bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonmutilating palmoplantar and periorificial kertoderma: a variant of Olmsted syndrome or a distinct entity?
Authors: Nofal Ahmad , Assaf Magda , Nassar Amani , Nofal Eman , Shehab Marwa , El‐Kabany Moustafa
Published: June 2010

Background  Olmsted syndrome is a rare keratinization disorder characterized by mutilating palmoplantar and periorificial keratoderma as the two major diagnostic features. Some authors believe that atypical cases without this standard combination may not really belong to Olmsted syndrome. Herein, we describe two familial cases with congenital nonmutilating palmoplantar and periorificial keratoderma, and discuss their similarities and differences with Olmsted syndrome.

Patients  The study included two sisters who presented with focal and punctate nonmutilating palmoplantar keratoderma (PPK), periorificial hyperkeratotic plaques, and widely distributed keratotic lesions. Fragile denuded areas of the skin were found in sites exposed to trauma. Fingernails showed a characteristic form of leukonychia.

Results  Histopathology of plantar keratoderma showed psoriasiform hyperplasia with marked compact hyperkeratosis, while vicinity of denuded skin revealed thin parakeratotic zone and dissolution of the granular cell layer. Immunohistochemistry demonstrated suprabasal staining pattern for acidic keratin (AE1) and uniform positivity, starting four to six layers above the basal layer, for cytokeratin 10. Electron microscopy showed defective keratinization. Cytogenetic studies revealed normal karyotype and no chromosomal breakage.

Conclusion  Our cases share Olmsted syndrome in the early onset, and the presence of symmetrical PPK, periorificial keratoderma and keratotic lesions. However, the striking nonmutilating nature of PPK and the presence of unique features in our patients suggest a newly described keratinization disorder.
Progressive multifocal leukoencephalopathy and antipsoriatic drugs
Authors: Di Lernia Vito
Published: June 2010

Progressive Multifocal Leukoencephalopathy (PML) is a rare and often fatal opportunistic demyelinating disorder secondary to central nervous system infection by the polyomavirus John Cunningham (JC), a common infecting agent in human populations, with 50–70% of healthy individuals having antibodies to the virus. Although human immunodeficiency virus (HIV) infection remains the most common predisposing factor for PML, which can occur also in association with hematologic malignant neoplasms or iatrogenic immunosuppression in the setting of organ transplantations, recently JC virus has been recognized as an important pathogen in patients with autoimmune and rheumatic diseases receiving immunosuppressive treatments. Following the availability of new biologic drugs, additional cases of PML have been reported in dermatologic patients as well. In particular, the occurrence of PML in psoriatic patients who had been taking efalizumab in the absence of any other concurrent immunosuppressive agents resulted in the decision of European Medicine Agency (EMEA) in February 2009 to recommend suspension of the marketing authorization for this drug in Europe. Some months later the manufacturer of the drug decided to voluntarily withdraw the product from the U.S. market. Since PML can occur as a potential side effect of different immunosuppressive drugs, including conventional treatments for psoriasis, and in consideration of the future development of new immunosuppressive biological agents, dermatologists need to become familiar with opportunistic infections including PML.
Feasibility of antegrade radical prostatectomy for clinically locally advanced prostate cancer: a comparative study with clinically localized disease
Authors: Yamamoto Shinya , Kawakami Satoru , Yonese Junji , Fujii Yasuhisa , Tsukamoto Tetsuro , Okubo Yuhei , Kijima Toshiki , Ishikawa Yuichi , Fukui Iwao
Published: June 2010

Objectives:  To investigate intraoperative and early postoperative complications of antegrade radical prostatectomy with intended wide resection (aRP) for clinically locally advanced prostate cancer (cLAD) and to compare with those of aRP for clinically localized prostate cancer (cLD).

Methods:  Between March 1994 and June 2007, 800 consecutive Japanese patients including 625 with cLD and 175 with cLAD underwent aRP and bilateral limited lymphadenectomy. Clinicopathological data including intraoperative and early postoperative complications (within 30 days after operation) were compared between cLD and cLAD groups.

Results:  No deaths occurred. Operative time and blood loss did not differ significantly between the groups. Intraoperative and early postoperative complications were observed in 11 (1.4%) and 123 (15.4%) of the entire cohort, respectively. Prevalent early postoperative complications were pelvic hematoma, wound infection, urinary retention and lymphocele or prolonged lymph drainage. There were no significant differences in the entire intraoperative and early postoperative complications between the groups. The majority of the early postoperative complications were minor.

Conclusions:  aRP for cLAD is technically feasible and a safe surgical procedure. If radical prostatectomy could be established as a standard treatment for cLAD in the future, aRP might be valuable as the first step of multimodal treatments.
Evolution of pancreas transplant surgery
Authors: Lam Vincent W. T. , Pleass Henry C. C. , Hawthorne Wayne , Allen Richard D. M.
Published: June 2010

Background: Type 1 diabetes mellitus is a chronic condition often leading to disabling complications including retinopathy, neuropathy and cardiovascular disease which can be modified by intensive treatment with insulin. Such treatment, however, is associated with a restrictive lifestyle and risk of hypoglycaemic morbidity and mortality.

Methods: This review examines the role of pancreas transplantation in patients with Type 1 diabetes mellitus.

