bluuebunny/crossref_metadata_2025 huggingface dataset:
Videoendoscopic assessment of swallowing function to predict the future incidence of pneumonia of the elderly
Authors: TAKAHASHI N. , KIKUTANI T. , TAMURA F. , GROHER M. , KUBOKI T.
Published: February 2012

Summary  The purpose of the present study was to examine what dysphagic signs identified by videoendoscopy (VE) could predict the incidence of pneumonia and body weight loss in elderly patients living in nursing homes. This study was performed at six nursing care facilities in Japan from March 2007 to February 2009. The 148 subjects (85·1 ± 8·0 years, male/female: 43/105) were evaluated for their feeding and swallowing movements by clinical and VE examinations during the consumption of a regular meal. The VE examination items included the existence/absence of pharyngeal residue, laryngeal penetration, and aspiration of food and saliva. The patients were followed‐up for 3 months with individualized feeding therapy based on the results of the clinical/VE examination at baseline, and the incidence of pneumonia was examined as the primary outcome. In patients without pneumonia, the body weight change was also measured as a secondary outcome. The risk factors for pneumonia and body weight loss (of 3% or more) were identified among the clinical/VE examination items by a Cox proportional hazard analysis. Even with elaborative feeding therapy, 12 (8·1%) of the 148 patients developed pneumonia during the 3 months follow‐up period. The existence of signs of ‘silent aspiration of saliva’ or ‘aspiration of saliva’ detected by VE examination was a significant risk factor for both pneumonia and a body weight loss of 3% or more. This study shows that ‘aspiration of saliva’ detected by VE is a significant risk factor for both pneumonia and body weight loss in elderly patients living in nursing homes.
Testing metapopulation dynamics using genetic, demographic and ecological data
Authors: LAMY T. , POINTIER J. P. , JARNE P. , DAVID P.
Published: February 2012

The metapopulation concept is a cornerstone in the recent history of ecology and evolution. However, determining whether a natural system fits a metapopulation model is a complex issue. Extinction‐colonization dynamics are indeed often difficult to quantify because species detectability is not always 100%, resulting in an imperfect record of extinctions. Here, we explore whether combining population genetics with demographic and ecological surveys can yield more realistic estimates of metapopulation dynamics. We apply this approach to the freshwater snailDrepanotrema depressissimumin a fragmented landscape of tropical ponds. In addition to studying correlations between genetic diversity and demographical or ecological characteristics, we undertake, for the first time, a detailed search for genetic signatures of extinction–recolonization events using temporal changes in allele frequencies within sites. Surprisingly, genetic data indicate that extinction is much rarer than suggested by demographic surveys. Consequently, this system is better described as a set of populations with different sizes and immigration rates than as a true metapopulation. We identify several cases of apparent extinction owing to nondetection of low‐density populations, and of aestivating individuals in desiccated ponds. More generally, we observed a frequent mismatch between genetic and demographical/ecological information at small spatial and temporal scales. We discuss the causes of these discrepancies and show how these two types of data provide complementary information on population dynamics and history, especially when temporal genetic samples are available.
The genetic differentiation at quantitative trait loci under local adaptation
Authors: LE CORRE VALÉRIE , KREMER ANTOINE
Published: February 2012

Most adaptive traits are controlled by large number of genes that may all together be the targets of selection. Adaptation may thus involve multiple but not necessarily substantial allele frequency changes. This has important consequences for the detection of selected loci and implies that a quantitative genetics framework may be more appropriate than the classical ‘selective sweep’ paradigm. Preferred methods to detect loci involved in local adaptation are based on the detection of ‘outlier’ values of the allelic differentiation FST. A quantitative genetics framework is adopted here to review theoretical expectations for how allelic differentiation at quantitative trait loci (FSTQ) relates to (i), neutral genetic differentiation (FST) and (ii), phenotypic differentiation (QST). We identify cases where results of outlier‐based methods are likely to be poor and where differentiation at selected loci conveys little information regarding local adaptation. A first case is when neutral differentiation is high, so that local adaptation does not necessitate increased differentiation. A second case is when local adaptation is reached via an increased covariance of allelic effects rather than via allele frequency changes, which is more likely under high gene flow when the number of loci is high and selection is recent. The comparison of theoretical predictions with observed data from the literature suggests that polygenic local adaptation involving only faint allele frequency changes are very likely in some species such as forest trees and for climate‐related traits. Recent methodological improvements that may alleviate the weakness of FST‐based detection methods are presented.
Only skin deep: shared genetic response to the deadly chytrid fungus in susceptible frog species
Authors: ROSENBLUM ERICA BREE , POORTEN THOMAS J. , SETTLES MATTHEW , MURDOCH GORDON K.
Published: February 2012

