bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical outcome following Doppler‐guided haemorrhoidal artery ligation: a systematic review
Authors: Pucher P. H. , Sodergren M. H. , Lord A. C. , Darzi A. , Ziprin P.
Published: March 2013

Aim

Doppler‐guided haemorrhoidal artery ligation (DGHL) has experienced wider uptake and has recently received National Institute for Health and Clinical Excellence (NICE) approval in the UK. A systematic review of the literature was conducted to assess its safety and efficacy.

Method

This review was conducted in keeping with PRISMA guidelines. MEDLINE, EMBASE, Google Scholar and Cochrane Library databases were searched. Studies describing DGHL as a primary procedure and reporting clinical outcome were considered. Primary end‐points were recurrence and postoperative pain. Secondary end‐points included operation time, complications and reintervention rates. Studies were scored for quality with either Jadad score or NICE scoring guidelines.

Results

Twenty‐eight studies including 2904 patients were included in the final analysis. They were of poor overall quality. Recurrence ranged between 3% and 60% (pooled recurrence rate 17.5%), with the highest rates for grade IV haemorrhoids. Postoperative analgesia was required in 0–38% of patients. Overall postoperative complication rates were low, with an overall bleeding rate of 5% and an overall reintervention rate of 6.4%. The operation time ranged from 19 to 35 min.

Conclusion

DGHL is safe and efficacious with a low level of postoperative pain. It can be safely considered for primary treatment of grade II and III haemorrhoids.
ECONOMIC FREEDOM OF THE WORLD: AN ACCOUNTING OF THE LITERATURE
Authors: HALL JOSHUA C. , LAWSON ROBERT A.
Published: March 2013

The Economic Freedom of the World (EFW) index was first produced by Gwartney, Block, and Lawson (Economic Freedom of the World: 1975–1995; 1996) and has been updated annually since. During this period, the EFW index has been cited in hundreds of academic articles. Here, we provide an accounting and description of this literature. Of 402 articles citing the EFW index, 198 used the index as an independent variable in an empirical study. Over two‐thirds of these studies found economic freedom to correspond to a “good” outcome such as faster growth, better living standards, more happiness, etc. Less than 4% of the sample found economic freedom to be associated with a “bad” outcome such as increased income inequality. The balance of evidence is overwhelming that economic freedom corresponds with a wide variety of positive outcomes with almost no negative tradeoffs. (JEL P0, O43)
Care complexity, mood, and quality of life in liver pre‐transplant patients
Authors: Lobo Elena , Stiefel Frederic , Söllner Wolfgang , Santabarbara Javier , Lobo Antonio , Huyse Frits , Marcos Guillermo , Michaud Laurent , Hohenberger Werner , Ludwig Gundula
Published: March 2013

Rationale

This study was intended to document the frequency of care complexity in liver transplant candidates, and its association with mood disturbance and poor health‐related quality of life (HRQoL).

Methods

Consecutive patients fulfilling inclusion criteria, recruited in three European hospitals, were assessed with INTERMED, a reliable and valid method for the early assessment of bio‐psychosocial health risks and needs. Blind to the results, they were also assessed with the Hospital Anxiety and Depression Scale (HADS). HRQoL was documented with the EuroQol and the SF36. Statistical analysis included multivariate and multilevel techniques.

Results

Among patients fulfilling inclusion criteria, 60 patients (75.9%) completed the protocol and 38.3% of them were identified as “complex” by INTERMED, but significant between‐center differences were found. In support of the working hypothesis, INTERMED scores were significantly associated with all measures of both the SF36 and the EuroQol, and also with the HADS. A one point increase in the INTERMED score results in a reduction in 0.93 points in EuroQol and a 20% increase in HADS score.

Conclusions

INTERMED‐measured case complexity is frequent in liver transplant candidates but varies widely between centers. The use of this method captures in one instrument multiple domains of patient status, including mood disturbances and reduced HRQoL.
Evaluation of a new endoscopic ultrasound‐guided multi‐fiducial delivery system: A prospective non‐survival study in a live porcine model
Authors: Draganov Peter V. , Chavalitdhamrong Disaya , Wagh Mihir S.
Published: March 2013

Background

Endoscopic ultrasound (EUS) is an excellent tool for implanting fiducials for gastrointestinal malignancies, but a dedicated delivery system for EUS‐guided fiducial placement is not available. The aim of the present study was to evaluate the performance characteristics of a new dedicated EUS‐guided multi‐fiducial delivery system.

Methods

This was a prospective live porcine study using prototype 22‐G EUS needles preloaded with four fiducials. Primary outcomes were technical success and accuracy of fiducial placement. Secondary outcomes were ease of passage of delivery system, ease of deployment, EUS visualization of the needle, visual appearance of fiducials on EUS, fluoroscopy and computed tomography (CT) scans, time taken for fiducial placement and adverse events. Outcomes were scored on a predetermined 5‐point Likert scale (1 = best, 5 = worst).

Results

Fiducial deployment was successful in 43 out of 45 needles (95.6%). All 172 fiducials (43 needles, four fiducials each)were successfully deployed on target. Fiducial placement accuracy score was 1.30 ± 0.64. All needles passed with ease (score 1.0 ± 0.0). Ease of fiducial deployment score was 1.85 ± 1.02. Mean scores for EUS visualization of the needle and fiducial were 1.02 ± 0.15 and 2.10 ± 0.91, respectively. Fluoroscopic and CT visualization of fiducials was excellent. Time for placement of four fiducials was <1 min (0.86 ± 0.50 min). No adverse events were seen.

