bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis of elderly patients with heart failure
Authors: Manzano Luis , Escobar Carlos , Cleland John G.F. , Flather Marcus
Published: July 2012

The prevalence and mortality of heart failure (HF) increase with age. As a result, the early diagnosis of HF in this population is useful to reduce cardiovascular morbidity and probably mortality. However, the diagnosis of HF in the elderly is a challenge. These challenges arise from the under‐representation of elderly patients in diagnostic studies and clinical trials, the increasing prevalence of HF with relatively normal ejection fraction, the difficulty in accurate diagnosis, the underuse of diagnostic tests, and the presence of co‐morbidities. Particularly in the elderly, symptoms and signs of HF may be atypical and can be simulated or disguised by co‐morbidities such as respiratory disease, obesity, and venous insufficiency. This review aims to provide a practical clinical approach for the diagnosis of older patients with HF based on the scarce available evidence and our clinical experience. Therefore, it should be interpreted in many aspects as an opinion paper with practical implications. The most useful clinical symptoms are orthopnoea and paroxysmal nocturnal dyspnoea. However, confirmation of the diagnosis always requires further tests. Although natriuretic peptides accurately exclude cardiac dysfunction as a cause of symptoms, the optimal cut‐off level for ruling out HF in elderly patients with other co‐morbidities is still not clear. In our opinion, echocardiography should be performed in all elderly patients to confirm the diagnosis of HF, except in those cases with low clinical probability and a concentration of brain natriuretic peptide (BNP) or N‐terminal proBNP (NT‐proBNP) lower than 100 or 400 pg/mL, respectively.
Why and how do elderly patients with heart failure die? Insights from the TIME‐CHF study
Authors: Rickenbacher Peter , Pfisterer Matthias , Burkard Thilo , Kiowski Wolfgang , Follath Ferenc , Burckhardt Dieter , Schindler Ruth , Brunner‐La Rocca Hans‐Peter ,   for the TIME‐CHF Investigators
Published: July 2012

Aims

Specific causes and modes of death (COD and MOD) of patients with heart failure (HF) are not well described, particularly in those with preserved ejection fraction >45% (HFPEF) and at old age. Thus, using the database of the TIME‐CHF study, patients with HFPEF were compared with those with reduced ejection fraction ≤45% (HFREF), and patients ≥75 with those 60–74 years of age to identify MOD and COD, predictors of death, and event rates before death as compared with survivors.

Methods and results

During the 18‐month follow‐up, 132/622 patients (21%) died, with similar rates in patients with HFPEF and HFREF and a trend to higher rates in patients aged ≥75 years (24% vs. 17%, P = 0.06). COD and MOD (ACME system) were not different in the age groups. COD was more often non‐cardiovascular in HFPEF patients than in HFREF patients (33% vs. 16%, P < 0.05) and cardiac MOD were more frequent in HFREF patients (75% vs. 56%, P < 0.05), mainly due to more sudden deaths (25% vs. 7%, P < 0.05). Patients who died experienced a median of four adverse events (interquartile range 1–7) and one (0–1) hospitalization within 60 days prior to death compared with 0.7 (0.4–1.4) and 0.1 (0.0–0.2) during a randomly selected 60 days in survivors (all P < 0.0001).

Conclusion

Despite similar 18‐month mortality in patients with HFREF and those with HFPEF, important differences in COD and MOD were found which were not observed between the two age groups. A high rate of adverse events and hospitalizations preceded death. These observations may be relevant for the management of HF patients.
Evidence for an epigenetic role in inbreeding depression
Authors: Vergeer Philippine , Wagemaker Niels (C. A. M.) , Ouborg N. Joop
Published: July 2012

Inbreeding depression (i.e. negative fitness effects of inbreeding) is central in evolutionary biology, affecting numerous aspects of population dynamics and demography, such as the evolution of mating systems, dispersal behaviour and the genetics of quantitative traits. Inbreeding depression is commonly observed in animals and plants. Here, we demonstrate that, in addition to genetic processes, epigenetic processes may play an important role in causing inbreeding effects. We compared epigenetic markers of outbred and inbred offspring of the perennial plant
Scabiosa columbaria
and found that inbreeding increases DNA methylation. Moreover, we found that inbreeding depression disappears when epigenetic variation is modified by treatment with a demethylation agent, linking inbreeding depression firmly to epigenetic variation. Our results suggest an as yet unknown mechanism for inbreeding effects and demonstrate the importance of evaluating the role of epigenetic processes in inbreeding depression.
New insights into ice growth and melting modifications by antifreeze proteins
Authors: Bar-Dolev Maya , Celik Yeliz , Wettlaufer J. S. , Davies Peter L. , Braslavsky Ido
Published: July 2012

Antifreeze proteins (AFPs) evolved in many organisms, allowing them to survive in cold climates by controlling ice crystal growth. The specific interactions of AFPs with ice determine their potential applications in agriculture, food preservation and medicine. AFPs control the shapes of ice crystals in a manner characteristic of the particular AFP type. Moderately active AFPs cause the formation of elongated bipyramidal crystals, often with seemingly defined facets, while hyperactive AFPs produce more varied crystal shapes. These different morphologies are generally considered to be growth shapes. In a series of bright light and fluorescent microscopy observations of ice crystals in solutions containing different AFPs, we show that crystal shaping also occurs during melting. In particular, the characteristic ice shapes observed in solutions of most hyperactive AFPs are formed during melting. We relate these findings to the affinities of the hyperactive AFPs for the basal plane of ice. Our results demonstrate the relation between basal plane affinity and hyperactivity and show a clear difference in the ice-shaping mechanisms of most moderate and hyperactive AFPs. This study provides key aspects associated with the identification of hyperactive AFPs.
Vibration and buckling analysis of a piezoelectric nanoplate considering surface effects and in-plane constraints
Authors: Yan Z. , Jiang L. Y.
Published: July 2012

