bluuebunny/crossref_metadata_2025 huggingface dataset:
Misperception among rural diabetic residents: a cross‐sectional descriptive study
Authors: Huang Tzu‐Ting , Guo Su‐Er , Chang Chia‐Hao , Huang Jui‐Chu , Lin Ming‐Shyan , Lee Chia‐Mou , Chen Mei‐Yen
Published: July 2012

Aims

To evaluate the self‐perception of diabetes control associated with physical indicators and with practicing exercise and a healthy diet, among rural residents.

Background

It remains unclear whether a subject's self‐perception of diabetes control increases its deleterious effects.

Design

Cross‐sectional, correlational.

Methods

We recruited 715 participants from 18 primary healthcare centres in the rural regions of Chiayi County, Taiwan. Data were collected between 1 January 2009–30 June 2010. Logistic regression was conducted to identify the determinant factors associated with perceptions of diabetes control.

Results

A high percentage of participants overestimated their fasting blood glucose and HbA1C status. Total cholesterol, triglyceride, low density lipoprotein cholesterol, blood pressure, and waist circumference exceeded the medical standard in the ‘feel good’ group, and many did not adopt a healthy diet and undertake physical activity. The final logistic regression model demonstrated that residents with diabetes who exercised frequently had normal fasting glucose, and normal HbA1C tended to perceive ‘feel good’ control.

Conclusion

Misperception and unawareness of diabetes control were prevalent among rural residents. Addressing misperceptions among rural residents with diabetes and increasing their knowledge of professional advice could be important steps in improving diabetes control in an elder population.
Systematic reviews showed insufficient evidence for clinical practice in 2004: what about in 2011? The next appeal for the evidence‐based medicine age
Authors: Villas Boas Paulo José Fortes , Spagnuolo Regina Stella , Kamegasawa Amélia , Braz Leandro Gobbo , Polachini do Valle Adriana , Jorge Eliane Chaves , Yoo Hugo Hyung Bok , Cataneo Antônio José Maria , Corrêa Ione , Fukushima Fernanda Bono , do Nascimento Paulo , Módolo Norma Sueli Pinheiro , Teixeira Marise Silva , de Oliveira Vidal Edison Iglesias , Daher Solange Ramires , El Dib Regina
Published: July 2012

Rationale and aim

The aims of the Cochrane systematic reviews are to make readily available and up‐to‐date information for clinical practice, offering consistent evidence and straightforward recommendations. In 2004, we evaluated the conclusions from Cochrane systematic reviews of randomized controlled trials in terms of their recommendations for clinical practice and found that 47.83% of them had insufficient evidence for use in clinical practice. We proposed to reanalyze the reviews to evaluate whether this percentage had significantly decreased.

Methods

A cross‐sectional study of systematic reviews published in the Cochrane Library (Issue 7, 2011) was conducted. We randomly selected reviews across all 52 Cochrane Collaborative Review Groups.

Results

We analyzed 1128 completed systematic reviews. Of these, 45.30% concluded that the interventions studied were likely to be beneficial, of which only 2.04% recommended no further research. In total, 45.04% of the reviews reported that the evidence did not support either benefit or harm, of which 0.8% did not recommend further studies and 44.24% recommended additional studies; the latter has decreased from our previous study with a difference of 3.59%.

Conclusion

Only a small number of the Cochrane collaboration's systematic reviews support clinical interventions with no need for additional research. A larger number of high‐quality randomized clinical trials are necessary to change the ‘insufficient evidence’ scenario for clinical practice illustrated by the Cochrane database. It is recommended that we should produce higher‐quality primary studies in active collaboration and consultation with global scholars and societies so that this can represent a major component of methodological advance in this context.
Differential expression of IGF1, IGFR1 and IGFBP3 in mandibular condylar cartilage between male and female rats applied with malocclusion
Authors: YU S. , SUN L. , LIU L. , JIAO K. , WANG M.
Published: July 2012

Summary  This study was designed to investigate the expression differences of insulin‐like growth factor‐1 (IGF1), IGF type 1 receptor (IGFR1) and IGF‐binding protein‐3 (IGFBP3) in mandibular condylar cartilage between male and female rats with experimentally created malocclusion. A total of 40 male and 40 female rats were used, and malocclusion was created by moving the first molars mesially and the third molars distally in the experimental group. Animals were killed at the end of the second and fourth weeks. Haematoxylin and eosin (HE) staining was performed to monitor the changes in cartilage morphology and thickness. Immunohistochemistry and real‐time PCR were used to detect the expression of IGF1, IGFR1 and IGFBP3. Osteoarthritis (OA)‐like changes were observed in the experimental groups, with 2‐week females showing larger OA‐like regions than 2‐week males (P < 0·05). Compared to their age‐ and sex‐matched controls, both 2‐ and 4‐week males in the experimental groups displayed increased cartilage thickness in the posterior regions (P < 0·05). Compared to their age‐ and sex‐matched controls, the expression of IGF1 was lower in 2‐week female group (P < 0·05), but higher in 4‐week female, 2‐ and 4‐week male experimental groups (P < 0·05). Similarly, the expression of IGFR1 was lower in 2‐week female experimental group (P < 0·05), but higher in 2‐week male experimental group (P < 0·05). The higher expression of IGFBP3 was observed in 2‐week female, 2‐ and 4‐week male experimental groups (P < 0·05). These results indicate that condylar cartilage from male and female rats respond differently to the malocclusion in early stage of OA, with more serious degeneration in females.
How far is too close? restricted, sex‐biased dispersal in black‐capped vireos
Authors: ATHREY GIRI , LANCE RICHARD F. , LEBERG PAUL L.
Published: July 2012

