bluuebunny/crossref_metadata_2025 huggingface dataset:
KCa3.1 channel downregulation and impaired endothelium‐derived hyperpolarization‐type relaxation in pulmonary arteries from chronically hypoxic rats
Authors: Kroigaard Christel , Kudryavtseva Olga , Dalsgaard Thomas , Wandall‐Frostholm Christine , Olesen Søren‐Peter , Simonsen Ulf
Published: December 2012

New Findings

What is the central question of this study?

Do the function and expression of small (KCa2) and intermediate (KCa3.1) conductance calcium‐activated potassium channels increase as a compensatory mechanism to counteract hypoxia‐induced pulmonary hypertension in rats?

What is the main finding and its importance?

Our findings provide evidence for impaired endothelium‐derived hyperpolarization‐type relaxation in chronically hypoxic pulmonary small arteries despite upregulation of KCa2.3 channels. Our findings suggest that KCa3.1 channels are important for the maintenance of endothelium‐derived hyperpolarization‐type relaxation.

Calcium‐activated potassium channels of small (KCa2, SK) and intermediate (KCa3.1, IK) conductance are involved in endothelium‐dependent relaxation of pulmonary arteries. We hypothesized that the function and expression of KCa2 and KCa3.1 increase as a compensatory mechanism to counteract hypoxia‐induced pulmonary hypertension in rats. For functional studies, pulmonary arteries were mounted in microvascular myographs for isometric tension recordings. The KCa channel expression was evaluated by immunoblotting and quantitative PCR. Although ACh induced similar relaxations, the ACh‐induced relaxations were abolished by the combined inhibition of nitric oxide synthase (by l‐nitro‐arginine, l‐NOARG), cyclo‐oxygenase (by indomethacin) and soluble guanylate cyclase (by ODQ) in pulmonary arteries from hypoxic rats, whereas 20 ± 6% (n= 8) maximal relaxation in response to ACh persisted in arteries from normoxic rats. Inhibiting Na+,K+‐ATPase with ouabain or blocking KCa2 and KCa3.1 channels reduced the persisting ACh‐induced relaxation. In the presence of l‐NOARG and indomethacin, a novel KCa2 and KCa3.1 channel activator, NS4591, induced concentration‐ and endothelium‐dependent relaxations, which were markedly reduced in arteries from chronically hypoxic rats compared with arteries from normoxic rats. The mRNA levels of KCa2.3 and KCa3.1 were unaltered, whereas KCa2.3 protein expression was upregulated and KCa3.1 protein expression downregulated in pulmonary arteries from rats exposed to hypoxia. In conclusion, endothelium‐dependent relaxation was conserved in pulmonary arteries from chronically hypoxic rats, while endothelium‐derived hyperpolarization (EDH)‐type relaxation was impaired in chronically hypoxic pulmonary small arteries despite upregulation of KCa2.3 channels. Since impaired EDH‐type relaxation was accompanied by KCa3.1 channel protein downregulation, these findings suggest that KCa3.1 channels are important for the maintenance of EDH‐type relaxation.
Effects of dietary history on energy metabolism and physiological parameters in C57BL/6J mice
Authors: Hoevenaars Femke P. M. , Keijer Jaap , Swarts Hans J. , Snaas‐Alders Sophie , Bekkenkamp‐Grovenstein Melissa , van Schothorst Evert M.
Published: December 2012

New Findings

What is the central question of this study?

Do intake patterns of diets with a different energy content have a lasting effect on body weight persistence?

What is the main finding and its importance?

After switches between semi‐purified diets differing only in the fat‐to‐sugar ratio, the last consumed diet determined the energy intake, energy expenditure, body weight, body fat stores, circulating hormones and metabolites in C57BL/6J mice. In contrast with persistent effects observed in studies using diets with different ingredients, suggesting diet‐induced set points, this study shows that body weight and metabolic parameters ‘settle’ based on current energetic input and output. This supports the settling point theory and underlines the importance of the choice of diet in physiological studies.

Understanding body weight regulation is essential to fight obesity. Mouse studies, using different types of diets, showed conflicting results in terms of body weight persistence after changing from an ad libitum high‐fat diet to an ad libitum low‐fat diet. In this study, we questioned specifically whether the energy content of the diet has a lasting effect on energy balance and body weight, using multiple switches and two purified diets with a different fat‐to‐sugar ratio, but otherwise identical ingredients. Young‐adult obesity‐prone male C57BL/6J mice were fed single or double switches of semi‐purified diets with either 10 energy % (en%) fat (LF) or 40en% fat (HF), with starch replaced by fat, while protein content remained equal. After none, one or two dietary changes, energy metabolism was assessed at 5, 14 and 19 weeks. We observed no systematic continuous compensation in diet and energy intake when returning to LF after HF consumption. Body weight, white adipose tissue mass and histology, serum metabolic parameters, energy expenditure and substrate usage all significantly reflected the current diet intake, independent of dietary changes. This contrasts with studies that used diets with different ingredients and showed persistent effects of dietary history on body weight, suggesting diet‐dependent metabolic set points. We conclude that body weight and metabolic parameters ‘settle’, based on current energetic input and output. This study also highlights the importance of considering the choice of diet in physiological and metabolic intervention studies.
Intracoronary secretin increases cardiac perfusion and function in anaesthetized pigs through pathways involving β‐adrenoceptors and nitric oxide
Authors: Grossini Elena , Molinari Claudio , Morsanuto Vera , Mary David A. S. G , Vacca Giovanni
Published: December 2012

New Findings

What is the central question of this study?