Conclusion

The new EUS‐guided multi‐fiducial delivery system provided quick, easy, and accurate fiducial deployment without adverse events.
Endoscopic ultrasonography‐guided pancreatic duct access: Techniques and literature review of pancreatography, transmural drainage and rendezvous techniques
Authors: Itoi Takao , Kasuya Kazuhiko , Sofuni Atsushi , Itokawa Fumihide , Kurihara Toshio , Yasuda Ichiro , Nakai Yousuke , Isayama Hiroyuki , Moriyasu Fuminori
Published: March 2013

Endoscopic ultrasonography‐guided (EUS)‐guided pancreatic interventions have gained increasing attention. Here we review EUS‐guided pancreatic duct (PD) access techniques and outcomes. EUS‐guided PD intervention is divided into two types, antegrade and rendezvous techniques, following EUS‐guided pancreatography. In the antegrade technique, pancreaticoenterostomy is carried out by stent placement between the PD and the stomach, duodenum, or jejunum. Transenteric antegrade PD stenting is conducted by stent placement, advancing anteriorly into the PD through the pancreatic tract. The rendezvous technique is carried out by using a guidewire through the papilla or anastomotic site for retrograde stent insertion. In terms of EUS‐guided PD stenting, 11 case reports totaling 75 patients (35 normal anatomy, 40 altered anatomy) have been published. The technical success rate was greater than 70%. Early adverse events, including severe hematoma and severe pancreatitis,occurred in seven (63.6%) of 11 reports. Regarding the rendezvous technique, 12 case reports totaling 52 patients (22 normal anatomy, 30 altered anatomy) have been published. The technical success rate ranged from 25% to 100%. It was 48% in one report that involved more than 20 cases. Once stents were placed, all patients became free of symptoms. Early mild adverse events occurred in four (36.4%) of 11 reports. In conclusion, although it can be risky because of possible serious or even fatal adverse events, including pancreatic juice leakage, perforation and severe acute pancreatitis, EUS‐PD access seems to be promising for treating symptomatic pancreatic diseases caused by PD stricture and pancreaticoenterostomy stricture.
Rett syndrome: an eye‐tracking study of attention and recognition memory
Authors: Rose Susan A , Djukic Aleksandra , Jankowski Jeffery J , Feldman Judith F , Fishman Iris , Valicenti‐Mcdermott Maria
Published: March 2013

Aim

The aim of this study was to examine attention and recognition memory for faces and patterns in Rett syndrome, a severely disabling neurodevelopmental disorder caused by mutations in the X‐linkedMECP2gene.

Method

Because Rett syndrome impairs speech and hand use, precluding most neuropsychological testing, the visual paired‐comparison paradigm (VPC) was used, together with eye tracking. In theVPC, two identical stimuli are presented for familiarization. On test, the familiar stimulus and a new one are paired, and recognition inferred from preferential looking to the novel target. Attention is measured by looking time, gaze dispersion, and number/length of fixations. Twenty‐seven female patients with Rett syndrome (mean age 10y 6mo; SD 6y 8mo, age range 2–22y) from the Rett clinic at a children's hospital were assessed in this study, along with 30 age‐ and sex‐matched typically developing participants (outpatients from the same hospital).

Results

Although patients with Rett syndrome showed recognition of both faces and patterns, with novelty scores greater than chance (50%), their performance was significantly poorer than that of the typically developing comparison group. Their attention to both was less mature and marked by a more narrowly focused gaze, with fewer and longer fixations. When inspecting faces, attention to the eyes was similar in both groups; however, patients with Rett syndrome tended to ignore the nose and mouth.

Interpretation

This is one of the first studies to characterize attention and memory in individuals withRett syndrome. Visually based techniques, such as theVPC, open a new avenue for quantifying the cognitive phenotype associated with this syndrome.
The need for unbiased cognitive assessment in Rett syndrome: is eye tracking the answer?
Authors: Byiers Breanne , Symons Frank
Published: March 2013

This commentary is on the original article by Rose et al. on pages 364–371 of this issue.
Prevalence of early childhood disability in a rural district of Sind, Pakistan
Authors: Ibrahim Shahnaz H , Bhutta Zulfiqar A
Published: March 2013

Aim

Children born in low‐ and mid‐income countries are at a high risk of developing disabilities, yet estimates of population‐based prevalence are sparse. Our aim was to determine the prevalence of early childhood (0–5 year) disability in Sind, a rural area of Pakistan.

Method

We conducted a cross‐sectional household survey in a population of 25 196 households. The Ten Questions screen and the Signs of Disability in Newborn and Infants screen were used.

Results

The disability prevalence in a population of 176 364 individuals was 5.5 out of 1000 in children under 2 years and 5.4 out of 1000 in children aged 2–5 years. Fifty‐six per cent were males, and 56% had the disability recognized from birth or soon after. The mortality rate of children aged 0–5 years in the area was estimated as 30 out of 1000 live births. Cerebral palsy was the most common disability identified. The Ten Questions screen had better interrater agreement than the Signs of Disability in Newborn and Infants screen.

