bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhibitory effects of marine‐derived DNA‐binding anti‐tumour tetrahydroisoquinolines on the Fanconi anaemia pathway
Authors: Martínez Sandra , Pérez Laura , Galmarini Carlos M , Aracil Miguel , Tercero Juan C , Gago Federico , Albella Beatriz , Bueren Juan A
Published: August 2013

Background and Purpose

We have previously shown that cells with a defective Fanconi anaemia (FA) pathway are hypersensitive to trabectedin, a DNA‐binding anti‐cancer tetrahydroisoquinoline (DBAT) whose adducts functionally mimic a DNA inter‐strand cross link (ICL). Here we expand these observations to new DBATs and investigate whether our findings in primary untransformed cells can be reproduced in human cancer cells.

Experimental Approach

Initially, the sensitivity of transformed and untransformed cells, deficient or not in one component of the FA pathway, to mitomycin C (MMC) and three DBATs, trabectedin, Zalypsis and PM01183, was assessed. Then, the functional interaction of these drugs with the FA pathway was comparatively investigated.

Key Results

While untransformed FA‐deficient haematopoietic cells were hypersensitive to both MMC and DBATs, the response of FA‐deficient squamous cell carcinoma (SCC) cells to DBATs was similar to that of their respective FA‐competent counterparts, even though these FA‐deficient SCC cells were hypersensitive to MMC. Furthermore, while MMC always activated the FA pathway, the DBATs inhibited the FA pathway in the cancer cell lines tested and this enhanced their response to MMC.

Conclusions and Implications

Our data show that although DBATs functionally interact with DNA as do agents that generate classical ICL, these drugs should be considered as FA pathway inhibitors rather than activators. Moreover, this effect was most significant in a variety of cancer cells. These inhibitory effects of DBATs on the FA pathway could be exploited clinically with the aim of ‘fanconizing’ cancer cells in order to make them more sensitive to other anti‐tumour drugs.
Headache and pituitary disease: a systematic review
Authors: Kreitschmann‐Andermahr I. , Siegel S. , Weber Carneiro R. , Maubach J. M. , Harbeck B. , Brabant G.
Published: August 2013

Headache is very common in pituitary disease and is reported to be present in more than a third of all patients with pituitary adenomas. Tumour size, cavernous sinus invasion, traction or displacement of intracranial pain‐sensitive structures such as blood vessels, cranial nerves and dura mater, and hormonal hypersecretion are implicated causes. The present review attempts to systematically review the literature for any combination of headache and pituitary or hormone overproduction or deficiency. Most data available are retrospective and/or not based on the International Headache Society (IHS) classification. Whereas in pituitary apoplexy a mechanical component explains the almost universal association of the condition with headaches, this correlation is less clear in other forms of pituitary disease and a positive impact of surgery on headaches is not guaranteed. Similarly, invasion into the cavernous sinus or local inflammatory changes have been linked to headaches without convincing evidence. Some studies suggest that oversecretion of GH and prolactin may be important for the development of headaches, and treatment, particularly with somatostatin analogues, has been shown to improve symptoms in these patients. Otherwise, treatment rests on general treatment options for headaches based on an accurate clinical history and a precise classification which includes assessment of the patient's psychosocial risk factors.
Patients' preferences when comparing analogue implant impressions using a polyether impression material versus digital impressions (Intraoral Scan) of dental implants
Authors: Wismeijer Daniel , Mans Ronny , van Genuchten Michiel , Reijers Hajo A.
Published: August 2013

Objectives

The primary objective of this clinical study was to assess the patients' perception of the difference between an analogue impression approach on the one hand and an intra‐oral scan (IO scan) on the other when restoring implants in the non‐aesthetic zone. A second objective was to analyse the difference in time needed to perform these two procedures.

Materials and methods

Thirty consecutive patients who had received 41 implants (Straumann tissue level) in the non‐aesthetic zone in an implant‐based referral practice setting in the Netherlands. As they were to receive crown and or bridge work on the implants, in one session, the final impressions were taken with both an analogue technique and with an intraoral scan. Patients were also asked if, directly after the treatment was carried out, they would be prepared to fill out a questionnaire on their perception of both techniques. The time involved following these two procedures was also recorded.

Results

The preparatory activities of the treatment, the taste of the impression material and the overall preference of the patients were significantly in favour of the IO scan. The bite registration, the scan head and gag reflex positively tended to the IO scan, but none of these effects were significant. The overall time involved with the IO scan was more negatively perceived than the analogue impression. Overall less time was involved when following the analogue impression technique than with the IO scan.

Conclusions

The overall preference of the patients in our sample is significantly in favour of the approach using the IO scan. This preference relates mainly to the differences between the compared approaches with respect to taste effects and their preparatory activities. The patients did perceive the duration of IO scan more negatively than the analogue impression approach.
‘Voluntary’ Poverty Alleviation Resettlement in China
Authors: Xue Longyi , Wang Mark Y. , Xue Tao
Published: August 2013

Current conceptualizations of resettlement in China as either voluntary or involuntary are too rigid. New guidelines and policies, particularly around Poverty Alleviation Resettlement (PAR), are emphasizing the importance of voluntarism. Little is known, however, about how the principle of voluntary relocation of villagers has actually been implemented. This study explores this process by examining local implementation and experiences of PAR in Linfen Prefecture, Shanxi. It introduces China's nationwide PAR programme, and then identifies the spatial and temporal characteristics of PAR in Linfen from 1997 to 2010, highlighting the factors that contribute to widespread voluntary resettlement.
Transcutaneous monitoring of partial pressure of carbon dioxide during endoscopic retrograde cholangiopancreatography using a double‐balloon endoscope with carbon dioxide insufflation under conscious sedation
Authors: Miyoshi Hideaki , Shimatani Masaaki , Kato Kota , Sumimoto Kimi , Kurishima Akiko , Kusuda Takeo , Fukata Norimasa , Ikeura Tsukasa , Takaoka Makoto , Okazaki Kazuichi
Published: August 2013

