bluuebunny/crossref_metadata_2025 huggingface dataset:
Extent, patterns, and burden of uncontrolled disease in severe or difficult‐to‐treat asthma
Authors: Sullivan S. D. , Rasouliyan L. , Russo P. A. , Kamath T. , Chipps B. E. ,   for the TENOR Study Group
Published: January 2007

Background:  Characterization of uncontrolled asthma burden in a natural treatment setting can influence treatment recommendations and clinical practice. The objective was to characterize and compare the economic burden of severe or difficult‐to‐treat asthma in uncontrolled and controlled patients.

Methods:  Baseline patient data (age ≥ 13 years; n = 3916) were obtained from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study. Disease control was assessed using two approaches: (i) applying criteria for control based on the Gaining Optimal Asthma ControL study, and (ii) using the Asthma Therapy Assessment Questionnaire (ATAQ) to identify the number of asthma control problems. Assessments were performed at baseline, and at months 12 and 24. Monetary values were assigned to productivity loss and medical resource use. Direct and indirect costs were aggregated over 24 months and compared using Student's t‐test for continuous measures and chi‐squared for categorical variables.

Results:  Throughout the study, most patients had uncontrolled asthma (83% uncontrolled; 16% inconsistent control; 1.3% controlled). Controlled patients experienced fewer work or school absences and less healthcare resource use than uncontrolled patients at all study time points. Using the multilevel ATAQ control score, asthma costs increased directly with the number of asthma control problems. Costs for uncontrolled patients were more than double those of controlled patients throughout the study ($14 212 vs$6452; adjusted to 2002 dollars; P < 0.0001).

Conclusions:  This study demonstrated that few severe or difficult‐to‐treat asthma patients achieved control over a 2‐year period and the economic consequence of uncontrolled disease is substantial.
Inverse relation between nasal fluid Clara Cell Protein 16 levels and symptoms and signs of rhinitis in allergen‐challenged patients with intermittent allergic rhinitis
Authors: Benson M. , Fransson M. , Martinsson T. , Naluai Å. T. , Uddman R. , Cardell L. O.
Published: January 2007

Background:  Decreased levels of the anti‐inflammatory Clara Cell Protein 16 (CC16) are found in intermittent allergic rhinitis (IAR) and asthma. In asthma this decrease has been associated with hyperreactivity and the A38G single nucleotide polymorphism (SNP). The aim of this study was to examine if IAR is associated with signs and symptoms of rhinitis and the A38G SNP.

Methods:  Nasal fluid CC16 was analyzed in 20 patients with IAR before allergen challenge and 1 and 6 h after challenge, and from 28 healthy controls. The A38G SNP was analyzed in 80 patients with IAR and 106 controls. Nasal biopsies were obtained from three subjects in each group for immunohistochemical analysis of CC16.

Results:  In the allergen‐challenged patients symptoms and rhinoscopic signs of rhinitis increased after 1 h and normalized after 6 h. In contrast, nasal fluid CC16 decreased 1 h after allergen challenge and returned to baseline after 6 h. Nasal fluid CC16 levels did not differ from controls before and 6 h after challenge. Immunohistochemical investigation showed intense CC16 staining in the nasal epithelium of both patients before season and healthy controls, but weak staining in symptomatic patients during season. No significant association between the A38G SNP and IAR was found.

Conclusion:  There was an inverse relation between nasal fluid CC16 levels and symptoms and signs of rhinitis in allergen‐challenged patients with IAR. However, there was no association between IAR and the A38G SNP.
Amoxicillin conjugates to HLA class I molecules and interferes with signalling through the ILT2/LIR‐1/CD85j inhibitory receptor
Authors: Morel E. , Bellón T.
Published: January 2007

Background:  Drugs behave as haptens and are recognized by specific T‐cell receptors in the context of major histocompatibility complex (MHC) molecules in allergic subjects. Natural killer cell receptors (NKRs) are MHC class I‐specific receptors that modulate the threshold of activation of immunocompetent cells. Amongst them, ILT2/LIR‐1/CD85j is an inhibitory NKR widely distributed in several cell lineages and with a broad spectrum of recognition of human leucocyte antigen (HLA) class I ligands.

Methods:  We have evaluated, at the biochemical and cellular level, the ability of amoxicillin (AX) conjugate to HLA class I molecules and to interfere with the inhibitory signal delivered by the HLA class I receptor ILT2/LIR‐1/CD85j.

Results:  We have detected AX bound to cell membrane proteins and in particular to HLA class I molecules. Preincubation with AX rendered target cells susceptible to NK cell‐mediated lysis. In conjugation experiments, target cell‐bound AX hampered tyrosine phosphorylation of ILT2/LIR‐1/CD85j upon ligand recognition and the subsequent recruitment of SHP‐1 phosphatase.

Conclusion:  Conjugation of AX to HLA class I molecules may mask HLA recognition by inhibitory receptors and attenuate the negative signal delivered by SHP‐1 phosphatase, thus lowering the threshold of activation of effector cells.
The limitations of severe asthma: the results of a European survey
Authors: Dockrell M. , Partridge M. R. , Valovirta E.
Published: January 2007

Background:  Asthma has a major impact on patients’ lives, and severe asthma is a serious health problem. The European Federation of Allergy and Airways Diseases Patients’ Associations (EFA) commissioned a telephonic survey to capture the views of people who are living with severe asthma in Europe.

