bluuebunny/crossref_metadata_2025 huggingface dataset:
The Roberts syndrome/SC phocomelia spectrum—A case report of an adult with review of the literature
Authors: Goh Elaine Suk‐Ying , Li Chumei , Horsburgh Sheri , Kasai Yumi , Kolomietz Elena , Morel Chantal France
Published: January 2010

Roberts syndrome (RBS) (OMIM #268300) is a rare autosomal recessive disorder characterized by tetraphocomelia (symmetrical limb reduction), craniofacial anomalies, growth retardation, mental retardation, cardiac and renal abnormalities. The syndrome is caused by mutations in the ESCO2 (establishment of cohesion 1 homolog 2) (Entrez 609353) gene, which is located at 8p21.1, and encodes a protein essential in establishing sister chromatid cohesion during S phase. SC phocomelia (SC) (OMIM #269000), has less severe symmetric limb reduction, flexion contractures of various joints, minor facial anomalies, growth retardation and occasionally, mental retardation. These two syndromes can be considered part of a spectrum, with RBS at the most severe range in which severely affected infants may be stillborn or die in the post‐natal period, while individuals with SC phocomelia represent the milder end of the spectrum and typically survive to adulthood. In both presentations, karyotype investigations characteristically reveal premature centromere separation (PCS), otherwise known as heterochromatin repulsion or puffing. There is little literature about the follow‐up of adults with the spectrum of RBS/SC phocomelia or their recommended management. We report on an adult presentation of RBS/SC phocomelia spectrum disorder with a history of major cardiac malformation in childhood, normal limbs on physical examination, mild facial anomalies, mild learning difficulties, and PCS. Molecular studies of ESCO2 have confirmed the diagnosis. A literature review, focussing on adult manifestations of this condition and a discussion of follow‐up guidelines are presented. © 2010 Wiley‐Liss, Inc.
Analysis of genotype–phenotype correlations in human holoprosencephaly
Authors: Solomon Benjamin D. , Mercier Sandra , Vélez Jorge I. , Pineda‐Alvarez Daniel E. , Wyllie Adrian , Zhou Nan , Dubourg Christèle , David Veronique , Odent Sylvie , Roessler Erich , Muenke Maximilian
Published: January 2010

Since the discovery of the first gene causing holoprosencephaly (HPE), over 500 patients with mutations in genes associated with non‐chromosomal, non‐syndromic HPE have been described, with detailed descriptions available in over 300. Comprehensive clinical analysis of these individuals allows examination for the presence of genotype–phenotype correlations. These correlations allow a degree of differentiation between patients with mutations in different HPE‐associated genes and for the application of functional studies to determine intragenic correlations. These early correlations are an important advance in the understanding of the clinical aspects of this disease, and in general argue for continued analysis of the genetic and clinical findings of large cohorts of patients with rare diseases in order to better inform both basic biological insight and care and counseling for affected patients and families. Published 2010 Wiley‐Liss, Inc.
Abnormal sterol metabolism in holoprosencephaly
Authors: Haas Dorothea , Muenke Maximilian
Published: January 2010

Holoprosencephaly (HPE) is the most common structural malformation of the developing forebrain in humans. The HPE phenotype is extremely variable and the etiology is heterogeneous. Among a variety of embryological toxins that can induce HPE, inhibitors, and other pertubations of cholesterol biosynthesis have been shown to be important factors, most likely because cholesterol is required in the Sonic hedgehog signaling cascade. Decreased levels of maternal cholesterol during pregnancy increase the risk for preterm delivery, but they are not associated with congenital malformations. However, if the fetus is affected by an inborn error of endogenous cholesterol synthesis, a reduction of maternal cholesterol concentration and cholesterol transport over the placenta aggravates the phenotypic expression. Exposure to lipophilic statins in early pregnancy may be associated with a substantial risk for structural CNS defects. © 2010 Wiley‐Liss, Inc.
The Lymph Node Revisited: Development, Morphology, Functioning, and Role in Triggering Primary Immune Responses
Authors: Sainte‐Marie Guy
Published: January 2010

Scenarios have been proposed to explain how lymphoid components of a lymph node favor the encounter of a drained antigen with a circulating competent naïve lymphocyte to trigger a primary immune response. However, these scenarios rest on incorrect concepts about the organ. This situation resulted from a loss of interest for studies on in vivo lymphoid organs due to a widespread switch, decades ago, to work on suspended lymphoid cells. However, an in vivo holistic study of the organ continued in our laboratory. The present review synthesizes resulting knowledge on lymph node morphology and global functioning. We show that the opening of an afferent lymphatic vessel into the subcapsular sinus is the focal point from which the related portion of a lymph node—a node compartment—is developed. As to the formation of a compartment's lymphoid components, it is neonatally orchestrated by the dichotomic nature and distribution of antigens in this subcapsular sinus, which determines a dichotomic recruitment of circulating cells and the compartment's architectural complexity. The transport process of an antigen from a given tissue territory into restricted sites of the draining compartment further defines its local morphological features and activities, while providing the possibility to reduce the wandering of a short‐lived naïve cell through innumerable target‐devoid sites. We also explain that the nodal lymphoid components are not implicated in the triggering of primary responses, but are rather products of such responses. Scenarios for the triggering of primary responses, consistent with real node morphology and functioning, are proposed. Anat Rec, 293:320–337, 2010. © 2010 Wiley‐Liss, Inc.
Hair Whorls in the Dog (Canis familiaris). I. Distribution
Authors: Tomkins L.M. , Mcgreevy P.D.
Published: January 2010

