bluuebunny/crossref_metadata_2025 huggingface dataset:
Enhancing team learning in nursing teams through beliefs about interpersonal context
Authors: Ortega Aída , Sánchez‐Manzanares Miriam , Gil Francisco , Rico Ramón
Published: April 2012

Aim.  This article is a report of a study that examines the relationship between team‐level learning and performance in nursing teams, and the role of beliefs about the interpersonal context in this relationship.

Background.  Over recent years, there has been an increasing interest in the learning processes of work teams. Researchers have investigated the impact of team learning on team performance, and the enabling conditions for this learning. However, team learning in nursing teams has been largely ignored.

Design.  A cross‐sectional field survey design was used.

Methods.  The sample comprises a total of 468 healthcare professionals working in 89 nursing teams at different public hospitals throughout Spain. Members of nursing teams participated voluntarily by completing a confidential individual questionnaire. Team supervisors evaluated nursing teams’ performance. Data were collected over 2007–2008.

Results.  The results show a mediating effect of team learning on the relationship between beliefs about interpersonal context (psychological safety, perceived task interdependence, and group potency) and team performance.

Conclusion.  Our findings suggest that beliefs about interpersonal context and team learning are important to effective nursing team performance.
Internight sleep variability: its clinical significance and responsiveness to treatment in primary and comorbid insomnia
Authors: SÁNCHEZ‐ORTUÑO MARÍA M. , EDINGER JACK D.
Published: April 2012

Although sleep diary and actigraphy data are usually collected daily for 1 or 2 weeks, traditional analytical approaches aggregate these data into mean values. Internight variability of sleep often accompanies insomnia. However, few studies have explored the relevance of this ‘construct’ in the context of diagnosis, clinical impact, treatment effects and/or whether having ‘variable sleep’ carries any prognostic significance. We explored these questions by conducting secondary analyses of data from a randomized clinical trial. The sample included primary (PI: n = 40) and comorbid insomnia (CMI: n = 41) sufferers receiving four biweekly sessions of cognitive–behavioural therapy (CBT) or sleep hygiene education. Using the within‐subject standard deviations of diary‐ and actigraphy‐derived measures collected for 2‐week periods [sleep onset latency (SOL), wake after sleep onset (WASO), total sleep time (TST) and sleep efficiency (SE)], we found that CMI sufferers displayed more variable self‐reported SOLs and SEs than PI sufferers. However, higher variability in diary and actigraphy‐derived measures was related to poorer sleep quality only within the PI group, as measured by the Pittsburgh Sleep Quality Index (PSQI). Within both groups, the variability of diary‐derived measures was reduced after CBT, but the variability of actigraphy‐derived measures remained unchanged. Interestingly, the variability of actigraphy measures at baseline was correlated with PSQI scores at 6‐month follow‐up. Higher SOL variability was associated with worse treatment outcomes within the PI group, whereas higher WASO variability was correlated with better treatment outcomes within the CMI group. Sleep variability differences across insomnia diagnoses, along with their distinctive correlates, suggest that mechanisms underlying the sleep disruption/complaint and treatment response in both patient groups are distinct. Further studies are warranted to support variability as a useful metric in insomnia studies.
Increased peripheral RORα and RORγt mRNA expression is associated with acute‐on‐chronic hepatitis B liver failure
Authors: Qi Z.‐X. , Wang L.‐Y. , Fan Y‐C. , Zhang J.‐J. , Li T. , Wang K.
Published: April 2012

Summary.  T helper cells17 (Th17) have accurate but inconclusive roles in the pathogenesis of acute‐on‐chronic hepatitis B liver failure (ACHBLF). Retinoic acid‐related orphan receptor γ t(RORγt) and RORα are two lineage‐specific nuclear receptors directly mediating Th17 differentiation. This study was aimed to evaluate the gene expression of RORα and RORγt and their potential role in ACHBLF. Forty patients with liver failure, 30 with chronic hepatitis B (CHB) and 20 healthy controls were studied. The mRNA levels of RORα and RORγt in peripheral mononuclear cells were determined by quantitative real‐time polymerase chain reaction. The frequency of peripheral Th17 cells was determined using flow cytometry. The serum levels of interleukin‐6(IL‐6), transforming growth factor –β (TGF‐β), interleukin‐17(IL‐17), interleukin‐23(IL‐23) and interferon‐γ (IFN‐γ) were measured by enzyme‐linked immunosorbent assay. The frequency of peripheral Th17 cells in patients with liver failure was significantly increased compared to patients with CHB and controls. The peripheral mRNA levels of RORα and RORγt in hepatitis B‐associated acute‐on‐chronic liver failure were significantly higher than in patients with CHB and controls as were the serum levels of IL‐6 and TGF‐β. The serum level of IFN‐γ in patients with acute‐on‐chronic liver failure from HBV was significantly higher than patients with CHB but lower than controls. In patients with acute‐on‐chronic liver failure associated with HBV, RORγt, IL‐6 and IL‐23 were positively correlated with the frequency of Th17 cells, while RORα, TGF‐β and IFN‐γ had no correlation with the latter. The mRNA level of RORγt was positively correlated with model of end‐stage liver disease (MELD) score, but there was no correlation of RORα and MELD score. RORγt plays an important role in the pathogenesis of acute‐on‐chronic HBV‐associated liver failure and might be considered to be a candidate factor consistent with the severity of disease.
Modulation of replication efficacy of the hepatitis C virus replicon Con1 by site‐directed mutagenesis of an NS4B aminoterminal basic leucine zipper
Authors: Welker M.‐W. , Susser S. , Welsch C. , Perner D. , Füller C. , Kronenberger B. , Herrmann E. , Zeuzem S. , Sarrazin C.
Published: April 2012

