bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital stationary night blindness is associated with the leopard complex in the miniature horse
Authors: Sandmeyer Lynne S. , Bellone Rebecca R. , Archer Sheila , Bauer Bianca S. , Nelson Janelle , Forsyth George , Grahn Bruce H.
Published: April 2011

Objective  To determine if congenital stationary night blindness (CSNB) exists in the miniature horse in association with leopard complex spotting patterns (LP), and to investigate if CSNB in the miniature horse is associated with three single nucleotide polymorphisms (SNPs) in the region of TRPM1 that are highly associated with CSNB and LP in Appaloosas.

Animals studied  Three groups of miniature horses were studied based on coat patterns suggestive of LP/LP (n = 3), LP/lp (n = 4), and lp/lp genotype (n = 4).

Procedures  Horses were categorized based on phenotype as well as pedigree analysis as LP/LP, LP/lp, and lp/lp. Neurophthalmic examination, slit‐lamp biomicroscopy, indirect ophthalmoscopy, and scotopic flash electroretinography were performed on all horses. Hair samples were processed for DNA analysis. Three SNPs identified and associated with LP and CSNB in the Appaloosa were investigated for association with LP and CSNB in these Miniature horses.

Results  All horses in the LP/LP group were affected by CSNB, while none in the LP/lp or lp/lp groups were affected. All three SNPs were completely associated with LP genotype (χ2 = 22, P << 0.0005) and CSNB status (χ2 = 11, P < 0.0005).

Conclusions  The Miniature Horse breed is affected by CSNB and it appears to be associated with LP as in the Appaloosa breed. The SNPs tested could be used as a DNA test for CSNB until the causative mutation is determined.
It pays to violate: how effective are the Basel accord penalties in encouraging risk management?
Authors: da Veiga Bernardo , Chan Felix , McAleer Michael
Published: April 2011

The internal models amendment to the Basel Accord allows banks to use internal models to forecast Value‐at‐risk (VaR) thresholds, which are used to calculate the required capital that banks must hold in reserve as a protection against negative changes in the value of their trading portfolios. As capital reserves lead to an opportunity cost to banks, it is likely that banks could be tempted to use models that underpredict risk and hence lead to low capital charges. To avoid this problem the Basel Accord introduced a backtesting procedure, whereby banks using models that led to excessive violations are penalised through higher capital charges. This paper investigates the performance of five popular volatility models that can be used to forecast VaR thresholds under a variety of distributional assumptions. The results suggest that, within the current constraints and the penalty structure of the Basel Accord, the lowest capital charges arise when using models that lead to excessive violations, thereby suggesting the current penalty structure is not severe enough to encourage adequate risk management. In addition, this paper suggests an alternative penalty structure that is more effective at aligning the interests of banks and regulators.
Individuals who are homozygous for the 2282del4 and R501X filaggrin null mutations do not always develop dermatitis and complete long‐term remission is possible
Authors: Thyssen J.P. , Carlsen B.C. , Bisgaard H. , Giwercman C. , Johansen J.D. , Linneberg A. , Meldgaard M. , Szecsi P.B. , Stender S. , Menné T.
Published: April 2011

Background  About 8–10% of the general population in Europe carry a null mutation in the filaggrin gene which is associated with early onset of atopic dermatitis as well as persistence into adulthood. No studies have investigated whether individuals with the homozygous filaggrin null genotype always develop dermatitis.

Objectives  The aim of this study was to describe the natural history of individuals with no filaggrin expression.

Materials  Three study populations were included: (i) a random sample of 3335 subjects aged 18–69 years from the general population in Copenhagen who underwent general health examination; (ii) a total of 499 patients seen in our dermatitis clinic since 2009 and who were filaggrin genotyped as a part of the routine diagnostic work up; and (iii) a prospective, longitudinal, birth cohort study of 411 children born to mothers with a history of asthma. Filaggrin genotyping was performed for the 2282del4 and R501X mutations.

Results  Filaggrin homozygous/compound heterozygous individuals accounted for 0.3% of adults, 3% of dermatitis patients and 0.7% of children. Respectively, one of nine adults and one of three children never experienced dermatitis until now. All hospital patients had atopic dermatitis with onset during (early) childhood. Year‐long complete remission was observed in half of patients.

Conclusions  The natural history of individuals with the filaggrin null genotype is fairly good in the sense that they may not develop dermatitis at all, and if they do, they may experience complete remission.
Decomposing Executive Stock Option Exercises: Relative Information and Incentives to Manage Earnings
Authors: Veenman David , Hodgson Allan , Van Praag Bart , Zhang Wei
Published: April 2011

Abstract:  This paper examines the information content of stock option exercises versus regular insider share trades by corporate executives. We argue that the asymmetric payoff structure of options makes managerial wealth – compared to holdings of shares – relatively more sensitive to stock price changes and more likely induces opportunistic behaviour. Consistent with our predictions, we find option exercises followed by share liquidations are associated with disappointing future earnings news, while sales of previously held shares are not. In addition, liquidation exercises of deep in‐the‐money options are associated with larger income‐increasing abnormal accruals, signalling lower quality earnings. On the buy side, we find that regular insider share purchases are associated with positive future earnings news while purchases through option conversions are not. This research has implications for investors, compensation committees, and future research on corporate insider trades.
Catechol‐O‐methyltransferase Val158Met genotype, parenting practices and adolescent alcohol use: testing the differential susceptibility hypothesis
Authors: Laucht Manfred , Blomeyer Dorothea , Buchmann Arlette F. , Treutlein Jens , Schmidt Martin H. , Esser Günter , Jennen‐Steinmetz Christine , Rietschel Marcella , Zimmermann Ulrich S. , Banaschewski Tobias
Published: April 2011

