bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and risk factors for non‐alcoholic fatty liver disease among adults in an urban Sri Lankan population
Authors: Dassanayake Anuradha S , Kasturiratne Anuradhani , Rajindrajith Shaman , Kalubowila Udaya , Chakrawarthi Sureka , De Silva Arjuna P , Makaya Miyuki , Mizoue Tetsuya , Kato Norihiro , Wickremasinghe A. Rajitha , De Silva H. Janaka
Published: May 2009

Background and Aims:  Non‐alcoholic fatty liver disease (NAFLD) is an emerging problem in the Asia–Pacific region. However, its prevalence and risk factors in Asian (especially South Asian) communities is poorly studied. In this study, the aim was to determine the community prevalence and risk factors for NAFLD among adults in an urban Sri Lankan population.

Methods:  The study population consisted of 35–64‐year‐old adults, selected by stratified random sampling. NAFLD was diagnosed on established ultrasound criteria for fatty liver, safe alcohol consumption (< 14 units/week for men, < 7 units/week for females) and absence of hepatitis B and C markers. Blood pressure (BP) and anthropometric measurements were made, and fasting glucose, glycosylated hemoglobin, serum lipids, fasting serum insulin and serum alanine aminotransferase (ALT) were determined.

Results:  Of the 2985 study participants, 974 (32.6%) had NAFLD (605 [62.1%] women, mean age 52.8 years [standard deviation, 7.3]). On multivariate analysis, obesity, acanthosis nigricans, insulin resistance, elevated diastolic BP, fasting plasma glucose, plasma triglycerides, and ALT twice the upper limit of the reference range or more were independently associated with NAFLD.

Conclusion:  The prevalence of NAFLD among adults in this urban Sri Lankan community is high and is strongly associated with constituent features of the metabolic syndrome.
Osteopontin is upregulated in malignant and inflammatory pleural effusions
Authors: MOSCHOS Charalampos , PORFIRIDIS Ilias , PSALLIDAS Ioannis , KOLLINTZA Androniki , STATHOPOULOS Georgios T. , PAPIRIS Spyros A. , ROUSSOS Charis , KALOMENIDIS Ioannis
Published: May 2009

Background and objective:  Osteopontin (OPN) is an important mediator of inflammation and cancer progression. In the present study, we asked whether pleural fluid (PF) and serum OPN concentrations differed between patients with pleural effusions of different aetiologies, and whether assessment of OPN levels was useful for diagnostic purposes.

Methods:  One hundred and nine consecutive patients with pleural effusions of different aetiologies were recruited prospectively during daily clinics. OPN levels were measured by ELISA.

Results:  PF OPN levels were 10‐fold higher in exudates than in transudates and were significantly correlated with markers of pleural inflammation and vascular hyper‐permeability, such as PF/serum LDH or protein ratios, PF protein and PF vascular endothelial growth factor levels. Patients with malignant pleural effusions had higher PF and lower serum OPN concentrations than those with benign disease. The diagnostic accuracies of PF and PF/serum OPN for malignancy were 71.5% (95% CI: 64–80) and 70.6% (95% CI: 62–80), respectively.

Conclusions:  OPN levels were elevated in exudative pleural effusions, as compared with the levels in blood or transudative pleural effusions. While PF and PF/serum OPN were higher in patients with malignancies, the diagnostic accuracy of the tests was not sufficient to permit routine use in clinical practice.
Electrical impedance tomography is able to track changes in respiratory function in endotoxin‐challenged rodents
Authors: HERBER‐JONAT Susanne , HAJEK Kerstin , MITTAL Rashmi , JUST Anita , HAHN Günter , SCHULZE Andreas , FLEMMER Andreas W.
Published: May 2009

Background and objective:  In order to assess and optimize the effect of new therapies for acute lung injury (ALI) in rodent models, a monitoring technique that continuously assesses the functional state of the lung is mandatory. Electrical impedance tomography (EIT) has been suggested as a technique for quantifying lung inflammation in ALI. However, EIT has not been evaluated in a rodent model of ALI.

Methods:  EIT measurements were compared in ventilated Sprague–Dawley rats (n = 14), randomly subjected to intratracheal administration of endotoxin (LPS) or saline (control). Lung mechanics, lung weight wet/dry ratio and inflammatory markers in bronchoalveolar lavage fluid were also evaluated.

Results:  LPS caused a significant decrease in lung compliance and TLC as compared with control (−42.0%, P = 0.04, and −27.9%, P = 0.02, respectively). These changes were paralleled by differences in mean impedance changes as detected by EIT (Spearman's rank correlation coefficient: ρ = 0.66 and 0.73, respectively, P < 0.01). LPS increased the lung weight wet/dry ratio (6.35 ± 0.42 vs 5.15 ± 0.07, P = 0.003), and the bronchoalveolar lavage total WCC (8.96 ± 1.87 vs 1.16 ± 0.10 × 109/L, P = 0.002) as compared with control. The lung weight wet/dry ratio was inversely related to the mean impedance change (ρ = −0.76, P < 0.01).

Conclusions:  This study has demonstrated for the first time that eight‐electrode EIT readily tracks the inflammatory response of lung tissue in a rodent model of ALI. EIT may thus provide a promising, non‐invasive technique for monitoring the time‐course of ALI in rodent models, and for testing novel pharmacological strategies to counter it.
Association of impaired respiratory function with urinary incontinence
Authors: HIRAYAMA Fumi , LEE Andy H. , BINNS Colin W. , NISHIMURA Koichi , TANIGUCHI Hiroyuki
Published: May 2009

Background and objective:  This study investigated the relationship between urinary incontinence and respiratory function in middle‐aged and older Japanese men.