Interpretation

This is the largest reported household screening survey for early childhood disability at a population level from rural Pakistan. The comparatively low prevalence may be due to the younger age studied and high early childhood mortality. Our data highlight the importance of prospective surveillance at a population level and the need for preventive and support services.
All in the hope of saving a few minutes: improving efficiency of the GMFM‐66
Authors: White Hank
Published: March 2013

This commentary is on the original article by Avery et al. on pages 534–538 of this issue.
Visualization of Submitral Structure by Three‐Dimensional Transesophageal Echocardiography
Authors: Obase Kikuko , Komeda Masashi , Saito Ken , Tamada Tomoko , Fukuhara Kenzo , Koyama Terumasa , Kume Teruyoshi , Hayashida Akihiro , Okura Hiroyuki , Yoshida Kiyoshi
Published: March 2013

Objective

The conventional mid‐esophageal observation by three‐dimensional transesophageal echocardiography (3DTEE) sometimes fails to visualize the subvalvular apparatus. In this study, we compared the effectiveness of the transgastric approach by 3DTEE in visualizing the mitral valve complex with the conventional mid‐esophageal approach.

Methods

We studied 10 consecutive patients who underwent mitral valve surgery for functional mitral regurgitation. The anatomy of the mitral complex was interpreted from the 3DTEE data acquired by both the mid‐esophageal and the transgastric approach preoperatively. The interpretations of the image of the mid‐esophageal approach and the transgastric approach were compared with surgical observations.

Results

In the concordance rate for surgical observation, the interpretation of the number of papillary heads and chordal distribution for the transgastric observation were superior to those for the mid‐esophageal observation both for anterior papillary muscle (P < 0.01 and 0.005, respectively) and posterior papillary muscle (P < 0.001 and 0.0005, respectively).

Conclusion

The accuracy of transgastric observations of submitral structure using 3DTEE was superior to that provided by the conventional mid‐esophageal approach. Transgastric approach offers a ventricular view and complementary information to conventional mid‐esophageal approach in patient with functional mitral regurgitation.
Impaired Coronary Microvascular Function and Its Association with Disease Duration and Inflammation in Patients with Psoriasis
Authors: Gullu Hakan , Caliskan Mustafa , Dursun Recep , Ciftci Ozgur , Guven Aytekin , Muderrisoglu Haldun
Published: March 2013

Subjects

Thirty‐six patients with psoriasis and 56 healthy volunteers were included in this study.

Methods

Echocardiographic examination included transmitral peak flow velocities of the early phase (E) and late phase (A) of the mitral inflow, left ventricular myocardial velocity measurements, and coronary flow reserve (CFR) measurement.

Results

Baseline coronary diastolic peak flow velocity (DPFV) of left anterior descending artery (LAD) was significantly higher in the psoriasis group. However, hyperemic DPFV was slightly lower and CFR (2.19 ± 0.39 vs. 2.60 ± 0.31, P < 0.0001) was significantly lower in the psoriasis group than in the control group. CFR was significantly and inversely correlated with disease duration, Psoriasis Area and Severity Index (PASI) score, and hsCRP.

Conclusion

CFR is decreased in patients with psoriasis, and it correlates to disease duration, PASI score, and inflammation.
Pulmonary Artery Distensibility in Chronic Obstructive Pulmonary Disease
Authors: Ertan Cagatay , Tarakci Neslihan , Ozeke Ozcan , Demir Ahmet Duran
Published: March 2013

Background

Pulmonary hypertension (PH) is an important complication in the natural history of chronic obstructive pulmonary disease (COPD) and is caused by the remodeling of pulmonary arteries impairing the distensibility and stiffness of the major pulmonary arteries.

Objectives

To evaluate the pulmonary artery distensibility by transthoracic echocardiography in patients with COPD.

Method

We prospectively investigated COPD male patients and compared with healthy controls. In addition to right ventricle (RV) conventional echocardiographic parameters, right pulmonary artery fractional shortening(RPA‐FS) and new pulmonary artery stiffness (PAS) parameters were compared.

Results

Fifty‐four COPD patients participated in the study and compared with a control group consisting of 24, all men, healthy, nonsmoking subjects. Six patients were excluded from study due to poor quality of echocardiographic recordings. The distensibility of PA evaluated by the RPA‐FS parameter was found to be significantly lower in patients with COPD than it was in normal subjects (13.3 ± 8.1 vs. 27.6 ± 4.9,P :< 0.001) and correlated positively with tricuspid annular systolic excursion (TAPSE) (r = 0.566, P < 0.001) and pulmonary acceleration time (r = 0.607, P < 0.001) and correlated inversely with pulmonary artery systolic pressure (r = −0.587, P < 0.001), PAS(r = −0.479, P < 0.001) and functional capacity (r = −0.586, P < 0.001). Similar to this, PAS found to be impaired in COPD patients (29.5 ± 13.6 vs. 15.7 ± 4.1, P < 0.001) and correlated inversely RPA‐FS (r = −0.479, P < 0.001). There were statistically significant difference for pulmonary artery distensibility (RPA‐FS) and PAS parameters among the COPD subgroups with regard to NYHA functional capacity (P < 0.001).

Conclusion

In this study, we found that PAS and distensibility were worsened in COPD patients and correlated with decreased functional capacity.
Feasibility and Observer Reproducibility of Speckle Tracking Echocardiography in Congenital Heart Disease Patients
Authors: Mokhles Palwasha , van den Bosch Annemien. E. , Vletter – McGhie Jackie S. , Van Domburg Ron T. , Ruys Titia P. E. , Kauer Floris , Geleijnse Marcel L. , Roos – Hesselink Jolien W.
Published: March 2013

Aims

The twisting motion of the heart has an important role in the function of the left ventricle. Speckle tracking echocardiography is able to quantify left ventricular (LV) rotation and twist. So far this new technique has not been used in congenital heart disease patients. The aim of our study was to investigate the feasibility and the intra‐ and inter‐observer reproducibility of LV rotation parameters in adult patients with congenital heart disease.