What is the primary effect of secretin on cardiac function and perfusion? Are the autonomic nervous system, secretin receptors and NO involved?

What is the main finding and its importance?

Intracoronary secretin increases cardiac perfusion and function through β‐adrenoceptors and secretin receptors in the anaesthetized pig, with the coronary vasodilatation involving NO release. As downstream effectors of the observed NO production, cAMP/protein kinase A and phosphoinositide 3‐kinase/Akt‐related signalling were found. Thus, secretin could play an important role in the modulation of cardiovascular reflexes elicited by stimulation of gastrointestinal mechano/chemoreceptors. Moreover, secretin could hypothetically have a potential use in the treatment of acute left ventricular failure or ischaemic heart disease.

Secretin has been implicated in cardiovascular regulation through its specific receptors, as well as through β‐adrenoceptors and nitric oxide, although data on its direct effect on coronary blood flow and cardiac function have remained scarce. The present study aimed to determine the primary in vivo effect of secretin on cardiac function and perfusion and the mechanisms related to the autonomic nervous system, secretin receptors and NO. In addition, in coronary endothelial cells the intracellular pathways involved in the effects of secretin on NO release were also examined. In 30 pigs, intracoronary secretin infusion at 2.97 pg for each millilitre per minute of coronary blood flow at constant heart rate and aortic blood pressure increased coronary blood flow, maximal rate of change of left ventricular pressure, segmental shortening, cardiac output and coronary NO release (P < 0.05). These responses were graded in a further five pigs. Moreover, while blockade of muscarinic cholinoreceptors (n= 5) and of α‐adrenoceptors (n= 5) did not abolish the observed responses to secretin, blockade of β1‐adrenoceptors (n= 5) prevented the effects of secretin on cardiac function. In addition, blockade of β2‐adrenoceptors (n= 5) and NO synthase inhibition (n= 5) prevented the coronary response and the effect of secretin on NO release. All these effects were abolished by a secretin receptor inhibitor (n= 5). In coronary endothelial cells, the increased NO production caused by secretin was found to be related to cAMP/protein kinase A signalling activated as downstream effectors of stimulation of secretin receptors and β2‐adrenoceptors. In conclusion, in anaesthetized pigs secretin primarily increased cardiac function and perfusion through the involvement of specific receptors, β‐adrenoceptors and NO release.
Multiscale Analysis of Composite Structures
Authors: Timofte Claudia
Published: December 2012

The goal of this paper is to present some homogenization results for diffusion problems in composite structures, formed by two media with different features. Our setting is relevant for modeling heat diffusion in composite materials with imperfect interfaces or electrical conduction in biological tissues. The approach we follow is based on the periodic unfolding method, which allows us to deal with general media.
A State-Efficient Zebra-Like Implementation of Synchronization Algorithms for 2D Rectangular Cellular Arrays
Authors: Umeo Hiroshi , Nomura A.
Published: December 2012

The firing squad synchronization problem on cellular automata has been studied extensively for more than forty years, and a rich variety of synchronization algorithms has been proposed for not only one-dimensional (1D) but two-dimensional (2D) arrays. In the present paper, we propose a simple and state-efficient mapping scheme: zebra-like mapping for implementing 2D synchronization algorithms for rectangular arrays. The zebra-like mapping we propose embeds two types of configurations alternately onto a 2D array like a zebra pattern, one configuration is a synchronization configuration of 1D arrays and the other is a stationary configuration which keeps its state unchanged until the final synchronization. It is shown that the mapping gives us a smallest, known at present, implementation of 2D FSSP algorithms for rectangular arrays. The implementation itself has a nice property that the correctness of the constructed transition rule set is clear and transparent. It is shown that there exists a nine-state 2D cellular automaton that can synchronize any (m x n) rectangle in (m+n+max(m,n)-3) steps.
Viral Dynamic Model of Antiretroviral Therapy Including the Integrase Inhibitor Raltegravir in Patients with HIV-1
Authors: Bon Dimitra , Stephan Christoph , Keppler Oliver , Herrmann Eva
Published: December 2012

Antiviral combination therapies consisting of reverse transcriptase inhibitors, protease inhibitors and an integrase inhibitor, have been developed to suppress HIV below the limit of detection. We introduce a mathematical model for the effect of different combination treatment regimens on the dynamics of HIV RNA and CD4 T-cell counts. We will especially focus on modelling the treatment effect of the integrase inhibitor-Raltegravir. The model consists of a system of ordinary differential equations and the parameters were chosen or estimated in order to agree with clinical data of a recent clinical trial. All the numerical simulations were calculated with Matlab.
Growth in a Turing Model of Cortical Folding
Authors: Toole Gregory , Hurdal Monica K.
Published: December 2012

