bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic papillary large balloon dilation in Billroth II gastrectomy patients with bile duct stones
Authors: Choi Cheol Woong , Choi Jung Sik , Kang Dae Hwan , Kim Bong Gap , Kim Hyung Wook , Park Su Bum , Yoon Ki Tae , Cho Mong
Published: July 2011

Background and Aims:  Patients with Billroth II (B‐II) gastrectomy present technical difficulties during endoscopic stone removal due to altered anatomy. Although endoscopic sphincterotomy alone or endoscopic balloon dilation alone has been used for removal of bile duct stones in patients with B‐II gastrectomy, the results are not satisfactory. The aim of this study was to evaluate the efficacy and safety of endoscopic papillary large balloon dilation (EPLBD) for removal of bile duct stones in patients with B‐II gastrectomy.

Methods:  Twenty‐six patients (20 men and six women; median age 72 years) with bile duct stones and a history of B‐II gastrectomy were enrolled. After cannulation, limited endoscopic sphincterotomy was performed. Then, balloon dilation (balloon size, 10–15 mm) was performed and stones were removed conventionally or via mechanical lithotripsy. Successful stone removal and complications were evaluated.

Results:  In all cases, stones were successfully removed. The median number of sessions for complete stone removal was one (range 1–3). Stone removal by mechanical lithotripsy was achieved in three patients (11.5%). There were no significant complications, such as bleeding, pancreatitis, or perforation.

Conclusions:  Endoscopic papillary large balloon dilation is an effective and safe method for removal of bile duct stones. We suggest consideration of this technique for removal of bile duct stones in patients with B‐II gastrectomy.
Transition from hepatic steatosis to steatohepatitis: Unique microRNA patterns and potential downstream functions and pathways
Authors: Jin Xi , Chen Yi‐peng , Kong Mei , Zheng Lin , Yang Yi‐da , Li You‐ming
Published: July 2011

Background and Aim:  This study aimed to explore the unique miRNA responsible for transition from hepatic steatosis to steatohepatitis and to investigate the functions and pathways of their downstream targets.

Methods:  Microarray and stem‐loop reverse transcription‐polymerase chain reaction were utilized to detect dysregulated miRNA in a rat model. SAM, PAM and clustering analysis were jointly applied to calculate significantly changed miRNA. The targets of miRNA were predicted through web server “microrna.” The functions and pathways of those predicted genes were analyzed using databases of Gene Ontology and KEGG by the web server “DAVID.”

Results:  Fourteen upregulated and six downregulated miRNA were selected as an accurate molecular signature in distinguishing hepatic steatohepatitis from steatosis. Through Gene ontology, 499 and 287 enriched functional categories were found for the target genes of upregulated and downregulated miRNA, including ion homeostasis, protein transport and so on. Through KEGG, 46 and 41 enriched pathways were collected for the target genes of upregulated and downregulated miRNA, including apoptosis, fatty acid metabolism and so on. Analysis of common target genes of all downregulated miRNA revealed potential involvement of ion transport and the membrane structure in steatohepatitis.

Conclusion:  We reported the dysregulated miRNA in transition from hepatic steatosis to steatohepatitis and showed potential clinical application in disease differentiation. This study provided data reservoir for miRNA exploration and revealed novel disease‐specific Gene Ontology functions and KEGG pathways such as uncoupling‐protein‐guided membrane change. Our data contributes to further researches on the pathogenesis and treatment of non‐alcoholic steatohepatitis.
Use of thiopurines in the treatment of inflammatory bowel disease is associated with an increased risk of non‐melanoma skin cancer in an at‐risk population: A cohort study
Authors: Setshedi Mashiko , Epstein David , Winter Trevor A , Myer Landon , Watermeyer Gillian , Hift Richard
Published: July 2011

Background and Aim:  The thiopurines azathioprine and 6‐mercaptopurine are effective in the management of patients with inflammatory bowel disease (IBD) in whom aminosalicylates, antibiotics and corticosteroids have failed to induce or maintain remission. Long‐term use of these agents has been linked to a greatly increased risk of non‐melanoma skin cancer and lymphatic cancer in organ transplant recipients. There is some evidence to suggest that IBD patients receiving thiopurines might be at increased risk of cancer. Our aim was to determine the incidence of cancer in a cohort of patients with IBD managed in our clinic, and to relate this to thiopurine exposure.

Methods:  We conducted a retrospective study based on the clinical and pathology records of patients attending a specialist IBD clinic at Groote Schuur Hospital, Cape Town, South Africa between 1960 and 2007.

Results:  We analyzed the records of 1084 patients. A total of 123 subjects (11.5%) had received thiopurine therapy. Cancer was identified in 51 patients (4.7%), including colorectal cancer (15 patients), melanoma (two patients), non‐melanoma skin cancer (seven patients) and non‐Hodgkin's lymphoma (five patients). A diagnosis of non‐melanoma skin cancer was significantly associated with thiopurine exposure (odds ratio 5.0, 95% confidence interval 1.1–22.8). Six of seven non‐melanoma skin cancers occurred in Caucasian patients, with a highly significant association with thiopurine use (odds ratio 12.4, 95% confidence interval 2.3–67.4).

