bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of osteoporosis in psoriasis with and without arthritis: correlation with disease severity
Authors: Attia Enas A. S. , Khafagy Ayman , Abdel‐Raheem Sameh , Fathi Sahar , Saad Abeer A.
Published: December 2010

Background  The most frequent extracutaneous association with psoriasis is arthritis. Because proinflammatory cytokines are increased in psoriasis, patients with this disease may be more prone to osteoporosis than the healthy individuals.

Methods  We evaluated 50 patients with psoriasis, with or without psoriatic arthritis (PsA), for the presence and degree of osteoporosis by performing dual energy x‐ray absorptiometry (DEXA) and obtaining serum osteoprotegrin (OPG) levels. In addition, we correlated these results with the extent of skin and joint disease. Psoriasis area and severity index (PASI) was determined in all 50 patients with psoriasis, and total joint score (TJS) was recorded in the 16 patients who also had PsA. Results of DEXA and serum OPG were also obtained for 20 healthy individuals who served as controls.

Results  Osteoprotegrin level was significantly increased in psoriasis patients (with or without PsA) vs. controls. However, DEXA revealed that PsA patients had a higher degree of osteoporosis in the femur neck and wrist. In PsA patients, TJS correlated positively with both disease duration and PASI but correlated negatively with Z score of the femur.

Conclusion  Psoriasis patients with or without arthritis may suffer from osteoporosis as evidenced by significantly increased serum OPG. Prolonged and extensive cutaneous disease is an important risk factor for the development and severity of PsA. Patients with a greater number of affected joints are at higher risk of osteoporosis.
Measuring performance in skin cancer practice: the SCARD initiative
Authors: Rosendahl Cliff , Hansen Craig , Cameron Alan , Bourne Peter , Wilson Tobias , Cook Ben , Baker Martin , Keir Jeff , Dicker Tony , Reid Mike , Williamson Richard , Weedon David , Soyer H. Peter , Youl Philippa H. , Wilkinson David
Published: December 2010

Background  The Skin Cancer College of Australia and New Zealand (SCCANZ) has developed a unique project named SCARD – the Skin Cancer Audit and Research Database. Designed initially as a self‐audit tool for primary care skin cancer practitioners, SCARD acts as a tracking tool to enhance practice safety, and it also creates practice performance reports. Pooling of de‐identified data enables participating practitioners to confidentially compare their own practice to that of their peers. Additionally, this creates a large database with significant research potential, as SCARD records for every lesion de‐identified practitioner and patient data, and extensive details of location, provisional and histological diagnosis, and the procedure(s) performed in its treatment.

Methods  Preliminary data collected in the database have been presented in this study.

Results  An initial pool of data from 177 practitioners contains 77,553 specimens from 41,006 individual patients.

Conclusions  The data presented are being analyzed for further studies, and additional data continues to be collected from this ongoing project. SCARD is a useful tool at practice level, and substantial uptake by Australian primary care skin cancer practitioners has provided a unique opportunity for research into skin cancer and its management. SCCANZ, a professional college of predominantly primary care medical practitioners, with a commitment to the management of skin cancer in Australia and New Zealand, has formed a partnership with the School of Medicine at the University of Queensland to ensure that these data are managed and analyzed appropriately.
Prurigo pigmentosa: a clinicopathological study and analysis of associated factors
Authors: Lu Pei‐Hsuan , Hui Rosaline C.‐Y. , Yang Li‐Cheng , Yang Chih‐Hsun , Chung Wen‐Hung
Published: December 2010

Background  Prurigo pigmentosa (PP), a rare inflammatory disease of the skin, is mostly reported in the ethnic Japanese population. Its pathogenesis remains unclear. The chronic and recurrent nature of PP implies a possible role of viral infection in the pathogenesis. The anti‐inflammatory mechanism of doxycycline, which is well documented as a good treatment for PP, is related to the suppression of interleukin expression.

Methods  We identified and retrospectively analyzed 16 biopsy‐proven and criteria‐matched patients over a seven year period at a single medical center. DNA extracted from formalin‐fixed, paraffin‐embedded specimens was analyzed for herpes simplex virus‐1 (HSV‐1), HSV‐2, and human herpes virus‐6 (HHV‐6) DNA by polymerase chain reaction. Immunohistochemistry was performed to determine the interleukin‐6 (IL‐6) and interleukin‐8 (IL‐8) expression in PP skin lesions.

Results  Clinicopathological findings in the ethnic Chinese population are similar to those reported in Japanese studies. All patients had a good response to doxycycline treatment, with a mean duration of use of 2.4 weeks. However, recurrence was noted in six patients. HSV‐1, HSV‐2, and HHV‐6 DNA in PP skin lesions were negative. Immunohistochemistry showed IL‐6 (P = 0.035) to be more strongly expressed in PP skin lesions. There was no statistical significance of elevated IL‐8 expression in PP (P = 0.123).

Conclusions  Prurigo pigmentosa is not uncommon in the ethnic Chinese population. There was no evidence of herpes virus DNA in PP skin lesions. Increased expression of IL‐6 in PP skin lesions may explain the effects of doxycycline in terms of its anti‐inflammatory properties.
Immunohistochemical expression of cyclooxygenage‐2 in melanocytic skin lesions
Authors: Minami Shoichiro , Lum Christopher A. , Kitagawa Kevin M. , Namiki Thomas S.
Published: December 2010

Background  Several reports have shown expression of cyclooxygenase‐2 (COX‐2) in malignant skin tumors. COX‐2 has also recently been reported as a marker of malignant melanoma (MM).

