bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Sorting the wheat from the chaff’: investigating overload in educational discussion systems
Authors: Kear K.L. , Heap N.W.
Published: January 2007

Abstract  This paper reports on research to investigate design features of asynchronous discussion systems for higher education. The research aims to identify features that increase the benefits of discussion systems and reduce the problems. The paper focuses on a major theme that emerged from interviews with learners and teachers: information overload.

Interview findings, together with literature and system reviews, were used to identify four areas of possible system enhancement aimed at alleviating overload: branched message threading; user recommendations of messages; message filtering; and a personal ‘clippings’ area for useful messages. The paper discusses these enhancements and their evaluation in a prototype discussion system used on a UK Open University course.

Data from the student evaluation indicated that students preferred branched threading to linear threading; they thought filtering and clippings were helpful in principle, although they did not use them very much; and they felt uncomfortable with the idea of recommending each others' messages. Students felt less overloaded in the second part of the course, which was when the system enhancements were made available.
Electronic books versus adult readers: effects on children's emergent literacy as a function of social class
Authors: Korat O. , Shamir A.
Published: January 2007

Abstract  We compared the effects of children's reading of an educational electronic storybook on their emergent literacy with those of being read the same story in its printed version by an adult. We investigated 128 5‐ to 6‐year‐old kindergarteners; 64 children from each of two socio‐economic status (SES) groups: low (LSES) and middle (MSES). In each group, children were randomly assigned to one of three subgroups. The two intervention groups included three book reading sessions each; children in one group individually read the electronic book; in the second group, the children were read the same printed book by an adult; children in the third group, which served as a control, received the regular kindergarten programme. Pre‐ and post‐intervention emergent literacy measures included vocabulary, word recognition and phonological awareness. Compared with the control group, the children's vocabulary scores in both intervention groups improved following reading activity. Children from both interventions groups and both SES groups showed a similarly good level of story comprehension. In both SES groups, compared with the control group, children's phonological awareness and word recognition did not improve following both reading interventions. Implications for future research and for education are discussed.
Analysing students' shared activity while modeling a biological process in a computer‐supported educational environment
Authors: Ergazaki M. , Zogza V. , Komis V.
Published: January 2007

Abstract  This paper reports on a case study with three dyads of high school students (age 14 years) each collaborating on a plant growth modeling task in the computer‐supported educational environment ‘ModelsCreator’. Following a qualitative line of research, the present study aims at highlighting the ways in which the collaborating students as well as the facilitator who supported them are engaged in the computer‐based modeling ‘activity’. The analysis is carried out with a two‐level analytic tool that has been derived within the theoretical framework of ‘activity theory’. Our results show that a wide range of modeling ‘operations’ is activated in the context of the three major modeling ‘actions’ of ‘analysis’, ‘synthesis’ and ‘testing‐interpreting’, which take place in the light of the facilitator‐driven ‘action’ of cognitive and technical support. Moreover, these actions are combined into ‘modeling units’ of various forms which are repeated several times until the modeling process comes to an end. These many‐fold repeats of the ‘modeling unit’ appear to shape a pattern which characterizes the computer‐supported shared ‘activity’ as a whole.
The leaf size/number trade‐off in trees
Authors: KLEIMAN DAVID , AARSSEN LONNIE W.
Published: January 2007

Using a sample of 24 common deciduous angiosperm trees of the Eastern Deciduous Forest region of North America, we tested the hypothesis that leaf size variation across species can be interpreted in terms of a trade‐off between individual leaf mass and the number of leaves produced.

The true nature of a resource allocation trade‐off is detectable only if variation in the total amount of growth is accounted for. We controlled for this effect by measuring all of the components of annual growth associated with leaf production at the individual terminal shoot level. Hence, number of leaves produced was expressed as ‘leafing intensity’, i.e. the number of leaves produced by newly emerged (current year's) shoots, divided by the total volume of these shoots.

Ninety per cent (r2 = 0.90) of the variation in mean individual leaf mass across species, spanning two orders of magnitude, could be accounted for by proportional variation in mean leafing intensity, i.e. representing an isometric trade‐off, with a slope for log‐transformed data that did not deviate significantly from −1.0.

We suggest that this isometric relationship may represent a generalized trade‐off strategy for leaf deployment at the shoot level within temperate deciduous woody species. Following traditional interpretations, adaptation here may involve a fitness benefit associated with a particular leaf size. The present results also suggest an alternative, i.e. selection may instead favour high leafing intensity, with small leaf mass resulting not as a direct adaptation, but simply as a trade‐off.

According to this ‘leafing intensity premium’ hypothesis, the fitness benefits of higher leafing intensity are associated primarily with the fitness benefits of a larger pool of lateral meristems, because each leaf is usually associated with an axillary bud. This may in turn provide greater facility for wide phenotypic plasticity in the allocation of these meristems to vegetative vs. reproductive functions. This represents a plausible hypothesis, we suggest, in accounting for why most woody deciduous angiosperms, even some of the largest/tallest ones, have relatively small leaves.
Over the (range) edge: a 45‐year transplant experiment with the perennial forest herbHyacinthoides non‐scripta
Authors: VAN DER VEKEN SEBASTIAAN , ROGISTER JULES , VERHEYEN KRIS , HERMY MARTIN , NATHAN RAN
Published: January 2007

Most experimental populations of perennial forest herbs have been monitored for only a few years and thus only apply to germination and early seedling survival. Moreover, there is a lack of long‐term, quantitative data on the rates of spread of populations.

