bluuebunny/crossref_metadata_2025 huggingface dataset:
Identification of Pregnancy-Associated MicroRNAs in Maternal Plasma
Authors: Miura Kiyonori , Miura Shoko , Yamasaki Kentaro , Higashijima Ai , Kinoshita Akira , Yoshiura Koh-ichiro , Masuzaki Hideaki
Published: August 2010

BACKGROUND

Several placental microRNAs (miRNAs) have been identified as pregnancy-associated molecules with the potential for use in estimating the condition of the placenta. Our understanding of these novel molecules is still limited, however. The aim of this study was to isolate and characterize pregnancy-associated miRNAs in maternal plasma.

METHODS

By microarray-based screening of 723 human miRNAs, we selected miRNAs that exhibited signal intensities >100 times higher in placental tissues than in the corresponding whole blood samples. Subsequent quantitative real-time reverse-transcription PCR revealed miRNAs produced predominantly in the placenta that showed significantly decreased concentrations in maternal plasma after delivery. These miRNAs were identified as pregnancy-associated miRNAs.

RESULTS

We selected 82 miRNAs produced predominantly in the placenta and identified 24 as pregnancy-associated miRNAs. The genes encoding these miRNAs included 16 that are clustered on 19q13.42 and 5 clustered on 14q32. As the pregnancy progressed into the third trimester, the plasma concentrations of cell-free chromosome 19–derived miRNAs (has-miR-515-3p, has-miR-517a, has-miR-517c, has-miR-518b, and has-miR-526b) increased significantly (P = 0.0284, 0.0069, 0.0125, 0.0284, and 0.0093, respectively, Wilcoxon signed rank test), whereas that of cell-free has-miR-323-3p on chromosome 14q32.31 showed no change (P = 0.2026).

CONCLUSIONS

In addition to the known pregnancy-associated miRNAs, we identified new pregnancy-associated miRNAs with our microarray-based approach. Most of the genes encoding these miRNAs were clustered on 19q13.42 or 14q32, which are critical regions for placental and embryonic development. These new pregnancy-associated miRNAs may be useful molecular markers for monitoring pregnancy-associated diseases.
Professional Issues: Leadership in the Product Development Process: Attitude Counts!
Authors: McLoone Hugh E.
Published: August 2010

Editor's Note: Our attitudes make a difference as we participate in the product development process and meet challenges that arise for us individually or for the team. The author offers 10 lessons learned about attitudes and how they have helped or hindered efforts to create superior user experiences and industry-leading products. Previous articles by Hugh McLoone in this Ergonomics in Design column have covered other aspects of leadership, including schedule constraints, decision making, communication, and teamwork.

Questioning the design of an existing product – or even the research on which it is based – can help design teams find new ways to succeed.
Colonnal történt nyelőcsőpótlás után kialakult vastagbél-adenocarcinoma
Authors: Sikorszki László , Horváth Örs Péter , Papp András , Cseke László , Pavlovics Gábor
Published: August 2010

Absztrakt

Esetismertetés: A szerzők a PTE KK Sebészeti Klinikán korrozív nyelőcsősérülés után 44 évvel a bőrcső-colon anastomosis területén, a nyakon kialakult vastagbél-adenocarcinoma operatív megoldását ismertetik. Megbeszélés: Betegüknél ezen műtétet megelőzően 44 évvel sósav ivását követően kialakult középsúlyos nyelőcső-, gyomor- és gégesérülés után sorozatos gégeplasztikák, majd végleges tracheostomia, illetve nyelőcső-eltávolítás történt, pylorus plasztikával, két ülésben végzett ileocolon transzpozíciójával. A műtét során antethoracalis nyelőcsőképzést végeztek ileocolonnal és bőrcső-kiegészítéssel. A felvitt colonban 44 évvel később kifekélyesedett adenocarcinoma igazolódott, melyet resecáltak és mikro-éranastomosisok alkalmazásával izolált jejunumszegmentum átültetésével állították helyre a beteg nyelésképességét.
Mediastinalis és retroperitonealis bronchogen cysták sikeresen operált esetei és tanulságaik
Authors: Sugár István , Vörös Attila , Diczházi Csaba , Barabás Loránd , Valkó Luca , Kovács Gábor László , Ondrejka Pál
Published: August 2010

Absztrakt

Esetismertetés:Két fiatal férfi betegünk egyikénél nyelési panaszait okozó mediastinalis szövetszaporulat exstirpatióját követő szövettani vizsgálat, a másiknál egyéb okból elvégzett hasi CT által valószínűsített mellékvese-adenoma „kivétele” után derítette ki a hisztológia a pontos diagnózist: a bronchialis cystát.Megbeszélés:A mediastinalis tumorok néhány százalékát fejlődési rendellenesség hatására keletkező bronchogen cysták alkotják. Csekély hányaduk okoz panaszt, ezek kerülnek felismerésre. Különösen ritka formája, amikor az ébrényi szakban, az egyedfejlődés során a cystakezdemény a hasüregbe vagy a retroperitoneumba vándorol. Diagnosztizálásuk praktikusan csak az eltávolítást követő szövettan révén lehetséges.
Chlamydia trachomatis Infection Among Women Reporting Sexual Activity With Women Screened in Family Planning Clinics in the Pacific Northwest, 1997 to 2005
Authors: Singh Devika , Fine David N. , Marrazzo Jeanne M.
Published: August 2010

Objectives. We sought to define Chlamydia trachomatis positivity among women who report sexual activity with women, a population for which sparse data on this infection are available and for whom health disparities including challenged access to comprehensive sexual and reproductive health services, have been reported.