Hair whorl characteristics were assessed in the domestic dog (Canis familiaris) in the regions of cephalic, cervical (dorsal, ventral, and lateral), thoracic and brachial axillary regions, the chest, shoulders, elbows, ventral abdominal region, and on the caudal thighs (ischiatic). They were classified as simple or tufted, and their position was recorded as the distance between their centers and bony landmarks within each region. The distribution of whorls was explored in a cohort of domestic dogs (N = 120) comprising a variety of breeds and cross‐breeds, sourced from shelters (N = 60) and the general public (N = 60). Whorls observed in the majority of dogs in this cohort typically occurred on the chest, brachial axillary region, elbows, and ischiatic region. Atypical whorls were present in fewer than 20% of the population, and included those on the head (cephalic), cervical regions (dorsal, ventral, and lateral), shoulders, thoracic axillary region, and on the ventral abdominal region. The majority of whorls on dogs were classified as simple. In contrast, those located on the elbows and the majority of chest whorls were tufted. The presence and position of whorls were often associated with several variables including coat length and thickness, and the sex and source of the dog. The palpation and hair‐cluster method of whorl assessment described in this article is best suited to dogs with short‐to‐medium coat lengths. The current methodology developed to assess hair whorl characteristics provides a framework for future investigations into any associations between hair whorl characteristics and other canine traits such as temperament. Anat Rec, 293:338–350, 2010. © 2010 Wiley‐Liss, Inc.
The Relationship Between Cephalic Scales and Bones in Lizards: A Preliminary Microtomographic Survey on Three Lacertid Species
Authors: Costantini David , Alonso Maria Lapresa , Moazen Mehran , Bruner Emiliano
Published: January 2010

3‐Dimensional models by surface rendering of the skull of L. bilineata. See Costantini et al., on page 186, in this issue. Anatomical Record 293:183–194.
Premature arthritis is a distinct type II collagen phenotype
Authors: Kannu Peter , Bateman John F. , Randle Susan , Cowie Shannon , du Sart Desiree , McGrath Shaun , Edwards Matthew , Savarirayan Ravi
Published: January 2010

Mutations in the gene encoding type II collagen (COL2A1) give rise to a spectrum of phenotypes predominantly affecting cartilage and bone. These chondrodysplasias are typically characterized by disproportionately short stature, eye abnormalities, cleft palate, and hearing loss. It is less recognized that mutations in COL2A1 can also present as degenerative joint disease in the absence of any other phenotypic clues. We report 2 Australian families presenting with an isolated arthritis phenotype, segregating as a dominant trait affecting both large and small joints, prior to age 30 years. Sequencing of COL2A1 in the propositi revealed 2 sequence changes resulting in glycine substitutions in the triple‐helical domain of type II collagen. We review the increasing evidence implicating COL2A1 mutations in individuals presenting with isolated degenerative joint disease, aiming to alert physicians who assess these patients to this possibility. The importance of finding a COL2A1 mutation in such patients lies in the subsequent ability to accurately assess recurrence risks, offer early (including prenatal) diagnosis, and provide information regarding the natural history of the condition. Most importantly, it enables at‐risk individuals to be identified for implementation of preventative strategies (i.e., weight loss, joint‐friendly exercise programs) and early ameliorative management of their condition.
Cellular characterization of the gouty tophus: A quantitative analysis
Authors: Dalbeth Nicola , Pool Bregina , Gamble Greg D. , Smith Timothy , Callon Karen E. , McQueen Fiona M. , Cornish Jillian
Published: January 2010

Objective

To characterize the cellular architecture of the tophus and to determine the presence of cytokines implicated in the initiation and resolution of gouty inflammation.

Methods

Sixteen fixed, paraffin‐embedded, uninfected tophus samples were surgically obtained from 12 patients with microscopically proven gout and were analyzed by quantitative immunohistochemistry. The number of cells present in the corona and fibrovascular zones of the tophus was analyzed by Genmod mixed models analysis.

Results

Numerous CD68+ mononucleated and multinucleated cells were present within the corona zone. Mast cells were identified in all tophus samples and at similar densities throughout the corona and fibrovascular zones. In contrast, neutrophils were rarely observed. Plasma cells were present in very high numbers within the corona zone. The overall number of CD20+ B cells was much lower. However, in 6 of 12 patients (50%), at least 1 B cell aggregate was present in the fibrovascular zone. Large numbers of cells expressing interleukin‐1β (IL‐1β) were observed in the corona zone. Transforming growth factor β1 (TGFβ1)–expressing mononucleated cells were also identified. The number of CD68+ cells correlated with the number of cells expressing IL‐1β (r = 0.691,P= 0.009) and the number expressing TGFβ1 (r = 0.518,P= 0.04).

Conclusion

The tophus represents a complex and organized chronic inflammatory tissue response to monosodium urate monohydrate crystals involving both innate and adaptive immune cells. The coexpression of IL‐1β and TGFβ1 suggests that both proinflammatory and antiinflammatory factors present within the tophus contribute to a cycle of chronic inflammation, attempted resolution, and tissue remodeling.
Control of Dkk‐1 ameliorates chondrocyte apoptosis, cartilage destruction, and subchondral bone deterioration in osteoarthritic knees
Authors: Weng Lin‐Hsiu , Wang Ching‐Jen , Ko Jih‐Yang , Sun Yi‐Chih , Wang Feng‐Sheng
Published: January 2010

Objective

Perturbation of Wnt signaling components reportedly regulates chondrocyte fate and joint disorders. The Wnt inhibitor Dkk‐1 mediates remodeling of various tissue types. We undertook this study to examine whether control of Dkk‐1 expression prevents joint deterioration in osteoarthritic (OA) knees.