Objective  Our aim was to investigate whether there is a difference in the immunohistochemical expression of COX‐2 between malignant and benign melanocytic lesions of the skin.

Methods  We selected 40 archival cases of MM including 10 cases of superficial spreading melanoma, 10 of lentigo maligna melanoma, 10 of nodular melanoma, and 10 of acral lentiginous melanoma. For comparison, we also selected 35 benign melanocytic lesions, which included 15 nonatypical nevi and 10 atypical nevi. The remaining 10 cases were Spitz nevi. COX‐2 immunohistochemical staining was performed, and intensities were assessed quantitatively.

Results  The MM group and the benign melanocytic nevi group showed a highly statistically significant difference in the intensity of COX‐2 expression (P < 0.0001). Staining intensity in the dermal component of MM cases also showed a tendency to increase with increasing tumor depth. By contrast, the intensity of the dermal component in the melanocytic nevi group decreased with increasing depth as the nevus cells matured from type A to type C cells. No statistical difference was noted between the MM and Spitz nevi cases (P = 0.20).

Conclusions  Malignant melanoma shows stronger immunohistochemical expression of COX‐2 than benign melanocytic nevi. Although COX‐2 cannot be used alone to differentiate MM from melanocytic nevi, it may serve as an aid in the differential diagnosis of melanocytic skin lesions.
Epidermal changes associated with symptomatic resolution of dandruff: biomarkers of scalp health
Authors: Kerr Kathy , Darcy Trevor , Henry James , Mizoguchi Haruko , Schwartz James R. , Morrall Stephen , Filloon Thomas , Wimalasena Rohan , Fadayel Gina , Mills Kevin J.
Published: December 2010

Background  Dandruff is a common scalp condition characterized by flakes, pruritus and sometimes mild erythema. These symptoms reflect underlying histopathologic and biochemical events that must be reversed if treatment is to be effective.

Objectives  This study aimed to better characterize the state of the epidermis in dandruff and to determine how a defined set of skin surface biomarkers of this state change during a successful course of treatment with a potentiated zinc pyrithione (ZPT) shampoo.

Methods  A population of dandruff sufferers was treated for 3 weeks with a commercial ZPT shampoo or a non‐medicated product, and the effect of treatment on adherent scalp flake (ASF) scores was evaluated. Biopsies were taken from lesional sites at baseline and at the end of the study for histomorphometric and histopathologic analysis. Stratum corneum (SC) samples were likewise obtained for evaluation of biochemical markers of inflammation (IL‐1α, IL‐1RA, IL‐8) and barrier integrity (keratin 1, 10, 11; involucrin; SC lipids; human serum albumin). The biomarker profile was evaluated first by comparison with that in non‐dandruff subjects at baseline, and then to determine whether any treatment‐induced changes were correlated with reductions in flaking in dandruff sufferers.

Results  Taken together, our studies showed that treatment with the ZPT shampoo led to an improvement in the overall scalp condition as assessed by the resolution of flaking, reduction in epidermal thickness and inflammatory biomarkers, and a dramatic improvement in biomarkers of epidermal barrier integrity.

Conclusions  The combination of biomarkers examined appears to be a good overall descriptor of the health of the scalp in dandruff, and changes in these biomarkers track with tissue‐level events that underlie clinical efficacy in the treatment of dandruff by ZPT shampoo. For the first time, we demonstrate a set of tools that extend beyond flaking scores to provide insight into specific biological changes occurring on the scalp to enable an objective assessment of scalp health.
A novel homozygous splice site mutation in COL7A1 in a Chinese patient with severe recessive dystrophic epidermolysis bullosa and squamous cell carcinoma
Authors: Huang Lin , Wong Yim‐Ping , Burd Andrew
Published: December 2010

Background  Recessive dystrophic epidermolysis bullosa (RDEB) is an inherited blistering skin disorder caused by mutations in COL7A1 gene encoding type VII collagen, the major component of anchoring fibrils in the dermo–epidermal junction. The development of cutaneous squamous cell carcinoma (SCC) is one of the most serious complications of this disease. We report herein a Chinese patient with the severe generalized subtype of RDEB (RDEB‐sev gen) complicated by SCC.

Methods  Skin biopsies were examined for histology, basement membrane ultrastructure, and type VII collagen expression. Genomic DNA was extracted from the peripheral blood samples and subjected to polymerase chain reaction amplification and direct automated DNA sequencing.

Results  Histopathological examination of the patient’s skin revealed an undetectable expression of type VII collagen polypeptides in the basement membrane zone. Mutation analysis identified a novel splice site mutation in intron 64 (IVS64+5g‐>a) of COL7A1 gene, which resulted in an in‐frame deletion of exon 64 in both alleles.

Conclusions  This report contributes to the expanding database of COL7A1 mutations and emphasizes the need to elucidate the underlying genetic mechanisms associated with the increased incidence of SCC in RDEB patients.
Purpuric macules with vesiculobullous lesions: a novel manifestation of Chikungunya
Authors: Pakran Jaheersha , George Mamatha , Riyaz Najeeba , Arakkal Riyaz , George Sandhya , Rajan Uma , Khader Anza , Thomas Sumi , Abdurahman Rahima , Sasidharanpillai Saritha , Thumbayil Lekha
Published: December 2010

Background  Chikungunya (CHIK) is an emerging viral disease with a myriad of cutaneous manifestations.

Aims  The aim of our study was to document the morphology and evolution of skin lesions in cases presenting with fever, purpuric macules and vesiculobullous lesions, to confirm its causative relationship with CHIK, and to investigate further in order to delineate possible mechanisms of bulla formation in these cases.