Summary.  The hepatitis C virus (HCV) nonstructural protein 4B (NS4B) is assumed to function as a membrane anchor and protein hub for the viral replication complex. The aim of the current work was to modulate HCV replication efficacy in the subgenomic Con1 replicon by mutations of specific sites within the aminoterminal‐located basic leucine zipper (bZIP), a candidate motif for protein–protein interactions involving NS4B. Mutational sites and amino acid substitutes were determined by in‐silico sequence analyses of the NS4B‐bZIP motif in 357 isolates of HCV genotype 1b from the euHCVdB and LosAlamos database and consecutive analysis of conserved physico‐chemical properties at bZIP specific positions. Mutants with predicted minor, medium or major reduction of replication efficacy were tested in the pFKI389neo/NS3‐3′/ET plasmid replicon model. Four sites (L25, T29, V39 and W43) of crucial importance for bZIP‐mediated protein interaction with predicted apolarity of respective amino acid positions were selected for mutational studies. Substitutes with physico‐chemical properties matching the predicted requirements either well (T29A), moderately (L25W, V39W), or insufficiently (T29E, W43E) were associated with slightly improved, moderate and marked decreased replication efficacy, respectively. Spontaneous (T29G) and adaptive (A28G, E40G) mutations occurred in the T29E mutation isolate only and were associated with marked reduction of replication efficacy. The bZIP motif region of NS4B is crucial for RNA replication in the subgenomic Con1 replicon system. RNA replication efficacy can be modulated by site‐directed mutagenesis at specific bZIP functional sites. New adaptive amino acid mutations were identified within the HCV NS4B protein.
The historical ecology of the large mammal populations of Ngorongoro Crater, Tanzania, east Africa
Authors: Oates Louise , Rees Paul A.
Published: April 2012

Ngorongoro Crater is an ecologically important protected area in Tanzania, east Africa. We review published and unpublished data on the crater's large mammal community from the first recorded visit by a European in 1892 to 2010.

Early estimates often exaggerated large herbivore numbers and regular scientific censuses have only been made since the 1960s. Since then, most large herbivore populations have declined, particularly wildebeest Connochaetes taurinus, which have been replaced by buffalo Syncerus caffer as the dominant herbivore in terms of biomass. The internationally important population of black rhinoceros Diceros bicornis has reduced from over 100 in the 1960s to around 30 in 2011. The lion Panthera leo population is genetically isolated, has declined since the 1960s and has consistently been held below carrying capacity.

Buffalo and warthogs Phacochoerus aethiopicus are relatively recent colonizers. Wild dogs Lycaon pictus were present in the 1960s but are probably now absent. Small numbers of elephants Loxodonta africana use the crater floor and cheetahs Acinonyx jubatus appear to be intermittent visitors.

Primary drivers of changes in herbivore populations are disease and vegetation change. Poaching has been implicated as the cause of decline in rhinoceros. Disease associated with anomalous weather conditions appears to be the main driver for population change in lions.

Recent scientific research on the large mammal community has largely been focused on lions and rhinoceros. The output of research on other species has not increased since the 1960s.

A wider dissemination of research on the crater's mammal populations would help to secure its status as an important site for conservation in the eyes of the wider scientific and conservation community.
Disruption of gene expression in hybrids of the fire ants Solenopsis invicta and Solenopsis richteri
Authors: OMETTO LINO , ROSS KENNETH G. , SHOEMAKER DeWAYNE , KELLER LAURENT
Published: April 2012

Transcriptome analysis is a powerful tool for unveiling the distribution and magnitude of genetic incompatibilities between hybridizing taxa. The nature of such incompatibilities is closely associated with the evolutionary histories of the parental species and may differ across tissues and between the sexes. In eusocial insects, the presence of castes that experience divergent selection regimes may result in additional distinct patterns of caste‐specific hybrid incompatibilities. We analysed levels of expression of >14 000 genes in two life stages of each caste in the fire ants Solenopsis invicta and Solenopsis richteri and in their hybrids. We found strong contributions of both developmental stage and caste to gene expression patterns. In contrast, variability in expression was only weakly associated with taxonomic identity, with hybrid scores falling between those of the two parental species. Hybrid incompatibilities were surprisingly modest, with only 32 genes being mis‐expressed, indicating low levels of disruption in gene regulation in hybrids; males and workers each mis‐expressed at least seven times as many genes as queens. Interestingly, homologues of many of the mis‐expressed genes have been implicated in behavioural variation in Drosophila melanogaster. General expression profiles of hybrids consistently were more similar to those of S. richteri than S. invicta, presumably because S. richteri trans‐regulatory elements tend to be dominant and/or because there is an overall bias in the genetic composition of the hybrids towards S. richteri. Altogether, our results suggest that selection acting on each caste may contribute differently to interspecific divergence and speciation in this group of ants.
Structural assessment of the impact of environmental constraints on Arabidopsis thaliana leaf growth: a 3D approach
Authors: WUYTS NATHALIE , MASSONNET CATHERINE , DAUZAT MYRIAM , GRANIER CHRISTINE
Published: April 2012

