bluuebunny/crossref_metadata_2025 huggingface dataset:
Host–parasite interactions and competition between tubificid species in a benthic community
Authors: ELWELL L. C. STEINBACH , KERANS B. L. , ZICKOVICH J.
Published: April 2009

1. Parasites can be important determinants of host community structure while host community structure can influence the success of parasites, although both are often overlooked. In two laboratory experiments, we examined interactions amongMyxobolus cerebralissynMyxosoma cerebralisHöfer, the myxozoan parasite that causes salmonid whirling disease, and two coexisting tubificid species:Tubifex tubifex(Müller),which is the alternate host of the parasite, andLimnodrilus hoffmeisteriClaparède,which is not susceptible. In the first experiment, we examinedT. tubifexinfection prevalence when exposed to nine doses of spores. In the second experiment, we examined tubificid and parasite success under three spore doses when tubificids were combined in a response surface experimental design used to detect interactions among species.

2. The outcomes of interactions between tubificid species were complex. The number and biomass of offspring of both tubificid species were density dependent when in monoculture or in combination with the other species. Adult growth ofT. tubifexwas also density dependent in monoculture, but whenL. hoffmeisterireplaced one‐half of theT. tubifexin the high‐density treatment, adult growth ofT. tubifexwas higher than in monoculture. Adult growth ofL. hoffmeisteriwas always density independent. WhetherT. tubifexwas exposed to the parasite or not did not change the outcome of these interactions. However, adult growth ofT. tubifex, but notL. hoffmeisteri,was highest whenM. cerebraliswas present.

3. Infection prevalence ofT. tubifexincreased with increasing spore dose. Infection prevalence was lowest in the high‐densityT. tubifexmonoculture and highest in the low‐densityT. tubifexmonoculture and whenT. tubifexwas in combination withL. hoffmeisteri.

4. Both intraspecific and interspecific competition influenced tubificid success, butT. tubifexgained some competitive advantage through increased adult growth when in combination withL. hoffmeisteri.WhetherT. tubifexwas exposed to the parasite or not did not change the outcome of the interactions between the tubificid species.

5. The presence ofL. hoffmeisteridid not decrease the prevalence of infection inT. tubifex, suggesting that parasite success was unaltered by the presence of this non‐susceptible species.
Herbivores inhibit climate‐driven shrub expansion on the tundra
Authors: OLOFSSON JOHAN , OKSANEN LAURI , CALLAGHAN TERRY , HULME PHILIP E. , OKSANEN TARJA , SUOMINEN OTSO
Published: April 2009

Recent Pan‐Arctic shrub expansion has been interpreted as a response to a warmer climate. However, herbivores can also influence the abundance of shrubs in arctic ecosystems. We addressed these alternative explanations by following the changes in plant community composition during the last 10 years in permanent plots inside and outside exclosures with different mesh sizes that exclude either only reindeer or all mammalian herbivores including voles and lemmings. The exclosures were replicated at three forest and tundra sites at four different locations along a climatic gradient (oceanic to continental) in northern Fennoscandia. Since the last 10 years have been exceptionally warm, we could study how warming has influenced the vegetation in different grazing treatments. Our results show that the abundance of the dominant shrub, Betula nana, has increased during the last decade, but that the increase was more pronounced when herbivores were excluded. Reindeer have the largest effect on shrubs in tundra, while voles and lemmings have a larger effect in the forest. The positive relationship between annual mean temperature and shrub growth in the absence of herbivores and the lack of relationships in grazed controls is another indication that shrub abundance is controlled by an interaction between herbivores and climate. In addition to their effects on taller shrubs (>0.3 m), reindeer reduced the abundance of lichens, whereas microtine rodents reduced the abundance of dwarf shrubs (<0.3 m) and mosses. In contrast to short‐term responses, competitive interactions between dwarf shrubs and lichens were evident in the long term. These results show that herbivores have to be considered in order to understand how a changing climate will influence tundra ecosystems.
Are pediatric and adult‐onset cyclic vomiting syndrome (CVS) biologically different conditions? Relationship of adult‐onset CVS with the migraine and pediatric CVS‐associated common mtDNA polymorphisms 16519T and 3010A
Authors: Boles R. G. , Zaki E. A. , Lavenbarg T. , Hejazi R. , Foran P. , Freeborn J. , Trilokekar S. , Mccallum R.
Published: April 2009

Abstract  Pediatric cyclic vomiting syndrome (CVS) is associated with a high prevalence of co‐morbid migraine and other functional disorders, and with two adult migraine‐associated mitochondrial DNA (mtDNA) polymorphisms: 16519T and 3010A. These potential associations have not been studied in adult CVS. The objective of this study is to determine the prevalence of 16519T and 3010A mtDNA polymorphisms and other functional disorders in adult CVS patients. Adults with CVS recruited from the University of Kansas meeting Rome III criteria and a population control group completed a self‐reported survey that included questions relating to the diagnostic criteria for several functional disorders. DNA was isolated from blood or saliva and genotyping was performed by standard methodologies. Adult CVS subjects, compared to controls, had significantly more symptoms consistent with several other functional disorders. 16519T was present in 22/31 cases (71%) of child‐onset (<12 years) and 9/31 (29%) cases of adult‐onset (18+ years) CVS (P = 0.01), vs 27% of controls. Among subjects with 16519T, 3010A was present in 30% of child‐onset vs 0% of adult‐onset CVS (P = 0.05) and 2% of controls. The conclusions drawn were: (i) unlike pediatric CVS, adult CVS is not associated with the 16519T and 3010A mtDNA polymorphisms, suggesting a degree of genetic distinction and (ii) similar to the pediatric setting, adult CVS is associated with a substantial burden of co‐morbid functional disorders.
Gonadectomy inhibits development of experimental amoebic liver abscess in hamsters through downregulation of the inflammatory immune response
Authors: CERVANTES‐REBOLLEDO C. , MORENO‐MENDOZA N. , MORALES‐MONTOR J. , DE LA TORRE P. , LACLETTE J. P. , CARRERO J. C.
Published: April 2009