Conclusions:  Patients with IBD who receive thiopurines are at increased risk of non‐melanoma skin cancer. The risk is highest in Caucasian patients, and is negligible in other groups.
Comparison of patients of chronic laryngitis with and without troublesome reflux symptoms
Authors: Wang An Jiang , Liang Mao Jin , Jiang Ai Yun , Lin Jin Kun , Xiao Ying Lian , Peng Sui , Chen Jie , Wen Wei Ping , Chen Min Hu
Published: July 2011

Background and Aim:  Little is known about the difference between patients of chronic laryngitis with and without troublesome reflux symptoms. The aim of this study was to compare the clinical characteristics and response to acid suppression between patients of chronic laryngitis with and without troublesome reflux symptoms.

Methods:  Consecutive patients with chronic laryngitis were enrolled. The frequency and severity of reflux and laryngeal symptoms were scored. All the patients underwent laryngoscopy, esophagogastroduodenoscopy and 24‐h multichannel intraluminal impedance and pH monitoring before receiving rabeprazole 10 mg b.i.d. for 3 months. Mild typical reflux symptoms (heartburn or regurgitation) occurring ≥ 2 days/week or moderate/severe symptoms occurring ≥ 1 day/week were defined as troublesome reflux symptoms.

Results:  Compared to patients without troublesome reflux symptoms, those with troublesome reflux symptoms were older and had more episodes of acid and liquid gastroesophageal reflux (GER) and acid and weakly acidic laryngopharyngeal reflux (LPR). They also had higher percentages of both bolus exposure time and acid exposure time of GER and LPR. Patients with troublesome reflux symptoms responded to acid suppression more often at 12 weeks (67.3% vs 20.9%, P < 0.001) and more rapidly (40.8% vs 14.0%, 3 weeks after the start of acid suppression; P = 0.004) compared to those without.

Conclusion:  Difference in reflux profile of GER and LPR between patients with and without troublesome reflux symptoms could partly explain the discrepancy of response to acid suppression among patients with chronic laryngitis. Acid suppression therapy may provide limited therapeutic benefits to patients of chronic laryngitis without troublesome reflux symptoms.
Long‐term cohort study of chronic hepatitis C according to interferon efficacy
Authors: Maruoka Daisuke , Imazeki Fumio , Arai Makoto , Kanda Tatsuo , Fujiwara Keiichi , Yokosuka Osamu
Published: July 2011

Background and Aim:  We investigated the prognosis of patients with C‐viral chronic liver disease (C‐CLD) according to the efficacy of interferon (IFN) therapy in a long‐term retrospective cohort study.

Methods:  Of 721 patients with C‐CLD who underwent liver biopsy between January 1986 and December 2005, 577 were treated with IFN, and 221 of these patients achieved sustained virological response (SVR) with a follow‐up period of 9.9 ± 5.3 years.

Results:  The annual rate of HCC development was 2.71%/year, 2.31%/year, and 0.24%/year in untreated, non‐SVR, and SVR patients, respectively. Multivariate Cox proportional regression analysis showed that the risk of HCC development was significantly lower in SVR patients than in untreated or non‐SVR patients; moreover, this risk was similar in non‐SVR patients and untreated patients. The annual mortality rate in overall death was 3.19%/year, 1.98%/year, and 0.44%/year in untreated, non‐SVR, and SVR patients, respectively. Multivariate Cox proportional hazards regression analysis showed that the SVR status reduced the risk ratio for overall death to 0.173, whereas the non‐SVR status did not significantly reduce the risk ratio.

Conclusions:  The risk ratio of overall death and HCC development was significantly reduced in SVR patients, whereas no significant reduction was found in non‐SVR patients in a long‐term cohort study.
Narrow‐band imaging in the colon: Limitations and potentials
Authors: Ng Siew C , Lau James YW
Published: July 2011

Narrow‐band imaging (NBI) is a new endoscopic technology that highlights surface structures and superficial mucosal capillaries during colonoscopy at a single push of a button. NBI has a high sensitivity and specificity for differentiating neoplastic and non‐neoplastic polyps by means of mucosal and capillary patterns. It is also useful in determining the invasion depth of early colorectal cancers and evaluating free margins after endoscopic resection. However, it has not been shown to improve the adenoma detection rate compared with white‐light endoscopy. Although narrow‐band imaging is now available commercially, its role in routine clinical practice during colonoscopy is not well defined. The difficulties in interpreting results partly relate to different NBI nomenclatures used in classifying colonic adenomas and their lack of standardization. Future research should focus on establishing a reliable NBI nomenclature for capillary patterns, defining the learning curve and interobserver variation, and validating the effectiveness of NBI in routine colonoscopy.
Continuous proton pump inhibitor treatment decreases upper gastrointestinal bleeding and related death in rural area in Japan
Authors: Miyamoto Masaki , Haruma Ken , Okamoto Takeshi , Higashi Yuusuke , Hidaka Toru , Manabe Noriaki
Published: July 2011

Background and Aims:  Proton pump inhibitors (PPI) have been rarely used for prevention of upper gastrointestinal bleeding (UGIB) induced by non‐steroidal anti‐inflammatory drugs (NSAIDs) and/or aspirin in Japan. The increased incidence of UGIB in the aged society is becoming a serious problem. The aim of this study was to retrospectively evaluate whether PPI can prevent UGIB.

Methods:  We examined records of 2367 patients (aged 67.9 ± 15.1 years, male 1271) attending the only hospital serving the rural area, with little population movement. We investigated the correlation between the frequency of usage of medicine (PPI, histamine 2 receptor antagonists [H2RA], NSAIDs, aspirin) and incidence of UGIB over 12 years. UGIB was defined as cases with hematemesis and/or melena and definite bleeding at upper gastrointestinal endoscopy. The annual incidence of UGIB of inhabitants (16 065 ± 375.3 persons/year) was evaluated. The frequency of usage of medicine was compared with the total number of patients prescribed any medication (1080 ± 33.2 persons/year).