Methods. We analyzed data from 9358 family planning clinic visits with C trachomatis tests among women aged 15 to 24 years who reported sexual activity within the past year exclusively with women (WSW) or with men and women (WSMW), in the Region X Infertility Prevention Project. Characteristics were compared with women who reported sexual activity exclusively with men (WSM).

Results. C trachomatis positivity among both WSW and WSMW was 7.1%, compared with 5.3% among WSM. Behavioral risks were more commonly reported by WSW and WSMW, compared with reports by WSM. Risks for C trachomatis positivity were comparable across groups and included younger age, non-White race, behavioral risks, and clinical signs.

Conclusions. Higher C trachomatis positivity among women reporting same-sex sexual behavior supports investigation into potential explanatory factors, including sexual behaviors, biological susceptibility, routine C trachomatis screening disparities, sexual identity disclosure, and sexual network assessment.
Consistency and Change in Club Drug Use by Sexual Minority Men in New York City, 2002 to 2007
Authors: Pantalone David W. , Bimbi David S. , Holder Catherine A. , Golub Sarit A. , Parsons Jeffrey T.
Published: August 2010

We used repeated cross-sectional data from intercept surveys conducted annually at lesbian, gay, and bisexual community events to investigate trends in club drug use in sexual minority men (N = 6489) in New York City from 2002 to 2007. Recent use of ecstasy, ketamine, and γ-hydroxybutyrate decreased significantly. Crystal methamphetamine use initially increased but then decreased. Use of cocaine and amyl nitrates remained consistent. A greater number of HIV-positive (vs HIV-negative) men reported recent drug use across years. Downward trends in drug use in this population mirror trends in other groups.
Household Expenditures for Medicines and the Role of Free Medicines in the Brazilian Public Health System
Authors: Bertoldi Andréa D. , Barros Aluísio J. D. , Camargo Aline Lins , Hallal Pedro C. , Vandoros Sotiris , Wagner Anita , Ross-Degnan Dennis
Published: August 2010

Objectives. We sought to investigate, across different socioeconomic groups, the proportion of household medicine expenses that were paid by households and the proportion paid by the Brazilian national health system.

Methods. We carried out a survey in Porto Alegre, Brazil, that included 2988 individuals of all ages. We defined 2 expenditure variables: “out-of-pocket medicines value” (the sum of retail prices of all medicines used by family members within the previous 15 days and paid for out of pocket) and “free medicines value” (a similar definition for medicines obtained without charge).

Results. In 2003, the Brazilian national health system provided, free of charge, 78% of the monetary value of medicines reported (79% in the bottom wealth quintile and 32% in the top 2 quintiles). The mean out-of-pocket expense for medicines was 6 times greater among the top wealth quintiles compared with those in lower quintiles, but free medicines constituted a 3-times-greater proportion of potential expenditures for medicines among the bottom quintile than among the top 2 quintiles.

Conclusions. Free provision of medicines seems to be saving substantial amounts of medicine expenditures for poor people in Brazil.
Age and Gender Trends in Long-Term Opioid Analgesic Use for Noncancer Pain
Authors: Campbell Cynthia I. , Weisner Constance , LeResche Linda , Ray G. Thomas , Saunders Kathleen , Sullivan Mark D. , Banta-Green Caleb J. , Merrill Joseph O. , Silverberg Michael J. , Boudreau Denise , Satre Derek D. , Von Korff Michael
Published: August 2010

Objectives. We describe age and gender trends in long-term use of prescribed opioids for chronic noncancer pain in 2 large health plans.

Methods. Age- and gender-standardized incident (beginning in each year) and prevalent (ongoing) opioid use episodes were estimated with automated health care data from 1997 to 2005. Profiles of opioid use in 2005 by age and gender were also compared.

Results. From 1997 to 2005, age–gender groups exhibited a total percentage increase ranging from 16% to 87% for incident long-term opioid use and from 61% to 135% for prevalent long-term opioid use. Women had higher opioid use than did men. Older women had the highest prevalence of long-term opioid use (8%–9% in 2005). Concurrent use of sedative-hypnotic drugs and opioids was common, particularly among women.

Conclusions. Risks and benefits of long-term opioid use are poorly understood, particularly among older adults. Increased surveillance of the safety of long-term opioid use is needed in community practice settings.
Effectiveness of HIV Prevention Social Marketing With Injecting Drug Users
Authors: Gibson David R. , Zhang Guili , Cassady Diana , Pappas Les , Mitchell Joyce , Kegeles Susan M.
Published: August 2010

Social marketing involves applying marketing principles to promote social goods. In the context of health behavior, it has been used successfully to reduce alcohol-related car crashes, smoking among youths, and malaria transmission, among other goals. Features of social marketing, such as audience segmentation and repeated exposure to prevention messages, distinguish it from traditional health promotion programs. A recent review found 8 of 10 rigorously evaluated social marketing interventions responsible for changes in HIV-related behavior or behavioral intentions. We studied 479 injection drug users to evaluate a community-based social marketing campaign to reduce injection risk behavior among drug users in Sacramento, California. Injecting drugs is associated with HIV infection in more than 130 countries worldwide.
Drinking Rainwater: A Double-Blinded, Randomized Controlled Study of Water Treatment Filters and Gastroenteritis Incidence
Authors: Rodrigo Shelly , Sinclair Martha , Forbes Andrew , Cunliffe David , Leder Karin
Published: August 2010

Objectives. We examined whether drinking untreated rainwater, a practice that is on the rise in developed countries because of water shortages, contributes to community gastroenteritis incidence.