Background:  Recently, first evidence has been reported for a gene–parenting interaction (G × E) with regard to adolescent alcohol use. The present investigation set out to extend this research using the catechol‐O‐methyltransferase (COMT) Val158Met polymorphism as a genetic susceptibility factor. Moreover, the current study examined whether a potential G×E would be consistent with one of two models of gene–environment interplay (genetic vulnerability vs. differential susceptibility).

Methods:  Data were collected as part of an ongoing epidemiological cohort study following the outcome of early risk factors from birth into adulthood. Two hundred and eighty‐five participants (130 males, 155 females) were genotyped for the COMT Val158Met polymorphism and were administered an alcohol interview, providing measures of current frequency and amount of drinking at ages 15 and 19 years. Information on three dimensions of perceived parenting behavior was obtained from the 15‐year‐olds.

Results:  Adolescents homozygous for the Met allele showed higher drinking activity at age 19 years when their parents had engaged in less supervision or were less involved, while their drinking activity was reduced under conditions of favorable parenting. No such relationship was found in individuals carrying the Val allele.

Conclusions:  The present findings correspond with the pattern of results predicted by the differential susceptibility hypothesis, suggesting that environmental variation would have a greater impact in individuals carrying a genetic susceptibility such that, in this group, exposure to negative environmental conditions would result in more adverse outcomes and the experience of favorable conditions would lead to more positive outcomes.
The pope, the painter, and the dynamics of social standing in the Stanza della Segnatura
Authors: UNGER DANIEL M.
Published: April 2011

Raphael's School of Athens received much attention in modern scholarship, yet little attention was given to the anonymous figures of classical beauty that are scattered, not only in this particular painting, but also in the Disputà, the painting on the opposite wall of the stanza. In this article, the focus of attention will be on three such figures in the School of Athens, which are situated on the left side of the painting. The three, a baby, a boy, and a young man, differ from all the other anonymous figures in this part of the painting in that they have their heads turned to the right and are gazing directly at the viewer. They will be considered as a group that may have had two purposes, both of which relate to political narratives. The first purpose was to accentuate the image and meaning of the pope – Julius II; the second, to draw attention to the painter's self‐portrait and his social agenda. Their placement together is based on a peculiar composition that has a precedent in Florentine mural painting.
Plasma lipocalin‐2 levels in pregnancy
Authors: CESUR SEMRA , YUCEL AYKAN , NOYAN VOLKAN , SAGSOZ NEVIN
Published: April 2011

Objective. To evaluate plasma levels of lipocalin‐2, which is a novel adipokine associated with obesity and insulin resistance, in pregnant women. Design. Prospective case–control study. Setting. University hospital. Population. Pregnant women with pre‐pregnancy body mass index >25kg/m2 (overweight; n=29) and body mass index <25kg/m2 (n=27), whose gestational ages were between 24 and 28weeks, as study groups and nonpregnant control women with body mass index <25kg/m2 (n=29). Methods. Plasma lipocalin‐2 levels, fasting plasma glucose and fasting plasma insulin levels; homeostasis model assessment insulin resistance index and fasting plasma glucose/fasting plasma insulin ratio were measured for each subject. Main Outcome Measures. Comparisons among the groups and correlations for lipocalin‐2 and the parameters of insulin resistance. Results. Plasma lipocalin‐2 levels among the pregnant women were significantly higher than those of the control group (p<0.001 for both group comparisons). Lipocalin‐2 levels were significantly higher in the group with pre‐pregnancy body mass index >25kg/m2 compared with the group with pre‐pregnancy body mass index <25kg/m2 (p=0.003). Lipocalin‐2 levels were positively correlated with homeostasis model assessment insulin resistance index and fasting plasma insulin and negatively correlated with fasting plasma glucose/fasting plasma insulin ratio in both pregnant groups. Conclusions. Lipocalin‐2 was found to be higher in pregnant women, especially when pre‐pregnancy body mass index was >25kg/m2, and it was correlated with markers of insulin resistance.
Can placental histology establish the timing of meconium passage during labor?
Authors: INCERTI MADDALENA , LOCATELLI ANNA , CONSONNI SARA , BONO FRANCESCA , LEONE BIAGIO E. , GHIDINI ALESSANDRO
Published: April 2011

