bluuebunny/crossref_metadata_2025 huggingface dataset:
From grass to grace: How SLMTA revolutionised the Bamenda Regional Hospital Laboratory in Cameroon
Authors: Nkwawir Siyem C. , Batumani Nakeli N. , Maruta Talkmore , Awasom Charles N.
Published: November 2014

Background: Public health laboratories form the foundation on which today’s clinical laboratory practice in Cameroon is built. The advent of the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme in 2009 empowered the Bamenda Regional Hospital Laboratory (BRHL) to improve its working culture, practices and management.Objectives: To evaluate the results of SLMTA implementation at BRHL and discuss lessons learned.Method: In 2010, the SLMTA programme was rolled out in Cameroon to improve laboratory quality management systems in five laboratories, including BRHL. Three workshops were conducted (the first centralised, the remaining two on-site at each laboratory) and improvement projects were implemented after each workshop with the assistance of mentors. Audits were used in order to evaluate performance and to identify areas for further improvement.Results: BRHL had the lowest score (18%) amongst the cohort at the baseline audit and the highest (81%) at the official Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) audit conducted in August 2013 by the African Society for Laboratory Medicine. Improvements were observed in each of the 12 Quality System Essentials; improvement was especially noteworthy in the areas of facilities and safety, and purchasing and inventory. Staff investment and pride in the quality of laboratory services increased.Conclusion: BRHL’s remarkable improvement was achieved with a combination of SLMTA training activities, intensive on-site mentorship and the collective focus of all laboratory staff. The experience at Bamenda Hospital illustrates what can be achieved when a laboratory successfully harnesses the energy of its staff and implements changes to improve the quality of services in a transformation taking them from grass to grace.
Accelerating the spread of laboratory quality improvement efforts in Botswana
Authors: Mokobela Kelebeletse O. , Moatshe Mpho T. , Modukanele Mosetsanagape
Published: November 2014

Background: In 2002, the Ministry of Health (MoH) of Botswana began its journey toward laboratory accreditation in an effort to enhance the quality of laboratory services. Aftera difficult start, the MoH recognised the need for a more practical and sustainable method for change that could be implemented nationally; they therefore adopted the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme.Objective: This study describes the spread of laboratory quality improvement efforts in Botswana.Methods: Eight laboratories were enrolled into the SLMTA programme in 2010, which included a series of workshops and improvement projects conducted over nine months. Four of these laboratories received supplementary training and focused mentorship from the Botswana Bureau of Standards (BOBS). Laboratory performance was measured at baseline and exit using the World Health Organization Regional Office for Africa’s StepwiseLaboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist. One laboratory did not receive an exit audit and was thus excluded from the analysis.Results: An 18 percentage-point improvement was observed when comparing the median baseline score (53%) to the median exit score (71%) for the seven laboratories. Laboratories that received additional training and mentorship from BOBS improved 21 percentage points, whilst non-BOBS-mentored laboratories improved eight percentage points. Hospital management buy-in and strong laboratory staff camaraderie were found to be essential forthe positive changes observed.Conclusion: SLMTA facilitated improvements in laboratory quality management systems,yielding immediate and measurable results. This study suggests that pairing the SLMTA programme with additional training and mentorship activities may lead to further increases in laboratory performance; and that SLMTA is a practical approach to extending quality improvement to MOH laboratories.
Driving hospital transformation with SLMTA in a regional hospital in Cameroon
Authors: Eno Laura T. , Asong Terence , Ngale Elive , Mangwa Beatrice , Ndasi Juliana , Mouladje Maurice , Lekunze Remmie , Mbome Victor , Njukeng Patrick , Shang Judith
Published: November 2014

Background: Inspired by the transformation of the Regional Hospital Buea laboratory through implementation of the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme, hospital management adapted the SLMTA toolkit to drive hospital wide quality improvement.Objective: This paper describes changes in the hospital following the quality improvement activities in hygiene and sanitation, the outpatient waiting area and the surgical and maternity wards.Methods: In March 2011, hospital management established a quality improvement task force and created a hospital-wide quality improvement roadmap, following the SLMTA model. The roadmap comprised improvement projects, accountability plans, patient feedback forms and log books to track quality indicators including patient wait time, satisfaction level, infectionrates, birth outcomes and hospital revenue.Results: There was steady improvement in service delivery during the 11 months after the introduction of the quality improvement initiatives: patient wait time at the reception was reduced from three hours to less than 30 minutes and patient satisfaction increased from 15% to 60%. Treatment protocols were developed and documented for various units, infrastructure and workflow processes were improved and there was increased staff awareness of the importance of providing quality services. Maternal infection rates dropped from 3% to 0.5% and stillbirths from 5% to < 1%. The number of clients increased as a result of improvedservices, leading to a 25% increase in hospital revenue.Conclusion: The SLMTA approach was adapted successfully to meet the needs of the entire hospital. Such a programme has the potential to impact positively on hospital quality systems; consideration should be made for development of a formal SLMTA-like programmefor hospital quality improvement.
Imaging in pediatric small bowel transplantation
Authors: Khan Nadir , Phillips Grace S , Heller Matthew T , Linam Leann E , Parnell Shawn E , Moshiri Mariam , Bhargava Puneet
Published: November 2014