Amphibian populations around the world are threatened by an emerging infectious pathogen, the chytrid fungus Batrachochytrium dendrobatidis (Bd). How can a fungal skin infection kill such a broad range of amphibian hosts? And do different host species have a similar response to Bd infection? Here, we use a genomics approach to understand the genetic response of multiple susceptible frog species to Bd infection. We characterize the transcriptomes of two closely related endangered frog species (Rana muscosa and Rana sierrae) and analyse whole genome expression profiles from frogs in controlled Bd infection experiments. We integrate the Rana results with a comparable data set from a more distantly related susceptible species (Silurana tropicalis). We demonstrate that Bd‐infected frogs show massive disruption of skin function and show no evidence of a robust immune response. The genetic response to infection is shared across the focal susceptible species, suggesting a common effect of Bd on susceptible frogs.
The role of immigration and in‐situ radiation in explaining blood parasite assemblages in an island bird clade
Authors: CORNUAULT JOSSELIN , BATAILLARD ANAÏS , WARREN BEN H. , LOOTVOET AMÉLIE , MIRLEAU PASCAL , DUVAL THOMAS , MILÁ BORJA , THÉBAUD CHRISTOPHE , HEEB PHILIPP
Published: February 2012

Parasite communities on islands are assembled through multiple immigrations and/or in‐situ diversification. In this study, we used a phylogenetic approach to investigate the role of such processes in shaping current patterns of diversity in Leucocytozoon, a group of haemosporidian blood parasites infecting whites eyes (Zosterops) endemic to the Mascarene archipelago (south‐western Indian Ocean). We found that this parasite community arose through a combination of multiple immigrations and in‐situ diversification, highlighting the importance of both processes in explaining island diversity. Specifically, two highly diverse parasite clades appear to have been present in the Mascarenes for most of their evolutionary history and have diversified within the archipelago, while another lineage apparently immigrated more recently, probably with human‐introduced birds. Interestingly, the evolutionary histories of one clade of parasites and Indian Ocean Zosterops seem tightly associated with a significant signal for phylogenetic congruence, suggesting that host–parasite co‐divergence may have occurred in this system.
Overlapping transport and chaperone‐binding functions within a bacterial twin‐arginine signal peptide
Authors: Grahl Sabine , Maillard Julien , Spronk Chris A. E. M. , Vuister Geerten W. , Sargent Frank
Published: February 2012

The twin‐arginine translocation (Tat) pathway is a protein targeting system present in many prokaryotes. The physiological role of the Tat pathway is the transmembrane translocation of fully‐folded proteins, which are targeted by N‐terminal signal peptides bearing conserved SRRxFLK ‘twin‐arginine’ amino acid motifs. In Escherichia coli the majority of Tat targeted proteins bind redox cofactors and it is important that only mature, cofactor‐loaded precursors are presented for export. Cellular processes have been unearthed that sequence these events, for example the signal peptide of the periplasmic nitrate reductase (NapA) is bound by a cytoplasmic chaperone (NapD) that is thought to regulate assembly and export of the enzyme. In this work, genetic, biophysical and structural approaches were taken to dissect the interaction between NapD and the NapA signal peptide. A NapD binding epitope was identified towards the N‐terminus of the signal peptide, which overlapped significantly with the twin‐arginine targeting motif. NMR spectroscopy revealed that the signal peptide adopted a α‐helical conformation when bound by NapD, and substitution of single residues within the NapA signal peptide was sufficient to disrupt the interaction. This work provides an increased level of understanding of signal peptide function on the bacterial Tat pathway.
The Trypanosoma brucei AIR9‐like protein is cytoskeleton‐associated and is required for nucleus positioning and accurate cleavage furrow placement
Authors: May Sophie F. , Peacock Lori , Almeida Costa Cristina I. C. , Gibson Wendy C. , Tetley Laurence , Robinson Derrick R. , Hammarton Tansy C.
Published: February 2012

AIR9 is a cytoskeleton‐associated protein in Arabidopsis thaliana with roles in cytokinesis and cross wall maturation, and reported homologues in land plants and excavate protists, including trypanosomatids. We show that the Trypanosoma brucei AIR9‐like protein, TbAIR9, is also cytoskeleton‐associated and colocalizes with the subpellicular microtubules. We find it to be expressed in all life cycle stages and show that it is essential for normal proliferation of trypanosomes in vitro. Depletion of TbAIR9 from procyclic trypanosomes resulted in increased cell length due to increased microtubule extension at the cell posterior. Additionally, the nucleus was re‐positioned to a location posterior to the kinetoplast, leading to defects in cytokinesis and the generation of aberrant progeny. In contrast, in bloodstream trypanosomes, depletion of TbAIR9 had little effect on nucleus positioning, but resulted in aberrant cleavage furrow placement and the generation of non‐equivalent daughter cells following cytokinesis. Our data provide insight into the control of nucleus positioning in this important pathogen and emphasize differences in the cytoskeleton and cell cycle control between two life cycle stages of the T. brucei parasite.
The metabolic blueprint of Phaeodactylum tricornutum reveals a eukaryotic Entner–Doudoroff glycolytic pathway
Authors: Fabris Michele , Matthijs Michiel , Rombauts Stephane , Vyverman Wim , Goossens Alain , Baart Gino J.E.
Published: February 2012

