bluuebunny/crossref_metadata_2025 huggingface dataset:
Use and costs of oral anticancer agents in the Netherlands in the period 2000–2008
Authors: Timmers Lonneke , Beckeringh Jan Jacob , van Herk‐Sukel Myrthe P. P. , Boven Epie , Hugtenburg Jacqueline G.
Published: September 2011

Purpose

In recent years, the number of oral anticancer agents has increased substantially. Although these agents have quickly been incorporated in the treatment of a variety of malignancies, data on their incidence, prevalence and costs are lacking. The objective of the present study was to obtain insight into the use and the costs of oral anticancer agents (with Anatomical Therapeutic Chemical classification system (World Health Organisation) code L01) in the Netherlands between 2000 and 2008.

Methods

Incidence and prevalence were determined using community pharmacy dispensing records obtained from the PHARMO Record Linkage System database. The data of costs were provided by the Genees‐ en hulpmiddelen Informatie Project of the Dutch Health Care Insurance Board (CVZ, Diemen, The Netherlands).

Results

In the years 2000–2008, the use of oral anticancer agents has more than doubled from 64 to 140 users per 100 000 inhabitants. The increase is mainly caused by the prescription of capecitabine for various indications. There was a 50‐fold rise in costs on oral anticancer agents from €2 m in 2000 to approximately €100 m in 2008. The share in the costs of tyrosine kinase inhibitors (TKIs) in 2008 was 67% (€70 m) with the oldest TKI, imatinib, having a share of more than 50% within the group of TKIs.

Conclusions

The increased use of oral anticancer agents is mainly due to the frequent prescription of capecitabine. The increased costs are caused by the registration of a variety of TKIs, in particular imatinib. The costs of new agents with an orphan drug status are very high as compared with those of capecitabine, a newer agent for which there are alternative treatment options. Copyright © 2011 John Wiley & Sons, Ltd.
Mental health professionals' attitudes to partnership in medicine taking: a validation study of the Leeds Attitude to Concordance Scale II
Authors: de las Cuevas Carlos , Rivero‐Santana Amado , Perestelo‐Perez Lilisbeth , Perez‐Ramos Jeanette , Gonzalez‐Lorenzo Marien , Serrano‐Aguilar Pedro , Sanz Emilio J.
Published: September 2011

Purpose

To explore psychiatrists' attitudes toward concordance by validating the Leeds Attitude to Concordance Scale II (LATCon II) in a Spanish sample.

Methods

This was a cross‐sectional survey. An opportunistic sample of 125 psychiatrist and 100 psychiatry registrars attending a national conference completed the LATCon II questionnaire and sociodemographic and professional data. The principal component analysis of the LATCon II items was performed. Associations with sociodemographic and mental health professional variables were calculated.

Results

Principal component analysis yielded three components labeled “communication/empathy,” “shared control,” and “eventual paternalistic style.” Women obtained significantly lower scores than men on the second component. Mental health professional variables were not related to attitude to concordance.

Conclusions

Psychiatrists show a favorable attitude to involve patients in a process of reciprocal communication, where patients' preferences, values, and expectations are considered, but they are more cautious in their attitude to sharing decisions with patients. There is scope for the different kinds of research in this area: studying sex‐based differences in psychiatrists' attitudes to concordance and also exploring the gap in mental health care between patients' and professionals' views of shared decision making. Only in this way can the real partnership for shared decision making be fully understood. Copyright © 2011 John Wiley & Sons, Ltd.
Work stress and well‐being in oncology settings: a multidisciplinary study of health care professionals
Authors: Jones Martyn C. , Wells Mary , Gao Chuan , Cassidy Bernadette , Davie Jackie
Published: September 2011

Objectives

Staff working in oncology report high levels of work‐related stress. This arises partly from the nature of clinical work, including practitioner perceptions of high demand and low control or high effort and low reward. This comparative study investigated the correlates of work stress in a multidisciplinary group of staff and the associations between staff perceptions of the work environment, emotional distress, job satisfaction and work‐based social support.

Methods

This questionnaire study combined quantitative and qualitative assessment in a cohort sample of multidisciplinary staff (N = 85) working in a cancer centre in North East Scotland. Ethical approval was granted by the local Research Ethics Committee. This paper reports on the quantitative element of the study,

Results

Response rate was 50.6% (N = 85). Older, female and nursing and support staff were more likely to participate. Support staff reported the lowest perceptions of control, job satisfaction and managerial support. Radiographers reported the highest levels of job satisfaction, co‐worker and managerial support. Nurses perceived lower decision control and job satisfaction than allied health professionals or doctors. In general, perceptions of decisional control and reward were protective of job satisfaction, particularly when work demands were high. Co‐worker support was associated with perceptions of reduced effort, greater reward and increased satisfaction. Managerial support was also associated with greater control beliefs. Overall, sickness absence exceeded the 5% rates seen in other National Health Service surveys, whereas turnover intention rates were similar.

Conclusion

The development and introduction of multilevel strategies to reduce demand, improve control and support perceptions are warranted, particularly for support staff. Copyright © 2011 John Wiley & Sons, Ltd.
Internet guidance in oncology practice: determinants of health professionals' Internet referral behavior
Authors: Emond Yvette , de Groot Jos , Wetzels Wendy , van Osch Liesbeth
Published: September 2011

Background

Many cancer patients turn to the Internet to obtain information on their disease. This digital quest is often motivated by a perceived discrepancy between the information received from health professionals and patients' actual informational needs. This discrepancy may be reduced by supplementing standard patient education with reliable online information sources. This study investigates health professionals' opinions, cognitions, and behavior regarding referring cancer patients to Internet‐based information.

Methods

Online and written questionnaires were distributed among Dutch oncology nurses and medical specialists, measuring perception of patients' informational needs, prompted and unprompted Internet referral, and socio‐cognitive factors regarding referral behavior.