Light and soil water content affect leaf surface area expansion through modifications in epidermal cell numbers and area, while effects on leaf thickness and mesophyll cell volumes are far less documented. Here, three‐dimensional imaging was applied in a study of Arabidopsis thaliana leaf growth to determine leaf thickness and the cellular organization of mesophyll tissues under moderate soil water deficit and two cumulative light conditions. In contrast to surface area, thickness was highly conserved in response to water deficit under both low and high cumulative light regimes. Unlike epidermal and palisade mesophyll tissues, no reductions in cell number were observed in the spongy mesophyll; cells had rather changed in volume and shape. Furthermore, leaf features of a selection of genotypes affected in leaf functioning were analysed. The low‐starch mutant pgm had very thick leaves because of unusually large palisade mesophyll cells, together with high levels of photosynthesis and stomatal conductance. By means of an open stomata mutant and a 9‐cis‐epoxycarotenoid dioxygenase overexpressor, it was shown that stomatal conductance does not necessarily have a major impact on leaf dimensions and cellular organization, pointing to additional mechanisms for the control of CO2 diffusion under high and low stomatal conductance, respectively.
Effects of flooding on germination and establishment of the invasive cordgrass Spartina densiflora
Authors: ABBAS A M , RUBIO‐CASAL A E , DE CIRES A , FIGUEROA M E , LAMBERT A M , CASTILLO J M
Published: April 2012

Abbas AM, Rubio‐Casal AE, De Cires A, Figueroa ME, Lambert AM & Castillo JM (2012). Effects of flooding on germination and establishment of the invasive cordgrass Spartina densiflora. Weed Research52, 269–276.

Flooding has been described as one of the most important environmental factors determining the distribution of salt marsh plants. We studied the impact of five water levels (from well‐drained to 8 cm deep) on the germination and establishment of the invasive cordgrass Spartina densiflora under controlled glasshouse conditions. The germination rate was ca. 60%, tending to decrease gradually with depth. There was no seedling emergence from deeper than 4 cm, because every seedling at 8 cm died. Spartina densiflora showed a high physiological plasticity. Seven months after germination, relative water content varied between 69 ± 13% at well‐drained conditions and 87 ± 7% at 4 cm, without significant differences between treatments. Plants rooted at 4 cm presented the highest quantum efficiency of photosystem II (PSII) with slightly lower maximum net photosynthesis rate than other treatments, reflecting high photoprotection levels, together with low nitrogen and pigments contents. Water level depth reduced shoot relative growth rate (RGR). Our results could be useful to fight S. densiflora invasion, because artificial inundation of invaded marshes to a water depth of 8 cm would prevent its establishment from the seed bank.
Basophil response and the induction of a tolerance in venom immunotherapy: a long‐term sting challenge study
Authors: Eržen R. , Košnik M. , Šilar M. , Korošec P.
Published: April 2012

Background

There is no in vitro test to predict the induction of long‐term tolerance in patients treated with venom immunotherapy (VIT). The aim of this study was to investigate whether immunotherapy‐induced changes in basophil responsiveness reflect a state of protection and the induction of a tolerance.

Methods

Twenty‐three patients with allergic reaction after Hymenoptera sting (11 wasp and 12 honeybee) were treated with VIT. In all patients, a CD63 basophil activation test was performed before the beginning of immunotherapy, after 1 year and after completing 4–6.5 years of immunotherapy (approximately 1 year after stopping). The tolerance was then evaluated by a sting challenge test. The basophil activation test was repeated 3–6 months after the challenge.

Results

Twenty‐two subjects showed a negative sting challenge, and one subject, a positive sting challenge. Allergen‐specific basophil response remained unchanged after 1 year of immunotherapy. However, after immunotherapy, a significant and approximately fourfold decrease was demonstrated in all tolerant subjects mainly in response to submaximal 0.1 μg/ml allergen concentration. This depression was sustained and did not change with the sting challenge test. In a nontolerant patient with a positive sting challenge, basophil response did not change.

Conclusions

Our results suggest that the depression of allergen‐specific basophil response seems to be associated with the induction of a tolerance after completing a course of VIT.
Liver transplantation in a child with liver failure due to chronic graft‐versus‐host disease after allogeneic hematopoietic stem cell transplantation from the same unrelated living donor
Authors: Englert C. , Ganschow R.
Published: April 2012

Englert C, Ganschow R. Liver transplantation in a child with liver failure due to chronic graft‐versus‐host disease after allogeneic hematopoietic stem cell transplantation from the same unrelated living donor.

Abstract:  We report a case of a six‐yr‐old boy who developed chronic GVHD of the liver, intestines, and skin following allogeneic hematopoietic SCT. The boy received an allogeneic hematopoietic stem cell transplant at the age of two yr because of early recurrence of ALL. Chimerism analysis showed complete chimerism. In the following year, he developed GVHD despite adequate immunosuppressive therapy. Liver biopsy showed liver GVHD resulting in liver cirrhosis by the age of five yr. LTx was performed with a left liver lobe from the unrelated donor from whom the stem cells had been taken. Immunosuppressive therapy consisted of low‐dose steroids and low‐dose cyclosporine. The postoperative course was uneventful. Graft function was excellent, and we performed protocol biopsies at seven days and three wk as well as three, six, and nine months after transplantation; none of these showed any signs of rejection or GVHD. Immunosuppressive therapy was discontinued nine months after LTx. Three yr after transplantation, the boy is in good condition with normal graft function. To our knowledge, this is the first report on LTx following allogeneic hematopoietic SCT from the same unrelated living donor.
Early induced protein 1 (PrELIP1) and other photosynthetic, stress and epigenetic regulation genes are involved in Pinus radiata D. don UV‐B radiation response
Authors: Valledor Luis , Cañal María Jesús , Pascual Jesús , Rodríguez Roberto , Meijón Mónica
Published: April 2012

