bluuebunny/crossref_metadata_2025 huggingface dataset:
Neutrophil-specific deletion of Syk kinase results in reduced host defense to bacterial infection
Authors: Van Ziffle Jessica A. , Lowell Clifford A.
Published: October 2009

Leukocyte-specific CD18 integrins are critical in mediating cell recruitment and activation during host defense responses to bacterial infection. The signaling pathways downstream of CD18 integrins are dependent on the spleen tyrosine kinase, Syk. To investigate the role integrin signaling plays in host defense, we examined the responses of Syk-deficient neutrophils to bacterial challenge with serum-opsonized Staphylococcus aureus and Escherichia coli. Syk-conditional knockout mice lacking this kinase specifically in myeloid cells or just neutrophils were also used to investigate host responses in vivo. Syk-deficient neutrophils manifested impaired exocytosis of secondary and tertiary granules, reduced cytokine release, and very poor activation of the NADPH oxidase in response to serum-opsonized S aureus and E coli. These functional defects correlated with impaired activation of c-Cbl, Pyk2, Erk1/2, and p38 kinases. Bacterial phagocytosis, neutrophil extracellular trap formation, and killing were also reduced in Syk-deficient cells, with a more profound effect after S aureus challenge. In vivo, loss of Syk in myeloid cells or specifically in neutrophils resulted in reduced clearance of S aureus after subcutaneous or intraperitoneal infection, despite normal recruitment of inflammatory cells. These results indicate that loss of Syk kinase-mediated integrin signaling impairs leukocyte activation, leading to reduced host defense responses.
How I treat acute promyelocytic leukemia
Authors: Tallman Martin S. , Altman Jessica K.
Published: October 2009

Acute promyelocytic leukemia is the first malignant disease highly curable with targeted therapy directed at a unique molecular abnormality. The characteristic bleeding diathesis is the most notorious manifestation of the disease, which historically has accounted for a high mortality rate during induction. Acute promyelocytic leukemia is one of the few hematologic diseases that must be recognized under the microscope by the practicing hematologist because early institution of all-trans retinoic acid (ATRA) at the first suspicion of the disease before confirmation of the diagnosis and aggressive blood product support are critical to reduce early mortality. ATRA plus anthracycline-based chemotherapy for induction and consolidation followed by maintenance ATRA with low-dose chemotherapy is currently the standard of care. However, the combination of ATRA and arsenic trioxide, with minimal chemotherapy to control leukocytosis, is very effective therapy for newly diagnosed patients. This combination may replace conventional approaches for most, if not all, patients in the very near future. Acute promyelocytic leukemia should be considered in any patient with newly diagnosed acute myeloid leukemia because the treatment is urgent and different from all other subtypes.
IL-21 preferentially enhances IL-15-mediated homeostatic proliferation of human CD28+ CD8 memory T cells throughout the adult age span
Authors: Nguyen Huy , Weng Nan-ping
Published: October 2009

IL-21 enhances IL-15-mediated proliferation of CD8 memory T cells, particularly CD28+ memory T cells, and also serves as an antagonist to the IL-15-induced increase of CD28− CD8 T cells.

An age-related decline in human immune response is marked by the accumulation of CD28– CD8 T cells, which is attributed to repeated antigenic stimulation and to homeostatic proliferation mediated by cytokines such as IL-15. However, the identity of the cytokines that are responsible for the maintenance of CD28 expression is less known. Here, we report the role of IL-21 in the regulation of IL-15-mediated growth and CD28 expression of CD8 memory T cells of young and old donors. We showed that IL-21 drives more IL-15-stimulated cells to enter cell division and to undergo apoptosis. Furthermore, IL-21 preferentially enhanced IL-15-induced proliferation of CD28+ CD8 memory T cells over their CD28– counterparts, as CD28+ cells expressed higher levels of IL-15R and IL-21R and greater pSTAT5 upon IL-15 and IL-21 stimulation. In addition, IL-21 reduced IL-15-induced CD28 down-regulation in CD8 memory T cells. Finally, the ability of proliferation and survival in response to homeostatic cytokines IL-15 and IL-21 of CD28+ CD8 memory T cells was well-maintained with age. Together, these findings suggest that IL-21 enhances IL-15-mediated proliferation of CD8 memory T cells, particularly CD28+ memory T cells, and also serves as an antagonist to the IL-15-induced increase of CD28– CD8 T cells.
Sphingosine Kinase as a Regulator of Calcium Entry through Autocrine Sphingosine 1-Phosphate Signaling in Thyroid FRTL-5 Cells
Authors: Gratschev Dan , Löf Christoffer , Heikkilä Jari , Björkbom Anders , Sukumaran Pramod , Hinkkanen Ari , Slotte J. Peter , Törnquist Kid
Published: October 2009