Methods

Anterior cruciate ligament transection–and collagenase‐induced OA in rat knees was treated with end‐capped phosphorothioate Dkk‐1 antisense oligonucleotide (Dkk‐1–AS). Articular cartilage destruction, cartilage degradation markers, bone mineral density (BMD), and subchondral trabecular bone volume of injured knee joints were measured using Mankin scoring, enzyme‐linked immunosorbent assay, dual x‐ray absorptiometry, and histomorphometry. Dkk‐1–responsive molecule expression and apoptotic cells in knee tissue were detected by quantitative reverse transcriptase–polymerase chain reaction, immunoblotting, and TUNEL staining.

Results

Up‐regulated Dkk‐1 expression was associated with increased Mankin score and with increased serum levels of cartilage oligomeric matrix protein and C‐telopeptide of type II collagen (CTX‐II) during OA development. Dkk‐1–AS treatment alleviated OA‐associated increases in Dkk‐1 expression, Mankin score, cartilage fibrillation, and serum cartilage degradation markers. Dkk‐1–AS also alleviated epiphyseal BMD loss and subchondral bone exposure associated with altered serum levels of osteocalcin and CTX‐I. The treatment abrogated chondrocyte/osteoblast apoptosis and subchondral trabecular bone remodeling in OA. Dkk‐1 knockdown increased levels of nuclear β‐catenin and phosphorylated Ser473‐Akt but attenuated expression of inflammatory factors (Toll‐like receptor 4 [TLR‐4], TLR‐9, interleukin‐1β, and tumor necrosis factor α), the apoptosis regulator Bax, matrix metalloproteinase 3, and RANKL in OA knee joints.

Conclusion

Interference with the cartilage‐ and bone‐deleterious actions of Dkk‐1 provides therapeutic potential for alleviating cartilage destruction and subchondral bone damage in OA knee joints.
Decreased expression of heparin‐binding epidermal growth factor–like growth factor as a newly identified pathogenic mechanism of antiphospholipid‐mediated defective placentation
Authors: Di Simone N. , Marana R. , Castellani R. , Di Nicuolo F. , D'Alessio M. C. , Raschi E. , Borghi M. O. , Chen P. P. , Sanguinetti M. , Caruso A. , Meroni P. L.
Published: January 2010

Objective

Heparin‐binding epidermal growth factor–like growth factor (HB‐EGF) plays a role in blastocyst implantation and is down‐regulated in preeclampsia and in hypertensive pregnancy disorders associated with defective extravillous trophoblast invasion. Defective placentation and severe preeclampsia are also features of the antiphospholipid syndrome (APS). The purpose of this study was to investigate whether abnormal HB‐EGF expression plays a pathogenic role in antiphospholipid antibody (aPL)–mediated defective placentation.

Methods

HB‐EGF expression in placental tissue was evaluated by Western blotting and messenger RNA analysis in normal and APS placentae. Polyclonal IgG fractions or monoclonal β2‐glycoprotein I–dependent aPL and their respective controls were investigated for the following 4 features: their binding to human trophoblast monolayers, as determined by cell enzyme‐linked immunosorbent assay (ELISA); their effect on HB‐EGF expression by Western blotting in trophoblast cell extracts as well as by ELISA as a protein secreted in the culture supernatants; their inhibitory effect on in vitro trophoblast invasiveness, as evaluated by Matrigel assay; and their inhibitory effect on matrix metalloproteinase (MMP) levels, as measured by gelatin zymography. Experiments were also performed in the presence of serial concentrations of heparin or recombinant HB‐EGF.

Results

Placental APS tissue displayed reduced expression of HB‐EGF. Polyclonal and monoclonal aPL bound to trophoblast monolayers and significantly reduced the in vitro synthesis and secretion of HB‐EGF. Heparin inhibited aPL binding and restored HB‐EGF expression in a dose‐dependent manner. Addition of recombinant HB‐EGF reduced the in vitro aPL‐induced inhibition of Matrigel invasiveness as well as MMP‐2 levels.

Conclusion

These preliminary findings suggest that the reduction of aPL‐mediated HB‐EGF represents an additional mechanism that is responsible for the defective placentation associated with APS and that heparin protects from aPL‐induced damage by inhibiting antibody binding.
Overexpression of the growth arrest and DNA damage–induced 45α gene contributes to autoimmunity by promoting DNA demethylation in lupus T cells
Authors: Li Yaping , Zhao Ming , Yin Heng , Gao Fei , Wu Xiaoyan , Luo Yongqi , Zhao Sha , Zhang Xiujuan , Su Yuwen , Hu Nan , Long Hai , Richardson Bruce , Lu Qianjin
Published: January 2010

Objective

Demethylation of CD11a and CD70 regulatory regions in CD4+ T cells contributes to the development of autoreactivity and overstimulation of autoantibodies. Because growth arrest and DNA damage–induced 45α (GADD45α) reduces epigenetic silencing of genes by removing methylation marks, this study examined whether the gadd45A gene could contribute to autoimmunity by promoting DNA demethylation in T cells from patients with systemic lupus erythematosus (SLE).

Methods

Levels of GADD45α, CD11a, and CD70 messenger RNA (mRNA) and protein were detected by real‐time reverse transcription–polymerase chain reaction and Western blotting or flow cytometry. Global DNA methylation was evaluated using Methylamp global DNA methylation quantification kits. Detection of CD4+ T cell proliferation and autologous B cell IgG antibodies was performed using commercially available kits. CD11a and CD70 promoter methylation was determined with bisulfite sequencing.