Methods:  A total of 1300 patients from the UK, France, Germany, Spain and Sweden who reported a previous diagnosis of asthma and reported receiving asthma medication took part in the survey.

Results:  Most patients reported having limitations to their lifestyles as a consequence of the symptoms of severe asthma. Almost 70% of patients reported that physical activity was restricted, 50% were restricted from having pets, 30% from taking holidays, and many felt their job prospects were limited. In addition, 50% of this population of patients were not convinced that guideline goals were being achieved, although it is not clear as to the cause of this failing. Patients indicated that they want treatments that are fast‐acting, long‐lasting and have minimal side effects, and they were optimistic for the development of effective therapies over the next 5 years.

Conclusions:  The results of this study provide insight into how greatly patients’ lives are affected by severe asthma.
GINA guidelines on asthma and beyond*
Authors: Bousquet J. , Clark T. J. H. , Hurd S. , Khaltaev N. , Lenfant C. , O'Byrne P. , Sheffer A.
Published: January 2007

Clinical guidelines are systematically developed statements designed to help practitioners and patients make decisions regarding the appropriate health care for specific circumstances. Guidelines are based on the scientific evidence on therapeutic interventions. The first asthma guidelines were published in the mid 1980s when asthma became a recognized public health problem in many countries. The Global Initiative on Asthma (GINA) was launched in 1995 as a collaborative effort between the NHLBI and the World Health Organization (WHO). The first edition was opinion‐based but updates were evidence‐based. A new update of the GINA guidelines was recently available and it is based on the control of the disease. Asthma guidelines are prepared to stimulate the implementation of practical guidelines in order to reduce the global burden of asthma. Although asthma guidelines may not be perfect, they appear to be the best vehicle available to assist primary care physicians and patients to receive the best possible care of asthma.
Asthma control or severity: that is the question
Authors: Humbert M. , Holgate S. , Boulet L.‐P. , Bousquet J.
Published: January 2007

In the first National Heart Lung and Blood Institute and Global Initiative for Asthma (GINA) guidelines, the level of symptoms and airflow limitation and its variability allowed asthma to be subdivided by severity into four subcategories (intermittent, mild persistent, moderate persistent, and severe persistent). It is important to recognize, however, that asthma severity involves both the severity of the underlying disease and its responsiveness to treatment. Thus, the first update of the GINA guidelines defined asthma severity depending on the clinical features already proposed as well as the current treatment of the patient. In addition, severity is not a fixed feature of asthma, but may change over months or years, whereas the classification by severity suggests a static feature. Moreover, using severity as an outcome measure has limited value in predicting what treatment will be required and what the response to that treatment might be. Because of these considerations, the classification of asthma severity is no longer recommended as the basis for treatment decisions, a periodic assessment of asthma control being more relevant and useful.
Cost‐effectiveness of omalizumab in patients with severe persistent allergic asthma
Authors: Brown R. , Turk F. , Dale P. , Bousquet J.
Published: January 2007

Background:  The health, economic and societal burden of asthma is considerable, and is greatest in patients with severe asthma, particularly when inadequately controlled. Real‐life studies that assess the effectiveness of treatment are of particular interest.

Methods:  We determined the incremental cost‐effectiveness ratio (ICER) of adding omalizumab to standard therapy using data from the real‐life 1‐year randomized open‐label study (ETOPA) and using Canada as a reference country. Only patients receiving high‐dose ICS plus LABA were included in the analysis, reflecting the EU label for omalizumab. Costs and quality‐adjusted life years (QALYs) gained were used to calculate the ICER for omalizumab (cost/QALY). Probabilistic sensitivity analysis was performed to determine the 95% confidence interval and one‐sided sensitivity analyses were performed.

Results:  The base case lifetime analysis of standard therapy vs standard therapy plus add‐on omalizumab for the first 5 years, gave an ICER of €31 209. Probabilistic sensitivity analysis indicated that the 95% confidence interval around the ICER was €27 739–€40 840. The ICER range for one‐way sensitivity analyses was €23 762 without discounting to €66 443 without inclusion of asthma‐related mortality.

Conclusions:  This study demonstrates that add‐on omalizumab therapy is cost‐effective in patients with severe persistent allergic asthma.
Distribution of Neurons Supplying the Porcine Mammary Gland
Authors: Franke‐Radowiecka A.
Published: January 2007

The distribution of neurons projecting to the mammary gland was investigated by using the retrograde tracing method in juvenile pigs (n = 12). Fluorescent retrograde tracer Fast Blue (FB) was injected into the nipple (n = 3) or parenchyma (n = 3) of the second, right thoracic mamma or into the nipple (n = 3) and parenchyma (n = 3) of the last, right abdominal mamma. FB‐positive (FB+) mammary gland‐projecting neurons were found in some right dorsal root ganglia (DRG) and sympathetic chain ganglia (SChG) only. After injection of the tracer into the second, right thoracic mamma, FB+ neurons were observed in Th9‐Th12 DRG but most of them were located in Th11 and Th12 ganglia. As concerns SChG, FB+ neurons were found in Th1‐Th4, Th7‐Th14 and L1‐L4 ganglia. The vast majority of them were located in Th10 and Th11 SChG, which appeared to be the main sources of efferent innervation of this mamma. Neurons projecting to the last right abdominal mamma were found in L1‐L3 DRG and L1‐L4 SChG but most of them were located in L1‐L2 ganglia and L1‐L2 ganglia, respectively. This study for the first time has disclosed the localization of neurons supplying the mammary gland in larger domestic animal species, the pig, by using the retrograde tracing method.
Sex Differences in Reconciliation and Post‐Conflict Anxiety in Bonnet Macaques
Authors: Cooper Matthew A. , Aureli Filippo , Singh Mewa
Published: January 2007

