bluuebunny/crossref_metadata_2025 huggingface dataset:
Preparing ITER ICRF: development and analysis of the load resilient matching systems based on antenna mock-up measurements
Authors: Messiaen A. , Vervier M. , Dumortier P. , Grine D. , Lamalle P.U. , Durodié F. , Koch R. , Louche F. , Weynants R.
Published: April 2009

The reference design for the ICRF antenna of ITER is constituted by a tight array of 24 straps grouped in eight triplets. The matching network must be load resilient for operation in ELMy discharges and must have antenna spectrum control for heating or current drive operation. The load resilience is based on the use of either hybrid couplers or conjugate-T circuits. However, the mutual coupling between the triplets at the low expected loading strongly counteracts the load resilience and the spectrum control. Using a mock-up of the ITER antenna array with adjustable water load matching solutions are designed. These solutions are derived from transmission line modelling based on the measured scattering matrix and are finally tested. We show that the array current spectrum can be controlled by the anti-node voltage distribution and that suitable decoupler circuits can not only neutralize the adverse mutual coupling effects but also monitor this anti-node voltage distribution. A matching solution using four 3 dB hybrids and the antenna current spectrum feedback control by the decouplers provides outstanding performance if each pair of poloidal triplets undergoes a same load variation. Finally, it is verified by modelling that this matching scenario has the same antenna spectrum and load resilience performances as the antenna array loaded by plasma as described by the TOPICA simulation. This is true for any phasing and frequency in the ITER frequency band. The conjugate-T solution is presently considered as a back-up option.
Radio-frequency current drive efficiency in the presence of ITBs and a dc electric field
Authors: Rosa P.R. da S. , Mourão R. , Ziebell L.F.
Published: April 2009

This paper discusses the current drive efficiency by the combined action of EC and LH waves in the presence of a dc electric field and transport, with an internal transport barrier. The transport is assumed to be produced by magnetic fluctuations. The study explores the different barrier parameters and their influence on the current drive efficiency. We study the subject by numerically solving the Fokker–Planck equation. Our main result is that the barrier depth and barrier width are important to determine the correct shape of the current density profile but not to determine the current drive efficiency, which is very little influenced by these parameters. We also found similar results for the influence of the level of magnetic fluctuations on the current density profile and on the current drive efficiency.
Anomalous transport of light and heavy impurities in Tore Supra ohmic, weakly sawtoothing plasmas
Authors: Guirlet R. , Villegas D. , Parisot T. , Bourdelle C. , Garbet X. , Imbeaux F. , Mazon D. , Pacella D.
Published: April 2009

Experimental results on impurity transport in tokamaks are based on various techniques. We study here how the choice of the injection technique and of the analysis method influences the results. We have used three different injection techniques available in Tore Supra: laser blow-off, gas puff and supersonic molecular beam injection. We show that the long time duration of the gas puff injection compared with particle confinement time provides very limited information. The laser blow-off technique and supersonic pulsed injections give satisfactory results for diffusion but low quality convection estimates, presumably because the fast source term quenches the role of convection in the continuity equation. The best method is shown to be the combined analysis of supersonic pulsed injections and continuous puffing of a gaseous species. We obtain convection velocity profiles to an uncertainty of about 0.5 m s−1. This method is applied to ohmic, weakly sawtoothing plasmas. The diffusion coefficient is independent of the impurity charge and the convection velocity is inward. Neoclassical calculations show that these plasmas are dominated by anomalous transport. Quasilinear gyrokinetic simulations are in qualitative agreement with the above experimental results. We deduce from the simulations that convection is dominated by the curvature term, which means that no charge dependence should be expected in this situation.
Improved confinement with internal electron transport barriers in RFX-mod
Authors: Carraro L. , Alfier A. , Bonomo F. , Fassina A. , Gobbin M. , Lorenzini R. , Piovesan P. , Puiatti M.E. , Spizzo G. , Terranova D. , Valisa M. , Zuin M. , Canton A. , Franz P. , Innocente P. , Pasqualotto R. , Auriemma F. , Cappello S. , Guo S.C. , Marrelli L. , Martines E. , Spolaore M. , Zanotto L.
Published: April 2009

RFX-mod reliably operates at 1.5 MA, the highest current ever achieved on a reversed field pinch device thanks to the the feedback control on multiple magnetohydrodynamic modes.

In these high current discharges magnetic topology spontaneously self-organizes in an Ohmic helical symmetry, the quasi single helicity (QSH) state, in which the magnetic dynamics is dominated by the innermost resonant mode, with the new magnetic axis helically twisting around the geometrical axis of the torus.

Inside the helical structure energy confinement is enhanced and electron temperatures exceeding 1 keV are measured, with steep gradients, which identify an internal transport barrier. Separatrix expulsion and symmetric electron temperature profiles with high gradients are obtained for ratios between the dominant mode and total B above about 4%. The measured electron temperature peak involves a large fraction of the plasma cross section, corresponding to an improvement in the global electron energy confinement up to a factor 2. The steep temperature profiles obtained in QSH conditions correspond to an electron thermal diffusivity reduced by more than one order of magnitude.