Results

Elevated gadd45A mRNA expression and global DNA hypomethylation were observed in CD4+ T cells from SLE patients. The levels of gadd45A mRNA were inversely proportional to the levels of DNA methylation. Positive correlations were found between gadd45A and CD11a/CD70 mRNA levels. Expression of gadd45A mRNA was increased in CD4+ T cells following ultraviolet B irradiation, and this was accompanied by increased levels of CD11a and CD70 mRNA. Moreover, increased expression of gadd45A, CD11a, and CD70 mRNA was accompanied by increased autoreactivity and excessive B cell stimulation in gadd45A‐transfected CD4+ T cells. CD11a promoter methylation was also significantly reduced in transfected cells. Transfection of gadd45A small interfering RNA inhibited the autoreactivity of SLE CD4+ T cells and led to significant increases in the methylation levels of the CD11a and CD70 promoter regions.

Conclusion

These findings indicate that gadd45A may contribute to lupus‐like autoimmunity by promoting DNA demethylation in SLE CD4+ T cells.
A framework of automatic subject term assignment for text categorization: An indexing conception‐based approach
Authors: Chung EunKyung , Miksa Shawne , Hastings Samantha K.
Published: January 2010

The purpose of this study is to examine whether the understandings of subject‐indexing processes conducted by human indexers have a positive impact on the effectiveness of automatic subject term assignment through text categorization (TC). More specifically, human indexers' subject‐indexing approaches, or conceptions, in conjunction with semantic sources were explored in the context of a typical scientific journal article dataset. Based on the premise that subject indexing approaches or conceptions with semantic sources are important for automatic subject term assignment through TC, this study proposed an indexing conception‐based framework. For the purpose of this study, two research questions were explored: To what extent are semantic sources effective? To what extent are indexing conceptions effective? The experiments were conducted using a Support Vector Machine implementation in WEKA (I.H. Witten & E. Frank, 2000). Using F‐measure, the experiment results showed that cited works, source title, and title were as effective as the full text while a keyword was found more effective than the full text. In addition, the findings showed that an indexing conception‐based framework was more effective than the full text. The content‐oriented and the document‐oriented indexing approaches especially were found more effective than the full text. Among three indexing conception‐based approaches, the content‐oriented approach and the document‐oriented approach were more effective than the domain‐oriented approach. In other words, in the context of a typical scientific journal article dataset, the objective contents and authors' intentions were more desirable for automatic subject term assignment via TC than the possible users' needs. The findings of this study support that incorporation of human indexers' indexing approaches or conception in conjunction with semantic sources has a positive impact on the effectiveness of automatic subject term assignment.
Delayed surgery for acute severe colitis is associated with increased risk of postoperative complications
Authors: Randall J , Singh B , Warren B F , Travis S P L , Mortensen N J , George B D
Published: January 2010

Background

This study determined the long-term outcome after colectomy for acute severe ulcerative colitis (ASUC) and assessed whether the duration of in-hospital medical therapy is related to postoperative outcome.

Methods

All patients who underwent urgent colectomy and ileostomy for ASUC between 1994 and 2000 were identified from a prospective database. Patient details, preoperative therapy and complications to last follow-up were recorded.

Results

Eighty patients were identified, who were treated with intravenous steroids for a median of 6 (range 1–22) days before surgery. Twenty-three (29 per cent) also received intravenous ciclosporin. There were 23 complications in 22 patients in the initial postoperative period. Sixty-eight patients underwent further planned surgery, including restorative ileal pouch–anal anastomosis in 57. During a median follow-up of 5·4 (range 0·5–9·0) years, 48 patients (60 per cent) developed at least one complication. Patients with a major complication at any time during follow-up had a significantly longer duration of medical therapy before colectomy than patients with no major complications (median 8 versus 5 days; P = 0·036).

Conclusion

Delayed surgery for patients with ASUC who do not respond to medical therapy is associated with an increased risk of postoperative complications.
Case–control comparison of profundaplasty and femoropopliteal supragenicular bypass for peripheral arterial disease
Authors: Koscielny A , Pütz U , Willinek W , Hirner A , Mommertz G
Published: January 2010

Background

The aim of this study was to compare preoperative and postoperative findings, and clinical progress in patients with peripheral arterial occlusive disease undergoing femoropopliteal supragenicular bypass or profundaplasty in a case–control study.

Methods

Between January 2001 and June 2004, 171 patients with occlusion of the superficial femoral artery underwent surgery. A retrospective analysis of 28 matched patient pairs was performed. Endpoints were bypass occlusion, surgical revision, amputation and death. Mean length of follow-up was 36 months.

Results

At 3 years after surgery there was no statistically significant difference in outcome between femoropopliteal bypass surgery and profundaplasty. There was a trend towards improved results in patients who had bypass surgery for critical leg ischaemia. Preoperative patency of the crural outflow arteries was an independent prognostic factor in multivariable analysis.

Conclusion

There were no significant outcome differences between supragenicular bypass surgery or profundaplasty in patients who had surgery for intermittent claudication or ischaemic rest pain. Patients with a single patent tibial artery and gangrene or ulceration appeared to benefit more from bypass surgery.
Comparison of radionuclide lymphoscintigraphy and dynamic magnetic resonance lymphangiography for investigating extremity lymphoedema
Authors: Liu N-F , Lu Q , Liu P-A , Wu X-F , Wang B-S
Published: January 2010

Background

Lymphoscintigraphy is widely used to image the lymphatic system. The aim of this study was to compare lymphoscintigraphy and dynamic magnetic resonance lymphangiography (MRL) in the investigation of extremity lymphoedema.

