bluuebunny/crossref_metadata_2025 huggingface dataset:
Tetralogy of Fallot and Hemophilia A: Successful Management of Intracardiac Repair
Authors: Rupert Emmanuel , Muralidhar Kanchi , Shetty Devi Prasad
Published: May 2013

A 4-year-old boy with moderately severe factor VIII deficiency underwent successful intracardiac repair of tetralogy of Fallot under cardiopulmonary bypass with the aid of factor VIII concentrates and aprotinin.
Surgical Treatment of Siblings with Marfan Syndrome
Authors: Kirali Kaan , Yakut Necmettin , Güler Mustafa , Mansuroğlu Denyan , Ömeroğlu Suat , Akinci Esat , Gürbüz Ali , Yakut Cevat
Published: May 2013

Rupture of an ascending aortic aneurysm is the most common cause of death in patients with Marfan syndrome, while type-A aortic dissection is the second most common fatal lesion. The aortic root dimension and the rate at which it increases are the best indications for surgical treatment. We regard aortic enlargement to 5.5 cm as the upper limit of safety and we are inclined to advocate surgery at an earlier stage in high-risk families. We report our results of the surgical management of aortic aneurysm in the two siblings; a third sibling is currently being followed medically.
Left Main Coronary Reconstruction for Ostial Stenosis with Patent Ductus Arteriosus
Authors: Gao Chang Qing , Zhu Lang Biao , Li Bo Jun , Xiao Cang Song
Published: May 2013

A case of congenital ostial stenosis of the left main coronary artery with a large short patent ductus arteriosus is described. Revascularization was performed by autologous pericardial patch angioplasty and the ductus was closed simultaneously with a fabric patch.
Epiaortic Ultrasound: Aortic Screening in Coronary Revascularization
Authors: Özatik Mehmet Ali , Vural Kerem M , Sener Erol , Taşdemir Oğuz
Published: May 2013

Two hundred and fourteen consecutive patients (174 males and 40 females; mean age, 61 years) undergoing coronary artery bypass grafting were screened by intraoperative epiaortic B-mode ultrasonography. The operative strategy was modified under ultrasonographic guidance in 26 patients to reduce the risk of stroke. Aortic cannulation, clamping, and vein graft attachment sites were changed in 15 patients (7%), the operation was performed on a beating heart in 7 (3.3%), cardiopulmonary bypass was established via femoral cannulation and coronary artery bypass grafting was performed on a fibrillating heart in 4 (1.9%). The incidence of stroke in our coronary artery bypass patients decreased from 2.8% to 0.9%. Sensitivity of detection of ascending aortic atherosclerosis was calculated as 35.48% for palpation and 96.8% for epiaortic ultrasonography. Risk factors for significant ascending aortic atherosclerosis were age over 70 years (p = 0.004), hypertension (p = 0.03), and associated peripheral arterial disease (p = 0.02). The most frequently affected segments were the anterior (41%) and upper left (32%) aspects of the aorta. Intraoperative epiaortic B-mode ultrasonography was found to be a reliable method of detecting ascending aortic atherosclerosis, allowing the surgeon to determine operative strategy to reduce the risk of perioperative stroke.
Ischemic Preconditioning Improves Protection with Cold Blood Cardioplegia
Authors: Li Guo Hu , Chen Shen Xi , Lu Er Xiong , Liu Qiu Qiu , Li Yuan Jian
Published: May 2013

This prospective randomized study was undertaken to test the hypothesis that ischemic preconditioning could improve myocardial protection with cold blood cardioplegia in patients undergoing valve replacement and to investigate the mechanism of ischemic preconditioning in human myocardium. After the institution of cardiopulmonary bypass, 20 patients undergoing double valve replacement were preconditioned with 2 cycles of 3 minutes of aortic crossclamping and 2 minutes of reperfusion before cardioplegic arrest. A further 20 patients served as controls. The hearts were arrested with blood cardioplegic solution at 4°C. In the perioperative period, blood samples were collected from the coronary sinus, samples of right atrial myocardial tissue were obtained, and cardiac function was measured. Ischemic preconditioning reduced oxygen free radial production, calcium overload, and myocardial ultrastructural damage, while the myocardial production of calcitonin gene-related peptide was increased to 95.3 ± 3.8 μg·L−1 compared with 61.2 ± 4.9 μg·L−1 in the controls. Cardiac index was also higher in the preconditioned patients at 2.8 L·min−1·m−2 compared to 2.3 L·min−1·m−2 in the controls. It was concluded that ischemic preconditioning enhanced cardioplegic protection in valve replacement patients by increasing the level of calcitonin gene-related peptide and decreasing oxygen free radicals.
Minimally Invasive Coronary Artery Bypass: Experience in 114 Patients
Authors: Yavuz Şenol , Celkan M Adnan , Eriş Cüneyt , Mavi Mustafa , Türk Tamer , Tiryakioğlu Osman , Ata Yusuf , Koca Vedat , Özdemir İ Ayhan
Published: May 2013