The brain's cerebral cortex is folded into many gyri (hills) and sulci (valleys). Little is known about how the cortex folds or why the folds are located where they are. We have developed a spatio-temporal mathematical model of cortical folding to address this question. Our model utilizes a Turing reaction-diffusion system on an exponentially growing prolate spheroidal domain. This domain approximates the shape of the lateral ventricle (LV) during cortical development. The Intermediate Progenitor Model (IPM) of cortical folding states that regional patterning of self-amplication of intermediate progenitor cells (IPCs) in the subventricular zone of the LV corresponds with the formation of cortical folding. As self-amplication of IPCs is genetically controlled via chemical gradients, a Turing system is a logical choice to create a mathematical representation of the IPM. A growing domain model of cortical folding may be more realistic than previous static domain models of cortical folding since it incorporates the growth that naturally occurs as the brain develops. By comparing patterns generated by our growing prolate spheroid Turing system with those generated by a static prolate spheroid Turing system, we show that the addition of growth causes a significant change in system behavior; the system produces transient patterns instead of converging to one final pattern. Our model illustrates the importance of including growth in a model of cortical folding and can be utilized to explain certain human diseases of cortical folding.
On Waves and Distributions in Population Dynamics
Authors: Vitanov Nikolay Kolev , Dimitrova Zlatinka Ivanova
Published: December 2012

We discuss dynamics of spatially distributed interacting populations.В The following two cases are discussed: (I.) migration waves for the caseВ or negligible random fluctuations of the populations densities and (II.) probabilityВ distributions of the spatially averaged populations densities for the case ofsignificant random fluctuations of these densities. For each of the cases we obtainВ in general a system of differential equations that is treated analytically (when possible)В or numerically. The obtained results are discussed from the point of view of population dynamics.
Multiregional SIR Model with Infection during Transportation
Authors: Knipl Diana H , Röst Gergely
Published: December 2012

We present a general epidemic model to describe the spread of an infectious disease in several regions connected by transportation. We take into account that infected individuals not only carry the disease to a new place while traveling from one region to another, but transmit the disease during travel as well. We obtain that a model structured by travel time is equivalent to a large system of differential equations with multiple delays. By showing the local Lipschitz property of the dynamically defined delayed feedback function, we obtain existence and uniqueness of solutions of the system.
The Art of Mathematical Biology: a Foreword for the Launch of BIOMATH
Authors: Schnell Santiago
Published: December 2012

We cannot debate that the advances made over the past 30 years in molecular biology, biochemistry and cell biology have dramatically changed biology and the biomedical sciences. Academic institutions and funding agencies increasingly recognize the interdisciplinary nature of biology and medicine, including the important role mathematical, statistical and computational modeling play in the analysis and interpretation of data and information.В  By and large, biologists and biomedical scientists appear to have more appreciation for mathematical biology research because they are increasingly attracted to discover new biological principles and mechanisms in collaboration with mathematicians.В  . . .
From the Editor-in-Chief
Authors: Anguelov Roumen
Published: December 2012

Interdisciplinary research involving mathematical and biological sciences has deep roots at the Bulgarian Academy of Sciences, established well before the contemporary terms of Mathematical Biology or Biomathematics were coined in. The father of Molecular Biology in Bulgaria, Rumen Tsanev, is also pioneer of Bio-Mathematical research at the Academy. His joint work with Blagovest Sendov in the nineteen sixties using mathematical modelling and computer simulation in studying the cellular proliferation, differentiation and carcinogenesis productively links new developments in both fields for further advancement of knowledge.В  . . .В В В В В В В
The Role of Strain Rate Response on Tribological Behavior of
Metals
Authors: Menezes Pradeep L. , Kishore  , Kailas Satish V. , Lovell Michael R.
Published: December 2012

In an effort to study the role of strain rate response on the tribological behavior of metals, room temperature experiments were conducted by sliding commercially pure titanium and a-iron pins against an H-11 die steel flats of various surface textures. The steel flat surface textures were specifically prepared to allow for imposing varying amounts of strain rates at the contacting interface during sliding motion. In the experiments, it was observed that titanium (a harder material than iron) formed a transfer layer on H-11 steel surface textures that produced higher strain rates. In contrast, the titanium pins abraded the steel surfaces that produced lower strain rates. The iron pins were found to abrade the H-11 steel surface regardless of the surface texture characteristics. This unique tribological behavior of titanium is likely due to the fact that titanium undergoes adiabatic shear banding at high strain rates, which creates pathways for lower resistance shear planes. These shear planes lead to fracture and transfer layer formation on the surface of the steel flat, which ultimately promotes a higher strain rate of deformation at the asperity level. Iron does not undergo adiabatic shear banding and thus more naturally abrades the surfaces. Overall, the results clear indicated that a materials strain rate response can be an important factor in controlling the tribological behavior of a plastically deforming material at the asperity level.
Journey in the Search for the Higgs Boson: The ATLAS and CMS Experiments at the Large Hadron Collider
Authors: Della Negra M. , Jenni P. , Virdee T. S.
Published: December 2012

The search for the standard model Higgs boson at the Large Hadron Collider (LHC) started more than two decades ago. Much innovation was required and diverse challenges had to be overcome during the conception and construction of the LHC and its experiments. The ATLAS and CMS Collaboration experiments at the LHC have discovered a heavy boson that could complete the standard model of particle physics.
Influence of Temperature, Medium, and Storage Duration on Chlamydia trachomatis DNA Detection by PCR
Authors: van Dommelen Laura , Wolffs Petra F. G. , van Tiel Frank H. , Dukers Nicole , Herngreen Selma B. , Bruggeman Cathrien A. , Hoebe Christian J. P. A.
Published: December 2012