Objective. To evaluate the relation between duration of placental exposure to recently passed meconium in vivo and histological evidence of meconium uptake by macrophages. Design. Retrospective cohort. Setting. University hospital. Population. A total of 44 term deliveries of singleton infants with moderate or thick meconium had placental examination and documented timing of meconium appearance after membrane rupture. Methods. Placentas were examined to assess the extent of meconium uptake by macrophages based on location in the amniochorionic membranes, chorionic plate and umbilical cord, and the intensity of uptake, based on the number of macrophages per field. An arbitrary score of severity of uptake was also created by multiplying the intensity of meconium uptake (number of meconium‐laden macrophages) by the extent in the three placental areas. Twenty cases of singleton term pregnancy with clear amniotic fluid throughout labor and at delivery were included as negative controls. Main Outcome Measures. Relation between interval of meconium exposure in vivo and uptake by macrophages. Results. The median interval from meconium appearance to delivery was 95minutes (range 10–510minutes). The median score of severity of meconium uptake was significantly higher than in the negative controls. There was no correlation between the interval of meconium appearance to delivery and score of severity of meconium uptake (p=0.76). Inflammatory lesions were present in 12 (27%) of 44 cases and vascular lesions in 11 (25%) of 44. Conclusions. Duration of placental exposure to meconium in vivo was not related to meconium uptake by macrophages where exposure was <8.5hours.
Dentists reflect on their problem‐based education and professional satisfaction
Authors: Bengmark D. , Nilner M. , Rohlin M.
Published: April 2011

Aim:  To determine the way in which Malmö University dental graduates perceive their problem‐based dental education and evaluate their professional satisfaction.

Method:  The first five cohorts (graduating in years 1995–1999) of the problem‐based curriculum were invited to participate. Of 166 graduates, 77% responded to a questionnaire comprising 20 questions on aspects of their dental education, professional situations and interest in postgraduate education. They were asked to rank their perception of their dental education and satisfaction with their professional situation on a visual analogue scale (VAS) with endpoints ranging from ‘Not at all’ (1) to ‘Very well’ (10). For other statements, the markings were made on a Likert scale from 1 (not important/not satisfied) to 5 (very important/very satisfied). There were also open‐ended questions.

Results:  Most respondents perceived their education to prepare them well for a career in dentistry (median score VAS 8), and 90% rated above six on a VAS for their professional satisfaction as dentists. Importance and satisfaction were highly correlated with principles of the curriculum: holistic view, oral health, lifelong learning, integration between theory and clinic, and clinical competence. Forty‐five per cent of the graduates noted the problem‐based learning approach as the most valuable asset of their education, and 19% cited training in oral surgery as a deficit. Of the respondents, 77% expressed interest in specialist training and 55% in research education.

Conclusion:  Problem‐based education was perceived to prepare graduates well for their profession, and their professional satisfaction was high.
Contraceptive Vaccines for Wildlife: A Review
Authors: Kirkpatrick Jay F. , Lyda Robin O. , Frank Kimberly M.
Published: April 2011

Citation Kirkpatrick JF, Lyda RO, Frank KM. Contraceptive vaccines for wildlife: a review. Am J Reprod Immunol 2011; 66: 40–50

Wildlife, free‐ranging and captive, poses and causes serious population problems not unlike those encountered with human overpopulation. Traditional lethal control programs, however, are not always legal, wise, safe, or publicly acceptable; thus, alternative approaches are necessary. Immunocontraception of free‐ranging wildlife has reached the management level, with success across a large variety of species. Thus far, the immunocontraceptive research and management applications emphasis have been centered on porcine zona pellucida and gonadotropin‐releasing hormone vaccines. Contraceptive success has been achieved in more than 85 different wildlife species, at the level of both the individual animal and the population. At the population management level with free‐ranging species, the primary focus has been on wild horses, urban deer, bison, and African elephants. The challenges in the development and application of vaccine‐based wildlife contraceptives are diverse and include differences in efficacy across species, safety of vaccines during pregnancy, the development of novel delivery systems for wild and wary free‐ranging animals, and the constraints of certain non‐contraceptive effects, such as effects on behavior. Beyond the constraints imposed by the public and a host of regulatory concerns, there exists a real limitation for funding of well‐designed programs that apply this type of fertility control.
Effectiveness of skin cancer screening for individuals age 14 to 34 years
Authors: Schmitt Jochen , Seidler Andreas , Heinisch Georg , Sebastian Günther
Published: April 2011

Background: Approximately 15 % of all cases of melanoma are diagnosed before age 35 years. In Germany, individuals ≥ 35 years are eligible for the national skin cancer screening program. The effectiveness of a population‐based skin cancer screening in general and in particular for young adults is unclear.

Objectives: Assessment of the effectiveness of a skin cancer screening program and of risk factors for detection of a melanoma/atypical nevus in the setting of a screening for the age group 14 to 34 years.

Methods: A total of 12 187 individuals age 14 to 34 years were screened in Saxony for skin cancer by a dermatologist in the program “Haut‐Check 14–34 Jahre” of the AOK PLUS, a large German health insurance, between January and July 2009. Demographic, clinical and histopathological data and UV‐exposure data were collected from each participant. Multivariate logistic regression models were used to assess risk factors for the detection of a (histopathologically confirmed) melanoma or atypical nevus.

Results: 2.8 % of the eligible individuals participated in the skin cancer screening program with women being more likely to do so. In 1 072 individuals (8.8 %) screening included at least one excision of a skin lesion leading to the diagnosis of melanoma in two participants, melanoma in situ in four persons, and atypical nevus in 641 persons. Use of tanning beds, higher age, number of nevi, and previous cutaneous excision were independent risk factors for the detection of a melanoma or atypical nevus.