Results

Health professionals (N = 130) positively appraised Internet use among cancer patients. Despite recognizing patients' needs for additional information (84%) and need for referral to reliable websites (67%), only 20% frequently referred patients to Internet‐based information. Prompted Internet referral was higher (64%). Motives for nonreferral included unfamiliarity with websites and uncertainty about information quality. Intentions towards future referral were moderate to high. To translate intentions into referral, health professionals need reminder tools and information on reliability and content of websites. Cognitive determinants of referral behavior included professionals' attitude, self‐efficacy, and intentions regarding referral.

Conclusions

Recognition of patients' information needs does not culminate in Internet referral among health professionals in cancer care. High intentions to change, however, indicate good prospects for future referral. This study yields valuable insights into behavioral determinants of health professionals' Internet referral behavior. Targeting determinants and barriers in future interventions will provide opportunities for optimization of educational practices. Copyright © 2011 John Wiley & Sons, Ltd.
Care needs after primary breast cancer treatment. Survivors' associated sociodemographic and medical characteristics
Authors: Pauwels Evelyn E. J. , Charlier Caroline , De Bourdeaudhuij Ilse , Lechner Lilian , Van Hoof Elke
Published: September 2011

Background

This study examines the care needs of rehabilitating breast cancer survivors and determines what sociodemographic and medical characteristics are associated with these care needs.

Methods

A large‐scale cross‐sectional study (n = 465, response rate = 65%) was conducted among survivors who had ended primary treatment less than 6 months previously. Questionnaires were completed regarding participants' care needs, how these needs were met and the time and manner preferred for receiving information and support. Care needs regarding seven specific rehabilitation topics were assessed separately: (1) physical functioning, (2) psychological functioning, (3) self and body image, (4) sexuality, (5) relationship with partner, (6) relationship with others, and (7) work, return to work and social security.

Results

High unmet needs were reported across all topics. The time preferred for receiving information and support across most topics was the period of breast cancer treatment. The most popular sources of information and support were informative brochures, consultation with a psychologist, information sessions and an informative website. Younger age and lower income were associated with care needs after treatment.

Conclusions

A valuable contribution is made to the literature on post‐treatment care needs by comprehensively mapping unmet needs and the preferred time and source for meeting those needs. This study leads to greater awareness of the struggle facing breast cancer survivors and should guide those developing post‐treatment interventions. As optimal tailoring to the needs of the target group is a prerequisite for success, preparatory needs assessment should be essential to the development of supportive interventions. Copyright © 2011 John Wiley & Sons, Ltd.
High‐sensitivity C reactive protein as a biomarker for grading of childhood asthma in relation to clinical classification, induced sputum cellularity, and spirometry
Authors: Deraz T.E. , Kamel Terez B. , El‐Kerdany Tahany A. , El‐Ghazoly Heba M.A.
Published: September 2011

Background

Asthma is the most common chronic inflammatory disease in childhood and some reports have demonstrated systemic inflammation. The relevance of high‐sensitivity assays for C‐reactive protein (hs‐CRP), which are known to be a sensitive marker of low‐grade systemic inflammation, has not been fully studied in childhood asthma.

Aim of study

This cross sectional case–control study aimed at evaluating serum hs‐CRP in asthmatic children with different grades of severity and control.

Methods

Serum hs‐CRP, sputum cytology study, and forced expiratory volume in 1 sec (FEV1) % of predicted for age and sex were estimated in 60 asthmatic children (30 uncontrolled steroid‐naïve, and 30 controlled on inhaled steroid). They were recruited from Pediatric Chest Clinic, Children's Hospital, Ain Shams University. Sixty healthy children‐age and sex‐matched were included as a control group.

Results

Serum hs‐CRP concentrations were significantly higher in asthmatics than in controls with a median of 1.93 mg/L and 0.24 mg/L, respectively. Serum hs‐CRP levels were significantly higher in uncontrolled steroid‐naïve asthmatics than those controlled on inhaled steroid with a median of 3.15 mg/L and 1.55 mg/L, respectively. Serum hs‐CRP showed a sensitivity of 72% and a specificity of 93%.

Conclusions

Despite that pulmonary function tests and clinical classification are the gold standard for grading of asthma, hs‐CRP can be considered as a new marker for assessment of different grades of asthma severity and control. It can be used for indirect detection and monitoring of airway inflammation, disease severity, and response to steroid treatment in asthmatic children. Pediatr Pulmonol. 2012; 47:220–225. © 2011 Wiley Periodicals, Inc.
Kojic acid–amino acid amide metal complexes and their melanogenesis inhibitory activities
Authors: Kwak Seon‐Yeong , Choi Hye‐Ryung , Park Kyoung‐Chan , Lee Yoon‐Sik
Published: September 2011

Tyrosinase plays a critical role in the early stages of the melanin synthetic pathway by catalyzing the oxidation of the substrate. Therefore, tyrosinase inhibitors have been intensively studied in both cosmetic and food industries to develop hypopigmentary agents and prevent enzymatic browning in food. Previously, we reported that kojic acid–amino acid amide (KA‐AA‐NH2) showed enhanced tyrosinase inhibitory activity compared with kojic acid alone, but this was not observed in a cell test because of poor cell permeability. To enhance cell permeability, we prepared copper and zinc complexes of KA‐AA‐NH2 and characterized them using FT‐IR spectroscopy, ESI‐MS spectrometry, and inductively coupled plasma analysis. We then showed that KA‐AA‐NH2 copper complexes exhibited melanogenesis inhibitory activity in Mel‐Ab cells. Copyright © 2011 European Peptide Society and John Wiley & Sons, Ltd.
Antimicrobial activity, bactericidal mechanism and LPS‐neutralizing activity of the cell‐penetrating peptide pVEC and its analogs
Authors: Nan Yong Hai , Park Il‐Seon , Hahm Kyung‐Soo , Shin Song Yub
Published: September 2011