Small bowel transplantation, alone or with other organs as multivisceral transplantation, is performed for patients with chronic intestinal failure. With advancing surgical techniques and improved post-surgical management, survival of these patients has increased tremendously in the last two decades. The radiologist has an important role in the preoperative and postoperative management of these patients. Knowledge of surgical techniques and post-surgical complications seen in the transplant recipient is necessary for adequate management of these patients.
Evolutionary Analysis and Prediction of Peptide Vaccine Candidates for Foot-and-Mouth-Disease Virus Types A and O in Bangladesh
Authors: Momtaz Samina , Rahman Arafat , Sultana Munawar , Hossain M. Anwar
Published: November 2014

Foot-and-mouth disease (FMD), an endemic disease of cloven-hoofed animals, causes an annual economic loss of US$60–150 million in Bangladesh. There is no cross-protection among the foot-and-mouth disease virus (FMDV) serotypes and vaccination escape mutation may happen. Peptide vaccine is a safer alternative. The aim of this study is to predict and map the B and T cell epitopes of VP1 proteins of FMDV serotypes O and A that were circulating in Bangladesh from 2011 to 2013. Using evolutionary and computational approach (BCPred, BepiPred, DiscoTope, ElliPro, and ProPred-I, IEDB analysis for MHC-I prediction), a total of 11 B and T cell epitopes were predicted. Also, the three-dimensional (3D) structure of VP1 protein showed that the predicted five epitopes residing on N- and C-termini can be considered as good vaccine candidates, and epitopes on the G–H loop can serve as receptor recognition sites for vaccine design. The scores of predicted epitopes of one method were cross-checked with other one for potential epitope mining. Within the VP1 antigenic sites, significant evidence of positive selection was present indicating evolution of VP1 under high immune surveillance.
Economic Evidence on the Health Impacts of Climate Change in Europe
Authors: Hutton Guy , Menne Bettina
Published: November 2014

Background

In responding to the health impacts of climate change, economic evidence and tools inform decision makers of the efficiency of alternative health policies and interventions. In a time when sweeping budget cuts are affecting all tiers of government, economic evidence on health protection from climate change spending enables comparison with other public spending.

Methods

The review included 53 countries of the World Health Organization (WHO) European Region. Literature was obtained using a Medline and Internet search of key terms in published reports and peer-reviewed literature, and from institutions working on health and climate change. Articles were included if they provided economic estimation of the health impacts of climate change or adaptation measures to protect health from climate change in the WHO European Region. Economic studies are classified under health impact cost, health adaptation cost, and health economic evaluation (comparing both costs and impacts).

Results

A total of 40 relevant studies from Europe were identified, covering the health damage or adaptation costs related to the health effects of climate change and response measures to climate-sensitive diseases. No economic evaluation studies were identified of response measures specific to the impacts of climate change. Existing studies vary in terms of the economic outcomes measured and the methods for evaluation of health benefits. The lack of robust health impact data underlying economic studies significantly affects the availability and precision of economic studies.

Conclusions

Economic evidence in European countries on the costs of and response to climate-sensitive diseases is extremely limited and fragmented. Further studies are urgently needed that examine health impacts and the costs and efficiency of alternative responses to climate-sensitive health conditions, in particular extreme weather events (other than heat) and potential emerging diseases and other conditions threatening Europe.
Older Men as Deep-Rooted Trees of Wisdom
Authors: Tambaum Tiina , Kuusk Helina
Published: November 2014

This qualitative study was carried out among older men in the rural municipality of Tartu, Estonia. The data was gathered with the intention of exploring the obstacles encountered and motivational aspects employed when trying to convince older men to share their knowledge. The study revealed the existence of untapped potential in the involvement of older men in the exchange of knowledge. It also highlights didactic solutions for challenges encountered in the processes of older men's learning and knowledge-sharing. The study revealed older men's preferences for practical learning and knowledge-sharing. Men are willing to share their professional skills: that which they have acquired either at work in the household. Older men also demonstrated a lack of flexibility when the correctness of their views was challenged, which may present an obstacle to informal knowledge sharing between generations. The Estonian educational system for the elderly is based on the participants' own initiative and active involvement, but unfortunately this is just what men in the municipality of Tartu lacked.
Simulating the connections of ENSO and the rainfall regime of East Africa and the upper Blue Nile region using a climate model of the Tropics
Authors: Zaroug M. A. H. , Giorgi F. , Coppola E. , Abdo G. M. , Eltahir E. A. B.
Published: November 2014

Abstract. We simulate the observed statistical relationship between ENSO and the rainfall regime of the upper Blue Nile using the tropical-band version of the regional climate model RegCM4 (or Reg-TB). An ensemble of nine simulations for the 28-year period 1982–2009 is completed to investigate the role of ENSO in modulating rainfall over the upper Blue Nile catchment. Reg-TB shows a good skill in simulating the climatology of temperature, outgoing long-wave radiation patterns as well as related atmospheric circulation features during the summer season (i.e. the rainy season over the Blue Nile catchment). The model also succeeds in reproducing the observed negative correlation between Pacific SST and rainfall anomalies over the Blue Nile catchment, and in particular the association of droughts over the Blue Nile with El Niño events that start in April–June. We thus propose that observations and model forecasts of Pacific SST during this season could be used in seasonal forecasting of summer rainfall over the upper Blue Nile region.
Characterization of Prostaglandin F2α Receptors in Human Eyelids
Authors: Nesher Ronit , Mimouni Michael , Elnaddaf Halah , Nemet Arie , Kidron Debora
Published: November 2014

Purpose

Elongation, thickening, and crowding of eyelashes are commonly seen after topical use of prostaglandin analog eyedrops for glaucoma treatment. The purpose of this study was to demonstrate the presence and characterize the location of prostaglandin analog F2α receptors (PGF2α) in human hair follicles.