Diatoms are one of the most successful groups of unicellular eukaryotic algae. Successive endosymbiotic events contributed to their flexible metabolism, making them competitive in variable aquatic habitats. Although the recently sequenced genomes of the model diatoms Phaeodactylum tricornutum and Thalassiosira pseudonana have provided the first insights into their metabolic organization, the current knowledge on diatom biochemistry remains fragmentary. By means of a genome‐wide approach, we developed DiatomCyc, a detailed pathway/genome database of P. tricornutum. DiatomCyc contains 286 pathways with 1719 metabolic reactions and 1613 assigned enzymes, spanning both the central and parts of the secondary metabolism of P. tricornutum. Central metabolic pathways, such as those of carbohydrates, amino acids and fatty acids, were covered. Furthermore, our understanding of the carbohydrate model in P. tricornutum was extended. In particular we highlight the discovery of a functional Entner–Doudoroff pathway, an ancient alternative for the glycolytic Embden–Meyerhof–Parnas pathway, and a putative phosphoketolase pathway, both uncommon in eukaryotes. DiatomCyc is accessible online (http://www.diatomcyc.org), and offers a range of software tools for the visualization and analysis of metabolic networks and ‘omics’ data. We anticipate that DiatomCyc will be key to gaining further understanding of diatom metabolism and, ultimately, will feed metabolic engineering strategies for the industrial valorization of diatoms.
Generation of an expressed sequence tag (EST) library from salt‐stressed roots of Jatropha curcas for identification of abiotic stress‐responsive genes
Authors: Eswaran N. , Parameswaran S. , Anantharaman B. , Raja Krishna Kumar G. , Sathram B. , Sudhakar Johnson T.
Published: February 2012

Improving salinity and drought tolerance of crop plants has been an important aim of modern agricultural development, which depends on understanding the functions of genes expressed during the process of stress adaptation. EST resources are an efficient and cost‐effective solution to gene discovery. Jatropha curcas is emerging as the most promising tree oil seed as a source of biodiesel. To identify genes that respond to abiotic stress, in the present study, we report 1240 ESTs generated from root cDNA libraries of J. curcas. ESTs were clustered and assembled into a collection of 865 unigenes, with 107 contigs and 758 singleton sequences. The putative functions of several ESTs could be assigned by similarity to plant gene sequence comparisons. It was found that 23 full‐length CDS (34%) and the majority of transcription factors had sequence similarity to genes known to be involved in abiotic and biotic stress tolerance. The expression pattern of nine selected genes revealed that these genes are differentially expressed in various tissues during adaptation to stress. The data could serve as a critical resource to enable plant improvement programmes towards enhancing the adaptability of J. curcas to growth on marginal lands.
Cafestol, a coffee‐specific diterpene, induces peripheral antinociception mediated by endogenous opioid peptides
Authors: Guzzo Luciana S , Perez Andrea C , Romero Thiago RL , Azevedo Adolfo O , Duarte Igor DG
Published: February 2012

The opioid peptides have been implicated in peripheral antinociception induced by non‐opioidergic compounds, including non‐steroidal anti‐inflammatory drugs and α2‐adrenoceptor agonists. The aims of the present study were to investigate the possible peripheral antinociceptive effect of cafestol, a diterpene present in the oil derived from coffee beans, and to evaluate the involvement of opioid peptides in its effect.

The rat paw pressure test was used to assess antinocipeptive effects. Hyperalgesia was induced by intraplantar injection of prostaglandin E2 (2 μg/paw). All drugs were locally administered into the hind‐paws of male Wistar rats.

Intraplantar injection of cafestol (20, 40 and 80 μg) induced peripheral antinociception. The antinociceptive effect of cafestol was due to a local action because the higher dose (80 μg/paw) did not produce any effect in the contralateral paw. The opioid receptor antagonist naloxone (25, 50 and 100 μg/paw) prevented the action of cafestol (80 μg/paw), whereas the aminopeptidase inhibitor bestatin (400 μg/paw) potentiated the antinociceptive effect of cafestol (40 μg/paw).

The results of the present study provide evidence that cafestol treatment has a peripheral antinociceptive effect and suggest that this effect is mediated by the release of endogenous opioids.
Double neuroendocrine ductal carcinomas in situ coexisting with a background of diffuse idiopathic neuroendocrine cell hyperplasia of breast: A case report and hypothesis of neuroendocrine tumor development
Authors: Miura Katsutoshi , Nasu Hatsuko , Ogura Hiroyuki
Published: February 2012

This article reports the case of a 72‐year‐old woman with two nodules of neuroendocrine (NE) ductal carcinoma in situ coexistent with a background of NE cell hyperplasia. Both tumors, 15 and 3 mm in size, were incidentally revealed on computed tomography without any apparent clinical symptoms. The tumors showed similar histological features, and more than 50% of the tumor cells patchily expressed NE markers, such as chromogranin A, synaptophysin, CD56, and somatostatin receptor type 2. The surrounding nontumor ductal cells also showed spotty or linear positivity for NE markers in contrast to the cells of normal atrophic breasts, which rarely present with NE cells. Moreover, focal mucin production was also observed in the peripheral ducts. It is hypothesized that idiopathic breast NE cell hyperplasia with multiple small nests of NE cells may extend to form a true mass of NE neoplasms.
Trends in prostate needle biopsy diagnosis. A ten year experience of a medical center in Taiwan
Authors: Kuo Ying‐Ju , Lin Shiou‐Fu , Chang Yen‐Hwa , Pan Chin‐Chen
Published: February 2012