The continuous atmospheric and environmental deterioration is likely to increase, among others, the influx of ultraviolet B (UV‐B) radiation. The plants have photoprotective responses, which are complex mechanisms involving different physiological responses, to avoid the damages caused by this radiation that may lead to plant death. We have studied the adaptive responses to UV‐B in Pinus radiata, given the importance of this species in conifer forests and reforestation programs. We analyzed the photosynthetic activity, pigments content, and gene expression of candidate genes related to photosynthesis, stress and gene regulation in needles exposed to UV‐B during a 96 h time course. The results reveal a clear increase of pigments under UV‐B stress while photosynthetic activity decreased. The expression levels of the studied genes drastically changed after UV‐B exposure, were stress related genes were upregulated while photosynthesis (RBCA and RBCS) and epigenetic regulation were downregulated (MSI1, CSDP2, SHM4). The novel gene PrELIP1, fully sequenced for this work, was upregulated and expressed mainly in the palisade parenchyma of needles. This gene has conserved domains related to the dissipation of the UV‐B radiation that give to this protein a key role during photoprotection response of the needles in Pinus radiata.
Use it or lose it: reproductive implications of ecological specialization in a haematophagous ectoparasite
Authors: ARBIV A. , KHOKHLOVA I. S. , OVADIA O. , NOVOPLANSKY A. , KRASNOV B. R.
Published: April 2012

Using experimentally induced disruptive selection, we tested two hypotheses regarding the evolution of specialization in parasites. The ‘trade‐off’ hypothesis suggests that adaptation to a specific host may come at the expense of a reduced performance when exploiting another host. The alternative ‘relaxed selection’ hypothesis suggests that the ability to exploit a given host would deteriorate when becoming obsolete. Three replicate populations of a flea Xenopsylla ramesis were maintained on each of two rodent hosts, Meriones crassus and Dipodillus dasyurus, for nine generations. Fleas maintained on a specific host species for a few generations substantially decreased their reproductive performance when transferred to an alternative host species, whereas they generally did not increase their performance on their maintenance host. The results support the ‘relaxed selection’ hypothesis of the evolution of ecological specialization in haematophagous ectoparasites, while suggesting that trade‐offs are unlikely drivers of specialization. Further work is needed to study the extent by which the observed specializations are based on epigenetic or genetic modifications.
The Canalicular System and the Osteoblast Domain in Human Secondary Osteons
Authors: Pazzaglia U. E. , Congiu T. , Marchese M. , Zarattini G. , Dell'Orbo C.
Published: April 2012

The lacunar–canalicular system in human secondary osteons was examined by two complementary techniques: light microscopy analysis of undecalcified thick sections and the SEM cortex‐fractured surface technique. Unlike the earlier definitions of ‘osteoblastic domain’ presented as the matrix volume produced by osteoblasts in the process of osteon infilling, this study measured the domain by the length of osteoblast dendritic processes. The domain extension was defined along radial vectors advancing from the reversal line towards the central canal. According to their lengths, domains were divided into three classes: peripheral, intermediate and internal. The mean length of peripheral domains was significantly shorter than those of the intermediate and internal domains. This suggests that the infilling process is modulated by an initial preparatory phase characterised by osteoblast adhesion to the wall of the cutting cone, and a limited matrix synthesis, followed by a regular matrix volume apposition organised in concentric layers. In addition to the radial canaliculae arranged along converging vectors in planes perpendicular to the central canal, we distinguished a further class of canaliculae, the equatorial canaliculae originating from the major perimeter of the lacuna and spreading out radially in the plane of the same lacuna (therefore, perpendicularly to the radial canaliculae). The whole lacunar–canalicular network was structured as a closed system around the vascular axis of the central canal with very few canaliculae crossing the reversal line and connecting the neighbouring osteons. These anatomical observations contribute to our knowledge of lacunar–canalicular system development.
Paediatrics and the doctor‐soldier
Authors: Pearn John H
Published: April 2012

Sick and injured children, like combatants wounded by shot and shell in war, are disproportionately represented in the tallies of both man‐made and national disasters. Paediatricians have a particularly proud heritage of military service, a nexus dating in Australia from the early 19th century. This paper traces this link between service to children in peacetime and the care of servicemen, women and children in times of war and disaster. The extraordinary record of Australian ‘paediatric’ doctors who also served in the Gallipoli Campaign (1915) is documented as an illustration of this duality. Paediatricians who serve in the Defence Reserves and in civilian non‐government organisations which respond to disasters and civil wars have special credentials in their advocacy for the protection of children enmeshed in conflict or disaster. Such applies particularly to the banning of the recruitment and use of child soldiers; support for children caught up in refugee and illegal immigrant confrontations; and continued advocacy for greater international compliance with the Ottawa Convention to ban the use of anti‐personnel landmines. Volunteering for such service must occur in cold ‘down time’, ensuring that paediatricians are trained in disaster and conflict response, when such challenges inevitably confront the paediatricians of the future.
Female gametogenesis and female gamete germination in the anisogamous green algaCodium fragilesubsp.novae‐zelandiae(Bryopsidophyceae, Chlorophyta)
Authors: Miravalles Alicia B. , Leonardi Patricia I. , Cáceres Eduardo J.
Published: April 2012