Incidence of amoebic liver abscess (ALA) in human males is considerably higher than in females, suggesting a role for sex hormones in this parasite infection. We describe here the effect of hamster gonadectomization on the development of ALA. After monitoring the decrease of oestradiol in females and testosterone in males to undetectable levels by ELISA and Radio Immuno Assay (RIA) in serum, hamsters were intraportally infected with Entamoeba histolytica trophozoites and killed 7 days later. ALA was absent in 50% of male and 15% of female gonadectomized (Gdx) hamsters, in comparison with 100% infection in non‐Gdx controls. This protection against ALA in Gdx hamsters was concomitant to a comparatively scarce inflammatory infiltrate and necrosis surrounding clusters of trophozoites in the liver tissue, as well as to a lack of response of spleen cells to Con A, evaluated in proliferation assays. As tissue damage in ALA has been associated with a local inflammatory Th1 response, we determined the profile of response in hamsters by immunohistochemistry on liver sections. In contrast to strong Th1 responses in non‐Gdx animals, Gdx females and males exhibited Th2 and Th3 profiles of cytokines, respectively, suggesting that protection against ALA following gonadectomization, could be related to downregulation of liver Th1 response during amoebic infection.
Eruption severity and characteristics in herpes zoster ophthalmicus: correlation with visual outcome, ocular complications, and postherpetic neuralgia
Authors: Nithyanandam Suneetha , Dabir Supriya , Stephen John , Joseph Mary
Published: April 2009

Introduction  Herpes zoster ophthalmicus (HZO) is characterized by a typical vesicular eruption affecting the distribution of the ophthalmic division of the trigeminal nerve which can be of varying severity. The correlation of eruption severity and ocular involvement and subsequent visual loss is still to be established. In this prospective longitudinal study we evaluated the correlation of eruption severity with ocular complications, visual outcome and postherpetic neuralgia.

Methods  Patients with HZO underwent detailed ophthalmological and dermatological examination at presentation and follow‐up on 1st , 2nd and 4th week and 3rd and 6th month. Eruption severity was graded as mild, moderate and severe based on the number of vesicles. The correlation of eruption severity and distribution with ocular complications, visual outcome and postherpetic neuralgia was statistically evaluated.

Results  Severe eruption was seen in 14(28%), moderate eruption in 21(42%) and mild eruption in 15(30%). Severe eruption was significantly associated with increased incidence and severity of ocular involvement (p = 0.04 and p = 0.04 respectively), occurrence of uveitis (p = 0.004), reduced visual outcome (p = 0.002) and the occurrence of PHN (p = 0.05). Lacrimal nerve involvement was also associated with increased incidence (p = 0.03) and severity (p = 0.02) of ocular complications and visual loss (p = 0.01).

Conclusion  Increasing eruption severity is a good predictor of occurrence of ocular complications and subsequent visual loss in HZO. Presence of a severe eruption is an indication for early ophthalmic intervention. Nasociliary nerve and lacrimal nerve involvement are also good predictors of ocular complications.
Antioxidant enzymes and lipid peroxidation at the tissue level in patients with stable and active vitiligo
Authors: Dammak Ines , Boudaya Sonia , Ben Abdallah Fatma , Turki Hamida , Attia Hamadi , Hentati Basma
Published: April 2009

Background  The pathogenetic mechanisms in vitiligo have not been clarified completely. One of the major hypotheses in the pathogenesis of vitiligo is the oxidative stress hypothesis. The active and stable phases of vitiligo are defined as the progression or appearance of new lesions in the last 3 months and the absence of new lesions or progression in the last 6 months, respectively.

Methods  We examined the levels of malondialdehyde, catalase, glutathione peroxidase, and superoxide dismutase in the tissues of 10 patients with active vitiligo, 10 patients with stable vitiligo, and 20 matched healthy controls.

Results  The results revealed that the levels of superoxide dismutase, glutathione peroxidase, and malondialdehyde in tissues were increased significantly in patients with active vitiligo relative to those in patients with stable vitiligo and matched controls; however, the levels of catalase in tissues were decreased significantly in patients with active vitiligo relative to those in patients with stable vitiligo and matched controls.

Conclusions  Our study shows that oxidative stress is involved in the pathophysiology of both active and stable vitiligo, but an increased imbalance of antioxidants is observed in the tissues of patients with active vitiligo.
Common sources of skin care education: a cross‐sectional study
Authors: Bhutani Tina , Peng David , Shin Thuzar , Lee Han
Published: April 2009

Background  The resources used by the public to locate health information are important.

Aim  To expose the sources from which the public gains a knowledge of dermatology.

Methods  An anonymous, multiple‐choice questionnaire was distributed to adults in college campuses, shopping malls, and community parks over a 4‐month period.

Results  Sixty‐six percent of individuals stated that they felt physicians had the most authority for making recommendations regarding the skin. When questioned about the sources of skin care advice, however, there was a discrepancy, with only 35% stating that they actually consulted professionals. Indeed, 37% admitted to using family and friends as their primary source of information, and 28% used the media first.