Perturbative experiments (pellets and impurity laser blow off injections) have been performed to study particle confinement inside and outside the thermal island. Inside the helical structure experimental evidence of main gas confinement increase has been obtained, while for impurities there is no evidence of confinement increase.
A graphical algorithm for fast computation of identity coefficients and generalized kinship coefficients
Authors: Abney Mark
Published: April 2009

Summary: Computing the probability of identity by descent sharing among n genes given only the pedigree of those genes is a computationally challenging problem, if n or the pedigree size is large. Here, I present a novel graphical algorithm for efficiently computing all generalized kinship coefficients for n genes. The graphical description transforms the problem from doing many recursion on the pedigree to doing a single traversal of a structure referred to as the kinship graph.

Availability: The algorithm is implemented for n = 4 in the software package IdCoefs at http://home.uchicago.edu/abney/Software.html.

Contact:  abney@bsd.uchicago.edu

Supplementary Information:  Supplementary data are available at Bioinformatics online.
Adiponectin is increased in cardiac cachexia irrespective of body mass index
Authors: Paulo Araújo José , Lourenço Patrícia , Rocha‐Gonçalves Francisco , Ferreira António , Bettencourt Paulo
Published: April 2009

Aims

Cardiac cachexia (CC) is a complication of chronic heart failure (CHF). Little is known about the mechanisms leading to CC. Adiponectin, leptin, and ghrelin are important regulators of energy metabolism and body weight. Previous studies of CHF and CC had great differences in body mass index (BMI) between cachectic and non‐cachectic patients. To assess serum adiponectin, leptin, and ghrelin concentrations in cachectic and non‐cachectic patients.

Methods and results

We conducted a case–control study in CHF patients matched for BMI. Cases (n = 33) were cachectic patients with unintentional weight loss of ≥7.5% of the previous baseline weight. Controls (n = 33) had no history of weight loss and were individually matched with cases for age, sex, and BMI. Cachectic patients had significantly higher adiponectin levels than controls: 25.0 ± 12.3 vs. 14.7 ± 8.8 µg/mL (P = 0.002). Leptin concentration was lower in the cachectic group: 7.5 (IQR 4.0–10.8) vs. 8.0 (IQR 7.1–10.5) ng/mL. Differences in leptin lost significance once adjusted for fat mass. Adiponectin remained higher in cachectics after such adjustment. Ghrelin was not significantly different between groups. Adiponectin correlated positively with weight loss and BNP.

Conclusion

Cachexia in CHF was associated with an increase in adiponectin, irrespective of BMI. This suggests a role of adiponectin in the wasting process of cachectic patients.
The impact of a self‐management group programme on health behaviour and healthcare utilization among congestive heart failure patients
Authors: Smeulders Esther S.T.F. , van Haastregt Jolanda C.M. , Ambergen Ton , Janssen‐Boyne Josiane J.J. , van Eijk Jacques Th.M. , Kempen Gertrudis I.J.M.
Published: April 2009

Aims

The ‘Chronic Disease Self‐Management Programme’ (CDSMP) emphasizes patients’ responsibility for the day‐to‐day management of their condition(s) and has shown favourable effects on health behaviour and healthcare utilization among various groups of patients with chronic conditions. However, the effects of the CDSMP among congestive heart failure (CHF) patients are unknown. We therefore aimed to assess the effects of the CDSMP on health behaviour and healthcare utilization in patients with CHF.

Methods and results

This randomized, controlled trial with 12 months of follow‐up included 317 CHF patients with a slight to marked limitation of physical activity. Control patients (n = 131) received usual care, consisting of regular checkups at an outpatient clinic. Intervention group patients (n = 186) received usual care and participated in a 6‐week self‐management group programme. Favourable effects on walking for exercise and other physical activities such as aerobic, stretching, and strength exercises, sports, and gardening were reported in the intervention group immediately after completion of the programme. The effect of the programme on other physical activities extended to 6 months of follow‐up. No favourable effects were found for the other outcomes.

Conclusion

The CDSMP significantly improved physical activity among CHF patients for up to 6 months after the end of the programme; however, it did not affect other health behaviour outcomes or healthcare utilization.
Upregulated expression of cardiac ankyrin repeat protein in human failing hearts due to arrhythmogenic right ventricular cardiomyopathy
Authors: Wei Ying‐Jie , Cui Chuan‐Jue , Huang Yin‐Xia , Zhang Xiao‐Lling , Zhang Hao , Hu Sheng‐Shou
Published: April 2009

Aims

Expression of cardiac ankyrin repeat protein (CARP) is augmented in heart failure due to dilated or ischaemic cardiomyopathy. It is unclear whether CARP is upregulated in heart failure due to arrhythmogenic right ventricular cardiomyopathy (ARVC). In the present study, we investigated the expression pattern of CARP and the correlation between CARP and the well‐known heart failure marker pro‐atrial natriuretic peptide (proANP) in ARVC failing hearts.

Methods and results

Gene microarray analysis demonstrated increased CARP expression in ARVC failing hearts compared with non‐failing control hearts, which was further validated by real‐time RT–PCR, western blot, and ELISA at the mRNA and protein levels. Fractionation experiments revealed that the upregulation of CARP expression is restricted to the nuclei of residual cardiac cells in ARVC failing hearts. Regression analysis showed a positive correlation between CARP and proANP in ARVC failing hearts.