Methods and Results

The study population consisted of 66 consecutive patients seen in the outpatient clinic (67% male, mean age 31 ± 7.7 years, NYHA class 1 ± 0.3) with a variety of congenital heart disease. First, feasibility was assessed in all patients. Intra‐ and inter‐observer reproducibility was assessed for the patients in which speckle tracking echocardiography was feasible. Adequate image quality, for performing speckle echocardiography, was found in 80% of patients. The bias for the intra‐observer reproducibility of the LV twist was 0.0°, with 95% limits of agreement of −2.5° and 2.5° and for interobserver reproducibility the bias was 0.0°, with 95% limits of agreement of −3.0° and 3.0°. Intra‐ and inter‐observer measurements showed a strong correlation (0.86 and 0.79, respectively). Also a good repeatability was seen. The mean time to complete full analysis per subject for the first and second measurement was 9 and 5 minutes, respectively.

Conclusion

Speckle tracking echocardiography is feasible in 80% of adult patients with congenital heart disease and shows excellent intra‐ and inter‐observer reproducibility.
The effects of drought and herbivory on plant–herbivore interactions across 16 soybean genotypes in a field experiment
Authors: GRINNAN ROSE , CARTER THOMAS E. , JOHNSON MARC T. J.
Published: March 2013

As the Earth's climate continues to change, drought and insect population outbreaks are predicted to increase in many parts of the world. It is therefore important to understand how changes in such abiotic and biotic stressors might impact agroecosystems.

The plant stress hypothesis predicts that, owing to physiological and biochemical changes, plants experiencing drought will be more susceptible to insect herbivory, which could have synergistic negative effects on plant performance. By contrast, the plant vigor hypothesis predicts that insects will preferentially feed on fast‐growing vigorous plants.

These hypotheses were tested in a field experiment using 16 soybean (Glycine max (L.) Merr.) genotypes to determine: (i) the combined effects of drought and herbivory on plant performance; (ii) the impact of drought on soybean resistance to herbivores; and (iii) how genetically variable phenotypic traits in soybean correlate with these responses.

It was found that drought had a greater effect on soybean performance than herbivory, and drought and herbivory did not interact to impact on any measure of plant performance. Drought caused decreased insect herbivory on average, suggesting that the plant vigor hypothesis is consistent with the effects of drought stress on soybean resistance to leaf‐chewing insect herbivores. This conclusion is further supported by genotypic correlations which show that plant growth rate is positively correlated with the amount of herbivory plants received.

These results suggest that, although the effects of climate‐associated changes in drought and herbivory will have negative effects on soybean, these potential effects are quantifiable with simple experiments and can be mitigated through continued breeding of varieties that are tolerant and resistant to these abiotic and biotic stressors.
Psychosis 101: evaluating a training programme for northern and remote youth mental health service providers
Authors: Cheng Chiachen , deRuiter Wayne K. , Howlett Andrew , Hanson Mark D. , Dewa Carolyn S.
Published: March 2013

Background

Most of the early psychosis intervention (EPI) training has focused on family physicians participants. In Northern Ontario, there is a shortage of primary care. This paper will present evaluation results of a pilot training programme for rural and remote youth mental health service providers.

Method

A mixed methods approach was used. We evaluated a 2‐day workshop about EPI for non‐medical mental health workers delivered onsite and simultaneously by videoconferencing. There were 19 participants across four agencies. Seven were onsite and 12 were offsite. Participants’ knowledge was measured using a validated questionnaire at pre‐intervention and at 3‐, 6‐ and 9‐month follow up. A repeated measures ANOVA was used to evaluate knowledge acquisition between the two modes of training. At 6 months, focus group interviews were conducted to explore their experiences of the mode of intervention delivery and evaluation. Emerging themes were iteratively derived through a series of discussions involving independent coders.

Results

Only 15 complete datasets were available of the 19 original participants. Differences in knowledge acquisition between the two groups did not reach statistical difference. Six‐month focus group data indicated that participants improved their relationship with EPI services and they were part of a strengthened network with other providers in the region. Post‐intervention, the accuracy of referrals from participating agencies increased dramatically, with an increase in proportion of referrals who were eligible for EPI services. The follow‐up process engaged participants in learning and re‐engaged them with the material taught during the training session.

Conclusions

The results about developing service partnerships and relationship with specialist services are encouraging for policy and service decision‐makers to address mental health service needs in northern and remote areas.
Body Size and Morph as Drivers of Copulation Duration in a Male Dimorphic Damselfly
Authors: Wong‐Muñoz Jesus , Anderson Chris N. , Munguía‐Steyer Roberto , Córdoba‐Aguilar Alex
Published: March 2013

Copulation duration is often highly variable within and among species. Here, we explore the roles of body size, male morph, morph frequency, and alternative reproductive tactics to explain copulation duration in the damselfly Paraphlebia zoe. P. zoe has two male morphs (pigmented or hyaline wings) which differ in reproductive tactics (territorial or non‐territorial behaviors). We also analyze the effects of season as the frequencies of both morphs tend to vary along the reproductive season. In the first non‐experimental year, we found that the relationship between body size and copulation duration depended on the time of year. Early in the season, body size positively correlated with copulation duration, while late in the year, body size negatively correlated with copulation duration. In the second experimental year (when we reversed the frequency of male morphs in the middle of the season: making pigmented males less frequent than hyaline males), size influenced copulation duration as well as morph – body size positively correlated with copulation duration, and hyaline males mated for longer than pigmented males. Contrary to our prediction, changes to the relative abundances of morphs did not influence copulation duration. Hyaline males may be under selection for longer copulation durations to compensate for their reduced access to females, as long copulations potentially lead to more rival sperm to be removed from the female sperm storage organs and/or increased mate guarding. We do not discard, however, other explanations that drive variation in copulation duration such as cryptic female choice and/or predation.
Standing low‐field magnetic resonance imaging of a comminuted central tarsal bone fracture in a horse
Authors: Bolt D. M. , Read R. M. , Weller R. , Sinclair C. , David F. H.
Published: March 2013