Female gametogenesis was studied in the dioecious siphonous green algaCodium fragilesubsp.novae‐zelandiae(J. Agardh) P. C. Silva using light and electron microscopy. Early during gametogenesis the protoplasm was uniform; then it separated in portions, while fusiform chloroplasts and nuclei increased in numbers. Some features of the nuclear divisions were similar to those of other Bryopsidophyceae. They were acentric and semi‐open. Pairs of parallel electron‐dense lines resembling synaptonemic complexes were observed in several prophase nuclei indicating meioses. In metaphase the nuclear envelope showed polar fenestrae from which the spindle emerged. No spindle microtubule nucleating material was visible and chromosome kinetochores were evident. Mature female gametes were pyriform with a hyaline anterior end from which the two flagella emerged. Mature gametes had a spherical nucleus surrounded by a mitochondrion and numerous discoid chloroplasts. Female gametes germinated parthenogenetically in culture and also inside gametangia, involving loss of flagella, rounding and lengthening of cells, multiplication of chloroplasts with well developed thylakoid systems, vacuolization and synthesis of a fibrillar cell wall.
Genetic structure of introduced swamp buffalo subpopulations in tropical Australia
Authors: MCMAHON CLIVE R. , ISAGI YUJI , KANEKO SHINGO , BOWMAN DAVID M. J. S. , BROOK BARRY W. , BRADSHAW COREY J. A.
Published: April 2012

High densities of introduced herbivores can damage sensitive ecosystems, increase the risk of extinction of native biota, and host and spread disease. An essential step in managing large ‘feral’ animal populations is to quantify how they use habitats so that management interventions, such as culling, can be targeted to reduce densities and to minimize migration into areas from which animals have been removed. An effective method to quantify animal movements is by measuring landscape‐scale genetic population structure. We describe the genetic population structure of one of Australia's more destructive introduced mammals – the Asian swamp buffalo (Bubalus bubalis). We collected 524 skin samples from buffalo across their range in the Northern Territory of Australia. Allelic diversity in the Northern Territory population was low compared to those reported from populations in their native Asian habitats. The Australian population is tentatively made of three subpopulations; Melville Island, Eastern Arnhem and Central‐Western Arnhem populations. The Melville Island population is represented by a single cluster, while the Eastern Arnhem population has three clusters and the Central‐Western Arnhem population seven clusters. We found some support for isolation by distance across all the sampled populations, but little evidence for this relationship when comparing the two well‐mixed mainland meta‐populations. Despite their small founder populations and limited genetic variation, the persistence of buffalo in Australia has likely been aided by release from high predation, parasitism and disease typical of their native habitats.
Usefulness of sodium hyaluronate solution in colorectal endoscopic mucosal resection
Authors: Kishihara Teruhito , Chino Akiko , Uragami Naoyuki , Yoshizawa Natsuko , Imai Mizuka , Ogawa Taishi , Igarashi Masahiro
Published: April 2012

Background:  In endoscopic mucosal resection (EMR), it is essential to inject submucosal fluid to prevent complications and ensure safe and complete en bloc resection of tumors. Sodium hyaluronate (SH) solution, which is effective in forming and maintaining a mucosal lift and is innocuous to mucosal tissue, is considered a useful injection solution for endoscopic submucosal dissection, a procedure associated with a high risk of perforation. This study was undertaken to assess the usefulness of this solution in EMR.

Methods:  Ninety‐four patients with colorectal tumors of ≤20 mm in diameter were enrolled for this study and randomized to a SH solution group (0.2% two‐fold diluted MucoUp) or to a normal saline group (control). Ease of EMR was primarily assessed based on ease of submucosal injection, ease of snaring and injection time.

Results:  SH solution was superior to normal saline for ease of submucosal injection (57 ± 0.7 vs 50 ± 0.7; P < 0.05), and it showed better results for ease of snaring with less variability (63 ± 0.8 vs 51 ± 1.0; P < 0.05). The mean injection time was similar between the two groups (3.0 ± 9.0 s and 3.0 ± 2.7 s, respectively). Post‐procedural hemorrhage occurred in 7% patients (3/46) injected with SH solution and in 6% of patients (3/48) in the control group; there was no significant difference between the groups.

Conclusions:  Use of two‐fold diluted MucoUp facilitated colorectal EMR.
Number of aberrant crypt foci in the rectum is a useful surrogate marker of colorectal adenoma recurrence
Authors: Uchiyama Takashi , Takahashi Hirokazu , Endo Hiroki , Kato Shingo , Sakai Eiji , Hosono Kunihiro , Yoneda Masato , Inamori Masahiko , Hippo Yoshitaka , Nakagama Hitoshi , Nakajima Atsushi
Published: April 2012

Aim:  Endoscopic screening and removal of colorectal adenomas can reduce the incidence of colorectal cancer. However, given the possibility of adenoma recurrence, surveillance colonoscopy is currently recommended after the initial screening and removal of colorectal adenomas. Aberrant crypt foci (ACF) have been shown to serve as a reliable surrogate marker of colorectal carcinogenesis. In this study, the relationship between the number of ACF at the initial endoscopic polypectomy and the likelihood of colorectal adenoma recurrence after polypectomy were investigated.

