bluuebunny/crossref_metadata_2025 huggingface dataset:
Elementary School Placements of African American Students Who Are Profoundly Deaf
Authors: Wilkens Christian P.
Published: March 2009

Data from the third wave (2003—2004) of the Special Education Elementary Longitudinal Study are used to generate nationally representative estimates of current school and classroom placements of elementary school—aged students who are African American and profoundly deaf. These students are found to have less access to regular schools and less access to typical classroom placements within schools than their White peers.
An Examination of the Roles of Trust and Functional Diversity on Virtual Team Performance Ratings
Authors: Peters Linda , Karren Ronald J.
Published: March 2009

This study investigates the relationship among trust, functional diversity, and team performance in a virtual environment. The authors conducted research on more than 200 team members representing 33 virtual teams and found that both trust and functional diversity had a direct impact on team performance using team member ratings; however, neither had a direct impact on team performance using external manager ratings. Instead, trust was found to moderate the functional diversity to performance relationship using the managers' ratings. Differences in the development of trust between virtual teams and face-to-face teams are also discussed, as are the implications that the results of this study may have on organizations, managers, and team members.
Shareholder Returns for a Catalyst Award
Authors: Arthur Michelle M. , Cook Alison
Published: March 2009

Using an event study methodology, the authors examine firm share price reactions to the designation of a Catalyst Award. They find a positive relationship between the human resource award and share price reactions. In addition, they find varying degrees of support that timing, firm size, and labor force composition moderate share price reactions. Specifically, the authors find that earlier award announcements generate larger share price reactions than more recent award announcements. They also find support that larger firms reap greater share price reactions than do smaller firms. And last, they find limited support that the proportion of women in an industry moderates the award and share price relationship.
Exploring Deep Subjectivity in Sociology and Organizational Studies
Authors: Jermier John M.
Published: March 2009

When William Catton and Riley Dunlap began publishing their groundbreaking work on paradigms in the late 1970s, sociologists had been grappling with fundamental questions about the discipline for at least two decades. According to Catton and Dunlap, however, significant blind spots still remained, the most important falling in the shadow cast by strong anthropocentrism and a worldview that was decidedly nonecological. This anthropocentric bias also dominated the field of organizational studies until the mid-1990s. Both sociology and organizational studies benefited from scholarly analyses conducted by Catton and Dunlap (and others) that uncovered underlying paradigmatic assumptions and that proposed ecologically grounded alternatives. But both fields still tend to be limited by anthropocentrism and need more research aimed at developing theories and models centered on ecological processes and radical organizing. Revisiting Catton and Dunlap's paradigms framework is suggested as a valuable step for both sociologists and organizational studies scholars interested in addressing major gaps in their fields.
Neuromyelitis optica in Brazil: a study on clinical and prognostic factors
Authors: Bichuetti DB , Oliveira EML , Souza NA , Rivero RLM , Gabbai AA
Published: March 2009

Objectives

To describe the clinical characteristics of patients with relapsing neuromyelitis optica (NMO) from a tertiary care center in Brazil and compare the groups with normal and abnormal brain magnetic resonance imaging (MRI).

Methods

Retrospective review of 41 patients followed at the Neuroimmunology Clinic of the Federal University of São Paulo, Brazil, from 1994 to 2007.

Results

All patients had relapsing-remitting optic-spinal disease, long extending spinal cord lesions, and brain MRI not meeting Barkhof criteria for multiple sclerosis (MS), thus fulfilling the 1999 and 2006 Wingerchuck criteria for NMO. Mean follow-up time was 52 months; mean age of onset was 32.6 years. The mean relapse rate (RR) and progression index (PI) were 1.0 and 0.9, respectively. Twenty-four patients had brain lesions not compatible with MS on MRI, and there were no statistical differences on PI and RR between patients who had brain lesions and patients who did not. Incomplete recovery, but not the type of first relapse, correlated with a worse prognosis. Seventeen patients were tested for NMO-IgG (anti-aquaporin-4 antibody) with 41% positivity.

Conclusions

In this series, we did not find a statistical difference of disease progression between patients with and without brain lesions, suggesting that the presence of brain abnormalities is not a marker of disease severity.
Serum IgG repertoire in clinically isolated syndrome predicts multiple sclerosis
Authors: Zéphir H , Lefranc D , Dubucquoi S , de Seze J , Boron L , Prin L , Vermersch P
Published: March 2009

Objective

We previously showed that serum IgG repertoires distinguished multiple sclerosis (MS) patients from healthy subjects and from patients with other inflammatory neurological diseases (OIND). We questioned whether the serum IgG repertoire of patients presenting a clinically isolated syndrome (CIS) could predict MS.

