bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary anastomosis vs nonrestorative resection for perforated diverticulitis with peritonitis: a prematurely terminated randomized controlled trial
Authors: Binda G. A. , Karas J. R. , Serventi A. , Sokmen S. , Amato A. , Hydo L. , Bergamaschi R. ,   for the Study Group on Diverticulitis
Published: June 2012

Aim  This randomized controlled trial (RCT) was performed to test the hypothesis that adverse event rates following primary anastomosis (PRA) are not inferior to those following nonrestorative colon resection for perforated diverticulitis with peritonitis.

Method  Patients admitted for perforated diverticulitis with peritonitis were randomly assigned to PRA (left colon resection with PRA and loop ileostomy) or nonrestorative colon resection (left colon resection with end colostomy). The endpoint was adverse events defined as mortality and morbidity following PRA or nonrestorative colon resection and stoma reversal. The estimated sample size was 300 patients in each study arm (alpha 0.10; 90% power).

Results  During a 9‐year period, 90 patients were randomly assigned to undergo PRA or nonrestorative colon resection in 14 centres in eight countries. Thirty‐four PRA patients were comparable to 56 nonrestorative colon resection patients for age (P = 0.481), gender (P = 0.190), APACHE III (P = 0.281), Hinchey stage III vs IV (P = 0.394) and Mannheim Peritonitis Index (P = 0.145). There were no differences in operating time (P = 0.231), surgeries performed at night (P = 0.083), open vs laparoscopic approach (P = 0.419) and litres of peritoneal irrigation (P = 0.096). There was no significant difference in mortality (2.9 vs 10.7%; P = 0.247) and morbidity (35.3 vs 46.4%; P = 0.38) following PRA or nonrestorative colon resection. After a similar lag time (P = 0.43), 64.7% of PRA patients and 60% of nonrestorative colon resection patients underwent stoma reversal (P = 0.659). Adverse event rates following stoma reversal differed significantly after PRA and reversal of nonrestorative resection (4.5 vs 23.5%; P = 0.0589).

Conclusion  No conclusions may be drawn on preference of one treatment over another from this RCT because it was prematurely terminated following accrual of 15% of its sample size.
Small bowel exploration and resection using single‐port surgery: a safe and feasible approach
Authors: Dhumane P. , Mutter D. , D’Agostino J. , Mavrogenis G. , Leroy J. , Marescaux J.
Published: June 2012

Aim  The aim of this study is to demonstrate the efficacy of wireless capsule endoscopy for preoperative identification of bleeding sources and/or small bowel tumours in surgical patients and to evaluate the feasibility of single‐port surgery in the treatment of such pathologies.

Method  Five patients presenting with obscure gastrointestinal bleeding or/and mild small bowel obstruction were investigated to diagnose and localize the bleeding source or tumour using capsule endoscopy imaging, and, if necessary, with other investigative modalities. All patients were operated on using single‐port surgery for small bowel exploration, lesion confirmation, small bowel resection and anastomosis.

Results  Small bowel pathology was successfully detected by video capsule endoscopy in three of four patients, and was further substantiated by contrast CT, double‐balloon endoscopy or enteroclysis. Complete small bowel exploration, intra‐operative identification and oncological resection of the involved segment and anastomosis (intracorporeal and extracorporeal) was successfully performed in all five patients using single‐port access without any complication, morbidity or mortality.

Conclusion  This study demonstrates the feasibility and safety of single‐port small bowel resection performed after a high‐quality preoperative localization of the tumour.
The frequency of advanced adenoma in consulting patients: a nationwide survey in Iceland (2003–2006)
Authors: Rubio C. A. , Kristjansdottir S. , Thodleifsson B. , Olafsdóttir E. , Jonasson J. G.
Published: June 2012

Aim  To assess the frequency of advanced colorectal adenomas in consulting patients in Iceland.

Method  The histological configuration of colorectal adenomas (CRA) found in 3603 patients was classified into tubular (TA), villous (VA) and serrated (SA) and the degree of neoplastic severity into low‐grade dysplasia (LGD), high‐grade dysplasia (HGD), carcinoma in situ (CIS), intramucosal carcinoma (IMC) and submucosal carcinoma (SMC). Advanced CRA were those showing HGD, CIS, IMC and/or SMCs. In patients with two or more adenomas, the adenoma with the highest degree of epithelial neoplasia was selected to record cases.

Results  Between 2003 and 2006 a total of 19 424 endoscopic examinations (13 572 colonoscopies and 5852 sigmoidoscopies) were performed in Iceland (mean, 4856 endoscopies per year). At histology a mean of 759.3 CRA per year were found. Thus, CRA were found in 15.6% of the colorectal endoscopies performed per year. Out of the 3037 CRA studied, 67% were TA, 29% VA and the remaining 4% SA. LGD was present in 79%, HGD in 15%, CIS in 2.4%, IMC in 1.9% and SMC in 1.9%. Consequently, out of 3037 CRA investigated, 652 (21.5%) were advanced CRA; 71% of these showed HGD, 11% CIS, 9% IMC and 9% SMC. Two‐thirds of the 652 advanced CRA were advanced VA, and more than three‐quarters of 58 advanced CRA with SMC, were advanced VA.