From February 1996 to May 1998, 114 patients underwent a small (6 to 8 cm) left anterior thoracotomy for single-vessel coronary artery bypass grafting on a beating heart. There were 85 men and 29 women with a mean age of 63.1 ± 9.4 years, ranging from 36 to 84 years, and a mean preoperative ejection fraction of 53.2% ± 6.9%. The left internal mammary artery was anastomosed to the left anterior descending coronary artery under direct vision without cardiopulmonary bypass. There was no mortality. Postoperative morbidity included superficial wound infection in 3 patients. The length of the left internal thoracic artery was insufficient in two patients and the radial artery was used as an extension. Sixty-five (57%) patients underwent repeat coronary angiography (49 early, 16 late) and all grafts were patent. On intraoperative transesophageal echocardio-graphy, no segmental wall motion was seen during local coronary occlusion. Mean operative time was 1.7 ± 0.3 hours. One hundred and three patients (90%) were discharged 2 to 4 days postoperatively. The mean follow-up was 21.7 months. Minimally invasive surgery for left anterior descending coronary artery revascu-larization was considered to be a simple and effective alternative to the standard operation or angioplasty in selected patients.
Inaccuracy of Prediction of Mitral Valve Prosthesis Size
Authors: Ghosh Probal , Bhonsle Narendra
Published: May 2013

Several formulae related to body surface area have been proposed to predict normal mitral annular size. This study examined the applicability of such formulae in predicting the size of mitral valve prostheses. Developmental criteria and echocardiographic parameters were used retrospectively to determine mitral annular size in 92 consecutive patients undergoing mitral valve replacement. Discrepancies were noted among the different predicted annular diameters. Moreover, predicted diameters differed from the diameters of the implanted prostheses. These differences were not influenced by type of prosthesis, type of lesion, technique of surgery, or sex of the patient. A greater degree of disparity was noted for larger body surface areas with all prediction formulae. However, valve size index and valve area index remained incremental with increasing prosthesis size. It was concluded that prediction formulae for mitral annular size based on body surface area do not help the surgeon to predetermine the size of mitral valve prosthesis that may be implanted at operation.
Late Follow-Up of Cyanoacrylate Usage in Cardiothoracic Surgery
Authors: Demirtaş M Murat , Cimen Serdar , Ketenci Bülend , Günay Rafet , Akçar Murat , Özler Azmi
Published: May 2013

In cardiovascular and thoracic surgery, troublesome bleeding and sternal dehiscence can be life-threatening if not managed appropriately. We used commercially available cyanoacrylate adhesive 21 times in 20 sporadic patients for the management of 6 different problems: sternal gluing in 7 cases; anastomotic line reinforcement and bleeding control with a glued Teflon or pericardial patch in 6; right ventricular or superior vena caval patch repair in 5; and 1 case each of left ventricular apical glued Teflon felt, arterial wall reinforcement, and control of air leakage after lung surgery. The mean age of the patients was 55.7 ± 12.5 years, ranging from 34 to 71 years. Successful results were obtained in 18 patients and 17 were alive on follow-up at 7.7 ± 5.5 months (range, 2 to 16 months). We used two different commercial brands of adhesive but obtained good results with only one of these preparations. Although commercially available cyanoacrylate is a new adjunct to cardiac surgery with documented safety and lifesaving results at negligible cost, the appropriate polymer for best results needs to be defined.
Right and Left Ventricular Diastolic Filling Parameters in Essential Hypertension
Authors: Akkoç Azad , Uçaman Berzal , Kaymak Halil , Temamoğullari Ali Vahip , Iltümür Kenan , Karadede Abdülaziz , Toprak Nizamettin
Published: May 2013

Right and left ventricular filling parameters were compared in 118 hypertensive patients (mean age, 54.4 ± 10.3 years) and 50 normotensive controls (mean age, 51.6 ± 8 years). Diastolic filling parameters were obtained by pulsed Doppler echocardiography at the tricuspid and mitral annular levels. The tricuspid early to late filling velocity ratios and the normalized peak filling rates were significantly reduced, while the atrial filling fraction was increased and tricuspid deceleration time was prolonged in hypertensive patients compared to controls. Right ventricular diastolic filling parameters correlated significantly with septal and posterior diastolic wall thickness, while left ventricular mass index correlated significantly with right ventricular diastolic filling parameters and right ventricular diastolic wall thickness in hypertensive subjects. Right ventricular diastolic wall thickness correlated significantly with the tricuspid early to late filling velocity ratio, tricuspid inflow total velocity-time integral, normalized peak filling rate, and peak filling fraction. Right ventricular diastolic filling parameters were closely related to left ventricular diastolic filling parameters in both groups. It was concluded that right ventricular filling parameters undergo a series of changes in essential hypertension and these parameters are closely related to left ventricular filling parameters and correlate with right ventricular wall thickness and left ventricular mass index.
Lung Volume Reduction Surgery following Single-Lung Transplantation
Authors: Cook Richard C , Fradet Guy , Ostrow David , Nelems Bill
Published: May 2013

Although single-lung transplantation is an established therapy for respiratory failure secondary to emphysema, hyperinflation of the native lung with concomitant compression of the transplanted lung is emerging as a cause of morbidity. In non-transplant emphysematous patients with hyperinflated lungs, pneumectomy was found to improve pulmonary function and quality of life. We report our experience on 5 single-lung transplant recipients with emphysema who underwent lung volume reduction surgery (pneumectomy, bullectomy, or anatomic resection) following transplantation. There were no perioperative deaths. Three patients underwent lung volume reduction because of a progressive symptomatic decline in pulmonary function that was thought to be secondary to hyperinflation of the native lung. Two of these patients had a sustained improvement in lung function and functional status over several years. Two other patients underwent lung volume reduction for removal of suspicious pulmonary nodules in the native lung. Both patients had a subsequent improvement in forced expiratory volume in one second. In our experience, lung volume reduction surgery after single-lung transplantation in emphysematous patients was a safe means of providing long-term improvement in pulmonary function.
Parenchymal Stapling in Pulmonary Lobectomies: Is it Really Necessary?
Authors: Cağirici Ufuk , Bilaceroğlu Semra , Cikirikçioğlu Mustafa , Posacioğlu Hakan , Atay Yüksel , Yağdi Tahir , Bilkay Önol
Published: May 2013