We report the results of a cross‐range‐edge transplant experiment established in 1960 with the perennial forest herbHyacinthoides non‐scripta.We evaluated determinants of survival/extinction, performance and migration distances and patterns of 27 transplanted populations after a period of 45 growing seasons.

Of 27 experimental populations ofHyacinthoides non‐scriptaimplanted in 1960, 11 (41%) were still found in 2005–06. Population survival was independent of soil type and changes in the vegetation layer. In contrast, physical disturbance of the soil and major changes in the tree layer as a result of forest management were the main determinants of population extinction. Current population surface areas ranged from 0.23 to 26.23 m2. Plant height, leaf length, number of flowers and seed size were generally lower in the introduced populations than in the source populations. However, densities and proportions of non‐flowering adults were higher, especially in the larger populations. This suggests that these populations are still expanding with more but younger, and thus smaller, individuals.

Observed migration rates were very low, ranging from 0.006 my−1to 0.06 my−1. Migration occurred by the establishment of isolated individuals, which were later absorbed by the advancing wave of the main population. The spread projected for the largest population in the next 45 years is only 14 m for the main population front and 42 m for the furthest individual.

Our results may be representative of population spread for slow dispersing forest plant species after occasional long‐distance dispersal events across a range edge. However, the slow rates of spread indicate that, even if such events occur, it can take a very long time to establish viable population sizes.
Co‐occurrence of birth defects and intellectual disability
Authors: Petterson Beverly , Bourke Jennifer , Leonard Helen , Jacoby Peter , Bower Carol
Published: January 2007

This study used population‐based databases to ascertain birth defects and intellectual disability (ID), defined as full IQ < 70, in children born in Western Australia during 1980–99. Of the children surviving to 1 year (n = 474 285), 4.9% had birth defects and 1.3% ID. ID was identified in 7.9% of children with birth defects. After adjusting for sex, mother’s age, race, parity, plurality, birthweight and gestational age the prevalence ratio (PR) [95% confidence interval (CI)] for ID in children with birth defects compared with those with no birth defects was 7.6 [7.2, 8.0]. Those with chromosomal anomalies comprised 3.2% of the group with birth defects. The percentage ID (and PR [95% CI]) in specific categories were: Down’s syndrome 97% (84.5 [79.4, 90.0]), sex chromosome anomalies 30.3% (31.0 [23.8, 40.3]), other chromosomal anomalies 64.2% (54.2 [47.2, 62.3]). Birth defects were categorised according to system in the 96.8% of children with non‐chromosomal anomalies. The percentage with ID (and PR [95% CI]) for birth defects in each system were: spina bifida 18.8 (16.7 [12.2, 23.0]); nervous (except spina bifida) 38.6 (33.4 [30.3, 36.9]); cardiovascular 4.2 (4.1 [3.5, 4.8]); gastro‐intestinal 2.2 (2.0 [1.5, 2.7]); urogenital 2.6 (2.4 [2.0, 2.8]; musculo‐skeletal 3.6 (4.0 [3.5, 4.6]); other non‐chromosomal 7.0 (7.3 [6.5, 8.3]); and multiple systems 12.3 (10.2 [8.6, 12.2]).

Birth defects were present in 30.2% of children with ID (27.7% of children with mild/moderate ID (IQ 40–69) and 54% of children with severe ID (IQ < 40)). Adjusted PRs for birth defects in children with any ID, mild/moderate ID and severe ID compared with children with normal intellectual function were 6.0 [5.8, 6.3], 5.5 [5.3, 5.8] and 10.5 [9.7, 11.4] respectively. The data are useful for those providing services for children with developmental disabilities especially for predicting family support and respite and accommodation requirements for children and adults with severe ID.
Data collected on maternal dietary exposures in the Danish National Birth Cohort
Authors: Olsen Sjúrdur Fródi , Mikkelsen Tina Broby , Knudsen Vibeke Kildegaard , Orozova‐Bekkevold Ivanka , Halldórsson Thórhallur Ingi , Strøm Marin , Østerdal Marie Louise
Published: January 2007

Recent research suggests that the diet consumed in, or shortly before, pregnancy can potentially lead to maldevelopment and diseases in the offspring, which may become apparent at any time from the embryonic stage until old age. For example, maternal diet may affect the chance of twinning (and associated complications), malformation risk, brain development, and the offspring’s fecundity and risk of contracting cardiovascular dieases and cancer in adult life. Prospectively designed longitudinal studies with sufficient size and data quality are much needed to substantiate or refute these hypotheses.

At present, the Danish National Birth Cohort is likely to be the largest epidemiological database containing extensive information on maternal dietary exposures. By October 2002, 100 000 women had been recruited in early pregnancy, for long‐term follow‐up of themselves and their offspring. The present paper details the information available in the database on early nutritional exposures with emphasis on maternal dietary intake. We also present distributions of selected nutritional exposures.
Lower mortality but higher neonatal morbidity over a decade in very preterm infants
Authors: De Kleine Martin J. K. , Den Ouden A. Lya , Kollée Louis A. A. , Ilsen Adri , Van Wassenaer Aleid G. , Brand Ronald , Verloove‐Vanhorick S. Pauline
Published: January 2007

Better perinatal care has led to better survival of very preterm children, but may or may not have increased the number of children with cerebral and pulmonary morbidity. We therefore investigated the relationship between changes in perinatal care during one decade, and short‐term outcome in very preterm infants. Perinatal risk factors and their effects on 28‐day and in‐hospital mortality, and on intraventricular haemorrhage and bronchopulmonary dysplasia (BPD) in survivors, were compared in two surveys of very preterm singleton infants in the Netherlands.

