.

METHODS

The procedure is performed using a stainless steel reusable trocar under local infiltrative anaesthesia, usually at the bedside. After clinical confirmation of a full bladder, the trocar is advanced into the bladder through a skin incision. Once the bladder is entered, the obturator is removed and the assistant inserts a Foley catheter followed by rapid balloon inflation. Slight traction is applied to the catheter for about five minutes. Patients with previous lower abdominal surgery, an inadequately distended bladder or acute pelvic trauma do not undergo suprapubic catheterisation using this method.

RESULTS

The procedure was performed in 72 men (mean age: 42.4 years, range: 18–78 years) with urinary retention with a palpable bladder. The average duration of the procedure was less than five minutes. No complications were noted in any of the patients.

CONCLUSIONS

Trocar suprapubic catheter insertion is a safe and effective bedside procedure for emergency bladder drainage and can be performed by resident surgeons. The common complications associated with the procedure can be avoided with a few careful steps.
Abdominal compartment syndrome caused by tension pneumoperitoneum in a scuba diver
Authors: Bunni J , Bryson PJ , Higgs SM
Published: November 2012

Abdominal compartment syndrome is a surgical emergency caused by a raised intra-abdominal pressure, which may lead to respiratory, cardiovascular and renal compromise. It is most commonly seen in post-operative and trauma patients and it has a variety of causes. Tension pneumoperitoneum (TP) is a rare cause of abdominal compartment syndrome most often seen after gastrointestinal endoscopy with perforation.

We present the case of a fit 52-year-old experienced female diver who developed TP and shock following a routine training dive to 27m. Following accidental inhalation of water, she had an unstaged ascent and, on reaching the surface, developed severe acute abdominal pain and distension. She was brought to our emergency department by air ambulance for assessment. Clinical and radiological examination revealed a shocked patient with dramatic free intra-abdominal gas and signs of abdominal compartment syndrome, which was treated with needle decompression. Symptoms and signs resolved quickly with no need for further surgical intervention. TP is a surgical emergency where surgery can be avoided with prompt diagnosis and treatment.
How safe is diathermy in patients with cochlear implants?
Authors: Frampton SJ , Ismail-Koch H , Mitchell TE
Published: November 2012

INTRODUCTION

Cochlear implants are surgically inserted electrical devices that enable severely or profoundly deaf individuals to interpret sounds from their environment and communicate more effectively. As a result of their electrical nature, they are susceptible to electromagnetic interference and can be damaged by excessive electrical energy. Surgical diathermy is one source of such potentially damaging energy. The British Cochlear Implant Group guidelines advise that monopolar diathermy should not be used in the head and neck region in patients with cochlear implants and that bipolar diathermy should not be used within 2cm of the implant ( http://www.bcig.org.uk/site/public/current/safety.htm ).

METHODS

A questionnaire was provided to 36 surgeons working in different specialties in the head and neck region, inquiring as to their knowledge of the safety considerations when using diathermy in cochlear implant patients. Thirty-five surgeons provided responses.

RESULTS

Overall, 77% of the respondents were unaware of the existence of published guidelines. Even when given an option to seek advice, 11% erroneously felt it was safe to use monopolar diathermy above the clavicles with a cochlear implant in situ and 49% felt that there was no restriction on the use of bipolar diathermy.

CONCLUSIONS

There is a significant deficit in the knowledge of safe operating practice in the rapidly expanding population of patients with cochlear implants which threatens patient safety. Through this publication we aim to increase awareness of these guidelines among members of the surgical community and this paper is intended to act as a point of reference to link through to the published safety guidelines.
Safety and efficacy of percutaneous nephrolithotomy for the treatment of paediatric urolithiasis
Authors: Veeratterapillay R , Shaw MBK , Williams R , Haslam P , Lall A , De la Hunt M , Hasan ST , Thomas DJ
Published: November 2012

INTRODUCTION

Paediatric percutaneous nephrolithotomy (PCNL) has revolutionised the treatment of paediatric nephrolithiasis. Paediatric PCNL has been performed using both adult and paediatric instruments. Stone clearance rates and complications vary according to the technique used and surgeon experience. We present our experience with PCNL using adult instruments and a 28Fr access tract for large renal calculi in children under 18 years.