This work investigates the surface effects on the vibration and buckling behaviour of a simply supported piezoelectric nanoplate (PNP) by using a modified Kirchhoff plate model. Two kinds of in-plane constraints are defined for the PNP, and the surface effects are accounted in the modified plate theory through the surface piezoelectricity model and the generalized Young–Laplace equations. Simulation results show that the influence of surface effects on the plate resonant frequency depends on the in-plane constraints significantly. For the PNP with different in-plane constraints, the effects of the applied electric potential, the mode number, the plate aspect ratio and the plate thickness on the resonant frequency are examined with consideration of the surface effects. The possible mechanical buckling of the PNP is also studied, and it is found that the surface effects on the critical electric voltage for buckling are sensitive to the plate thickness and aspect ratio. Our results also reveal that there exists a critical transition point at which the combined surface effects on the critical electric voltage may vanish under certain conditions.
Compact acoustic travelling waves in a class of fluids with nonlinear material dispersion
Authors: Jordan P. M. , Saccomandi G.
Published: July 2012

We apply a phenomenological theory of continua put forth by Rubin, Rosenau and Gottlieb in 1995 to an important class of compressible media. Regarding the material characteristic length coefficient,
α
, not as constant, but instead as a quadratic function of the velocity gradient, we carry out an in-depth analysis of one-dimensional acoustic travelling waves in inviscid, non-thermally conducting fluids. Analytical and numerical methods are employed to study the resulting waveforms, a special case of which exhibits compact support. In particular, a phase plane analysis is performed; simplified approximate/asymptotic expressions are presented; and a weakly nonlinear, KdV-like model that admits compact travelling wave solutions (TWSs), but which is not of the class
K
(
m
,
n
), is derived and analysed. Most significantly, our formulation allows for compact, pulse-type, acoustic waveforms in both gases and liquids.
Cohesin regulates tissue-specific expression by stabilizing highly occupied cis-regulatory modules
Authors: Faure Andre J. , Schmidt Dominic , Watt Stephen , Schwalie Petra C. , Wilson Michael D. , Xu Huiling , Ramsay Robert G. , Odom Duncan T. , Flicek Paul
Published: July 2012

The cohesin protein complex contributes to transcriptional regulation in a CTCF-independent manner by colocalizing with master regulators at tissue-specific loci. The regulation of transcription involves the concerted action of multiple transcription factors (TFs) and cohesin's role in this context of combinatorial TF binding remains unexplored. To investigate cohesin-non-CTCF (CNC) binding events in vivo we mapped cohesin and CTCF, as well as a collection of tissue-specific and ubiquitous transcriptional regulators using ChIP-seq in primary mouse liver. We observe a positive correlation between the number of distinct TFs bound and the presence of CNC sites. In contrast to regions of the genome where cohesin and CTCF colocalize, CNC sites coincide with the binding of master regulators and enhancer-markers and are significantly associated with liver-specific expressed genes. We also show that cohesin presence partially explains the commonly observed discrepancy between TF motif score and ChIP signal. Evidence from these statistical analyses in wild-type cells, and comparisons to maps of TF binding in Rad21-cohesin haploinsufficient mouse liver, suggests that cohesin helps to stabilize large protein–DNA complexes. Finally, we observe that the presence of mirrored CTCF binding events at promoters and their nearby cohesin-bound enhancers is associated with elevated expression levels.
Antibiotic resistance of microbial strains isolated from Korean acne patients
Authors: MOON Sang Ho , ROH Hyun Soo , KIM Young Hoon , KIM Jeong Eun , KO Joo Yeon , RO Young Suck
Published: July 2012

Over several decades, topical and systemic antibiotics have been the mainstay of treatment for acne vulgaris. The widespread and long‐term use of antibiotics in the treatment of acne has resulted in the spread of resistant bacterial strains and treatment failure. We aimed to examine the bacteriology of acne vulgaris and to evaluate its susceptibility to the antibiotics widely used for acne in Korea. We examined the species of bacteria aerobically and anaerobically isolated from 100 Korean acne patients. Among the bacteria isolated, Staphylococcus epidermidis (36 patients) was the most common, followed by Propionibacterium acnes (30 patients). Eleven strains of P. acnes (36.7%) and 25 strains of S. epidermidis (69.4%) were resistant to one or other of the antibiotics tested. A higher proportion of P. acnes isolates were resistant to clindamycin (30%) and erythromycin (26.7%), than to any other antibiotics tested (P = 0.0003). Some S. epidermidis isolates were resistant to tetracycline and doxycycline in addition to clindamycin and erythromycin. In the previous studies, few strains of P. acnes were found to be resistant to any of the antibiotics, but this study shows that antibiotic‐resistant strains have been increasing in Korea acne patients.
Cancer risk in patients with pyogenic liver abscess: a nationwide cohort study
Authors: Kao W.‐Y. , Hwang C.‐Y. , Chang Y.‐T. , Su C.‐W. , Hou M.‐C. , Lin H.‐C. , Lee F.‐Y. , Lee S.‐D. , Wu J.‐C.
Published: July 2012

Background

There has been no large‐scale population‐based study on the relationship between pyogenic liver abscesses (PLA) and subsequent cancer risk.