Conclusion

Augmented CARP expression may be a common molecular event in failing hearts regardless of cardiomyopathic aetiology. The upregulation of nuclear CARP expression and positive correlation between cardiac CARP and proANP suggests that CARP may be used as a genetic marker existing in the nuclei in contrast to proANP existing in the cytosol of cardiac cells in heart failure patients.
The use of an adaptive acoustic-survey design to estimate the abundance of highly skewed fish populations
Authors: Harbitz Alf , Ona Egil , Pennington Michael
Published: April 2009

Harbitz, A., Ona, E., and Pennington, M. 2009. The use of an adaptive acoustic-survey design to estimate the abundance of highly skewed fish populations. – ICES Journal of Marine Science, 66: 1349–1354. The uncertainty (relative root-mean-square error) of abundance estimates based on a simple and easily implemented adaptive design for an acoustic survey is examined. The study is limited to surveys with parallel transects and independent observations with extremely skewed distributions. The adaptive approach defines a stratum for each conventional observation and how to take additional observations in that stratum when the acoustic density exceeds a predetermined threshold. The cost (sailing distance) of each added observation is about three times that of a conventional observation. This method was demonstrated using high-resolution transect data from a herring (Clupea harengus) acoustic survey conducted in 2006 off the north coast of Norway. The primary sampling unit for this winter survey was 5 nautical miles, and the usual distance between transects was 20 nautical miles. The results indicate that an adaptive survey design would substantially reduce the root-mean-square error of the abundance estimates compared with that of the conventional survey design.
Consecutive acoustic observations of an Atlantic herring school in the Northwest Atlantic
Authors: Weber Thomas C. , Peña Héctor , Jech J. Michael
Published: April 2009

Weber, T. C., Peña, H., and Jech, J. M. 2009. Consecutive acoustic observations of an Atlantic herring school in the Northwest Atlantic. – ICES Journal of Marine Science, 66: 1270–1277. Several successive images of the same school of Atlantic herring (Clupea harengus) were collected over the course of ∼1 h just north of Georges Bank in the Northwest Atlantic. Although the fish may not have been in their natural, undisturbed state, we observed what appeared to be the fish school fragmenting and dispersing, using a split-beam and a multibeam echosounder. Calibrated, 38 kHz, split-beam echosounder (Simrad EK60) and trawl-catch data provided accurate measures of the fish density beneath the vessel. Uncalibrated, 400 kHz, multibeam-echosounder (Reson 7125) data provided synoptic observations of the fish school including estimates of the school volume, morphology, and behaviour. Observations of the angular dependence in the multibeam-echosounder measurements of backscatter from fish allow investigation of the efficacy of extrapolating fish-school densities measured by the split-beam echosounder to the entire school.
First Report of Bean Rust Caused by Uromyces appendiculatus Race 19-63 in Puerto Rico
Authors: Vega Byron , Beaver James S. , de Jensen Consuelo Estévez , Steadman James R.
Published: April 2009

Bean rust caused by Uromyces appendiculatus (Pers.) Unger is an important disease in common bean (Phaseolus vulgaris L.) worldwide. To our knowledge this is the first report of a new race of U. appendiculatus (19-63) in Puerto Rico and in the western hemisphere.

Accepted for publication 4 February 2009. Published 25 March 2009.
Effects of Diseases on Soybean Yields in the United States 1996 to 2007
Authors: Wrather Allen , Koenning Steve
Published: April 2009

Research must focus on management of diseases that cause extensive losses, especially when funds for research are limited. Knowledge of yield suppression caused by various soybean diseases is essential when prioritizing research. The objective of this project was to compile estimates of soybean yield suppression due to diseases in the USA from 1996 to 2007. The goal was to provide information to help funding agencies and scientists prioritize research objectives and budgets. Yield suppression due to individual diseases varied among years. Soybean cyst nematode suppressed USA soybean yield more from 1996 to 2007 than any other disease. Phytophthora root and stem rot ranked second among diseases that most suppressed yield seven of 12 years. Seedling diseases and charcoal rot also suppressed soybean yield during these years. Research and extension efforts must be expanded to provide more preventive and therapeutic disease management strategies for producers to reduce disease suppression of soybean yield.

Accepted for publication 25 February 2009. Published 1 April 2009.
Kaolin Particle Film Prevents Galling by Gynaikothrips uzeli
Authors: Held David W. , Wheeler Corey , Boyd David W.
Published: April 2009

Feeding by Gynaikothrips uzeli Zimmerman (Thysanoptera: Phlaeothripidae), a pest thrips, induces galls on the ornamental plant Ficus benjamina, which disfigures plants and can facilitate incidental transport of pests. This study evaluated foliar applications of azadirachtin (Azatin XL), bifenthrin (Talstar), or kaolin (Surround WP) to prevent galling in field and laboratory experiments. Azadirachtin did not significantly prevent galling, but kaolin-treated cuttings had 80% reduction in number of galls in laboratory tests, and in the field, kaolintreated plants had ≥ 74% reduction in number of galls versus unprotected plants. Weekly applications of kaolin provided comparable protection to bifenthrin. Laboratory choice and no-choice tests indicate kaolin is not lethal and adult G. uzeli do not avoid kaolin-treated surfaces. Particle film products are an effective alternative to insecticides for preventing leaf galls on weeping fig.

