bluuebunny/crossref_metadata_2025 huggingface dataset:
Solanum resistance genes against Phytophthora infestans and their corresponding avirulence genes
Authors: Rodewald Jan , Trognitz Bodo
Published: May 2013

Resistance genes against Phytophthora infestans (Rpi genes), the most important potato pathogen, are still highly valued in the breeding of Solanum spp. for enhanced resistance. The Rpi genes hitherto explored are localized most often in clusters, which are similar between the diverse Solanum genomes. Their distribution is not independent of late maturity traits. This review provides a summary of the most recent important revelations on the genomic position and cloning of Rpi genes, and the structure, associations, mode of action and activity spectrum of Rpi and corresponding avirulence (Avr) proteins. Practical implications for research into and application of Rpi genes are deduced and combined with an outlook on approaches to address remaining issues and interesting questions. It is evident that the potential of Rpi genes has not been exploited fully.
Stomatal responses to changes in vapor pressure deficit reflect tissue‐specific differences in hydraulic conductance
Authors: OCHELTREE T. W. , NIPPERT J. B. , PRASAD P. V. V.
Published: May 2013

The vapor pressure deficit (D) of the atmosphere can negatively affect plant growth as plants reduce stomatal conductance to water vapor (gwv) in response to increasing D, limiting the ability of plants to assimilate carbon. The sensitivity of gwv to changes in D varies among species and has been correlated with the hydraulic conductance of leaves (Kleaf), but the hydraulic conductance of other tissues has also been implicated in plant responses to changing D. Among the 19 grass species, we found that Kleaf was correlated with the hydraulic conductance of large longitudinal veins (Klv, r2 = 0.81), but was not related to Kroot (r2 = 0.01). Stomatal sensitivity to D was correlated with Kleaf relative to total leaf area (r2 = 0.50), and did not differ between C3 and C4 species. Transpiration (E) increased in response to D, but 8 of the 19 plants showed a decline in E at high D, indicative of an ‘apparent feedforward’ response. For these individuals, E began to decline at lower values of D in plants with low Kroot (r2 = 0.72). These results show the significance of both leaf and root hydraulic conductance as drivers of plant responses to evaporative demand.
Management of intratonsillar abscess in children
Authors: Ulualp Seckin O. , Koral Korgun , Margraf Linda , Deskin Ronald
Published: May 2013

Background

The aim of this study was to assess outcomes of medical and surgical treatment of intratonsillar abscess in children.

Methods

The medical charts of children with intratonsillar abscess were reviewed to obtain information on history and physical examination, imaging, management, and follow‐up assessment.

Results

Eleven children (six male, five female; age range, 4–18 years) were identified. The common complaints included sore throat, fever, and odynophagia. Asymmetric tonsil hypertrophy was present in nine patients and erythema of tonsils in all patients. Peritonsillar fullness was present in three patients. One patient needed emergency intubation due to respiratory compromise. Computed tomography indicated unilateral intratonsillar abscess in nine patients, bilateral intratonsillar abscess in one, and unilateral phlegmon in one. Inflammatory changes were observed in the parapharyngeal space in all patients, retropharyngeal space in one, and pyriform sinus and aryepiglottic folds in two. Antibiotic treatment included clindamycin in seven patients, ampicillin/sulbactam in one, and clindamycin plus ceftriaxone in three. The patients with respiratory compromise underwent surgery prior to antibiotic treatment. Patients with isolated intratonsillar abscess or phlegmon had resolution of their symptoms with i.v. antibiotic treatment. Patients with combination of intratonsillar and peritonsillar abscess required incision and drainage of peritonsillar abscess.

Conclusions

Clinically stable children with intratonsillar abscess or phlegmon respond to i.v. antibiotic therapy. Surgical drainage can accomplish clinical resolution in the presence of a combination of intra‐ and peri‐tonsillar abscess, airway compromise, or unresponsiveness to medical treatment.
Low CD8 T cells in neonates and infants prior to surgery, and health‐care‐associated infections: Prospective observational study
Authors: Grosek Stefan , Petrin Ziva , Kopitar Andreja Natasa , Grosek Jan , Erzen Janez , Gmeiner Tanja Stopar , Petreska Mirjana , Primozic Janez , Ihan Alojz
Published: May 2013

Background

Major surgery suppresses the cell‐mediated immune response in children and adults. Data on preoperative and postoperative T‐cell counts in pediatric surgical patients and their relationship to health‐care‐associated infection (HAI) are not yet known.

Methods

A prospective observational study was carried out in a level III multidisciplinary neonatal and pediatric intensive care unit. Before and after, and in the first 3 days after surgery, lymphocyte subsets in peripheral blood were measured in 28 neonates and infants on flow cytometry. HAI were classified according to CDC/NHSN criteria.

Results

Six out of 28 neonates and infants (21.4%) developed HAI (group I‐HAI), while 22 out of 28 (78.6%) remained infection free (group II‐non‐HAI). In group I with HAI, the preoperative median cytotoxic T‐lymphocyte (CD8‐T‐cell) level was found to be below normal, and remained very low throughout the study period. In addition, the median and interquartile CD8 T‐cell range (358 cells/μL; 304–424 cells/μL) were twice as low compared to group II without HAI (822 cells/μL; 522–933 cells/μL; P = 0.013). No differences were found between the two groups with regard to patient demographics and clinical data.