Understanding the interplay of dispersal and how it translates into gene flow is key to understanding population processes, and especially so for endangered species occupying fragmented habitats. In migratory songbirds, there is evidence that long‐distance movement capabilities do not translate well into observed dispersal. Our objectives were to (i) define the fine‐scale spatial genetic structure in endangered black‐capped vireos to characterize dispersal patterns and (ii) to correlate dispersal dynamics to overall population genetic structure using a simulation approach. We sampled 160 individuals over 2 years to (i) describe the fine‐scale genetic structuring and (ii) used this information to model scenarios to compare with actual data on change in population structuring over a 100‐year interval. We found that black‐capped vireos exhibit male philopatry and restricted dispersal distances, relative to females. Our simulations also support a sex‐biased dispersal model. Additionally, we find that fragmentation related changes in rates of dispersal might be a likely cause for increasing levels of population structure over a 100‐year period. We show that restricted sex‐biased dispersal can explain population structuring in this species and that changes in dispersal rates due to fragmentation may be a continuing threat to genetic viability in this species.
Molecular insights into the terminal energy acceptor in cyanobacterial phycobilisome
Authors: Gao Xiang , Wei Tian‐Di , Zhang Nan , Xie Bin‐Bin , Su Hai‐Nan , Zhang Xi‐Ying , Chen Xiu‐Lan , Zhou Bai‐Cheng , Wang Zhi‐Xin , Wu Jia‐Wei , Zhang Yu‐Zhong
Published: July 2012

The linker protein LCM (ApcE) is postulated as the major component of the phycobilisome terminal energy acceptor (TEA) transferring excitation energy from the phycobilisome to photosystem II. LCM is the only phycobilin‐attached linker protein in the cyanobacterial phycobilisome through auto‐chromophorylation. However, the underlying mechanism for the auto‐chromophorylation of LCM and the detailed molecular architecture of TEA is still unclear. Here, we demonstrate that the N‐terminal phycobiliprotein‐like domain of LCM (Pfam00502, LP502) can specifically recognize phycocyanobilin (PCB) by itself. Biochemical assays indicated that PCB binds into the same pocket in LP502 as that in the allophycocyanin α‐subunit and that Ser152 and Asp155 play a vital role in LP502 auto‐chromophorylation. By carefully conducting computational simulations, we arrived at a rational model of the PCB‐LP502 complex structure that was supported by extensive mutational studies. In the PCB‐LP502 complex, PCB binds into a deep pocket of LP502 with a distorted conformation, and Ser152 and Asp155 form several hydrogen bonds to PCB fixing the PCB Ring A and Ring D. Finally, based on our results, the dipoles and dipole–dipole interactions in TEA are analysed and a molecular structure for TEA is proposed, which gives new insights into the energy transformation mechanism of cyanobacterial phycobilisome.
Altered expression and splicing of Ca2+ metabolism genes in myotonic dystrophies DM1 and DM2
Authors: Vihola A. , Sirito M. , Bachinski L. L. , Raheem O. , Screen M. , Suominen T. , Krahe R. , Udd B.
Published: July 2012

A. Vihola, M. Sirito, L. L. Bachinski, O. Raheem, M. Screen, T. Suominen, R. Krahe and B. Udd (2013) Neuropathology and Applied Neurobiology39, 390–405

Altered expression and splicing of Ca2+ metabolism genes in myotonic dystrophies DM1 and DM2

Aims: Myotonic dystrophy types 1 and 2 (DM1 and DM2) are multisystem disorders caused by similar repeat expansion mutations, with similar yet distinct clinical features. Aberrant splicing of multiple effector genes, as well as dysregulation of transcription and translation, has been suggested to underlie different aspects of the complex phenotypes in DM1 and DM2. Ca2+ plays a central role in both muscle contraction and control of gene expression, and recent expression profiling studies have indicated major perturbations of the Ca2+ signalling pathways in DM. Here we have further investigated the expression of genes and proteins involved in Ca2+ metabolism in DM patients, including Ca2+ channels and Ca2+ binding proteins. Methods: We used patient muscle biopsies to analyse mRNA expression and splicing of genes by microarray expression profiling and RT‐PCR. We studied protein expression by immunohistochemistry and immunoblotting. Results: Most of the genes studied showed mRNA up‐regulation in expression profiling. When analysed by immunohistochemistry the Ca2+ release channel ryanodine receptor was reduced in DM1 and DM2, as was calsequestrin 2, a sarcoplasmic reticulum lumen Ca2+ storage protein. Abnormal splicing of ATP2A1 was more pronounced in DM2 than DM1. Conclusions: We observed abnormal mRNA and protein expression in DM affecting several proteins involved in Ca2+ metabolism, with some differences between DM1 and DM2. Our protein expression studies are suggestive of a post‐transcriptional defect(s) in the myotonic dystrophies.
Identification of OsbHLH133 as a regulator of iron distribution between roots and shoots in Oryza sativa
Authors: WANG LU , YING YINGHUI , NARSAI REENA , YE LINGXIAO , ZHENG LUQING , TIAN JINGLUAN , WHELAN JAMES , SHOU HUIXIA
Published: July 2012