Rates of reconciliation vary widely between different types of opponents, and post‐conflict anxiety has been proposed to mediate individual variation in reconciliation rates. We investigated the form and function of reconciliation in a wild, provisioned group of bonnet macaques (Macaca radiata) with the prediction that sex differences in post‐conflict anxiety would be associated with sex differences in conciliatory tendency. Individuals in the study group had a conciliatory tendency of 29.3%. Victims avoided their former opponents at a higher rate following aggression than during matched‐control samples, and reconciliation decreased the rate of avoidance. Although victims showed a higher rate of anxiety‐related behavior than did aggressors, anxiety‐related behavior was elevated after aggression and reduced following reconciliation in both victims and aggressors. Female–female opponents showed higher rates of anxiety‐related behavior before reconciliation than they did following unreconciled aggression. In contrast, male–male and female–male opponents showed increased anxiety‐related behavior following aggression regardless of the occurrence of reconciliation. Moreover, female–female opponents had a higher conciliatory tendency than did female–male opponents. The elevated post‐conflict anxiety shown by female–female opponents before reconciliation, along with their high conciliatory tendency, suggests that post‐conflict anxiety promotes reconciliation. In sum, the sex differences in post‐conflict behavior found in this study support the hypothesis that variation in post‐conflict anxiety mediates differential rates of reconciliation.
Recent Physical Encounters Affect Chemically Mediated Retreat‐Site Selection in a Gecko
Authors: Kondo Junko , Downes Sharon J. , Keogh Scott J.
Published: January 2007

Chemoreception is well documented in a range of animals but the effects of recent behavioural interactions on an animal's response to subsequent chemical information are poorly understood. Using a series of laboratory experiments with a rock‐dwelling gecko (Oedura lesueurii), we examined whether latest social experience affects how animals used chemoreception to mediate microhabitat selection. Males of this species defend retreat‐sites and the outcomes of physical duels are maintained during second physical contests staged up to 1 wk after first contests. Retreat‐site selection experiments showed that past social experience affects the behavioural responses of adult male geckos to chemical cues from conspecific male lizards. When offered a choice between retreat‐sites labelled with chemicals from an unknown male vs. the opponent from a recent contest, geckos that won their previous fight selected retreat‐sites at random. In contrast, under the same conditions, geckos that lost their previous fight significantly preferred retreat‐sites scented with an unknown male conspecific over those scented with the winning opponent. During these experiments males that lost their previous fight were significantly more vigilant, and spent greater time near the retreat‐site of the unknown male, compared with males that won their previous fight. These results support the notion that recent physical social encounters can affect the way that animals respond to chemical information from potential competitors.
The Role of Early Learning in Determining Shoaling Preferences Based on Visual Cues in the Zebrafish, Danio rerio
Authors: Spence Rowena , Smith Carl
Published: January 2007

Social preferences for specific colour patterns learned in early development, termed imprinting, may influence social and mating decisions. Imprinting has been demonstrated in both birds and fish and has been proposed to play a role in speciation. We raised wild‐type zebrafish, Danio rerio, either with individuals of the same colour pattern, an alternative colour pattern (leopard), or a closely related, unpatterned species, D. albolineatus. We also cross‐reared individual ‘leopard’D. rerio and D. albolineatus with wild‐type D. rerio. We tested the prediction that Danio would prefer to shoal with fish of the colour pattern with which they had been raised, irrespective of their own appearance. Rearing condition affected shoaling preferences between D. rerio and D. albolineatus, with individuals of both colour patterns preferring to associate with shoals of the colour pattern with which they had been raised. The more subtle distinction between the wild‐type and ‘leopard’D. rerio colour patterns did not elicit a shoaling preference. Thus, zebrafish exhibit shoaling preferences based on visual cues, the effect being stronger when patterns are more distinct. There is a strong learned component to these preferences, although the extent to which they may influence mating decisions is unclear.
Aggression Level in Different Water Velocities Depends on Population Origin in Grayling, Thymallus thymallus
Authors: Salonen Annamari , Peuhkuri Nina
Published: January 2007