Results: Pancreas transplantation is currently the only proven option to achieve long‐term insulin independence, resulting in an improvement or stabilization of those diabetic related complications. The hazards of pancreas transplantation as a major operation are well known.

Balancing the risks of a surgical procedure, with the benefits of restoring normoglycaemia remains an important task for the pancreas transplant surgeon. Pancreas transplantation is not an emergency operation to treat poorly managed and non‐compliant patients with debilitating complications. It is a highly specialized procedure which has evolved both in terms of the surgical technique, patient selection and assessment.

Conclusion: Pancreas transplantation has emerged as the single most effective way to achieve normal glucose homeostasis in patients with Type 1 diabetes mellitus.
Role of an acute assessment and review area for general surgical patients
Authors: Perry Ellen , Mackintosh Stuart , Connor Saxon
Published: June 2010

Background:  Increasing demand for acute surgical services is one of the major challenges facing modern health systems. The aim of this study was to assess the impact of implementing a dedicated surgical assessment and review area (SARA) on patient flow for acute general surgical patients at a major teaching hospital in New Zealand.

Methods:  A specific area within inpatient surgical beds was redeveloped and staffed by a dedicated surgical team. Prospective data pertaining to patient flow and outcomes were collected (10‐month period) and compared with historical controls (preceding 14 months prior to implementation).

Results:  During the 24‐month period 9182 acute general surgical patients were admitted (3836 [41.1%] post implementation of SARA). Subsequent to the introduction of SARA, 865 (22.5%) patients were referred directly from their general practitioner. Length of stay was reduced in all patients from 2.58 to 2.04 days (P < 0.001) and in those who did not require surgery from 2.56 to 1.96 days (P < 0.001). However, the number of days in which the department of surgery had outlying patients increased significantly from 76.7% to 86.3%, P < 0.001.

Conclusions:  The introduction of a dedicated SARA significantly reduced hospital stay and improved efficiencies of the emergency department.
Physician assistants: trialling a new surgical health professional in Australia
Authors: Ho Phyllis , Pesicka Dawanda , Schafer Amy , Maddern Guy
Published: June 2010

Background:  The Australia health workforce productivity Commission Research Report in 2005 identified workforce shortages. One of the recommendations is that new models of health care be established. As a result South Australia is trialling United States trained physician assistants in a pilot program. This paper summaries the review of literature of the physician assistant role and safety in the surgical setting.

Methods:  A literature search using Medline and Pubmed from 1966 until 2009 with key words: physician assistants, midlevel providers, surgery. The references of the results were also searched for suitable articles. The Google search engine was also used with the above keywords to search for latest developments from nontraditional sources.

Results:  There were over 200 suitable articles relating to the quality and safety of physician assistants. The overwhelming majority of the articles originate from the United States and these vary in quality. There were 13 published studies identified that documented physician assistants in the surgical setting.

Conclusion:  From the published data physician assistants have been shown to provide safe and provide high quality care in surgical units. It is important that prior to their commencement their role is defined to alleviate conflict and confusion in the team. Continued auditing should be conducted to monitor progress and impact.
Guidelines for patient selection and performance of carotid artery stenting
Authors:   The Carotid Stenting Guidelines Committee
Published: June 2010

Background:  The endovascular treatment of carotid atherosclerosis with carotid artery stenting (CAS) remains controversial. Carotid endarterectomy remains the benchmark in terms of procedural mortality and morbidity. At present, there are no consensus Australasian guidelines for the safe performance of CAS.

Methods:  We applied a modified Delphi consensus method of iterative consultation between the College representatives on the Carotid Stenting Guidelines Committee (CSGC).

Results:  Selection of patients suitable for CAS needs careful consideration of clinical and patho‐anatomical criteria and cannot be directly extrapolated from clinical indicators for carotid endarterectomy (CEA). Randomized controlled trials (including pooled analyses of results) comparing CAS with CEA for treatment of symptomatic stenosis have demonstrated that CAS is more hazardous than CEA. On current evidence, the CGSC therefore recommends that CAS should not be performed in the majority of patients requiring carotid revascularisation. The evidence for CAS in patients with symptomatic severe carotid stenosis who are considered medically high risk is weak, and there is currently no evidence to support CAS as a treatment for asymptomatic carotid stenosis. The use of distal protection devices during CAS remains controversial with increased risk of clinically silent stroke. The knowledge requirements for the safe performance of CAS include an understanding of the evidence base from randomized controlled trials, carotid and aortic arch anatomy and pathology, clinical stroke syndromes, the differing treatment options for stroke and carotid atherosclerosis, and recognition and management of periprocedural complications. It is critical that all patients being considered for a carotid intervention have adequate pre‐procedural neuro‐imaging and an independent, standardized neurological assessment before and after the procedure. Maintenance of proficiency in CAS requires active involvement in surgical/endovascular audit and continuing medical education programs. These standards should apply in the public and private health care settings.