Between 1983 and 1993, 28‐day mortality decreased from 52.1% to 31.8% in infants of 25–27 weeks’ gestation and from 15.2% to 11.3% in infants of 28–31 weeks’ gestation. The incidence of intraventricular haemorrhage in survivors did not change (44.4% and 43.3% in infants of 25–27 weeks’ gestation, and 29.0% and 24.0% in infants of 28–31 weeks’ gestation). The incidence of BPD in survivors increased from 40.3% to 60.0% in infants of 25–27 weeks’ gestation and remained similar in infants of 28–31 weeks’ gestation (8.5% and 9.8% respectively). In multivariable analysis, higher mortality was associated with congenital malformation, low gestational age, low birthweight, no administration of steroids before birth, low Apgar scores and intraventricular haemorrhage, in 1983 as well in 1993, and with male gender in 1993. The effect of maternal age on mortality diminished significantly between 1983 and 1993. Intraventricular haemorrhage in surviving children was associated with low gestational age and artificial ventilation, both in 1983 and in 1993. The effect of artificial ventilation on the incidence of intraventricular haemorrhage diminished significantly between 1983 and 1993. BPD was associated with low gestational age and artificial ventilation, both in 1983 and in 1993, and with low birthweight and caesarean section in 1993.

We conclude that the better survival of very preterm infants, especially of those of 25–27 weeks’ gestation, has been accompanied by a similar incidence (and thus with an increased absolute number) of children with intraventricular haemorrhage and by an increased incidence of children with BPD.
The relationship between birthweight, weight gain in infancy, and educational attainment in childhood
Authors: Corbett Sally S. , Drewett Robert F. , Durham Matthew , Tymms Peter , Wright Charlotte M.
Published: January 2007

Previous studies have examined the relationship between low weight gain (failure to thrive) in infancy and later cognitive ability, but no study to date appears to have examined the relationship between weight gain in infancy across the ‘normal’ range and later cognitive ability. We report results for a large prospective birth cohort of the relationship between weight gain in infancy and educational attainment at age 10.

Routinely recorded weights from child health clinic records for an annual birth cohort of 3418 children born with gestation >36 weeks were collected, as well as gestation in weeks, birthweight and the postcode, for which the Townsend Deprivation Score was identified. At 10 years of age, those attending schools within the Newcastle Education Authority were given a picture vocabulary and a non‐verbal ability test, and tests of educational attainment in maths and reading. These were successfully linked to the infant weight data for 2294 (63%) of the children, and complete growth data were available for 1724 (47%) of the children who had completed at least one educational test.

There was a significant positive relationship between weight gain in infancy and picture vocabulary, adjusted for economic deprivation, gestational age and birthweight, but not with any of the other outcomes. There was a statistically significant association between birthweight and all four outcomes, which was positive up to about one SD above average birthweight, and negative above.

In this population, the association between early growth and cognitive outcomes is stronger for growth before birth, postnatal weight gain having a relatively minor impact.
Maternal age and parity‐associated risks of preterm birth: differences by race/ethnicity
Authors: Schempf Ashley H. , Branum Amy M. , Lukacs Susan L. , Schoendorf Kenneth C.
Published: January 2007

There is a well‐known interaction between maternal age and parity in the risk of adverse perinatal outcomes, including preterm birth (PTB), such that young multiparae and older primiparae have greater risks. Yet it is not known whether this interaction varies by race/ethnicity. US birth records for singleton births from 2000 to 2002 were used to examine the incidence of PTB by maternal age and parity within non‐Hispanic White, non‐Hispanic Black and Hispanic subgroups. PTB was categorised as moderately (32–36 weeks), very (28–31 weeks), or extremely (<28 weeks) preterm. Odds ratios of PTB according to age and parity were calculated in racial/ethnic specific multinomial logistic regression models. Within each race/ethnicity, comparisons were made relative to 25‐ to 29‐year‐old primiparae.

Young teenagers (<18), particularly multiparae, generally had a higher risk of each degree of PTB among all three racial/ethnic groups. However, Black teenagers did not have a higher risk of extremely PTB. For very and extremely PTB, teenagers had considerably higher risk among Whites than Blacks or Hispanics. Within each racial/ethnic group, older (35+ years) primiparae had similarly higher risk of each category of PTB relative to 25‐ to 29‐year‐old primiparae. Older multiparae had higher risk of moderately and very PTB among Black and Hispanic women only. Adjustment for education did not alter these findings. Teenagers and older primiparae are already widely regarded as having greater perinatal risks. This study suggests that, among Black and Hispanic women, older multiparae may also have a higher risk of moderately and very PTB.
Interprofessional education of medical students and paramedics in emergency medicine
Authors: Hallikainen J. , Väisänen O. , Rosenberg P. H. , Silfvast T. , Niemi‐Murola L.
Published: January 2007

Background:  Emergency medicine is team work from the field to the hospital and therefore it is also important for physicians to understand the work of paramedics, and vice versa. Interprofessional emergency medicine education for medical and paramedic students in Helsinki was started in 2001. It consisted of a 15 European credit transfer system (ECTS) credits programme combining 22 students in 2001. In 2005, the number of students had increased to 25. The programme consisted of three parts: acute illness in childhood and adults (AI), advanced life support (ALS) and trauma life support (TLS). In this paper, we describe the concept of interprofessional education of medical students and paramedics in emergency medicine.

