bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical phenotypes associated with type II collagen mutations
Authors: Kannu Peter , Bateman John , Savarirayan Ravi
Published: February 2011

COL2A1 mutations give rise to a spectrum of phenotypes predominantly affecting cartilage and bone from the severe disorders that are perinatally lethal to the milder conditions that are recognised in the post‐natal period and childhood. The milder chondrodysplasias are characterised by disproportionate short stature, eye abnormalities, cleft palate and hearing loss. It remains poorly recognised that there is significant variability in the disease presentation, with early onset short stature conditions and later onset milder phenotypes. Similarly, it is under‐acknowledged that COL2A1 mutations may solely cause joint disease in the absence of the other mentioned phenotypic clues. The underlying hypothesis is that there are novel phenotypes caused by mutations in type II collagen that extend from premature arthritis through to more severe bone dysplasias. The importance of finding a COL2A1 mutation lies in the subsequent ability to accurately assess recurrence risks and offer information regarding disease natural history. Most importantly, it enables at‐risk individuals to be identified for implementation of preventative strategies and early ameliorative management of their condition. Such interventions potentially translate into a reduction in health costs associated with musculoskeletal disease.
Early functional echocardiogram and inhaled nitric oxide: Usefulness in managing neonates born following extreme preterm premature rupture of membranes (PPROM)
Authors: Shah Dharmesh M , Kluckow Martin
Published: February 2011

Aim:  Poor neonatal outcome of preterm premature rupture of membranes (PPROM) <24 weeks' gestational age (GA) is probably a result of abnormalities in both airway and vascular developments, ventilation perfusion mismatch, and possibly persistent pulmonary hypertension of the newborn (PPHN). Perinatal mortality of 50–90% has been reported in the past, with recent literature reporting significant improvement in neonatal survival. We report our 8‐year experience in this group of infants using early diagnostic functional echocardiography (fECHO), high‐frequency ventilation (HFV) and inhaled nitric oxide (iNO).

Methods:  The obstetric and neonatal databases were searched to identify babies with PPROM (<20 weeks' gestation) or rupture earlier than 25 weeks for more than 14 days.

Results:  Twenty‐six infants were identified, of whom 20 were admitted to the neonatal intensive care unit (NICU; mean GA 27.8 weeks, mean birth weight (BW) 1207 g). Early echocardiographic data were available in 12/15 infants requiring mechanical ventilation of whom 10 had evidence of PPHN. All infants who received iNO therapy survived to discharge and only two infants died. Survival to discharge was 69% for the whole cohort of infants and 90% for infants admitted to the NICU. In contrast, for the cohort from pre‐iNO and ‐HFV era, the overall survival to discharge was 62% and 66% for the infants admitted to the NICU.

Conclusion:  Premature infants with PPROM and presumed severe hypoxemic respiratory failure because of hypoplastic lungs often have significant PPHN and may show improvement in oxygenation after treatment with HFV and iNO. Early fECHO results in earlier identification and treatment of infants with PPHN in this high‐risk group.
Caustic ingestion and oesophageal damage in children: Clinical spectrum and feeding practices
Authors: Sánchez‐Ramírez Carmen A , Larrosa‐Haro Alfredo , Vásquez Garibay Edgar M , Larios‐Arceo Francisco
Published: February 2011

Aim:  The study aims to evaluate the association of oesophageal damage with clinical data and feeding practices in children who suffered a caustic substance ingestion (CSI).

Methods:  Cross‐sectional design was used in this study. The setting was at a paediatric referral hospital in 2006. Ninety‐four children with CSI were used as study samples, with mean age of 38.4 months, and 37.2% were females. The independent variable was oesophageal damage; the dependent variables were clinical data and feeding practices.

Results:  Main symptoms included salivation, oropharyngeal burns and vomiting. On endoscopy, 84.6% had second‐ or third‐degree burns. Oesophageal stricture occurred in 48.9%. Severe burns were associated with oesophageal stricture and ingestion of alkaline products; dysphagia was associated with oesophageal stricture. In about one fourth of the cases, a nutritional intervention with complete and balanced liquid diets was required to maintain the adequate daily recommended intake (DRI).

Conclusions:  Alkali ingestion was associated with severe burns and oesophageal stricture. The presence of oesophageal strictures and dysphagia required changes in the feeding practices in order to maintain an adequate nutritional status and/or to complete their DRI.
Norovirus as cause of benign convulsion associated with gastro‐enteritis
Authors: Chan Chi‐man Victor , Chan Chun‐wing Desmond , Ma Che‐kwan , Chan Hin‐biu
Published: February 2011

Aim:  Rotavirus and norovirus gastro‐enteritis (GE) are common in children. Complications, except severe dehydration, are rare. Rotavirus was known to cause seizures and even GE encephalopathy, but these complications are less described in norovirus infection. The objective of this study is to compare the demographic features, clinical manifestations including the incidence of afebrile seizure, and the outcomes in children with rotavirus and norovirus infections.

Methods:  This is a retrospective review of children between age 1 month and 6 years admitted to the paediatric department of a regional hospital in Hong Kong with rotavirus and norovirus infections over a period of 3 years from 1 June 2006 to 31 May 2009. Their demographic data, clinical features, laboratory results and outcomes were compared and analysed.