Methods

The global IgG immune responses against brain antigens in sera from 50 CIS patients were evaluated by immunoblotting. The IgG reactivities were compared with those from MS sera ( n = 82), healthy sera ( n = 27), and sera from OIND ( n = 42). A linear discriminant analysis (LDA) defined a score for each individual.

Results

About 78% of scores obtained from CIS patients were located in the “MS area.” During the follow-up (3.5 ± 1.3 years), 28 patients fulfilled the McDonald criteria for MS, 15 patients remained CIS, and 7 patients developed OIND. Among the patients with an LDA score in the “MS area,” 61.5% converted to MS.

Discussion

Our results suggest that a pathological distortion of the self-reactive IgG repertoire occurs early so that immunomodulating treatment should be started as early as possible; they also highlight the early involvement of B cells in the physiopathological process in MS.
Is neuromyelitis optica associated with human leukocyte antigen?
Authors: Zéphir H , Fajardy I , Outteryck O , Blanc F , Roger N , Fleury M , Rudolf G , Marignier R , Vukusic S , Confavreux C , Vermersch P , de Seze J
Published: March 2009

Background

To establish whether or not multiple sclerosis (MS) and neuromyelitis optica (NMO) are different pathological entities, we wondered whether MS patients and NMO patients share the same pattern of human leukocyte antigen (HLA) predisposition.

Objective

To study a putative association between susceptibility to NMO and HLA class I or class II loci in Caucasians.

Methods

A total of 39 unrelated Caucasian patients with NMO and six patients at a high risk of converting to NMO were studied. DNA genotyping of HLA class I and class II loci was assessed and allelic frequencies were reported at a high-resolution level. A case-control study by comparing the allelic distribution in the NMO patients with that of a French Caucasian MS group and a French Caucasian healthy group was carried out.

Results

The frequencies of HLA-DQA1, DQB1, and HLA-DRB1 DR2 alleles in the NMO group were intermediate between the healthy control group and the MS group. The DPB1*0501 allele was not increased in the NMO group compared with the healthy control group. The distribution of HLA-DRB1 allele enabled to distinguish between NMO-IgG-positive patients and healthy controls ( P = 0.01). NMO-IgG-negative patients presented an HLA II pattern closer to that of the MS group ( P = 0.01).

Conclusion

In contrast to the reported results in Asian opticospinal MS, we found no association between the DPB1*0501 allele and NMO in our Caucasian patients. Moreover, we suggest that NMO-IgG-positive patients could represent a distinct NMO group in terms of their genetic susceptibility.
Othering the Self: Dissonant Visual Culture and Quotidian Trauma in United States Suburbia
Authors: Gournelos Ted
Published: March 2009

At a time when American politics has reached an almost uncanny level of absurdity in its self-contradictions, nationalistic appeals, and stunning disregard for large majorities of the population, it becomes increasingly necessary to look for clues as to why various public spheres speak and exist and how those interested in change can locate and infiltrate nodes of instability or change. Rhetoric surrounding the suburbs in high and popular culture provides such a framework, as it maps out areas of creation and consumption that have great appeal but are either logically incoherent or dangerously fragmented. This article enters the discussion through Gregory Crewdson's famous staged photographs before turning to traumatic identity in the films Pleasantville, American Beauty, and True Lies. The resulting dissonant political ambiguity in daily life suggests a new, flexible line of postmodern discourse in the post-9/11 public spheres.
Cultural Studies Legacies: Visiting James Carey's Border Country
Authors: Chakravarty Sumita S.
Published: March 2009

A generally forgotten figure in the proliferating discursive spaces of an international cultural studies, James Carey was nevertheless one of the first to explore actively the interstices and to show the overt connections between media, culture, politics, and society. He integrated the study of media (and media as technology) into the broader processes of cultural and educational politics, a kind of convergence that is increasingly being called for today.
Sleep Disturbances and Their Relationship to Cardiovascular Disease
Authors: Quan Stuart F.
Published: March 2009

Sleep disturbances are a common problem, with chronic insomnia occurring in 10% of the general adult population and obstructive sleep apnea present in 4% and 2% of middle-aged men and women, respectively. In addition, Americans are sleeping fewer hours per night than they did 20 years ago. There is now increasing evidence that reductions and increases in sleep duration, as well as various sleep disorders, including obstructive sleep apnea and insomnia, may be causal factors in the development of cardiovascular disease. Some of the evidence linking disturbances of sleep with cardiovascular disease is described in this review.
Biological Mechanisms for the Cardioprotective Effects of Aerobic Exercise
Authors: Leon Arthur S.
Published: March 2009