Methods:  After finishing the programmes in 2001 and in 2005, the students’ opinions regarding the education were collected using a standardized questionnaire.

Results:  There were good ratings for the courses in AI (2001 vs. 2005, whole group; 4.3 ± 0.7 vs. 4.2 ± 0.4, P= 0.44) ALS (4.7 ± 0.5 vs. 4.4 ± 0.5, P= 0.06) and TLS (3.9 ± 0.7 vs. 4.4 ± 0.5, P= 0.01) in both years. Most of the medical students considered that this kind of co‐education should be arranged for all medical students (2001 vs. 2005; 4.8 ± 0.6 vs. 4.4 ± 0.5, P= 0.02) and should be obligatory (3.5 ± 1.5 vs. 3.1 ± 1.3, P= 0.35).

Conclusions:  Co‐education was well received and determined by the students as an effective way of improving their knowledge of emergency medicine and medical skills. The programme was rated as very useful and it should be included in the educational curriculum of both student groups.
Circumscribed palmar hypokeratosis
Authors: Jarrett Paul , Sutton Timothy
Published: January 2007

A 66‐year‐old woman presented with a 40‐year history of a slowly enlarging erythematous patch on the left thenar eminence. Histopathology showed a sharp ‘step’ between the uninvolved and involved skin. Epidermal dysplasia and a cornoid lamella were not seen. These are the typical features of circumscribed palmar hypokeratosis.
Therapeutic options for Bowen’s disease
Authors: Moreno Gilberto , Chia Alvin LK , Lim Adrian , Shumack Stephen
Published: January 2007

Multiple therapeutic options are available for treatment of Bowen’s disease. The choice of therapy depends on clinical circumstance and medical practitioner experience. Newer therapies have more extensive support from the literature, but more established therapies may be preferred because of accessibility, cost and efficacy. An overview of the current therapeutic options for Bowen’s disease is presented.
Comparison of direct smear, culture and histology for the diagnosis of onychomycosis
Authors: Karimzadegan‐Nia Motahareh , Mir‐Amin‐Mohammadi Akram , Bouzari Navid , Firooz Alireza
Published: January 2007

A sensitive and efficient diagnostic strategy is needed to confirm the clinical suspicion of onychomycosis. The purpose of this study was to compare the sensitivity of three most commonly used diagnostic methods for onychomycosis. Nail specimens of 96 patients with clinically suspected onychomycosis were evaluated using potassium hydroxide smear, culture and histology. A positive result of any of these tests was considered confirmatory for fungal infection and the sensitivity of each test as well as various combinations of them was calculated. The diagnosis of onychomycosis was confirmed in 47 patients (48.9%). Histology was the most sensitive single test for the diagnosis of onychomycosis, although its sensitivity (80.8%) was not statistically different from smear (76.5%). Both histology and smear were significantly more sensitive than culture (53.2%). The most sensitive combination of tests, smear plus histology, was 97.8% sensitive with 98% negative predictive value. In conclusion, direct smear combined with histological examination is the most sensitive diagnostic approach for onychomycosis.
Dermatologist and family practitioner practice patterns for occupational contact dermatitis
Authors: Holness D Linn , Tabassum Shehrina , Tarlo Susan M , Liss Gary M , Silverman Frances , Manno Michael
Published: January 2007

Medical practitioners have a role in the recognition of occupational contact dermatitis. The longer the duration of symptoms before diagnosis, the poorer the outcome. Our objective was to understand practice patterns, barriers and needs for early diagnosis of occupational contact dermatitis. A survey to obtain information on practice patterns was developed based on the literature and interviews with dermatologists and family practitioners. The survey was sent to all dermatologists and a random sample of 600 family practitioners in Ontario. Fifty‐seven per cent of dermatologists and 9% of family practitioners report seeing more than 20 patients per year with occupational contact dermatitis. The majority of practitioners report taking a workplace exposure history. Barriers to taking a workplace exposure history include time constraints and lack of knowledge. Reasons for referral to specialists include a lack of expertise, testing facilities and knowledge about workers’ compensation, time constraints and inadequate re‐imbursement, whereas lack of access to specialists is a barrier for referral. Although most practitioners identify a need for further education, a low volume of patients and time constraints are key barriers to continuing education. Opportunities are identified to improve educational initiatives and health services delivery for occupational contact dermatitis, tailored to each practitioner group.
Clinical review of 202 patients with vulval lichen sclerosus: A possible association with psoriasis
Authors: Simpkin Susan , Oakley Amanda
Published: January 2007