Methods:  Seven hundred community‐dwelling men aged 40 years or above were recruited from community centres and hospital outpatient clinics. The International Consultation on Incontinence Questionnaire‐Short Form was administered to ascertain their urinary incontinence status. Standardized spirometric measurements of respiratory function were performed.

Results:  The prevalence of urinary incontinence was 7.6% among the 668 eligible participants (mean age 62.7 years). The 51 men who leaked urine had significantly lower FEV1 and FVC than those who were continent (P < 0.01). The adjusted risks of urinary incontinence were 0.67 (95% CI: 0.43–1.04) and 0.63 (95% CI: 0.40–0.98) for the two continuous respiratory function variables (L), respectively.

Conclusion:  The findings indicate an inverse association between urinary incontinence and respiratory function and an additional health burden in lung diseases.
Pulmonary alveolar proteinosis in China: A systematic review of 241 cases
Authors: XU Zhihao , JING Jiyong , WANG Huiying , XU Feng , WANG Jiaoli
Published: May 2009

Background and objective:  Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disease. It was first described in China in 1965, and more cases have been reported subsequently. A systematic review was performed on 241 cases of PAP in China and progress in the diagnosis and treatment of this disease is discussed.

Methods:  The Chinese biological and medical databases from 1965 to 2006 were searched and 241 cases with complete clinical and pathological data were identified. The clinical characteristics of the disease were summarized and longitudinal comparisons were made of diagnostic and treatment methods over time.

Results:  The morbidity associated with PAP has increased in recent years. The clinical manifestations were non‐specific. Progressive dyspnoea, cough and sputum were the most common symptoms. The percentage of patients undergoing CT examination has increased over the years. The combination of bronchoscopic biopsy and bronchoalveolar lavage (BAL) was usually sufficient to establish the diagnosis. Treatment was reported for a total of 142 cases. BAL and whole lung lavage were both effective and were only required once by most patients.

Conclusions:  The demographic characteristics and clinical manifestations of PAP patients in China are largely consistent with previous reports. Morbidity has increased dramatically in recent years, mainly due to the broad application of bronchoscopy since 1995. CT is very important for diagnosis of the disease. The long‐term effects of treatment by whole lung lavage and BAL are similar.
Nocturnal hypoxic stress activates invasive ability of monocytes in patients with obstructive sleep apnoea syndrome
Authors: TAMAKI Shinji , YAMAUCHI Motoo , FUKUOKA Atsuhiko , MAKINODAN Kiyoshi , KOYAMA Noriko , TOMODA Koichi , YOSHIKAWA Masanori , KIMURA Hiroshi
Published: May 2009

Background and objective:  Obstructive sleep apnoea syndrome (OSAS) is known to be a risk factor for cardiovascular events. However, the precise mechanism has not been fully elucidated. OSAS‐induced hypoxic stress may promote the production of inflammatory cytokines and chemokines by monocytes, which has a crucial role in the development of atherosclerosis. In addition, adhesion to the vascular endothelium and transendothelial migration of monocytes are considered to induce atherosclerosis. The aim of this study was to investigate the effects of hypoxic stress on the invasive ability of monocytes in OSAS.

Methods:  Twenty‐one male patients with OSAS and 17 healthy male control subjects, who were matched for age and BMI, were enrolled. Venous blood samples were collected before and after sleep, and also after CPAP titration, for the purpose of monocyte isolation. The invasive ability of monocytes was evaluated by counting the number of invading cells using a BD BioCoat Matrigel Invasion Chamber.

Results:  The number of cells, which represents the invasive ability of monocytes, was significantly higher in patients with OSAS compared with control subjects, in the early morning (P < 0.001). In patients with OSAS, invasive ability in the early morning after sleep was significantly elevated as compared with that before sleep (P < 0.001), and was positively correlated with the oxygen desaturation index (P < 0.05). CPAP titration led to a decrease in the invasive ability (P < 0.001).

Conclusions:  These results indicate that OSAS‐induced hypoxic stress activates the invasive ability of monocytes, and that the occurrence of this phenomenon during sleep may contribute to the development of atherosclerosis in OSAS.
Transpleural perfusion with oxygenated perfluorocarbon increases systemic oxygenation
Authors: LEE Sungsoo , CHO Sukki , PARK Kay‐Hyun , SUNG Sook Whan , JHEON Sanghoon
Published: May 2009

Background and objective:  There is a need for new methods of increasing systemic oxygenation in patients with hypoxia due to potentially reversible pulmonary failure. The goal of this study was to determine if it is possible to increase systemic oxygenation by perfusing the thoracic cavity with oxygenated perfluorocarbon in animals with induced hypoxia.

Methods:  Fifteen Sprague–Dawley rats were intubated, and hypoxia was induced by hypoventilation (room air, respiratory rate <30/min). Inflow and outflow tubes were placed in the thoracic cavity and connected to a perfusion circuit containing a roller pump, warmer and oxygenator. Rats in Group I were not treated during hypoventilation, those in Group II were perfused with oxygenated saline, and those in Group III were perfused with oxygenated perfluorocarbon. Arterial blood gases were collected every 30 min for 180 min. At the conclusion of the experiments, pathological examination of the lungs and parietal pleura was performed.

Results:  PaO2 in Group III was significantly higher than that in Group I or Group II. PaCO2 in Group III was significantly lower than that in the other two groups. Histological examination showed no damage to the lungs and parietal pleura in Group III.