Automatic stapling devices are widely used for pulmonary exeresis, particularly in wedge or segmental resections. Infrequently, these instruments are also employed in lobectomies for the division of incomplete fissures. A prospective randomized study was undertaken to determine the efficacy of staplers in performing a lobectomy. Among 102 lobectomy patients, 59 (44 men, 15 women) who had incomplete fissures were included in the study. A stapler was used in 38 patients for completion of the fissures, whereas sharp dissection and the classic suture closure technique were employed in the remaining 21 patients. Duration of air leakage postoperatively did not differ significantly (p > 0.05) but the operation time was found to be shorter in the stapled-lobectomy group (67.63 ± 13.7 min versus 85.71 ± 18.3 min; p < 0.001).
Posterior Mediastinal Goiters: Literature Review and Report of Three Cases
Authors: Dhaliwal Rajinder Singh , Puri Deepak , Rana Sandeep Singh , Singh Gurpreet
Published: May 2013

Posterior mediastinal goiters are very rare and occur mostly due to descent of a posterolaterally enlarging inferior pole of the thyroid gland, or very infrequently to failure of fusion of the ultimobranchial bodies with the isthmus in the 7th embryonic week. Most patients present with a cervical mass and symptoms due to compression or distortion of the trachea, esophagus, or superior vena cava. The diagnosis is established by chest skiagram, computed tomography scan, and barium esophagogram. Progressive enlargement, risk of sudden hemorrhage within the gland causing respiratory impairment, and the possibility of associated malignancy, make excision of the goiter mandatory. A combined cervicothoracic approach is the procedure of choice as it provides easy access and visualization, better control of blood vessels, and avoids the risk of perioperative tumor seeding. We present our experience of 3 such cases successfully managed at our institute. All 3 patients presented with a cervical mass and symptoms of posterior mediastinal compression; one had thyrotoxicosis. A combined cervicothoracic approach was used for surgical excision with excellent results.
Right Atrial Pedunculated Ball Thrombus
Authors: Inoue Takehiro , Otaki Masaki , Ku Kwansong , Saga Tosihiko , Oku Hidetaka
Published: May 2013

Two rare cases of right atrial pedunculated ball thrombus associated with constrictive pericarditis and systemic lupus erythematosus are reported. Under cardiopulmonary bypass, the large thrombus in each patient was removed with care to avoid pulmonary embolism. Both patients have been doing well postoperatively and warfarin has been administered to prevent a recurrence of intracardiac thrombotic episodes.
Hydatid Cysts with Pulmonary and Cardiac Involvement
Authors: Elbeyli Levent , Kervancioğlu Reşat , Bayram Metin , Filiz Ayten
Published: May 2013

Surgical treatment of a case of pulmonary and cardiac hydatid cysts is described. The role of computed tomography in demonstrating multivesicular cystic lesions is highlighted.
Ankylosing Spondylitis and the Mitral Valve
Authors: John Alexander , Glauner Christoph , Warnecke Henning
Published: May 2013

Recurrent valve dehiscence was encountered in a patient with ankylosing spondylitis who had undergone mitral valve replacement. A method of reinforcing the native annulus with bovine pericardium and reattaching the valve is described.
Delayed Repair of Popliteal Artery following Blunt Injury
Authors: Chandra Abha , Dilip Dronamraju , Kola Srinivas , Rao Sreeram Eswara Vara Prasada , Pal Pramod
Published: May 2013

Popliteal artery injury resulting from blunt trauma carries a risk of limb loss. Severe ischemia of prolonged duration is a strong determinant of poor outcome. We report a case of popliteal artery injury in an 18-year-old male who underwent successful repair after a delay of 20 hours.
Taurine Potentiates the Efficacy of Hypothermia
Authors: Ohno Nobuhisa , Miyamoto Koho-Julio , Miyamoto Tadaomi-Alfonso
Published: May 2013

To assess the protective effect of exogenous taurine on the central nervous system, spinal cord ischemia was induced for 60 minutes in 16 rabbits randomized into 3 groups. Group 1 (n = 5) had hypothermia targeted to 30.5°C and 10 mmol·kg−1 taurine, group 2 (n = 5) had hypothermia targeted to 29.5°C, and group 3 (n = 6) had hypothermia targeted to 30°C. Group 1 was cooled to 30.6 ± 0.07°C and group 2 was cooled to 29.4 ± 0.07°C; both had total functional recovery (rabbits able to keep normal posture, to walk, and to hop) within 6 hours of reperfusion. None of the group 3 animals that were cooled to 29.9 ± 0.05°C recovered function. It was concluded that taurine combined with hypothermia protected the spinal cord from 60 minutes of ischemia at a temperature that could not otherwise ensure protection. The protective effect contributed by taurine was equivalent to 1.2°C.
Brucella Endocarditis: Seven Cases Treated Surgically
Authors: Renzulli Attilio , Gregorio Rosario , Romano GianPaolo , Carozza Antonio , Marmo Joseph , Utili Riccardo , De Feo Marisa , Cotrufo Maurizio
Published: May 2013