Conclusions: In 5.5 % of all cases skin cancer screening resulted in the excision of a malignant or atypical melanocytic lesion. It remains unclear what proportion of these cases would have been detected in routine care. The rate of excisions per newly diagnosed melanoma was 179 : 1. Further investigations are necessary to explore the reasons for this low diagnostic specificity. This study highlights the possibilities and limitations of routine data to evaluate screening programs and indicates the need to collect additional information on healthcare utilization behaviour.
EPISTEMOLOGIES OF SITUATED KNOWLEDGES: “TROUBLING” KNOWLEDGE IN PHILOSOPHY OF EDUCATION
Authors: Lang James C.
Published: April 2011

Epistemologies of situated knowledges, advanced by scholars such as Donna Haraway, Lorraine Code, and Maureen Ford, challenge mainstream epistemology's claim to be the gold standard in determining what counts as knowledge. In this essay, James Lang uses the work of these and other feminist theorists to explicate the notion of situated knowledges and then uses this notion to trouble the legitimacy of employing Kantian‐inspired propositional rationalism to justify all knowledge claims. Lang challenges the notions of the discrete, objective, impartial, interchangeable subject and the static passivity of objects of knowing. He demonstrates the inevitable involvement of the subjective in knowledge construction and justification; he claims that knowledge is necessarily embodied, partial, and situated and, further, that its construction, claiming, and enacting are activities with moral and political ramifications. Finally, Lang shows that re‐visioning contexts of education through lenses of epistemologies of situated knowledges reveals a vastly expanded moral landscape with significant implications for educators, students, and educational theorists.
MATERIAL SPECTERS: INTERNATIONAL CONFLICTS, DISASTER MANAGEMENT, AND EDUCATIONAL PROJECTS
Authors: Papastephanou Marianna
Published: April 2011

In this essay, Marianna Papastephanou discusses three books—Michalinos Zembylas's The Politics of Trauma in Education; Sigal Ben‐Porath's Citizenship Under Fire: Democratic Education in Times of Conflict; and Kenneth Saltman's Capitalizing on Disaster: Taking and Breaking Public Schools—from the perspective of the material causality of conflict and of the significance this might have for conflict resolution and the role that education may play in it. Setting out from the Derridean standpoint of spectrality, Papastephanou explores divergences and convergences of Zembylas's critical emotional praxis, Ben‐Porath's counterposition of belligerent and expansive citizenship education, and Saltman's critique of educational programs that capitalize on natural disasters and wars. Papastephanou examines various operations of ontology in an interplay with hauntology (to use Jacques Derrida's terminology) and thus puts forward a critical approach to the contribution of each perspective.
Serving the Service Sector: Gendering Regional (Un)Employment in Geelong, Australia1
Authors: JOHNSON LOUISE
Published: April 2011

This paper will briefly examine employment trends in regional Australia before focusing on one manufacturing, coastal region ‐ Geelong, Victoria –over the 1990s. It will consider the experience of a differentiated sample of women as they enter (and re‐enter) the one sphere of economic activity seen by many as the economic future of cities and regions ‐the service sector. Interviews detailed women's employment histories and experiences but despite the complexity of their multiple locations, this paper will argue that it is their disadvantaged positions as women workers that is fundamental in shaping that experience, regardless of how it is complicated by age, ethnicity or disability.
Adhesive capsulitis: Contrast‐enhanced shoulder MRI findings
Authors: Gokalp Gokhan , Algin Oktay , Yildirim Nalan , Yazici Zeynep
Published: April 2011

Purpose: Evaluation of contrast‐enhanced magnetic resonance imaging (CE‐MRI) findings in cases clinically diagnosed as adhesive capsulitis (AC).

Methods: CE‐MRI images of 12 cases diagnosed as AC (13 shoulder joints) and nine control cases were retrospectively evaluated. AC diagnosis was established based on the history and clinical symptoms. MR signal intensity changes in the axillary pouch, rotator interval, biceps anchor and anterior–posterior capsules were analysed with regard to the presence of abnormal soft tissue and contrast enhancement. Capsular and synovial thickening were measured in the axillary recess and rotator interval on coronal oblique CE T1‐weighted images. Patient and control groups were compared by Fisher's exact and McNemar tests in terms of signal intensity changes and contrast enhancement in the described areas.

Results: Comparison of the group with AC and the control group regarding intensity changes showed a statistically significant difference in the axillary pouch (P < 0.001). No significant difference was found in the rotator interval, biceps anchor and anterior–posterior capsules (P > 0.05). Comparison of AC and control groups in terms of contrast enhancement revealed statistically significant differences in the axillary pouch, rotator interval, biceps anchor and anterior–posterior capsules (P < 0.001). A significant difference was determined between the AC and control groups with regard to thickening in axillary pouch and rotator interval (P < 0.001).

Conclusion: CE studies are useful for diagnosis of AC as it demonstrates thickening of specific soft‐tissue areas like joint capsule and synovium.
Review of the dimensions of the median nerve and carpal tunnel using sonography in asymptomatic adults
Authors: Mani Betty , Sarawagi Radha , Cherian Rekha A
Published: April 2011

Objective: The study aims to establish the normal range of all sonologic measurements of carpal tunnel (CT) structures in an asymptomatic population.