Conclusions:  Perfusion of the thoracic cavity with oxygenated perfluorocarbon in an animal model of induced hypoxia resulted in a significant increase in systemic oxygenation without lung damage and might be a useful method for improving systemic oxygenation.
Acute retinal necrosis: a case series with clinical features and treatment outcomes
Authors: Sims Joanne L , Yeoh Jonathan , Stawell Richard J
Published: May 2009

Abstract

Purpose:  To determine clinical features, viral aetiology and treatment outcomes of eyes with acute retinal necrosis (ARN).

Methods:  Retrospective, interventional, non‐comparative case series.

Results:  Twenty‐two patients (23 eyes) were identified between 1996 and 2007. Varicella zoster virus was the causative agent in 12 patients (nine confirmed by polymerase chain reaction), herpes simplex virus type 1 in six (five polymerase chain reaction‐confirmed) and unknown in three patients. Five patients had documented herpes zoster infection in the month prior to the onset of ARN. Twelve patients (55%) had identifiable (clinical or subclinical) immune dysfunction. At 6 months, 3 out of 15 eyes (20%) maintained vision 6/12 or better and 7 (47%) were 6/60 or worse. Median final VA was 6/60. Nine eyes developed retinal detachment and two‐thirds of these had received prior barrier laser. Poor prognostic factors for severe visual loss by univariate analysis were male gender (P = 0.019), and the development of retinal detachment (P = 0.05). Delay between onset of symptoms and diagnosis was associated with moderate visual loss (P = 0.018). Barrier laser did not reduce the risk of retinal detachment.

Conclusions:  Acute retinal necrosis still has poor visual prognosis. Early diagnosis and initiation of treatment may improve outcome.
PR01 A 5 YEAR PROGRAM OF SURGICAL TREATMENT OF ENCEPHALOCOELES IN VIETNAM BY OPERATION SMILE AUSTRALIA
Authors: Breidahl A. F. , Lewandowski R.
Published: May 2009

Operation Smile Australia (OSA) was founded by Richard Lewandowski and is a not for profit volunteer organisation, associated with Operation Smile International.

OSA's mission is to bring modern craniofacial and plastic surgery techniques to developing countries. To this end, a five year plan is developed for each location, with the aim that by the end of the program the local medical teams are self sufficient and able to continue the surgical treatment of patients in their own countries without outside assistance.

We report on a five year program to Cho Ray Hospital in Ho Chi Minh City, Vietnam, where the local team has been successfully taught how to manage encephalocoeles. During this time 19 patients with encephalocoeles were surgically treated by the Operation Smile Team, with increasing responsibility assumed by the local medical team. Three patients with very large encephalocoeles were brought to Australia for treatment, and two Vietnamese Neurosurgeons were brought to Australia for further education and experience. Complications were minimal, and consist of a false passage created by urethral catheterisation and a CSF leak from a lumbar drain, both of which recovered completely with conservative management.
VS08 ENDOVASCULAR VENOUS LASER VS OESCH PIN STRIPPER IN MANAGEMENT OF PRIMARY VARICOSITIES OF THE GREAT SAPHENOUS VEIN: A RANDOMIZED CONTROL TRIAL
Authors: Desai D. J. , Pedgoankar P. , Sekhar R.
Published: May 2009

Aim:   Varicosities of the lower limb are a major economic and medical burden. Various modalities of treatment have been proposed. This study aims to compare minimally invasive Endovenous Laser Ablation (EVLA) with conventional High ligation and stripping using Oesch Pin stripper (HLS) in the management of primary varicosities of the Great Saphenous vein (GSV). Principal outcomes were abolition of GSV reflux and comparison of postoperative morbidity and mortality.

Material and Methods:  

This trial was prospectively conducted over 2 years and comprised to a total of 60 consecutive consenting patients randomized (randomized by a random number assigned by a blinded person) equally between the EVLA and Surgery groups. The inclusion criteria were patients with symptomatic primary GSV reflux and varicosities suitable for both modalities of treatment. Exclusion criteria were secondary GSV varicosities and recurrent varicosities. All patients were followed up at regular interval for a period of 3 months.

Results:   GSV reflux was abolished in all patients in both groups. Patients with EVLA had a shorter length of stay (LOS) of 0.47 compared to 2.6 with HSL. One patient had minor burns with EVLA and in one venotomy had to be done due to slippage of guide wire. All other post‐operative complications such as haematoma, ecchymosis, and pain were significantly lower in the EVLA group. There was no mortality in either group.

Conclusion:   EVLA being an outpatient procedure resulted in a safer and quicker recovery and less socioeconomic burden with a shorter LOS, however the early peri‐operative pain was higher in the EVLA group. The long term results of recurrence have not been studied in this study and warrants further investigation.
Enameloid microstructure in the oldest known chondrichthyan teeth
Authors: Botella H. , Donoghue P. C. J. , Martínez‐Pérez C.
Published: May 2009

Previous studies on tooth enameloid microstructure in several chondrichthyan taxa spanning the phylogeny of the group provided support for the homology of chondrichthyan tooth enameloid. This hypothesis requires that a single crystallite enameloid (SCE) monolayer must be present in the teeth of the most primitive chondrichthyan. However, the dental microstructure of the earliest sharks has yet to be investigated. We have studied the tooth enameloid microstructure of the two oldest tooth‐bearing shark species currently known, Leonodus carlsi Mader (1986) and Celtiberina maderi Wang (1993), from the lowermost Lochkovian (Lower Devonian) of Spain. Our study demonstrates the presence of a SCE monolayer in the teeth of both species. These results show that a superficial cap of SCE is present in the oldest shark teeth known, which suggest its presence in the most basal chondrichthyans.
A redescription of the Early Carboniferous acanthodian Acanthodes lopatini Rohon, 1889
Authors: Beznosov Pavel
Published: May 2009