pVEC is a cell‐penetrating peptide derived from the murine vascular endothelial‐cadherin protein. To evaluate the potential of pVEC as antimicrobial peptide (AMP), we synthesized pVEC and its analogs with Trp and Arg/Lys substitution, and their antimicrobial and lipopolysaccharide (LPS)‐neutralizing activities were investigated. pVEC and its analogs displayed a potent antimicrobial activity (minimal inhibitory concentration: 4–16 μM) against Gram‐positive and Gram‐negative bacteria but no or less hemolytic activity (less than 10% hemolysis) even at a concentration of 200 μM. These peptides induced a near‐complete membrane depolarization (more than 80%) at 4 μM against Staphylococcus aureus and a significant dye leakage (35–70%) from bacterial membrane‐mimicking liposome at a concentration as low as 1 μM. The fluorescence profiles of pVEC and its analogs in dye leakage from liposome and membrane depolarization were similar to those of a frog‐derived AMP, magainin 2. These results suggest that pVEC and its analogs kill bacteria by forming a pore or ion channel in the cytoplasmic membrane. pVEC and its analogs significantly inhibited nitric oxide production or tumor necrosis factor‐α release in LPS‐stimulated mouse macrophage RAW264.7 cells at 10 to 50 μM, in which RAW264.7 were not damaged. Taken together, our results suggest that pVEC and its analogs with potent antimicrobial and LPS‐neutralizing activities can serve as AMPs for the treatment of microbial infection and sepsis. Copyright © 2011 European Peptide Society and John Wiley & Sons, Ltd.
Bounding the parameters of block‐structured nonlinear feedback systems
Authors: Cerone V. , Piga D. , Regruto D.
Published: September 2011

In this paper, a procedure for set‐membership identification of block‐structured nonlinear feedback systems is presented. Nonlinear block parameter bounds are first computed by exploiting steady‐state measurements. Then, given the uncertain description of the nonlinear block, bounds on the unmeasurable inner signal are computed. Finally, linear block parameter bounds are evaluated on the basis of output measurements and computed inner‐signal bounds. The computation of both the nonlinear block parameters and the inner‐signal bounds is formulated in terms of semialgebraic optimization and solved by means of suitable convex LMI relaxation techniques. The problem of linear block parameter evaluation is formulated in terms of a bounded errors‐in‐variables identification problem. Copyright © 2011 John Wiley & Sons, Ltd.
RESTORATION OF SPAWNING HABITATS OF BROWN TROUT (SALMO TRUTTA) IN A REGULATED CHALK STREAM
Authors: Pulg Ulrich , Barlaup Bjørn T. , Sternecker Katharina , Trepl Ludwig , Unfer Guenther
Published: September 2011

Gravel bed spawning grounds are essential for the reproduction of salmonids. Such spawning grounds have been severely degraded in many rivers of the world because of river regulation and erosive land use. To reduce its effects on salmonid reproduction rates, river managers have been restoring spawning grounds. However, measures of effectiveness are lacking for the restored spawning sites of brown trout (Salmo trutta).

In this study, two methods were used to restore gravel bed spawning grounds in the Moosach River, a chalk stream in Southern Germany: the addition of gravel and the cleaning of colmated gravel. Seven test sites were monitored in the years 2004 to 2008, focussing on sediment conditions. Furthermore, brown trout egg survival and changes in the brown trout population structure were observed.

Both gravel addition and gravel cleaning proved to be suitable for creating spawning grounds for brown trout. Brown trout reproduced successfully at all test sites. The relative number of young‐of‐the‐year brown trout increased clearly after the restoration. Sediment on the test sites colmated during the 4 years of the study. In the first 2 years, highly suitable conditions were maintained, with a potential egg survival of more than 50%. Afterwards, the sites offered moderate conditions, indicating an egg survival of less than 50%. Conditions unsuitable for reproduction were expected to be reached 5 to 6 years after restoration. Copyright © 2011 John Wiley & Sons, Ltd.
Prioritizing the creation of unit tests in legacy software systems
Authors: Shihab Emad , Jiang Zhen Ming , Adams Bram , Hassan Ahmed E. , Bowerman Robert
Published: September 2011

Test‐driven development (TDD) is a software development practice that prescribes writing unit tests before writing implementation code. Recent studies have shown that TDD practices can significantly reduce the number of pre‐release defects. However, most TDD research thus far has focused on new development. We investigate the adaptation of TDD‐like practices for already‐implemented code, in particular legacy systems. We call such an adaptation ‘Test‐driven maintenance’ (TDM). In this paper, we present a TDM approach that assists software development and testing managers to use the limited resources they have for testing legacy systems efficiently. The approach leverages the development history of a project to generate a prioritized list of functions that managers should focus their unit test writing resources on. The list is updated dynamically as the development of the legacy system progresses. We evaluate our approach on two large software systems: a large commercial system and the Eclipse Open Source Software system. For both systems, our findings suggest that heuristics based on the function size, modification frequency and bug fixing frequency should be used to prioritize the unit test writing efforts for legacy systems. Copyright © 2011 John Wiley & Sons, Ltd.
Reactions of Perfluorinated Alkenyl‐, Alkynyl‐, Alkyltrifluoroborates, and Selected Hydrocarbon Analogues with the Halogenating Agents Hal2 (Hal = F, Cl, Br), “BrF” (BrF3–Br2 1:1), and ICl
Authors: Bardin Vadim V. , Adonin Nicolay Yu. , Frohn Hermann‐Josef
Published: September 2011

