bluuebunny/crossref_metadata_2025 huggingface dataset:
Sternum Sparing Thoracotomy Incisions in Lung Transplantation Surgery a Superior Technique to the Clamshell Approach
Authors: Bittner Hartmuth Bruno , Lehmann Sven , Binner Christian , Garbade Jens , Barten Markus , Mohr Friedrich Wilhelm
Published: April 2011

Objective

Bilateral anterior transsternal thoracotomy incision (clamshell technique) is the standard approach used for bilateral sequential lung transplantation (LTX). The morbidity and wound complications of this large incision can be considerable and costly. Muscle sparing anterior thoracotomies without division of the sternum may lead to decreasing the sequelae of wound complications. The objective of this study was to determine the rate of wound complications in the nonsternal incising lung transplant patients.

Methods

We used the single-institution-based transplant data bank, phone questionnaire, and ambulatory care unit follow-up data to investigate retrospectively the incidence of wound healing complications following muscle and sternum sparing and mammary artery protecting limited access small submammary anterior thoracotomy incisions (AT) for LTX surgery. In the need for cardiopulmonary bypass, the femoral artery and vein were cannulated.

Results

After exclusion of seven clamshell operations for LTX combined with cardiac surgery, 91 recipients (65% male), aged 19 to 68 years (mean, 54 ± 8 years), underwent 84 AT and 48 lateral thoracotomies (LT) for idiopathic pulmonary fibrosis (IPF) (48%), obstructive disease (40%), cystic fibrosis (CF) (5%), and pulmonary arterial hypertension (PAH) (7%). AT ranged from 5.5 to 26 cm (mean, 20.3 ± 4.8 cm) and LT from 12 to 25 cm (mean, 19.8 ± 2.4 cm) and was not significantly different (P = 0.37). Warm ischemic times ranged from 30 to 92 minutes (mean, 56 ± 11 minutes). Four patients required rethoracotomy for bleeding/hematoma formation. Cardiopulmonary bypass/intraop extracorporeal membrane oxygenation (ECMO) was used in 64%. Superficial wound infection and subsequent drainage/care was needed in four LTX incisions. Reoperation for lung herniation using patch repair technique for thoracic wall stabilization was required in two AT and three LT.

Conclusions

Sternum sparing and mammary artery protecting limited access submammary anterior and lateral thoracotomy incisions for LTX surgery are safe and effective. This approach avoids complications related to sternal transaction and may minimize the development of severe wound complications following LTX surgery.
Short- and Long-Term Outcomes in Octogenarian Patients Undergoing Off-Pump Coronary Artery Bypass Grafting Compared with On-Pump Coronary Artery Bypass Grafting
Authors: Sarin Eric L. , Kayatta Michael O. , Kilgo Patrick , Dara Ameesh , Puskas John D. , Lattouf Omar M. , Chen Edward P. , Halkos Michael E. , Guyton Robert A. , Thourani Vinod H.
Published: April 2011

Objective

Coronary artery bypass grafting (CAB) on elderly patients presenting with multivessel coronary artery disease has become routine in modern day operating rooms. The aim of our study was to compare short- and long-term outcomes in octogenarian patients undergoing off-pump CAB (OPCAB) versus on-pump CAB (ONCAB).

Methods

A propensity-adjusted, retrospective review of patients older than 80 years who underwent primary CAB from January 1996 to September 2008 at our institution's hospitals was performed. Nine hundred thirty-seven patients were divided into two groups: OPCAB (n = 540) or ONCAB (n = 397). A propensity score was calculated based on 29 preoperative risk factors to adjust for selection bias when comparing the groups for differences in death, stroke, myocardial infarction incidence, and their composite (major adverse cardiac events). Long-term survival status was determined by cross-referencing patient records with the Social Security Death Index. Logistic regression analysis and Cox proportional hazards analysis were used to determine group differences in short- and long-term survival, respectively, adjusted for the propensity score. Kaplan-Meier curves were fit to estimate 10-year survival.

Results

The mean age (OPCAB: 82.9 ± 2.8 years vs ONCAB: 82.3 ± 2.4, P = 0.003) and male sex (OPCAB: 292/540, 54.1% vs ONCAB: 220/397, 55.4%, P = 0.68) were clinically similar between groups. Although the ejection fraction (OPCAB: 52.1 ± 12.5% vs ONCAB: 50.6 ± 13.1, P = 0.10) were similar between groups, the mean number of distal anastomoses [OPCAB: 2.7 ± 1.0 (median 3) vs ONCAB: 3.4 ± 0.9 (median 3), P < 0.001] were less in the OPCAB group. The median postoperative length of stay was 7 days for OPCAB group and 6 for the ONCAB group (P = 0.31). The Society of Thoracic Surgery predicted risk of in-hospital mortality was similar for OPCAB (5.4%) and ONCAB (5.3%) patients (P = 0.81). However, observed in-hospital mortality was improved for patients in the OPCAB group (OPCAB: 15/540, 2.8% vs ONCAB: 37/397, 9.3%, P = 0.007). Ten-year survival was similar between groups (OPCAB: 28.8% vs ONCAB: 26.3%, P = 0.22).

Conclusions

In this series, OPCAB reduced the incidence of in-hospital mortality compared with ONCAB. Long-term mortality was similar between groups.
Prebiotics and Oxidative Stress in Constipated Rats
Authors: Li Yanning , Zong Yanhong , Qi Jinsheng , Liu Kun
Published: April 2011

Objectives:

Constipation can adversely affect children's health, with disorders of host immunity and enhanced oxidative stress. As nondigestible carbohydrates, prebiotics can affect the host with constipation; however, whether the prebiotics have effects on the content of intestinal secretory immunoglobulin A (sIgA) and the contents of superoxide dismutase (SOD) and malondialdehyde (MDA) in constipation has not been fully clarified.