Conclusions  In our opinion, the best method to ensure healthy skin habits and early diagnosis of disease would be to combine the efforts of healthcare and the media. These public resources should make people aware of skin diseases and preventative measures, whilst encouraging regular check‐ups with dermatologists and persuading patients to employ open conversation with their physicians regarding care of their skin.
Helicobacter pylori infection in patients with chronic urticaria: correlation with pathologic findings in gastric biopsies
Authors: Abdou Asmaa Gaber , Elshayeb Elsayed I. , Farag Azza G. A. , Elnaidany Nada Farag
Published: April 2009

Background  Chronic urticaria is a persistent urticaria lasting longer than 6 weeks, affecting 20% of the general population. Various infectious agents have been reported as causes of urticaria, including Helicobacter pylori, which is a common worldwide bacterial infection. Its role in inducing allergic conditions, such as chronic urticaria, has been suggested in some reports and ignored in others.

Aims  To assess the prevalence of H. pylori infection in patients with chronic urticaria and to explore the possible etiopathogenetic link between them.

Methods  Thirty‐five patients suffering from chronic urticaria and 10 normal control individuals were subjected to upper endoscopic gastric biopsies to assess and semiquantify H. pylori infection and to address other pathologic abnormalities, using routine hematoxylin and eosin staining and Giemsa staining.

Results  Forty percent of control subjects and 57% of patients were positive for H. pylori infection, but the difference did not reach statistically significant levels (P = 0.47). The severity of urticarial symptoms was greater in the H. pylori‐positive than in the H. pylori‐negative group (P = 0.019). Heavy bacterial colonization (P = 0.008) and intense gastric inflammation (P < 0.0001) were associated significantly with severe clinical manifestations. Eighty percent of the H. pylori‐positive urticaria group experienced complete remission after receiving eradication therapy for H. pylori.

Conclusions  Helicobacter pylori may have a role in the exacerbation of urticarial symptoms, even though it is not involved directly in its etiology, and its eradication may lead to symptom improvement in a considerable number of infected urticaria patients. The severity of symptoms is dependent on the density of bacterial infection and the intensity of inflammatory infiltrate in the gastric biopsy.
Frequency, risk stratification and therapeutic management of acute post‐traumatic coagulopathy
Authors: Maegele M.
Published: April 2009

Background  Uncontrolled haemorrhage is still responsible for more than 50% of all trauma‐related deaths within the first 48 h after hospital admission. Clinical observations together with recent research resulted in a new appreciation of the central role of coagulopathy in acute trauma care. A synopsis of different analyses based on datasets from severely multiple‐injured patients derived from the TR‐DGU database (Trauma Registry of the Deutsche Gesellschaft für Unfallchirurgie (DGU)/German Society of Trauma Surgery) with respect to incidence, risk stratification and therapeutic management of acute post‐traumatic coagulopathy is presented.

Methods  Retrospective analyses based on datasets from severely multiple‐injured patients derived from the TR‐DGU database and development/validation of a scoring system (TASH score = trauma‐associated severe haemorrhage) that allows an early and reliable estimation for the probability of massive transfusion as a surrogate for life‐threatening haemorrhage after severe multiple injuries.

Results/conclusion  There is a high frequency of acute post‐traumatic coagulopathy already present upon ER admission which is associated with significant morbidity and mortality in multiple‐injured patients. The TASH score is recognized as an easy‐to‐calculate and valid scoring system to predict the individual's probability for massive transfusion and thus ongoing life‐threatening haemorrhage at a very early stage after severe multiple injuries. An early aggressive management of acute post‐traumatic coagulopathy including a more balanced administration of blood products to favour improved outcome is advocated.
Plant Disease Complex: Antagonism and Synergism Between Pathogens of the Ascochyta Blight Complex on Pea
Authors: Le May Christophe , Potage Gael , Andrivon Didier , Tivoli Bernard , Outreman Yannick
Published: April 2009

In a disease complex, different pathogen species cause similar symptoms on a common host plant species. These pathogens commonly develop simultaneously in a field and can then infect the same host individuals. Co‐occurring pathogens may affect each other, through antagonism and/or synergism. An important question is the ecological and pathological consequences of co‐occurrence of pathogenic species within a disease complex. By using two pathogens (Mycosphaerella pinodes and Phoma medicaginis var. pinodella) of the Ascochyta blight complex, this study aimed at describing how co‐occurrence affects the development of pathogens and disease severity, and at defining the prerequisites for interactions between pathogens. Results showed that the presence of the two pathogens on the same host plant organ limited the disease development and their reproduction. Damages caused by the two pathogens, however, increased when plants that had been previously inoculated were inoculated with the other species. The development of one pathogen species can be affected by a subsequent pathogen inoculation. Co‐occurrence of pathogens within a disease complex can then limit or favour plant damages and pathogens reproduction. It would be one of the main forces that shape pathogen community structures and therefore the dynamics of diseases in field.
Cloning and Characterization of a Novel Hypersensitive‐induced Reaction Gene from Wheat Infected by Stripe Rust Pathogen
Authors: Zhang Gang , Dong Yan‐Ling , Zhang Yi , Li Yi‐Min , Wang Xiao‐Jie , Han Qing‐Mei , Guo Jun , Huang Li‐Li , Kang Zhen‐Sheng
Published: April 2009