Results:  Two hundred and thirty‐two children with rotavirus and 173 children with norovirus GE were admitted within the study period. Afebrile seizure commonly occurred in norovirus infection (8.67% vs. 1.29%, P < 0.001). Children with rotavirus infection had higher temperature and more diarrhoea episodes, while more blood‐stained stool was noted in the norovirus group. Rotavirus‐infected patients stayed longer in hospital. All of them had full recovery without any complication. Among the 18 patients who developed afebrile convulsions, 17 of them had neuroimaging performed, which was normal. Fourteen of them had electroencephalogram (EEG) performed, demonstrating normal or non‐specific findings. None of them developed subsequent seizure attack after the GE episode.

Conclusions:  Norovirus is more commonly associated with benign convulsion in GE than rotavirus. We need to identify the presence of virus, in particular norovirus, in children with GE and afebrile generalised tonic–clonic seizure. Further neuro‐investigations may not be necessary once the aetiology is established. Prognosis is excellent in this group of children and prophylactic anticonvulsant is not needed.
Childhood outcomes of neonates diagnosed with portal vein thrombosis
Authors: Morag Iris , Shah Prakesh S , Epelman Monica , Daneman Alan , Strauss Tzipi , Moore Aideen M
Published: February 2011

Aim:  The study aims to determine childhood outcomes of neonates diagnosed with portal vein thrombosis (PVT).

Methods:  A retrospective chart review of neonates diagnosed with PVT who had documented follow up (physical examination, laboratory tests or ultrasonographic examination) at the age of 2 years or beyond was conducted.

Results:  Data were available for 70 children (71% of eligible neonates) at a median age of 5 years (range 2–8 years). Physical examination was unremarkable in all who were examined (n= 68). Twenty‐five children had liver functions assessed and only mild abnormalities were detected in nine children. Six of 25 patients tested for thrombophilia showed abnormalities. Thirty‐seven children had ultrasonographic follow up. Left lobar atrophy (LLA) was noted in 20 children (16 had isolated LLA, two had LLA and splenomegaly, and two had LLA and portal hypertension). Five children who had normal ultrasound examinations at discharge had splenomegaly (two with additional finding of LLA) at follow up. Two children with portal hypertension diagnosed during neonatal period needed porta‐caval shunting.

Conclusion:  Our results show that among patients, who had PVT as neonates, 28% still had asymptomatic LLA in childhood, 7% had slowly progressive splenomegaly and 3% required shunting because of progression of portal hypertension. Ultrasonographic follow up was the most sensitive method in detecting progression associated with neonatal PVT. Until more data are available, periodic long‐term ultrasonographic follow up should be considered for neonates diagnosed with PVT.
Cardiac function in survivors of acute lymphoblastic leukaemia and Hodgkin's lymphoma
Authors: Krawczuk‐Rybak Maryna , Dakowicz Łucja , Hryniewicz Andrzej , Maksymiuk Agnieszka , Żelazowska‐Rutkowska Beata , Wysocka Jolanta
Published: February 2011

Aim:  The study objective was to assess plasma N‐terminal–pro‐brain natriuretic peptide (BNP) levels and to evaluate left ventricular mass as well as left ventricular systolic and diastolic functions in 44 children who had undergone treatment for acute lymphoblastic leukaemia and Hodgkin's lymphoma, with regard to gender, age at disease onset, time that had passed since therapy completion, cumulative dose of antracyclines and mediastinal radiotherapy applied.

Methods:  The median levels of pro‐BNP were found to be higher in the whole study group as compared with the control (55.9 ± 53.1 ng/mL vs. 38.5 ± 47.7 ng/mL, P= 0.059). The pro‐BNP values >80.0 ng/mL (standard deviation score (SDS)) were noted in 11/44 patients, including those exceeding 115.0 ng/mL (2 SDS) – in 6/44 patients.

Results:  No correlation was observed of pro‐BNP levels with the accumulated dose of antracyclines (r=−0.42, P= 0.79) or mediastinal radiotherapy (r= 0.197, P= 0.2). However, negative correlation was found between pro‐BNP and the time that had passed since therapy completion (r=−0.378, P= 0.009). In echocardiography, shortening and ejection fractions remained normal, whereas the indexed stroke volume was below 40 mL/m2 in 16/44 patients. The E/A index below 1.5 was found in 6/44 cases. The left ventricular systolic mass remained within the normal range. Negative correlation was noted between isovolumetric diastolic time and pro‐BNP level.

Conclusions:  Increased levels of pro‐BNP after anti‐cancer treatment with the involvement of cardiotoxic substances may indicate the first symptoms of myocardial dysfunction, despite the lack of major echocardiographic disorders.
Evaluation of working memory impairment in children with primary nocturnal enuresis: Evidence from event‐related functional magnetic resonance imaging
Authors: Yu Bing , Guo Qiyong , Fan Guoguang , Ma Hongwei , Wang Lu , Liu Na
Published: February 2011

Aim:  To assess the working memory and explore the differential activations of brain areas in children with primary nocturnal enuresis (PNE) by performing functional magnetic resonance imaging (fMRI) scans using the categorical N‐Back task.