Methods:

In the present study, constipation was induced in female Sprague‐Dawley rats by diphenoxylate, and the prebiotics dissolved in milk were used as an intervention. The indicators of intestinal peristalsis, including the time of passing black stool initially, the grains of black stool in 24 hours, and the advance rate of ponceau, were measured. The content of intestinal sIgA was detected by enzyme‐linked immunosorbent assay. The contents of SOD and MDA in serum and intestinal tissue were analyzed by their detection kits.

Results:

The changes in intestinal peristalsis show obvious constipation. The content of intestinal sIgA decreases, the content of SOD decreases, but the content of MDA increases in constipated rats. Prebiotics can attenuate the constipation‐caused abnormal indicators significantly.

Conclusions:

Prebiotics can attenuate decreased intestinal immunity and enhanced oxidative stress, in addition to reduced intestinal peristalsis and of the constipated rats.
Effects of Lactobacillus rhamnosus Strain GG in Pediatric Obesity‐related Liver Disease
Authors: Vajro Pietro , Mandato Claudia , Licenziati Maria Rosaria , Franzese Adriana , Vitale Dino Franco , Lenta Selvaggia , Caropreso Maria , Vallone Gianfranco , Meli Rosaria
Published: April 2011

Objective:

Various lines of evidence suggest that malfunctioning of the gut–liver axis contributes to hepatic damage of rodents and humans with nonalcoholic fatty liver disease. We evaluated the effects of short‐term probiotic treatment in children with obesity‐related liver disease who were noncompliant with lifestyle interventions.

Patients and Methods:

Twenty obese children (age 10.7 ± 2.1 years) with persisting hypertransaminasemia and ultrasonographic (US) bright liver were enrolled in this double‐blind, placebo‐controlled pilot study. At baseline, patients underwent clinical and laboratory anthropometric evaluation, measurement of the US hepatorenal ratio, standard liver function tests, oral glucose tolerance test, serum tumor necrosis factor‐alpha, the glucose hydrogen breath test, and evaluation of serum antibodies to antipeptidoglycan‐polysaccharide polymers. After exclusion of causes of liver disease other than obesity, patients received either probiotic Lactobacillus rhamnosus strain GG (12 billion CFU/day) or placebo for 8 weeks.

Results:

Multivariate analysis after probiotic treatment revealed a significant decrease in alanine aminotransferase (average variation vs placebo P = 0.03) and in antipeptidoglycan‐polysaccharide antibodies (average variation vs placebo P = 0.03) irrespective of changes in BMI z score and visceral fat. Tumor necrosis factor‐alpha, and US bright liver parameters remained fairly stable.

Conclusions:

Probiotic L rhamnosus strain GG warrants consideration as a therapeutic tool to treat hypertransaminasemia in hepatopathic obese children noncompliant with lifestyle interventions.
Behavioral specifications of reward-associated long-term memory enhancement in humans
Authors: Wittmann Bianca C. , Dolan Raymond J. , Düzel Emrah
Published: April 2011

Recent functional imaging studies link reward-related activation of the midbrain substantia nigra–ventral tegmental area (SN/VTA), the site of origin of ascending dopaminergic projections, with improved long-term episodic memory. Here, we investigated in two behavioral experiments how (1) the contingency between item properties and reward, (2) the magnitude of reward, (3) the uncertainty of outcomes, and (4) the contextual availability of reward affect long-term memory. We show that episodic memory is enhanced only when rewards are specifically predicted by the semantic identity of the stimuli and changes nonlinearly with increasing reward magnitude. These effects are specific to reward and do not occur in relation to outcome uncertainty alone. These behavioral specifications are relevant for the functional interpretation of how reward-related activation of the SN/VTA, and more generally dopaminergic neuromodulation, contribute to long-term memory.
Control of Abscisic Acid Catabolism and Abscisic Acid Homeostasis Is Important for Reproductive Stage Stress Tolerance in Cereals1
Authors: Ji Xuemei , Dong Baodi , Shiran Behrouz , Talbot Mark J. , Edlington Jane E. , Hughes Trijntje , White Rosemary G. , Gubler Frank , Dolferus Rudy
Published: April 2011

Drought stress at the reproductive stage causes pollen sterility and grain loss in wheat (Triticum aestivum). Drought stress induces abscisic acid (ABA) biosynthesis genes in anthers and ABA accumulation in spikes of drought-sensitive wheat varieties. In contrast, drought-tolerant wheat accumulates lower ABA levels, which correlates with lower ABA biosynthesis and higher ABA catabolic gene expression (ABA 8′-hydroxylase). Wheat TaABA8′OH1 deletion lines accumulate higher spike ABA levels and are more drought sensitive. ABA treatment of the spike mimics the effect of drought, causing high levels of sterility. ABA treatment represses the anther cell wall invertase gene TaIVR1, and drought-tolerant lines appeared to be more sensitive to the effect of ABA. Drought-induced sterility shows similarity to cold-induced sterility in rice (Oryza sativa). In cold-stressed rice, the rate of ABA accumulation was similar in cold-sensitive and cold-tolerant lines during the first 8 h of cold treatment, but in the tolerant line, ABA catabolism reduced ABA levels between 8 and 16 h of cold treatment. The ABA biosynthesis gene encoding 9-cis-epoxycarotenoid dioxygenase in anthers is mainly expressed in parenchyma cells surrounding the vascular bundle of the anther. Transgenic rice lines expressing the wheat TaABA8′OH1 gene under the control of the OsG6B tapetum-specific promoter resulted in reduced anther ABA levels under cold conditions. The transgenic lines showed that anther sink strength (OsINV4) was maintained under cold conditions and that this correlated with improved cold stress tolerance. Our data indicate that ABA and ABA 8′-hydroxylase play an important role in controlling anther ABA homeostasis and reproductive stage abiotic stress tolerance in cereals.
Induction of a Longer Term Component of Isoprene Release in Darkened Aspen Leaves: Origin and Regulation under Different Environmental Conditions
Authors: Rasulov Bahtijor , Hüve Katja , Laisk Agu , Niinemets Ülo
Published: April 2011