Conclusion  Advanced VA displaying intraepithelial neoplasia (HGD and CIS) showed a propensity to evolve into invasive carcinoma. Accordingly, VA displaying HGD and CIS might be regarded as biological markers for predicting colorectal cancer risk. This is the first study in which the frequency of CRA and advanced CRA detected in consulting patients is reported on a nationwide basis.
Survival outcome of patients with screening versus symptomatically detected colorectal cancers
Authors: Pande R. , Froggatt P. , Baragwanath P. , Harmston C.
Published: June 2012

Aim  The national Bowel Cancer Screening Programme has been rolled out nationwide following pilot screening in two health authorities in the UK. The aim of this study was to define overall 5‐year survival of screen detected cancers and to compare the overall survival outcome of screened vs symptomatic patients over a 10‐year period.

Method  All patients with colorectal cancer treated at one trust in patients of screening age (50–69 years) during the pilot screening programme (2000–2008) were analysed. Patients were defined as screen detected or symptomatically detected. Disease pathology and recurrence data were obtained from the hospital’s computerized results reporting system and mortality was cross‐matched with data from the West Midlands Cancer Intelligence Network.

Results  In all, 633 patients aged 50–69 were identified in the study period; 155 patients had a screen detected cancer and 478 did not. A log‐rank test completed on survival outcomes indicated that survival was significantly worse in the symptomatic group. This difference persisted if only patients treated with curative intent were considered.

Conclusion  Survival outcome was significantly better in the screened vs the symptomatic population in all groups and also in those treated for curative intent. There was a trend towards better survival for screen detected cancer when compared stage for stage.
Is colorectal surveillance indicated in patients with PTEN mutations?
Authors: Nieuwenhuis M. H. , Kets C. M. , Murphy‐Ryan M. , Colas C. , Möller P. , Hes F. J. , Hodgson S. V. , Olderode‐Berends M. J. W. , Aretz S. , Heinimann K. , Gomez Garcia E. B. , Douglas F. , Spigelman A. , Timshel S. , Lindor N. M. , Vasen H. F. A.
Published: June 2012

Aim  Patients with germline phosphatase and tensin homologue (PTEN) mutations develop hamartomatous lesions in several organs and are at increased risk of various malignancies. We assessed the lifetime risk of benign and malignant gastrointestinal lesions in patients with a proven PTEN mutation.

Method  Data on gender, mutation, dates of birth, last contact, and diagnosis, location and type of gastrointestinal lesions were collected from nine countries. The lifetime risk of gastrointestinal lesions was calculated by Kaplan–Meier methods.

Results  A total of 156 patients (67 men, 43%) from 101 families with a PTEN mutation were included. Patients were born between 1928 and 2008. Benign gastrointestinal polyps were reported in 49 (31%) patients at a mean age of 38 years (range 18–62 years) and were most often hamartomas. Twenty‐two (44%) patients had upper as well as lower gastrointestinal lesions, 14 (29%) had only colonic lesions and 13 (27%) had gastrointestinal lesions at unknown sites. The cumulative risk of developing benign gastrointestinal polyps was 70% at age 60. Four patients (two men) developed colorectal carcinoma at 53, 57, 59 and 62 years, respectively. The cumulative risk of developing colorectal carcinoma was 18% at age 60. Except for one carcinoid in the small intestine, no upper gastrointestinal cancers were observed.

Conclusion  Benign gastrointestinal lesions are common in PTEN mutation carriers, and a three‐ to four‐fold increased lifetime risk of colorectal cancer compared with the general population may exist. Colorectal screening of patients with germline PTEN mutations is recommended, starting at age 40 years.
The WIMAT colonoscopy suitcase model: a novel porcine polypectomy trainer
Authors: Ansell J. , Arnaoutakis K. , Goddard S. , Hawkes N. , Leicester R. , Dolwani S. , Torkington J. , Warren N.
Published: June 2012

Aim  Simulation allows the acquisition of complex skills within a safe environment. Endoscopic polypectomy has a long learning curve. Our novel polypectomy simulator may be a useful adjunct for training. The aim of this study was to assess its content validity.

Method  The Welsh Institute for Minimal Access Therapy (WIMAT) endoscopy suitcase was designed to simulate colonic polypectomy. Participants from regional and national courses were recruited into the study. Each undertook a standardized simulated polypectomy and completed a seven‐point Likert scale questionnaire examining its realism.

Results  In all, 17 participants completed the questionnaire: 15 (88.2%) gastroenterologists, one (5.9%) colorectal surgeon and one (5.9%) experienced endoscopic nurse specialist. Of the gastroenterologists, seven (46.7%) were consultants and eight (53.3%) were senior trainees or Post CCT (Certificate of Completion of Training) fellows. The mean number of real‐life polypectomies performed by the cohort was 156 (95% CI 35–355). The highest scores were for ‘mucosal realism’ (median score 6.0, P = 0.001), ‘endoscopic snare control’ (median score 6.0, P = 0.001), ‘handling the polyp’ (median score 6.0, P = 0.001) and ‘raising mucosa’ (median score 6.0, P < 0.001). Of the 15 parameters examined only three were not statistically significant in favour of the simulator. These were ‘anatomical realism of sessile polyps’, ‘resistance of scope movement’ and ‘paradoxical motion’. The overall score for the simulation was 6.0 (P < 0.001). There was no significant difference between the level of difficulty of the simulator compared with real life (median score 4.0, P = 0.559).

Conclusion  The WIMAT colonoscopy suitcase model has excellent content validity for several parameters. This may have potential applications in medical training and assessment.
Combined modality treatment for complex fistulating perianal Crohn’s disease
Authors: Antakia R. , Shorthouse A. J. , Robinson K. , Lobo A. J.
Published: June 2012

Aim  Perianal disease affects 33% (range 8–90%) of patients with Crohn’s disease. Fistulae are often complex and their management is often difficult and unsatisfactory. This study was a retrospective assessment of a combination of surgical treatment with a standardized protocol of infliximab (IFX) therapy.

