bluuebunny/crossref_metadata_2025 huggingface dataset:
Ghrelin Induces Abdominal Obesity Via GHS-R-Dependent Lipid Retention
Authors: Davies Jeffrey S. , Kotokorpi Pia , Eccles Sinan R. , Barnes Sarah K. , Tokarczuk Paweł F. , Allen Sophie K. , Whitworth Hilary S. , Guschina Irina A. , Evans Bronwen A. J. , Mode Agneta , Zigman Jeffrey M. , Wells Timothy
Published: March 2009

Circulating ghrelin elevates abdominal adiposity by a mechanism independent of its central orexigenic activity. In this study we tested the hypothesis that peripheral ghrelin induces a depot-specific increase in white adipose tissue (WAT) mass in vivo by GH secretagogue receptor (GHS-R1a)-mediated lipolysis. Chronic iv infusion of acylated ghrelin increased retroperitoneal and inguinal WAT volume in rats without elevating superficial sc fat, food intake, or circulating lipids and glucose. Increased retroperitoneal WAT mass resulted from adipocyte enlargement probably due to reduced lipid export (ATP-binding cassette transporter G1 mRNA expression and circulating free fatty acids were halved by ghrelin infusion). In contrast, ghrelin treatment did not up-regulate biomarkers of adipogenesis (peroxisome proliferator-activated receptor-γ2 or CCAAT/enhancer binding protein-α) or substrate uptake (glucose transporter 4, lipoprotein lipase, or CD36) and although ghrelin elevated sterol-regulatory element-binding protein 1c expression, WAT-specific mediators of lipogenesis (liver X receptor-α and fatty acid synthase) were unchanged. Adiposity was unaffected by infusion of unacylated ghrelin, and the effects of acylated ghrelin were abolished by transcriptional blockade of GHS-R1a, but GHS-R1a mRNA expression was similar in responsive and unresponsive WAT. Microarray analysis suggested that depot-specific sensitivity to ghrelin may arise from differential fine tuning of signal transduction and/or lipid-handling mechanisms. Acylated ghrelin also induced hepatic steatosis, increasing lipid droplet number and triacylglycerol content by a GHS-R1a-dependent mechanism. Our data imply that, during periods of energy insufficiency, exposure to acylated ghrelin may limit energy utilization in specific WAT depots by GHS-R1a-dependent lipid retention.
Mutational Analysis of Progesterone Receptor Functional Domains in Stable Cell Lines Delineates Sets of Genes Regulated by Different Mechanisms
Authors: Quiles Ignacio , Millán-Ariño Lluís , Subtil-Rodríguez Alicia , Miñana Belén , Spinedi Nora , Ballaré Cecilia , Beato Miguel , Jordan Albert
Published: March 2009

Steroid hormone receptors act directly in the nucleus on the chromatin organization and transcriptional activity of several promoters. Furthermore, they have an indirect effect on cytoplasmic signal transduction pathways, including MAPK, impacting ultimately on gene expression. We are interested in distinguishing between the two modes of action of progesterone receptor (PR) on the control of gene expression and cell proliferation. For this, we have stably expressed, in PR-negative breast cancer cells, tagged forms of the PR isoform B mutated at regions involved either in DNA binding (DNA-binding domain) or in its ability to interact with the estrogen receptor and to activate the c-Src/MAPK/Erk/Msk cascade (estrogen receptor-interacting domain). Both mutants impair PR-mediated activation of a well-understood model promoter in response to progestin, as well as hormone-induced cell proliferation. Additional mutants affecting transactivation activity of PR (activation function 2) or a zinc-finger implicated in dimerization (D-box) have also been tested. Microarrays and gene expression experiments on these cell lines define the subsets of hormone-responsive genes regulated by different modes of action of PR isoform B, as well as genes in which the nuclear and nongenomic pathways cooperate. Correlation between CCND1 expression in the different cell lines and their ability to support cell proliferation confirms CCND1 as a key controller gene.
NDST1-dependent heparan sulfate regulates BMP signaling and internalization in lung development
Authors: Hu Zhonghua , Wang Chaochen , Xiao Ying , Sheng Nengyin , Chen Yibin , Xu Ye , Zhang Liang , Mo Wei , Jing Naihe , Hu Gengxi
Published: March 2009

Heparan sulfate proteoglycans (HSPGs) are required for various signaling pathways, one of which is the bone morphogenetic protein (BMP) signaling pathway. N-deacetylase/N-sulfotransferase-1 (NDST1) participates in synthesizing heparan sulfate (HS) chains of HSPGs, and is involved in bone and lung development. Here, we report that in spite of the redundant expression of Ndst2, Ndst3 and Ndst4 genes, Ndst1–/– mice display defective differentiation of lung cells and increased cell proliferation. Loss of Ndst1 in the lung enhances downstream BMP signaling in vivo. Noggin, which is an antagonist of BMP, can rescue the Ndst1–/– lung morphogenetic defects in explant cultures. Further studies in vitro indicated that loss of Ndst1 significantly impairs BMP internalization by decreasing BMP binding to endogenous HS. Exogenous heparin can rescue both the BMP signaling and BMP internalization abnormalities in Ndst1–/– lung. Thus, we propose that HS regulates BMP signaling by controlling the balance between BMP binding to HS, and that BMP receptors and NDST1-dependent modification are essential for this process. The results suggest that NDST1-dependent HS is essential for proper functioning of BMP in embryonic lung development.
Stability of the small γ-tubulin complex requires HCA66, a protein of the centrosome and the nucleolus
Authors: Fant Xavier , Gnadt Nicole , Haren Laurence , Merdes Andreas
Published: March 2009