Aim

To estimate all cancer risk following a diagnosis of PLA.

Methods

Based on Taiwan's National Health Insurance Research Database, 1257 patients with PLA without prior cancers in the period 1996–2008 were identified and followed‐up. The standard incidence ratio (SIR) of each cancer was calculated as the number of observed cancer cases arising among the PLA patients divided by the expected case number of cancer cases according to the national cancer rates.

Results

Of the 1257 PLA patients identified, 598 (47.6%) had diabetes mellitus. After a median (±s.d.) follow‐up of 3.33 ± 3.45 years, 186 were diagnosed with cancers, including 56 liver cancer, 22 biliary tract cancer and 40 colorectal cancer patients. Patients with PLA had a higher risk of all cancers (SIR, 3.83; 95% CI, 3.30–4.42), liver cancer (SIR, 7.87; 95% CI, 5.94–10.21), biliary tract cancer (SIR, 34.58; 95% CI, 21.67–52.36) and colorectal cancer (SIR, 5.27; 95% CI, 3.76–7.18). The highest SIRs of all cancers, liver cancer, biliary tract cancer and colorectal cancer occurred within 90 days of follow‐up (360.82; 95% CI, 278.46–459.91, 257.28; 95% CI, 186.17–346.56, 1153.38; 95% CI 694.08–1801.24, and 52.63; 95% CI 25.2–96.8 respectively).

Conclusions

Pyogenic liver abscesses may herald the onset of cancer, especially hepato‐biliary and colon cancer. Further surveys should be conducted for the detection of occult cancers in such patients.
The significance of carbon‐enriched dust for global carbon accounting
Authors: Webb Nicholas P. , Chappell Adrian , Strong Craig L. , Marx Samuel K. , McTainsh Grant H.
Published: July 2012

Soil carbon stores amount to 54% of the terrestrial carbon pool and twice the atmospheric carbon pool, but soil organic carbon (SOC) can be transient. There is an ongoing debate about whether soils are a net source or sink of carbon, and understanding the role of aeolian processes in SOC erosion, transport and deposition is rudimentary. The impacts of SOC erosion by wind on the global carbon budget, and its importance for carbon accounting remain largely unknown. Current understanding of SOC losses to wind erosion is based on the assumption that the SOC content of eroded material is the same as that of the parent soils. However, measured enrichment factors for the SOC content of Australian dusts relative to parent soils show that the SOC content of dusts can be up to seven times (by weight) larger than that of source‐area soils, with enrichment factors ranging from 1.67 to 7.09. Assuming dust emissions from the continent of ~110 Mt yr−1, SOC dust emissions would be 0.13–4.65 Mt SOC yr−1 without enrichment but 0.94–7.77 Mt SOC yr−1 with enrichment; which represents an uncertainty of around 60%. Representing SOC enrichment within dust emission models will reduce uncertainty in estimates of the impact of wind erosion on SOC flux and provide an approach for the inclusion of wind erosion processes in carbon accounting systems.
Effects of spreading species‐rich green hay on the botanical composition of an agriculturally improved hay meadow in northern England
Authors: Kirkham F. W. , Bhogal A. , Chambers B. J. , Dunn R. M. , Tallowin J. R. B.
Published: July 2012

The technique of enhancing species diversity by spreading species‐rich green hay following turf scarification was tested in a semi‐improved meadow site in Cumbria, UK. Botanical assessments were carried out in May 2008 (prior to treatment), May and October 2009, and May 2010. Both total species‐richness (number of species per m2) and the richness and aggregate cover of positive indicator species were enhanced by hay spreading, with an average of 21·8 species per m2 compared with 17·0–18·7 species per m2 for other treatments by May 2010. Significant increases in all three variables occurred by May 2009, with even greater increases between this assessment and May 2010. Hay spreading introduced seven new species, most of which subsequently increased over time, and enhanced the frequency of a further seven. All these species together accounted for only about 5% of vegetation cover in 2010, but the level of species‐richness achieved was equivalent to that of good quality semi‐improved grassland and also equivalent to that achieved in studies where the technique was developed. Results are discussed in detail in relation to the seeding phenology of species at the donor site, as are other factors affecting the technique's potential and possible means of enhancing it.
Addressing adult hearing loss in primary care
Authors: McCullagh Marjorie C. , Frank Karen
Published: July 2012

Aims

To (a) determine the extent to which primary care providers screen adults for environmental or occupational hearing loss during the primary care visit and (b) determine what techniques are used to screen for hearing loss in the adult primary care patient.

Background

Although the prevalence of hearing loss is high, the frequency and techniques of screening for hearing loss among primary care providers are unknown. According to the United States Preventative Task Force, hearing screening promotes early detection, adequate treatment, and improved quality of life.

Design

It is a retrospective audit.

Methods

Thirty client records were randomly selected from two clinics in 2009 for this retrospective patient record audit.

Results/findings

Physical assessment of the structure of the auditory system was completed in all cases selected. Hearing acuity in all cases was determined by patient self‐assessment, as indicated on patient‐completed history forms; there was no documentation of objective assessment of auditory function.