Results:  The frequency of PPI usage has increased significantly 4.6%→30.8% (P < 0.05). NSAIDs and aspirin usage increased significantly in the latter half of the survey period (P < 0.05). The annual incidence of UGIB significantly decreased 160.8 →23.6/100 000 inhabitants per annum (P ≤ 0.05) due to widespread use of PPI. No patients died due to UGIB after 2006. The incidence of UGIB and the prevalence of PPI usage were found to have a negative correlation (r = −0.804, P = 0.0016).

Conclusions:  By widespread use of PPI, UGIB and related death has declined significantly. This survey showed that continuous PPI treatment decreases UGIB and related death in community medicine.
Animal model for the study of the relationship between lower urinary tract symptoms/bladder outlet obstruction and erectile dysfunction
Authors: Kobayashi Ko , Kato Ryuichi , Hisasue Shin‐ichi , Yamashita Shinichi , Tanaka Toshiaki , Masumori Naoya , Tsukamoto Taiji
Published: July 2011

Objectives:  Lower urinary tract symptoms (LUTS) are frequently associated with erectile dysfunction (ED) in aged men, and both significantly influence quality of life. However, the mechanism linking LUTS to ED has not been clarified completely. The purpose of the present study was to establish an animal model of ED following LUTS/bladder outlet obstruction (BOO) and investigate the expression of molecules related to the cause of this type of ED.

Methods:  Male Sprague‐Dawley rats with partial BOO were used as an experimental model of LUTS. Sham‐operated animals served as controls. Voiding and erectile function were evaluated 4, 8, and 16 weeks after obstruction or sham operation. The mRNA expression of penile tissue genes related to penile corporal smooth muscle relaxation was examined by quantitative real‐time reverse transcription–polymerase chain reaction.

Results:  Voiding and bladder function of BOO rats were significantly worse than in sham‐operated rats 4, 8, and 16 weeks after obstruction. The erectile function of BOO rats was significantly decreased compared with that of the sham‐operated controls (P < 0.01) 16 weeks after obstruction, although it was similar to that of sham‐operated animals at 4 and 8 weeks after obstruction. The expression of endothelial nitric oxide synthase (eNOS) mRNA was significantly decreased 16 weeks after obstruction compared with that in sham‐operated rats (P < 0.01).

Conclusion:  An animal model for investigations into the association between LUTS and ED is described herein. Endothelial dysfunction induced by impaired eNOS function is likely to be involved in ED following LUTS/BOO.
Mothers' experiences of the time after the diagnosis of an intrauterine death until the induction of the delivery: A qualitative Internet‐based study
Authors: Erlandsson Kerstin , Lindgren Helena , Malm Mari‐Cristine , Davidsson‐Bremborg Anna , Rådestad Ingela
Published: July 2011

Aim:  This study aims to describe how mothers spend the period of time between being diagnosed with a dead baby in utero and the induction of the delivery.

Material and Methods:  Data were collected using a web questionnaire. Five hundred and fifteen women who had experienced a stillbirth after the 22nd week of gestation answered the open question: ‘What did you do between the diagnosis of the child's death and the beginning of the delivery?’ A qualitative content analysis method was used.

Results:  The results show that some mothers received help to adapt to the situation, while for others, waiting for the induction meant further stress and additional psychological trauma in an already strained situation.

Conclusion:  There is no reason to wait with the induction unless the parents themselves express a wish to the contrary. Health care professionals, together with the parents, should try to determine the best time for the induction of the birth after the baby's death in utero. That time may vary, depending on the parents' preferences.
Primary transitional cell carcinoma of the fallopian tube
Authors: Elsokkari Ihab , Napaki Sarbar , Greening Sian , Aghmesheh Morteza
Published: July 2011

The fallopian tube is the least common site for origin of malignancy in the female genital tract. Most primary fallopian tube malignancies are adenocarcinomas. Primary transitional cell carcinoma (TCC) of the fallopian tube is an extremely rare tumor with a small number of cases reported in the literature. We present a 67‐year‐old woman who was found incidentally to have a left adnexal mass on a screening pelvic ultrasound. Subsequently the patient underwent laparoscopic left salpingo‐oophorectomy and the specimen was submitted for intraoperative frozen section, which revealed a high‐grade carcinoma; therefore, she underwnt a laparotomy and total abdominal hysterectomy, right salpingo‐oophorectomy and omentectomy. Histopathology revealed high‐grade transitional cell carcinoma in the left fallopian tube. Post‐surgery she was treated with four cycles of adjuvant chemotherapy with carboplatin and paclitaxel with no complications. Our patient had a family history of malignancy, so genetic testing for BRCA1 and BRCA2 mutations was undertaken and did not reveal any mutation or unclassified variants. Multiplex ligation‐dependent probe amplification (MLPA) was normal.
Five‐year study assessing the feasibility and safety of autologous blood transfusion in pregnant Japanese women
Authors: Watanabe Noriyoshi , Suzuki Tomo , Ogawa Kohei , Kubo Takahiko , Sago Haruhiko
Published: July 2011

Aim:  To assess the feasibility and safety of autologous blood donation during pregnancy in Japanese women.