After darkening, isoprene emission continues for 20 to 30 min following biphasic kinetics. The initial dark release of isoprene (postillumination emission), for 200 to 300 s, occurs mainly at the expense of its immediate substrate, dimethylallyldiphosphate (DMADP), but the origin and controls of the secondary burst of isoprene release (dark-induced emission) between approximately 300 and 1,500 s, are not entirely understood. We used a fast-response gas-exchange system to characterize the controls of dark-induced isoprene emission by light, temperature, and CO2 and oxygen concentrations preceding leaf darkening and the effects of short light pulses and changing gas concentrations during dark-induced isoprene release in hybrid aspen (Populus tremula × Populus tremuloides). The effect of the 2-C-methyl-d-erythritol-4-phosphate pathway inhibitor fosmidomycin was also investigated. The integral of postillumination isoprene release was considered to constitute the DMADP pool size, while the integral of dark-induced emission was defined as the “dark” pool. Overall, the steady-state emission rate in light and the maximum dark-induced emission rate responded similarly to variations in preceding environmental drivers and atmospheric composition, increasing with increasing light, having maxima at approximately 40°C and close to the CO2 compensation point, and were suppressed by lack of oxygen. The DMADP and dark pool sizes were also similar through their environmental dependencies, except for high temperatures, where the dark pool significantly exceeded the DMADP pool. Isoprene release could be enhanced by short lightflecks early during dark-induced isoprene release, but not at later stages. Fosmidomycin strongly suppressed both the isoprene emission rates in light and in the dark, but the dark pool was only moderately affected. These results demonstrate a strong correspondence between the steady-state isoprene emission in light and the dark-induced emission and suggest that the dark pool reflects the total pool size of 2-C-methyl-d-erythritol-4-phosphate pathway metabolites upstream of DMADP. These metabolites are converted to isoprene as soon as ATP and NADPH become available, likely by dark activation of chloroplastic glycolysis and chlororespiration.
Sexual signals and mating patterns in Syngnathidae
Authors: Rosenqvist G. , Berglund A.
Published: April 2011

Male pregnancy in the family Syngnathidae (pipefishes, seahorses and seadragons) predisposes males to limit female reproductive success; sexual selection may then operate more strongly on females and female sexual signals may evolve (sex‐role reversal). A bewildering array of female signals has evolved in Syngnathids, e.g. skin folds, large body size, colouration, markings on the body and elaborate courtship. These female sexual signals do not seem quantitatively or qualitatively different from those that evolve in males in species with conventional sex roles where males provide females or offspring with direct benefits. In several syngnathid species, males also evolve ornaments, females are choosy in addition to being competitive and males compete as well as choosing partners. Thus, sex roles form a continuum, spanning from conventional to reversed within this group of fishes. Cases are presented here suggesting that stronger sexual selection on females may be most extreme in species showing classical polyandry (one male mates with several females, such as many species where males brood their eggs on the trunk), intermediate in polygynandrous species (males and females both mate with more than one partner, as in many species where males brood their eggs on the tail) and least extreme, even exhibiting conventional sex roles, in monogamous species (one male mates solely with one female, as in many seahorses and tropical pipefishes). At the same time caution is needed before unanimously establishing this pattern: first, the connection between mating patterns, strength of sexual selection, sex roles and ornament expression is far from simple and straightforward, and second, knowledge of the actual morphology, ecology and behaviour of most syngnathid species is scanty. Basically only a few Nerophis, Syngnathus and Hippocampus species have been studied in any detail. It is known, however, that this group of fishes exhibits a remarkable variation in sex roles and ornamentation, making them an ideal group for the study of mating patterns, sexual selection and sexually selected signals.
Effects of fesoterodine on the pharmacokinetics and pharmacodynamics of warfarin in healthy volunteers
Authors: Malhotra Bimal , Alvey Christine , Gong Jason , Li Xiaoxi , Duczynski Gregory , Gandelman Kuan
Published: April 2011

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• Drug–drug interactions with warfarin are common with potentially harmful consequences. Preclinical in vitro studies suggest that fesoterodine or 5‐hydroxymethyl tolterodine are not likely to affect warfarin metabolism, but a lack of interaction has not been demonstrated in a clinical study.

WHAT THIS STUDY ADDS

• This study shows that the pharmacokinetics and pharmacodynamics of warfarin 25 mg in healthy adults are unaffected by fesoterodine 8 mg, and that co‐administration of warfarin 25 mg and fesoterodine 8 mg is safe and well tolerated.

AIMS To confirm the lack of an interaction of fesoterodine 8 mg with warfarin pharmacokinetics and pharmacodynamics in healthy adults.