Methods: Sonological evaluation of 150 wrists in 75 asymptomatic adults was performed. The cross‐sectional area (CSA) of the median nerve at four levels, the flattening ratio (FR) at three levels, the antero‐posterior (AP) diameter of the CT and the distance of the transverse carpal ligament (TCL) from the trapezium‐hamate (TmH) line were measured.

Results: The mean (standard deviation (SD)) CSA of the median nerve at the distal forearm, CT inlet, mid and outlet were 6.8 (1.3), 7.4 (1.1), 7.5 (1.0), 7.1 (1.0) mm2, respectively. The mean (SD) FR at the CT inlet, mid and outlet were 2.66 (0.54), 2.55 (0.54), 3.69 (0.82), respectively. The mean (SD) AP diameter of the CT was 10.4 mm (1.1). Volar bowing of the retinaculum was seen in 7.3% of normal wrists.

Conclusions: The normal range at two SDs of the CSA of the median nerve at the inlet was 5.2–9.6 mm2. The upper limit of volar bowing of the flexor retinaculum was 0.8 mm. The FR overlaps with values obtained in other studies of patients with carpal tunnel syndrome. The mean AP diameter of the CT was 10.4 mm (SD 1.1). To the best of our knowledge, this is the largest study performed in an asymptomatic population assessing the different sonological parameters related to the CT.
Low volume contrast CTPA in patients with renal dysfunction
Authors: Singh Tushar , Lam Kay‐Vin , Murray Conor
Published: April 2011

Introduction: The study aims to evaluate a method for and technical feasibility of performing CT pulmonary angiography (CTPA) with just 30 mL of contrast.

Methods: Twenty‐four patients with renal dysfunction suspected of having pulmonary embolus underwent CTPA using 30 mL of contrast. A modified acquisition protocol was employed where sequential monitoring of the central superior vena cava (SVC) was performed following injection of contrast. Scanning was triggered at the first visualised arrival of contrast within the SVC. Hounsfield unit (HU) measurements were performed at the main pulmonary artery to the subsegmental branches to determine the adequacy of each study.

Results: The level of pulmonary arterial enhancement achieved was high, averaging 247 HU across all measured arteries. Average enhancement within more peripheral lobar, segmental and subsegmental arteries was also greater than 200. Only one study was considered non‐diagnostic.

Conclusion: Low‐volume CTPA is technically feasible and provides excellent enhancement of the pulmonary arterial tree.
Comparison of 3MP medical‐grade to 1MP office‐grade LCD monitors in mammographic diagnostic and perceptual performance
Authors: Ong Aaron HJ , Pitman Alexander G , Tan Shu Yi , Gledhill Samuel , Hennessy Oliver , Lui Belinda , Lemish Wayne , Tauro Paul , Styles Colin , Pun Emma , Waugh John , Padmanabhan Meenakshi , Lee Allan
Published: April 2011

Introduction: Picture archiving and communication systems images designed to be viewed on high‐resolution medical‐grade monitors are routinely viewed on office‐grade monitors on the wards or at home. This study aimed to determine whether a statistically significant difference in diagnostic (cancer detection) and perceptual (microcalcification detection) performance exists between 3MP grade and 1MP office‐grade monitors.

Methods: 3MP Dome medical‐grade liquid crystal display (LCD) monitors (Planar, Beaverton, OR, USA) were compared to 1MP Dell office‐grade LCD monitors (Dell Inc, Round Rock, TX, USA). Eight radiologists (reader experience 8–30 years) read the same set of 100 mammograms (23/100 with proven cancers and 52/100 with microcalcifications) presented in random order on three occasions separated by two time intervals of 12 weeks. Reads 1 and 3 utilised 3MP monitors and formed the baseline read. Read 2 utilised 1MP monitors and constituted the experimental read. Reading conditions were standardised. Readers were aware of which monitors they were using. Multivariate logistic regression analysis (to account for reader variability and monitor impact) was performed to assess for statistical significance.

Results: At α = 5%, confidence intervals analysis comparing the measured parameters between 1MP to 3MP monitors demonstrated no statistically significant difference in diagnostic and perceptual performance for the reader group. In cancer detection (the diagnostic task), reader accuracy remained high irrespective of monitor type. Regression analysis comparing performance with 1MP against 3MP monitors found P values of 0.693 and 0.324 for diagnostic and perceptual performance, respectively.

Conclusion: There were no statistically and clinically significant differences between 3MP and 1MP monitors in mammographic diagnostic and perceptual performance. Comparable performance may be due to compensatory behaviour by readers.
CT grading scales for splenic injury: Why can't we agree?
Authors: Clark Rhys , Hird Kathryn , Misur Philip , Ramsay Duncan , Mendelson Richard
Published: April 2011

Introduction: Computed tomography (CT) has been proven to be able to accurately diagnose splenic injury. Many have published CT splenic injury grading scales to quantify the extent of injury. However, these scales have failed at predicting clinical outcomes and therefore cannot be used to accurately predict the need for intervention. We hypothesised that low interrater reliability is the reason why these scales have failed at predicting clinical outcomes.

Methods and Materials: This is a retrospective study of patients who were admitted to the Royal Perth Hospital with blunt splenic injury as coded in the trauma registry. The abdominal CT images of these patients were reviewed by three consultant radiologists and were graded using the six different splenic injury grading scales. We assessed interrater reliability between each of the scales using generalised kappa and proportion of agreement calculations.