Brucella endocarditis is a lifethreatening, often under-diagnosed complication of brucellosis. Seven cases of brucella endocarditis treated surgically in the last 25 years are described. The infection was localized on the aortic valve in 5 cases and on a prosthetic mitral valve in 2. All patients had a positive history of risk factors for brucella infection and all were in cardiac failure (5 in New York Heart Association functional class III and 2 in class IV). All underwent valve replacement followed by antibiotic therapy. Follow-up ranged from 1 and 206 months. One patient died following prosthetic valve replacement to treat a periprosthetic leak unrelated to the brucella infection. Brucella antibody tests and careful clinical history are mandatory in all patients with negative blood cultures in order to identify brucella earlier during the course of the infection before embolization or annular involvement occur.
Techniques and Outcomes of Two Modes of Pericardial Drainage
Authors: Suen Albert Leung Wai , Ho Leung Sing , Chan Ngai Yin , Chan Mui Tong , Tsang Hing Hung , Kwok Miu Fong
Published: May 2013

The techniques and outcomes of two modes of pericardial drainage, percutaneous pericardiocentesis and surgical pericardiotomy, were analyzed. Percutaneous pericardiocentesis was performed using the Seldinger technique. The puncture site was determined by selected criteria. Surgical pericardiotomy was performed mainly through the subxiphoid route. There were 20 pericardiocenteses and 27 pericardiotomies performed in 39 patients; 19 pericardiocenteses were successful with no complications noted, all 27 pericardiotomies were successful with only minor complications. Bloodstained fluid was found in 27 of the 38 samples of drainage (71%). Cytology for malignancy was positive in 21% and culture for tuberculosis was positive in 1 case. Biopsies improved the diagnostic yield of either disease from 18% to 38%. Malignancy was the most common cause of effusion (41%), followed by uremia. No secondary causes were found in uremic patients. The causes in 7 patients (18%) were not identified. During the study period, 16 patients died, including 1 soon after surgical drainage. Both techniques were considered to be safe and effective. In view of a case of sudden death soon after surgical drainage, it is recommended that patients with severe tamponade should have controlled percutaneous drainage.
Lung Infections Due to Aspirated Foreign Bodies: Analysis of 84 Cases
Authors: Kahraman Cemal , Oğuzkaya Fahri , Akçali Yiğit , Sahin Atalay
Published: May 2013

Tracheobronchial foreign body aspiration is a significant cause of morbidity and mortality in the pediatric population because of serious early and late complications. In our department, 84 patients with pneumonia (75), bronchiectasis (7), or lung abscess (2) due to aspirated foreign bodies were managed between 1978 and 1997. Neither the patients nor their parents reported aspiration of an object. Foreign bodies were verified during diagnostic bronchoscopies. One patient with an abscess and 74 of the patients with pneumonia were managed by medical therapy after removal of the foreign body. All patients with bronchiectasis underwent surgical treatment with lobectomy (6) or segmentectomy (1). The patients were discharged from hospital after a mean of 10 days. The mortality was 2.4% (2 patients). An aspirated foreign body should be suspected in cases of persistent or recurrent lung infection in the same location and bronchoscopy should be performed for diagnosis and management.
Right Heart Bypass for Inferior Vena Cava Tumor Thrombus Extending into Heart
Authors: Aggarwal Bhuvnesh Kumar , Shatapathy Pitambar , Kamath Sevagur Ganesh , Yawari Gulam Ali , Krishnapillai Sasidharan
Published: May 2013

Radical nephrectomy with en bloc inferior vena caval tumor thrombectomy improves survival in patients with renal cell carcinoma with a tumor thrombus extending into the inferior vena cava. Cardiopulmonary bypass with or without deep-hypothermic circulatory arrest is advocated when the tumor thrombus extends into the right heart chambers. Right heart bypass was used to remove such a tumor thrombus successfully for the first time in a patient with renal cell carcinoma.
Science, Politics, and Prejudice: The Dynamics and Significance of British Anthropology’s Failure to Confront Nazi Racial Ideology
Authors: Hart Bradley W
Published: May 2013

For two years in the turbulent mid-1930s, the Royal Anthropological Institute co-convened an expert committee tasked with scientifically evaluating Nazi claims about race. Called the Race and Culture Committee, this body was created at the behest of Charles G. Seligman and given the unofficial objective of producing a strong anti-racist statement attacking the anthropological notion of a pure Aryan race. Scientists and other scholars of Jewish descent were intentionally excluded from the Committee to pre-emptively avert attacks on the report’s validity by anti-Semites. However, such a report was never produced due to the interference of members who were committed to defending Nazi Germany and the country’s racial policies. Using newly uncovered sources, this article argues that the Committee was doomed to failure from the start, and that its demise prevented the collective British anthropological establishment from attacking Nazi views on race with a unified voice before the Second World War despite an emerging consensus that the German government’s pronouncements were scientifically indefensible. More significantly, there is also now evidence that the obstructionist faction within the Committee was taking its ideological direction directly from German scientific practitioners with their own agendas during this period, raising questions about the relationship between science, politics, and interactions between academics and the state. It was only with the later publication of We Europeans that mainstream British scientists would declare their opposition to Nazi racial views, but by then the opportunity to make a more impactful stand had been lost.
Images and Meaning-Making in a World of Resemblance: The Bavarian-Saxon Kidney Stone Affair of 1580
Authors: Stein Claudia
Published: May 2013