Calcium entry is one of the main regulators of intracellular signaling. Here, we have described the importance of sphingosine, sphingosine kinase 1 (SK1), and sphingosine 1-phosphate (S1P) in regulating calcium entry in thyroid FRTL-5 cells. In cells incubated with the phosphatase inhibitor calyculin A, which evokes calcium entry without mobilizing sequestered intracellular calcium, sphingosine inhibited calcium entry in a concentration-dependent manner. Furthermore, inhibiting SK1 or the ATP-binding cassette ABCC1 multidrug transporter attenuated calcium entry. The addition of exogenous S1P restored calcium entry. Neither sphingosine nor inhibition of SK1 attenuated thapsigargin-evoked calcium entry. Blocking S1P receptor 2 or phospholipase C attenuated calcium entry, whereas blocking S1P receptor 3 did not. Overexpression of wild-type SK1, but not SK2, enhanced calyculin-evoked calcium entry compared with mock-transfected cells, whereas calcium entry was decreased in cells transfected with the dominant-negative G82D SK1 mutant. Exogenous S1P restored calcium entry in G82D cells. Our results suggest that the calcium entry pathway is blocked by sphingosine and that activation of SK1 and the production of S1P, through an autocrine mechanism, facilitate calcium entry through activation of S1P receptor 2. This is a novel mechanism by which the sphingosine-S1P rheostat regulates cellular calcium homeostasis.
Central Nesfatin-1 Reduces Dark-Phase Food Intake and Gastric Emptying in Rats: Differential Role of Corticotropin-Releasing Factor2 Receptor
Authors: Stengel Andreas , Goebel Miriam , Wang Lixin , Rivier Jean , Kobelt Peter , Mönnikes Hubert , Lambrecht Nils W. G. , Taché Yvette
Published: October 2009

Nesfatin-1, derived from nucleobindin2, is expressed in the hypothalamus and reported in one study to reduce food intake (FI) in rats. To characterize the central anorexigenic action of nesfatin-1 and whether gastric emptying (GE) is altered, we injected nesfatin-1 into the lateral brain ventricle (intracerebroventricular, icv) or fourth ventricle (4v) in chronically cannulated rats or into the cisterna magna (intracisternal, ic) under short anesthesia and compared with ip injection. Nesfatin-1 (0.05 μg/rat, icv) decreased 2–3 h and 3–6 h dark-phase FI by 87 and 45%, respectively, whereas ip administration (2 μg/rat) had no effect. The corticotropin-releasing factor (CRF)1/CRF2 antagonist astressin-B or the CRF2 antagonist astressin2-B abolished icv nesfatin-1’s anorexigenic action, whereas an astressin2-B analog, devoid of CRF-receptor binding affinity, did not. Nesfatin-1 icv induced a dose-dependent reduction of GE by 26 and 43% that was not modified by icv astressin2-B. Nesfatin-1 into the 4v (0.05 μg/rat) or ic (0.5 μg/rat) decreased cumulative dark-phase FI by 29 and 60% at 1 h and by 41 and 37% between 3 and 5 h, respectively. This effect was neither altered by ic astressin2-B nor associated with changes in GE. Cholecystokinin (ip) induced Fos expression in 43% of nesfatin-1 neurons in the paraventricular hypothalamic nucleus and 24% of those in the nucleus tractus solitarius. These data indicate that nesfatin-1 acts centrally to reduce dark phase FI through CRF2-receptor-dependent pathways after forebrain injection and CRF2-receptor-independent pathways after hindbrain injection. Activation of nesfatin-1 neurons by cholecystokinin at sites regulating food intake may suggest a role in gut peptide satiation effect.
In Pursuit of Leucine-Rich Repeat-Containing G Protein-Coupled Receptor-5 Regulation and Function in the Uterus
Authors: Sun Xiaofei , Jackson Lindsey , Dey Sudhansu K. , Daikoku Takiko
Published: October 2009

Leucine-rich repeat-containing G protein-coupled receptor (LGR)-5 is a recently identified marker of stem cells in adult intestinal epithelium and hair follicles. Because of this characteristic, we studied the status of Lgr5 expression in the mouse uterus under various conditions. Lgr5 is highly expressed in the uterine epithelium of immature mice and is dramatically down-regulated after the mice resume estrous cycles. Surprisingly, whereas its expression is up-regulated in uteri of ovariectomized mice, the expression is down-regulated by estrogen and progesterone via their cognate nuclear receptors, estrogen receptor-α and progesterone receptor, respectively. Using a mouse endometrial cancer model, we also found that Lgr5 is highly expressed in the epithelium during the initial stages of tumorigenesis but is remarkably down-regulated in fully developed tumors. Lgr5 is a downstream target of Wnt signaling in the intestine. Genetic evidence shows that either excessive or absence of Wnt signaling dampens Lgr5 expression in the uterus. Collectively, our results show that Lgr5 expression in the mouse uterine epithelium is unique and dynamically regulated under various physiological and pathological states of the uterus, suggesting that this orphan receptor has important functions in uterine biology. However, identifying definitive uterine function of LGR5 will require further investigation using conditional deletion of uterine Lgr5 because systemic deletion of this gene is neonatally lethal.
Progesterone Receptor Membrane Component-1 Regulates the Development and Cisplatin Sensitivity of Human Ovarian Tumors in Athymic Nude Mice
Authors: Peluso John J. , Gawkowska Anna , Liu Xiufang , Shioda Toshi , Pru James K.
Published: October 2009