Methods

Sixteen patients with primary extremity lymphoedema and two with Klippel–Trenaunay syndrome with lymphoedema were examined by lymphoscintigraphy using the tracer 99Tc-labelled dextran, and by MRL using gadobenate dimeglumine as contrast agent. Morphological abnormalities and functional state of the lymphatic systems of affected limbs were compared between the two imaging methods.

Results

Lymphatic vessels were imaged in 14 of 18 limbs with lymphoedema using MRL, compared with one of 18 using lymphoscintigraphy. MRL detected the inguinal nodes in 16 of 17 patients, whereas lymphoscintigraphy revealed inguinal nodes in only nine. MRL revealed more precise information about structural and functional abnormalities of lymph vessels and nodes than lymphoscintigraphy by real-time measurement of lymph flow in vessels and nodes.

Conclusion

Dynamic MRL was more sensitive and accurate than lymphoscintigraphy in the detection of anatomical and functional abnormalities in the lymphatic system in patients with extremity lymphoedema.
Open adhesiolysis is more effective in reducing adhesion reformation than laparoscopic adhesiolysis in an experimental model
Authors: Prushik S G , Stucchi A F , Matteotti R , Aarons C B , Reed K L , Gower A C , Becker J M
Published: January 2010

Background

This study compared adhesion reformation after open and laparoscopic adhesiolysis in a rat model.

Methods

Adhesions were induced by surgically creating ischaemic buttons on the peritoneal side wall. After 7 days the animals underwent laparoscopy with carbon dioxide insufflation or laparotomy to score and lyse adhesions. Peritoneal tissue and fluid were collected after 24 h in a subset of animals, and adhesion reformation was scored 7 days after lysis in the remainder. Tissue plasminogen activator (tPA), plasminogen activator inhibitor (PAI) 1, transforming growth factor (TGF) β1 and tumour necrosis factor (TNF) α mRNA, and total fibrinolytic activity were assessed. The abdomen of non-operated animals was insufflated for 7, 15 or 30 min with carbon dioxide, after which tPA and PAI-1 mRNA and total fibrinolytic activity were measured.

Results

Animals that underwent open adhesiolysis had 60 per cent fewer reformed adhesions than the laparoscopic adhesiolysis group (P < 0·001). There were no differences in tPA activity or tPA, PAI-1 and TNF-α mRNA between groups, but TGF-β1 mRNA levels were significantly increased in the open group. Carbon dioxide insufflation did not affect peritoneal tPA activity.

Conclusion

Open adhesiolysis may be more beneficial in minimizing adhesion reformation in the management of adhesion-related complications.
Optimizing the outcome of surgery in patients with rectal cancer and synchronous liver metastases
Authors: van der Pool A E , de Wilt J H , Lalmahomed Z S , Eggermont A M , IJzermans J N , Verhoef C
Published: January 2010

Background

This study evaluated the outcome of patients treated for rectal cancer and synchronous hepatic metastases in the era of effective induction radiotherapy and chemotherapy.

Methods

All patients undergoing surgical treatment of rectal cancer and synchronous liver metastases between 2000 and 2007 were identified retrospectively from a prospectively collected database. Three approaches were followed: the classical staged, the simultaneous and the liver-first approach.

Results

Of 57 patients identified, the primary tumour was resected first in 29 patients (group 1), simultaneous resection was performed in eight patients (group 2), and 20 patients underwent a liver-first approach (group 3). The overall morbidity rate was 24·6 per cent; there was no in-hospital mortality. Median in-hospital stay was significantly shorter for the simultaneous approach (9 days versus 18 and 15 days for groups 1 and 3 respectively; P < 0·001). The overall 5-year survival rate was 38 per cent, with an estimated median survival of 47 months.

Conclusion

Long-term survival can be achieved using an individualized approach, with curative intent, in patients with rectal cancer and synchronous liver metastases. Simultaneous resections as well as the liver-first approach are attractive alternatives to traditional staged resections.
Randomized clinical trial to compare the effects of preoperative oral carbohydrate versus placebo on insulin resistance after colorectal surgery
Authors: Wang Z G , Wang Q , Wang W J , Qin H L
Published: January 2010

Background

Preoperative oral carbohydrate (OCH) reduces postoperative insulin resistance (PIR). This randomized trial investigated whether this effect is related to insulin-induced activation of the phosphatidylinositol 3-kinase (PI3K)/protein kinase B (PKB) signalling pathway.

Methods

Patients with colorectal cancer scheduled for elective open resection were randomly assigned to preoperative OCH, fasting or placebo. Preoperative general well-being, insulin resistance before and immediately after surgery, and postoperative expression of PI3K, PKB, protein tyrosine kinase (PTK) and glucose transporter 4 (GLUT4) in rectus abdominis muscle were evaluated.

Results

Patient and operative characteristics did not differ between groups. Subjective well-being was significantly better in OCH and placebo groups than in the fasting group, primarily because of reduced thirst (P = 0·005) and hunger (P = 0·041). PIR was significantly greater in fasting and placebo groups (P < 0·010). By the end of surgery, muscle PTK activity as well as PI3K and PKB levels were significantly increased in the OCH group compared with values in fasting and placebo groups (P < 0·050), but GLUT4 expression was unaffected.