Prostate cancer has seen a rapid rise in Taiwanese men. The current study was undertaken to evaluate trends of the disease diagnosed on prostate needle biopsy during a ten‐year period at the Department of Pathology, Taipei Veterans General Hospital. The study included 8236 men who underwent a total of 9995 prostate needle biopsies at this institute from 1994 to 2003. Pathologic features pertinent to diagnosis of cancer were reviewed and compared for cases diagnosed before and after 1999. There were statistically significant increases of the overall cancer detection rate (from 17.6% to 19.9%), proportion of cases with a Gleason score ≤6 (from 16.6% to 40.9%) and focal adenocarcinoma (from 3.0% to 12.8%) in the latter 5 years. The incidence of high‐grade prostatic intraepithelial neoplasia (HGPIN) increased from 0.1% to 1.5%. Patients with HGPIN had a significantly higher risk for subsequent cancer discovered on repeat biopsy than did those with a primary benign diagnosis (29.9% versus 13.7%). Despite a relatively lower incidence of cancer and HGPIN in Taiwanese men compared with that reported in Western studies, in recent years we have found an increase of relevant diagnoses, especially cancer of limited extent and lower grade, which may represent the progress in prostate cancer diagnosis.
Ultrastructural characterization of the mesostriatal dopamine innervation in mice, including two mouse lines of conditional VGLUT2 knockout in dopamine neurons
Authors: Bérubé‐Carrière Noémie , Guay Ginette , Fortin Guillaume M. , Kullander Klas , Olson Lars , Wallén‐Mackenzie Åsa , Trudeau Louis‐Eric , Descarries Laurent
Published: February 2012

Despite the increasing use of genetically modified mice to investigate the dopamine (DA) system, little is known about the ultrastructural features of the striatal DA innervation in the mouse. This issue is particularly relevant in view of recent evidence for expression of the vesicular glutamate transporter 2 (VGLUT2) by a subset of mesencephalic DA neurons in mouse as well as rat. We used immuno‐electron microscopy to characterize tyrosine hydroxylase (TH)‐labeled terminals in the core and shell of nucleus accumbens and the neostriatum of two mouse lines in which the Vglut2 gene was selectively disrupted in DA neurons (cKO), their control littermates, and C57BL/6/J wild‐type mice, aged P15 or adult. The three regions were also examined in cKO mice and their controls of both ages after dual TH–VGLUT2 immunolabeling. Irrespective of the region, age and genotype, the TH‐immunoreactive varicosities appeared similar in size, vesicular content, percentage with mitochondria, and exceedingly low frequency of synaptic membrane specialization. No dually labeled axon terminals were found at either age in control or in cKO mice. Unless TH and VGLUT2 are segregated in different axon terminals of the same neurons, these results favor the view that the glutamatergic cophenotype of mesencephalic DA neurons is more important during the early development of these neurons than for the establishment of their scarce synaptic connectivity. They also suggest that, in mouse even more than rat, the mesostriatal DA system operates mainly through non‐targeted release of DA, diffuse transmission and the maintenance of an ambient DA level.
Diversity and functional analysis of proteorhodopsin in marine Flavobacteria
Authors: Yoshizawa Susumu , Kawanabe Akira , Ito Hiroyasu , Kandori Hideki , Kogure Kazuhiro
Published: February 2012

Proteorhodopsin (PR) genes are widely distributed among marine prokaryotes and functions as light‐driven proton pump when expressed heterologously in Escherichia coli, suggesting that light energy passing through PR may be substantial in marine environment. However, there are no data on PR proton pump activities in native marine bacteria. Here, we demonstrate light‐driven proton pump activity (c. 124 H+ PR−1 min−1) in recently isolated marine Flavobacteria. Among 75 isolates, 38 possessed the PR gene. Illumination of cell suspensions from all eight tested strains in five genera triggered marked pH drops. The action spectrum of proton pump activity closely matched the spectral distribution of the sea surface green light field. Addition of hydroxylamine to a solubilized membrane fraction shifted the spectrum to a form characteristic of PR photobleached into retinal oxime, indicating that PRs in flavobacterial cell membranes transform the photon dose in incident radiation into energy in the form of membrane potential. Our results revealed that PR‐mediated proton transport can create the sufficient membrane potential for the ATP synthesis in native flavobacterial cells.
Sorafenib rechallenge in patients with metastatic renal cell carcinoma
Authors: Nozawa Masahiro , Yamamoto Yutaka , Minami Takafumi , Shimizu Nobutaka , Hatanaka Yuji , Tsuji Hidenori , Uemura Hirotsugu
Published: February 2012

Study Type – Therapy (case series)

Level of Evidence 4

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

Targeted agents with a similar or different target molecule are often used sequentially in the treatment of metastatic RCC. Two tyrosine kinase inhibitors, sorafenib and sunitinib, have been reported to show little cross‐resistance, when used sequentially. In addition, a recent report showed that sunitinib rechallenge could potentially benefit selected patients.

This case series shows that patients once refractory to sorafenib could regain disease control on rechallenge with sorafenib during sequential treatment. Outcomes of the sorafenib rechallenge were not significantly affected by the response to the initial sorafenib treatment or by the duration of intervening treatments between first sorafenib and rechallenge.

OBJECTIVE

To investigate clinical outcomes of sorafenib rechallenge during sequential therapy for patients with metastatic renal cell carcinoma (RCC).