Background and Aim

A double‐balloon (DB) endoscope can be selectively inserted into the afferent loop to carry out endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgically altered anatomy, allowing various types of endoscopic treatments for pancreaticobiliary diseases to be successfully carried out. In order to make such a lengthy procedure more comfortable and safe, sedatives and carbon dioxide (CO2) insufflation are widely used for gastrointestinal endoscopy. However, these techniques can increase the risk of CO2 retention. Recently, a new sensor for transcutaneous measurement of partial pressure of carbon dioxide (PCO2) has been introduced. The aim of the present study was to evaluate the changes in transcutaneous PCO2 (PtcCO2) during DB‐ERCP with CO2 insufflation under conscious sedation and assess any complications related to sedation and CO2 insufflation.

Methods

A total of 312 patients underwent DB‐ERCP with CO2 insufflation at our hospital between March 2009 and December 2012. The patients were moderately sedated using midazolamwith or without pentazocine. PtcCO2 was measured by a non‐invasive sensor throughout DB‐ERCP in all patients.

Results

The mean peak PtcCO2 during the procedure was significantly higher than the mean PtcCO2 value before and after DB‐ERCP. Body mass index, procedure time and dose of pentazocine were significantly higher in the CO2 retention group (peak PtcCO2 ≥ 50 mmHg). CO2 narcosis was observed in one case.

Conclusions

DB‐ERCP with CO2 insufflation under conscious sedation might have the potential to increase the risk of CO2 retention. Hence, non‐invasive and continuous PtcCO2 measurement is useful for early detection of hypercapnia.
The Role of Paternity Presumption and Custodial Rights for Understanding Marriage Patterns
Authors: Edlund Lena
Published: August 2013

In marriage, men obtain and women surrender parental rights because: (i) by default, an unmarried woman giving birth is the child's only known parent and sole custodian; (ii) a married mother shares custody with her husband and the presumed father; (iii) custody allocation in marriage is fixed; (iv) private contracts on rights over children amount to trade in children and have limited legal validity. As a result: (i) women, not men, marry up; (ii) higher income has opposite effects on men's and women's willingness to marry; (iii) out‐of‐wedlock fertility results when trade is not feasible.
Cardiac hormones target nuclear oncogenes c‐Fos and c‐Jun in carcinoma cells
Authors: Manimala Neil J. , Frost Chelsea D. , Lane Meghan L. , Higuera Mariana , Beg Rana , Vesely David L.
Published: August 2013

Background

c‐Fos is a cellular proto‐oncogene which dimerizes with c‐Jun proto‐oncogene to form AP‐1 transcription factor, which upregulates transcription of genes involved in proliferation and cancer formation. Four cardiac hormones, that is, long‐acting natriuretic peptide (LANP), vessel dilator, kaliuretic peptide (KP) and atrial natriuretic peptide (ANP) with anticancer effects in vivo are potent inhibitors of the Ras‐MEK 1/2‐ERK 1/2 kinase cascade and signal transducer and activator of transcription‐3 (STAT‐3) that activate c‐Fos and c‐Jun. These four cardiac hormones were investigated for their effects on proto‐oncogenes c‐Fos and c‐Jun within the nucleus of cancer cells.

Materials and methods

Four cardiac hormones were evaluated for their ability to decrease proto‐oncogenes c‐Fos and c‐Jun, measured by ELISA in extracted nuclei of three human cancer cell lines.

Results

Vessel dilator, LANP, KP and ANP over a concentration range of 100 pM–10 μM, maximally decreased c‐Fos by 61%, 60%, 61% and 59% in human hepatocellular cancer cells, by 82%, 74%, 78% and 74% in small‐cell lung cancer cells, and by 82%, 73%, 78% and 74% in human renal adenocarcinoma cells. c‐Jun was maximally reduced by vessel dilator, LANP, KP and ANP by 43%, 31%, 61% and 35% in hepatocellular cancer cells, by 65%, 49%, 59% and 40% in small‐cell lung cancer cells, and by 47%, 43%, 57% and 49% in renal cancer cells.

Conclusion

Four cardiac hormones are potent inhibitors of c‐Fos and c‐Jun proto‐oncogenes within the nucleus of cancer cells.
Impaired slow axonal transport in diabetic peripheral nerve is independent of RAGE
Authors: Juranek Judyta K. , Geddis Matthew S. , Rosario Rosa , Schmidt Ann Marie
Published: August 2013