Conclusion:  These guidelines represent the consensus of an inter‐collegiate committee in order to direct appropriate patient selection and the range of cognitive and technical requirements to perform CAS. Advances in endovascular technologies and the results of randomized controlled trials will guide future revisions of these guidelines.
Analysis of the effects of cold expansion of holes using thermoelasticity and image correlation
Authors: BACKMAN D. , COWAL C. , PATTERSON E. A.
Published: June 2010

Although cold expansion has been shown to have a positive effect on fatigue life, little work to date has been performed to evaluate the evolution of the strain field surrounding the crack tip on the mandrel entry and exit faces in cold‐expanded coupons. Full‐field strain measurements using both digital image correlation (DIC) and thermoelastic stress analysis (TSA) were used to compare the strains during crack growth around holes that had and had not been cold‐expanded by 4%. Simple rectangular fatigue coupons were machined from 2024‐T3 aluminium sheet, half had simple open, unexpanded holes and half had cold‐expanded open holes. A DIC system was used to monitor the (mandrel) entry face of the coupon while a TSA system was used to monitor the (mandrel) exit face of the coupon during cyclic tensile loading (R‐ratio = 0.1). These two systems provide the first published measurements of the simultaneous mandrel entry and exit surface strains surrounding a crack initiating from a cold‐expanded hole. The cracks originating from the unexpanded hole exhibit a strain field around the crack tip which is characteristic of a mode I fatigue crack while those emanating from the cold‐expanded holes show a significantly lower distribution of strains around the crack tip. Crack opening displacements evaluated from the strain data obtained from DIC, are substantially reduced by the residual compressive stresses from cold expansion, while the overall fatigue data show the life improvement achieved at various applied stress levels.
Impaired fear extinction in mice lacking protease nexin‐1
Authors: Meins Marita , Herry Cyril , Müller Christian , Ciocchi Stéphane , Moreno Eliza , Lüthi Andreas , Monard Denis
Published: June 2010

The serine protease inhibitor protease‐nexin‐1 (PN‐1) has been shown to modulate N‐methyl‐d‐aspartate receptor (NMDAR)‐mediated synaptic currents and NMDAR‐dependent long‐term potentiation of synaptic transmission. Here, we analysed the role of PN‐1 in the acquisition and extinction of classical auditory fear conditioning, two distinct forms of learning that both depend on NMDAR activity in the amygdala. Immunostaining revealed that PN‐1 is expressed throughout the amygdala, primarily in γ‐aminobutyric acid containing neurons of the central amygdala and intercalated cell masses (ITCs) and in glia. Fear extinction was severely impaired in mice lacking PN‐1 (PN‐1 KO). Consistent with a role for the basal nucleus of the amygdala in fear extinction, we found that, compared with wild‐type (WT) littermate controls, PN‐1 KO mice exhibited decreased numbers of Fos‐positive neurons in the basal nucleus after extinction. Moreover, immunoblot analysis of laser‐microdissected amygdala sub‐nuclei revealed specific extinction‐induced increases in the level of phosphorylated alpha‐calcium/calmodulin protein kinase II in the medial ITCs and in the lateral subdivision of the central amygdala in WT mice. These responses were altered in PN‐1 KO mice. Together, these data indicate that lack of extinction in PN‐1 KO mice is associated with distinct changes in neuronal activity across the circuitry of the basal and central nuclei and the ITCs, supporting a differential impact on fear extinction of these amygdala substructures. They also suggest a new role for serine protease inhibitors such as PN‐1 in modulating fear conditioning and extinction.
Targeting Cash to Malawi's Ultra‐Poor: A Mixed Methods Evaluation
Authors: Miller Candace M. , Tsoka Maxton , Reichert Kathryn
Published: June 2010

Governments target transfers so that limited resources reach impoverished households; targeting errors therefore indicate inefficiency in resource use and inability to reach the poorest households. This article examines the Malawi Social Cash Transfer Scheme (SCTS), using mixed methods and multiple data sources, including examination of underlying assumptions, the operationalisation of key concepts, questions of implementation, and errors of inclusion and exclusion. Despite serious challenges, the scheme's error rates are within the range of global averages. Its impressive impacts provide strong motivation for improving the targeting process before it is scaled up to the national level.
The Location of Manufacturing Exporters in Africa: Empirical Evidence
Authors: Naudé Wim , Matthee Marianne
Published: June 2010

Abstract:  The costs of accessing and using a port/export hub should be high on the list of priorities for export promotion agencies in Africa. This conclusion emanates from this paper focusing on the geographical location of manufacturing export industries in South Africa. Here manufacturing export firms tend to be spatially concentrated with about 84 per cent of total manufacturing exports produced in only 6 per cent of magisterial districts. Distance from an export hub is negatively related to the density of manufactured exports. The largest volumes of manufactured exports are generated within 100 km of an export hub. For electronics, about 98 per cent of manufacturing takes place within 100 km of an export hub. Comparison over time showed that the number of locations from which manufacturing exports occur increased by 15 per cent over 1996–2004 and that manufacturing exports increased in the band between 200 and 400 km from the nearest hub.
Flexibility or exploitation? Corporate social responsibility and the perils of universalization (Respond to this article at http://www.therai.org.uk/at/debate)
Authors: Smith Jessica , Helfgott Frederico
Published: June 2010

