bluuebunny/crossref_metadata_2025 huggingface dataset:
Allergic bronchopulmonary aspergillosis: New concepts of pathogenesis and treatment
Authors: Wark Peter A. B. , Gibson Peter G.
Published: September 2010

Allergic bronchopulmonary aspergillosis (ABPA) is a condition that results from a hypersensitivity reaction to the fungus Aspergillus fumigatus. The purpose of the present review is to examine the pathogenesis of this condition and the evidence for treatments available. Allergic bronchopulmonary aspergillosis is characterized by an intense airway inflammation with eosinophils and the formation of mucus plugs. Clinically, there are periods of exacerbation and remission that may lead to proximal bronchiectasis and fibrotic lung disease. New evidence confirms the role of intense airway inflammation with eosinophils, but also suggests a role for interleukin (IL)‐8/neutrophil‐mediated inflammation in this process, and the potential deficiency of anti‐inflammatory cytokines such as reduced IL‐10. Treatment for ABPA has so far focused on corticosteroids to suppress eosinophilic airway inflammation. An expanding knowledge of the pathology of ABPA also suggests other therapies may be of potential benefit, particularly the use of azole antifungal agents. Allergic bronchopulmonary aspergillosis is itself an important complication of asthma and cystic fibrosis. A greater understanding of the condition is required to improve management and well‐designed clinical trials need to be carried out to critically assess new and current treatments. In addition, the information gained from the studies of its pathogenesis has the potential to benefit our understanding of the disease processes in asthma and bronchiectasis.
Influence of body fat distribution on oxygen uptake and pulmonary performance in morbidly obese females during exercise
Authors: Li Jing , Li Shiyue , Feuers Ritchie J. , Buffington Cynthia K. , Jr George S. M. Cowan
Published: September 2010

Objective: The aim of this study was to determine the effects of fat distribution on aerobic and ventilatory response to exercise testing in morbidly obese (MO) females.

Methodology: The study population consisted of 164 MO females, 55% (n = 90) with upper body or abdominal adiposity (UBD), as defined by waist–hip circumference ratio (WHR) ≥ 0.80, and 45% (n = 74) with lower body fat distribution (LBD) (WHR < 0.80). An incremental exercise testing on cycle ergometer was performed to determine the effect of exercise on oxygen consumption (V·O2), carbon dioxide production (V·CO2), minute ventilation (V·E), tidal volume (

T), respiratory rate (fb) and heart rate (HR).

Results: Upper body adiposity individuals had significantly higher O2 and V·CO2 than LBD subjects (P < 0.05) from 0 watt (W) of pedalling up to their anaerobic threshold (AT) and maximal exercise.

E was significantly higher in UBD subjects compared with LBD subjects, from 20 W during exercise up to AT and peak work levels (P < 0.05). Upper body adiposity group also had a significantly higher fb than the LBD group at rest, after each workload and at AT and peak exercise work rates (P < 0.05).

T was lower in UBD subjects at free pedalling and up to AT and peak workload with significant difference at 60 and 80 W (P < 0.05). The anaerobic threshold, expressed as work rate, was significantly lower in the UBD subjects (P < 0.05) and peak workload achieved did not differ significantly between the two groups.

Conclusions: Upper body adiposity subjects had higher oxygen requirement, more rapid and shallow breathing, higher ventilatory demand, but lower anaerobic threshold than the LBD individuals during progressive exercise. It suggests that the cardiopulmonary endurance to exercise in MO patients with upper body fat distribution is lower than in those with lower body fat distribution.
Penicillin resistance in Streptococcus pneumoniae in Isparta
Authors: Şahin Ünal , Ünlü Mehmet , Demirci Mustafa , Akkaya Ahmet , Turgut Erhan
Published: September 2010

Objective: The first case reports of infection with penicillin‐resistant pneumococci were made in Australia in 1967 and South Africa in 1977. Since this time the increasing emergence of penicillin‐ resistant strains of Streptococcus pneumoniae have been a serious therapeutic problem. Therefore, the aim of the present study was to determine the penicillin resistance of S. pneumoniae strains isolated in the laboratory. The effect of procaine penicillin treatment against these strains was also investigated.

Methods: Sensitivity testing was done by disc diffusion method using oxacillin discs. Minimal inhibitory concentration (MIC) values were determined in tests with penicillin by the use of E‐test (AB Biodisc, Solna, Sweden). Patients were treated with 2 × 800 000 U of i.m. procaine penicillin every 12 h for 10 days.

Results: Thirty‐seven strains of S. pneumoniae were isolated from the sputa of adult patients who had pneumonia. Moderately resistant (0.12–1.00 μg/mL) and penicillin‐sensitive (≤ 0.06 μg/mL) strains were identified in nine (24.3%) and 28 (75.7%) isolates, respectively. There were no high‐level penicillin‐resistant strains in the study. There was no therapeutic failure.

Conclusion: These results suggest that procaine penicillin may still be useful in the empirical therapy of pneumococcal pneumonia.
Efficacy of budesonide Turbuhaler® compared with that of beclomethasone dipropionate pMDI in Japanese patients with moderately persistent asthma
Authors: Miyamoto Terumasa , Takahashi Terumi , Nakajima Shigenori , Makino Sohei , Yamakido Michio , Mano Kenji , Nakashima Mitsuyoshi , Tollemar Ulf , Selroos Olof
Published: September 2010

Objective: The aim of the study was to compare the efficacy and safety of budesonide Turbuhaler® with that of beclomethasone dipropionate (BDP) pMDI.