Diabetic peripheral nerve dysfunction is a common complication occurring in 30–50% of long‐term diabetic patients. The pathogenesis of this dysfunction remains unclear but growing evidence suggests that it might be attributed, in part, to alteration in axonal transport. Our previous studies demonstrated that RAGE (Receptor for Advanced Glycation Endproducts) contributes to the pathogenesis of diabetic peripheral neuropathy and impairs nerve regeneration consequent to sciatic nerve crush, particularly in diabetes. We hypothesize that RAGE plays a role in axonal transport impairment via the interaction of its cytoplasmic domain with mammalian Diaphanous 1 (mDia1) – actin interacting molecule. Studies showed that mDia1–RAGE interaction is necessary for RAGE‐ligand‐dependent cellular migration, AKT phosphorylation, macrophage inflammatory response and smooth muscle migration. Here, we studied RAGE, mDia1 and markers of axonal transport rates in the peripheral nerves of wild‐type C57BL/6 and RAGE null control and streptozotocin‐injected diabetic mice at 1, 3 and 6 h after sciatic nerve crush. The results show that in both control and diabetic nerves, the amount of RAGE accumulated at the proximal and distal side of the crush area is similar, indicating that the recycling rate for RAGE is very high and that it is evenly transported from and towards the neuronal cell body. Furthermore, we show that slow axonal transport of proteins such as Neurofilament is affected by diabetes in a RAGE‐independent manner. Finally, our study demonstrates that mDia1 axonal transport is impaired in diabetes, suggesting that diabetes‐related changes affecting actin binding proteins occur early in the course of the disease.
Energy‐efficient encoding by shifting spikes in neocortical neurons
Authors: Malyshev Aleksey , Tchumatchenko Tatjana , Volgushev Stanislav , Volgushev Maxim
Published: August 2013

The speed of computations in neocortical networks critically depends on the ability of populations of spiking neurons to rapidly detect subtle changes in the input and translate them into firing rate changes. However, high sensitivity to perturbations may lead to explosion of noise and increased energy consumption. Can neuronal networks reconcile the requirements for high sensitivity, operation in a low‐noise regime, and constrained energy consumption? Using intracellular recordings in slices from the rat visual cortex, we show that layer 2/3 pyramidal neurons are highly sensitive to minor input perturbations. They can change their population firing rate in response to small artificial excitatory postsynaptic currents (aEPSCs) immersed in fluctuating noise very quickly, within 2–2.5 ms. These quick responses were mediated by the generation of new, additional action potentials (APs), but also by shifting spikes into the response peak. In that latter case, the spike count increase during the peak and the decrease after the peak cancelled each other, thus producing quick responses without increases in total spike count and associated energy costs. The contribution of spikes from one or the other source depended on the aEPSCs timing relative to the waves of depolarization produced by ongoing activity. Neurons responded by shifting spikes to aEPSCs arriving at the beginning of a depolarization wave, but generated additional spikes in response to aEPSCs arriving towards the end of a wave. We conclude that neuronal networks can combine high sensitivity to perturbations and operation in a low‐noise regime. Moreover, certain patterns of ongoing activity favor this combination and energy‐efficient computations.
Regional increase of cerebral cortex thickness in juvenile myoclonic epilepsy
Authors: Alhusaini Saud , Ronan Lisa , Scanlon Cathy , Whelan Christopher D. , Doherty Colin P. , Delanty Norman , Fitzsimons Mary
Published: August 2013

The goal of this study was to characterize cerebral cortex thickness patterns in juvenile myoclonic epilepsy (JME). Surface‐based morphometry (SBM) was applied to process brain magnetic resonance images acquired from 24 patients with JME and 40 healthy controls and quantify cerebral cortex thickness. Differences in cortical thickness between patients and controls were determined using generalized linear model (covariates: age and gender). In patients with JME, thickness increase was detected bilaterally within localized regions in the orbitofrontal and mesial frontal cortices. Such thickness patterns coexisted with significant bilateral reduction in thalamic volume. These findings confirm that the underlying mechanisms in JME are related to aberrant corticothalamic structure and indicate that frontal cortex abnormalities are possibly linked to regional increase in cerebral cortical thickness.
Diphenhydramine produces local cutaneous analgesia in response to dorsal skin noxious stimuli in the rat
Authors: Chen Yu‐Wen , Tzeng Jann‐Inn , Chen Ting‐Yun , Wang Jhi‐Joung , Chen Yu‐Chung , Hung Ching‐Hsia
Published: August 2013

Although diphenhydramine has been shown to produce longer duration of spinal block than lidocaine, few studies disclose its skin infiltrative anesthesia when compared with a long‐lasting local anesthetic, bupivacaine. The purpose of this study was to investigate whether diphenhydramine elicited cutaneous analgesia in comparison with bupivacaine. After inhibition of cutaneous trunci muscle reflex via subcutaneous injection of drugs in rats, we examined the local anesthetic effect of diphenhydramine and bupivacaine as infiltrative cutaneous analgesia in a dose‐dependent fashion. We showed that diphenhydramine, as well as bupivacaine displayed a dose‐dependent cutaneous analgesia in response to dorsal cutaneous noxious stimuli. The relative potency (50% effective dose) was bupivacaine (0.023 [0.013–0.035]%) > diphenhydramine (0.078 [0.068–0.091]%; P < 0.001). On an equipotent basis, diphenhydramine had a similar duration of action to bupivacaine. Neither local injection of saline nor intraperitoneal administration of a large dose of diphenhydramine or bupivacaine produced cutaneous analgesia (data not shown). We conclude that diphenhydramine is less potent than bupivacaine at producing cutaneous analgesia. At equipotent doses for infiltrative cutaneous analgesia, the duration of action of diphenhydramine is equal to that of bupivacaine.
An investigation on rotatory bending fretting fatigue damage of railway axles
Authors: Song C. , Shen M. X. , Lin X. F. , Liu D. W. , Zhu M. H.
Published: August 2013