Phenotypic plasticity is recognized as an important mechanism of adaptation. However, because of its potential costs and limits, it has been hypothesized to be reduced and ultimately become lost when there is no selection for its maintenance. Heterogeneous environments in particular are expected to favour and thus maintain plastic phenotypes. Lakes and rivers differ in their flow regimes. In addition to higher average water velocity, rivers are characterized by distinct spatial and temporal variation in water flow, whereas lakes can be regarded as quite uniform in this respect. We studied whether behaviour, which is generally considered to be highly plastic, shows differences in the degree of plasticity between lake and river populations of the European grayling, Thymallus thymallus, fry in response to different water velocities. Given that aggressive behaviour in fish has been shown to relate to ambient flow regime, we compared aggressiveness of hatchery‐reared grayling originating from hatchery stocks of two lake and two river populations in still and flowing water. River fish showed higher aggressiveness in flowing water compared with still water, whereas aggressiveness of lake fish did not appear to vary according to water velocity. The higher plasticity of aggressiveness evoked in river fish by different water velocities may thus represent an adaptation to more variable flow and presumably related feeding conditions in their natural environment.
Is Divorce in Young Common Terns,Sterna hirundo, after Recruitment just a Question of Timing?
Authors: Ludwigs Jan‐Dieter , Becker Peter H.
Published: January 2007

The probability of divorce in birds has been linked with age, breeding experience, reproductive output and synchrony in return. Here, we investigate the consequences of first breeding attempts in common terns for mating in the subsequent season. Nearly 20% of all first‐time breeders disappeared or skipped at least one season after recruitment. In 84 pairs, which consisted of at least one recruit and of which both partners returned to the colony, the divorce rate was 45%. We compared reproductive success, arrival dates, and asynchrony in arrival dates of pairs of the first breeding season against the second season, for both reunited and divorced pairs and males and females separately. First, in pairs of which both members came back to the colony, we found an increase of reproductive success most pronounced in males. In the second season reproductive success of divorced compared with reunited pairs was higher, as only divorced pairs significantly improved the number of fledglings, and again this relation was stronger in males. Secondly, females of reunited pairs arrived significantly earlier from the first to the second season and by far more days than their males. However, in divorced pairs former mates did not differ in the number of days they advance their arrivals. Finally, divorced males arrived on average 4 d earlier than their former mates, whereas divorced females arrived 5 d later compared with their former mates of the recruitment season. Contradictory to nearly all other divorce studies in birds so far, we found a clear fitness gain in divorced males. We suggest that the improvement in reproductive success of young males stems from a side‐effect of the birds’ quality and ability to reach the breeding site in appropriate time and earlier as potential competitors. In long‐lived bird species the heterogeneity among young individuals in the timing of arrival at the colony seems to explain why former recruit‐pairs reunite or split. For young males we suggest as best explanation of divorce that they profit from ‘pushing for an empty chair’, while females seem to profit from their choosiness and may actively decide between former and other mates.
Feeding or Resting? The Strategy of Rutting Male Alpine Chamois
Authors: Willisch Christian S. , Ingold Paul
Published: January 2007

Optimal foraging theory suggests that animals normally maximize energy intake to optimize their energy balance. However, when efficiency to assimilate energy falls below the level necessary to ascertain basal energetic requirements, they should shift to an energy saving strategy. Males of many ruminant species considerably reduce their food intake during the rut. Nevertheless, they are commonly assumed to maximize energy intake besides their investments in rutting activities. Based on predictions of optimal foraging theory and the specific ruminant digestive physiology, we propose, however, that rutting males in polygynous species with time consuming mating tactics should instead use an energy saving strategy. Particularly, we predict this to be the case in Alpine chamois (Rupicapra rupicapra rupicapra), a highly polygynous mountain ungulate, of which the males defend mating territories during the rut. By combining observational and telemetry data of eight radio‐collared males we constructed individual 24‐h time budgets, and compared the behavior of males before, during and after the rut. Males spent significantly less time feeding during the rut (0.9 h) compared with before (8.5 h) and afterwards (6.4 and 7.5 h, respectively), whereas time spent lying remained more or less unchanged (pre‐rut; 12.7 h, rut; 13.3 h, post‐rut; 12.9 and 13.9 h, respectively). The ratio of time spent feeding to lying dropped from 0.67 in the pre‐rut period to 0.05 in the rutting period. As a result, males allocated on average approx. 90% of their non‐rutting time to lying, and a negative relationship between rutting and lying time emerged. Hence, males seemed to trade lying time against rutting time. We conclude from these results that male Alpine chamois do not maximize their energy intake during the rut, but rather adopt an energy saving strategy to optimize their energy balance.
Reproductive Isolation in the Wood Cricket Gryllus vernalis (Orthoptera: Gryllidae)
Authors: Jang Yikweon , Bockhorst Amanda , Carl Gerhardt Howard
Published: January 2007

Two species of closely related wood crickets, Gryllus vernalis (Orthoptera: Gryllidae) and G. fultoni, occur together in the eastern USA and have a similar calling‐song structure, consisting of three‐pulse chirps. Previous studies revealed that male calling song and female selectivity were divergent between sympatric and far allopatric populations of G. fultoni, consistent with the pattern expected of reproductive character displacement. We studied the reproductive isolation of G. vernalis in relation to G. fultoni by investigating the geographic variation in calling songs of G. vernalis and by examining close‐range mating behaviors. Neither field nor laboratory studies revealed differences in any of the calling‐song characters between sympatric and allopatric populations, but this could reflect the limited sampling within the relatively small region of allopatry for G. vernalis. Although close‐range mating trials revealed that females of both species discriminated against heterospecific mating partners, the strength of discrimination was especially strong in females of sympatric G. vernalis populations. Our studies of long‐range and close‐range mating behaviors suggest that selection pressures for reproductive isolation are exerted primarily on close‐range mating behaviors in G. vernalis but on long‐range mating behaviors in G. fultoni.
Impact factor statistics and publication practice: What can we learn?
Authors: Taborsky Michael
Published: January 2007