Epidemiologic studies have consistently identified a strong inverse association between coronary heart disease (CHD) and regular, predominantly moderate-intensity physical activity and cardiorespiratory fitness. Supporting evidence of causative relationships has been provided by aerobic exercise training studies in both animals and humans. This research demonstrated multiple plausible cardioprotective biological mechanisms. These include direct antiatherosclerotic effects by improving artery endothelial function and reducing inflammation and indirectly via modification of other risk factor components of the metabolic syndrome, by reducing risk of a coronary thrombotic occlusion (antithrombotic effects), by decreasing myocardial oxygen demands and increasing its vascular supply (anti-ischemic effects), and by improving cardiomyocyte electrical stability and autonomic nervous system adaptations (antiarrhythmic effects). Although much additional research is needed to better define and establish optimal dose-response relationships, clearly these pleotropic effects strongly suggest that aerobic exercise can attenuate the risk of CHD at all stages of the underlying atherothrombotic process.
Axin expression in thymic stromal cells contributes to an age-related increase in thymic adiposity and is associated with reduced thymopoiesis independently of ghrelin signaling
Authors: Yang Hyunwon , Youm Yun-Hee , Sun Yuxiang , Rim Jong-Seop , Galbán Craig J , Vandanmagsar Bolormaa , Dixit Vishwa Deep
Published: March 2009

The adipocytes are the predominant cell types that constitute the bulk of the thymic microenvironment by the fifth decade of life in healthy humans. An age-related increase in thymic adiposity is associated with reduced thymopoiesis and compromised immune surveillance in the elderly. However, the mechanisms regulating the generation of intrathymic adipocytes during aging remain to be elucidated. Here, we report that the CD45– thymic stromal cells (TSCs) are amenable to adipogenesis. We identified that the Wnt inhibitor axin is expressed in the lymphoid as well as stromal cells of the thymus with increased expression in CD45– TSCs of older mice. Knockdown of axin by RNA interference in CD45– primary TSCs led to a marked reduction in adipogenesis with significantly lower expression of adipogenic transcripts peroxisome proliferator-activated receptor γ2 (PPAR), adipocyte fatty acid-binding protein (aP2), and perilipin. Age-related elevated axin expression was increased specifically in thymic fibroblasts and medullary thymic epithelial cells (TECs) but not in the cortical TEC or CD45+ cells. Consistent with a role of axin in promoting thymic adipogenesis, axin expression was also colocalized with lipid-expressing adipogenic cells in aging thymus. The prolongevity intervention, caloric restriction (CR), prevented the age-related increase in axin and the adipogenic cell in the thymus together with increase in thymic output. We have recently demonstrated that CR induces ghrelin, which can partially reverse thymic involution. Here, we show that axin expression is not affected by ablation of ghrelin receptors in aging mice, suggesting a ghrelin-independent mechanism for regulation of axin. Our data are consistent with the hypothesis that blocking the specific proadipogenic signals in the thymus may complement the present approaches to rejuvenate thymic function during aging.
Perilipin Is Present in Islets of Langerhans and Protects against Lipotoxicity When Overexpressed in the β-Cell Line INS-1
Authors: Borg Jörgen , Klint Cecilia , Wierup Nils , Ström Kristoffer , Larsson Sara , Sundler Frank , Lupi Roberto , Marchetti Piero , Xu Guoheng , Kimmel Alan , Londos Constantine , Holm Cecilia
Published: March 2009

Lipids have been shown to play a dual role in pancreatic β-cells: a lipid-derived signal appears to be necessary for glucose-stimulated insulin secretion, whereas lipid accumulation causes impaired insulin secretion and apoptosis. The ability of the protein perilipin to regulate lipolysis prompted an investigation of the presence of perilipin in the islets of Langerhans. In this study evidence is presented for perilipin expression in rat, mouse, and human islets of Langerhans as well as the rat clonal β-cell line INS-1. In rat and mouse islets, perilipin was verified to be present in β-cells. To examine whether the development of lipotoxicity could be prevented by manipulating the conditions for lipid storage in the β-cell, INS-1 cells with adenoviral-mediated overexpression of perilipin were exposed to lipotoxic conditions for 72 h. In cells exposed to palmitate, perilipin overexpression caused increased accumulation of triacylglycerols and decreased lipolysis compared with control cells. Whereas glucose-stimulated insulin secretion was retained after palmitate exposure in cells overexpressing perilipin, it was completely abolished in control β-cells. Thus, overexpression of perilipin appears to confer protection against the development of β-cell dysfunction after prolonged exposure to palmitate by promoting lipid storage and limiting lipolysis.
Up-Regulation of Cyclooxygenase-2 Expression and Prostaglandin E2 Production in Human Endometriotic Cells by Macrophage Migration Inhibitory Factor: Involvement of Novel Kinase Signaling Pathways
Authors: Carli Cédric , Metz Christine N. , Al-Abed Yousef , Naccache Paul H. , Akoum Ali
Published: March 2009