Methods:  High‐magnification chromoscopic colonoscopy was performed in 82 subjects who underwent endoscopic polypectomy to identify ACF in the lower rectum. Surveillance colonoscopy was then performed 3 years after the baseline polypectomy at Yokohama City University Hospital.

Results:  The number of ACF was greater in patients who showed adenoma recurrence (7.88 ± 6.35) than in those who did not (2.19 ± 2.95) (P < 0.001). Receiver–operating curve analysis showed that the number of ACF was a highly specific predictor of the risk of adenoma recurrence.

Conclusions:  This is the first study conducted to investigate the relationship between the number of ACF after endoscopic polypectomy and the likelihood of recurrence of colorectal adenomas. These results suggest that the number of ACF is a useful predictor of the likelihood of colorectal adenoma recurrence.
Influence of endoscopic submucosal dissection on serum levels of pepsinogens in patients with early gastric cancer
Authors: Iino Chikara , Shimoyama Tadashi , Sasaki Yoshihiro , Sawaya Manabu , Hanabata Norihiro , Fukuda Shinsaku
Published: April 2012

Background:  The serum levels of pepsinogens (PG) have been considered to be a useful marker for assessing the risk of metachronous gastric cancer in patients who undergo endoscopic submucosal dissection. However, the influence of endoscopic submucosal dissection (ESD) on serum levels of PG has not yet been examined. The aim of this study was to examine whether the level of PG after ESD can be used to predict the risk of metachronous cancer.

Patients and Methods:  The study included of 100 consecutive patients who underwent ESD for gastric cancer at Hirosaki University Hospital from September 2009 to February 2011. Serum levels of PG I and II on the day before and after ESD were compared. Stool antigen test was also performed to examine the presence of Helicobacter pylori infection.

Results:  The mean serum level of PG I before and after ESD was 34.3 ± 31.6 ng/mL and 70.5 ± 100.0 ng/mL (P < 0.001), respectively. PG I/II ratio before and after ESD was 2.40 ± 1.51 and 2.79 ± 1.70 (P < 0.001). The serum level of PG I and the PG I/II ratio were significantly changed after ESD, regardless of the use of proton pump inhibitor, Helicobacter pylori infection or the location of the tumor.

Conclusions:  ESD treatment modulates the serum level of PG I and significantly increases the PG I/II ratio. Serum levels of PG should be measured before the ESD procedure is performed to predict the risk of developing metachronous gastric cancer after ESD.
Atrial fibrillation is not associated with rehabilitation outcomes of elderly hip fracture patients
Authors: Adunsky Abraham , Arad Marina , Koren‐Morag Nira , Fleissig Yudit , Mizrahi Eliyahu Haim
Published: April 2012

Aim:  To study possible differences in rehabilitation outcomes of patients with hip fracture, with and without atrial fibrillation.

Methods:  A retrospective cohort study comprising 1114 patients, divided into three groups: patients with sinus rhythm, paroxysmal atrial fibrillation or chronic atrial fibrillation. All patients underwent a standard orthogeriatric care comprising surgical hip repair and a rehabilitation course. Main outcome measures included functional status at discharge by the Functional Independence Measure, post‐fracture functional status category and type of postdischarge living arrangement.

Results:  Patients with atrial fibrillation differed from patients in sinus rhythm by female sex (P = 0.018), older age (P = 0.008) and higher rates of heart failure (P < 0.001), ischemic heart disease (P < 0.001), previous stroke (P < 0.001), and American Society of Anesthesiologists score (P < 0.001). No differences were observed among the three groups regarding Functional Independence Measure motor and total scores. In regression analysis, Mini‐Mental State Examination (P < 0.001), prefracture status (P < 0.001), postsurgery motor Functional Independence Measure (P < 0.0001) and Parkinson's disease (P = 0.009) were predictive of higher motor Functional Independence Measure at discharge, whereas atrial fibrillation had no predictive value whatsoever. There were no differences among groups in magnitude of postfracture change of functional status category or type of postdischarge living arrangement.

Conclusions:  Discharge motor Functional Independence Measure scores, postfracture changes in functional status and in discharge placement are similar in hip fracture patients with sinus rhythm, compared with those with atrial fibrillation. Atrial fibrillation should not be considered to adversely affect the rehabilitation outcome of these patients. Geriatr Gerontol Int 2012; ••: ••–••.
MUTYH hotspot mutations in unselected colonoscopy patients
Authors: Casper M , Plotz G , Juengling B , Zeuzem S , Lammert F , Raedle J
Published: April 2012

Aim  Biallelic MutY human homologue (MUTYH) germline mutations predispose to recessively inherited adenomatous polyposis, designated MUTYH‐associated polyposis (MAP), and colorectal cancer (CRC). The hotspot mutations p.Y179C and p.G396D account for the majority of pathogenic variants of MUTYH in Caucasians. Our aim was to evaluate the prevalence of MUTYH mutations in a prospective cohort of unselected patients with different colorectal diseases.

Method  The hotspot mutations p.Y179C and p.G396D were genotyped in 352 consecutive patients undergoing colonoscopy at our tertiary referral centre. Exons 2–14 were sequenced in hotspot mutation carriers to exclude additional variants.