To determine whether progesterone receptor membrane component 1 (PGRMC1) regulates the development and cisplatin (CDDP)-sensitivity of human ovarian tumors, PGRMC1 was depleted from a human ovarian cancer cell line, dsRed-SKOV-3 cells, using a short hairpin RNA knockdown approach. Compared with parental dsRed-SKOV-3 cells, the PGRMC1-deplete cells grew slower in vitro and did not show progesterone’s (P4) antiapoptotic effect. In fact, P4 induced apoptosis in PGRMC1-deplete cells in a dose-dependent manner. When transplanted into the peritoneum of athymic nude mice, parental dsRed-SKOV-3 cells developed numerous tumors, which were classified as either typical or oxyphilic clear cell tumors. CDDP increased the percentage of apoptotic nuclei in typical clear cell tumors and P4 attenuated CDDP-induced apoptosis. In contrast, the percentage of apoptotic nuclei in oxyphilic clear cell tumors was low (≤1%) and was not significantly affected by CDDP and/or P4. Compared with tumors derived from parental dsRed SKOV-3 cells, PGRMC1-deplete tumors: 1) developed in fewer mice, 2) formed less frequently, 3) appeared smaller, and 4) resulted in fewer oxyphilic clear cell tumors. These PGRMC1-deplete tumors were not responsive to CDDP’s apoptotic effects. The failure to respond to CDDP could be due to their poorly developed microvasculature system as judged by percentage of CD31-stained endothelial cells and/or their increased expression of ATP-binding cassette transporters, which are involved in drug resistance. Taken together, these findings indicate that PGRMC1 plays an essential role in the development and CDDP sensitivity of human ovarian tumors.
Neat fuel influence on biodiesel blend emissions
Authors: Thompson G J , Nuszkowski J
Published: October 2009

The emissions of oxides of nitrogen (NO x) from biodiesel blended fuels reported in the literature vary from an NO x increase to an NO x decrease relative to the neat petroleum diesel fuel (PDF). To explain these NO x differences, three PDFs with varying fuel properties were admixed with a neat soy-derived biodiesel at 10 per cent and 20 per cent volume ratios and evaluated using a heavy-duty diesel engine exercised over transient and steady-state cycles. The PDFs with ‘low’ and ‘medium’ cetane numbers led to a change in combustion phasing when blended with the neat biodiesel, resulting in reduced NO x emissions at low engine power. The B100 blended with the ‘high’-cetane-number PDF showed minimal change in combustion phasing and resulted in an NO x increase at all engine loads. The derived peak in-cylinder gas temperature variation correlated with the brake-specific NO x emissions indicating that the thermal NO x formation responds to the addition of biodiesel. The biodiesel blends had an NO x—particulate matter trade-off, also suggesting a thermal NO x effect. The increase in NO x emissions of the biodiesel blends also had a strong correlation with the level of saturated hydrocarbons at high engine power.
Optimal periodical time for preventive replacement based on a cumulative repair-cost limit and random lead time
Authors: Chien Y-H , Chang C-C , Sheu S-H
Published: October 2009

This paper considers and extends the preventive replacement model with a cumulative repair-cost limit policy by introducing the random lead time for replacement delivery. A cumulative repair-cost limit policy uses information about a system's entire repair-cost history to decide whether the system is repaired or replaced. A random lead time models delay in delivery of a replacement once it is ordered. Long-run expected cost per unit time is formulated, and the optimal scheduled time for preventive replacement minimizing that cost is derived. Existence and uniqueness of that optimal time are shown, and the structural properties are presented. Various special cases are included and compared, and a numerical example is demonstrated.
Minimal cutsets-based reduction approach for the use of binary decision diagrams on probabilistic safety assessment fault tree models
Authors: Ibáñez-Llano C , Rauzy A , Meléndez E , Nieto F
Published: October 2009

Binary decision diagrams (BDDs) are a well-known alternative to the minimal cutsets (MCS) approach to assess Boolean reliability models. While the application of fault tree analysis can be considered to be consolidated, its application to the event trees involved in the probabilistic safety assessment (PSA) studies of the nuclear industry require extended efforts. For many real PSA models the full conversion procedure remains out of reach in terms of computational resources owing to their size, non-coherency, redundancy, and complexity. A potential solution to improve the quality of assessment methods is to design hybrid algorithms that combine the information derived from the calculation of MCS with the BDD methodology.

As a first step to develop this new approach, this paper explores various procedures and strategies based on this principle. First, a method is presented to reduce the fault tree model by considering only the domain of the most relevant MCS of the system prior to the BDD conversion and the impact on the final probability of the model is analysed. Second, several ordering heuristics derived from the MCS and the structural information of the model are proposed and compared, both in terms of their general performance and their sensitivity to the initial rewriting of the model. This preliminary study is applied on a set of fault tree models belonging to a real PSA study. The results obtained lead to some promising conclusions: it is shown that the topological information proves to be essential for the ordering and conversion procedures; it is also revealed that the rewriting strategies should be considered when designing variable ordering methods; and, finally, it is demonstrated that the reduction procedure provides a faster computation process without affecting the final probability. The long-term objective, which has motivated this work, is to apply this reduction procedure to quantify sequences of linked fault trees, both static and dynamic, a task for which further work is required.
An unusual case of profound hyponatraemia and bilateral adrenal calcifications
Authors: Cassar Charmaine , Procter Richard , Davidson Fraser , Collier Andrew , Malik Iqbal A , Ghosh Sujoy , Elhadd Tarik A
Published: October 2009