Iron (Fe) is an essential micronutrient element for plant growth. Regulation of Fe‐deficiency signalling networks is one of the many functions reported for basic helix‐loop‐helix (bHLH) transcription factors in plants. In the present study, OsbHLH133 was found to be induced by Fe‐deficiency conditions in Oryza sativa. Insertional inactivation of OsbHLH133 (bhlh133) resulted in growth retardation, with enhanced Fe concentration seen in shoots, and reduced Fe concentration in roots. Overexpression of OsbHLH133 had the opposite effect, that is resulted in an enhanced Fe concentration in roots and reduced Fe concentration in shoots and also in xylem sap. Microarray analysis showed that some of the genes encoding Fe‐related functions were up‐regulated under Fe‐sufficient conditions, in bhlh133 mutant plants compared to wild‐type plants. Significant differential expression of a number of signalling pathways, including calcium signalling, was also seen in bhlh133 plants compared to wild‐type plants, independent of Fe conditions.
Characterization of a dodecapeptide containing a dominant epitope of Par j 1 and Par o 1, the major allergens of P. judaica and P. officinalis pollen
Authors: Menna T. , Cassese G. , Di Modugno F. , Chersi A. , Buono C. , Ruffilli A.
Published: July 2012

The pollen of Parietaria, a weed of the Urticaceae family, is a major cause of respiratory allergy in Europe, where the most common species are P. judaica and P. officinalis. Previously, we reported that a β‐galactosidase fusion protein (6a‐BG) expressing a 26‐bp cDNA fragment (6a cDNA) contained a dominant IgE‐binding epitope (6a epitope) of the major allergens Par o 1 and Par j 1. The present study aimed to define the amino‐acid sequence containing the 6a epitope. We analyzed the reactivity of anti‐Par o 1 antibodies affinity purified from allergic patient sera with:

) a panel of synthetic peptides deduced from the 6a nucleotide sequence using different reading frames

) glutathione S‐transferase (GST) fusion proteins containing selected peptides.

The peptide NSARARADSCRI (p102) specifically bound anti‐Par o 1 antibodies affinity purified from allergic patient sera or from rabbit anti‐Par o 1 antiserum (ELISA). The related peptide NSARAGTSSCRI (p101) reacted to human but not to rabbit, anti‐Par o 1 antibodies. GST fusion proteins containing p101 (GST 3.5) or p102 (GST 3.2) extensively inhibited the binding between Par o 1 and IgE or IgG antibodies from an allergic patient serum pool according to a dose‐response curve. Percent inhibition of IgE antibodies binding obtained by absorbing a solution (50 μl) of affinity‐purified antibodies with 5 μg of GST 3.2 or with 1.2 mg of GST 3.5 was 69% and 66%, respectively. In conclusion, the results of the present study indicate that the amino‐acid sequences NSARARADSCRI (p102) and NSARAGTSSCRI (p101) contain the dominant epitope of Par o 1 and Par j 1 for human IgE and IgG antibodies indicated as 6a epitope. Moreover, the study shows that the epitope is conserved in recombinant molecules containing these peptides, irrespective of the fused polypeptide (β‐galactosidase or GST). The knowledge of the amino‐acid sequence of this dominant epitope is important in therapeutic approaches to the development of allergen‐derived haptens.
The effect of leaffolder Cnaphalocrocis medinalis (Guenee) [Lepidoptera: Pyralidae] injury on the plant physiology and yield loss in rice
Authors: Padmavathi Ch. , Katti G. , Padmakumari A. P. , Voleti S. R. , Subba Rao L. V.
Published: July 2012

Influence of leaffolder feeding on chlorophyll, PS II activity and plant–water relations, effect of larval density on leaf damage and time course studies on larval feeding behaviour on altered physiological changes in TN1 rice culture were studied. Quantification of yield losses in the field caused by leaffolder was also assessed. Leaffolder damage resulted in 57% reduction in chlorophyll content, 23% reduction in PS II activity and 23% reduction in relative water content in comparison with control. Rice leaffolder larva folds the leaf and scrapes the green tissue from within the fold resulting in scorching and drying of the leaves. Larval density had differentially influenced effective leaf area of rice crop. Larval densities of more than 3 larvae per hill at maximum tillering stage resulted up to 20% unfilled grains, 28–57% reduction in PS II activity and 23% reduction in relative water content in comparison with the control. At flowering stage, flag leaf area damage of above 25% resulted in more than 50% unfilled grains over control, indicating direct effect of yield reduction in rice. Thus, a cumulative effect of loss in chlorophyll, reduced photosynthate availability and altered water relations caused by the leaffolder injury to flag leaf lead to greater yield loss in rice.
Safety and efficacy of a non–pesticide‐based head lice treatment: Results of a randomised comparative trial in children
Authors: Greive Kerryn A , Lui Ada H , Barnes Tanya M , Oppenheim V M Jane
Published: July 2012

Background/Objectives

Increasing resistance to pesticide‐based head lice treatments has resulted in the need for alternative products to treat head lice infestations, but there are few clinical studies that have adequately tested these products. This multicentre, randomised, assessor‐blind, parallel‐group phase IV trial compared the safety and efficacy of a non–pesticide‐based head lice shampoo with malathion foam in children.

Methods

This trial used strict entry criteria, standardised treatment and assessment regimes, sibling control and a primary efficacy end‐point defined as the absence of live head lice 21 days after initiating treatment. Repeat insult patch tests were performed to further assess the safety of the non–pesticide‐based shampoo. In vitro tests were used to assess its ovicidal and pediculicidal efficacy.

Results

A total of 216 children were enrolled, of whom 172 were per‐protocol. The non–pesticide‐based shampoo was significantly more effective than malathion foam for the intent‐to‐treat population (62.3 vs 40.4% louse‐free, unadjusted P = 0.002; adjusted P = 0.003), as well as for the per‐protocol population (67.8 vs 43.0% louse‐free, unadjusted P = 0.001; adjusted P = 0.004). Adverse events were limited to itching or stinging. Patch testing with the non–pesticide‐based shampoo resulted in no adverse reactions. In vitro tests using body lice demonstrated that the non–pesticide‐based shampoo is ovicidal and pediculicidal.