Two hundred and two patients with clinically typical or biopsy‐confirmed vulval lichen sclerosus were reviewed either at consultation (75%) or by retrospectively examining their chart. At diagnosis, 79% were 50 years or older. Ninety‐six per cent complained of itching, pain and/or dyspareunia. Lichen sclerosus most often affected the labia minora and perineum but 50% had perianal and 13% had extragenital disease. Thirty‐five patients gave a history of psoriasis (17%), which affected the vulval area in 10. Thyroid disease was reported in 39 patients (19%), and 33 gave a family history of thyroid disease. Of those tested (142), 20% had elevated thyroid antibodies. Topical clobetasol propionate was very effective but at least intermittent treatment was required long term in 85%. At follow up, 101 of 185 patients (56%) were asymptomatic but 22 (12%) continued to have moderate‐to‐severe symptoms. Thyroid disease and psoriasis are common associated conditions.
Photo‐onycholysis due to indapamide
Authors: Rutherford Tim , Sinclair Rodney
Published: January 2007

Photo‐onycholysis due to indapamide presented in a 75‐year‐old woman who was being treated with the diuretic for hypertension. The onset of her photo‐onycholysis was delayed because of inadvertent photoprotection in the form of artificial nails and occurred in the absence of a generalized photosensitive eruption. Her nails returned to normal after withdrawal of the drug and application of opaque nail polish.
Fabry disease in a heterozygote presenting as hand ischaemia and painful acroparaesthesia
Authors: Martin Linda , Sturgess Allan , Sillence David , Murrell Dédée F
Published: January 2007

A 48‐year‐old woman presented with acute unilateral ischaemia of the left hand. She had a background of chronic peripheral neuropathic pain, palpitations, anaemia and an episode of superficial thrombophlebitis. Physical examination revealed non‐blanching purple discoloration of her left fingers and her left thumb, index finger and thenar eminance appeared ischaemic. Digital subtraction angiography of the left hand demonstrated reduced flow. Skin punch biopsy histology was unremarkable. The diagnosis of Fabry disease was made on urine lipid profile analysis and confirmed by reduced peripheral blood leukocyte α‐galactosidase A activity.
Pure cutaneous Langerhans cell histiocytosis resembling varicella
Authors: Gönül Müzeyyen , Kılıç Arzu , Çakmak Seray K , Gül Ülker , Ünal Tuba
Published: January 2007

A 5‐month‐old boy presented with multiple, pinkish‐yellow, umblicated, varicelliform vesicles on his trunk. The lesions first appeared on his scalp 2 months earlier. There was also an erythematous, moist and erosive eruption on both axillae, inguinal regions and intergluteal sulcus. He had been treated with topical antibacterial and antiviral therapies. Histopathological investigation of the lesions revealed the diagnosis of Langerhans cell histiocytosis. Systemic involvement was not detected, although detailed investigation was performed. We present our case because he had a varicelliform and intertriginous eruption but did not have internal organ and haematological involvement.
Digital nerve blocks: More gain with less pain
Authors: Scarff Catherine E , Scarff Christopher W
Published: January 2007

Digital nerve blocks are commonly used and effective techniques for achieving anaesthesia of the digit for the purposes of enabling a variety of surgical procedures to be performed. Several techniques have been described including the traditional method, the metacarpal block and the transthecal approach. We favour the traditional technique, and describe a variation of the technique.
Contact dermatitis to a canine anti‐dandruff shampoo
Authors: Rademaker Marius , Barker Scott
Published: January 2007

A 40‐year‐old teacher presented after her third episode of acute facial oedema within 4 months. Each episode occurred 1–2 days after visiting her mother’s house. Patch testing showed positive reactions to miconazole and econazole nitrate. The patient denied use of any antifungal creams, but it transpired that her mother’s dog was being shampooed weekly with an antifungal shampoo containing miconazole. No further episodes were recorded after discontinuing the antifungal shampoo.
Treatment of female pattern hair loss with a combination of spironolactone and minoxidil
Authors: Hoedemaker Carlijn , Van Egmond Sylvia , Sinclair Rodney
Published: January 2007

A 53‐year‐old woman with clinical evidence of female pattern hair loss and histological evidence of androgenetic alopecia was initially treated with the oral antiandrogen spironolactone 200 mg daily. Serial scalp photography documented hair regrowth at 12 months; however, the hair regrowth plateaued, and at 24 months there had been no further improvement in hair density. Twice daily therapy with topical minoxidil 5% solution was then introduced and further regrowth documented, confirming the additive effect of combination therapy.
Facial Sweet’s syndrome mimicking rosacea fulminans
Authors: Anavekar Namrata S , Williams Richard , Chong Alvin H
Published: January 2007

A 36‐year‐old man presented with a non‐pruritic, erythematous facial rash with peri‐oral and peri‐orbital sparing. The initial clinicopathological diagnosis was rosacea fulminans, which was treated with 25 mg oral prednisolone and cephalexin. The patient re‐presented 1 week later with exacerbation of his rash in addition to constitutional symptoms of fever and malaise. A further skin biopsy was taken and the marked neutrophilic infiltrate in the absence of vasculitis made the diagnosis of Sweet’s syndrome (acute febrile neutrophilic dermatosis). High‐dose prednisolone (50 mg daily), topical hydrocortisone cream and ichthammol in zinc ointment were commenced with rapid clinical improvement. This case highlights the importance of considering Sweet’s syndrome as a differential diagnosis when presented with a facial eruption.
Analysis of national database for TEM resected rectal cancer
Authors: Bach S. , Mortensen N. ,   the TEM Users Group
Published: January 2007

Objective:  Transanal endoscopic microsurgery (TEM) is a minimally invasive alternative to rectal resection for cancer. Patients benefit from rapid recovery, excellent function and stoma avoidance.