Conclusion

Neonates and infants who underwent a major surgical procedure and who had a very low preoperative CD8 T‐cell level, developed HAI postoperatively.
The imaging Maastricht Acute Stress Test (iMAST): A neuroimaging compatible psychophysiological stressor
Authors: Quaedflieg Conny W. E. M. , Meyer T. , Smeets T.
Published: May 2013

Several protocols have been developed for inducing acute stress in laboratory settings. Still, effectively eliciting stress in a neuroimaging environment remains challenging. Here, we describe the evaluation of a combined physical and psychosocial stress protocol (n = 42). The imaging Maastricht Acute Stress Test (iMAST) consists of a 5‐min preparation phase and a 10‐min acute stress phase, with alternating trials of cold pressor stress generated through an advanced thermal stimulator and mental arithmetic challenges along with social‐evaluative pressure (i.e., negative feedback). Results demonstrate that participants displayed meaningful subjective stress responses, as well as significant increases in salivary alpha‐amylase and cortisol levels. Our data show that the iMAST may prove to be a potent alternative to existing imaging stress paradigms to explore poststress neuronal changes and brain determinants of resilience.
Hemodynamic, hemostatic, and endothelial reactions to acute psychological stress in depressed patients following coronary angiography
Authors: Plourde Annik , Lavoie Kim L. , Ouellet Karine , Carroll Douglas , Ring Christopher , Bacon Simon L.
Published: May 2013

Although there is evidence that depression is associated with an increased risk for coronary artery disease (CAD), the mechanisms underlying this association remain unclear. This study examined the association between depression and hemodynamic, hemostatic, and endothelial responses to psychological stress. Seventy‐two postcoronary angiography patients completed a mental stress task. Blood pressure, heart rate, and impedance cardiography were recorded at rest and during the task. Blood samples were taken at the end of rest and immediately after the task. Depression was evaluated using the Diagnostic Interview Schedule Self‐Administered (DISSA). In total, 21% of the participants were depressed. Analyses revealed that depression was associated with blunted pre‐ejection period stress reactivity and with increased platelet factor 4 reactivity. These data provide potential mechanistic pathways linking depression to increased CAD.
Acid sulphate soil characterization in Negara Brunei Darussalam: a case study to inform management decisions
Authors: Grealish G.J. , Fitzpatrick R.W.
Published: May 2013

A diverse range of acid sulphate soils occur in Negara Brunei Darussalam on the inland flat areas that are important agricultural lands. Prior to this study, there was no information on their occurrence. Information about these soils is critical because they present significant management challenges for both agriculture and protection of the environment. Field surveys and laboratory analysis conducted in eight areas of the Brunei‐Muara district and four areas of the Belait district identified, characterized and classified using Soil Taxonomy, a wide range of 10 acid sulphate soil types in four soil orders: Histosols, Vertisols, Inceptisols and Entisols. A user‐friendly soil identification key using easily observed soil characteristics was developed to assist users with the recognition of the range of acid sulphate soils. Conceptual soil hydro‐toposequence models in the form of cross‐sections were constructed to explain the spatial heterogeneity of (i) acid sulphate soil properties comprising a range of features (e.g. organic‐rich materials/peats, clays, sands, cracks and jarosite‐rich mottles), sulphidic material and sulphuric horizons, (ii) pyrite shale outcrops and (iii) soil types using both the soil identification key and Soil Taxonomy. The soil hydro‐toposequence models together with the soil identification key helped to easily visualize and illustrate the complexities and importance of understanding specific sites to assess the detailed behaviour and implications of various soil, regolith and topographic features.
Altered expression of antimicrobial peptide genes in the skin of dogs with atopic dermatitis and other inflammatory skin conditions
Authors: Lancto Cheryl A. , Torres Sheila M. F. , Hendrickson Julie A. , Martins Kyra V. , Rutherford Mark S.
Published: May 2013

Background

Reports indicate that human and canine patients with atopic dermatitis (AD) have reduced production of several skin antimicrobial peptides, but more recent data have called those results into question.

Hypothesis/Objectives

To compare the mRNA expression of seven antimicrobial peptide genes in lesional and adjacent nonlesional skin biopsy specimens from dogs with AD with those from normal dogs and from dogs experiencing other inflammatory skin conditions.

Animals

Normal dogs and patients with AD or other inflammatory skin conditions were enrolled with owner permission and approval of the Institutional Animal Care and Use Committee.

Methods

Transcripts were measured by quantitative RT‐PCR using a standard curve assessment.

Results

Normal transcript levels for all seven antimicrobial peptides varied depending on the body site assessed. Transcripts for secretory leukocyte proteinase inhibitor (SLPI) and skin‐derived antileucoproteinase (SKALP; also known as elafin) were typically ~10‐fold greater in number than transcripts for the canine β‐defensins (CBD)‐1, ‐102, ‐103, ‐122 and ‐124. Transcripts for SKALP, SLPI, CBD‐1, CBD‐103 and CBD‐122 were lower in both lesional and adjacent nonlesional skin from dogs with AD in comparison to normal skin. Transcripts were reduced to a similar extent versus normal dogs in skin of dogs with inflammatory skin conditions from both lesional and nonlesional biopsies, except for CBD‐122, which was reduced only in lesional skin. Compared with normal dog skin, transcripts for CBD‐102 and CBD‐124 were unaffected in dogs with AD.