We validated the use of stored samples for
Chlamydia trachomatis
research.
C. trachomatis
DNA was detected by real-time PCR in clinical (urine and self-taken vaginal swabs) and spiked samples using six different media, five different time points (up to 2 years), and four different temperature conditions.
C. trachomatis
was detected in all 423 samples, and no clinically relevant degradation impact was detected.
Twin pregnancy complicated by vasa previa
Authors: Carnide Cátia , Jerónimo Mónica , Faria Dolores , Silva Isabel Santos
Published: December 2012

Perinatal morbidity and mortality rates for vasa previa are high when it is not diagnosed antenatally. In this report, a case of vasa previa in a twin pregnancy was diagnosed postnatally, which leads to complications with the first twin. Serial ultrasound during pregnancy did not diagnose a bilobed placenta, a velamentous insertion of the umbilical cord or vasa previa. At 37 weeks, vaginal bleeding was detected in the expulsive stage and vaginal-assisted delivery of both fetuses was undertaken. The first fetus was born pale and anaemic, and required a blood transfusion and therapeutic hypothermia. A high risk of vasa previa is associated with placentas with low-lying insertion, bilobed placentas, velamentous insertions of the umbilical cord, multiple pregnancy and pregnancies conceived after the use of assisted reproductive technologies. Transvaginal ultrasound screening with colour flow Doppler can allow antenatal diagnoses of vasa previa and an improved outcome.
Subacute sclerosing panencephalitis presenting as neuromyelitis optica
Authors: Raut Tushar Premraj , Singh Maneesh Kumar , Garg Ravindra Kumar , Naphade Pravin Umakant
Published: December 2012

Subacute sclerosing panencephalitis (SSPE) is a slowly progressing inflammatory and degenerative disorder of the brain caused by a mutant measles virus. The diagnosis of SSPE is based on characteristic clinical and EEG findings (periodic complexes) and demonstration of elevated antibody titres against measles in cerebrospinal fluid. SSPE can have atypical clinical features at the onset. The authors here report a case of a 3-year-old child who presented with vision loss followed 15 months later by quadriparesis with bladder involvement. These clinical features resembled that of neuromyelitis optica. However, as the disease progressed, appearance of myoclonic jerks, periodic discharges on EEG and positive cerebrospinal fluid serology for measles led to the final diagnosis of SSPE.
An unusual suspect causing behavioural problems and pituitary failure in a child
Authors: Heathcote Adam Charles , Wormald Justin Conrad Rosen , Stocks Richard
Published: December 2012

A 9-year-old boy presented with feeding and behavioural problems and was diagnosed with Autistic Spectrum Disorder and Attention Deficit Hyperactivity Disorder. By age 11 he was becoming increasingly disinhibited and was refusing almost all oral food intake. Believing the cause to be psychogenic, he was placed in an inpatient eating disorder facility. After 3 days of continuous vomiting and minimal intake, he was admitted back to hospital for further investigations. A hypovolaemic hypernatraemia prompted an MRI brain scan, revealing several tumour masses with suprasellar and pituitary involvement. Histological investigation revealed primary, non-malignant germ-cell tumours. The tumours were treated with craniopharyngeal radiotherapy and permanent pituitary hormone replacement.
Neonatal intestinal obstruction secondary to a floppy meckel's diverticulum successfully treated by minimal access surgery
Authors: Aziz Dayang Anita Abdul , Sehat Syariz I , Osman Marjmin , Zaki Faizah Mohd
Published: December 2012

Meckel's diverticulum has several known complications including diverticulitis and perforation. The presence of mesodiverticular band or a band from the diverticulum to the anterior abdominal wall is also described and can cause obstruction or rotation of the small bowel leading to volvulus. Meckel's diverticulum is also well known as the lead point for intussusception. It may be lined by ectopic gastric mucosa and can cause life-threatening gastrointestinal bleeding. We report a neonate who presented with acute intestinal obstruction secondary to a large, mobile Meckel's diverticulum which due to a direct compression effect on the adjacent small bowel caused mechanical intestinal obstruction. Diagnosis was confirmed at laparoscopy, and treated by curative surgical resection. This is the first report of a large mobile Meckel's diverticulum causing small bowel obstruction due to direct compression that was managed by minimally invasive surgical resection.
Isolated metachronous splenic metastasis from renal cell carcinoma after 5 years
Authors: Nunes Thiago Franchi , Szejnfeld Denis , Miiji Luciana Nakao Odashiro , Goldman Suzan Menasce
Published: December 2012

Primary and metastatic tumours of the spleen are uncommon. The incidence of isolated metastasis from other organs is less than 1%. We report the case of a 55-year-old woman with clear cell carcinoma of the kidney, who underwent radical nephrectomy. After a 5-year follow-up period, a hypervascular nodule was detected in the spleen on MRI. Six months later, control MRI showed that its appearance had changed to a hypervascular mass with areas of central necrosis. A splenectomy was performed and histopathological examination of the spleen confirmed the presence of clear cell carcinoma with infiltration of the capsule. This is only the seventh case described in the literature of isolated splenic metastasis from clear cell carcinoma and the first such case containing MRI.
Pseudodementia caused by severe depression
Authors: Tobe Edward
Published: December 2012

