bluuebunny/crossref_metadata_2025 huggingface dataset:
Uniformly closed replaced AKTT or ∗AKTT condition to get strong convergence theorems for a countable family of relatively quasi-nonexpansive mappings and systems of equilibrium problems
Authors: Zhang Jingling , Su Yongfu , Cheng Qingqing
Published: May 2014

The purpose of this paper is to construct a new iterative scheme and to get a strong convergence theorem for a countable family of relatively quasi-nonexpansive mappings and a system of equilibrium problems in a uniformly convex and uniformly smooth real Banach space using the properties of generalized f-projection operator. The notion of uniformly closed mappings is presented and an example will be given which is a countable family of uniformly closed relatively quasi-nonexpansive mappings but not a countable family of relatively nonexpansive mappings. Another example shall be given which is uniformly closed but does not satisfy condition AKTT and ∗AKTT. Our results can be applied to solve a convex minimization problem. In addition, this paper clarifies an ambiguity in a useful lemma. The results of this paper modify and improve many other important recent results.

MSC:47H05, 47H09, 47H10.
Intestinal permeability in children/adolescents with functional dyspepsia
Authors: Neilan Nancy A , Garg Uttam C , Schurman Jennifer Verrill , Friesen Craig A
Published: May 2014

Background

An altered intestinal mucosal barrier has been demonstrated in subsets of patients with IBS and FAP and may be an additional biological factor contributing to symptom generation in children with FD. The objective of this study was to determine if intestinal permeability is increased in children/adolescents with functional dyspepsia (FD) and whether intestinal permeability is correlated with mucosal inflammation and/or symptoms of anxiety or depression in this population.

Methods

A sugar absorption test was performed in 19 patients with FD and 19 controls. Anxiety and depression were assessed in both groups utilizing a standard questionnaire. In FD patients, duodenal mean and peak mast cell and eosinophil densities were determined.

Results

Intestinal permeability as measured by the sugar absorption test did not differ between children with FD and controls. In children with FD, there was no correlation between permeability and mast cell density, eosinophil density, anxiety scores, or depression scores, respectively.

Conclusions

Pediatric FD does not appear to be associated with increased small bowel intestinal permeability, however, there are some limitations to the current study.

Trial registration

ClinicalTrials.gov;NCT00363597.
Autism-associated gene Dlgap2 mutant mice demonstrate exacerbated aggressive behaviors and orbitofrontal cortex deficits
Authors: Jiang-Xie Li-Feng , Liao Hsiao-Mei , Chen Chia-Hsiang , Chen Yuh-Tarng , Ho Shih-Yin , Lu Dai-Hua , Lee Li-Jen , Liou Horng-Huei , Fu Wen-Mei , Gau Susan Shur-Fen
Published: May 2014

Background

As elegant structures designed for neural communication, synapses are the building bricks of our mental functions. Recently, many studies have pointed out that synaptic protein-associated mutations may lead to dysfunctions of social cognition. Dlgap2, which encodes one of the main components of scaffold proteins in postsynaptic density (PSD), has been addressed as a candidate gene in autism spectrum disorders. To elucidate the disturbance of synaptic balance arising from Dlgap2 loss-of-function in vivo, we thus generated Dlgap2

−/−
mice to investigate their phenotypes of synaptic function and social behaviors.

Methods

The creation of Dlgap2

−/−
mice was facilitated by the recombineering-based method, Cre-loxP system and serial backcross. Reversal learning in a water T-maze was used to determine repetitive behaviors. The three-chamber approach task, resident–intruder test and tube task were performed to characterize the social behaviors of mutant mice. Cortical synaptosomal fraction, Golgi-Cox staining, whole-cell patch electrophysiology and transmission electron microscopy were all applied to investigate the function and structure of synapses in the orbitofrontal cortex (OFC) of Dlgap2

−/−
mice.

Results

Dlgap2

−/−
mice displayed exacerbated aggressive behaviors in the resident–intruder task, and elevated social dominance in the tube test. In addition, Dlgap2

−/−
mice exhibited a clear reduction of receptors and scaffold proteins in cortical synapses. Dlgap2

−/−
mice also demonstrated lower spine density, decreased peak amplitude of miniature excitatory postsynaptic current and ultra-structural deficits of PSD in the OFC.

Conclusions

Our findings clearly demonstrate that Dlgap2 plays a vital role in social behaviors and proper synaptic functions of the OFC. Moreover, these results may provide valuable insights into the neuropathology of autism.
Survival analyses of postoperative lung cancer patients: an investigation using Japanese administrative data
Authors: Kunisawa Susumu , Yamashita Kazuto , Ikai Hiroshi , Otsubo Tetsuya , Imanaka Yuichi
Published: May 2014

