bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety in numbers: extinction arising from predator‐driven Allee effects
Authors: Gregory Stephen D. , Courchamp Franck
Published: March 2010

image

A.M. Kramer & J.M. Drake (2010) Experimental demonstration of population extinction due to a predator‐driven Allee effect. Journal of Animal Ecology, 79, 633–639.

Experimental evidence of extinction via an Allee effect (AE) is a priority as more species become threatened by human activity. Kramer & Drake (2010) begin the International Year of Biodiversity with the important – but double‐edged – demonstration that predators can induce an AE in their prey. The good news is that their experiments help bridge the knowledge gap between theoretical and empirical AEs. The bad news is that this predator‐driven AE precipitates the prey extinction via a demographic AE. Although their findings will be sensitive to departures from their experimental protocol, this link between predation and population extinction could have important consequences for many prey species.
Small‐scale dispersal and survival in a long‐lived seabird, the wandering albatross
Authors: Gauthier Gilles , Milot Emmanuel , Weimerskirch Henri
Published: March 2010

1. Dispersal is a fundamental but still poorly known process in population dynamics and several hypotheses have been proposed to explain its patterns. We studied natal and breeding dispersal and survival in a long‐lived seabird, the wandering albatross (Diomedea exulansL.), and examined several hypotheses concerning dispersal patterns in birds.

2. We applied multi‐state capture–recapture models to a 36‐year data set (1969–2004) collected at three albatross colonies on Île de Possession, Crozet Islands. Because the species has biennial reproduction, we introduced unobservable states in the model to account for the absence of individuals in those years.

3. Adults were highly faithful to their nesting colony but colony fidelity, as well as survival rate, differed slightly among colonies (fidelity ranged from 0·957 to 0·977). Breeding fidelity was highest in the colony where survival was lowest and individuals were not more likely to change colony following a failed breeding attempt than after a successful one. The colony that attracted most dispersers had the lowest density of nesting birds.

4. Philopatry (the probability that young return to breed at a birth site) was generally high but variable among colonies (ranging from 0·70 to 0·92), and survival of young differed little. Philopatry was highest in the largest colony, where the availability of potential mates was presumably greatest. However, among dispersing individuals, the colony that had the lowest density of nesting individuals, not the largest colony, attracted the most recruits.

5. Although size of the colony influenced the decision to stay or to leave in young, density was most influential in the selection of a new colony among both adult and young dispersers. Our results support the hypothesis that philopatry is the strategy favoured by most recruits and that conspecific attraction can explain variation in the level of philopatry among colonies but not settlement patterns among dispersing individuals.
The immunology of susceptibility and resistance to scabies
Authors: WALTON S. F.
Published: March 2010

The transmission of scabies occurs with the burrowing of Sarcoptes scabiei var. hominis mites into the skin. Infestation invariably leads to the development of localized cutaneous inflammation, pruritis and skin lesions. Classical transmission studies document an initial increase in S. scabiei numbers subsequent to primary infestation with a gradual reduction as host immunity develops. However, certain individuals fail to control infection and develop severe crusting of the skin, accompanied with extremely high mite burdens, elevated antibody levels and eosinophilia. These individuals have the nonhealing form of the human disease known as crusted scabies. The genetic predisposition for susceptibility or resistance to S. scabiei infection in humans is hypothesized to correlate with the dominance of an IgE‐driven Th2 response in severe disease or an interferon‐γ‐dominated Th1 response that promotes parasite control. However, recent data reveals complexities in cytokine regulation in the skin and the mechanisms of acquired resistance and immune escape. In this review, we consider the recent immunological and biomolecular advances in understanding the human host immune response to S. scabiei infestations in the context of earlier studies and attempt to reconcile apparent differences and emphasize those aspects of the Th1/Th2 model that are supported or refined.
Interference between maize and Xanthium strumarium or Datura stramonium
Authors: KARIMMOJENI H , RAHIMIAN MASHHADI H , ALIZADEH H M , COUSENS R D , BEHESHTIAN MESGARAN M
Published: March 2010

Karimmojeni H, Rahimian Mashhadi H, Alizadeh HM, Cousens RD & Beheshtian Mesgaran M (2010). Interference between maize and Xanthium strumarium or Datura stramonium. Weed Research50, 253–261.

Xanthium strumarium and Datura stramonium are two of the most important weeds of maize in Iran. Their growth was compared in a field study conducted over 2 years. Relationships were derived between weed density and crop yield, yield components and various growth parameters. Yield, grain number ear−1 and grain weight were affected more by X. strumarium than by D. stramonium. Xanthium strumarium followed a pattern of growth resembling that of the maize, whereas D. stramonium continued growing for a longer period, mainly affecting maize during the grain‐filling period. A large portion of the loss in maize yield caused by X. strumarium could be explained by a reduction in grain number ear−1, whereas a greater portion of the maize yield loss from D. stramonium was explained by a reduction in grain weight. Weed biomass was greater for X. strumarium than for D. stramonium, whereas seed production was higher for D. stramonium. It is concluded that although X. strumarium should be given the highest priority for control in maize on the basis of its superior competitive ability, control of D. stramonium is also essential because of both its considerable competitiveness in the current crop and its long‐term effects resulting from its greater seed production.
Expression and release of IL‐29 by mast cells and modulation of mast cell behavior by IL‐29
Authors: He S. , Zhang H. , Chen H. , Yang H. , Huang T. , Chen Y. , Lin J. , Wang F. , Chen X. , Li T.‐L. , Yang P.
Published: March 2010

To cite this article:He S, Zhang H, Chen H, Yang H, Huang T, Chen Y, Lin J, Wang F, Chen X, Li T‐L, Yang P. Expression and release of IL‐29 by mast cells and modulation of mast cell behavior by IL‐29.Allergy2010;65: 1234–1241.