See also Clinical Commentary by Judy
How a host cell signalling molecule modifies carbon metabolism in symbionts of the coral Plesiastrea versipora
Authors: Grant Adrienne , People Julie , Rémond Marc , Frankland Sarah , Hinde Rosalind
Published: March 2013

Cnidarian cell signalling remains poorly understood. This study has expanded our knowledge of the cell signalling molecule host release factor (HRF) from the coral Plesiastrea versipora. We have now confirmed that HRF is present in coral host cells that lack intracellular algae. Previous studies showed that HRF stimulates the release of photosynthetic products (mainly glycerol) from Symbiodinium algae, thus providing the host with carbon; glycerol release was accompanied by reduced synthesis of algal triacylglycerols and starch. In this study, we have shown that supplying glycerol to algae incubated with HRF does not restore normal triacylglycerol and starch synthesis. Release of 14C‐labelled products from algae may continue after photosynthesis ceases, although at a much lower rate. When algae were placed in the dark for 4 h with HRF following 2 h of photosynthesis in seawater, 14C‐labelled products were released, but at ≤ 15% of the amount released during 2 h of photosynthesis with HRF. HRF did not stimulate the release of compounds derived from a nonphotosynthetic source. The response of Symbiodinium from P. versipora to HRF has been compared with the response of Symbiodinium algae from Tridacna maxima, Heliofungia actiniformis, Aiptasia pulchella and Pocillopora damicornis to both their own HRF and to P. versipora HRF. Algae from P. versipora showed the highest response to both P. versipora HRF and to the other hosts’ HRF. Further purification of P. versipora HRF suggests that HRF is a peptide with an acidic pI. We propose that HRF will provide a useful tool for the study of carbon metabolism.
Determining fatigue limits with thermal analysis of static traction tests
Authors: Risitano A. , Risitano G.
Published: March 2013

This work evaluates the limit stress of the thermo‐elastic phase of deformation by thermo‐analysing the surface of a specimen during a static traction test.

By adding a temperature curve measured over a small area of the surface to the classical stress–strain curve, it is possible to evaluate a limit temperature T0that is coincident with the beginning of the curve's nonlinear trend. The corresponding stress value is as estimation of the fatigue limit of the component under analysis.

The authors derive an expression to evaluate temperature during a mono‐axial static traction test. As an example, temperature curves recorded during traction tests performed on two notched steel specimens are reported and compared with this proposed expression. The change to the linearity in the temperature curve during the static traction test is evident in these examples and the corresponding stress value is an estimation of the fatigue limit of the component under analysis.
Simplified analysis of fracture behaviour of a Francis hydraulic turbine runner blade
Authors: Vantadori Sabrina , Carpinteri Andrea , Scorza Daniela
Published: March 2013

Each welded connection between blades and band or crown of a Francis hydraulic turbine runner can be considered as a T‐joint subjected to pure bending induced by the water action. A semi‐elliptical crack is assumed to exist at the surface of one of the aforementioned welded connections. The actual geometry of the T‐joint can be simplified, that is, only the cracked plate (representing the blade) under a given stress distribution acting on the defect faces is examined. A numerical procedure already proposed by the authors to compute the stress‐intensity factor (SIF) along the crack front is here applied by introducing some changes to simplify such computations. The obtained values of SIF are compared with some results available in the literature.
Ankle fusion in patients with haemophilia
Authors: Bluth B. E. , Fong Y. J. , Houman J. J. , Silva M , Luck J. V.
Published: March 2013

Ankle fusion in patients with haemophilia is a well‐accepted treatment for end‐stage arthropathy. However, current published outcome data are based on small sample sizes and generally short‐term follow‐up. The aim of this study was to evaluate the long‐term results of ankle fusion in a large group of haemophilic patients treated at a single institution. The results of 57 ankle fusions performed on 45 patients between 1971 and 2010 were reviewed retrospectively. Data were gathered for type and severity of haemophilia, HIV status, fixation technique, postoperative complications and requirement of additional surgeries. A modified American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was calculated for 20 ankles available for follow‐up. Patients were followed for a mean of 6.6 years. There were no intra‐operative or immediate postoperative complications related to fusion of the ankle. The overall non‐union rate was 10.4% for tibio‐talar fusion and 8.3% for sub‐talar fusion. This rate was reduced to 3.7% and 5.6%, respectively, after the introduction of newer surgical techniques in 1995. None of these non‐unions required revision surgery. The modified AOFAS scale demonstrated that 75% had no pain in the operated ankle a mean of 7.2 years following surgery. The remaining 25% scored their average pain as 3 of 10. The functional portion of the score suggested that patients have good alignment, minimal activity limitations or gait abnormalities, and can walk long distances. We conclude that ankle fusion successfully relieves pain and provides a good functional outcome. It is an appropriate treatment for end‐stage haemophilic arthropathy of the ankle.
Ictal Adiponectin Levels in Episodic Migraineurs: A Randomized Pilot Trial
Authors: Peterlin B. Lee , Tietjen Gretchen E. , Gower Barbara A. , Ward Thomas N. , Tepper Stewart J. , White Linda W. , Dash Paul D. , Hammond Edward R. , Haythornthwaite Jennifer A.
Published: March 2013

Objective

To assess ictal adiponectin (ADP) levels before and after acute abortive treatment in women episodic migraineurs.