Methods:  Thirteen right‐handed PNE children (M/F = 7:6, average age 11.4 ± 0.8 years) and 15 age‐matched, right‐handed, healthy controls (M/F = 9:6, 11.3 ± 1.0 years) were recruited for the study. First, intelligence tests were performed using Chinese Wechsler Young Children Scales of Intelligence in PNE children and controls. The full intelligence quotient (FIQ), verbal IQ (VIQ), performance IQ (PIQ) and memory/caution (M/C) factor were measured. After intelligence tests, event‐related fMRI scans were performed using the categorical N‐Back working memory task on a 3.0T MR scanner. The percent of correct responses (PCR) and the mean reaction time to correct response (mRT) were recorded and compared; fMRI data were analysed using SPM2, the differences in activation were compared with the single subject and between‐group levels.

Results:  The FIQ, VIQ and PIQ in the PNE group were within the normal range and did not significantly differ from the control group (P > 0.05). The M/C factor was statistically significantly lower in the PNE group (P < 0.05). In the N‐Back test, PNE children had lower PCR and longer mRT than controls (P < 0.05). A between‐group analysis of fMRI data revealed significant attenuation in the left posterior cerebellar lobes of PNE children.

Conclusion:  PNE children had deficits in working memory, and dysfunction in the left cerebella might be associated with their working memory deficits.
Maternal mortality in Australia: Learning from maternal cardiac arrest
Authors: Catling‐Paull Christine , McDonnell Nolan , Moores Alison , Homer Caroline S. E.
Published: February 2011

Cardiac arrest in pregnancy is fortunately a rare event that few midwives will see during their career. The increase in maternal age, the Body Mass Index, cesarean sections, multiple pregnancies, and comorbidities over recent years have increased the probability of cardiac arrest. The early warning signs of impending maternal cardiac arrest are either absent or go unrecognized. Maternal mortality reviews highlight the deficiencies that maternity care providers have in managing cardiac arrest in pregnancy. The aim of this article is to address the knowledge deficiencies of health professionals by reviewing the physiological changes in pregnant women that complicate the management of cardiopulmonary resuscitation, using a case scenario. There are key differences in the management of pregnant women, when compared to standard adult resuscitation. The outcome is dependent on the speed of the response and the consideration of a number of crucial pregnancy‐specific interventions. Staff members need to be adequately trained in order to deal with maternal cardiac arrest and have access to training packages and in‐service education programs. As cardiac arrest in pregnancy is a rare event, emergency drill simulations are an important component of ongoing education.
External validation of the proposed T and N categories of squamous cell carcinoma of the penis
Authors: Al‐Najar Amr , Alkatout Ibrahim , Al‐Sanabani Sakhr , Korda Joanna Beate , Hegele Axel , Bolenz Christian , Jünemann Klaus‐Peter , Naumann Carsten Maik
Published: February 2011

Objectives:  The aim of this study was to validate recently proposed modifications to the current TNM classification of penile squamous cell carcinoma (PSCC) by using data from four German urological centers.

Methods:  We identified 89 patients treated for histologically confirmed PSCC between 1996 and 2008 and reclassified them according to the proposed TNM staging revisions. The proposed changes restricted T2 to tumoral invasion of the corpus spongiosum, whereas invasion of the corpus cavernosum was considered as T3. No changes were made to T1 and T4. Furthermore, N1 was limited to unilateral and N2 to bilateral inguinal lymph node involvement regardless of their number. Pelvic lymph node involvement and fixed lymph node were considered as N3 tumors. The range of follow up after initial treatment was 1–142 months (mean 38).

Results:  Node‐negative cases following the current classification were 65.2% (30/46), 48.5% (16/33) and 87.5% (7/8) for T1, T2 and T3, respectively. According to the proposed classification, N0 cases were markedly reduced in the T3 group (55.5%, 10/18) and relatively changed in the T2 group (56.5%, 13/23). T4 patients had no negative disease status. The 3‐year disease‐specific survival (DSS) rates for the proposed categories were 85.4%, 71.6% and 62.4% for T1, T2 and T3, respectively. For the current categories, the 3‐year DSS rates were 85.4%, 66.9% and 100% for T1, T2 and T3, respectively. The 3‐year DSS of the current N categories was 78.7%, 51% and 13.3% for N1, N2 and N3, respectively. According to the newly proposed categories, the 3‐year DSS was 70%, 50% and 13.3% for N1, N2 and N3, respectively.

Conclusion:  Tumor and nodal staging of the newly proposed TNM classification show a more distinctive survival compared to the current one. However, a multi‐institutional validation is still required to further corroborate the proposed modifications.
Screening for uncorrected refractive error in secondary school‐age students in Fiji
Authors: Lindquist Anthea C , Cama Ana , Keeffe Jill E
Published: February 2011

Abstract

Background:  To estimate the rate of uncorrected refractive error and the associations with gender, age, ethnicity and place of residence.

Design:  Population‐based study.

Participants:  Secondary school students in the Central Division of Fiji.

Methods:  All 58 secondary schools in the Central Division of Fiji were invited to participate and one class per year level at each participating school was randomly selected for screening. Visual acuity was tested using a logMAR chart and pinhole. Outcomes of screening included normal vision, corrected refractive error, uncorrected refractive error (VA <6/12 and improvement to ≥6/12 with pinhole (myopia) or hyperopia (tested with +2.00‐D lens) and low vision (corrected VA <6/18).

Main Outcome Measure:  Prevalence of uncorrected refractive error.

