bluuebunny/crossref_metadata_2025 huggingface dataset:
Delayed β-cell response and glucose intolerance in young women with Turner syndrome
Authors: Hjerrild Britta E , Holst Jens J , Juhl Claus B , Christiansen Jens S , Schmitz Ole , Gravholt Claus H
Published: March 2011

Background

To investigate glucose homeostasis in detail in Turner syndrome (TS), where impaired glucose tolerance (IGT) and type 2 diabetes are frequent.

Methods

Cross sectional study of women with Turner syndrome (TS)(n = 13) and age and body mass index matched controls (C) (n = 13), evaluated by glucose tolerance (oral and intravenous glucose tolerance test (OGTT and IVGTT)), insulin sensitivity (hyperinsulinemic, euglycemic clamp), beta-cell function (hyperglycaemic clamp, arginine and GLP-1 stimulation) and insulin pulsatility.

Results

Fasting glucose and insulin levels were similar. Higher glucose responses was seen in TS during OGTT and IVGTT, persisting after correction for body weight or muscle mass, while insulin responses were similar in TS and C, despite the higher glucose level in TS, leading to an insufficient increase in insulin response during dynamic testing. Insulin sensitivity was comparable in the two groups (TS vs. control: 8.6 ± 1.8 vs. 8.9 ± 1.8 mg/kg*30 min; p = 0.6), and the insulin responses to dynamic β-cell function tests were similar. Insulin secretion patterns examined by deconvolution analysis, approximate entropy, spectral analysis and autocorrelation analysis were similar. In addition we found low IGF-I, higher levels of cortisol and norepinephrine and an increased waist-hip ratio in TS.

Conclusions

Young normal weight TS women show significant glucose intolerance in spite of normal insulin secretion during hyperglycaemic clamping and normal insulin sensitivity. We recommend regularly testing for diabetes in TS.

Trial Registration

Registered with http://clinicaltrials.com, ID nr: NCT00419107
Short-chain fatty acid level and field cancerization show opposing associations with enteroendocrine cell number and neuropilin expression in patients with colorectal adenoma
Authors: Yu Danny CW , Bury Jonathan P , Tiernan James , Waby Jennifer S , Staton Carolyn A , Corfe Bernard M
Published: March 2011

Background

Previous reports have suggested that the VEGF receptor neuropilin-1 (NRP-1) is expressed in a singly dispersed subpopulation of cells in the normal colonic epithelium, but that expression becomes dysregulated during colorectal carcinogenesis, with higher levels in tumour suggestive of a poor prognosis. We noted that the spatial distribution and morphology if NRP-1 expressing cells resembles that of enteroendocrine cells (EEC) which are altered in response to disease state including cancer and irritable bowel syndrome (IBS). We have shown that NRP-1 is down-regulated by butyrate in colon cancer cell lines in vitro and we hypothesized that butyrate produced in the lumen would have an analogous effect on the colon mucosa in vivo. Therefore we sought to investigate whether NRP-1 is expressed in EEC and how NRP-1 and EEC respond to butyrate and other short-chain fatty acids (SCFA - principally acetate and propionate). Additionally we sought to assess whether there is a field effect around adenomas.

Methodology

Biopsies were collected at the mid-sigmoid, at the adenoma and at the contralateral wall (field) of 28 subjects during endoscopy. Samples were fixed for IHC and stained for either NRP-1 or for chromogranin A (CgA), a marker of EEC. Stool sampling was undertaken to assess individuals' butyrate, acetate and propionate levels.

Result

NRP-1 expression was inversely related to SCFA concentration at the colon landmark (mid-sigmoid), but expression was lower and not related to SCFA concentration at the field. Likewise CgA+ cell number was also inversely related to SCFA at the landmark, but was lower and unresponsive at the field. Crypt cellularity was unaltered by field effect. A colocalisation analysis showed only a small subset of NRP-1 localised with CgA. Adenomas showed extensive, weaker staining for NRP-1 which contrastingly correlated positively with butyrate level. Field effects cause this relationship to be lost. Adenoma tissue shows dissociation of the co-regulation of NRP-1 and EEC.

Conclusion

NRP-1 is inversely associated with levels of butyrate and other SCFA in vivo and is expressed in a subset of CgA expressing cells. EEC number is related to butyrate level in the same way.
B cells Can Modulate the CD8 Memory T Cell after DNA Vaccination Against Experimental Tuberculosis
Authors: Almeida Luciana P , Trombone Ana PF , Lorenzi Julio CC , Rocha Carolina D , Malardo Thiago , Fontoura Isabela C , Gembre Ana F , Silva Ricardo LL , Silva Célio L , Castelo Ademilson P , Coelho-Castelo Arlete AM
Published: March 2011

Background

Although B cells are important as antigen presenting cells (APC) during the immune response, their role in DNA vaccination models is unknown.

Methods

In this study in vitro and in vivo experiments were performed to evaluate the ability of B cells to protect mice against Mycobacterium tuberculosis challenge.

Results

In vitro and in vivo studies showed that B cells efficiently present antigens after naked plasmid pcDNA3 encoding M. leprae 65-kDa heat shock protein (pcDNA3-Hsp65) internalization and protect B knock-out (BKO) mice against Mycobacterium tuberculosis infection. pcDNA3-Hsp65-transfected B cells adoptively transferred into BKO mice rescued the memory phenotypes and reduced the number of CFU compared to wild-type mice.