As anthropologists and other critics of capitalism turn their attention to the controversial and burgeoning corporate social responsibility (CSR) movement, most focus on conflicts in community relations and environmental degradation. Few scholars have examined equally pertinent questions of labor restructuring, even though these transformations emerged at about the same time as the rise of CSR. In this article, we draw on research in two Peruvian mining communities to explore the potential contradiction between the simultaneous mandate for corporations to present themselves as responsible employers, on the one hand, and the drive to rationalize labor and reduce financial responsibility for the workforce, on the other. We suggest that for both corporate officials and some scholars, this tension remains a latent one because CSR discourses and documents generalize corporate interests as the interests of mines as a whole.
Tax‐and‐Transfer Tensions: Designing Direct Tax Structures
Authors: Creedy John
Published: June 2010

Direct tax structures are regularly revised and debates over changes are heated. Taxes affect the behaviour of individuals and families in ways which are hard to predict, but which impose constraints on governments trying to achieve their objectives. Attempts to help one group of individuals often have unintended consequences on other groups. Views about the role of a tax system vary substantially but, in debates, the basic value judgements which influence policy recommendations are seldom made explicit. This article attempts to clarify the main tensions involved in tax planning and to explain why consensus is unlikely ever to be achieved.
Vacancies and Unemployment in Australia
Authors: Chindamo Phillip , Uren Lawrence
Published: June 2010

This article examines the extent to which the Mortensen–Pissarides model of labour market search can quantitatively match business cycle fluctuations in Australia. With productivity and job‐separation‐rate shocks, the model fails to produce substantial volatility among unemployment or vacancies, a result similar to Shimer's (2005) findings for the United States. Examining a broader range of shocks significantly increases the magnitude of business cycle fluctuations, but still only explains roughly 25 per cent of labour market volatility. The implied volatility of wages in the model is similar to that in the data and hence excessive wage flexibility is unlikely to be central to the failure of the model as claimed in the literature.
The Effects of Domestic Climate Change Measures on International Competitiveness
Authors: Kee Hiau Looi , Ma Hong , Mani Muthukumara
Published: June 2010

(1286) Hiau Looi Kee, Hong Ma and Muthukumara Mani Under the Kyoto Protocol, industrialised countries (called Annex I countries) have to reduce their combined emissions to 5 per cent below 1990 levels in the first commitment period of 2008–12. Efforts to reduce emissions to meet Kyoto targets and beyond have raised issues of competitiveness in countries that are implementing these policies, as well as fear of leakage of carbon‐intensive industries to non‐implementing countries. This has also led to proposals for tariff or border tax adjustments to offset any adverse impact of capping CO2 emissions. In this paper we examine the implications of climate change policies such as carbon tax and energy efficiency standards on competitiveness across industries, as well as issues related to leakage, if any, of carbon‐intensive industries to developing countries. Though competitiveness issues have been much debated in the context of carbon taxation policies, the study finds no evidence that industries’ competitiveness is affected by carbon taxes. In fact, the analysis suggests that exports of most energy‐intensive industries increase when a carbon tax is imposed by the exporting countries, or by both importing and exporting countries. This finding gives credence to the initial assumption that recycling the taxes back to the energy‐intensive industries by means of subsidies and exemptions may be overcompensating for the disadvantage to those industries. There is, however, no conclusive evidence that supports relocation (leakage) of carbon‐intensive industries to developing countries due to stringent climate change policies.
Cars, Employment, and Single Mothers: The Effect of Welfare Asset Restrictions
Authors: BANSAK CYNTHIA , MATTSON HEATHER , RICE LORIEN
Published: June 2010

This article measures the effect of asset rules for welfare eligibility on car ownership among single mothers without a college education, and investigates whether these changes lead to changes in employment. We combine micro‐level data with data on state welfare asset rules and find that the probability of owning a car is greater in states with higher overall asset limits, states that value vehicles on an equity basis, and states with exemptions for multiple vehicles.
Gender‐Compensation Differences Among High‐Level Executives in the United States
Authors: MUÑOZ–BULLÓN FERNANDO
Published: June 2010

Bertrand and Hallock (2001: 3) present compelling evidence that female executives in the United States earned 45 percent less total compensation than their male counterparts for 1992–1997. We complement their results by analyzing data over a longer time period and, more importantly, contend that most of the unexplained gender difference in total pay among executives was due to gender differences in the portion of variable pay, in particular a different cash payout from stock option exercises.
Stromal expression of cathepsin K in squamous cell carcinoma
Authors: Yan X , Takahara M , Xie L , Oda Y , Nakahara T , Uchi H , Takeuchi S , Tu Y , Moroi Y , Furue M
Published: June 2010

Background  Cathepsin K (CTSK), a cysteine protease with strong collagenolytic and elastolytic properties involved in extracellular matrix turnover, may be produced by neoplastic cells as well as stromal macrophages and fibroblasts. Its expression is suggested as associated with increased invasive and metastatic potential.

Objectives  The aim of this study is to examine stromal expression of cathepsin K in skin tumors.

Methods  A series of 13 normal skin and 109 skin tumours, including 51 benign and 58 malignant epidermal tumours were tested for CTSK and Ki‐67 expression by immunohistochemical analysis.

Results  Stromal CTSK expression and the tumoral Ki‐67 labelling index were significantly higher in invasive squamous cell carcinoma (SCC) than in other epidermal tumours.