Results:  The participation rate of schools was 91% with 8201 students aged 12–20 years; 8021 students had normal vision; 180 had impaired vision (166 refractive error and 14 low vision). The rate of refractive error was 2.0% (95% CI: 1.7–2.3). Indian students were nearly 6 times more likely (OR: 5.89; 95% CI: 4.17–8.34; P < 0.001) to have refractive error than Fijians. The rate of uncorrected refractive error was 0.9% (95% CI: 0.7–1.1) in Fijian students (OR: 2.89; 95% CI: 1.37–6.10; P = 0.01) and those living in rural areas (OR: 3.28; 95% CI: 1.32–8.16; P = 0.01) were more likely to have uncorrected refractive error. The rate decreased by 20% (95% CI: 4.0–33.0) with each year of increasing age.

Conclusion:  The prevalence of uncorrected refractive error in children is relatively low in Fiji with higher rates in Fijian and rural children.
Diagnostic accuracy of sonohysterography, hysterosalpingography and diagnostic hysteroscopy in diagnosis of arcuate, septate and bicornuate uterus
Authors: Ludwin Artur , Ludwin Inga , Banas Tomasz , Knafel Anna , Miedzyblocki Margaret , Basta Antoni
Published: February 2011

Aim:  To evaluate the diagnostic accuracy of sonohysterography (SHG), hysterosalpingography (HSG) and diagnostic hysteroscopy (DH) in uterine anomaly detection and to assess the role of these various modalities in the differential diagnosis of arcuate, septate and bicornuate uteri.

Methods:  Eighty‐three women, with a history of recurrent spontaneous abortions or infertility and initial diagnosis of uterine anomaly were included in the study. Diagnostic work‐up comprised of SHG, HSG and DH. To assess the accuracy of these methods all the patients underwent hysterolaparoscopy to establish the final diagnosis. The correlation between the results of each method was evaluated and diagnostic accuracy of each method was assessed in the whole group of women as well as in subgroups of arcuate, septate and bicornuate uteri using receiver operator curve (ROC) method by estimating the area under the curve (AUC).

Results:  In the overall diagnosis of uterine anomalies, SHG with accuracy of 95.2% and correlation index of 0.873 (P < 0.001) proved to be a significantly better tool compared to DH (SHGAUC = 0.924 versus DHAUC = 0.761 P = 0.008), while no significant differences were observed between SHG versus HSG and DH versus HSG. SHG showed significantly higher accuracy (100.0%) compared to DH (80.7%) and HSG (80.7%) in differentiation of a septate (SHGAUC = 1.000 versus DHAUC = 0.816 P < 0.001 and SHGAUC = 1.000 versus HSGACC = 0.818; P < 0.001) and bicornuate uterus (SGHAUC = 1.000 versus DHACC = 0.707; P < 0.001 and SHGACC = 1.000 versus HSGAUC = 0.790; P = 0.002).

Conclusion:  SHG is a noninvasive, cost‐effective method available in an outpatient setting that is highly accurate in identifying uterine anomalies, in particular septate and bicornuate uterus.
Confidential enquiries into maternal mortality in the United Arab Emirates: A feasibility study
Authors: Ghazal‐Aswad Saad , Badrinath Padmanabhan , Sidky Islam , Abdul‐Razak Yousef , Davison John , Mirghani Hisham M.
Published: February 2011

Aim:  Routine confidential enquiry into maternal deaths is not yet part of the United Arab Emirates health care system. A confidential enquiry into maternal deaths was undertaken to test the feasibility of this approach and to identify the causes and preventability of maternal deaths.

Material & Methods:  Data on all maternal deaths over a six year period from 1998 to 2003 were abstracted and reviewed by a panel of experts to assign the cause if in doubt, and to determine whether the deaths were preventable.

Results:  Over the six year period, 26 deaths were identified with 122 075 births and the maternal mortality ratio was 21.2/100 000 live births. The mean maternal age at death was 32.3 years and two‐thirds of the deaths occurred during the postpartum period. The leading causes of death were thromboembolic events, hemorrhage and infection. After reviewing the clinical data the expert panel concluded that one third of the deaths were avoidable.

Conclusion:  This first ever confidential enquiry has shown that it is feasible to adopt this approach in the United Arab Emirates and the causes identified would be of help in prioritizing clinical guidelines development and training programs aimed at professionals, which will ultimately lead to safer motherhood for women.
Measurement of the placental total antioxidant status in preeclamptic women using a novel automated method
Authors: Ozturk Ebru , Balat Ozcan , Acılmıs Yurdanur Gurcay , Ozcan Caglayan , Pence Sadrettin , Erel Özcan
Published: February 2011

Aim:  We aimed to measure the levels of total antioxidant status (TAS) in placental samples from preeclamptic pregnant women and evaluate the relation of placental TAS, total oxidant status (TOS) and oxidative stress index (OSI) with fetomaternal compartments using the more recently designated Erel method.

Material and Methods:  Thirty four preeclamptic and 27 normotensive pregnant women were enrolled in this prospective controlled study. Subjects were selected from women attending the Obstetrics and Gynecology Department of Gaziantep University. TAS, TOS, OSI were measured from placental, maternal and cord blood samples using a novel automated method. Statistical analyses were performed with SPSS for Windows version 13.0 (SPSS Inc., Chicago, IL, USA).

Results:  The TAS level of the placenta was evaluated as significantly lower (P < 0.001) in preeclamptic women compared to normotensive women. In preeclamptic pregnancies, while the placental TAS level was not correlated with placental TOS level, the TAS levels of maternal plasma (P < 0.001; r = 0.584) and cord plasma (P < 0.005; r = 0.529) were significantly correlated with the TOS level of the placenta.