METHODS

All patients undergoing PCNL at our institution between 2000 and 2009 were reviewed. Demographics, surgical details and post-operative follow-up information were obtained to identify stone clearance rates and complications.

RESULTS

PCNL was performed in 32 renal units in 31 patients (mean age: 10.8 years). The mean stone diameter was 19mm (range: 5–40mm). Twenty-six cases required single puncture and six required multiple tracts. Overall, 11 staghorn stones, 10 multiple calyceal stones and 11 single stones were treated. Twenty-seven patients (84%) were completely stone free following initial PCNL. Two cases had extracorporeal shock wave lithotripsy for residual fragments, giving an overall stone free rate of 91% following treatment. There was no significant bleeding or sepsis encountered either during the operation or in the post-operative setting. No patient required or received a blood transfusion.

CONCLUSIONS

Paediatric PCNL can be performed safely with minimal morbidity using adult instruments for large stone burden, enabling rapid and complete stone clearance.
Stapled diverticulectomy for solitary caecal diverticulitis
Authors: Uwechue RU , Richards ER , Kurer M
Published: November 2012

Caecal diverticulitis is an uncommon phenomenon in western countries. The clinical diagnosis is often difficult as it mimics other acute abdominal conditions like appendicitis, colitis or neoplasia. Diagnosis is often made at operation. Operative strategy has been controversial and there is no broad consensus emerging. We report the case of a 71-year-old woman, known to have chronic obstructive pulmonary disease, who presented acutely with right iliac fossa pain. A clinical diagnosis of appendicitis was made. At laparoscopy, a solitary, inflamed, gangrenous caecal diverticulum was found. A laparoscopic stapled diverticulectomy was performed. The patient made a steady post-operative recovery. Histology confirmed diverticulitis. We conclude that stapled diverticulectomy for solitary caecal diverticulitis is a safe and effective surgical strategy when confronted with this scenario.
Managing chondrosarcoma of the epiglottis: a case report
Authors: Maughan E , Pankhania M , Shah K , Gurr P
Published: November 2012

Laryngeal chondrosarcomas are a very rare malignancy with less than 150 cases reported in the literature. Of these, the epiglottis is the most unusual primary neoplastic subsite. Uncertainties arise owing to the extremely rare nature of the condition with regard to treatment and investigation for metastases in overtly low grade cases. We present the case of a 62-year-old woman with a low grade chondrosarcoma, arising from the tip of the epiglottis, presenting with dysphagia but no other symptoms.
Metabolic acidosis: neo-considerations for general surgeons
Authors: Martin LCE , Abah U , Bean E , Gupta S
Published: November 2012

Hyperchloraemic metabolic acidosis is a documented complication of neobladder formation. However, it usually improves with time and is mild. Severe and persistent metabolic acidosis may manifest when patients undergo further surgery for other reasons. Neobladder formation following radical cystectomy or cystoprostatectomy is becoming increasingly more common, and surgeons treating patients with neobladders should recognise and treat metabolic acidosis with intravenous fluids and bicarbonate.
Ectopic Cushing’s syndrome due to a mesenteric neuroendocrine tumour
Authors: Mashoori N , Rabani AH , Kazemeini AR
Published: November 2012

INTRODUCTION

Neuroendocrine tumours (NETs) are tumours that commonly involve the gastrointestinal system. Common primary sites in the gastrointestinal system include the small intestine, appendix, rectum and pancreas. Mesenteric NETs are extremely rare entities and are sparsely reported in the literature.