Reactions of [Bu4N][RBF3] [R = CnF2n+1CF=CF (cis, trans), CF2=CF, CF2=C(CF3), trans‐C4H9CF=CF, trans‐C6H5CF=CF, C4H9CH=CH (cis, trans), CF3C≡C, and C4H9C≡C] with chlorine, bromine, BrF3 + Br2 (as equivalent of “BrF”), and ICl in solution (CH2Cl2, CHCl3, CF3CH2CF2CH3) led to 1, 2‐addition of halogen and/or replacement of boron by halogen (halodeboration). The reaction of [Bu4N][CF3C≡CBF3] with less than equimolar amounts of diluted fluorine (5 %) in 1, 1, 1, 3, 3‐pentafluorobutane (PFB) showed only [Bu4N][CF3CF2CF2BF3] as fluorine addition product besides extensive fluorodeboration. Suspensions of the insoluble K[CF2=CFBF3] salt reacted with Cl2 and Br2 in CH2Cl2 giving preferentially products of halogen addition across the C=C bond. In reactions with ICl iododeboration with formation of CF2=CFI occurred besides 1, 2‐addition with formation of [CF2I–CFClBF3]–. The halodeboration reaction of[Bu4N][trans‐C4H9CF=CFBF3] with Br2, “BrF”, and ICl, of K[trans‐C6H5CF=CFBF3] with Br2, and of [Bu4N][trans‐C4F9CF=CFBF3] with ICl proceeded stereospecifically.
Novel Alkali Triazine Tricarboxylates Li3[C3N3(CO2)3]·4H2O, Rb3[C3N3(CO2)3]·2H2O and Cs3[C3N3(CO2)3]·2H2O – Synthesis, Crystal Structure and Thermal Behavior
Authors: Makowski Sophia J. , Calta Evelyn , Schnick Wolfgang
Published: September 2011

The alkali 1,3,5‐triazine‐2,4,6‐tricarboxylates Li3[C3N3(CO2)3]·4H2O, Rb3[C3N3(CO2)3]·2H2O and Cs3[C3N3(CO2)3]·2H2O were synthesized by saponification of the respective triethyl ester in aqueous solution. In the crystal structure, the triazine tricarboxylate (TTC) units and metal ions are arranged in layers alternating with layers of crystal water molecules. Within the layers the triazine tricarboxylate entities form either strands in Li3[C3N3(CO2)3]·4H2O or a hexagonal arrangement in Rb3[C3N3(CO2)3]·2H2O and Cs3[C3N3(CO2)3]·2H2O. Perpendicular to the layers, the triazine cores exhibit varying degrees of π–π stacking dependent on the metal ions resulting in the formation of rods in Rb3[C3N3(CO2)3]·2H2O and Cs3[C3N3(CO2)3]·2H2O. Additionally, the thermal behavior of the alkali triazine tricarboxylates was investigated by means of FT‐IR spectroscopy, TG and DTA measurements. Differences and similarities regarding structural features and thermal behavior are discussed for the obtained novel alkali triazine tricarboxylates and potassium triazine tricarboxylate dihydrate.
Four 1D and 2D Cadmium(II) Complexes Based on Different Anions and Two Modified Bipyridyl Ligands: Syntheses, Structures, Thermogravimetric, and Fluorescent Properties
Authors: Li Linke , Zhao Jingjing , Wang Changhong , Yang Sisi , Hou Hongwei
Published: September 2011

A series of cadmium(II) coordination polymers constructed from 1, 3‐bis(pyridine‐3‐carbonyl)imidazolidin‐2‐thioxo (3‐bpit) and 1, 3‐bis(pyridine‐4‐carbonyl)imidazolidin‐2‐thioxo (4‐bpit), namely,{[Cd(SCN)2(3‐bpit)2]·2(CH3OH)}n (1), {[Cd(NO3)2(3‐bpit)2]·2(CH3OH)}n(2), [CdI2(4‐bpit)]n (3), and [CdCl2(4‐bpit)4]n (4) were prepared and characterized by single‐crystal X‐ray diffraction. Complexes 1 and 2 display different types of infinite 1D helical chain structures, both of which contain 24‐membered metallocyclic rings. Complex 3 is composed of 1D zigzag chains, which further form a 3D supramolecular architecture by weak C–H···S and S···I interactions. Complex 4 also features a 3D supramolecular network assembled from 2D rhombus‐shaped layer through intermolecular hydrogen bonding. These structures indicate that the conformation of the ligand and the diverse anions take important roles in the formation of different frameworks. Thermogravimetric and fluorescent properties over complexes are also discussed.
Cobalt(II) Complex with a Tridentate N Donor Ligand: Synthesis, Crystal Structure, Antioxidation, and DNA Binding Studies
Authors: Wu Huilu , Liu Bin , Kou Fan , Jia Fei , Yuan Jingkun , Bai Ying
Published: September 2011

A heptacoordinated mononuclear cobalt(II) complex of tridentate bis(N‐ethylbenzimidazol‐2‐ylmethyl)aniline (Etbba) formulated as [Co(Etbba)(pic)2]·(MeCN) (pic = picrate), was synthesized and characterized by elemental analysis, electric conductivity measurements, as well as IR and UV/Vis spectroscopy. The crystal structure of the cobalt(II) complex was determined by single‐crystal X‐ray diffraction. The study shows the metal atom in a distorted monocapped octahedral arrangement that comprises two picrate molecules and one Etbba ligand molecule. The DNA‐binding properties of the cobalt(II) complex were investigated by electronic absorption and fluorescence spectroscopy, as well as viscosity measurements. The experimental results suggest that the cobalt(II) complex binds to DNA in an intercalating mode. In addition, the complex shows strong scavenging effects for hydroxyl radicals.
Value of Visual Inspection, Bimanual Palpation, and Intraoperative Ultrasonography During Hepatic Resection for Liver Metastases of Colorectal Carcinoma
Authors: Hata Shojiro , Imamura Hiroshi , Aoki Taku , Hashimoto Takuya , Akahane Masaaki , Hasegawa Kiyoshi , Bekku Yoshifumi , Sugawara Yasuhiko , Makuuchi Masatoshi , Kokudo Norihiro
Published: September 2011

Background

Intraoperative detection of new nodules is common in patients undergoing hepatectomy for colorectal liver metastases, although the value of intraoperative diagnosis is not well assessed.