Investigation of numerous well‐preserved specimens of Early Carboniferous acanthodians collected over recent decades from southern central Siberia allowed their redescription as Acanthodes lopatini Rohon, 1889. The morphological characteristics supporting this classification, some peculiarities of ontogeny and a new reconstruction of this species are given. The genus Carycinacanthus Miles 1966 is regarded as a junior synonym of Acanthodes. Homalacanthus bergi (Obruchev 1962) is regarded as a junior synonym of A. lopatini.
A new specimen ofHelicoprionKarpinsky, 1899 from Kazakhstanian Cisurals and a new reconstruction of its tooth whorl position and function
Authors: Lebedev O. A.
Published: May 2009

A newHelicoprion bessonowiKarpinsky, 1899 (Chondrichthyes, Eugeneodontiformes) specimen from the Artinskian of Kazakhstan is described. This is the southernmost occurrence of this species in the Cisurals area. Its presence suggests a biogeographical link for this species between the Cisurals and Japan. Residue obtained from chemical preparation of the sample included numerous scales and several teeth, which are tentatively assigned toHelicoprion. This assumption is based upon morphological similarity of the scales to those known in other eugeneodontiforms.Campodus‐like teeth might be part of the lateral dentition ofHelicoprion. A new reconstruction of the interaction of the lower tooth whorl with the upper jaw dentition is suggested and its function is discussed. It is proposed that there was no symphysial whorl in the upper jaw but its role was played by a rigid cover formed by a series of small teeth at the palatoquadrates. Microscopic study of the tooth crown surface revealed scratch marks, which might have resulted from pressing the food object against the upper jaw. Using extant odontocetans as an ecological model led to a conclusion that helicoprionids most likely fed on cephalopods and to some extent on fish. This assumption is based upon the concentration of functional dentition in the area of the lower jaw symphysis in both groups of animals.
Fossils provide better estimates of ancestral body size than do extant taxa in fishes
Authors: Albert James S. , Johnson Derek M. , Knouft Jason H.
Published: May 2009

The use of fossils in studies of character evolution is an active area of research. Characters from fossils have been viewed as less informative or more subjective than comparable information from extant taxa. However, fossils are often the only known representatives of many higher taxa, including some of the earliest forms, and have been important in determining character polarity and filling morphological gaps. Here we evaluate the influence of fossils on the interpretation of character evolution by comparing estimates of ancestral body size in fishes (non‐tetrapod craniates) from two large and previously unpublished datasets; a palaeontological dataset representing all principal clades from throughout the Phanerozoic, and a macroecological dataset for all 515 families of living (Recent) fishes. Ancestral size was estimated from phylogenetically based (i.e. parsimony) optimization methods. Ancestral size estimates obtained from analysis of extant fish families are five to eight times larger than estimates using fossil members of the same higher taxa. These disparities arise from differential survival of large‐bodied members of early branching lineages, and are not statistical or taphonomic artefacts. Estimates of ancestral size obtained from a limited but judicious selection of fossil fish taxa are more accurate than estimates from a complete dataset of extant fishes.
New arthrodires (Family Williamsaspididae) from Wee Jasper, New South Wales (Early Devonian), with comments on placoderm morphology and palaeoecology
Authors: Young Gavin C.
Published: May 2009

Two new arthrodire species represented by articulated trunk armours from the Early Devonian (Emsian) limestones of the Burrinjuck area are placed in a new genusElvaspis(E. tuberculata,E. whitei), assigned to the Family Williamsaspididae. On new evidence of the dermal neck‐joint and shape of the median dorsal plate this family is reassigned from the Phlyctaeniina to the Brachythoraci. The strongly ornamented post‐branchial lamina of the trunk armour relates to a recent hypothesis that special post‐branchial denticles in placoderms are homologous to pharyngeal denticles of crown‐gnathostomes rather than modified external tubercles. Variable development of the post‐branchial lamina and its ornament in different placoderm subgroups, with specific resemblance to the external ornament characteristic of that subgroup, indicates that modification of normal external dermal ornament is the most parsimonious interpretation. A comparison of fish diversity in modern and ancient tropical reef environments is consistent with an equilibrium model for species diversification through time.
The histology of the Upper Silurian osteostracan Timanaspis kossovoii Obruchev (Agnatha) from North Timan, Russia
Authors: Afanassieva Olga B. , Karatajūtė‐Talimaa Valentina N.
Published: May 2009

The fine structure of the exoskeleton of Timanaspis kossovoii Obruchev 1962 was investigated based on new well‐preserved material. The remains come from the lower part of the Eptarma Formation (Upper Silurian). Timanaspis kossovoii was referred by Obruchev to the family Tremataspididae and most authors agree with the placement of Timanaspis among tremataspidid osteostracans. Histological study of the shield of T. kossovoii has revealed the presence of unusual features in the exoskeletal structure. The smooth and shiny surface of the ventral side of the shield of T. kossovoii is similar to that of species of Tremataspis, but thin sections show differences in histological composition. The exoskeleton of T. kossovoii consists mainly of dense bony tissue in the middle layer and a laminated basal layer. No osteocyte cavities of typical form and size were found in the middle layer. The upper parts of the elongated tubercles of the dorsal side of the shield are formed by a well‐developed dentine‐like tissue; the arrangement of numerous tubules within this tissue is far more regular than in the mesodentine of Tremataspis. No traces of perforated septa, pore fields or a polygonal model were detected in the structure of the exoskeleton of Timanaspis. We conclude that Timanaspis can be differentiated from conventional tremataspidids by histological features and refer it to the new family Timanaspididae. Moreover, the Timanaspis exoskeleton provides evidence that an acellular condition of bony tissue does not appear to be characteristic of only Late Devonian osteostracans.
Identifying patterns of diversity of the actinopterygian fulcra
Authors: Arratia Gloria
Published: May 2009