Cyclooxygenase (COX) is the rate-limiting enzyme in the metabolic conversion of arachidonic acid to prostaglandins (PGs), including prostaglandin E2 (PGE2), a major mediator of inflammation and angiogenesis. Herein, we report that macrophage migration inhibitory factor (MIF), a potent proinflammatory and growth-promoting factor found at elevated concentrations in the peritoneal fluid of women with endometriosis and active endometriosis lesions, acts directly on ectopic endometrial cells to stimulate the synthesis of COX-2, the inducible form of COX, and the release of PGE2. MIF treatment strongly activated p38 and ERK MAPK, and specific inhibitors of both pathways completely blocked basal and MIF-induced PGE2 synthesis. Whereas p38 inhibitors negatively affected the stimulated synthesis of COX-2 and that of PGE2, ERK inhibitors only decreased the production of PGE2. These findings show for the first time a direct role for MIF in the up-regulation of COX-2 synthesis and PGE2 secretion in ectopic endometrial cells. They further indicate that whereas p38 and ERK MAPK signaling pathways both play a significant role in the regulation of basal and MIF-induced synthesis of PGE2 by ectopic endometrial cells, only p38 kinase is involved in the regulation of COX-2 expression in these cells. This suggests that MIF acts at more than one level to stimulate the synthesis of PGE2 and triggers the coordinate activation of multiple enzymes in the biosynthesis pathway. Our data provide evidence for a novel mechanism by which MIF can induce a proinflammatory phenotype in ectopic endometrial cells, and favor the establishment of endometriosis and its related clinical symptoms.
Unique Profile of Chicken Adiponectin, a Predominantly Heavy Molecular Weight Multimer, and Relationship to Visceral Adiposity
Authors: Hendricks Gilbert L. , Hadley Jill A. , Krzysik-Walker Susan M. , Prabhu K. Sandeep , Vasilatos-Younken Regina , Ramachandran Ramesh
Published: March 2009

Adiponectin, a 30-kDa adipokine hormone, circulates as heavy, medium, and light molecular weight isoforms in mammals. Plasma heavy molecular weight (HMW) adiponectin isoform levels are inversely correlated with the incidence of type 2 diabetes in humans. The objectives of the present study were to characterize adiponectin protein and quantify plasma adiponectin levels in chickens, which are naturally hyperglycemic relative to mammals. Using gel filtration column chromatography and Western blot analysis under nonreducing and non-heat-denaturing native conditions, adiponectin in chicken plasma, and adipose tissue is predominantly a multimeric HMW isoform that is larger than 669 kDa mass. Under reducing conditions and heating to 70–100 C, however, a majority of the multimeric adiponectin in chicken plasma and adipose tissue was reduced to oligomeric and/or monomeric forms. Immunoprecipitation and elution under neutral pH preserved the HMW adiponectin multimer, whereas brief exposure to acidic pH led to dissociation of HMW multimer into multiple oligomers. Mass spectrometric analysis of chicken adiponectin revealed the presence of hydroxyproline and differential glycosylation of hydroxylysine residues in the collagenous domain. An enzyme immunoassay was developed and validated for quantifying plasma adiponectin in chickens. Plasma adiponectin levels were found to be significantly lower in 8- compared with 4-wk-old male chickens and inversely related to abdominal fat pad mass. Collectively, our results provide novel evidence that adiponectin in chicken plasma and tissues is predominantly a HMW multimer, suggesting the presence of unique multimerization and stabilization mechanisms in the chicken that favors preponderance of HMW adiponectin over other oligomers.
Aberrant Histone Modifications at the Thyrotropin-Releasing Hormone Gene in Resistance to Thyroid Hormone: Analysis of F455S Mutant Thyroid Hormone Receptor
Authors: Umezawa Ryohei , Yamada Masanobu , Horiguchi Kazuhiko , Ishii Sumiyasu , Hashimoto Koshi , Okada Shuichi , Satoh Teturou , Mori Masatomo
Published: March 2009