Methods

A prospectively collected and recorded database was retrospectively analyzed. Helical computed tomography (CT) results were correlated with those of the intraoperative diagnosis in 183 consecutive patients undergoing 254 consecutive hepatectomies, including repeated resection for colorectal liver metastases.

Results

In total, 270 nodules were newly detected during 65 hepatectomies. The sensitivity of CT to detect metastatic nodules was 72.8% (722/992), but it decreased to 34.6% (125/361) for small (≤1 cm diameter) tumors. Intraoperative visual inspection and/or palpation detected 207 of 270 nodules. Intraoperative ultrasonography (IOUS) played an important role in identifying deep (≥1 cm from the surface) and comparatively small (≤1 cm diameter) nodules (4/9 vs. 16/18, respectively, for those >1 cm vs. ≤1 cm diameter). The likelihood of intraoperative detection of new nodules increased from 10 in 112 to 6 in 9 when the preoperative tumor number increased from solitary to ≥10, resulting in an overall likelihood of 65 in 254 (25.6%). Of 65 patients with new nodules, 21 had at least one nodule that was detected only by IOUS. Preoperatively scheduled hepatectomy was altered in 47 (72%) patients, although additional limited resection(s) were sufficient to remove these nodules in 43 (91%) of them.

Conclusions

Visual inspection, palpation, and IOUS had equally indispensable roles in detecting new nodules during hepatectomy. Detection was common and usually necessitated alteration, albeit moderately, of the surgical plan.
Laparoscopic Intersphincteric Resection for Low Rectal Cancer
Authors: Lim Sang Woo , Huh Jung Wook , Kim Young Jin , Kim Hyeong Rok
Published: September 2011

Background

Laparoscopic intersphincteric resection (ISR) after neoadjuvant chemoradiation is helpful in the management of patients with low rectal cancer. With the advent of this technique, the need for performance of abdominoperineal resection seems to have decreased in patients with very low rectal tumors. The aim of the present study was to evaluate the feasibility, the functional outcome, and the short‐term oncologic outcomes of laparoscopic ISR for low rectal adenocarcinoma at our institution.

Methods

We retrospectively reviewed the data of 111 consecutive patients who underwent laparoscopic ISR for low rectal adenocarcinoma between July 2005 and December 2009. Demographic status, surgical outcomes, functional outcome data, and oncologic outcome data were collected.

Results

The mean distance of the tumor from the anal verge was 3.4 cm (range: 1–5 cm). The mean operative time was 214.7 min (range, 150–450 min). The mean distal resection margin was 1.3 ± 1.1 cm. Morbidity occurred in 24 patients (21.6%), including anastomotic leakage in 2 patients (1.8%). The mean Wexner continence score after stoma repair was 7.5 ± 2.7 (range: 2 ~ 19), and 9.8 in total ISR, 7.3 in partial ISR (P = 0.071). The 3‐year overall survival rate was 92.8%, and the 3‐year disease‐free survival rate was 73.0%. Local recurrence was noted in 6 of the 111 patients with TNM stage I to III (5.4%). The patients with lesions at 2 cm to the dentate line had a 7.07‐fold greater risk of local recurrence, including a 13.42‐fold greater risk of lateral pelvic wall recurrence and perineal recurrence (95% Confidence interval [CI], 1.141–158.006; P = 0.009) than in those who had lesions more than 2 cm from the anal verge (95% CI, 1.290–38.832; P = 0.011).

Conclusions

Laparoscopic ISR after neoadjuvant chemoradiation can be recommended as a technically feasible, minimally invasive, and a sphincter‐saving procedure with acceptable functional and short‐term oncologic outcomes in patients with very low rectal cancer.
Elevation of Liver Function Tests After Laparoscopic Gastrectomy Using a Nathanson Liver Retractor
Authors: Kinjo Yousuke , Okabe Hiroshi , Obama Kazutaka , Tsunoda Shigeru , Tanaka Eiji , Sakai Yoshiharu
Published: September 2011

Background

Although pneumoperitoneum has been suspected as a possible cause of transient elevation of liver function tests (LFTs) after laparoscopic surgery, liver damage by direct retraction could also influence postoperative LFTs. The aim of this study was to clarify whether laparoscopic gastrectomy (LG) using a Nathanson retractor was associated with the postoperative elevation of LFTs compared with open gastrectomy (OG).

Methods

A retrospective cohort study of 199 LG and 120 OG patients was conducted. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin were measured before operation and at postoperative days 1, 3, and 7. Abnormal elevation of LFTs was defined as a grade 2 or greater elevation in any parameter. To assess the possible effect of pneumoperitoneum, patients who underwent laparoscopic (n = 324) and open (n = 56) colectomy for colorectal cancer were also compared.

Results

In both LG and OG groups, LFTs were significantly elevated postoperatively compared with baseline values. Mean ALT and total bilirubin levels on days 1, 3, and 7 were significantly higher in the LG than OG group. Abnormal elevation of LFTs was more frequent in the LG than OG group (50 vs. 12%). In multivariate analysis, LG was significantly associated with postoperative liver dysfunction (odds ratio [OR] = 7.99; 95% confidence interval [95% CI] = 3.69–18.85). No significant difference in the elevation of the LFTs was observed between laparoscopic and open colectomy (6% and 9%, respectively).