Conclusion:  Our results support the concept that placental defective response to an oxidant stimulus plays a central role in the etiopathogenesis of preeclampsia by using the novel automated Erel method.
Lymphangioleiomyomatosis suspected to be a gynecologic disease
Authors: Yamashita Soichi , Nakamura Kazuto , Shinozaki Hiromitsu , Minegishi Takashi
Published: February 2011

Lymphangioleiomyomatosis (LAM) is a rare, systemic disorder that predominantly affects women. Although patients with LAM mostly present with pulmonary symptoms, some patients may present initially with extrapulmonary symptoms. We present a case of a 30‐year‐old Japanese female with abdominal pain during menstrual periods was suspected of having ovarian cancer due to exaggerated ascites observed at a local clinic. Subsequently, she was transferred to our hospital for further investigations, and was diagnosed with LAM. Three years after diagnosis, she had a girl by cesarean section to avoid the progression of pulmonary LAM by vaginal delivery. The patient is undergoing follow‐up treatment with the administration of gonadotropin‐releasing hormone‐analog. Though LAM is rare, gynecologists should know about it because it may occur with gynecological symptoms in young women.
Endometrial cancer implanted within a cesarean section scar
Authors: Baba Tsukasa , Mandai Masaki , Yamanishi Yukio , Suzuki Ayako , Kang Hyun Sook , Konishi Ikuo
Published: February 2011

Several reports have documented adenocarcinoma arising from endometriotic implants within cesarean section (C‐S) scars on the serosal surface of the uterus; however, endometrial cancer invading the C‐S scar from the uterine cavity has not been described. We report a case of a grade 1 endometrioid adenocarcinoma ‘drop’ lesion invading a previous C‐S scar with resultant cervical stromal invasion. Using both MR images and a thorough review of the pathology, the tumor at the C‐S scar was determined to be an implant derived from a primary lesion at the uterine fundus. With increases in the incidence of both endometrial cancer and births by C‐S, it is likely we will encounter more cases of iatrogenic implants of endometrial cancers in C‐S scars.
Intramyometrial uterine cysts with special reference to ultrastructural findings: Report of two cases
Authors: Kim Na Rae , Cho Hyun Yee , Ha Seung‐Yeon
Published: February 2011

An intramyometrial cyst is an extremely rare condition that is characterized by a benign, endometrial, epithelium‐lined cyst within the thickened myometrium. Few cases of intramyometrial cysts have currently been reported in the literature, with or without microscopic description. We have experienced two cases of intramyometrial cysts. One was a 6.5 cm‐sized cyst and the other was a 3.0 cm‐sized cyst accompanied by adenomyosis. Case 1 was a 41‐year‐old female and case 2 was a 51‐year‐old female who had been suffering from menorrhagia for several days. A total hysterectomy was performed for both women. Histological examination showed that the huge cysts were composed of single‐layered, ciliated, cuboidal epithelia surrounded by diffusely thickened myometrium. Ultrastructural examination of case 1 showed the lining cells of the cyst consisted of the basalis‐type endometrial epithelial cells that have surface microvilli. The cells were surrounded by a duplicated basal lamina and joined by well‐formed desmosomes. We report here on two cases of intramyometrial cyst with special reference to the ultrastructural examination, and we discuss the pathogenesis of this rare lesion.
Discovery and structural characterization of a novel glycosidase family of marine origin
Authors: Rebuffet Etienne , Groisillier Agnès , Thompson Andrew , Jeudy Alexandra , Barbeyron Tristan , Czjzek Mirjam , Michel Gurvan
Published: February 2011

The genomic data on heterotrophic marine bacteria suggest the crucial role that microbes play in the global carbon cycle. However, the massive presence of hypothetical proteins hampers our understanding of the mechanisms by which this carbon cycle is carried out. Moreover, genomic data from marine microorganisms are essentially annotated in the light of the biochemical knowledge accumulated on bacteria and fungi which decompose terrestrial plants. However marine algal polysaccharides clearly differ from their terrestrial counterparts, and their associated enzymes usually constitute novel protein families. In this study, we have applied a combination of bioinformatics, targeted activity screening and structural biology to characterize a hypothetical protein from the marine bacteriumZobellia galactanivorans, which is distantly related to GH43 family. This protein is in fact a 1,3‐α‐3,6‐anhydro‐l‐galactosidase (AhgA) which catalyses the last step in the degradation pathway of agars, a family of polysaccharides unique to red macroalgae. AhgA adopts a β‐propeller fold and displays a zinc‐dependent catalytic machinery. This enzyme is the first representative of a new family of glycoside hydrolases, especially abundant in coastal waters. Such genes of marine origin have been transferred to symbiotic microbes associated with marine fishes, but also with some specific human populations.
The management of residual curvature after penile prosthesis implantation in men with Peyronie’s disease
Authors: Garaffa Giulio , Minervini Andrea , Christopher Nim A. , Minhas Suks , Ralph David J.
Published: February 2011

Study Type – Therapy (case series)

Level of Evidence 4

OBJECTIVE

• To report our experience in the management of residual curvature after implantation of a penile prosthesis in men with Peyronie’s disease (PD).

PATIENTS AND METHODS

• From January 1985 to June 2009, 62 (29%) of the 209 patients with PD that have undergone the insertion of a penile prosthesis have required an additional straightening procedure to correct the residual curvature after the insertion of the cylinders of the implant.