Background: The role of interleukin (IL)‐29 in innate immunity has been recognized recently, and it is regarded as a potent bioactive molecule. However, little is known about its role in the pathogenesis of allergy. Because mast cells are recognized as primary effector cells of allergy, we investigated the potential relationship between IL‐29 and mast cells in this study.

Objective: To examine the expression of IL‐29 in mast cells and the influence of IL‐29 on mast cell mediator release and accumulation.

Methods: Expression of IL‐29 in mast cells was determined by double‐labeling immunohistochemistry and flow cytometry analysis. Mast cell cell‐line was cultured to examine the mediator release, and mouse peritoneal model was employed to observe the mast cell accumulation.

Results: Large proportions of mast cells expressing IL‐29 were localized in human tissue including the colon, tonsil and lung. Mast cells can release substantial quantity of IL‐29 upon challenge with proteolytic allergens. Extrinsic IL‐29 provoked IL‐4 and IL‐13 release from mast cell line P815 cells through PI3K/Akt and (JAK)/STAT3 signaling pathways, but failed to induce mast cell histamine release from human mast cells. Extrinsic IL‐29 also induced mast cell infiltration in mouse peritoneum by a CD18‐ and ICAM1‐dependent mechanism.

Conclusion: Mast cell‐derived IL‐29 has the potential to be involved in the pathogenesis of allergic inflammation.
Clinical evaluation of DFN3 patients with deletions in the POU3F4 locus and detection of carrier female using MLPA
Authors: Song MH , Lee HK , Choi JY , Kim S , Bok J , Kim U‐K
Published: March 2010

Song MH, Lee HK, Choi JY, Kim S, Bok J, Kim U‐K. Clinical evaluation of DFN3 patients with deletions in the POU3F4 locus and detection of carrier female using MLPA.

X‐linked deafness type 3 (DFN3), the most prevalent X‐linked form of hereditary deafness, is caused by mutations of the POU3F4 locus in the Xq21 region. We evaluated two Korean families showing typical characteristics of DFN3, such as congenital hearing loss and pathognomonic inner ear anomalies. Genetic analysis of these families did not reveal any mutations in the POU3F4 coding sequence. Instead, one family carried a genomic deletion upstream of POU3F4 gene, where the regulatory element is predicted to reside, and the other family possessed a deletion of almost the entire Xq21 region. The lack of mutation in the POU3F4 coding sequence makes the detection of carrier females using conventional sequencing methods difficult. By applying the multiplex ligation‐dependent probe amplification (MLPA) method, we successfully determined the carrier status of female members in these families, demonstrating that MLPA is a rapid and accurate way to detect POU3F4 deletions in sporadic undiagnosed carriers of DNF3.
Novel missense mutations in the ubiquitination‐related gene UBE2A cause a recognizable X‐linked mental retardation syndrome
Authors: Budny B , Badura‐Stronka M , Materna‐Kiryluk A , Tzschach A , Raynaud M , Latos‐Bielenska A , Ropers HH
Published: March 2010

Budny B, Badura‐Stronka M, Materna‐Kiryluk A, Tzschach A, Raynaud M, Latos‐Bielenska A, Ropers HH. Novel missense mutations in the ubiquitination‐related gene UBE2A cause a recognizable X‐linked mental retardation syndrome.

Recently, a truncating mutation of the UBE2A gene has been observed in a family with X‐linked mental retardation (XLMR) (1). The three affected males had similar phenotypes, including seizures, obesity, marked hirsutism and a characteristic facial appearance. Here, we report on two families with a total of seven patients and a clinically very similar syndromic form of XLMR. Linkage analysis was performed in the larger of these families, and screening several positional candidate genes revealed a G23R missense mutation in the UBE2A gene. Subsequent UBE2A screening of a phenotypically similar second family revealed another missense mutation, R11Q, again affecting an evolutionarily conserved amino acid close to the N‐terminus of the protein. SIFT and PolyPhen analyses suggest that both mutations are pathogenic, which is supported by their absence in 168 healthy controls. Thus, both missense and truncating mutations can give rise to a specific, syndromic form of XLMR which is identifiable in a clinical setting.
Ancient origin of the CTH alelle carrying the c.200C>T (p.T67I) variant in patients with cystathioninuria
Authors: Espinós C , García‐Cazorla A , Martínez‐Rubio D , Martínez‐Martínez E , Vilaseca MA , Pérez‐Dueñas B , Kožich V , Palau F , Artuch R
Published: March 2010

Espinós C, García‐Cazorla A, Martínez‐Rubio D, Martínez‐Martínez E, Vilaseca MA, Pérez‐Dueñas B, Kožich V, Palau F, Artuch R. Ancient origin of the CTH alelle carrying the c.200C>T (p.T67I) variant in patients with cystathioninuria.