Conclusion

Given the low correlation between perceived and measured hearing ability, assessment of hearing ability by patient report alone may result in failure to detect hearing loss. Research into the nature and extent of barriers to hearing assessment in primary care needs to be explored, and criteria for screening of adults in the primary care setting should be established.
Sex differences in yohimbine‐induced increases in the reinforcing efficacy of nicotine in adolescent rats
Authors: Li Sophia , Zou Sheng , Coen Kathleen , Funk Douglas , Shram Megan J. , Lê A.D.
Published: July 2012

Stress is an important factor in the initiation and maintenance of smoking in adolescents. Women are more vulnerable to the development of addiction to smoking and have more difficulty quitting than men. Women also showe enhanced responses to stress. Despite these differences, no work has been done examining the effects of stress on the reinforcing efficacy of self‐administered nicotine in adolescent rats, or if there are sex differences. Male and female adolescent Long Evans rats were trained to self‐administer one of three different intravenous doses of nicotine (7.5, 15, 30 μg/kg/infusion) first on fixed ratio, and then on a progressive ratio (PR) schedule beginning on postnatal day 33. The effect of the pharmacological stressor yohimbine (0.3, 0.6 mg/kg, i.p.) on the reinforcing efficacy of nicotine was then determined using the PR schedule. Yohimbine stimulated nicotine intake and increased PR breakpoints and numbers of infusions received in both male and female adolescent rats. The infusion dose of nicotine was positively associated with yohimbine‐induced increases in responding. Female rats showed significantly increased breakpoints at yohimbine doses and nicotine infusion doses at which males did not. The effects of the pharmacological stressor, yohimbine on the reinforcing efficacy of nicotine are therefore linked to sex and nicotine infusion dose. Female rats are more sensitive to stress‐induced potentiation of nicotine self‐administration.
Impact of clinical and patient‐reported outcomes on patient satisfaction with cataract extraction
Authors: Garcia‐Gutierrez Susana , Quintana Jose M. , Aguire Urko , Barrio Irantzu , Hayas Carlota Las , Gonzalez Nerea ,   IRYSS‐Cataract Group
Published: July 2012

Background

To date, factors that influence satisfaction with cataract surgery have not been broadly explored.

Objective

To identify variables related to patient satisfaction after cataract extraction by phacoemulsification and to determine the relationship between satisfaction and visual acuity (VA) and visual function (VF).

Design

Prospective cohort study.

Setting

Five hospitals belonging to the Basque Health Care Service.

Participants

4335 consecutive patients undergoing cataract extraction.

Interventions

Clinical data on vision were collected before the intervention and 6 weeks afterwards. Before cataract extraction, patients answered a global question about their expectations for the procedure, answered three questions related to specific activities (reading, going out and recognizing people, and doing housework) and completed the Visual Function‐14 (VF‐14) and Short‐Form‐36 (SF‐36) instruments. Three months after cataract extraction, they again completed the VF‐14 and SF‐36 along with questions about global satisfaction with the procedure and satisfaction with the three specific activities.

Main outcome measures

Three months after cataract extraction, they again completed the VF‐14 and SF‐36 along with questions about global satisfaction with the procedure and satisfaction with the three specific activities.

Results

Pre‐intervention VA and VF‐14 scores and their post‐intervention changes were associated with both global satisfaction and satisfaction with the ability to perform specific activities. Unresolved ocular complications were related to global satisfaction with cataract extraction (OR
95% = 0.39(0.27, 0.55), P < 0.001). Both the mental and physical component scales of the SF‐36 were related to global satisfaction. A group of patients were not satisfied with the intervention in spite of achieving similar vision‐related improvements as patients who were quite satisfied with the procedure.

Conclusion

Satisfaction with cataract extraction is related to clinical outcomes and is also associated with patients' expectations of their improvement in visual function.
Oxidative, inflammatory and immunologic status in children with undescended testes
Authors: Imamoğlu Mustafa , Bülbül Serap Samut , kaklikkaya Neşe , Sarihan Haluk
Published: July 2012

Background:  In order to better understand the pathogenesis of risk of future sub‐/infertility in children with undescended testes (UDT), we designed this prospective study to examine the oxidative stress, inflammatory response and autoimmunity in children with UDT. We examined the concentrations of malondialdehyde (MDA), interleukin‐6 (IL‐6) and antisperm antibodies (ASA) in children with UDT and healthy controls.

Methods:  The UDT group consisted of 88 boys (aged 1–14 years, unilateral in 67 and bilateral in 21 cases), and 44 boys with normal descended testes served as a control group. Clinical evaluation revealed no testicular or other system abnormalities. MDA was used as lipid peroxidation index. IL‐6 levels were measured using a commercial enzyme‐linked immunosorbent assay kit. ASA was determined with an anti‐human spermatozoa immunoglobulin G test.

Results:  Mean age values ± SD were 4.6 ± 3.2 in the UDT group and 4.7 ± 3.4 in the control group (P= 0.872). MDA and IL‐6 results for the UDT and control groups were significantly different (P= 0.003 and P= 0.019, respectively), but those for ASA were not (P= 0.473). The mean MDA and IL‐6 values were significantly higher in bilateral cases than the respective values in the unilateral cases (MDA: 4.03 ± 3.68 vs 3.49 ± 5.22, P= 0.015; IL‐6: 7.70 ± 6.86 vs 3.48 ± 6.50, P= 0.001) (P= 0.015).