Methods. We conducted a double-blinded, randomized controlled trial in Adelaide, Australia. Sham or active water treatment units were installed, and participants recorded incidences of illness in a health diary for 12 months. The primary outcome was highly credible gastroenteritis (HCG; characterized by a specified number of loose stools or vomiting alone or in combination with abdominal pain or nausea in a 24-hour period), and we used generalized estimating equations to account for correlations between numbers of HCG events for individuals in the same family.

Results. Participants reported 769 episodes during the study (0.77 episodes/person/year), with an HCG incidence rate ratio (active vs sham) of 1.05 (95% confidence interval [CI] = 0.82, 1.33). Blinding of the participants was effective (index = 0.65; 95% CI = 0.58, 0.72).

Conclusions. Our results suggest that consumption of untreated rainwater does not contribute appreciably to community gastroenteritis. However, our findings may not be generalizable to susceptible and immunocompromised persons because these groups were specifically excluded from the study.
The Myth of Meritocracy and African American Health
Authors: Kwate Naa Oyo A. , Meyer Ilan H.
Published: August 2010

Recent theoretical and empirical studies of the social determinants of health inequities have shown that economic deprivation, multiple levels of racism, and neighborhood context limit African American health chances and that African Americans' poor health status is predicated on unequal opportunity to achieve the American Dream.

President Obama's election has been touted as a demonstration of American meritocracy—the belief that all may obtain the American Dream—and has instilled hope in African Americans. However, we argue that in the context of racism and other barriers to success, meritocratic ideology may act as a negative health determinant for African Americans.
Gun Shows and Gun Violence: Fatally Flawed Study Yields Misleading Results
Authors: Wintemute Garen J. , Hemenway David , Webster Daniel , Pierce Glenn , Braga Anthony A.
Published: August 2010

A widely publicized but unpublished study of the relationship between gun shows and gun violence is being cited in debates about the regulation of gun shows and gun commerce. We believe the study is fatally flawed.

A working paper entitled “The Effect of Gun Shows on Gun-Related Deaths: Evidence from California and Texas” outlined this study, which found no association between gun shows and gun-related deaths. We believe the study reflects a limited understanding of gun shows and gun markets and is not statistically powered to detect even an implausibly large effect of gun shows on gun violence. In addition, the research contains serious ascertainment and classification errors, produces results that are sensitive to minor specification changes in key variables and in some cases have no face validity, and is contradicted by 1 of its own authors’ prior research. The study should not be used as evidence in formulating gun policy.
The Effect of Dilution Rate upon Protein Content and Cellular Amino Acid Profiles in Chemostat Cultures of Saccharomyces Cerevisiae CABI 039916
Authors: Finn Beverley , Harvey Linda M , McNeil Brian
Published: August 2010

In the present study we examined the use of a chemostat system to investigate the impact of changes in the specific growth rate of Saccharomyces cerevisiae CABI 039916 on cellular amino acid profiles and total protein content. This experimental system allowed the unambiguous examination of the link between changes in dilution rate and the culture response, which would have been difficult in batch or fed-batch cultures. Alteration of the specific growth rate (via manipulation of the dilution rate) within a carbon and energy-limited chemostat has a significant impact on the physiology of Saccharomyces cerevisiae. Low dilution rates (<0.1h-1) led to predominantly respiratory metabolism and the maximisation of cellular protein content within the cell (58%), by contrast high dilution rates (>0.2h-1) led to respirofermentative metabolism, where the cellular protein content was minimal (~40%). The content of nearly all amino acids in the yeast protein pool fell significantly as dilution rate increased in parallel with the decline in cell protein content. By contrast, the concentration of two related key food/feed amino acids in the cell protein poolglutamic acid and arginine could be increased within the cellular protein by 5% (increasing the dilution rate from 0.05h-1 to 0.25h-1) and 1.5% respectively (decreasing the dilution rate from 0.05h-1 to 0.2h-1). Despite previous studies showing that metabolic change was associated with major changes in free amino acid levels, the present study indicates that the total cellular yeast protein amino acid composition is largely invariant despite profound metabolic changes, with one or two key exceptions.
Anticipating the Interaction between Technology and Morality: A Scenario Study of Experimenting with Humans in Bionanotechnology
Authors: Boenink Marianne , Swierstra Tsjalling , Stemerding Dirk
Published: August 2010

During the last decades several tools have been developed to anticipate the future impact of new and emerging technologies. Many of these focus on hard, quantifiable impacts, investigating how novel technologies may affect health, environment and safety. Much less attention is paid to what might be called soft impacts: the way technology influences, for example, the distribution of social roles and responsibilities, moral norms and values, or identities. Several types of technology assessment and of scenario studies can be used to anticipate such soft impacts. We argue, however, that these methods do not recognize the dynamic character of morality and its interaction with technology. As a result, they miss an important opportunity to broaden the scope of social and political deliberation on new and emerging technologies.In this paper we outline a framework for building scenarios that enhance the techno-moral imagination by anticipating how technology, morality and their interaction might evolve. To show what kind of product might result from this framework, a scenario is presented as an exemplar. This scenario focuses on developments in biomedical nanotechnology and the moral regime of experimenting with human beings. Finally, the merits and limitations of our framework and the resulting type of scenarios are discussed.
Genetic Susceptibility to Obesity and Related Traits in Childhood and Adolescence
Authors: den Hoed Marcel , Ekelund Ulf , Brage Søren , Grontved Anders , Zhao Jing Hua , Sharp Stephen J. , Ong Ken K. , Wareham Nicholas J. , Loos Ruth J.F.
Published: August 2010

OBJECTIVE

Large-scale genome-wide association (GWA) studies have thus far identified 16 loci incontrovertibly associated with obesity-related traits in adults. We examined associations of variants in these loci with anthropometric traits in children and adolescents.