This article de-constructs and re-constructs the dynamic of a sixteenth-century political dispute between the Catholic Bavarian Duke Wilhelm V and the Protestant Saxon Elector August I. By focusing on the visual imagery which ignited the dispute, the paper explores sixteenth-century ‘ways of seeing’ and the epistemic role realistic images played in the production of knowledge about the natural world. While the peculiar dynamic of the affair is based on a specific understanding of the evidential role of images, the paper also argues that the wider socio-cultural context, in particular certain strategies of truth-telling, provide further clues as to the dynamic and closure of the affair.
Alcohol use among adolescents as a coordination problem in a dynamic network
Authors: Corten Rense , Knecht Andrea
Published: May 2013

Whereas most research on substance (ab)use by adolescents studies only the effects of personal networks of adolescents, we propose a theoretical approach that allows for predictions on the effects of the macro-level social network structure on usage rates. We model alcohol use as risk-dominant but inefficient behaviour in a coordination problem, given that adolescents face incentives to align their behaviour with their friends. We propose a game-theoretical model in which actors choose behaviour in a repeated coordination game in an endogenous network. Predictions on levels of alcohol use depending on initial network structure are based on computer simulations of this model. We test the predictions using longitudinal data on alcohol use and friendship choices in school classes in Dutch high schools. We replicate the predicted ‘catalysing’ effect of initial network density on the development of alcohol use but the predicted opposing effect of centralization could not be confirmed.
Division of labor in child care: A game-theoretic approach
Authors: Vierling-Claassen Angela
Published: May 2013

This paper uses a game of repeated play to model parental child care in order to examine the gap between the expectations of egalitarian-minded couples before the transition to parenthood and the reality of parenthood, with its gendered roles. This is done first in a gender-free context in order to examine the mechanism by which the division of labor is established in a family – it is this same process through which gendered expectations have an impact. The analysis shows that it is difficult to achieve the equilibrium of equal sharing of child care, even when this is the preference of the parents. This leads to a discussion of alterations and meta-strategies for couples who want to share care equally. Gender differences between parents are also modeled, including the impact these have on outcomes and equilibria.
Fellowship, social network externalities, and management of religious risk
Authors: Raynold Prosper
Published: May 2013

Given the existence of religious risk, rational choice theory implies that – barring impediments – risk-averse religious actors will mitigate the effects of religious risk by constructing diversified religious portfolios and/or by purchasing relevant insurance. The absence of evidence that such portfolio diversification is a feature of monotheistic religions and the absence of markets for insuring against religious risk indicates that impediments abound. This paper proposes that social network externalities associated with religious fellowship mitigate religious risks faced by religious firms and their adherents and articulates a theory of firm location in fellowship space. The theory implies that religious firms’ locations in fellowship space are determined by the quantity and type of religious risks firms and their adherents face; by their degree of aversion to these risks; by members’ perception of the feasibility of mitigating religious risk via diversification and/or purchasing insurance; and by the market opportunity costs of fellowship activities relative to the market opportunity costs of private religious activities.
Paradox Lost and Paradox Regained
Authors: Datta Lois-ellin
Published: May 2013

Jill Chouinard, in her article “The Case for Participatory Evaluation in an Era of Accountability” (this issue, p. 237), may be re-iterating what has often been claimed and arguably is infused already in much of our theory and practice: the value of participatory approaches in some, perhaps many situations. She summarizes these claims eloquently and well. Chouinard also may be saying that we should continue to examine evaluation policy in light of a changing world, evolving approaches, and new experiences with a wide range of evaluative thinking. If so, amen, sister. This is an on-going task, but necessary and worthwhile. Less benignly, however, Chouinard may be trying to make the case for participatory evaluation as a new uber-standard for all evaluation, particularly national studies in a “technocratic culture of accountability.” If so, I disagree. Such a claim seems unjustified for several reasons, including the benefits and current uses of evaluative multiplism, the limitations of evaluative monotheism, and value of building bridges rather than burning them.
Long-term follow-up of women with genital lichen sclerosus
Authors: Green Cathy , Guest Jacqueline , Ngu Wee
Published: May 2013

Genital lichen sclerosus (LS) is usually managed with potent topical corticosteroids. There is a small (<5%) increased risk of skin cancer and long-term follow-up is recommended. We audited patients discharged to the care of their general practitioner (GP) from our regional vulval clinic. Only 29% had seen their GP in the last 12 months; 53% self-examined; 48% were unaware of the need to report abnormalities immediately; 24.4% were unaware of the recommended duration of use of their 30 g tube of steroid and only 66.7% were aware of the risk of skin cancer. Further education of both LS patients and their family practitioners is required.
Estrogen and the brain: does estrogen treatment improve cognitive function?
Authors: Hogervorst Eef
Published: May 2013