Conclusion  Cathepsin K‐positive stromal fibroblasts may play a crucial role in SCC progression by promoting extracellular matrix degradation, thereby facilitating SCC growth and invasion into surrounding tissue and vasculature. CTSK inhibitors may be a potential novel therapeutic option to decrease SCC progression.
Treatment of mucous hypersecretion
Authors: Baraniuk J. N. , Zheng Y.
Published: June 2010

Airway secretions are produced by glandular and epithelial exocytosis and vascular permeability. Each process plays a unique role in different disease states, and so treatment must be tailored to the pathophysiological mechanism(s). In acute allergic rhinitis, the watery rhinorrhea is predominantly plasma with only about one‐third derived from histamine‐induced nociceptive afferent nerve and parasympathetic reflexes. The acetylcholine acts on muscarinic M3 receptors on glands to stimulate exocytosis from both mucous and serous cells. Parasympathetic, cholinergic reflex‐mediated glandular secretion responds very well to anticholinergic drugs. More chronic inflammation as seen in chronic rhinosinusitis and bronchitis leads to goblet cell hyperplasia and increased secretion of mucin 5AC (MUC5AC), a secreted, gel‐forming mucin that contains many serine–threonine repeats that are studded with large O‐linked carbohydrate groups. Progressively worsening inflammation leads to the addition of sialic acid and sulphate to generate acidic mucins. The protein chains are cross‐linked by disulphide bonds to form large, buoyant islands that float on the epithelial lining fluid. These sticky macromolecules form complexes with albumin and neutrophil‐derived DNA, F‐actin, and proteolytic enzymes, creating mucoclots. These tenacious, viscous, mucoclots can adhere to epithelial linings, which may lead to occlusion of small airways that causes reduced airflow in chronic obstructive pulmonary disease and asthma. Mucous plugging is a problem leading to the overwhelming mucous hypersecretion and solidification of ‘end‐stage’ acute asthma attacks. Mucous hypersecretion of this severity has been correlated with increased morbidity and mortality in lung disease. Anticholinergic drugs are essential therapies in these conditions. Other medications for mucous hypersecretion include expectorants, anti‐inflammatory agents, macrolides, inhaled DNase, and a host of unproven products. Information about signal transduction, transcriptional regulation, and mucin synthesis has provided a framework for understanding the excess production of goblet cell MUC5AC in disease, and has identified potential targets for future drug therapy.
Seasonal allergic rhinitis: impact of the disease and considerations for its management
Authors: Terada N.
Published: June 2010

Many changes to our medical care services are expected to occur in the next several years, and these will substantially affect the treatment of pollinosis. Patients with pollinosis are becoming increasingly dependent on over‐the‐counter (OTC) medicines; today, as many as 25–30% of patients with allergic rhinitis report using these agents. This trend will be further accelerated if switched OTC medicines such as ketotifen and azelastine are sold at general retailers as well as pharmacies and drug stores under new laws. We conducted three surveys on the prescription pattern of drugs against pollinosis during the high pollen count season in 1998, 2003, and 2009. Whereas the use of chemical mediator‐release inhibitors tended to decrease, that of second‐generation antihistamines increased during the period examined. Especially, use of anti‐leukotrienes and prostaglandin D2/chemoattractant receptor‐homologous molecule expressed on Th2 cells antagonists either alone or in combination increased rapidly after their launch in 2000. Despite many successful advances in treatment, however, many patients still remain dissatisfied with their anti‐pollinosis therapy. Therefore, it is essential that physicians keep abreast of what medications are to be switched to OTC status and to maintain patient satisfaction by the appropriate use of good prescription drugs.
Should simple hysterectomy be added after chemo‐radiation for stage IB2 and bulky IIA cervical carcinoma?
Authors: EITAN Ram , LEVAVI Hanoch , PELED Yoav , BRENNER Ronen , SABAH Gad , BEN‐ARIE Alon , DGANI Ram , FISHMAN Ami , SULKES Aaron , FENIG Eyal , KOREN Claude
Published: June 2010

Background and Aims:  Management of bulky cervical tumours is controversial. We describe the addition of high dose rate brachytherapy with concomitant chemotherapy to an attenuated protocol of radiation followed by simple hysterectomy in the management of bulky cervical tumours.

Methods:  Between January, 2003 and December, 2006, 23 patients diagnosed with bulky cervical tumours underwent a fixed chemo‐radiation protocol followed by simple hysterectomy. Fractionated external beam pelvic radiation (4500 cGy) followed by two high‐dose rate applications of brachytherapy (700 cGy – prescription dose to point A) was given with weekly concomitant cisplatin (35 mg/m2). Patients then underwent simple hysterectomy. Clinical information was prospectively collected and patient charts were then further reviewed.

Results:  Twenty patients had stage IB2 and three bulky IIA. Median tumour size was 5 cm. Sixteen patients (70%) achieved a clinical complete and seven (30%) a clinical partial response. All patients had a total abdominal hysterectomy and bilateral salpingo‐oophorectomy (TAH BSO). On final pathology, 12 patients (52%) had a pathological complete response, whereas 11 patients (48%) had residual carcinoma in the cervix. Surgical margins were not involved. With a median follow‐up time of 20 months (range 10–50 months), four patients (17.4%), all from the pathological partial response group, have suffered a pelvic recurrence, within 6 months from therapy; nineteen patients (82.6%) remain free of disease.