Hereditary cystathioninuria is due to mutations in the CTH gene that encodes for cystathionase, a pyridoxal‐5′‐phosphate (PLP) dependent enzyme. To date, mutations in this gene have been described in 10 unrelated cystathioninuric patients. Enzyme assays have showed that mutated cystathionase exhibits lower activity than controls. As cystathioninuria is usually accompanied by a wide variety of symptoms, it has been questioned whether it is a disease or just a biochemical finding not associated with the clinical picture of these patients. This is the first report of Spanish patients with cystathioninuria and mild to severe neurological symptoms in childhood. After oral pyridoxine therapy biochemical parameters have normalized but clinical amelioration was not evident. All patients were homozygotes for the c.200C>T (p.T67I) variant which is the most prevalent inactivating mutation in the CTH gene. To further investigate the history of the alleles carrying the c.200C>T transition in Europe, we also constructed the haplotypes on the CTH locus in our Spanish patients as well as in a clinical series of cystathioninuric patients from the Czech Republic harboring the same nucleotide change. We suggest that the CTH p.T67I substitution could have an ancient common origin, which probably occurred in the Neolithic Era and spread throughout Europe.
NEMO mutation as a cause of familial occurrence of Behçet's disease in female patients
Authors: Takada H , Nomura A , Ishimura M , Ichiyama M , Ohga S , Hara T
Published: March 2010

Takada H, Nomura A, Ishimura M, Ichiyama M, Ohga S, Hara T. NEMO mutation as a cause of familial occurrence of Behçet's disease in female patients.

Behçet's disease is a chronic, relapsing, multisystem inflammatory disease of unknown etiology. Nuclear factor κB (NF‐κB) essential modulator (NEMO) that is required for the activation of NF‐κB plays an important role in inflammation. To investigate the role of NEMO in the pathogenesis of Behçet's disease, we analyzed NEMO gene and its expression pattern in tissues in a family with Behçet's disease. We found a heterozygous mutation (1217A> T, D406V) in a 6‐year‐old girl and her mother. Skewed X‐chromosome inactivation was not observed in the peripheral blood mononuclear cells as well as in oral and intestinal mucosa of the patients. Accordingly, there was a significant proportion of peripheral blood monocytes that did not produce sufficient intracellular tumor necrosis factor‐α with the stimulation of lipopolysaccharide. Heterozygous NEMO mutation is a cause of familial occurrence of Behçet's disease in female patients.
Ten‐yr results of the trans‐Atlantic kidney transplant airlift between the Dutch Caribbean and the Netherlands
Authors: Minnee Robert C. , Lardy Neubury , Ajubi Nouaf , Idu Mirza M. , Kock Romeo V. , Legemate Dink A. , van Donselaar‐van der Pant Karlijn A.M.I. , Bemelman Frederike J.
Published: March 2010

Minnee RC, Lardy N, Ajubi N, Idu MM, Kock RV, Legemate DA, van Donselaar‐van der Pant KAMI, Bemelman FJ. Ten‐yr results of the trans‐Atlantic kidney transplant airlift between the Dutch Caribbean and the Netherlands.  Clin Transplant 2011: 25: 302–307. © 2010 John Wiley & Sons A/S.

Abstract:  The prevalence of end‐stage renal failure in Curaçao (Dutch Caribbean) is one of the highest in the world. In 1998, the St. Elisabeth Hospital started a unique trans‐Atlantic collaboration with the Academic Medical Center in Amsterdam, the Netherlands, and the Eurotransplant Foundation. The partnership aimed to achieve a structured transplantation program for patients in the Dutch Caribbean, who otherwise would need lifelong dialysis. This study is an analysis of the 10‐yr transplantation results of this trans‐Atlantic program. In 41 consecutive transplantations performed between January 1998 and April 2007, one‐yr graft survival and complication rates were retrospectively studied. Twenty‐four men and 17 women with a median age of 54 were transplanted. The median dialysis period prior to transplantation was 6.8 yr. The one‐yr graft survival rate was 69% (95% confidence interval: 52–80%). Initially 28 grafts functioned (68%); four grafts showed primary non‐function (10%) and delayed graft function developed in nine patients (22%). Ten recipients had 16 post‐operative complications. Our trans‐Atlantic program affords patients with end‐stage renal failure, who otherwise would need lifelong dialysis, a chance to be transplanted.
Primary HHV 6 infection after liver transplantation with acute graft rejection and multi‐organ failure: Successful treatment with a 2.5‐fold dose of cidofovir and reduction of immunosuppression
Authors: Dohna‐Schwake C. , Fiedler M. , Gierenz N. , Gerner P. , Ballauf A. , Breddemann A. , Läer S. , Baba H. A. , Hoyer P. F.
Published: March 2010

Dohna‐Schwake C, Fiedler M, Gierenz N, Gerner P, Ballauf A, Breddemann A, Läer S, Baba H. A, Hoyer P. F. Primary HHV 6 infection after liver transplantation with acute graft rejection and multi‐organ failure: Successful treatment with a 2.5‐fold dose of cidofovir and reduction of immunosuppression.  Pediatr Transplantation 2011: 15: E126–E129. © 2010 John Wiley & Sons A/S.

Abstract:  HHV type 6 has been reported with enhanced pathogenicity in immunocompromised patients. Herein, we report about a two‐yr‐old girl who experienced primary HHV 6 infection after liver transplantation. She clinically presented with graft rejection and necrotic hepatitis as well as high fever, pneumonitis with respiratory failure and a rash. Therapy with cidofovir of 5 mg/kg per wk did not show improvement, so that a full pharmacokinetic profile of cidofovir was performed. It demonstrated enhanced body weight normalized clearance of cidofovir and cidofovir dosage was augmented to 12 mg/kg per wk to reach adequate drug exposure. With additional reduction of immunosuppression, the patient dramatically improved and liver function stabilized.
Clonal erosion and genetic drift in cyclical parthenogens – the interplay between neutral and selective processes
Authors: VANOVERBEKE J. , DE MEESTER L.
Published: March 2010