Conclusion

PIR involves the PI3K/PKB signalling pathway. Preoperative OCH intake improves preoperative subjective feelings of hunger and thirst compared with fasting, while attenuating PIR by stimulation of the PI3K/PKB pathway. Registration number: NCT00755729 (http://www.clinicaltrials.gov).
Inter‐rater reliability of the PCL‐R total and factor scores among psychopathic sex offenders: are personality features more prone to disagreement than behavioral features?
Authors: Edens John F. , Boccaccini Marcus T. , Johnson Darryl W.
Published: January 2010

Despite considerable support for the inter‐rater reliability of the Hare Psychopathy Checklist—Revised (PCL‐R; Hare, 1991, 2003) in research contexts, there is increasing concern that scores from this instrument may be considerably less stable across examiners in applied contexts, particularly when scoring is based on separate interviews. The present study examines archival data from a sample of imprisoned sex offenders (n = 20) who obtained relatively high PCL‐R total scores (≥25) and were administered this instrument on a second occasion by a different examiner. Intraclass correlations for the total and Factor 2 score were lower than those generally reported in research studies. Of greater concern, Factor 1 scores were only negligibly related to each other (ICCA,1 = .16). Correcting for potential range restriction among these high scoring individuals resulted in total and Factor 2 score measures of agreement that were somewhat more consistent with published research, but Factor 1 continued to display exceedingly poor agreement across examiners. Copyright © 2010 John Wiley & Sons, Ltd.
Assessing risk of sexually abusive behavior among youth in a child welfare sample
Authors: Prentky Robert A. , Li Nien‐Chen , Righthand Sue , Schuler Ann , Cavanaugh Deborah , Lee Austin F.
Published: January 2010

Statutory management of juvenile sexual offenders demands reliable, valid methods for assessing the risk posed by these youth. This study examined the predictive validity of the J‐SOAP‐II using samples of adolescent and pre‐adolescent boys who were wards of the Massachusetts Department of Social Services. The base rate for sexual recidivism among the adolescents (14–16%) is generally in line with what has been reported. The equivalent base rate for the pre‐adolescents (25–28%), however, was notably higher. Although the J‐SOAP‐II was developed for adolescents, the scale also worked with the pre‐adolescents in predicting sexual recidivism over 7 years, with AUC values of 0.77, 0.74, 0.77, and 0.80 for Scales 1, 3, 4, and Total among the pre‐adolescents and AUC values of 0.80, 0.82, and 0.83 for Scales 1, 4, and Total among the adolescents. Discussion focuses on extant J‐SOAP research and sample dependent variability, as well as social policy implications. Copyright © 2010 John Wiley & Sons, Ltd.
Psychological mechanisms underlying support for juvenile sex offender registry laws: prototypes, moral outrage, and perceived threat
Authors: Salerno Jessica M. , Najdowski Cynthia J. , Stevenson Margaret C. , Wiley Tisha R. A. , Bottoms Bette L. , Vaca Roberto , Pimentel Pamela S.
Published: January 2010

In three studies, we investigated support for applying sex offender registry laws to juveniles. Family law attorneys supported registry laws less for juveniles than for adults. Laypeople and prosecutors supported juvenile and adult sex offender registration equally—even though they perceived juveniles as generally less threatening than adults (Study 1)—because most people spontaneously envision a severe sex offender prototype regardless of offender age (Study 2). People are less supportive of registry laws, however, when they envision less severe prototypes spontaneously (Study 2) or when induced to do so (Study 3). Effects of offender age, offender prototypes, and offense severity were mediated by perceptions of threat posed by the juvenile sex offender (i.e., utilitarian concerns). The effect of offense severity was also mediated by moral outrage (i.e., retributive concerns). Copyright © 2010 John Wiley & Sons, Ltd.
Transcatheter aortic valve implantation through the left subclavian artery with a patent LIMA graft
Authors: Taramasso Maurizio , Giacomini Andrea , Maisano Francesco
Published: January 2010

We report the case of an 80‐year‐old male with severe aortic valve stenosis previously submitted to surgical myocardial revascularization with patent mammary graft treated by TAVI through left‐transaxillary approach because of unsuitable transfemoral and transapical approaches.© 2010 Wiley‐Liss, Inc.
Comparison of door‐to‐balloon times for primary PCI using transradial versus transfemoral approach
Authors: Pancholy Samir , Patel Tanuj , Sanghvi Kintur , Thomas Marie , Patel Tejas
Published: January 2010

Objectives: The objective of this study was to compare door‐to‐balloon times and other variables in ST‐segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) using transfemoral or transradial approaches. Background: Transradial PCI has been shown to lower the risk of access site complications but the procedure is not applied to STEMI patients, due to concerns of procedural complexity adversely affecting prompt reperfusion. There is paucity of real‐world data comparing TRI with TFI in patients with STEMI. Methods: Three hundred sixteen consecutive patients with STEMI undergoing primary PCI were studied. Patients were divided in two groups, Group I (n = 204) undergoing PCI transfemorally and Group II (n = 109) patients transradially. Demographic data, door‐to‐balloon times, procedural variables, predischarge adverse events, access site complications, and 1 year follow‐up major adverse cardiac events (MACE) were recorded. Results: Door‐to‐balloon time was 72 ± 14 min in Group I compared with 70 ± 17 min in Group II, the difference was not statistically significant (t = 1.096, P > 0.27). Group II patients had significantly fewer access site complications compared with Group I (20 vs. 1 patient, χ2 = 10.8, P < 0.05). Demographics, predischarge adverse events, and MACE at 1 year follow‐up were comparable between the two groups. Conclusions: Transradial approach to primary PCI provides similar door‐to‐balloon times to transfemoral approach, and significantly lowers access site related complications, in patients presenting with STEMI. © 2010 Wiley‐Liss, Inc.
ViewIT improves intravascular ultrasound‐guided wiring in coronary intervention of chronic total occlusion
Authors: Okamura Atsunori , Iwakura Katsuomi , Fujii Kenshi
Published: January 2010