METHODS In this open‐label, two‐treatment, crossover study, subjects (n= 14) aged 20–41 years with normal prothrombin time (PT) and International Normalized Ratio (INR) were randomized to receive a single dose of warfarin 25 mg alone in one period and fesoterodine 8 mg once daily on days 1–9 with a single dose of warfarin 25 mg co‐administered on day 3 in the other period. There was a 10‐day washout between treatments. Pharmacokinetic endpoints were area under the plasma concentration–time curve from time 0 to infinity (AUC(0,∞)), maximum plasma concentration (Cmax), AUC from time 0 to the time of the last quantifiable concentration (AUC(0,last)), time to Cmax (tmax), and half‐life (t1/2) for S‐ and R‐warfarin. Pharmacodynamic endpoints were area under the INR‐time curve (AUCINR), maximum INR (INRmax), area under the PT‐time curve (AUCPT) and maximum PT (PTmax).

RESULTS Across all pharmacokinetic and pharmacodynamic comparisons, the point estimates of treatment ratio (warfarin co‐administered with fesoterodine vs. warfarin alone) were 92–100%. The 90% confidence intervals for the ratios of the adjusted geometric means were contained within (80%, 125%). There were no clinically relevant changes in laboratory tests, vital signs or ECG recordings.

CONCLUSIONS The pharmacokinetics and pharmacodynamics of warfarin 25 mg in healthy adults are unaffected by fesoterodine 8 mg. Concomitant administration of fesoterodine and warfarin was well tolerated.
Correlation between insulin requirements and anti-galactose antibodies in patients with type 1 diabetes transplanted with neonatal pig islets
Authors: Esquivel-Pérez R , Rodriguez-Ventura A L , Dorantes L M , Ramírez-González B , López-Santos M G , Valdes-Gonzalez R
Published: April 2011

Pig xenografts represent an alternative source of organs for transplantation. Immunosuppression can prevent rejection, but involves high risk and cost. New anti-rejection techniques have been developed; however, results have not been successful. Few studies have reported xenoantibody levels in xenotransplanted patients with diabetes and no patients have reported a clinical correlation. We analysed anti-galactose (Gal) and other anti-pig antibody (APA) levels in xenotransplanted patients with type 1 diabetes and the relation to the clinical outcome. Twenty-three patients with type 1 diabetes were transplanted with porcine islets inside a device without immunosuppression. Demographic characteristics, insulin dose and xenoantibody levels at different periods were recorded. Anti-Gal and anti-pig antibodies were measured through indirect enzyme-linked immunosorbent assay (ELISA) and haemolytic anti-pig antibody assay. More than 50% were female; the mean current age, current diabetes duration, diabetes duration at xenotransplantation and time post-transplantation were: 20·8, 11, 5·5 and 5·7 years, respectively. Insulin doses remained with a mean reduction greater than 33% in more than 50% of the patients. The lowest anti-Gal antibody levels were related to the highest insulin dose reductions. This relationship could be explained by the device, Sertoli cells and accommodation process.
Nuclear factor kappa B plays a pivotal role in polyinosinic-polycytidylic acid-induced expression of human β-defensin 2 in intestinal epithelial cells
Authors: Omagari D , Takenouchi-Ohkubo N , Endo S , Ishigami T , Sawada A , Moro I , Asano M , Komiyama K
Published: April 2011

Intestinal epithelial cells (IECs) play an important role in protecting the intestinal surface from invading pathogens by producing effector molecules. IECs are one of the major sources of human beta-defensin 2 (hBD-2), and can produce it in response to a variety of stimuli. Although IECs express Toll-like receptor 3 (TLR-3) and can respond to its ligand, double-stranded RNA (dsRNA), hBD-2 expression in response to dsRNA has not been elucidated. In the present study, using an artificial analogue of dsRNA, polyinosinic-polycytidylic acid (poly I:C), we investigated whether the human IEC line, HT-29, can produce hBD-2 in response to poly I:C. HT-29 cells can express hBD-2 mRNA only when stimulated with poly I:C. The induction of hBD-2 mRNA expression was observed at 3 h after stimulation and peaked at 12 h of post-stimulation. Pre-incubation of the cells with nuclear factor kappa B (NF-κB)-specific inhibitor, l-1–4′-tosylamino-phenylethyl-chloromethyl ketone (TPCK) and isohelenine abolished the expression of hBD-2. Detection of the poly I:C signal by TLR-3 on the surface of HT-29 cells was revealed by pre-incubating the cells with anti-TLR-3 antibody. The 5′-regulatory region of the hBD-2 gene contains two NF-κB binding sites. A luciferase assay revealed the importance of the proximal NF-κB binding site for poly I:C-induced expression of hBD-2. Among NF-κB subunits, p65 and p50 were activated by poly I:C stimulation and accumulated in the nucleus. Activation of the p65 subunit was investigated further by determining its phosphorylation status, which revealed that poly I:C stimulation resulted in prolonged phosphorylation of p65. These results indicate clearly that NF-κB plays an indispensable role in poly I:C induced hBD-2 expression in HT-29 cells.
Seasonal variation in sesquiterpene lactone concentration and composition of forage chicory (Cichorium intybus L.) cultivars
Authors: Foster J. G. , Cassida K. A. , Sanderson M. A.
Published: April 2011

Palatability and anthelmintic activity of chicory (Cichorium intybus L.) forage are influenced by the sesquiterpene lactones lactucin (LAC), 8‐deoxylactucin (DOL) and lactucopicrin. Therefore, the objective of this study was to determine how sesquiterpene lactone concentration and composition vary during the growing season. Three forage chicory cultivars (Puna, Forage Feast and Lacerta) grown in West Virginia and Pennsylvania (USA) were managed during two consecutive years to maintain plants in the vegetative stage, and sesquiterpene lactones in leaves were quantified after each growth interval. Cultivars differed in the total concentration of sesquiterpene lactones and in the proportions of LAC and DOL. Total sesquiterpene lactone concentration generally decreased or remained constant during the season, but the specific response depended on the cultivar. Differences in seasonal patterns between years corresponded with unusual climatic conditions. The three cultivars had similar concentrations of DOL in the spring. Forage Feast provided a dramatically lower concentration of DOL during the summer. Uniformly high concentrations of DOL across the growing season in Puna and Lacerta make these cultivars attractive for use in bioactive pastures for control of Haemonchus contortus. Changes in both sesquiterpene lactone concentration and composition during the season result in large variations in forage bitterness.
γδT‐cell function in sepsis is modulated by C5a receptor signalling
Authors: Han Gencheng , Geng Shaoxia , Li Yurong , Chen Guojiang , Wang Renxi , Li Xinying , Ma Yuanfang , Shen Beifen , Li Yan
Published: April 2011