Conclusion

The non–pesticide‐based shampoo is significantly more effective in eliminating head lice than malathion foam in children, while being associated with a low incidence of mild, transient adverse events.
Resistin‐like molecule‐β is induced following bronchoconstriction of asthmatic airways
Authors: GRAINGE CHRISTOPHER , DULAY VALDEEP , WARD JONATHAN , SAMMUT DAVID , DAVIES ELIZABETH , GREEN BENJAMIN , LAU LAURIE , COTTEY LAURA , HAITCHI HANS‐MICHAEL , DAVIES DONNA E. , HOWARTH PETER H.
Published: July 2012

Background and objective:  Resistin‐like molecule‐β (RELM‐β) is a necessary and sufficient stimulus for airway remodelling in animal models of asthma, but until recently, its role in human disease had not been investigated. The hypothesis that RELM‐β expression would increase with increasing asthma severity and further increase following acute bronchoconstrictor challenges has been examined.

Methods:  Bronchial biopsies from healthy subjects and patients with mild and severe asthma were immunostained for RELM‐β, as were airway biopsies obtained in mild asthmatics before and 4 days after repeated inhalation challenges with either allergen, methacholine or methacholine preceded by salbutamol as a control. Bronchial brushings were also evaluated for RELM‐β mRNA.

Results:  RELM‐β immunoreactivity, which co‐localized to airway epithelial cells, increased with disease severity; healthy volunteers, median per cent epithelial area 1.98%, mild asthma 3.49% and severe asthma 5.89% (P < 0.001 between groups). RELM‐β immunoreactivity significantly and inversely correlated in asthma with forced expiratory volume in 1 s % predicted (P = 0.005). Acute changes in immunoexpression were evident after repeated inhalation challenge with allergen (2.15 % to 4.35 % (P = 0.01)) and methacholine (4.21 % to 6.16 % (P = 0.01)) but did not change in the salbutamol/methacholine challenge group. These changes correlated with change in basement membrane thickness (r = 0.38, P = 0.02). Epithelial RELM‐β gene expression was not altered in asthma.

Conclusions:  RELM‐β may play an important role not only in animal models of airway remodelling, but also in human airway pathology.
Delayed resolution of inflammatory response compared with clinical recovery in patients with acute exacerbations of chronic obstructive pulmonary disease
Authors: MOHAN ANANT , PRASAD DHARMENDRA , SHARMA ALPANA , ARORA SNEH , GULERIA RANDEEP , SHARMA SURENDRA K. , PANDEY RAVINDER M.
Published: July 2012

Background and objective:  The temporal profile of inflammatory markers during acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and their relationship to clinical response are not well characterized. The aim was to assess the changes in levels of inflammatory markers in AECOPD and correlate these with clinical and laboratory indices of recovery.

Methods:  Serum levels of C‐reactive protein (CRP), interleukin (IL)‐6 and fibrinogen were measured in patients with AECOPD within 24 h of hospitalization and pre‐discharge (stable state).

Results:  Ninety‐seven patients were evaluated (79 males; mean (SD) age, 61.4 (10.3) years). Eighty eight (90.7%) were current or former smokers, with a median consumption of 15 (0–75) packs/year. The median duration of COPD was 8 (2–25) years. Forty‐six patients (56.9%) required mechanical ventilation for a median of 5 days (1–34) while in hospital. The median duration of hospital stay was 13 days (1–77). At reassessment before planned discharge, the levels of dyspnoea, leucocyte counts, erythrocyte sedimentation rate, creatinine, partial pressure of oxygen, and albumin normalized. The levels of CRP, IL‐6 and fibrinogen reduced significantly but did not reach the normal range. Changes in IL‐6 and fibrinogen levels correlated significantly with the acute physiologic assessment and chronic health evaluation II score, smoking history, blood pressure and leucocyte counts. Baseline IL‐6 and fibrinogen levels significantly predicted a prolonged duration of mechanical ventilation.

Conclusions:  During AECOPD, the inflammatory response lags behind clinical and biochemical improvement. Fibrinogen and IL‐6 are potentially useful markers for monitoring clinical response following an acute episode.
Perioperative fluid therapy in elective colectomy in an enhanced recovery programme
Authors: Srinivasa Sanket , Singh Simran P. , Kahokehr Arman Adam , Taylor Matthew H. G. , Hill Andrew G.
Published: July 2012

Background:  Although intraoperative fluid restriction is thought to provide clinical benefits, it may not be suitable for patients with significant co‐morbidities, who may ultimately require greater amounts of intravenous fluid (IVF) post‐operatively. This study investigates whether intraoperative fluid restriction can be implemented uniformly in patients undergoing elective colectomy within an Enhanced Recovery after Surgery (ERAS) protocol and investigates the association between fluid administration and clinical outcomes.

Methods:  A retrospective review of prospectively collected data was conducted for all patients who underwent elective colectomy from September 2006 to 2010 within our ERAS programme. Patients received intraoperative fluid restriction with post‐operative fluid administered as per clinical indications. Demographic data, American Society of Anaesthesiology (ASA) status, IVF administered and clinical outcomes were recorded.

Results:  There were 227 patients (ASA 1: 47; ASA 2: 108; ASA 3: 72) with a median age of 71 years. Patients received a median of 2000 mL of crystalloid intraoperatively. There were no statistically significant differences between post‐operative IVF amounts. Patients who experienced complications received significantly greater amounts of IVF post‐operatively (5000 mL versus 2000 mL; P < 0.01) and post‐operative IVF administration was the strongest predictor of complications in a logistic regression model. There was a trend suggesting higher median post‐operative IVF prior to patients experiencing major complications (3000 mL versus 2000 mL; P= 0.07).