Fin rays, scutes or ridge scales, and fulcra have been traditionally interpreted as modified scales, but their diversity has been almost ignored. Based on results presented here, revised definitions of these elements are provided. At least two patterns of basal fulcra are found in actinopterygians: in Pattern I all or most basal fulcra are paired elements, whereas in Pattern II, a series of unpaired basal fulcra that are bifurcated proximally, and whose forking gradually becomes larger caudad, are followed by a series of paired elements. Basal fulcra are commonly present on unpaired fins of lower actinopterygians, including basal neopterygians. Among living fish they are absent in polypteriforms,Amiaand teleosts. Fringing fulcra are always paired. Three patterns of fringing fulcra series are described: the series of fringing fulcra in basal actinopterygians is formed by expanded terminal segments of marginal lepidotrichia (Pattern A). Another series is formed by a combination of slightly expanded or modified terminal segments of rays and independent spiny, small elements (Pattern B). The third series is formed of small, spiny ossified elements positioned along the leading marginal fin ray(s) (Pattern C). Other patterns of basal and fringing fulcra remain to be investigated, along with their phylogenetic implications.
Heddleichthys– a new tristichopterid genus from the Dura Den Formation, Midland Valley, Scotland (Famennian, Late Devonian)
Authors: Snitting Daniel
Published: May 2009

A new tristichopterid genus,Heddleichthys, from the Famennian of Scotland is described based on material previously assigned to a number of different genera, includingGlyptopomus,GyroptychiusandEusthenopteron. The validity of the new genus is established by a discussion of the reasons for the invalidity of the previous assignments.Heddleichthysis characterized by a combination of derived and primitive tristichopterid features. Derived features include the presence of symphyseal dentary fangs and premaxillary pseudofangs, a diamond‐shaped symmetric caudal fin, a low posterodorsal expansion of the maxilla, and a posteriorly positioned kite‐shaped pineal series. Primitive features include a postorbital and jugal contribution to the orbital margin and a parasphenoid with a ventral keel. External dermal bones are rather poorly preserved in the referred material, with few easily discernible sutures. The holotype specimen, a three‐dimensionally preserved skull, was scanned by computed tomography to reveal well‐preserved internal dermal bones, including entopterygoids, vomers and parasphenoid. There is no preserved endoskeletal material. As the first representative of derived tristichopterids described from Britain,Heddleichthyslends support to the idea that faunal dispersion between Gondwana and Laurussia in the Late Devonian was widespread. Derived tristichopterids have been described from all continents except South America. In contrast, the basal tristichopteridsEusthenopteronandTristichopterusare still only described from Laurussia.
A new tooth‐plated lungfish from the Middle Devonian of Yunnan, China, and its phylogenetic relationships
Authors: Qiao Tuo , Zhu Min
Published: May 2009

A new genus and species of tooth‐plated lungfish,Sinodipterus beibeigen. et sp. nov., is described from the Qujing Formation (Middle Devonian, late Eifelian) of Zhaotong, Yunnan, China. The new form resemblesDipterusin the skull table, but differs in its tooth‐plate: cosmine‐like tissue absent near the midline, tooth rows fewer in number (7 to 8) and less divergent radiating, and no reparative dentine layers. Phylogenetic analysis of Devonian lungfish based on a dataset of 150 characters and 33 taxa indicates that the new taxon is more crownward thanDipterusand the clade comprisingAdololopas,SorbitorhynchusandPillararhynchus. Our results agree broadly with previous cladistic solutions.Diabolepisis placed as a sister group to all other Devonian lungfish. The species referred toChirodipterusfail to form a monophyletic group. The result shows a large number of convergences corresponding to early radiation of lungfish compressed in time.
Great northern researchers: discoverers of the earliest Palaeozoic vertebrates
Authors: Schultze Hans‐Peter , Turner Susan , Grigelis Algimantas
Published: May 2009

The lives and works of Dr Elga Mark‐Kurik and Dr Valentina Karatajute‐Talimaa, Estonian and Lithuanian palaeontologists, respectively, are presented as part of their celebration at the 11th Symposium on Early/Lower Vertebrates at Uppsala. Both graduated from the university of their home town, Tartu and Vilnius, respectively. Elga became a Researcher at the Institute of Geology of the Estonian S.S.R. Academy of Sciences, in Tallinn, whereas Valentina worked for the Institute of Geology, Vilnius. Both were mentored by D. V. Obruchev of Moscow. Elga chose placoderms and psammosteid heterostracans as main research objects. Valentina also began with whole fish, antiarch placoderms, but then chose fish microfossils with W. Gross as mentor and discovered the oldest chondrichthyans. Both work as palaeobiologists understanding the implications of their fossils for functional interpretation and palaeogeography; their main contribution is in biostratigraphy (over 50% of their publications). In 1976 Elga organized the 1st Middle Palaeozoic Fossil Fish Symposium in Tallinn. The co‐operation of young eastern and western palaeoichthyologists begun there culminating in the 1990s with the international research effort of the UNESCO‐IUGS International Geological Correlation Programmes (328, 406 and 491).
Predicting tumour location in radical prostatectomy specimens: same‐patient comparisons of 21‐sample versus sextant biopsy
Authors: De Laet Kevin , De La Taille Alexandre , Ploussard Guillaume , Hoznek Andras , Vordos Dimitrios , Yiou René , Allory Yves , Azoulay Sandy , Abbou Claude , Salomon Laurent
Published: May 2009

OBJECTIVE

To determine the value of a 21‐sample biopsy protocol in predicting tumour localization in radical prostatectomy (RP) specimens, compared with sextant biopsies.