We previously showed that γδT cells are involved in the pathogenesis of sepsis, but, the underlying mechanisms remained unclear. The present study demonstrates, for the first time, that γδT cells express the complement C5a receptor (C5aR, CD88) and that CD88 expression in γδT cells was up‐regulated in mice following sepsis both at protein and mRNA levels. Complement C5a itself contributed to the regulation of C5aR expression on γδT cells, as (i) neutralization of C5a in vivo prevented the expression of C5aR on γδT cells in septic mice and (ii) incubation of mouse spleen cells or purified γδT cells with recombinant C5a in vitro increased CD88 expression by γδT cells at both protein and mRNA levels. C5a receptor on γδT cells also mediates increased interleukin‐17 (IL‐17) expression as incubation of mouse spleen cells or purified γδT cells with recombinant C5a promotes the IL‐17 expression by γδT cells. Ligation of the C5aR on γδT cells activated the phosphoinositide 3‐kinase (PI3K)/Akt signalling pathway, which enhances CD88 expression and promotes IL‐17 secretion. These results demonstrate that C5a acts directly on the C5aR expressed on γδT cells, resulting in cell activation, and subsequently enhances their capacity for IL‐17 production. The up‐regulation of the PI3K/Akt pathway following C5a stimulation contributes to up‐regulation of γδT‐cell function.
An ecological perspective on extreme climatic events: a synthetic definition and framework to guide future research
Authors: Smith Melinda D.
Published: April 2011

1. Growing recognition of the importance of climate extremes as drivers of contemporary and future ecological dynamics has led to increasing interest in studying these locally and globally important phenomena.

2. Many ecological studies examining the impacts of what are deemed climate extremes, such as heat waves and severe drought, do not provide a definition of extremity, either from a statistical context based on the long‐term climatic record or from the perspective of the response of the system – are the effects extreme (unusual or profound) in comparison to normal variability?

3. A synthetic definition of an extreme climatic event (ECE) is proposed that includes ‘extremeness’ in both the driver and the response: an ECE is as an episode or occurrence in which a statistically rare or unusual climatic period alters ecosystem structure and/or function well outside the bounds of what is considered typical or normal variability. This definition is accompanied by a mechanistic framework based on the concept that extreme response thresholds associated with significant community change and altered ecosystem function must be crossed in order for an ECE to occur.

4. Synthesis. A definition and mechanistic framework for ECEs is used to identify priorities for future research that will enable ecologists to more fully assess the ecological consequences of climate extremes for ecosystem structure and function today and in a future world where their frequency and intensity are expected to increase.
Medical practice variations: what the literature tells us (or does not) about what are warranted and unwarranted variations
Authors: Mercuri Mathew , Gafni Amiram
Published: April 2011

This paper examines the sources of practice variations and definitions of unwarranted variation, as derived from the literature. The literature suggests variables/factors related to patient health needs, doctor ‘practice style’ and environmental constraints/opportunities as sources of practice variations. However, this list is likely to be incomplete because of significant unexplained variation in each study. Furthermore, it is unclear which factors are sources of unwarranted variation because the reviewed studies do not clearly discriminate between those variations that are unwarranted and those that are not. It is also unclear if context plays a role in determining if and when a factor is unwarranted. The literature contains few frameworks of what constitutes unwarranted variation. Among those offered, more information is needed regarding the scientific basis for including the selected factors, and how to operationalize the framework provided a particular one is chosen. A clear and consistent framework for unwarranted variation, and a clear indication how each component factor could be measured and integrated can help investigators determine which variables should be included in their studies, such that the sources of unwarranted variations may be identified. A better understanding of the role of patient preference as a potential source of practice variations is also required.
Rapid Nongenomic Effects of Oestradiol on Gonadotrophin‐Releasing Hormone Neurones
Authors: Moenter S. M. , Chu Z.
Published: April 2011

That oestradiol can have both negative‐ and positive‐feedback actions upon the release of gonadotrophin‐releasing hormone (GnRH) has been understood for decades. The vast majority of studies have investigated the effects of in vivo oestrogen administration. In the past decade, evidence has accumulated in many neuronal and non‐neuronal systems indicating that, in addition to traditional genomic action via transcription factor receptors, steroids can also initiate effects rapidly via signalling cascades typically associated with the cell membrane. Here, we review work examining the rapid actions of oestradiol on GnRH neurones, addressing the questions of dose dependence, receptor subtypes, signalling cascades and intrinsic and synaptic properties that are rapidly modulated by this steroid.
Larval habitat segregation between the molecular forms of the mosquito Anopheles gambiae in a rice field area of Burkina Faso, West Africa
Authors: GIMONNEAU G. , POMBI M. , CHOISY M. , MORAND S. , DABIRÉ R. K. , SIMARD F.
Published: April 2011