Results: The images of 64 patients were reviewed. The interrater reliability yielded a generalised kappa score of 0.32–0.60 and proportion of agreement ranging from 34.4% to 65.5%.

Conclusion: The six studied CT splenic injury grading scales did not have a high enough interrater reliability to be adequate for clinical use. The poor interrater reliability is likely to contribute to the failure of the scales at predicting clinical outcomes. Further research to improve the interrater reliability is recommended.
Magnetic resonance imaging (MRI) lower limb length measurement
Authors: Doyle Anthony J , Winsor Sandra
Published: April 2011

An MRI‐based method was developed to measure lower limb lengths. By comparison with direct measurement of a cadaver femur, the accuracy of the method was verified as over 99%. Reliability and inter‐observer agreement were excellent (correlation coefficients r > 0.99.). This method is accurate and reliable. It shows promise for reducing radiation dose to the paediatric population at large by replacing measurements based on radiographs or computed tomography.
Mediastinal nodal angiomatosis – an unusual mass lesion in the superior mediastinum
Authors: Steinke Karin , Sanadgol Babak , Singh Mahendra
Published: April 2011

Although very rare, mediastinal nodal angiomatosis is an entity radiologists should be aware of to be a differential diagnosis for a hypervascular mediastinal mass lesion. The CT‐ and MR‐morphological features are non‐specific and only histopathology can reveal the definitive diagnosis.
Evaluation of image‐guidance strategies with helical tomotherapy for localised prostate cancer
Authors: Yeung Timothy PC , Yartsev Slav , Rodrigues George , Bauman Glenn
Published: April 2011

Introduction: Set‐up accuracy of different image‐guidance (IG) protocols using reduced imaging frequency was compared with daily IG. Anatomical characteristics were investigated for their potential to help select the suitable IG protocols for individual patients.

Methods: Set‐up corrections from 26 prostate cancer patients treated with daily IG on helical tomotherapy were used to simulate IG protocols with reduced imaging frequency, where average set‐up corrections from a subset of initial IG sessions were used for subsequent fractions with no IG. Residual set‐up error, the difference between the average set‐up correction and the actual correction required, was used to evaluate the accuracy of each protocol. Adaptive treatment margins required to encompass these errors were calculated. Body mass index and daily bladder and rectum cross‐sectional areas (CSAs) were measured, and their correlations with set‐up corrections were evaluated. We also investigated the use of reduced imaging schedules to estimate changes in bladder and rectum CSAs.

Results: As expected, residual set‐up errors and adaptive treatment margins were effectively reduced with frequent imaging. For the majority of patients (81%), 10 IG sessions were sufficient to reduce residual set‐up errors to within the adaptive treatment margins. Daily IG was more suitable than using a reduced IG protocol for a minority of patients (19%) with residual set‐up errors that consistently exceeded the margins for >10% of fractions. These patients could be identified with 10 imaging sessions via the analysis of anatomical variations.

Conclusions: The accuracy of modified IG protocols should be validated in the context of institutional practice regarding patient set‐up and bowel/bladder preparation.
Mythologising culture
Authors: Cowlishaw Gillian
Published: April 2011

This second part of Mythologising Culture examines the responses of Aboriginal people in western Sydney to the valorizing of Aboriginality by the Australian nation. As Aboriginal culture has become the object of restitution, regret and reconciliation, Aboriginal people are being called upon to represent and produce Culture in iconic forms such as painting, dancing and other performances and representations. These activities, often depicted as remedial, are seldom initiated and controlled by Aboriginal people, but rather disturb cultural adjustments and established social relations. I discuss a range of responses elicited by these post‐colonial activities, from enthusiastic embrace to the rejection of state sponsored culture. Further, I consider the structural implications of suburban Aborigines being offered the chance to distance themselves from the anonymous suburban poor.
Iatrogenic Radial Head Dislocation
Authors: Obolensky Lucy , David Huw
Published: April 2011

The following case report describes recurrent radial head dislocation following surgery for a radial shaft fracture. This is the first case to document iatrogenic radial head dislocation following treatment for a radial shaft fracture as far as we are aware.
Five-Year outcomes of Arthroscopic Capsular Release for Adhesive Capsulitis of the Shoulder in Patients with Type I Diabetes Mellitus
Authors: Chye Yew Ng , Phillips Christine , McBirnie Julie , Nutton Richard W.
Published: April 2011

Background

We evaluated the medium-term functional outcome of patients with type I diabetes mellitus who have undergone arthroscopic capsular release for adhesive capsulitis of their shoulders.

Methods

We identified 21 patients who were operated between 2000 and 2008. Fourteen (67%) patients completed the review. Eleven (79%) were male and three (21%) were female.

Results

The mean (range) duration of symptoms was 2.7 years (1 year to 5 years). Mean (range) age at the time of surgery was 50.6 years (38 years to 66 years). The mean (range) follow-up period was 59 months (22 months to 99 months). The mean ± SD ranges of movement of the operated shoulders at the final review were: forward flexion 138.8 ± 17.9°, abduction 138.1 ± 34.2° and external rotation 45.6 ± 10.3°, with internal rotation to T10 (±3 levels). The mean ± SD Disabilities of the Arm, Shoulder and Hand score was 20.8 ± 15.3, visual analogue scale for pain was 1.7 ± 2.1 and Constant score was 82.6 ± 11.9. All patients considered that the operation had offered them significant improvement. There was no perioperative neurovascular injury, infection or fracture.