Methods

In this observational clinical laboratory study, excised eyelid specimens following eyelid surgery were studied. Resected portions of eyelids were submitted for histopathologic evaluation. For immunohistochemistry evaluation, a polyclonal antibody directed against PGF2α was purchased from Cayman Chemical. The staining procedure was carried out on an automatic stainer.

Results

Out of 26 patients recruited, final analysis was conducted on 17 eyes of 15 patients. There were 10 men and 5 women (mean age 77 ± 14 years). Staining was detected only in hair follicles in the anagen stage (37 slices). No variation in pattern, distribution, or intensity of immunostaining was noted among sections of different individuals. Only the bulb and stem of the hair follicle stained positive. In the bulb, the strongest staining occurred in the matricular cells and in the inner sheath layer. In the stem, the strongest staining occurred in the Huxley layer of the inner sheath.

Conclusions

This immunohistologic study found that PGF2α receptors were located predominantly in the inner root sheath of the bulb and stem of eyelashes and expressed only in eyelashes in the anagen phase.
Bimanual Microincision versus Standard Coaxial Small-Incision Cataract Surgery: Meta-Analysis of Randomized Controlled Trials
Authors: Chen Chong , Zhu Minjiao , Sun Yong , Qu Xinhua , Xu Xun
Published: November 2014

Purpose

This meta-analysis aimed to evaluate the outcomes of bimanual microincision cataract surgery (B-MICS) through a 1.2- to 1.5-mm incision versus standard coaxial small-incision cataract surgery (C-SICS) through a 2.8- to 3.2-mm incision.

Methods

A comprehensive literature search was performed according to the Cochrane Collaboration methodology to identify randomized controlled clinical trials comparing B-MICS with standard C-SICS. Main outcome measures were mean surgical time, mean phacoemulsification power, effective phacoemulsification time, best-corrected visual acuity, surgically induced astigmatism (SIA), mean laser flare photometry values, mean endothelial cell loss, mean increased central corneal thickness, and intraoperative and postoperative complications.

Results

We identified 14 randomized controlled clinical trials that included 1235 eyes diagnosed with cataracts. No statistically significant differences were detected between the 2 surgical procedures in terms of best-corrected visual acuity (p>0.05), SIA at postoperative 1 month (p = 0.09), laser flare photometry values (p = 0.38), mean endothelial cell loss (p = 0.53), increased central corneal thickness at postoperative 1 month (p = 0.64) or 3 months (p = 0.88), intraoperative complications (p = 0.68), and postoperative complications (p = 0.30); however, statistically significant differences were apparent for mean surgical time (p<0.00001), mean phacoemulsification power (p = 0.008), effective phacoemulsification time (p = 0.0009), SIA at postoperative 3 months (p = 0.02), and increased central corneal thickness at postoperative 1 day (p = 0.04).

Conclusions

The meta-analysis shows that the 2 techniques have similar outcomes in terms of final visual acuity and complications. Bimanual MICS has the advantage of less SIA and phaco time whereas C-SICS has the advantage of quicker surgery and less likelihood of early-onset corneal edema.
Use of Intravitreal Dexamethasone Implant in Patients with Cataract and Macular Edema Undergoing Phacoemulsification
Authors: Sze Amy M. , Luk Fiona O. , Yip Terri P. , Lee Gary K. , Chan Carmen K.
Published: November 2014

Purpose

To study the safety and efficacy of intravitreal dexamethasone implant in patients with cataract and macular edema undergoing phacoemulsification and intraocular lens (IOL) implantation.

Methods

Twenty-four eyes with macular edema secondary to diabetic retinopathy (diabetic macular edema [DME]) and retinal vein occlusion (RVO) were retrospectively reviewed. These eyes underwent phacoemulsification with IOL implantation and intravitreal dexamethasone implant 0.7 mg at the same setting between September 2012 and September 2013. Demographic data, best-corrected visual acuity (BCVA), central macular thickness (CMT), intraocular pressure (IOP), surgical time, and complications were recorded.

Results

Twelve eyes had DME and 12 eyes had RVO (10 central RVO and 2 branch RVO). Median baseline logMAR BCVA was 1.0 (Snellen 20/200) and mean baseline CMT was 530.2 ± 218.9 µm. Median follow-up duration was 13 months. At last follow-up, median visual acuity improved significantly to 0.523 (Snellen 20/66) (p = 0.003) and CMT decreased to 300.7 ± 78.1 µm (p = 0.000). Median surgical time was 23 minutes. There were no intraoperative complications. In 12 eyes, macular edema recurred, requiring further treatment, and median time to recurrences was 21 weeks. One eye had raised IOP after second dexamethasone implant for recurrent macular edema. No major complication such as vitreous hemorrhage, retinal detachment, or endophthalmitis occurred.