Conclusions

These data not only suggest that B cells play an important role in the induction of CD8 T cells but also that they improve bacterial clearance in DNA vaccine model.
Effect of Peierls transition in armchair carbon nanotube on dynamical behaviour of encapsulated fullerene
Authors: Poklonski Nikolai A , Vyrko Sergey A , Kislyakov Eugene F , Hieu Nguyen Ngoc , Bubel' Oleg N , Popov Andrei M , Lozovik Yurii E , Knizhnik Andrey A , Lebedeva Irina V , Viet Nguyen Ai
Published: March 2011

The changes of dynamical behaviour of a single fullerene molecule inside an armchair carbon nanotube caused by the structural Peierls transition in the nanotube are considered. The structures of the smallest C20 and Fe@C20 fullerenes are computed using the spin-polarized density functional theory. Significant changes of the barriers for motion along the nanotube axis and rotation of these fullerenes inside the (8,8) nanotube are found at the Peierls transition. It is shown that the coefficients of translational and rotational diffusions of these fullerenes inside the nanotube change by several orders of magnitude. The possibility of inverse orientational melting, i.e. with a decrease of temperature, for the systems under consideration is predicted.
Migration of carbon nanotubes from liquid phase to vapor phase in the refrigerant-based nanofluid pool boiling
Authors: Peng Hao , Ding Guoliang , Hu Haitao
Published: March 2011

The migration characteristics of carbon nanotubes from liquid phase to vapor phase in the refrigerant-based nanofluid pool boiling were investigated experimentally. Four types of carbon nanotubes with the outside diameters from 15 to 80 nm and the lengths from 1.5 to 10 μm were used in the experiments. The refrigerants include R113, R141b and n-pentane. The oil concentration is from 0 to 10 wt.%, the heat flux is from 10 to 100 kW·m-2, and the initial liquid-level height is from 1.3 to 3.4 cm. The experimental results indicate that the migration ratio of carbon nanotube increases with the increase of the outside diameter or the length of carbon nanotube. For the fixed type of carbon nanotube, the migration ratio decreases with the increase of the oil concentration or the heat flux, and increases with the increase of the initial liquid-level height. The migration ratio of carbon nanotube increases with the decrease of dynamic viscosity of refrigerant or the increase of liquid phase density of refrigerant. A model for predicting the migration ratio of carbon nanotubes in the refrigerant-based nanofluid pool boiling is proposed, and the predictions agree with 92% of the experimental data within a deviation of ±20%.
Thermal conductivity and viscosity measurements of ethylene glycol-based Al2O3 nanofluids
Authors: Pastoriza-Gallego María José , Lugo Luis , Legido José Luis , Piñeiro Manuel M
Published: March 2011

The dispersion and stability of nanofluids obtained by dispersing Al2O3 nanoparticles in ethylene glycol have been analyzed at several concentrations up to 25% in mass fraction. The thermal conductivity and viscosity were experimentally determined at temperatures ranging from 283.15 K to 323.15 K using an apparatus based on the hot-wire method and a rotational viscometer, respectively. It has been found that both thermal conductivity and viscosity increase with the concentration of nanoparticles, whereas when the temperature increases the viscosity diminishes and the thermal conductivity rises. Measured enhancements on thermal conductivity (up to 19%) compare well with literature values when available. New viscosity experimental data yield values more than twice larger than the base fluid. The influence of particle size on viscosity has been also studied, finding large differences that must be taken into account for any practical application. These experimental results were compared with some theoretical models, as those of Maxwell-Hamilton and Crosser for thermal conductivity and Krieger and Dougherty for viscosity.
Heterogeneous nanofluids: natural convection heat transfer enhancement
Authors: Oueslati Fakhreddine Segni , Bennacer Rachid
Published: March 2011

Convective heat transfer using different nanofluid types is investigated. The domain is differentially heated and nanofluids are treated as heterogeneous mixtures with weak solutal diffusivity and possible Soret separation. Owing to the pronounced Soret effect of these materials in combination with a considerable solutal expansion, the resulting solutal buoyancy forces could be significant and interact with the initial thermal convection. A modified formulation taking into account the thermal conductivity, viscosity versus nanofluids type and concentration and the spatial heterogeneous concentration induced by the Soret effect is presented. The obtained results, by solving numerically the full governing equations, are found to be in good agreement with the developed solution based on the scale analysis approach. The resulting convective flows are found to be dependent on the local particle concentration φ and the corresponding solutal to thermal buoyancy ratio N. The induced nanofluid heterogeneity showed a significant heat transfer modification. The heat transfer in natural convection increases with nanoparticle concentration but remains less than the enhancement previously underlined in forced convection case.
Optimal synthesis and characterization of Ag nanofluids by electrical explosion of wires in liquids
Authors: Ju Park Eun , Won Lee Seung , Bang In Cheol , Park Hyung Wook
Published: March 2011