We report a case of a 65-year-old lady who presented with acute confusion and profound hyponatraemia (plasma sodium of 97 mmol/L). Five years earlier she had developed sepsis and was found to have hyponatraemia, thought to be due to syndrome of inappropriate antidiuretic hormone secretion. The patient was lost to follow-up. The patient was covered with steroids and investigations confirmed primary adrenal failure with flat response of cortisol to adrenocorticotropic hormone (ACTH) stimulation and very high level of ACTH. Adrenal auto-antibodies were negative and a computed tomography of the adrenals showed bilateral adrenal calcifications, suggestive of previous haemorrhage or infarction. Bilateral adrenal calcification due to haemorrhage/infarction usually does not present with severe hyponatraemia; however, adrenal insufficiency should be excluded in all cases of severe hyponatraemia. In suspected cases, patients should be treated with steroids, even when symptoms or signs are absent, while results of investigations are awaited.
Re-Admissions Following Hip Fracture Surgery
Authors: Hahnel James , Burdekin Hannah , Anand Sanjeev
Published: October 2009

INTRODUCTION

Hip fractures in the elderly are a growing problem with a predicted incidence of 117,000 cases per year by 2016. Re-admission following a healthcare episode is an important outcome measure, which reflects non-fatal adverse events and indicates the natural history of disease. The purpose of this observational, multicentre audit was to examine rates and reasons for re-admission following hip fracture, to identify areas in the index admission and rehabilitation care that could be improved to prevent re-admission.

PATIENTS AND METHODS

A total of 535 patients (> 65 years old) in two district general hospitals in the UK who underwent hip fracture surgery were recruited into the study.

RESULTS

Of the study cohort, 72 patients (13.5%) died during their index admission and 88 (19.0%) of 463 patients were re-admitted once within 3 months. Causes of re-admission were attributed to medical (54.8%), failure to rehabilitate (23.8%), orthopaedic (19.0%) and surgical (2.4%) reasons. Infection was the most common (31.0%) reason for re-admission and arguably the most treatable. During the 3-month postoperative period, the mortality rate was 21.3%, increasing in those re-admitted to 35.1% representing the frailty of this group of patients.

CONCLUSIONS

High rates of re-admission are seen following discharge in elderly patients with hip fractures. Re-admitted patients have high mortality rates. Understanding causes of re-admission may help to reduce this burden.
Laparoscopic Appendicectomy: Calculating the Cost
Authors: Needham PJ , Laughlan KA , Botterill ID , Ambrose NS
Published: October 2009

INTRODUCTION

Laparoscopic appendicectomy is a commonly performed procedure presenting a considerable cost burden. Given the additional operative costs of laparoscopic versus open appendicectomy, it is not clear whether the national tariffs are appropriate for laparoscopic appendicectomy. We conducted a study to establish the institutional costs, and to determine whether re-imbursement according to the national tariffs was sufficient.

PATIENTS AND METHODS

Data were collected prospectively on patients undergoing laparoscopic appendicectomy within Leeds Teaching Hospitals Trust. Theatre and bed costs were obtained. Cost analysis was performed, and costs were compared to the re-imbursement due.

RESULTS

Fifty laparoscopic appendicectomies were performed. Median operative time was 60 min. The median total operative cost of laparoscopic appendicectomy was £906. Median equipment cost for laparoscopically completed cases was £254. Median total in-patient cost was £1617 (range, £880–£3360). This compared with a mean re-imbursement of £1981 representing a cost benefit of £233 per case (P = 0.0009).

CONCLUSIONS

Despite a liberal use of disposable equipment, laparoscopic appendicectomy can still be performed within the confines of the national tariffs. There is a considerable variation in the cost of this procedure, and it may be possible to reduce costs by more stringent use of disposable equipment and standardising recovery protocols.
Improving Osteoporosis Assessment in the Fracture Clinic
Authors: Charalambous CP , Mosey C , Johnstone E , Akimau P , Gullett TK , Siddique I , Wilkes RA
Published: October 2009

INTRODUCTION

The aim of this study was to compare the effectiveness of different ways of referring patients to an osteoporosis assessment service at an orthopaedic fracture clinic of a hospital in the UK.

PATIENTS AND METHODS

Three methods of identifying and referring to an osteoporosis assessment service were evaluated.

RESULTS

Relying on doctors for such a referral gave a catchment rate of only 1.6%. Involving patients themselves, asking them to self-refer, increased the catchment rate to 63% (P < 0.0001). Having a specialist osteoporosis and fracture liaison nurse present in clinic and reviewing the notes of patients checking in, to see if they match criteria for osteoporosis assessment, further increased catchment to 77% (P = 0.036).

CONCLUSIONS

Simply having an osteoporosis assessment service and strict criteria to identify which patients should be referred to such a service will not necessarily increase catchment rate for osteoporosis patients. A nurse physically present in the clinic provided the best result, and supports the need of investing in an osteoporosis and fracture liaison nurse.
‘Nephrostomy-Free’ Percutaneous Nephrolithotomy: Experience in a UK District General Hospital
Authors: Yates DR , Safdar RK , Spencer PA , Parys BT
Published: October 2009

INTRODUCTION

Percutaneous nephrolithotomy (PCNL) is the first-line treatment for large and complex renal calculi. Accepted UK practice is to insert a nephrostomy tube at the end of the procedure to drain the kidney and reduce potential complications. ‘Tubeless’ or ‘nephrostomy-free’ PCNL has been advocated in selected patients as it is thought to reduce length of hospital stay, analgesia requirements and pain experienced. We present our outcomes of a consecutive series (n = 101) of ‘nephrostomy-free’ PCNLs compared to standard PCNL over a 4-year period.