Fretting damage failure analysis of a Chinese carbon railway axle RD2 was carried out. The wheel hub was in situ cut to expose the damaged surface of the wheel seat to avoid additional damage. A small‐scale axle test rig was developed, and simulation tests were performed at different rotator speeds of 1800 and 2100 rpm. The wear mechanism of fretting damage areas was a combination of abrasive wear, oxidative wear and delamination. The fracture surfaces exhibited characterization of multisource and step‐profile. The fretting fatigue crack initiated at the subsurface and propagated along an inclined angle at the first stage. The fretting damage at the higher speed was more severe compared with the lower speed, which lead to a relatively shorter fatigue life. The damage morphologies of the axle in the simulation tests were in good agreement with that observed in the failure analysis on real axle.
Creation of arteriovenous fistulae for hemodialysis in octogenarians
Authors: Watorek Ewa , Golebiowski Tomasz , Kusztal Mariusz , Letachowicz Krzysztof , Letachowicz Waldemar , Augustyniak Bartosik Hanna , Garcarek Jerzy , Madziarska Katarzyna , Weyde Wacław , Klinger Marian
Published: August 2013

Elderly patients, defined as octogenarians and nonagenarians, are an increasing population entering renal replacement therapy. Advanced age appears as an exclusive factor negatively influencing dialysis practice. Elderly patients are referred late for the initiation of hemodialysis and more likely are offered catheters rather than arteriovenous fistulae (AVF), which increase mortality and negatively affect quality of life. We present our approach to the creation of vascular access for hemodialysis in this demanding population. In 2006–2012, 39 patients aged 85.9 ± 2.05 with end‐stage renal disease, mainly resulting from ischemic nephropathy, were admitted to the Department of Nephrology to establish permanent vascular access for hemodialysis: preferably AVF. Temporary dialysis catheters were implanted in uremic emergency to bridge the time to fistula creation/maturation. AVF was attempted in 87.2% of the patients. Primary AVF function was achieved in 54% of the patients. Cumulative proportional survival of AVF at months 12 and 24 was 81.5%. Ninety‐four percent of AVF were localized on the forearm: 74% in the distal and 20% in the proximal part. Mean duration of hemodialysis therapy was 20.80 ± 19.45 months. The mean time of AVF use was 15.9 ± 20.2 months. Until present, 38% have been dialyzed using AVF for 31.0 ± 18.8 months. Five patients died with functioning fistula. Eight patients initiated hemodialysis therapy with fistula. During further observation, the use of AVF increased to 62%. Elderly patients should not be denied creation of AVF as a rule. The outcome of AVF benefits more from acknowledging individual vascular conditions rather than age of the patient.
Discrimination of fibrotic staging of chronic hepatitis C using multiple fibrotic markers
Authors: Ikeda Kenji , Izumi Namiki , Tanaka Eiji , Yotsuyanagi Hiroshi , Takahashi Yoshihisa , Fukushima Junichi , Kondo Fukuo , Fukusato Toshio , Koike Kazuhiko , Hayashi Norio , Tsubouchi Hirohito , Kumada Hiromitsu
Published: August 2013

Aim

In order to evaluate and judge a fibrotic stage of patients with chronic hepatitis C, multivariate regression analysis was performed using multiple fibrotic markers.

Methods

A total of 581 patients from eight hepatology units and institutes were diagnosed by needle biopsy as having chronic liver disease caused by hepatitis C virus. Twenty‐three variables and their natural logarithmic transformation were employed in the multivariate analysis.

Results

Multivariate regression analysis finally obtained the following function: z = 2.89 × ln (type IV collagen 7S) (ng/mL) − 0.011 × (platelet count) (×103/mm3) + 0.79 × ln (total bilirubin) (mg/dL) + 0.39 × ln (hyaluronic acid) (μg/L) − 1.87. Median values of the fibrotic score of F1 (n = 172), F2 (n = 80), F3 (n = 37) and F4 (n = 16) were calculated as 1.00, 1.45, 2.82 and 3.83, respectively. Multiple regression coefficient and coefficient of determination were 0.56 and 0.320, respectively. Validation with patient data from other institutions demonstrated good reproducibility of the fibrotic score for hepatitis C (FSC), showing 1.10 in F1 (n = 156), 2.35 in F2 (n = 73), 3.16 in F3 (n = 36) and 3.58 in F4 (n = 11).

Conclusion

A concise multiple regression function using four laboratory parameters successfully predicted pathological fibrotic stage of patients with hepatitis C virus infection.
Concurrent partial splenic embolization with transcatheter arterial chemoembolization for hepatocellular carcinoma can maintain hepatic functional reserve
Authors: Ishikawa Toru , Kubota Tomoyuki , Horigome Ryoko , Kimura Naruhiro , Honda Hiroki , Iwanaga Akito , Seki Keiichi , Honma Terasu , Yoshida Toshiaki
Published: August 2013

Aim

Hepatocellular carcinoma (HCC) is frequently complicated with cirrhosis, and it is not unusual for treatment options to be limited as a result of pancytopenia due to hypersplenism. Partial splenic embolization (PSE) has been performed for thrombocytopenia resulting from hypersplenism. We studied the efficacy in terms of hepatic functional reserve and safety in patients who underwent concurrent transcatheter arterial chemoembolization (TACE) with PSE for HCC.

Methods

The study population consisted of 101 HCC patients with thrombocytopenia. Fifty‐three patients were treated with concurrent TACE/PSE (PSE group), and the remaining 48 TACE patients without PSE (non‐PSE group) were investigated hepatic functional reserve.