Long-term survival rates of cancer patients represent important information for policymakers and providers, but analyses from voluntary cancer registries in Japan may not reflect the overall situation. In 2003, the Diagnosis Procedure Combination Per-Diem Payment System (DPC/PDPS) for hospital reimbursement was introduced in Japan; more than half of Japan’s acute care beds are currently covered under this system. Administrative data produced under the DPC system include claims data and clinical summaries for each admission. Due to the large amount of data spanning multiple institutions, this database may have applications in providing a more general and inclusive overview of healthcare. Here, we investigate the use of administrative data for analyses of long-term survival in cancer patients. We analyzed postoperative survival in 7,064 patients with primary non-small cell lung cancer admitted to 102 hospitals between April 2008 and March 2013 using DPC data. Survival was defined at the last date of examination or discharge within the study period, and the event was mortality during the same period. Overall survival rates for different cancer stages were calculated using the Kaplan-Meier method. Additionally, survival rates of cancer patients at clinical stage IA were compared between low- and high-volume hospitals using the Log-rank test. Postoperative 5-year survival for patients at stage IA was 85.8% (95% CI = 78.6%–93.0%). High-volume hospitals had higher survival rates than hospitals with lower volume. Our findings using large-scale administrative data were similar to previous clinical registry reports, showing potential applications as a new method in analyzing up-to-date healthcare information.
Performance and sex difference in ultra-triathlon performance from Ironman to Double Deca Iron ultra-triathlon between 1978 and 2013
Authors: Rüst Christoph A , Rosemann Thomas , Knechtle Beat
Published: May 2014

It was assumed that women would be able to outperform men in ultra-marathon running. The present study investigated the sex difference in performance for all ultra-triathlon distances from the Ironman distance (i.e. 3.8 km swimming, 180 km cycling and 42 km running) in the ‘Ironman Hawaii’ to the Double Deca Iron ultra-triathlon distance (i.e. 76 km swimming, 3,600 km cycling and 840 km running) between 1978 and 2013. The changes in performance and in the sex difference in performance for the annual three fastest finishers were analysed using linear, non-linear and multi-variate regression analyses from 46,123 athletes (i.e. 9,802 women and 46,123 men). Women accounted for 11.9 ± 5.8% of the total field and their percentage was highest in ‘Ironman Hawaii’ (22.1%) and lowest in Deca Iron ultra-triathlon (6.5%). In ‘Ironman Hawaii’, the sex difference decreased non-linearly in swimming, cycling, running and overall race time. In Double Iron ultra-triathlon, the sex difference increased non-linearly in overall race time. In Triple Iron ultra-triathlon, the sex difference increased non-linearly in cycling and overall race time but linearly in running. For the three fastest finishers ever, the sex difference in performance showed no change with increasing race distance with the exception for the swimming split where the sex difference increased with increasing race distance (r2 = 0.93, P = 0.001). The sex differences for the three fastest finishers ever for swimming, cycling, running and overall race times for all distances from Ironman to Deca Iron ultra-triathlon were 27.0 ± 17.8%, 24.3 ± 9.9%, 24.5 ± 11.0%, and 24.0 ± 6.7%, respectively. To summarize, these findings showed that women reduced the sex difference in the shorter ultra-triathlon distances (i.e. Ironman distance) but extended the sex difference in longer distances (i.e. Double and Triple Iron ultra-triathlon). It seems very unlikely that women will ever outperform men in ultra-triathlons from Ironman to Double Iron ultra-triathlon.
Oxidizability assay of unfractionated plasma of patients’ with different plasma profile: a methodological study
Authors: Imam Hasan , Chowdhury Arfia , Mahbub Nasir Uddin , Hossain Amir , Karim Mohammed Faisal Bin , Uddin Mohammad Burhan , Sarker Md Moklesur Rahman
Published: May 2014

Background

Present study describe the in vitro model of plasma oxidation of patients with different lipid profile, that can be correlated to their invivo plasma oxidizability in order to find the arterial diseases prone patient groups.

Method

The method applied here to measure the invitro plasma oxidizability, accounts a convenient way that can be well suited in any clinical laboratory settings. Un-fractionated plasma was exposed to CuSO4 (5.0 mmol/L), a pro-oxidant, and low frequency ultrasonic wave to induce oxidation, and finally oxidizability was calculated by TBARS and Conjugated Diene methods.

Result

In our study, plasma LDL greater than 150 mg/dL possess 1.75 times more risk to undergo oxidation (CI, 0.7774 to 3.94; p = 0.071) than the low LDL plasma, percent of oxidation increased from 38.3% to 67.1% for the LDL level upto 150 mg/dL and high. Lag phase, which is considered as the plasma antioxidative protection, was also influenced by the higher LDL concentration. The mean lag time was 65.27 ± 20.02 (p = 0.02 compared to healthy), where as for 94.71 ± 35.11 min for the normolipidemic subject. The plasma oxidizability was also changed drastically for total cholesterol level, oxidative susceptibility shown 35% and 55.02% for 200 mg/dL and high respectively, however it didn’t appear as risk factor. Patient samples were also stratified according to their age, gender, and blood glucose level. Older persons (≥40 years) were 1.096 times (95% CL, 0.5607 to 2.141, p = 0.396) than younger (≤39 years age), males are 1.071 (95% CI, 0.5072- 2.264) times than the females, and diabetic patients are 1.091 (CI, 0.6153 to 1.934, p = 0.391) times in more risk than the non-diabetic counterpart.