The occurrence of alternating phases of clonal and sexual reproduction may strongly impact the interplay between neutral and selective genetic variation in populations. Using a physiologically structured model of the life history ofDaphnia, we investigated to what extent clonal erosion associated with selection during the clonal phase affects the genetic structure as observed by neutral markers. Incorporating conservative levels of quantitative genetic variation at 11 physiological and life history traits induces strong clonal erosion, reducing clonal diversity (CD) near the end of the simulations (1000 days) to a level between 1 and 5, even in habitats with high initial CD (108clones). This strong clonal erosion caused by selection can result in reduced genetic diversity, significant excess of heterozygotes and significant genetic differentiation between populations as observed by neutral markers. Our results indicate that, especially in relatively small habitats, clonal selection may strongly impact the genetic structure and may contribute to the often observed high level of neutral genetic differentiation among natural populations of cyclical parthenogens.
Use of mouse models to study the mechanisms and consequences of RBC clearance
Authors: Hod E. A. , Arinsburg S. A. , Francis R. O. , Hendrickson J. E. , Zimring J. C. , Spitalnik S. L.
Published: March 2010

Mice provide tractable animal models for studying the pathophysiology of various human disorders. This review discusses the use of mouse models for understanding red‐blood‐cell (RBC) clearance. These models provide important insights into the pathophysiology of various clinically relevant entities, such as autoimmune haemolytic anaemia, haemolytic transfusion reactions, other complications of RBC transfusions and immunomodulation by Rh immune globulin therapy. Mouse models of both antibody‐ and non‐antibody‐mediated RBC clearance are reviewed. Approaches for exploring unanswered questions in transfusion medicine using these models are also discussed.
A silenced allele in the Colton blood group system
Authors: Karpasitou K. , Frison S. , Longhi E. , Drago F. , Lopa R. , Truglio F. , Marini M. , Bresciani S. , Scalamogna M. , Poli F.
Published: March 2010

Background  The antigens of the Colton blood group system, Coa and Cob, are encoded by a single gene that produces the aquaporin‐1 (AQP1) protein, a water channel‐forming protein, and are characterized by a single nucleotide polymorphism (SNP). A healthy Caucasoid blood donor originally typed as Co(a−b−) with commercial anti‐Cob typed Co(a−b+) when retested with another anti‐Cob. Retyped with two different molecular biology methods, the sample came out Coa/Cob. With the aim of understanding these discrepancies, serological, cytometric and molecular biology tests were carried out.

Methods  Absorption/elution studies with propositus red cells and controls were performed. The region spanning exon 1 to exon 4 of the Colton gene was sequenced, and flow cytometry analyses were carried out.

Results  Absorption/elution studies showed the absence of Coa and a weak expression of Cob. DNA sequencing confirmed a CT heterozygosity at nucleotide position 134 (i.e. Coa/Cob), and an additional heterozygous CT was found at position 112. The presence of the Cob allele that encodes for the Cob antigen was confirmed. The new allele has the base cytosine at nucleotide 134 (Coa), in cis with the new nucleotide 112T. The nucleotide substitution 112C>T causes a missense mutation leading to an amino acid change from proline (CCG) to serine (TCG) at codon 38.

Conclusion  The substitution found at codon 38 results in a modified AQP1 protein which explains the Co(a−b+) phenotype and possibly the weak expression of Cob.
Glycine maintains mitochondrial activity and bile composition following warm liver ischemia‐reperfusion injury
Authors: Sheth Hemant , Hafez Tariq , Glantzounis George K , Seifalian Alexander M , Fuller Barry , Davidson Brian R
Published: March 2010

Background and Aim: Experimental studies have shown protective effect by the non‐essential amino acid glycine to liver ischemia‐reperfusion (I/R) injury but the mechanism of action is unknown.

Methods: A rabbit model of hepatic lobar I/R was used. Three groups of animals (n = 6) were studied: Sham group (laparotomy alone), ischemia reperfusion (I/R) group (1 h of liver lobar ischemia and 6 h of reperfusion), and a glycine I/R group (intravenous glycine 5 mg/kg prior to the I/R protocol). Systemic and hepatic hemodynamics, degree of liver injury (bile flow, transaminases), hepatic microcirculation, mitochondrial activity (redox state of cytochrome oxidase), bile composition and cytokines (tumor necrosis factor‐α and interleukin‐8) were measured during the experiment.

Results: Glycine administration increased portal blood flow, bile production, hepatic microcirculation and maintained cytochrome oxidase activity as compared with the I/R group during reperfusion. Glycine also reduced bile lactate surge and stimulated acetoacetate release in bile during reperfusion versus the I/R group. Cytokine levels (tumor necrosis factor‐α, interleukin‐8) and hepatocellular injury (aspartate aminotransferase and alanine aminotransferase) were significantly reduced by glycine administration.

Conclusion: Intravenous glycine administration reduces liver warm I/R injury by reducing the systemic inflammatory response, and maintaining cellular energy production.
Endoscopic ultrasound‐guided drainage of pelvic abscess without fluoroscopy guidance
Authors: Puri Rajesh , Eloubeidi Mohamad A , Sud Randhir , Kumar Mandhir , Jain Parvesh
Published: March 2010

Background and Aims:  Few case series are reported on endoscopic ultrasound (EUS)‐guided drainage of pelvic abscesses under fluoroscopy guidance. We hypothesized that EUS‐guided drainage of pelvic abscesses without fluoroscopy is an effective alternative to surgery in patients whose abscesses are not amenable to percutaneous drainage techniques. The aim of this study is to evaluate the clinical efficacy of EUS‐guided trans‐rectal/transcolonic drainage of pelvic abscess without fluoroscopy.