Results

Platelet counts were significantly higher in the PSE group after 2 weeks, 2 months and 6 months after TACE than the non‐PSE group. Child–Pugh score significantly deteriorated from 7.13 ± 1.16 to 7.60 ± 1.20 at 2 weeks, to 7.71 ± 1.25 at 2 months, and 7.71 ± 1.35 at 6 weeks after TACE in the non‐PSE group. Hence, it worsened from 7.04 ± 1.05 to 7.21 ± 0.99 at 2 weeks temporally, but improved to 7.00 ± 1.17 after 2 months and 6.70 ± 1.16 at 6 weeks after TACE in the PSE group.

Conclusion

Thrombocytopenia has been improved and treatment continued using concurrent PSE. In addition, hepatic functional reserve could be maintained even after treatment for HCC. Concurrent TACE and PSE for HCC with thrombocytopenia can be expected to help maintain hepatic reserve, and may contribute to improving the prognosis of HCC.
Poor Laws: A Historiography of Vagrancy in Australia
Authors: Kimber Julie
Published: August 2013

The study of vagrancy forms part of a larger investigation into the social origins of law, the structures of inequality and the gendered and racially discriminatory aspects of societies. A full analysis of vagrancy in Australia must necessarily begin with the inherited traditions of its colonial master, its convict origins and the defensive nature of European settlement. While the former provided the moral and legal framework, the latter played a longer and more influential role in establishing the interventionist nature of government in Australia. Despite sharing significant commonalities with the British, Australia's vagrancy laws differed in their application in important ways. As with other colonial regimes, most notably the United States and South Africa, vagrancy laws provided authorities with broad powers, which enabled them to punish vice and to impose social order on the structures of inequality in class, race and gender.
One stop nurse‐led macroscopic haematuria clinic: waiting times and patient satisfaction
Authors: Osborne Sue , Koya Madhusudan
Published: August 2013

In 2011, a large District Health Board Hospital in New Zealand established a nurse practitioner‐led, one stop macroscopic haematuria clinic (OSMC) in an effort to improve the timeliness and quality of the investigative process offered to individuals referred with macroscopic haematuria. Patients were identified during the referrals triage process and graded to be seen at OSMC within 30 d. The OSMC process allows for completion of all basic investigations (urine microscopy and culture, urine cytology, renal tract ultrasound and flexible cystoscopy) by the end of the single clinic visit. This report outlines the OSMC process and reports on adherence to the 30‐d timeframe for the first 100 patients, along with patient satisfaction data from patients 51 to 100. The dates of referral and OSMC visits were recorded prospectively for 100 patients and analysed to determine compliance with the 30‐d timeframe. For patients 51–100, an anonymous, self‐administered questionnaire was utilized to evaluate satisfaction with pre‐appointment information, waiting times, interactions with clinicians and education. Of the first 100 patients at OSMC, 81% were seen within 30 d, with all patients rating the clinic timeframes, processes and personnel highly. While the reliability of the Haematuria Clinic Questionnaire results could have been influenced by multiple factors, the OSMC appears to offer service users timely access to diagnostic investigations with clinics timeframes, processes and personnel they rate highly. While 81% of patients were seen within 30 d, work is needed to increase compliance to 100%. This model of care could be adopted at other public hospitals.
Recurrent hospitalisation with pneumonia is associated with higher 1‐year mortality in frail older people
Authors: Ma H. M. , Yu R. H. Y. , Woo J.
Published: August 2013

Background

Previous studies persistently showed that functional dependence was associated with higher long‐term (≥1 year) mortality of older patients hospitalised with community‐acquired pneumonia (CAP). The importance of other factors was, however, not well reported.

Aim

This study aimed to investigate the relative contributions of comorbidity, nutritional status and frailty to 1‐year mortality.

Methods

We prospectively recruited older patients, aged ≥65 years, hospitalised with CAP from October 2009 to September 2010 at the Prince of Wales Hospital, Hong Kong. Demographics, Charlson's Comorbidity Index, mid‐arm circumference (MAC) and Clinical Frailty Scale (CFS) were recorded as baseline characteristics. The severity of pneumonia was evaluated by the CURB score (confusion, blood urea nitrogen, respiratory rate and low blood pressure). The surviving patients were followed for 1 year since discharge to monitor readmission for CAP and all‐cause mortality. We entered the following variables into the multivariate Cox regression model to identify independent predictors of 1‐year all‐cause mortality: age, sex, residential status, MAC, Charlson's Comorbidity Index, CFS and readmission for CAP.

Results

The final cohort consisted of 428 patients who were discharged from hospital. Within 1 year after hospital discharge, all‐cause mortality and readmission for CAP were 22.4% and 32.0% respectively. Independent predictors of 1‐year mortality were male sex (hazard ratio (HR) = 1.57, 95% confidence interval (CI) = 1.02–2.48), severe under‐nutrition (MAC ≤21 cm) (HR = 3.75, 95% CI = 1.66–8.46), frailty (CFS ≥5) (HR = 2.36, 95% CI = 1.29–4.27) and readmission for CAP (HR = 4.50, 95% CI = 2.82–7.17).

Conclusions

Recurrent pneumonia may be a terminal life event of frail older people so that advance care planning should be considered in those with recurrent admission for pneumonia.
Does subjective evaluation of the frequency of salty food intake predict the risk of incident hypertension? A 4‐year follow‐up study in a middle‐aged population
Authors: Otsuka T. , Kato K. , Ibuki C. , Kodani E. , Kusama Y. , Kawada T.
Published: August 2013

Background

Excess salt intake increases blood pressure (BP). Identifying individuals with excess salt intake is, therefore, important for the prevention of hypertension.