Conclusion:  Intraoperative fluid restriction can be employed uniformly in ASA 1–3 patients undergoing colectomy. Post‐operative administration of greater fluid volumes was associated with adverse outcomes.
Factors influencing motorcycle crash victim outcomes: a prospective study
Authors: Cunningham Gregory , Chenik David , Zellweger René
Published: July 2012

Background:  Motorcyclists have the highest morbidity and mortality rates of all road users. Little evidence is available to demonstrate how rider, crash and speed influence short‐ and long‐term patient outcomes.

Methods:  A prospective study of 208 consecutive crash presentations was undertaken at the Royal Perth Hospital, Western Australia. All motorcycle, scooter, trike and quad bike accident victims over a 4‐month period ending 31 March 2009 were included.

Results:  One hundred and forty‐three admissions and 1344 days of hospitalization were recorded, with 6.56 days mean length of stay and 9.27 mean Injury Severity Scores. Loosing control due to intoxication, being hit by another vehicle and travelling above the speed limit yielded the worst patient outcomes. Hitting a stationary object and travelling below the speed limit were the most common accident features. Travelling in excess of 50 kph increased risk of intracranial injury, with an odds ratio of 4.8.

Conclusion:  Crash factors including intoxication, speed and accident cause significantly influence both short‐ and long‐term patient outcomes.
The Burkholderia cenocepacia sensor kinase hybrid AtsR is a global regulator modulating quorum‐sensing signalling
Authors: Aubert Daniel F. , O'Grady Eoin P. , Hamad Mohamad A. , Sokol Pamela A. , Valvano Miguel A.
Published: July 2012

Burkholderia cenocepacia is commonly found in the environment and also as an important opportunistic pathogen infecting patients with cystic fibrosis. Successful infection by this bacterium requires coordinated expression of virulence factors, which is achieved through different quorum sensing (QS) regulatory systems. Biofilm formation and Type 6 secretion system (T6SS) expression in B. cenocepacia K56‐2 are positively regulated by QS and negatively regulated by the sensor kinase hybrid AtsR. This study reveals that in addition to affecting biofilm and T6SS activity, the deletion of atsR in B. cenocepacia leads to overproduction of other QS‐regulated virulence determinants including proteases and swarming motility. Expression of the QS genes, cepIR and cciIR, was upregulated in the ΔatsR mutant and resulted in early and increased N‐acylhomoserine lactone (AHL) production, suggesting that AtsR plays a role in controlling the timing and fine‐tuning of virulence gene expression by modulating QS signalling. Furthermore, a ΔatsRΔcepIΔcciI mutant could partially upregulate the same virulence determinants indicating that AtsR also modulates the expression of virulence genes by a second mechanism, independently of any AHL production. Together, our results strongly suggest that AtsR is a global virulence regulator in B. cenocepacia.
A survey of smartphone and tablet computer use by colorectal surgeons in the UK and Continental Europe
Authors: Smart N. J.
Published: July 2012

Aim  The prevalence of smartphone or tablet computer ownership among colorectal surgeons in the UK and Continental Europe, and their use for academic activity, is unknown. The aims of this study were to ascertain the level of ownership of such devices, to determine their use in accessing medical literature and to obtain opinions on online publishing.

Method  A Web‐based electronic 11‐point questionnaire was emailed in March and April 2012 to all members of the Association of Coloproctology of Great Britain and Ireland (ACPGBI), the Dukes’ Club and the European Society of Coloproctology (ESCP). Members at all levels of training were included. Questions covered demographic details, technology ownership, current technology usage, options for future developments and attitudes to online publishing.

Results  The survey was sent to 1048 surgeons, and 182 (17.4%) responses were received. Smartphone and tablet ownership was 83.5% (152/182) and 36.8% (67/182), respectively. Respondents in the 21–50 years age group were more likely to own a smartphone and use it to access full‐text versions of scientific papers or to access journals using an application (app). As an author, just over half (56.7%) of respondents were happy for their article to be published online only rather than in print. Nevertheless, journals published online only were perceived to be of lower status by 55.6% of respondents.

Conclusion  Younger age groups are more likely to use smartphones and tablet computers to access medical publishing. The publishing of papers online only by journals with a print version is acceptable, but online only journals are perceived to have a lower status than print journals.
Trends in colon cancer surgery in Ontario: 2002–2009
Authors: Chan B. P. , Gomes T. , Musselman R. P. , Auer R. C. , Moloo H. , Mamdani M. , Al‐Omran M. , Boushey R. P. , AlObeed O.
Published: July 2012

Aim  The safety and efficacy of laparoscopic surgery for colon cancer is well established but its uptake in the province has not been previously explored. We report an investigation of the trends of open and laparoscopic surgery for colon cancer in Ontario, Canada.

Method  A retrospective cross‐sectional time‐series analysis examining population‐based rates of elective surgery for colon cancer among 10.5 million adults in Ontario was conducted from 1 April 2002 to 31 March 2009. Databases were linked to assess quarterly elective procedure rates over time.

Results  During the study period, 3950 laparoscopic and 13 048 open elective colon cancer operations were performed in Ontario. The overall quarterly rate of colon cancer surgery remained stable at an average of 5.8 per 100 000 population (P = 0.10). From the first and last quarter, the rate of laparoscopic operations increased nearly threefold from 0.8 to 2.2 per 100 000 population with a notable increase after 2005 (P < 0.01). In contrast, open surgery decreased by more than 30% from 5.3 to 3.5 per 100 000 population (P < 0.01). If current trends continue, the projected proportion of laparoscopic colon operations is estimated to reach 41% by 2015. Patients receiving open surgery had a significantly higher preoperative comorbidity (Charlson comorbidity score ≥ 3) than those having laparoscopy (47.8%vs 39.1%, standardized difference 0.26).