Conclusion:  The results indicate that children with UDT are exposed to high levels of oxidative stress and inflammatory reaction. This could negatively affect the future fertility in these children.
A yeast two‐hybrid screen reveals that osteopontin associates with MAP1A and MAP1B in addition to other proteins linked to microtubule stability, apoptosis and protein degradation in the human brain
Authors: Long Philip , Samnakay Parwez , Jenner Peter , Rose Sarah
Published: July 2012

Osteopontin (OPN) expression is reduced in surviving dopaminergic neurones in the substantia nigra (SN) in Parkinson’s disease (PD), and protects against MPP+‐induced cell death in primary mesencephalic cultures and 6‐OHDA‐induced cell loss in the rat, while inactivation of OPN aggravates cell death. OPN is thought to act through interactions with integrin receptors or CD44. However, the specific protein interactions involved in OPN‐mediated neuroprotection are unknown and are the focus of this study. The yeast two‐hybrid (YTH) technique was utilised to investigate OPN–protein interactions, using full‐length human OPN to screen a human foetal brain cDNA library. Proteins involved in apoptosis, protein degradation and microtubule stability were identified as OPN binding partners. These included: MAP1A and MAP1B, which regulate microtubule stability; RNF138, an E3 ubiquitin‐ligase; proteasome β1 subunit, a subunit of the 20S proteasome involved in the ubiquitin‐dependent cleavage of peptides; BAG6, SGTΑ and EF1A, proteins implicated in control of apoptosis; DnaJB1, a co‐chaperone of Hsp70s; and pleiotrophin, a growth factor. The use of site‐directed mutagenesis to modify known OPN protein binding sites outside the RGD integrin binding domain, specifically Y165A and D139E, inhibited some of these interactions. Further investigation using affinity pull‐down assays, co‐immunoprecipitation and immunohistochemistry confirmed that OPN associates with MAP1A and MAP1B in rat SN and striatum. These findings indicate a role for OPN in the regulation of microtubule dynamics, apoptosis and proteolysis in the brain, suggesting that OPN may act as an endogenous multifunctional protective protein in PD.
The role of dopamine in the accumbens core in the expression of Pavlovian‐conditioned responses
Authors: Saunders Benjamin T. , Robinson Terry E.
Published: July 2012

The role of dopamine in reward is a topic of debate. For example, some have argued that phasic dopamine signaling provides a prediction‐error signal necessary for stimulus–reward learning, whereas others have hypothesized that dopamine is not necessary for learning per se, but for attributing incentive motivational value (‘incentive salience’) to reward cues. These psychological processes are difficult to tease apart, because they tend to change together. To disentangle them we took advantage of natural individual variation in the extent to which reward cues are attributed with incentive salience, and asked whether dopamine (specifically in the core of the nucleus accumbens) is necessary for the expression of two forms of Pavlovian‐conditioned approach behavior – one in which the cue acquires powerful motivational properties (sign‐tracking) and another closely related one in which it does not (goal‐tracking). After acquisition of these conditioned responses (CRs), intra‐accumbens injection of the dopamine receptor antagonist flupenthixol markedly impaired the expression of a sign‐tracking CR, but not a goal‐tracking CR. Furthermore, dopamine antagonism did not produce a gradual extinction‐like decline in behavior, but maximally impaired expression of a sign‐tracking CR on the very first trial, indicating the effect was not due to new learning (i.e. it occurred in the absence of new prediction‐error computations). The data support the view that dopamine in the accumbens core is not necessary for learning stimulus–reward associations, but for attributing incentive salience to reward cues, transforming predictive conditional stimuli into incentive stimuli with powerful motivational properties.
Male sexual function after laparoscopic total mesorectal excision
Authors: Hida K. , Hasegawa S. , Kataoka Y. , Nagayama S. , Yoshimura K. , Nomura A. , Kawada K. , Kawamura J. , Kinjo Y. , Sakai Y.
Published: July 2012

Aim  The aim of this prospective study was to clarify the frequency of male sexual dysfunction after laparoscopic total mesorectal excision (LTME) and to examine the relationship between pelvic autonomic nerve (PAN) preservation status and functional outcomes.

Method  Candidates for LTME were included in this study. PAN preservation status after LTME was examined in detail by video review. Patients completed a functional questionnaire (the International Index of Erectile Function) before and 3, 6 and 12 months after the operation.

Results  Twenty‐six patients who underwent LTME were assessable. Detailed video reviews identified inadvertent PAN damage during surgery. PAN injury was observed in 11 cases (41%), including eight cases (32%) of inadvertent PAN damage (incomplete preservation group). There was a trend toward increasing inadvertent PAN injury rate in patients with high body mass index and large tumours. The results from all patients who underwent LTME showed no deterioration in total International Index of Erectile Function or its domain scores 12 months after surgery. In the incomplete preservation group, these scores temporarily decreased (3 and 6 months after surgery), but such deterioration was not observed in the complete preservation group. Most of the 12 patients with potentially active erectile function before the operation recovered this function, and only one patient (7%) with PAN injury was still judged as inactive 12 months after surgery.

Conclusion  The proportion of patients with sexual dysfunction after LTME is low. With the enhanced visibility of the laparoscope, inadvertent PAN injury was detected in a significant number of cases and associated with transient deterioration of sexual function.
Systematic review of the management of ischaemic colitis
Authors: O’Neill S. , Yalamarthi S.
Published: July 2012

Aim  The study reviews the literature related to ischaemic colitis (IC) to establish an evidence base for its management and to identify factors predicting severity and mortality.