Methods:  Fourteen consecutive patients with pelvic abscesses not amenable to percutaneous drainage underwent EUS‐guided drainage over a period of 22 months. Main outcome measures were the resolution of the pelvic abscess on repeat imaging and improved clinical symptoms.

Results:  Fourteen consecutive patients were enrolled. EUS‐guided aspiration was performed in three patients. In two patients, dilatation and aspiration was performed, while trans‐rectal stent was placed in nine patients. All patients became afebrile within 72 h. Stent was removed in all patients, after confirming the resolution of the abscess on repeat computed tomography after 7 days. One patient in whom only aspiration was done had recurrence of fever and abscess on the seventh day and was treated by surgical drainage. A follow‐up EUS done in 13 of the patients after 3 months revealed no recurrence, and all patients were asymptomatic at 6 months. The procedure was uneventful in all patients.

Conclusion:  Endoscopic ultrasound‐guided drainage without fluoroscopy is a safe and effective modality of treatment for pelvic abscesses not amenable to radiologically guided drainage, thus reducing the need for surgical intervention.
Using the clinical challenges encountered by junior residents to inform curriculum for paediatric pre‐intern students
Authors: Lester‐Smith David , Campbell Dianne E , Elliott Elizabeth J
Published: March 2010

Aim:  To develop and evaluate a novel skills‐based education programme for medical students completing a paediatric pre‐internship (PrInt) at the Children's Hospital at Westmead (CHW), Sydney which incorporated a mini‐clinical evaluation exercise style formative assessment component and was based upon a local needs assessment of junior staff.

Methods:  We designed a teaching programme which included four interactive tutorials and formative assessment tasks using observed clinical exercises (OCE). The final programme was informed by a local need‐based assessment of out‐of‐hours junior doctors' tasks. Students rated their level of confidence prior to and after the tutorial and following the OCE. Students provided structured and free text feedback on the programme.

Results:  Of 29 PrInt students (2007–2008), with collectively 85 tutorial attendances, 84% rated the programme excellent (39%) or very good (45%). For each topic students' confidence increased after the tutorial and again after the OCE (P < 0.001). Improvement was most marked for skills for which students rated themselves pre‐teaching as having poor confidence (pain management and calculation of rehydration fluids). Overall, the proportion with ‘high’ confidence increased from 8.2% pre‐tutorial to 38.8% post‐tutorial and 72.9% post‐OCE (P < 0.001). Competence in skills was assessed by OCE and all students achieved scores of >90%. Diaries from junior doctors during 20 shifts at the CHW recorded 398 out‐of‐hours activities, the most common of which are ordering intravenous fluids (19.6%), reviewing asthmatics (16.6%) and recharting medications (16.3%).

Conclusion:  PrInt students value structured teaching incorporating OCE, which allows assessment of clinical skills and direct formative feedback and promotes gains in confidence, knowledge and skills. Addition of OCE to the teaching programme significantly increased the confidence of PrInt students in performing specific tasks compared with an educational session alone. Local needs assessment of junior doctors by out‐of‐hours survey both confirmed selection of appropriate topics (pain, fluids) and informed additional topics (asthma management and bronchodilator weaning regime) for future PrInt student programmes.
Anti‐angiogenesis drugs in lung cancer
Authors: LEE Siow Ming , BAAS Paul , WAKELEE Heather
Published: March 2010

In the last years much attention has been given to the implementation of the so‐called targeted drugs. One of the targets of tumours is the vasculature and this has led to the development of anti‐angiogenic drugs. In lung cancer the use of these drugs has resulted in both positive and negative studies. In this paper the pros and cons are presented. We hope that this information will help the physician in making a proper treatment choice.
ENDOSCOPIC DIAGNOSIS OF INTRADUCTAL PAPILLARY‐MUCINOUS NEOPLASM OF THE PANCREAS BY MEANS OF PERORAL PANCREATOSCOPY USING A SMALL‐DIAMETER VIDEOSCOPE AND NARROW‐BAND IMAGING
Authors: Miura Tomihiro , Igarashi Yoshinori , Okano Naoki , Miki Kazumasa , Okubo Yoichiro
Published: March 2010

Background:  Intraductal papillary‐mucinous neoplasm (IPMN) is an intraductal tumor in which the mucin‐producing epithelium shows proliferated papillary and a wide variety of pathological changes ranging from hyperplasia to adenocarcinoma. Therefore, it is important to determine whether an IPMN is benign or malignant. In the present study of patients with IPMN, the protrusion was observed by a peroral pancreatoscopy (PPS) using a small‐diameter videoscope and narrow‐band imaging (NBI). We carried out the differential diagnosis of benign lesion to malignant lesion.

Methods:  Between April 2003 and May 2009, PPS using a small‐diameter videoscope by means of NBI was carried out on 21 hospitalized patients with IPMN (10 cases of adenocarcinoma, 11 cases of adenoma or hyperplasia; 14 males and seven females, with a mean age of 69.4 years).

Results:  Fifteen focal lesions of the 16 cases in the head of the pancreas (93.7%) and four focal lesions of the five cases in the pancreatic body (80%) were observable, whereas two lesions (adenocarcinoma in the pancreatic body, and adenoma in the uncus of pancreas) were not observable. Endoscopically, seven cases were classified as villous type and two cases as vegetative type, and nine cases were diagnosed as adenocarcinoma. Ten cases with sessile type or semipedunculated type were diagnosed as adenoma or hyperplasia. Vascular patterns and protrusions were detected more clearly in the NBI images than under white light observation.