Material and Methods:  We enrolled patients who were either at high risk for massive blood loss during delivery or had blood that was difficult to match for transfusion between March 2005 and February 2010. After delivery, we reviewed hospital records of these patients to collect data on blood donation procedures, obstetric outcome and blood transfusions received.

Results:  We enrolled 314 patients during the study period and performed 809 blood donations. The median volume of donated blood was 1200 mL (range, 400–2000 mL). Vasovagal reflex as an adverse donor reaction occurred in 10 of the 314 patients (3.2%) during 11 of the 809 donations (1.4%). There were no cases of non‐reassuring fetal heart rate patterns during blood donations. Twenty‐five (7.8%) of the 322 neonates were admitted to the neonatal intensive care unit. All 322 infants were healthy 1 month after delivery. Among 314 patients, autologous blood re‐transfusion was performed for 56 (17.8%) and homologous blood transfusion was performed concurrently for 5 (1.6%). Placenta previa was the indication with the highest re‐transfusion rate (42.4%). All re‐transfusions were performed without side‐effects.

Conclusion:  Autologous blood donation is feasible and safe for pregnant women and their infants. Although indications of autologous blood donation are controversial, it should be considered for cases of placenta previa.
Endothelial nitric oxide synthase gene polymorphisms in preeclampsia with or without eclampsia in a Turkish population
Authors: Ozturk Ebru , Balat Ozcan , Pehlivan Sacide , Ugur Mete Gurol , Özcan Çağlayan , Sever Tugce , Kul Seval
Published: July 2011

Aim:  To evaluate endothelial nitric oxide synthase (eNOS) gene polymorphisms in preeclampsia with or without eclampsia in a Turkish population.

Material and Methods:  Fifty‐seven preeclamptic and 60 normotensive women were enrolled in the present study. The study focused on two functional variants: a variant in exon 7—G to T conversion at nucleotide position 894 resulting in the replacement of glutamic acid with aspartic acid at codon 298 (Glu298Asp) and a variant variable number of 27 bp tandem repeats in intron 4 (VNTR intron 4). Two polymorphisms in the maternal eNOS gene were characterized by polymerase chain reaction and restriction fragment length polymorphism (PCR‐RFLP) method. Preeclamptic pregnant women were evaluated into two subgroups according to the presence of eclampsia.

Results:  We demonstrated a significant difference in patients with preeclampsia in terms of Glu298Asp/eNOS genotype frequency. G/G homozygotes of Glu298Asp among healthy pregnancies were significantly frequent when T/T homozygotes were significantly frequent among preeclamptic pregnancies. We showed that G/T heterozygotes of Glu298Asp/eNOS gene were significantly frequent among preeclamptic pregnant women who did not develop eclampsia than in preeclamptic pregnant women with eclampsia.

Conclusion:  Glu298Asp polymorphism in the eNOS gene could be an individual's risk factor and may modulate progression to an eclampsia complication of preeclampsia in the Turkish population.
Prediction model for the incidence of emergent cesarean section during induction of labor specialized in nulliparous low‐risk women
Authors: Isono Wataru , Nagamatsu Takeshi , Uemura Yukari , Fujii Tomoyuki , Hyodo Hironobu , Yamashita Takahiro , Kamei Yoshimasa , Kozuma Shiro , Taketani Yuji
Published: July 2011

Aim:  This study aimed to clarify the factors affecting the outcome of induction of labor (IOL) in a Japanese population and to develop a prediction model to assess the probability of emergent cesarean section (CS).

Material and Methods:  By reviewing the medical records of 1029 women who underwent IOL, we compared the emergent CS rate during IOL among subgroups divided by parity and pre‐labor risk, such as fetal anomaly and maternal complication. We created a prediction model to predict the CS rate during IOL focusing on 392 cases of nulliparous women with premature rupture of membrane (PROM). Six factors, including Bishop score (BS), gestational age, maternal body mass index (BMI), maternal height (MH) and birth weight (BW) were extracted and multivariable logistic regression analysis followed by cross‐validation test were performed.

Results:  The emergent CS rate was remarkably higher in the nulliparous group than in the multiparous group (17.6% vs 2.0%). In the nulliparous group, the high‐risk group demonstrated a higher CS rate than the low‐risk group (33.8% vs 15.6%). Multivariate analysis on nulliparous low‐risk cases with PROM demonstrated significant odds ratios for emergent CS in BS, MH and BW. Cross‐validation test selected these three factors as the best combination of parameters. The prediction formula was determined as follows: probability of CS (%) = (odds/1 + odds) ∗ 100, odds = eX and X = 8.18 + 1.23 ∗ BW (kg) − 7.74 ∗ MH (m) − 0.253 ∗ BS.