Aim

To examine the predictive value of subjective evaluation of salty foods intake for the risk of incident hypertension in a middle‐aged population.

Methods

A total of 970 non‐hypertensive workers (mean age, 44 ± 6 years) was followed for a maximum period of 4 years, and their BP was measured annually. At baseline, all participants were asked about their subjective frequency of salty foods intake (seldom, sometimes or always), and they were divided into three groups according to their answers. Hypertension was defined as systolic/diastolic BP ≥ 140/90 mmHg or use of antihypertensive medications.

Results

There were no significant differences in the 4‐year cumulative incident rate of hypertension among the ‘seldom’, ‘sometimes’ and ‘always’ groups (15.8%, 14.3% and 10.3%, respectively, log–rank test P = 0.44). In a multivariate Cox proportional hazards model, age, body mass index and the baseline BP category were independent predictors for developing hypertension, whereas the frequency of salty foods intake was not a predictor (adjusted hazard ratio (95% confidence interval), 0.99 (0.64–1.54) in the ‘sometimes’ group and 0.64 (0.33–1.28) in the ‘always’ group as compared with the ‘seldom’ group).

Conclusion

The subjective evaluation of salty foods intake did not predict the 4‐year risk of incident hypertension in this study population. Further investigations with a longer follow‐up period are needed to clarify whether the present insignificant results are maintained for more than 4 years.
ESTABLISHING A RESIDENTS‘ GROUP AT PERRY PARK NURSING HOME
Authors: Ramsay K. , Wright A. , Bak S.
Published: August 2013

This article describes the establishment of a small residents' group at the Perry Park Nursing Home, the purpose of which was to provide the residents with the opportunity for some say in matters affecting their lives and environment. The article discusses the major issues that became evident as the group developed, how these were dealt with and what was learned from them. The authors believe that their findings will be useful for others who plan to establish similar groups.
SOME SOCIETAL RESPONSES TO DEMENTIA IN DEVELOPED COUNTRIES
Authors: GIBSON MARY JO
Published: August 2013

In this article, the generic term dementia will be used dementia due to Alzheimer's disease, to multi‐infarct demen, cerebral infarction, and to other dementias of rarer types. A. the term usually also encompasses potentially reversible dem, as. the focus in this article is on the non‐reversible dementias. For stylistic and space reasons. “dementia” will be used as short‐hand for what should properly be referred to as “the dementias”.
THE SAFER CLINICAL SYSTEMS PROJECT IN RENAL CARE
Authors: Weale Andy R. ,   on behalf of the study team (Rommel Ravannan, Maria Pippias, Paul Bevis, Arlene Hill, James Bushnell, James Bayliss, Tom Jorna, Pete Hayes)
Published: August 2013

Background

Current systems in place in healthcare are designed to detect harm after it has happened (e.g critical incident reports) and make recommendations based on an assessment of that event. Safer Clinical Systems, a Health Foundation funded project, is designed to proactively search for risk within systems, rather than being reactive to harm.

Objectives

The aim of the Safer Clinical Systems project in Renal Care was to reduce the risks associated with shared care for patients who are undergoing surgery but are looked after peri‐operatively by nephrology teams on nephrology wards. This report details our findings of the diagnostic phase of Safer Clinical Systems: the proactive search for risk.

Methods

We have evaluated the current system of care using a set of risk evaluation and process mapping tools (Failure Modes and Effects Analysis (FMEA) and Hierarchical Task Analysis HTA).

Results

We have engaged staff with the process mapping and risk assessment tools. We now understand our system and understand where the highest risk tasks are undertaken during a renal in‐patient stay during which a patient has an operation. These key tasks occur across the perioperaive period and are not confined to one aspect of care. A measurement strategy and intervention plan have been designed around these tasks.

Conclusion

Safer Clinical Systems has identified high risk, low reliability tasks in our system. We look forward to fully reporting these data in 2014.
Ultrasonography is not more reliable than anthropometry for assessing visceral fat in obese children
Authors: Koot B. G. P. , Westerhout R. , Bohte A. E. , Vinke S. , Pels Rijcken T. H. , Nederveen A. J. , Caan M. W. A. , van der Baan‐Slootweg O. H. , Merkus M. P. , Stoker J. , Benninga M. A.
Published: August 2013

What is already known about this subject

Visceral fat accumulation is a risk factor for obesity‐related complications.

Waist circumference is used in clinical practice to assess visceral adiposity.

What this study adds

Ultrasound is not superior to waist circumference for assessing visceral obesity in obese children.

The optimal site for measuring waist circumference in obese children is at the smallest body circumference between xiphisternum and umbilicus.

Objective

Visceral fat accumulation is a well‐established risk factor for obesity‐related complications. In children, it has not been determined whether ultrasonography is superior to waist measurement for assessing visceral fat. Moreover, the optimal site for waist measurement has not been determined.

Design

In a prospective cohort of 92 severely obese children and adolescents (age 13.9 ± 2.2 years, body mass index z‐score 3.29 ± 0.33), we evaluated the performance of ultrasonography and two different methods of waist circumference measurement, using magnetic resonance imaging as the reference standard.

Results

Waist circumference, defined as the smallest body circumference between xiphisternum and umbilicus had the strongest correlation with visceral fat quantity (r = 0.69 all, r = 0.68 girls, r = 0.64 boys). It was not outperformed by ultrasonography (r = 0.60 all, r = 0.62 girls, r = 0.50 boys) and correlated significantly better than the World Health Organization standard for waist measurement, midway between lower margin of the last rib and the crest of the ilium, (r = 0.51 all, r = 0.39 girls, r = 0.46 boys).