We reported a novel mutation of thyroid hormone receptor (TR)-β, F455S, in a patient with pituitary resistance to thyroid hormone (RTH), who showed impaired release of nuclear receptor corepressor and abnormal histone deacetylation. In the present study, we further analyzed the histone modifications and the dynamics of TR and RNA polymerase II on the TRH gene. The lysine residues 9 (H3K9) and 14 (K14) of the histone H3 were acetylated in the absence of thyroid hormone (TH), and addition of TH caused a temporary deacetylation of both residues. Although H3K4 was di- and trimethylated in the absence of T3, no methylation of H3K9 or K27 was detected. Long-term incubation with T3 decreased the level of trimethylated H3K4, the amount of TR, and the level of phosphorylated RNA polymerase II but not dimethylated H3K4. Treatment with an inhibitor for H3K4 methyltransferase, 5′-deoxy-5′-methylthioadenosine, decreased basal promoter activity but did not affect the repression by TH. Conversely, overexpression of MLL, an H3K4-specific methyltransferase, caused an increase in basal activity. In the presence of F455S, methylation of H3K4 and the dynamics of TR were intact, but both H3K9 and H3K14 were hyperacetylated, and T3-induced deacetylation was impaired, resulting in a high transcriptional level. These findings demonstrated that 1) negative regulation of the TRH gene by TH involves both the acetylation and methylation of specific residues of histone tails and changing the amount of TR, and 2) the major impairment to histone modifications in F455S was hyperacetylation of the specific histone tails.
Hypermethylation of Homeobox A10 by in Utero Diethylstilbestrol Exposure: An Epigenetic Mechanism for Altered Developmental Programming
Authors: Bromer Jason G. , Wu Jie , Zhou Yuping , Taylor Hugh S.
Published: March 2009

Diethylstilbestrol (DES) is a nonsteroidal estrogen that induces developmental anomalies of the female reproductive tract. The homeobox gene HOXA10 controls uterine organogenesis, and its expression is altered after in utero DES exposure. We hypothesized that an epigenetic mechanism underlies DES-mediated alterations in HOXA10 expression. We analyzed the expression pattern and methylation profile of HOXA10 after DES exposure. Expression of HOXA10 is increased in human endometrial cells after DES exposure, whereas Hoxa10 expression is repressed and shifted caudally from its normal location in mice exposed in utero. Cytosine guanine dinucleotide methylation frequency in the Hoxa10 intron was higher in DES-exposed offspring compared with controls (P = 0.017). The methylation level of Hoxa10 was also higher in the caudal portion of the uterus after DES exposure at the promoter and intron (P < 0.01). These changes were accompanied by increased expression of DNA methyltransferases 1 and 3b. No changes in methylation were observed after in vitro or adult DES exposure. DES has a dual mechanism of action as an endocrine disruptor; DES functions as a classical estrogen and directly stimulates HOXA10 expression with short-term exposure, however, in utero exposure results in hypermethylation of the HOXA10 gene and long-term altered HOXA10 expression. We identify hypermethylation as a novel mechanism of DES-induced altered developmental programming.
Chemokine signaling in embryonic cell migration: a fisheye view
Authors: Raz Erez , Mahabaleshwar Harsha
Published: March 2009

Chemokines and their receptors were discovered about twenty years ago as mediators of leukocyte traffic. Over the past decade, functional studies of these molecules have revealed their importance for cell migration processes during embryogenesis, which, in addition to providing mechanistic insights into embryonic development, could complement information about chemokine function in the immune system. Here, we review the roles of the chemokine stromal cell-derived factor 1 (SDF-1/CXCL12) and its receptor CXCR4 during zebrafish and mouse embryonic development, and discuss their function in regulating the interactions of cells with their extracellular environment, in directing their migration, and in maintaining their location.
Recruitment and maintenance of tendon progenitors by TGFβ signaling are essential for tendon formation
Authors: Pryce Brian A. , Watson Spencer S. , Murchison Nicholas D. , Staverosky Julia A. , Dünker Nicole , Schweitzer Ronen
Published: March 2009

Tendons and ligaments mediate the attachment of muscle to bone and of bone to bone to provide connectivity and structural integrity in the musculoskeletal system. We show that TGFβ signaling plays a major role in the formation of these tissues. TGFβ signaling is a potent inducer of the tendon progenitor (TNP) marker scleraxis both in organ culture and in cultured cells, and disruption of TGFβ signaling in Tgfb2-/-;Tgfb3-/- double mutant embryos or through inactivation of the type II TGFβ receptor (TGFBR2;also known as TβRII) results in the loss of most tendons and ligaments in the limbs, trunk, tail and head. The induction of scleraxis-expressing TNPs is not affected in mutant embryos and the tendon phenotype is first manifested at E12.5, a developmental stage in which TNPs are positioned between the differentiating muscles and cartilage, and in which Tgfb2 or Tgfb3 is expressed both in TNPs and in the differentiating muscles and cartilage. TGFβ signaling is thus essential for maintenance of TNPs,and we propose that it also mediates the recruitment of new tendon cells by differentiating muscles and cartilage to establish the connections between tendon primordia and their respective musculoskeletal counterparts, leading to the formation of an interconnected and functionally integrated musculoskeletal system.
Neuronal activity and Wnt signaling act through Gsk3-β to regulate axonal integrity in matureDrosophilaolfactory sensory neurons
Authors: Chiang Albert , Priya Rashi , Ramaswami Mani , VijayRaghavan K. , Rodrigues Veronica
Published: March 2009