Methodology: Three hundred and fifty adult asthma patients (mean age 52.7 years, mean baseline morning peak expiratory flow (PEF) 294 L/min (< 80% predicted normal)), taking BDP via pressurized metered‐dose inhaler (pMDI), 400 μg daily for at least 2 months, were randomized in an open 6 week study to receive daily doses of either budesonide 100 μg or 400 μg twice daily via Turbuhaler or continued treatment with BDP, 100 μg four times daily. The primary efficacy variable was the mean change in morning PEF from baseline to the end of treatment. Outcome was also assessed using symptom scores and investigators' assessments employed in Japanese clinical trials.

Results: At the end of the 6 week treatment period, mean morning PEF improved significantly from baseline in both budesonide groups, 16 L/min and 33 L/min in the 200 μg and 800 μg groups, respectively, but not in the BDP group, 5 L/min. There was no significant difference between 200 μg budesonide and 400 μg BDP treatment in the effect on PEF (P = 0.29), but 800 μg budesonide was significantly superior to BDP (P < 0.001). Final assessment of improvement and usefulness ratings showed that both budesonide treatments were significantly superior to BDP (P < 0.001). All treatments were well tolerated.

Conclusion: Budesonide Turbuhaler (200 μg) was as effective as 400 μg BDP pMDI. The efficacy of budesonide was improved significantly by increasing the dosage to 800 μg daily. The study design shows the importance of including a higher dose treatment group when comparing two formulations of inhaled corticosteroids in order to determine whether the treatments to be compared are on the steep part of the dose–response curve. Without that information, comparative studies are usually inconclusive.
New quinolone, grepafloxacin, inhibits Cl− secretion across bovine airway epithelium in culture
Authors: Kanoh Soichiro , Tamaoki Jun , Kondo Mitsuko , Nagai Atsushi
Published: September 2010

Objective: Transepithelial ion transport plays an important role in the regulation of the amount and the rheological properties of bronchial secretion. The effect of grepafloxacin (GPFX), a new quinolone agent, on bioelectrical properties of airway epithelium was determined.

Methodology: Electrical properties of bovine tracheal epithelium cultured under an air–liquid interface condition were measured by the short‐circuit technique.

Results: Addition of GPFX (100 μg/mL) to the mucosal side decreased short‐circuit current (Isc) from 14.4 ± 1.3 to 5.6 ± 0.6 μA/

cm2 (P < 0.001), and the response was accompanied by corresponding decreases in transepithelial potential difference and cell conductance. This effect was concentration dependent, and a similar response was also noted when GPFX was added to the submucosal side. The GPFX‐induced decrease in Isc was not altered by the Na+ channel blocker amiloride, but was inhibited by the Cl− channel blocker diphenylamine‐2‐carboxylate or Cl−‐free medium (P < 0.001, in each case). Furthermore, GPFX reduced Cl− conductance (P < 0.01) without affecting Na+ conductance of the epithelium.

Conclusions: Grepafloxacin selectively inhibits Cl− secretion across tracheal epithelial cells, which may result in the inhibition of water secretion and, hence, the reduction of airway secretion.
The incidence of tuberculosis in a cohort of South‐East Asian refugees arriving in Australia 1984–94
Authors: Marks Guy B. , Bai Jun , Simpson Sheila E. , Stewart Gregory J. , Sullivan Elizabeth A.
Published: September 2010

We have used record linkage analysis to describe the incidence of tuberculosis in a cohort of 24 652 predominantly south‐east Asian refugees who arrived in Sydney, Australia during the period 1984 to 1994. Cases that had been registered with the State Department of Health were confirmed by examination of case records. After an average follow‐up interval of 10.3 years there were 189 cases of tuberculosis, equivalent to an average incidence rate of 74.9 cases per 100 000 person‐years. The highest incidence rate was in 40–49 year olds and 47% of cases were in women. One hundred and twenty seven cases (67%) were pulmonary and, of these, 64 (50%) were direct smear positive. The incidence of tuberculosis in this cohort is similar to that observed among Vietnamese migrants to Australia and the USA and substantially higher than the incidence among people born in Australia. It is important to maintain awareness of the diagnosis of tuberculosis, especially in countries such as Australia, where the incidence in the general population is low but where there are large populations of migrants and refugees in whom a higher incidence is expected.
Nitric oxide modulates interleukin‐1β and tumour necrosis factor‐α synthesis, and disease regression by alveolar macrophages in pulmonary tuberculosis
Authors: Wang Chun‐Hua , Kuo Han‐Pin
Published: September 2010

Abstract: Pretreatment with nitric oxide synthase (NOS) inhibitors profoundly increases mortality, bacterial burden and pathological tissue damage in mice infected with Mycobacterium tuberculosis. Nitric oxide (NO) production is enhanced in alveolar macrophages (AM) of tuberculosis (TB) patients. Interleukin (IL)‐1β and tumour necrosis factor (TNF)‐α released from AM are involved in the immune response to mycobacterial infection. The aim of the present study was to examine whether NO is implicated in IL‐1β and TNF‐α synthesis by AM and related to the resolution of disease activity in TB patients. Purified AM were retrieved by bronchoalveolar lavage from TB patients and normal subjects, and cultured in the presence or absence of a NO inhibitor, NG‐monomethyl‐L‐arginine (L‐NMMA). The release of IL‐1β and TNF‐α, and their mRNA expression were determined by enzyme‐linked immunosorbent assay (ELISA) and northern analysis, respectively. The level of nitrite released into the culture medium was determined. The rate of disease regression was evaluated by serial chest radiography. The release of nitrite, IL‐1β and TNF‐α was much greater from AM of TB patients than normal subjects. NG‐monomethyl‐L‐arginine inhibited the production of nitrite as well as IL‐1β and TNF‐α in TB patients. The mRNA expression for IL‐1β and TNF‐α was upregulated in TB patients and was depressed by L‐NMMA. Immunocytochemistry using a monoclonal antibody against nuclear factor‐κB (NF‐κB) subunit p65 showed NF‐κB was highly expressed and translocated to the nuclei of AM in TB patients, and was inhibited by L‐NMMA. An inhibition of NF‐κB by pyrrolidine dithiocarbamate attenuated IL‐1β and TNF‐α synthesis. More generation of NO from cultured AM increased the disease regression in TB patients. We conclude that the enhanced NO generation by AM of TB patients may play an autoregulatory role in amplifying the synthesis of pro‐inflammatory cytokines, probably through the activation of NF‐κB. Nitric oxide may also play an important role in resistance to M. tuberculosis infection.
Epidemiology of pleural mesothelioma in a population with non‐occupational asbestos exposure
Authors: METINTAS Muzaffer , METINTAS Selma , AK Guntulu , ERGINEL Sinan , ALATAS Fusun , KURT Emel , UCGUN Irfan , YILDIRIM Huseyin
Published: September 2010