Accepted for publication 18 February 2009. Published 7 April 2009.
Precocious realists: perceptual and cognitive characteristics associated with drawing talent in non-autistic children
Authors: Drake Jennifer E. , Winner Ellen
Published: April 2009

A local processing bias in the block design task and in drawing strategy has been used to account for realistic drawing skill in individuals with autism. We investigated whether the same kind of local processing bias is seen in typically developing children with unusual skill in realistic graphic representation. Forty-three 5–11-year-olds who drew a still life completed a version of the block design task in both standard and segmented form, were tested for their memory for the block design items, and were given the Kaufmann Brief Intelligence Test-II. Children were classified as gifted, moderately gifted or typical on the basis of the level of realism in their drawings. Similar to autistic individuals, the gifted group showed a local processing bias in the block design task. But unlike autistic individuals, the gifted group showed a global advantage in the visual memory task and did not use a local drawing strategy; in addition, their graphic realism skill was related to verbal IQ. Differences in the extent of local processing bias in autistic and typically developing children with drawing talent are discussed.
Autistic autobiography
Authors: Hacking Ian
Published: April 2009

Autism narratives are not just stories or histories, describing a given reality. They are creating the language in which to describe the experience of autism, and hence helping to forge the concepts in which to think autism. This paper focuses on a series of autobiographies that began with Grandin's
Emergence.
These are often said to show us autism from the ‘inside’. The paper proposes that instead they are developing ways to describe experience for which there is little pre-existing language. Wittgenstein has many well-known aphorisms about how we understand other people directly, without inference. They condense what he had found in Wolfgang Köhler's
Gestalt Psychology
. These phenomena of direct understanding what other people are doing are, Köhler wrote, ‘the common property and practice of mankind'. They are not the common property and practice of people with autism. Ordinary language is rich in age-old ways to describe what others are thinking, feeling and so forth. Köhler's phenomena are the bedrock on which such language rests. There is no such discourse for autism, because Köhler's phenomena are absent. But a new discourse is being made up right now, i.e. ways of talking for which the autobiographies serve as working prototypes.
Enhanced perception in savant syndrome: patterns, structure and creativity
Authors: Mottron Laurent , Dawson Michelle , Soulières Isabelle
Published: April 2009

According to the enhanced perceptual functioning (EPF) model, autistic perception is characterized by: enhanced low-level operations; locally oriented processing as a default setting; greater activation of perceptual areas during a range of visuospatial, language, working memory or reasoning tasks; autonomy towards higher processes; and superior involvement in intelligence. EPF has been useful in accounting for autistic relative peaks of ability in the visual and auditory modalities. However, the role played by atypical perceptual mechanisms in the emergence and character of savant abilities remains underdeveloped. We now propose that enhanced detection of patterns, including similarity within and among patterns, is one of the mechanisms responsible for operations on human codes, a type of material with which savants show particular facility. This mechanism would favour an orientation towards material possessing the highest level of internal structure, through the implicit detection of within- and between-code isomorphisms. A second mechanism, related to but exceeding the existing concept of redintegration, involves completion, or filling-in, of missing information in memorized or perceived units or structures. In the context of autistics' enhanced perception, the nature and extent of these two mechanisms, and their possible contribution to the creativity evident in savant performance, are explored.
A truncated two-α-helix F-box present in poxvirus ankyrin-repeat proteins is sufficient for binding the SCF1 ubiquitin ligase complex
Authors: Sonnberg Stephanie , Fleming Stephen B. , Mercer Andrew A.
Published: April 2009

Poxviruses encode a large family of ankyrin-repeat (ANK) proteins, most of which contain an F-box-like motif necessary for the interaction of the ANK proteins with SCF1 (Skp1–Cullin1–F-box) complexes. The viral motif is generally truncated compared with the three-α-helix cellular F-box. Cellular F-box α-helices 1–3 and regions C-terminal to them have been shown to contribute to Skp1 binding. We report that the poxvirus F-boxes generally contain only two α-helices, corresponding to cellular F-box α-helices 1 and 2. A third α-helix was detected in some poxvirus F-boxes, but was not predicted to interact with Skp1. All but one of the poxvirus ANK/F-box proteins examined terminated directly after the F-box, excluding any contribution by C-terminal regions to the binding of Skp1. Here we show that, despite this truncation, the F-box of a prototypical poxvirus ANK protein, containing two α-helices, is not only necessary but also sufficient for interaction with SCF1.
Early effects of Sertoli cell‐selective androgen receptor ablation on testicular gene expression
Authors: Willems A. , De Gendt K. , Allemeersch J. , Smith L. B. , Welsh M. , Swinnen J. V. , Verhoeven G.
Published: April 2009

Evidence from several models of hormone depletion and/or replacement and from knockout animals points to a key role of androgens in the control of spermatogenesis. In testes of mice with a Sertoli cell‐selective ablation of the androgen receptor (SCARKO), transcriptional profiling, using microarray technology, revealed that, already on postnatal day 10 692 genes are differentially expressed compared with testes of control mice. Further evaluation of a subset of these genes by quantitative RT‐PCR suggested that differences in expression may already be evident on day 8 or earlier. As the androgen receptor in mouse Sertoli cells becomes immunologically detectable around day 5, we tried to identify the earliest responses to androgens by a new transcriptional profiling study on testes from 6‐day‐old SCARKO and control mice. No obvious and novel early androgen response genes, potentially acting as mediators of subsequent indirect androgen actions, could be identified. However, several genes differentially expressed on day 10 already displayed a response to androgen receptor ablation on day 6. Quantitative RT‐PCR studies for 12 of these genes on 10 paired SCARKO and control testes from 4‐, 6‐, 8‐, 10‐, 20‐ and 50‐day‐old mice revealed significant differences in expression level from day 4 onwards for three genes (Eppin, PCI, Cldn11) and from day 6 onwards for one more gene (Rhox5). For at least two of these genes (Rhox5 and Eppin), there is evidence for direct regulation via the androgen receptor. For three additional genes (Gpd1, Tubb3 and Tpd52l1) significantly lower expression in the SCARKO was noted from day 8 onwards. For all the studied genes, an impressive increase in transcript levels was observed between day 4–50 and differential expression was maintained in adulthood. It is concluded that the SCARKO model indicates incipient androgen action in mouse Sertoli cells from day 4 onwards.
An experimental investigation on aspects of infectious salmon anaemia virus (ISAV) infection dynamics in seawater Atlantic salmon, Salmo salar L.
Authors: Gregory A , Munro L A , Snow M , Urquhart K L , Murray A G , Raynard R S
Published: April 2009