The diagnosis of pseudodementia may be difficult in a patient with a history of major depressive disorder. Clinical case history. A 70-year-old man with a history of major depressive disorder, in remission for 3 years, presented with confusion, agitation and cognitive disorder. The differential diagnosis included depression with pseudodementia, drug-induced dementia or Alzheimer disease. Mild cognitive improvement was noted after discontinuation of simvastatin. After 9 months of treatment for depression, the patient had remission that was sustained for >1 year, with mild residual difficulty remembering words of songs. The differential diagnosis of dementia includes major depressive disorder and adverse events from simvastatin.
Coexistent metastatic melanoma of the kidney with unknown primary and renal cell carcinoma
Authors: Dhandha Maulik , Chu Melinda B , Richart John M
Published: December 2012

In this report, we present an African-American female patient who presented with haematuria to her primary care physician. The symptoms persisted and coexistent metastatic spindle cell-type melanoma of the kidney and renal cell carcinoma were discovered on further evaluation. No primary site for melanoma was identified. Despite aggressive treatment with ipilimumab, the patient's disease progressed quickly. The patient opted for palliative care and was referred to a hospice. Coexistent melanoma and renal cell carcinoma is exceedingly rare. Melanoma itself is rare in the African-American population. However, when it does present, it usually is at an advanced stage, as was the case in our patient. Since no primary tumour site for melanoma was found and the diagnosis was made after the tumour had metastasised, we think this case highlights the importance of cutaneous cancer surveillance in the non-Caucasian population. Earlier identification of melanoma in this population will help to improve outcomes.
Bullet embolus to the right ventricle following shotgun wound to the leg
Authors: Hussein Nabil , Rigby James , Abid Qamar
Published: December 2012

Bullet embolism to the heart is a rare complication of gunshot trauma to the body and if not identified can have a severe impact on a patient's morbidity and mortality. This paper presents the case of a patient who sustained a shotgun wound to the leg 10 years prior to presenting with shortness of breath and localised chest pain. Routine chest radiograph for possible chest infection was reported normal apart from a small metallic artefact overlying the left side of the heart, which had the same appearance as the pellets from the gunshot wound in the leg. Following referral to our cardiothoracic surgeons, further investigations confirmed the presence of a pellet within the patient's right ventricle, which had embolised from the original injury site. The case was discussed globally to decide on the best management plan. To date, the patient has been successfully managed conservatively, with regular follow-up.
Parotid sialolithiasis
Authors: Moghe Swapnil , Pillai Ajay , Thomas Shaji , Nair Preeti P
Published: December 2012

Salivary dysfunction may be due to systemic diseases and medications. The development of sialoliths is a multifactorial event in which disturbance in secretion, microliths and bacteria may play a major role. A case of sialolith in the parotid gland of a 25-year-old man, with no relevant medical history is reported here.
Rapidly progressive kidney failure induced by fungal mycelia obstructing indwelling ureteral stents
Authors: Dubert Marie , Loi Valeria , Tligui Mohamed , Hertig Alexandre
Published: December 2012

Antibiotics reduce the commensal flora in the gut, thereby facilitating the overgrowth of undesirable microorganisms such asCandida albicans. Here, we report the case of a 48-year-old woman with a history of obstructive uropathy consecutive to a radiation therapy, in whom both indwelling ureteral stents were rapidly occluded by fungal mycelia, resulting in a rapidly progressive kidney failure. Ascendant infection byC albicanshad occurred after a 2- week course of antibiotics, prescribed for a perforative peritonitis also due to radiation-induced colitis. As shown by iterative CT scans made before (at the time of the diagnosis of peritonitis) and after the antibiotic course, kidney failure was explained by a sudden and bilateral pyelocaliceal dilation, due to the obstruction of the ureteral stents. Fungal mycelia were objectivised during the replacement procedure. Intravenous fluconazole was started, and renal function recovered ad integrum with the relief of the obstruction.
Persistent pulmonary interstitial emphysema presenting as solitary lung cyst in a preterm infant
Authors: Srinivasan Ramesh , Ali Haytham , Harigopal Sundeep
Published: December 2012

Solitary unilateral lung cyst is an unusual finding in preterm infants. It may be difficult to distinguish acquired from congenital lung cysts clinically. The definitive diagnosis is histological; however, CT scan of the chest is a useful diagnostic tool. We present an extremely preterm infant with solitary lung cyst and background chronic lung disease. The initial chest x-rays showed solitary right lung cyst. At 6 weeks he required an escalation of ventilator support coupled with x-ray evidence of increased size of the cyst. CT scan confirmed large solitary cyst of the right lower lobe with evidence of compression and mediastinal shift, suspicious of congenital cystic adenomatoid malformation. The cyst was surgically removed in view of clinical deterioration. However, histology showed persistent pulmonary interstitial emphysema (PPIE). This case illustrates that in the context of prematurity PPIE can present as a solitary lung cyst and may require surgery.
A mistaken diagnosis ofMolluscum contagiosumin a HIV-positive patient in rural South Africa
Authors: Sornum Alvin
Published: December 2012