To investigate changes at the centrosome during the cell cycle, we analyzed the composition of the pericentriolar material from unsynchronized and S-phase-arrested cells by gel electrophoresis and mass spectrometry. We identified HCA66, a protein that localizes to the centrosome from S-phase to mitosis and to the nucleolus throughout interphase. Silencing of HCA66 expression resulted in failure of centrosome duplication and in the formation of monopolar spindles, reminiscent of the phenotype observed after γ-tubulin silencing. Immunofluorescence microscopy showed that proteins of the γ-tubulin ring complex were absent from the centrosome in these monopolar spindles. Immunoblotting revealed reduced protein levels of all components of the γ-tubulin small complex (γ-tubulin, GCP2, and GCP3) in HCA66-depleted cells. By contrast, the levels of γ-tubulin ring complex proteins such as GCP4 and GCP-WD/NEDD1 were unaffected. We propose that HCA66 is a novel regulator of γ-tubulin function that plays a role in stabilizing components of the γ-tubulin small complex, which is in turn essential for assembling the larger γ-tubulin ring complex.
A Golgi-associated protein 4.1B variant is required for assimilation of proteins in the membrane
Authors: Kang Qiaozhen , Wang Ting , Zhang Huizheng , Mohandas Narla , An Xiuli
Published: March 2009

The archetypal membrane skeleton is that of the erythrocyte, consisting predominantly of spectrin, actin, ankyrin R and protein 4.1R. The presence in the Golgi of a membrane skeleton with a similar structure has been inferred, based on the identification of Golgi-associated spectrin and ankyrin. It has long been assumed that a Golgi-specific protein 4.1 must also exist, but it has not previously been found. We demonstrate here that a hitherto unknown form of protein 4.1, a 200 kDa 4.1B, is associated with the Golgi of Madin-Darby canine kidney (MDCK) and human bronchial epithelial (HBE) cells. This 4.1B variant behaves like a Golgi marker after treatment with Brefeldin A and during mitosis. Depletion of the protein in HBE cells by siRNA resulted in disruption of the Golgi structure and failure of Na+/K+-ATPase, ZO-1 and ZO-2 to migrate to the membrane. Thus, this newly identified Golgi-specific protein 4.1 appears to have an essential role in maintaining the structure of the Golgi and in assembly of a subset of membrane proteins.
Low-density lipoprotein receptor-related protein 1 is an essential receptor for myelin phagocytosis
Authors: Gaultier Alban , Wu Xiaohua , Le Moan Natacha , Takimoto Shinako , Mukandala Gatambwa , Akassoglou Katerina , Campana W. Marie , Gonias Steven L.
Published: March 2009

Multiple sclerosis (MS) is an autoimmune disease in which myelin is progressively degraded. Because degraded myelin may both initiate and accelerate disease progression, clearing degraded myelin from extracellular spaces may be critical. In this study, we prepared myelin vesicles (MV) from rat brains as a model of degraded myelin. Murine embryonic fibroblasts (MEFs) rapidly internalized MVs, which accumulated in lysosomes only when these cells expressed low-density lipoprotein receptor-related protein (LRP1). Receptor-associated protein (RAP), which binds LRP1 and inhibits interaction with other ligands, blocked MV uptake by LRP1-expressing MEFs. As a complementary approach, we prepared primary cultures of rat astrocytes, microglia and oligodendrocytes. All three cell types expressed LRP1 and mediated MV uptake, which was inhibited by RAP. LRP1 gene-silencing in oligodendrocytes also blocked MV uptake. Myelin basic protein (MBP), which was expressed as a recombinant protein, bound directly to LRP1. MBP-specific antibody inhibited MV uptake by oligodendrocytes. In experimental autoimmune encephalomyelitis in mice, LRP1 protein expression was substantially increased in the cerebellum and spinal cord. LRP1 colocalized with multiple CNS cell types. These studies establish LRP1 as a major receptor for phagocytosis of degraded myelin, which may function alone or in concert with co-receptors previously implicated in myelin phagocytosis.
Three-dimensional cellular architecture of the flagellar pocket and associated cytoskeleton in trypanosomes revealed by electron microscope tomography
Authors: Lacomble Sylvain , Vaughan Sue , Gadelha Catarina , Morphew Mary K. , Shaw Michael K. , McIntosh J. Richard , Gull Keith
Published: March 2009

This study uses electron tomography linked to a variety of other EM methods to provide an integrated view of the flagellar pocket and basal body area of the African trypanosome procyclic trypomastigote. We reveal the pocket as an asymmetric membranous `balloon' with two boundary structures. One of these – the collar – defines the flagellum exit point. The other defines the entry point of the flagellum into the pocket and consists of both an internal transitional fibre array and an external membrane collarette. A novel set of nine radial fibres is described in the basal body proximal zone. The pocket asymmetry is invariably correlated with the position of the probasal body and Golgi. The neck region, just distal to the flagellum exit site, is a specialised area of membrane associated with the start of the flagellum attachment zone and signifies the point where a special set of four microtubules, nucleated close to the basal bodies, joins the subpellicular array. The neck region is also associated with the single Golgi apparatus of the cell. The flagellar exit point interrupts the subpellicular microtubule array with discrete endings of microtubules at the posterior side. Overall, our studies reveal a highly organised, yet dynamic, area of cytoplasm and will be informative in understanding its function.
Characterization of a thermostable archaeal polynucleotide kinase homologous to human Clp1
Authors: Jain Ruchi , Shuman Stewart
Published: March 2009

