bluuebunny/crossref_metadata_2025 huggingface dataset:
A quasi-static state examination of handle forces and translational acceleration at impending planar motion for the four-caster manually manoeuvred vehicle
Authors: Abraham B B , Johnson G R
Published: April 2010

Motion resistance, handle forces, and translational acceleration of a four-caster manually manoeuvred vehicle (FMV) are examined at impending planar motion.

FMV-wheel angular acceleration directions occur in polygon regions of the FMV-body translational acceleration. The mass centre force and torque, which balance motion resistance, using a Coulomb model, are non-linear and discontinuous functions of FMV-body acceleration.

The transformation from mass centre force and torque to a dynamically equivalent handle-force measure is examined. A reference manoeuvre with a single set of caster orientations shows that FMV-body translational acceleration has a substantial effect on handle-force measure variation: an almost three-fold variation exists.

The reference manoeuvre analysis is repeated with a representative sample of all caster orientations. The mean handle-force measure for this sample also shows a substantial handle-force measure variation, e.g. relatively high handle forces occur when the translational acceleration is directed as the impending change of FMV heading. This effect is independent of motion resistance values. As the handle forces required to balance motion resistance vary substantially depending on FMV-body translational acceleration, spatial constraints may have a substantial effect on handle forces. A relationship between handle forces and spatial constraints indicates that architectural planning has health and safety implications for the FMV operator.
Plate/shell element of variable thickness based on the absolute nodal coordinate formulation
Authors: Abbas L K , Rui X , Hammoudi Z S
Published: April 2010

For almost a decade, static and dynamic analyses of large rotation and deformation are carried out using finite-element absolute nodal coordinate formulation (ANCF). In this context, a three-dimensional rectangular plate/shell element of variable thickness based on ANCF has been developed. In the approach to the problem, a continuum mechanics approach for the definition of elastic forces within the finite element is considered. Both shear strain and transverse normal strain are taken into account. All formulations and computations are built up in FORTRAN 90 computer program after it was confirmed by Mathematica 5 software. Four case studies are analysed for eigenfrequencies to conform the accuracy of the developed formulation. Results of analyses demonstrate that the presented formulation agrees well with the experimental analysis of published researches or with results obtained from known commercial software. However, some results indicate that the known problem of locking (ANCF with uniform thickness) persists in the current developed formulation.
Design of a force acquisition system for high-energy short-duration impacts
Authors: Walker P J , Rothberg S J , Holmes C E , Harland A R
Published: April 2010

This paper describes a novel force acquisition system capable of measuring the force profiles of high-energy short-duration impacts. This force acquisition system was used to test dynamically a cricket leg guard and to create a contour map of the peak transmitted forces across the garment's surface. The cricket leg guard was found to provide most protection in the central shin and knee regions, areas most likely to be impacted normally and so to receive the highest-energy impacts. The use of this system will enable a dynamic test procedure to be developed to mimic impact conditions encountered during a game, allowing optimization of cricket pad designs for specific impacts.
Negotiating care: patient tactics at an urban South African hospital
Authors: Schneider Helen , le Marcis Frederic , Grard Julien , Penn-Kekana Loveday , Blaauw Duane , Fassin Didier
Published: April 2010

Objectives:

To examine the various ways in which patients sought to influence the care they received in the admission and adult medical services of a large urban, academic hospital in South Africa. These included the steps taken by patients to increase their access to services and improve their experience of care.

Methods:

Part of a qualitative study of rationing behaviour, the methods combined, observations, interviews and a survey.

Results:

Patient's actions were oriented to two main goals: obtaining care and preserving their sense of self and dignity. These actions shaped patients’ pathways in five key ways: meeting the entry criteria for admission; presenting as a cooperative, expert patient; mobilizing social networks among health care staff; making use of complaints mechanisms; and deploying narratives of resistance.

Conclusions:

Patients made tactical use of small spaces at the margins of the health care system. Although, with some exceptions, they had limited impact on the care received in the hospital, they highlight patients as active players and point to the ways in which patient agency can be strengthened in the light of the shift towards chronic disease care and greater patient involvement in care.
Scrub typhus: an unrecognized threat in South India – clinical profile and predictors of mortality
Authors: Chrispal Anugrah , Boorugu Harikishan , Gopinath Kango Gopal , Prakash John Antony Jude , Chandy Sara , Abraham O C , Abraham Asha Mary , Thomas Kurien
Published: April 2010

Scrub typhus is an important cause of acute undifferentiated febrile illnesses in the Indian subcontinent. Delay in diagnosis and in the initiation of appropriate treatment can result in severe complications such as acute respiratory distress syndrome (ARDS), septic shock and multisystem organ failure culminating in death. We conducted a prospective, observational study to delineate the clinical profile and predictors of mortality in scrub typhus in adults admitted to the medical wards of a tertiary care, referral hospital in South India over a one-year period. The case fatality rate in this study was 12.2%. Metabolic acidosis (odds ratio [OR] 6.1), ARDS (OR 3.6), altered sensorium (OR 3.6) and shock (OR 3.1) were independent predictors of mortality. It appears that scrub typhus has four possible overlapping clinical presentations: mild disease; respiratory predominant disease; central nervous system predominant disease (meningoencephalitis); or sepsis syndrome. Given the telltale presence of an eschar (evident in 45.5%), the characteristic clinical profile and the dramatic therapeutic response to a cheap, yet effective, drug such as doxycycline, medical practitioners in the region should have ample opportunity to reach an early diagnosis and initiate treatment which could, potentially, reduce the mortality and morbidity associated with scrub typhus.
Systematic comparison of microarray profiling, real-time PCR, and next-generation sequencing technologies for measuring differential microRNA expression
Authors: Git Anna , Dvinge Heidi , Salmon-Divon Mali , Osborne Michelle , Kutter Claudia , Hadfield James , Bertone Paul , Caldas Carlos
Published: April 2010