Conclusion  Trends in Ontario of laparoscopic colon cancer surgery show an increase between 2002 and 2009, but the incidence remains lower than for open surgery.
A comparison of published rates of resection margin involvement and intra‐operative perforation between standard and ‘cylindrical’ abdominoperineal excision for low rectal cancer
Authors: Krishna A. , Rickard M. J. F. X. , Keshava A. , Dent O. F. , Chapuis P. H.
Published: July 2012

Aim  The study aimed to compare recent reports on standard and alternative methods of abdominoperineal excision for low rectal cancer regarding the rates of circumferential resection margin involvement and intra‐operative bowel perforation.

Method  Data on rates of margin involvement and perforation were obtained from eight recently published reports and also from a prospective registry of resections at Concord Hospital. Rates of these outcomes and their 95% confidence intervals were evaluated.

Results  There was no evidence that extralevator abdominoperineal excision yielded significantly lower rates of resection margin involvement or intra‐operative bowel perforation compared with standard abdominoperineal excision in six independent hospital‐ and population‐based patient series. Abdominosacral resection of the rectum, on the other hand, did show significantly lower rates of these endpoints, albeit in selected patients.

Conclusion  The role of extralevator abdominoperineal excision and abdominosacral resection of the rectum should be investigated further in randomized controlled trials.
Helping and Quiet Hours: Interruption‐Free Time Spans Can Harm Performance
Authors: Käser Philipp A.W. , Fischbacher Urs , König Cornelius J.
Published: July 2012

Whereas helping is costly for the helper, it is beneficial for the person who requests help. However, there is only scarce evidence on the relative costs and benefits of helping and this evidence is mixed. In addition, hardly any research investigates how these costs and benefits can be manipulated. With a laboratory experiment, we first examined how helping affects the performance of the helper, the help requester, and the dyad. Second, we investigated whether quiet hours that structure time into spans with interruptions and spans without interruptions decrease the costs of helping while keeping its benefits. We found that the requester's performance was higher and the helper's performance lower when help requests were permitted at any time rather than when no help was allowed. However, overall performance fell short of being significantly higher with help at any time. In addition, the helper's performance failed to be higher with quiet hours compared to interruptions at any time. Instead, both the helper's and the requester's performance were lower with quiet hours, resulting also in a lower overall performance. In search of an explanation, our data indicate that structuring time into spans with and without interruptions might generate costs of their own that could be reduced by setting fewer but longer spans without interruptions.
Extended biopsy based criteria incorporating cumulative cancer length for predicting clinically insignificant prostate cancer
Authors: Komai Yoshinobu , Kawakami Satoru , Numao Noboru , Fujii Yasuhisa , Saito Kazutaka , Kubo Yuichi , Koga Fumitaka , Kumagai Jiro , Yamamoto Shinya , Yonese Junji , Ishikawa Yuichi , Fukui Iwao , Kihara Kazunori
Published: July 2012

Study Type – Prognosis (inception cohort)

Level of Evidence 2

What's known on the subject? and What does the study add?

The criteria used for selecting patients with prostate cancer for active surveillance (AS) are still not satisfactory due to the difficulty in predicting the significance of the prostate cancer.

Urologists could predict insignificant prostate cancer by incorporating cumulative cancer length and biopsy Gleason score, derived from extended biopsy. The present study has added new criteria for predicting insignificant prostate cancer, which would lead to a better selection of candidates for AS.

OBJECTIVE

To develop extended biopsy based criteria for predicting insignificant cancer (IC) using extended biopsy findings.

PATIENTS AND METHODS

From 2000 to 2009, 1575 patients with prostate cancer were primarily treated by radical prostatectomy in two referral hospitals.

Of these, the study cohort comprised 499 patients with extended biopsy confirmed, clinically organ‐confined (cT1–2N0M0) prostate cancer with PSA levels of <20 ng/mL.

Cancer information obtained through extended biopsy included cumulative cancer length (CCL) divided by the number of biopsy cores (CCL/core).

RESULTS

Pathological examination revealed 39 ICs (7.8%). All these ICs fell in a category of prostate cancer with clinical stage ≤T2a and 2005 International Society of Urological Pathology Consensus Conference (ISUP) modified biopsy Gleason score ≤7.

Accordingly, we analysed predictors of IC in a subset cohort of 370 patients in this category. A multivariate logistic regression analysis revealed that 2005 ISUP modified biopsy Gleason score and CCL/core were independently significant predictors of IC.

We determined a threshold value of CCL/core of 0.20 mm for predicting IC using receiver operating characteristic analysis.

Based on these findings, we developed simple extended biopsy based criteria for predicting IC as follows: (i) PSA level of <20 ng/mL; (ii) Clinical stage ≤T2a; (iii) 2005 ISUP modified biopsy Gleason score ≤6; (iv) CCL/core of <0.20 mm.

The specificity of the criteria was 91%, which was significantly higher than the value from a subset of criteria without item iv (P < 0.001).

CONCLUSION

We have developed extended biopsy based criteria for predicting IC incorporating the 2005 ISUP modified biopsy Gleason score and CCL/core.
Long‐term oncological outcomes after laparoscopic radical prostatectomy
Authors: Hruza Marcel , Bermejo Justo Lorenzo , Flinspach Bettina , Schulze Michael , Teber Dogu , Rumpelt Hans Joachim , Rassweiler Jens Jochen
Published: July 2012

What's known on the subject? and What does the study add?