The hypersensitive response is one of the most sophisticated and efficient forms of plant defence response against fighting pathogen infection; it involves the rapid death of plant cells at and around infection sites, together with the restriction of pathogen growth. Based on a differentially expressed transcribed derived fragment previously identified from the large‐scale transcript profiling of adult‐plant wheat resistant to stripe rust – which was highly similar to the barley HvHIR3 gene – a novel hypersensitive‐induced reaction (HIR) gene from wheat infected by stripe rust pathogen, designated as TaHIR3, was identified using in silico cloning, combined with reverse transcriptase‐polymerase chain reaction (RT‐PCR) method. TaHIR3 was predicted to encode a 287‐amino acid protein with a deduced molecular weight of 31.5 kDa and a pI of 5.68. An amino acid sequence analysis of TaHIR3 demonstrated the presence of the Stomatins, Prohibitin, Flotillins, HflK/C protein domain and prohibitin homologues. A phylogenetic analysis of 17 HIR genes from different plant species indicated that the wheat TaHIR3 gene was highly homologous to the barley HvHIR3 gene, at both the cDNA and deduced amino acid levels. Using a real‐time quantitative RT‐PCR, expression profiles of TaHIR3 in wheat leaves that had been infected with stripe rust fungus at the adult‐plant (incompatible) and seedling (compatible) stages were analysed. The results revealed that at the adult‐plant stage, TaHIR3 was significantly induced after inoculation, with the occurrence maximum induction at 48 h postinoculation (hpi). At the seedling stage, TaHIR3 was also up‐regulated as early as 12 hpi. However, the transcript amount was relatively lower than that of the adult‐plant stage.
Actions of 6‐Pentyl‐alpha‐pyrone in Controlling Seedling Blight Incited by Fusarium moniliforme and Inducing Defence Responses in Maize
Authors: El‐Hasan Abbas , Buchenauer Heinrich
Published: April 2009

The antifungal metabolite 6‐pentyl‐alpha‐pyrone (6PAP) exhibited phytotoxic effects on germination and elongation growth of coleoptiles when maize kernels were germinated on filter papers impregnated with 300 and 200 mg/l 6PAP, respectively. 6PAP severely retarded development of both roots and shoots of maize seedlings in nutrient solutions at increasing concentrations (200–300 mg/l). In contrast, under greenhouse conditions, 6PAP, applied as soil drenches, exhibited no phytotoxic effects. Soil drench applications of 6PAP 4 days before inoculation (dbi) with Fusarium moniliforme showed considerable seedling blight suppression and substantial plant growth promotion compared with the untreated control. In the presence of 200 mg/l 6PAP, both shoot and root developments were increased and higher dry weights were attained compared with the healthy control. To study the ability of 6PAP to induce the defence responses, the compound was applied on maize seedlings 2 dbi and the activities of peroxidase (PO), polyphenoloxidase (PPO) and β‐1,3‐glucanase in plant tissues were determined at two sampling times. Application of 6PAP on maize seedlings distinctly enhanced PO, PPO and β‐1,3‐glucanase activities in both shoot and root tissues compared with the untreated controls. Generally, 6PAP treatments induced higher activities of PO, PPO and β‐1,3‐glucanase in maize tissues than F. moniliforme infections. These results, however, provide the first evidence of the ability of 6PAP to control seedling blight disease incited by F. moniliforme in vivo and to induce defence responses in maize plants against the pathogen.
A gene for susceptibility to the fungicide azoxystrobin in apple and a tightly linked microsatellite marker
Authors: Tobutt K. R. , Clarke J. B. , Bošković G. , De la Rosa R. , Bošković R. I.
Published: April 2009

Various apple cultivars, including ‘McIntosh’ and ‘Cox’, are reported to be susceptible to the strobilurin fungicide azoxystrobin whereas others, including ‘Delicious’ and ‘Golden Delicious’, are resistant. To investigate the genetic control, progenies from various crosses between these four cultivars were raised and the seedlings tested for response by painting three expanded leaves with 200 mg/l of azoxystrobin solution and noting symptoms about a week later. From the segregations, it was concluded that susceptibility to azoxystrobin is due to a dominant gene, Azs, for which ‘McIntosh’ and ‘Cox’ are heterozygous. By scoring the segregation in the mapping progeny ‘Fiesta’ × ‘Totem’ and comparing it with the segregation of microsatellite [simple sequence repeat (SSR)] markers, Azs was found to co‐segregate with SSR‐GD127 on linkage group 12 and this tight linkage was confirmed in the progeny from the cross of ‘Golden Delicious’ × ‘Cox’ and ‘McIntosh’ × ‘Golden Delicious’. The susceptibility of ‘McIntosh’, attributed to allele Azs‐m, was greater than that of ‘Cox’, Azs‐c, and in the ‘McIntosh’ × ‘Cox’ progeny the GD127 marker showed that Azs‐c is dominant to Azs‐m.
C4d deposition in allograft renal biopsies is an independent risk factor for graft failure
Authors: WANG RENDING , WANG HUIPING , CHEN JIANGHUA , WU JIANYONG , WANG YIMIN , HUANG HONGFENG , HE QIANG
Published: April 2009

Aim:  Association between C4d deposition and renal allograft survival is still uncertain. We retrospectively evaluated the clinical outcome of C4d deposition in allograft renal biopsies.

Methods:  One hundred and fifty biopsies from 150 patients with a histological diagnosis of acute rejection from December 1997 to March 2007 were included. Paraffin‐embedded sections were stained with a polyclonal antibody using an immunoperoxidase technique. Detailed clinical data were obtained by retrospective review.