Conclusions and clinical importance

Both SKALP and SLPI may be important contributors to skin innate immunity, but their decreased expression in AD patients does not account for increased skin infections compared with other skin conditions.
The maximum likelihood degree of a very affine variety
Authors: Huh June
Published: May 2013

We show that the maximum likelihood degree of a smooth very affine variety is equal to the signed topological Euler characteristic. This generalizes Orlik and Terao’s solution to Varchenko’s conjecture on complements of hyperplane arrangements to smooth very affine varieties. For very affine varieties satisfying a genericity condition at infinity, the result is further strengthened to relate the variety of critical points to the Chern–Schwartz–MacPherson class. The strengthened version recovers the geometric deletion–restriction formula of Denhamet al. for arrangement complements, and generalizes Kouchnirenko’s theorem on the Newton polytope for nondegenerate hypersurfaces.
Organic Fluids in a Supercritical Rankine Cycle for Low Temperature Power Generation
Authors: Vidhi Rachana , Kuravi Sarada , Yogi Goswami D. , Stefanakos Elias , Sabau Adrian S.
Published: May 2013

This paper presents a performance analysis of a supercritical organic Rankine cycle (SORC) with various working fluids with thermal energy provided from a geothermal energy source. In the present study, a number of pure fluids (R23, R32, R125, R143a, R134a, R218, and R170) are analyzed to identify the most suitable fluids for different operating conditions. The source temperature is varied between 125 °C and 200 °C, to study its effect on the efficiency of the cycle for fixed and variable pressure ratios. The energy and exergy efficiencies for each working fluid are obtained and the optimum fluid is selected. It is found that thermal efficiencies as high as 21% can be obtained with 200 °C source temperature and 10 °C cooling water temperature considered in this study. For medium source temperatures (125–150 °C), thermal efficiencies higher than 12% are obtained.
Process Parameters Influencing Tertiary Scale Formation at a Hot Strip Mill Using a Multinomial Logit Model
Authors: Evans Mark , Kennedy Jonathan , Thomas Paul
Published: May 2013

Scale is highly detrimental to the surface quality of tinplate products and this problem is created during the hot rolling process. In this paper, a multinomial logit model is used to both quantify the influence of hot mill process parameters on tertiary scale formation and to identify how to optimize the running conditions at the hot mill, that is, to identify what base chemistries to use and what temperatures to run the hot mill at so that the percentage of coils produced with significant scale formation is kept as low as is required for meeting customer requirements. Principal component analysis is used to reduce the dimensionality of the dataset while retaining the majority of the variability in the process variables. It was found that a multinomial logit model containing these components was consistent with the process data and it was further determined from this model that the most significant variables were the temperature at which the steel strip was entering the finishing mill, together with the percentage of phosphorus and aluminum present within the slab entering the mill. More importantly, for process control it was found that to keep the rate of coils containing medium or high scale counts below 10%, the average rougher mill temperature should be kept at 1020 °C or less, or alternatively the aluminum content should be kept below 0.024% wt when running the hot mill at the mean values for all the other process variables. The multinomial logit model was capable of identifying many other optimal running conditions for the hot mill.
The Needle With Lancet Point: Geometry for Needle Tip Grinding and Tissue Insertion Force
Authors: Wang Yancheng , Tai Bruce L. , Chen Roland K. , Shih Albert J.
Published: May 2013

The grinding procedure and setup, the cutting edge inclination and rake angles of the needle with lancet point (NLP), and the NLP tissue insertion force are investigated in this paper. The NLP is the most commonly used needle tip geometry. However, there is a lack of research on the NLP grinding and cutting edge characteristics. In this study, a four-step grinding procedure and a mathematical model to calculate the inclination and rake angles along the cutting edge of the NLP are developed. Three cases of NLP are defined based on the relative position of the lancets. Prototype NLP for each case was produced and analyzed. Compared to the regular bias bevel needle, grinding two lancets in NLP can increases the inclination angle, particularly at the needle tip. Experiments with needle insertion into the porcine liver were conducted and results showed that NLP could achieve over 40% reduction of the initial peak needle insertion force compared to that of the regular bias bevel needle tip.
Simple Correlations and Analysis of Cuttings Transport With Newtonian and Non-Newtonian Fluids in Horizontal and Deviated Wells
Authors: Sorgun Mehmet
Published: May 2013

In this study, simple empirical frictional pressure losses and cuttings bed thickness correlations including pipe rotation are developed for solid-liquid flow in horizontal and deviated wellbores. Pipe rotation effects on cuttings transport in horizontal and highly inclined wells are investigated experimentally. Correlations are validated experimental data with pure water as well as four different non-Newtonian fluids for hole inclinations from horizontal to 60 degrees, flow velocities from 0.64 m/s to 3.56 m/s, rate of penetrations from 0.00127 to 0.0038 m/s, and pipe rotations from 0 to 250 rpm. Pressure drop within the test section, and stationary and/or moving bed thickness are recorded besides the other test conditions. The new correlations generated in this study are believed to be very practical and handy when they are used in the field.
Epitaxial V0.6W0.4N/MgO(001): Evidence for ordering on the cation sublattice
Authors: Kindlund H. , Lu J. , Jensen J. , Petrov I. , Greene J. E. , Hultman L.
Published: May 2013