Laparoscopic radical prostatectomy (LRP) has shown good oncological short‐term and mid‐term outcomes, but long‐term outcomes are still lacking.

We present long‐term oncological outcomes of LRP in a large cohort of patients operated on in one of the pioneering European centres. The data from the present study show high rates of biochemical and clinical recurrence‐free survival and low cancer‐specific mortality compared with open series.

Objectives

To investigate long‐term oncological outcomes after laparoscopic radical prostatectomy (LRP).

To identify parameters influencing recurrence‐free survival in a single‐institution series.

Patients and Methods

All patients underwent LRP using the transperitoneal retrograde Heilbronn technique. High‐risk patients received adjuvant treatment according to an institutional algorithm based on prostate‐specific antigen (PSA), Gleason score, tumour‐node‐metastasis stage, margin status and tumour volume.

Data were collected prospectively on operative and postoperative parameters beginning in 1999. Complete follow‐up data of 370 of the first 500 consecutive patients are available.

Biochemical recurrence was defined as two consecutive PSA levels <0.2 ng/mL within the follow‐up period.

Kaplan–Meier estimates and Cox regression were applied to examine recurrence‐free survival times.

Results

The estimated biochemical recurrence‐free survival (BCRFS) rates 10 years after LRP were 80.2% in patients staged pT2, 47.4% in those staged pT3a and 49.8% in those staged pT3b/4, confirming a better prognosis in patients with organ‐confined disease (P < 0.001).

In the multivariate Cox regression analysis, only Gleason score and pT stage significantly influenced BCRFS.

The 10‐year clinical progression‐free survival rates were 97.2% (pT2), 84.4% (pT3a) and 78.1% (pT3b/4), and prostate cancer‐specific survival estimates were 100% (pT2), 97.3% (pT3a) and 90.6% (pT3b/4).

Conclusions

The 10‐year biochemical and clinical progression‐free survival after LRP combined with a risk‐adapted concept of adjuvant therapy is high, while prostate‐cancer specific mortality is low. Our data shows no negative impact of laparoscopic techniques on oncologic outcomes compared to large series after retropubic radical prostatectomy.

In a multivariate Cox regression, only Gleason score and pT stage had significant impact on BCRFS.
From prostate‐specific antigen (PSA) to precursor PSA (proPSA) isoforms: a review of the emerging role of proPSAs in the detection and management of early prostate cancer
Authors: Hori Satoshi , Blanchet Jean‐Sebastien , McLoughlin John
Published: July 2012

What's known on the subject? and What does the study add?

Despite the popularity of PSA blood testing for prostate cancer, there are a number of important limitations of this popular serum marker including the limited ability to accurately distinguish patients with and without prostate cancer and those who harbour an aggressive form of the disease. This is especially true when the total PSA is <10 ng/mL. Thus, significant efforts have been placed to find new serum markers that can help overcome these limitations.

In this review article, we discuss the emerging role of the various precursor forms of PSA (proPSAs), with a special emphasis on [‐2]proPSA in the detecion and management of early prostate cancer. The clinical utility of Prostate Health Index (phi) is also discussed.

Despite the overall success of prostate‐specific antigen (PSA) blood test, its use as a serum marker for prostate cancer has been limited due to the lack of specificity, especially in men presenting with a total PSA (tPSA) level of <10 ng/mL. PSA testing has also resulted in an increase in the number of patients being diagnosed with low‐grade, potentially clinically insignificant prostate cancer.

There is therefore an urgent need for new markers that can accurately detect as well as differentiate patients with aggressive vs unaggressive prostate cancer.

In this review, we discuss the emerging role of precursor forms of PSA (proPSAs) and the Prostate Health Index (phi) measurement in the detection and management of early stage prostate cancer.

A literature search was conducted using PubMed® to identify key studies.

Studies to date suggest that [‐2]proPSA, a truncated form of proPSA is the most cancer‐specific form of all, being preferentially expressed in cancerous prostatic epithelium and being significantly elevated in serum of men with prostate cancer.

There is evidence to suggest that %[‐2]proPSA measurement ([‐2]proPSA/free PSA [fPSA] × 100) improves the specificity of both tPSA and fPSA in detecting prostate cancer.

phi incorporating [‐2]proPSA, fPSA and tPSA measurements has also yielded promising results and appears superior to tPSA and fPSA in predicting those patients with prostate cancer. Increased phi levels also seem to preferentially detect patients harbouring more aggressive disease.

Further studies in the form of large, multicentre, prospective trials with detailed health economic analyses are required to evaluate the true clinical applicability of these novel markers.
Does radical nephrectomy increase the risk of erectile dysfunction compared with partial nephrectomy? A cohort analysis
Authors: Kopp Ryan P. , Dicks Brian M. , Goldstein Irwin , Mehrazin Reza , Silberstein Jonathan L. , Colangelo Caroline J. , Bagrodia Aditya , Bazzi Wassim M. , Wake Robert W. , Patterson Anthony L. , Kane Christopher J. , Wan Jim Y. , Derweesh Ithaar H.
Published: July 2012

Study Type – Therapy (prospective cohort)

Level of Evidence 2b

What's known on the subject? and What does the study add?

Erectile dysfunction (ED) is a form of endothelial dysfunction that is prevalent in patients with chronic kidney disease (CKD). We hypothesized that partial nephrectomy (PN) would limit development of ED compared with radical nephrectomy (RN), primarily due to renal function preservation, and found that patients undergoing RN had significantly higher de novo ED compared with a contemporary, well‐matched cohort undergoing PN; in addition to RN, hypertension, CKD and diabetes mellitus were associated with developing ED. To our knowledge, this is the first study demonstrating an increased risk of ED after RN compared with PN.