This study investigated infection dynamics of infectious salmon anaemia virus (ISAV) by conducting two experiments to examine minimum infective dose and viral shedding of ISAV. In terms of minimum infective dose, the high variability between replicate tanks and the relatively slow spread of infection through the population at 1 × 101 TCID50 mL−1 indicated this dose is approaching the minimum infective dose for ISAV in seawater salmon populations. A novel qPCR assay incorporating an influenza virus control standard with each seawater sample was developed that enabled the quantity of ISAV shed from infected populations to be estimated in values equivalent to viral titres. Viral shedding was first detected at 7 days post‐challenge (5.8 × 10−2 TCID50 mL−1 kg−1) and rose to levels above the minimum infective dose (4.2 × 101 TCID50 mL−1 kg−1) on day 11 post‐challenge, 2 days before mortalities in ISAV inoculated fish started. These results clearly demonstrate that a large viral shedding event occurs before death. Viral titres peaked at 7.0 × 101 TCID50 mL−1 kg−1 15 days post‐infection. These data provide important information relevant to the management of ISA.
Identification of HLA‐B*5410 in Taiwan
Authors: Chu C.‐C. , Lee K.‐C. , Lee H.‐L. , Lin M.
Published: April 2009

A new human leukocyte antigen‐B allele, B*5410, has been detected in Taiwan. It has one nucleotide change from B*5401 at codon 156 (CTG→CGG), resulting in one amino acid change (L→R).
Two new HLA‐DQB alleles routinely identified by sequence‐based typing: DQB1*030103 and DQB1*0505
Authors: Giannoli C. , Paturel L. , Favre‐Victoire I. , Béra O. , Dubois V.
Published: April 2009

Here, we report the identification of two novel human leukocyte antigen‐DQB1 alleles, DQB1*030103 and DQB1*0505, found by routine typing using commercial kits.
Characterization of resistance response of pea (Pisum spp.) against rust (Uromyces pisi)
Authors: Barilli E. , Sillero J. C. , Moral A. , Rubiales D.
Published: April 2009

Components of resistance to the pea rust (Uromyces pisi) were studied at the histological level in seedlings of seven pea (Pisum spp.) accessions showing partial resistance under field conditions. Resistance was characterized macroscopically by an increased latent period and a decreased infection frequency in spite of a compatible interaction (high infection type). Histological investigations revealed little differences among accessions in spore germination and appressoria formation, differences being more evident once the stomata were penetrated by the infection structures. Resistance was mainly due to a restriction of haustorium formation with significant levels of early aborted colonies in accessions IFPI3260, PI347321 and PI347347. Furthermore, a reduction in the number of haustoria per colony, hyphal tips per colony and smaller colony size were found in all genotypes studied. Resistance was not associated with early‐ or late‐acting hypersensitivity in any of the genotypes studied.
Suppression of the postoperative neutrophil leucocytosis following neoadjuvant chemoradiotherapy for rectal cancer and implications for surgical morbidity
Authors: Kerr S. F. , Klonizakis M. , Glynne‐Jones R.
Published: April 2009

Objective  The extent to which neoadjuvant chemoradiotherapy for rectal cancer influences postoperative morbidity is controversial. This study investigated whether this treatment suppresses the normal perioperative inflammatory response and explored the clinical implications.

Method  Prospective databases were queried to identify 37 consecutive study patients undergoing definitive surgery following 5‐FU/capecitabine‐based chemoradiotherapy and 34 consecutive untreated control patients operated upon for rectal or rectosigmoid cancer. Preoperative (< 10 days) and postoperative (< 24 h) neutrophil counts, along with morbidity data, were confirmed retrospectively. Univariate and multivariate analyses assessed the apparent effect of chemoradiotherapy on change in neutrophil count. The latter’s association with postoperative morbidity was then examined.

Results  Sufficient data were available for 34 study and 27 control patients. Repeated‐measures ANCOVA revealed significant differences between their perioperative neutrophil counts (P = 0.02). Of the other characteristics which differed between the groups, only age and tumour location were prognostically significant regarding perioperative change in neutrophil count. Accounting for relevant covariates, chemoradiotherapy was significantly associated with a suppressed perioperative neutrophil leucocytosis. Local postoperative complications affected 25 of 61 patients, who had lower perioperative neutrophil increases than their counterparts (P = 0.016).