V0.6W0.4N alloys are grown on MgO(001) by ultrahigh vacuum reactive magnetron sputtering from V and W targets in 10 mTorr pure-N2 atmospheres at temperatures Ts ranging from 600 to 900 °C. Based on x-ray diffraction and transmission electron microscopy results, all films have the B1-NaCl crystal structure and grow with a cube-on-cube epitaxial relationship to the substrate, (001)VWN‖(001)MgO and [100]VWN‖[100]MgO. Rutherford backscattering spectrometry analyses show that the N content in V0.6W0.4Nx alloys decreases with increasing Ts from overstoichiometric with x = 1.13 at 600 °C, to approximately stoichiometric with x = 1.08 at 700 °C, to understoichiometric at 800 °C (x = 0.80) and 900 °C (x = 0.75). High-resolution scanning transmission electron microscopy, Z-contrast, and selected-area electron diffraction investigations of V0.6W0.4N(001) alloys grown at 600 and 700 °C reveal the onset of W ordering on adjacent 111 planes of the metal sublattice; no ordering is observed for understoichiometric films grown at higher temperatures.
MR‐CT registration using a Ni‐Ti prostate stent in image‐guided radiotherapy of prostate cancer
Authors: Korsager Anne Sofie , Carl Jesper , Østergaard Lasse Riis
Published: May 2013

Purpose:

In image‐guided radiotherapy of prostate cancer defining the clinical target volume often relies on magnetic resonance (MR). The task of transferring the clinical target volume from MR to standard planning computed tomography (CT) is not trivial due to prostate mobility. In this paper, an automatic local registration approach is proposed based on a newly developed removable Ni‐Ti prostate stent.

Methods:

The registration uses the voxel similarity measure mutual information in a two‐step approach where the pelvic bones are used to establish an initial registration for the local registration.

Results:

In a phantom study, the accuracy was measured to 0.97 mm and visual inspection showed accurate registration of all 30 data sets. The consistency of the registration was examined where translation and rotation displacements yield a rotation error of 0.41° ± 0.45° and a translation error of 1.67 ± 2.24 mm.

Conclusions:

This study demonstrated the feasibility for an automatic local MR‐CT registration using the prostate stent.
Protein Equilibration Through Somatic Ring Canals in
Drosophila
Authors: McLean Peter F. , Cooley Lynn
Published: May 2013

Lord of the Ring Canal

In
Drosophila
, some cells maintain direct cytoplasmic connections with their siblings by intercellular bridges known as ring canals that arise from mitotic cleavage furrows. In ovarian follicle cells and imaginal discs,
McLean and Cooley
(p.
1445
, published online 23 May) found that ring canals allowed diffusion of cytoplasmic proteins between cells and across mitotic clone boundaries, which may suggest a role in compensating for transcriptional variation between cells.
A Secreted Disulfide Catalyst Controls Extracellular Matrix Composition and Function
Authors: Ilani Tal , Alon Assaf , Grossman Iris , Horowitz Ben , Kartvelishvily Elena , Cohen Sidney R. , Fass Deborah
Published: May 2013

Form and Function

The contribution of disulfide bonding to oxidative protein folding and assembly, quality control, and stress responses in the endoplasmic reticulum (ER) are widely recognized. In contrast, catalysis of disulfide bond formation downstream of the ER is uncharted territory. QSOX, a Golgi-localized or secreted disulfide catalyst, was identified in the 1970s and was more recently shown to be upregulated in many cancers. However, the physiological importance of QSOX catalytic activity has been unclear.

Ilani
et al.

(p.
74
, published online 23 May) found that human QSOX1 is essential for incorporation of laminin into the extracellular matrix, with profound effects on the capability of the matrix to support integrin-mediated cell adhesion and migration.
Infectivity, Transmission, and Pathology of Human-Isolated H7N9 Influenza Virus in Ferrets and Pigs
Authors: Zhu H. , Wang D. , Kelvin D. J. , Li L. , Zheng Z. , Yoon S.-W. , Wong S.-S. , Farooqui A. , Wang J. , Banner D. , Chen R. , Zheng R. , Zhou J. , Zhang Y. , Hong W. , Dong W. , Cai Q. , Roehrl M. H. A. , Huang S. S. H. , Kelvin A. A. , Yao T. , Zhou B. , Chen X. , Leung G. M. , Poon L. L. M. , Webster R. G. , Webby R. J. , Peiris J. S. M. , Guan Y. , Shu Y.
Published: May 2013

Avian Flu in Ferrets

A recent outbreak of avian H7N9 influenza in humans in eastern China has been closely monitored for any evidence of human-to-human transmission and its potential for sparking a pandemic.

Zhu
et al.

(p.
183
, published online 23 May) examined the behavior of the avian virus in the ferret, a mammalian model for human influenza. The virus was excreted by the ferrets and could be transmitted readily by contact but displayed limited capacity for airborne infectivity. The pathology of H7N9 is similar to H1N1, and it seems that factors other than the intrinsic pathogenicity of the virus contribute to the reported high fatality rate.
Noncontiguous Finished Genome Sequence of Staphylococcus aureus KLT6, a Staphylococcal Enterotoxin B-Positive Strain Involved in a Food Poisoning Outbreak in Switzerland
Authors: Tobes Raquel , Manrique Marina , Brozynska Marta , Stephan Roger , Pareja Eduardo , Johler Sophia
Published: May 2013

We present the first complete genome sequence of a
Staphylococcus aureus
strain assigned to clonal complex 12. The strain was isolated in a food poisoning outbreak due to contaminated potato salad in Switzerland in 2009, and it produces staphylococcal enterotoxin B.
Genome Sequences of the Guillain-Barré Syndrome Outbreak-Associated Campylobacter jejuni Strains ICDCCJ07002 and ICDCCJ07004
Authors: Zhang Maojun , Yang Xianwei , Liu Hongying , Liu Xiayang , Huang Yufen , He Lihua , Gu Yixin , Zhang Jianzhong
Published: May 2013