PATIENTS AND METHODS

Between January 2004 and October 2006, we performed 55 standard (with nephrostomy tube) PCNLs (Group 1). From October 2006 onwards, we changed our technique and have performed 46 consecutive ‘nephrostomy-free’ PCNLs (JJ stent inserted), independent of patient and stone factors (Group 2). We have compared the two groups in terms of length of hospital stay (LOS), analgesia requirements, transfusion rates, haemoglobin (Hb) decrease and immediate, early and late complications.

RESULTS

‘Nephrostomy-free’ PCNL significantly reduced the length of hospital stay (2.8 vs 5.1 days; P < 0.001), morphine-based analgesia requirements (23% no morphine required vs 2.8%; P < 0.001), transfusion rate (2.5% vs 7%; P < 0.01) and mean Hb decrease (1.89 g/dl vs 2.25 g/dl; P > 0.05). Overall, no patient experienced a serious complication. All attempted ‘nephrostomy-free’ PCNLs were completed (stone clearance 95%) and no patient needed an unplanned nephrostomy. Only 5% in Group 2 needed their ureteric JJ stent removing earlier than planned secondary to pain. Both groups were comparable in terms of immediate, early and late complications, though three patients in Group 1 developed chronic loin pain and one patient in the ‘nephrostomy-free’ group developed a delayed perirenal haematoma.

CONCLUSIONS

‘Nephrostomy-free’ percutaneous nephrolithotomy is a safe, effective and feasible procedure independent of patient and stone factors. It decreases the length of hospital stay, the pain experienced and the need for morphine-based analgesia; we feel it should be the standard of care for patients undergoing a PCNL.
The Use of Examination Under Anaesthesia and Panendoscopy in Patients Presenting with Oral Cavity and Oropharyngeal Squamous Cell Carcinoma
Authors: Kerawala Cyrus J , Bisase Brian , Lee Jon
Published: October 2009

INTRODUCTION

Although examination under anaesthesia and panendoscopy (EUAP) has traditionally been used in the assessment of patients presenting with oral cavity and oropharyngeal squamous cell carcinoma (SCC), the era of modern medicine with its advanced imaging techniques has meant that the indications for this technique have potentially reduced.

SUBJECTS AND METHODS

In an attempt to quantify the current use of EUAP in the UK, a structured telephone questionnaire was undertaken of 50 maxillofacial units. Information was gathered regarding whether the technique was adopted on a routine or selective basis. Likewise perceived disadvantages were sought.

RESULTS

Twenty-two units (44%) carried out EUAP on all patients presenting with oral cavity and oropharyngeal SCC. Of the remaining 28 units, all employed EUAP on a selective basis, the most commonly for the assessment of the primary tumour. The most common perceived disadvantage of carrying out EUAP routinely was its potential to increase the waiting time to definitive treatment.

CONCLUSIONS

These results suggest a gradual move towards the selective use of EUAP in patients presenting with oral cavity and oropharyngeal SCC.
National Comparative Audit of Blood Use in Elective Primary Unilateral Total Hip Replacement Surgery in the UK
Authors: Boralessa H , Goldhill DR , Tucker K , Mortimer AJ , Grant-Casey J
Published: October 2009

INTRODUCTION

Blood is a scarce and expensive product. Although it may be life-saving, in recent years there has been an increased emphasis on the potential hazards of transfusion as well as evidence supporting the use of lower transfusion thresholds. Orthopaedic surgery accounts for some 10% of transfused red blood cells and evidence suggests that there is considerable variation in transfusion practice.

PATIENTS AND METHODS

NHS Blood and Transplant, in collaboration with the Royal College of Physicians, undertook a national audit on transfusion practice. Each hospital was asked to provide information relating to 40 consecutive patients undergoing elective, primary unilateral total hip replacement surgery. The results were compared to indicators and standards.

RESULTS

Information was analysed relating to 7465 operations performed in 223 hospitals. Almost all hospitals had a system for referring abnormal pre-operative blood results to a doctor and 73% performed a group-and-save rather than a cross-match before surgery. Of hospitals, 47% had a transfusion policy. In 73%, the policy recommended a transfusion threshold at a haemoglobin concentration of 8 g/dl or less. There was a wide variation in transfusion rate among hospitals. Of patients, 15% had a haemoglobin concentration less than 12 g/dl recorded in the 28 days before surgery and 57% of these patients were transfused compared to 20% with higher pre-operative values. Of those who were transfused, 7% were given a single unit and 67% two units. Of patients transfused two or more units during days 1–14 after surgery, 65% had a post transfusion haemoglobin concentration of 10 g/dl or more.

CONCLUSIONS

Pre-operative anaemia, lack of availability of transfusion protocols and use of different thresholds for transfusion may have contributed to the wide variation in transfusion rate. Effective measures to identify and correct pre-operative anaemia may decrease the need for transfusion. A consistent, evidence-based, transfusion threshold should be used and transfusion of more than one unit should only be given if essential to maintain haemoglobin concentrations above this threshold.
The Norman Capener Travelling Fellowship in complex spinal oncological surgery
Authors: Quraishi Nasir A
Published: October 2009

I had been working as a consultant spine surgeon in Oxford (Nuffield Orthopaedic Centre and the John Radcliffe Hospitals) for approximately one year when I was given the opportunity to lead the spinal oncology department at the internationally known AOSpine centre of excellence in England, the Queens Medical Centre, Nottingham. Before starting my new post, I decided to embark on a travelling fellowship in complex spinal oncological surgery under the leadership of Professor Ziya Gokaslan at the Johns Hopkins Hospital, Baltimore, which is the number one ranked hospital in the US.
Educating surgeons in a 48-hour week: time to change mindset
Authors: Jefferis Tony , Snelling James , Collins John , de Cossart Linda
Published: October 2009