The roles played by signaling pathways and neural activity during the development of circuits have been studied in several different contexts. However, the mechanisms involved in maintaining neuronal integrity once circuits are established are less well understood, despite their potential relevance to neurodegeneration. We demonstrate that maintenance of adult Drosophila olfactory sensory neurons requires cell-autonomous neuronal activity. When activity is silenced, development occurs normally, but neurons degenerate in adulthood. These detrimental effects can be compensated by downregulating Glycogen synthase kinase-3β (Gsk-3β). Conversely,ectopic expression of activated Gsk-3β or downregulation of Wnt effectors also affect neuron stability, demonstrating a role for Wnt signaling in neuroprotection. This is supported by our observation that activated adult neurons are capable of increased Wingless release, and its targeted expression can protect neurons against degeneration. The role of Wnt signaling in this process is non-transcriptional, and may act on cellular mechanisms that regulate axonal or synaptic stability. Together, we provide evidence that Gsk-3β is a key sensor involved in neural circuit integrity, maintaining axon stability through neural activity and the Wnt pathway.
Translation initiation factors are not required for Dicistroviridae IRES function in vivo
Authors: Deniz Nilsa , Lenarcic Erik M. , Landry Dori M. , Thompson Sunnie R.
Published: March 2009

The cricket paralysis virus (CrPV) intergenic region (IGR) internal ribosome entry site (IRES) uses an unusual mechanism of initiating translation, whereby the IRES occupies the P-site of the ribosome and the initiating tRNA enters the A-site. In vitro experiments have demonstrated that the CrPV IGR IRES is able to bind purified ribosomes and form 80S complexes capable of synthesizing small peptides in the absence of any translation initiation factors. These results suggest that initiation by this IRES is factor-independent. To determine whether the IGR IRES functions in the absence of initiation factors in vivo, we assayed IGR IRES activity in various yeast strains harboring mutations in canonical translation initiation factors. We used a dicistronic reporter assay in yeast to determine whether the CrPV IGR IRES is able to promote translation sufficient to support growth in the presence of various deletions or mutations in translation initiation factors. Using this assay, we have previously shown that the CrPV IGR IRES functions efficiently in yeast when ternary complexes (eIF2•GTP•initiator tRNAmet) are reduced. Here, we demonstrate that the CrPV IGR IRES activity does not require the eukaryotic initiation factors eIF4G1 or eIF5B, and it is enhanced when eIF2B, the eIF3b subunit of eIF3, or eIF4E are impaired. Taken together, these data support a model in which the CrPV IGR IRES is capable of initiating protein synthesis in the absence of any initiation factors in vivo, and suggests that the CrPV IGR IRES initiates translation by directly recruiting the ribosomal subunits in vivo.
Security Swipe Cards and Scanners are a Potential Reservoir for Hospital-Acquired Infection
Authors: Sultan MJ , Alm A , Hindmarsh A , Greatorex RA
Published: March 2009

INTRODUCTION

Hospital-acquired infections complicate 10% of hospital admissions resulting in increased morbidity, mortality and cost to hospitals. Most hospitals issue doctors with plastic swipe cards that function as electronic keys to access clinical areas. The card is handled many times a day, often before direct patient contact. The aim of this study was to determine if swipe cards harbour potentially harmful bacteria.

SUBJECTS AND METHODS

On a single day, doctors working in the surgical directorate completed a questionnaire to determine their pattern of swipe card use. Cards were inoculated onto agar plates and incubated for 48 h under standard laboratory conditions, following which the number of colony forming units (CFUs) cultured from each card was determined. Representative colonies were sampled and sub-cultured for staphlococcal, enterococcal, coliform and pseudomonad species. Isolated bacterial pathogens were tested for antimicrobial sensitivity. Swipe-card scanners were swabbed for microbiological culture on the same day.

RESULTS

All cards were colonised with environmental bacteria (mean, 73 CFU). Of cards, 21% were contaminated with pathogenic bacteria including Staphylococcus aureus (5.1%), Pseudomonas putida (2.6%), and coliform species (12.8%). The pattern of card use did not significantly affect the amount of bacterial contamination, but infrequent use of the card and keeping the card in a pocket or wallet was associated with higher levels of contamination. Environmental bacteria were cultured from 88% of card scanners, the highest counts coming from scanners in main theatres and the day-surgery unit.

CONCLUSIONS

Doctors' swipe cards are contaminated with, and may therefore be a reservoir for, pathogenic bacteria implicated in hospital-acquired infection.
Referral Letters for 2-Week Wait Suspected Colorectal Cancer do not Allow a ‘Straight-to-Test’ Pathway
Authors: Aljarabah MM , Borley NR , Goodman AJ , Wheeler JMD
Published: March 2009

INTRODUCTION

Some clinicians have argued that 2-week wait suspected colorectal cancer patients can go ‘straight-to-test’ to facilitate time to diagnosis and treatment. The aim of this study was to evaluate whether the currently used referral letters are reliable enough to allow that pathway.