Method  A consecutive series of patients with complex perianal Crohn’s disease, presenting between January 2003 and June 2008, were included. Acute sepsis was initially treated with antibiotics and/or surgical drainage (MRI guided when appropriate) and loose seton insertion. IFX was given at 5 mg/kg, at 0, 2 and 6 weeks. End‐points were complete, partial or no response. Setons were empirically removed after the second cycle of IFX.

Results  Forty‐eight patients, average age 46 (range 24–82) years, with perianal Crohn’s disease were identified. Three patients stopped IFX after the second infusion, either because of allergy (two patients) or for failure to respond (one patient). Fourteen patients were given maintenance IFX at 8‐weekly intervals. Results were recorded for 48 patients, of whom 14 (29%) had a complete response, 20 (42%) had a partial response and 14 (29%) had no response to treatment. Outpatient follow‐up was for a median of 20 months.

Conclusion  Combining surgical procedures with IFX resulted in complete and partial remission in 29% and 42% of patients, respectively. No serious side effects occurred. Using a combined, intensive medico‐surgical approach, good initial control of perianal disease was achieved safely.
New developments in castrate‐resistant prostate cancer
Authors: Shore N. , Mason M. , de Reijke Th. M.
Published: June 2012

Castrate‐resistant prostate cancer (CRPC) occurs when disease progresses in the presence of castrate levels of androgens and remains sensitive to further hormonal manipulation. For many years the treatment of CRPC was limited to the use of docetaxel for metastatic disease. However, this has recently changed with the approval of several new agents. Sipuleucel‐T, an immunotherapeutic vaccine, is now available in the US for patients with non‐metastatic CRPC and abiraterone, an oral enzyme inhibitor of androgen biosynthesis, as well as cabazitaxel, a cytotoxic chemotherapeutic, have been approved for the treatment of metastatic CRPC. Also, denosumab, a subcutaneous antibody, is now an option for the treatment of patients with CRPC with bone metastases, in addition to zoledronic acid, an intravenous bisphosphonate.

Further treatment advances for metastatic CRPC therapeutics are in late stage phase III development. These include therapies affecting the androgen receptor (MDV3100) as well as additional immune‐based therapeutics, PROSTVAC and ipilimumab. A broad range of agents is also emerging under the term targeted therapies. The endothelin‐A receptor antagonist zibotentan, the tyrosine kinase inhibitors dasatinib, sorafenib and cabozantinib, the anti‐angiogenic agent aflibercept, and the clusterin inhibitor custirsen, are all currently being tested for efficacy in metastatic CRPC. The mechanism of action of these and other promising agents are discussed alongside current therapeutic options and their potential place in the treatment landscape for CRPC is considered.
A pocket‐sized disposable device for testing the integrity of sensation in the outpatient setting
Authors: Bowling F. L. , Abbott C. A. , Harris W. E. , Atanasov S. , Malik R. A. , Boulton A. J. M.
Published: June 2012

Diabet. Med. 29, 1550–1552 (2012)

Aims  To compare the Ipswich Touch Test and the VibraTip with the Neuropathy Disability Score and the vibration perception threshold for detecting the ‘at‐risk’ foot.

Methods  We directly compared the Ipswich Touch Test and the VibraTip with both the Neuropathy Disability Score ≥ 6 and the vibration perception threshold ≥ 25 V indicating ‘at‐risk’ feet in 83 individuals.

Results  The vibration perception threshold and Neuropathy Disability Score tests exhibited almost perfect agreement with each other (P < 0.001). The VibraTip and Ipswich Touch Test results were identical (P < 0.001). The VibraTip and Ipswich Touch Test results also exhibited almost perfect agreement with the vibration perception threshold (P < 0.001) and the Neuropathy Disability Score (P < 0.001).

Conclusions  These two simple and efficient tests are easy to teach, reliable and can be used in any setting, and neither requires an external power source. We conclude that both the VibraTip and the Ipswich Touch Test are reliable and sensitive tests for identifying the ‘high‐risk’ foot.
Key Resources and Internationalization Modes of Creative Knowledge‐Intensive Business Services: The Case of Design Consultancies
Authors: Abecassis‐Moedas Celine , Ben Mahmoud‐Jouini Sihem , Dell'Era Claudio , Manceau Delphine , Verganti Roberto
Published: June 2012

In the ‘knowledge economy’, knowledge‐intensive business services (KIBS) are a key driver for innovation and competitiveness. The internationalization of these businesses raises challenges given their specificities such as knowledge intensity, the importance of customer interaction and intimacy in service delivery. This paper focuses on design consultancies as a specific type of creative KIBS for which these characteristics are emphasized. The objective of this research is to analyse the resources leveraged by the firms to compete internationally. It is based on 11 case studies of design consultancies located in five different countries (France, Italy, Portugal, Spain and the UK) that were selected for their capacity to perform at the international level for several years. The paper advances three internationalization modes depending on contingent variables and focusing on specific resources that enable international competitiveness: star‐based, process‐based and glocality‐based. In star‐based creative KIBS, the individual designer has developed a reputation that attracts customers internationally, operating as a brand. In process‐based creative KIBS, the reputation of a collective creative process attracts clients from other countries. In glocality‐based creative KIBS, the geographical proximity obtained by opening international offices helps to develop a close understanding of the client through frequent interactions, and also to know the client's market well and to better understand local codes and signs. These modes complement those presented in the existing internationalization literature which takes the peculiarities of creative KIBS into consideration.
Vacancy Referrals, Job Search, and the Duration of Unemployment: A Randomized Experiment
Authors: Engström Per , Hesselius Patrik , Holmlund Bertil
Published: June 2012