A 25-year-old gentleman presented with multiple small ulcerations and papules covering a large portion of his face and neck, associated with general malaise. He was HIV seropositive with a total CD4 count of 78 cells/µl. A diagnosis ofMolluscum contagiosumwas made and the patient discharged. He re-presented 3 weeks later with a 2-day history of progressively worsening headache associated with photophobia and diarrhoea. The generalised skin eruption had worsened, now involving his torso and upper limbs. Cerebrospinal fluid examination was highly positive for cryptococcal antigens and the patient was started on amphotericin B. Skin biopsy confirmed cutaneousCryptococcus neoformans. After 4 days, the headache and photophobia resolved. A mild improvement in his skin was seen after completing 14 days of treatment. He was discharged with lifelong fluconazole therapy.
Renal angiomyolipomas in tuberous sclerosis—rare but potentially life-threatening lesions
Authors: Azim Adnan , Rajkumar Govindaraj
Published: December 2012

We discuss an 18-year-old girl, diagnosed with tuberous sclerosis complex and known to have renal angiomyolipomas (AMLs) but having no regular urological follow-up, who presented with left-sided abdominal pain and haematuria on urine dipstick testing at the out-of-hours General Practitioner (GP) service. She was diagnosed as having urinary tract infection/pyelonephritis and discharged with simple analgesia and antibiotics. Subsequent imaging of her renal tract demonstrated multiple large AMLs with evidence of recent bleeding, which required arterial embolisation.
Primary hypertrophic osteoarthropathy (incomplete form) in young adults: a case report and review of literature
Authors: Nayak Hemanta K , Rajkumar Vangipuram Deepak , Kumar Naresh , Kar Premashis
Published: December 2012

Hypertrophic osteoarthropathy is characterised by digital clubbing and periosteal reaction of long bones. Most cases are associated with malignancy or other conditions such as congenital heart disease, liver cirrhosis, pulmonary fibrosis, biliary atresia and inflammatory bowel diseases. We report a middle-aged man found to have 15-year history of clubbing of the fingers and toes on his routine check-up for dyspepsia. Skiagram of hand joints showed periosteal apposition without any periosteal reaction of long bones. The search for a secondary cause of clubbing remained negative. The primary or idiopathic form is rare and has a good prognosis and has to be differentiated from secondary form. He was eradicated successfully with Pylori kit for his antral predominantHelicobacter-induced gastritis.
Naltrexone-induced Nicolau syndrome masquerading as cutaneous abscess
Authors: Perli Daniel , Martone Catharine , Rapose Alwyn
Published: December 2012

Nicolau syndrome—also known as Embolia Cutis Medicamentosa—is a rare complication of intramuscular and subcutaneous injections manifesting as necrosis of skin and the underlying tissues. The exact pathogenesis is uncertain. There are several hypotheses including direct damage to the end artery, cytotoxic effects of the implicated drug or additives in the injectable preparations. Naltrexone is a long-acting opioid antagonist used primarily in the management of alcohol and opioid dependence. The patient received intramuscular naltrexone for treatment of alcoholism. A week later, she presented with what appeared to be cellulitis at the site of injection. It progressed in spite of antibiotics and mimicked an abscess. Attempted incision and drainage however yielded no pus. Deep tissue necrosis was seen and histopathology was consistent with Nicolau syndrome. As per our knowledge, this is the first reported case of naltrexone associated Nicolau syndrome that masqueraded as a buttock abscess.
Von Hippel Lindau disease: keep it in the family
Authors: Mikhail Michael Adly , Ng Jia , Mathew Joseph , Koshy Zachariah
Published: December 2012

We describe a case of von Hippel-Lindau disease (VHL) through three generations of the same family. First presentation was a young female with a 6-week history of headaches behind the eyes. On examination she was found to have bilateral retinal capillary haemangiomas (RCH). Preliminary diagnosis of VHL was suspected and further investigations confirmed the initial diagnosis. The patient was found to have pancreatic and kidney lesions and her mother had a cerebellar haemangioblastoma. Following genetic testing, the VHL gene appeared in the 9-year-old boy. On recent presymptomatic ophthalmic screening, the child was found to have RCH. Both patient and child's RCHs were successfully managed with a variety of treatments.
Spinal dural arteriovenous malformation presented with intracranial hypertension in a young patient
Authors: Inci Mehmet Fatih , Senoğlu Mehmet , Ozkan Fuat , Yuksel Murvet
Published: December 2012

Spinal dural arteriovenous malformations (AVM), the most common type of spinal cord vascular malformation, can be a challenge to diagnosis and prompt treatment. The disorder is rare, and the presenting clinical symptoms and signs are non-specific and insidious at onset. Spinal dural AVMs preferentially affect middle-aged men, and patients most commonly present with gait abnormality or lower-extremity weakness and sensory disturbances. İt may rarely present with symptoms of intracranial hypertension including headache and visual disorders.

In this report, we present the radiological findings of a 19-year-old male patient with spinal dural AVM presenting with raised intracranial pressure symptoms including papilloedema and headache, and discuss with recent literature.
Prognostic factors for patellofemoral pain: a multicentre observational analysis
Authors: Collins Natalie J , Bierma-Zeinstra Sita M A , Crossley Kay M , van Linschoten Robbart L , Vicenzino Bill , van Middelkoop Marienke
Published: December 2012

Objectives

Describe proportions of individuals with patellofemoral pain (PFP) with an unfavourable recovery over 12 months; identify clinical predictors of poor recovery at 3 and 12 months; and determine baseline values of predictors that identify those with poor 12-month prognosis.