RNA abundance and DNA copy number are routinely measured in high-throughput using microarray and next-generation sequencing (NGS) technologies, and the attributes of different platforms have been extensively analyzed. Recently, the application of both microarrays and NGS has expanded to include microRNAs (miRNAs), but the relative performance of these methods has not been rigorously characterized. We analyzed three biological samples across six miRNA microarray platforms and compared their hybridization performance. We examined the utility of these platforms, as well as NGS, for the detection of differentially expressed miRNAs. We then validated the results for 89 miRNAs by real-time RT-PCR and challenged the use of this assay as a “gold standard.” Finally, we implemented a novel method to evaluate false-positive and false-negative rates for all methods in the absence of a reference method.
Hepatitis C virus genomic RNA dimerization is mediated via a kissing complex intermediate
Authors: Shetty Sumangala , Kim Seungtaek , Shimakami Tetsuro , Lemon Stanley M. , Mihailescu Mihaela-Rita
Published: April 2010

With over 200 million people infected with hepatitis C virus (HCV) worldwide, there is a need for more effective and better-tolerated therapeutic strategies. The HCV genome is a positive-sense; single-stranded RNA encoding a large polyprotein cleaved at multiple sites to produce at least ten proteins, among them an error-prone RNA polymerase that confers a high mutation rate. Despite considerable overall sequence diversity, in the 3′-untranslated region of the HCV genomic RNA there is a 98-nucleotide (nt) sequence named X RNA, the first 55 nt of which (X55 RNA) are 100% conserved among all HCV strains. The X55 region has been suggested to be responsible for in vitro dimerization of the genomic RNA in the presence of the viral core protein, although the mechanism by which this occurs is unknown. In this study, we analyzed the X55 region and characterized the mechanism by which it mediates HCV genomic RNA dimerization. Similar to a mechanism proposed previously for the human immunodeficiency 1 virus (HIV-1) genome, we show that dimerization of the HCV genome involves formation of a kissing complex intermediate, which is converted to a more stable extended duplex conformation in the presence of the core protein. Mutations in the dimer linkage sequence loop sequence that prevent RNA dimerization in vitro significantly reduced but did not completely ablate the ability of HCV RNA to replicate or produce infectious virus in transfected cells.
Mutational analyses of trimethylguanosine synthase (Tgs1) and Mud2: Proteins implicated in pre-mRNA splicing
Authors: Chang Jonathan , Schwer Beate , Shuman Stewart
Published: April 2010

Yeast and human Tgs1 are orthologous RNA cap (guanine-N2) methyltransferases that convert m7G caps into the 2,2,7-trimethylguanosine (TMG) caps characteristic of spliceosomal snRNAs. TMG caps are dispensable for vegetative yeast growth, but are essential in the absence of Mud2, the putative yeast homolog of human splicing factor U2AF. Here we exploited the synthetic lethal interactions of tgs1Δ and mud2Δ mutations to identify essential structural features of the Tgs1 and Mud2 proteins. Thirty-two new mutations were introduced into human Tgs1 and surveyed for their effects on function in vivo in yeast and on the two sequential guanine-N2 methylation reactions in vitro. The structure-function data highlight a strictly essential π-cation interaction between Trp766 and the m7G base and a network of important enzymic contacts to the cap triphosphate via Lys646, Tyr771, Arg807, and Lys836. Mud2 is a 527-amino acid polypeptide composed of a hydrophilic N-terminal domain and a C-terminal RRM domain. We found that the RRM domain is necessary but not sufficient for Mud2 function in complementing growth of tgs1Δ mud2Δ and mud1Δ mud2Δ strains. Other changes in Mud2 elicited distinct phenotypes in tgs1Δ versus mud1Δ backgrounds. mud2Δ also caused a severe growth defect in cells lacking the Tgs1-binding protein encoded by the nonessential gene YNR004w (now renamed SWM2, synthetic with mud2Δ). Mud2 mutational effects in the swm2Δ background paralleled those for mud1Δ. The requirements for Mud2 function are apparently more stringent when yeast cells lack TMG caps than when they lack Mud1 or Swm2.
The requirement for the highly conserved G−1 residue of Saccharomyces cerevisiae tRNAHis can be circumvented by overexpression of tRNAHis and its synthetase
Authors: Preston Melanie A. , Phizicky Eric M.
Published: April 2010