PATIENTS AND METHODS

General practitioner (GP) letters referring patients under the Two Week-Wait Rule for suspected colorectal cancer were prospectively reviewed over a 6-month period. Three examining consultants were asked to outline the tests they would perform having only read the letter, and then again after a clinical consultation with the patient. The outcome of these tests was tracked.

RESULTS

A total of 217 referral letters of patients referred under Two Week Wait Rule for suspected colorectal cancer were studied. Having just read the referral letter, the most frequently requested test was colonoscopy (148), then CT scan (48), barium enema (44), followed by gastroscopy (23) and flexible sigmoidoscopy in 15 patients (some patients would have had more than one test requested). After consultation with the patients, tests requested as guided by the GP letter were changed in 67 patients (31%), where 142 colonoscopies, 61 CT scans, 37 barium enemas, 23 flexible sigmoidoscopies and 19 gastroscopies were organised. The referral indication which had tests changed most often was definite palpable rectal mass (67%), while patients referred with definite palpable right-sided abdominal mass had their tests least often changed (9%). A total of 22 patients were found to have colorectal cancers (10%) and 30 patients were diagnosed with polyps (14%). Out of 142 colonoscopies performed, 19 (13%) showed some pathology beyond the sigmoid colon and of the 23 patients who had flexible sigmoidoscopy initially, only three went on to have colonoscopy subsequently. During the 6-month period of the study, only five breaches of the waiting time targets were recorded (1 to the 31-day target and 4 to the 62-day target).

CONCLUSIONS

A significant number of patients would have had tests changed after a clinical consultation. However, only a small number required further investigations having had a consultation prior to their initial investigations. We conclude that 2-week wait suspected colorectal cancer patients should be seen in the clinic first and should not proceed ‘straight-to-test’.
Clinical Impact of Tumour Involvement of the Anastomotic Doughnut in Oesophagogastric Cancer Surgery
Authors: Sillah K , Griffiths EA , Pritchard SA , Swindell R , West CM , Page R , Welch IM
Published: March 2009

INTRODUCTION

Published colorectal cancer surgery data suggest no role for the analysis of the anastomotic doughnuts following anterior resection. The usefulness of routine histological analysis of the upper gastrointestinal doughnut is not clear. Our study assessed the impact of cancer involvement of the doughnut on clinical practice. Factors associated with doughnut involvement and the effect on patients' survival were also analysed.

PATIENTS AND METHODS

The clinicopathological details of 462 patients who underwent potentially curative oesophagogastrectomy for cancer with a stapled anastomosis between 1994 and 2006 in two specialist centres were retrospectively analysed. Univariate, multivariate and survival analyses were carried out.

RESULTS

Approximately 5% of doughnuts (22 of 462) were histologically involved with cancer. Microscopic involvement of the proximal resection margin, local lymph node metastasis and lymphatic invasion within the main resected specimen were independently associated with doughnut involvement (all P < 0.05). However, these three factors taken together failed to predict doughnut involvement. Doughnut involvement was an independent adverse prognostic factor for overall survival (P = 0.0013).

CONCLUSIONS

In contrast to findings in colorectal surgery, doughnut involvement with cancer appears to have useful prognostic information following oesophagogastrectomy. Routine histological analysis of upper gastrointestinal doughnuts is justified. Doughnut involvement could potentially strengthen the indications for adjuvant therapy in the future.
Improving Operation Notes to Meet British Orthopaedic Association Guidelines
Authors: Morgan David , Fisher Noel , Ahmad Aman , Alam Fazle
Published: March 2009

INTRODUCTION

Operation notes are an important part of medical records for clinical, academic and medicolegal reasons. This study audited the quality of operative note keeping for total knee replacements against the standards set by the British Orthopaedic Association (BOA).

PATIENTS AND METHODS

A prospective review of all patients undergoing total knee replacement at a district general hospital over 8 months. Data recorded were compared with those required by the BOA good-practice guidelines. Change in practice was implemented and the audit cycle completed. Data were statistically analysed.

RESULTS

A total of 129 operation notes were reviewed. There was a significant improvement in the mean number of data points recorded from 9.6 to 13.1. The least well recorded data were diagnosis, description of findings, alignment and postoperative flexion range. All had a significant improvement except description of findings. The operating surgeon writing the note improved from 56% to 67%. Detailed postoperative instructions also improved in quality.