Materials and Methods  A prospective, descriptive hospital‐based study was carried out at a tertiary health care centre in Kerala. A total of 10 patients were enrolled in the study and investigated.

Results  All cases had morbilliform eruption prior to onset of purpuric macules. Eight cases developed vesiculobullous lesions that arose either de novo or over a part or whole of the purpuric macules. Skin lesions resolved within an average of 7.6 days leaving post‐inflammatory hypopigmentation. IgM CHIK enzyme‐linked immunosorbent assay (ELISA) was positive in all 10 patients. Tzanck smear from the bullae showed lymphocytes in most cases along with acantholytic cells, necrotic keratinocytes or occasional neutrophils. Skin biopsy showed intraepidermal or subepidermal bullae. Immunohistochemistry revealed predominantly CD8 positive T lymphocytes in the infiltrate. The prognosis was good with supportive management alone.

Discussion  The clinical features in our cases are comparable to the 3 previous reports of vesiculobullous lesions in CHIK affected infants. Based on the current evidence, we hypothesize that at least 2 mechanisms are at play for these skin lesions; CHIK virus induced keratinocyte necrosis followed by a cytotoxic immune response, and possible modulation of rash by drugs.

Conclusion  With severe epidemics of CHIK spreading from Asia and Africa to the Western hemisphere, we must consider bullous CHIK as a differential diagnosis in cases with fever and purpuric and vesiculobullous lesions.
Full‐spectrum light phototherapy for atopic dermatitis
Authors: Byun Hee Jin , Lee Hye In , Kim Beomjoon , Kim Myeung Nam , Hong Hyuckki , Choi Yeonshik , Jo Youngchang , Cho Kwang Hyun , Mun Seog‐Kyun
Published: December 2010

Background  Atopic dermatitis (AD) is a chronic skin disease resulting in a profound deterioration in quality of life. The FSL® is a newly developed phototherapy device generating full‐spectrum light (FSL) with a continuous wavelength (320–5000 nm). This study aimed to evaluate the efficacy and safety of FSL® phototherapy in AD.

Methods  We enrolled 38 patients with moderate to severe AD in this open, randomized, controlled, prospective study. In the FSL‐irradiated group (20 patients), irradiation was conducted twice per week for 4 consecutive weeks. In the control group (18 patients), only emollient application was allowed. SCORing Atopic Dermatis (SCORAD) values were obtained at baseline, week 4 and 8. Patients were asked to give subjective assessments of improvement and laboratory tests including serum eosinophil counts, ECP levels, IgE levels and 22 cytokine levels were performed.

Results  In the FSL‐irradiated group, the mean SCORAD value decreased significantly after 4 weeks of phototherapy and remained reduced for a further 4 weeks after the cessation of treatment. In the control group, the mean SCORAD value did not change significantly over the study period. Patients’ subjective assessments indicated good to excellent responses in 75% of the FSL‐irradiated group, by contrast with 50% of the control group. The mean values for serum eosinophil counts, IL‐4 and IL‐5 levels decreased significantly after FLS phototherapy. No serious adverse effects were reported.

Conclusions  In this study, we showed that FSL® phototherapy can be an effective and safe treatment option in AD.
Tuberous sclerosis complex: tumors and tumorigenesis
Authors: Borkowska Julita , Schwartz Robert A. , Kotulska Katarzyna , Jozwiak Sergiusz
Published: December 2010

Tuberous sclerosis complex (TSC) is an inherited disorder characterized by hamartomas in different body organs, mainly in the brain, skin, kidney, liver, lung, and heart. The clinical manifestations of TSC are the result of a mutation of one of two tumor suppressor genes, TSC1 and TSC2. Cutaneous findings in TSC should be regarded as cutaneous signs of a pivotal systemic disease. The authors elucidate the variety of neoplasms seen in TSC patients, along with their clinical significance, and suggest suitable evaluation and management strategies.
How pharmacogenomics of biological response modifiers will influence clinical response and toxicity in dermatology
Authors: Dalle Stéphane , Thomas Luc , Shear Neil H.
Published: December 2010

Biological response modifiers (BRMs) have dramatically changed therapeutic approaches in dermatology. Pharmacogenomic studies are increasingly integral to the early development phases of targeted therapies. The first evidence supporting the impact that genetic background has on responses to BRMs was from rituximab, where the clinical response was correlated with Fc‐gamma receptor gene polymorphisms. Later, many studies were done to investigate the impact of gene polymorphism on the mechanism of action of BRMs. Growing evidence supports the view that both efficacy and toxicity of BRMs can be highly influenced by genetic background. The foreseeable objective is to select personalized therapeutics, based on genetics characteristics that will result in more efficient and less toxic treatment. We review the current data focusing on the BRMs widely used in the practice of dermatology.
Bone mineral disease in children after renal transplantation in steroid‐free and steroid‐treated patients – a prospective study
Authors: Grenda Ryszard , Karczmarewicz Elżbieta , Rubik Jacek , Matusik Halina , Płudowski Paweł , Kiliszek Małgorzata , Piskorski Jarosław
Published: December 2010

Grenda R, Karczmarewicz E, Rubik J, Matusik H, Płudowski P, Kiliszek M, Piskorski J. Bone mineral disease in children after renal transplantation in steroid‐free and steroid‐treated patients – a prospective study. Pediatr Transplantation 2011: 15:205–213. © 2010 John Wiley & Sons A/S.