Nearly all tRNAHis species have an additional 5′ guanine nucleotide (G−1). G−1 is encoded opposite C73 in nearly all prokaryotes and in some archaea, and is added post-transcriptionally by tRNAHis guanylyltransferase (Thg1) opposite A73 in eukaryotes, and opposite C73 in other archaea. These divergent mechanisms of G−1 conservation suggest that G−1 might have an important cellular role, distinct from its role in tRNAHis charging. Thg1 is also highly conserved and is essential in the yeast Saccharomyces cerevisiae. However, the essential roles of Thg1 are unclear since Thg1 also interacts with Orc2 of the origin recognition complex, is implicated in the cell cycle, and catalyzes an unusual template-dependent 3′–5′ (reverse) polymerization in vitro at the 5′ end of activated tRNAs. Here we show that thg1-Δ strains are viable, but only if histidyl-tRNA synthetase and tRNAHis are overproduced, demonstrating that the only essential role of Thg1 is its G−1 addition activity. Since these thg1-Δ strains have severe growth defects if cytoplasmic tRNAHis A73 is overexpressed, and distinct, but milder growth defects, if tRNAHis C73 is overexpressed, these results show that the tRNAHis G−1 residue is important, but not absolutely essential, despite its widespread conservation. We also show that Thg1 catalyzes 3′–5′ polymerization in vivo on tRNAHis C73, but not on tRNAHis A73, demonstrating that the 3′–5′ polymerase activity is pronounced enough to have a biological role, and suggesting that eukaryotes may have evolved to have cytoplasmic tRNAHis with A73, rather than C73, to prevent the possibility of 3′–5′ polymerization.
Comparing RNA secondary structures using a relaxed base-pair score
Authors: Agius Phaedra , Bennett Kristin P. , Zuker Michael
Published: April 2010

The use of free energy-based algorithms to compute RNA secondary structures produces, in general, large numbers of foldings. Recent research has addressed the problem of grouping structures into a small number of clusters and computing a representative folding for each cluster. At the heart of this problem is the need to compute a quantity that measures the difference between pairs of foldings. We introduce a new concept, the relaxed base-pair (RBP) score, designed to give a more biologically realistic measure of the difference between structures than the base-pair (BP) metric, which simply counts the number of base pairs in one structure but not the other. The degree of relaxation is determined by a single relaxation parameter, t. When t = 0, (no relaxation) our method is the same as the BP metric. At the other extreme, a very large value of t will give a distance of 0 for identical structures and 1 for structures that differ. Scores can be recomputed with different values of t, at virtually no extra computation cost, to yield satisfactory results. Our results indicate that relaxed measures give more stable and more meaningful clusters than the BP metric. We also use the RBP score to compute representative foldings for each cluster.
One-stage tubeless antegrade ureteric stenting: a safe and cost-effective option?
Authors: Chitale Sudhanshu , Raja Vaiyapuri , Hussain Nabeel , Saada Janak , Girling Simon , Irving Stuart , Cockburn JF
Published: April 2010

INTRODUCTION

Antegrade insertion of ureteric stent has become an established mode of management of upper tract obstruction secondary to ureteric pathology. It is conventionally performed as a two-stage procedure for various reasons but, more recently, a one-stage approach has been adopted.

PATIENTS AND METHODS

We discuss our experience of primary one-stage insertion of antegrade ureteric stent as a safe and cost-effective option for the management of these difficult cases in this retrospective observational case cohort study of patients referred to a radiology department for decompression of obstructed upper tracts. Data were retrieved from case notes and a radiology database for patients undergoing one-stage and two-stage antegrade stenting. It was followed by telephone survey of regional centres about the prevalent local practice for antegrade stenting. Outcome measures like hospital stay, procedural costs, requirement of analgesia/antimicrobials and complication rates were compared for the two approaches.

RESULTS

a one-stage approach was found to be suitable in most cases with many advantages over the two-stage approach with comparable or better outcomes at lower costs. Some of the limitations of the study were retrospective data collection, more than one radiologist performing stenting procedures and non-availability of interventional radiologist falsely raising the incidence of two-stage procedures.

CONCLUSIONS

In the absence of any clinical contra-indications and subject to availability of an interventional radiologist’s support, one-stage antegrade stenting could easily be adopted as a routine approach for the management of benign or malignant ureteric obstruction.
Understanding of intra-operative tourniquets amongst orthopaedic surgeons and theatre staff – a questionnaire study
Authors: Sadri Amir , Braithwaite Ian J , Abdul-Jabar Hani B , Sarraf Khaled M
Published: April 2010

INTRODUCTION

Pneumatic tourniquets are used frequently in orthopaedic theatres to provide a bloodless field whilst operating on the extremities. Their use has given rise to complications and preventable damage due to over-pressurisation and prolonged application. We designed a questionnaire to assess the knowledge on tourniquet use among operating department assistants (ODAs) and specialist registrars (SpRs) in orthopaedic surgery.

SUBJECTS AND METHODS

A questionnaire was constructed using set guidelines from the Association of periOperative Registered Nurses (AORN) for recommended practice of tourniquet application. This was distributed to orthopaedic registrars with varying levels of experience and ODAs from five different NHS hospitals. The unpaired, two tailed t-test was used to test for statistical significance of results.

RESULTS

A total of 54 completed questionnaires were collected for analysis. The study population included 29 orthopaedic SpRs and 25 ODAs. The mean score for the orthopaedic SpRs as a group was 41.3% (SD 6.85; range, 29.0–54.8%). The mean score for the ODAs was 46.7% (SD 9.64; range, 23.3–62.9%) with a P-value of 0.024.