Terumo intravascular ultrasound (IVUS) ViewIT facilitates IVUS‐guided wiring in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) due to its low profile and surface coating. In PCI for CTO, the first guidewire is sometimes inserted into the subintimal space, and observation by IVUS through the first guidewire in the subintima can allow the second guidewire to be led visually into the true lumen. We describe a case of CTO in which ViewIT was inserted into the subintimal space of the CTO lesion and scanning from the coronary ostium to the CTO subintimal space allowed the second guidewire to be led into the true lumen. © 2010 Wiley‐Liss, Inc.
Five‐year long‐term clinical follow‐up of the XIENCE V everolimus eluting coronary stent system in the treatment of patients with de novo coronary artery lesions: The SPIRIT FIRST trial
Authors: Wiemer Marcus , Serruys Patrick W. , Miquel‐Hebert Karine , Neumann Franz‐Josef , Piek Jan J. , Grube Eberhard , Haase Jürgen , Thuesen Leif , Hamm Christian
Published: January 2010

Background: Drug‐eluting stents have shown to be superior over bare metal stents in clinical and angiographic outcomes after percutaneous treatment of coronary artery stenosis. However, long‐term follow‐up data are scarce and only available for sirolimus‐ and paclitaxel‐eluting stents. Aim: To assess the feasibility and performance of the XIENCE V everolimus‐eluting stent (EES) versus an identical bare metal stent after a 5‐year follow‐up period. Methods: SPIRIT FIRST was a First in Man, multicentre, prospective, single‐blind, clinical trial, randomizing 60 patients with a single de novo coronary artery lesion in a ratio of 1:1 to either an everolimus eluting or a bare metal control stent. Results: At 5‐year clinical follow‐up, data were available in 89% and 86% of patients in the everolimus and control arm, respectively. In the everolimus arm, no additional death, myocardial infarction, clinically driven target lesion revascularization (TLR), or clinically driven target vessel revascularization (TVR) events were observed between 1‐ and 5‐year follow‐up. The 5‐year hierarchical major adverse cardiac events (MACE) and target vessel failure (TVF) rates for the everolimus arm were 16.7% (4/24) for both endpoints. In the control group, no additional cardiac death, myocardial infarction, or clinically driven TLR events were observed between 2‐ and 5‐year follow‐up. No additional clinically driven TVR events were observed between 3‐ and 5‐year follow‐up. The 5‐year hierarchical MACE and TVF rates for the control arm were 28.0% (7/25) and 36.0% (9/25), respectively. No stent thromboses were observed in either the everolimus arm or the control arm up to 5 years. Conclusion: The favorable 5‐year long term clinical outcome of the EES is consistent with the results from other studies of the EES with shorter follow‐up. © 2010 Wiley‐Liss, Inc.
Feasibility of carotid artery stenting in patients with angiographic string sign
Authors: Barker Colin M. , Gomez Jaime , Grotta James C. , Smalling Richard W.
Published: January 2010

Background: Treatment of angiographic string sign (SS) of the carotid artery with carotid endarterectomy or carotid artery stenting (CAS) has been associated with a high incidence of periprocedural neurological events. We describe our experience with CAS in a case series of symptomatic patients with severe carotid stenosis and angiographic SS. Methods: We performed a retrospective review from 1999 to 2009 using our cardiac cath laboratory database and identified nine patients with the angiographic SS who underwent CAS. All patients were referred for carotid angiography by a neurologist due to symptoms (stroke or transient ischemic attack (TIA)). All lesions were predilated and treated with self‐expanding stents. Distal protection devices were utilized (six patients) once they became available. Periprocedural outcomes and long‐term follow‐up was reviewed when available. Results: The average time from onset of symptoms to CAS was 45 days. All CAS procedures were technically and clinically successful without acute complications. One year follow‐up was available in eight patients. One patient had a possible TIA, and the remaining seven patients did not report any events (death, stroke, TIA or myocardial infarction). Carotid ultrasound evaluation at 12 months was available in six patients and showed no evidence of restenosis. Conclusions: In our experience, CAS in patients with severe symptomatic carotid stenosis and angiographic SS is feasible, with an acceptably low periprocedural complication rate. © 2010 Wiley‐Liss, Inc.
Percutaneous closure of multiple defects of the atrial septum: Procedural results and long‐term follow‐up
Authors: Butera Gianfranco , Romagnoli Enrico , Saliba Zakhia , Chessa Massimo , Sangiorgi Giuseppe , Giamberti Alessandro , Cappato Riccardo , Bussadori Claudio , Abella Raul , Pelissero Gabriele , Frigiola Alessandro , Carminati Mario
Published: January 2010

Background: The percutaneous closure of single atrial septal defect (ASD) is a valid alternative to surgery. Objectives: To assess the feasibility of percutaneous treatment of multiple ASDs. Methods: Between 1998 and 2007, 165 out of 1280 consecutive patients undergoing ASD percutaneous closure at our institution showed multiple defects that were classified in four categories: double atrial septal defects (d‐ASD), multifenestrated atrial septal defects (f‐ASD), multifenestrated defects with no signs of right heart overload (f‐PFO), and complex cases (c‐ASD). The following end points were taken into consideration: (1) immediate procedural success; (2) long term safety and efficacy. In this study, up to 81% of multiple ASDs were suitable for percutaneous closure. Results: Multiple device implantations were required in 47% of cases, especially in patients with d‐ASD and c‐ASD. Complication rate, residual shunt, and long term outcome were comparable among the four different categories. In particular, at long term follow‐up (6 ± 2 years) no patient required further surgical or percutaneous treatment and complete closure was confirmed in 99% of cases. Conclusions: Percutaneous closure of multiple ASDs is feasible and associated with a good outcome. A thorough identification and analysis of morphological aspects are mandatory in order to select the appropriate device and the optimal strategy. © 2010 Wiley‐Liss, Inc.
Safety and effectiveness of the INVATEC MO.MA® proximal cerebral protection device during carotid artery stenting: Results from the ARMOUR pivotal trial
Authors: Ansel Gary M. , Hopkins L. Nelson , Jaff Michael R. , Rubino Paolo , Bacharach J. Michael , Scheinert Dierk , Myla Subbarao , Das Tony , Cremonesi Alberto ,   The Investigators for the ARMOUR Pivotal Trial
Published: January 2010