In this article the authors report back from a colloquium held at Balliol College, Oxford, last September. The meeting, convened by the Oxford School of Surgery, considered the challenges posed to education by the reduced hours brought in August 2009 by the European Working Time Directive (EWTD).
Organising an overseas fellowship in Australia
Authors: Arbuthnot James E , Arbuthnot Carolina D
Published: October 2009

You may be in the middle of the nightmare segment of your life that is the exit exam or you may be revelling in the well-deserved lubrications of the celebrations after passing it. You suddenly realise that the end of your training rotation is nearing. Should you stay with it to the end in the familiar, safe realms of being a senior trainee in hospitals you now know well, with supervising consultants whose idiosyncrasies you have come to understand and perhaps even emulate? Or should you go on a fellowship?
Craft specialty disciplinary tribunals: a proposed model for coloproctology
Authors: Saunders Mike
Published: October 2009

The regulation of doctors is currently very much in the spotlight, especially in the era of revalidation and recertification. Here Mike Saunders of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) outlines the setting-up, supported by the College, of a formal panel that allows specialty input into disciplinary processes, offering a possible model for other specialties to follow.
The College at the party conferences
Authors: Black John
Published: October 2009

The Royal College of Surgeons is a professional body dedicated to setting the highest possible standards for surgery. It is a charity, not a political organisation, but in furtherance of its charitable aims, namely advancing surgical standards, it can enter the political arena and I think that it is vitally important that it does. Our membership survey tells me that you approve of the College entering the national political debate and putting forward to ministers and opposition parties the views of working surgeons in England, Wales and Northern Ireland.
Faculty conference for dentists with special interests
Authors: O'Sullivan Julia
Published: October 2009

The Faculty of General Dental Practice (UK), in conjunction with the Department of Health (DH) England and the Oxford Dental Deanery, organised the Moving on conference to support and encourage commissioning of services involving dentists with special interests (DwSIs).
No more nil by mouth?
Authors: Towell Elaine
Published: October 2009

Anyone who has had surgery in hospital will be familiar with the 'nil by mouth' rule: no food or liquid for hours on end, a horribly dry mouth, a feeling of being starved half to death and wondering whether the doctors and nurses are torturing you just for fun.
Systematic review of practice‐based research on psychological therapies in routine clinic settings
Authors: Cahill Jane. , Barkham Michael. , Stiles William B.
Published: October 2009

Purpose. To review the published material on practice‐based research and to compare results with benchmarks derived from efficacy studies.

Methods. Electronic and manual searches were carried out up to and including 2008. Studies were screened for content relevance and selected according to specified inclusion criteria. Data were extracted from all studies that met criteria and were quality assessed using an adapted version of a checklist designed for the appraisal of both randomized and non‐randomized studies of health care interventions. Studies were synthesized according to (1) the type of problem being treated and (2) study design using descriptive and meta‐analytic methods where appropriate.

Results. Psychological treatment conducted in routine clinic settings is effective for a range of client problems, particularly common mental health problems (uncontrolled effect size=1.29; 95% CI=1.26–1.33, N = 10,842). When benchmarked against data from efficacy studies, practice‐based studies yielded effect sizes that fell short of the selected benchmark. In contrast, the practice‐based studies achieved the benchmark for percentage of clients meeting a stringent criterion for recovery.

Conclusions. Clients receiving treatment as normally delivered within routine practice report significant relief of symptoms. However, the result of comparisons with efficacy benchmarks is dependent on the outcome index used. Notwithstanding this, substantive factors are also likely to contribute. Therefore, in addition to attending to methodological issues, further work is required to understand the relative contribution of these factors.
Dropout from Internet‐based treatment for psychological disorders
Authors: Melville Katherine M. , Casey Leanne M. , Kavanagh David J.
Published: October 2009

Purpose. The purpose of this review was to present an in‐depth analysis of literature identifying the extent of dropout from Internet‐based treatment programmes for psychological disorders, and literature exploring the variables associated with dropout from such programmes.

Methods. A comprehensive literature search was conducted on PSYCHINFO and PUBMED with the keywords: dropouts, drop out, dropout, dropping out, attrition, premature termination, termination, non‐compliance, treatment, intervention, and program, each in combination with the key words Internet and web. A total of 19 studies published between 1990 and April 2009 and focusing on dropout from Internet‐based treatment programmes involving minimal therapist contact were identified and included in the review.

Results. Dropout ranged from 2 to 83% and a weighted average of 31% of the participants dropped out of treatment. A range of variables have been examined for their association with dropout from Internet‐based treatment programmes for psychological disorders. Despite the numerous variables explored, evidence on any specific variables that may make an individual more likely to drop out of Internet‐based treatment is currently limited.

Conclusions. This review highlights the need for more rigorous and theoretically guided research exploring the variables associated with dropping out of Internet‐based treatment for psychological disorders.
Urotensin II Immunoreactivity in the Human Circulation: Evidence for Widespread Tissue Release
Authors: Chen Yen-Hsing , Yandle Timothy G , Richards A Mark , Palmer Suetonia C
Published: October 2009

Background: The sources of secretion and clearance of plasma urotensin II (UII) in the human circulation remain uncertain and may be relevant to understanding the role of UII in human physiology and cardiovascular disease.