Method:  The national TEM database has prospectively collated data from 21 centres since 1993. Details of preoperative evaluation, neoadjuvant therapy, technical aspects of surgery, postoperative complications, pathological staging, salvage, recurrence and survival have been recorded for 454 cases of rectal cancer, median follow up 35 months.

Results:  Intention was curative in 69%, for compromise in 22% and palliative in 5%. The morbidity and mortality of TEM was 17.2% and 1.5%. Neoadjuvant radiotherapy was administered in 8% of cases. Pathological staging: pT0 (1.8%), pT1 (52.9%), pT2 (32.8%), pT3 (9.9%) and pTx (3.1%). Margin positivity (<1 mm) occurred in 20%; this was markedly stage dependent. 18% received adjuvant radiotherapy while 13% progressed to major surgery. 5 year disease free survival was 77% pT1, 74% pT2 and 35% pT3 with local recurrence rates of 20%, 25% and 59% respectively. Age (P = 0.01), tumour area (P = 0.02) and pT stage (P = 0.07) predicted for relapse (Cox regression model).

Conclusion:  TEM offers a safe alternative to major surgery curing three quarters of patients with pT1 disease. Although classical surgery must remain the standard of care we envisage future studies of TEM combined with adjuvant therapy.
Total pelvic clearance for advanced pelvic malignancy
Authors: Leon R. , O’Dwyer S. T. , Wilson M. S.
Published: January 2007

Objective:  Advanced pelvic tumours require multidisciplinary care in order to improve outcome.

This is an audit of one specialist unit's experience.

Method:  Consecutive patients referred from 2001 to 2005 for consideration of pelvic clearance were evaluated by retrospective review.

Results:  Of 100 patients assessed, 55 were considered unsuitable for surgery. Exclusions included unresectable pelvic side‐wall disease (25), widespread disease (23) and severe co‐morbidity (7). Forty‐five patients were operated on; 22 had locally advanced disease, 14 had recurrence and nine had residual disease following previous surgery. The primary cancers were colorectal in 24, gynaecological in 10 and urogenital in 10; one patient had nonneoplastic disease. Preoperatively 39 (87%) had examination under anaesthetic (87%) and all had MR and CT imaging. Neoadjuvant radiotherapy and chemotherapy was given in 27 and 18 patients respectively. Following resection by a multi‐speciality team, surgery was considered curative in 40 (90%) of cases as judged by a histologically negative margin. All patients received level 2 care postoperatively with only two requiring level 3 care. There was no 30‐day mortality but there were 17 complications treated conservatively and five that required surgery.

Conclusion:  Advanced pelvic tumours require careful multidisciplinary assessment and treatment. This study shows that this can be done safely with high levels of histological clearance of tumour.
Phylogeny of the parasitic wasp subfamily Charipinae (Hymenoptera, Cynipoidea, Figitidae)
Authors: Paretas‐Martínez Jordi , Arnedo Miquel A. , Melika George , Selfa Jesús , Seco‐Fernández Maria Victoria , Fülöp David , Pujade‐Villar Juli
Published: January 2007

The Charipinae are a major group of hyperparasitoids of Hemiptera. Here, we present the first cladistic analysis of this subfamily's internal relationships, based on 96 morphological characters of adults. The data matrix was analysed using uniformly weighted parsimony. The effects of using alternative weighting schemes were explored by performing additional searches employing implied weights criteria. One of the caveats of implied weights analysis is that it lacks an objective criterion for selecting the value of the concavity function. In the present study, differential weighting was used to explore the sensitivity of our results to the alternative assumptions made in the analysis and to select one of the most parsimonious trees under equal weights, which we regard as being the hypothesis that minimizes the amount of ad hoc assumptions. The validity of the two existing tribes and the monophyly of all the genera of Charipinae were tested, in particular the cosmopolitan and highly species‐rich Alloxysta and Phaenoglyphis, which appear repeatedly in ecological and biochemical studies of host–parasitoid associations. The evolution of several major characters and the relationships between genera are discussed. On the basis of the phylogenetic results, we discuss a number of taxonomic issues. A new classification of the subfamily is proposed in which no tribes are maintained, Carvercharips is synonymyzed with Alloxysta, and the creation of a new genus from Nepal is justified. Our analysis points to the need for a world revision of the basal genus Phaenoglyphis, which is shown as paraphyletic.
Phylogeographic structure suggests multiple glacial refugia in northern Victoria Land for the endemic Antarctic springtailDesoria klovstadi(Collembola, Isotomidae)
Authors: Stevens Mark I. , Frati Francesco , McGaughran Angela , Spinsanti Giacomo , Hogg Ian D.
Published: January 2007