Conclusions

Combined cataract surgery with intravitreal dexamethasone implant seems to be safe and effective in treating patients with cataract and macular edema in this small case series. A larger prospective study with longer follow-up is necessary to demonstrate the long-term benefit of this combined procedure.
Pilot Study of Inactive Polypoidal Lesions in Polypoidal Choroidal Vasculopathy
Authors: Zeng Renpan , Zhang Xiongze , Li Meng , Wen Feng
Published: November 2014

Purpose

This pilot study was conducted to describe the angiographic characteristics of inactive polypoidal lesions that were observed during indocyanine green angiography (ICGA) in polypoidal choroidal vasculopathy (PCV).

Methods

This was a retrospective study involving 40 eyes of 39 consecutive Chinese patients with PCV with inactive polypoidal lesions. All patients underwent fundus fluorescein angiography and ICGA examinations. We used ICGA to make a definitive diagnosis of PCV in each patient. The clinical and angiographic characteristics of inactive polypoidal lesions were recorded and analyzed.

Results

In the 40 eyes that were studied, the time between receiving an injection of indocyanine green and the initial appearance of inactive polypoidal lesions ranged from 8.2 minutes to 25.1 minutes, with a mean time of 15.1 ± 5.6 minutes. Inactive polypoidal lesions were divided into 4 groups: 5 eyes (12.5%) in the asymptomatic group; 8 eyes (20.0%) in the atrophic and/or cicatricial group; 24 eyes (60.0%) in the combined group (coexisting with active polypoidal lesions); and 3 eyes (7.5%) in the mixed group (coexisting with choroidal neovascularization). Twelve of the 40 eyes were followed up for 9 to 29 months (mean 12.4 ± 5.3 months). Over this time period, inactive polypoidal lesions completely regressed (not observed in ICGA) in 3 eyes (25.0%), partially regressed in 3 eyes (25.0%), and were stable (the same as the first visit) in 6 eyes (50.0%).

Conclusions

Inactive polypoidal lesions in patients with PCV most commonly appeared during the middle phase of ICGA and were manifested in 4 groups. These lesions represented the sites of PCV in a regressed or quiescent stage.
Metallographic Evaluation of Hip Joint Implants wear and Electrochemical Implants Potential
Authors: Kmieć Krzysztof , Sibinski Marcin , Synder Marek , Drobniewski Marek , Kozłowski Piotr
Published: November 2014

We performed metallographic evaluations of implants, removed during revision hip arthroplasty. The implants were evaluated for electrochemical potentials and the presence of wear products on the implants surface. A total of 50 patients (50 hips) underwent revision hip arthroplasty during the years 2007-2009 for aseptic loosening. The mean follow-up from primary hip replacement to revision was 10.1 years (from six months to 17 years). All hip joint implants removed during the revision arthroplasty were submitted to metallographic analysis and all heads were submitted to analysis under a scanning microscope. All polyethylene (PE) cups and inserts showed numerous features of wear (friction wear, plastic deformation and creeping, fatigue wear and degradation), six PE cups were broken. In six ceramic cups, only friction wear features were found; one of them was mechanically broken. In all heads articulating on PE not one had any mechanical damage. Heads of ceramic implants in ceramic-ceramic articulation undergo abrasive wear. None of the studied stems (cemented or uncemented) revealed any features of wear. Areas of titanium crystals (formed by electrolytic sedimentation of metals) were macroscopically identified on the sliding surface of six heads that was confirmed by chemical composition and scanning microscope.

In the course of prosthesis use, wear products are produced and transferred onto the sliding surfaces of implant heads and cups via ways other than purely mechanical contact. It has been confirmed that metals used for implant construction, make galvanic cells with different electrochemical potentials.
Clinically Significant Corrosion at the Head-Neck Taper Interface in Total Hip Arthroplasty: A Systematic Review and Case Series
Authors: Carli Alberto , Politis Angelos , Zukor David , Huk Olga , Antoniou John
Published: November 2014

Corrosion of the head-neck junction of the femoral component in total hip arthroplasty has been associated with symptomatic adverse local tissue reactions, trunion fracture and elevated serum metal ions. An analysis of risk factors and treatment strategies for corrosion at this interface is lacking in the literature. We therefore performed a systematic review of AAOS proceedings, MEDLINE and EMBASE databases, and included our own case series. A total of 24 articles representing 776 cases of head-neck corrosion met inclusion criteria. The combination of large femoral head sizes and small taper dimensions comprised the majority of published corrosion cases. Revision to ceramic head and ceramic/polyethylene liner was the most commonly utilised treatment. Coating precipitation, mixed alloy coupling and head-neck modulus mismatch collectively appear to contribute to the corrosive process.
Current Concepts in Management of Slipped Capital Femoral Epiphysis
Authors: Bittersohl Bernd , Hosalkar Harish S. , Zilkens Christoph , Krauspe Rüdiger
Published: November 2014

Slipped capital femoral epiphysis (SCFE) is a common hip condition that can be disabling. In this review, we provide an orientation on current trends in the clinical management of SCFE including conventional procedures and specialised surgical developments. Different methods of fixation of the epiphysis, risks of complications, and the rationale of addressing deformity, primarily or secondarily, are presented. Although improved understanding of the anatomy, vascularity and implications of residual deformity have changed management strategies, the best modality of treatment that would restore complete vascularity to the femoral head and prevent any residual deformity, impingement and early osteoarthritis remains elusive.
Highly Cross-Linked Polyethylene in Hip Resurfacing Arthroplasty: Long-Term Follow-up
Authors: Amstutz Harlan C. , Takamura Karren M. , Ebramzadeh Edward , Le Duff Michel J.
Published: November 2014

Highly cross-linked polyethylene (XLPE) has improved wear properties. This study reports the results of a small series of patients treated over 10 years ago with a metal-on-XLPE hip resurfacing.