RESEARCH DESIGN AND METHODS

Seventeen variants representing 16 obesity susceptibility loci were genotyped in 1,252 children (mean ± SD age 9.7 ± 0.4 years) and 790 adolescents (15.5 ± 0.5 years) from the European Youth Heart Study (EYHS). We tested for association of individual variants and a genetic predisposition score (GPS-17), calculated by summing the number of effect alleles, with anthropometric traits. For 13 variants, summary statistics for associations with BMI were meta-analyzed with previously reported data (Ntotal = 13,071 children and adolescents).

RESULTS

In EYHS, 15 variants showed associations or trends with anthropometric traits that were directionally consistent with earlier reports in adults. The meta-analysis showed directionally consistent associations with BMI for all 13 variants, of which 9 were significant (0.033–0.098 SD/allele; P < 0.05). The near-TMEM18 variant had the strongest effect (0.098 SD/allele P = 8.5 × 10−11). Effect sizes for BMI tended to be more pronounced in children and adolescents than reported earlier in adults for variants in or near SEC16B, TMEM18, and KCTD15, (0.028–0.035 SD/allele higher) and less pronounced for rs925946 in BDNF (0.028 SD/allele lower). Each additional effect allele in the GPS-17 was associated with an increase of 0.034 SD in BMI (P = 3.6 × 10−5), 0.039 SD, in sum of skinfolds (P = 1.7 × 10−7), and 0.022 SD in waist circumference (P = 1.7 × 10−4), which is comparable with reported results in adults (0.039 SD/allele for BMI and 0.033 SD/allele for waist circumference).

CONCLUSIONS

Most obesity susceptibility loci identified by GWA studies in adults are already associated with anthropometric traits in children/adolescents. Whereas the association of some variants may differ with age, the cumulative effect size is similar.
Pharmacological Vasodilation Improves Insulin-Stimulated Muscle Protein Anabolism but Not Glucose Utilization in Older Adults
Authors: Timmerman Kyle L. , Lee Jessica L. , Fujita Satoshi , Dhanani Shaheen , Dreyer Hans C. , Fry Christopher S. , Drummond Micah J. , Sheffield-Moore Melinda , Rasmussen Blake B. , Volpi Elena
Published: August 2010

OBJECTIVE

Skeletal muscle protein metabolism is resistant to the anabolic action of insulin in healthy, nondiabetic older adults. This defect is associated with impaired insulin-induced vasodilation and mTORC1 signaling. We hypothesized that, in older subjects, pharmacological restoration of insulin-induced capillary recruitment would improve the response of muscle protein synthesis and anabolism to insulin.

RESEARCH DESIGN AND METHODS

Twelve healthy, nondiabetic older subjects (71 ± 2 years) were randomized to two groups. Subjects were studied at baseline and during local infusion in one leg of insulin alone (Control) or insulin plus sodium nitroprusside (SNP) at variable rate to double leg blood flow. We measured leg blood flow by dye dilution; muscle microvascular perfusion with contrast enhanced ultrasound; Akt/mTORC1 signaling by Western blotting; and muscle protein synthesis, amino acid, and glucose kinetics using stable isotope methodologies.

RESULTS

There were no baseline differences between groups. Blood flow, muscle perfusion, phenylalanine delivery to the leg, and intracellular availability of phenylalanine increased significantly (P < 0.05) in SNP only. Akt phosphorylation increased in both groups but increased more in SNP (P < 0.05). Muscle protein synthesis and net balance (nmol · min−1 · 100 ml · leg−1) increased significantly (P < 0.05) in SNP (synthesis, 43 ± 6 to 129 ± 25; net balance, −16 ± 3 to 26 ± 12) but not in Control (synthesis, 41 ± 10 to 53 ± 8; net balance, −17 ± 3 to −2 ± 3).

CONCLUSIONS

Pharmacological enhancement of muscle perfusion and amino acid availability during hyperinsulinemia improves the muscle protein anabolic effect of insulin in older adults.
Cardiac metastasis of osteosarcoma
Authors: Sahin Hilal , Ceylan Naim , Bayraktaroglu Selen , Savas Recep
Published: August 2010

Cardiac osteosarcoma metastasis is extremely rare and is documented in several case reports in the literature. The behaviour of osteosarcoma metastases is similar to the primary tumour. Thoracic non-enhanced computed tomography (CT) examination is beneficial in the detection of calcific cardiac metastases. In this case report, we describe a 29-year-old woman with cardiac osteosarcoma metastasis after 7 years of follow-up, compare the demographic features with previous cases and discuss the imaging findings.
The effects of one-year simvastatin therapy on women’s bone mineral density
Authors: Dimic Aleksandar , Jankovic Dimitrije , Jankovic Irena , Savic Todorka , Karanovic Nevena
Published: August 2010

Only few studies have reported that bone fracture risk is decreased in hypercholesterolemic postmenopausal women treated with statin therapy. Because of a lack of longitudinal studies on the effect of statins on bones, the aim of our investigation was to estimate the simvastatin therapy effects on bone mineral density in hypercholesterolemic postmenopausal women. Our investigation was carried out on 53 postmenopausal women with hypercholesterolemia. The women included in the study were divided into two groups. Group 1 was comprised of women with two or more (n=32) atherosclerosis risk factors, whereas group 2 had women with less than two (n=21) of these risk factors. All the women included in the study were placed on a hypocholesterolemic diet and the women in group 1 were additionally treated with 20 mg of simvastatin daily. The parameters of lipid status, body mass index, and L2–L4 densitometry were determined at baseline and then after one year. The simvastatin-treated group showed significant improvement of lipid parameters and increased bone mineral density. Finally, changes in bone mineral density between the groups showed significant differences (p<0.05). Although our investigation was carried out on a small group, our results showed a positive effect of the simvastatin therapy on the bone mineral density of postmenopausal women.
Objective voice analysis for vocal polyps following microlaryngeal phonosurgery
Authors: Toran SiKC , Lal BK
Published: August 2010