In this paper we describe potential reasons for the discrepancies between data from basic sciences and observational studies and those of large treatment studies investigating the association between brain function and sex steroids. Observational studies which often showed positive associations between hormone use and cognition can be affected by ‘recall bias’ and ‘healthy user bias’, while outcomes of treatment studies were hypothesized to be modified by age at treatment, age at or type of menopause, health status, addition of a progestogen or type of estrogen treatment. However, meta-analyses of data from treatment studies negate many of these hypotheses showing at best mainly short-term (up to 6 months) positive effects of estrogen treatment on cognition regardless of age. This positive effect may reverse, particularly in older women with prolonged hormone treatment, which was predominantly seen after addition of progestogen. Medroxyprogesterone acetate seemed to have worse effects on cognition than other types of progestogen in these long-term studies. Estradiol with or without a progestogen was three times more likely to have positive effects on cognition than conjugated equine estrogens. However, two-thirds of studies showed no associations at all which may be an underestimate given the possibility of publication bias. We briefly review alternative treatments, such as testosterone and soy-derived supplements, but currently insufficient data are available for conclusive comments. Women who have undergone surgical menopause or who undergo natural menopause before age 47 may benefit most from hormone treatment and a special case may need to be made for this group. Long-term safety studies for this group are urgently needed.
The use of hormone therapy and its alternatives in women with a history of hormone dependent cancer
Authors: Sekar Hashviniya , Singhal Tasneem , Holloway Debra , Rymer Janice
Published: May 2013

Objective

Treating the effects of menopause in women with history of oestrogen-dependent cancers presents a clinical dilemma. Endocrine adjuvant agents like tamoxifen and other cancer treatments, often induce premature menopause. Vasomotor, psychological and somatic symptoms may be more severe in these women. The risk of hormone therapy (HT) and its efficacy must be balanced. Currently, there are no consensus guidelines for the management of these patients.

Study Design

This is a retrospective study carried out between 10/01/2011 and 27/01/2012 in a tertiary referral menopausal clinic.

Main Outcome measures

Data was collected about cancer type and treatment, symptoms, prior use of T, bone density analyses and menopause treatments.

Results

590 patient records were scanned and 146 patients (24.7%) had a history of cancer. Of these, 45.9% were younger than 50 years old. 67.1% comprised breast cancer patients, of which 69.4% were on adjuvant endocrine agents. 24.7% consisted of gynaecological cancer patients who were predominantly treated with surgery in conjunction with adjuvant therapies. 90.4% of the women had at least one menopause-related symptom, vasomotor symptoms being most prevalent, followed by psychological and vaginal symptoms. Women used a variety of HT and non-HRT therapies for their symptoms. Of the 77 women who had a personal history of oestrogen receptor positive cancers, 19.5% chose to take HT in spite of it being contraindicated.

Conclusions

Prescribing HT to women with a history of hormone dependent cancer remains controversial. Patient ‘Quality of Life’ must be considered. More research is required in this area.
Older adults are mobile too!Identifying the barriers and facilitators to older adults’ use of mHealth for pain management
Authors: Parker Samantha J , Jessel Sonal , Richardson Joshua E , Reid M Cary
Published: May 2013

Background

Mobile health (mHealth) is a rapidly emerging field with the potential to assist older adults in the management of chronic pain (CP) through enhanced communication with providers, monitoring treatment-related side effects and pain levels, and increased access to pain care resources. Little is currently known, however, about older adults’ attitudes and perceptions of mHealth or perceived barriers and facilitators to using mHealth tools to improve pain management.

Methods

We conducted six focus groups comprised of 41 diverse older adults (≥60 years of age) with CP. Participants were recruited from one primary care practice and two multiservice senior community day-visit centers located in New York City that serve older adults in their surrounding neighborhoods. Focus group discussions were recorded and transcribed, and transcriptions were analyzed using direct content analysis to identify and quantify themes.

Results

Focus group discussions generated 38 individual themes pertaining to the use of mHealth to help manage pain and pain medications. Participants had low prior use of mHealth (5% of participants), but the vast majority (85%) were highly willing to try the devices. Participants reported that mHealth devices might help them reach their healthcare provider more expeditiously (27%), as well as help to monitor for falls and other adverse events in the home (15%). Barriers to device use included concerns about the cost (42%) and a lack of familiarity with the technology (32%). Facilitators to device use included training prior to device use (61%) and tailoring devices to the functional needs of older adults (34%).

Conclusions

This study suggests that older adults with CP are interested and willing to use mHealth to assist in the management of pain. Participants in our study reported important barriers that medical professionals, researchers, and mHealth developers should address to help facilitate the development and evaluation of age-appropriate, and function-appropriate, mHealth devices for older persons with CP.
Localization of putative binding sites for cyclic guanosine monophosphate and the anti-cancer drug 5-fluoro-2′-deoxyuridine-5′-monophosphate on ABCC11 in silico models
Authors: Honorat Mylène , Terreux Raphaël , Falson Pierre , Di Pietro Attilio , Dumontet Charles , Payen Lea
Published: May 2013

Background

The Multidrug Resistance Protein ABCC11/MRP8 is expressed in physiological barriers and tumor breast tissues in which it secretes various substrates including cGMP (cyclic guanosine monophosphate) and 5FdUMP (5-fluoro-2′-deoxyuridine-5′-monophosphate), the active metabolite of the anticancer drug 5-FluoroUracil (frequently included to anticancer therapy).