CASE HISTORY

We report the case of a 62-year-old woman with ectopic Cushing’s syndrome due to excessive adrenocorticotropic hormone secretion by a primary mesenteric tumour in the small intestine and its liver metastases.

CONCLUSIONS

Although rare, the mesentery can be a primary site for NETs. It can cause similar symptoms and require similar treatment options. Tumour resection and debulking are acceptable ways to improve both the survival and symptoms.
Management of colorectal polyp cancers
Authors: Naqvi S , Burroughs S , Chave HS , Branagan G
Published: November 2012

INTRODUCTION

Management of malignant colorectal polyps is controversial. The options are resection or surveillance. Resection margin status is accepted as an independent predictor of adverse outcome. However, the rate of adverse outcome in polyps with a resection margin of <1mm has not been investigated.

METHODS

A retrospective search of the pathology database was undertaken. All polyp cancers were included. A single histopathologist reviewed all of the included polyp cancers. Polyps were divided into three groups: clear resection margin, involved resection margin and unknown resection margin. Polyps were also analysed for tumour grade, morphology, Haggitt/Kikuchi level and lymphovascular invasion. Adverse outcome was defined as residual tumour at the polypectomy site and/or lymph node metastases in the surgical group and local or distant recurrence in the surveillance group.

RESULTS

Sixty-five polyps (34 male patients, mean age: 73 years, range: 50–94 years) were included. Forty-six had clear polyp resection margins; none had any adverse outcomes. Sixteen patients had involved polyp resection margins and twelve of these underwent surgery: seven had residual tumour and two of these patients had lymph node metastases. Four underwent surveillance, of whom two developed local recurrence. Three patients had resection margins on which the histopathologist was unable to comment. All patients with a clear resection margin had no adverse outcome regardless of other predictive factors.

CONCLUSIONS

Polyp cancers with clear resection margins, even those with <1mm clearance, can be treated safely with surveillance in our experience. Polyp cancers with unknown or involved resection margins should be treated surgically.
The impact of systemic fungal infection in patients with perforated oesophagus
Authors: Elsayed H , Shaker H , Whittle I , Hussein S
Published: November 2012

INTRODUCTION

Perforated oesophagus is a surgical emergency with significant morbidity and mortality. Systemic fungal infection represents a poor response to the magnitude of the insult, which adds significantly to the risk of morbidity and mortality in these patients. We reviewed our experience with this group of patients over a six-year period in a tertiary referral centre.

METHODS

A retrospective clinical review was conducted of patients who were admitted following a ruptured oesophagus over a period of six years (January 2002 – January 2008).

RESULTS

We had 27 admissions (18 men and 9 women) following an isolated perforated oesophagus to our unit. The median patient age was 65 years (range: 22–87 years). The majority (n=24,89%) presented with spontaneous perforations (Boerhaave’s syndrome) and three (11%) were iatrogenic. Fungal organisms, predominantly Candida albicans, were positively cultured in pleural or blood samples in 16 (59%) of the 27 patients. Fourteen patients grew yeasts within the first seven days while two showed a delayed growth after ten days. Overall mortality was 5 out of 27 patients (19%). There was no mortality among the group that did not grow yeasts in their blood/pleural fluid while mortality was 31% (5/16) in the group with systemic fungal infection (p<0.001). A positive fungal culture was also associated with increase ventilation time, intensive care unit stay and inpatient hospital stay but not an increased rate of complications.