• The types of additional manoeuvres, their success in correcting the residual curvature and eventual complications have been reported.

RESULTS

• Among the additional straightening procedures, modelling was more successful in achieving straightening when performed on an inflatable device (84%) than on a malleable implant (54%).

• If the curvature persisted after modelling or if the curvature was ventral, straightening was achieved with tunical plications or incision with or without grafting.

CONCLUSION

• Although it is common for the simple implantation of cylinders alone to straighten the penis, some patients will present a residual curvature that must be successfully corrected with additional straightening procedures.
Predictors of citations in the urological literature
Authors: Willis Daniel L. , Bahler Clint D. , Neuberger Molly M. , Dahm Philipp
Published: February 2011

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

Citation rates have been previously studied in the general medical literature and in a few subspecialties. The results of these studies have differed showing an association with citation rates and multiple study characteristics that include the design of the study, study topic, industry funding, the number of authors and institutions, newsworthiness, sample size, and journal prestige.

Correlates with citation rates have never been studied within the field of urology, but are important as urology is a unique surgical discipline with complex disease processes and rapidly changing technology. Our study is the first to evaluate the factors associated with increased citation rates in the urological literature and will assist authors in improving the impact of their work in urology.

To assess the factors associated with increased citation rates in the urological literature by reviewing articles published in the four major urological journals to help authors improve the impact of their work. A random sample of 200 original research articles published between January and June 2004 was analysed from The Journal of Urology, Urology, European Urology and BJU International. Study information was abstracted by two independent reviewers and citation counts within 4 years of publication were collected using Web of ScienceTM. Study characteristics and citation rates were analysed using median and interquartile ranges (IQRs), and logistic regression analysis was used to evaluate which factors predicted greater citation rates. The overall median number of citations per published article was 6.0 (IQR 3–12). After univariate analysis, we found that study design, study topic, continent of origin and sample size were associated with greater median citation rates. In a multivariate linear regression model, study design and study topic (oncology) predicted increased citation rates. Randomized controlled trials were cited a median of 13.5 times and were the strongest predictor of citation rates with an odds ratio of 115.5 (95% confidence interval 9.4–1419.6). Citation rates are associated with study design and study topic in the urological literature. Authors may improve the impact of their work by designing clinical studies with greater methodological safeguards against bias.
Outpatient department repair of urethrocutaneous fistulae using n‐butyl‐cyanoacrylate (NBCA): a single‐centre experience
Authors: Prestipino Marco , Bertozzi Mirko , Nardi Niccolò , Appignani Antonino
Published: February 2011

Study Type – Therapy (case series)

Level of Evidence 4

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

Cyanoacrylates are tissue glues which polymerize when getting in contact with blood or water, creating a tight closure. It is usually used as octyl or butyl‐cyanoacrylate, and in pediatric age it is applied to close tension free wounds, and it is as an alternative to conventional sutures. Its applications are in the management of low fistula‐in‐ano, or in the treatment of ano‐rectal fistula; other uses include endoscopic treatment in the first episode of variceal bleeding, sutureless circumcision, and the closure of laparoscopic trocar site wounds. Lapointe SP et al. had applied n‐butyl‐cyanoacrylate glue to repair “early fistulae” which occurred after urethroplasty with a good result.

Our experience emphasizes that n‐butyl cyanoacrylate may be applied to repair, not only “early fistulae”, but also the long standing ones with good results.

OBJECTIVES

• To evaluate urethrocutaneous fistula repair after urethroplasty using n‐butyl cyanoacrylate (NBCA) in an outpatient setting.

• To compare results of application of NBCA in ‘early’ and long‐standing fistulae.

PATIENTS AND METHODS

• From January 2003 to December 2006, 13 children (mean age 36 months) were treated in our Outpatient Department for urethrocutaneous fistula, which occurred after hypospadias repair.

• We analysed the data dividing the patients in two groups: group A comprised six children (mean age 22.6 months) that developed a fistula within 2–3 days of catheter removal after urethroplasty (‘early’ fistula) and group B comprised seven children (mean age 42.6 months) with long‐standing fistulae.

• In all patients, a multilayer of NBCA was applied, attaching the edges of the fistula taking care to perform a scarification of the edges of the fistula in patients in group B before the application of the glue.

RESULTS

• Four patients in group A and three patients in group B had definitive fistula repair (seven of 13), and six of the 13 had fistula recurrence.

• Fistulae of ≤2 mm were more easily repaired than fistulae of >2 mm (five of seven vs two of six).

• Fistulae that tended to recover were those that responded to the first applications.

CONCLUSIONS

• In this experience the use of NBCA as a minimally invasive treatment for fistula repair gave good results for repairing fistulae.

• These preliminary results encourage the use of NBCA as a first non‐surgical attempt to repair urethrocutaneous fistulae especially if the fistula is ≤2 mm.