Background: Vocal polyps are the products of voice overuse, misuse and abuse as the most common causative factors. Treatment generally advised for them are voice therapy and Microlaryngeal Phonosurgery (MLPS). The improved or changed quality of voice is generally assessed perceptually and can cause intra rater variability. In this study we compared and analysed the acoustic characteristics before and after MLPS. Objective: The purpose of the study was to acoustically determine the changes in voice quality of a group of patients before and after the surgery. Material and methods: The following patients group were studied prior to and in between 3 and 4 weeks of surgery. Altogether there were 23 patients with either unilateral or bilateral vocal polyps. Voice recording and analysis were performed with Dr. Speech acoustic software (Tiger electronics, USA). The parameters analyzed were in terms of perturbation (Jitter and shimmer), harmonic-to-noise ratio (HNR) and fundamental frequency (F0). Results: The results showed that shimmer, HNR and F0 decreased significantly (p<0.05) following MLPS, but jitter though reduced, was not statistically significant (p=0.694). Conclusion: The acoustic output generally improved after MLPS as evidenced by decreased values of all the four acoustic parameters. The study also stress that voice quality can be improved through the phonosurgical procedures. This multidimensional voice analysis can be very helpful in our ability to provide objective clinical analysis of voices with vocal polyps, and following their surgical treatment. Key words: Acoustic analysis; Vocal polyps; Micro-laryngeal phonosurgery DOI: 10.3126/kumj.v8i2.3555 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 185-189
Upper gastro-intestinal bleeding: Aetiology and demographic profile based on endoscopic examination at Dhulikhel Hospital, Kathmandu University Hospital
Authors: Gurung RB , Joshi G , Gautam N , Pant P , Pokhrel B , Koju R , Bedi TRS
Published: August 2010

Background: The upper gastrointestinal bleeding (UGIB) is defined as bleeding within the intraluminal gastrointestinal tract from any location between the upper oesophagus to the duodenum at the ligament of Treitz. It is one of the important medical emergencies worldwide. Objective: The objective of this study is to study the aetiology of upper gastrointestinal bleeding based on endoscopic examination findings in patients of various demographic characteristics. Materials and methods: This is a retrospective observational study. The endoscopic record book from 2007 January to 2009 October was reviewed for all the cases who underwent oesophago-gastro-duodenoscopic examination for upper GI bleeding. The clinico-epidemiological data of all the patients was reviewed and analyzed in concert with the aetiology of bleeding. Results: A total of 90 patients (58 males, 32 females; mean age 45.32+ 18.47 years) of upper gastrointestinal bleeding was studied and analyzed in terms of aetiology of bleeding and demographic profile. Among the ethnic groups, Aryan 46 (51%) was the most common ethnic group to have upper GI bleeding followed by Newars 24 (27%), Mongolians 16 (18%), Dalits 3 (3%) and others 1 (1%). Out of 90 patients, 47( 52.2%) cases was less than 45 years of age, 30(33.3%) of 46 to 65 age ; and 13(14.4 %) more than 65 years of age. Gastric ulcer 23(25.6%) was the most common endoscopic finding, followed by oesophageal varices 14 (15.6%), acute erosive/haemorrhagic gastropathy 11 (12.2%), duodenal ulcer 9(10%), growth 7(7.8%), vascular lesions 3(3.3%), Mallory-Weiss tear 1(1.1%), fundal varices 1(1.1%) and, no cause was identified in 21(23.3%) cases. The peptic ulcer bleeding was the most common finding in Aryan 22(47.9%), whereas oesophageal varices and growth were more common in Newar 7(29.2%) and 3 (12.5%) respectively. Conclusion: Peptic ulcer disease is the most common cause of upper GI bleeding which was most commonly found in Aryan population; followed by oesophageal varices and growth as second and third most common causes and were more prevalent in Newar and Mongolian people. Key words: Endoscopy; Peptic ulcer disease; Upper GI bleeding; Varices DOI: 10.3126/kumj.v8i2.3560 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 208-211
Post partum haemorrhage: Prevalence, morbidity and management pattern in Dhulikhel Hospital
Authors: Dongol AS , Shrestha A , Chawla CD
Published: August 2010