Silver nanoparticles were produced by electrical explosion of wires in liquids with no additive. In this study, we optimized the fabrication method and examined the effects of manufacturing process parameters. Morphology and size of the Ag nanoparticles were determined using transmission electron microscopy and field-emission scanning electron microscopy. Size and zeta potential were analyzed using dynamic light scattering. A response optimization technique showed that optimal conditions were achieved when capacitance was 30 μF, wire length was 38 mm, liquid volume was 500 mL, and the liquid type was deionized water. The average Ag nanoparticle size in water was 118.9 nm and the zeta potential was -42.5 mV. The critical heat flux of the 0.001-vol.% Ag nanofluid was higher than pure water.
Extensive complement-dependent enhancement of HIV-1 by autologous non-neutralising antibodies at early stages of infection
Authors: Willey Suzanne , Aasa-Chapman Marlén MI , O'Farrell Stephen , Pellegrino Pierre , Williams Ian , Weiss Robin A , Neil Stuart JD
Published: March 2011

Background

Non-neutralising antibodies to the envelope glycoprotein are elicited during acute HIV-1 infection and are abundant throughout the course of disease progression. Although these antibodies appear to have negligible effects on HIV-1 infection when assayed in standard neutralisation assays, they have the potential to exert either inhibitory or enhancing effects through interactions with complement and/or Fc receptors. Here we report that non-neutralising antibodies produced early in response to HIV-1 infection can enhance viral infectivity.

Results

We investigated this complement-mediated antibody-dependent enhancement (C'-ADE) of early HIV infection by carrying out longitudinal studies with primary viruses and autologous sera derived sequentially from recently infected individuals, using a T cell line naturally expressing the complement receptor 2 (CR2; CD21). The C'-ADE was consistently observed and in some cases achieved infection-enhancing levels of greater than 350-fold, converting a low-level infection to a highly destructive one. C'-ADE activity declined as a neutralising response to the early virus emerged, but later virus isolates that had escaped the neutralising response demonstrated an increased capacity for enhanced infection by autologous antibodies. Moreover, sera with autologous enhancing activity were capable of C'ADE of heterologous viral isolates, suggesting the targeting of conserved epitopes on the envelope glycoprotein. Ectopic expression of CR2 on cell lines expressing HIV-1 receptors was sufficient to render them sensitive to C'ADE.

Conclusions

Taken together, these results suggest that non-neutralising antibodies to the HIV-1 envelope that arise during acute infection are not 'passive', but in concert with complement and complement receptors may have consequences for HIV-1 dissemination and pathogenesis.
Disease-specific prospective family study cohorts enriched for familial risk
Authors: Hopper John L
Published: March 2011

Most common diseases demonstrate familial aggregation; the ratio of the risk for relatives of affected people to the risk for relatives of unaffected people (the familial risk ratio)) > 1. This implies there are underlying genetic and/or environmental risk factors shared by relatives. The risk gradient across this underlying 'familial risk profile', which can be predicted from family history and measured familial risk factors, is typically strong. Under a multiplicative model, the ratio of the risk for people in the upper 25% of familial risk to the risk for those in the lower 25% (the inter-quartile risk gradient) is an order of magnitude greater than the familial risk ratio. If familial risk ratio = 2 for first-degree relatives, in terms of familial risk profile: (a) people in the upper quartile will be at more than 20 times the risk of those in the lower quartile; and (b) about 90% of disease will occur in people above the median. Historically, therefore, epidemiology has compared cases with controlsdissimilarfor underlying familial risk profile. Were gene-environment and gene-gene interactions to exist, environmental and genetic effects could be stronger for people with increased familial risk profile. Studies in which controls are better matched to cases for familial risk profile might be more informative, especially if both cases and controls are over-sampled for increased familial risk. Prospective family study cohort (ProF-SC) designs involving people across a range of familial risk profile provide such a resource for epidemiological, genetic, behavioural, psycho-social and health utilisation research. The prospective aspect gives credibility to risk estimates. The familial aspect allows family-based designs, matching for unmeasured factors, adjusting for underlying familial risk profile, and enhanced cohort maintenance.
Induction of Cyclooxygenase-2 Expression by Hepatitis B Virus Depends on Demethylation-associated Recruitment of Transcription Factors to the Promoter
Authors: Yue Xin , Yang Fang , Yang Yongbo , Mu Yongxin , Sun Wei , Li Wei , Xu Dongping , Wu Jianguo , Zhu Ying
Published: March 2011

Background

The hepatitis B virus (HBV) is a major etiological factor of inflammation and damage to the liver resulting in hepatocellular carcinoma. Transcription factors play important roles in the disordered gene expression and liver injury caused by HBV. However, the molecular mechanisms behind this observation have not been defined.

Results

In this study, we observed that circulating prostaglandin (PGE) 2 synthesis was increased in patients with chronic hepatitis B infection, and detected elevated cyclooxygenase (COX)-2 expression in HBV- and HBx-expressing liver cells. Likewise, the association of HBx with C/EBPβ contributed to the induction of COX-2. The COX-2 promoter was hypomethylated in HBV-positive cells, and specific demethylation of CpG dinucleotides within each of the two NF-AT sites in the COX-2 promoter resulted in the increased binding affinity of NF-AT to the cognate sites in the promoter, followed by increased COX-2 expression and PGE2 accumulation. The DNA methylatransferase DNMT3B played a key role in the methylation of the COX-2 promoter, and its decreased binding to the promoter was responsible for the regional demethylation of CpG sites, and for the increased binding of transcription factors in HBV-positive cells.