Results:  C4d was stained positively in 74 (49.3%) of 150 cases: 47 (61.5%) biopsies showed diffuse C4d deposition and 27 (38.5%) showed focal C4d deposition. During follow up, significantly more C4d‐positive patients (24/74 patients, 32.4%) lost their grafts, compared with the C4d‐negative group (10/76 patients, 13.2%) (P = 0.005). After a Kaplan–Meier analysis, grafts from the C4d‐negative group had a markedly higher survival as compared with the C4d‐positive group (P = 0.003, log–rank test). Graft survival among C4d‐negative, C4d diffuse‐positive, and C4d focal‐positive groups was significantly different (P = 0.007, log–rank test). The graft survival rate among C4d‐negative patients in early (<6 months) and later biopsies (>6 months), and C4d‐positive patients in early and in later biopsies was different (P = 0.028, log–rank test). The adjusted risk ratio of graft failure after Cox proportional hazards multivariate analyses for C4d‐positive patients was 3.309 (95% confidence interval, 1.413–6.537; P = 0.004).

Conclusion:  Patients with C4d deposition had an inferior graft survival, especially with diffused C4d deposition, and later experienced acute rejection. C4d deposition was an independent risk factor for graft survival.
Selective gelfoam embolization of primary racemose haemangioma of the bronchial artery
Authors: SANNO Ken , HATANAKA Nobuyuki , YAMAGISHI Toru , NAKAZAWA Ichiro , HIRANO Yusuke , HOSAKA Kimio , KAMEMURA Hirotaka
Published: April 2009

A 54‐year‐old male presented with haemoptysis. Bronchial arteriography revealed a bent, meandering and dilated bronchial artery with vascular hyperplasia in multiple locations. The patient was diagnosed as having primary racemose haemangioma of the bronchial artery. Using a microcatheter, TorconNB (5 Fr) and Progreat (2.7 Fr), selective gelfoam embolization of the descending branch of the right bronchial artery was performed using the double catheter method. This approach would allow effective treatment of the haemorrhage and avoid spinal cord injury.
The efficacy and safety of tiotropium in Chinese patients with stable chronic obstructive pulmonary disease: A meta‐analysis
Authors: WU Qibiao , LI Guochun , LEI Wun I. , ZHOU Xiqiao
Published: April 2009

Background and objective:  Tiotropium is the only long‐acting inhaled anticholinergic bronchodilator currently available in China, but information about its clinical effect in this population is limited. This meta‐analysis assessed the efficacy and safety of tiotropium in Chinese patients with stable COPD.

Methods:  An electronic search of the literature was undertaken to identify randomized controlled trials (RCTs) of tiotropium in Chinese patients, which were then assessed for inclusion in a meta‐analysis. The efficacy and safety of tiotropium was compared with placebo and ipratropium, using the outcomes of FEV1, FEV1%, symptoms, frequency of exacerbations, adverse events and safety.

Results:  Eleven RCTs recruiting 1006 patients were included in the meta‐analysis. Compared with both placebo and ipratropium, tiotropium significantly improved FEV1[weighted mean difference (WMD) = 304 mL, 95% CI 271–337], FEV1% (WMD = 8.35%, 95% CI 5.40–11.31) and symptoms [relative risk (RR) = 2.00, 95% CI 1.61–2.49]. Tiotropium significantly reduced the risk of exacerbations (RR = 0.07, 95% CI 0.01–0.54) compared with placebo, and there was a non‐significant reduction in the risk of exacerbations compared with ipratropium (RR = 0.70, 95% CI 0.13–3.75). Tiotropium was well tolerated with a similar safety profile to placebo and ipratropium (RR = 1.16, 95% CI 0.76–1.77, P = 0.49).

Conclusions:  Tiotropium improved pulmonary function and symptoms, reduced exacerbations and was well tolerated and safe. On the basis of its efficacy and safety profile, tiotropium appears to be a reasonable first‐line choice for the management of Chinese patients with stable COPD. Additional long‐term RCTs are required to further evaluate the efficacy and safety of tiotropium.
Simple and effective local anesthesia for transperineal extended prostate biopsy: Application to three‐dimensional 26‐core biopsy
Authors: Kubo Yuichi , Kawakami Satoru , Numao Noboru , Takazawa Ryoji , Fujii Yasuhisa , Masuda Hitoshi , Tsujii Toshihiko , Kihara Kazunori
Published: April 2009

Abstract:  We developed a local anesthetic procedure for three‐dimensional 26‐core prostate biopsy (3D26PBx), a combination of transperineal 14‐core biopsy (TP14PBx) and transrectal 12‐core biopsy (TR12PBx). At first, a periapical triangle, confined by the levator ani, the rhabdosphincter and the external anal sphincter muscle, was made visible by transrectal ultrasound. After administration of 1 mL of 1%‐lidocaine into the midline perineal skin 1.5 cm above the anus, we inserted a spinal needle toward the periapical triangle for injection of 1.5–2.0 mL of 1%‐lidocaine and performed the TP14PBx. After administration of the periprostatic nerve block with 10 mL of 1%‐lidocaine, we performed the TR12PBx. The efficacy of the procedure was evaluated prospectively in 45 consecutive men undergoing the 3D26PBx. The 3D26PBx was completed with just local anesthesia in all patients. The pain levels, assessed by an 11‐point visual analog scale, were not different between the TP14PBx and the TR12PBx.
Identification of a calcium‐controlled negative regulatory system affecting Vibrio cholerae biofilm formation
Authors: Bilecen Kivanc , Yildiz Fitnat H.
Published: April 2009