Background: Post partum haemorrhage (PPH) is the leading cause of maternal death worldwide. PPH occurs in up to 18% of total births. Among different factors, PPH due to uterine atony is the primary and direct cause of maternal mortality comprising about 90%. Objective: The objective of the present study was to assess the prevalence, morbidity and management pattern of PPH in Dhulikhel Hospital. Materials and methods: Hospital based retrospective study was carried out at Kathmandu University School of Medical Science, Dhulikhel Hospital from the period of January 2007 till October 2009. The study group included total of 60 patients. All women who had PPH both primary and secondary were studied. Information regarding total number of deliveries obtained from Obstetrics ward. The cases with PPH were identified and detail records were reviewed using standard format. The main outcome measures used for the analysis were amount of blood loss, cause of PPH and treatment methods. Results: In Dhulikhel hospital, from January 2007 till October 2009 a total of 3805 deliveries took place. Out of which 60 women had PPH. The prevalence was 16/1000 deliveries. There are 41 (68.3%) cases of primary PPH and 19 (31.7%) cases of secondary PPH. PPH was found more in home deliveries, unbooked case and in multiparas. The mean blood loss was 1055ml. As an aetiology, retained placenta and retained placental bits of tissue was found in 37(61.7%) cases, atonic uterus in 10 (16.7%) cases, genital tract trauma in 8(13.3%), sepsis of genital tract in 3(5%), case of ruptured uterus in one case and a case of angle bleeding from previous uterine scar following caesarean section. Among all 15 (25%) cases underwent manual removal of placenta, 5(8.3%) underwent controlled cord traction, 3 (5%) underwent manual removal of placenta followed by check curettage in cases of retained placenta, 16 (26.7%) cases were managed by check curettage for retained bits of placental tissue and membrane. Trauma in genital tract was managed by repair of trauma in 6 (10%) cases. Hysterectomy was required in 3 (5%) cases. Conservative management with uterotonics only required in 12 (20%) cases. Conclusion: Active management of third stage of labour can prevent PPH so delivery by skilled hand in hospital should be promoted. Secondary PPH besides primary can result in significant maternal morbidity. It also deserves similar attention. Key words: Atonic uterus; Postpartum haemorrhage DOI: 10.3126/kumj.v8i2.3561 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 212-215
Alport's syndrome
Authors: Bastola P , Joshi SN , Chaudhary M , Shah DN
Published: August 2010

Alport's syndrome (Haemorrhagic Familial Nephritis) is a rare syndrome. It encompasses a group of heterogeneously inherited disorders involving the basement membrane of the kidney frequently involving the cochlea and the eye. We describe here the detailed ocular findings and the systemic problems of a case of Alport's syndrome in a 30 years male from Nepal. The current understanding of the clinical features and aetiopathogenesis are also discussed. Key words: Alport's syndrome; Anterior lenticonus; Oil droplet sign; Anterior capsular cataract; Perimacular flecks DOI: 10.3126/kumj.v8i2.3566 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 238-240
Retinoblastoma in a 37 years old man in Nepal: A case report
Authors: Shrestha A , Adhikari RC , Saiju R
Published: August 2010

Retinoblastoma is extremely rare in adults. We report a case of Retinoblastoma diagnosed by histopathology in an enucleated specimen of a 37 year old patient who presented with pain and diminished visual acuity with intraocular mass and serous detachment. CT head and orbit showed uniform hyperdense mass in nasal quadrant of left globe projecting into adjacent vitreous cavity. Chest X Ray and USG abdomen was unremarkable. Initially provisional diagnosis of amelanotic melanoma was made. In view of nil visual prognoses enucleation was done. Sections from the enucleated eyeball showed diffuse proliferation of tumour cells. These tumour cells were small sized with scanty cytoplasm, and oval and hyper chromatic nuclei. A diagnosis of poorly differentiated Retinoblastoma was made with TNM (AJCC) stage as T1NXMX.This paper highlights the delayed presentation of retinoblastoma in adult. Although retinoblastoma is rare in adult, we suggest keeping retinoblastoma in differential diagnosis of intraocular mass until proven histopathology report is available. Key words: Retinoblastoma; Adult; Intraocular mass DOI: 10.3126/kumj.v8i2.3569 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 247-250
Variation of total serum cholesterol among the patient with thyroid dysfunction
Authors: Risal P , Maharjan BR , Koju R , Makaju RK , Gautem M
Published: August 2010

Background: Thyroid hormone has its effect in the lipid metabolism. Thus, thyroid disorder is usually associated with the dyslipidaemia. Hypercholesterolemia is an established risk factor for the cardiovascular disease (CVD) and therefore in case of overt hypothyroidism which is associated with hypercholesterolemia, CVD is most likely to occur. Objectives: controversies still persist about the hypercholesterolemia and sub clinical hypothyroidism. Hence, we conducted our study to elucidate the relation of thyroid hormone with cholesterol in different thyroid disorder. Material and Method: All patients suspected of thyroid disorder within a period of one year were included in the study and free thyroxine-3 (fT3), free thyroxine-4 fT4, Thyroid Stimulating Hormone (TSH) and total cholesterol (TC) in the serum were estimated. Statistical analysis was carried out by using SPSS. 13. Results: Among the 169 cases, 32.5% of the patients were having thyroid disorder. In which 8.3% were of hypothyroid, 7.1% were of sub clinical hypothyroid, 8.3% were of hyperthyroid, 7.7% were of sub clinical hyperthyroid and 1.2% cases were of pan hypothyroid. We observed significant negative correlation between TC & fT3(r = -0.226, p = 0.003), significant negative correlation between total cholesterol & fT4(r = -0.197, p = 0.010) and significant positive correlation between TC & TSH(r = 0.365, p = 0.000). Total cholesterol was significantly raised in hypothyroidism (Mean ±SD 283±53, p = 0.000) in comparison to euthyroid population (mean ±SD, 195±58). But cholesterol was not significantly increased in sub clinical hypothyroidism (mean ±SD, 240±46) Conclusion: Our results show that total cholesterol level in serum is affected by the blood thyroid hormone level. Therefore, screening for hypercholesterolemia could be useful in patients with hypothyroidism to reduce associated disease. Key words: Thyroid hormone; Cholesterol; Nepal DOI: 10.3126/kumj.v8i2.3573 Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 265-268
Vaginal hysterectomy for pelvic organ prolapse in Nepal
Authors: Sah DK , Doshi NR , Das CR
Published: August 2010