Methods: In 94 subjects undergoing clinically indicated cardiac catheterization, we collected blood samples from arterial and multiple venous sites to measure transorgan gradients of plasma UII immunoreactivity.

Results: Net UII release occurred (in descending order of proportional transorgan gradient) across the heart, kidney, head and neck, liver, lower limb, and pulmonary circulations (P < 0.01). Although no specific clearance site was localized, the absence of an overall subdiaphragmatic aorto-caval peptide gradient indicated that there were lower body segment sites of UII clearance as well as secretion. The proportional increase in UII immunoreactivity was significantly correlated across all sites of net peptide release within an individual (P ≤ 0.05). In univariate analyses, mixed venous UII concentrations were correlated with diagnosis of acute coronary syndrome and femoral artery oxygen tension and inversely with systolic blood pressure and body mass index. Diagnosis of acute coronary syndrome and body mass index were independent predictors of mixed venous UII immunoreactivity in multivariate analysis. No correlates of net cardiac UII release were identified.

Conclusions: UII is secreted from the heart and multiple other tissues into the circulation. Related increments in UII immunoreactivity across multiple tissue sites suggest that peptide release occurs via a shared mechanism. Increased UII immunoreactivity is observed in subjects with acute coronary syndrome.
Library of Prefabricated Locked Nucleic Acid Hydrolysis Probes Facilitates Rapid Development of Reverse-Transcription Quantitative Real-Time PCR Assays for Detection of Novel Influenza A/H1N1/09 Virus
Authors: Wenzel Jürgen J , Walch Heiko , Bollwein Markus , Niller Hans Helmut , Ankenbauer Waltraud , Mauritz Ralf , Höltke Hans-Joachim , Zepeda Héctor Manuel , Wolf Hans , Jilg Wolfgang , Reischl Udo
Published: October 2009

Background: The emergence of a novel pandemic human strain of influenza A (H1N1/09) has clearly demonstrated the need for flexible tools enabling the rapid development of new diagnostic methods.

Methods: We designed a set of reverse-transcription quantitative real-time PCR (RT-qPCR) assays based on the Universal ProbeLibrary (UPL)—a collection of 165 presynthesized, fluorescence-labeled locked nucleic acid (LNA) hydrolysis probes—specifically to detect the novel influenza A virus. We evaluated candidate primer/UPL-probe pairs with 28 novel influenza A/H1N1/09 patient samples of European and Mexican origin.

Results: Of 14 assays in the hemagglutinin (HA) and neuraminidase (NA) genes, 12 detected viral nucleic acids from diluted patient samples without need for further optimization. We characterized the diagnostic specificity of the 2 best-performing assays with a set of samples comprising various influenza virus strains of human and animal origin that showed no cross-reactivity. The diagnostic sensitivity of these 2 primer/probe combinations was in the range of 100–1000 genomic copies/mL. In comparison to a reference assay recommended by the German health authorities, the analytical sensitivities and specificities of the assays were equivalent.

Conclusions: Facing the emergence of novel influenza A/H1N1/09, we were able to develop, within 2 days, a set of sensitive and specific RT-qPCR assays for the laboratory diagnosis of suspected cases. H1N1/09 served as a model to show the feasibility of the UPL approach for the expedited development of new diagnostic assays to detect emerging pathogens.
Twin Loss: The Annual Convention / Twin Research Reviews: Childhood Empathy; Hormone Replacement Therapy and Skeletal Muscle; Multiple Birth Conception in Older Women / Twins in the Media: Twins With Kidney Disease; A Pair of Poets; The Other Twins in the Metrodome
Authors: Segal Nancy L.
Published: October 2009

Loss of a twin has been largely overlooked by bereavement counselors and clinicians. This particular type of loss is also poorly understood among the public. Consequently, some bereaved twins have established a unique organization, Twinless Twins Support Group International, for the purpose of sharing this traumatic life experience with one another. The present article reviews events from the annual convention of Twinless Twins, held in July 2009, in Denver, Colorado. Selected findings from research on twin loss are also presented. Next, twin research concerned with the origins and implications of empathy, hormone replacement therapy and multiple birth conception will be reviewed. This article concludes with summaries of real life stories of twins' kidney disease, literary talent and retirement festivities.
Analysis of the trophic role of Mediterranean seagrasses in marine coastal ecosystems: a review
Authors: Vizzini Salvatrice
Published: October 2009

Seagrasses form high-productivity coastal ecosystems, providing habitats for many organisms, including species of commercial value. They play a significant role as a direct food source for herbivores and also enter detrital food webs. In this review, the trophic ecology of Mediterranean seagrass ecosystems is revised, with major emphasis on Posidonia oceanica, the most extensively studied seagrass. The major topics are the role of herbivory and detritus, the contribution to littoral fish production, exportation to other ecosystems and the seagrass role as a vector of anthropogenic nutrients into food webs. Topics are discussed by analysing both conventional knowledge and new insights derived from the application of carbon and nitrogen stable isotope analysis. In conclusion, perspectives for future research are highlighted, with particular emphasis on areas demanding further study and on the effects of seagrass decline on trophic organisation in coastal environments.
New cross section measurements for production of the positron emitters 75Br and 76Br via intermediate energy proton induced reactions
Authors: Spahn I. , Steyn G. F. , Vermeulen C. , Kovács Zoltán , Szelecsényi Ferenc , Coenen Heinz H. , Qaim Syed M.
Published: October 2009