Methods

Peripheral blood specimens were collected from women episodic migraineurs before and after acute abortive treatment with sumatriptan/naproxen sodium vs placebo. Univariate and multivariate models were utilized to examine the relationship between serum total ADP (T‐ADP), ADP oligomers (high molecular weight [HMW], middle molecular weight, and low molecular weight [LMW]‐ADP), and ADP ratio levels and pain severity. Paired t‐tests and random intercept longitudinal models were utilized to assess the mean changes in T‐ADP, ADP oligomers, and ratios over time in treatment responders and nonresponders.

Results

Twenty participants (11 responders, 9 nonresponders) have been studied to date. In all participants, increases in the HMW : LMW ADP ratio were associated with an increase in pain severity. For every 1 point increase in the HMW : LMW ratio, pain severity increased by 0.22 (Confidence Interval [CI]: 0.07, 0.37; P = .004). In contrast, for every 0.25 μg/mL increase in LMW‐ADP, pain severity decreased by 0.20 (CI: −0.41, −0.002; P = .047). In treatment responders, T‐ADP levels were reduced at 30 minutes (12.52 ± 3.4; P = .03), 60 minutes (12.32 ± 3.2; P = .017), and 120 minutes (12.65 ± 3.2; P = .016) after treatment as compared with onset (13.48 ± 3.8). Additionally, in responders, the HMW : LMW ratio level was greater at pain onset (3.70 ± 1.9 μg/mL) as compared with nonresponders (2.29 ± 0.71 μg/mL), P = .050. Responders also showed a decrease in the HMW : LMW ratio at 60 minutes (2.37 ± 1.1; P = .002) and 120 minutes (2.76 ± 1.4; P = .02) after treatment as compared with onset (3.70 ± 1.9). These changes in responders remained significant after adjusting for covariates, including measured body mass index (m‐BMI). Although nonresponders showed no significant changes in unadjusted T‐ADP or ADP oligomer or ratio levels, the HMW : LMW ratio was increased in nonresponders after adjustments (P = .025).

Conclusion

In this pilot study of women episodic migraineurs, the HMW : LMW ADP ratio level was associated with migraine severity and predictive of acute treatment response. ADP and the HMW : LMW ratio of ADP represent potential novel biomarkers and drug targets for episodic migraine.
Adjuvant interferon therapy after surgical treatment for hepatitis B/C virus‐related hepatocellular carcinoma: A meta‐analysis
Authors: Xu Jian‐Bo , Qi Fu‐Zhen , Xu Gang , Chen Guo‐Feng , Huang Ming‐De , Zhang Jian‐Huai
Published: March 2013

Aim

This meta‐analysis aimed to determine whether interferon (IFN) therapy could improve clinical effects of patients with chronic hepatitis B virus (HBV)or hepatitis C virus (HCV) infection‐related primary hepatocellular carcinoma (HCC) after surgery.

Methods

An electronic search from January 1998 to December 2012 was conducted to identify comparative studies evaluating IFN therapy on recurrence and survival after surgical treatment of HCC.

Results

The estimated odds ratios (OR) for the 1‐, 2‐, 3‐ and 5‐year overall survival rates of HBV‐related HCC were 3.37 (95% confidence interval [CI], 1.18–6.27), 2.36 (95% CI, 1.45–3.83), 1.81 (95% CI, 1.21–2.72) and 1.93 (95% CI, 1.35–2.75), respectively; and the OR for the 1‐, 2‐, 3‐ and 5‐year recurrence rates were 0.63 (95% CI, 0.44–0.91), 0.84 (95% CI, 0.60–1.18), 0.88 (95% CI, 0.63–1.22) and 0.78 (95% CI, 0.56–1.07), respectively. The overall survival rates of HCV‐related HCC were significantly higher in IFN groups than in control groups at 1, 2, 3 and 5 years (OR, 2.10; 95% CI, 0.96–4.55; OR, 1.71; 95% CI, 1.01–2.89; OR, 1.76; 95% CI, 1.09–2.83; and OR, 3.03; 95% CI, 1.97–4.65, respectively); and the recurrence rates of IFN groups were lower than control groups at 1, 2, 3 and 5 years (OR, 0.60; 95% CI, 0.38–0.92; OR, 0.57; 95% CI, 0.41–0.81; OR, 0.58; 95% CI, 0.41–0.80; and OR, 0.52; 95% CI, 0.36–0.75, respectively).