Background: UVP is a significant Public Health Problem in Nepal. This problem is mainly prevalent in rural areas where the women are socio - economically less privileged and cannot afford the costs of treatment. Objective: An analysis of peri operative and post operative complications of vaginal hysterectomies for pelvic organ prolapse. Materials and methods: A hospital based prospective study was carried out in the department of obstetrics and gynaecology, NGMC followed up from the time of operation to time of discharge. Results: 632 cases underwent vaginal hysterectomy with financial support from UNFPA. There were no operative complications. The most common post operative complications as noted were retention of urine, pelvic infection & pelvic abscess. In two cases laparotomy was done for haemoperitoneum. Pelvic abscess was drained vaginally. Mortality was nil. Conclusion: Proper screening before operation is the key to reduce operative as well as peri operative complications. Key words: vaginal hysterectomy; pelvic organ prolapse; peri operative complications of vaginal hysterectomy DOI: 10.3126/kumj.v8i2.3576   Kathmandu University Medical Journal (2010), Vol. 8, No. 2, Issue 30, 281-284
‘A local habitation and a name’: Britten Adapts Shakespeare
Authors: Larson Katherine R. , Wiliford Lawrence
Published: August 2010

Benjamin Britten was acutely sensitive to the significance of place in his operas – a feature that lies at the heart of his adaptation of Shakespeare's A Midsummer Night's Dream. This essay argues that the revision choices preserved in the libretto, coupled with Britten's musical setting, reveal a determination to blur the boundaries between forest and Athens to an even greater degree than Shakespeare does. Unlike Shakespeare, Britten situates the bulk of the opera's action in the woods, foregrounding the play's dreamlike qualities while also drawing attention to the composer's fascination with the threshold between dreams and reality. In examining the impact that the ‘local conditions’ of the woods have on Britten's interpretation of A Midsummer Night's Dream, this essay focuses in particular on the transformation of Shakespeare's ‘rude mechanicals’ into Britten's ‘rustics.’ Bottom and his fellow actors, who together bridge the gap between the human and the supernatural, exemplify the extent to which the textual changes and the rich soundscapes of Britten's opera reframe the characters and realms of Shakespeare's famous comedy.
‘Alles, was ist, endet:’ On Dramatic Text, Absolute Music, Adorno, and Wagner'sRing
Authors: Lee Sherry D.
Published: August 2010

The crux of the operatic genre has always been the perennially problematic relationship between text and music. Richard Wagner attempted to solve this conundrum in his new art form of music drama – first embodied in his monumental Ring cycle – which he theorized in gendered terms as a union of poetry (male) and music (female), an imagined marriage between the qualities of Shakespearean drama and Beethovenian symphony. But according to Theodor Adorno, the very notion of symphonic music, which follows its own musical logic, is antithetical to the genre of opera, which demands that music construct itself according to its relationship to language. From the impasse between the demands of the operatic art form and the increasingly autonomous music of the late nineteenth and early twentieth centuries, he theorized the end of opera itself in the age of modernism. This article entwines Wagner's concept of music drama, the musico-dramatic character of Erda who prophesies the end of the world in the Ring, and Adorno's diagnosis of opera's fatal condition in the decades following Wagner, to examine the principle of ending in opera, and of opera, and how the former can be read as a prefiguration of the latter.
Opera as Translation: Ezra Pound's Le Testament
Authors: Canton Kimberly Fairbrother
Published: August 2010

In Ezra Pound's Le Testament, the first of his three operatic compositions, the relentless drive for linguistic precision is undermined by an ironic recourse to the imprecise, even mystical, signifying capacity of music and rhythm. Given Pound's lifelong engagement with translation, it is likely not surprising that his turn to opera was essentially literary in purpose, serving the poet as a means to ‘translate’ the category of poetic language he termed melopoeia (in this case, François Villon's Le Testament). What is surprising, however – particularly given Pound's notorious fascist sympathies and his own esoteric poetic style – is Pound's determination to make this poetry accessible, intellectually and materially. Though Le Testament unapologetically valorizes Villon's poems for their unique difficulty, the use of opera (and later radio opera) as the means of translation reflects Pound's desire to make Villon's poetry ‘sing’ to the masses – calling into question the common conflation of modernist difficulty with modernist elitism.
The H(e)art of the Matter: Modernist Theatrical Liberalism inPal Joey
Authors: Most Andrea
Published: August 2010

Throughout the 1920s and 1930s, first- and second-generation American Jewish writers and composers working in popular entertainment largely resisted the modernist despair so fashionable among many of their contemporaries, choosing instead to devote themselves to an optimistic set of truths promised by American liberalism and expressed in the theatre. By the late 1930s and early 1940s, however, the lingering Great Depression, rising anti-Semitism, fascism, and the Second World War led to the hollowing out of many of the ideals of the immigrant generation and their children. A number of Jewish writers, many of whom had made their reputations defining and celebrating an ideology defined in this essay as theatrical liberalism, began to echo their modernist contemporaries. Just as modernist poets and novelists experimented with form in order to raise questions about truth, so modernist writers of popular plays and movies used the heavily formulaic nature of their genres to shock audiences into questioning the assumptions of theatrical liberalism upon which these popular forms relied. This essay explores how Richard Rodgers and Lorenz Hart's 1940 musical Pal Joey uses the popular genre of the backstage musical to raise questions about the viability of theatrical liberalism in an era plagued by fascism, Nazism, and war.
A Change Ain't Gonna Come: Sam Cooke and the Protest Song
Authors: Trigg Christopher
Published: August 2010