Previously, we described that ABCC11 high levels are associated to the estrogen receptor (ER) expression level in breast tumors and in cell lines resistant to tamoxifen. Consequently, by lowering the intracellular concentration of anticancer drugs, ABCC11 likely promotes a multidrug resistance (MDR) phenotype and decreases efficiency of anticancer therapy of 5FdUMP. Since no experimental data about binding sites of ABCC11 substrate are available, we decided to in silico localize putative substrate interaction sites of the nucleotide derivatives. Taking advantage of molecular dynamics simulation, we also analysed their evolution under computational physiological conditions and during the time.

Results

Since ABCC11 crystal structure is not resolved yet, we used the X-ray structures of the mouse mdr3 (homologous to human ABCB1) and of the bacterial homolog Sav1866 to generate two independent ABCC11 homology models in inward- and outward-facing conformations. Based on docking analyses, two putative binding pockets, for cGMP and 5FdUMP, were localized in both inward- and outward-facing conformations. Furthermore, based on our 3D models, and available biochemical data from homologous transporters, we identified several residues, potentially critical in ABCC11 transport function. Additionally, molecular dynamics simulation on our inward-facing model revealed for the first time conformation changes assumed to occur during transport process.

Conclusions

ABCC11 would present two binding sites for cGMP and for 5FdUMP. Substrates likely first bind at the intracellular side of the transmembrane segment while ABCC11 is open forward the cytoplasm (inward-facing conformation). Then, along with conformational changes, it would pass through ABCC11 and fix the second site (close to the extracellular side), until the protein open itself to the extracellular space and allow substrate release.
Effects of Lung Support Formula on respiratory symptoms among older adults: results of a three-month follow-up study in Shanghai, China
Authors: Cai Yong , Shi Rong , Song Huijiang , Shang Meili , Shen Tian , Shariff Mina , Kami Kenneth , Gu Pingping , Nguyen Tuong , Rao Jianyu
Published: May 2013

Background

With the acceleration of industrialization in low or middle-income nations, the prevalence of respiratory symptoms among older adults is even more significant now in China. Contemporary treatments using Western medicine, such as anti-inflammatory regimens, may be effective in relieving the symptoms, but may have unexpected side effects. Some natural products may be effective in improving respiratory functions, yet their efficacies remain to be examined in randomized, placebo-controlled studies. To evaluate the effects of Lung Support Formula, a nutritional supplement which contains naturally derived Chinese herbal medicines, we conducted a clinical study among older adults in Shanghai, China.

Methods

A total of 100 patients over 50 years old were recruited and blindly randomized into the treatment or control group. The subjects took either 1 Lung Support Formula capsule or a placebo capsule twice a day for 12 weeks. All subjects were followed-up every 4 weeks to perform investigative and clinical examinations. Repeated measure of analysis of variance was employed to compare the trend of respiratory symptoms scores between the 2 groups during 12 weeks of follow-up.

Results

Fifty patients from the treatment group and 49 patients in the control group completed the 3-month follow-up. No adverse events were reported in the treatment duration. The percentage of patients reported to have chronic cough, chronic expectoration and chronic bronchitis were significantly decreased in the treatment group when compared with baseline after a 3-month intervention (P < 0.05). The respiratory symptoms scores declined gradually with the lapse of time (P < 0.05) in the treatment group and there were no significant changes in the control group by repeated measure of analysis of variance (P > 0.05).

Conclusions

The clinical research shows that use of Lung Support Formula shows significant improvements of respiratory symptoms and is well-tolerated in short-term use among older adults. An additional study involving more subjects and longer-term follow-up would be needed to provide convincing evidence of the improvement of respiratory symptoms in the treatment group.
One-pot synthesis of α-Fe2O3 nanospheres by solvothermal method
Authors: Wang Caihua , Cui Yumin , Tang Kaibin
Published: May 2013

We have successfully prepared α-Fe2O3 nanospheres by solvothermal method using 2-butanone and water mixture solvent for the first time, which were about 100 nm in diameter and composed of very small nanoparticles. The as-prepared samples were characterized using X-ray diffraction, scanning electron microscopy, and transmission electron microscopy. The results showed that the product was α-Fe2O3 nanosphere, and the temperature was an important factor on the formation of α-Fe2O3 nanospheres.
High level of susceptibility to human TRIM5α conferred by HIV-2 capsid sequences
Authors: Takeuchi Junko S , Perche Benjamin , Migraine Julie , Mercier-Delarue Séverine , Ponscarme Diane , Simon François , Clavel François , Labrosse Béatrice
Published: May 2013

Background

HIV-2, which was transmitted to humans from a distant primate species (sooty mangabey), differs remarkably from HIV-1 in its infectivity, transmissibility and pathogenicity. We have tested the possibility that a greater susceptibility of HIV-2 capsid (CA) to the human restriction factor TRIM5α (hTRIM5α) could contribute to these differences.

Results

We constructed recombinant clones expressing CA from a variety of HIV-2 viruses in the context of HIV-1 NL4-3-luciferase. CA sequences were amplified from the plasma of HIV-2 infected patients, including 8 subtype A and 7 subtype B viruses. CA from 6 non-epidemic HIV-2 subtypes, 3 HIV-2 CRF01_AB recombinants and 4 SIVsmm viruses were also tested. Susceptibility to hTRIM5α was measured by comparing single-cycle infectivity in human target cells expressing hTRIM5α to that measured in cells in which hTRIM5α activity was inhibited by overexpression of hTRIM5γ.