The radionuclides 75Br and 76Br are of considerable interest for application in Positron Emission Tomography (PET). For their production so far mostly low-energy or low-yield production processes have been employed. In this work the production of both isotopes was investigated using intermediate energy proton induced reactions and enriched target materials. Cross section data of the 77,78,80Se(p,xn)75Br processes were measured up to 66 MeV and those of the 77,78,80Se(p,xn)76Br processes up to 85 MeV. The measured excitation functions were compared with calculated results of the nuclear model code ALICE-IPPE. From the experimental excitation curves, thick target yields were calculated. They are fairly high over the investigated intermediate energy ranges. The production possibilities of 75Br and 76Br via various routes and the radionuclidic impurities associated with them are discussed.
Validity and reliability of the novel thyroid-specific quality of life questionnaire, ThyPRO
Authors: Watt Torquil , Hegedüs Laszlo , Groenvold Mogens , Bjorner Jakob Bue , Rasmussen Åse Krogh , Bonnema Steen Joop , Feldt-Rasmussen Ulla
Published: October 2009

Background

Appropriate scale validity and internal consistency reliability have recently been documented for the new thyroid-specific quality of life (QoL) patient-reported outcome (PRO) measure for benign thyroid disorders, the ThyPRO. However, before clinical use, clinical validity and test–retest reliability should be evaluated.

Aim

To investigate clinical (‘known-groups’) validity and test–retest reliability of the Danish version of the ThyPRO.

Methods

For each of the 13 ThyPRO scales, we defined groups expected to have high versus low scores (‘known-groups’). The clinical validity (known-groups validity) was evaluated by whether the ThyPRO scales could detect expected differences in a cross-sectional study of 907 thyroid patients. Test–retest reliability was evaluated by intra-class correlations of two responses to the ThyPRO 2 weeks apart in a subsample of 87 stable patients.

Results

On all 13 ThyPRO scales, we found substantial and significant differences between the groups expected to have high versus low scores. Test–retest reliability was above 0.70 (range 0.77–0.89) for all scales, which is usually considered necessary for comparisons among patient groups, but below 0.90, which is the usual threshold for use in individual patients.

Conclusion

We found support for the clinical validity of the new thyroid-specific QoL questionnaire, ThyPRO, and evidence of good test–retest reliability. The questionnaire is now ready for use in clinical studies of patients with thyroid diseases.
The Choice between Retirement and Bridge Employment: A Continuity Theory and Life Course Perspective
Authors: Von Bonsdorff Monika E. , Shultz Kenneth S. , Leskinen Esko , Tansky Judith
Published: October 2009

The rapid aging of the workforce in most developed countries, and the strengthening presence of bridge employment among older employees, has brought about a need for a deeper theoretical and practical understanding of this employment phenomenon. This study examined the concept of bridge employment from a continuity theory and life course perspective. Several personal and job-related antecedents of 539 middle-aged and older U.S. Federal Government employees' intentions of full retirement or engagement in bridge employment were investigated. A multinomial logistic regression analysis provided support for most of the hypotheses on the antecedents of full retirement and overall bridge employment intentions and hence offered several practical implications for the U.S. Federal Government, as well as other governmental employers. Implications of these results are discussed from a continuity theory and life course perspective.
Analyzing the Process of Patent Submission with a Special Emphasis on the Phases of the Research Process - the Case of Slovenia
Authors: Ruzzier Mitja , Nagy Tine , Ravnihar Robert
Published: October 2009

Analyzing the Process of Patent Submission with a Special Emphasis on the Phases of the Research Process - the Case of Slovenia

This article presents some findings about the process of patenting of Slovenian and foreign researchers in scientific research. Based on the reviewed literature and with help of our conceptual model, we establish that the patenting process can be divided into three separate phases: knowledge detection phase, knowledge dissemination phase and knowledge transfer phase. During the process of researching and patenting, a variety of factors affect the results, which can be divided into two groups: internal and external factors. In Slovenia, patents are statistically significant for researchers working and exploring in the fields of natural science and engineering. Research results in the form of a patent largely depend on financial support and work experiences of individual researchers or research groups. The commercialization of a patent means a successful ending of the research process, as many positive benefits are expected.
An Overview of Models for Assessment of Organization Virtuality
Authors: Veber Peter
Published: October 2009

An Overview of Models for Assessment of Organization Virtuality

A virtual organization is a network of legally independent organizations and/or individuals that produce products and/or services based on a common business understanding. This new organization structure is posited as radical departure from the traditional, hierarchic, bureaucratic and co-located mode of organizing that dominated the twentieth century. In contrast, the characteristics of the new, virtual organization forms are seen to be dynamic, networked, distributed, digital, flexible, collaborative and innovative. The challenge, however, is to determine which organization as a subject employs virtual form and which not. The answer to this question is decidedly complex as most organizations have forms that are somewhere in between; therefore, it is usually only possible to determine how virtual one organization is on certain aspects. In the other words: what is the level of its virtuality? Several models for the assessment of organization virtuality have been developed by many different authors. The purpose of this paper is to investigate and present all the published models of virtual organization that are publicly available in the world literature. The strengths and weaknesses of all models found are presented, together with their mutual relations.