Background and objective:  This study describes the epidemiology of malignant pleural mesothelioma (MPM) in a rural population with environmental asbestos exposure.

Methods:  Patients with diagnosed MPM were recruited and their relevant demographic and exposure data were analysed.

Results:  A total of 131 patients with MPM (59 men, 72 women) were studied. The patients' mean age was 57.8 years and the mean exposure duration was 28.9 years. The cumulative fibre count of the villagers ranged from 0.19 to 14.61 fibre/mL‐years. Of the 131 patients, 85 had epithelial cell type, 20 had mixed, and eight had sarcomatous pleural mesothelioma. No significant relationship was found between asbestos fibre type and age, exposure period, or cellular type of MPM; similarly, no significant relationship could be found between the cellular type and age or exposure period. Patients with sarcomatous mesotheliomas were considerably older. Only five of 131 (3.8%) patients had a family history of mesothelioma.

Conclusions:  Environmental exposure to asbestos begins at birth and this may be important in the age of disease onset, if a threshold model for cancer initiation is operative. Both men and women had an excess risk of mesothelioma. Given that a family history of MPM was not common in this relatively homogenous patient group, a genetic predisposition to mesothelioma appears unlikely.
Diagnostic value of pleural fluid N‐terminal pro‐brain natriuretic peptide levels in patients with cardiovascular diseases
Authors: LIAO Huai , NA Moon Jun , DIKENSOY Oner , LANE Kirk B. , RANDAL Barnette , LIGHT Richard W.
Published: September 2010

Background and objective:  The diagnosis of the cause of pleural effusions caused by cardiovascular diseases such as congestive heart failure (CHF) and acute pulmonary embolism is sometimes difficult. The purpose of the present study was to evaluate the utility of pleural fluid levels of N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) in differentiating pleural effusions due to CHF, pulmonary embolism and post‐coronary artery bypass graft (CABG) surgery.

Methods:  The levels of pleural fluid NT‐proBNP were measured by ELISA in a total of 40 patients: 10 with CHF, 10 with pulmonary embolism, 10 post‐CABG and 10 with carcinoma.

Results:  The median level of NT‐proBNP in the pleural fluid of patients with CHF was 5390 pg/mL (25th to 75th percentiles, 4566 to 8158 pg/mL), which was significantly higher than that in patients with post‐CABG effusions (424 pg/mL, 352 to 873), with pulmonary embolism (311 pg/mL, 212 to 1159), or with carcinoma (302 pg/mL, 208 to 626) (P < 0.001, CHF group vs all other groups). In receiver‐operating curve analysis, an NT‐proBNP level of ≥2220 pg/mL demonstrated a sensitivity of 100% and a specificity of 96.7% for the identification of CHF.

Conclusions:  Measurement of the NT‐proBNP level in pleural fluid is accurate in diagnosing the etiology of the effusion as CHF. Pleural fluid levels above 2220 pg/mL are essentially diagnostic that the pleural effusion is due to CHF.
Air trapping: The major factor limiting diaphragm mobility in chronic obstructive pulmonary disease patients
Authors: DOS SANTOS YAMAGUTI Wellington Pereira , PAULIN Elaine , SHIBAO Simone , CHAMMAS Maria Cristina , SALGE João Marcos , RIBEIRO Marcos , CUKIER Alberto , CARVALHO Celso Ricardo Fernandes
Published: September 2010

Background and objective: Patients with COPD can have impaired diaphragm mechanics. A new method of assessing the mobility of the diaphragm, using ultrasound, has recently been validated. This study evaluated the relationship between pulmonary function and diaphragm mobility, as well as that between respiratory muscle strength and diaphragm mobility, in COPD patients.

Methods: COPD patients with pulmonary hyperinflation (n = 54) and healthy subjects (n = 20) were studied. Patients were tested for pulmonary function, maximal respiratory pressures and diaphragm mobility using ultrasound to measure the craniocaudal displacement of the left branch of the portal vein.

Results: COPD patients had less diaphragm mobility than did healthy individuals (36.5 ± 10.9 mm vs 46.3 ± 9.5 mm,P = 0.001). In COPD patients, diaphragm mobility correlated strongly with pulmonary function parameters that quantify air trapping (RV:r = −0.60,P < 0.001; RV/TLC:r = −0.76,P < 0.001), moderately with airway obstruction (FEV1:r = 0.55,P < 0.001; airway resistance:r = −0.32,P = 0.02) and weakly with pulmonary hyperinflation (TLC:r = −0.28,P = 0.04). No relationship was observed between diaphragm mobility and respiratory muscle strength (maximal inspiratory pressure:r = −0.11,P = 0.43; maximal expiratory pressure:r = 0.03,P = 0.80).