Method  A systematic review of the English language literature was conducted according to recommendations of the Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) statement. MEDLINE, Embase and Cochrane Library databases were searched using the keyword search ‘ischaemic colitis OR colon ischaemia OR colonic ischaemia OR management ischaemic colitis’. IC is often misdiagnosed so only studies where the diagnosis was supported by histopathology in every case were included. Critical appraisal was performed of included studies using predefined quality assessment checklists and narrative data synthesis.

Results  In all, 2610 publications were identified. Of these, eight retrospective case series and three case controlled studies describing 1049 patients were included. Medical management was used in 80.3% patients of whom 6.2% died. Surgery was required in 19.6% of whom 39.3% died. The overall mortality of IC was 12.7%. Lack of rectal bleeding, peritonism and renal dysfunction were commonly quoted predictors of severity; however, right sided IC appeared to be the most significant predictor of outcome.

Conclusion  Most patients with IC can be managed conservatively. Right sided IC may be the most significant predictor of severity.
Safety and short‐term effectiveness of EEA stapler vs PPH stapler in the treatment of degree III haemorrhoids: prospective randomized controlled trial
Authors: Giuratrabocchetta S. , Pecorella G. , Stazi A. , Tegon G. , De Fazio M. , Altomare D. F.
Published: July 2012

Aim  Stapled haemorrhoidopexy has gained wide acceptance due to less postoperative pain although postoperative bleeding and prolapse recurrence are among the major drawbacks of this technique compared with the standard Milligan–Morgan hemorrhoidectomy. The aim was to investigate a new stapler device designed to overcome these side effects.

Method  In all, 135 patients (71 men, mean age 42 years) with degree III haemorrhoids were randomly allotted to stapled haemorrhoidopexy with PPH® staplers (Ethicon EndoSurgery) (63 patients) or with an EEA® stapler (Covidien) (72 patients) in four referral colorectal centres. The number of haemostatic overstitches apposed on the stapled suture, the area of the resected mucosa (in square centimetres) and any postoperative bleeding within 30 days were recorded.

Results  The mean area of the resected mucosa was significantly wider in EEA than PPH patients (35.75± 17.51 vs 28.05 ± 10.23 cm2, P = 0.002). The median number of haemostatic stitches apposed in the EEA group was significantly lower than in the PPH groups (median value 1, vs 3, interquartile range 0–2, vs 2–5, P < 0.0001). Intraoperative haemostasis was better in the EEA group compared with the PPH01 and PPH03 groups. Postoperative bleeding occurred only in two PPH patients.

Conclusion  Data suggest that the EEA stapler has better haemostatic properties than the PPH stapler and allows resection of a larger area of mucosal prolapse with potential benefits over the recurrence rate of haemorrhoid prolapse.
Repeat 2‐week wait referrals for colorectal cancer
Authors: Vaughan‐Shaw P. G. , Cutting J. E. , Borley N. R. , Wheeler J. M. D.
Published: July 2012

Aim  The inappropriate use of the ‘2‐week wait’ pathway for suspected colorectal cancer (CRC2ww) may overload urgent clinics and delay the assessment and investigation of other patients. Those who have been previously referred and investigated for suspected colorectal cancer may present one group that does not warrant repeat urgent referral. This paper aims to identify the incidence and diagnostic yield of repeat CRC2ww referrals.

Method  All CRC2ww patients referred to our unit over a 4‐year period were identified retrospectively. Referral indication, outcome and instances of repeat referral were identified from multidisciplinary team, endoscopy and imaging databases.

Results  In all, 2735 CRC2ww referrals were made over the study period. Of these, 122 were repeated CRC2ww referrals, with the incidence increasing from 2% in 2008 to 6% in 2010 (P = 0.0006). The median time to repeat referral was 1070 days. After initial referral 267 cancers were detected, including 212 colorectal cancers. The diagnostic yield was lower but not significantly so after repeated referral (six cancers) compared with initial referral (5%vs 10%, P = 0.07).

Conclusion  The incidence of repeat referral is low but the diagnostic yield is not insignificant. Exclusion of these patients from urgent assessment and investigation will not significantly reduce workload and may risk missing some patients with cancer.
Single‐incision right hemicolectomy for malignancy: a feasible technique with standard laparoscopic instrumentation
Authors: Mufty H. , Hillewaere S. , Appeltans B. , Houben B.
Published: July 2012

Aim  Single‐incision laparoscopy is a rapidly evolving technique in the spectrum ‘standard laparoscopy‐natural orifice transluminal endoscopic surgery (NOTES)’. From a commercial perspective, purchase of articulating instruments is advised. However, here we present our early experience with single‐incision laparoscopy for right hemicolectomy with standard laparoscopic instrumentation.

Method  Between June 2010 and December 2011, 25 patients presenting with malignant disease underwent single‐incision laparoscopy for right hemicolectomy. Four different ports (SILS™ port, Covidien; SSL® Access system, Ethicon; X‐Cone/S‐Portal®, Storz; and OCTO™ port, AFS Medical) were used. Patients were recruited prospectively and all data were processed retrospectively.

Results  Twenty‐five patients were included in our study (and their characteristics, described later in this paragraph, are expressed as median (range)). Four conversions to standard laparoscopy were performed. The age of patients was 69 (36–89) years, and they had a body mass index (BMI) of 24.5 (19.1–34.2). The duration of surgery was 110 (70–148) min with a healed skin incision length of 35 (20–60) mm. Hospital stay was 5 (2–15) days. In four patients discharge was delayed because of comorbidity. One patient suffered an overwhelming pneumonia.