Clp1 proteins are essential components of the eukaryal mRNA 3′ cleavage-polyadenylation machinery. Human Clp1 has an additional function as an RNA-specific 5′-OH polynucleotide kinase, which is implicated in RNA end healing. Yeast Clp1 has no kinase activity, although it binds ATP. Here we report that Clp1-like proteins are extant in archaea. Purification and characterization of Pyrococcus horikoshii Clp1 (PhoClp1) reveals it to be a thermostable 5′-OH polynucleotide kinase optimally active at 55°C to 85°C. PhoClp1 catalyzes transfer of the gamma phosphate from ATP (Km 16 μM) to either 5′-OH RNA or DNA ends, although it prefers RNA in a competitive situation. Increasing the monovalent salt concentration to 250 mM suppresses the DNA kinase without affecting RNA phosphorylation, suggesting that RNA is a likely substrate for this enzyme in vivo. Indeed, we show that expression of PhoClp1 in budding yeast can complement a lethal mutation in the 5′-OH RNA kinase module of tRNA ligase. PhoClp1 is a member of the P-loop phosphotransferase superfamily. Alanine mutations at the P-loop lysine (Lys49) and a conserved aspartate (Asp73) inactivate the kinase. Our studies fortify emerging evidence for an enzymatic RNA repair capacity in archaea and provide a new reagent for polynucleotide phosphorylation at high temperatures.
A Randomised Trial of Conventional versus BAUS Procedure-Specific Consent Forms for Transurethral Resection of Prostate
Authors: Finch William JG , Rochester Mark A , Mills Robert D
Published: March 2009

INTRODUCTION

Conventional consent forms often contain incomplete information regarding risks associated with invasive procedures. BAUS has introduced procedure-specific consent forms (PSCF) documenting the risks associated with urological procedures. We compared patients' understanding of the risks and benefits of TURP after the consenting process with either conventional documentation or PSCF.

PATIENTS AND METHODS

One hundred patients were randomised to be consented with either a conventional or PSCF. After 3 h, their understanding was assessed with a questionnaire asking patients to document the indication and likelihood of symptomatic improvement, estimate frequency of complications and the risk of future re-operation. Data were compared by Mann–Whitney test.

RESULTS

Fifty patients were randomised to each group. There was no significant difference in mean age, grade of doctor obtaining consent or time interval from consent to questionnaire. Both groups accurately predicted the chance of improved symptoms (median, 80%). There was no significant difference in patients' median estimation of risk of complications such as incontinence, erectile dysfunction, or retrograde ejaculation. Patients consented with the PSCF predicted the risk of re-operation more accurately (median answer, 10% versus 30%; P = 0.007, Mann–Whitney test).

CONCLUSIONS

Recall of data was sub-optimal in both groups. For most data points there was no significant difference in estimation of risks between groups. Those consented with a procedure-specific consent form predicted risk of re-operation at 10 years more accurately. Procedure-specific consent forms offer an advantage over conventional consent in this study. We feel that the provision of a written structured framework allows better informed consent for TURP.
The Management of Multi-Site, Bleeding, Visceral Artery Pseudoaneurysms, Secondary to Necrotising Pancreatitis
Authors: Skipworth J , Raptis D , Brennand D , Imber C , Shankar A
Published: March 2009

We present the case of a 45-year-old man, who presented to his local casualty department with severe epigastric pain following an alcohol binge, and was subsequently diagnosed with acute pancreatitis. Pancreatic necrosis with multiple collections ensued, necessitating transfer to an intensive care unit (ITU) in a tertiary hepatopancreaticobiliary centre. Initially, the patient appeared to slowly improve and was discharged to the ward, albeit following a prolonged ITU admission. However, during his subsequent recovery, he suffered multiple episodes of haematemesis and melaena associated with haemodynamic instability and requiring repeat admission to the ITU. Computerised tomographic angiography, followed by visceral angiography, was used to confirm the diagnosis of multisite visceral artery pseudoaneurysms, secondary to severe, necrotising pancreatitis. Pseudoaneurysms of the splenic, left colic and gastroduodenal arteries were sequentially, and successfully, radiologically embolised over a period of 9 days. Subsequent sequelae of radiological embolisation included a clinically insignificant splenic infarct, and a left colonic infarction associated with subsequent enterocutaneous fistula formation. The patient made a prolonged, but successful, recovery and was discharged from hospital after 260 days as an in-patient. This case illustrates the rare complication of three separate pseudoaneurysms, secondary to acute pancreatitis, successfully managed radiologically in the same patient. This case also highlights the necessity for multidisciplinary involvement in the management of pseudoaneurysms, an approach that is often most successfully achieved in a tertiary setting.
The Importance of Early Carotid Endarterectomy in Symptomatic Patients
Authors: Kulkarni SR , Gohel MS , Bulbulia RA , Whyman MR , Poskitt KR
Published: March 2009

INTRODUCTION

Early carotid endarterectomy (CEA) in symptomatic patients may prevent repeat cerebral events. This study investigates the relationship between waiting time for CEA and the incidence of repeat cerebral events prior to surgery in symptomatic patients.