Conclusion: The results of this study suggest that the reduction in diaphragm mobility in COPD patients is mainly due to air trapping and is not influenced by respiratory muscle strength or pulmonary hyperinflation.
The utility of the chest radiograph in diagnosing exacerbations of pulmonary sarcoidosis
Authors: JUDSON Marc A. , GILBERT Gregory E. , RODGERS J. Keith , GREER Charles F. , SCHABEL Stephen I.
Published: September 2010

Background and objective: To quantify the CXR using a profusion of small lung opacities score in patients with pulmonary exacerbation of sarcoidosis. In particular, the study sought to determine whether the CXR changes were a reliable indicator of disease exacerbation.

Methods: The study recruited patients with an exacerbation of pulmonary sarcoidosis, who were attending a university medical centre sarcoidosis clinic. Pulmonary exacerbation was defined as worsening pulmonary symptoms, thought to be related to sarcoidosis, that responded to an increase in corticosteroid dose. A subset of patients were identified who met the criteria of spirometric decline of ≥10% in FVC or FEV1from the previous (baseline) visit. Patients required a baseline CXR and spirometry and had CXR and spirometry performed at the initial assessment. Two International Labour Organisation B readers interpreted the CXR in a blinded manner.

Results: All study patients (n = 36) were African American; there were 24 patients in the ‘spirometric decline’ subgroup. Agreement between the B readers was moderate (kappa = 0.54,P < 0.01). The mean profusion score increased, or worsened by 1.38 points (SD = 3.60,P = 0.008) for the exacerbation group while the ‘spirometric decline’ group worsened by an average of 1.80 points (SD = 3.81,P = 0.031). There was too much variation for a cut‐off to be identified that would reliably diagnose exacerbations. There was no significant correlation between FVC or FEV1and profusion score.

Conclusions: The CXR International Labour Organisation profusion score is not a reliable test to detect pulmonary exacerbations of sarcoidosis. However, a CXR may be useful to exclude other diagnostic possibilities.
Aspiration pneumonia due to polyethylene glycol‐electrolyte solution (Golytely) treated by bronchoalveolar lavage
Authors: HUR Gyu‐Young , LEE Sung‐Yong , SHIM Jae‐Jeong , IN Kwang‐Ho , KANG Kyung‐Ho , YOO Se‐Hwa
Published: September 2010

Abstract:  Polyethylene glycol (PEG)‐electrolyte solution (Golytely), is most commonly used for bowel preparation before colonoscopy, as well as for barium enema and colon surgery. In this case, a 70‐year‐old man developed ARDS following the administration of Golytely by mouth before a scheduled colonoscopy. Aspiration of PEG‐electrolyte solution was suspected, and the patient was successfully treated by BAL. Therefore, early bronchoscopy and BAL should be considered as initial treatment for PEG aspiration, because removal of PEG is most important for managing the disease.
Surveillance culture utility and safety using low‐volume blind bronchoalveolar lavage in the diagnosis of ventilator‐associated pneumonia
Authors: BOOTS Robert J. , PHILLIPS Gael E. , GEORGE Narelle , FAOAGALI Joan L.
Published: September 2010

Background and objectives:  Surveillance cultures may improve the prediction of ventilator‐associated pneumonia (VAP) and empirical antibiotic selection. This study examined the utility and patient safety of blind, non‐protected, low‐volume mini‐bronchial lavage (BM‐BAL) surveillance cultures in predicting VAP.

Methodology:  A prospective, cohort study was performed in a large general intensive care unit. BM‐BALs were collected within 12 h of admission then thrice weekly. Each BM‐BAL was screened by Gram staining for intracellular organisms and then quantitatively cultured. VAP was diagnosed using the Clinical Pulmonary Infection Score. The concordance for isolates from the BM‐BAL was assessed against concurrently collected endotracheal aspirates (EA).

Results:  Four hundred and twelve patients requiring a minimum of 48 h of mechanical ventilation were enrolled. Fifty patients developed 58 episodes of VAP. Concordant pathogens were found in 85% of BM‐BAL specimens collected 2 days prior to VAP onset. Their antibiograms were stable over the preceding 4 days. The isolation of pathogens with colony counts ≥104 cfu/mL from BM‐BAL performed 2 days prior to the clinical onset of VAP had a sensitivity of 84%, specificity of 50%, positive predictive value of 31% and a negative predictive value of 93% for predicting the development of VAP. BM‐BAL WCC, quantification of bacterial growth and the percentage of intracellular organisms were not helpful in predicting VAP diagnosis.

Conclusions:  BM‐BAL surveillance cultures are well tolerated and useful in predicting the pathogens and their antibiograms causing VAP. Diagnostic specimen collection at the time of VAP onset is still required as surveillance cultures may be negative even one day prior to VAP onset.
Amoxapine‐associated acute respiratory distress
Authors: ANDO Masaru , MIYAZAKI Eishi , TAKENAKA Ryu‐ichi , OKUBO Toshiyuki , MATSUNO Osamu , NUREKI Shin‐ichi , ITO Kazunobu , TSUDA Tomiyasu , KUMAMOTO Toshihide
Published: September 2010

Abstract:  A 37‐year‐old woman was admitted to our hospital because of acute respiratory distress. Two weeks previously, amoxapine (75 mg/day) had been administered for the first time. Ten days later she developed a high fever, severe hypoxaemia and pulmonary infiltrates on chest CT, including patchy areas of ground‐glass opacity, thickening of the interlobular septae and bronchial walls and pleural effusions. BAL showed a predominance of neutrophils, lymphocytes and erythrocytes but not eosinophils. Amoxapine was stopped, resulting in complete resolution of the pulmonary infiltrates. When the patient was re‐exposed to amoxapine (52.5 mg total dose), high fever, reduced SaO2 and pulmonary infiltrates reappeared. We concluded that acute respiratory distress may be associated with amoxapine treatment.
Respiratory infections unique to Asia
Authors: TSANG Kenneth W. , FILE Jr Thomas M.
Published: September 2010