PATIENTS AND METHODS

In all, 300 consecutive patients underwent 21‐sample prostate biopsies, followed by RP. The protocol consisted of sextant, three midline, six far lateral and six transitional zone biopsies. Tumour locations on biopsies and RP specimens were compared. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) and accuracy were calculated.

RESULTS

There was no difference between sextant and 21‐sample biopsies for sensitivity (38% vs 36%; P = 0.50) and specificity (84% vs 87%; P = 0.46), but the NPV was higher for 21‐sample biopsies (57% vs 68% ; P < 0.001). The PPV was higher in the sextant biopsies (74% vs 59%; P = 0.007). Sextant, transitional zone and far lateral biopsies were re‐grouped in six regions. Compared with 21‐sample biopsies, sensitivity (54%) and PPV (79%) were higher (P < 0.001), while specificity (74%) and NPV (46%) were lower (P = 0.05 and P = 0.001, respectively).

CONCLUSION

A negative biopsy does not confirm the absence of cancer in the corresponding site in the RP specimen in a sextant or 21‐sample biopsy protocol and cannot be used as a prognostic element before RP. A positive biopsy does not always correspond with a tumour in the same zone of the RP specimen. When 21‐sample biopsies are re‐grouped in to six regions, the value of a positive biopsy increases. A positive biopsy corresponds thus to a tumour in the same region, rather than in precisely the same location. The results of this study could help in the biopsy protocol used for making surgical decisions, e.g. preserving the bladder neck or neurovascular bundles.
Civiale, stones and statistics: the dawn of evidence‐based medicine
Authors: Herr Harry W.
Published: May 2009

The statistical research on bladder stones conducted by Paris urologist Jean Civiale in the early 19th century provided historical roots for evidence‐based medicine. Translations of original documents by Civiale describing his work on treating bladder stones, and the discussion by members of the Paris Academy of Sciences that commented on his results in 1835, were reviewed. By collecting statistical data on a wide scale throughout Europe, Civiale argued that his new transurethral procedure, called lithotripsy, was superior to the more widely used but highly morbid technique, lithotomy. The Paris Academy of Sciences commented on his research and chose the occasion to debate whether or not numerical reasoning and statistics had any place in medical and surgical practice. Civiale’s insights and methods espoused similar concepts and ideas driving today’s new paradigm of evidence‐based medicine.
The Whitaker test: 35 years on
Authors: Lupton Eric W. , George Nicholas J.R.
Published: May 2009

Study Type – Diagnosis (case series) Level of Evidence 4

OBJECTIVE

To describe a 25‐year experience of using the Whitaker test in a single tertiary centre for assessing upper urinary tract dilatation, and to evaluate the role of perfusion pressure‐flow studies in contemporary urological surgery for equivocal upper tract obstruction.

PATIENTS AND METHODS

In all, 143 patients with suspected upper urinary tract obstruction were investigated by at least one Whitaker test. The original method was extended to include observations on high flow‐rate perfusion, abnormal renal pelvic peristalsis and loin pain with no pressure increase. Data on clinical presentation, perfusion pressure‐flow studies, diuresis renography and choice of initial therapy were collected prospectively, and the long‐term clinical outcome was analysed retrospectively.

RESULTS

In total, 145 studies were assessed; the Whitaker test showed obstructive features at conventional or higher flow rates in 61 cases and unobstructive patterns in 53. There were four equivocal results. Seventeen studies showed abnormal peristalsis within the renal pelvis and in 10 there was ‘sensory’ loin pain during the test. In patients with idiopathic hydronephrosis, there was agreement between the results of the pressure‐flow studies and diuresis renography in 72%. The Whitaker test determined or contributed to the clinical management in 84% of the cases studied. It was accurate in its prediction of outcome in 77% of cases where obstruction was diagnosed and in 77% of unobstructive cases.

CONCLUSIONS

The Whitaker test continues to have a role in modern urological surgery. It should be reserved for assessing potential upper urinary tract obstruction in the following circumstances: equivocal results from less invasive tests; suspected obstruction with poor kidney function; loin pain with a negative diuresis renogram; suspected intermittent obstruction; and gross dilatation with a positive diuresis renogram.
Muscarinic receptor activation in the lumbosacral spinal cord ameliorates bladder irritation in rat cystitis models
Authors: Masuda Hitoshi , Ichiyanagi Nobutaka , Yokoyama Minato , Sakai Yasuyuki , Kihara Kazunori , Chancellor Michel B. , De Groat William C. , Yoshimura Naoki
Published: May 2009

OBJECTIVE

To investigate whether activation of spinal cholinergic pathways affects bladder activity in rats with chemical cystitis induced by acetic acid (AA) and cyclophosphamide (CYP).

MATERIALS AND METHODS

The effects of intrathecal (i.t.) application of neostigmine as an acetylcholine esterase (AChE) inhibitor, oxotremorine‐M (OXO‐M) as a muscarinic ACh receptor (mAChR) agonist or epibatidine as a nicotinic AChR (nACHR) agonist with or without atropine as a mAChR antagonist or mecamylamine (MEC) as a nAChR antagonist at the level of L6‐S1 spinal cord on C‐fibre mediated bladder irritation were examined by using continuous‐infusion cystometry (0.1 mL/min) in urethane‐anaesthetized female Spraque‐Dawley rats. Bladder irritation was induced by intravesical AA (0.25%) or pretreatment with intraperitoneal injection of CYP (150 mg/kg) 24 h before cystometry. In control rats during intravesical saline, the effects of above drugs on the bladder activity were also examined.