One goal of the Public Employment Service is to facilitate matching between unemployed job‐seekers and job vacancies; another goal is to monitor job search so as to bring search efforts among the unemployed in line with search requirements. The referral of job‐seekers to vacancies is one instrument used for these purposes. We report results from a randomized Swedish experiment where the outcome of referrals is examined. To what extent do unemployed individuals actually apply for the jobs they are referred to? Does information to job‐seekers about increased monitoring affect the probability of applying and the probability of leaving unemployment? The experiment indicates that a relatively large fraction (one‐third) of the referrals do not result in job applications. Information about intensified monitoring causes an increase in the probability of job application, especially among young people. However, we find no significant impact on the duration of unemployment.
Problems in pattern alopecia
Authors: Richards Kristen N , Rashid Rashid M
Published: June 2012

Female pattern hair loss (FPHL) was originally described as synonymous with androgenetic alopecia. However, the role of androgens in FPHL has not been proven, and the etiology is not yet defined. Several patterns of hair loss in women have been described, in addition to descriptions of scarring alopecias mimicking FPHL. In this paper, we discuss FPHL as an entity other than androgenetic alopecia and suggest that de‐emphasizing the physicians reliance on pattern in the diagnosis of hair loss in women, and instead utilizing other tools including dermoscopy and histopathology, would benefit clinician’s efforts in treating alopecias.
Hyaluronic acid plus mannitol treatment for improved skin hydration and elasticity
Authors: Taieb Maryna , Gay Christian , Sebban Sandrine , Secnazi Pierre
Published: June 2012

Background  Mesotherapy treatment of aging skin aims to replace depleting levels of minerals, vitamins, amino acids, and hyaluronic acid (HA).

Aim  To investigate the efficacy of 13.5 mg/g uncross‐linked HA+0.9% mannitol (HA+mannitol) on skin hydration and elasticity.

Patients/Methods  Four centers enrolled 34 women: Subgroup 1 comprised 27 subjects injected using a “depot” technique; Subgroup 2 comprised seven subjects injected using a “picotage” technique.

Results  A notable difference was seen between the two subgroups in outcome and subject satisfaction. In Subgroup 1, a significant improvement was seen in hydration, anisotropy, and skin roughness, but Subgroup 2 showed no significant improvements. Most physicians assessed HA+mannitol as “easy/very easy” to inject. Physician esthetic assessment in Subgroup 1 was “improved/very improved” for >90% of subjects at Day 60, and >80% according to subject assessment. 95% of subjects were delighted with treatment, and 85% would undergo repeat treatment and would recommend treatment to a friend. However, results for Subgroup 2 indicated 86% of subjects were unhappy with treatment and 83% would refuse to undergo repeat treatment.

Conclusions  HA+mannitol is effective for skin hydration, anisotropy, and roughness when treated using a depot technique.
Modulation of telomere binding proteins: a future area of research for skin protection and anti‐aging target
Authors: Imbert Isabelle , Botto Jean‐Marie , Farra Claude D. , Domloge Nouha
Published: June 2012

Telomere shortening is considered as one of the main characteristics of cellular aging by limiting cellular division. Besides the fundamental advances through the discoveries of telomere and telomerase, which were recognized by a Nobel Prize, telomere protection remains an essential area of research. Recently, it was evidenced that studying the cross‐talks between the proteins associated with telomere should provide a better understanding of the mechanistic basis for telomere‐associated aging phenotypes. In this review, we discuss the current knowledge on telomere shortening, telomerase activity, and the essential role of telomere binding proteins in telomere stabilization and telomere‐end protection. This review highlights the capacity of telomere binding proteins to limit cellular senescence and to maintain skin tissue homeostasis, which is of key importance to reduce accelerated tissue aging. Future studies addressing telomere protection and limitation of DNA damage response in human skin should include investigations on telomere binding proteins. As little is known about the expression of telomere binding proteins in human skin and modulation of their expression with aging, it remains an interesting field of skin research and a key area for future skin protection and anti‐aging developments.
Skin presenting a higher level of caspase‐14 is better protected from UVB irradiation according to in vitro and in vivo studies
Authors: Bergeron Laurine , Gondran Catherine , Oberto Gilles , Garcia Noelle , Botto Jean Marie , Cucumel Karine , Dal Farra Claude , Domloge Nouha
Published: June 2012

Caspase‐14, a cysteine endoproteinase belonging to the conserved family of aspartate‐specific proteinases, was shown to play an important role in the terminal differentiation of keratinocytes and barrier function of the skin. In the present study, we developed a biofunctional compound that we described as a modulator of caspase‐14 expression. Using normal human keratinocytes (NHK) in culture and human skin biopsies, this compound was shown to increase caspase‐14 expression and partially reverse the effect of caspase‐14‐specific siRNA on NHK. Moreover, the increase in filaggrin expression visualized on skin biopsies and the recovery of the barrier structure after tape‐stripping indicated that this compound could exhibit a beneficial effect on the skin barrier function. Considering the possible link between caspase‐14 and the barrier function, a UVB irradiation on NHK and skin biopsies previously treated with the caspase‐14 inducer, was performed. Results indicated that pretreated skin biopsies exhibited less signs of UV damage such as active caspase‐3 and cyclobutane pyrimidine dimers (CPDs). Likewise, pretreated NHK were protected from UV‐induced genomic DNA damage, as revealed by the Comet Assay. Finally, a clinical test showed a reduction of transepidermal water loss (TEWL) on the treated skin compared with placebo, under UV stress condition, confirming a protecting effect. Taken together, these results strongly suggest that, by increasing caspase‐14 expression, the biofunctional compound could exhibit a protective effect on the skin barrier function, especially in case of barrier damage and UV irradiation.
Greater Than 95% Success with 14‐day Bismuth Quadruple Anti‐Helicobacter pylori Therapy: A Pilot Study in US Hispanics
Authors: Salazar Cesar O. , Cardenas Victor M. , Reddy Rita K. , Dominguez Delfina C. , Snyder Lindsey K. , Graham David Y.
Published: June 2012