Peer review procedures and citation statistics are important yet often neglected components of the scientific publication process. Here I discuss fundamental consequences of such quality measures for the scientific community and propose three remedial actions: (1) use of a ‘‘Combined Impact Estimate’’ as a measure of citation statistics, (2) adoption of an open reviewing policy and (3) acceleration of the publication process in order to raise the reputation of the entire discipline (in our case: behavioural science). Authors, reviewers and editors are invited to contribute to the improvement of publication practice.
Species co‐existence and character divergence across carnivores
Authors: Jonathan Davies T. , Meiri Shai , Barraclough Timothy G. , Gittleman John L.
Published: January 2007

Co‐occurring species might be morphologically similar because they are adapted to the same environment, or morphologically dissimilar to minimize competition. We use sister species comparisons to evaluate the relationship between morphological disparity and regional patterns of co‐occurrence across carnivores. Up to 63% of the variation in range overlap can be explained by morphological divergence in dentition. Species that differ more in carnassial tooth length overlap more in their geographical range. Carnassials are the primary teeth associated with food processing, and hence difference in carnassial size may be a good indicator of difference in resource use. We suggest this pattern is consistent with competition in sympatry driving ecological character displacement, or competitive exclusion among ecologically similar species. Our study uses newly available data on global distributions, morphology and phylogeny, and is the first to demonstrate a close relationship between morphological disparity and co‐occurrence at a regional scale encompassing multiple communities.
A trait‐based approach to community assembly: partitioning of species trait values into within‐ and among‐community components
Authors: Ackerly D. D. , Cornwell W. K.
Published: January 2007

Plant functional traits vary both along environmental gradients and among species occupying similar conditions, creating a challenge for the synthesis of functional and community ecology. We present a trait‐based approach that provides an additive decomposition of species’ trait values into alpha and beta components: beta values refer to a species’ position along a gradient defined by community‐level mean trait values; alpha values are the difference between a species’ trait values and the mean of co‐occurring taxa. In woody plant communities of coastal California, beta trait values for specific leaf area, leaf size, wood density and maximum height all covary strongly, reflecting species distributions across a gradient of soil moisture availability. Alpha values, on the other hand, are generally not significantly correlated, suggesting several independent axes of differentiation within communities. This trait‐based framework provides a novel approach to integrate functional ecology and gradient analysis with community ecology and coexistence theory.
Diversity–stability relationship varies with latitude in zooplankton
Authors: Shurin Jonathan B. , Arnott Shelley E. , Hillebrand Helmut , Longmuir Allyson , Pinel‐Alloul Bernadette , Winder Monika , Yan Norman D.
Published: January 2007

Analyses of temporal patterns of diversity across a wide range of taxa have found that more diverse communities often show smaller compositional changes over time. This generality indicates that high diversity is associated with greater temporal stability in species composition. We examined patterns of diversity and community stability in zooplankton time series data from 36 lakes sampled over a combined 483 years. The species–time relationship was flatter in more species‐rich lakes in the temperate zone. However, high‐latitude lakes had both low richness and low turnover. These patterns were consistent for turnover both within and among years. Daily, annual and long‐term richness were all higher in large lakes while turnover was unaffected by the surface area. Richness on all time scales, as well as turnover within and among years, all declined at high latitude. Species–area relations and latitudinal gradients in richness therefore reflect different temporal components of diversity. Our results suggest that diversity shows strong associations with compositional stability that vary qualitatively across biogeographical provinces. Community stability increases with diversity among lakes in the temperate zone; however, the two are negatively correlated across latitudinal gradients. These patterns indicate that either the direct effects of diversity on stability or their covariance with environmental fluctuations vary with latitude.
Psoas abscess – not as rare as we think?
Authors: Garner J. P. , Meiring P. D. , Ravi K. , Gupta R.
Published: January 2007

Objective  Iliopsoas abscess (IPA) is a rare condition with a reported worldwide incidence of 12 new cases per year with primary abscesses now predominating. The presentation is often vague and the diagnosis not considered.

Method  The medical records of 15 consecutive patients presenting to our hospital in a 3‐year period with IPA were reviewed. Demographic data, presenting features, predisposing factors and the investigations performed were recorded. Abscesses were classified as primary or secondary and the treatment provided and eventual outcomes were analysed.

Results  Fifteen patients (eight males) were included. Nine patients were pyrexial on admission, 14 were anaemic and all had raised inflammatory markers. Only five patients presented with the classical triad of pain, fever and limp. The median time to diagnosis was 3 days with a median hospital stay of 27 days (range 7–243 days). Fourteen patients were diagnosed by computed tomographic scan. Three patients were treated with antibiotics alone whilst 11 received percutaneous drainage (PCD) as well. Of these, five had recurrence following initial drainage, needing further PCD procedures but none needed open drainage. Only one patient underwent open drainage initially. The mortality rate was 20%.