Conclusion

This method addressing its easy applicability in biomedical research. And by this we were able to show that patients with high LDL (≥150 mg/dL) are in alarming condition besides diabetic and elderly (≥40 years age) males are considered to be susceptible and more prone to develop vascular diseases.
Body cell mass evaluation in critically ill patients: killing two birds with one stone
Authors: Fiaccadori Enrico , Morabito Santo , Cabassi Aderville , Regolisti Giuseppe
Published: May 2014

Body cell mass (BCM) is the metabolically active cell mass involved in O2 consumption, CO2 production and energy expenditure. BCM measurement has been suggested as a tool for the evaluation of nutritional status. Since BCM is closely related to energy expenditure, it could also represent a good reference value for the calculation of nutrient needs. In a recent issue of Critical Care, Ismael and colleagues used bioelectrical impedance analysis parameters and anthropometric variables to evaluate BCM in patients with acute kidney injury, before and after a hemodialysis session. The results of this study suggest that BCM is relatively insensitive to major body fluid shifts, a well known factor interfering with nutritional evaluation/monitoring and energy need calculations in the ICU. Thus, BCM seems to be a more 'stable' nutritional variable, as it is apparently less influenced by non-nutritional factors. The results of this paper emphasize the need to identify biologically sound parameters for nutritional status evaluation and energy need calculation in critically ill patients; in this regard, BCM could fulfill these expectations.
Payment by results for mental health services: economic considerations of case-mix funding
Authors: Jacobs Rowena
Published: May 2014

Against the backdrop of a tight financial climate, a new method of funding mental health services is being rolled out in England's National Health Service. Called payment by results (PbR), it represents a fundamental change to the way providers of psychiatric services are paid for care of patients. The Mental Health Clustering Tool has been developed to capture activity which reflects the relative needs of patients, and cluster costs are being collected by service providers. The ultimate goal is the creation of a national tariff or fixed price for each cluster. This article describes the incentives generated by PbR and gives evidence on PbR in acute physical care services where it has been in operation for a decade, with respect to efficiency, quality, volume of activity, administrative costs, upcoding or gaming, equity of provision, and cross-subsidisation. It explores the challenges for mental health services as PbR is introduced.

LEARNING OBJECTIVES

Understand the difference between retrospective and prospective reimbursement systems and the incentives generated by each financing system.

Understand the three key building blocks of PbR: currency, reference costs and tariffs.

Consider the evidence on PbR in acute physical care and the implications for mental health services.
METIS: a Swedish programme to boost recruitment in psychiatry
Authors: Kyaga Simon
Published: May 2014

Psychiatrists are wanting in Sweden and many other countries. Among Swedish efforts to improve specialist training in psychiatry and to make a future psychiatric career attractive is a national course-based project named METIS. An evaluation of METIS courses run between 2007 and 2012 revealed that, in parallel with the initiative, the number of doctors obtaining proofs of specialist competence in psychiatry increased by more than a third. This article outlines current specialist training in Sweden and describes how the 40-hour METIS programme fits within it.
The 25th anniversary of the launch of Prozac gives pause for thought: where did we go wrong?
Authors: Shorter Edward
Published: May 2014

The creation, in DSM-III, of the category ‘major depression’ can be linked to the launch, and success, of Prozac. The consequences of creating this broad diagnostic category are of concern in relation to the treatment of individuals with a diverse variety of depressive disorders.
Early responding to traumatic events
Authors: Bisson Jonathan I.
Published: May 2014

How to respond optimally following traumatic events remains a Holy Grail. A number of early interventions lack evidence of effect. Practical, pragmatic support provided in an empathic manner is likely to be an appropriate initial response and complement the high levels of resilience shown by individuals exposed to traumatic events.
[18F]Fluorodeoxyglucose Positron Emission Tomography Predicts Survival After Chemoimmunotherapy for Primary Mediastinal Large B-Cell Lymphoma: Results of the International Extranodal Lymphoma Study Group IELSG-26 Study
Authors: Martelli Maurizio , Ceriani Luca , Zucca Emanuele , Zinzani Pier Luigi , Ferreri Andrés J.M. , Vitolo Umberto , Stelitano Caterina , Brusamolino Ercole , Cabras Maria Giuseppina , Rigacci Luigi , Balzarotti Monica , Salvi Flavia , Montoto Silvia , Lopez-Guillermo Armando , Finolezzi Erica , Pileri Stefano A. , Davies Andrew , Cavalli Franco , Giovanella Luca , Johnson Peter W.M.
Published: May 2014

Purpose

To assess the role of [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) after rituximab and anthracycline-containing chemoimmunotherapy in patients with primary mediastinal large B-cell lymphoma (PMLBCL).

Patients and Methods

Among 125 patients prospectively enrolled, 115 were eligible for central review of PET/CT scans at the completion of standard chemoimmunotherapy, by using a five-point scale. Consolidation radiotherapy (RT) was permitted and given to 102 patients.

Results

Fifty-four patients (47%) achieved a complete metabolic response (CMR), defined as a completely negative scan or with residual [18F]FDG activity below the mediastinal blood pool (MBP) uptake. In the remaining 61 patients (53%), the residual uptake was higher than MBP uptake but below the liver uptake in 27 (23%), slightly higher than the liver uptake in 24 (21%), and markedly higher in 10 (9%). CMR after chemoimmunotherapy predicted higher 5-year progression-free survival (PFS; 98% v 82%; P = .0044) and overall survival (OS; 100% v 91%; P = .0298). Patients with residual uptake higher than MBP uptake but below liver uptake had equally good outcomes without any recurrence. Using the liver uptake as cutoff for PET positivity (boundary of score, 3 to 4) discriminated most effectively between high or low risk of failure, with 5-year PFS of 99% versus 68% (P < .001) and 5-year OS of 100% versus 83% (P < .001).