Asia is a highly heterogeneous region with vastly different cultures, social constitutions and populations affected by a wide spectrum of respiratory diseases caused by tropical pathogens. Asian patients with community‐acquired pneumonia differ from their Western counterparts in microbiological aetiology, in particular the prominence of Gram‐negative organisms,Mycobacterium tuberculosis,Burkholderia pseudomalleiandStaphylococcus aureus. In addition, the differences in socioeconomic and health‐care infrastructures limit the usefulness of Western management guidelines for pneumonia in Asia. The importance of emerging infectious diseases such as severe acute respiratory syndrome and avian influenza infection remain as close concerns for practising respirologists in Asia. Specific infections such as melioidosis, dengue haemorrhagic fever, scrub typhus, leptospirosis, salmonellosis, penicilliosis marneffei, malaria, amoebiasis, paragonimiasis, strongyloidiasis, gnathostomiasis, trinchinellosis, schistosomiasis and echinococcosis occur commonly in Asia and manifest with a prominent respiratory component. Pulmonary eosinophilia, endemic in parts of Asia, could occur with a wide range of tropical infections. Tropical eosinophilia is believed to be a hyper‐sensitivity reaction to degenerating microfilariae trapped in the lungs.

This article attempts to address the key respiratory issues in these respiratory infections unique to Asia and highlight the important diagnostic and management issues faced by practising respirologists.
Can adiponectin predict abnormal glucose tolerance in Thai women with polycystic ovary syndrome?
Authors: Weerakiet Sawaek , Tingthanatikul Yada , Boonnag Pongamorn , Wansumrith Surapee , Rattanasiri Sasivimol , Leelaphiwat Supatra
Published: September 2010

Aim:  To evaluate whether adiponectin levels could predict abnormal glucose tolerance (AGT) in Thai women with polycystic ovary syndrome (PCOS).

Methods:  A 75‐g oral glucose tolerance test (OGTT) with fasting adiponectin and insulin (FI) blood sampling in 170 women with PCOS were performed consecutively.

Results:  The prevalence of AGT was 45.9%. The body mass index (BMI), waist‐to‐hip ratio (WHR), fasting glucose and 2‐h postload glucose were greater in the PCOS women with AGT than those without AGT (P < 0.001). In addition, the PCOS women with AGT had more severe insulin resistance (IR) and lower adiponectin levels than those without AGT. However, the area under the ROC curve of adiponectin and insulin in predicting AGT was smaller than that of homeostatic model of IR (HOMA‐IR) (P < 0.01). The arbitrary cut‐off values at 12 ug/mL of adiponectin, 10 μiu/mL of FI and 2 of HOMA‐IR showed the sensitivity and specificity of 80.8% and 33.7%; 87.2% and 34.8%; and 89.7% and 31.5%, respectively. With these cut‐off points, 46 (27.1%), 42 (24.7%) and 37 (21.8%) women, respectively, could be eliminated from performing OGTT. However, 15 (19.2%), 10 (12.8%) and 8 (10.3%), respectively, missed the diagnosis. In addition, with WHR and acanthosis nigricans adjustment, HOMA‐IR, but not adiponectin, was a significant predictor of AGT.

Conclusion:  Our study demonstrated that almost half of the women with PCOS had AGT. Adiponectin levels were significantly lower in the PCOS women with AGT than those without AGT. However, adiponectin was not shown to be as strong a predictive factor and might not be such an excellent screening test as FI and HOMA‐IR.
Giant abdominal tumor of the ovary
Authors: Ueda Sachiyo , Yamada Yoshihiko , Tsuji Yoriko , Kawaguchi Ryuji , Haruta Shoji , Shigetomi Hiroshi , Kanayama Seiji , Yoshida Shozo , Sakata Mariko , Sado Toshiyuki , Kitanaka Koji , Kobayashi Hiroshi
Published: September 2010

A giant abdominal tumor can exert a mass effect on surrounding structures. We report here a 34‐year‐old single female who presented with an increased abdominal girth and was subsequently found to have a giant abdominal mass. Large volume aspiration (85 L) at a slow rate (1 L/min) was initially performed before surgical resection to prevent the development of severe clinical hypotension after large volume aspiration. The patient underwent left salpingo‐oophorectomy. Histology revealed a serous cystadenoma of the ovary. Systemic hemodynamics were sequentially measured during the perioperative period. The patient is now well.
Intractable recurrent cervical cancer with pelvic bone involvement successfully treated with external hemipelvectomy
Authors: Hamanishi Junzo , Higuchi Toshihiro , Mandai Masaki , Fukuhara Ken , An Masae , Nakayama Tomitaka , Takakura Kenji , Fujii Shingo
Published: September 2010

The indication of external hemipelvectomy for lateral recurrent cervical cancer involving the pelvic bone is controversial. We report the second longest surviving patient of recurrent cervical cancer successfully treated by external hemipelvectomy. A 38‐year‐old woman who had undergone conization for stage Ia1 cervical cancer six years earlier had severe right inguinal pain. A large multicystic recurrent tumor was identified in the right obturator region. After chemotherapy and chemoradiation, the tumor regressed, but soon relapsed. The patient's symptoms flared and the tumor was enlarged involving the right iliac bone. We performed right external hemipelvectomy with amputation of the right lower extremity, right iliac wing and ischiopubic bone. There was no major complication after the operation and the patient was discharged on postoperative day 48. After 27 months of follow‐up, she has no complaints and is without evidence of recurrence. In selected cases of intractable lateral recurrent cervical cancer with pelvic bone involvement, relief from tumor‐related pain and a possibility of prolonged survival can be expected by external hemipelvectomy.
Magnetic resonance imaging and hysteroscopy to diagnose colo‐uterine fistula: A rare complication of diverticulitis
Authors: Kassab Ahmed , El‐Bialy Gehan , Hashesh Hany , Callen Peter
Published: September 2010