• The failure of this procedure does not compromise a possible subsequent surgical repair.
Upper urinary tract urothelial carcinoma with loco‐regional nodal metastases: insights from the Upper Tract Urothelial Carcinoma Collaboration
Authors: Youssef Ramy F. , Shariat Shahrokh F. , Lotan Yair , Wood Christopher G. , Sagalowsky Arthur I. , Zigeuner Richard , Kikuchi Eiji , Weizer Alon , Raman Jay D. , Remzi Mesut , Kabbani Wareef , Langner Cord , Guo Charles C. , Roscigno Marco , Montorsi Francesco , Bolenz Christian , Kassouf Wassim , Margulis Vitaly
Published: February 2011

Study Type – Therapy (multi‐insititutional cohort)

Level of Evidence 2b

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

Neoadjuvant chemotherapy offers survival benefits for patients with urothelial carcinoma of the bladder. However, it is still underutilized in the ‘biologically similar’ upper tract urothelial carcinoma. Systemic chemotherapy in a neoadjuvant setting is a more attractive option, as loss of renal function after nephrectomy can complicate the administration of adjuvant chemotherapy. We found that preoperative systemic therapy followed by aggressive surgical debulking is a promising treatment strategy for upper tract urothelial carcinoma patients with known or at risk of loco‐regional nodal metastasis.

OBJECTIVE

• To describe a multicentre experience with preoperative platinum‐based chemotherapy before radical nephroureterectomy (RNU) in patients with upper tract urothelial carcinoma (UTUC) with loco‐regional nodal metastases.

PATIENTS AND METHODS

• We identified 313 patients from the UTUC Collaboration (over 1200 patients), who underwent RNU with concomitant retroperitoneal lymph node dissection between 1990 and 2007 and met the inclusion criteria for one of three groups.

• Group 1 comprised patients who received chemotherapy before RNU because of biopsy‐proven loco‐regional nodal metastases.

• Group 2 consisted of patients who underwent primary RNU and were found to have metastatic nodal disease on final pathological review (node‐positive).

• Group 3 comprised a comparative cohort of patients treated with primary RNU for invasive or locally advanced (pT2/pT4) node‐negative (N0) UTUC.

RESULTS

• Groups 1, 2 and 3 included 18, 120 and 175 patients, respectively. The 5‐year disease‐free survival rates were 49%, 30% and 64%, whereas the 5‐year cancer‐specific survival rates were 44%, 36% and 69% in groups 1, 2 and 3, respectively.

• In group 1, on final pathological evaluation, nine patients were pN0, six patients were pT0 and five patients had pT0N0 disease. Kaplan–Meier survival analyses showed similar recurrence and survival rates in group 1 compared with group 3 (P= 0.14 and P= 0.06, respectively).

• Meanwhile, group 2 had significantly lower disease‐free and cancer‐specific survival rates compared with group 3 (P < 0.001 and P < 0.001, respectively) and compared with group 1 (P= 0.04 and P= 0.06, respectively).

CONCLUSIONS

• Preoperative chemotherapy followed by aggressive surgical consolidation may yield favourable oncological outcomes in patients with UTUC with loco‐regional nodal metastases.

• These data support further evaluation of neoadjuvant systemic therapy in patients at risk for locally advanced UTUC.
New Zealand general practice nurses' roles in mental health care
Authors: McKinlay E. , Garrett S. , McBain L. , Dowell T. , Collings S. , Stanley J.
Published: February 2011

MCKINLAY E., GARRETT S., MCBAIN L., DOWELL T., COLLINGS S., & STANLEY J. (2011) New Zealand general practice nurses' roles in mental health care. International Nursing Review58, 225–233

Aim:  To examine the roles of nurses in general practice interdisciplinary teams caring for people with mild to moderate mental health conditions.

Background:  Supporting mental health and well‐being is an important aspect of primary care. Until now nurses in general practice settings have had variable roles in providing mental health care. The New Zealand Primary Mental Health Initiatives are 26 government‐funded, time‐limited projects using different service delivery models.

Methods:  An analysis was undertaken of a qualitative data set of interviews, which included commentary about nurses mental health work collected from the different project stakeholders throughout a 29‐month external evaluation.

Findings:  Two main groups of roles for nurses within the general practice interdisciplinary team were identified: specialist mental health nurses working in newly created roles and practice nurses working in existing roles. Barriers exist to the development of the latter roles.

Conclusions:  Mental health care is a key role in general practice as this is where people frequently present. Internationally, nurses represent a large workforce with the potential to provide effective mental health care. This study found that attitudinal, structural and professional barriers are restricting New Zealand practice nurse role development in the care of those with mild to moderate mental health conditions. There is potential to develop their role within a structured pathway by workforce development and recognition of the value of interdisciplinary care. Given the shortage of mental health professionals this will be an important aspect of the improvement of primary mental health care.
Language Brokering: Stimulating Creativity during the Concept Development Phase
Authors: Dell'Era Claudio , Buganza Tommaso , Fecchio Camilla , Verganti Roberto
Published: February 2011

To improve product styling and ergonomics, a growing number of companies are exploring new ways to involve design consultants in their innovation processes. Many studies have underlined the importance of designers in the innovation processes of successful companies, and some designers have achieved ‘superstar’ status. By capturing, recombining and integrating socio‐cultural knowledge and product semantics across social and industrial settings, designers can help create breakthrough product meanings. The relationship between briefs written by managers and solutions developed by designers is quite complex. Very often managers are unable to appropriately communicate and commercialize new products and services conceptualized by designers because they know only the final output of the innovation process rather than its entire story. The Language Brokering Process can enrich the dialectic between managers and designers, and consequently, it can improve both current and future innovation projects. This methodology elucidates the structure and process adopted by several designers and also illustrates an effective framework for communicating choices to managers. We present results from a student application of this methodology in the development of a new product‐service system for Aquarius (a brand of the Coca‐Cola Group) for two target demographics: ‘desperate housewives’ and ‘young adults’.
Creativity‐Stimulating Leadership: A Critical Incident Study of Leaders' Influence on Creativity in Research Groups
Authors: Hemlin Sven , Olsson Lisa
Published: February 2011