PATIENTS AND METHODS

A prospective database of consecutive patients undergoing CEA between January 2002 and December 2006 was reviewed. Repeat event rates prior to surgery were calculated using Kaplan–Meier analysis and predictive factors identified using Cox regression analysis.

RESULTS

A total of 118 patients underwent CEA for non-disabling stroke, TIA and amaurosis fugax. Repeat cerebral events occurred in 34 of 118 (29%) patients at a median 51 days (range, 2–360 days) after the first event. The estimated risk of repeat events was 2% at 7 days and 9% at 1 month after first event (Kaplan–Meier survival analysis). Age (HR 1.059; 95% CI 1.014–1.106; P = 0.009] was identified as a predictor of repeat events. Patients underwent surgery at median 97 days (range, 7–621 days) after the first event. Eleven of 60 (18%) patients waiting ≤?97 days for surgery and 23 of 58 (40%) patients waiting >?97 days had repeat events. (P = 0.011, chi-squared test).

CONCLUSIONS

Delays in surgery should be reduced in order to minimise repeat cerebral events in patients with symptomatic carotid stenosis, particularly in the elderly population.
Manipulation Under Anaesthesia for Stiffness Following Knee Arthroplasty
Authors: Mohammed Riazuddin , Syed Shakir , Ahmed Naveed
Published: March 2009

INTRODUCTION

Stiffness following knee arthroplasty is a frustrating complication and a significantly disabling problem. We present our experience of knee stiffness requiring manipulation under anaesthesia (MUA) as the first line of treatment following partial or total knee arthroplasty.

PATIENTS AND METHODS

All stiff knees requiring MUA over a 6-month period from March to August 2007 were retrospectively analysed from theatre records and case notes. Data were collected regarding demographics, range of knee motion before and after manipulation and at subsequent follow-up. Complications of the procedure and outcomes were also analysed.

RESULTS

Twenty-one patients (11 female, 10 male) underwent MUA. The average age was 62 years (range, 56–80 years). Sixteen primary and 3 revision total knee replacements underwent manipulation, as did one medial unicompartmental replacement and one patellofemoral arthroplasty. General anaesthesia with good muscle relaxation was used in all but one patient. The mean duration between arthroplasty and MUA was 13.2 weeks (range, 6-32 weeks). The range of knee movement improved from a mean range of 10.4–71.2° in the pre-MUA period to 2.1–94.0° post-MUA and at follow-up was 2.3–91.9°. The mean arc of motion improved from 60.2° (range, 40–80°) pre-MUA to 91.9° (range, 45–120°) post-MUA. The mean improvement in the arc of motion was 31.6° (P < 0.001). At an average follow-up of 3 months (range, 6 weeks to 8 months), the mean arc of motion was 90.4° (range, 40–120°). The mean improvement in knee movement from the pre-MUA at the follow-up was 30.2° (P < 0.001). One patient failed to gain any improvement from MUA. There were no complications noted from the procedure.

CONCLUSIONS

MUA has a role in the treatment of early stiffness with excellent immediate outcomes. We advocate that MUA should be the first line of management for stiff knee arthroplasties after failed physiotherapy.
White Cell Count and C-Reactive Protein Measurement in Patients with Possible Appendicitis
Authors: Sengupta Anshuman , Bax George , Paterson-Brown Simon
Published: March 2009

INTRODUCTION

Clinical assessment outweighs the use of investigations in the diagnosis of acute appendicitis. Nevertheless, white cell count (WCC) and C-reactive protein (CRP) are regularly measured in patients with suspected appendicitis. The aim of this study was to assess the utility of these markers in patients presenting with acute lower abdominal pain.

PATIENTS AND METHODS

WCC and CRP were measured prospectively in 98 patients presenting with lower abdominal pain, and the results were correlated with each patient's outcome.

RESULTS

No patients with WCC and CRP both in the normal range had acute appendicitis. Raised WCC and CRP were poor positive predictors of appendicitis, both alone and in combination, and correlated poorly with the development of complications.

CONCLUSIONS

This result may have important clinical and economic implications. We suggest that patients experiencing lower abdominal pain, with normal WCC and CRP values, are unlikely to have acute appendicitis and can be safely sent home.
The Timing of Calcium Measurements in Helping to Predict Temporary and Permanent Hypocalcaemia in Patients Having Completion and Total Thyroidectomies
Authors: Pfleiderer AG , Ahmad N , Draper MR , Vrotsou K , Smith WK
Published: March 2009

INTRODUCTION

Postoperative hypocalaemia commonly occurs after extensive thyroid surgery and may require calcium and/or vitamin D supplements to alleviate or prevent the symptoms. In this study, we determined the risk factors for developing hypocalcaemia and whether early serum calcium levels can predict the development of or differentiate between temporary or permanent hypocalcaemia.

PATIENTS AND METHODS

A total of 162 patients who either had a completion or total thyroidectomy formed the basis of this prospective study. Serial serum calcium measurements were recorded as well as details of the operation, pathology, indications for surgery, number of parathyroids identified at operation and any complications.

RESULTS

Eighty-four (52%) patients did not develop hypocalcaemia but 69 (43%) were found to have temporary hypocalcaemia and 9 (5%) had permanent hypocalcaemia. Hypocalcaemia was more common after total than completion thyroidectomies and the identification of parathyroids at operation appears to have a significant adverse effect on outcome. The calcium levels measured on day 1 postoperatively and the slope (serum calcium levels of day 1 postoperative minus day of operation) were statistically significant in predicting the development of hypocalcaemia and possibly to differentiate between temporary or permanent hypocalcaemia.