Conclusions:  This attenuated protocol of chemo‐radiation using HDR brachytherapy followed by simple hysterectomy is a viable option in the treatment of bulky cervical carcinomas. The rate of residual cervical disease after chemo‐radiation is substantial, but simple hysterectomy achieved negative surgical margins in all cases.
The development and initiation of the NSW Department of Health interprofessional Fetal welfare Obstetric emergency Neonatal resuscitation Training project
Authors: COOKE Helen , FOUREUR Maralyn , KINNEAR Ann , BISITS Andrew , GILES Warwick
Published: June 2010

Background:  The Fetal Welfare Obstetric emergency Neonatal resuscitation Training (FONT) project was initiated on a background of rising notifications of adverse events in NSW maternity units, the significant proportion of which were related to fetal welfare assessment.

Aims:  The aim of the study is to describe the development and introduction of the NSW state‐wide interprofessional FONT project.

Methods:  Following development and risk assessment, FONT was launched in February 2008. The project consists of an online component and two face‐to‐face training days to be completed each 3 years; the first day for fetal welfare assessment and the second for obstetric and newborn emergencies. Eight, 2‐day training sessions were conducted throughout NSW for FONT trainers. Each trainer underwent pre‐ and post‐testing for changes in knowledge of fetal welfare assessment. The 2005–2008 NSW adverse event report numbers were assessed.

Results:  From 20 February to 17 April 2008, 240 trainers had been trained in fetal welfare assessment, and by the end of 2008 these trainers had trained 954 clinicians. There were significant improvements in the interpretation and management planning of electronic fetal heart rate patterns following training. Analysis of Severity Assessment Codes 1 and 2 showed no significant trend in the number of notifications for adverse events related to fetal welfare assessment.

Conclusions:  In the first 11 months, 25% of the state’s maternity practitioners had received training in the first stage of the FONT project. The FONT project has shown short‐term improvements in learning and communication skills and in the participants of the project.
Predicting the outcome of induction of labour
Authors: NADER Ralph , SHEK Ka Lai , DIETZ Hans Peter
Published: June 2010

Objective:  To test whether prediction of delivery outcome is feasible in post‐term nulliparous pregnant women, using a published model and a locally produced model combining clinical and ultrasound assessment.

Methods:  This is a prospective pilot study of 53 nulliparous women seen in a postdates clinic between 40 weeks four days and 41 weeks three days of gestation. They underwent a routine assessment including transabdominal ultrasound to determine amniotic fluid index, a Bishop score, and translabial ultrasound to determine the station of the fetal head at rest and bladder neck descent at rest and on valsalva. Additional information such as body weight at booking and current weight, height and a family history of caesarean section was obtained. Delivery outcome and labour details were obtained from the local obstetric database. Two models for prediction of delivery outcome were tested.

Results:  Forty‐nine complete datasets were analysed. Fourteen women had a normal vaginal delivery, 17 instrumental deliveries and 18 caesarean sections. A published model predicted the induction outcome in 62%. A local model using maternal age, body mass index, family history of caesarean section, station of the fetal head and bladder neck descent predicted vaginal delivery in 70% in our study.

Conclusion:  Prediction of delivery outcome is of limited feasibility in post‐term nulliparous pregnant women. Our locally produced model was successful in predicting vaginal delivery in 70% of women. Prediction of delivery outcome may not be sufficiently powerful to allow modification of current obstetric practice.
The Use of Bivalirudin for Cardiopulmonary Bypass Anticoagulation in Pediatric Heparin‐Induced Thrombocytopenia Patients
Authors: Gates Richard , Yost Paul , Parker Beth
Published: June 2010

Infants with heparin‐induced thrombocytopenia (HIT) represent a challenging and high‐risk group of patients when they require cardiopulmonary bypass (CPB). Bivalirudin offers many potential pharmacologic advantages over other nonheparin anticoagulants for such patients. We describe our protocol for the use of bivalirudin in a 5‐month‐old infant undergoing stage 2 Norwood for hypoplastic left heart syndrome. The patient was a 5‐ month‐old, 6‐kg infant who developed HIT after a bowel resection complicating initial Norwood stage 1. After sternotomy and dissection had been redone, the child received an initial dose of bivalirudin of 1.0 mg/kg and 0.5 mg/kg 5 min later. The CPB circuit was primed with 50 mg/kg bivalirudn/400 cc volume. With the initiation of CPB, a continuous infusion of 2.5 mg/kg bivalirudin was begun. Activated clotting time (ACT) was targeted for over 400 s, with an examination prior to bypass and each 15 min thereafter. Bivalirudin was discontinued with separation from bypass and during modified ultrafiltration (MUF). The ACT was 286 s after the initial 1 mg/kg bolus and 597 s after the second 0.5 mg/kg bolus and initiation of CPB. At a rate of 2.5 mg/kg/min, ACT ranged between 461 and 597 s. At the completion of MUF, the ACT was 316 s. The ACT was 214 s 20 min after MUF. No clots were noted in the CPB circuit, and good hemostasis was achieved within 10 min after MUF was completed. Incision to closure time was 160 min; time from completion of MUF to sternal closure was 30 min. Post‐MUF, 60 cc of processed cell saver blood was reinfused, and no clotting factors were required. Chest tube output was 10, 10, 3, and 4 ccs, respectively, at hours 1–4 post operation. Bivalirudin provides effective anticoagulation in infants requiring CPB in the presence of HIT. Bivalirudin's efficacy is effectively monitored by ACT, and, after CPB, its short half‐life and ability to be ultrafiltered facilitate the ability to achieve hemostasis in a timely fashion.
Efficacy of Bone Marrow Mononuclear Cells to Promote Bone Regeneration Compared With Isolated CD34+ Cells From the Same Volume of Aspirate
Authors: Yasuhara Shinji , Yasunaga Yuji , Hisatome Takashi , Ishikawa Masakazu , Yamasaki Takuma , Tabata Yasuhiko , Ochi Mitsuo
Published: June 2010