RESULTS

The intercontraction intervals (ICI) in AA‐ and CYP‐treated rats were significantly shorter than those in control rats. Neostigmine (i.t.) significantly increased ICI dose‐dependently without changing maximum voiding pressure in all groups. The mean (sem) maximal percentage increases in ICI after i.t. neostigmine as compared with the pretreatment value in control, AA‐ and CYP‐treated rats were 93.2 (18.5)%, 117.5 (20.2)% and 200.7 (19.6)%, respectively. The percentage increases of ICI in the CYP‐treated group were significantly (P < 0.05) higher than those in the AA‐treated or control groups. In all groups, pretreatment with atropine, but not MEC, almost completely antagonized the inhibitory effects of neostigmine. OXO‐M produced almost the same effects as that of neostigmine in all groups. Conversely, i.t. epibatidine decreased the ICI in all groups and these excitatory effects were completely antagonized by pretreatment with MEC and significantly inhibited by pretreatment with MK‐801(noncompetitiven‐methyl‐d‐aspartate receptor antagonist).

CONCLUSIONS

These results indicate that accumulation of ACh by AChE inhibition in the spinal cord can ameliorate frequent urination in chemical cystitis via mAChRs, but not nAChRs.
Lack of effectiveness of botulinum neurotoxin A on isolated detrusor strips and whole bladders from mice and guinea‐pigs in vitro
Authors: Howles Sarah , Curry Jonathan , McKay Ian , Reynard John , Brading Alison F.
Published: May 2009

OBJECTIVE

To differentiate between the effects of parasympathetic and sensorimotor stimulation of isolated mouse and guinea‐pig bladders in vitro by measuring the pressure increases to electrical field stimulation (EFS) and then comparing the effects of botulinum neurotoxin A (BoNT‐A) applied either to the lumen or to the external bathing medium.

MATERIALS AND METHODS

Isolated mouse and guinea‐pig bladders and detrusor strips were exposed to EFS in vitro before and after the addition of BoNT‐A. The rationale of this method was that BoNT‐A applied to the outside of the bladder would first affect the parasympathetic nerves before diffusing inwards to affect the sensorimotor innervation. BoNT‐A applied intravesically would first reach the sensorimotor nerves and only later the parasympathetic nerves. Initial experiments on strips of detrusor were conducted to establish the correct dosage and application time of BoNT‐A.

RESULTS

Contrary to our expectations, BoNT‐A application failed to produce any significant effects on either the detrusor strips or whole bladders.

CONCLUSIONS

Our experimental design failed to show any effect of BoNT‐A on the contractility of detrusor muscle strips or whole bladders from mice and guinea‐pigs. The reason for this is unclear, but may be related to tissue spending inadequate time incubated with BoNT‐A under physiological conditions.
Validation of a nomogram to predict disease progression following salvage radiotherapy after radical prostatectomy: results from the SEARCH database
Authors: Moreira Daniel M. , Jayachandran Jayakrishnan , Presti Jr Joseph C. , Aronson William J. , Terris Martha K. , Kane Christopher J. , Amling Christopher L. , Stephenson Andrew J. , Freedland Stephen J.
Published: May 2009

OBJECTIVE

To externally validate the nomogram published by Stephenson et al. (termed the ‘Stephenson nomogram’) to predict disease progression after salvage radiotherapy (SRT) among patients with prostate cancer from the Shared Equal Access Regional Cancer Hospital (SEARCH) database.

PATIENTS AND METHODS

We analysed data from 102 men treated with SRT for prostate‐specific antigen (PSA) failure after prostatectomy, of whom 30 (29%) developed disease progression after SRT during a median follow‐up of 50 months. The predicted 6‐year progression‐free survival (PFS) was compared to the actuarial PFS using calibration plots. The accuracy of the nomogram to risk‐stratify men for progression was assessed by the concordance index.

RESULTS

The median PSA and PSA doubling time before SRT was 0.6 ng/mL and 10.3 months, respectively. The 6‐year actuarial disease‐free progression after SRT was 57% (95% confidence interval 42–69%). The overall concordance index of the Stephenson nomogram was 0.65. The nomogram predicted failure more accurately at the extremes of risk (lowest and highest) but in intermediate groups, the accuracy was less precise. Of the 11 variables used in the nomogram, only negative margins and high PSA level before SRT were significantly associated with increased disease progression.

CONCLUSION

The Stephenson nomogram is an important tool to predict disease progression after SRT following radical prostatectomy. It adequately predicted progression in SEARCH with reasonable accuracy. Also, in SEARCH, disease progression was predicted by similar disease characteristics. However, the overall modest performance of the model in our validation cohort indicates there is still room for improvement in predictive models for disease progression after SRT.
Effect of bony pelvic dimensions measured by preoperative magnetic resonance imaging on performing robot‐assisted laparoscopic prostatectomy
Authors: Hong Sung Kyu , Lee Seung Tae , Kim Sung Soo , Min Kyung Eun , Hwang In Sik , Kim Myung , Jeong Seong Jin , Byun Seok‐Soo , Hwang Sung Il , Lee Sang Eun
Published: May 2009

OBJECTIVE

To evaluate the effect of bony pelvic dimensions measured by preoperative magnetic resonance imaging (MRI) on performing robot‐assisted laparoscopic prostatectomy (RALP).