Abstract:  Bone disease may persist after transplantation. Different approaches aiming to ameliorate this problem have been investigated. The aim of the study was to compare the long‐term effect of three medical interventions: (i) two prophylactic oral doses of 50 mg ibandronate; (ii) daily oral dose of 0.25 μg of 1α‐OHD3 (both of these regimens in patients receiving steroids), and (iii) steroid minimization immunosuppressive protocol in patients with no other specific prophylaxis. Patients: A total of 37 children, at a mean age of 13.33 ± 3.49 yr, dialyzed for 15.93 ± 16.7 months before transplantation, were divided into three groups, depending on medical intervention. Bone mineral content and density (BMC, BMD, DXA), serum markers of bone resorption and formation (CTX, P1NP), calcium, phosphate, 25OHD3/1.25 (OH)2D3 and PTH concentration were evaluated during two yr of follow‐up. The mean values of BMD in the whole population and among the three subgroups remained within the age‐ and gender‐matched normal range during follow‐up. Patients from groups II (alphacalcidiol) and III (steroid minimization) showed a significant decrease in BMD Z‐scores over time, and this effect was determined with increasing age using multivariate analysis. Patients receiving two doses of ibandronate maintained unchanged Z‐scores for BMD and BMC over time.
Biomarkers of liver fibrosis
Authors: Adams Leon A
Published: December 2010

Fibrosis prediction is an essential part of the assessment and management of patients with chronic liver disease. Blood‐based biomarkers offer a number of advantages over the traditional standard of fibrosis assessment of liver biopsy, including safety, cost‐savings and wide spread accessibility. Current biomarker algorithms include indirect surrogate measures of fibrosis, including aminotransaminases and platelet count, or direct measures of fibrinogenesis or fibrinolysis such as hyaluronic acid and tissue inhibitor of metalloproteinase‐1. A number of algorithms have now been validated across a range of chronic liver disease including chronic viral hepatitis, alcoholic and non‐alcoholic fatty liver disease. Furthermore, several models have been demonstrated to be dynamic to changes in fibrosis over time and are predictive of liver‐related survival and overall survival to a greater degree than liver biopsy. Current limitations of biomarker models include a significant indeterminate range, and a predictive ability that is limited to only a few stages of fibrosis. Utilization of these biomarker models requires knowledge of patient co‐morbidities which may produce false positive or negative results in a small proportion of individuals. Furthermore, knowledge of the underlying prevalence of fibrosis in the patient population is required for interpretation of the positive or negative predictive values of a test result. Novel proteins identified by proteomic technology and genetic polymorphisms from genome association studies offer the possibility for further refinement and individualization of biomarker fibrosis models in the future.
Alteration in the phenotype of macrophages in the repair of renal interstitial fibrosis in mice
Authors: KUSHIYAMA TAKETOSHI , ODA TAKASHI , YAMADA MUNEHARU , HIGASHI KEISHI , YAMAMOTO KOJIRO , SAKURAI YUTAKA , MIURA SOICHIRO , KUMAGAI HIROO
Published: December 2010

Aim:  Renal interstitial fibrosis is the final common pathway determining long‐term prognosis of chronic kidney diseases, but its repair process is scarcely understood. Because recent reports indicate that M2 macrophages play important roles in the repair of various tissues, special attention was paid to the phenotypes of infiltrating macrophages in the present study when the histological changes occurring in mouse kidneys after the release of unilateral ureteral obstruction (UUO) inducing renal fibrosis were analyzed.

Methods:  The left ureter of male mice was obstructed for 10 days by using a vascular clamp, and that kidney was removed for analysis either on the day when the clamp was removed or after the kidney had been allowed to recover for 3, 7 or 21 days.

Results:  Interstitial fibrosis assessed by picrosirius red staining decreased with time after the release, and this decrease was paralleled by a decrease in the interstitial area positive for α‐smooth muscle actin. Macrophage infiltration assessed by F4/80 staining also significantly decreased from day 3. In contrast, real‐time reverse transcription polymerase chain reaction revealed that the ratios of mRNA for the macrophage scavenger receptor (CD204) and the mannose receptor (CD206), both of which are preferentially expressed on M2 macrophages, to CD68 (a general macrophage marker) were significantly greater on day 7 than on day 0 in the UUO‐released mice.

Conclusion:  Although the total number of infiltrating myofibroblasts and macrophages decreased after UUO release, the ratios of macrophages expressing CD204 and CD206 increased, suggesting that M2 macrophages play an important role in the repair of renal fibrosis.
Sterol biosynthesis in the harmful marine dinoflagellate, Karenia brevis: Identification of biosynthetic intermediates produced during exposure to the fungicide fenpropidine
Authors: Leblond Jeffrey D. , Roche Shannon A. , Porter Nicole M. , Howard James C. , Dunlap Norma K.
Published: December 2010

Karenia brevis is a harmful marine dinoflagellate that forms yearly blooms in the Gulf of Mexico. Under normal growth conditions, K. brevis forms two predominant sterols (24R)‐4α‐methyl‐5α‐ergosta‐8(14),22‐dien‐3β‐ol (gymnodinosterol) and its 27‐nor isomer (brevesterol). At the current time, there are no published studies concerning the biosynthesis of these two sterols. We have therefore undertaken experiments in which K. brevis was exposed to the fungicide fenpropidine, an inhibitor of the Δ14‐reductase and the Δ8→7‐isomerase that operate in sterol biosynthesis in both fungal and plant systems. Such exposure to fenpropidine has produced two, tri‐unsaturated intermediates. The identifications of these two K. brevis sterol biosynthesis intermediates, via gas chromatography/mass spectrometry and nuclear magnetic resonance spectroscopy techniques, were 4α‐methyl‐5α‐ergosta‐8,14,22‐trien‐3β‐ol and 5α‐ergosta‐8,14,22‐trien‐3β‐ol.
Conjugation processes of Penium margaritaceum (Zygnemophyceae, Charophyta)
Authors: Tsuchikane Yuki , Tsuchiya Miki , Kokubun Yume , Abe Jun , Sekimoto Hiroyuki
Published: December 2010