The first world-known and largest outbreak of 36 cases of Guillain-Barré syndrome caused by a preceding
Campylobacter jejuni
infection was reported previously in China. During the outbreak,
Campylobacter jejuni
strain ICDCCJ07002 was isolated from a patient with persistent diarrhea for 21 days, and
C. jejuni
strain ICDCCJ07004 was from a healthy carrier without any clinical symptoms at the same time. Here, we report the draft genome sequence of strain ICDCCJ07002 (1,698,407 bp, with a G+C content of 30.45%) and the genome resequencing result of strain ICDCCJ07004 (1,701,584 bp, with a G+C content of 30.51%), and we compared these with the completed genome of
C. jejuni
strain ICDCCJ07001.
Complete Genome of a Methanosarcina mazei Strain Isolated from Sediment Samples from an Amazonian Flooded Area
Authors: Assis das Graças Diego , Thiago Jucá Ramos Rommel , Vieira Araújo Ana Carolina , Zahlouth Ramiro , Ribeiro Carneiro Adriana , Souza Lopes Thiago , Azevedo Baraúna Rafael , Azevedo Vasco , Cruz Schneider Maria Paula , Pellizari Vivian Helena , Silva Artur
Published: May 2013

Methanosarcina mazei
is a strictly anaerobic methanogen from the
Methanosarcinales
order, which is known for its broad catabolic range among methanogens and is widespread throughout diverse environments. The draft genome of the strain presented here was cultivated from sediment samples collected from the Tucuruí hydroelectric power station reservoir.
Draft Genome Sequence of “
Candidatus
Liberibacter americanus” Bacterium Associated with Citrus Huanglongbing in Brazil
Authors: Lin Hong , Coletta-Filho Helvecio D. , Han Cliff S. , Lou Binghai , Civerolo Edwin L. , Machado Marcos A. , Gupta Goutam
Published: May 2013

We report here the draft genome sequence of “
Candidatus
Liberibacter americanus” strain PW_SP. The 1,176,071-bp genome, with 31.6% G+C content, comprises 948 open reading frames, 38 tRNAs, and three complete rRNAs.
Nasopharyngeal perforation by a new electromagnetically visualised enteral feeding tube
Authors: Khasawneh Faisal A , Al-Janabi Mohammed G , Ali Ahmad H
Published: May 2013

Enteral nutrition is the preferred route of feeding in critically ill patients. It has multiple advantages over parenteral nutrition and potentially improves patients’ outcome. Enteral nutrition is delivered via gastric or postpyloric (small intestine) feeding tubes. The latter option used to be a more challenging choice to achieve unless the feeding tube is placed endoscopically or by interventional radiology. Multiple technical advances have facilitated postpyloric feeding, including a new electromagnetically visualised jejunal feeding tube system (CORTRAK Enteral Access System). We are presenting a case of a 50-year-old woman who suffered a nasopharyngeal perforation caused by this novel technology. The complication was recognised promptly and managed successfully with conservative measures. This case illustrates the importance of recognising patients at high risk for feeding tube placement complications, meticulous placement technique and appropriate follow-up once the tube has been inserted.
Total pancreatectomy for recurrent intraductal papillary mucinous carcinoma in remnant pancreas of pancreaticoduodenectomy for intraductal papillary mucinous adenocarcinoma
Authors: Ohkura Yu , Sasaki Kazunari , Matsuda Masamichi , Hashimoto Masaji
Published: May 2013

A 62-year-old man underwent pancreaticoduodenectomy (PD) for intraductal papillary mucinous carcinoma (IPMC) in 2006. No signs of adenocarcinoma at the resection margin were found by intraoperative pathological examination of frozen sections. The postoperative pathological diagnosis was invasive carcinoma derived from IPMC and moderately differentiated tubular adenocarcinoma. A blood analysis in 2011 showed serum (CA19-9) to be increased since the initial resection. Imaging test showed a recurrent tumour at the site of the pancreaticogastrostomy (PG) in the remnant pancreas. We conducted total remnant pancreatectomy for recurrent IPMC and partial gastrectomy. Because both lesions had a histopathological resemblance, the pathological diagnosis was recurrent invasive IPMC. Based on this experience, it is important to facilitate early detection by annual check-up. And also, we recommend PG as a reconstructive intervention in patients at high risk of IPMC recurrence in the remnant pancreas following PD as it is grossly visible on upper gastrointestinal endoscopy.
Injury situations in Freestyle Ski Cross (SX): a video analysis of 33 cases
Authors: Randjelovic Stefan , Heir Stig , Nordsletten Lars , Bere Tone , Bahr Roald
Published: May 2013

Background

Although injury risk in Freestyle Ski Cross (SX) is high, little is known about the situations leading up to time-loss injuries.

Objective

To describe the situations leading up to time-loss injuries in elite Freestyle SX.

Study design

Descriptive video analysis.

Methods

Thirty-three video recordings of SX injuries reported through the International Ski Federation Injury Surveillance System for four World Cup seasons (2006/2007 through 2010) were obtained. Five experts in the fields of sport medicine and SX analysed each case to describe in detail the situation leading up to the injury (skiing situation and skier behaviour).