CONCLUSIONS

Most surgeons are taught how to use pneumatic tourniquets by their senior colleagues as no formal teaching is given. Most of the complications are infrequent and preventable. However, their consequences can be devastating to the patient with medicolegal implications. Our results show suboptimal knowledge of tourniquets and their use among SpRs and ODAs. This study highlights the need for amendments in training to improve the knowledge and awareness of medical practitioners on the application and use of tourniquets to prevent adverse events and improve patient safety.
Treating the boxer's fracture in Wales: a postal survey
Authors: Jones Rhidian , Burdett Sadie , Jefferies Matthew , Guha Abhijit R
Published: April 2010

INTRODUCTION

There is no standardised treatment for fifth metacarpal neck fractures. Treatment of this common fracture can vary from immediate mobilisation to immobilisation in a plaster cast for 3 weeks. There is no literature identifying current practice amongst surgeons.

SUBJECTS AND METHODS

This survey's aim was to reveal current practice in Wales by means of a postal questionnaire sent to all Welsh orthopaedic consultants.

RESULTS

The questionnaire had a 60% response rate. Results demonstrated varied opinion regarding the degree of displacement warranting reduction. Overall, 10% of surgeons reduce the fracture at 30° of displacement, 29% at 40°, 18% at 50° and 20% at 60° of displacement. The treatment was also very varied. Most surgeons preferred to treat these fractures with neighbour strapping (43%,) while others preferred plaster immobilisation (39%) or immediate mobilisation (10%.) Only 22% of surgeons discharge these patients back to the community after their first visit to out-patients while 13% offer two follow-up appointments.

CONCLUSIONS

The treatment being offered for this common fracture in Wales is inconsistent. There is a need to develop evidence- based best practice guidelines which should standardise the treatment of this common injury. Perhaps, a large multicentre outcome study may enable this to be drawn up in the future.
Assessing the adequacy of procedure-specific consent forms in orthopaedic surgery against current methods of operative consent
Authors: Barritt Andrew W , Clark Laura , Teoh Victoria , Cohen Adam MM , Gibb Paul A
Published: April 2010

INTRODUCTION

This is an audit of patient understanding following their consent for orthopaedic procedures and uses information on new Orthoconsent forms endorsed by the British Orthopaedic Association as the set standard. The objectives were to: (i) assess whether patients& understanding of knee arthroscopy (KA) and total knee replacement (TKR) at the point of confirming their consent reaches the set standard; and (ii) to ascertain whether issuing procedure-specific Orthoconsent forms to patients can improve this understanding.

SUBJECTS AND METHODS

This was a prospective audit using questionnaires consisting of 26 (for KA) or 35 (for TKR) questions based on the appropriate Orthoconsent form in a department of orthopaedic surgery within a UK hospital. Participants were 100 patients undergoing KA and 60 patients undergoing TKR between February and July 2008. Participants were identified from sequential operating lists and all had capacity to give consent. During the first audit cycle, consent was discussed with the patient and documented on standard yellow NHS Trust approved generic consent forms. During the second audit cycle, patients were additionally supplied with the appropriate procedure-specific consent form downloaded from < www.orthoconsent.com > which they were required to read at home and sign on the morning of surgery.

RESULTS

Knee arthroscopy patients consented with only the standard yellow forms scored an average of 56.7%, rising to 80.5% with use of Orthoconsent forms. Similarly, total knee replacement patients& averages rose from 57.6% to 81.6%.

CONCLUSIONS

Providing patients with an Orthoconsent form significantly improves knowledge of their planned procedure as well as constituting a more robust means of information provision and consent documentation.
Prospective evaluation of a selective approach to cholangiography for suspected common bile duct stones
Authors: Horwood James , Akbar Fayaz , Davis Katherine , Morgan Richard
Published: April 2010

INTRODUCTION

Common bile duct (CBD) stones can cause serious morbidity or mortality, and evidence for them should be sought in all patients with symptomatic gallstones undergoing cholecystectomy. Routine intra-operative cholangiography (IOC) involves a large commitment of time and resources, so a policy of selective cholangiography was adopted. This study prospectively evaluated the policy of selective cholangiography for patients suspected of having choledocholithiasis, and aimed to identify the factors most likely to predict the presence of CBD stones positively.

PATIENTS AND METHODS

Data from 501 consecutive patients undergoing laparoscopic cholecystectomy (LC) for symptomatic gallstones, of whom 166 underwent IOC for suspected CBD stones, were prospectively collected. Suspicion of choledocholithiasis was based upon: (i) deranged liver function tests (past or present); (ii) history of jaundice (past or present) or acute pancreatitis; (iii) a dilated CBD or demonstration of CBD stones on imaging; or (iv) a combination of these factors. Patient demographics, intra-operative findings, complications and clinical outcomes were recorded.

RESULTS

Sixty-four cholangiograms were positive (39%). All indications for cholangiogram yielded positive results. Current jaundice yielded the highest positive predictive value (PPV; 86%). A dilated CBD on pre-operative imaging gave a PPV of 45% for CBD calculi; a history of pancreatitis produced a 26% PPV for CBD calculi. Patients with the presence of several factors suggestive of CBD stones yielded higher numbers of positive cholangiograms. Of the 64 patients having a laparoscopic common bile duct exploration (LCBDE), four (6%) required endoscopic retrograde cholangiopancreatography (ERCP) for retained stones (94% successful surgical clearance of the common bile duct) and one (2%) for a bile leak. Of the 335 patients undergoing LC alone, three (0.9%) re-presented with a retained stone, requiring intervention. There were 12 (7%) requiring conversion to open operation.