PATIENTS AND METHODS

Patients with metastatic RCC who received sorafenib rechallenge after failed treatment first with sorafenib and subsequently with other agents, were retrospectively reviewed for patient characteristics, best response, progression‐free survival (PFS), and adverse events (AEs).

RESULTS

Of the 14 patients who received sorafenib rechallenge, 12 were evaluable for response. Eleven patients had previously undergone nephrectomy, and 10 had previously received systemic therapy, mostly interferon‐α (nine patients) and interleukin‐2 (six patients), with a median duration of 9 months.

The best responses after the first sorafenib therapy were partial response (PR) in two patients, stable disease (SD) in seven, and progressive disease (PD) in two. The median PFS was 5.7 months. Initial sorafenib therapy was discontinued because of PD in eight patients and AEs in four patients.

Rechallenge with sorafenib was undertaken after a 7.6 month median interval from the initial sorafenib challenge. Eight patients achieved SD on sorafenib rechallenge and median PFS was 5.4 (95% confidence interval, 3.8–7.0) months.

The outcome of the sorafenib rechallenge was not significantly affected by the response to the initial sorafenib treatment or by the duration of treatments received between first sorafenib and rechallenge.

No severe AE was newly observed on the rechallenge.

CONCLUSION

In the systemic treatment of advanced RCC, it was suggested that patients once refractory to sorafenib could regain disease control on rechallenge with sorafenib during sequential treatment.
The results of real‐time brachytherapy for the management of low‐ and intermediate‐risk prostate cancer in patients with prostate volumes up to 100 mL
Authors: Dallas Nicola L. , Malone Peter R. , Jones Adam , Doggart Andrew J. , McConway Kevin J. , Rogers Paul B.
Published: February 2012

Study Type – Therapy (case series)

Level of Evidence 4

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

Historically, the majority of centres in the UK practise a pre‐plan brachytherapy technique which is limited to prostate volumes <50 ml. This study provides further evidence that it is technically possible to deliver a quality implant in a large prostate using real‐time brachytherapy and that the treatment is well tolerated. It has emphasized the value of functional parameters in selecting appropriate patients and concluded that prostate volumes up to 100 ml should not exclude patients from brachytherapy.

OBJECTIVES

To report the results of real‐time brachytherapy in the management of low‐risk and intermediate‐risk prostate cancer in patients with prostate volumes up to 100 mL, over a 6‐year period.

To prospectively determine whether prostate volume influences the ability to achieve a quality implant and therefore impact upon prostate‐specific antigen (PSA) relapse‐free survival, and urinary and rectal toxicity.

SUBJECTS AND METHODS

In all, 216 men with localized prostate cancer were treated with real‐time prostate brachytherapy using 125I implants between November 2003 and December 2009.

Patient selection was based upon functional parameters; International Prostate Symptom Score (IPSS) and flowmetry.

Patients had computed tomography imaging at 1 month to assess post‐implant dosimetry. PSA, IPSS and Radiation Therapy Oncology Group rectal toxicity scores were recorded prospectively over the follow‐up period.

Patients with prostate volumes ≤50 mL and those with volumes >50 mL were compared.

RESULTS

Overall PSA relapse‐free survival was 98.8%; 97.0% for intermediate‐risk patients and 100.0% for low‐risk patients. By volume, 98.5% of men with standard prostates were free from PSA relapse compared with 100.0% of men with large prostates.

The mean post‐implant D90 was 177.0 Gy; 175.5 Gy in standard prostates and 183.5 Gy in large prostates.

The overall acute urinary retention rate was 1.9%; 1.7% in standard prostates and 2.4% in large prostates. There were three urethral strictures, all in the standard prostate group. The mean IPSS increased to 11 and 14 at 3 months for the standard and large prostate groups, respectively, before settling to 2 above baseline for both groups at 12 months.

There were no rectovesical fistulae. Persistent rectal bleeding was reported by one (0.5%) patient in the standard prostate group.

CONCLUSIONS

Prostate brachytherapy is effective in the treatment of low‐risk and intermediate‐risk prostate cancer.

It is technically possible to deliver a quality implant in a large prostate using real‐time brachytherapy.

The treatment itself is well tolerated. Prostate volumes up to 100 mL should not exclude patients from brachytherapy providing either flow rate ≥14 mL/s or symptom score (IPSS) ≤ 10.
Laparoscopic partial nephrectomy: beyond the straightforward T1a
Authors: Tsivian Alexander , Tsivian Matvey , Stanevsky Yury , Benjamin Shalva , Sidi A. Ami
Published: February 2012

Study Type – Therapy (case series)

Level of Evidence 4

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

Complex tumour features (e.g. size, hilar location, multifocality) are generally considered contraindicative for LPN and only a handful of studies reporting encouraging outcomes with more complex tumours. Herein we suggest that in experience hands the benefits of minimally‐invasive surgery may be safely extended to patients with more complex renal masses.

OBJECTIVE

To report on our experience in extending the indications for LPN beyond the single, T1a renal mass assessing the perioperative outcomes in a comparative fashion.

PATIENTS AND METHODS

Retrospective review of consecutive patients undergoing LPN for a renal mass in an academic centre between 2005–2010.

150 patients were divided into two groups based on tumours characteristics: straightforward T1a (group 1: single, <4 cm, n = 84) and complex (group 2: multiple and/or hilar and/or ≥4 cm, n = 66).