Background

A combination capsule of bismuth, metronidazole, and tetracycline plus omeprazole given as 10‐day therapy has an overall effectiveness of 92–93% in per‐protocol analysis (Grade B) with eradication of 86–91% of metronidazole‐resistant
Helicobacter pylori. This study aimed to explore whether extending the duration to 14 days would improve overall effectiveness per protocol to ≥95% (Grade A) in a population in which metronidazole resistance was anticipated to exist.

Methods

A one‐arm, open‐label pilot study of
H. pylori‐infected, asymptomatic/mildly dyspeptic adults, Hispanic residents of El Paso, Texas, received a 14‐day course of omeprazole, plus the combination capsule. We cultured and Gram‐stained specimens obtained using a minimally invasive orogastric brush.
Helicobacter pylori status was determined by 13
C‐urea breath test at 4 or more weeks post‐therapy.

Results

Forty‐seven subjects (7 men and 40 women, average age 42 years) were entered. The per‐protocol effectiveness was 97.1% (33/34) (95% mid‐P
CI: 86.3, 99.9); 100% of metronidazole‐resistant strains were eradicated. Side effects were mild and self‐limited but contributed to nonadherence. Therapy taken for <10 days was more likely to result in eradication failure (p < .001). Office‐based orogastric brushing was well tolerated; positive cultures were obtained in 95%. Gram staining showed
H. pylori‐like forms in all specimens.

Conclusions

This pilot study supports the concept that 14‐day OBMT therapy is likely to be more efficacious for
H. pylori eradication (Grade A, PP basis) than a 10‐day course where metronidazole resistance is suspected. If confirmed, 14 days should be recommended in populations where metronidazole resistance is common.
Recent Advances in the Discovery and Preclinical Testing of Novel Compounds for the Prevention and/or Treatment of Alcohol Use Disorders
Authors: Davies Daryl L. , Bortolato Marco , Finn Deborah A. , Ramaker Marcia J. , Barak Segev , Ron Dorit , Liang Jing , Olsen Richard W.
Published: June 2012

Alcohol abuse and dependence have a staggering socioeconomic impact, yet current therapeutic strategies are largely inadequate to treat these disorders. Thus, the development of new strategies that can effectively prevent alcohol use disorders (AUDs) is of paramount importance. Currently approved medications attempt to deter alcohol intake by blocking ethanol metabolism or by targeting the neurochemical systems downstream of the cascades leading to craving and dependence. Unfortunately, these medications have provided only limited success as indicated by the continued high rates of alcohol abuse and alcoholism. The lack of currently available effective treatment strategies is highlighted by the urgent call by the NIAAA to find new and paradigm‐changing therapeutics to either prevent or treat alcohol‐related problems. This mini‐review highlights recent findings from 4 laboratories with a focus on compounds that have the potential to be novel therapeutic agents that can be developed for the prevention and/or treatment of AUDs.
Methicillin‐Resistant Staphylococcus aureus Burden in Nursing Homes Associated with Environmental Contamination of Common Areas
Authors: Murphy Courtney R. , Eells Samantha J. , Quan Victor , Kim Diane , Peterson Ellena , Miller Loren G. , Huang Susan S.
Published: June 2012

Objectives

To determine whether environmental cleaning and contamination are associated with variation in the prevalence of methicillin‐resistant Staphylococcus aureus (MRSA) between nursing homes.

Design

Prospective study of environmental contamination and cleaning quality.

Setting

Nursing home.

Participants

Ten California nursing homes.

Measurements

Nursing homes were categorized into two groups based upon high and low differences in MRSA point prevalence and admission prevalence (delta prevalence) from nares screenings of nursing home residents. Environmental cleaning and infection control practices were evaluated by culturing common area objects for MRSA, assessing removal of intentionally applied marks visible only under ultraviolet (UV) light, and administering surveys on infection control and cleaning.

Results

Overall, 16% (78/500) of objects were MRSA positive, and 22% (129/577) of UV‐visible marks were removed. A higher proportion of MRSA‐positive objects was found in the high (19%) than in low (10%) nursing home groups (P = .005). Infection control and cleaning policies varied, including the frequency of common room cleaning (median 2.5 times daily, range 1–3 times daily) and time spent cleaning per room (median 18 minutes, range 7–45 minutes). In multivariate models, MRSA‐positive objects were associated with high delta prevalence nursing homes (odds ratio (OR) = 2.8, P = .005), less time spent cleaning each room (OR = 2.9, P < .001), and less‐frequent cleaning of common rooms (OR = 1.5, P = .01).