In West Africa, lineage splitting between the M and S molecular forms of the major Afro‐tropical malaria mosquito, Anopheles gambiae (Diptera: Culicidae), is thought to be driven by ecological divergence, occurring mainly at the larval stage. Here, we present evidence for habitat segregation between the two molecular forms in and around irrigated rice fields located within the humid savannahs of western Burkina Faso. Longitudinal sampling of adult mosquitoes emerging from a range of breeding sites distributed along a transect extending from the heart of the rice field area into the surrounding savannah was conducted from June to November 2009. Analysis revealed that the two molecular forms and their sibling species Anopheles arabiensis are not randomly distributed in the area. A major ecological gradient was extracted in relation to the perimeter of the rice fields. The M form was associated with larger breeding sites mostly consisting of rice paddies, whereas the S form and An. arabiensis were found to depend upon temporary, rain‐filled breeding sites. These results support hypotheses about larval habitat segregation and confirm the suggestion that the forms have different larval habitat requirements. Segregation appears to be clearly linked to anthropogenic permanent habitats and the community structure they support.
Responses to procedural information about colorectal cancer screening using faecal occult blood testing: the role of consideration of future consequences
Authors: von Wagner Christian , Good Anna , Smith Samuel G. , Wardle Jane
Published: April 2011

Background  Colorectal cancer (CRC) screening participation is low despite its effectiveness in reducing CRC mortality. Identifying benefits and barriers requires consideration of specific characteristics of screening modalities.

Aims and Research Questions  To monitor the impact of providing information about CRC screening via faecal occult blood testing (FOBt) on intentions to participate. To investigate moderation by individual differences in consideration of future consequences (CFC).

Design, setting and participants  A total of 211 healthy adults (aged 45–59) with no experience of CRC screening were presented with eight consecutive statements about FOBt‐based screening in a web survey. Participants completed measures of i) intention (after each statement), ii) CFC and iii) the importance of screening practicalities (e.g. unpleasantness of completing the test) and benefits (e.g. early detection of cancer).

Results  An 8 (information) × 2 (CFC) mixed ancova showed that intentions varied across the eight statements. (P < 0.001): increasing after information about FOBt being completed at home (P < 0.001) before subsequently decreasing after information about the requirement to collect faecal samples (P < 0.001) in a plastic tub (P < 0.01) on three occasions (P < 0.01) with the low CFC group generally being less inclined to complete the test (P < 0.01). Two between‐group anovas demonstrated that the low CFC group attributed greater importance to practicalities of screening than the high CFC group while the opposite was found for the importance of benefits (both P’s < 0.001).

Conclusion  Deconstructing FOBt‐based screening pointed to specific benefits and barriers which can advance research into public preferences of screening and educational materials.
Holoprosencephaly and ZIC2 microdeletions: novel clinical and epidemiological specificities delineated
Authors: Chabchoub E , Willekens D , Vermeesch JR , Fryns J‐P
Published: April 2011

Chabchoub E, Willekens D, Vermeesch JR, Fryns J‐P. Holoprosencephaly and ZIC2 microdeletions: novel clinical and epidemiological specificities delineated.

Holoprosencephaly (HPE), the most common malformation of the human brain results from abnormal cleavage of the forebrain during the early embryonic developmental stages. The spectrum of malformations in HPE is wide, ranging from the classical cyclopia/proboscis to fairly asymptomatic forms [i.e. a single maxillary central incisor (SMCI)]. HPE may be caused by environmental or genetic factors. ZIC2 (13q32) was the second gene identified in which mutations cause HPE and recently a specific phenotype was ascribed to ZIC2‐mutation HPE.

Earlier, we reported a boy presenting HPE and deafness. Cytogenetic analyses were normal. Using array‐comparative genomic hybridization (aCGH), we found a de novo 129 kb del(13)(q32) encompassing ZIC2 and ZIC5. There is no evidence for the involvement of ZIC5 in human diseases. We reviewed the literature for ZIC2‐ZIC5 deletions and their involvement in neural tube defects (NTDs).

Interestingly, we found evidence for a specific facial phenotype for ZIC2 gene deletion patients distinct from those with point mutations. In addition, based on the clinical data together with pathology, imaging and functional studies, we suggest an outline for a model explaining the genetic heterogeneity of ZIC2‐ZIC5‐associated NTDs and propose further studies for validation.
Identification of a novel HLA‐C*01 variant allele, C*01:46
Authors: Wang D.‐M. , Xu Y.‐P. , Deng Z.‐H.
Published: April 2011

A novel HLA‐C*01 variant allele differs from the closest allele C*01:02:01 by single nucleotide change at coding sequence nt 316 C>T (codon 82 CGC>TGC) in exon 2, which causes an amino acid change Arg82Cys.
HLA‐A, HLA‐B, and HLA‐DRB1 allele distribution in a large Armenian population sample
Authors: Matevosyan L. , Chattopadhyay S. , Madelian V. , Avagyan S. , Nazaretyan M. , Hyussian A. , Vardapetyan E. , Arutunyan R. , Jordan F.
Published: April 2011