Results  Overall, we identified five heterozygous p.Y179C mutations and three heterozygous p.G396D mutations in seven hotspot mutation carriers (risk allele frequencies 0.7% and 0.4%, respectively). Two of these hotspot mutation carriers harboured a heterozygous p.Q338H variant, which is of uncertain clinical significance, on the other allele. Three individuals were biallelic MUTYH variant carriers (p.Y179C/p.G382D: typical MAP; p.Y179C/p.Q338H: atypical MAP with late onset and lower polyp burden; p.G382D/p.Q338H: inflammatory bowel disease), and four subjects were monoallelic mutation carriers.

Conclusion  MUTYH‐associated disease, and hence genetic counselling and MUTYH genetic testing, should be considered in the clinical routine of an endoscopy unit, but the wide range of phenotypes represents a challenge for patient identification. The clinical significance of p.Q338H should be evaluated in future case–control studies because compound heterozygotes for pathogenic mutations and p.Q338H may be at increased risk for mild polyposis or CRC. In addition, MUTYH should be assessed as a potential susceptibility gene for the development of colitis‐associated CRC in future.
Musosal tumour necrosis factor α in diverticular disease of the colon is overexpressed with disease severity
Authors: Tursi A. , Elisei W. , Brandimarte G. , Giorgetti G. M. , Inchingolo C. D. , Nenna R. , Picchio M. , Giorgio F. , Ierardi E.
Published: April 2012

Aim  Inflammation occurs in diverticular disease (DD), but there is little information on inflammatory cytokines such as tumour necrosis factor α (TNF‐α). The aim of this study was to assess TNF‐α expression in DD and to see whether it is related to the severity of the disease.

Method  Twenty‐four patients with symptomatic DD were divided into those with acute uncomplicated diverticulitis (AUD) (12 patients) and those with symptomatic uncomplicated diverticular disease (SUDD) (12 patients). Twelve further patients with asymptomatic diverticulosis (AD), six with segmental colitis associated with diverticulosis (SCAD), with ulcerative colitis (UC) and six healthy individuals (HC) were enrolled as controls. TNF‐α expression in the colonic mucosa was assessed by the amount of mRNA codifying for the synthesis of TNF‐α.

Results  TNF‐α expression was significantly higher in AUD than in HC (P = 0.0007), in AD (P = 0.0001) and in SUDD (P = 0.0179). It was significantly higher also in SUDD than in HC (P = 0.0007) and in AD (P = 0.0001). TNF‐α expression in AUD did not differ significantly from that in UC (P = 0.0678) and SCAD (P = 0.0610). It was significantly higher in UC, SCAD and AUD than in SUDD (P = 0.0007, P = 0.0001, P = 0.0179).

Conclusion  TNF‐α expression in DD seems to be related to the severity of the disease. In particular, it appears to be overexpressed in DD with inflammation (AUD and SUDD) compared with DD without (AD).
Outcome of retinal reattachment surgery in dogs: a retrospective study of 145 cases
Authors: Steele Kirsten A. , Sisler Steve , Gerding Paul A.
Published: April 2012

Objective To summarize the clinical outcomes and complications of pars plana vitrectomy with perfluoro‐n‐octane (PFO)‐silicone oil exchange and endolaser retinopexy for treatment of retinal detachment (RD) in dogs, at one surgical center.

Procedure Records of 145 dogs (168 eyes) that underwent retinal reattachment surgery (RR) between 2005 and 2009 were reviewed. All surgeries were performed by the same surgeon (SS). Data collected from the medical records included signalment, duration of time from diagnosis of RD to surgical intervention, if prior lensectomy was performed, time from surgery to restoration of vision, and postoperative complications. The data was analyzed to test the effect of breed, prior lensectomy, and time from diagnosis to surgery on visual outcome, tendency for complications, and time of complication onset.

Results One hundred thirty pure‐bred dogs (36 breeds) and 15 mixed‐breed dogs were represented. One hundred fifty‐five of 168 eyes (92%) were visual after surgery. Six of 155 eyes (3.8%) were visual before the procedure and retained vision; one hundred forty‐nine of 155 eyes (96%) were nonvisual before and regained vision afterward. Thirteen of 168 eyes (8%) that were nonvisual prior to the procedure did not regain vision. The most common complications in order of occurrence included: cataract development, silicone prolapse into the anterior chamber, corneal ulceration, retinal degeneration, glaucoma, and uveitis.

Conclusions Pars plana vitrectomy with PFO‐silicone oil exchange and endolaser retinopexy for treatment of RD in dogs is highly successful and associated with overall good visual outcome.
Comparative study of sperm ultrastructure of Donax hanleyanus and Donax gemmula (Bivalvia: Donacidae)
Authors: Introíni Gisele O. , Passos Flávio D. , Recco‐Pimentel Shirlei M.
Published: April 2012

The ultrastructure of bivalve spermatozoa can be species‐specific and often provides important taxonomic traits for systematic reviews and phylogenetic reconstructions. Young individuals of the Donacidae species Donax hanleyanus are often identified as samples of Donax gemmula. Hence, the spermatozoa ultrastructure of both species was described in the present work, aiming to identify characters that could be useful for further taxonomic and phylogenetic analyses. D. hanleyanus and D. gemmula spermatozoa were different especially in relation to acrosomal characteristics and chromatin condensation. The spermatozoon produced by D. hanleyanus had a nucleus (exhibiting granular chromatin with a rope‐like appearance) capped by a long and conical acrosomal vesicle, which extended itself outward beyond the anterior nuclear fossa. Otherwise, the nucleus of the sperm cell of D. gemmula showed well‐compacted chromatin, and its acrosome, which was partially inserted into the anterior nuclear fossa, had a bubble‐like tip. In conclusion, the conspicuous ultra‐structural differences found between the spermatozoan morphologies were helpful for the discrimination of the species. In conclusion, our results suggest that analyses of sperm ultrastructure of the bivalves in the family Donacidae can be valuable to investigate their taxonomic relatedness. The present results also contribute to assess the monophyletic status of the family.
Inpatient safety trends in laparoscopic and open nephrectomy for renal tumours
Authors: Stroup Sean P. , Palazzi Kerrin L. , Chang David C. , Ward Nicholas T. , Parsons J. Kellogg
Published: April 2012