Conclusion

Substantial variation was found in MRSA environmental contamination, infection control practices, and cleaning quality. MRSA environmental contamination was associated with greater differences between MRSA point and admission prevalence, less‐frequent common room cleaning, and less time spent cleaning per room, which suggests that modifying cleaning practices may reduce MRSA environmental contamination and burden in nursing homes.
Electrophysiology Testing and the National Cardiovascular Data Registry: Stimulating, yet Inconclusive
Authors: WINTERS STEPHEN L. , CURWIN JAY H.
Published: June 2012

In this issue of PACE, Cheng et al. do an impressive job in evaluating clinical variables associated with electrophysiology studies (EPS) performed within 1 month before implantable cardioverter defibrillator (ICD) placement in 33,786 individuals entered into the National Cardiovascular Data Registry for Implantable Cardioverter Defibrillators (NCDR®‐ICD) over a 3‐year period. Although of great interest, most of the conclusions are by necessity based on conjecture drawn from observations alone, since the inherent, point‐in‐time structure of the Registry limits the ability to assess accurate longitudinal clinical correlations and outcomes. The fact is, we really do not know why these patients underwent EPS or how the data from these tests were used. In addition to stimulating speculation on the role of EPS in ICD recipients, the present report should promote caution regarding what conclusions can and should be drawn from the NCDR®‐ICD in its present format. As constructed, the Registry provides demographic data and clinical elements up to only a fixed point in time. Hence, the ability to draw conclusions is limited by the abundance of disconnected variables and snapshot quality of data in the NCDR. (PACE 2012; 35:909–911)
Comparison of a Shortened Isosorbide Dinitrate‐Potentiated Head‐Up Tilt Testing with the Conventional Protocol: Tolerance and Diagnostic Accuracy
Authors: MACEDO PAULA G. , ASIRVATHAM SAMUEL J. , MAIA LEILA , NETO EUSTÁQUIO FERREIRA , ZANATTA ANDRÉ , NETO JOSÉ SOBRAL , BARRETO JOSÉ ROBERTO , MAIA HENRIQUE , OLIVEIRA EDNA M. , DA ROCHA JAIRO M. , MARGALHO CARLA S. , SEIXAS TAMER , PERES AYRTON , SANTOS‐NETO LEOPOLDO , LEITE LUIZ R.
Published: June 2012

Background:

The head‐up tilt test (HUT) is widely used to investigate unexplained syncope; however, in clinical practice, it is long and sometimes not well tolerated.

Objectives:

To compare the sensitivity, specificity, accuracy, and patients’ tolerance of a conventional and shortened HUT.

Methods:

Patients with a history of vasovagal syndrome (VVS) were randomized to a conventional HUT (group I) consisting of 20‐minute passive tilt followed by 25 minutes after administration of sublingual isosorbide dinitrate (ISDN), or a shortened HUT (group II) where ISDN was given immediately after tilt and observed for 25 minutes. The control group consisted of age‐ and gender‐matched subjects without VVS symptoms. A specific questionnaire to evaluate tolerance was applied.

Results:

Sixty patients (29 ± 10 years, 82% female) were included. In group I, 22/30 patients had a positive HUT compared to 21/30 in group II (73% vs 70%, P = 0.77). There was also no difference in the accuracy between the two protocols (63% vs 73%, P = 0.24). The time to positivity was shorter in group II (13.2 minutes vs 30 minutes, P < 0.001). Within the control group (n = 60), the frequency of false‐positives was 47% and 23% for the conventional and shortened HUT, respectively (P = 0.058). After conventional HUT, 65.2% subjects reported that the test was too long compared to 25% subjects after the shortened HUT (P = 0.002).

Conclusion:

In this study, the HUT without passive phase was not inferior to the conventional HUT regarding sensitivity, specificity, and accuracy. Furthermore, the shortened ISDN‐potentiated protocol allowed faster diagnosis and was better tolerated.
(PACE 2012; 35:1005–1011)
QRS Fragmentation and the Risk of Sudden Cardiac Death in MADIT II
Authors: BRENYO ANDREW , PIETRASIK GRZEGORZ , BARSHESHET ALON , HUANG DAVID T. , POLONSKY BRONISLAVA , McNITT SCOTT , MOSS ARTHUR J. , ZAREBA WOJCIECH
Published: June 2012

QRS Fragmentation and the Risk of Sudden Cardiac Death in MADIT II.

Background: QRS fragmentation (fQRS) has been reported as a useful ECG parameter in predicting mortality in high‐risk postinfarction patients. Its prognostic value for sudden cardiac death (SCD) and ventricular arrhythmias in ischemic cardiomyopathy (ICM) remains unknown.

Methods: MADIT II enrollment 12‐lead ECGs were analyzed for fQRS defined as RSR’ patterns (≥1 R’ or notching of S or R wave) in patients with a normal QRS duration and >2 notches on the R or S wave in patients with abnormal QRS duration, present in 2 contiguous leads. Exclusion criteria included a paced rhythm and an uninterpretable or incomplete ECG. Study endpoints included SCD, SCD or appropriate implantable cardioverter defibrillator (ICD) shock, and total mortality (TM).

Results: Of the 1,232 ECGs reviewed, 1,040 were of suitable quality for fQRS analysis. QRS fragmentation was found in 33% of patients in any leads, in 10% of patients in anterior leads, in 8% of patients in lateral leads and in 21% of patients in inferior leads. Anterior and lateral location of QRS fragmentation was not associated with follow‐up events. Inferior location of fQRS was found to be predictive of SCD/ICD shock (hazard ratio [HR] 1.46, P = 0.032), SCD (HR 2.05, P = 0.007), and TM (HR 1.44, P = 0.036). This association was driven primarily by the increase in events found in LBBB patients: SCD/ICD shock (HR 2.05, P = 0.046), SCD (HR 4.24, P = 0.002), and TM (HR 2.82, P = 0.001).