Conclusions:  When combined with a videoscope and NBI, pancreatoscopy provided a clear image and was useful for evaluating whether the IPMN was benign or malignant.
ISOLATED GRANULOMATOUS GASTRITIS SHOWING DISCOLORATION OF LESIONS AFTER HELICOBACTER PYLORI ERADICATION
Authors: Yamane Tateki , Uchiyama Kan , Ishii Takayuki , Nakano Masataka , Kanetsuna Yukiko , Okusa Toshifumi , Tajiri Hisao
Published: March 2010

We report a case of isolated granulomatous gastritis (IGG) with a submucosal tumor and multiple ulcer scars which showed discoloration after Helicobacter pylori (Hp) eradication. Furthermore, other discolored areas were newly observed after Hp eradication in the present case. Although IGG is extremely rare, the relation between IGG and Hp infection has attracted recent attention, and some case reports of IGG with Hp eradication have appeared in the literature. Discoloration after Hp eradication, however, has never been noted in any case reports and, therefore, this feature made the present case clinically interesting.
MAGNIFYING ENDOSCOPIC OBSERVATION WITH NARROW BAND IMAGING FOR SPECIALIZED INTESTINAL METAPLASIA IN BARRETT'S ESOPHAGUS WITH SPECIAL REFERENCE TO LIGHT BLUE CRESTS
Authors: Norimura Daisuke , Isomoto Hajime , Nakayama Toshiyuki , Hayashi Tomayoshi , Suematsu Takashi , Nakashima Yujiro , Inoue Naoki , Matsushima Kayoko , Yamaguchi Naoyuki , Ohnita Ken , Mizuta Yohei , Inoue Kenichiro , Shikuwa Saburo , Nakao Kazuhiko , Kohno Shigeru
Published: March 2010

Aim:  Barrett's esophagus (BE) with specialized intestinal metaplasia (SIM) is at high risk of esophageal adenocarcinoma. Magnified endoscopy with narrow band imaging (ME‐NBI) can be useful for detecting this condition. In addition to pit patterns, light blue crests (LBC), blue‐whitish patchy areas on the metaplastic epithelia of the stomach, can predict SIM in BE under ME‐NBI observation.

Methods:  A total of 54 patients with BE underwent ME‐NBI to identify IM pits (tubular and villous pits) and LBC. Biopsy samples were taken for histological evaluation of IM, immunohistochemical staining for CD10, MUC2 and MUC5AC antigen, transmission electron microscopy and real‐time polymerase chain reaction (RT‐PCR) analysis of CD10 mRNA expression.

Results:  IM pit pattern with ME‐NBI for the diagnosis of IM yielded acceptable sensitivity, specificity and accuracy at 92%, 77% and 83%, respectively. However, the sensitivity, specificity and accuracy of LBC with ME‐NBI for IM were comparably high at 79%, 97% and 89%, respectively. Upon immunohistochemistry, all 19 metaplastic epithelia of LBC‐positive BE showed immunoreactivity against anti‐MUC2 antibody, whereas CD10 antigen was identified in 11 of the 19 LBC‐positive BE. Brush borders were seen on IM epithelia using electron microscopy. On real‐time PCR analysis, CD10 mRNA levels in the LBC‐positive BE were higher compared to those in the LBC‐negative BE.

Conclusion:  The appearance of LBC can be an accurate sign to predict SIM in BE and may be associated with high CD10 expression, possibly along with brush borders.
HEALING OF SOLITARY RECTAL ULCERS WITH MULTIPLE SESSIONS OF ARGON PLASMA COAGULATION
Authors: Somani Sanjay Kumar , Ghosh Arindam , Avasthi Gurcharan , Goyal Richa , Gupta Puneet
Published: March 2010

Background:  Solitary rectal ulcer syndrome (SRUS) is an uncommon disorder of evacuation. Management of bleeding ulcers is usually unsatisfactory with conventional treatment. Argon plasma coagulation (APC) has been reported to control bleeding; however, it has not been shown to result in ulcer healing. The aim of the present study was to: (i) to investigate the efficacy and safety of APC in controlling bleeding from SRUS; and (ii) to study its efficacy in the healing of ulcer/s.

Methods:  Twenty‐four patients with bleeding SRUS diagnosed on clinical, colonoscopic, and histological findings were randomized to receive either standard care alone (12 patients) or to undergo multiple sessions of APC in addition (12 patients). All patients were followed up to determine ulcer healing.

Results:  Twenty‐four patients with a mean duration of symptoms of 12.6 ± 4.8 months were included. Bleeding was controlled with one (n = 5) or two sessions (n = 7) of APC. Reduction in size and depth of ulcer was noted. Eight out of 12 patients who received APC had complete healing of ulcers after four to eight sessions, carried out 2–4 weeks apart. The remaining four patients had a reduction in size and depth of ulcers compared to their pretreatment appearance. All patients were advised to have a high intake of fluids, fiber and laxatives, and to undergo biofeedback and behavior modification therapy in addition to the treatment.

Conclusions:  APC controls bleeding in patients with SRUS and it also improves the healing of these ulcers.
COMPARISON OF ULTRAFLEX AND NITI‐S STENTS FOR PALLIATION OF UNRESECTABLE MALIGNANT GASTRODUODENAL OBSTRUCTION
Authors: Maetani Iruru , Ukita Takeo , Nambu Tomoko , Shigoka Hiroaki , Omuta Shigefumi , Endo Takuro , Takahashi Kei
Published: March 2010

Aim:  Self‐expandable metallic stents are widely used for palliation of malignant gastric outlet obstruction (GOO), but clinical outcomes of different stents have not been compared. Here, we compared outcomes in patients with a GOO receiving either an Ultraflex (UF) or a Niti‐S (NS) stent.