CONCLUSIONS

Systemic fungal infection in patients with a ruptured oesophagus affects a significant proportion of these patients and carries a poor prognosis despite advanced critical care interventions. It may represent a general marker of poor host response to a major insult but can add to mortality and morbidity. It is worth considering adding antifungal therapy empirically at an early stage to antimicrobials in patients with an established diagnosis of a perforated oesophagus.
Single-Incision Laparoscopic Surgery Versus Conventional Techniques
Authors: Johal KS , Tsim P , Redfern A , Weeks C , Park HM , Morris C , Kang P , Maxwell-Armstrong C
Published: November 2012

Single-Incision laparoscopic surgery (SILS) is a relatively novel technique that employs a single incision to gain access to the peritoneal cavity. Potential advantages over conventional laparoscopy include reduction of port site complications, reduced pain and improved cosmesis. Given that the incidence of surgical site complications in conventional laparoscopic surgery (infection 0.5%, incisional hernia 7.9%, haematoma 6.25%) are all correlated directly with the incisional site, a reduction in the number of incisions has been suggested as a means of improving post-operative morbidity from laparoscopic surgery.
Surgical Professionalism 2012
Authors: Taylor Irving
Published: November 2012

This paper is based on the Bradshaw Lecture delivered at the college in July 2012. It is a personal reflection on surgical professionalism garnered from experience not only as a professor of surgery for 31 years, and recently as Vice-Dean for Professional Affairs at University College London, but also from experience acquired as the only surgeon case examiner in the Fitness to Practise Directorate of the General Medical Council (GMC) over the last 7 years. During this time, I have been involved in the investigation of over 2,000 doctors referred to the GMC regarding fitness-to-practise allegations. Some issues have been addressed in a previous Bulletin article. This paper provides an update and highlights some recent concepts that were presented in the Bradshaw Lecture.
Intercollegiate Basic Surgical Skills course: assessments revisited and revised
Authors: Goldring Louise , McCloy Rory , Underwood John Weston , Thomas Bill , Albeyatti Abdullah
Published: November 2012

The Intercollegiate Basic Surgical Skills course has a long history and runs regionally and internationally at multiple centres. The Royal College of Surgeons of England ran 81 courses for a total of 1,083 participants between 1 July 2011 and 30 June 2012. The fifth edition was officially launched on 25 September 2012 with content agreed by representatives from the four Royal Colleges of Surgeons. As a result of feedback from faculty, participants and centres running the course, it has been reduced to two days, in alignment with the ISCP for basic surgical skills and without losing vital hands-on practice.
who's really in charge in the operating theatre?
Authors: Sutton Pa , McFaul C , Vimalachandran D , Johnson M , McNally S
Published: November 2012

The Opportunities in Surgery committee of the RCS provides advice and guidance to surgeons and aspiring surgeons. For the 2012 annual medical student prize, entrants were required to submit a 500-word abstract in response to the question 'Who is in charge in the operating theatre?' A wide range of suggestions, parallels, anecdotes and, clearly, some traumatic memories were recollected. But are we any closer to answering the question?
From Xin nüxing to Liren xing: Changing Conceptions of the “New Woman” in Republican Era Chinese Films
Authors: Shen Vivian
Published: November 2012

Gender politics in the male-dominated world of republican era leftist filmmaking is exemplified quite well in cinematic portrayals of the New Woman. Throughout the 1930s and 1940s, the concept of the New Woman conveyed in Chinese films shifted so dramatically that a study of the changes
sheds considerable light not only on male-female relationships, but also on the general social and political context of that era.
Tapping the Abundant Resources Available To Teach Asia Through Film
Authors: Lent John A.
Published: November 2012

Certainly, the task of teaching Asia through film has become considerably easier in recent years. First of all, a tradition has been established that allows for increased use of audio-visual materials in classrooms, made more convenient by easier-to-use technology. Second, more films
for classroom use are available, obtainable through a larger number of distributors of Asian films in the United States. Of course, more possibilities exist because of videocassettes.
Teaching Japan Through Cinema
Authors: McDonald Keiko I.
Published: November 2012

Initiation of Japanese film courses marks one of the most salient features in the recent development of Japanese Studies at major American academic institutions. Needless to say, in this age of high-tech communication, easy access to Japanese films on video (with English subtitles)
has much to do with this favorable trend.
Problems of Teaching Asian Cinema in a World Film History Course
Authors: Landy Marcia
Published: November 2012