Conclusions: Fragmented QRS, especially identified in inferior leads, is predictive of SCD, SCD or appropriate ICD shock, and all‐cause mortality in patients with ICM. Identifying inferior fQRS in patients with LBBB is of particular prognostic significance and should reinforce the use of ICD therapy in this high‐risk group. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1343‐1348, December 2012)
Echocardiographic Guidance of Percutaneous Patent Foramen Ovale Closure: Head‐to‐Head Comparison of Transesophageal versus Rotational Intracardiac Echocardiography
Authors: Vigna Carlo , Marchese Nicola , Zanchetta Mario , Chessa Massimo , Inchingolo Vincenzo , Pacilli Michele Antonio , Amico Cesare , Fanelli Mario , Fanelli Raffaele , Loperfido Francesco
Published: June 2012

Background: Transesophageal (TEE) and intracardiac (ICE) echocardiography are commonly used to guide percutaneous patent foramen ovale (PFO) closure. The study aim was to perform a head‐to‐head comparison between TEE and rotational ICE echocardiography in the measurement of the fossa ovalis and device selection. Methods: In 45 patients with cryptogenic stroke or peripheral embolism and PFO with large right‐to‐left shunt, fossa ovalis dimensions were assessed preoperatively by TEE and intraoperatively by rotational ICE. The Amplatzer devices, deployed on the basis of ICE, were compared with those that would have been selected by TEE. Results: A good correlation between TEE and rotational ICE was observed for both longitudinal and transverse fossa ovalis dimensions (TEE four‐chamber vs. ICE four‐chamber: r = 0.75; TEE bicaval vs. ICE four‐chamber: r = 0.77; TEE aorta vs. ICE aorta: r = 0.59; P < 0.001 for all). However, no such correlation was found in 13 patients with atrial septal aneurysm (ASA) (TEE four‐chamber vs. ICE four‐chamber: r = 0.33; TEE bicaval vs. ICE four‐chamber: r = 0.49; TEE aorta vs. ICE aorta: r = 0.05; P = NS for all). At Bland‐Altman analysis, slight systematic differences with wide limits of agreement for each comparison were observed, particularly in patients with ASA, suggesting that the two imaging modalities cannot be used interchangeably. As regards device selection, a moderate agreement was found between TEE‐ and ICE‐guided device size (72%, κ= 0.53, P < 0.001), except in patients with ASA (36%, κ= 0.02, P = NS). Conclusions: Our study suggests a significant disagreement between TEE and rotational ICE in measuring fossa ovalis and selecting the device for PFO closure, particularly in patients with ASA.
The Impact of Mitral Stenosis on Left Atrial Function Assessed by Two‐Dimensional Speckle Tracking Echocardiography
Authors: Demirkol Sait , Kucuk Ugur , Baysan Oben , Balta Sevket , Celik Turgay , Kurt Ibrahim Halil , Kucuk Hilal Olgun , Yuksel Uygar Cagdas , Unlu Murat , Yokusoglu Mehmet
Published: June 2012

Aims: The aim of this study is to investigate the effect of mitral stenosis (MS) on left atrial (LA) function using two‐dimensional speckle tracking echocardiography (2DSTE). Methods and Results: The study subjects consisted of 52 patients with asymptomatic MS and 52 control subjects. LA function was assessed using prototype speckle tracking software and manual tracking method. Maximal LA volume (LAVmax) and minimal LA volume (LAVmin) and LA volume before atrial contraction (LAVpre‐a) were measured. Using these volumes, LA reservoir, conduit and booster pump fuction parameters were calculated. Indexed LAVmax, LAVmin, and LAVpre‐a measurements via speckle tracking were highly correlated with manual tracing methods in both groups. Expansion index (67.8 ± 36.4 vs. 148.3 ± 44.2), diastolic emptying index (37.7 ± 12.9 vs. 58.0 ± 8.5), passive emptying (37.3 ± 14.1 vs. 70.4 ± 10.4) and passive emptying index (13.3 ± 6.3 vs. 41.3 ± 10.6) were decreased significantly in MS patients (P < 0.001). In contrast active emptying index (62.6 ± 4.1 vs. 29.5 ± 10.1) increased in MS group (P < 0.001) while active emptying (28.1 ± 13.0 vs. 28.3 ± 6.9) remained same among both groups. Conclusions: This is the first study relating LA volumes and function assessed by 2DSTE to MS. 2D speckle tracking analysis of LA volume is relatively easy and provides more detailed information regarding the changes in LA volumes during the cardiac cycle.
Prognostic Value of Echocardiographic‐Derived Calcium Index in Coronary Artery Disease Diagnosed by 64‐Multidetector Computed Tomography
Authors: Lacalzada Juan , de la Rosa Alejandro , Jiménez Juan José , Juárez Rubén , Barragán Antonio , Blanco Gabriela , Iribarren José Luis , Bonilla Juan Alfonso , Laynez Ignacio
Published: June 2012

Purpose: To determine whether echocardiographic calcium index (ECI) calculated using transthoracic echocardiography (TTE) predicts coronary ischemic events. We also wished to determine coronary artery calcium score (CACS), the presence of obstructive coronary artery disease (CAD) and plaque composition, all of which were assessed by multidetector computed tomography (MDCT). Methods: We carried out a prospective cohort study of 82 consecutive outpatients with chest pain and low‐moderate risk of CAD, referred for noninvasive coronariography by MDCT. ECI was blindly assessed by TTE and correlated with subsequent cardiovascular events during a follow up period of 36 months. Results: ECI values of ≥7 had a sensitivity of 77.3%, a specificity of 90%, positive predictive value of 73.9%, and negative predictive value of 91.5% with respect to future coronary ischemic events. In addition, patients with ECI ≥ 7 showed a greater presence of severe calcified and obstructive CAD and a linear increase of obstructed vessels and mixed and calcified plaques, with a linear trend according to ECI values. Conclusion: ECI values of ≥7 determine poor CAD prognosis in relation to ischemic events. Furthermore, ECI ≥ 7 may serve as a marker of content of coronary artery calcium, intraluminal obstruction, and plaque composition. Therefore, ECI seems to provide prognostic information as well as information about the characteristics of the plaque of atheroma.
A Primary Pericardial Undifferentiated Sarcoma Invading the Right Atrium and Superior Vena Cava
Authors: Bi Wenjing , Qu Ran , Ren Weidong
Published: June 2012