Conclusions

Waist circumference measurement, defined as the smallest body circumference between xiphisternum and umbilicus, is the preferred non‐invasive technique for daily clinical practice to assess visceral fat accumulation in severely obese children and adolescents. There is no place for ultrasonography for the quantification of visceral fat in this group.
An International prevalence measurement of care problems: study protocol
Authors: van Nie‐Visser Noémi C. , Schols Jos M.G.A. , Meesterberends Esther , Lohrmann Christa , Meijers Judith M.M. , Halfens Ruud J.G.
Published: August 2013

Aim

The aim of this article was to describe the design of an international audit of the prevalence of care problems in different healthcare sectors using identical methodologies.

Background

Audits, defined as a monitor of quality of health care, are increasingly applied in many countries as a strategy to improve professional practice and quality and safety of care. A prerequisite to enable a reliable comparison of quality of care audits is the use of identical instruments and methodology.

Design

Annual cross‐sectional multi‐centre point prevalence survey.

Method

This international prevalence measurement of care problems in hospitals, care homes and home care is performed in the Netherlands, Austria, Switzerland and New Zealand. This study is based on a prevalence measurement of care problems originally performed in the Netherlands. For each care problem (pressure ulcer, incontinence, malnutrition, falls and restraints) at patient level, next to patient characteristics, data are gathered about the prevalence, prevention and treatment of each care problem. In addition, at ward/department and institution level, specific quality indicators are measured related to the care problems. After the measurement, institutions enter their data into a web‐based data‐entry program. Institutions receive an overview of their own results and results at national level to enable a process of benchmarking.

Discussion

A uniform way of measuring the prevalence of care problems internationally is a significant step forward in gaining insight into the quality of basic care in different healthcare settings in different countries and may lead to more awareness and improvement programmes.
‘Radical Interpretation’ and the Assessment of Decision‐Making Capacity
Authors: Banner Natalie F. , Szmukler George
Published: August 2013

The assessment of patients' decision‐making capacity (DMC) has become an important area of clinical practice, and since it provides the gateway for a consideration of non‐consensual treatment, has major ethical implications. Tests of DMC such as under the Mental Capacity Act (2005) for England and Wales aim at supporting autonomy and reducing unwarranted paternalism by being ‘procedural’, focusing on how the person arrived at a treatment decision. In practice, it is difficult, especially in problematic or borderline cases, to avoid a consideration of beliefs and values; that is, of the substantive content of ideas rather than simple ‘cognitive’ or procedural abilities.

However, little attention has been paid to how beliefs and values might be assessed in the clinical context and what kind of ‘objectivity’ is possible. We argue that key aspects of Donald Davidson's ideas of ‘Radical Interpretation’ and the ‘Principle of Charity’ provide useful guidance as to how clinicians might approach the question of whether an apparent disturbance in a person's thinking about beliefs or values undermines their DMC. A case example is provided, and a number of implications for clinical practice are discussed.
Has Admission Blood Pressure Any Prognostic Value in Patients With Subarachnoid Hemorrhage: An Emergency Department Experience
Authors: Duran Latif , Balci Kemal , Kati Celal , Akdemir Hızır Ufuk , Kocabicak Ersoy , Doğruel Canan
Published: August 2013

Hypertension is a well‐known risk factor for the development and rupture of cerebral aneurysms. The authors conducted a study to investigate the prognostic value of admission blood pressure (BP) on prognosis in patients with subarachnoid hemorrhage (SAH). Two hundred patients with SAH were divided into two groups according to Hunt Hess score (good prognosis: 1 to 3, and poor prognosis: 4 and 5) and according to death in hospital (surveyed and died). The prognostic factors of SAH and BP changes according to Hunt Hess scores in the acute stages of the event were evaluated. Admission mean arterial BP values of the patients who died in hospital were significantly lower than in the patients who were surveyed (P=.026). The admission mean arterial BP values were found to be lower in the poor prognostic patients (Hunt Hess score of 4 and 5) (P<.001). Decreased admission BP values were found to be associated with poor prognosis and mortality.
Application of relative real‐time PCR to detect differential expression of virulence genes in Vibrio anguillarum under standard and stressed growth conditions
Authors: Crisafi F , Denaro R , Genovese M , Yakimov M , Genovese L
Published: August 2013

In this study, we aimed to understand whether abiotic factors affect the expression of virulence genes in Vibrio anguillarum. We observed the in vitro responses of two Mediterranean strains of V. anguillarum to temperature, NaCl and iron concentration changes. We monitored growth performance and gene transcription levels by comparing the results obtained under stressed conditions (temperatures of 5 °C, 15 °C and 37 °C; NaCl concentrations of 3% and 5%; and iron depletion and excess) with those obtained under standard growth conditions (25 °C, 1.5% NaCl and 0.6 μm of iron). The results showed that the strains respond differently. The strain 975/I was most strongly affected by conditions of 15 °C and iron depletion; these conditions induced increased transcription levels of empA, angR and fatA. Growth of the strain 17/I was inhibited at 15 °C and in iron depletion conditions; this strain also showed dramatic changes in the transcription levels of toxR and tonB2 under increased NaCl concentrations. These results demonstrate that environmental stress affects the expression of virulence genes in V. anguillarum that have implications for the competitiveness, stress tolerance and the ability of V. anguillarum to cause infection.
Phylogeny and Classification of Prunus sensu lato (Rosaceae)
Authors: Shi Shuo , Li Jinlu , Sun Jiahui , Yu Jing , Zhou Shiliang
Published: August 2013