Conclusion

More than 90% of patients are projected to be alive and progression-free at 5 years, despite a low CMR rate (47%) after chemoimmunotherapy. This study provides a basis for using PET/CT to define the role of RT in PMLBCL.
Assessment of Tumor Size Reduction Improves Outcome Prediction of Positron Emission Tomography/Computed Tomography After Chemotherapy in Advanced-Stage Hodgkin Lymphoma
Authors: Kobe Carsten , Kuhnert Georg , Kahraman Deniz , Haverkamp Heinz , Eich Hans-Theodor , Franke Mareike , Persigehl Thorsten , Klutmann Susanne , Amthauer Holger , Bockisch Andreas , Kluge Regine , Wolf Hans-Heinrich , Maintz David , Fuchs Michael , Borchmann Peter , Diehl Volker , Drzezga Alexander , Engert Andreas , Dietlein Markus
Published: May 2014

Purpose

Positron emission tomography (PET) after chemotherapy can guide consolidating radiotherapy in advanced-stage Hodgkin lymphoma (HL). This analysis aims to improve outcome prediction by integrating additional criteria derived by computed tomography (CT).

Patients and Methods

The analysis set consisted of 739 patients with residues ≥ 2.5 cm after chemotherapy from a total of 2,126 patients treated in the HD15 trial (HD15 for advanced stage Hodgkin's disease: Quality assurance protocol for reduction of toxicity and the prognostic relevance of fluorodeoxyglucose-positron-emission tomography [FDG-PET] in the first-line treatment of advanced-stage Hodgkin's disease) performed by the German Hodgkin Study Group. A central panel performed image analysis and interpretation of CT scans before and after chemotherapy as well as PET scans after chemotherapy. Prognosis was evaluated by using progression-free survival (PFS); groups were compared with the log-rank test. Potential prognostic factors were investigated by using receiver operating characteristic analysis and logistic regression.

Results

In all, 548 (74%) of 739 patients had PET-negative residues after chemotherapy; these patients did not receive additional radiotherapy and showed a 4-year PFS of 91.5%. The 191 PET-positive patients (26%) receiving additional radiotherapy had a 4-year PFS of 86.1% (P = .022). CT alone did not allow further separation of patients in partial remission by risk of recurrence (P = .9). In the subgroup of the 54 PET-positive patients with a relative reduction of less than 40%, the risk of progression or relapse within the first year was 23.1% compared with 5.3% for patients with a larger reduction (difference, 17.9%; 95% CI, 5.8% to 30%).

Conclusion

Patients with HL who have PET-positive residual disease after chemotherapy and poor tumor shrinkage are at high risk of progression or relapse.
Psychological and Behavioral Approaches to Cancer Pain Management
Authors: Syrjala Karen L. , Jensen Mark P. , Mendoza M. Elena , Yi Jean C. , Fisher Hannah M. , Keefe Francis J.
Published: May 2014

This review examines evidence for psychological factors that affect pain across the cancer continuum from diagnosis through treatment and long-term survivorship or end of life. Evidence is convincing that emotional distress, depression, anxiety, uncertainty, and hopelessness interact with pain. Unrelieved pain can increase a desire for hastened death. Patients with cancer use many strategies to manage pain, with catastrophizing associated with increased pain and self-efficacy associated with lower pain reports. A variety of psychological and cognitive behavioral treatments can reduce pain severity and interference with function, as indicated in multiple meta-analyses and high-quality randomized controlled trials. Effective methods include education (with coping skills training), hypnosis, cognitive behavioral approaches, and relaxation with imagery. Exercise has been tested extensively in patients with cancer and long-term survivors, but few exercise studies have evaluated pain outcomes. In survivors post-treatment, yoga and hypnosis as well as exercise show promise for controlling pain. Although some of these treatments effectively reduce pain for patients with advanced disease, few have been tested in patients at the end of life. Given the clear indicators that psychological factors affect cancer pain and that psychological and behavioral treatments are effective in reducing varying types of pain for patients with active disease, these methods need further testing in cancer survivors post-treatment and in patients with end-stage disease. Multidisciplinary teams are essential in oncology settings to integrate analgesic care and expertise in psychological and behavioral interventions in standard care for symptom management, including pain.
Apical constriction: themes and variations on a cellular mechanism driving morphogenesis
Authors: Martin Adam C. , Goldstein Bob
Published: May 2014

Apical constriction is a cell shape change that promotes tissue remodeling in a variety of homeostatic and developmental contexts, including gastrulation in many organisms and neural tube formation in vertebrates. In recent years, progress has been made towards understanding how the distinct cell biological processes that together drive apical constriction are coordinated. These processes include the contraction of actin-myosin networks, which generates force, and the attachment of actin networks to cell-cell junctions, which allows forces to be transmitted between cells. Different cell types regulate contractility and adhesion in unique ways, resulting in apical constriction with varying dynamics and subcellular organizations, as well as a variety of resulting tissue shape changes. Understanding both the common themes and the variations in apical constriction mechanisms promises to provide insight into the mechanics that underlie tissue morphogenesis.
A Simple and Efficient Procedure for the One-pot Three-component Synthesis of Spiro[indoline-3,9′-tetrazolo[5,1-b]quinazoline]-2,8′(5′H)-dione in PEG–H2O Medium
Authors: Shen Minggui , Wang Juan , Shang Shibin , Song Zhanqian
Published: May 2014

Novel spiro[indoline-3,9′-tetrazolo[5,1-b]quinazoline]-2,8′(5′H)-dione derivatives have been synthesized by the three-component reaction of isatin, 5-amino-1H-tetrazole, and 5,5-dimethylcyclohexane-1,3-dione in PEG–H2O medium catalyzed by p-TSA. This protocol provides a simple one-step procedure with the advantages of easy work-up, mild reaction conditions, and environmental benignity.
Hydrothermal Synthesis of Cerium Oxide Nanoassemblies through Coordination Programming with Amino Acids
Authors: Litwinowicz Andrzej-Alexander , Takami Seiichi , Hojo Daisuke , Aoki Nobuaki , Adschiri Tadafumi
Published: May 2014