Conclusion

In conclusion, IFN therapy in this meta‐analysis shows a significant clinical effect in postoperative patients of HCC, particularly in HCV‐related HCC.
The regulatory role of the tetrapeptide AcSDKP in skin and hair physiology and the prevention of ageing effects in these tissues – a potential cosmetic role
Authors: Hajem N. , Chapelle A. , Bignon J. , Pinault A. , Liu J.‐M. , Salah‐Mohellibi N. , Lati E. , Wdzieczak‐Bakala J.
Published: March 2013

Synopsis

The naturally occurring tetrapeptide acetyl‐N‐Ser‐Asp‐Lys‐Pro (AcSDKP) recognized as a potent angiogenic factor was shown recently to contribute to the repair of cutaneous injuries. In the current article, we report the ability of AcSDKP to exert a beneficial effect on normal healthy skin and scalp and to compensate for the ageing process. In vitro AcSDKP at 10−11–10−7 M significantly stimulates the growth of human keratinocytes, fibroblasts and follicle dermal papilla cells. Moreover, it enhances the growth of human epidermal keratinocyte progenitor and stem cells as shown in a clonogenic survival assay. Topical treatment of ex vivo cultured skin explants with 10−5 M AcSDKP increases the thickness of the epidermis and upregulates the synthesis of keratins 14 and 19, fibronectin, collagen III and IV as well as the glycoaminoglycans (GAGs). In the ex vivo‐cultured hair follicles, AcSDKP promotes hair shaft elongation and induces morphological and molecular modifications matching the criteria of hair growth. Furthermore, AcSDKP at 10−11–10−7 M was shown to improve epidermal barrier, stimulating expression of three protein components of tight junctions (claudin‐1, occludin, ZO‐1) playing an important role in connecting neighbouring cells. This tetrapeptide exercises also activation of SIRT1 implicated in the control of cell longevity. Indeed, a two‐fold increase in the synthesis of SIRT1 by cultured keratinocytes was observed in the presence of 10−11–10−7 M AcSDKP. In conclusion, these findings provide convincing evidence of the regulatory role of AcSDKP in skin and hair physiology and suggest a cosmetic use of this natural tetrapeptide to prevent skin ageing and hair loss and to promote the cutaneous regeneration and hair growth.
A novel bi‐enzymatic system for lactose conversion
Authors: Lorenzen Peter Chr. , Breiter Judith , Clawin‐Rädecker Ingrid , Dau Alexandra
Published: March 2013

The potential of β‐galactosidase (β‐GAL) and glucose isomerase (GLI) to enhance the sweetening power of lactose and to generate galactooligosaccharides (GOS) and lactulose was studied. UF‐permeates of skim milk, sweet whey, acid whey and lactose solutions were incubated with β‐GAL and GLI. Lactose hydrolysis (LH) was 96–99%, glucose isomerisation (GI) about 53%. On a scale from 0 to 5, the intensity of sweetness increased from 1 to 3. The bi‐enzymatic process was also applied to yoghurt manufacture. Because of the inhibiting effect of calcium on GLI, the incubation was performed in UF‐permeates of skim milk. LH in yoghurt was 94%, whereas GI was 36% on average. Whey syneresis in yoghurt decreased from 12% to 5%. The sweetness increased from 1.4 to 2.9 on average. Applying the bi‐enzymatic system to 40% lactose solutions led to synthesis of about 20% prebiotic GOS. Products, such as 6‐galactobiose, allolactose and 6‐galactosyllactose were identified. About 1% lactulose was generated. Lactulose‐derived oligosaccharides were not found.
Type of Admission is Associated with Outcome of Spontaneous Subarachnoid Hemorrhage
Authors: Drazin Doniel , Rosner Jack , Nuño Miriam , Alexander Michael J. , Schievink Wouter I. , Palestrant David , Lyden Patrick D. , Miller Chad
Published: March 2013

Background

Admitting facility may significantly affect outcome for spontaneous subarachnoid hemorrhage patients. We assessed outcomes of patients admitted directly to a comprehensive stroke center with those initially admitted to a general hospital and subsequently transferred. The comprehensive stroke center included a neurocritical care ICU, cerebrovascular neurosurgeons and endovascular specialists.

Methods

We identified 107 consecutive spontaneous subarachnoid hemorrhage cases. Of these cases, 31 (29%) patients were admitted directly and 76 (71%) were transferred from general hospitals. Univariate and multivariate analyses evaluated differences in mortality, complications, discharge disposition, and in-hospital length of stay.

Results

Differences in baseline parameters (age, gender, admission Glasgow Coma Scale, Fisher grade, admission Hunt and Hess grade) were not statistically significant between direct-admit and transfer patients at our institution. Transferred patients developed vasospasm more frequently (58% vs. 32%; P < 0·05) and had a longer delay time to surgery (3·9-days vs. 2·4-days: P < 0·05). Multivariate analysis showed that the likelihood of vasospasm was significantly higher for transfer patients (OR 3·46, CI: 1·2–10·3, P = 0·03). In addition, longer in-hospital stays and higher odds of non-routine discharge were observed in transferred patients ( P < 0·01). No differences in outcome could be identified for surgical vs. endovascular treatment rates between direct-admit and transfer patients. An association, but no causative link, can be made between the effect of transfer and the outcomes of SAH patients due to the retrospective nature of our study.

Conclusions

Spontaneous subarachnoid hemorrhage patients admitted directly to our comprehensive stroke center showed less complications compared to those transferred from general hospitals. This improvement was independent of time to treatment. Additional research in multiple centers using prospective analysis should be conducted to confirm that preferential direct transport to a comprehensive stroke center would likely yield considerable improvements in public health.
A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial to Test Efficacy and Safety of Magnetic Resonance Imaging-Based Thrombolysis in Wake-up Stroke (WAKE-UP)
Authors: Thomalla Götz , Fiebach Jochen B. , Østergaard Leif , Pedraza Salvador , Thijs Vincent , Nighoghossian Norbert , Roy Pascal , Muir Keith W. , Ebinger Martin , Cheng Bastian , Galinovic Ivana , Cho Tae-Hee , Puig Josep , Boutitie Florent , Simonsen Claus Z. , Endres Matthias , Fiehler Jens , Gerloff Christian ,   WAKE-UP investigators
Published: March 2013

Rationale

In about 20% of acute ischemic stroke patients stroke occurs during sleep. These patients are generally excluded from intravenous thrombolysis. MRI can identify patients within the time-window for thrombolysis (≤4·5 h from symptom onset) by a mismatch between the acute ischemic lesion visible on diffusion weighted imaging (DWI) but not visible on fluid-attenuated inversion recovery (FLAIR) imaging. Aims and hypothesis The study aims to test the efficacy and safety of MRI-guided thrombolysis with tissue plasminogen activator (rtPA) in ischemic stroke patients with unknown time of symptom onset, e.g., waking up with stroke symptoms. We hypothesize that stroke patients with unknown time of symptom onset with a DWI-FLAIR-mismatch pattern on MRI will have improved outcome when treated with rtPA compared to placebo.