Methods:  Prospective outcomes in 53 patients receiving palliative placement of an NS stent for symptomatic GOO over a 3‐year period were compared with those obtained retrospectively in 31 patients receiving a UF stent in a previous 5‐year period. Main outcome measurement was between‐group comparison of clinical outcome, complications, and reintervention.

Results:  Baseline characteristics between the groups were comparable. No difference in technical or clinical success rate was observed. Median procedure time for NS placement was shorter than for UF (15 vs 40 min; P < 0.0001). Complications were more frequent with NS than with UF placement, albeit without statistical significance (16% vs 25%). Although two severe complications occurred in each group, neither was stent related in the NS group. Reintervention was more frequent in the NS group (3% vs 21%; P = 0.0485). Median survival time was 53 versus 88 days for UF versus NS stents, respectively.

Conclusion:  Although no significant difference was seen with regard to feasibility, reintervention was less frequent with UF stents than with NS stents. However, UF stents require much more procedure time, and a complicated and difficult placement procedure. These observations suggest that although NS stents placed using a through‐the‐scope technique may be more patient friendly than UF stents, further optimization of through‐the‐scope stents is still required. Further prospective comparison of NS and UF stents in GOO treatment is warranted.
ASCARIASIS AS A CAUSE OF RECURRENT ABDOMINAL PAIN
Authors: Guzman Gerly Edson , Teves Pedro Montes , Monge Eduardo
Published: March 2010

Ascariasis is the most common helminthic infection in developing countries. It may cause chronic abdominal pain, tenderness and bloating. Our aim is to report a case of acute episodic abdominal pain and pancreatitis associated with ascariasis. We report a 59‐year‐old female patient who was admitted for acute abdominal pain, having had several previous similar events before one of them was diagnosed as acute idiopathic pancreatitis. On admission, her physical exam was normal. Laboratory results showed hemoglobin 12.2 g/dL, white blood cell count 11 900 cells/mm3, eosinophils 420 cells/mm3, serum amylase 84 IU/mL, lipase 22 IU/mL and normal liver function tests. Abdominal ultrasound and a plain abdominal X‐ray were also normal. An upper endoscopy showed round white worms in the duodenum and the stomach, some of them with bile in their intestines. The intestinal parasites were diagnosed as Ascaris lumbricoides, and the patient was started on albendazole, with full recovery within a week. We believe that ascariasis should be considered in patients with recurrent abdominal pain and idiopathic pancreatitis.
CLINICAL EVALUATION OF EMERGENCY ENDOSCOPIC HEMOSTASIS WITH BIPOLAR FORCEPS IN NON‐VARICEAL UPPER GASTROINTESTINAL BLEEDING
Authors: Kataoka Mikinori , Kawai Takashi , Yagi Kenji , Tachibana Chizuko , Tachibana Hiroyuki , Sugimoto Hiroko , Hayama Yasutaka , Yamamoto Kei , Nonaka Masaya , Aoki Takaya , Oshima Toshihiro , Fujiwara Mari , Fukuzawa Mari , Fukuzawa Masakatsu , Kawakami Kouhei , Sakai Yoshihiro , Moriyasu Fuminori
Published: March 2010

The present study was designed to evaluate the usefulness and safety of bipolar hemostatic forceps, known as a less invasive and highly safe means of thermal coagulation used for hemostasis in cases of non‐variceal upper gastrointestinal bleeding. This technique of bipolar forceps is simple, safe and unlikely to induce complications, and is therefore promising as a new technique of endoscopic hemostasis. The study involved 39 cases where hemostasis was attempted with bipolar forceps to deal with non‐variceal upper gastrointestinal bleeding, including 28 cases of gastric ulcer, six cases of duodenal ulcer, three cases of bleeding after endoscopic submucosal dissection (ESD), one case of Mallory‐Weiss syndrome and one case of postoperative bleeding from the anastomosed area. There were 34 males and five females, with a mean age of 63.6 years. Bipolar forceps were the first‐line means of hemostasis in cases of oozing bleeding (venous bleeding), pulsatile or spurting bleeding (arterial bleeding) and exposed vessels without active bleeding. The primary hemostasis success rate was 92.3%, and the re‐bleeding rate was 0%. In cases where the bleeding site was located along the tangential line or in cases where large respiration‐caused motions hampered identification of the bleeding site, hemostasis by means of coagulation was easily effected by application of electricity while the forceps were kept open and compressed the bleeding area. In addition, there were no complications. This technique of bipolar forceps is simple, safe and unlikely to induce complications, and is therefore promising as a new technique of endoscopic hemostasis.
Centralization and the relationship between volume and outcome in knee arthroplasty procedures
Authors: Marlow Nicholas E. , Barraclough Bruce , Collier Neil A. , Dickinson Ian C. , Fawcett Jonathon , Graham John C. , Maddern Guy J.
Published: March 2010

Background:  Centralization aims to reduce adverse patient outcomes by concentrating complex surgical procedures in specified hospitals.

Objectives:  This review assessed the efficacy of centralization for knee arthroplasty by examining the relationship between hospital and surgeon volume and patient outcomes.

Data Sources and Review Methods:  The systematic review identified studies using multiple databases, including Medline and Embase. Two independent researchers ensured studies met the inclusion criteria. Morbidity, mortality, length of stay, financial outcomes and statistical rigour were examined. Correlations between volume and outcome were reported.