Conclusion:  This study is the first to provide a prediction formula targeting an Asian population. Our model, which is specialized for nulliparous low‐risk women could enable obstetricians to inform patients of the precise prospect of IOL outcome.
Rotational torsion fatigue failure of an engine driven fuel pump coupling
Authors: WITHY B. , JAMES A. , WILLIAMS J.
Published: July 2011

Between 2005 and 2007 serious flight safety concerns arose when a small fleet of single engine basic trainer aircraft experienced five critical failures of engine driven fuel pump (EDFP) couplings, and a further instance of a cracked coupling. Consequent investigations showed that the coupling fractures were likely to have been caused by a combination of reverse torsional loading and bending. Engine ground runs were then carried out to evaluate linear and torsional engine vibration levels in the drive train affecting the fuel pumps. Analysis of the vibration data indicated that engines, which had caused pump‐coupling failures exhibited high‐amplitude torsional vibration at certain power settings. The excessive vibration level was eventually attributed to detuning of the crankshaft counterweight dampers. This investigation resulted in a change to the maintenance practises on the aircraft in question and no fuel pump failures have occurred since December 2008.
Feasibility and early outcomes of robotic‐assisted laparoscopic Mitrofanoff appendicovesicostomy in patients with prune belly syndrome
Authors: Wille Mark A. , Jayram Gautam , Gundeti Mohan S.
Published: July 2011

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

What’s known on the subject? and What does the study add?

There is a single case reported in the literature describing this approach in prune belly syndrome. To our knowledge there are two case reports and two series in which laparoscopic appendicovesicostomy using the da Vinci robotic system was performed with good results. There are also several case reports of appendicovesicostomy creation using a pure laparoscopic approach. Additionally, several case reports have described combined procedures involving pure laparoscopic and robotic assisted techniques, including appendicovesicostomy with concurrent augmentation, nephrectomy, orchiopexy, antegrade continence enema and cecostomy tube placement. Nguyen et al. have a similar experience in terms of number of patients (ten) who have undergone RALMA, but have not operated on patients with PBS. To our knowledge this is the largest series of patients undergoing RALMA in patients with prune belly syndrome.

OBJECTIVES

• To evaluate the feasibility and report our initial experience with Robotic‐ Assisted Laparoscopic Mitrofanoff Appendicovesicostomy (RALMA) in patients with prune belly syndrome.

• The Mitrofanoff appendicovesicostomy procedure uses the appendix to create an easily accessible continent, catheterizable channel into the urinary bladder. Historically, the procedure is performed by an open surgical approach in prune belly patients. We describe our initial experience herein.

MATERIALS AND METHODS

• Between October 2008 and February 2010 three patients with prune belly syndrome underwent RALMA.

• The appendicovesicostomy anastomosis was performed on the anterior bladder wall and the stoma was brought to the umbilical site or right lower quadrant.

• At least 4 cm of detrusor backing was ensured.

• The appendicovesicostomy stent was left in place for 4 weeks postoperatively before initiation of catheterization.

RESULTS

• Mean age at surgery was 9.7 years (range 5–14 years).

• Blood loss volume was 20 mL in each case. Overall mean operative time was 352 min (range 319–402 min). There were no intraoperative complications and no open conversions.

• There was one postoperative complication in the form of wound infection.

• All patients are catheterizing their stomas and are continent at an average follow‐up of 14.7 months (range 5–21 months).

CONCLUSION

• In our initial experience, RALMA is a feasible option with encouraging early experience for creating a continent catheterizable channel into the urinary bladder in patients with prune belly syndrome.
Morbidity of tumour enucleation for renal cell carcinoma (RCC): results of a single‐centre prospective study
Authors: Minervini Andrea , Vittori Gianni , Lapini Alberto , Tuccio Agostino , Siena Giampaolo , Serni Sergio , Carini Marco
Published: July 2011

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

What’s known on the subject? and What does the study add?

Nephron sparing surgery is the standard treatment for RCC up to a diameter of 7 cm, but it’s intra and postoperative morbidity is not negligable. Tumour enucleation is a nephron sparing technique with a demonstrated oncological efficacy while no prospective study evaluated its surgical results and postoperative morbidity to date.

Our study adds a prospective evaluation of tumour enucleation morbidity. Our results showed that this technique has a low incidence of postoperative complications, especially of urinary fistula. Major tumour dimension and endorenal tumour growth resulted predictors of postoperative complications.

OBJECTIVE

To evaluate the incidence and risk factors of adverse events (AEs) after tumour enucleation (TE).

PATIENTS AND METHODS

Between 2006 and 2009, clinical, surgical and functional data were prospectively gathered from 200 consecutive patients who had open TE.

TE was done by blunt dissection using the natural cleavage plane between the tumour capsule and normal parenchyma.

All the AEs were stratified for severity according to the National Cancer Institute Common Toxicity Criteria version 2.0 grading system.

Risk factors for AEs were determined by univariate analysis.

RESULTS

The mean (range) tumour size was 3.2 (0.8–10.0) cm, and mean (range) warm ischaemia time (WIT) was 16.5 (5–31) min.

Overall, 32 AEs (six grade I, 20 grade II, and six grade III) occurred after TE in 30 patients and of those 27 were surgical (13.5%) and five were medical AEs (2.5%).

On univariate analysis, imperative/relative surgical indication was the only predictive factor for the development of medical AEs. Statistically significant predictors of overall surgical AEs and urinary fistula were clinical tumour dimension, completely endorenal tumour growth and a positive tumour relationship with the urinary collecting system (UCS).

A completely endorenal tumour growth and a positive tumour relationship with the UCS also correlated with bleeding requiring transfusions. Completely endorenal tumour growth was significantly associated with major (grade III) AEs.

CONCLUSIONS

The TE technique was associated with a 16% AE rate and of those only 3% required re‐intervention (grade III).