Methods

An observational analysis utilised data from 310 individuals with PFP enrolled in two randomised clinical trials. Thirteen baseline variables (participant, PFP, study characteristics) were investigated for their prognostic ability. Pain, function and global recovery were measured at 3 and 12 months. Multivariate backward stepwise regression analyses (treatment-adjusted, p<0.10) were performed for each follow-up measure. Receiver operator characteristic curves identified cut-points associated with unfavourable recovery at 12 months.

Results

55% and 40% of participants had an unfavourable recovery at 3 and 12 months, respectively. Longer baseline pain duration was significantly associated with poor 3-month and 12-month recovery on measures of pain severity (β 11.36 to 24.94), Anterior Knee Pain (AKP) Scale (−4.44 to −11.33) and global recovery (OR: 2.32 to 6.11). Greater baseline pain severity and lower AKP Scale score were significantly associated with poor recovery on multiple measures (p<0.05). Baseline duration >2 months and AKP Scale score <70/100 were associated with unfavourable 12-month recovery.

Conclusions

A substantial number of individuals with PFP have an unfavourable recovery over 12 months, irrespective of intervention. Knee pain duration >2 months is the most consistent prognostic indicator, followed by AKP Scale score <70. Sports medicine practitioners should utilise interventions with known efficacy in reducing PFP, and promote early intervention to maximise prognosis.

Trial registration

Australian study: Australian Clinical Trials Registry (ACTRN012605000463673), ClinicalTrials.gov (NCT00118521); Dutch study: International Standard Randomised Controlled Trial Number Register (ISRCTN83938749)
Do changes to the local street environment alter behaviour and quality of life of older adults? The ‘DIY Streets’ intervention
Authors: Ward Thompson Catharine , Curl Angela , Aspinall Peter , Alves Susana , Zuin Affonso
Published: December 2012

Background

The burden of ill-health due to inactivity has recently been highlighted. Better studies on environments that support physical activity are called for, including longitudinal studies of environmental interventions. A programme of residential street improvements in the UK (Sustrans ‘DIY Streets’) allowed a rare opportunity for a prospective, longitudinal study of the effect of such changes on older adults’ activities, health and quality of life.

Methods

Pre–post, cross-sectional surveys were carried out in locations across England, Wales and Scotland; participants were aged 65+ living in intervention or comparison streets. A questionnaire covered health and quality of life, frequency of outdoor trips, time outdoors in different activities and a 38-item scale on neighbourhood open space. A cohort study explored changes in self-report activity and well-being postintervention. Activity levels were also measured by accelerometer and accompanying diary records.

Results

The cross-sectional surveys showed outdoor activity predicted by having a clean, nuisance-free local park, attractive, barrier-free routes to it and other natural environments nearby. Being able to park one's car outside the house also predicted time outdoors. The environmental changes had an impact on perceptions of street walkability and safety at night, but not on overall activity levels, health or quality of life. Participants’ moderate-to-vigorous activity levels rarely met UK health recommendations.

Conclusions

Our study contributes to methodology in a longitudinal, pre–post design and points to factors in the built environment that support active ageing. We include an example of knowledge exchange guidance on age-friendly built environments for policy-makers and planners.
The accuracy of the olfactory sense in detecting alcohol intoxication in trauma patients
Authors: Malhotra Shweta , Kasturi Kannan , Abdelhak Nachama , Paladino Lorenzo , Sinert Richard
Published: December 2012

Introduction

A common presentation to the emergency department (ED) is the trauma patient with altered sensorium who is presumed to be alcohol intoxicated by physicians based on their olfactory sense. ED physicians may often leave patients suspected of alcohol intoxication aside until the effects wear off, potentially missing trauma as the source of confusion. This often results in delays in diagnosing acute potentially life-threatening injuries in patients with presumed alcohol intoxication.

Objective

This study aimed to determine the accuracy of a physician's olfactory sense for diagnosing alcohol intoxication.

Methods

Patients suspected of major trauma in the ED underwent an evaluation by the examining physician for alcohol odour and a blood alcohol level. Alcohol intoxication was defined as a serum ethanol level ≥80 mg/100 ml. Data were reported as means with 95% CI or proportions with IQR 25–75%.

Results

151 patients (70% men) were enrolled, with a median age of 45 years (IQR 33–56). The prevalence of alcohol intoxication was 43% (95% CI 35% to 51%).

Operating Characteristics

Physician assessment of alcohol intoxication: sensitivity 84% (95% CI 73% to 92%), specificity 87% (95% CI 78% to 93%), positive likelihood ratio 6.6 (95% CI 3.8 to 11.6), negative likelihood ratio 0.18 (95% CI 0.1 to 0.3) and accuracy 86% (95% CI 80% to 91%). 7.3% (95% CI 4% to 13%) of patients were falsely suspected of being intoxicated.