Cerium oxide was hydrothermally synthesized from an aqueous solution of Ce(NO3)3 in the presence of either l-glutamic acid, l-aspartic acid, or l-arginine using a continuous flow reactor at 275 °C. The products synthesized with l-glutamic acid were cubic nanoassemblies comprising primary CeO2 nanoparticles bound by coordination bonds. This result suggests that inorganic nanoparticles can be used as a component to build functional nanodevices using the idea of coordination programming.
Electrophilic Tandem Transannular Cyclization of Octadehydrotribenzo[14]annulene to Benzodiindenocyclooctatetraenes
Authors: Nobusue Shunpei , Tobe Yoshito
Published: May 2014

Treatment of octadehydrotribenzo[14]annulene ([14]DBA) with bromine or iodine gave the corresponding tetrahalo-substituted benzodiindenocyclooctatetraenes selectively via tandem twofold transannular bond formations. The exclusive mode of cyclization in contrast to that observed for the nucleophile-induced cyclizations is interpreted in terms of the relative stabilities of the key intermediates in both processes.
A Theoretical Study on Reduction of Acyl Radicals with Borohydride Anions
Authors: Kawamoto Takuji , Matsubara Hiroshi , Ryu Ilhyong
Published: May 2014

Ab initio and DFT calculations predict that the reduction of the acetyl radical with borohydride proceeds via hydride attack to afford the ketyl radical; the energy barrier for the hydride transfer was calculated to be 54.5 kJ mol−1 at the CCSD(T)/aug-cc-pVDZ//BHandHLYP/aug-cc-pVDZ level of theory. The DFT calculations also indicated that the hydroxymethylation of iodocyclohexane with CO in the presence of borohydride would proceed smoothly.
Bovine Peptic Casein Hydrolysate Ameliorates Cardiovascular Risk Factors in a Model of ApoE-deficient Mice but not Overweight, Mildly Hypercholesterolaemic Men
Authors: Chan Y , Mcgill A , Kanwar R , Krissansen G , Haggarty N , Xin L , Poppitt S
Published: May 2014

Associations have been shown between consumption of bovine dairy and decreased prevalence of metabolic related disorders. Milk peptides may promote both angiotensin-I- converting enzyme (ACE) inhibition for blood pressure (BP) lowering and insulin action for better glycaemic control. Less is known of other metabolic parameters. The aim of this study was to investigate effects of dairy peptic casein hydrolysate (CH) on markers of cardiovascular disease (CVD) risk in (1) an apolipoproteinE (ApoE) - deficient mouse model of high-fat fed hypercholesterolaem- ia, and, (2) a clinical study of moderate overweight and hypercholesterolaemia. In Trial 1, ApoE-deficient mice were supplemented with high dose CH (~1g/kg body weight) in a randomised, 9-wk, parallel design intervention, and blood and tissue samples harvested. In Trial 2, 24 mildly hypercholesterolaemic men were supplemented with lower dose CH (~0.1g/kg body weight, 10g/day, 3-wks) and matched whey protein control (WP, 10g/day, 3-wks) in a randomised, 9-wk, cross-over design intervention. Diets were separated by a 3-wk washout. Fasting blood and urine samples were collected, and blood pressure (BP) measured weekly. Clinical trial registration number, ACTRN 12611001013954. In ApoE-deficient mice, administration of CH significantly inhibited circulating total cholesterol concentrations by 37% (TC, P<0.01) and decreased aorta atherosclerotic lesion score by 25% (P<0.01). In the clinical study there were no significant differential effects of CH supplementation on CV markers, including serum lipids (TC, LDL-C, HDL-C, triglyceride), glucose and BP. Whilst high dose bovine peptic CH attenuated CVD risk in a murine ApoE deficient model of aggressive hypercholesterolaemia, no evidence of amelioration of risk by supplementation with a lower dose of CH in an overweight population of mildly hypercholesterolaemic men was found.
Present Scenario of Health Status of University Students at Arrah (Bhojpur), Bihar
Authors: D Pandit , Kumari Priyanka , Kumari Suman
Published: May 2014

A cross sectional study was made to know health status of students and research scholars of age group of 20–29 years of Department of different disciplines of Veer Kunwar Singh University, Arrah–802 301 from July 2011 to May 2013. Out of 2428 participants, 1527 (62.89%) participants possessing normal health status followed by 495 (20.39%) of overweight, 235 (9.68%) of underweight and 171 (7.04%) of obese category.

The respective proportion of female participants of normal, overweight, underweight and obese category in relation to age ranges from 3.14 to 14.91%, 8.89 to 34.87%, 7.76 to 50.49% and 9.33 to 28.01%. The statistical analysis indicates that the proportion of normal health status decreases significantly (r=-0.637, p<0.05). Conversely, an insignificant increase was calculated (r=0.159; p>0.05) between overweight and age.