Conclusion  Single‐incision laparoscopy using standard laparoscopic instruments appears to be a safe and feasible technique for malignant disease requiring right hemicolectomy. Randomized, prospective trials are ongoing to prove the benefits of this technique and to compare its oncological outcome measures with those of conventional laparoscopy. In our experience, a low‐profile port with a wide intra‐abdominal range of motion is most preferable.
The productivity of peasant agriculture: Oakington, Cambridgeshire, 1360–991
Authors: SAPOZNIK ALEXANDRA
Published: July 2012

Agriculture was the largest and most important sector of the medieval English economy. Yet although peasants comprised the majority of the population, and were responsible for the greater part of land use, surprisingly little is known about peasant cropping patterns and production strategies. Taking the Crowland Abbey manor of Oakington, Cambridgeshire as a case study, this article examines peasant land use and agricultural strategies. Using data collected from the Oakington tithe accounts and manor court rolls, this article demonstrates that peasants used their land more extensively than did the lord, raising their output per acre above that of the demesne. This was driven by peasant need for fodder crops, and the strain placed on agricultural systems that required peasants to use their land to produce grains and legumes for consumption, fodder, and sale.
Gene‐by‐preschool interaction on the development of early externalizing problems
Authors: Tucker‐Drob Elliot M. , Harden K. Paige
Published: July 2012

Background:  Preschool involves an array of new social experiences that may impact the development of early externalizing behavior problems over the transition to grade school.

Methods:  Using longitudinal data from a nationally representative sample of over 600 pairs of US twins, we tested whether the genetic and environmental influences on externalizing problems differed between children who did versus did not attend preschool.

Results:  At age 4, the genetic and environmental etiology of externalizing did not differ by preschool attendance. In contrast, by age 5 years (kindergarten age), the genetic and environmental etiology of externalizing significantly differed by preschool attendance. Among children who did not attend preschool, externalizing at age 5 was predominantly due to environmental influences (52% shared environment, 34% non‐shared environment) rather than genetic differences (13%), whereas among children who had attended preschool, externalizing at age 5 was primarily due to genes (67%), and shared environmental influences were negligible (0%). These interactions represented the differential longitudinal persistence of genes and environments that contributed to externalizing at age 4. Sensitivity analyses ruled out confounding due to early mental ability, socioeconomic status, minority status, child age, and prior history of childcare.

Conclusions:  These results indicate that preschool enrollment is associated with increased genetic and decreased shared environmental influences on the development of early externalizing behavior problems.
StCDPK5 confers resistance to late blight pathogen but increases susceptibility to early blight pathogen in potato via reactive oxygen species burst
Authors: Kobayashi Michie , Yoshioka Miki , Asai Shuta , Nomura Hironari , Kuchimura Kazuo , Mori Hitoshi , Doke Noriyuki , Yoshioka Hirofumi
Published: July 2012

See also the Commentary by Mair and Teige
Novel Mouth‐Exercising Device for Oral Submucous Fibrosis
Authors: Patil Pravinkumar G. , Patil Smita P.
Published: July 2012

Oral submucous fibrosis (OSMF) is a chronic inflammatory disease resulting in progressive juxtaepithelial fibrosis of the oral soft tissues and can cause increasing difficulty in mastication, swallowing, speaking, and mouth opening. The treatment of severe trismus requires a combination of surgical release and physiotherapy. Often physiotherapy alone can modify tissue remodeling in OSMF to increase oral opening. This article describes the fabrication and use of a new mouth‐exercising device that helps the patient to squeeze/stretch the cheek mucosa to increase elasticity. The device can be used as a sole treatment modality or can be used in association with pharmacological and surgical treatment modalities for OSMF. Improvement in mouth opening was observed in four OSMF patients treated with a mouth‐exercising device for 6 months as a sole treatment modality.
Follicular mucinosis and mycosis‐fungoides‐like drug eruption due to leuprolide acetate: a case report and review
Authors: Shalin Sara C. , Brantley Julie , Hafeez Diwan A.
Published: July 2012

Leuprolide acetate represents a gonadotropin‐releasing hormone agonist, used as part of the treatment of prostate cancer. We report an unusual case of disseminated urticarial rash following leuprolide injection in a 67‐year‐old man that histopathologically and immunohistochemically resembled mycosis‐fungoides, including the presence of follicular mucinosis and eosinophils in the follicles. This histopathologic pattern has not been previously described as a drug reaction pattern due to leuprolide, and it underscores the importance of correlation with the clinical impression to arrive at a correct diagnosis.
Amelogenin splice isoforms stimulate chondrogenic differentiation of ATDC5 cells
Authors: Mitani K , Haruyama N , Hatakeyama J , Igarashi K
Published: July 2012

Objective

Amelogenins are the most abundant matrix proteins in enamel. Among the amelogenin isoforms, full‐length amelogenin (M180) and leucine‐rich amelogenin peptide (LRAP) are expressed in various tissues and are implicated as signalling molecules in mesenchymal cells. Here, we examined the effects of M180 and LRAP on a chondrogenic cell line, ATDC5, to investigate the role of amelogenins in chondrogenesis.