Conclusion

Our results indicate that upregulation of COX-2 by HBV and HBx is mediated by both demethylation events and recruitment of multiple transcription factors binding to the promoter.
Comparative analysis of oncogenic genes revealed unique evolutionary features of field Marek's disease virus prevalent in recent years in China
Authors: Tian Mingxing , Zhao Yang , Lin Yan , Zou Nianli , Liu Cheng , Liu Ping , Cao Sanjie , Wen Xintian , Huang Yong
Published: March 2011

Background

Marek's disease (MD) is an economically important viral disease of chickens caused by Marek's disease virus (MDV), an oncogenic herpesvirus. This disease was well controlled since the widespread use of commercial vaccines, but field MDVs have shown continuous increasing in virulence and acquired the ability to overcome the immune response induced by vaccines. Nowadays, MD continues to be a serious threat to poultry industry, isolation and characterization of MDVs are essential for monitoring changes of viruses and evaluating the effectiveness of existing vaccines.

Results

Between 2008 and 2010, 18 field MDV strains were isolated from vaccinated chicken flocks in Sichuan province, China. Three oncogenic genes including Meq, pp38 and vIL-8 genes of the 18 isolates were amplified and sequenced. Homology analysis showed that the deduced amino acid sequences of these three genes exhibit 95.0-98.8%, 99.3-100% and 97.0-98.5% homology respectively with these of other reference strains published in GenBank. Alignment analysis of the nucleotide and deduced amino acid sequences showed that four amino acid mutations in Meq gene and two amino acid mutations in vIL-8 gene displayed perfect regularity in MDVs circulating in China, which could be considered as features of field MDVs prevalent in recent years in China. In addition, one amino acid mutation in pp38 gene can be considered as a feature of virulent MDVs from USA, and three amino acid mutations in Meq gene were identified and unique in very virulent plus (vv+) MDVs. Phylogenetic analysis based on Meq and vIL-8 protein sequences revealed that field MDVs in China evolved independently. Virulence studies showed that CVI988 could provide efficient protection against the field MDVs epidemic recently in China.

Conclusions

This study and other published data in the GenBank have demonstrated the features of Meq, pp38 and vIL-8 genes of MDVs circulating in recent years in Sichuan, China. Mutations, deletions or insertions were observed in these three genes, and some mutations could be considered as the unique marks of the MDVs circulating presently in China. The paper supplies some valuable information concerning the evolution of MDV which is useful for the vaccine development and control of MD in China.
A decade of modelling research yields considerable evidence for the importance of concurrency: a response to Sawers and Stillwaggon
Authors: Goodreau Steven M
Published: March 2011

In their recent article, Sawers and Stillwaggon critique the “concurrency hypothesis” on a number of grounds. In this commentary, I focus on one thread of their argument, pertaining to the evidence derived from modelling work. Their analysis focused on the foundational papers of Morris and Kretzschmar; here, I explore the research that has been conducted since then, which Sawers and Stillwaggon leave out of their review. I explain the methodological limitations that kept progress on the topic slow at first, and the various forms of methodological development that were pursued to overcome these. I then highlight recent modelling work that addresses the various limitations Sawers and Stillwaggon outline in their article. Collectively, this line of research provides considerable support for the modelling aspects of the concurrency hypothesis, and renders their critique of the literature incomplete and obsolete. It also makes clear that their call for “an end (or at least a moratorium) to research on sexual behaviour in Africa” that pertains to concurrency is unjustified.
Efficient co-expression of bicistronic proteins in mesenchymal stem cells by development and optimization of a multifunctional plasmid
Authors: Krause Christopher D , Izotova Lara S , Ren Gwangwen , Yuan Zeng-Rong , Shi Yufang , Chen Chiann-Chyi , Ron Yacov , Pestka Sidney
Published: March 2011

Introduction

Local synthesis of interferon within B16 tumors mediates anti-tumor effects. Based on reports that stem cells are recruited to tumors, and because systemic administration of interferon causes dose-limiting undesirable side effects, we wanted to improve the anti-tumor effects of interferon while simultaneously minimizing its systemic side effects by employing mesenchymal stem cells (MSCs) as tumor-localized ectopic producers of interferon. Many vectors exist to fulfill this purpose, but their transfection efficiency and resulting expression levels vary considerably.

Methods

To follow both the recruitment to tumors and the synthesis of interferon by MSCs, we designed a bicistronic vector system that permits fluorescent visualization of vector-transfected and interferon-producing MSCs. We used Mu-IFNαA cDNA as the first cistron and the cherry fluorescent protein cDNA as the second cistron, whose translation requires the internal ribosome entry sequence (IRES) from the encephalomyocarditis virus 5' untranslated region. Observing inconsistent expression of these cistrons in various vectors and cell lines, especially compared with a control plasmid pmaxGFP, we optimized the expression of this bicistronic message by mutating pcDNA3 to facilitate exchange of the promoter and polyadenylation segments controlling both the gene of interest and the eukaryotic antibiotic resistance gene as well as the eukaryotic antibiotic resistance gene itself, and effectively compare the effects of these exchanges, creating plasmid pc3.5.

Results

Murine MSCs stably and ectopically expressing Mu-IFNαA inhibited the establishment of tumors in homogeneic C57/BL6 mice. Mu-IFNαA expressed from the bicistronic message is fully biologically active, but is expressed at only two-thirds of the level observed from a monocistronic message. Cap-dependent translation is threefold more efficient than IRES-driven translation in 293T, B16, and MSC cell lines. Both efficient expression and good transfection efficiency require strong expression of the gene of interest and a chimeric intron. High doses of Mu-IFNαA within tumors inhibited tumor establishment but may not inhibit tumor growth.