DISCUSSION

Although almost half the patients having extensive thyroid surgery developed hypocalcaemia (as defined by any postoperative corrected serum calcium level of < 2.12 mmol/l) only 24% had a serum calcium of < 2.12 mmol/l associated with clinical symptoms of hypocalcaemia or a calcium level of < 2.0 mmol/l. Only 5% had persistent hypocalcaemia defined as requiring exogenous supplements at 6 months' postoperatively. Patients having a completion thyroidectomy appear to be less likely to develop hypocalcaemia perhaps as a result of any iatrogenic effects on the parathyroids at the first operation being reversed before the second operation. Identification and, therefore, exposure of parathyroids at operation may have an adverse effect on the blood supply to the glands affecting their function.

CONCLUSIONS

Serum calcium levels measured 6 hours' post-surgery and on day 1 postoperatively can be useful in predicting if the patient will develop hypocalcaemia and the slope may indicate whether the hypocalcaemia will be temporary or permanent. Patients with toxic goitres and those having a one-stage total thyroidectomy are most at risk of developing hypocalcaemia.
Ear, Nose and Throat Day-Case Surgery at a District General Hospital
Authors: Pézier T , Stimpson P , Kanegaonkar RG , Bowdler DA
Published: March 2009

INTRODUCTION

In 2000, The NHS Plan in the UK set a target of 75% for all surgical activity to be performed as day-cases. We aim to assess day-case turnover for ENT procedures and, in particular, day-case rates for adult and paediatric otological procedures together with re-admissions within 72 h as a proxy measure of safety.

PATIENTS AND METHODS

Retrospective collection of data (procedure and length of stay) from the computerised theatre system (Galaxy) and Patient Information Management System (PIMS) of all elective patients operated over one calendar year. The setting was a district general hospital ENT department in South East England. All ENT operations are performed with the exception of oncological head and neck procedures and complex skull-base surgery.

RESULTS

Overall, 2538 elective operations were performed during the study period. A total of 1535 elective adult procedures were performed with 74% (1137 of 1535) performed as day-cases. Of 1003 paediatric operations, 73% (730 of 1003) were day-cases. Concerning otological procedures, 93.4% (311 of 333) of paediatric procedures were day-cases. For adults, we divided the procedures into major and minor, achieving day-case rates of 88% (93 of 101) and 91% (85 of 93), respectively. The overall day-case rate for otological procedures was 91% (528 of 580). Re-admission rates overall were 0.7% (11 of 1535) for adults and 0.9% (9 of 1003) for paediatric procedures. The most common procedure for re-admission was tonsillectomy accounting for 56% of all adult re-admissions and 78% of paediatric re-admissions. The were no deaths following day-case procedures.

DISCUSSION

ENT surgery is well-suited to a day-case approach. UK Government targets are attainable when considering routine ENT surgery. Day-case rates for otology in excess of targets are possible even when considering major ear surgery.
Consent for Non-Therapeutic Male Circumcision on Religious Grounds
Authors: Robinson Richard , Makin Erica , Wheeler Robert
Published: March 2009

INTRODUCTION

The aim of this study was to assess whether surgeons are conforming to guidance laid down by professional organisations and the courts in obtaining dual parental consent for non-therapeutic circumcision.

PATIENTS AND METHODS

A retrospective case-note review over a 12-month period (April 2005 to April 2006) of circumcisions in boys under the age of 16 years in a tertiary paediatric surgical unit was undertaken.

RESULTS

A total of 62 boys aged 1–14 years (median age, 4 years) underwent non-therapeutic circumcision. Written consent from both parents was obtained in only 4 cases (6.4%). In no case was written consent obtained from the patient or their views documented. In 58 cases, the written consent was provided by only one parent; the mother in 34 (55%), the father in 24 (45%). Of these 58 cases, in 25 (43%) both parents attended with the child on the day of surgery.

CONCLUSIONS

The data reveal a consistent non-conformity with recommended practice and the common law. It seems unlikely that the doctors involved are deliberate and inveterate law-breakers. The reason for this non-compliance may be ignorance of the rules, or due to the impracticality of their implementation. There is evidence that doctors are ignorant of the legal rules pertaining to their patients, and the results may reflect this ignorance. However, there are also practical difficulties in obtaining dual consent that may be partially responsible for the variance. Inevitably, investment will be required to overcome these difficulties. Cost may tempt service providers to abandon the provision, leaving parents to their own devices.
Endometriosis-Associated Intestinal Tumours: A Consequence of Long-Term Unopposed Oestrogen?
Authors: Efthymiou Christopher A
Published: March 2009

A case of malignant transformation in an extra-ovarian site, 13 years after total abdominal hysterectomy and bilateral salpingo-oophorectomy, is discussed in a patient on long-term oestrogen implants, which highlights the potential risks surrounding the use of long-term oestrogen replacement therapy.
How Should Accredited Specialists be Trained to do New Procedures?
Authors: Campbell Bruce , Patrick Hannah , Barnes Steven , Marlow Mirella
Published: March 2009