I will confine my presentation to outlining problems in teaching Asian film in our film studies courses, specifically focusing on a course such as World Film History. As a devotee of melodrama, I intend in the comments that follow to inject an affective, particularly querulous, even
inflated focus, into my comments on teaching Asian film so that I can foreground the difficulties that I have encountered in teaching films from China, Japan, India, and other Asian countries in my courses on World Film History. I hope that by concentrating on my experiences, certain issues
will arise that can generate a productive engagement with the intellectual and pedagogical issues involved. While my observations may appear to be dour and skeptical, weighted heavily toward identifying problems, other colleagues in this symposium will perhaps present a more positive and constructive
view of the pedagogical and critical situation.
Floating Weeds: Tea...Afloatching Asian Cinema
Authors: Fischer Lucy
Published: November 2012

Since Marcia Landy has so aptly sketched some of the broad theoretical issues concerning the teaching of Asian cinema as part of a class on World Film History, I will turn to a highly specific, concrete, and, perhaps, unique instantiation of such a pedagogical situation.
Thoughts on Teaching Chinese Cinemas in the United States
Authors: Lu Sheldon H.
Published: November 2012

In this short note, I want to comment on four aspects of teaching Chinese cinemas in the United States: 1) what to teach: Chinese cinema or cinemas; 2) who are the teachers: area studies, film studies, media studies; 3) need for good textbooks for undergraduate students; 4) availability
of Chinese films on videotape.
Recent Publications on Asian Cinema
Authors: Lent John A.
Published: November 2012

This series has appeared sporadically from the beginning of Asian Cinema. The last installment was in 9:2, Spring 1998; these entries are mainly 1998 and 1999.
Eileen Chang, Woman's Film, and Domestic Shanghai in the 1940s
Authors: Fu Poshek
Published: November 2012

Eileen Chang (Zhang Ailing) is a twentieth-century Chinese legend. Born in Shanghai in 1920, she devoted all of her literary life to capturing the glamour, decadence, and moral ambiguity of the city. At the age of 23, Chang leapt to fame in Shanghai under the Japanese Occupation. During
those three years, she published over a dozen short stories and many essays in the city's leading cultural journals and literary magazines. Her short story collection, Chuanqi (Romance) sold out in four days. The early 1940s marked not only the heyday of her literary creativity but also of
her personal life. Financially independent, she married Hu Lancheng, a dilettante and top propaganda official of the collaborationist regime of Wang Jingwei.
Two sides of the mountains and three sides to every story: Towards a study of the development of the BBC’s multimedia newsgathering
Authors: Rodgers James
Published: November 2012

Based on a comparison between two reporting assignments – one to the North Caucasus in 2000, and another to the South Caucasus in 2008 – this article tracks the evolution of BBC newsgathering techniques as technology and editorial demand evolved. In doing so, the article
also takes in examples from other assignments which the author carried out as a BBC correspondent, and considers how changing technology shaped editorial agendas for the first generation of journalists to work in the multiplatform world.
Lara Fielden of the Reuters Institute for the Study of Journalism on press regulation in an era of blended media
Authors: Fielden Lara
Published: November 2012

The UK is at a pivotal point in the regulation of its journalism. Following the ‘phone-hacking’ scandal which enveloped the British press in 2011, the UK’s government has established an Inquiry to gather evidence on the culture, practices and ethics of the press and
recommend reform of its regulation. However this paper argues that the future of press regulation cannot be isolated from a wider settlement for regulated media content. The range of broadcast, print, self-scheduled and wider online content with which consumers engage is characterised by mutation
and convergence. By contrast, media regulation remains essentially static, divided and determined by an accident of delivery platform. This paper draws on an analysis of UK and international approaches to media regulation. It argues for a new regulatory settlement that incentivises standards
as a selling point for content providers, and enables citizens to make informed, democratic choices across media platforms.