Conclusion  The incidence of IPA is probably under‐reported. The vague presentation leads to delays in diagnosis and increases morbidity and a high index of suspicion is the key to early diagnosis. Percutaneous drainage with antibiotics is the first line of treatment although recurrence rate is high. Open drainage allows simultaneous treatment of underlying pathology in secondary abscesses.
The significance of involvement of a free serosal surface for recurrence and survival following resection of clinicopathological stage B and C rectal cancer
Authors: Keshava A. , Chapuis P. H. , Chan C. , Lin B. P. C. , Bokey E. L. , Dent O. F.
Published: January 2007

Objective  To determine whether the presence of tumour at a free serosal surface was independently associated with pelvic recurrence or survival in patients who had a resection for clinicopathological stage B or stage C rectal cancer and who had not received adjuvant therapy.

Method  Data were drawn from a comprehensive, prospective hospital registry of all resections for rectal cancer from January 1971 to December 1998 with follow up to December 2003. Statistical analysis employed the χ2 test or Fisher's exact probability, Kaplan–Meier estimation and proportional hazards regression, with a significance level of ≤0.05 and 95% confidence intervals (CI).

Results  In 665 patients with stages B or C tumour, 35 (5.3%; CI 3.7–7.2%) had tumour at a free serosal surface. These comprised 6/332 (1.8%; CI 0.8–3.7%) patients with stage B tumour and 29/333 (8.7%; CI 6.1–12.2%) with stage C tumour. After adjustment for other relevant variables, involvement of a free serosal surface was significantly associated with pelvic recurrence [hazard ratio (HR) 2.7; CI 1.3–5.5] and diminished survival (HR 1.6; CI 1.1–2.4) but not with systemic (only) recurrence.

Conclusion  This study has confirmed that direct tumour spread to a free serosal surface independently predicts pelvic recurrence and diminished survival after resection of clinicopathological stage B and C rectal cancer. This feature should always be sought by the pathologist and reported when present, and noted by the surgeon and oncologist. Serosal involvement should be evaluated further for its utility in selecting patients for adjuvant therapy.
Diagnostic value of self‐reported symptoms in Danish outpatients referred with symptoms consistent with colorectal cancer
Authors: Bjerregaard N. C. , Tøttrup A. , Sørensen H. T. , Laurberg S.
Published: January 2007

Objective  To assess the association between self‐reported symptoms and a diagnosis of colorectal cancer (CRC) in symptomatic outpatients without CRC risk factors, defined by a Danish expert group.

Method  A cross‐sectional study of patients aged 40 years and older referred by general practitioners to two Danish surgical outpatient clinics for symptoms consistent with CRC during a 16‐month period. CRC was diagnosed at endoscopy and through follow up. Before their first appointment, participants completed a questionnaire about symptoms.

Results  The study included 2172 patients. Of these, 122 were diagnosed with CRC (5.6%). Median age was 61 years (range: 40–97) and 44.0% were men. All symptoms had high (93.4–96.8%) negative predictive values for CRC. The highest positive predictive values (PPV) were found for dark rectal bleeding (PPV: 20.6%) and CRC was diagnosed in a first‐degree relative over the age of 50 years (PPV: 11.2%). At multiple logistic regression analysis dark rectal blood was the most important predictor of CRC (OR: 7.4). Other predictors were age 60 years or older (OR: 3.0), change in frequency of bowel movements (OR: 2.5), CRC diagnosed in a first‐degree relative over the age of 50 years (OR: 2.6), male gender (OR: 2.2) and mono‐symptomatic fresh rectal blood (OR: 1.7).

Conclusion  No self‐reported symptoms presented by outpatients without CRC risk factors can be used accurately to identify patients with CRC with certainty. For clinical purposes self‐reported symptoms seems thus not to be a useful accurate tool to distinguish between symptomatic outpatients with and without CRC.
Quality of life after transanal endoscopic microsurgery and total mesorectal excision in early rectal cancer
Authors: Doornebosch P. G. , Tollenaar R. A. E. M. , Gosselink M. P. , Stassen L. P. , Dijkhuis C. M. , Schouten W. R. , Van De Velde C. J. , De Graaf E. J. R.
Published: January 2007

Objective  Total mesorectal excision (TME) is the gold standard in rectal cancer, if curation is intended. Transanal endoscopic microsurgery (TEM) is a much safer technique and seems to have comparable survival in early rectal cancer. The impact of both procedures on quality of life has never been compared. In this study we compared quality of life after TEM and TME.

Method  Fifty‐four patients underwent TEM for a T1 carcinoma. Only patients without known locoregional or distant recurrences were included, resulting in 36 eligible patients in whom quality of life after TEM was studied. The questionnaires used included the EuroQol EQ‐5D, EQ‐VAS, EORTC QLQ‐C30 and EORTC QLQ‐CR38. The results were compared with a sex‐and age‐matched sample of T+N0 rectal cancer patients who had undergone sphincter saving surgery by TME and a sex‐ and age matched community‐based sample of healthy persons.

Results  Thirty‐one patients after TEM returned completed questionnaires (overall response rate 86%). Quality of life was compared with 31 TME patients and 31 healthy controls. From the patients’ and social perspective quality of life did not differ between the three groups. Compared with TEM, significant defecation problems were seen after TME (P < 0.05). A trend towards better sexual functioning after TEM, compared with TME, was seen, especially in male patients, although it did not reach statistical significance.