OBJECTIVES

To evaluate prevalence and risk factors for development of erectile dysfunction (ED) in patients who underwent radical nephrectomy (RN) and partial nephrectomy (PN).

ED is a form of endothelial dysfunction that is prevalent in patients with chronic kidney disease (CKD). PN confers superior renal functional preservation compared with RN; however, the impact on ED is unclear.

METHODS

This was a retrospective study of 432 patients (264 RN/168 PN, mean age 58 years, mean follow‐up 5.8 years) who underwent surgery for renal tumours between January 1998 and December 2007.

The primary outcome was rate of de novo ED postoperatively. Secondary outcomes included development of CKD (estimated GFR < 60 mL/min/1.73 m2) and response to phosphodiesterase‐5 inhibitors.

Multivariate analysis was performed to determine risk factors for de novo ED postoperatively.

RESULTS

RN and PN groups had similar demographics and comorbidities.

Tumour size (cm) was larger for RN (RN 7.0 vs PN 3.7, P < 0.001) and more preoperative ED existed in PN vs RN (P= 0.042). No differences were observed for preoperative CKD, hyperlipidaemia and diabetes mellitus.

Postoperatively, higher rates of de novo ED (29.5% vs 9.5%, P < 0.001) and CKD (33.0% vs 9.8%, P < 0.001) developed in RN vs PN cohorts, respectively.

Of men with ED, 63% responded to phosphodiesterase inhibitors, without significant difference between the two groups (P= 0.896).

Multivariate analysis demonstrated de novo ED to be associated with RN (odds ratio [OR] 3.56, P < 0.001), hypertension (OR 2.32, P= 0.014), preoperative (OR 8.77, P < 0.001) and postoperative (OR 2.64, P= 0.001) CKD, and postoperative diabetes mellitus (OR 2.93, P < 0.001).

CONCLUSIONS

Patients undergoing RN had significantly higher de novo ED compared with a contemporary, well‐matched cohort undergoing PN. In addition to RN, hypertension, CKD and diabetes mellitus were associated with developing ED.

Further investigation on effects of surgically induced nephron loss on ED is requisite.
Telomere length in blood and skeletal muscle in relation to measures of glycaemia and insulinaemia
Authors: Ahmad S. , Heraclides A. , Sun Q. , Elgzyri T. , Rönn T. , Ling C. , Isomaa B. , Eriksson K.‐F. , Groop L. , Franks P. W. , Hansson O.
Published: July 2012

Diabet. Med. 29, e377–e381 (2012)

Aims  Skeletal muscle is a major metabolic organ and plays important roles in glucose metabolism, insulin sensitivity and insulin action. Muscle telomere length reflects the myocyte’s exposure to harmful environmental factors. Leukocyte telomere length is considered a marker of muscle telomere length and is used in epidemiologic studies to assess associations with ageing‐related diseases where muscle physiology is important. However, the extent to which leucocyte and muscle telomere length are correlated is unknown, as are their relative correlations with glucose and insulin concentrations. The purpose of this study was to determine the extent of these relationships.

Methods  Leucocyte and muscle telomere length were measured by quantitative real‐time polymerase chain reaction in participants from the Malmö Exercise Intervention (n = 27) and the Prevalence, Prediction and Prevention of Diabetes—Botnia studies (n = 31). Participants in both studies were free from Type 2 diabetes. We assessed the association between leucocyte telomere length, muscle telomere length and metabolic traits using Spearmen correlations and multivariate linear regression. Bland–Altman analysis was used to assess agreement between leucocyte and muscle telomere length.

Results  In age‐, study‐, diabetes family history‐ and sex‐adjusted models, leucocyte and muscle telomere length were positively correlated (r = 0.39, 95% CI 0.15–0.59). Leucocyte telomere length was inversely associated with 2‐h glucose concentrations (r = −0.58, 95% CI −1.0 to −0.16), but there was no correlation between muscle telomere length and 2‐h glucose concentrations (r = 0.05, 95% CI −0.35 to 0.46) or between leucocyte or muscle telomere length with other metabolic traits.

Conclusions  In summary, the current study supports the use of leucocyte telomere length as a proxy for muscle telomere length in epidemiological studies of Type 2 diabetes aetiology.
Single nucleotide polymorphism discovery from wheat next‐generation sequence data
Authors: Lai Kaitao , Duran Chris , Berkman Paul J. , Lorenc Michał T. , Stiller Jiri , Manoli Sahana , Hayden Matthew J. , Forrest Kerrie L. , Fleury Delphine , Baumann Ute , Zander Manuel , Mason Annaliese S. , Batley Jacqueline , Edwards David
Published: July 2012

Single nucleotide polymorphisms (SNPs) are the most abundant type of molecular genetic marker and can be used for producing high‐resolution genetic maps, marker‐trait association studies and marker‐assisted breeding. Large polyploid genomes such as wheat present a challenge for SNP discovery because of the potential presence of multiple homoeologs for each gene. AutoSNPdb has been successfully applied to identify SNPs from Sanger sequence data for several species, including barley, rice and Brassica, but the volume of data required to accurately call SNPs in the complex genome of wheat has prevented its application to this important crop. DNA sequencing technology has been revolutionized by the introduction of next‐generation sequencing, and it is now possible to generate several million sequence reads in a timely and cost‐effective manner. We have produced wheat transcriptome sequence data using 454 sequencing technology and applied this for SNP discovery using a modified autoSNPdb method, which integrates SNP and gene annotation information with a graphical viewer. A total of 4 694 141 sequence reads from three bread wheat varieties were assembled to identify a total of 38 928 candidate SNPs. Each SNP is within an assembly complete with annotation, enabling the selection of polymorphism within genes of interest.