Urinary fistula occurred in six patients (3%) and ureteric stenting was required in 0.5% of cases.
The Acceptability Cline in VP Ellipsis
Authors: Kim Christina S. , Kobele Gregory M. , Runner Jeffrey T. , Hale John T.
Published: July 2011

Abstract. This paper lays the foundations for a processing model of relative acceptability levels in verb phrase ellipsis (VPE). In the proposed model, mismatching VPE examples are grammatical but less acceptable because they violate heuristic parsing strategies. This analysis is presented in a Minimalist Grammar formalism that is compatible with standard parsing techniques. The overall proposal integrates computational assumptions about parsing with a psycholinguistic linking hypothesis. These parts work together with the syntactic analysis to derive novel predictions that are confirmed in a controlled experiment.
Is sensory over‐responsivity distinguishable from childhood behavior problems? A phenotypic and genetic analysis
Authors: Van Hulle Carol A. , Schmidt Nicole L. , Goldsmith H. Hill
Published: July 2011

Background:  Although impaired sensory processing accompanies various clinical conditions, the question of its status as an independent disorder remains open. Our goal was to delineate the comorbidity (or lack thereof) between childhood psychopathology and sensory over‐responsivity (SOR) in middle childhood using phenotypic and behavior‐genetic analyses.

Method:  Participants (N = 970) were drawn from the Wisconsin Twin Project, a population‐based sample of twins and their families. Mothers completed a sensory responsivity checklist when their offspring were on average 7 years old, followed by a diagnostic interview (Diagnostic Interview Schedule for Children; DISC) within 6–12 months. We examined the incidence of DISC diagnoses – attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, agoraphobia, general anxiety, obsessive‐compulsive disorder, panic disorder, separation anxiety, social phobia, specific phobia, depression, enuresis, trichtollomaniatics, selective mutism, and pica – among children with SOR, and vice versa. Children with autism or pervasive developmental disorders were excluded from the present study. In addition, we examined parent‐reported physical health diagnoses among nondiagnosed children and three groups of children with SOR and/or DISC diagnoses. Biometric models explored common underlying genetic and environmental influences on symptoms of SOR and psychopathology.

Results:  A majority of individuals who screened positive for SOR did not qualify for a DISC diagnosis (58.2%), and vice versa (68.3%). Children who screened positive for SOR only and typical children had similar rates of physical health problems. Turning to a dimensional approach, multivariate twin models demonstrated that modest covariation between SOR and DISC symptoms could be entirely accounted for by common underlying genetic effects.

Conclusions:  Our results suggest that SOR occurs independently of recognized childhood psychiatric diagnoses but is also a relatively frequent comorbid condition with recognized diagnoses. Genetic sources of this comorbidity are implicated.
Introducing HPV vaccine and scaling up screening procedures to prevent deaths from cervical cancer in Japan: a cost‐effectiveness analysis
Authors: Yamamoto N , Mori R , Jacklin P , Osuga Y , Kawana K , Shibuya K , Taketani Y
Published: July 2011

Please cite this paper as:Yamamoto N, Mori R, Jacklin P, Osuga Y, Kawana K, Shibuya K, Taketani Y. Introducing HPV vaccine and scaling up screening procedures to prevent deaths from cervical cancer in Japan: a cost‐effectiveness analysis. BJOG 2012;119:177–186.

Objective To assess the cost‐effectiveness of universal vaccination of 11‐year‐old girls against human papillomavirus (HPV) infection and increased screening coverage to prevent cervical cancer in Japan where the coverage of Papanicolaou smears is very low.

Design A cost–utility analysis from a societal perspective.

Setting Japan, 2010.

Population The female Japanese population aged 11 years or older.

Methods A Markov model of the natural history of cervical cancer was constructed to compare six strategies: i.e. a screening coverage rate of 20, 50 and 80% with and without routine vaccination at age 11.

Main outcome measures Cervical cancer incidence, quality‐adjusted life years (QALYs), costs and incremental cost‐effectiveness ratios.

Results Expanding the coverage of Papanicolaou smears from the current level of 20–50 and 80% yields a 45.5 and 63.1% reduction in cervical cancer incidence, respectively. Impact of combined strategies increases with coverage. Coverages of 20, 50 and 80% showed a 66.1, 80.9 and 86.8% reduction in disease, respectively. The costs of strategies with vaccination are four times higher than the cost of strategies without vaccination. Vaccinating all 11‐year‐old girls with bivalent vaccines with a Papanicolaou smear coverage rate of 50% is likely to be the most cost‐effective option among the six strategies.

Conclusions The introduction of HPV vaccination in Japan is cost‐effective as in other countries. It is more cost‐effective to increase the coverage of the Papanicolaou smear along with the universal administration of HPV vaccine.
Conceptions of inclusion and inclusive education: a critical examination of the perspectives and practices of teachers in Poland
Authors: Starczewska Ania , Hodkinson Alan , Adams Gill
Published: July 2011

This small‐scale study details the development and execution of a system of inclusive education in 20th and 21st century in Poland. A detailed review of the literature and employment of in‐depth semi‐structured interviews aimed to establish how inclusion is defined and operationalised in Poland. In addition, the study sought to establish how the teachers' levels of professional development and personal attitudes towards inclusion were influencing the evolution of this important educational initiative. The data from the study detail that the concept of inclusion is not well known in Poland, and that integrative education still dominates educational thinking. The study provides data to suggest integration in Poland works well in the early stages of education, but that it struggles to provide for and integrate older children into the mainstream educational settings. The research concludes that Poland has taken an important but perhaps faltering step towards educating all children in the mainstream schools.
Fragmentation and comparative genetic structure of four mediterranean woody species: complex interactions between life history traits and the landscape context
Authors: Aparicio Abelardo , Hampe Arndt , Fernández‐Carrillo Laura , Albaladejo Rafael G.
Published: July 2011

Aim  The effect of habitat fragmentation on population genetic structure results from the interaction between species’ life history traits and the particular landscape context, and both components are inherently difficult to tease apart. Here, we compare the genetic (allozyme) structure of four co‐occurring woody species with contrasting life histories to explore how well their response to the same fragmentation process can be predicted from their functional traits.