Results:  Twelve primary knee arthroplasty studies examined hospital volume, which was significantly associated with decreased morbidity (five of seven studies), mortality (two of five studies) and length of stay (two of three studies). Three primary knee arthroplasty studies examined surgeon volume, which was significantly associated with decreased morbidity (two of three studies), mortality (zero of two studies) and length of stay (one of one study). Two revision knee arthroplasty studies examined hospital volume. One study examined but did not test for significance between hospital volume and patient morbidity; both studies examined volume and patient mortality reporting inconclusive results; and one study reported no significant association between volume and length of stay. None of the revision knee arthroplasty studies examined surgeon volume.

Conclusions:  Significant associations between increased hospital and surgeon volume and improved patient outcomes were reported. However, when these results were separated by arthroplasty type, the association appeared tenuous. Judgements regarding centralization of knee arthroplasty should be made with caution until further evidence is published.
ORIGINAL ARTICLE: Severe hyponatraemia in elderly hospitalized patients: prevalence, aetiology and outcome
Authors: Shapiro D. S. , Sonnenblick M. , Galperin I. , Melkonyan L. , Munter G.
Published: March 2010

Background: Hyponatraemia is the commonest electrolyte disorder in the elderly. Data on severe hyponatraemia and the prevalence of cerebral salt wasting syndrome (CSWS) in elderly hospitalized patients are lacking. We studied the incidence, frequency of various aetiologies, outcome and the possible role of CSWS in severe hyponatraemia in elderly medical patients.

Methods: A prospective, observational, non‐interventional study conducted over a 5‐month period in medical wards. Eighty‐six patients aged over 65 years with serum sodium levels ≤125 mEq/L were included. All patients were examined by one of the authors, who also evaluated potential contributing factors. Demographic, clinical and outcome data were extracted from the medical records.

Results: The mean age of the patients was 82.1 + 8.7 years. The prevalence of hyponatraemia was 6.2% (8.1% women and 4.0% men (P < 0.001)). There was no increase in incidence of hyponatraemia with age. The leading cause of hyponatraemia was the syndrome of inappropriate antidiuretic hormone secretion (SIADH), whose aetiology could be determined in only 46% of cases. Aetiology was multifactorial in 51% of patients (1.7 aetiological factors per patient). All patients with thiazide‐induced hyponatraemia had other contributing factors. Hyperglycaemia and hypoalbuminaemia were predictors of neurological manifestations of hyponatraemia. Overall in‐hospital mortality was 19%. Only hypoalbuminaemia was found as an independent risk factor for death. In none of the patients was the hyponatraemia due to CSWS.

Conclusion: Severe hyponatraemia in elderly hospitalized medical patients is more frequent in women and of multifactorial aetiology in 50% of cases. It is most commonly caused by SIADH; CSWS is an unlikely cause.
Malignant mesothelioma
Authors: Kao S. C.‐H. , Reid G. , Lee K. , Vardy J. , Clarke S. , Van Zandwijk N.
Published: March 2010

Malignant mesothelioma (MM) is an aggressive tumour that commonly affects the mesothelial surfaces of the pleural and peritoneal cavities, and occasionally, the tunica vaginalis and the pericardium. Formerly a rare tumour, MM is increasing in incidence in Australia due to the heavy nationwide use of asbestos from 1940 until the 1980s. The incidence is expected to peak in Australia in the next decade, mirroring the long latency period between asbestos exposure and development of MM. Diagnosis of MM can be difficult. Definitive pathological diagnosis is required and it often requires an experienced pathologist to differentiate MM from other benign or malignant processes. Treatment of MM requires a multidisciplinary approach, regardless of palliative or curative intent. Treatment options, such as surgery, chemotherapy, radiotherapy and active symptom control or a combination of these, may be used. Further research is needed to advance the therapeutic options for MM, and strategies to realize personalisation of therapy through discovery of predictive markers. In the Australian society where asbestos contamination of the built environment is very high, education and stringent public health measures are required to prevent a second wave of increased MM incidence.
Transfer from residential aged care to emergency departments: an analysis of patient outcomes
Authors: Arendts G. , Dickson C. , Howard K. , Quine S.
Published: March 2010

Background: In order to design optimal systems to meet the acute healthcare needs of the frail elderly living in residential care, good clinical information is essential. The aims of this study were to analyse the casemix and outcomes of patients transferred from residential aged care facilities to public hospital emergency departments in New South Wales.

Methods: Individual patient data from six hospital emergency departments and inpatient wards were obtained from merged databases and analysed using descriptive and comparative statistics.

Results: Outcomes in 4680 patient transfers over a 12‐month period in 2006–2007 were analysed. Transfers occur mostly in high‐acuity patients, with approximately three of every four transfers admitted; one in every 12 dying; and admitted patients undergoing an average of 2.4 interventions or procedures during each hospital stay. Several variables are associated with prolonged length of emergency department stay including triage urgency, type of hospital and transfers occurring in winter or out of hours.

Conclusions: Patients transferred from aged care facilities to emergency departments are predominantly high‐acuity patients with a substantial likelihood of hospitalisation, intervention and death. Nevertheless, scope exists for some episodes of acute care, in both discharged and admitted patients, to be provided outside a hospital setting.
Assessing individual clinical performance: a primer for physicians
Authors: Scott I. A. , Phelps G. , Brand C.
Published: March 2010

The assessment of individual physician performance has attracted interest from several quarters, including statutory licensing agencies and credentialing bodies of healthcare institutions. Performance measures and assessment methods have been developed, although their validity, reliability and feasibility in regards to physician specialty practice are open to challenge. Despite this, professional colleges and societies will be increasingly obliged to ensure their members are demonstrating high‐quality performance on the basis of assessment methods viewed as being transparent, impartial and reproducible. This article provides an overview of the current state of the art which hopefully will serve to inform future debate both within and outside professional circles.