Although Sam Cooke's ‘A Change is Gonna Come’ is inextricably linked to the civil rights movement of the 1960s, it has an uneasy relationship with the genre of the protest song. Where protest songs enact the social change they seek to accomplish, Cooke's composition places its singer at a distance from an imminent, unspecified change. While protest songs are confident that the development they desire will materialize, the musical and lyrical structure of ‘A Change Is Gonna Come’ implies that the change in question may never arrive. Insofar as it depends upon contained progression – thematic and harmonic movement that is both linear and cyclical – the song could be described as a blues. Like many blues, moreover, it engages with the theme of human mortality: death, which every individual expects but never experiences, could be the ‘change’ to which the title and refrain refer. At the same time, change is the very word through which the lyric participates in the protest genre. If it were to be stricken from the text, the song would have no political referent, nothing to take its meaning beyond the confessional and personal.
Premorbid oral antithrombotic therapy and risk for reaccumulation, reoperation, and mortality in acute subdural hematomas
Authors: Panczykowski David M. , Okonkwo David O.
Published: August 2010

Object

Acute subdural hematomas (SDHs) impart serious morbidity and mortality on the elderly population, with only 5% of those older than 65 years of age attaining functional independence. Despite its widespread use, oral antithrombotic therapy (OAT) in the context of acute SDH has not been extensively studied. The authors sought to evaluate the impact of premorbid OAT on recurrence of SDH, radiographic outcome, and mortality in patients undergoing surgical evacuation of an acute SDH.

Methods

The authors conducted a retrospective comparative cohort study reviewing all surgically treated cases of acute SDH at their institution between September 2005 and December 2008. They assessed baseline demographics, coagulation parameters, surgical management, and clinical course. Study end points included additional craniotomy for SDH reaccumulation, follow-up Rotterdam score, recurrent SDH volumetric analysis, Glasgow Outcome Score, and death.

Results

A total of 300 patients with acute SDH treated by craniotomy were assessed. Of these patients, 49% (148 patients) were receiving OAT. Of those who were on a regimen of OAT, 49% were taking warfarin (mean international normalized ratio 3.1 ± 1.8), 31% were receiving antiplatelet therapy, and 20% were on a regimen of a combination of agents. On presentation, 72% of those using OAT received reversal agents. Recurrence of SDH necessitating additional evacuation was not significantly different with respect to premorbid OAT status (13% vs 14%). Patients with a history of OAT did not demonstrate a significant difference in Rotterdam score (2 vs 2), recurrent SDH volume (24.1 vs 19.6 cm3), GOS score (4 vs 3), or mortality (21% vs 24%). These findings remained stable after controlling for age, injury mechanism, and injury severity.

Conclusions

Premorbid OAT was not a significant risk factor for recurrence of SDH necessitating additional evacuation following acute SDH. Additionally, postoperative Rotterdam score, volume of SDH reaccumulation, and overall mortality were not predicted by antithrombotic history. While premorbid use may predispose the patient to an SDH, OAT does not increase the risk of morbidity or mortality following surgical intervention.
Lactation performance of Red Chittagong Cattle and effects of environmental factors
Authors: Habib MA , Afroz MA , Bhuiyan AKFH
Published: August 2010

The present study was undertaken to estimate effects of environmental factors onmilk production traits in Red Chittagong Cattle (RCC). A total of 103 milk yield recordsof 45 RCC cows obtained between 2005 and 2009 were analysed. Actual lactation yield,lactation length, daily milk yield and dry period were estimated as 500.7 ± 19.3 kg, 259.6 ±6.2 days, 1.9 ± 0.1 kg and 162.4 ± 7.7 days, respectively. Age and season correctedlactation yield, 305 day milk yield and daily milk yield were estimated as 605.4 ± 22.9,677.1 ± 19.4 and 2.2 ± 0.1 kg, respectively. Sex of calf and season of birth did notsignificantly (P>0.05) affect production, but lactation order significantly (P<0.05) affectedproduction except lactation length. Year of birth had no effect (P>0.05) on the traitsanalysed except daily milk yield (P<0.05). Calving age significantly (P<0.05) affectedlactation yield but did not other traits. Cows in 5th lactation produced highest total (604.3± 69.3 kg) and daily milk yield (2.17 ± 1.8 kg). Cows aged 6 – 7 years had best lactationyield (576.8 ± 60.5 kg).(Bangl. vet. 2010. Vol. 27, No. 1, 18 – 25)DOI: 10.3329/bvet.v27i1.5911
Behavioral and Reproductive Response of White Pine Weevil (Pissodes strobi) to Resistant and Susceptible Sitka Spruce (Picea sitchensis)
Authors: Robert Jeanne A. , Bohlmann Jörg
Published: August 2010

White pine weevil (Pissodes strobi, Peck.) is a native forest insect pest in the Pacific Northwest of North America that attacks species of spruce (Picea spp.) and pine (Pinus spp.). Young Sitka spruce [Picea sitchensis (Bong.) Carr.] trees are particularly susceptible to weevil attack. Pockets of naturally occurring Sitka spruce resistance have been identified in high weevil hazard areas in coastal British Columbia. In this study, we characterize behavioral, physiological and reproductive responses of weevils to an extremely resistant Sitka spruce genotype (H898) in comparison to a highly susceptible genotype (Q903). The experiments relied on a large number of three-year-old clonally propagated trees and were therefore restricted to two contrasting Sitka spruce genotypes. When exposed to resistant trees, both male and female weevils were deterred during host selection and mating, females showed delayed or reduced ovary development, and successful reproduction of weevils was prevented on resistant trees.