Conclusions

Although the physicians had a high degree of accuracy in identifying patients with alcohol intoxication based on their olfactory sense, they still falsely overestimated intoxication in significant numbers of non-intoxicated trauma patients.
What factors affect the success rate of the first attempt at endotracheal intubation in emergency departments?
Authors: Kim Changsun , Kang Hyung Goo , Lim Tae Ho , Choi Bo Youl , Shin Young-jeon , Choi Hyuk Joong
Published: December 2012

Study objective

This study aimed to determine the factors associated with successful endotracheal intubation (ETI) on the first-attempt in an emergency department.

Method

We studied all of the ETI data at two urban emergency departments over a 5-year period. We assessed the intubator's specialty and training level, intubation method, device used, predicted airway difficulty and cause of ETIs. Univariate and multivariate logistic regression models were used to identify factors affecting the first-attempt success (FAS) of ETI in emergency departments.

Results

A total of 1478 adult ETIs were analysed. A multivariate logistic analysis revealed that factors such as a non-difficult airway (OR=5.11; 95% CI 3.38 to 7.72), senior physicians (2nd-year to 4th-year resident and attending physicians) (OR=2.39; 95% CI 1.61 to 3.55) and the rapid sequence intubation/induction (RSI) method (OR=2.06; 95% CI 1.04 to 3.03) had significant associations with the FAS for emergency medicine (EM) physicians. For non-EM physicians, however, a non-difficult airway was the only independent predictor of FAS (OR=3.10; 95% CI 1.82 to 5.28).

Conclusions

The predicted airway difficulty was the major factor associated with FAS in emergency department ETI on adults regardless of intubator's specialty. Especially in EM physician group, level of training and using of RSI also affecting on first–attempt success. The overall ETI success rate on first attempt was 80.1%, but EM physicians had success rate of 87.3%. Systematic technical and non-technical airway skill training focused on RSI and continuous quality control and ETI recording could help non-EM physicians increase their FAS rate.
The impact of appropriateness of antimicrobial therapy in adults with occult bacteraemia
Authors: Lee Ching-Chi , Hong Ming-Yuan , Chan Tsung-Yu , Hsu Hsiang-Chin , Ko Wen-Chien
Published: December 2012

Purpose

To investigate the clinical characteristics and outcomes of adults with occult bacteraemia and the clinical impact of appropriate antibiotics.

Methods

A case-control study was conducted to retrospectively analyse the bacteraemic adults visiting the emergency department (ED) during the period between January 2005 and August 2006. The patients with occult bacteraemia were the case group. Two control groups (CGs) were selected for comparisons: CG I, those with bacteraemia and the same Pittsburgh bacteremia score who were admitted at the first ED visit temporally near a case patient; and CG II, those with bacteraemia admitted at their first ED visit, irrespective of the Pittsburgh bacteraemia score.

Results

There were 119 adults composing of the case group, 119 matched adults as the CG I and 293 adults as the CG II. Demographic characteristics, clinical conditions and outcomes were retrieved from chart records. A lower 28-day death rate (5.0% vs 11.9%, p=0.03) and less critical illness (ie, Pittsburgh bacteremia score ≥4 points; 1.7% vs 22.2%; p<0.001) were noted among case patients compared with those in CG II. However, no difference in the 28-day death rate (5.0% vs 5.9%; p=0.77) between the case group and CG I was discovered. Among the case patients, thrombocytopenia (<100 000/mm3; OR, 8.87; p=0.03) and inappropriate antibiotic therapy at the second ED or outpatient-clinic visit (OR 7.59; p=0.045) were the independent factors of 28-day mortality in the multivariate analysis. Moreover, the survival curve revealed a significant difference in the survival rate between those with occult bacteraemia receiving inappropriate and appropriate antibiotic therapy after index bacteraemic-onset (p=0.02).

Conclusions

For adults with occult bacteraemia, a lower severity of illness and death rate than those of bacteraemic patients hospitalised for ED visit could be demonstrated, demonstrating the importance of appropriate antibiotic therapy.
A multidisciplinary team model of caring for patients with perianal Crohn's disease incorporating a literature review, topical therapy and personal practice
Authors: Garrick Vikki , Stenhouse Emily , Haddock Graham , Russell Richard K
Published: December 2012

Background

Crohn's disease (CD) is characterised by periods of relapse and remission. Over time the disease leads almost inevitably to the complications of stricturing, penetration and fistulisation. Perianal CD involves areas of chronic abscess formation, ulceration, skin tags or fistula formation. This can be a particularly challenging and complex problem to manage, and a range of potential treatment modalities exist.

Methods

This review covers the management of perianal CD and provides recommendations for practice for the multidisciplinary team (MDT), including the use of wound management products and relevant clinical images.

Results

Current practice focuses predominantly on the use of antibiotic therapy, immunosuppression, immunomodulation and surgery. These therapies are used individually or in combination. The majority of evidence suggests that a combination of medical and surgical management produces the best disease outcomes. However, this treatment regime can be debilitating for the patient and compliance can be difficult. Published work on the use of topical therapy in the management of perianal CD focuses specifically on topical drug therapy; it does not, however, address the basic guiding principles of chronic wound management—in particular, optimal moisture control and the management of bacterial burden on the wound surface. Honey and silver-containing wound management products act as topical antimicrobial agents and therefore address these principles.

Conclusions

Perianal CD is the archetypal condition that exemplifies the need for an MDT approach in caring for patients with inflammatory bowel disease. A combination of treatment modalities that includes topical wound management is likely to produce the best patient outcomes.