Conclusion  Transanal endoscopic microsurgery and TME do not seem to differ in quality of life postoperatively, but defecation disorders are more frequently encountered after TME. This difference could play a role in the choice of surgical therapy in (early) rectal cancer. Further prospective studies are needed to confirm our conclusions.
Laparoscopic colorectal surgery – results from 200 patients
Authors: Scala A. , Huang A. , Dowson H. M. P. , Rockall T. A.
Published: January 2007

Objective  Laparoscopic surgery is increasingly being performed for benign and malignant colorectal disease. This study examines the short‐term results in a consecutive series of laparoscopic colorectal procedures performed over 2 years.

Method  A prospective database was established for all elective patients undergoing laparoscopic colorectal surgery by one surgeon. The main outcome measures assessed were operative duration, conversion rate, length of hospital stay, morbidity and mortality and lymph node harvest.

Results  Two hundred and thirty‐one consecutive patients were referred for elective colorectal surgery, with 18 patients excluded from laparoscopic surgery. Thirteen patients had nonresective laparoscopic colorectal procedures for endometriosis and have been excluded from the series. Of 200 patients who underwent a laparoscopic colorectal procedure, 114 (57%) were female, the median age was 67 years (inter‐quartile range (IQR) 57–76), and there were 116 malignancies. The most common operations were anterior resection and sigmoid colectomy (n = 82), right hemicolectomy (n = 62) and left hemicolectomy (n = 12). The median operating time was 120 min (IQR 90–150) and 10 patients (5%) required conversion to open surgery. The median lymph node harvest in malignancies was 21 nodes (IQR 15–30) and no positive resection margins were found. There were two deaths and 29 significant complications (14.5%), with seven patients requiring re‐operations because of postoperative complications. The median postoperative hospital stay was 4 days (IQR 3–6) and 13 patients (6.5%) were re‐admitted within 30 days of hospital discharge.

Conclusion  Laparoscopic colorectal surgery is possible for most benign and malignant conditions, with low conversion and complication rates, as well as short hospital stay.
Inter general practice variability in use of referral guidelines for colorectal cancer
Authors: John S. K. P. , Jones O. M. , Horseman N. , Thomas P. , Howell R. D. , Fozard J. B. J.
Published: January 2007

Objective  The Two‐Week Wait (TWW) referral system for suspected colorectal cancers has a low yield. To examine this, we assessed the referral pattern of general practices within four primary care trusts and looked at the variability of yield of colorectal cancer amongst all TWW referrals and assessed the reasons for variability.

Method  A prospectively collected database of all colorectal cancers was examined for new cases diagnosed in the 12 months from April 1st 2004. Patients were cross‐referenced via general practitioner (GP) codes to identify the referral origin. Reasons for the variability in referral patterns from each general practice were assessed in relation to TWW referrals, population demographics and through postal questionnaire of GPs.

Results  A total of 175 patients diagnosed with colorectal cancer were referred from 49 general practices. Whilst there was a positive correlation between the number of TWW referrals and colorectal cancer per 1000‐practice population (P = 0.001; Spearman correlation coefficient rs=0.447, two‐tailed), there was a big discrepancy between referrals and cancer diagnosed in many general practices. Twenty‐six general practices (53%) had no colorectal cancer diagnosed via the TWW route and these practices had significantly lower utilization of the TWW referral pathway. In the postal survey, 22% of GPs were unaware of TWW clinics or colorectal cancer referral guidelines and only 8% of GPs knew the number of referral criteria.

Conclusion  This study demonstrates wide variability within primary care, in the appropriate use of colorectal cancer referral guidelines. General practices should be targeted for education.
The positive correlation between avian species richness and human population density in Britain is not attributable to sampling bias
Authors: Evans Karl L. , Greenwood Jeremy J.D. , Gaston Kevin J.
Published: January 2007

Aim  To assess whether spatial variation in sampling effort drives positive correlations between human population density and species richness.

Location  British 10 × 10 km squares.

Methods  We calculated three measures of species richness from atlas data of breeding birds in Britain: total species richness, species richness standardised for sampling effort, and the number of species only recorded in supplementary casual records in a manner not standardised for survey effort. We then assessed the form of the relationship between these richness estimates and human population density, both with and without taking spatial autocorrelation into account.

Results  Both total and standardised species richness exhibit similar species richness–human population density relationships; species richness generally increases with human population density, but decreases at the very highest densities. Supplementary species richness is very weakly correlated with human population density.

Main conclusions  In this example, sampling effort only slightly influences the form of species richness–human population density relationships. The positive correlation between species richness and human population density and any resultant conservation conflicts are thus not artefactual patterns generated by confounding human density and sampling effort.
A human‐induced downward‐skewed elevational abundance distribution of pteridophytes in the Bolivian Andes
Authors: Jácome Jorge , Kessler Michael , Smith Alan R.
Published: January 2007

Aim  To search for differences in the spatial variability of upper and lower elevational distribution limits of tropical ferns, based on the assumption that these are determined to different degrees by biotic and abiotic factors.

Location  The Yungas biogeographical region, in the Bolivian Andes.