When and how specialists should receive training to perform newly introduced procedures is a topic which has received relatively scant attention. The demands of clinical governance and the prospect of revalidation make this an issue which clinicians and their specialist organisations cannot ignore. NICE has been advised by specialist clinical advisers to make recommendations about training in its guidance, but wanted both to review the literature and to consider the views of specialists on how this might best be done. All this is about accredited specialists who have completed their specialist training: it is not about ‘training for trainees’.
Munchausen's Syndrome by Google©
Authors: Griffiths EJ , Kampa R , Pearce C , Sakellariou A , Solan MC
Published: March 2009

A case is discussed of the use of medical images from the internet to support claims of injury. There were several inconsistencies in both history and examination even prior to the presentation of the specimen radiograph from the internet. Clinicians are advised to be vigilant, to question histories that do not match with examination findings, to ensure that all radiographs are adequately labelled with patient-specific information and to look for radiographic inconsistencies such as the presence or absence of accessory ossicles.
Challenging Dogma: Radical Conservation Surgery for Early Stage Cervical Cancer in Order to Retain Fertility
Authors: Shepherd John H
Published: March 2009

INTRODUCTION

Cervical cancer is the second commonest cancer to affect women with over half a million cases world-wide yearly. Screening programmes have reduced the incidence and death rate dramatically in Western societies. At the same time, professional and social pressures may delay child bearing such that a significant number of women will present with early stage disease, but be anxious to retain their fertility potential. Standard treatment by radical hysterectomy or radiotherapy has good results, but inevitably renders the women infertile. The rationale for extensive surgery resecting parametrium or destructive radiotherapy treating the whole pelvis in all cases of cervical cancer has been questioned.

PATIENTS AND METHODS

Lessons learnt from the less radical surgical approach to breast cancer can be applied to cervical cancer whilst still observing Halstead's principles of surgical oncology. Wide, local excision of early stage small tumours by radical vaginal trachelectomy combined with a laparoscopic pelvic lymphadenectomy utilises modern technology with traditional surgery. Radical vaginal trachelectomy comprises the distal half of a radical abdominal (Wertheim's) or vaginal (Schauta's) hysterectomy. An isthmic–vaginal anastomosis restores continuity of the lower genital tract after insertion of a cerclage that is necessary to maintain competence during future pregnancies.

RESULTS

A total of 142 cases were performed between 1994 and 2006, most (98%) in women with Stage 1B carcinoma of the cervix with a mean follow-up of 57 months. Twelve (9%) had completion treatment, 11 with chemo/radiotherapy and one radical hysterectomy. There were four recurrences (3%) among the women who did not have completion treatment, and two (18%) in those that did. There were 72 pregnancies in 43 women and 33 live births in 24 women. The 5-year accumulative pregnancy rate among women trying to conceive was 53%. Delivery was by classical caesarean section in a high-risk feto-maternal units with 8 babies (25%) born before 32 weeks.

CONCLUSIONS

Radical vaginal trachelectomy appears safe when performed in centres with appropriate experience of radical vaginal surgery and laparoscopic techniques. The impact of this new approach questions traditional teaching whilst preserving potential fertility in hitherto impossible circumstances.
Inaccuracy in Hospital Surgical Coding
Authors: Khwaja HA , Kerr P , Kelley C , Patel K , Babu ED
Published: March 2009

Coding data in hospitals in the UK has notoriously proved to be liable to inaccuracy. This finding from previous studies has significant implications for hospital trusts, with the dawn of the concept of payment by results, which determines how much money a hospital receives from its local primary care trust (PCT) on the basis of operations performed and associated patient comorbidities. Inaccuracies in hospital coding could potentially affect such payments and contribute to the financial crisis afflicting many NHS trusts.
Perceived impact of EWTD on UK doctors
Authors: Wade Ryckie G , Henderson James
Published: March 2009

Doctors have historically worked long hours to provide patient care but also to gain experience. Over the last decade, working hours have decreased significantly, and the introduction of the European Working Time Directive (EWTD) has formalised this. In August 2009, junior doctors (but not consultants) will be limited to a 48-hour working week (see http://www.dh.gov.uk/en/Managingyourorganisation/Huma nresourcesandtraining/Modernisingworkforceplanninghome/Europeanworkingtimedirective/index.htm). There are concerns at all levels of the profession that doctors will not be adequately trained to function at the standard of a current NHS consultant. Doctors with the least experience make the most errors and familiarity with situations and equipment is directly related to competency.
Reality dawns?
Authors: Black John
Published: March 2009

The meeting with Greg Beales, senior advisor for health and social care to the prime minister, took place as promised at 10 Downing Street. He listened carefully, as had Alan Johnson a few days before, to our argument for an opt-out to a 65-hour maximum week for surgeons and undertook to discuss this further in the Department of Health (DH). We considered whether we should request a meeting with the prime minister but this will be kept in reserve at the moment.
Stereotype threat contributes to social difficulties in people with schizophrenia
Authors: Henry Julie D. , von Hippel Courtney , Shapiro Lisa
Published: March 2009

Objective. The experience of stereotype threat (where the prospect of conforming to a stereotype, or of being treated in terms of it, becomes self‐threatening) affects members of social groups about whom devaluing stereotypes exist. Although a widely endorsed stereotype of schizophrenia concerns social skill impairment, it is unclear whether the experience of stereotype threat impacts social functioning in this group. The purpose of the present study was to test whether people with schizophrenia would perform more poorly in a social setting in which they felt stereotyped as mentally ill.