Primary undifferentiated cardiac sarcomas are rare. The literature demonstrated that 81% of primary cardiac undifferentiated sarcomas arose in the left atrium. We reported herein a case of 56‐year‐old male farmer with a primary pericardial undifferentiated sarcoma, which was revealed only on echocardiography but not computed tomography. The tumor, which invaded the right atrium and superior vena cava, was not completely resected.
Transradial Szabo Technique for Intervention of Ostial Lesions
Authors: KWAN TAK W. , CHEN JACK P. , CHERUKURI SANJAY , HUANG YILI , LIOU MICHAEL , EL SAKR FREDY , WONG SALLY , COPPOLA JOHN
Published: June 2012

Objectives:
 The aim of our study is to assess the feasibility and safety of transradial intervention (TRI) of coronary ostial lesions using the Szabo technique.

Background:
 When performing TRI of coronary ostial lesions, precise stent positioning is of paramount importance. TRI has experienced increasing popularity in the U.S.; however, utilization of the Szabo technique has not been systematically evaluated in this setting. We report the results of ostial stent deployment using the Szabo technique for 2 experienced TRI operators and centers.

Methods:
 This was a retrospective analysis of 40 consecutive patients who underwent PCI from April 2009 to September 2011. All patients who underwent PCI via the transradial route with the Szabo technique for ostial lesions performed by experienced transradial operators (>200 cases/yr) were included.

Results:
 In our study of 40 patients with 41 coronary ostial lesions, overall procedural success rate was 100%. Stent dislodgement was seen in 1 patient. Clinical follow up was 100%, with a mean duration of 292.7±200 days. Target lesion revascularization (TLR) was seen in 2 patients (5%). One patient had an episode of transient ischemic attack (TIA) at 33 days after PCI; another experienced subacute stent thrombosis at 81 days while on dual antiplatelet therapy. MACE was 7.5% overall.

Conclusion:
 In our study, treatment of coronary ostial lesions with the Szabo technique via TRI is associated with a high procedural success rate and a low MACE of 7.5%. (J Interven Cardiol 2012;25:447–451)
Family Planning Outcomes and Primary School Attendance in Sub‐Saharan Africa
Authors: Longwe Abiba , Smits Jeroen
Published: June 2012

This study examines the relationship between women's family planning outcomes and primary school enrollment among their 8‐11‐year‐old children. We analyze household‐ and wider‐context‐level data for 103,000 children in 30 sub‐Saharan African countries. Negative associations with school enrollment are found for those who have short preceding or succeeding birth intervals, a young sibling, or a mother who is pregnant. These findings remain unchanged after controlling for socioeconomic and demographic characteristics. Analysis of interaction effects shows that many associations with family planning outcomes depend on the context in which the household is living, revealing the importance of a situation‐specific approach. Findings indicate that helping families improve their pregnancy planning will increase children's schooling opportunities and lead to more effective use of household and community resources.
Effectiveness of Interventions Designed to Prevent Female Genital Mutilation/Cutting: A Systematic Review
Authors: Berg Rigmor C. , Denison Eva
Published: June 2012

Female genital mutilation/cutting (FGM/C) is widely considered a human rights infringement, although communities that practice the tradition view it as an integral part of their culture. Given these vastly different views, the effectiveness of efforts to abandon FGM/C is uncertain. We conducted a systematic review of the best available evidence regarding evaluations of interventions to prevent FGM/C, including eight controlled before‐and‐after studies with 7,042 participants from Africa. Findings indicate that 19 of 49 outcomes (with baseline similarity) were significantly different at study level, mostly favoring the intervention, but results from four meta‐analyses showed considerable heterogeneity. The limited effectiveness and weak overall quality of the evidence from the studies appear related to methodological limitations of the studies and shortcomings in the implementation of the interventions. Nevertheless, the findings point to possible advantageous developments from the interventions.
Phylogeny of the green lacewing Chrysoperla nipponensis species‐complex (Neuroptera: Chrysopidae) in China, based on mitochondrial sequences and AFLP data
Authors: Nie Rui‐E , Mochizuki Atsushi , Brooks Stephen J. , Liu Zhi‐Qi , Yang Xing‐Ke
Published: June 2012

Abstract  Several studies have indicated that the green lacewing, Chrysoperla nipponensis (Neuroptera: Chrysopidae) may include more than one valid species. We investigated the phylogenetic status of Chrysoperla nipponensis s.l. in China and Japan using mitochondrial sequences and AFLP data. The molecular phylogenetic analyses based on mitochondrial genes showed that the C. nipponensis species‐complex comprises four clades, each having high support values. In addition, the phylogenetic tree based on AFLP data indicates that the species‐complex comprises three groups. These results confirm that C. nipponensis s.l. comprises at least three genetically distinct clades and suggests that two of these clades may be closely related to populations of C. nipponensis in Japan. However, these clades cannot be recognized as species until analysis of their courtship songs has been completed.