Conclusions

LG resulted in frequent elevation of LFTs. Care should be taken to minimize intraoperative liver damage when performing LG using a Nathanson retractor.
Hepatic hilar transection method for liver surgery (with video)
Authors: Kokudo Norihiro , Aoki Taku
Published: September 2011

The procedure used to isolate the hepatic artery, the portal vein and the bile duct separately at the hepatic hilum was first reported in the 1940s, and remains significant as an essential technique for liver surgery in the era of more complicated liver surgery and liver transplantation. The anatomy of the vessels at the hepatic hilum is highly variable; therefore, preoperative imaging studies are indispensable for understanding the anatomy in each individual patient. The minimal extent of the transection should be defined according to the operative procedure, as excessive disruption of the blood flow and lymphatic vessels can induce postoperative complications. When isolating the vessels, gentle handling and appropriate ligation/division of the vessels are required to avoid bleeding and injuries to the vessels to be preserved. The bile duct is wrapped with perivascular connective tissue and is difficult to isolate separately. Therefore, the hilar plate should be divided together with the bile duct, under the guidance of intraoperative cholangiography.
Subjective age in early adolescence: Relationships with chronological age, pubertal timing, desired age, and problem behaviors
Authors: Hubley Anita M. , Arım Rübab G.
Published: September 2011

Subjective age generally refers to the age that one feels. In a cross‐sectional questionnaire study of 245 adolescents ages 10–14 years, we examined (a) whether, and when, a cross‐over in subjective age occurs, (b) differences in subjective age among pubertal timing groups, (c) correlations between subjective age and each of desired age and five problem behaviors, and (d) the relative contributions of chronological age, pubertal timing, desired age, and problem behaviors to subjective age in boys and girls. Adolescents generally reported subjective and desired ages that were slightly older than their chronological ages. A cross‐over in subjective age occurred at 10.4 years. Late maturing adolescents reported relatively younger subjective ages than their early and on‐time maturing peers. For boys, only desired age significantly predicted subjective age. For girls, an older desired age, late maturation, and higher scores on anxious/depressed feelings, rule‐breaking behavior, and aggressive behavior significantly predicted older subjective ages.
Postlobectomy Chest Radiographic Changes: A Quantitative Analysis
Authors: Kim Choo-Won , Godelman Alla , Jain Vineet R. , Merav Avraham , Haramati Linda B.
Published: September 2011

Purpose

To provide a quantative analysis of postlobectomy chest radiographic changes and to evaluate whether the scarring from prior sternotomy affects the size of the hemithorax and the duration of air leak in patients with subsequent lobectomy.

Methods

In this retrospective case-controlled series, 10 consecutive patients who had a lobectomy after a prior sternotomy and 30 controls, 3 for each case, matched for lobectomy site were identified. Pre- and postoperative chest radiographs were quantitatively analysed for diaphragmic elevation, size of each hemithorax, mediastinal shift, and the presence of pneumothorax. Charts were reviewed for air-leak duration, surgical complications, and duration of hospitalization.

Results

There was no difference between patients with lobectomy and with and without prior sternotomy for the following variables expressed as mean (SD): hemidiaphragm elevation (1.5 ± 2.5 vs 0.5 ± 2.0 cm; P = .2), change of hemithorax size (mean transverse, 0.99 ± 0.05 vs 0.97 ± 0.07; P = .5; craniocaudal, 0.93 ± 0.08 vs 0.91 ± 0.08; P = .4) and mediastinal shift (upper, 1.2 ± 0.4 vs 1.3 ± 0.6; P = .5; lower, 1.2 ± 0.4 vs 1.2 ± 0.3; P = .8), the latter 2 were expressed as the ratio of post- to preoperative measurements. These postlobectomy radiographic findings varied, depending on the resected lobe, and became progressively more pronounced during the first 12 months after surgery. There was no difference in pneumothorax duration (mean [SD]) (9.5 ± 21 days vs 6.4 ± 7.5 days; P = .5), air leak duration (mean [SD]) (0.7 ± 0.8 days vs 1.3 ± 3.9 days; P = .6), complication rate (20% vs 30%; P = .5), or hospital stay (mean [SD]) (6.0 ± 1.7 days vs 6.9 ± 4.7 days; P = .6).

Conclusion

There are specific patterns of volume loss, mediastinal shift, and hemidiaphragm displacement that can be quantified on postlobectomy chest radiographs. Prior sternotomy did not affect postlobectomy radiographic changes or patient outcome.
Maternal α‐linolenic acid availability during gestation and lactation alters the postnatal hippocampal development in the mouse offspring
Authors: Niculescu Mihai D. , Lupu Daniel S. , Craciunescu Corneliu N.
Published: September 2011

The availability of ω‐3 polyunsaturated fatty acids is essential for perinatal brain development. While the roles of docosahexaenoic acid (the most abundant ω‐3 species) were extensively described, less is known about the role of α‐linolenic acid (ALA), which is the initial molecular species undergoing elongation and desaturation within the ω‐3 pathways. This study describes the association between maternal ALA availability during gestation and lactation, and alterations in hippocampal development (dentate gyrus) in the mouse male offspring, at the end of lactation (postnatal day 19, P19). Postnatal ALA supplementation increased cell proliferation (36% more proliferating cells compared to a control group) and early neuronal differentiation, while postnatal ALA deficiency increased cellular apoptosis within the dentate gyrus of suckling pups (61% more apoptotic cells compared to a control group). However, maternal ALA deficiency during gestation prevented the increased neurogenesis induced by postnatal supplementation. Fatty acid analysis revealed that ALA supplementation increased the concentration of the ω‐3 species in the maternal liver and serum, but not in the brain of the offspring, excepting for ALA itself. Interestingly, ALA supplementation also increased the concentration of dihomo γ‐linolenic acid (a ω‐6 species) in the P19 brains, but not in maternal livers or serum. In conclusion, postnatal ALA supplementation enhances neurogenesis in the dentate gyrus of the offspring at postnatal day 19, but its beneficial effects are offset by maternal ALA deficiency during gestation. These results suggest that ALA is required in both fetal and postnatal stages of brain development.
Efficacy of the levonorgestrel‐releasing intrauterine system in uterine leiomyoma
Authors: Kriplani Alka , Awasthi Divya , Kulshrestha Vidushi , Agarwal Nutan
Published: September 2011