Autologous bone marrow mononuclear cell (BMMNC) transplantation is currently an emerging clinical treatment in the orthopedic as well as cardiovascular fields. It is believed that the therapeutic effect of the BMMNCs is due to neovascularization enhanced by the CD34+ cells contained therein, which include endothelial progenitor cells. However, isolation of the CD34+ cell fraction for clinical application has many disadvantages such as cost and invasiveness related to cell mobilization with cytokine. To investigate whether a purification step is in fact necessary for bone regeneration, we separated BMMNCs, CD34+, and CD34‐ cells from the same initial volume of rabbit bone marrow aspirates. We then transplanted them back into a femoral bone defect of the same rabbit together with atelocollagen gel and basic fibroblast growth factor (bFGF) and evaluated neovascularization and bone regeneration up to 8 weeks after transplantation. The greatest potential for neovascularization and bone regeneration medicated by cells from the same volume of bone marrow aspirate was found in the BMMNC group. Although purified CD34+ cells might be an ideal cell source, BMMNCs could be a practical and feasible cell source for bone regeneration in present clinical settings with limited cost, availability of materials, and technical issues for transplantation.
Do 8‐Month‐Old Infants Consider Situational Constraints When Interpreting Others’ Gaze as Goal‐Directed Action?
Authors: Luo Yuyan
Published: June 2010

Some actions of agents are ambiguous in terms of goal‐directedness to young infants. If given reasons why an agent performed these ambiguous actions, would infants then be able to perceive the actions as goal‐directed? Prior results show that infants younger than 12 months can not encode the relationship between a human agent’s looking behavior and the target of her gaze as goal‐directed. In the present experiments, 8‐month‐olds responded in ways suggesting that they interpreted an agent’s action of looking at object‐A as opposed to object‐B as evidence for her goal directed toward object‐A, if her looking action was rational given certain situational constraints: a barrier separated her from the objects or her hands were occupied. Therefore, the infants seem to consider situational constraints when attributing goals to agents’ otherwise ambiguous actions; they seem to realize that within such constraints, these actions are efficient ways for agents to achieve goals.
Early Theory of Mind Competencies: Do Infants Understand Others’ Beliefs?
Authors: Träuble Birgit , Marinović Vesna , Pauen Sabina
Published: June 2010

Recent studies suggest that even infants attend to others’ beliefs in order to make sense of their behavior. To warrant the assumption of early belief understanding, corresponding competences need to be demonstrated in a variety of different belief‐inducing situations. The present study provides corresponding evidence, using a completely nonverbal object‐transfer task based on the general violation‐of‐expectation paradigm. A total of n = 36 infants (15‐month‐olds) participated in one of three conditions. Infants saw an actor who either observed an object’s location change, did not observe it, or performed the location change manually without seeing it (i.e., variations in the actor’s information access). Results are in accordance with the assumption that 15‐month‐old infants master different belief‐inducing situations in a highly flexible way, accepting visual as well as manual information access as a proper basis for belief induction.
Interior Monologue: Reflections on a Journey into Guyana's Heartland
Authors: Barry Angela
Published: June 2010

In 2002, a group made up mainly of American academics embarked on an excursion to the interior of Guyana. It was soon very clear that there would be a shift in accepted assumptions about the relationship between the developed and the developing world. But it was only when the group left the city behind and entered the rain forest itself that the travelers understood the true power of the experience, the encounter with the majestic landscape and the indigenous peoples who had lived in harmony with it for millennia; and, in the silence of the forest, the encounter with the self.
Rumpelstiltskin's Deliverables: Grimm Inspiration for Humanism in Development
Authors: Heatherington Tracey
Published: June 2010

Is there space for humanistic anthropology within the development sciences used to plan economic growth and ecological modernization? This article adapts a provocative fable to ponder a “global assemblage” designed to transfer authoritative knowledge and advanced technology for “sustainability” from the American Midwest to postsocialist eastern Europe. I retell the story of Rumpelstiltskin to reflect on participation in global systems of outsourced expertise, guessing at the nature of “the helper” with the aid of the fanciful.
Willful Overlooking: Stories from the Islamic Diaspora and the Palestinian West Bank
Authors: Rothenberg Celia E.
Published: June 2010

This article tells a series of stories that speak to the importance of the human capacity of willful overlooking. When we exercise willful overlooking in our interactions with others, we may allow a potentially fracturing moment to pass, an uncomfortable situation to be tolerated, or an opportunity to present itself. Willful overlooking is exercised in our friendships and romances, our bureaucratic and public exchanges, and in many other social encounters. The paper draws on two sets of events, my former village research assistant's wedding in Canada (2007) and my fieldwork (1995–96) in his village of Artas in the Palestinian West Bank.
Neurocutaneous melanosis and negative fluorodeoxyglucose positron emission tomography
Authors: Li Lai‐Fung , Leung Shue‐Cheong , Chan Siu‐Ki , Leung Gilberto Ka‐Kit
Published: June 2010