As far as number of male participants is concerned, their respective proportion of health categories varies from 43.13 to 71.06%, 14.21 to 40.00%, 3.03 to 32.88% and 3.61 to 32.84%. Statistically, the proportion of normal health category increases insignificantly (r=0.310; p>0.05) but an insignificant decrease (r=-0.277, p>0.05) was calculated between overweight category and age.
Personalized Modification of Breast Milk to Help Enhancing Nutrition Profile of Neonates: A short Communication
Authors: Ray Subhasree
Published: May 2014

Personalized Nutrition means in practice, adapting food to individual needs, depending on the host’s genome, this calls for an emerging field of nutrigenomic approach in order to build the tools for individualized diet, health maintenance and disease prevention. Based on this principle, breast milk is now being analyzed, modified and administered in smaller infants to provide them personalized diet, ensuring the premature infants are receiving correct amounts of nutrients they need to thrive. In the past, all milk was fortified to the same and it was ‘one-size-fits-all’. Now, nutrigenomics is moving towards having the ability to personalize each mother’s milk to give her baby precise nutrition he needs by stressing upon nutrition and interaction of three health relevant genomes in perspective, namely the food, the gut microbial and the human host genome in context of individualized nutrition and optimum health.
An analysis of the best method for evaluating anteversion of the acetabular component after total hip replacement on plain radiographs
Authors: Nomura T. , Naito M. , Nakamura Y. , Ida T. , Kuroda D. , Kobayashi T. , Sakamoto T. , Seo H.
Published: May 2014

Several radiological methods of measuring anteversion of the acetabular component after total hip replacement (THR) have been described. These studies used different definitions and reference planes to compare methods, allowing for misinterpretation of the results. We compared the reliability and accuracy of five current methods using plain radiographs (those of Lewinnek, Widmer, Liaw, Pradhan, and Woo and Morrey) with CT measurements, using the same definition and reference plane. We retrospectively studied the plain radiographs and CT scans in 84 hips of 84 patients who underwent primary THR. Intra- and inter-observer reliability were high for the measurement of inclination and anteversion with all methods on plain radiographs and CT scans. The measurements of inclination on plain radiographs were similar to the measurements using CT (p = 0.043). The mean difference between CT measurements was 0.6° (-5.9° to 6.8°).

Measurements using Widmer’s method were the most similar to those using CT (p = 0.088), with a mean difference between CT measurements of -0.9° (-10.4° to 9.1°), whereas the other four methods differed significantly from those using CT (p < 0.001).

This study has shown that Widmer’s method is the best for evaluating the anteversion of the acetabular component on plain radiographs.

Cite this article: Bone Joint J 2014; 96-B:597–603.
Supracondylar osteotomy for the treatment of cubitus varus in children
Authors: Solfelt D. A. , Hill B. W. , Anderson C. P. , Cole P. A.
Published: May 2014

Cubitus varus is the most frequent complication following the treatment of supracondylar humeral fractures in children. We investigated data from publications reporting on the surgical management of cubitus varus found in electronic searches of Ovid/MEDLINE and Cochrane Library databases. In 894 children from 40 included studies, the mean age at initial injury was 5.7 years (3 to 8.6) and 9.8 years (4 to 15.7) at the time of secondary correction. The four osteotomy techniques were classified as lateral closing wedge, dome, complex (multiplanar) and distraction osteogenesis. A mean angular correction of 27.6º (18.5° to 37.0°) was achieved across all classes of osteotomy. The meta-analytical summary estimate for overall rate of good to excellent results was 87.8% (95% CI 84.4 to 91.2). No technique was shown to significantly affect the surgical outcome, and the risk of complications across all osteotomy classes was 14.5% (95% CI 10.6 to 18.5). Nerve palsies occurred in 2.53% of cases (95% CI 1.4 to 3.6), although 78.4% were transient. No one technique was found to be statistically safer or more effective than any other.

Cite this article: Bone Joint J 2014;96-B:691–700.
Assessing treatment outcomes using a single question
Authors: Hamilton D. F. , Lane J. V. , Gaston P. , Patton J. T. , MacDonald D. J. , Simpson A. H. R. W. , Howie C. R.
Published: May 2014

Satisfaction with care is important to both patients and to those who pay for it. The Net Promoter Score (NPS), widely used in the service industries, has been introduced into the NHS as the ‘friends and family test’; an overarching measure of patient satisfaction. It assesses the likelihood of the patient recommending the healthcare received to another, and is seen as a discriminator of healthcare performance. We prospectively assessed 6186 individuals undergoing primary lower limb joint replacement at a single university hospital to determine the Net Promoter Score for joint replacements and to evaluate which factors contributed to the response.

Achieving pain relief (odds ratio (OR) 2.13, confidence interval (CI) 1.83 to 2.49), the meeting of pre-operative expectation (OR 2.57, CI 2.24 to 2.97), and the hospital experience (OR 2.33, CI 2.03 to 2.68) are the domains that explain whether a patient would recommend joint replacement services. These three factors, combined with the type of surgery undertaken (OR 2.31, CI 1.68 to 3.17), drove a predictive model that was able to explain 95% of the variation in the patient’s recommendation response. Though intuitively similar, this ‘recommendation’ metric was found to be materially different to satisfaction responses. The difference between THR (NPS 71) and TKR (NPS 49) suggests that no overarching score for a department should be used without an adjustment for case mix. However, the Net Promoter Score does measure a further important dimension to our existing metrics: the patient experience of healthcare delivery.