This study examines how group leaders in academic and industrial research settings stimulate creativity in group members. The study uses a modified version of the critical incident technique to collect creative incidents as perceived and reported in interviews with research group members. These incidents were content analysed according to the reported creative situation and the creativity‐stimulating leadership behaviours. Reasons for the importance of the incidents are given (each incident is subdivided into categories and subcategories). The highest ranked categories deal with how leaders provide expertise in research meetings and in supervisory situations, in particular for the advancement of research. Four types of creativity‐stimulating leadership behaviours are also discussed. The study finds few differences between how leaders in universities and industries stimulate creativity.
Antecedents and Consequences of Interaction Quality in Virtual End‐User Communities
Authors: Frey Karsten , Lüthje Christian
Published: February 2011

Research has identified virtual communities as a valuable source of innovation. This study aims to provide an understanding of what makes some end‐user communities more successful in creating innovations than others. Specifically, we explore how the attractiveness of innovations is influenced by the quality of interaction between the community members. Additionally, we consider trust in benevolent behaviour and competition for reputation, as well as their interaction effect, as being possible antecedents of interaction quality. Drawing on data collected through a web‐based survey, this study explores the innovation activities of 127 virtual end‐user communities within the fields of sports, car and motorbike tuning and model building. The findings confirm that interaction quality is positively related to the innovativeness of virtual communities. As regards the antecedents of interaction quality, the analysis indicates that trust is a key prerequisite to co‐operative behaviour among the members of virtual communities. The level of competition, however, only affects interaction quality if a high level of trust is present among members. The results highlight the need to create an environment that facilitates interaction among the members of innovation communities. Furthermore, community managers should ensure that a minimum level of trust is established within the community before stimulating competition.
A RANK SIZE RULE IN A FIRM, PRODUCED FROM A HIERARCHICAL BRANCH OFFICE LOCATION MODEL
Authors: Okumura Makoto , Tsukai Makoto , Takada Naoki
Published: February 2011

Although many studies of the rank‐size rule have examined cities, few have provided a micro‐behavioral foundation for the rule itself. Using a hierarchical branch office location model, this study confirmed that the rank‐size rule appears in the hierarchical structure of a firm calculated using the model. Results show that the power coefficient does not change through a numerical decrease in branch offices when the branch set‐up cost increases. Results also show, however, that the power coefficient becomes larger and that employment becomes more evenly distributed when the effectiveness of branch offices, in terms of the ability to compress and aggregate business information, is enhanced. Progress in information and communications technology (ICT) has enhanced the effectiveness of branch offices. Therefore, a flatter organization of firms can be expected in the future.
LOCAL FISCAL EQUALIZATION IN ESTONIA: IS A REFORM NECESSARY?
Authors: Friedrich Peter , Nam Chang Woon , Reiljan Janno
Published: February 2011

Estonian municipalities perform a broad range of functions, while their fiscal resources are often limited, and large disparities in fiscal capacity prevail within them. Moreover, the power to regulate fiscal affairs is mostly in the hands of the central government. We discuss how a strict application of the connexity principle can protect municipalities from the fiscal bottleneck in this country. We also recommend the introduction of the principle of parallelism and investigate its effects on the unconditional grant system in Estonia. In particular, the procedure of determining the total sum of block grants needs to be changed.
SPATIAL ANALYSIS OF THE JAPANESE GAS INDUSTRY
Authors: Kusakabe Akio , Oh Jinhwan
Published: February 2011

This study analyzes gas prices, costs, and expenditures in Japan from a spatial perspective. The main findings are as follows: (1) Gas prices, costs, and expenditures exhibit spatially dependent patterns throughout Japan and are related to the service area locations of the gas distributors. (2) Regional conditions, including weather, production shipment, and availability and method of procuring domestic natural gas are the main determinants influencing gas prices and cost levels in Japan. These findings indicate that the Japanese government pays special attention to geographical perspectives in dealing with gas policies.
Iceland's Economic Crash and Integration Takeoff: An End to European Union Scepticism?
Authors: Thorhallsson Baldur , Rebhan Christian
Published: February 2011

Iceland's application for European Union (EU) membership in summer 2009 suggests that the country's political parties had reconsidered their longstanding scepticism towards European integration and opted for closer engagement with the EU after the financial crisis. Applying Moravcsik's liberal theory of preference formation, this article investigates the European policies of Iceland's political parties from 2007 to 2010, focusing on four related European issues which have been prominent in the Icelandic EU debate: an application to join the EU with no reservations; the unilateral adoption of the euro; the inclusion of a clause in the constitution allowing a transfer of sovereignty; and the holding of a referendum on an EU application. It analyses whether the economic crash actually led to a change in the political parties' economic preferences and to a subsequent reformulation and adaptation of their long‐term European policy goals and, if not, then how Iceland's decision to apply for EU membership is to be understood. The article concludes that the parties' European policies have remained remarkably stable despite the EU application. This indicates that Iceland's EU membership application can only be understood through a thorough examination of domestic politics, to which liberal intergovernmentalism pays insufficient attention.