We carried out a phylogeographic study using mtDNA (COII) for the endemic springtailDesoria klovstadi(formerlyIsotoma klovstadi) from northern Victoria Land, Antarctica. Low levels of sequence divergence (≤ 1.6%) across 26 unique haplotypes (from 69 individuals) were distributed according to geographic location. Cape Hallett and Daniell Peninsula contained the highest nucleotide (both > 0.004) and haplotype (both > 0.9) diversity with 10 (of 16) and 8 (of 12) unique haplotypes, respectively. All other populations (Football Saddle, Crater Cirque, Cape Jones) had lower diversity with 2–4 unique haplotypes. Across the 69 individuals from five populations there was only a single haplotype shared between two populations (Daniell Peninsula and Football Saddle). Furthermore, nested clade analyses revealed that some of the Daniell Peninsula haplotypes were more closely related to Football Saddle haplotypes than to any other population. Such discrete haplotype groupings suggest historical (rare) dispersal across the Pleistocene (1.8 mya−11 kya) and Holocene (11 kya–present), coupled with repeated extinction, range contraction and expansion events, and/or incomplete sampling across the species range. The nested clade analyses reveal that a common pattern of climatic and geological history over long‐term glacial habitat fragmentation has determined the geographic and haplotype distributions found forD. klovstadi.
Pelvi‐ureteric junction obstruction in children: the role of urinary transforming growth factor‐β1 and epidermal growth factor
Authors: Taha Mohamed A. , Shokeir Ahmed A. , Osman Hussein G. , Abd El‐Aziz Abd El‐Aziz F. , Farahat Sami E.
Published: January 2007

In this section authors from Egypt describe the use of urinary TGFβ1 and epidermal growth factor in PUJ obstruction. In another paper, authors from London herald what they consider to be a new era in the management of end‐stage renal disease in children, presenting the technique of bilateral synchronous posterior prone retroperitoneoscopic nephrectomy with simultaneous peritoneal dialysis.

OBJECTIVES

To investigate the role of transforming growth factor β1 (TGF‐β1) and epidermal growth factor (EGF) in voided urine for the diagnosis and follow‐up of children with pelvi‐ureteric junction obstruction (PUJO).

PATIENTS, SUBJECTS AND METHODS

The study included 35 children with unilateral PUJO who had a pyeloplasty, and 30 healthy control children. Urine samples were obtained from the bladders of patients before surgery, and as voided samples at 1, 2, 3, 6, 9 and 12 months after surgery. Bladder urine samples were also collected from all 30 children in the control group. TGF‐β1 and EGF were then measured in all the urine samples.

RESULTS

The level of bladder TGF‐β1 before surgery in the patients was significantly higher than that in the healthy control group. A threshold of 190 pg/mg creatinine gave a sensitivity of 100%, a specificity of 80%, a positive predictive value of 85.4%, negative predictive value of 100% and an overall accuracy of 90.8%. Compared with the value before surgery, urinary TGF‐β1 was significantly lower at 1 year after pyeloplasty. There was no significant difference between the level of EGF before surgery in the patients and that in the control group, and no significant difference in the level of EGF before and after surgery over the follow‐up.

CONCLUSION

We do not recommend using EGF levels in voided urine in the routine diagnosis of children with hydronephrosis. The urinary level of TGF‐β1 is a useful noninvasive tool for the long‐term follow‐up of children with PUJO treated by pyeloplasty. Further studies with various controls are required to confirm the diagnostic accuracy of TGF‐β1 in children with PUJO.
Differences and commonalities in the management of locally advanced prostate cancer: results from a survey of oncologists and urologists in the UK
Authors: Payne Heather A. , Gillatt David A.
Published: January 2007

OBJECTIVE

To determine the management practices used by UK oncologists and urologists for patients with locally advanced (non‐metastatic) prostate cancer.

METHODS

Using a postal questionnaire, 155 practising specialist oncologists and urologists were surveyed in the UK. Their views were sought on a multidisciplinary approach to the management of locally advanced prostate cancer and their current management practices.

RESULTS

Over half of respondents recognized the need for both oncologists and urologists to take the lead in management decisions, but almost as many still expected the sole responsibility to lie within their own speciality. Radical radiotherapy (RT) was considered the current optimum treatment by most respondents, but 22% of urologists thought that radical prostatectomy is optimal. Most responders would use luteinizing hormone‐releasing hormone agonists as neoadjuvant and adjuvant to RT but there was significant variation in the favoured duration of treatment of these drugs, and in the dose of RT.

CONCLUSION

This survey suggests that there are still wide variations in the management practices for locally advanced prostate cancer in the UK, and between urologists and oncologists. Improved consensus guidelines are required.
The role of the urothelium in mediating bladder responses to isoprenaline
Authors: Murakami Shigetaka , Chapple Christopher R. , Akino Hironobu , Sellers Donna J. , Chess‐Williams Russell
Published: January 2007

OBJECTIVES

To investigate whether the responses of the pig bladder to isoprenaline (a nonselective β‐adrenoceptor agonist) are influenced by the presence of an intact urothelium and whether any influence might be attributed to the release of nitric oxide (NO), since stimulation of β‐adrenoceptors induces a direct relaxation of detrusor smooth muscle and β‐adrenoceptors are also present on the urothelium.

MATERIAL AND METHODS

Paired (in the presence or absence of urothelium) longitudinal strips of pig bladder dome were set up in tissue baths and the developed tension recorded. Relaxation responses to isoprenaline were examined after pre‐contraction with carbachol. The inhibitory effects of isoprenaline were examined by comparing responses to carbachol in the absence and presence of isoprenaline. To examine a possible role for NO, similar experiments were performed in the presence of the NO synthase inhibitor NG‐nitro‐l‐arginine (L‐NNA).