Conclusion  Chemoradiotherapy appears to suppress the perioperative inflammatory response, thereby increasing susceptibility to local postoperative complications.
Laparoscopic ventral rectopexy for external rectal prolapse improves constipation and avoids de novo constipation
Authors: Boons P. , Collinson R. , Cunningham C. , Lindsey I.
Published: April 2009

Objective  Abdominal rectopexy is ideal for otherwise healthy patients with rectal prolapse because of low recurrence, yet after posterior rectopexy, half of the patients complain of severe constipation. Resection mitigates this dysfunction but risks a pelvic anastomosis. The novel nerve‐sparing ventral rectopexy appears to avoid postero‐lateral rectal dissection denervation and thus postoperative constipation. We aimed to evaluate our functional results with laparoscopic ventral rectopexy.

Method  Consecutive rectal prolapse patients undergoing laparoscopic ventral rectopexy were prospectively assessed (Wexner Constipation and Faecal Incontinence Severity Index scores) pre‐, 3 months postoperatively, and late (> 12 months).

Results  Sixty‐five consecutive patients with external rectal prolapse (median age 72 years, 34% > 80 years, median follow up 19 months) underwent laparoscopic ventral rectopexy. There was one recurrence (2%) and one conversion. Morbidity (17%) and mortality (0%) were low. Median operating time was 140 min and median length of stay 2 days. At 3 months, constipation was improved in 72% and  mildly induced in 2% (median pre‐and postoperative Wexner scores 9 vs 4, P < 0.0001). Continence was improved in 83% and mild incontinence was induced or  worsened in 5% (median pre‐ and postoperative incontinence score 40 vs 4, P < 0.0001). Significant improvement in both constipation and incontinence (P < 0.0001) remained at median 24 months late follow‐up.

Conclusion  Ventral rectopexy has a recurrent prolapse rate of < 5%, similar to that of posterior rectopexy. Its correction of preoperative constipation and avoidance of de novo constipation appear superior to historical functional results of posterior rectopexy. A laparoscopic approach allows low morbidity and short hospital stay, even in those patients over 80 years of age in whom a perineal approach is usually preferred for safety.
Intussusception in adults: a retrospective study
Authors: Hanan B. , Diniz T. R. , Da Luz M. M. P. , Da Conceição S. A. , Da Silva R. G. , Lacerda‐Filho A.
Published: April 2009

Objective  Intestinal intussusception in adult patients is rare. In contrast with paediatric patients, it is usually secondary to a definable lesion, often malignant. The purpose of this study was to determine the causes and the management of intussusception in adult patients.

Method  A retrospective review was performed looking at patients over 18 years with intestinal intussusception who were admitted to a tertiary university hospital from 1997 to 2007.

Result  There were 16 patients (out of whom 10 were female subjects) of mean age 49 years (range 19–76). All presented with abdominal pain and in seven (46.6%) patients, this was acute. The diagnosis of intussusception was correctly made preoperatively in eight (50%) patients. Six (37.5%) patients had the lead point for the intussusception at the ileocaecal valve, five (31.25%) in the small bowel and five (31.25%) had a colonic lead point. An anatomical cause was found in 14 (87.5%). In two (12.5%), the intussusception occurred in the postoperative period without any definable lesion. Half the patients had a malignant neoplasm. All patients underwent surgery. In 14 (87.5%) patients, this was by resection and in two (12.5%), a reduction with no resection was carried out.

Conclusion  The features of intussusception may be nonspecific and the diagnosis is often made only during laparotomy. An identifiable organic lesion is present in most cases. En bloc resection is recommended for ileocaecal and colocolic intussusception.
Sigmoid diverticulitis. Longitudinal analysis of 222 patients with a minimal follow up of 5 years
Authors: Frileux P. , Dubrez J. , Burdy G. , Roullet‐Audy J.‐C. , Dalban‐Sillas B. , Bonnaventure F. , Frileux M.‐A.
Published: April 2009

Objective  The surgical treatment of severe attacks of sigmoid diverticulitis and the indications for prophylactic surgery are currently matters of debate. We have analysed our experience in a university hospital, bringing new information into the discussion.

Method  All patients admitted to our department between 1995 and 2002 for an attack of sigmoid diverticulitis were reviewed. There were 222 who had had a first attack and these formed the basis of the study. Analysis of short‐ and long‐term outcomes was made.

Results  Of the 222 patients, 66 underwent an operation during the first admission (mainly Hartmann’s opertation) with no death. Twenty‐five patients were operated during a subsequent admission, either for a deterioration of their symptoms or prophylaxis. One hundred and twenty‐eight patients were managed conservatively, and were followed up for 5–12 years. Recurrence was observed in 43% of the patients with a trend to a higher incidence in patients under 50 years. Recurrent exacerbating diverticulitis were severe in 13% of cases.

Conclusion  Complicated diverticulitis can be managed with a low mortality. Hartmann’s operation was proven safe in our experience. The risk of recurrence was higher than observed in many recent studies but few reccurences were severe.
Endoscopists’ estimation of size should not determine surveillance of colonic polyps
Authors: Moug S. J. , Vernall N. , Saldanha J. , McGregor J. R. , Balsitis M. , Diament R. H.
Published: April 2009

Objective  Current British Society of Gastroenterology guidelines use adenomatous polyp size as one of the key factors in determining polyp follow‐up. This study aimed to compare polyp size assessment by colonoscopists and pathologists before and after fixation to determine the optimal method for measurement.

Method  Thirty‐five colorectal polyps were found during pre‐arranged colonoscopies in one centre. Polyp size was measured to the nearest 1 mm by three different methods:

by the endoscopist at colonoscopy;

by the pathologist fresh, following removal;

by the pathologist fixed, following fixation.