Human leukocyte antigen (HLA)‐A, HLA‐B, and HLA‐DRB1 gene frequencies were investigated in 4279 unrelated Armenian bone marrow donors. HLA alleles were defined by using PCR amplification with sequence specific primers (PCR‐SSP) high‐ and low‐resolution kits. The aim of this study was to examine the HLA diversity at the high‐resolution level in a large Armenian population sample, and to compare HLA allele group distribution in Armenian subpopulations. The most frequently observed alleles in the HLA class I were HLA‐A*0201, A*0101, A*2402, A*0301, HLA‐B*5101, HLA‐B*3501, and B*4901. Among DRB1 alleles, high frequencies of DRB1*1104 and DRB1*1501 were observed, followed by DRB1*1101 and DRB1*1401. The most common three‐locus haplotype found in the Armenian population was A*33‐B*14‐DRB1*01, followed by A*03‐B*35‐DRB1*01. Our results show a similar distribution of alleles in Armenian subpopulations from different countries, and from different regions of the Republics of Armenia and Karabagh. The low level of genetic distances between subpopulations indicates a high level of population homogeneity, and the genetic distances between Armenians and other populations show Armenians as a distinct ethnic group relative to others, reflecting the fact that Armenians have been an ‘isolated population’ throughout centuries. This study is the first comprehensive investigation of HLA–allele group distribution in a subset of Armenian populations, and the first to provide HLA–allele and haplotype frequencies at a high‐resolution level. It is a valuable reference for organ transplantation and for future studies of HLA‐associated diseases in Armenian populations.
Ultrastructural changes and the distribution of arabinogalactan proteins during somatic embryogenesis of banana (Musa spp. AAA cv. ‘Yueyoukang 1’)
Authors: Pan Xiao , Yang Xiao , Lin Guimei , Zou Ru , Chen Houbin , Šamaj Jozef , Xu Chunxiang
Published: April 2011

A better understanding of somatic embryogenesis in banana (Musa spp.) may provide a practical way to improve regeneration of banana plants. In this study, we applied scanning electron microscopy (SEM) and transmission electron microscopy (TEM) to visualize the ultrastructural changes during somatic embryogenesis of banana (Musa AAA cv. ‘Yueyoukang 1’). We also used histological and immunohistochemical techniques with 16 monoclonal antibodies to study the spatial distribution and cellular/subcellular localization of different arabinogalactan protein (AGP) components of the cell wall during somatic embryogenesis. Histological study with periodic acid‐Schiff staining documented diverse embryogenic stages from embryogenic cells (ECs) to the late embryos. SEM revealed a mesh‐like structure on the surface of proembryos which represented an early structural marker of somatic embryogenesis. TEM showed that ECs were rich in juvenile mitochondria, endoplasmic reticulum and Golgi stacks. Cells in proembryos and early globular embryos resembled ECs, but they were more vacuolated, showed more regular nuclei and slightly more developed organelles. Immunocytochemical study revealed that the signal of most AGP epitopes was stronger in starch‐rich cells when compared with typical ECs. The main AGP component in the extracellular matrix surface network of banana proembryos was the MAC204 epitope. Later, AGP immunolabelling patterns varied with the developmental stages of the embryos. These results about developmental regulation of AGP epitopes along with developmental changes in the ultrastructure of cells are providing new insights into the somatic embryogenesis of banana.
Evaluation of a clinical scoring system and directed laboratory testing for respiratory virus infection in hematopoietic stem cell transplant recipients
Authors: Ferguson P.E. , Gilroy N.M. , Sloots T.P. , Nissen M.D. , Dwyer D.E. , Sorrell T.C.
Published: April 2011

P.E. Ferguson, N.M. Gilroy, T.P. Sloots, M.D. Nissen, D.E. Dwyer, T.C. Sorrell. Evaluation of a clinical scoring system and directed laboratory testing for respiratory virus infection in hematopoietic stem cell transplant recipients. Transpl Infect Dis 2011: 13: 448–455. xx: 000–000. All rights reserved

Abstract: A simple clinical screening (CS) tool for respiratory virus (RV) infection was introduced and evaluated in a single hematology ward, as part of a strategy to reduce nosocomial RV infection. Up to 6 clinical symptoms or signs were scored and a predefined threshold score of ≥2 prompted paired nose/throat swab (NTS) collection for RV testing. The criterion standard for RV infection was positive immunofluorescence (IF) or polymerase chain reaction (PCR) for 7 and 15 viruses, respectively. The tool was shown to be most beneficial at excluding infection at a threshold score of 1 (negative predictive value [NPV] 89%, [95% confidence interval 78–96%], sensitivity 85% [70–94%], specificity 35% [27–43%]), compared with a score of 2 (NPV 85% [76–91%], sensitivity 63% [46–77%], specificity 57% [48–65%]) at a prevalence of 22%. The tool's ability to diagnose infection was limited (positive predictive value 27% and 29% at thresholds 1 and 2). The sensitivity of IF compared with PCR was 45% for the 7 viruses common to both, and 23% for the extended virus panel detected by PCR. An algorithm incorporating CS, paired NTS collection at a threshold of 1 symptom or sign, and sensitive testing including PCR can guide infection control measures in hospitalized hematopoietic stem cell transplant recipients.
Pathological spectrum of intrahepatic cholangiocarcinoma arising in non‐biliary chronic advanced liver diseases
Authors: Nakanuma Yasuni , Xu Jing , Harada Kenichi , Sato Yasunori , Sasaki Motoko , Ikeda Hiroko , Kim Jihun , Yu Eunsil
Published: April 2011

Intrahepatic cholangiocarcinoma (ICC) is reported to develop in non‐biliary chronic advanced liver diseases (CALD). Herein, we characterize the pathological features of ICC arising in CALD in comparison with those in non‐CALD livers. Of 471 surgically resected cases of ICC in Kanazawa, Japan and Seoul, Korea, 53 were associated with CALD (group A), while the remaining 418 arose in otherwiswe normal livers (group B). When ICC were classified into bile duct type, bile ductular type, variants, and intraductal papillary neoplasm of the bile duct (IPNB), the whole spectrum of subtypes were found in group A; the majority of ICC belonged to the bile duct type in both groups. In group A, bile ductular type was rather frequent (22.6%) compared with group B (8.4%). IPNB was more frequent in group B (22.5%) than group A (3.8%), and in group B, frequent in Seoul cases (24.8%), but rare in Kanazawa cases (2.3%). Variants of ICC were rare in both groups. These results imply that cholangiocarcinogenesis itself is upregulated in group A in comparison with group B and that the bile ductular type is specifically related to group A. Some unique environmental factors in Seoul may be responsible for the frequent development of IPNB.
Noninvasive electrical impedance analysis to measure human urinary bladder volume
Authors: Liao Wen‐Chien , Jaw Fu‐Shan
Published: April 2011

Aim:  To assess urinary bladder volume in a noninvasive manner using a portable and modified device that measures electrical impedance.