A total of 21 hips in 20 patients received a hip resurfacing with a cobalt-chromium metal femoral head and metal-backed acetabular cup lined with a XLPE insert and were retrospectively studied. Kaplan-Meier Survivorship was calculated.

Five patients who had initial extreme cystic disease in the femoral head failed due to femoral loosening. Survivorship was 95.2% at 5 years and 81.0% at 10 years.

We found that XLPE wear was not implicated in these failures, which were primarily attributed to poor bone quality of the femoral head, early bone preparation, cementing technique and excessive head reaming to near the neck diameter, necessitated for the implantation of a thick two-part socket.
Outcomes of Polyethylene Liner Cementation into a Fixed Metal Acetabular Shell with Minimum Follow-up of 7 Years
Authors: Park Myung-Sik , Yoon Sun-Jung , Lee Ju Rang
Published: November 2014

Cementation of a polyethylene liner into the well-fixed shell is a convenient option for revision total hip arthroplasty. We retrospectively reviewed 45 patients who had liner cementation to investigate the risk factors which gave rise to major complications and reoperation. Patients were observed for a minimum of 7 years (range 7.8-14 years). Relevant risk factors (age, BMI, surgical approach, previous cup size and position, types of coated surface) were assessed with Cox regression analysis. The mean Harris Hip Score was improved from 62.5 (range 57-68) preoperatively to 87.1 (range 70-97). A total of 7 hips (15.5%) had acetabular component loosening that was treated with reoperation. Prevalence of acetabular component loosening was statistically significantly higher in hydroxyapatite-coated group (5 of 13) than in the Ti-coated group (2 of 32, p = 0.015). All recurrent dislocations occurred in patients treated with a posterior approach. Diameter of the previous metal shell of below 54 mm showed a lower 10-year survival rate than those greater than 54 mm in diameter. PE liner cementation in stable metal cup is a useful alternative option for carefully selected patients. Pre-existing HA-coated cups as well as small sized cups were indicative of poor outcomes.
MRI and Clinical Analysis of Hip Abductor Repair
Authors: McGonagle Lorcan , Haebich Samantha , Breidahl William , Fick Daniel P.
Published: November 2014

Introduction

Hip abductor insufficiency is often associated with lateral hip pain, movement disorder and Trendelenburg gait. The aims of this study are to predict if preoperative radiological findings correlate with postoperative outcomes and if pre and postoperative radiological findings correlate with postoperative function.

Methods

Patients with clinical and MRI evidence of hip abductor tears that had failed to nonoperative treatment underwent surgical repair. Pre and postoperative MRI analysis was carried out by an experienced musculo-skeletal radiologist. Clinical analysis consisted of Harris Hip Score, a measure of patient satisfaction, pre and postoperative walking aids and Trendelenburg test.

Results

This study shows no real improvement in the MRI appearances of the tendons after surgery. Preoperative MRI absence of gluteus minimus was 100% predictive of a poor outcome, whilst thickening of the posterior gluteus medius was 83% predictive of a poor outcome. Postoperative MRI absence of posterior gluteus medius was 75% predictive of a poor outcome. Thickening of anterior gluteus medius and posterior gluteus medius were 71% and 83% predictive of a poor outcome respectively. Absence of posterior gluteus medius correlated with poor outcome in 75% of cases.

Discussion

The MRI appearance of the tendon does not normalise after surgery and there is limited correlation between the MRI appearances pre and postoperatively with the postoperative outcome.
Bilateral Character of Total Hip Replacement Does Not Change the Overall Survival
Authors: Lampropoulou-Adamidou Kalliopi , Macheras George A. , Hartofilakidis George
Published: November 2014

The purpose of this study was to compare the long-term survivorship of total hip replacement in unilaterally and bilaterally operated patients and try to answer the question whether analyses of combined unilateral and bilateral cases could result in erroneous interpretations. The material consisted of 266 Charnley's low-friction arthroplasties performed on 193 patients with osteoarthritis of the hip, followed for a minimum of 15 years. The 25-year survivorship of unilaterally operated hips was 69.2% (95% CI 57%-81.4%) and of bilaterally 66.4% (95% CI 57.6%-75.2%), respectively (p = 0.324). Cox regression analysis of unilateral and bilateral cases for confounding factors of gender, age and primary diagnosis confirmed that there was no significant relationship between survival of THR and whether the patient is unilaterally or bilaterally operated. Only age had a significant relationship with the survival of THR. In bilateral cases, Cox analysis for possible predictive factors found that the primary diagnosis, time interval between the two operations and sequence of the operation were not significantly correlated with the survivorship of bilateral THRs. We thus concluded that in analysing a combination of unilateral and bilateral cases, and presenting the long-term THR results, the bilateral character does not change the overall survival.
Basic Principles and Uniform Terminology for the Head-Neck Junction in Hip Replacement
Authors: Werner Paul H. , Ettema Harmen B. , Witt Florian , Morlock Michael M. , Verheyen Cees C.P.M.
Published: November 2014