Methods. Thirty individuals with schizophrenia engaged in conversations with two confederates, one of whom they were told knew nothing about them (control conversation), and the other of whom they were told had been informed of their diagnosis (stereotype threat conversation). In reality, neither confederate had been informed of participants' mental health status.

Results. Although participants with schizophrenia did not perceive any differences in their own social behaviour across the two conditions, their social skill was rated by the confederates as poorer in the stereotype threat conversation on three out of the six measures used.

Conclusions. These results suggest that social skill difficulties in people with schizophrenia may be exacerbated by their awareness that others know of their diagnosis. These findings have implications for disclosure of mental health status.
Salivary Leptin as a Candidate Diagnostic Marker in Salivary Gland Tumors
Authors: Schapher Mirco , Wendler Olaf , Gröschl Michael , Schäfer Renate , Iro Heinrich , Zenk Johannes
Published: March 2009

Background: Since the discovery of autonomous leptin production in salivary glands, very few studies have reported on the physiological or pathological meaning of this particular cytokine in saliva. The aim of this study was to investigate the expression of leptin and its receptors Ob-Ra and Ob-Rb in parotid salivary gland tumors, with particular regard to a potential use of leptin as a tumor marker.

Methods: Parotid tissue samples from healthy individuals (n = 31) and tumor patients (n = 97, including tissue samples from pleomorphic adenomas, adenolymphomas, basal cell adenomas, and diverse carcinomas) were analyzed by use of ApoTome-technique microscopy, immunohistochemistry, immunofluorescence, immunoblotting, and quantitative real-time PCR. Salivary and plasma leptin concentrations were measured by using ELISA. Ultrasound was used to determine tumor size before surgery.

Results: In all salivary gland tumors leptin was expressed in much higher amounts than in healthy parotid tissues. The cytokine was not imported from the blood but actively produced by the tumors. Immunoblotting results indicated that leptin was present as oligomers in salivary glands. Furthermore, the examined tumors overexpressed the receptor isoforms Ob-Ra and Ob-Rb. Measured leptin concentrations in mixed saliva samples were significantly increased in patients with parotid tumors [mean (SD) 673 (484) pg/mL in pleomorphic adenomas, 679 (465) pg/mL in adenolymphomas, and 880 (618) pg/mL in carcinomas] vs controls [125 (36) pg/mL] (P < 0.001).

Conclusions: This is the first study to show that the analysis of salivary leptin in mixed saliva samples may allow preoperative differentiation between tumor patients and healthy individuals.
Internet adoption in the newsroom: Journalists' use of the Internet explained by attitudes and perceived functions
Authors: Hermans Liesbeth , Vergeer Maurice , Pleijter Alexander
Published: March 2009

Journalists differ in the degree to which they have adopted the Internet professionally. While earlier studies were predominantly descriptive, this study explains why journalists differ in the amount (time spent on the Internet) and nature (diversity of Internet applications) of their use of the Internet. Based on a random sample of members of the Dutch Association of Journalists, results indicate that the digital divide in terms of demographic characteristics is absent. The perceived functionality of the Internet as a professional tool is the most important explanatory factor for the use of the Internet. Surprisingly, professional attitudes towards journalistic quality are not reflected in journalists' use of the Internet.
Schwere Verfehlung mit schweren Folgen – Die Verwirkung des Verwandtenunterhalts nach § 1611 Abs. 1 S. 1, 3. Fall BGB
Authors: Jenak Andreas , Seifarth Dennis
Published: March 2009

Unterhaltsstreitigkeiten zwischen Verwandten sind in der Praxis an der Tagesordnung. Das Verhältnis zwischen den Parteien ist oft emotional sehr belastet. Die Gerichte müssen sich daher häufig mit der Frage auseinandersetzen, ob der Unterhaltsbegehrende seinen Unterhaltsanspruch durch sein Verhalten teilweise oder gar vollständig verwirkt hat. § 1611 Abs. 1 S. 1, 3. Fall BGB stellt hierzu auf den unbestimmten Rechtsbegriff der schweren Verfehlung ab, der hier näher beleuchtet werden soll.
A New Automatic Device for Measuring Large Volume Changes
Authors: Fair Peter , Anderson William F.
Published: March 2009

The design and construction of a new automatic volume change unit, which is capable of measuring large volume changes without the need for reversing flow direction, is described. It works on the principle of a floating magnet at an air-water interface activating a magnetorestrictive sensor. Its performance is assessed against the criteria listed by Lade (1988) as desirable for any automatic volume change measuring device, and is shown to satisfy these criteria.
Developing a Project Evaluation and Testing Model to Assess Stable Photovoltaic Slicing Machine
Authors: Chang Che-Wei , Wu Cheng-Ru , Chen Huang-Chu
Published: March 2009

This study discusses and develops a project selection model for the purchase of diamond cutting machines for 12-in. photovoltaic silicon wafer slicing based on an analytical network process and preference by similarity to ideal solution (ANP-TOPSIS) method. Simultaneously, process capability indices are presented to test and verify the feasibility and effectiveness of the proposed method. The proposed method can help decision makers to establish a project evaluation and testing mode to affect and choose the best mode for diamond cutting machines of photovoltaic wafer slicing.
Symposium on Spectroscopic Excitation
Authors: ASTM Committee E-2
Published: March 2009

Description

Four papers cover matrix effects, sample effects and environment
Crack-Velocity Considerations
Authors: Krafft JM , Irwin GR
Published: March 2009

If resistance to crack growth always increased with crack velocity, then its measure at nil velocity, Gc or GIc, would always represent minimum toughness and thus a safe criterion. The practical difficulty arises if an increased crack speed, or loading rate of a fixed crack, results first in a decrease in R, possibly to some minimum, prior to its increase for the “stable” propagation balance. Arrest of such a crack will require reduction of the crack driving force, G, at least to minimum R. In strain-rate and temperature-sensitive materials this minimum can lie far below initiation levels. Even in relatively high-strength materials, speed-thermal effects can be large.