Conclusion

Arthroscopic capsular release is a safe and effective treatment option for adhesive capsulitis of the shoulder in patients with type I diabetes mellitus. Good pain relief and improved shoulder function were reported at a mean of 5 years postoperatively.
The Cortical Ring Sign: Clinical Results of Percutaneous Coracoclavicular Fixation
Authors: Garrigues Grant E. , Lewis Gemma C. , Gupta Anil K. , Singh Anshuman , Marchant Milford H. , Richard Marc J. , Higgins Laurence D. , Basamania Carl J.
Published: April 2011

Background

The coracoid cortical ring sign is a radiographical view that targets the coracoid base. We hypothesized that the use of this view to treat acromioclavicular separations would achieve desirable results with a rapid, percutaneous procedure.

Methods

Percutaneous coracoclavicular screws, guided by the cortical ring sign view, were used to treat acute, Rockwood grade III or greater acromioclavicular separations with instability to cross-body adduction. The anaesthesia database, clinical and radiographical outcomes were retrospectively reviewed for 41 cases (average age 35 years, range 18 years to 78 years). Average follow-up was 4.7 months (range 1 month to 23 months).

Results

There were six episodes of screw loosening (15%); three of six required an additional surgical procedure. The average residual joint subluxation at final follow-up was approximately 40%, which was significantly improved from the pre-operative displacement ( p < 0.01) and not statistically different from the reduction achieved with the screw in place. All patients had full range of motion and, using the modified UCLA score, 98% (40/41) achieved ‘Good to Excellent’ results. The procedure was rapid (average surgical time: 35 minutes), minimally invasive (average blood loss: 15 mL), and the coracoid cortical ring sign view averaged less than 5 minutes to localize.

Conclusion

When using the coracoid cortical ring sign to target a coracoclavicular screw, the procedure is rapid, minimally invasive, and clinically predictable. There is, however, a high rate of screw loosening and subluxation.
Distal Biceps Tendinopathy: Conservative Treatment
Authors: Maree Michelle N. , Vrettos Basil C. , Roche Stephen J. L , Osch Greg V.
Published: April 2011

Background

Non-traumatic distal biceps tendinopathy related to overuse, has not been previously reported in the literature. We describe the symptoms and signs, a novel injection technique onto the bicipital tuberosity of the radius and outcomes of this treatment.

Materials and Methods

We retrospectively reviewed the clinical notes of 20 patients (24 elbows), in whom the diagnosis of distal biceps tendinopathy was made. Twenty-two of 24 elbows were treated with one or more cortisone injections. The patients were followed up via a telephonic questionnaire.

Results

Average duration of follow-up was 3 years and 4 months. Eighteen elbows returned to full function. Five elbows (four patients) had partial resolution of symptoms, and one had no relief. In these six elbows, symptoms had been ongoing for ≥ 8 months prior to injection.

Conclusion

Distal biceps tendinopathy is often misdiagnosed. The majority of cases respond well to steroid injections without the risk of rupture or neurological injury. Resolution of pain with restoration to previous function is more likely when symptoms have been present for less than 8 months.
Phase I and pharmacokinetic clinical trial of oral administration of the acyclic retinoid NIK‐333
Authors: Okusaka Takuji , Ueno Hideki , Ikeda Masafumi , Morizane Chigusa
Published: April 2011

Aim:  NIK‐333 (an acyclic retinoid) has been reported to prevent recurrence of hepatocellular carcinoma (HCC) in patients after curative treatment. This study was conducted to determine the maximum tolerated dose, dose‐limiting toxicities (DLT) and pharmacokinetics of NIK‐333 administrated p.o. at doses ranging 300–900 mg/day.

Methods:  Patients who were cancer‐free after percutaneous local ablation or surgical resection of HCC were enrolled. The total daily dose was administrated as a single dose (single‐dose stage) followed by a week of rest, and then in two equally divided doses administrated after breakfast and supper for 48 consecutive weeks (repeated‐dose stage).

Results:  No patients at the dose levels of 300 mg/day and 600 mg/day developed any DLT. At the final dose level of 900 mg/day, three of the nine patients developed grade 3 hypertension as a DLT. There were no significant difference values of maximum drug concentration (Cmax) and log(Cmax) between fasting and postprandial condition. In the repeated‐dose stage, there was no significant difference between the start and week 24 of NIK‐333 administration within any dose cohort in either the mean area under the blood concentration time curve (0–6 h) or the Cmax. NIK‐333 was well‐tolerated when administrated p.o. at doses of up to 600 mg/day for 48 weeks.

Conclusion:  Hypertension was noted as a DLT at the dose level of 900 mg/day, and this dose was considered to be inappropriate. The recommended dose for the phase II/III clinical trial is thought to be 300 mg/day and 600 mg/day.
Long‐term effect of interferon treatment on the progression of chronic hepatitis B: Bayesian meta‐analysis and meta‐regression
Authors: Jin Hui , Pan Ning , Mou Yi , Wang Bei , Liu Pei
Published: April 2011

Aim:  The long‐term effects of interferon treatment on the progression of chronic hepatitis B (CHB) have been studied extensively, but its true clinical benefits and the predictors of its efficacy remain unclear.