Objective

To evaluate the efficacy of the levonorgestrel‐releasing intrauterine system (LNG‐IUS) in reducing menstrual blood loss (MBL) in myoma‐related menorrhagia and to assess the effect of the LNG‐IUS on uterine and leiomyoma volume.

Methods

A prospective comparative study investigated the effect of LNG‐IUS use in women with myoma‐related menorrhagia (n = 54) and women with idiopathic menorrhagia (n = 50). The outcome was assessed in terms of reductions in MBL and in myoma and uterine volume.

Results

Within 1 month of LNG‐IUS insertion, the Pictorial Blood Loss Assessment Chart score in the myoma group fell by 86.8% (P < 0.0001). At 3, 12, 24, 36, and 48 months, the MBL was reduced by 92.1%, 97.4%, 97.4%, 99.5%, and 99.5%, respectively, similar to the effect seen in the idiopathic menorrhagia group. The mean uterine volume was significantly reduced in both groups, but the reduction was greater in the group with leiomyomas (idiopathic menorrhagia, P = 0.038; myoma‐related menorrhagia, P = 0.012). There was no statistically significant reduction in the myoma volume (P = 0.409).

Conclusion

Use of the LNG‐IUS appears to lead to a significant reduction in the uterine volume of women with menorrhagia, as well as reducing the MBL in women with uterine leiomyomas.
Case Report of Probable Desert Black Snake Envenomation in 22-Year-Old Male Causing Profound Weakness and Respiratory Distress
Authors: Lauer Cynthia , Zickgraf Thomas L. , Weisse Martin E.
Published: September 2011

We describe a case of a 22-year-old male who presented to our facility 1 hour after a snake bite, which he identified as the desert black snake. He presented with severe weakness and respiratory distress. He was treated with polyvalent antivenom and observed in the Intensive Care Unit (ICU) with resolution of his respiratory symptoms. He developed paresthesias locally around his wound and later complained of diplopia. Two days later, he had total resolution of his symptoms. This is one of the only clinical reports of neurotoxic effects after Walterinnesia morgani envenomation.
On the liquid lining in fluid-conveying curved tubes
Authors: Hazel Andrew L. , Heil Matthias , Waters Sarah L. , Oliver James M.
Published: September 2011

We consider axially uniform, two-phase flow through a rigid curved tube in which a fluid (air) core is surrounded by a film of a second, immiscible fluid (water): a simplified model for flow in a conducting airway of the lung. Jensen (1997) showed that, in the absence of a core flow, surface tension drives the system towards a configuration in which the film thickness tends to zero on the inner wall of the bend. In the present work, we demonstrate that the presence of a core flow, driven by a steady axial pressure gradient, allows the existence of steady states in which the film thickness remains finite, a consequence of the fact that the tangential stresses at the interface, imposed by secondary flows in the core, can oppose the surface-tension-driven flow. For sufficiently strong surface tension, the steady configurations are symmetric about the plane containing the tube’s centreline, but as the surface tension decreases the symmetry is lost through a pitchfork bifurcation, which is closely followed by a limit point on the symmetric solution branch. This solution structure is found both in simulations of the Navier–Stokes equations and a thin-film model appropriate for weakly curved tubes. Analysis of the thin-film model reveals that the bifurcation structure arises from a perturbation of the translational degeneracy of the interface location in a straight tube.
Link between lipid metabolism and voluntary food intake in rainbow trout fed coconut oil rich in medium-chain TAG
Authors: Figueiredo-Silva A. Cláudia , Kaushik Sadasivam , Terrier Frédéric , Schrama Johan W. , Médale Françoise , Geurden Inge
Published: September 2011

We examined the long-term effect of feeding coconut oil (CO; rich in lauric acid, C12) on voluntary food intake and nutrient utilisation in rainbow trout (Oncorhynchus mykiss), with particular attention to the metabolic use (storage or oxidation) of ingested medium-chain TAG. Trout were fed for 15 weeks one of the four isoproteic diets containing fish oil (FO) or CO as fat source (FS), incorporated at 5 % (low fat, LF) or 15 % (high fat, HF). Fat level or FS did not modify food intake (g/kg0·8per d), despite higher intestinal cholecystokinin-T mRNA in trout fed the HF-FO diet. The HF diets relative to the LF ones induced higher growth and adiposity, whereas the replacements of FO by CO resulted in similar growth and adiposity. This, together with the substantial retention of C12 (57 % of intake), suggests the relatively low oxidation of ingested C12. The down-regulation of carnitine palmitoyl-transferase-1 (CPT-1) confirms the minor dependency of medium-chain fatty acids (MCFA) on CPT-1 to enter the mitochondria. However, MCFA did not up-regulate mitochondrial oxidation evaluated using hepatic hydroxyacyl-CoA dehydrogenase as a marker, in line with their high retention in body lipids. At a low lipid level, MCFA increased mRNA levels of fatty acid synthase, elongase and stearoyl-CoA desaturase in liver, showing the hepatic activation of fatty acid synthesis pathways by MCFA, reflected by increased 16 : 0, 18 : 0, 16 : 1, 18 : 1 body levels. The high capacity of trout to incorporate and transform C12, rather than to readily oxidise C12, contrasts with data in mammals and may explain the absence of a satiating effect of CO in rainbow trout.
Stool-fermented Plantago ovata husk induces apoptosis in colorectal cancer cells independently of molecular phenotype
Authors: Sohn Vanessa R. , Giros Anna , Xicola Rosa M. , Fluvià Lourdes , Grzybowski Mike , Anguera Anna , Llor Xavier
Published: September 2011