Results

Injuries occurred in four different skiing situations: jumping (n=16), turning (n=8), jumping and turning (n=7) and rollers (n=2). All injured skiers lost control before time of injury (n=33), due to skier–opponent contact (n=13), technical errors (n=8) or inappropriate strategy (n=8), which led to a fall (n=29). Contact occurred in 21 of 33 cases, usually unintentional at landing or take-off, caused by the opponent (n=11) or injured skier (n=8). The technical error cases (n=8) were dominated by bad jumping technique (n=6) and too much inside lean in turning situations (n=2), while inappropriate course line and bad timing at take off (n=7) dominated the inappropriate strategy cases (n=8).

Conclusions

We identified four main injury situations in elite SX, dominated by jumping situations. The primary cause of injury was unintentional skier–opponent contact in jumping, bank turning and roller situations. Another common cause of injury was personal errors (inappropriate technique and strategy) at take-off and in turning situations.
Practices to prevent venous thromboembolism: a brief review
Authors: Lau Brandyn D , Haut Elliott R
Published: May 2013

Background

Venous thromboembolism (VTE) is a common cause of preventable harm for hospitalised patients. Over the past decade, numerous intervention types have been implemented in attempts to improve the prescription of VTE prophylaxis in hospitals, with varying degrees of success. We reviewed key articles to assess the efficacy of different types of interventions to improve prescription of VTE prophylaxis for hospitalised patients.

Methods

We conducted a search of MEDLINE for key studies published between 2001 and 2012 of interventions employing education, paper based tools, computerised tools, real time audit and feedback, or combinations of intervention types to improve prescription of VTE prophylaxis for patients in hospital settings. Process outcomes of interest were prescription of any VTE prophylaxis and best practice VTE prophylaxis. Clinical outcomes of interest were any VTE and potentially preventable VTE, defined as VTE occurring in patients not prescribed appropriate prophylaxis.

Results

16 articles were included in this review. Two studies employed education only, four implemented paper based tools, four used computerised tools, two evaluated audit and feedback strategies, and four studies used combinations of intervention types. Individual modalities result in improved prescription of VTE prophylaxis; however, the greatest and most sustained improvements were those that combined education with computerised tools.

Conclusions

Many intervention types have proven effective to different degrees in improving VTE prevention. Provider education is likely a required additional component and should be combined with other intervention types. Active mandatory tools are likely more effective than passive ones. Information technology tools that are well integrated into provider workflow, such as alerts and computerised clinical decision support, can improve best practice prophylaxis use and prevent patient harm resulting from VTE.
Individual patient data meta-analysis of diagnostic studies: opportunities and challenges
Authors: Ter Riet Gerben , Bachmann Lucas M , Kessels Alfons G H , Khan Khalid S
Published: May 2013

Individual patient data meta-analyses using the raw data from primary diagnostic accuracy studies are taking hold in systematic reviews evaluating tests. Conventional reviews and meta-analyses that summarise study-level data on test accuracy (sensitivity and specificity) have several disadvantages. The most fundamental limitation of this approach is that it estimates the rates of test result-given disease (sensitivity is probability of positive test result-given disease is present; and specificity is probability of negative test result-given disease is absent). This may be addressed by summarising predictive values, but estimating accuracy for individual tests without consideration of other tests in the test chains that make up everyday diagnostic work-ups remain a problem. To inform clinical practice it is essential that test evaluation generates information about probability of disease given test results, and that it does so in view of the preceding contribution to diagnosis of other tests, for example, symptoms and signs. A multivariable (logistic regression) framework generates disease probabilities taking into account the important factors that play a role in diagnosis. Most primary accuracy studies lack statistical power to do this, particularly because of the small absolute number of disease events per test included in the diagnostic work. Synthesis using their raw data can overcome this problem, but meta-analysts will have limited success if there are difficulties in obtaining the large majority of valid studies, without ‘missing’ data on the tests relevant in clinical decision-making. Successful individual patient data meta-analyses create the opportunity to calculate directly and reliably disease probabilities corresponding with realistic chains of tests, thereby making outputs of reviews of test accuracy clinically applicable.
The obstetric caseload of a physician-based helicopter emergency medical service: case review and recommendations for retrieval physician training
Authors: Kaye Richard , Shewry Elizabeth , Reid Cliff , Burns Brian
Published: May 2013

Background

The Greater Sydney Area Helicopter Emergency Medical Service provides physicians for undertaking prehospital and inter-hospital critical care. We quantified the obstetric caseload of our service with respect to primary diagnosis and interventions in order to provide targeted physician training.

Materials and methods

Retrieval records over a 4-year period were searched to identify keywords associated with pregnancy or obstetric complications. The data collected related to gestation, diagnosis, nature of transfer and interventions.

Results and discussion

Of 66 pregnant or postpartum cases, 38 were transported by road and 28 by air. 33 had obstetric-related conditions, and 33 had non-obstetric medical conditions. 61 patients required mechanical ventilation, 23 of whom were intubated by the retrieval physicians prior to transport. 33 patients required vasoactive circulatory support, and arterial and/or central venous access was established in 48 and 30 patients, respectively. The only obstetric interventions provided by retrieval physicians were intravenous tocolytic therapy (two cases) and one case of resuscitative hysterotomy (peri-mortem caesarean section).