Colo‐uterine fistula of diverticular origin is an extremely rare disease due to the resistance of uterine tissue. Methods for diagnosis remain to be established. Non‐invasive imaging like magnetic resonance imaging (MRI) may help to establish a proper diagnosis, but confirmation may be reached by diagnostic hysteroscopy or even surgical exploration. We report a 78‐year‐old female who presented with continuous dull aching pain associated with increasing constipation. MRI suspected a fistula between the posterior aspect of the uterine body and the sigmoid colon which contained extensive diverticulosis. Hysteroscopy confirmed the fistulous opening, but colonoscopy confirmed diverticular disease with no evidence of malignancy. The patient had en block surgical treatment of the uterus and the adjacent colon, followed by an uneventful recovery. The sensitivity and specificity of non‐invasive imaging procedures to diagnose such cases remain to be established. As imaging procedures cannot rule out neoplasia, endoscopic procedures need to be added.
Hysterectomy for hematometra in a 15‐year‐old mentally handicapped girl with congenital cervicovaginal agenesis and concomitant ovarian adenoma
Authors: Rana Ashma , Gurung Geeta , Begum Syeda H. , Adhikari Shilu , Neupane Bhanu B.
Published: September 2010

We report a case of hematometra and bilateral hematosalphinx in a 15‐year‐old mentally handicapped adolescent girl, complicated by vaginal agenesis over cervical atresia in the presence of an ovarian adenoma. The case was managed by abdominal hysterectomy and bilateral salphingectomy of the hematosalphinx, which had formed a tubo‐ovarian mass. One ovary was preserved. This case also considers the management of the mentally handicapped patient unable to comprehend pain arising from cryptomenorrhea.
Anatomical and functional results after stapled transanal rectal resection (STARR) for obstructed defaecation syndrome
Authors: Meurette G. , Wong M. , Frampas E. , Regenet N. , Lehur P. A.
Published: September 2010

Aim  The STARR procedure is a surgical option for the treatment of rectocoele associated with obstructed defaecation syndrome (ODS). The aim of the study was to assess the efficacy of this technique in restoring anatomy and the long‐term sustainability of symptom control and quality of life.

Methods  Of 48 patients operated on from 2003 to 2007, 30 were enrolled for this prospective assessment of anatomical correction and functional improvement of ODS. Results from a standardized questionnaire concerning functional results (ODS score), faecal incontinence (Cleveland Clinic score) and Patient Assessment of Constipation Quality of Life (PAC‐QoL) were prospectively collected. Systematic dynamic defaecography, together with anorectal physiology testing, were performed before surgery and 6 months after. Twenty‐five patients were available for long‐term assessment of functional outcome (more than 4 years).

Results  The mean age of the population was 57 ± 7 years. STARR produced significant improvements in the PAC QoL (P < 0.05) and ODS score (P < 0.0001), but not in the incontinence score. At defaecography, correction was significant with respect to the depth (P = 0.007), perimeter (P < 0.0001) and neck (P = 0.001) of rectocoele. Anorectal physiology revealed a lower maximal tolerated rectal volume (P < 0.0001). After 58 months, the 25 patients showed sustained functional results and QoL. Four patients (16%) underwent further surgical procedure for pelvic floor disorders and eight patients (32%) still required laxatives.

Conclusion  Our study confirms the efficacy of the STARR procedure, with sustained improvement in function and QoL. However, a substantial number of patients remain symptomatic.
Analysis of the outcome of intracytoplasmic sperm injection using fresh or frozen sperm
Authors: Kalsi Jas , Thum M. Yau , Muneer Asif , Pryor John , Abdullah Hossam , Minhas Suks
Published: September 2010

Study Type – Diagnostic (retrospective cohort)  Level of Evidence 2b

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

The results of ICSI using fresh or frozen sperm on the site of sperm retrieval remains controversial with respect to outcome.

The results of this study showed no difference in outcome using ICSI either with respect to the site of retrieval or whether the sperm used was fresh or frozen. It also showed that the outcome of ICSI is not related to the underlying cause of the azoospermia.

OBJECTIVES

• To compare the outcome of first‐attempt intracytoplasmic sperm injection (ICSI) ICSI–embryo transfer (ET) cycles using frozen‐thawed testicular sperm (FTTS), fresh testicular sperm (FTS), frozen‐thawed epididymal sperm (FTES) and fresh epididymal sperm (FES) so as to determine which of these has the most successful ICSI outcome with respect to fertilization rate (FR), pregnancy rate (PR) and birth rate.

• To assess the outcomes according to the underlying aetiology of azoospermia.

PATIENTS AND METHODS

• The records of 493 patients undergoing first‐attempt ICSI between 1993 and 2008 were reviewed retrospectively. FTS was used in 112 cycles, FTTS in 43 cycles, FES in 279 cycles, and FTES in 59 cycles.

• Within each group, the aetiology of the azoospermia was recorded according to history, clinical examination and histological analysis (n= 316).

• The FR, clinical PR and delivery rate were calculated for each group with respect to the type of sperm retrieval used.

RESULTS

• Analysis of the data showed no significant differences between any of the four groups in the FR, PR or delivery rate (P > 0.05).

• There were no significant differences seen between fresh sperm (FTS and FES) and frozen sperm (FTTS and FTES) or between epididymal sperm (FES and FTES) and testicular sperm (FTS and FTTS) in any of the outcomes measured (P > 0.05). However, sub‐set analysis showed a statistically higher FR and PR for FTTS over fresh sperm.