Conclusions

Our modified vector and its derived plasmids will find use in stem cell therapeutics, gene expression, mRNA regulation, and transcription regulation. Local release of Mu-IFNαA within tumors may differently affect tumor establishment and tumor growth.
Plasminogen activator inhibitor 1 is an intracellular inhibitor of furin proprotein convertase
Authors: Bernot Denis , Stalin Jimmy , Stocker Pierre , Bonardo Bernadette , Scroyen Ilse , Alessi Marie-Christine , Peiretti Franck
Published: March 2011

Proprotein convertases (PCs) are a family of serine proteases that are involved in the post-translational processing and activation of a wide range of regulatory proteins. The upstream role of PCs in the control of many physiological and pathological processes generates a growing interest in understanding their regulation. Here, we demonstrate that the serine protease inhibitor plasminogen activator inhibitor 1 (PAI-1) forms an SDS-stable complex with the PC furin, which leads to the inhibition of the intra-Golgi activity of furin. It is known that elevated PAI-1 plasma levels are correlated with the occurrence of the metabolic syndrome and type 2 diabetes, and we show that PAI-1 reduces the furin-dependent maturation and activity of the insulin receptor and ADAM17: two proteins involved in the onset of these metabolic disorders. In addition to demonstrating that PAI-1 is an intracellular inhibitor of furin, this study also provides arguments in favor of an active role for PAI-1 in the development of metabolic disorders.
Congenital Dislocation or Developmental Dysplasia of the newborn hip?
Authors: Thomas M R , Urquhart S D , Wefers B.
Published: March 2011

The role of universal primary ultrasound screening for detection of developmental dysplasia of the hip of the newborn remains controversial in Britain. Two infants in whom ultrasonography was reported to show no evidence of developmental dysplasia in the newborn period, but who later presented with acetabular dysplasia and subluxation requiring surgery, are presented.
Polyarteritis nodosa presenting as a febrile rash and severe fatal myocarditis
Authors: Ziglam HM , France AJ , Evans A , Nathwani D.
Published: March 2011

Polyarteritis nodosa (PAN) is a necrotizing vasculitis of small and medium sized muscular arteries. The spectrum of the clinical presentation can range from an apparently limited disease to fulminant polyvisceral failure. We report a fatal case of isolated cardiac PAN presenting as an acute febrile rash and hypotension.
Title: Obstetric Cholestasis Presenting With Unusually High Levels Of Serum Transaminases
Authors: Popli Kiran , Roberts Judith , Mills Peter R.
Published: March 2011

Obstetric cholestasis is typically suspected when a pregnant woman presents with generalized pruritus without a rash. Biochemically, only a mild abnormality of liver function tests is seen without any systemic signs and symptoms. The patient is usually treated with Ursodeoxycholic acid which improves both pruritus and liver function tests. We present a case where a pregnant woman presented with pruritus and was found to have unusually high levels of serum transaminases. The diagnosis of obstetric cholestasis was made only by exclusion of other causes of hepatobiliary dysfunction. Fortunately the condition responded well to the standard treatment and both mum and baby had a favourable outcome.
Acute Osteomyelitis Presenting As Cholestatic Jaundice
Authors: Hakeem M J M L , Bhattacharyya D N
Published: March 2011

Cholestatic jaundice is a well recognised complication of late sepsis. However, cholestatic liver injury preceding sepsis is less well known and appreciated. This leads to delays in diagnosis in clinical practice and may result in significant morbidity and mortality. The development of a cholestatic blood picture should be considered as an early warning sign of an underlying infection, even in the absence of signs or symptoms of sepsis. This report describes the case of a previously healthy patient who presented with cholestatic jaundice. Staphylococcal osteomyelitis involving the left sacroiliac joint was diagnosed. Literature relating to cholestatic jaundice in sepsis is reviewed.
An Audit of the Quality of Endometrial Cancer Care in a Specialised Unit
Authors: De Parkin , Warraich Q , Fleming DJ , Chew GK , Cruickshank ME
Published: March 2011

Background

Endometrial cancer is the 5th most common female cancer in Scotland and though cure rates are good, 25% of women still die of their disease. Staging has been shown to be poorly performed in Scotland-wide audit and inadequate staging is a predictor of worse outcome. Only 12% of women with endometrial cancer in Scotland are operated upon by a specialist gynaecological oncologist.

Aims

To determine if the quality of staging information in endometrial cancer is improved in a region where all cases are managed by specialist gynaecological oncologists

Methods

All 108 women diagnosed and treated with endometrial cancer in Grampian in 2002 and 2003 had a retrospective case note assessment of the completeness of staging information. This was compared to previously published Scottish results.

Results

Completeness of staging was high. The International Federation of Gynecology and Obstetrics (FIGO) stage was available in 100% of women. Chest X Ray was performed in 85% and peritoneal cytology in 93%. Pelvic lymphadenectomy was performed in 28%. All these results were significantly better than in the Scottish audit.