Cite this article: Bone Joint J 2014;96-B:622–8.
Functional outcome and alignment in computer-assisted and conventionally operated total knee replacements
Authors: Gøthesen Ø. , Espehaug B. , Havelin L. I. , Petursson G. , Hallan G. , Strøm E. , Dyrhovden G. , Furnes O.
Published: May 2014

We performed a randomised controlled trial comparing computer-assisted surgery (CAS) with conventional surgery (CONV) in total knee replacement (TKR). Between 2009 and 2011 a total of 192 patients with a mean age of 68 years (55 to 85) with osteoarthritis or arthritic disease of the knee were recruited from four Norwegian hospitals. At three months follow-up, functional results were marginally better for the CAS group. Mean differences (MD) in favour of CAS were found for the Knee Society function score (MD: 5.9, 95% confidence interval (CI) 0.3 to 11.4, p = 0.039), the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales for ‘pain’ (MD: 7.7, 95% CI 1.7 to 13.6, p = 0.012), ‘sports’ (MD: 13.5, 95% CI 5.6 to 21.4, p = 0.001) and ‘quality of life’ (MD: 7.2, 95% CI 0.1 to 14.3, p = 0.046). At one-year follow-up, differences favouring CAS were found for KOOS ‘sports’ (MD: 11.0, 95% CI 3.0 to 19.0, p = 0.007) and KOOS ‘symptoms’ (MD: 6.7, 95% CI 0.5 to 13.0, p = 0.035). The use of CAS resulted in fewer outliers in frontal alignment (> 3° malalignment), both for the entire TKR (37.9% vs 17.9%, p = 0.042) and for the tibial component separately (28.4% vs 6.3%, p = 0.002). Tibial slope was better achieved with CAS (58.9% vs 26.3%, p < 0.001). Operation time was 20 minutes longer with CAS. In conclusion, functional results were, statistically, marginally in favour of CAS. Also, CAS was more predictable than CONV for mechanical alignment and positioning of the prosthesis. However, the long-term outcomes must be further investigated.

Cite this article: Bone Joint J 2014; 96-B:609–18.
A prospective study of the incidence and outcomes of incidental dural tears in microendoscopic lumbar decompressive surgery
Authors: Tsutsumimoto T. , Yui M. , Uehara M. , Ohta H. , Kosaku H. , Misawa H.
Published: May 2014

Little information is available about the incidence and outcome of incidental dural tears associated with microendoscopic lumbar decompressive surgery. We prospectively examined the incidence of dural tears and their influence on the outcome six months post-operatively in 555 consecutive patients (mean age 47.4 years (13 to 89)) who underwent this form of surgery. The incidence of dural tears was 5.05% (28/555). The risk factors were the age of the patient and the procedure of bilateral decompression via a unilateral approach. The rate of recovery of the Japanese Orthopaedic Association score in patients with dural tears was significantly lower than that in those without a tear (77.7% vs 87.6%; p < 0.02), although there were no significant differences in the improvement of the Oswestry Disability Index between the two groups. Most dural tears were small, managed by taking adequate care of symptoms of low cerebrospinal fluid pressure, and did not require direct dural repair. Routine MRI scans were undertaken six months post-operatively; four patients with a dural tear had recurrent or residual disc herniation and two had further stenosis, possibly because the dural tear prevented adequate decompression and removal of the fragments of disc during surgery; as yet, none of these patients have undergone further surgery.

Cite this article: Bone Joint J 2014;96-B:641–5.
Proximal femoral resection without post-operative traction for the painful dislocated hip in young patients with cerebral palsy
Authors: Dartnell J. , Gough M. , Paterson J. M. H. , Norman-Taylor F.
Published: May 2014

Proximal femoral resection (PFR) is a proven pain-relieving procedure for the management of patients with severe cerebral palsy and a painful displaced hip. Previous authors have recommended post-operative traction or immobilisation to prevent a recurrence of pain due to proximal migration of the femoral stump. We present a series of 79 PFRs in 63 patients, age 14.7 years (10 to 26; 35 male, 28 female), none of whom had post-operative traction or immobilisation.

A total of 71 hips (89.6%) were reported to be pain free or to have mild pain following surgery. Four children underwent further resection for persistent pain; of these, three had successful resolution of pain and one had no benefit. A total of 16 hips (20.2%) showed radiographic evidence of heterotopic ossification, all of which had formed within one year of surgery. Four patients had a wound infection, one of which needed debridement; all recovered fully. A total of 59 patients (94%) reported improvements in seating and hygiene.

The results are as good as or better than the historical results of using traction or immobilisation. We recommend that following PFR, children can be managed without traction or immobilisation, and can be discharged earlier and with fewer complications. However, care should be taken with severely dystonic patients, in whom more extensive femoral resection should be considered in combination with management of the increased tone.

Cite this article: Bone Joint J 2014; 96-B:701–6.
The risk of surgical site infection and re-admission in obese patients undergoing total joint replacement who lose weight before surgery and keep it off post-operatively
Authors: Inacio M. C. S. , Kritz-Silverstein D. , Raman R. , Macera C. A. , Nichols J. F. , Shaffer R. A. , Fithian D. C.
Published: May 2014

This study evaluated whether obese patients who lost weight before their total joint replacement and kept it off post-operatively were at lower risk of surgical site infection (SSI) and re-admission compared with those who remained the same weight.

We reviewed 444 patients who underwent a total hip replacement and 937 with a total knee replacement who lost weight pre-operatively and sustained their weight loss after surgery. After adjustments, patients who lost weight before a total hip replacement and kept it off post-operatively had a 3.77 (95% confidence interval (CI) 1.59 to 8.95) greater likelihood of deep SSIs and those who lost weight before a total knee replacement had a 1.63 (95% CI 1.16 to 2.28) greater likelihood of re-admission compared with the reference group.