Recent problems with large head metal on metal hip replacements have spiked renewed interest in the head-neck junction. A thorough knowledge of the principles of the locking mechanism, the assembly technique and affecting factors on the strength of this junction is needed. Currently a confusing variability in terms is used to describe this junction. This overcomplicates an already complex issue. The purpose of this literature review is to collect and list the different terms used and to propose a uniform terminology. Two authors independently searched the electronic databases of PubMed, CINAHL and MEDLINE with specific key words and combinations according to the PRISMA guidelines. The initial search yielded a total of 518 articles with ultimately 53 articles included in the present analysis. No consensus for a uniform term for the 2 sides of the head-stem junction was found. Since there is already pronounced variability in taper designs between different manufacturers (even so similarly named, e.g. “12/14”), a uniform terminology could be the first step to simplify the situation. “Male” and “female taper” is proposed as the appropriate terminology for the stem and head junction in hip replacement, respectively. The importance of the assembly technique understanding the principles of the locking mechanism is emphasised.
Two-Staged Reconstruction for Ankylosed Hip with Severe Limb Shortening: A Case Report
Authors: Goto Koji , So Kazutaka , Kuroda Yutaka , Kawanabe Keiichi , Matsuda Shuichi
Published: November 2014

A 58-year-old man developed a 14 cm limb length discrepancy with a shortened and ankylosed right hip as a sequelae of multiple surgeries for recurrent dislocation and periprosthetic joint infection. He was successfully treated by limb elongation with external fixation and subsequent revision total hip arthroplasty. We discuss the efficacy of the two-staged reconstruction with initial limb elongation.
Acute Allograft Rejection following Interferon Therapy for Hepatitis C in Recipients who have Returned to Dialysis after Kidney Transplant Failure: Case Study
Authors: Fabrizi Fabrizio , D'Ambrosio Roberta , Pallotti Francesco , Berardinelli Luisa , Messa Piergiorgio , Martin Paul , Aghemo Alessio
Published: November 2014

Interferon-based therapy remains the gold standard for hepatitis C in patients with chronic kidney disease; however, due to the high rate of IFN-induced rejection after transplant, treatment of HCV-infected kidney transplant recipients is recommended only in particular circumstances. We report the case of a 45-year-old Caucasian female with chronic hepatitis C (genotype 1b) who returned to hemodialysis following the complete functional loss of her kidney transplant. She started combination antiviral therapy with peg-IFN-α2a (135 mcg sc weekly) plus ribavirin (200 mg daily) nine months after the re-initiation of hemodialysis. Antiviral therapy was neither effective nor safe; ribavirin was stopped at week 38 due to hemolytic anemia; on-treatment HCV breakthrough was observed at week 48; and acute rejection occurred after four months of IFN-based therapy. Diagnosis of acute allograft rejection was suspected on the grounds of clinical, radiographic, and laboratory data. Allograft nephrectomy was then performed and histology showed acute-on-chronic rejection. This is an uncommon case of IFN-associated kidney rejection in an allograft recipient who had functional loss of her graft and had returned to hemodialysis. In view of the risk of rejection of renal allograft, and the limited efficacy of IFN-based treatment of hepatitis C, physicians should be aware of effective treatment with oral antiviral agents and avoid the use of IFN in patients on maintenance dialysis with failed renal allograft.
Gene Mutation Analysis in Non-Small Cell Lung Cancer Patients using Bronchoalveolar Lavage Fluid and Tumor Tissue as Diagnostic Markers
Authors: Li Jian , Hu Yi-Ming , Wang Yi , Tang Xing-Ping , Shi Wei-Lin , Du Yong-Jie
Published: November 2014

Non-small cell lung cancer (NSCLC) is one of the main causes of cancer death in the world. Early detection of NSCLC can improve its outcome. The aim of this study was to identify the mutations of the KRAS and p53 genes in bronchoalveoar lavage (BAL) fluid for the early detection of peripheral NSCLC. We examined the DNA obtained from the tumor, nearby normal lung tissue, and matched BAL fluid for mutations in the KRAS and p53 genes; the material was obtained from 48 patients with peripheral NSCLC, and was analyzed by PCR-single strand conformation polymorphism and DNA sequencing. BAL fluids from 26 patients with benign lung disease were used as controls. Positive rates of KRAS and p53 mutations were distributed as follows: in NSCLC tissue, 52% and 58%; in BAL fluid of NSCLC patients, 38% and 44%; in normal lung tissue, 6% and 4%; and in BAL fluid of patients with benign lung disease, 8% and 4%. The combined detection of both KRAS and p53 mutations yielded a sensitivity of 66% for the diagnosis of peripheral NSCLC, which is markedly higher than that of cytology plus histology by first bronchoscopy (38%, p=0.008). In each patient with the 2 gene mutations in BAL fluid, mutation type and location were the same as those of the primary tumor. Our study indicates that the detection of the KRAS and p53 mutations in BAL fluids could be a helpful addition to cytology and histology examination for the diagnosis of peripheral NSCLC.
The Presence of Anti-GRP78 Antibodies in the Serum of Patients with Colorectal Carcinoma: A Potential Biomarker for Early Cancer Detection
Authors: Raiter Annat , Vilkin Alexander , Gingold Rachel , Levi Zohar , Halpern Marisa , Niv Yaron , Hardy Britta
Published: November 2014

Background

The identification of new biomarkers is required for early diagnosis of colorectal carcinoma patients (CRC), since about 20% of these patients are initially diagnosed with a distant metastatic disease. GRP78, a heat shock protein, functions also as a cell surface signaling receptor of cells under physiological stress. GRP78 was found to be expressed on the cell surface of various tumor cells. The presence of autoantibodies to GRP78 in cancer patient's serum was found to be correlated with a poor prognosis. In this study we aimed to identify anti-GRP78 antibodies in the serum of 85 patients diagnosed by colonoscopy, as an early detection biomarker.