Study Type – Cohort study

Level of Evidence 2b

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

Laparoscopic radical nephrectomy for renal cancer provides equivalent long‐term cancer control with shorter hospital stays, less postoperative pain, and faster resumption of normal activities, but it has diffused slowly into clinical practice, perhaps as a result of perceptions about safety. Patient safety outcomes for laparoscopic and open radical nephrectomy using validated measures remain incompletely characterized.

This is the first study to investigate peri‐operative outcomes of radical nephrectomy using validated patient safety measures. We found a 32% decreased probability of adverse patient safety events occurring in laparoscopic compared with open radical nephrectomy. The safety benefits of laparoscopy were attained only after 10% of cases were completed laparoscopically – a proportion some have proposed as the ‘tipping point’ for the adoption of surgical innovations. This observation could have implications for patient safety in the setting of diffusion of new surgical techniques.

OBJECTIVE

To compare peri‐operative adverse patient safety events occurring in laparoscopic radical nephrectomy (LRN) with those occurring in open radical nephrectomy (ORN).

METHODS

We used the US Nationwide Inpatient Sample to identify patients undergoing kidney surgery for renal tumours from 1998 to 2008.

We used patient safety indicators (PSIs), which are validated measures of preventable adverse outcomes, and multivariate regression to analyse associations of surgery type with patient safety.

RESULTS

Open radical nephrectomy accounted for 235 098 (89%) cases while 28 609 (11%) cases were LRN.

Compared with ORN, LRN patients were more likely to be male (P= 0.048), have lower Charlson comorbidity scores (P < 0.001), and to undergo surgery at urban (P < 0.001) and teaching (P < 0.001) hospitals.

PSIs occurred in 18 714 (8%) of ORN and 1434 (5%) of LRN cases (P < 0.001).

On multivariate analysis, LRN was associated with a 32% decreased probability of any PSI (adjusted odds ratio 0.68, 95% confidence interval: 0.6 to 0.77, P < 0.001). Stratification by year showed that this difference was initially manifested in 2003, when the proportion of LRN cases first exceeded 10%.

CONCLUSIONS

We found that LRN was associated with substantially superior peri‐operative patient safety outcomes compared with ORN, but only after the national prevalence of LRN exceeded 10%.

Further study is needed to explain these patterns and promote the safe diffusion of novel surgical therapies into broad practice.
Factors associated with difficulty accessing crack cocaine pipes in a Canadian setting
Authors: TI LIANPING , BUXTON JANE , WOOD EVAN , SHANNON KATE , ZHANG RUTH , MONTANER JULIO , KERR THOMAS
Published: April 2012

Introduction and Aims. Crack cocaine pipe sharing is associated with various health‐related harms, including hepatitis C transmission. Although difficulty accessing crack pipes has been found to predict pipe sharing, little is known about the factors that limit pipe access in settings where pipes are provided at no cost, albeit in limited capacity. Therefore, we investigated crack pipe access among people who use drugs in Vancouver, Canada.

Design and Methods. Data were collected through two Canadian prospective cohort studies. Generalised estimating equations with logit link for binary outcomes were used to identify factors associated with difficulty accessing crack pipes.

Results. Among 914 participants who reported using crack cocaine, 33% reported difficulty accessing crack pipes. In multivariate analyses, factors independently associated with difficulty accessing crack pipes included: sex work involvement [adjusted odds ratio (AOR) = 1.57; 95% confidence interval (CI): 1.03–2.39], having shared a crack pipe (AOR = 1.69; 95% CI: 1.32–2.16), police presence where one buys/uses drugs (AOR = 1.47; 95% CI: 1.10–1.95), difficulty accessing services (AOR = 1.74; 95% CI: 1.31–2.32) and health problems associated with crack use (AOR = 1.37; 95% CI: 1.04–1.79). Reasons given for difficulty accessing pipes included sources being closed (48.2%) and no one around selling pipes (18.1%).

Discussion and Conclusions. A substantial proportion of people who smoke crack cocaine report difficulty accessing crack pipes in a setting where pipes are available at no cost but in limited quantity. These findings indicate the need for enhanced efforts to distribute crack pipes and address barriers to pipe access.[Ti L, Buxton J, Wood E, Shannon K, Zhang R, Montaner J, Kerr T. Factors associated with difficulty accessing crack cocaine pipes in a Canadian setting. Drug Alcohol Rev 2012;31:890–896]
Intergovernmental Relations in the UK: Co-Operation, Competition and Constitutional Change
Authors: Gallagher Jim
Published: April 2012

This article provides a commentary on the evolution of intergovernmental relations in the UK from one of its leading practitioners. As the former Director General for Devolution in the UK Cabinet Office and the UK Ministry of Justice, Jim Gallagher was at the centre of the process of intergovernmental exchange, and provides rich practice-based insights into both the character and dynamics of IGR before and after 2007.