CONCLUSIONS

A selective policy for intra-operative cholangiography yields acceptably high positive results. Pre-operatively, asymptomatic bile duct stones rarely present following LC; thus, routine imaging of the biliary tree for occult calculi can safely be avoided. Therefore, a rationing approach to the use of intra-operative imaging based on the pre-operative indicators presented in this paper, successfully identifies those patients with bile duct stones requiring exploration. Laparoscopic bile duct exploration, performed by an experienced laparoscopic surgeon, is a safe and effective method of clearing the bile duct of calculi, with minimal complications, avoiding the necessity for an additional intervention and prolonged hospital stay.
Evaluation of the introduction of a standardised protocol for the staging and follow-up of colorectal cancer on resection rates for liver metastases
Authors: Tiernan J , Briggs CD , Irving GRB , Swinscoe MT , Peterson M , Cameron IC
Published: April 2010

INTRODUCTION

In 2004, an audit in our unit demonstrated wide variation in liver resection rates for colorectal cancer (CRC) metastases within the cancer network. Subsequently, a network-wide CT-based follow-up and referral policy was introduced for all patients. A second audit was performed to assess the impact of the guidelines on liver resection rates.

SUBJECTS AND METHODS

Analysis of prospective liver resection database between 1997 and 2004 and after the introduction of standardised guidelines between January 2005 and April 2008.

RESULTS

A total of 362 patients underwent liver resection for CRC metastases between 1997 and 2008, 237 prior to the introduction of the referral guidelines and 125 after. Liver resection rates according to referring hospital varied from 0.92 to 2.32 per 100,000 population before guidelines were introduced. After 2005, resection rates from the four district hospitals standardised (1.68–1.84 per 100,000 population), but the central unit rate (Sheffield) remained significantly higher (2.67 per 100,000 population). No significant difference in 1-year disease-free survival between patients from Sheffield and the outlying hospitals was found (P = 0.553).

CONCLUSIONS

Introduction of a referral protocol standardised resection rates from the four district hospitals, but these remain lower compared to the specialist centre. The wide-spread adoption of a policy to discuss all patients with liver metastases at an advanced disease multidisciplinary team meeting, in the presence of hepatobiliary specialists, may further increase resection rates across the UK.
Five-year prospective follow-up of 430 laparoscopic totally extraperitoneal inguinal hernia repairs in 275 patients
Authors: Messenger DE , Aroori S , Vipond MN
Published: April 2010

INTRODUCTION

Favourable short-term results, with respect to less postoperative pain and earlier return to physical activity, have been demonstrated with laparoscopic totally extraperitoneal (TEP) hernia repair compared with open mesh repair. However, there is limited data regarding long-term results.

PATIENTS AND METHODS

The study cohort consisted of 275 consecutive patients undergoing TEP repair between 1996 and 2002. Patient demographics, details of surgery, postoperative complications, recurrence and chronic pain were collected from patient records and from a prospective database. All patients were seen at 6 weeks and then annually for 5 years following surgery.

RESULTS

A total of 430 repairs were performed in the 275 patients (median age, 56 years; range, 20–94 years; men, 97.5%). Bilateral repair was performed in 168 patients (61.1%) and recurrent hernia repair in 79 patients (28.7%). Two patients were converted to an open procedure. Five-year follow-up was achieved in 72% of patients. Eleven patients (4%) died during the follow-up period due to unrelated causes. Hernia recurrence rate at 5 years was 1.1% per patient (three repairs). Recurrences were noted at 7 months, 2 years and 4 years following surgery. Chronic groin pain was reported by 21 patients (7.6%), seven of whom required referral to the pain team.

CONCLUSIONS

TEP hernia repair is associated with a recurrence rate of 1% at 5 years in this series. Chronic groin symptoms are also acceptably few. This recurrence rate following TEP repair compares extremely favourably with open mesh repair, particularly as it includes a high proportion of recurrent repairs. As well as the proven early benefits, TEP repair can be considered a safe and durable procedure with excellent long-term results.
The triceps–flexor carpi ulnaris (TRIFCU) approach to the elbow
Authors: Deakin DE , Deshmukh SC
Published: April 2010

INTRODUCTION

Intra-articular fractures of the distal humerus frequently require internal fixation. Several approaches have been described, with the posterior approaches being most common. We present a new approach to the distal humerus via the lateral border of the triceps muscle.

PATIENTS AND METHODS

The senior author has used this technique for fixation of intra-articular fractures of the distal humerus in 12 patients.

RESULTS

The approach is equally useful for intra- and extra-articular fractures. No cases of postoperative ulna nerve neuropraxia have been encountered. There have been no postoperative wound complications. The exposure has allowed sufficient access to allow anatomically contoured plates to be easily applied to both sides of the distal humerus with confirmation of intra-articular fracture reduction.