The endoscopist and the pathologist were blinded to each other’s measurements.

Results  Seventeen men, eighteen women with mean age of 66.2 years (SD: 9.4, range: 38.7–85.5) underwent polypectomy/s with all polyps removed intact. Polypectomies were performed by consultants (43%), nurse specialists (34%) and specialist registrars (23%).

The median size (mm) of polyps measured were endoscopically, 6.5 (2–25 mm); fresh specimen 7.0 (4–28 mm) and fixed 7.0 (4–28 mm). Endoscopic measurements were significantly lower than that of fresh and fixed sizes (P < 0.001 and P = 0.003 respectively), with poor correlation [correlation of variance (CV): 21.0% and intraclass correlation coefficient (ICCC): 0.841 for endoscopic and fresh measurements; CV: 21.1% and ICCC: 0.838 for endoscopic and fixed measurements]. There was no statistical difference between fresh and fixed specimen measurements (P > 0.05; CV: 4.2%, ICCC: 0.974). In three patients, the endoscopic measurement was < 1 cm in polyps that were found to be ≥ 1 cm on pathological measurement.

Conclusions  Endoscopists consistently underestimated polyp size. Fixation had no effect on polyp size. Pathologists’ measurement of polyp size on fixed specimens should determine the need for further colonoscopic follow‐up.
The impact of national guidelines on the waiting list for colonoscopy: a quantitative clinical audit
Authors: Chivers K. , Basnyat P. , Taffinder N.
Published: April 2009

Objective  To assess the compliance of the surveillance colonoscopy waiting list with ACPGBI/BSG guidelines for colonoscopy follow‐up and to measure the impact of adjusting referrals to be inline with the guidelines.

Design and Setting  This is a quantitative five‐stage clinical audit cycle involving a large patient cohort from the Kent and Medway Cancer Network, which includes seven hospitals across four NHS Hospital Trusts and an estimated population of 1.8 million.

Participants  3020 patients were waiting for a surveillance colonoscopy. Their notes were reviewed and the indications for colonoscopy were compared with the ACPGBI/BSG 2002 guidelines.

Interventions  Those patients whose referral to the surveillance colonoscopy waiting list was not found to be compliant were adjusted to be inline with the guidelines.

Main outcome measures  The impact of adjusting the surveillance colonoscopy waiting list on the diagnostic colonoscopy service was assessed by measuring the average waiting times for a colonoscopy before and after the intervention.

Results  Around 22% (n = 664) of surveillance colonoscopy referrals were inline with the guidelines, 51% (n = 1540) could be cancelled from the list and 27% (n = 816) could be given a new date. Implementing these recommendations reduced the average wait for a diagnostic colonoscopy from 76.8 to 56.0 days (P = 0.0022).

Conclusion  Following guidelines for surveillance colonoscopy can reduce waiting times for diagnostic colonoscopy. This allows a faster patient journey for diagnostic colonoscopy and a uniform plan for duration and frequency of surveillance colonoscopy. However, this action promoted serious debate on the social, moral and ethical issues.
Surgery for obstructed defaecation: does the use of the Contour device (Trans‐STARR) improve results?
Authors: Wadhawan H. , Shorthouse A. J. , Brown S. R.
Published: April 2009

Aim  The objective of the study was to assess safety, efficacy and outcomes of stapled transanal rectal resection (STARR) procedure for obstructed defaecation syndrome (ODS) with two stapling devices, PPH01 and Trans‐STARR.

Method  Data were collected on all patients undergoing PPH01 or Trans‐STARR over a 2 year period. Initially, all were treated using the PPH01 device and during the last 8 months using the Trans‐STARR.

Results  During the analysis period, 25 consecutive patients were treated with PPH01 and 27 patients were treated with Trans‐STARR. The median follow up was 12 months (range 3–12 months) for the PPH01 group and 6 months (range 3–12 months) for the Trans‐STARR group. Although the resected specimen was larger in the Trans‐STARR group (P < 0.001), there was no difference in early adverse events, time to discharge or late complications between the groups. In both groups, postoperative urgency was common (occurring more than occasionally in up to 40% at last review) but the incidence was high preoperatively. ODS and symptom severity scores improved with surgery (P < 0.001). However, the degree of improvement was similar with complete resolution of symptoms occurring in 64% of the PPH01 group and 67% of the Trans‐STARR group.

Conclusion  Our study shows that both procedures are safe and effective in the surgical treatment of obstructed defaecation but despite a larger resection the Trans‐STARR procedure does not offer any additional benefit. A policy of individualizing techniques tailored to the extent of prolapse may be appropriate, but requires further evaluation.
Prevalence of faecal incontinence in adults aged 30 years or more in general population
Authors: Aitola P. , Lehto K. , Fonsell R. , Huhtala H.
Published: April 2009

Objective  The aim of this study was to estimate the prevalence of and factors associated with faecal incontinence in a Finnish population.

Method  A population‐based age‐stratified random sample of 8000 people aged 30–81 years from a large city was obtained from the national population registry. A postal questionnaire was sent to all subjects. Questions regarding faecal incontinence were adopted from a previously developed validated questionnaire.