Objective: The multicenter ARMOUR (ProximAl PRotection with the MO.MA Device DUring CaRotid Stenting) trial evaluated the 30‐day safety and effectiveness of the MO.MA® Proximal Cerebral Protection Device (Invatec, Roncadelle, Italy) utilized to treat high surgical risk patients undergoing carotid artery stenting (CAS). Background: Distal embolic protection devices (EPD) have been traditionally utilized during CAS. The MO.MA device acts as a balloon occlusion “endovascular clamping” system to achieve cerebral protection prior to crossing the carotid stenosis. Methods: This prospective registry enrolled 262 subjects, 37 roll‐in and 225 pivotal subjects evaluated with intention to treat (ITT) from September 2007 to February 2009. Subjects underwent CAS using the MO.MA device. The primary endpoint, myocardial infarction, stroke, or death through 30 days (30‐day major adverse cardiac and cerebrovascular events [MACCE]) was compared to a performance goal of 13% derived from trials utilizing distal EPD. Results: For the ITT population, the mean age was 74.7 years with 66.7% of the cohort being male. Symptomatic patients comprised 15.1% and 28.9% were octogenarians. Device success was 98.2% and procedural success was 93.2%. The 30‐day MACCE rate was 2.7% [95% CI (1.0–5.8%)] with a 30‐day major stroke rate of 0.9%. No symptomatic patient suffered a stroke during this trial. Conclusions: The ARMOUR trial demonstrated that the MO.MA® Proximal Cerebral Protection Device is safe and effective for high surgical risk patients undergoing CAS. The absence of stroke in symptomatic patients is the lowest rate reported in any independently adjudicated prospective multicenter registry trial to date. © 2010 Wiley‐Liss, Inc.
Native chronic total occlusion recanalization after lower limb bypass graft occlusion: A series of nine cases
Authors: Kawarada Osami , Yokoi Yoshiaki
Published: January 2010

Objective: The aim of the study was to report the clinical utility of native chronic total occlusion (CTO) recanalization as an endovascular strategy in lower limb bypass graft occlusion. Background: There is no consensus on the best approach for threatened limbs in patients with graft occlusion. Methods: The subjects were nine consecutive patients with limb‐threatening ischemia after bypass graft occlusion. Native CTO recanalization was attempted endovascularly using conventional intraluminal and subintimal angioplasty techniques supported by stents. Results: The mean age of the bypass grafts was 6.7 ± 7.3 (range: 1–24) months and the mean number of previous lower limb bypass surgeries was 1.4 ± 0.5 (range: 1–2). Native CTO recanalization was performed in the iliofemoral (n = 2), iliac (n = 2), superficial femoral (n = 3), popliteal (n = 1), and popliteal‐tibial (n = 1) arteries. Technical success was achieved in 89% (8/9) of cases without complications or major adverse cardiovascular events. The ankle‐brachial index and skin perfusion pressure of the foot significantly increased after revascularization, with marked improvement of clinical symptoms (Rutherford class: 4.5 ± 1.1→0.9 ± 1.4, P < 0.001). Limb salvage was achieved in all successful recanalization cases during the mean follow‐up time of 25 ± 20 months (range: 9–60). Conclusions: In this preliminary study, endovascular recanalization of native CTO showed satisfactory outcomes in patients with bypass graft occlusion. © 2010 Wiley‐Liss, Inc.
Stent thrombosis after complex multivessel stenting in an elderly patient
Authors: Ito Shigenori , Yoshida Takayuki
Published: January 2010

We report a challenging case in terms of procedural difficulty as well as long‐term patency. Multivessel stenting procedures for long subtotal occlusions in the right coronary artery (RCA) and left anterior descending coronary artery (LAD) were successfully performed in an 84‐year‐old female who had complications of severe left ventricular dysfunction and a recent history of gastric ulcer bleeding. Two bare‐metal stents were successfully deployed in the mid and distal RCA. A drug‐eluting stent could only be deployed in the proximal RCA. Two drug‐eluting stents were deployed in the proximal LAD and LMT. Late stent thrombosis in the proximal RCA occurred about 3 months later. We speculated that a lack of aspirin and bare metal stent restenosis were the reasons for the late stent thrombosis. This case was very challenging in terms of balancing the risk of ischemia and bleeding after coronary stent deployment. © 2010 Wiley‐Liss, Inc.
Treatment of splenic artery aneurysm with polytetrafluoroethylene‐covered stent
Authors: Aslam Mohammad Shakil , Shalev Yoseph
Published: January 2010

Splenic artery aneurysm (SAA) is a rare condition, mostly treated with surgery. Usually an incidental finding, prevalence varies from 0.04 to 0.10%. If left untreated, SAA carries a high risk of rupture and high mortality. We describe a 53‐year‐old male patient with SAA, where a balloon‐expandable, polytetrafluoroethylene‐covered stent was used for treatment. The stent remains patent without any leakage after 2 years. © 2010 Wiley‐Liss, Inc.