These findings raise questions about the safety of weight management before total replacement of the hip and knee joints.

Cite this article: Bone Joint J 2014;96-B:629–35.
A case–control study of surgical site infection following operative fixation of fractures of the ankle in a large UK trauma unit
Authors: Korim M. T. , Payne R. , Bhatia M.
Published: May 2014

Most of the literature on surgical site infections following the surgical treatment of fractures of the ankle is based on small series of patients, focusing on diabetics or the elderly. None have described post-operative functional scores in those patients who develop an infection. We performed an age- and gender-matched case–control study to identify patient- and surgery-related risk factors for surgical site infection following open reduction and internal fixation of a fracture of the ankle. Logistic regression analysis was used to identify significant risk factors for infection and to calculate odds ratios (OR). Function was assessed using the Olerud and Molander Ankle Score. The incidence of infection was 4% (29/717) and 1.1% (8/717) were deep infections. The median ankle score was significantly lower in the infection group compared with the control group (60 vs 90, Mann–Whitney test p < 0.0001). Multivariate regression analysis showed that diabetes (OR = 15, p = 0.031), nursing home residence (OR = 12, p = 0.018) and Weber C fractures (OR = 4, p = 0.048) were significant risk factors for infection.

A low incidence of infection following open reduction and internal fixation of fractures of the ankle was observed. Both superficial and deep infections result in lower functional scores.

Cite this article: Bone Joint J 2014;96-B:636–40.
Continuous distal migration and internal rotation of the C-stem prosthesis without any adverse clinical effects
Authors: von Schewelov T. , Carlsson Å. , Sanzén L. , Besjakov J.
Published: May 2014

In 2005, we demonstrated that the polished triple-tapered C-stem at two years had migrated distally and rotated internally. From that series, 33 patients have now been followed radiologically, clinically and by radiostereometric analysis (RSA) for up to ten years. The distal migration within the cement mantle had continued and reached a mean of 2 mm (0.5 to 4.0) at ten years. Internal rotation, also within the cement mantle, was a mean 3.8° (external 1.6° to internal 6.6°) The cement mantle did not show any sign of migration or loosening in relation to the femoral bone. There were no clinical or radiological signs indicating that the migration or rotation within the cement mantle had had any adverse effects for the patients.

Cite this article: Bone Joint J 2014;96-B:604–8.
Nanotechnology
Authors: Sullivan M. P. , McHale K. J. , Parvizi J. , Mehta S.
Published: May 2014

Nanotechnology is the study, production and controlled manipulation of materials with a grain size < 100 nm. At this level, the laws of classical mechanics fall away and those of quantum mechanics take over, resulting in unique behaviour of matter in terms of melting point, conductivity and reactivity. Additionally, and likely more significant, as grain size decreases, the ratio of surface area to volume drastically increases, allowing for greater interaction between implants and the surrounding cellular environment. This favourable increase in surface area plays an important role in mesenchymal cell differentiation and ultimately bone–implant interactions.

Basic science and translational research have revealed important potential applications for nanotechnology in orthopaedic surgery, particularly with regard to improving the interaction between implants and host bone. Nanophase materials more closely match the architecture of native trabecular bone, thereby greatly improving the osseo-integration of orthopaedic implants. Nanophase-coated prostheses can also reduce bacterial adhesion more than conventionally surfaced prostheses. Nanophase selenium has shown great promise when used for tumour reconstructions, as has nanophase silver in the management of traumatic wounds. Nanophase silver may significantly improve healing of peripheral nerve injuries, and nanophase gold has powerful anti-inflammatory effects on tendon inflammation.

Considerable advances must be made in our understanding of the potential health risks of production, implantation and wear patterns of nanophase devices before they are approved for clinical use. Their potential, however, is considerable, and is likely to benefit us all in the future.

Cite this article: Bone Joint J 2014; 96-B: 569–73.
Exam Corner – May 2014
Authors: Khanduja V.
Published: May 2014

The FRCS (Tr & Orth) examination has three components: MCQs, Vivas and Clinical Examination. The Vivas are further divided into four sections comprising Basic Science, Adult Pathology, Hands and Children’s Orthopaedics and Trauma. The Clinical Examination section is divided into Upper and Lower limb cases. The aim of this section in the Journal is to focus specifically on the trainees preparing for the exam and to cater to all the sections of the exam. The vision is to complete the cycle of all relevant exam topics (as per the syllabus) in four years.
Border Controls in Europe: Policies and Practices Outside the Law
Authors: Cetti Fran
Published: May 2014

The forced migrant
1 to Europe is hostage to a tight “migration-security nexus”,
2 their conversion into a globally ubiquitous “illegal” presence facilitated by the incorporation of the global security industry into the region's system of external border controls. The European Union
3 not only outsources its border control activities to private security concerns (as well as third-party states), but also consults them on the direction of its policies, adopting their discourse and practices. It is using their expertise to meld member states' border technology into an apparatus of detection and deterrence that stretches far beyond the region to intercept forced migrants long before they reach its borders. The agencies that patrol on Europe's behalf outside its geopolitical boundaries also operate outside national legal structures, without regard to international human rights or refugee rights. Under cover of the privatization and securitization
4 of its immigration and asylum regime, the European Union acts with impunity in a parallel world of extra-legal
5 practices.