CONCLUSIONS

The approach has the advantages of leaving the muscular bed of the ulna nerve undisturbed, whilst still providing excellent exposure of the distal humerus. The triceps mechanism is not divided or split allowing rapid recovery of extensor function. Additionally, because of the natural carrying angle of the elbow, repositioning of the reflected triceps aponeurosis is easy.
Temporal trends in primary total hip and knee arthroplasty surgery: results from a UK regional joint register, 1991–2004
Authors: Ibrahim T , Bloch B , Esler CN , Abrams KR , Harper WM
Published: April 2010

INTRODUCTION

The aim of this study was to evaluate temporal trends in the prevalence of primary total hip and knee replacements (THRs and TKRs) throughout the Trent region from 1991 to 2004.

PATIENTS AND METHODS

The Trent Regional Arthroplasty Study records details of primary THR and TKR prospectively and data from the register were examined. Age and gender population data were provided by the Office for National Statistics.

RESULTS

A total of 26,281 THRs and 23,606 TKRs were recorded during this period. Analysis showed that females had an increased incidence rate ratio (IRR) for both primary THR (IRR = 1.29; 95% CI 1.26–1.33; P < 0.001) and TKR (IRR = 1.17; 95% CI 1.14–1.20; P < 0.001). Patients aged 74–85 years had the largest IRR for both primary THR (IRR = 6.7; 95% CI 6.4–7.0; P < 0.001) and TKR (IRR = 15.3; 95% CI 14.4–16.3; P < 0.001).

CONCLUSIONS

The prevalence of primary TKR increased significantly over time whereas THR remained steady in the Trent region between 1991 and 2004.
Impact of laparoscopic right hemicolectomy for colon cancer
Authors: Abdel-Halim MRE , Moore HM , Cohen P , Dawson P , Buchanan GN
Published: April 2010

INTRODUCTION

This study specifically examined right colonic cancer resection, a common operation for colorectal surgeons starting laparoscopic resection, to assess the impact of commencing laparoscopy.

PATIENTS AND METHODS

A total of 56 patients undergoing open (n = 34) and attempted laparoscopic (n = 22) elective right hemicolectomy for colorectal cancer between November 2003 and March 2007 were compared. Postoperative stay was the primary outcome. Secondary outcomes included analgesic requirements, bowel recovery, morbidity and mortality. Frequency of laparoscopic versus open surgery over time was also examined.

RESULTS

Resections attempted laparoscopically increased from 9.1% to 75% in the first and last quarters of the study period, respectively (P = 0.0002). Uptake of ‘enhanced recovery’ was mainly in the laparoscopic group. Conversion was required in two of 22 patients. Attempted laparoscopic cases had a shorter median postoperative stay (6 vs 10 days; P < 0.0001), duration of parenteral or epidural analgesia (48 vs 72 h; P < 0.0001) and time to first bowel action (3 vs 4 days; P = 0.001) compared with open cases. Demography, tumour characteristics, morbidity and mortality were comparable between groups. Multivariate analysis identified decreased age, attempted laparoscopic surgery, use of enhanced recovery and absence of complications as independently shortening postoperative stay.

CONCLUSIONS

Advantages of laparoscopic surgery and enhanced recovery, even early in a surgeon's experience, suggest this is the preferred mode for elective right colon cancer resection.
Immediate breast reconstruction after mastectomy: what are the long-term prospects?
Authors: Rusby Jennifer E , Waters Ruth A , Nightingale Peter G , England David W
Published: April 2010

INTRODUCTION

Immediate breast reconstruction after mastectomy has known psychological and financial advantages but it is difficult to compare the outcome of various methods of reconstruction. Re-operation rates are an objective measure of surgical intervention required to attain and maintain acceptable cosmesis.

PATIENTS AND METHODS

A series of 95 patients (110 immediate reconstructions) was analysed for number of re-operations required within 5 years of initial surgery, magnitude of procedures, ‘survival’ of the reconstruction and effect of radiotherapy.

RESULTS

Although more intervention was seen in patients with implant-based reconstruction and the time-course over which autologous and implant-based reconstructions fail is different these did not reach statistical significance. Radiotherapy has a significant effect on failure of implant-based reconstruction.

CONCLUSIONS

Long-term, large studies of immediate reconstruction are required to assess adequately the impact of type of reconstruction on re-operation rates. The National Mastectomy and Breast Reconstruction Audit is ideally placed to provide answers to remaining questions about longevity of immediate breast reconstruction and the effect that late failure has on patient satisfaction.
Minimally invasive excision of gynaecomastia – a novel and effective surgical technique
Authors: Qutob O , Elahi B , Garimella V , Ihsan N , Drew PJ
Published: April 2010

INTRODUCTION

More aesthetically acceptable treatment options have been sought to minimise the morbidity associated with open surgery for gynaecomastia. This study investigated the use of a vacuum-assisted biopsy device (VABD) and liposuction to provide minimally invasive approach.

PATIENTS AND METHODS

Patients diagnosed with idiopathic benign gynaecomastia referred to the Breast Care Unit of Castle Hill Hospital between June 2002 and April 2007 and requesting surgical intervention underwent VABD excision and liposuction. All patients underwent thorough investigations to exclude any underlying cause for their gynaecomastia. The procedure was carried out by a single consultant surgeon with special interest in breast surgery. An 8-G mammotome probe was advanced through a 4-mm incision positioned in the corresponding anterior axillary line to excise the glandular disc. Liposuction was performed through the same incision. Incision wounds were closed with Steristrips. A pressure dressing was applied over wound by corset and an inflatable device.