Methods

We developed an ELISA assay with recombinant GRP78 immobilized on 96-well culture plates and used an anti-IgG antibody to measure the sole anti-GRP78 IgGs.

Results

Testing for anti-GRP78 showed a significant increase in antibody titer in patients with a polyp and in CRC patients (p<0.001) compared to healthy subjects.

Conclusions

This is the first study showing the presence of anti-GRP78 at the very early stages of CRC.
Evaluation of cell-free DNA as a biomarker for pancreatic malignancies
Authors: Sikora Katarzyna , Bedin Chiara , Vicentini Caterina , Malpeli Giorgio , D'Angelo Edoardo , Sperandio Nicola , Lawlor Rita T. , Bassi Claudio , Tortora Giampaolo , Nitti Donato , Agostini Marco , Fassan Matteo , Scarpa Aldo
Published: November 2014

Background

Currently, no reliable blood-based assay for early detection of pancreatic ductal adenocarcinoma (PDAC) is available. Cell-free DNA (cfDNA) quantitation in patients’ plasma has been recently applied in monitoring several cancer types. This study evaluates the diagnostic potential of cfDNA in PDAC patients.

Methods

Plasma cfDNA levels and integrity ratio were assayed using quantitative real-time PCR of Alu-repeat amplicons in patients with pancreatic ductal adenocarcinoma (n=50), pancreatic neuroendocrine tumor (n=23), and chronic pancreatitis (n=20), as well as in healthy volunteers without evidence of pancreatic disease (n=23).

Results

The total load of cfDNA, obtained by Alu83 quantitation, was the highest in PDAC patients than in any of the other patient groups (Welch t test; p<0.001) and was an average predictor of PDAC disease (AUC=0.664; CI, 0.56-0.77). A nonlinear association between Alu83 levels and subjects’ age was detected (Spearman's rho=0.35; p<0.001) in the overall population, as well as within the PDAC patients’ group (Spearman's rho=0.47; p<0.001). Necrosis-derived cfDNA fragments, quantitated with the Alu244 amplicon, were barely detectable in any of the samples and, in that respect, comparable between the different subject groups. CfDNA integrity estimation (Alu244/Alu83 ratio) was significantly affected by the limited detectability of plasma Alu244 levels.

Conclusion

The lack of detectable levels of necrosis-derived cfDNA in pancreatic pathologies considerably affects the clinical use of such biomarker in PDAC patients. Different methods of analysis should be applied in the evaluation of the cfDNA diagnostic value in pancreas pathology.
Expression profile of standard and variants forms of CD44 related to prostate cancer behavior
Authors: Moura Caio M. , Pontes Jose , Reis Sabrina T. , Viana Nayara I. , Morais Denis R. , Dip Nelson , Katz Betina , Srougi Miguel , Leite Katia R. M.
Published: November 2014

CD44 is a transmembrane glycoprotein and is regarded as a potential marker in various tumors. The aim of our study was to analyze the expression of the standard form of CD44 (CD44s) and its isoforms in localized prostate cancer (PCa), and to correlate these data with the classical prognostic factors and biochemical recurrence. Ninety-four surgical specimens were analyzed in this study. The expression levels of CD44s and all its 9 variants were analyzed by quantitative real time PCR (qRT-PCR). The control group consisted of 14 specimens from patients with benign prostatic hyperplasia. We correlated all the expression profiles with biochemical recurrence, as defined by a PSA >0.4 ng/mL in a mean follow-up period of 53.3 months. In PCa, CD44s was underexpressed and all the other isoforms were overexpressed. The mean expression level of most variants was higher in patients who had not recurred, and a higher expression of CD44v2 independently correlated with a better recurrence-free survival rate (p=0.045). This variant was also underexpressed in metastatic PCa cell lines. There was no correlation between the expression levels of any of the CD44 isoforms and the classical prognostic factors. We here demonstrated that PCa cases are characterized by a change in the expression of CD44, with a loss of CD44s and an overexpression of all the other CD44 variants. However, during cancer progression we found a loss of expression of all CD44 variants, and a correlation between higher expression of CD44v2 and a better recurrence-free survival rate. The understanding of the CD44 expression patterns in PCa could contribute to its use as a new prognostic marker.
A Pharmacogenetic Survey of Androgen Receptor (CAG)N and (GGN)N Polymorphisms in Patients Experiencing Long Term Side Effects after Finasteride Discontinuation
Authors: Cecchin Erika , De Mattia Elena , Mazzon Giorgio , Cauci Sabina , Trombetta Carlo , Toffoli Giuseppe
Published: November 2014