Results  Response rate was 39.8%. Overall, the prevalence of faecal incontinence occurring in any frequency within the last year was 10.6% (CI: 9.5–11.6%). Women suffered significantly more often than men (11.9% vs. 8.7%). The prevalence of faecal incontinence occurring at least twice a month was 5.2% (CI: 4.5–6%). Of these subjects, 62.3% used a pad at least twice a month to protect their underwear (91 women, 10 men), 23.6% used it daily. There was a strong correlation between faecal incontinence and urinary incontinence. Of the 162 subjects reporting faecal incontinence at least twice a month, only 27.2% had discussed the problem with their physician. In 12.4%, their physician had raised the question of faecal incontinence. Only 10% had received treatment for it, but 66% (107/162) felt they needed treatment.

Conclusion  Faecal incontinence is a common problem. Only a minority had reported this symptom to their physician and surprisingly few had received treatment for it. General awareness of faecal incontinence and treatment options should be improved among primary care physicians and general population.
Capecitabine/oxaliplatin as first‐line treatment for metastatic colorectal cancer: a meta‐analysis
Authors: Zhao G. , Gao P. , Yang K. H. , Tian J. H. , Ma B.
Published: April 2009

Objective  A meta‐analysis of randomized controlled trials (RCT) was carried out to determine the efficacy and safety of capecitabine plus oxaliplatin (CAPOX) or fluorouracil plus oxaliplatin (FUOX) as first‐line treatment for metastatic colorectal cancer (MCRC).

Method  A literature search was conducted of the Cochrane Controlled Trials Register Databases, Medline, Embase, ISI databases and Chinese Biomedical Literature Database without exclusion of material published in any language. RCTs conducted between 1998 and 2008 of CAPOX compared with FUOX regimens were considered for inclusion. Statistical analyses were carried out using RevMan software.

Results  Ten RCTs were included, involving 3208 patients. The meta‐analysis showed that there were no statistically significant differences in tumour response rate (RR, 0.93; 95% CI, 0.87–1.01; P = 0.09), progression‐free survival (PFS) (RR, 0.98; 95% CI, 0.94–1.01; P = 0.19), and overall survival (OS) (RR, 1.02; 95% CI, 0.97–1.07; P = 0.47) between CAPOX and FUOX regimen. However, symptoms of thrombocytopenia and hand‐foot syndrome (HFS) were increased in the CAPOX regimen (RR, 1.89; 95% CI, 1.33–2.69; P = 0.0004 and RR, 3.40; 95% CI, 2.25–5.15; P < 0.00001 respectively), while neutropenia and leucopenia occurred more frequently in the FUOX regimen (RR, 0.29; 95% CI, 0.15–0.55; P = 0.0002 and RR, 0.41; 95% CI, 0.18–0.95; P = 0.04respectively).

Conclusion  CAPOX was equivalent to FUOX in terms of tumour response rate, progression‐free survival (PFS), and OS in first‐line treatment for patients with MCRC, which may be considered as standard first‐line treatment in patients with MCRC.
Histological identification of epithelium in perianal fistulae: a prospective study
Authors: Van Koperen P. J. , Ten Kate F. J. W. , Bemelman W. A. , Slors J. F. M.
Published: April 2009

Aim  A procedure often performed following fistulotomy and advancement flap is curettage of the fistula tract after fistulotomy or after closing the internal opening. Epithelialization of the fistula tract might prevent closure of the fistula tract. The aim of this study was to assess the incidence and origin of epithelialization of the fistula tract in patients with perianal fistulae undergoing fistulotomy.

Method  Only patients with low perianal fistulae that were surgically treated by fistulotomy were included. Surgical biopsies were taken from the fistula tract from three different locations; on the proximal side at the internal opening, in the middle of the fistula tract and near the distal end close to the external opening.

Results  In the study period, 18 patients with low perianal fistulae were included. In 15 of the 18 patients, squamous epithelium was found at least in one of the biopsies taken from the fistula tract. Epithelium was predominantly found near the internal opening. There was no relation between the duration of fistula complaints and the amount of epithelialization (P = 0.301). The amount of epithelium was not related to the presence of a history of fistula surgery (P = 1.000).

Conclusion  This study demonstrated epithelialization in the fistula tract in the majority of the patients surgically treated by fistulotomy for low perianal fistulae. Curettage of perianal fistulae must therefore be considered an essential step in the surgical treatment of perianal fistula.
Long‐term results of biofeedback treatment for faecal incontinence: a comparative study with untreated controls
Authors: Lacima G. , Pera M. , Amador A. , Escaramís G. , Piqué J. M.
Published: April 2009

Aim  Long‐term results of biofeedback for faecal incontinence are controversial. Moreover, its value compared with standard care has been recently questioned. The study aimed to analyse the long‐term efficacy of biofeedback therapy for faecal incontinence to formed stool and to compare it with no treatment.

Method  Seventy‐nine patients with faecal incontinence to solid stool were evaluated at baseline and 1, 6, 36 and 60 months after treatment. To compare the long‐term results with no treatment, 40 patients initially evaluated but not referred for therapy were used as controls.

Results  More than 80% of patients recovered continence or had a reduction in the number of episodes of incontinence greater than 75% at 1, 6, 36 and 60 months, indicating that the success rate of biofeedback was maintained over time. At 60 months, 86% of patients treated with biofeedback were fully continent or had a > 75% reduction in the number of incontinent episodes compared to 26% of the untreated patients (P < 0.001).

Conclusion  Biofeedback therapy is effective in patients with faecal incontinence to formed stool compared with no treatment. Overall, clinical improvement is maintained in the long term.