Conclusions

A half of all peri-partum patients in our critical care transport service are retrieved for non-obstetric diagnoses. Obstetric interventions by retrieval physicians are rare, but resuscitative hysterotomy may be required. Most interventions are general critical care procedures. Exhaustive training in obstetric emergencies may not reflect the learning needs of retrieval physicians in services such as ours. Educational resources should prioritise general critical care of the pregnant woman rather than specific obstetric procedures. We have used these findings to construct a targeted obstetric module as part of our retrieval physician training programme.
Piloting a multidisciplinary clinic for the management of non-alcoholic fatty liver disease: initial 5-year experience
Authors: Cobbold Jeremy F L , Raveendran Sarrah , Peake Christopher M , Anstee Quentin M , Yee Michael S , Thursz Mark R
Published: May 2013

Objective

A multidisciplinary approach is advocated for the management of Non-Alcoholic Fatty Liver Disease (NAFLD), but few clinical data exist to support this. The objective of this study was to investigate the effectiveness of a multidisciplinary NAFLD clinic using surrogate markers of liver injury and cardiovascular risk.

Design

Retrospective survey of clinical practice.

Setting

The multidisciplinary NAFLD clinic in a secondary/tertiary care setting with hepatology, diabetology, dietetic and exercise therapy input: initial 5-years’ experience (2007–2012).

Patients

180 patients with NAFLD but without hepatic comorbidities were followed up for a median of 19.5 (range 3–57) months. 52% had type 2 diabetes mellitus, 48% were Europoid Caucasian, 17% were South Asian.

Interventions

Multiple clinical interventions were employed including lifestyle (diet and exercise) advice, pharmacological intervention for cardiovascular risk factors, weight loss and exercise therapy.

Main outcome measures

Change in alanine aminotransferase (ALT), weight, HbA1c, lipid profile and blood pressure.

Results

Median ALT fell from 61 (12–270) U/l to 50 (11–221) U/l, −18%, p<0.001, and weight fell from 90.5 (42.7–175.0) kg to 87.3 (45.9–175.3) kg, −3.5%, p<0.001. There were significant improvements in total cholesterol overall, triglycerides (among dyslipidaemic patients), HbA1c (among diabetic patients) and systolic blood pressure (among hypertensive patients). 24% of patients achieved ≥7% weight loss during follow-up and 17% maintained this weight loss throughout.

Conclusions

Improvement in liver biochemistry and cardiovascular risk factors was seen in patients attending the multidisciplinary NAFLD clinic. Refinement of this approach is warranted in light of these data, novel therapies and a growing evidence base.
Contributing determinants of overall and wealth-related inequality in under-5 mortality in 13 African countries
Authors: Van Malderen Carine , Van Oyen Herman , Speybroeck Niko
Published: May 2013

Objective

To investigate and compare the main determinants of overall inequality and wealth-related inequality in under-5 mortality in 13 African countries.

Methods

Data from Demographic and Health Surveys conducted in 2007–2010 in African countries were used. The study assessed the contribution of determinants to (1) overall inequality in under-5 mortality measured by the Gini index and (2) wealth-related inequality in under-5 mortality measured by the concentration index. Techniques used were multivariate logistic regression and decomposition of Gini and concentration indexes.

Results

Birth order and interval and region contributed the most to overall inequality in under-5 mortality in a majority of countries. A significant wealth-related inequality was observed in five countries: DRCongo, Egypt, Madagascar, Nigeria and Sao Tome & Principe. Overall, household wealth, father's occupation and mother's education contributed the most to this inequality, though the ranking of the most important determinants differed across countries.

Conclusions

Assessing the contribution of determinants to overall inequality and to wealth-related inequality in under-5 mortality help in prioritising interventions aiming at improving child survival and equity.
Abortion care services delivered from a community sexual and reproductive health setting: views of health care professionals
Authors: Michie Lucy , Cameron Sharon T , Glasier Anna
Published: May 2013

Background

Abortion services should provide high-quality contraceptive care. The community sexual and reproductive health (SRH) services may be well placed to deliver more abortion care in the UK. We wished to determine the views of health professionals working in SRH regarding their attitudes towards providing more abortion services and also the views of staff within one community SRH centre in Scotland where a service providing early medical abortion (EMA) was due to commence.

Methods

An anonymous questionnaire distributed to attendees at a UK SRH scientific meeting collected data on demographics, current practice of and attitude to abortion, and views on delivery of abortion services. An internet questionnaire distributed by e-mail to staff at a community SRH clinic in Scotland sought demographics, views regarding the planned introduction of an EMA service and willingness to participate in it.

Results

165 questionnaires were completed out of 200 distributed at the scientific meeting (an 82% response rate). 128 (78%) respondents felt that abortion services were suited to community clinics and 115 (70%) stated that they would be willing to participate in them. 62/90 (69%) staff from the SRH clinic responded to the internet questionnaire. 44 (71%) felt the plan to introduce abortion services was a natural extension to services already offered and the same number would be willing to be involved in such a service.

Conclusion

There is clear support amongst health professionals in community SRH in the UK towards greater participation in the provision of abortion care services.
Early carotid angioplasty and stenting may offer non-inferior treatment for symptomatic cases of carotid artery stenosis
Authors: Wach Michael M , Dumont Travis M , Mokin Maxim , Kass-Hout Tareq , Snyder Kenneth V , Hopkins L Nelson , Levy Elad I , Siddiqui Adnan H
Published: May 2013

Objective

Early intervention is desirable in patients presenting with stroke or transient ischemic attack (TIA) referable to carotid artery stenosis because of the high incidence of recurrent ischemic events within 48 h post-ictus. However, the optimal timing of performing carotid angioplasty and stenting (CAS) in these patients remains unclear amid concerns for an elevated risk of perioperative complications. The primary outcome of this study was the combined incidence of major perioperative complications (stroke, myocardial infarction (MI), death) based on timing of CAS relative to symptom onset.