Vibrio cholerae's capacity to cause outbreaks of cholera is linked to its survival and adaptability to changes in aquatic environments. One of the environmental conditions that can vary in V. cholerae's natural aquatic habitats is calcium (Ca+2). In this study, we investigated the response of V. cholerae to changes in extracellular Ca2+ levels. Whole‐genome expression profiling revealed that Ca2+ decreased the expression of genes required for biofilm matrix production. Luria–Bertani (LB) medium supplemented with Ca2+ (LBCa2+) caused V. cholerae to form biofilms with decreased thickness and increased roughness, as compared with biofilms formed in LB. Furthermore, addition of Ca2+ led to dissolution in biofilms. Transcription of two genes encoding a two‐component regulatory system pair, now termed calcium‐regulated sensor (carS) and regulator (carR), was decreased in cells grown in LBCa2+. Analysis of null and overexpression alleles of carS and carR revealed that expression of vps (Vibriopolysaccharide) genes and biofilm formation are negatively regulated by the CarRS two‐component regulatory system. Through epistasis analysis we determined that CarR acts in parallel with HapR, the negative regulator of vps gene expression.
Resection of the primary tumour or other palliative procedures in incurable stage IV colorectal cancer patients?
Authors: Mik M. , Dziki L. , Galbfach P. , Trzcinski R. , Sygut A. , Dziki A.
Published: April 2009

Objective  The aims of the study were to analyse the early and late results of surgical treatment in patients with stage IV colorectal cancer (CRC) and to evaluate the effect of primary tumour resection and other clinical factors on survival.

Method  A group of 134 patients with stage IV CRC was electively operated on between 1996 and 2000. The first group underwent resection of the primary tumour (52 patients; mean age 63.4 ± 10.3) and the second group of patients underwent procedures without resection (82 patients; mean age 62.6 ± 10.6).

Results  Postoperative morbidity occurred significantly more often (P = 0.041) in the first group – in 26 patients (50%) than in the second group – 19 patients (23.1%). The resection of the primary tumour increased the survival probability; hazard ratio (HR): 1.78; 95% confidence interval (CI): 1.21–2.78%; P = 0.004. Bi‐lobar metastases increased mortality risk compared with uni‐lobar; HR 2.32; 95% CI: 1.47–3.68; P = 0.0003. The 2‐year survival rate in patients with uni‐lobar metastases in the first group was 44.2%, in the second group: 30.7%; P = 0.023.

Conclusion  Primary tumour resection in stage IV CRC increases the risk of postoperative complications. In the given setting, however, it results in an increased 2‐year survival rate but it may not influence the 5‐year survival rate. In patients with bi‐lobar liver metastases resection of the primary tumour does not prolong survival time.
Surgery of recurrent parastomal hernia: direct repair or relocation?
Authors: Riansuwan W. , Hull T. L. , Millan M. M. , Hammel J. P.
Published: April 2009

Purpose  Parastomal hernia is a common late complication after stoma creation. The management options are many; unfortunately, most literature suggests unsatisfactory results. There are few studies comparing the outcomes after repair of parastomal hernias especially in recurrent cases, and the results are controversial. The aim of this study was to compare outcomes after repair of recurrent parastomal hernias between direct repair (DR) and relocation (RL).

Method  We performed a retrospective chart review of patients who underwent direct repair or RL for recurrent parastomal hernia during the period between 1990 and 2005. Perioperative data and re‐recurrence rates were obtained and analysed with appropriate statistical methods.

Results  With mean follow‐up time of 2 years, 50 operations were available for evaluation; 27 (54%) DR and 23 (46%) RL [five same‐side RL (SSRL) and 18 opposite‐side RL (OSRL)]. There were no deaths and there were similar complication rates between groups. Four of five (80%) SSRL had a re‐recurrent parastomal hernia. Considering only DR with OSRL, although OSRL had longer operative time and hospital stay than DR, the re‐recurrence rate was lower (38%vs 74%; P = 0.02). However, with Kaplan–Meier calculated and longer predicted follow‐up time, re‐recurrence rates were similar (Log rank P = 0.09).

Conclusion  Recurrent parastomal hernia repair is associated with high re‐recurrence rates.OSRL seems to have promising short‐term outcomes; however, whether these results hold up long‐term remains unclear. Therefore, larger cohorts of patients with longer follow‐up or prospective randomized trials are needed.
Do guidelines improve clinical practice? – a national survey on surveillance colonoscopies
Authors: John B. J. , Irukulla S. , Mendall M. A. , Abulafi A. M.
Published: April 2009

Background  Colonoscopic services are increasingly being utilized in surveillance of conditions predisposing to colorectal cancers (CRC). The ACPGBI/BSG guidelines are the most commonly followed recommendations. Numerous retrospective studies have shown poor compliance with them. We conducted a national survey of colonoscopic practitioners investigating attitudes, awareness and implementation of surveillance guidelines.

Method  A postal questionnaire was sent to a random population of 250 ACPGBI and 200 BSG members. Questions assessed practice as regards colorectal polyp surveillance, family screening and surveillance for past history of CRC.

Results  The ACPGBI/BSG guidelines were the most commonly followed recommendations. Only 17.2% of practitioners used the criteria that would ensure accurate implementation of guidelines for colorectal adenoma surveillance. With regards to familial surveillance for CRC, 53.5% respondents assessed familial risk accurately, while 69.3% recommended surveillance incorrectly. A total of 48.8% of ACPGBI members recommended five yearly colonoscopies following curative treatment for CRC.