RESULTS

Thirty-six male patients with grade I and II gynaecomastia were recruited (22 bilateral, 14 unilateral). Average age was 33.3 years (range, 16–88 years). All underwent mammotome excision and liposuction. There were no conversions to an open procedure. The average procedure time was 50.3 min (range, 30–80 min). One intra-operative complication was recorded. The minimum follow-up time was 2 months. Thirty-four patients reported excellent satisfaction, two patients had residual gynaecomastia and needed a re-do procedure. Three patients developed small haematomas that resolved spontaneously.

CONCLUSION

This novel, minimally invasive, surgical approach for gynaecomastia gives excellent results with minimal morbidity.
Legal implications of tissue
Authors: Lucassen Anneke , Wheeler Robert
Published: April 2010

This paper reviews the legal rules that govern the way surgeons deal with human tissues during the course of diagnosing and treating their patients. The topic is dominated by the Human Tissue Act 2004, which was enacted in September 2006; thus, the article applies specifically only to England, Wales and Northern Ireland, since Scotland has separate legislation (Human Tissue (Scotland) Act 2006). Although the Human Tissue Act 2004 was built largely upon a plethora of legal principles that were developed throughout the Commonwealth and in the US, some of the principles underlying it will be equally familiar and applicable to surgeons across the world. Much everyday clinical activity falls outside the remit of the Act, and depends both upon other statutes, and on common law rules, principally those relating to consent.
Evolution of imaging for abdominal perforation
Authors: Singh JP , Steward MJ , Booth TC , Mukhtar H , Murray D
Published: April 2010

INTRODUCTION

Gastrointestinal (GI) perforation is a common surgical presentation. In recent years, computed tomography (CT) has been shown to be accurate for predicting the site of GI perforation, and has become the investigation of choice. However the signs may be subtle or only indirectly related to the site or aetiology of perforation.

SUBJECTS AND METHODS

A MEDLINE and PubMed search was performed for journals before June 2009 with MeSH major terms ‘CT’ and ‘perforation’. Non-English speaking literature was excluded.

RESULTS

Examples of GI perforation of various aetiologies are reviewed (inflammatory, neoplastic, traumatic and iatrogenic) high-lighting characteristic CT appearances as well as pitfalls in diagnosis. Features of perforation include the presence of free gas or fluid within the supra- and/or inframesocolic compartments, segmental bowel wall thickening, bowel wall discontinuity, stranding of the mesenteric fat and abscess formation.

CONCLUSIONS

These differentiating features facilitate accurate multidisciplinary pre-operative evaluation, necessary to plan patient management and potential surgical approach.
Low-Cost Model for Laparoscopic Appendicectomy in a Webcam Simulator
Authors: Oliver JC , Carty NJ , Wakefield C
Published: April 2010

Rapid progression of surgical technologies over the last 30 years has led to considerable attention to the teaching and evaluation of surgical skills. The laparoscopic appendicectomy (LA) is often the first laparoscopic procedure performed unsupervised by a surgical trainee and it can be a useful training operation. However, there is little published literature regarding simulations to teach this procedure.
Anatomy Demonstration in the Era of 'Run-Through' Training: An Integrated Approach Trialled in the Oxford Deanery
Authors: Burgess C , Jones L , Morris J , Jefferis A
Published: April 2010

An accurate knowledge of anatomy is a cornerstone of safe surgical intervention. Anatomy is therefore a key component of all stages of the Membership of the Royal College of Surgeons (MRCS) examinations. Partly for this reason, many trainees have traditionally spent a period of time attached to a university anatomy department relearning their anatomy and assisting in its teaching to undergraduate students.
Is the UK Contribution to Published Clinical Otolaryngology Research Changing?
Authors: Awad Z , Khalil S , Maini S , Nunez DA
Published: April 2010

The UK led other European countries in the number of otolaryngology publications between 1995 and 2000 and accounted for 19.6% of all papers in ten leading otolaryngology journals over the period of 1985 to 1994. Sandhu and Wright reviewed the trends in eight journals, between January 1997 and December 1999, and found no major change in the output when compared with an earlier study by Hussain and Nunez between January 1984 and December 1989.
Should Physicians be Co-Managing Elective Joint Replacements with Orthopaedic Surgeons?
Authors: Barr L , Kalra S , Kollakuzhiyil M , Vindlacheruvu M , Khanduja V
Published: April 2010

Orthopaedic surgeons have worked closely with geriatricians in the management of elderly patients with trauma, predominantly with fractures of the neck of femur, for over 50 years. This collaborative orthogeriatric model of care, pioneered by Devas and Irvine in Hastings in the 1960s, is now practised to some degree in most trauma units in the UK with success.
New diploma in dental care leadership and management
Authors: Powell Jacquie
Published: April 2010

Effective leadership and management in dental healthcare and services can be a challenge. It is a skill for professionals to understand the driving force that operates within the healthcare system; how to manage their business effectively; as well as how to contribute to the development and delivery of local and national oral health policy and strategy.
Core surgical training: time to get SMART
Authors: Munsch Chris
Published: April 2010