The onset and arrest of rapid fracture provide relatively abrupt measurement points suitable for crack toughness evaluation. An understanding of these behaviors can be sought through study of the influence of plastic flow properties. Use of strain-rate sensitive materials over a wide range of temperatures and strain rates permits study of the influences of flow properties without alteration of the inherent flaws. A correlation of rising-load KIc values with the strain-hardening exponent, n, suggests that the onset of fast fracture is controlled to a substantial degree by a tensile instability with a simple relationship to the strain-hardening exponent. The limited information available suggests that crack-arrest conditions can be predicted on the basis of adiabatic values of n at high strain rates.
Fracture Toughness Testing in Alloy Development
Authors: Wei RP
Published: March 2009

In the past five years, fracture mechanics has been used as a basis for the evaluation of the fracture toughness of high-strength steels and other high-strength alloys. Some of the considerations involved in the selection of plane-strain fracture toughness as the most appropriate and significant parameter for ultrahigh-strength alloy steel development are discussed in this paper.

The contribution of fracture mechanics to steel research and development is illustrated by brief reviews of three investigations: (1) a study of the relationships between microstructure and toughness in quenched and tempered low-alloy ultrahigh-strength steels, (2) an investigation of the effect of sulfur level on the fracture toughness of AISI 4345 alloy steel, and (3) a study of the influence of banding on fracture toughness anisotropy in a maraging steel.
Fracture Toughness Testing at Alcoa Research Laboratories
Authors: Kaufman JG , Hunsicker HY
Published: March 2009

At Alcoa Research Laboratories, fracture toughness determinations are made on commercial and promising experimental alloys and tempers with center-cracked specimens, single- and double-edge-notched specimens, and notched round specimens. Compliance techniques are usually used to detect the initiation of unstable crack growth. Kahn-type tear tests and sharp-notch tension tests are used as screening tests to supplement fracture toughness testing in the evaluation of the effects of composition, fabrication procedure, temper, and environment on the fracture characteristics of aluminum alloys. Tear tests have the advantage that direct measures of the relative amounts of energy required to propagate a crack can be obtained even for the toughest of aluminum alloys; furthermore, the unit propagation energy from the tear test is directly correlated with the valid values of Kc and KIc. Sharp-notch tension tests are economical and, particularly when general yielding is not obtained, the ratio of notch strength to yield strength provides a meaningful measure of relative toughness. Specific examples are given of instances in which these techniques have been used to: (1) determine which series of aluminum alloys shows the most promise for the development of high-toughness alloys; (2) establish optimum compositions and fabricating procedures for specific alloys; (3) develop optimum tempers; and (4) indicate the outstanding alloys for cryogenic applications.
Fracture Testing of Weldments
Authors: Kies JA , Smith HL , Romine HE , Bernstein H
Published: March 2009

A new and improved apparatus has been designed and built for three-point loading of bend bars. A new formula for KIc independent of Young's modulus has been derived which fits experimental calibrations and calculations by B. Gross with satisfactory accuracy. A formula is provided by which the requirements for specimen size and notch depth can be calculated for measuring KIc for a given yield strength of material. A number of comparisors are shown for the effect of rolling direction on KIc for base plate and for several different kinds of welding. The effect of notch position on KIc is shown. The slow bend test has advantages of adaptability and simplicity for the purpose at hand.

It seems noteworthy that the effect of directionality on KIc in the base plate is in the same direction but magnified in tests of the welds in the 250-ksi yield-strength grade. For some welding procedures the KIc for some positions in welds was better than for the base plate with no deficiency of hardness. Significance tests were applied to the differences between average values of KIc. From the KIc numbers listed one may calculate the largest tolerable surface crack corresponding to a given stress applied. The center of the weld presents the lowest toughness of any position.
Introduction to the Panel Discussion
Authors: Brown WF
Published: March 2009

During the planning for this Symposium it became quite evident that ample opportunity should be provided for those interested in fracture testing to ask questions of the authors and to make comments on their papers. Such opportunity is normally provided by a discussion period after each presentation, but this is almost always too short to be effective. It was therefore decided to devote an entire session to a panel discussion, the panel being made up of a group of people who have been closely connected with the ASTM Special Committee for Fracture Testing of High Strength Materials, and most of whom also wrote papers for the symposium. The panel discussion was based on questions submitted to the members. These related not only to information presented in the symposium papers but also included questions of general interest in fracture mechanics.
Performance Study of Soil Sampler for Deep-Penetration Marine Borings
Authors: Emrich WJ
Published: March 2009

A relatively economical method for performing foundation investigations in several hundred feet of water to penetrations as much as 500 ft from a floating platform has been devised. The exploration system employs drill pipe and a 2.25-in.-outside diameter thin-wall open drive sampler operated by a wire line. Comparative land trials show that the shear strength of clay samples obtained by this procedure are consistently lower than that associated with conventional sampling methods. Application of correction factors provides satisfactory soil strength information that can be used in the foundation design of offshore platforms.