Detailed conjugation processes in Penium, a unicellular conjugating green alga, are described for the first time. A homothallic strain of Penium margaritaceum (Ehrenb.) Bréb. (Designation, izu84‐10) was isolated from a rice paddy field in Japan. The species was identified based on its morphology, and a molecular phylogeny confirmed that izu84‐10 was closely related to another identified strain of this species. Using time‐lapse photography, the conjugation processes in P. margaritaceum were observed and then categorized into the following six stages: (1) cell division, resulting in the formation of two sister gametangial cells from one vegetative cell; (2) formation of a sexual pair between the two sister gametangial cells (or between gametangial cells of another nearby individual); (3) formation of conjugation papillae by elongation of the cell wall; (4) release of a gamete from one of the pair members; (5) release of a gamete from the other pair member; and (6) formation of the zygospore by gamete fusion. By alcian blue staining, possible involvement of mucilage to facilitate this cell adhesion and cell–cell communication was suggested.
Cellular therapies for lung disease: A distant horizon
Authors: MOODLEY Yuben , MANUELPILLAI Ursula , WEISS Daniel J.
Published: December 2010

Lung diseases constitute a major global burden of health and are characterized by inflammation and chronic fibrosis resulting in a loss of gas exchange units. To date there has been no effective treatment to reverse these chronic inflammatory changes and tissue remodelling. Recently, stem cells have been shown to successfully treat animal models of lung disease. In addition, certain cells have demonstrated a capacity to differentiate into lung cells. Based on these preliminary data, there are clinical trials underway to examine the potential for cellular therapies in lung disease. Recently, there have been a variety of cell examined for both their immunomodulatory effects on the lung as well as their potential for differentiation into lung cells. These range from lung progenitor cells, circulating cells, mesenchymal stem cells (MSCs), induced pluripotent stem cells (iPS), placental stem cells and embryonic stem cells (ESCs). Several cell types demonstrate immunomodulatory effects including circulating cells, MSCs and placental stem cells. In addition, iPS, placental cells and ESCs have shown some capacity for differentiation.

Despite these major steps forward cellular therapy for lung diseases still faces challenges. Issues that need to be resolved include bioethical issues, the safety of cell transplantation, ideal routes of delivery, the timing and the specific indications that would make cellular therapy effective.
Effects of a nematode Meloidogyne incognita and its interaction with above‐ground herbivory on an invasive wetland plant, alligator weed (Alternanthera philoxeroides)
Authors: MAO RUNPING , LU XINMING , DING JIANQING
Published: December 2010

Invasive plants may be attacked both above ground and below ground. Few studies have, however, investigated the simultaneous effects of above‐ground and below‐ground herbivory. In the present study, we report the effects of beetle herbivory and nematode infection on alligator weed, Alternanthera philoxeroides, an invasive plant in China. We found that the root‐knot nematode Meloidogyne incognita widely occurred on the plant in south China. To examine its effect on the plant in conjunction with above‐ground herbivory, we conducted a field common garden experiment with a local insect defoliator, Cassida piperata. We also included the native congener Alternanthera sessilis in our experiments for a comparison of the response of invasive and native species. We found no significant effects on plant biomass of the nematode infection in conjunction with the above‐ground herbivory. Further chemical analysis, however, showed that the water‐soluble carbohydrate content in roots of A. philoxeroides was significantly increased in plants attacked by both the nematode and the herbivore compared with the water‐soluble carbohydrate content in plants attacked by only the nematode or herbivore alone. We found no such change in the native congener A. sessilis. Together these results may suggest that A. philoxeroides tolerates joint above‐ground and below‐ground damage by allocating more resources to below‐ground material.
Current state of laparoscopic rectal cancer surgery in Australasia
Authors: Ong Eugene J. S. , Stevenson Andrew R. L.
Published: December 2010

Background:  To establish the current surgical approach to rectal cancer in a group of colorectal surgeons in Australasia and the current opinion regarding laparoscopic rectal cancer surgery.

Methods:  An online survey was distributed to the Colorectal Surgical Society of Australia and New Zealand members.

Results:  123/177 surgeons responded. During the last year, 94.3% had performed a laparoscopic colorectal case, 77.2% a laparoscopic rectal case and 65% a laparoscopic rectal cancer case. The most common approach to high anterior resection was pure laparoscopic (52.8%). Low anterior resections were most commonly performed with a laparoscopic component (25.2% pure laparoscopic, 33.3% hybrid). Most surgeons (>50%) performed ultra‐low anterior resections or abdomino‐perineal resections via an open technique. In addition, 64.2% intended to perform laparoscopic total mesorectal excision (TME) within 2 years. Most surgeons believe that the quality of laparoscopic TME and oncological outcomes are similar, and surgical access and short‐term outcomes are superior when compared to the open procedure. The major concerns were in performing a low rectal transection, controlling haemorrhage and resource utilization/cost.