Methods:  A systematic published work search was undertaken. Eligible studies included those with interferon treatment and control groups, and with liver cirrhosis (LC), hepatocellular carcinoma (HCC) or death as main outcomes. Bayesian meta‐analysis and meta‐regression were performed to assess associations between interferon treatment and disease progression, and the impacts of potential covariates.

Results:  Eleven articles met the inclusion criteria. LC, HCC and death were end‐points in four, nine and six studies, respectively. In all studies, interferon was associated with significant preventive effects on HCC according to the DerSimonian–Laird method (relative risk [RR] = 0.470, 95% confidence interval [CI] = 0.260–0.850) and Bayesian method adjusting underlying risk (RR = 0.249, 95% Bayesian credible intervals [BCI] = 0.049–0.961), but not according to Bayesian meta‐analysis (RR = 0.274, 95% BCI = 0.059–1.031); and it showed similar effects in death but not in LC. However, most of the high‐quality studies never revealed protective benefits in these end‐points. Bayesian meta‐regression identified Asian ethnicity in death, higher hepatitis B e‐antigen (HBeAg) seroconversion rate or positivity rate, and length of follow up (≤5 years) in HCC as potentially protective against disease progression. Subgroup analysis confirmed similar effects from these factors in HCC and death.

Conclusion:  Additional evidence is needed to support the role of interferon in delaying CHB progression.
Serum chemokine levels are associated with the outcome of pegylated interferon and ribavirin therapy in patients with chronic hepatitis C
Authors: Yoneda Suguru , Umemura Takeji , Joshita Satoru , Ichijo Tetsuya , Matsumoto Akihiro , Yoshizawa Kaname , Katsuyama Yoshihiko , Ota Masao , Tanaka Eiji ,   and the Nagano Interferon Treatment Research Group
Published: April 2011

Aim:  Serum chemokine levels and amino acid substitutions in the interferon‐sensitivity determining region (ISDR) and core region have been associated with treatment outcome of pegylated interferon and ribavirin therapy in genotype 1 hepatitis C virus (HCV)‐infected patients. The present study was conducted to clarify the association between serum chemokines and treatment outcome in patients with chronic HCV‐1 infection in a Japanese cohort.

Methods:  A total of six serum chemokines were quantified before, during and after pegylated interferon and ribavirin treatment in 79 genotype 1 chronic HCV patients using a multiple bead array system. Viral ISDR and core region variants were determined by direct sequencing.

Results:  The baseline serum levels of eotaxin, IP‐10 and RANTES were significantly higher in chronic HCV patients than in controls. High levels of eotaxin and macrophage inflammatory protein (MIP)‐1β before therapy and more than two mutations in the ISDR were associated with a sustained virological response, and patients with more than two mutations in the ISDR also had significantly higher MIP‐1β levels. Receiver–operator curve analysis showed a 77% sensitivity and 73% specificity for predicting an SVR using MIP‐1β values.

Conclusion:  Serum MIP‐1β levels may predict the response to HCV treatment with pegylated interferon and ribavirin and are associated with amino acid substitutions in the ISDR.
Hepatitis C virus infection causes hypolipidemia regardless of hepatic damage or nutritional state: An epidemiological survey of a large Japanese cohort
Authors: Miyazaki Teruo , Honda Akira , Ikegami Tadashi , Saitoh Yoshifumi , Hirayama Takeshi , Hara Takashi , Doy Mikio , Matsuzaki Yasushi
Published: April 2011

Aim:  Infection with hepatitis C virus (HCV) is the leading cause of liver cirrhosis that develops into hepatocellular carcinoma. Previous studies have shown in vitro that lipids within hepatocytes are crucially important for a series of HCV infection–proliferation–release processes. On the other hand, in the patients with HCV, the serum total cholesterol (Total‐C) and low‐density lipoprotein cholesterol (LDL‐C) levels have been reported to be lower. We conducted an epidemiological survey of a large cohort and investigated whether the lower serum lipid levels were caused by a direct or the secondary effects of HCV infection (i.e. hepatic damage or nutritional disorder).

Methods:  Among 146 857 participants (male, 34%; female, 66%) undergoing public health examinations between 2002 and 2007 in Ibaraki Prefecture, Japan, the HCV positive rates determined by HCV antibody/antigen and/or RNA tests were 1.37% and 0.67% in males and females, respectively.

Results:  In addition to Total‐C and LDL‐C, serum high‐density lipoprotein cholesterol and triglyceride concentrations were also significantly lower in the HCV positive subjects compared with the negative subjects, regardless of sex, age or nutritional state evaluated by body mass index. Multivariate analysis showed that HCV infection was the strongest among the factors to be significantly associated with the lower level of these lipids. Particularly, the hypolipidemia was also confirmed in the HCV positive subjects with normal aminotransferase levels (alanine aminotransferase ≤30 and aspartate aminotransferase ≤30).

Conclusion:  This epidemiological survey in a large Japanese cohort suggests that the HCV infection itself might directly cause hypolipidemia, irrespective of host factors including age, hepatic damage and nutritional state.