Comparison of demographic, clinical, radiographic and perioperative outcomes (operative times, blood loss, warm ischemia times, intra‐ and postoperative complications).

RESULTS

In group 2, 19 tumours were hilar, 15 were multifocal and 44 measured ≥4 cm; 2 of these criteria were present in 7, and all three in 3 cases.

Warm ischemia times and blood loss were comparable (medians of 21 vs 20 min, and 100 vs 100 mL).

Operative times were longer in group 2 (190 vs 140min, P < 0.001).

Complications occurred in 11.9% and 12.1% of patients in group 1 and 2, with Clavien grade 3 events in 8.3 and 10.9%, respectively (P = 1.00 and P = 0.547).

There were 4 conversions to laparoscopic radical nephrectomy (1 in group 1, 3 in group 2).

CONCLUSION

With adequate laparoscopic expertise, the indications for LPN can be safely extended beyond the single, small, peripheral T1a renal mass. In this series, more complex masses were effectively treated with LPN combining the advantages of minimally‐invasive surgery to those of nephron‐sparing approach.
Does severe hypoglycaemia influence microvascular complications in Type 1 diabetes? An analysis of the Diabetes Control and Complications Trial database
Authors: Kilpatrick E. S. , Rigby A. S. , Atkin S. L. , Frier B. M.
Published: February 2012

Diabet. Med. 29, 1195‐1198 (2012)

Aims Severe hypoglycaemia may have a role in aggravating micro‐ and macrovascular disease in diabetes. Data from the Diabetes Control and Complication Trial have been reanalysed to ascertain whether the frequency of severe hypoglycaemia exerted an influence on the development and progression of retinopathy or nephropathy in people with Type 1 diabetes.

Methods Using binary longitudinal multiple logistic regression, HbA1cat study baseline, mean HbA1cthroughout the study and the number of severe hypoglycaemic episodes during the trial were compared to examine the risk of development/progression of retinopathy and nephropathy.

Results Average HbA1cduring the study and/or HbA1cat baseline were independently predictive of retinopathy and nephropathy both in the intensively and the conventionally treated patients (allP ≤ 0.001). However, the number of hypoglycaemic episodes did not add to HbA1cin predicting retinopathy [odds ratio (95% CI) 0.99 (0.96–1.01),P = 0.51 in intensively treated patients, 0.94 (0.89–1.00),P = 0.05, conventional] or nephropathy [odds ratio (95% CI) 0.98 (0.95–1.01),P = 0.48 intensive, 1.03 (0.98–1.10),P = 0.17 conventional].

Conclusions The frequency of exposure to severe hypoglycaemia did not predict a different risk of developing retinopathy or nephropathy in either treatment group of the Diabetes Control and Complications Trial at any given HbA1c.
Ethical review from the inside: repertoires of evaluation in Research Ethics Committee meetings
Authors: de Jong Jean Philippe , van Zwieten Myra C.B. , Willems Dick L.
Published: February 2012

Evaluating the practice of ethical review by Research Ethics Committees (REC) could help protect the interests of human participants and promote scientific progress. To facilitate such evaluations, we conducted an ethnographic study of how an REC reviews research proposals during its meetings. We observed 13 meetings of a Dutch REC and studied REC documents. We coded this material inductively and categorised these codes in two repertoires of evaluation: a repertoire of rules and a repertoire of production. In the repertoire of rules the REC applies rules, weighs scientific value and burdens to the participants and makes a final judgment on a research proposal in a meeting. In the repertoire of production, REC members check documents and forms and advise researchers on how to improve their proposals and can use informal communication. Based on these findings, we think that evaluations of the practice of ethical review should take into account the fact that RECs can use a repertoire of rules and a repertoire of production to evaluate research proposals. Combining these two repertoires can be a viable option so that the REC gives researchers advice on how to improve their proposals to prevent rejection of valuable research.
Carers’ representations of affective mental disorders in British Chinese communities
Authors: Koo Kevin
Published: February 2012

Infrequent use of and delayed presentation to professional services have increased the burden of mental illness in minority ethnic communities. Within the growing literature on informal carers, the Chinese remain relatively unstudied. This article reports a qualitative study of 14 carers to explore illness representations of affective disorders in British Chinese communities. Firstly, it places the study within a theoretical framework that permits an understanding of mental health and illness in different sociocultural belief systems. Next, it presents carers’ narrative accounts in conceptualising mental illness, including its causes, manifestations and impact on patients and carers, and contextualises the findings within the existing literature. Finally, the article examines how the caring role may be constructed from the broader social experience of carers and their relationships within a community structure that values the group over the individual. Coping mechanisms are discussed in the context of the practice of caring as a moral obligation and of policy implications for more culturally appropriate support services for both Chinese carers and mental health patients.
Pontine‐to‐midbrain ratio indexes ocular‐motor function and illness stage in adult Niemann–Pick disease type C
Authors: Walterfang M. , Macfarlane M. D. , Looi J. C. L. , Abel L. , Bowman E. , Fahey M. C. , Desmond P. , Velakoulis D.
Published: February 2012

Background and purpose:  Niemann–Pick disease type C (NPC) is a progressive neurovisceral disorder associated with dystonia, ataxia and a characteristic gaze palsy. Neuropathological studies have demonstrated brainstem atrophy associated with neuronal inclusions and loss, and neurofibrillary tangles, although it is not known whether this pathology can be detected in vivo or how these changes relate to illness variables, particularly ocular‐motor changes. Our aim was to utilize a method for brainstem atrophy, validated in progressive supranuclear palsy (PSP), in a group of adult patients with NPC, and explore its relationship to illness variables and ocular‐motor functioning.