Design

WAKE-UP is an investigator initiated, European, multicentre, randomized, double-blind, placebo-controlled clinical trial. Patients with unknown time of symptom onset who fulfil clinical inclusion criteria (disabling neurological deficit, no contraindications against thrombolysis) will be studied by MRI. Patients with MRI findings of a DWI-FLAIR-mismatch will be randomised to either treatment with rtPA or placebo. Study outcome The primary efficacy endpoint will be favourable outcome defined by modified Rankin Scale 0–1 at day 90. The primary safety outcome measures will be mortality and death or dependency defined by modified Rankin Scale 4–6 at 90 days.

Discussion

If positive, WAKE-UP is expected to change clinical practice making effective and safe treatment available for a large group of acute stroke patients currently excluded from specific acute therapy.
Leadership styles in ethical dilemmas when head nurses make decisions
Authors: Zydziunaite V. , Lepaite D. , Suominen T.
Published: March 2013

Background

The overlooked aspect in Lithuania is the dearth of leaders among head nurses, who bear the responsibility for decisions in ethical dilemmas. Understanding the application of leadership styles is fundamental to ensuring head nurses' abilities to influence outcomes for healthcare providers and patients.

Aim

To identify the leadership styles applied by head nurses in decision making in ethical dilemmas on hospital wards.

Methods

The data were collected by questionnaires completed by head nurses (n = 278) working in five major state‐funded hospitals in each of the five regions of Lithuania. The data were analysed using SPSS 16.0, calculating descriptive statistics and analysis of variance.

Findings

Head nurses apply democratic, affiliative, transformational and sustainable leadership styles when resolving ethical dilemmas. The application of leadership styles is associated not only with specific situations, but also with certain background factors, such as years of experience in a head nurse's position, ward specialization and the incidence of ethical dilemmas. Nurses having been in a head nurse's position over 10 years use primitive leadership styles, notably bureaucratic leadership, more often than do those head nurses with only a few years of experience in such a position.

Conclusions

The results highlight the need for head nurses to reflect on their practices and to find new ways of learning from practice, colleagues and patients. Head nurses' managerial decisions due to their ‘executive power’ can turn into a new state‐of‐the‐art leadership in nursing.
Acute and chronic wound fluids inversely influence adipose‐derived stem cell function: molecular insights into impaired wound healing
Authors: Koenen Paola , Spanholtz Timo A , Maegele Marc , Stürmer Ewa , Brockamp Thomas , Neugebauer Edmund , Thamm Oliver C
Published: March 2013

Wound healing is a complex biological process that requires a well‐orchestrated interaction of mediators as well as resident and infiltrating cells. In this context, mesenchymal stem cells play a crucial role as they are attracted to the wound site and influence tissue regeneration by various mechanisms. In chronic wounds, these processes are disturbed. In a comparative approach, adipose‐derived stem cells (ASC) were treated with acute and chronic wound fluids (AWF and CWF, respectively). Proliferation and migration were investigated using 3‐(4,5‐Dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide (MTT) test and transwell migration assay. Gene expression changes were analysed using quantitative real time–polymerase chain reaction. AWF had a significantly stronger chemotactic impact on ASC than CWF (77·5% versus 59·8% migrated cells). While proliferation was stimulated by AWF up to 136·3%, CWF had a negative effect on proliferation over time (80·3%). Expression of b‐FGF, vascular endothelial growth factor (VEGF) and matrix metalloproteinase‐9 was strongly induced by CWF compared with a mild induction by AWF. These results give an insight into impaired ASC function in chronic wounds. The detected effect of CWF on proliferation and migration of ASC might be one reason for an insufficient healing process in chronic wounds.
Comparison of the effects of topical fusidic acid and rifamycin on wound healing in rats
Authors: Gurel Mehmet S , Naycı Sillan , Turgut Aslı V , Bozkurt Erol R
Published: March 2013

Wound healing is an active and dynamic process that begins from the moment of injury. Any delay in the initiation of the response to injury can prolong the healing process. The aim of this study was to investigate the effects of topically applied fusidic acid and rifamycin on wound healing in a full‐thickness wound model. Ten female Sprague‐Dawley rats, aged 4 months and weighing 200–250 g, were used. Four rifamycin (R), four fusidic acid (F) and four control (K) areas were generated on their backs by using a 5‐mm punch biopsy pen. On the 4th, 7th, 14th and 21st days, biopsies were taken from each wound area of all the rats. Fusidic acid group demonstrated a statistically significant increase of collagen and intensity of fibroblast proliferation on the 21st day of wound healing, whereas in the rifamycin group, healing time was, as expected, similar to physiological wound‐healing phases. Despite the limited number of subjects, topical fusidic acid was found to delay wound healing by prolonging fibroblast proliferation.