• When comparing aetiologies, there was no significant difference in the FR, clinical PR and delivery rate between obstructive azoospermia (OA) and non‐obstructive azoospermia (NOA) groups. However, sub‐set analysis showed a higher PR and birth rate for FTTS over fresh sperm in both OA and NOA groups.

CONCLUSIONS

• The results of the present study suggest that using frozen sperm in ICSI cycles is a reliable and favourable method with the same outcome as fresh sperm.

• Testicular and epididymal sperm have similar ICSI outcomes for both fresh and frozen samples. However, results suggest a tendency for higher PRs and birth rates for frozen than for fresh testicular sperm in both OA and NOA aetiologies.

• The aetiology of azoospermia does not significantly affect the outcome of first‐attempt ICSI. The higher rates in the frozen groups suggest that these patients have had better quality semen when they were initially harvested and frozen.
A novel cost‐effective approach to post‐vasectomy semen analysis
Authors: Senanayake Eshan , Pacey Allan A. , Maddireddy Vinod , Shariff Umar , Hastie Ken , Rosario Derek J.
Published: September 2010

Study Type – Diagnostic (cost minimisation analysis)  Level of Evidence 3b

OBJECTIVE

To examine compliance, clearance rates and cost‐effectiveness of a novel approach to managing men following vasectomy based on the testing of sperm viability.

PATIENTS AND METHODS

Between January 2003 and March 2005, 832 men undergoing vasectomy were followed prospectively for a minimum of 12 months.

Post‐vasectomy semen analysis (PVSA) was carried out at 16 weeks with repeat at 20 weeks only if sperm were detected on initial PVSA i.e. a single clear PVSA on simple microscopy was deemed sufficient for declaring vasectomy successful.

In men with persistent non‐motile sperm (PNMS) in the second specimen, comprehensive analysis of number and viability of sperm using a fluorescent probe was carried out on a fresh semen specimen taken in accordance with British Andrology Society (BAS) guidelines.

RESULTS

Overall compliance with the PVSA protocol was 81.3% (95% CI 78.5 to 83.8). No sperm were seen in 540 (78.8%) and 70 (10.3%) at the initial and 2ndPVSA respectively.

Persistent spermatozoa at 20 weeks were present in 66 (9.8%, 7.8 to 12.2) cases with 58 (8.6%, 6.7 to 11.0) having PNMS and 8 (1.2%, 0.6 to 2.3) having motile sperm.

Fluorescent viability testing in 53 of the 58 with PNMS showed viable sperm in 2 (3.8%, 1.0 to 12.8). The failure rate of vasectomy defined by PVSA (8 with motile sperm on 2ndPVSA and 2 with viable non‐motile sperm on fluorescent testing) was 1.2% (0.7 to 2.2).

Average cost per vasectomy of PVSA using this protocol was £10.77 (US$ 16.67) compared with a minimum likely average cost using BAS guidelines of £18.10 (US$ 28).

CONCLUSION

Demonstrating absence of sperm on simple light microscopy in a single specimen of semen at 16 or 20 weeks post‐vasectomy and reserving comprehensive testing of sperm viability for only the higher risk group with PNMS improves compliance and represents a cost‐effective strategy for declaring surgical success. This reduces the costs of PVSA by least 40% compared with adherence with BAS guidelines without compromising success in determining outcome after vasectomy.
HISTORY DEPENDENCE AND THE FORMATION OF SOCIAL PREFERENCES: AN EXPERIMENTAL STUDY
Authors: COOPER DAVID J. , STOCKMAN CAROL KRAKER
Published: September 2010

We study the minimal contributing set (MCS) game, a three‐person sequential step‐level public goods game. The behavior of critical third players changes with experience in this game even though they face no strategic or payoff uncertainty. We explore why these changes occur by manipulating subjects' experience in the first half of the experiment. The treatments give subjects very different initial experiences, but all treatments move subjects' choices toward experienced subjects' play in the control sessions. Long‐run play is indistinguishable across treatments. Our results are more consistent with the “discovered preferences” hypothesis (Plott 1996) than either the “constructed preference” or “reference point” hypotheses.(JELH41, C72, C92)
SLEEPING WITH THE ENEMY: THE ECONOMIC COST OF INTERNAL ENVIRONMENTAL CONFLICTS
Authors: CHERRY TODD L. , COTTEN STEPHEN J.
Published: September 2010

This paper extends the literature on collective rent‐seeking by introducing the possibility that a competing group may be a subset of another. We develop a model that incorporates the potential for some individuals to be party of both sides of a conflict, which creates interdependence of payoffs. Results indicate that strategic individual behavior, and the resulting rent dissipation, is affected by the relative size of the groups. We conduct an experimental test of the model and find that observed laboratory behavior corresponds well with the game‐theoretic comparative‐static predictions.(JELC72, C9, Q5, D74)
Barycentric Coordinates on Surfaces
Authors: Rustamov Raif M.
Published: September 2010

This paper introduces a method for defining and efficiently computing barycentric coordinates with respect to polygons on general surfaces. Our construction is geared towards injective polygons (polygons that can be enclosed in a metric ball of an appropriate size) and is based on replacing the linear precision property of planar coordinates by a requirement in terms of center of mass, and generalizing this requirement to the surface setting. We show that the resulting surface barycentric coordinates can be computed using planar barycentric coordinates with respect to a polygon in the tangent plane. We prove theoretically that the surface coordinates properly generalize the planar coordinates and carry some of their useful properties such as unique reconstruction of a point given its coordinates, uniqueness for triangles, edge linearity, similarity invariance, and smoothness; in addition, these coordinates are insensitive to isometric deformations and can be used to reconstruct isometries. We show empirically that surface coordinates are shape‐aware with consistent gross behavior across different surfaces, are well‐behaved for different polygon types/locations on variety of surface forms, and that they are fast to compute. Finally, we demonstrate effectiveness of surface coordinates for interpolation, decal mapping, and correspondence refinement.
Fuzzy Geodesics and Consistent Sparse Correspondences For: eformable Shapes
Authors: Sun Jian , Chen Xiaobai , Funkhouser Thomas A.
Published: September 2010