Finasteride is a steroid 5-alpha-reductase inhibitor, approved for the treatment of androgenetic alopecia (AGA) and benign prostate hyperplasia. In some patients the treatment is associated with adverse side effects that could become persistent after therapy discontinuation, resulting in the so-called post-finasteride syndrome (PFS). A pharmacogenetic component in the response to finasteride treatment was previously demonstrated. Two polymorphisms (CAG) rs4045402 and (GGN) rs3138869 in the gene encoding for the androgen receptor (AR) have been hypothesized to play a role in finasteride sensitivity. We aimed to compare the rs4045402 and rs3138869 polymorphisms prevalence in a group of 69 selected subjects (AGA+PFS) that used finasteride to treat alopecia and developed persistent side effects, with that in a group of 91 untreated subjects with AGA (AGA), and a group of 76 untreated subjects without AGA (NO-AGA). The rs4045402 and rs3138869 polymorphisms extreme-lengths alleles were more frequent among AGA+PFS (odds ratio, 5.88; 95% CI, 1.87-18.52) and AGA subjects (odds ratio, 3.55; 95% CI, 1.13-11.21) than among NO-AGA subjects, probably reflecting the genetic predisposing factors for AGA development. In conclusion, we described a predictive effect of the less common repeats’ length CAG-rs4045402 and GGN-rs3138869 on AGA development. Prospective trials are required to confirm our findings also in other ethnicities, and to highlight possible further pharmacogenetic predictive markers of susceptibility to adverse effects.
Chromogranin-A Levels Measured with Automated Immunoassay
Authors: Gruson Damien , Lepoutre Thibault , Smits Françoise
Published: November 2014

Measurement of chromogranin-A (CgA) levels is relevant for the diagnosis of neuroendocrine neoplasms. The use of CgA testing for risk stratification of cardiovascular diseases is also increasing. The objective of our study was to determine the performances and reference values of a novel automated assay for CgA testing. The new method was compared with an enzyme-linked immunosorbent assay. Our results showed that the performances of the automated assay were satisfactory and that the agreement between the two methods was excellent. The automation of CgA testing also reduced the turnaround time of analysis and, therefore, might contribute to a faster delivery of the results to physicians.
An exploratory biomarker study in metastatic tumors from colorectal cancer patients treated with bevacizumab
Authors: Sclafani Francesco , Rimassa Lorenza , Colombo Piergiuseppe , Destro Annarita , Stinco Sergio , Lutman Fabio R. , Carnaghi Carlo , Beretta Giordano , Zanello Alessandro , Roncalli Massimo , Giordano Laura , Santoro Armando
Published: November 2014

Aims

Inhibition of angiogenesis is an effective treatment option for metastatic colorectal cancer. Predictive biomarkers to select patients who are most likely to benefit from this therapeutic strategy are lacking. We conducted a pilot, retrospective biomarker study in a cohort of metastatic colorectal cancer patients treated with bevacizumab. The objectives of this study were to evaluate the prognostic value of biomarker expression in metastases and to compare their expression in paired tumor specimens.

Materials and methods

Eligible patients were treated with a bevacizumab-containing therapy; from these patients, tumor tissue from metastases was available. PTEN, PI3K p110a, c-MET, and CAIX were analyzed by immunohistochemistry.

Results

Forty-two patients received bevacizumab, 13 (31%) with first-line and 29 (69%) with second-line chemotherapy. Expression of CAIX, PI3K p110a, and c-MET in metastases did not predict objective response. PTEN loss was associated with response to treatment (p=0.02) and this association remained significant after adjusting for prognostic variables (p=0.006). However, no association with survival outcomes was found. In 32 patients (76%) with available paired specimens, we observed an equal expression between primary tumors and corresponding metastases in 75% of cases for CAIX in epithelial tumor cells, 56% for CAIX in stromal cells, 63% for PTEN, and 87% for c-MET.

Conclusion

PTEN loss in metastases appears to be associated with response to bevacizumab-based therapy. However, larger studies are necessary to confirm the potential role of the PI3K/AKT/mTOR pathway in modulating the therapeutic effect of bevacizumab. Tumor heterogeneity should be taken into consideration when analyzing tumor tissues for biomarker studies.
Overexpression of PSF1 is correlated with poor prognosis in hepatocellular carcinoma patients
Authors: Zhou Lei , Sun Xue-jun , Liu Chang , Wu Qi-fei , Tai Ming-hui , Wei Ji-chao , Lei Lei , Meng Fan-di , Qu Kai , Xu Jia
Published: November 2014

Background

PSF1 is a subunit of the GINS complex which is essential for establishment of DNA replication forks, and the progression of the replisome. Previous studies have shown a close relationship between PSF1 and cell cycle in the proliferation of immature cells as well as tumors. The purpose of this study was to measure PSF1 expression in hepatocellular carcinoma (HCC) tissues, and determine the effects of down-regulation of PSF1 expression on growth of cancer cells, the cell cycle, apoptosis and cell invasiveness.

Methods

Samples from 137 HCC tissues, 67 from adjacent nontumor tissue and 15 from normal liver were studied using immunochemistry. The HepG2 cell line was used for knockdown experiments studied by RT-PCR, real-time PCR, apoptosis and invasiveness assays.

Results

PSF1 was overexpressed in HCC tissues compared with normal liver tissues. High PSF1 expression correlated with a more aggressive phenotype as well as worse prognosis in HCC patients. Knockdown of PSF1 expression using small interfering RNA (siRNA) slowed the growth of cancer cell by suppressing the cell cycle progression as well as increasing apoptosis, especially early apoptosis. In addition, the invasiveness of HepG2 cells was also reduced by down-regulation of PSF1.

Conclusions

These results suggest that the inhibition of PSF1 might provide new therapeutic approaches for HCC.