Methods:  We calculated the midbrain and pontine area, and pontine‐to‐midbrain ratio (PMR) from midsagittal images of 10 adult patients with NPC and 27 age‐ and gender‐matched controls. Measures were correlated with illness variables, and measures of horizontal saccadic functioning.

Results:  Pontine‐to‐midbrain ratio was 14% higher in the NPC group, but this difference was not significant. However, PMR showed a significant positive correlation with duration of illness and a measure of illness severity. Furthermore, PMR was significantly negatively correlated with saccadic peak velocity and gain, and self‐paced saccadic performance.

Conclusions:  Pontine‐to‐midbrain ratio was increased in adult patients with NPC compared to controls, although not to the same degree as previously described in PSP, which also presents with significant gaze palsy. These changes were driven predominantly by progressive midbrain atrophy. The strong correlation with illness and ocular‐motor variables suggests that it may be a useful marker for illness progression in NPC.
Perceived relationships between severity of psoriasis symptoms, gender, stigmatization and quality of life
Authors: Böhm D. , Stock Gissendanner S. , Bangemann K. , Snitjer I. , Werfel T. , Weyergraf A. , Schulz W. , Jäger B. , Schmid‐Ott G.
Published: February 2012

Background  Psoriasis is a skin disease with negative physical, psychological and social repercussions for those affected, but we still lack knowledge of how somatic and non‐somatic factors directly and indirectly combine to affect patients’ quality of life (QoL).

Objectives  This study seeks a better understanding of the relations between symptom severity, discomfort, stigmatization, gender and QoL among psoriasis patients.

Methods  The sample comprised 381 psoriasis patients in inpatient care. Symptom severity and discomfort were measured subjectively with single items. Stigmatization was measured with the Questionnaire on Experience with Skin Complaints. QoL was measured using the Dermatology Life Quality Index (DLQI) and the Short Form‐8 Health Survey (SF‐8).

Results  Symptom severity was associated with higher discomfort, stigmatization and lower skin‐related QoL. Symptom severity correlated weakly with more general aspects of QoL as measured by the SF‐8. Men and women reported different experiences with discomfort, stigmatization and mental aspects of QoL (SF‐8 mental component summary score). Some stigmatization parameters function as mediating variables between symptom severity and QoL.

Conclusions  Our findings suggest that the effect of stigmatization on skin‐related QoL is driven by symptom severity and stigmatization combined, whereas its effect on mental health is driven mostly by stigmatization alone. Further, although women and men experience the social impact of psoriasis differently, the effect of stigmatization on QoL is similar for both genders.
Symbol and power: the Dalai Lama as a charismatic leader
Authors: Bentz Anne‐Sophie
Published: February 2012

This article originated in a brief but inspiring analysis by Margaret Nowak. Nowak used Sherry Ortner's concept of ‘summarising symbol’ to imply that, much the same way as the American flag was the epitome of the United States to each and every American, the Dalai Lama encompasses everything Tibetan to the Tibetan people. What does this comparison say about the Dalai Lama? I examine the relationship between symbol, power and charisma with Tenzin Gyatso, the current Dalai Lama, as a case in point. With exile, there has been a shift in the symbolic importance of the Dalai Lama, both as a man and as an institution, from a symbol of Tibet and Tibetan Buddhism to a symbol of the Tibetan cause and, more generally, to a symbol of Buddhism in the world. These changes have given Tenzin Gyatso a new authority in the Tibetan community: he is now the unique and unquestioned leader of the Tibetan cause in the world. I discuss the problems that occur when a symbol is also a man and a leader, as well as the solutions proposed, at a moment when the Tibetan community in exile is experiencing democratisation.
Differential effects of moderate alcohol consumption on motion and contrast processing
Authors: Weschke Sarah , Niedeggen Michael
Published: February 2012

Although a moderate blood alcohol concentration already affects attention, an effect on early visual processing is still questionable. Using psychophysical measures and visually evoked potentials (VEP), we examined the effects of alcohol on the processing of contrast and motion features. In our tasks, two lateralized stimuli were briefly presented, and participants had to identify either the stimulus of higher contrast or motion coherence. In the contrast task, alcohol was found to decrease the discrimination ability and induced a global attenuation of VEP amplitudes. In the motion task, discrimination was not impaired. VEP amplitudes were reduced contralateral to the target position, indicating an effect of alcohol on the deployment of visuospatial attention. In sum, our data suggest that specialized areas for motion and contrast processing within the visual cortex are differently sensitive to moderate alcohol exposure.
Learning to fear suffocation: A new paradigm for interoceptive fear conditioning
Authors: Pappens Meike , Smets Elyn , Vansteenwegen Debora , Van Den Bergh Omer , Van Diest Ilse
Published: February 2012