PATIENTS AND METHODS

In this exploratory study, we analysed the data of 141 patients who underwent RALP for clinically localized prostate cancer after undergoing MRI at our institution. Associations of various clinicopathological factors were analysed, including pelvic dimensions measured by preoperative MRI, with operative duration, estimated blood loss (EBL), surgical margin status, and postoperative urinary continence and erectile function.

RESULTS

For operative duration, no pelvic dimension had a significant association on univariate analysis, with only the newly developed variable of pelvic cavity index approaching significance (P = 0.071). Only prostate volume had a significant association with operative duration on multivariate analysis (P = 0.015). For EBL, no bony pelvic dimension had a significant association on univariate analysis, with only intertuberous distance and interspinous distance approaching significance (P = 0.087 and P = 0.072, respectively). Again, only prostate volume was significantly associated with EBL on univariate analysis (P = 0.045). No pelvic dimension had any significant effect on surgical margin status, recovery of urinary continence or erectile function at 6 months after RALP.

CONCLUSION

Bony pelvic dimensions may not be a significant factor contributing to the technical difficulty of RALP among Korean patients compared with other patient‐related factors such as prostate volume.
Outcome after radical cystectomy in patients with clinical T2 bladder cancer in whom neoadjuvant chemotherapy has failed
Authors: Manoharan Murugesan , Katkoori Devendar , Kishore Thekke A. , Kava Bruce , Singal Rakesh , Soloway Mark S.
Published: May 2009

OBJECTIVE

To analyse the outcome after radical cystectomy (RC) in patients with clinical T2 bladder cancer not responding to neoadjuvant chemotherapy (NAC).

PATIENTS AND METHODS

In a retrospective analysis, study patients received NAC for clinical T2 disease before RC and a control group had RC for clinical T2 disease with no NAC. Patients treated with NAC were further grouped based on the pathological response; failure to respond was defined as ‘no change in T stage or a higher T stage in the RC specimen (≥pT2)’, and the relevant clinical and pathological data were analysed.

RESULTS

In all, 53 patients satisfied the inclusion criteria for the study group and 200 for the control group. In the study group 18 (34%) responded to NAC (group 1) of whom 11 (61%) were pT0 and seven (39%) pT1, and among the non‐responders (group 2) 19 (54%) were pT3/pT4 and 16 (46%) were pT2; 16 (46%) patients in group 2 had lymph node metastasis. The mean follow‐up was 26 months. In group 2, local recurrence occurred in six (17%) vs none in group 1. Seven patients (20%) in group 2 developed metastases, vs one (5%) in group 1 (P = 0.01). The 5‐year disease‐free survival was significantly lower for group 2 (40%) than group 1 (91%, P = 0.007) and the control group (67%, P = 0.04). There were 14 deaths from bladder cancer in group 2, vs one in group I (P = 0.01). The 5‐year disease‐specific survival was significantly lower for group 2 (52%) than group 1 (83%, P = 0.008) and the control group (70%, P = 0.001).

CONCLUSION

A lack of response to NAC is associated with a significantly higher local and distant recurrence, and with lower survival.
Screening: should more biopsies be taken in larger prostates?
Authors: Van Leeuwen Pim , Van Den Bergh Roderick , Wolters Tineke , Schröder Fritz , Roobol Monique
Published: May 2009

OBJECTIVE

To assess the number of missed prostate cancers and the frequency of aggressive disease when taking lateralized sextant prostate biopsies, irrespective of the total prostate volume (Pvol), during screening for prostate cancer.

SUBJECTS AND METHODS

Men participating in the European Randomized Study of Screening for Prostate Cancer, Rotterdam section, aged 55–74 years, with a prostate‐specific antigen (PSA) level of ≥3.0 ng/mL, and a negative sextant biopsy result at the initial screening round, were followed for 8 years. Cases of prostate cancer detected during the follow‐up by screening, or detected clinically as interval cancers, were assessed. Pvol at the initial screening round was related to the number of cancers found during the follow‐up. Furthermore, the frequency of aggressive cancer (N1 or M1, PSA >20 ng/mL, Gleason >7) was evaluated using multivariate logistic regression analysis, including age, PSA level and Pvol.

RESULTS

In the total of 1305 men, 152 prostate cancers were detected during 8 years of follow‐up (11.6%); 23 were classified as aggressive (15.1%), and 50 (32.9%) were detected as interval cancers. There was a significant relation between a larger Pvol at the initial screening round and fewer cancers (odds ratio 0.1, P < 0.001). In multivariate logistic regression, the initial PSA level (odds ratio 3.21, 95% confidence interval, CI 1.2–8.3) and smaller Pvol (0.08, 95% CI 0.03–0.26) were statistically significant predictors for all cancers and aggressive cancers (PSA odds ratio 70.37, 95% CI 13.5–366.2; Pvol odds ratio 0.03, 95% CI 0.01–0.35).

CONCLUSIONS

Men with a smaller Pvol and an initially high PSA level were at greater risk of cancer detection and of an aggressive cancer during the follow‐up. The use in clinical practice of volume‐adjusted biopsy schemes should not be implemented automatically in screening programmes with repeated screening.
Impact of International Financial Reporting Standard adoption on key financial ratios
Authors: Lantto Anna‐Maija , Sahlström Petri
Published: May 2009

Although previous research has investigated the economic consequences of International Financial Reporting Standard (IFRS) adoption, there is little evidence on the impact of IFRS adoption on key financial ratios. To fill this gap, we examine this issue in a continental European country (Finland). Our results show that the adoption of IFRS changes the magnitude of the key accounting ratios. Moreover, we extend the literature by showing that the adoption of fair value accounting rules and stricter requirements on certain accounting issues are the reasons for the changes observed in accounting figures and financial ratios.