Location  A highly fragmented forest landscape located in the lower Guadalquivir catchment, south‐western Spain.

Methods  We sampled four species (Cistus salviifolius, Myrtus communis, Pistacia lentiscus and Quercus coccifera) from the same 23 forest fragments known to form a representative array of habitat characteristics in the region. We assessed genetic diversity (A, He and Ng) and differentiation (FIS and FST) for each species and explored their potential drivers using a model‐selection approach with four fragment features (size, historical and current connectivity, and stability) as predictor variables.

Results  Regional‐scale genetic diversity increased from the shortest‐lived to the longest‐lived species, while population differentiation of the self‐compatible species was roughly double that of the three self‐incompatible species. Fragment size was the only feature that did not consistently affect the genetic diversity of local populations across all species. Three species showed signs of being affected by fragmentation, yet each responded differently to the set of fragment features considered. We observed several trends that were at odds with simple life history‐based predictions but could arise from patterns of gene flow and/or local‐scale demographic processes.

Main conclusions  Our comparative study of various landscape features and species underscores that the same fragmentation process can have very different, and complex, consequences for the population genetic structure of plants. This idiosyncrasy renders generalizations across natural systems very difficult and highlights the need of context‐oriented guidelines for an efficient conservation management of species‐rich landscapes.
Novel intraocular and systemic absorption drug delivery and efficacy of N‐acetylcarnosine lubricant eye drops or carcinine biologics in pharmaceutical usage and therapeutic vision care
Authors: Babizhayev Mark A. , Khoroshilova‐Maslova Inna P. , Kasus‐Jacobi Anne
Published: July 2011

The latest estimates of the World Health Organization indicate that there are 161 million visually impaired individuals worldwide, 37 million of whom are blind, with a yearly increase of 1–2 million. The scientists developed and patented the lubricant eye drops formulated as 1%N‐acetylcarnosine prodrug of l‐carnosine containing a mucoadhesive cellulose‐based compound combined with corneal absorption promoters in an ocular drug delivery system. Carcinine is suitable for the systemic administration (per oral) for ophthalmic therapeutic indications. The HPLC analysis was developed to search the pathways of ocular metabolic activities of 1%N‐acetylcarnosine and the bioactivation of this drug molecule promoting transcorneal uptake of l‐carnosine in the aqueous humor. A meta‐analysis of phase 2 randomized double‐blind placebo‐controlled clinical trial data was conducted. The intraocular absorbed l‐carnosine demonstrated a number of pharmacological mechanisms of prevention and reversal of cataracts. Results of systemic absorption of l‐carnosine provide tuberomammillary activation that regulates neuronal functions such as hypothalamic control promoting sensory input in the primary vision perceptual pathway. The parabulbar, subconjunctival, and intravitreal injection of carcinine with most of the vehicle removed is not toxic to intraocular structures, reduces postoperative intraocular inflammation, is a potentially useful tool in the treatment of proliferative vitreoretinopathy as well as considered as the antiapoptotic drug for the protection of photoreceptor cells from oxidative light‐induced stress. The discovery of naturally occurring carnosine derivatives introduces N‐acetylcarnosine and carcinine as effective medical treatment for sight‐threatening eye disorders.
Evidence for the involvement of the serotonergic, noradrenergic, and dopaminergic systems in the antidepressant‐like action of riparin III obtained from Aniba riparia (Nees) Mez (Lauraceae) in mice
Authors: Melo Carla Thiciane Vasconcelos , de Carvalho Alyne Mara Rodrigues , Moura Brinell Arcanjo , Teixeira Caroline Porto Leite , Vasconcelos Leonardo Freire , Feitosa Mariana Lima , de Oliveira Gersilene Valente , Barbosa‐Filho José Maria , Chavez Gutierrez Stanley Juan , de França Fonteles Marta Maria , Vasconcelos Silvânia Maria Mendes , de Sousa Francisca Cléa Florenço
Published: July 2011

Previous work has shown that intraperitoneal administration of riparin III (ripIII) reduces immobility time in the forced swimming test (FST), which suggests potential antidepressant activity. As the mechanism of action is not completely understood, this study is aimed at investigating the antidepressant‐like action of ripIII. Following intraperitoneal administration of ripIII at doses of 25 and 50 mg/kg, there were decreases in the immobility time in the FST and tail suspension test without accompanying changes in ambulation (data not shown). The pretreatment of mice with sulpiride (50 mg/kg, i.p.), prazosin (1 mg/kg, i.p.), yohimbine (1 mg/kg, i.p.), and p‐chlorophenylalanine (PCPA, 100 mg/kg, i.p. for, four consecutive days) significantly prevented the anti‐immobility effect of ripIII in the FST. On the other hand, the anti‐immobility effect of ripIII (50 mg/kg, v.o.) was not altered by pretreatment of mice with SCH23390 (15 μg/kg, i.p.) Furthermore, ripIII potentiated the sleeping latency and sleeping time of the pentobarbital‐induced sleeping time test and also potentiated apomorphine (16 mg/kg, i.p.)‐induced hypothermia in mice. In conclusion, the present study provides evidence that the antidepressant‐like effect of ripIII is dependent on its interaction with the serotonergic, noradrenergic (α1‐ and α2‐ receptors), and dopaminergic (dopamine D2 receptors) systems.
The summer treatment program meets the south side of Chicago: bridging science and service in urban after‐school programs
Authors: Frazier Stacy L. , Chacko Anil , Van Gessel Christine , O’Boyle Caroline , Pelham William E.
Published: July 2011

Background:  This paper describes efforts to apply the principles and strategies of an empirically‐supported treatment for children with disruptive behaviour problems to a park after‐school program serving children in urban poverty.