Conclusion

Centralisation of women with endometrial cancer results in accurate staging information. However it is not yet known what effect this may have on outcome.
Acute Sporting Injuries to the Hand and Wrist in the General Population
Authors: Simpson D , McQueen MM
Published: March 2011

We report the incidence of acute sporting injuries to the hand and wrist in the general population that required management in the Orthopaedic department. During a four month period, we prospectively identified all sports related injuries, which were referred for continued management in the Orthopaedic department. Eight hundred and fifty-one sports injuries were identified. Of them 400 (47%) were to the hand and wrist. There were 304 (76%) males and 96 (24%) females with an average age of 24.6 years and 26.5 years respectively. Injuries comprised of 286 (71%) fractures, 88 (22%) soft tissue injuries, 16 (4%) dislocations and 10 (3%) miscellaneous injuries. Twenty-eight (7%) patients required hospital admission. Thirty-seven different sporting activities were identified, with most injuries occurring in popular, physically demanding sports, such as football and rugby. Approximately half of all sporting injuries sustained by the general population are to the hand or wrist. In the majority of cases outpatient management was sufficient.
Vitamin D Deficiency in Outpatients: - a Scottish Perspective
Authors: Burleigh E , Potter J
Published: March 2011

Vitamin D deficiency is common in older people and increases risk of falls, osteoporosis and fracture. This may be reduced with supplements. Recent Scottish guidelines recommend routine use of vitamin D and calcium for all older housebound, sunlight deprived or institutionalised people. Whilst many outpatients will undoubtedly meet these criteria, others who would benefit may not. We have determined the extent of vitamin D deficiency in older outpatients in our geographical area, to clarify further whether those found to be deficient, would receive supplementation under current guidelines

Methodology

102 new patient referrals to outpatient clinics and day hospital were questioned over their social circumstances and activity levels, and had serum 25 - Hydroxy Vitamin D (25(OH)D) levels measured in wintertime

Results

Mean age was 79.6 (SD 7.3), 31.4% were housebound and 51.0% exposed their skin to sunlight. 72.6% had insufficient vitamin D levels [25(OH)D <50 nmol/l], 27.5% of whom levels were frankly deficient [25(OH)D <25 nmol/l]. Deficiency was significantly more common in females (p=0.002), those attending the falls clinic or day hospital (p=0.021), the housebound (p=0.012) or patients who never exposed their skin to sunlight (p=0.007). However, even in those patients who were outdoors frequently or who did expose their skin to the sun, the mean vitamin D levels remained insufficient [mean 25(OH)D = 45.6 (SD 26.2) nmol/l and 47.9 (SD 26.3) nmol/l respectively].

Conclusions

The prevalence of vitamin D deficiency is high in older outpatients in this geographical area. These patients may benefit from routine vitamin D and calcium, but currently many would not be targeted in recent Scottish Executive recommendations because they are not housebound and sunlight deprived.
An Unusual Presentation of Metastatic Actinomycosis: A case report
Authors: Cheng Kenneth , Kinninmonth Andrew , Tansey Patrick
Published: March 2011

We report a case of a 49-year-old man presenting with a history of painful swollen leg, due to a solitary metastatic deposit in the tibia. After investigation, it was found to be secondary to infection with Actinomycosis israelii, which is normally a commensal of the oral and buccal cavity.

Actinomycosis israelii is the predominant organism causing infectious disease in humans3 and although soft tissue infections are well documented, osseous involvement is very rare.
Clınıcal And Cytogenetıc Evaluatıon Of Three Patıents Wıth Swyer-James Syndrome
Authors: Zamanı Adil , Zamanı Ayse Gul
Published: March 2011

Swyer-James syndrome (SJS) is a rare disorder characterized radiologically by a unilateral hyperlucent lung. Although respiratory tract infections play an important role in the development of SJS, some cases have no documented history of repeated episodes of childhood respiratory infection. It has been suggested that some congenital factor(s) may contribute to the development of SJS. The purpose of this study was to investigate clinical and cytogenetic features of three patients with this syndrome. Diagnosis of SJS was first suspected based on admission chest radiographs. Chest computed tomography, ventilation-perfusion lung scintigraphy and pulmonary magnetic resonance angiography confirmed the diagnosis. Bronchiectases were revealed on the affected sides of all patients. In addition, two of them had asthma, and one patient had cor pulmonale. There was no bronchoscopic evidence of benign or malignant endobronchial obstruction. Bronchial mucosa cells (BMC) and peripheral blood lymphocytes(PBL) cultures were obtained from all patients. Cytogenetic analyses of these samples revealed normal karyotype in two patients. Due to bronchial candidiasis, cytogenetic analysis of BMC could not be performed in the remaining patient;however, his culture of PBL demonstrated a normal karyotype. In conclusion, other pulmonary disorders such as asthma, bronchiectasis, and fungal infection of the respiratory tract can be demonstrated in conjuction with the SJS. Although, normal karyotypes were demonstrated in our patients, further cytogenetic studies are needed to elucidate the molecular basis of SJS.
Negligence Claims for Treatment of Neurological Disease: Cases from the Medical and Dental Defence Union of Scotland
Authors: Mcneill A , Mathewson B
Published: March 2011

There is no detailed description of negligence claims made against clinicians treating neurological disease in the U.K. Here negligence claims concerning treatment of neurological disease, which were handled by the Medical and Dental Defence Union of Scotland (MDDUS), were audited. Sixty-two cases were identified; in 38 cases the clinician was a neurosurgeon, in 16 a neurologist and in 8 a General Practitioner (G.P). The most common conditions were inter-vertebral disc disease and neoplasia, the most common misadventure was improper performance of procedure and most of the cases resulted in severe permanent disability.
Dietary and Social Characteristics of Children with Severe Tooth Decay
Authors: Cameron FL , Weaver LT , Wright CM , Welbury RR
Published: March 2011

Background and Aims

Dental decay remains a major public health problem in Scottish children. The aim of this study was to investigate the relationship between diet, bowel habit, social class, and body mass index (BMI) in children with severe tooth decay.