The insertion of HIV-2 CA sequences in the context of HIV-1 did not affect expression and maturation of the HIV-2 CA protein. The level of susceptibility hTRIM5α expressed by viruses carrying HIV-2 CA sequences was up to 9-fold higher than that of HIV-1 NL4-3 and markedly higher than a panel of primary HIV-1 CA sequences. This phenotype was found both for viruses carrying CA from primary HIV-2 sequences and viruses carrying CA from laboratory-adapted HIV-2 clones. High hTRIM5α susceptibility was found in all HIV-2 subtypes. In this series of viruses, susceptibility to hTRIM5α was not significantly affected by the presence of a proline at position 119 or by the number of prolines at positions 119, 159 or 178 in HIV-2 CA. No significant correlation was found between HIV-2 viremia and sensitivity to hTRIM5α.

Conclusions

HIV-2 capsid sequences expressed high levels of susceptibility to hTRIM5α. This property, common to all HIV-2 sequences tested, may contribute in part to the lower replication and pathogenicity of this virus in humans.
Oral immunization with an attenuated Salmonella Gallinarum mutant as a fowl typhoid vaccine with a live adjuvant strain secreting the B subunit of Escherichia coliheat-labile enterotoxin
Authors: Jeon Byung Woo , Nandre Rahul M , Lee John Hwa
Published: May 2013

Background

The Salmonella Gallinarum (SG) lon/cpxR deletion mutant JOL916 was developed as a live vaccine candidate for fowl typhoid (FT), and a SG mutant secreting an Escherichia coli heat-labile enterotoxin B subunit (LTB), designated JOL1229, was recently constructed as an adjuvant strain for oral vaccination against FT. In this study, we evaluated the immunogenicity and protective properties of the SG mutant JOL916 and the LTB adjuvant strain JOL1229 in order to establish a prime and boost immunization strategy for each strain. In addition, we compared the increase in body weight, the immunogenicity, the egg production rates, and the bacteriological egg contamination of these strains with those of SG 9R, a widely used commercial vaccine.

Results

Plasma IgG, intestinal secretory IgA (sIgA), and cell-mediated responses were significantly induced after a boost inoculation with a mixture of JOL916 and JOL1229, and significant reductions in the mortality of chickens challenged with a wild-type SG strain were observed in the immunized groups. There were no significant differences in increases in body weight, cell-mediated immune responses, or systemic IgG responses between our vaccine mixture and the SG 9R vaccine groups. However, there was a significant elevation in intestinal sIgA in chickens immunized with our mixture at 3 weeks post-prime-immunization and at 3 weeks post-boost-immunization, while sIgA levels in SG 9R-immunized chickens were not significantly elevated compared to the control. In addition, the SG strain was not detected in the eggs of chickens immunized with our mixture.

Conclusion

Our results suggest that immunization with the LTB-adjuvant strain JOL1229 can significantly increase the immune response, and provide efficient protection against FT with no side effects on body weight, egg production, or egg contamination.
Effect of induced ruminal acidosis on blood variables in heifers
Authors: Marchesini Giorgio , De Nardi Roberta , Gianesella Matteo , Stefani Anna-Lisa , Morgante Massimo , Barberio Antonio , Andrighetto Igino , Segato Severino
Published: May 2013

Background

Ruminal acidosis is responsible for the onset of different pathologies in dairy and feedlot cattle, but there are major difficulties in the diagnosis. This study modelled the data obtained from various blood variables to identify those that could indicate the severity of ruminal acidosis. Six heifers were fed three experimental rations throughout three periods. The diets were characterised by different starch levels: high starch (HS), medium starch (MS) and low starch, as the control diet (CT). Ruminal pH values were continuously measured using wireless sensors and compared with pH measurements obtained by rumenocentesis. Blood samples were analysed for complete blood count, biochemical profile, venous blood gas, blood lipopolysaccharide (LPS) and LPS-binding proteins (LBP).

Results

The regression coefficient comparing the ruminal pH values, obtained using the two methods, was 0.56 (P = 0.040). Feeding the CT, MS and HS led to differences in the time spent below the 5.8, 5.5 and 5.0 pH thresholds and in several variables, including dry matter intake (7.7 vs. 6.9 vs. 5.1 kg/d; P = 0.002), ruminal nadir pH (5.69 vs. 5.47 vs. 5.44; P = 0.042), mean ruminal pH (6.50 vs. 6.34 vs. 6.31; P = 0.012), haemoglobin level (11.1 vs. 10.9 vs. 11.4 g/dL; P = 0.010), platelet count (506 vs. 481 vs. 601; P = 0.008), HCO3
- (31.8 vs. 31.3 vs. 30.6 mmol/L; P = 0.071) and LBP (5.9 vs. 9.5 vs. 10.5 μg/mL; P < 0.001). A canonical discriminant analysis (CDA) was used to classify the animals into four ruminal pH classes (normal, risk of acidosis, subacute ruminal acidosis and acute ruminal acidosis) using haemoglobin, mean platelet volume, β-hydroxybutyrate, glucose and reduced haemoglobin.

Conclusions

Although additional studies are necessary to confirm the reliability of these discriminant functions, the use of plasma variables in a multifactorial model appeared to be useful for the evaluation of ruminal acidosis severity.