No one would dispute the fact that the first few years of surgical training are of vital importance; these core years provide the bedrock on which future surgical training and practice is built. It is a matter for serious concern, therefore, that the quality of core surgical training is variable and in some instances falls below an acceptable standard. This is despite determined efforts to improve training and despite the development of the Intercollegiate Surgical Curriculum Programme (ISCP).
Collaborative Commissioning of Vascular Services
Authors: Hermans Louisa
Published: April 2010

Vascular surgeons across the UK have been trying to influence the development of sensible local plans for delivering the service for over a decade. One of the major stumbling blocks to success has been the absence of a formal mechanism through which surgeons can engage with commissioners. This is one of the reasons why the College has established the director for professional affairs (DPA) role, working with the specialty associations through the regional professional affairs boards.
Busy times ahead
Authors: Black John
Published: April 2010

My last newsletter in support of the concept of the consultant's personal medical secretary produced a lot of very supportive correspondence and it is clear that Bulletin readership is high among surgeons' secretaries or at least those who are still in a job! It is clear that the national position is not all bad and some surgeons have managed to retain their personal secretaries, very much to the advantage of the efficiency of their departments and the welfare of their patients. It can be done if you are determined. May I repeat the advice I gave you in January: 'What can you do about it? Please stand up for your secretaries, turn up for the management meetings when their future is discussed and point out how essential they are to safe, efficient surgical care with a human face.'
Genotoxicity and Cytotoxicity of Multi‐wall Carbon Nanotubes in Cultured Chinese Hamster Lung Cells in Comparison with Chrysotile A Fibers
Authors: Asakura Masumi , Sasaki Toshiaki , Sugiyama Toshie , Takaya Mitsutoshi , Koda Shigeki , Nagano Kasuke , Arito Heihachiro , Fukushima Shoji
Published: April 2010

Genotoxicity and Cytotoxicity of Multi‐wall Carbon Nanotubes in Cultured Chinese Hamster Lung Cells in Comparison with Chrysotile A Fibers: Masumi Asakura, et al. Japan Bioassay Research Center, Japan Industrial Safety and Health Association

Objectives

The potential applications and industrial production of multi‐wall carbon nanotubes (MWCNT) have raised serious concerns about their safety for human health and the environment. The present study was designed to examine the in vitro cytotoxicity and genotoxicity of MWCNT and UICC chrysotile A (chrysotile).

Methods

Cytotoxicity using both colony formation and lactate dehydrogenase (LDH) assays and genotoxicity including chromosome aberration, micronucleus induction and hgprt mutagenicity were examined by exposing cultured Chinese hamster lung (CHL/IU) cells to MWCNT or chrysotile at different concentrations.

Results

The in vitro cytotoxicity of MWCNT depended on the solvent used for suspension of MWCNT and ultrasonication duration of the MWCNT suspension. A combination of DMSO/culture medium and 3‐minute ultrasonication resulted in a well‐dispersed medium with dispersion and isolation of agglomerated MWCNT by ultrasonication which manifested the highest cytotoxicity. The cytotoxicity was more potent for chrysotile than MWCNT. The genotoxicity of MWCNT was characterized by the formation of polyploidy without structural chromosome aberration, and an increased number of bi‐ and multi‐nucleated cells without micronucleus induction, as well as negative hgprt mutagenicity. Chrysotile exhibited essentially the same genotoxicity as MWCNT, except for marginal but significant induction of micronuclei. MWCNT and chrysotile were incompletely internalized in the cells and localized in the cytoplasm.

Conclusions

MWCNT and chrysotile were cytotoxic and genotoxic in Chinese hamster lung cells, but might interact indirectly with DNA. The results suggest that both test substances interfere physically with biological processes during cytokinesis.
The TRβ-selective agonist, GC-1, stimulates mitochondrial oxidative processes to a lesser extent than triiodothyronine
Authors: Venditti P , Chiellini G , Di Stefano L , Napolitano G , Zucchi R , Columbano A , Scanlan T S , Di Meo S
Published: April 2010

Specific tissue responses to thyroid hormone are mediated by the hormone binding to two subtypes of nuclear receptors, TRα and TRβ. We investigated the relationship between TRβ activation and liver oxidative metabolism in hypothyroid rats treated with equimolar doses of triiodothyronine (T3) and GC-1, a TRβ agonist. T3 treatment produces increases in O2 consumption and H2O2 production higher than those elicited by GC-1. The greater effects of T3 on oxidative processes are linked to the higher hormonal stimulation of the content of respiratory chain components including autoxidizable electron carriers as demonstrated by the measurement of activities of respiratory complexes and H2O2 generation in the presence of respiratory inhibitors. It is conceivable that these differential effects are dependent on the inability of GC-1 to stimulate TRα receptors that are likely involved in the expression of some components of the respiratory chain. The greater increases in reactive oxygen species production and susceptibility to oxidants exhibited by mitochondria from T3-treated rats are consistent with their higher lipid and protein oxidative damage and lower resistance to Ca2+ load. The T3 and GC-1 effects on the expression levels of nuclear respiratory factor-1 and -2 and peroxisome proliferator-activated receptor-γ coactivator-1α suggest the involvement of respiratory factors in the agonist-linked changes in mitochondrial respiratory capacities and H2O2 production.