Conclusion  This study has revealed the widespread ignorance of guidelines, which will potentially translate into the gross over utilization of colonoscopic resources. Strategies to improve and audit guideline implementation must be integral to guideline formation. Methods to improve accurate guideline implementation need to be explored.
Incontinence following sphincter division for treatment of anal fistula
Authors: Bokhari S. , Lindsey I.
Published: April 2009

Objective  Management of anal fistula poses problems because of competing goals of cure and maintenance of continence. There is increasing recognition of significant rates of incontinence after sphincter‐dividing anal surgery. We aimed to determine cure and continence status in a cohort of anal fistula patients managed by both sphincter‐dividing and conserving approaches.

Method  Data on fistula, healing and continence status were gathered by patient questionnaire (Cleveland Clinic incontinence questionnaire), telephone interview and chart review. Fistulae were defined as simple (low risk of incontinence) or complex (high risk). Surgery was defined as sphincter conservation and sphincter division. Incontinence was graded by traditional severity scale (minor/major). Fistula healing was defined as absence of acute or chronic sepsis symptoms from surgery to date of last follow‐up.

Results  One hundred and twenty‐eight patients were evaluated  (out of whom 71% were male subjects, age range 17–82, median age 45 years).Fifty‐two percent of the fistulae were complex and 48% were simple, of which 51% and 85% underwent sphincter division respectively. Healing rates were higher for sphincter division than conservation  (87%vs 73%, P = 0.06). Complex fistulae undergoing sphincter division led to a higher rate of major incontinence (13%) than sphincter conservation (0%) (P = 0.03). For simple fistulae treated by sphincter division, major (5%) and minor incontinence (11%) was not inconsiderable.

Conclusion  Though cure rates are excellent, incontinence rates remain unacceptably high following sphincter division for complex fistulae and are not insignificant even for simple fistulae. More sphincter conservation should be undertaken.
Positron‐emission tomography/computed tomography (PET/CT) in the initial staging of primary rectal cancer
Authors: Eglinton T. , Luck A. , Bartholomeusz D. , Varghese R. , Lawrence M.
Published: April 2009

Objective  The aim of this study was to assess the role of 18flourodeoxyglucose positron‐emission tomography/computed tomography (PET/CT) in the initial staging of primary rectal adenocarcinoma.

Method  A total of 20 patients with adenocarcinoma of the rectum were assessed with both PET/CT and conventional staging (CT chest/abdomen/pelvis, MRI rectum). Discordance with conventional imaging and incidental findings on PET were recorded and the patients presented to a colorectal cancer multidisciplinary team to assess management changes. Patients were followed up so that discordant or incidental findings could be verified by intra‐operative examination, imaging or histology where possible.

Results  Positron‐emission tomography/computed tomography correctly identified the primary tumour in all 20 patients. Comparing PET/CT with conventional staging modalities, there were 11 discordant or incidental findings in nine patients (45%). This resulted in a potential change in stage in 30% (four patients downstaged and two upstaged). PET/CT suggested additional neoplastic pathology in three patients and excluded the same in two patients. The incidental neoplastic findings were of minor clinical significance and one was eventually deemed false positive. While PET/CT resulted in potential management changes in five patients (25%), no changes in surgical management occurred. When tumours were grouped according to conventional stage, PET/CT resulted in fewer changes in stage in stage I (0%), compared with stages II to IV (43%) (P = 0.08).

Conclusion  Positron‐emission tomography/computed tomography provides additional information to conventional staging in primary rectal cancer. This information produced minor management changes in this study and did not effect surgical management. PET/CT may be most appropriately used selectively in more advanced stages and where indeterminate findings exist with conventional staging.
Quality assurance in colonoscopy: role of endomucosal clips
Authors: Maslekar S. , Avery G. , Duthie G. S.
Published: April 2009

Objective  Quality assurance in colonoscopy is important, and subjective assessment of completion based on endoscopic signs can be inaccurate leading to missed lesions. We aimed to determine the technique of endomucosal clips with follow‐up X‐rays in objectively documenting completion and correlation with pathology miss rates.

Method  A total of 82 patients undergoing colonoscopy by trained colonoscopists had an endomucosal clip applied to the most proximal bowel reached. A plain abdominal X‐ray was performed while there was still a pneumocolon, and the clip position was assessed by a blinded radiologist to determine objective completion rates. Repeat colonoscopies were performed in patients with incomplete procedures. Pathology and endoscopy database were also reviewed to identify missed lesions at a median follow‐up of 6 years. These were correlated with colonoscopy completions.

Results  The clip was found in caecum of 76 (93%), ascending‐colon in three (3.6%), hepatic flexure in one (1.2%) and splenic flexure in two (2.4%) patients. The endoscopist opinion was incorrect in six incomplete colonoscopies. A total of 33 patients underwent repeat colonoscopies over the median 6‐year follow‐up. Three adenomas and one carcinoma were missed in the incomplete group and were subsequently picked up in repeat endoscopies. Only one adenoma was truly missed in complete colonoscopies, providing an overall miss rate of 1.3%.

Conclusion  Use of endomucosal clips with follow‐on abdominal X‐ray is a safe and effective method of determining completion of colonoscopy. This technique is also an excellent objective measure of quality assurance of completion and miss rates in colonoscopy, especially when combined with an audit to determine the missed lesions at two years postprocedure.
Changes in fatigability of the striated anal canal after childbirth
Authors: Cattle K. R. , Telford K. , Kiff E. S.
Published: April 2009

Aim  Anal manometry is an established assessment tool for patients with faecal incontinence. Fatigue rate index (FRI) has been shown to discriminate between symptomatic patients and controls. The aim of this study was to compare manometry and fatigability of the anal canal in nulliparous women before and after childbirth.