Children and Methods

A cross sectional study of 165 children aged 3 -11 years attending Glasgow Dental Hospital for extraction of teeth under dental general anaesthesia (DGA), was undertaken. A structured questionnaire was used to obtain information from each child on diet, bowel habit, and social status of their parents. Fibre and sugar scores were calculated from the frequency of consumption of a range of relevant foods.

Results

The children (mean age 5.7 (SD1.8) years) had between 1 and 20 decayed, missing or filled primary teeth (dmft) with a mean dmft of 7.9 (SD 3.5). 37% ate a chocolate bar daily, and 29% regularly drank a sugary drink after brushing their teeth. An excess of children were from the most deprived parts of the city and they had the worst decay. Children with the worst decay were also significantly thinner. No relationship was found between tooth decay and bowel habit.

Conclusions

In this selected group of children with poor dental health, those from deprived families were over-represented and had significantly more decay. Severe dental decay was also associated with underweight.
Lyon Playfair (1818-1898) and Compulsory Vaccination
Authors: Butler A
Published: March 2011

Lyon Playfair was born in India but brought up by his uncle in St Andrews. He studied medicine in Glasgow and Edinburgh but never practised as a doctor. Instead he worked for the chemist Thomas Graham in London and then studied for a PhD with Liebig in Germany. While serving on a government commission he became very interested in public health, particularly the control of infectious diseases. In 1883, while a member of parliament, he made a passionate speech in support of a government bill in favour of compulsory vaccination against smallpox. He was violently attacked for his speech in a pamphlet by William White, an adherent of the teachings of the Swedish mystic Emanuel Swedenborg. Playfair died in 1898 and is buried in St Andrews.
Impact of a salmonella outbreak investigation in a maximum security Scottish prison
Authors: Hamlet N , Miller J , Gourlay H , Kerr J , Cunningham G
Published: March 2011

Following notification of a stool sample positive for Salmonella from an inmate of a maximum security prison a concerted multidisciplinary public health response was undertaken. Lanarkshire NHS Board Health Protection Team (HPT) held one Problem Assessment Group Meeting and two Outbreak Control Team Meetings. The outbreak period spanned three weeks during which there were three confirmed and six probable cases of Salmonella enteritidis PT4 in prison inmates. The source was not identified despite thorough investigation, however the outbreak control team (OCT) was able to identify key recommendations around general hygiene, shared toilet facilities and storage of cooked food in cells. The outbreak stimulated closer working arrangements between the prison medical services and the local HPT. Co-operation during the outbreak investigation and subsequent to the OCT report facilitated both operational changes at the prison and improvements to the management of infection control across the Scottish Prison Service.
Exercise Responses Following Heart Transplantation: 5 Year Follow-Up
Authors: Carter R , Al-Rawas OA , Stevenson A , Mcdonagh T , Stevenson RD
Published: March 2011

Heart transplantation is an established treatment for end stage heart failure. In addition to increased life expectancy, heart transplant recipients report a remarkable improvement in symptoms and functional capacity. Exercise performance following heart transplantation, however, remains impaired even in the absence of exertional symptoms. We have assessed the response to exercise in 47 patients with cardiac failure prior to and then at yearly intervals to five years post transplantation. All patients performed incremental symptom limited exercise tests during which minute ventilation (V'E), oxygen consumption (V'O2) and carbon dioxide production (V'CO2) and heart rate (HR) were measured. Ventilatory response (V'E/V'CO2), anaerobic threshold (V'O2 AT %predicted) and heart rate response (HR/VO2) were calculated. The dead space to tidal volume ratio (VD/VT) and alveolar-arterial oxygen gradient (A-aO2) were computed from transcutaneous monitoring. Despite substantial improvement in subjective functional capacity, heart transplant recipients continue to have limited exercise performance [Maximal V'O2% predicted pre-transplant 41.3 (2.2); 1 year 48.6 (1.7), p <0.001: V'O2 AT% 31.5 (1.1); 1 year 35.6 (1.0); respectively p<0.05]. The maximal oxygen uptake continued to improve at two years post-transplant but, thereafter, there was no further significant change at up to 5 years post transplant [50.9 (1.5)]. At one year post-transplantation peak HR [65.2 (0.9) vs 79.1(1.4)] and the HR/VO2 response [24.0(1.8) vs 79.6(4.2)] were significantly reduced compared to pre-transplant values. The heart rate response remained lower compared to predicted at 5 years post-transplant although there was a significant increase compared to one year post-transplant (32.9 vs 24.0mls/bt). There was a weak but significant relationship between maximal VO2 and peak HR (0.39, p<0.05) and HR/VO2 (r= 0.37, p<0.05) at one year post-transplant. Prior to transplantation the ventilatory response to exercise was elevated [V'E/V'CO2 45.6 (2.5)] and decreased significantly following transplantation [1 yr 34.1 (1.3), respectively p<0.001]. In addition, despite significant improvement in VD/VT after transplantation, it remained higher than normal [Pre VD/VT at maximum exercise 0.35 (0.02); 1 yr 0.31 (0.02); p<0.05]. There was a further fall in the VE/VCO2 and VD/VT at two years post-transplantation with no further change at up to 5 years post transplantation [VE/VCO2 32.0 (1.0); VD/VT 0.29 (0.01)].