The present study aimed to establish a new interoceptive fear conditioning paradigm. The conditioned stimulus (CS) was a flow resistor that slightly obstructs breathing; the unconditional stimulus (US) was a breathing occlusion. The paired group (N = 21) received 6 acquisition trials with paired CS–US presentations. The unpaired group (N = 19) received 6 trials of unpaired CS–US presentations. In the extinction phase, both groups were administered 6 CS‐only trials. Measurements included startle eyeblink response, electrodermal responses, and self‐reported US expectancy. In the paired group, startle blink responses were larger during CS compared to intertrial interval during acquisition and extinction. Electrodermal and US expectancies were larger for the paired than for the unpaired group during acquisition, but not during extinction. The present paradigm successfully established interoceptive fear conditioning with panic‐relevant stimuli.
The impact and management of symptoms experienced at midlife: a community‐based study of women in northeast Scotland
Authors: Duffy OK , Iversen L , Hannaford PC
Published: February 2012

Please cite this paper as: Duffy O, Iversen L, Hannaford P. The impact and management of symptoms experienced at midlife: a community‐based study of women in northeast Scotland. BJOG 2012;119:554–564.

Objectives  To determine the frequency and management of menopausal symptoms among community‐dwelling women.

Design  Cross‐sectional study.

Setting  Northeast Scotland.

Population  Women aged 45–54 years registered with 16 general practices.

Methods  In 2009, a self‐completed questionnaire enquiring about the frequency, associated level of bothersomeness and management of 23 symptoms experienced during the previous month was sent to 8206 women.

Main outcome measures  The proportion (95% CI) of women reporting each symptom and management strategy.

Results  Hot flushes, night sweats and vaginal dryness were reported by 46.7% (95% CI 45.2–48.2), 46.4% (95% CI 44.9–47.9) and 28.2% (95% CI 26.9–29.6) of women, respectively. Two‐fifths of women rated these symptoms as quite bothersome or extremely bothersome. More than 60% managed menopausal symptoms using social support by talking to friends and family. Avoidance or alleviating options were common. Herbal remedies were more commonly used than prescription drugs. Current hormone replacement therapy use was highest among surgically menopausal women (21%); 8% of postmenopausal and <2% of perimenopausal women with symptoms were using hormone replacement therapy. Many women had sought information about symptom management. More than one‐third of women wanted more support about menopausal symptoms from their general practitioner or practice nurse.

Conclusion  Following the publication of the Women’s Health Initiative trial results, menopausal symptoms remain common and are often bothersome. Many women seek information about menopausal symptoms from healthcare professionals. Future studies should look beyond frequently researched management strategies, to consider other commonly used options, such as social support, strategies to reduce core body temperature and information about managing menopausal symptoms.
Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion‐based audit at two Tanzanian rural hospitals
Authors: Maaløe N , Sorensen BL , Onesmo R , Secher NJ , Bygbjerg IC
Published: February 2012

Please cite this paper as: Maaløe N, Sorensen B, Onesmo R, Secher N, Bygbjerg I. Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion‐based audit at two Tanzanian rural hospitals. BJOG 2012;119:605–613.

Objective  To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour.

Design  A quality assurance analysis of a retrospective criterion‐based audit supplemented by in‐depth interviews with hospital staff.

Setting  Two Tanzanian rural mission hospitals.

Population  Audit of 144 cases of women undergoing caesarean sections for prolonged labour; in addition, eight staff members were interviewed.

Methods  Criteria of realistic best practice were established, and the case files were audited and compared with these. Hospital staff were interviewed about what they felt might be the causes for the audit findings.

Main outcome measures  Prevalence of suboptimal management and themes emerging from an analysis of the transcripts.

Results  Suboptimal management was identified in most cases. Non‐invasive interventions to potentially avoid operative delivery were inadequately used. When deciding on caesarean section, in 26% of the cases labour was not prolonged, and in 16% the membranes were still intact. Of the women with genuine prolonged labour, caesarean sections were performed with a fully dilated cervix in 36% of the cases. Vacuum extraction was not considered. Amongst the hospital staff interviewed, the awareness of evidence‐based guidelines was poor. Word of mouth, personal experience, and fear, especially of HIV transmission, influenced management decisions.

Conclusion  The lack of use and awareness of evidence‐based guidelines led to misinterpretation of clinical signs, fear of simple interventions, and an excessive rate of emergency caesarean sections.
Is pregnancy safe after uterine artery embolisation?
Authors: Kitson SJ , Macphail S , Bulmer J
Published: February 2012

Please cite this paper as: Kitson S, Macphail S, Bulmer J. Is pregnancy safe after uterine artery embolisation? BJOG 2012;119:519–521.
Is cellular senescence an example of antagonistic pleiotropy?
Authors: Giaimo Stefano , d’Adda di Fagagna Fabrizio
Published: February 2012

It is generally accepted that the permanent arrest of cell division known as cellular senescence contributes to aging by an antagonistic pleiotropy mechanism: cellular senescence would act beneficially early in life by suppressing cancer, but detrimentally later on by causing frailty and, paradoxically, cancer. In this review, we show that there is room to rethink this common view. We propose a critical appraisal of the arguments commonly brought in support of it, and we qualitatively analyse published results that are of relevance to understand whether or not cellular senescence‐associated genes really act in an antagonistic‐pleiotropic manner in humans.