Several studies have suggested that the partially fermentable fibre Plantago ovata husk (PO) may have a protective effect on colorectal cancer (CRC). We studied the potentially pro-apoptotic effect of PO and the implicated mechanisms in CRC cells with different molecular phenotypes (Caco-2, HCT116, LoVo, HT-29, SW480) after PO anaerobic fermentation with colonic bacteria as it occurs in the human colon. The fermentation products of PO induced apoptosis in all primary tumour and metastatic cell lines, independent of p53, adenomatous polyposis coli, β-catenin or cyclo-oxygenase-2 status. Apoptosis was caspase-dependent and both intrinsic and extrinsic pathways were implicated. The intrinsic pathway was activated through a shift in the balance towards a pro-apoptotic environment with an up-regulation of B-cell lymphoma protein 2 homologous antagonist killer (BAK) and a down-regulation of B-cell lymphoma-extra large (Bcl-xL) seen in HCT116 and LoVo cells. This resulted in mitochondrial membrane depolarisation, increased expression of caspase activators second mitochondria-derived activator of caspases (Smac)/Diablo, death effector apoptosis-inducing factor, apoptosome member apoptotic protease activating factor 1 and down-regulation of inhibitors of apoptosis Survivin and X-linked inhibitor of apoptosis in most cells. The extrinsic pathway was activated presumably through the up-regulation of death receptor (DR5). Some important differences were seen between primary tumour and metastatic CRC cells. Thus, metastatic PO-treated LoVo cells had a remarkable up-regulation of TNF-α ligand along with death-inducing signalling complex components receptor interacting protein and TNF-α receptor 1-associated death domain protein. The extrinsic pathway modulator FCICE-inhibitory protein (FLIP), an inhibitor of both spontaneous death ligand-independent and death receptor-mediated apoptosis, was significantly down-regulated after PO treatment in all primary tumour cells, but not in metastatic LoVo. These findings suggest that PO could potentially be a useful chemotherapy adjuvant.
Coffee polyphenols modulate whole-body substrate oxidation and suppress postprandial hyperglycaemia, hyperinsulinaemia and hyperlipidaemia
Authors: Murase Takatoshi , Yokoi Yuka , Misawa Koichi , Ominami Hideo , Suzuki Yasuto , Shibuya Yusuke , Hase Tadashi
Published: September 2011

Postprandial energy metabolism, including postprandial hyperglycaemia, hyperinsulinaemia and hyperlipidaemia, is related to the risk for developing obesity and CVD. In the present study, we examined the effects of polyphenols purified from coffee (coffee polyphenols (CPP)) on postprandial carbohydrate and lipid metabolism, and whole-body substrate oxidation in C57BL/6J mice. In mice that co-ingested CPP with a lipid–carbohydrate (sucrose or starch)-mixed emulsion, the respiratory quotient determined by indirect calorimetry was significantly lower than that in control mice, whereas there was no difference inVO2(energy expenditure), indicating that CPP modulates postprandial energy partitioning. CPP also suppressed postprandial increases in plasma glucose, insulin, glucose-dependent insulinotropic polypeptide and TAG levels. Inhibition experiments on digestive enzymes revealed that CPP inhibits maltase and sucrase, and, to a lesser extent, pancreatic lipase in a concentration-dependent manner. Among the nine kinds of polyphenols (caffeoyl quinic acids (CQA), di-CQA, feruloyl quinic acids (FQA)) contained in CPP, di-CQA showed more potent inhibitory activity than CQA or FQA on these digestive enzymes, suggesting a predominant role of di-CQA in the regulation of postprandial energy metabolism. These results suggest that CPP modulates whole-body substrate oxidation by suppressing postprandial hyperglycaemia and hyperinsulinaemia, and these effects are mediated by inhibiting digestive enzymes.
Coarse, but not finely ground, dietary fibre increases intestinalFirmicutes:Bacteroidetesratio and reduces diarrhoea induced by experimental infection in piglets
Authors: Molist Francesc , Manzanilla Edgar Garcia , Pérez José Francisco , Nyachoti Charles Martin
Published: September 2011

Using dietary fibre to control childhood diarrhoea has rarely been discussed. However, dietary fibre is being proposed to prevent diarrhoea in piglets. The present study aimed to study the effects of introducing fibre in the post-weaning piglet diet and its particle size on the intestinal ecosystem before and after an experimental infection withEscherichia coli. A total of thirty-six post-weaning piglets were assigned to four experimental diets: a negative control (NC) diet, the same diet with 4 % wheat bran coarse (WBc) particle size or finely milled (WBF) and a positive control (PC) diet with an antibiotic. On day 9, animals were challenged withE. coli. Faecal and digesta samples were obtained before and after the experimental infection and changes in the microbial ecosystem were measured. Animals fed the WBc and the PC diets showed a significant reduction in the faecal score compared with the NC diet. The inclusion of WBc in the diet increased total volatile fatty acid concentration, reduced Bacteroidetes in the faeces before and after the experimental infection compared with the NC diet and increased Firmicutes at the end of the experiment. Based on the results, diarrhoea scours and the composition of the pig gut microbial community are modified by the inclusion of a relatively small amount of wheat bran in the diet, being the physical presentation of the fibre a determinant of that difference.