Although cardiac output is markedly improved after transplantation, due to chronotropic incompetence associated with denervation, its response remains subnormal and this may explain the residual abnormalities of ventilatory and gas exchange responses to exercise following transplantation.
Patients’ attitudes towards mydriasis for diabetic eye disease screening
Authors: Murgatroyd H , Macewen C , Leese Gp
Published: March 2011

Aims

The purpose of the questionnaire was to explore attitudes of patients towards mydriasis for diabetic retinopathy screening.

Methods

Two groups of patients were invited to take part: group 1 comprised patients attending the diabetic clinic and had previous experience of mydriasis, group 2 patients attending the mobile screening unit for non-mydriatic digital retinal photograph and who were not previously used to receiving mydriatic eye drops. Basic demographic data was recorded and the volunteers invited to complete a questionnaire.

Results

292 patients were recruited into group 1 (median age 63 years range 20-94) and 103 into group 2 (median age 68 years range 29-96). 42% of patients in group 2 indicated that they were unhappy with the use of dilating eye drops and 26% of this group reported that they may be discouraged from attending screening for diabetic retinopathy if drops were introduced. These figures were statistically lower in group 1 at 8% and 1-8% respectively (p<0.001). Blurring of vision was identified as the most troublesome feature of the use of mydriasis for patients. A large proportion of patients drove themselves to their last screening appointment; 58% in group 2 and 39% in group 1. A third of all patients (33%) indicated that they worked outside the home.

Conclusions

Many patients attending diabetic eye screening return to driving and work immediately after the appointment. Introduction of the use of routine drops may discourage attendance. Education and experience may have an important role in improving acceptability of mydriatic eye drops. Retinal screeners need to have clear guidelines with which to advise patients.
Further Observations on the Removal of an Enormous Facial Tumour by Robert Liston in 1834
Authors: Kaufman Mh
Published: March 2011

In 1834, shortly before Robert Liston (1794-1847) left Edinburgh to take up the post of senior surgeon to the North London (now University College) Hospital, he operated on Mrs Fraser, from Banchory, in north-east Scotland. Her tumour was believed to have originated as a result of trauma to the left maxillary antrum. It was immense in size when he first saw it, and produced an enormous degree of facial distortion. The tumour was associated with drooping and disfigurement of the left angle of her mouth and extended forwards from her left external ear to the left side of her nose. Its upper part eventually obstructed the vision of her left eye, while its lower part extended for some inches below the level of her mandible. The volume of the tumour was just slightly less than that of her face. Liston provided a detailed description of her appearance when he first saw her, and gave a detailed history that suggested its possible aetiology. Descriptions of her pre-operative cast were previously published in this Journal in 2000. Since then, additional casts showing her post-operative appearance and that of her tumour have been located, and these form the basis for this follow-up account.
The Relationship Between Serum Creatinine and Estimated Glomerular Filtration Rate: Implications for Clinical Practice
Authors: Nelson Aw , Mackinnon B , Traynor J , Geddes CC
Published: March 2011

Introduction

A new classification of chronic kidney disease (CKD) has been widely adopted that stratifies patients into 5 ‘stages’ according to estimated glomerular filtration rate (eGFR). In adults the most commonly used formulae to calculate eGFR are the Cockcroft and Gault (C&G) and Modification of Diet in Renal Disease (MDRD) formulae. The UK Renal Association has recommended calculation of MDRD eGFR to screen for reduced kidney function in primary and secondary care.

Aim

The aim of this study was to explore the implication of using these predictive formulae.

Methods

We searched for patients currently attending a renal clinic who have ever had a serum creatinine (SCr) of exactly 100 mol/L, 150 mol/L or 200 mol/L. The C&G and MDRD eGFRs corresponding to that SCr were calculated. The proportion of patients in each stage of the CKD classification was determined.

Results

For a SCr of 100 mol/L mean eGFR was 86.5ml/min (range 31.0 - 192.8) by C&G and 63.8ml/min (range 39.7 - 99.9) by MDRD (p<0.0001; t-test of mean). For SCr 150 mol/L mean eGFR was 51.7ml/min (18.0 - 110.4) by C&G and 38.0ml/min (20.7 - 54.8) by MDRD (p<0.0001). For SCr of 200 mol/L mean eGFR was 34.4ml/min (12.6 - 89.5) by C&G and 27.3ml/min (16.7 - 41.3) by MDRD (p<0.0001). Using MDRD eGFR 46.5% patients with a SCr of 100 mol/L have stage 3 CKD (GFR 30-60ml/min) and all patients with a SCr of 150 mol/L or 200 mol/L have CKD 3 or worse. 8.6% of males with SCr 100 mol/L had stage 3 CKD or worse compared with 86.8% females. 70.2% patients > 65 years old with SCr 100 mol/L had stage 3 CKD.

Conclusions

Targeted screening of patients at-risk for CKD will identify a large number of patients who require management of CKD and potential referral to nephrology services even at levels of SCr regarded as ‘normal’ or mildly elevated. This will apply especially to elderly patients and females.