Methods:  A novel method was attempted to measure electrical impedance and indirect bladder volume, and these data were used to calculate the actual bladder volume.

Results:  An increase of 0.01 V in the abdominal voltage was observed with every 50 mL increase in the amount of physiological saline infused into the bladder.

Conclusions:  It is a simple procedure and can be used by technical staff or the patients themselves to obtain continuous, real‐time urinary bladder volume data.
Retroperitoneal Castleman's disease presenting with hydronephrosis indistinguishable from lymphoma
Authors: Kim Young Sun , Jung Min Hyung
Published: April 2011

Castleman's disease is a rare benign lymphoproliferative disease. We describe a patient with an unusual case of retroperitoneal Castleman's disease who initially presented with hydronephrosis. Her disease manifested with a malignant appearance in positron emission tomography/computed tomography and was located in the common and internal iliac area. Retrograde double‐J stent insertion failed and nephrostomy was then performed. Complete surgical removal of the disease failed because the disease was severely adherent to the ureter and adjacent iliac vessels. Antegrade double‐J stent insertion also failed. The patient eventually underwent laparoscopic ureteroneocystostomy. Retroperitoneal Castleman's disease should be added to the extensive list of differential diagnoses for primary retroperitoneal tumors.
A case of spontaneous rupture of a uterine superficial varicose vein in midgestation
Authors: Nakaya Yoshio , Itoh Hiroaki , Muramatsu Keiko , Otome Masako , Kobayashi Yukiko , Hirai Kyuya , Uchida Toshiyuki , Suzuki Kazunao , Sugihara Kazuhiro , Kanayama Naohiro
Published: April 2011

A 25‐year‐old gravida two, nulliparous pregnant woman complained of a sudden onset of severe pain in the right lateral abdominal area and went to hospital at 28 weeks and 5 days' gestation. Since cyclic uterine contractions were observed, a diagnosis of preterm labor was made and tocolysis was carried out by the continuous venous infusion of ritodorine. She was transferred to Hamamatsu University Hospital and an emergency cesarean section was carried out due to non‐reassuring fetal status. A hemoperitoneum of 850 mL was observed in the peritoneal cavity and an immature male baby weighing 1140 g was born. There was bleeding from a ruptured superficial varicose vein in the right lateral portion of the uterus, which was stopped by compression and the attachment of oxidized cellulose cotton. The clinical management and differential diagnosis were discussed.
Comparisons of urodynamic effects, therapeutic efficacy and safety of solifenacin versus tolterodine for female overactive bladder syndrome
Authors: Hsiao Sheng‐Mou , Chang Ting‐Chen , Wu Wen‐Yih , Chen Chi‐Hau , Yu Hung‐Jeng , Lin Ho‐Hsiung
Published: April 2011

Aim:  To evaluate the urodynamic effects, therapeutic efficacy and safety of solifenacin versus tolterodine treatment for women with overactive bladder syndrome.

Methods:  Patients were randomized to receive either solifenacin 5 mg or tolterodine ER 4 mg once a day for 12 weeks at each four‐week visit in a post‐marketing study. Only women (solifenacin [n = 26] vs. tolterodine [n = 22]) were included in this subgroup analysis. Adverse events and changes of urodynamic values and clinical data were compared between the solifenacin and tolterodine groups.

Results:  The volume voided per micturition increased in the solifenacin group (n = 21) (P = 0.04). The strong desire to void and pad‐test result improved in the tolterodine group (n = 21; P = 0.02 and 0.03, respectively). There were no between‐group differences in changes of any urodynamic data, voiding diary values or adverse events after treatment; however, changes of heart rate differed between the two groups (P = 0.0004), especially at visit 2 (solifenacin vs. tolterodine, −4.3 vs. 3.8, P = 0.02) and visit 3 (−3.2 vs. 4.8, P = 0.03).

Conclusions:  Both solifenacin and tolterodine had similar urodynamic effects, therapeutic efficacy and adverse events in treating women with overactive bladder syndrome; however, tolterodine had a greater effect in increasing heart rate than solifenacin.
Fourteen‐year‐old girl with recurrent luteal‐phase‐dependent episodes of high fever
Authors: Yamasaki Hideki , Oki Toshimichi , Iwamoto Ichiro , Douchi Tsutomu
Published: April 2011

Recurrent episodes of high fever during the luteal phase are exceedingly rare. A 14‐year‐old girl with a 1‐year history of recurrent febrile episodes associated with the menstrual cycle was referred to our department. Febrile episode (39–41°C) occurred for 10 to 12 days concomitantly with the luteal phase of each ovulatory cycle. To suppress the ovulatory cycle, gonadotropin releasing hormone agonist was administered for 5 months, and then febrile attack disappeared (34.5–36.2°C). Before and during gonadotropin releasing hormone agonist therapy, serum levels of inflammatory cytokines (interleukin [IL]‐1β, IL‐2, IL‐6, IL‐8, IL‐10, and tumor necrosis factor‐α) were unchanged and all of these were within the normal ranges. In our case, luteal‐phase‐dependent febrile episodes may not be attributable to the intervention of inflammatory cytokines as major fever mediators.