Neurocutaneous melanosis is a rare condition characterized by cutaneous melanocytic naevi and the presence of melanocytes in the leptomeninges. It is commonly associated with malignant melanoma formation in the central nervous system (CNS) with poor prognosis. Herein, we report a 13‐year‐old boy with neurocutaneous melanosis who presented with seizure with diffuse CNS malignant melanoma, as demonstrated by magnetic resonance imaging (MRI). 18F‐fluorodeoxyglucose positron emission tomography (PET) was carried out, but was unable to detect the CNS involvement. So far, this is the first report involving the use of PET in neurocutaneous melanosis and we suggest that MRI is more sensitive than PET with 18F‐fluorodeoxyglucose in such conditions.
Urethral carcinoid tumour presenting as lower urinary tract symptoms
Authors: Li Cheuk‐Man , Law In‐Chak , Chan Alice
Published: June 2010

Primary carcinoid tumour of the urethra is an extremely rare condition. There are only four reported cases in the literature. It is the first reported case in a Chinese man presenting with lower urinary tract symptoms.
Natural orifices transluminal endoscopic surgery: Current development and future implications
Authors: Chiu Philip Wai‐Yan
Published: June 2010

The concept of natural orifices transluminal endoscopic surgery (NOTES) started in 2000 when transgastric peritoneoscopy was experimental. Although numerous surgical procedures had been performed successfully in animal models, the application of NOTES in humans was limited. The main obstacles to the performance of NOTES in humans included the security of closing the gastrointestinal (GI) access site, the lack of a stable multi‐tasking platform and prospective clinical studies. The present article reviews the current developments in the field of NOTES with special focus on developments in the closure of GI access, a multi‐tasking platform and the potential future applications of NOTES.
TNF microsatellite alleles may confer protection against the development of lipodystrophy syndrome in Brazilian HIV patients
Authors: Silva M. M. , Simões R. T. , Castelli E. C. , Mendes‐Junior C. T. , Deghaide N. H. S. , Tsuda L. C. , Machado A. A. , Donadi E. A. , Fernandes A. P. M.
Published: June 2010

The aim of this study was to evaluate the frequency of TNFa–e microsatellites and the promoter region (TNF‐308 and TNF‐238) in HIV/AIDS‐infected patients presenting or not lipodystrophy syndrome (LS). The design is the genetic case–control association study. Microsatellite and the TNF promoter region polymorphisms were amplified by PCR and submitted to polyacrylamide gel electrophoresis. The genotypes and allele frequencies for 67 HIV‐positive patients with lipodystrophy were compared with 50 HIV‐positive patients with no evidence of lipodystrophy and with 131 healthy HIV‐negative individuals. The presence of the TNFa5 allele could provide HIV/AIDS patients with protection against developing LS. The presence of TNF‐308G allele, as well as of its homozygote TNF‐308GG, were associated with susceptibility to developing LS. In addition, the presence of the haplotype TNFe3‐d3–238G–308A‐c1‐a5–b7 suggests protection against developing that syndrome. This study highlights that polymorphic sites spanning the region nearby the TNF locus are associated with LS development in HIV/AIDS patients.
Let a Thousand Flowers Bloom: A Tour of Logical Pluralism
Authors: Cook Roy T.
Published: June 2010

Logical pluralism is the view that there is more than one correct logic. In this article, I explore what logical pluralism is, and what it entails, by: (i) distinguishing clearly between relativism about a particular domain and pluralism about that domain; (ii) distinguishing between a number of forms logical pluralism might take; (iii) attempting to distinguish between those versions of pluralism that are clearly true and those that are might be controversial; and (iv) surveying three prominent attempts to argue for logical pluralism and evaluating them along the criteria provided by (ii) and (iii).
Basolateral ion transporters involved in colonic epithelial electrolyte absorption, anion secretion and cellular homeostasis
Authors: Bachmann O. , Juric M. , Seidler U. , Manns M. P. , Yu H.
Published: June 2010

Electrolyte transporters located in the basolateral membrane of the colonic epithelium are increasingly appreciated as elaborately regulated components of specific transport functions and cellular homeostasis: During electrolyte absorption, Na+/K+ ATPase, Cl− conductance, Cl−/HCO3− exchange, K+/Cl− cotransport and K+ channels are candidates for basolateral Na+, Cl− and K+ extrusion. The process of colonic anion secretion involves basolateral Na+/K+/2Cl−, and probably also Na+/HCO3− cotransport, as well as Na+/K+ ATPase and K+ channels to supply substrate, stabilize the membrane potential and generate driving force respectively. Together with a multitude of additional transport systems, Na+/H+ exchange and Na+/HCO3− cotransport have been implicated in colonocyte pHi and volume homeostasis. The purpose of this article is to summarize recently gathered information on the molecular identity, function and regulation of the involved basolateral transport systems in native tissue. Furthermore, we discuss how these findings can help to integrate these systems into the transport function and the cellular homoeostasis of colonic epithelial cells. Finally, disturbances of basolateral electrolyte transport during disease states such as mucosal inflammation will be reviewed.