Materials and Methods

Recombinant mouse M180‐ or LRAP‐protein‐containing medium or control medium was mixed with a chondrogenesis‐stimulating medium, and changes in the phenotype, gene expression levels and cell proliferation of cultured ATDC5 cells were analysed.

Results

The addition of amelogenins increased alkaline phosphatase activity and glycosaminoglycan secretion at 14 and 21 days of culture, respectively, as compared with the control. Quantitative PCR (Q‐PCR) analysis revealed that LRAP increased the gene expression levels of Runx2, Col2a1 and Aggrecan at 7 days of differentiation. Moreover, both M180 and LRAP significantly increased the gene expression levels of ALP, Aggrecan, Col10a1 and osteopontin at 28 days of culture. Bromodeoxyuridine assay and Q‐PCR analysis for Wnt signalling indicated that both M180 and LRAP reduced proliferation, but induced the cell differentiation possibly through altered non‐canonical Wnt signalling.

Conclusion

M180 and LRAP accelerate chondrogenic differentiation and maturation of ATDC5 cells.
Salivary high‐sensitivity cardiac troponin T levels in patients with acute myocardial infarction
Authors: Mirzaii‐Dizgah I , Riahi E
Published: July 2012

Objective

Accurate and rapid diagnosis of acute myocardial infarction (MI) is of major medical and economic importance. The objective of this study was to identify whole saliva high‐sensitivity cardiac troponin T (hs‐cTnT) in patients with acute MI.

Subjects and Methods

A case–control study was carried out in 30 normal healthy individuals, and 30 patients with acute MI were hospitalized in CCU of Imam Hossein hospital, Tehran, Iran. The hs‐cTnT levels were assayed in serum and whole saliva in the first and second morning following the MI by ELISA method. Statistical analysis of the Student's t‐test and Pearson correlation coefficient was performed.

Results

The mean stimulated and unstimulated saliva and serum levels of hs‐cTnT at both the first and the second morning following the acute MI were significantly higher in patients with acute MI compared with healthy individuals. Furthermore, stimulated and unstimulated saliva hs‐TnT levels correlated significantly with serum hs‐TnT level (r = 0.415, P < 0.023; r = 0.466, P < 0.021, respectively).

Conclusion

Results suggest that salivary hs‐cTnT can be used as an alternative to serum hs‐cTnT for diagnosis and monitoring of myocardial infarction.
Parents' perspectives on centralized cleft services for children: the development of a DCE questionnaire
Authors: Ke KM , Mackichan F , Sandy JR , Ness AR , Hollingworth W
Published: July 2012

Objective

Incorporating user's perspectives in healthcare delivery is important. Simple questionnaires may not capture these as well as a discrete choice experiment (DCE) which enables the exploration of users' trade‐offs between different service attributes. Qualitative methods are increasingly used to improve a DCE's face validity, but few studies adequately describe them. This paper describes the qualitative investigations in the development of a DCE questionnaire to elicit parents' perspectives on centralized services for children with cleft lip and palate.

Methods

Semi‐structured telephone interviews were conducted with 16 parents from across the UK, except Wales. Data analysis was carried out by the constant comparative method.

Results

Five attributes and their levels were inductively identified: usefulness and amount of information (four levels); staff attitude at cleft centres (two levels); continuity of care (two levels); personal costs of attending appointments (four levels); and cleft centres facilities (two levels). An unexpected finding was that parents' sense of responsibility towards their child made a ‘willingness‐to‐travel’ attribute unacceptable to them, but they were receptive to a ‘willingness‐to‐pay’ attribute.

Conclusion

Using qualitative methods with service users in attribute development for a DCE helps to uncover issues that may not be apparent to researchers or health service staff.
Anti‐inflammatory effect of pachymic acid promotes odontoblastic differentiation via HO‐1 in dental pulp cells
Authors: Lee Y‐H , Lee N‐H , Bhattarai G , Kim G‐E , Lee I‐K , Yun B‐S , Hwang P‐H , Yi H‐K
Published: July 2012

Objectives

Heme oxygenase‐1 (HO‐1) is contributed to odontoblast differentiation in human dental pulp cells (HDPCs). In this study, pachymic acid from mushroom Formitopsis niagra is examined to determine whether it affects pulpal inflammation and promotes odontogenesis via HO‐1 gene expression.

Materials and Methods

The HDPCs were given H2O2 for inflammation. The anti‐inflammatory character and odontoblast differentiation by pachymic acid were analyzed by Western blotting, alkaline phosphatase activity, and alizarin red S staining. To understand the mechanism of pachymic acid via HO‐1 induction, the cells were treated with zinc protoporphyrin IX (ZnPP: HO‐1 inhibitor).

Results

H2O2 induced pulp inflammation and disturbed odontoblast differentiation. However, the HDPCs treated with pachymic acid affected anti‐inflammatory effect and induction of odontoblast differentiation through increasing HO‐1 expression. In addition, pachymic acid has potent cytoprotection and mineralization under H2O2 treatment. Furthermore, pachymic acid significantly suppressed nuclear factor‐kappa B (NF‐κB) translocation into nucleus and induced NE‐E2‐related factor‐2 (Nrf2) translocation into nucleus. Overall, NF‐κB and Nrf2 translocation were regulated by the HO‐1 pathway.

Conclusions

The pachymic acid showed anti‐inflammatory function and odontoblast differentiation via HO‐1 pathway. These results suggested that pachymic acid may be applicable for prevention of oral inflammation or to improve dentin mineralization against several stresses.