Methods

A prospectively maintained database of all neuroendovascular procedures at our hospital was searched for consecutive cases of extracranial internal CAS procedures performed for symptomatic atherosclerotic carotid stenosis between January 2009 and January 2012. Rates of perioperative complications including 30-day stroke, MI and death were assembled in a total of 221 patients.

Results

The primary outcome was not statistically different among groups stratified based on intervention timing, with a combined incidence of stroke, MI or death of 7.1% in patients treated within 2 days, 4.5% in patients treated between days 3 and 7, 2.8% in patients treated between days 8 and 14 and 3.7% in patients treated between days 15 and 90 (p=0.749, Fisher exact test).

Conclusions

Our results support the conclusion that early CAS (within 2 days) carries no additional risks compared with CAS after 2 days or any other timing of the intervention up to 90 days. Early CAS may represent a reasonable option for acute revascularization to minimize the risk of perioperative stroke and overall perioperative complications.
Thrombus length estimation in acute ischemic stroke: a potential role for delayed contrast enhanced CT
Authors: Mortimer Alex M , Little David H , Minhas Kishore S , Walton Edward RJ , Renowden Shelley A , Bradley Marcus D
Published: May 2013

Purpose

Thrombus length has been shown to be an important determinant of recanalization using intravenous thrombolysis in hyperacute ischemic stroke. Various studies have attempted to quantify thrombus based on non-contrast CT (NCCT) or CT angiography (CTA). However, thrombus may not be seen on NCCT, and CTA may fail to delineate the distal extent of the thrombus. Contrast enhanced CT (CECT) following CTA can be used to estimate infarct core, but we investigated whether the angiographic data available on these images provided reliable information on thrombus length.

Materials and methods

15 consecutive patients, mean age 81 years (range 63–93), with terminal internal carotid artery or M1-middle cerebral artery occlusions underwent NCCT, CTA (bolus tracked technique), and CECT (acquired 80 s post initial CTA injection). Three radiologists assessed thrombus length on thin slice NCCT, and CTA and CECT.

Results

CTA overestimated thrombus length relative to NCCT (p<0.001) and CECT (p<0.001). There was less difference between CTA and CECT estimation in patients with good collateral scores (p<0.05). There was good correlation between NCCT and CECT (Pearson's correlation coefficient=0.90, 95% CI 0.81 to 0.95, p<0.001). Inter-rater reliability assessed using intraclass correlation was 0.95 (95% CI 0.87 to 0.98) for NCCT and 0.98 (95% CI 0.94 to 0.99) for CECT.

Conclusions

CTA regularly overestimates thrombus length as the distal end of the thrombus is not delineated. This can be overcome through the use of a CECT acquisition which can reliably be used to estimate thrombus length.
Indications for cobalamin level assessment in departments of internal medicine: a prospective practice survey
Authors: Chiche Laurent , Mancini Julien , Arlet Jean-Benoît ,   BDOSE study investigators, Bernard Fanny , Bernard Sylvain , Carassou Philippe , Chaigne Benjamin , Chaussade Hélène , Cinquetti Gaël , Contentin Laetitia , Deboysson Hubert , Ebbo Mikaël , Géri Guillaume , Graveleau Julie , Jamilloux Yvan , Karkowski Ludovic , Inghilleri Marie-Laure , Lioget Bertrand , Lhommet Claire , Mourot Rachel , Nielsen Louise , Pasquet Florian , Peigne Vincent , Puyade Mathieu , Roux Xavier , Saadi Samir , Savini Hélène , Weitten Thierry
Published: May 2013

Background

Cobalamin (Cb) blood levels are frequently measured among inpatients, but the relevance of Cb determination has not been correctly assessed in this clinical setting.

Purpose

We aimed to prospectively evaluate current indications compared to traditional guidelines for assessing Cb blood levels among inpatients from internal medicine departments.

Study design

This study was conducted in French departments of internal medicine between 2008 and 2009. Inpatients who underwent Cb blood level determination during a 6-week study period were eligible.

Results

380 consecutive adult patients were included. The three most common indications for Cb assessment were anaemia (62.6%), cognitive impairment (20.2%) and undernutrition (17.4%). Traditional indications (ie, macrocytic non-regenerative anaemia, isolated macrocytosis, dementia and proprioceptive disorders) accounted for only 33.9% of all tests. Cb deficiency was identified in 40 (10.5%) of the 380 patients tested. Overall, traditional indications were not associated with a significantly higher prevalence of patients with low Cb levels than current guidelines (14% vs 8.8%; p=0.119). Non-regenerative macrocytic anaemia was the only indication with a significantly better performance compared to all other indications (11 of 62 patients (17.7%) vs 29 of 318 patients (9.1%); OR 2.15 (1.01−4.57), p=0.047). The main aetiological causes of Cb deficiency were intake deficiency, pernicious anaemia and food-Cb malabsorption. Homocysteine or methylmalonic acid dosage testing was very rarely performed.

Conclusions

Traditional indications did not perform better than other indications observed in current practice for identifying low Cb levels among inpatients from internal medicine departments. Future studies are needed to establish robust guidelines for inpatient screening.