Conclusion:  Laparoscopic rectal surgery is now widely practiced by Australasian colorectal surgeons and projected to increase in the near future. However, only 10% of surgeons are routinely performing total laparoscopic ultra‐low anterior resections which may have implications for the generalizability of clinical trials in laparoscopic TME and the ability to credential surgeons in this technically challenging field. Quality of TME and oncological outcomes were rated similar to the open operation. Areas of concern included low rectal transection, haemorrhage control and resource utilization/cost.
Operative experience of general surgeons in a rural hospital
Authors: Campbell Nicole A. , Kitchen Graham , Campbell Ian A.
Published: December 2010

Background:  There is a lack of published data on the range of procedures currently carried out by rural general surgeons. The aim of this study is to demonstrate the diversity of conditions encountered and managed by rural general surgeons, in order to determine the scope of training necessary to adequately equip trainees for rural practice.

Methods:  An audit of surgical procedures completed by two surgeons over 5 years from June 2004 to June 2009 in a rural Victorian hospital was carried out. Operations were further categorized into specialty groups.

Results:  A total of 8336 operations were completed over 5 years, by two surgeons servicing a catchment population of 54 000 people. Traditional general surgical procedures accounted for 44.3% with endoscopies accounting for a further 27.4% of cases. The remainder was accounted for by 11.8% orthopaedics, 4.5% urology, 4.4% vascular (including pacemaker insertion), 3.4% ear, nose and throat, 2.7% neurosurgery, 0.88% obstetrics and 0.42% thoracics. There was a need to be able to perform procedures well outside the field of traditional general surgery, including multisystem trauma, vascular emergencies, caesarean sections and post‐partum hysterectomy.

Conclusion:  General surgeons servicing small rural communities are required to carry out a variety of procedures outside the realms of traditional general surgery. Trainees need to acquire a broad skill base, and should be competent managing surgical emergencies across all specialties. A supportive team of medical, nursing and paramedical staff are required for achieving the best outcome for patients.
Parathyroid carcinoma: increasing incidence and changing presentation
Authors: Brown Sebastian , O'Neill Christine , Suliburk James , Sidhu Stan , Sywak Mark , Gill Anthony , Robinson Bruce , Delbridge Leigh
Published: December 2010

Background:  Parathyroid carcinoma has been regarded as an exceedingly rare disease worldwide, responsible for less than 1% of cases of primary hyperparathyroidism. However, there have been anecdotal reports recently of an increasing number of patients presenting with parathyroid carcinoma. The aim of this study was to examine the changing incidence and presentation of parathyroid cancer within a single centre.

Patients and methods:  This is a retrospective case series. Data were obtained from the University of Sydney Endocrine Surgical Unit database, as well as a review of hospital records. All pathology was independently reviewed.

Results:  Over the 52‐year period of the study from 1958 to 2010, there were 21 cases of confirmed parathyroid cancer. Only three cases were reported in the first 30 years of the study with the majority of cases (n= 11) presenting in the last 5 years. Despite the exponential increase in presentations, no significant differences in demographics or mode of presentation were found.

Conclusion:  Possible reasons for the dramatic increase in parathyroid cancer include increased screening, an increase in referrals for parathyroid surgery overall associated with the availability of minimally invasive techniques, changes in diagnostic techniques with immunohistochemistry for parafibromin and protein gene product 9.5 (PGP9.5) or possibly a true increase in the incidence of the disease.
Quantitative lymph node evaluation as an independent marker of long‐term prognosis in stage III rectal cancer
Authors: Vather Ryash , Sammour Tarik , Kahokehr Arman , Connolly Andrew , Hill Andrew
Published: December 2010

Background:  The prognostic significance of lymph node evaluation is not well described for rectal cancer due to a lack of reproducibility in nodal counts and variable use of adjuvant and neoadjuvant therapy. The aim of this study was to examine the role of quantitative lymph node evaluation as an independent marker of prognosis in stage III rectal cancer.

Methods:  New Zealand Cancer Registry data were retrieved for consecutive patients with rectal cancer from January 1995 to July 2003. Cases with node‐negative tumours, distant metastases, death within 30 days of surgery and incomplete data fields were excluded. Three nodal stratification systems were investigated – Total Number of Nodes examined (TNN), Absolute number of Positive Nodes (APN) and Lymph Node Ratio (LNR). Univariate and Cox regression analyses were performed with 5‐year all‐cause mortality as the primary end point.

Results:  The study identified 895 stage III rectal cancer cases. The mean APN and LNR were significantly higher in patients who died within 5 years. An increasing APN or LNR was associated with a significant increase in 5‐year mortality. The APN and LNR were also powerful predictors of 5‐year mortality after correcting for other factors using Cox regression. The TNN was of no prognostic significance.

Conclusions:  Both the APN and LNR are highly effective at independently predicting and stratifying 5‐year mortality in stage III rectal cancer. The significant predictive value of the LNR is likely to be a reflection of the APN rather than one functioning in autonomy, given that the TNN was of no prognostic significance.
Fresh frozen cadavers in surgical teaching: a gelatine arterial infusion technique
Authors: Jansen Shirley , Kirk Darryl , Tuppin Kristie , Cowie Margaret , Bharadwaj Avinash , Hamdorf Jeffrey M.
Published: December 2010

Background:  Fresh frozen human cadavers have been used at the Clinical Training and Evaluation Centre, The University of Western Australia, Perth, WA for years and are an excellent model for surgical dissection thanks to their representative tissue quality. Differentiation between artery and vein can be difficult as both collapse post mortem. A historical technique was therefore refined to increase arterial rigidity using gelatine prior to freezing.