Method:  Collaboration with staff proceeded in stages: (1) relationship building, needs assessment, and resource mapping; (2) intervention adaptation and implementation; and (3) implementation support, problem‐solving, and sustainability.

Results:  Four tools capitalised on inherent strengths of the parks, accommodated child and staff needs, and emerged as feasible and effective: Group Discussion, Good Behaviour Game, Peers as Leaders, and Good News Notes.

Conclusions:  Recreational settings offer opportunities for mental health promotion for children in urban poverty.
ASSESSMENT OF THE BINDER IN HISTORICAL MORTARS BY VARIOUS TECHNIQUES
Authors: MIRANDA J. , CARVALHO A. P. , PIRES J.
Published: July 2011

Three different historical mortars, one from the 18th–19th centuries and two from the 12th century, were crushed and sieved to give eight fractions between less than 0.063 mm and 4 mm for each sample. Each fraction was chemically analysed for the amount of calcium carbonate binder, using the reactions with HCl and EDTA and by means of atomic absorption spectroscopy. The samples were also characterized by X‐ray diffraction (XRD) and by low‐temperature nitrogen adsorption isotherms. The limitations and advantages of each of the various methodologies for the determination of the binder are discussed. Reactions with HCl and XRD were shown to be the methods that gave the more coherent results.
Microvascular responsiveness in obesity: implications for therapeutic intervention
Authors: Bagi Zsolt , Feher Attila , Cassuto James
Published: July 2011

Obesity has detrimental effects on the microcirculation. Functional changes in microvascular responsiveness may increase the risk of developing cardiovascular complications in obese patients. Emerging evidence indicates that selective therapeutic targeting of the microvessels may prevent life‐threatening obesity‐related vascular complications, such as ischaemic heart disease, heart failure and hypertension. It is also plausible that alterations in adipose tissue microcirculation contribute to the development of obesity. Therefore, targeting adipose tissue arterioles could represent a novel approach to reducing obesity. This review aims to examine recent studies that have been focused on vasomotor dysfunction of resistance arteries in obese humans and animal models of obesity. Particularly, findings in coronary resistance arteries are contrasted to those obtained in other vascular beds. We provide examples of therapeutic attempts, such as use of statins, ACE inhibitors and insulin sensitizers to prevent obesity‐related microvascular complications. We further identify some of the important challenges and opportunities going forward.

LINKED ARTICLES This article is part of a themed section on Fat and Vascular Responsiveness. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2012.165.issue‐3
The Relationship Between rs3779084 in the Dopa Decarboxylase (DDC) Gene and Alcohol Consumption is Mediated by Drinking Motives in Regular Smokers
Authors: Kristjansson Sean D. , Agrawal Arpana , Lessov‐Schlaggar Christina N. , Madden Pamela A. F. , Lynne Cooper M. , Bucholz Kathleen K. , Sher Kenneth J. , Lynskey Michael T. , Heath Andrew C.
Published: July 2011

Background:  Motivational models of alcohol use propose that the motivation to consume alcohol is the final common pathway to its use. Both alcohol consumption and drinking motives are influenced by latent genetic factors that partially overlap. This study investigated whether drinking motives mediate the associations between alcohol consumption and 2 single‐nucleotide polymorphisms (SNPs) from genes involved in serotonin (TPH2; rs1386496) and dopamine synthesis (DDC; rs3779084). Based on earlier work showing that enhancement and coping motives were heritable in regular smokers but not in nonregular smokers, we hypothesized these motives would mediate the relationships between alcohol consumption and these SNPs in regular smokers.

Methods:  Drinking motives data were available from 830 young adult female twins (n = 344 regular smokers and n = 486 never/nonregular smokers). We used confirmatory factor analyses to model enhancement, coping, and alcohol consumption factors and to conduct mediation analyses in the regular smoker and never/nonregular smoker groups.

Results:  Our hypothesis was partially supported. The relationship between alcohol consumption and rs1386496 was not mediated by drinking motives in either group. However, in the regular smokers, the relationship between alcohol consumption and rs3779084 was mediated by enhancement and coping motives. Carriers of the rs3779084 minor allele who were regular smokers reported more motivation to consume alcohol. Given this pattern of results was absent in the never/nonregular smokers, our results are consistent with a gene × smoking status interaction.

Conclusions:  In regular smokers, variability at the locus marked by rs3779084 in the DDC gene appears to index biologically based individual differences in the motivation to consume alcohol to attain or improve a positive affective state or to relieve a negative one. These results could be because of increased sensitivity to the reinforcing effects of alcohol among minor allele carriers who smoke, which might be due to structural or functional differences in mesorticolimic dopamine “reward” circuitry.