A geodesic is a parameterized curve on a Riemannian manifold governed by a second order partial differential equation. Geodesics are notoriously unstable: small perturbations of the underlying manifold may lead to dramatic changes of the course of a geodesic. Such instability makes it difficult to use geodesics in many applications, in particular in the world of discrete geometry. In this paper, we consider a geodesic as the indicator function of the set of the points on the geodesic. From this perspective, we present a new concept called fuzzy geodesics and show that fuzzy geodesics are stable with respect to the Gromov‐Hausdorff distance. Based on fuzzy geodesics, we propose a new object called the intersection configuration for a set of points on a shape and demonstrate its effectiveness in the application of finding consistent correspondences between sparse sets of points on shapes differing by extreme deformations.
Persistent Heat Signature for Pose‐oblivious Matching of Incomplete Models
Authors: Dey T.K. , Li K. , Luo C. , Ranjan P. , Safa I. , Wang Y.
Published: September 2010

Although understanding of shape features in the context of shape matching and retrieval has made considerable progress in recent years, the case for partial and incomplete models in presence of pose variations still begs a robust and efficient solution. A signature that encodes features at multi‐scales in a pose invariant manner is more appropriate for this case. The Heat Kernel Signature function from spectral theory exhibits this multi‐scale property. We show how this concept can be merged with the persistent homology to design a novel efficient pose‐oblivious matching algorithm for all models, be they partial, incomplete, or complete. We make the algorithm scalable so that it can handle large data sets. Several test results show the robustness of our approach.
One Point Isometric Matching with the Heat Kernel
Authors: Ovsjanikov Maks , Mérigot Quentin , Mémoli Facundo , Guibas Leonidas
Published: September 2010

A common operation in many geometry processing algorithms consists of finding correspondences between pairs of shapes by finding structure‐preserving maps between them. A particularly useful case of such maps is isometries, which preserve geodesic distances between points on each shape. Although several algorithms have been proposed to find approximately isometric maps between a pair of shapes, the structure of the space of isometries is not well understood. In this paper, we show that under mild genericity conditions, a single correspondence can be used to recover an isometry defined on entire shapes, and thus the space of all isometries can be parameterized by one correspondence between a pair of points. Perhaps surprisingly, this result is general, and does not depend on the dimensionality or the genus, and is valid for compact manifolds in any dimension. Moreover, we show that both the initial correspondence and the isometry can be recovered efficiently in practice. This allows us to devise an algorithm to find intrinsic symmetries of shapes, match shapes undergoing isometric deformations, as well as match partial and incomplete models efficiently.
Iso‐geometric Finite Element Analysis Based on Catmull‐Clark : ubdivision Solids
Authors: Burkhart D. , Hamann B. , Umlauf G.
Published: September 2010

We present a volumetric iso‐geometric finite element analysis based on Catmull‐Clark solids. This concept allows one to use the same representation for the modeling, the physical simulation, and the visualization, which optimizes the design process and narrows the gap between CAD and CAE. In our method the boundary of the solid model is a Catmull‐Clark surface with optional corners and creases to support the modeling phase. The crucial point in the simulation phase is the need to perform efficient integration for the elements. We propose a method similar to the standard subdivision surface evaluation technique, such that numerical quadrature can be used.

Experiments show that our approach converges faster than methods based on tri‐linear and tri‐quadratic elements. However, the topological structure of Catmull‐Clark elements is as simple as the structure of linear elements. Furthermore, the Catmull‐Clark elements we use are C2‐continuous on the boundary and in the interior except for irregular vertices and edges.
Polygonal mesh watermarking using Laplacian coordinates
Authors: Yang Y. , Ivrissimtzis I.
Published: September 2010

We propose a watermarking algorithm for polygonal meshes based on the modification of the Laplacian coordinates. More specifically, we first compute the Laplacian coordinates (x,y,z) of the mesh vertices, then construct the histogram of the lengths of the (x,y,z) vectors, and finally, insert the watermark by altering the shape of that histogram. The watermark extraction is carried out blindly, with no reference to the host model. The proposed method is more robust than several existing high capacity watermarking algorithms. In particular, it is able to resist attacks such as translations, rotations, uniform scaling and vertex reordering, due to the invariance of the histogram of the Laplacian vector lengths under such transformations. Compared to the existing robust watermarking methods, our experiments show that the proposed method can better resist common mesh editing attacks, due to the good behaviour of the Laplacian coordinates under such operations.
Fast and Scalable CPU/GPU Collision Detection for Rigid and Deformable Surfaces
Authors: Pabst Simon , Koch Artur , Straßer Wolfgang
Published: September 2010

We present a new hybrid CPU/GPU collision detection technique for rigid and deformable objects based on spatial subdivision. Our approach efficiently exploits the massive computational capabilities of modern CPUs and GPUs commonly found in off‐the‐shelf computer systems. The algorithm is specifically tailored to be highly scalable on both the CPU and the GPU sides. We can compute discrete and continuous external and self‐collisions of non‐penetrating rigid and deformable objects consisting of many tens of thousands of triangles in a few milliseconds on a modern PC. Our approach is orders of magnitude faster than earlier CPU‐based approaches and up to twice as fast as the most recent GPU‐based techniques.