Methods:  Two fresh human cadavers were selected after ethical approval. Gelatine was infused into the carotid artery in one, and into the common femoral artery in the second at a more dilute concentration. In both cases, infusion continued until the rate slowed spontaneously indicating filling prior to setting. The cadavers were frozen according to our standard policy and thawed for a teaching course.

Results:  These were observational. Examination by palpation and dissection after freezing and subsequent thawing revealed arterial turgor to have developed at the popliteal and brachial levels in the first cadaver, and to the distal vessels in the second. Arterial/venous discrimination was therefore enhanced and confirmed by participant feedback on subsequent courses.

Conclusion:  The fresh frozen cadaver is already a superior model for teaching thanks to its near life‐like representation of tissue quality and handling. A successful technique for infusion of gelatine into the arterial tree of fresh human cadavers prior to freezing has been refined resulting in enhancement of arterial/venous discrimination during anatomical, interventional and surgical teaching, further optimizing its use in teaching and this now our standard means of preparation.
Iatrogenic upper limb nerve injuries: a systematic review
Authors: Zhang John , Moore Abigail E. , Stringer Mark D.
Published: December 2010

Purpose:  Peripheral nerve injuries are among the most frequent iatrogenic complications and are responsible for considerable morbidity and litigation. Most occur within surgical settings and upper limb nerves are most frequently involved.

Methods:  A systematic review of major iatrogenic upper limb nerve injuries was undertaken to evaluate the contemporary spectrum of such injuries. The electronic databases MEDLINE, PubMed, Cochrane Library and Google Scholar were searched for relevant articles listed between January 2000 and May 2010. Iatrogenic injuries to the brachial plexus, radial, axillary, ulnar, median, musculocutaneous and major cutaneous nerves were analysed, focusing on context, mechanisms of injury and incidence.

Results:  Iatrogenic upper limb nerve injuries are relatively common and can affect patients in any surgical specialty. Even patients undergoing diagnostic procedures under general anaesthesia are at risk. Orthopaedic surgery and plastic and reconstructive surgery figure prominently in these complications. The spectrum of iatrogenic peripheral nerve injuries has changed in parallel with technological advances in surgery, anaesthesia and medicine.

Conclusions:  Some iatrogenic upper limb peripheral nerve injuries may be unavoidable, but most cases are probably preventable by an adequate knowledge of surgical anatomy and an awareness of the types of procedures in which peripheral nerves are particularly vulnerable.
Acceptance of a 5‐mm distal bowel resection margin for rectal cancer: is it safe?
Authors: Rutkowski A. , Nowacki M. P. , Chwalinski M. , Oledzki J. , Bednarczyk M. , Liszka‐Dalecki P. , Gornicki A. , Bujko K.
Published: December 2010

Aim  Acceptance of a short distal bowel margin results in a higher rate of anterior resection but may compromise oncological safety. This study aimed to evaluate the safety of a 5‐mm distal margin.

Method  A retrospective analysis was carried out of 412 consecutive patients with rectal cancer treated with anterior resection with a negative circumferential resection margin. Radiotherapy was given to 63% of patients with an advanced tumour. The median follow up was 75 months.

Results  Fewer patients in the group with a distal margin of ≤ 5 mm had a tumour with an advanced pT stage compared to patients in the group with a distal margin of > 5 mm (P = 0.033). Two patients were converted to abdominoperineal resection because of a positive ‘doughnut’, leaving 410 patients, in whom 5.4% (95% CI, 0–11.3%) of the group with a distal margin of ≤ 5 mm had local recurrence at 5 years compared with 4.2% (95% CI, 2.1–6.3%) of the group with a distal margin of > 5 mm (P = 0.726). The corresponding figures for the 5‐year overall survival were 82.4% (95% CI, 72.6–92.2%) vs 76.3% (95% CI, 71.8–80.8%) (P = 0.581). All four anastomotic recurrences occurred in the group with a distal margin of > 5 mm.

Conclusion  A distal margin of ≤ 5 mm did not compromise oncological safety in patients undergoing preoperative radiation for an advanced rectal cancer.
Extending the indications and anatomical limits of pelvic lymph node dissection for prostate cancer: improved staging or increased morbidity?
Authors: Touijer Karim , Fuenzalida Rodrigo Pinochet , Rabbani Farhang , Paparel Philippe , Nogueira Lucas , Cronin Angel M. , Fine Samson W. , Guillonneau Bertrand
Published: December 2010

Study Type – Therapy (case series)

Level of Evidence 4

OBJECTIVE

To assess, in a risk/benefit analysis, the additional risk for complications and benefits of extending the indications and anatomical limits of pelvic lymph node dissection (PLND).

PATIENTS AND METHODS

In total, 971 consecutive patients with clinically localized prostate cancer underwent laparoscopic radical prostatectomy from 2003–2007.

Before 1 February 2005, patients with a nomogram probability of lymph node invasion (LNI) <2% did not undergo PLND (No PLND group), whereas those with a LNI ≥2% had a PLND limited to the external iliac nodal group (limited PLND group).

After 1 February 2005, all patients underwent a standard PLND including the external iliac, hypogastric and obturator fossa nodal groups (standard PLND group).

The risk parameters were PLND‐related complications and operating time. Complications were graded using a modified Clavien classification. The benefit was the detection of nodal metastases.

RESULTS

In the subgroup of patients with a LNI ≥2%, standard PLND was a superior operation than the limited PLND in detecting nodal metastases (14.3% vs 4.5%, respectively; P = 0.003).