Method  An air‐filled manometry device was used to record maximum resting and squeeze pressures, fatigue rate (recorded over 20 s) and FRI. Recordings were made before and after vaginal delivery.

Results  Nineteen women were studied. Resting anal canal pressure was not significantly different before and after delivery (57.1 ± 13.6 vs 51.1 ± 11.9 cmH2O, P = 0.1). Squeeze pressure was significantly lower postpartum (106.5 ± 43.6 vs 75.5 ± 45.6 cmH2O, P < 0.001). Fatigue rate was significantly reduced postpartum (−129.5 ± 74.7 vs−76.1 ± 54.8 cmH2O/min, P = 0.001), but FRI was not significantly altered (1.23 ± 1.49 vs 1.41 ± 1.27 min, P = 0.09).

Conclusion  Maximal squeeze pressure and fatigue rate of the anal canal are significantly reduced after childbirth. Resting anal canal pressure and FRI are not significantly different.
Relationships within the Munnopsidae (Crustacea, Isopoda, Asellota) based on three genes
Authors: Osborn Karen J.
Published: April 2009

The Munnopsidae are a diverse group of asellote isopods that are an important component of deep‐sea fauna. Morphologically‐based phylogenetic inference attempts have proven to be of limited use due to the ecological and morphological diversity within the clade. Monophyly of the family is well‐established but relationships within the group remain unresolved. This project is the first molecularly‐based effort focused specifically on resolving phylogenetic relationships within the Munnopsidae. Partial 28S and COI and complete 18S genes were sequenced for 28 asellotes, 15 additional taxa were included from which only one or two of the three target sequences could be obtained, and 18S sequences for five additional taxa were available from GenBank. Sequences were analysed both as individual genes and in combination using Bayesian and maximum parsimony approaches. Each gene provided a phylogenetic signal that could be identified in the combined analyses, with 18S analyses providing the most resolution of phylogenetic relationships. The available representatives of subfamilies Munnopsinae and Ilyarachninae were monophyletic, as was the genus Munneurycope. Relationships within the subfamily Munnopsinae were well‐resolved by thorough taxon sampling, several new species were placed, and the need for taxonomic revision of Munnopsis/Munnopsoides was supported. These analyses supported putative Eurycope paraphyly and emphasized the need for careful revision of this highly variable genus. Tytthocope was sister to Munnopsurus. Syneurycope was suggested as the sister group to the ilyarachnines. Combined analyses provided increased support for clades suggested in at least two individual gene analyses and for clades not strongly contradicted by individual analyses. Further work is required to fully resolve the munnopsid phylogeny and should consist of increased taxon sampling for the complete 18S sequence and possibly identification of at least one slowly evolving, nuclear protein‐coding gene to resolve the basal polytomy and enable placement of the root.
Hempel's Paradox, Law‐likeness and Causal Relations
Authors: Schroeder Severin
Published: April 2009

It is widely thought that Bayesian confirmation theory has provided a solution to Hempel's Paradox (the Ravens Paradox). I discuss one well‐known example of this approach, by John Mackie, and argue that it is unconvincing. I then suggest an alternative solution, which shows that the Bayesian approach is altogether mistaken. Nicod's Condition should be rejected because a generalisation is not confirmed by any of its instances if it is not law‐like. And even law‐like non‐basic empirical generalisations, which are expressions of assumed underlying causal regularities, are not so confirmed if they are absurd in the light of our causal background knowledge or if their instances are not also possible instances of the relevant causal claim.
Ethics Beyond Moral Theory
Authors: Chappell Timothy
Published: April 2009

I develop an anti‐theory view of ethics. Moral theory (Kantian, utilitarian, virtue ethical, etc.) is the dominant approach to ethics among academic philosophers. But moral theory's hunt for a single Master Factor (utility, universalisability, virtue . . .) is implausibly systematising and reductionist. Perhaps scientism drives the approach? But good science always insists on respect for the data, even messy data: I criticise Singer's remarks on infanticide as a clear instance of moral theory failing to respect the data of moral perceptions and moral intuitions.

Moral theory also fails to provide a coherent basis for real‐world motivation, justification, explanation, and prediction of good and bad, right and wrong. Consider for instance the marginal place of love in moral theory, compared with its central place in people's actual ethical outlooks and decision making. Hence, moral theory typically fails to ground any adequate ethical outlook. I propose that it is the notion of an ethical outlook that philosophical ethicists should pursue, not the unfruitful and distorting notion of a moral theory.
General framework for the rotation of units in repeated survey sampling
Authors: Nedyalkova Desislava , Qualité Lionel , Tillé Yves
Published: April 2009

Coordination of probabilistic samples is a challenging theoretical problem faced by statistical institutes. One of their aims is to obtain good estimates for each wave while spreading the response burden across the entire population. There is a collection of existing solutions that try to attend to these needs. These solutions, which were developed independently, are integrated in a general framework and their corresponding longitudinal designs are computed. The properties of these longitudinal designs are discussed. It is also noted that there is an antagonism between a good rotation and control over the cross‐sectional sampling design. A compromise needs to be reached between the quality of the sample coordination, which appears to be optimal for a systematic longitudinal sampling design, and the freedom of choice of the cross‐sectional design. In order to reach such a compromise, an algorithm that uses a new method of longitudinal sampling is proposed.