Methods  From a data base of > 25,000 herbarium records, we analysed the skewness of the elevational distribution of 220 montane pteridophyte species, each with  15 records. Additionally, we compared the spatial variability of upper and lower elevational range limits of ferns in 351 plots of 400 m2 each along four elevational transects separated by 15–450 km.

Results  Individual species showed variable elevational distribution patterns, ranging from symmetric to asymmetric, i.e. downward and upward skewed, but overall there was a statistically significant trend towards asymmetric distributions with abrupt upper limits and diffuse lower limits. This trend, however, was almost exclusively due to terrestrial species occurring at and above the current timberline. The analysis of the elevational transects revealed no significant trends.

Main conclusions  The downward‐skewed distributional abundance of terrestrial, open‐country ferns near the timberline appears to be a result of the extensive forest destruction that has lowered the timberline in the high Andes by 500–800 m, opening up habitats for a restricted suite of species. Our study shows that a limited number of species can cause a general trend in the overall data set, and that failure to extract these data may result in unsupported conclusions, in our case to assign a greater importance to biotic and abiotic factors in the elevational limitation of plants at lower and upper elevations, respectively.
Vanishing bile duct syndrome in a patient with advanced AIDS
Authors: Hindupur S , Yeung M , Shroff P , Fritz J , Kirmani N
Published: January 2007

A 39‐year‐old HIV‐infected woman developed signs and symptoms of obstructive jaundice and cholestasis. Serological tests were positive for cytomegalovirus (CMV) infection. There was no evidence of AIDS cholangiopathy in ultrasonography or magnetic resonance cholangiopancreatography (MRCP). A liver biopsy revealed marked ductopenia and the patient was diagnosed with vanishing bile duct syndrome, thought to be secondary to CMV infection as a result of profound immunosuppression. To the best of our knowledge, this is the first reported case of vanishing bile duct syndrome diagnosed in a patient with HIV/AIDS.
Cervical lipomatosis in HIV‐infected patients: a case–control study
Authors: Palacios R , Galindo MJ , Arranz JA , Lozano F , Estrada V , Rivero A , Morales D , Asensi V , Del Arco A , Muñoz A , Santos J ,   for the Grupo de Estudio de Alteraciones Metabólicas (GEAM)
Published: January 2007

Objectives

The aim of the study was to analyse the prevalence of cervical lipomatosis (CL) in HIV‐infected patients on highly active antiretroviral therapy (HAART) and the factors associated with its development.

Methods

This was a multicentre, observational, 1:1 case–control study. HIV‐infected patients with CL (cases) and HIV‐infected patients from the same cohort, controlled for age (±5 years), sex and body mass index (±2.5 kg/m2) (controls), were included in the study, and a multiple conditional logistic regression was performed to identify factors related to CL.

Results

CL was reported in 80 patients (1.8%) from a cohort of 4214 patients on HAART followed up in 10 Spanish hospitals. CL was associated with time of exposure to stavudine [for each 6‐month increase, odds ratio (OR) 5.82, 95% confidence interval (CI) 5.70–5.94, P=0.0073] and lipoatrophy (OR 8.04, 95% CI 2.93–22.02, P=0.00001).

Conclusions

Although lipodystrophy is very frequent among HIV‐infected patients on HAART, CL is an uncommon type of fat redistribution in this population, and in our cohort it was related to time of exposure to stavudine and lipoatrophy.
No association between HIV disease and its treatment and thyroid function
Authors: Madge S , Smith CJ , Lampe FC , Thomas M , Johnson MA , Youle M , Vanderpump M
Published: January 2007

Objectives

The aims of the study were (i) to investigate the prevalence of overt and subclinical thyroid disease in HIV‐positive patients in a London teaching hospital; (ii) to determine risk factors associated with the development of thyroid dysfunction, including highly active antiretroviral therapy (HAART) and individual antivirals, and (iii) to determine the occurrence of thyroid dysfunction longitudinally over 3 years.

Methods

The study consisted of retrospective analyses of thyroid function tests (TFT) in HIV‐positive patients. The period prevalence of and factors associated with clinical and subclinical thyroid dysfunction were investigated. Patients with normal TFT but previous thyroid disease were identified from pharmacy records and included in the overt category.

Results

A total of 1565 patients (73% of the clinic population) had at least one TFT taken since 2001. Overall, 3584 samples were analysed. Of the patients included in the study, 1233 (79%) were male, 1043 (66%) were white and 365 (23%) were black African, and in 969 (62%) the main risk for HIV was homosexual sex. Median age at baseline was 37 years. Nine hundred patients (58%) were on HAART at the start of the study. Thirty‐nine (2.5%) were found to have overt hypothyroidism, and eight (<1%) had overt hyperthyroidism. Sixty‐one (4%) had subclinical hypothyroidism, five (<1%) had subclinical hyperthyroidism and 263 (17%) had a nonthyroidal illness. A normal TFT was obtained for 1118 patients (75.5%). Multivariate analysis suggested that no independent variables were significantly associated with overt hypothyroidism, including HAART and stavudine use specifically. Repeated measurements over 3 years were available for 825 patients and only eight new cases (1%) of overt thyroid disease occurred.

Conclusions

The prevalence of overt thyroid disease was low in this cohort, suggesting that screening is not warranted.