The risk/benefit of standard vs limited PLND would be one additional grade 3 complication per 20 additional patients with nodal metastases. In the subgroup of patients with LNI <2%, three patients (1.0%) had positive nodes after a standard PLND.

The risk/benefit of standard PLND vs no PLND would be one additional grade 3 complication per three or four additional patients with nodal metastasis. The no PLND group was associated with the lowest risk of grade 1, 2 and 3 complications compared to either the limited or standard PLND groups (P < 0.001).

CONCLUSIONS

In patients with LNI ≥2%, standard PLND detects more nodal metastasis. PLND is associated with higher but non‐prohibitive complications rate.

The present study found no evidence that the incidence of complications would be reduced by a limited PLND.
Are men on 5α‐reductase inhibitors appropriately referred to urology? A survey of primary care physicians
Authors: Yafi Faysal A. , Aprikian Armen G. , Tanguay Simon , Kassouf Wassim
Published: December 2010

Study Type – Therapy (practice pattern survey)

Level of Evidence 2b

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

Benign prostatic hyperplasia is one of the most common urologic conditions encountered by general practitioners. 5‐alpha‐reductase inhibitors are newer drugs used for its treatment. Their use, however, can affect PSA kinetics and potentially mask the early detection of prostate cancer.

This study further confirms that most general practitioners prefer to use alpha‐blockers over 5‐alpha‐reductase inhibitors in the management of BPH. Furthermore, it clearly shows that there is a lack of awareness of the effect of these medications on PSA kinetics and, as such, further education among GPs is recommended about these drugs in order to optimize their usage at the primary care level and to avoid delays in cancer detection.

OBJECTIVE

• To investigate among general practitioners (GPs) their level of awareness and indications for urological consultations in patients treated with 5α‐reductase inhibitors (5ARIs).

SUBJECTS AND METHODS

• We conducted a survey of GPs in Quebec.

• Questions covered GPs’ preferred benign prostatic hyperplasia (BPH) management, knowledge of 5ARIs, their role in prostate cancer prevention, and triggers for urology consultation.

RESULTS

• Of the surveys mailed, 599 were returned (15.7% response rate).

• Therapy with 5ARIs was initiated by GPs in 34.3%, with 20% and 12% preferring 5ARIs alone and combined with an α‐blocker as first‐line therapy for BPH, respectively.

• Once on therapy, 74% did not refer to a urologist if the PSA level did not decline after 6–12 months.

• Finally, 40.7% would not advocate 5ARI chemoprevention for prostate cancer, regardless of risk reduction.

• Findings were not associated with GP gender, experience or geographic location of practice (urban versus rural).

CONCLUSIONS

• There was a preference amongst GP to use α‐blockers over 5ARIs for BPH and hesitancy to use them in prostate cancer chemoprevention.

• There is a lack of awareness of 5ARI effects on PSA kinetics and a reluctance to refer to a urologist.

• Further education in Quebec is needed about 5ARIs to optimize their usage and avoid delaying cancer detection.
Laparoscopic partial nephrectomy for multiple tumours: feasibility and analysis of peri‐operative outcomes
Authors: Tsivian Alexander , Tsivian Matvey , Benjamin Shalva , Sidi A. Ami
Published: December 2010

Study Type – Therapy (case series)

Level of Evidence 4

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

Laparoscopic nephron‐sparing procedures have been increasingly utilized. However, in the presence of multiple tumours the procedure choice is usually shifted to radical nephrectomy.

In view of favourable perioperative outcomes, the benefits of minimally‐invasive, nephron‐sparing surgery in experienced hands could be safely extended to patients presenting with multiple ipsilateral renal masses.

OBJECTIVE

To describe our experience with laparoscopic partial nephrectomy (LPN) for multiple kidney tumours and compare the outcomes with LPN performed for single masses.

PATIENTS AND METHODS

Retrospective analysis of medical records of patients undergoing LPN at our institution between 2005 and 2009 was performed.

The cohort was divided in two groups based on tumour focality: group 1, LPN for a single tumour (n= 99) and group 2, LPN for multiple ipsilateral tumours (n= 12).

The groups were compared with regards to demographic and peri‐operative variables.

RESULTS

Demographic variables were not different between the groups. Median dominant tumour size was 3.1 cm (interquartile range [IQR] 2.4–4.0) and 4.0 cm (2.3–5.9) in groups 1 and 2, respectively.

Median secondary tumour size in group 2 was 1.0 cm (1.0–1.8).

Operative times were longer in group 2 compared with group 1 (220 vs 160 min, P= 0.009).

Warm ischaemia times (WIT) (23 vs 22 min) and estimated blood loss (EBL) (100 vs 85 mL) were similar.

CONCLUSIONS

LPN is a viable option for the treatment of multiple ipsilateral renal tumours.

Peri‐operative outcomes are similar to standard LPN with the exception of longer operative time.

In experienced hands, the advantages of minimally invasive surgery may be extended to select patients with ipsilateral multifocal renal tumours.
HORIZONTAL MERGERS, STRUCTURAL REMEDIES, AND CONSUMER WELFARE IN A COURNOT OLIGOPOLY WITH ASSETS*
Authors: VERGÉ THIBAUD
Published: December 2010

Competition authorities sometimes require that firms divest some of their assets to rivals in order to allow a merger to take place. This paper extends the results of Farrell and Shapiro [1990a] and shows that, in the absence of technological synergies, a merger is highly unlikely to benefit consumers, even if it is subjected to appropriate structural remedies. For instance, a merger may ultimately lead to a lower price only if at least two different firms acquire the divested assets, and if the merging parties had relatively important pre‐merger market shares.