The classification of the economically important genus Prunus L. sensu lato (s.l.) is controversial due to the high levels of convergent or the parallel evolution of morphological characters. In the present study, phylogenetic analyses of fifteen main segregates of Prunus s.l. represented by eighty‐four species were conducted with maximum parsimony and Bayesian approaches using twelve chloroplast regions (atpB‐rbcL, matK, ndhF, psbA‐trnH, rbcL, rpL16, rpoC1, rps16, trnS‐G, trnL, trnL‐F and ycf1) and three nuclear genes (ITS, s6pdh and SbeI) to explore their infrageneric relationships. The results of these analyses were used to develop a new, phylogeny‐based classification of Prunus s.l. Our phylogenetic reconstructions resolved three main clades of Prunus s.l. with strong supports. We adopted a broad‐sensed genus, Prunus, and recognised three subgenera corresponding to the three main clades: subgenus Padus, subgenus Cerasus and subgenus Prunus. Seven sections of subgenus Prunus were recognised. The dwarf cherries, which were previously assigned to subgenus Cerasus, were included in this subgenus Prunus. One new section name, Prunus L. subgenus Prunus section Persicae (T. T. Yü & L. T. Lu) S. L. Zhou and one new species name, Prunus tianshanica (Pojarkov) S. Shi, were proposed.
Phosphorylation‐dependent Trafficking of Plasma Membrane Proteins in Animal and Plant Cells
Authors: Offringa Remko , Huang Fang
Published: August 2013

In both unicellular and multicellular organisms, transmembrane (TM) proteins are sorted to and retained at specific membrane domains by endomembrane trafficking mechanisms that recognize sorting signals in the these proteins. The trafficking and distribution of plasma membrane (PM)‐localized TM proteins (PM proteins), especially of those PM proteins that show an asymmetric distribution over the PM, has received much attention, as their proper PM localization is crucial for elementary signaling and transport processes, and defects in their localization often lead to severe disease symptoms or developmental defects. The subcellular localization of PM proteins is dynamically regulated by post‐translational modifications, such as phosphorylation and ubiquitination. These modificaitons mostly occur on sorting signals that are located in the larger cytosolic domains of the cargo proteins. Here we review the effects of phosphorylation of PM proteins on their trafficking, and present the key examples from the animal field that have been subject to studies for already several decades, such as that of aquaporin 2 and the epidermal growth factor receptor. Our knowledge on cargo trafficking in plants is largely based on studies of the family of PIN FORMED (PIN) carriers that mediate the efflux of the plant hormone auxin. We will review what is known on the subcellular distribution and trafficking of PIN proteins, with a focus on how this is modulated by phosphorylation, and identify and discuss analogies and differences in trafficking with the well‐studied animal examples.

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Remko Offringa

(Corresponding author)
Epidermal Patterning Genes Impose Non‐cell Autonomous Cell Size Determination and have Additional Roles in Root Meristem Size Control
Authors: Löfke Christian , Dünser Kai , Kleine‐Vehn Jürgen
Published: August 2013

The regulation of cellular growth is of vital importance for embryonic and postembryonic patterning. Growth regulation in the epidermis has importance for organ growth rates in roots and shoots, proposing epidermal cells as an interesting model for cellular growth regulation. Here we assessed whether the root epidermis is a suitable model system to address cell size determination. In Arabidopsis thaliana L., root epidermal cells are regularly spaced in neighbouring tricho‐ (root hair) and atrichoblast (non‐hair) cells, showing already distinct cell size regulation in the root meristem. We determined cell sizes in the root meristem and at the onset of cellular elongation, revealing that not only division rates but also cellular shape is distinct in tricho‐ and atrichoblasts. Intriguingly, epidermal‐patterning mutants, failing to define differential vacuolization in neighbouring epidermal cell files, also display non‐differential growth. Using these epidermal‐patterning mutants, we show that polarized growth behaviour of epidermal tricho‐ and atrichoblast is interdependent, suggesting non‐cell autonomous signals to integrate tissue expansion. Besides the interweaved cell‐type‐dependent growth mechanism, we reveal an additional role for epidermal patterning genes in root meristem size and organ growth regulation. We conclude that epidermal cells represent a suitable model system to study cell size determination and interdependent tissue growth.
A SURVEY ON THE FOUR FAMILIES OF PERFORMANCE MEASURES
Authors: Caporin Massimiliano , Jannin Grégory M. , Lisi Francesco , Maillet Bertrand B.
Published: August 2013

Performance measurement is one of the most studied subjects in financial literature. Since the introduction of the Sharpe ratio in 1966, a large variety of new measures has appeared constantly in scientific journals as well as in practitioners' publications. The most complete and significant studies of performance measures, so far, have been written by Aftalion and Poncet, Le Sourd, Bacon, and Cogneau and H übner. A review of the most recent literature led us to collect several dozen measures that we classify into four families. We first present the class of relative measures, starting with the Sharpe ratio. Secondly, we analyse absolute measures, beginning with the most famous one ‐ the Jensenalpha. Thirdly, we study general measures based on specific features of the return distribution, where the pioneering contributions are those of Bernardo and Ledoit, and Keating and Shadwick. Finally, the fourth set concerns a few measures that explicitly take into account the investor's utility functions.