RESULTS

In the presence of the urothelium, both the potency (pEC50) and the maximum contractile responses to carbachol were depressed. In relaxation experiments, isoprenaline relaxed carbachol pre‐contracted tissues by ≈75%, and the potency and maximum relaxation were similar in the absence and presence of the urothelium. In the inhibition experiments, the presence of isoprenaline caused rightward parallel shifts of the concentration‐response curves to carbachol, but isoprenaline did not influence the maximum contractions. In the presence of the urothelium there was a greater shift with 0.1 µm isoprenaline than in denuded tissues. Incubation with L‐NNA did not affect the influence of the urothelium on responses to isoprenaline in any experimental group.

CONCLUSIONS

The relaxation responses of the bladder to isoprenaline do not appear to involve the urothelium or NO release in vitro. However, contractile responses to carbachol were inhibited in the presence of an intact urothelium, and this might reflect the release of an inhibitory factor other than NO.
The long‐term results of transurethral vaporization of the prostate using plasmakinetic energy
Authors: Kaya Cevdet , Ilktac Abdullah , Gokmen Ersin , Ozturk Metin , Karaman Ihsan M.
Published: January 2007

OBJECTIVE

To assess the long‐term efficacy and the safety of plasmakinetic vaporization of prostate (PKVP, Gyrus Medical Ltd., Bucks, UK) against standard transurethral resection of the prostate (TURP) for symptomatic prostatic obstruction.

PATIENTS AND METHODS

Of 75 patients admitted to our clinic with symptomatic prostatic obstruction between 2001 and 2003, 40 who were randomized to undergo either TURP or PKVP, and who had returned for the follow‐up, were included in this study. All treated patients completed the 36‐months of follow‐up; 25 had had PKVP and 15 a standard TURP. After surgery the treatment outcome was evaluated using the International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax) and long‐term complications of surgery.

RESULTS

The two groups had similar baseline characteristics. The improvement in both groups was statistically significant for the IPSS and Qmax at 24 and 36 months vs the baseline values (P < 0.05). The mean (sd) IPSS decreased from 21 (3.4) to 7.1 (1.5) and 7.6 (1.4) after PKVP and from 22 (3.8) to 5.2 (1.1) and 5.7 (1.2) after TURP, at 24 and 36 months, respectively. The mean Qmax for the both groups increased significantly from baseline values at 2 and 3 years, respectively, at 20.8 (2.4) and 21.8 (3.1) mL/s after TURP, which was statistically significantly better than after PKVP, at 12.5 (2.1) and 14.4 (2.6) mL/s, respectively (P < 0.05). Although three patients (12%) in the PKVP group had TURP at 14, 20 and 36 months, respectively, for residual adenoma tissue, one patient had an additional operation after TURP. Bulbar urethral strictures occurred in one patient in each group, requiring internal optical urethrotomy. Erectile dysfunction was reported by three patients after PKVP (12%) and by two of 15 after TURP who were potent before surgery (P > 0.05). The retrograde ejaculation rates in patients with erectile function were similar in both groups (56% and nine of 15, respectively; P > 0.05). In the PKVP and TURP groups, 12 (48%) and nine of 15 patients were satisfied overall.

CONCLUSIONS

Although early results showed that PKVP was a good alternative technique among the minimally invasive methods for surgically managing prostatic obstruction, the clinical outcome of PKVP in the long term was not comparable to the results after TURP.
The relationship between daily calcium intake and bone mineral density in men with prostate cancer
Authors: Planas Jacques , Morote Juan , Orsola Anna , Salvador Carlos , Trilla Enrique , Cecchini Lluis , Raventós Carles X.
Published: January 2007

OBJECTIVE

To analyse the relationship between daily calcium intake (DCI) and bone mineral density (BMD) in patients with prostate cancer, and to assess if DCI is a risk factor for osteoporosis in this group of patients.

PATIENTS AND METHODS

DCI was assessed by a standard questionnaire answered by men with prostate cancer who had had bone densitometry. BMD was measured by dual‐energy X‐ray absorptiometry in the lumbar spine and different hip sites, in a cross‐sectional study including 372 men with prostate cancer free of bone metastases, 71.5% (266) under androgen‐deprivation therapy (ADT) and 28.5% (106) after radical prostatectomy (RP). Osteoporosis was defined according to the International Society for Clinical Densitometry official position (2005).

RESULTS

A DCI of <1000 mg, the National Institute of Health recommendation, was detected in 93% of the men, (93.5% under ADT and 91.5% after RP). Osteoporosis was identified in 49.2% (183) of the patients, 54.9% (146) under ADT and 34.9% (37) after RP. The mean DCI was 609.7 mg in men with osteoporosis and 682.8 mg in those without (P < 0.001); in men under ADT the mean DCI remained significantly lower in those with osteoporosis (615.5 vs 700.4 mg, P < 0.001). A multivariate analysis showed that DCI was an independent risk factor for osteoporosis, together with patient age, ADT and its duration.

CONCLUSIONS

DCI seems to be related to BMD; a low DCI was an independent risk factor for osteoporosis in men with prostate cancer. In the study population overall the DCI was inadequate. Urologists should recommend a DCI of >1000 mg in patients with prostate cancer, especially in those under ADT.