CONCLUSIONS

Surgeon education and the use of a checklist produce better quality total knee replacement operation notes in line with BOA guidelines. Further improvements may be made by making the data points part of the operation note itself.
Do Scoring Systems Help in Predicting Survival Following Ruptured Abdominal Aortic Aneurysm Surgery?
Authors: Gatt Marcel , Goldsmith Paul , Martinez Marcos , Barandiaran Jesus , Grover Kartikae , El-Barghouti Naif , Perry Eugene P
Published: March 2009

INTRODUCTION

The aim of this study was to assess the value of the Hardman Index and the Glasgow Aneurysm Score in predicting postoperative mortality in patients with ruptured abdominal aortic aneurysm (rAAA), and to assess the correlation between the two.

PATIENTS AND METHODS

Patients admitted with rAAA were identified from a hospital database. Hospital records were reviewed and a retrospective Hardman Index and Glasgow Aneurysm Score was calculated. Poor postoperative prognosis was considered at a Glasgow Aneurysm Score > 95 or a Hardman Index ≥ 3.

RESULTS

A total of 96 patients with a median age of 77.5 years (interquartile range, 71–83 years) and a male:female ratio of 2:1 were identified. Of these, 37 patients were not offered surgery and this was associated with 100% mortality. Of the 59 operated patients, 36 (61%) patients died postoperatively. Operated patients had a median Glasgow Aneurysm Score of 91 (interquartile range, 77–101) and a Hardman Index of 2 (interquartile range, 1–2). In this group, a Glasgow Aneurysm Score > 95 or a Hardman Index ≥ 3 was not associated with mortality (P = 0.10 and P = 0.79, respectively). Correlation between the scoring systems was poor (+0.42 τb).

CONCLUSIONS

The scoring systems assessed did not help predict the outcome of rAAA surgery, and correlated poorly with each other. They do not aid clinical judgement.
Sending NHS Patients for Operations Abroad: Is the Holiday Over?
Authors: Hanna Sammy A , Saksena Joyti , Legge Stella , Ware Howard E
Published: March 2009

INTRODUCTION

The UK Department of Health, in its attempt to help NHS trusts reduce long elective waiting lists, set up the overseas commissioning scheme in 2002. This allowed hospitals to send their patients abroad for their surgery. In theory, this was a win-win situation, where pressures upon surgeons were reduced, and trusts could reach UK Government targets and avoid breaches. At our hospital, a significant number of patients, who had undergone a total joint replacement abroad, were discharged after only one postoperative review and often had very little physiotherapy. A few presented to our clinic with more serious problems.

PATIENTS AND METHODS

This is a retrospective review of two matched groups of patients (22 each), all of whom underwent a total knee replacement in 2003. The first group (abroad, Belgium) included 10 males and 12 females with a mean age of 74.5 years and a mean follow-up of 37 months. The second group (local institution) included 10 males and 12 females with a mean age of 71.4 years and a mean follow-up of 34 months. All patients were evaluated using the Oxford Knee Score (OKS), Knee Society Score (KSS), and SF-12 systems.

RESULTS

OKS and KSS were similar in the two groups. However, SF-12 figures revealed a statistically significant difference in both the physical (PCS) and mental components (MCS). Belgium group – mean PCS 40, mean MCS 48: local group – mean PCS 47, mean MCS 57; P < 0.05.

CONCLUSIONS

The results demonstrate that, although the majority of patients operated upon abroad got comparable functional results to patients operated locally, they often felt dissatisfied with the overall experience of travelling for their operation. Furthermore, the issues of ‘patient ownership’ and long-term follow-up need to be fully addressed in order to safeguard the high standard of care we should offer our patients.
Primary Total Knee Replacement: Is Suction a Portal of Infection?
Authors: Budnar Vijaya M , Amirfeyz Rouin , Ng Michael , Bannister Gordon C , Blom Ashley W
Published: March 2009

INTRODUCTION

Pulsed lavage during a total knee replacement usually leaves a pool of fluid on the surgical drapes. It is common practice to suck away this fluid using the same suction device used intra-operatively. This could be a cause of direct wound contamination. We hypothesised that bacteria contaminate fluid that collects around the foot in total knee replacement surgery and that suction equipment could be a portal of contamination. We also hypothesised that bacterial count in the fluid is lower if chlorhexidine, rather than saline, is used in the pulsed lavage.

PATIENTS AND METHODS

Forty patients undergoing primary total knee replacement were divided into two groups. The first group had pulsed lavage with normal saline and the second with 0.05% chlorhexidine.

RESULTS

At the end of the operation, 20 ml of fluid, pooled on the surgical drapes was aspirated and cultured for bacterial growth. None of the fluid samples showed bacterial growth.

CONCLUSIONS

Suction device used peri-operatively during knee replacement is unlikely to be a cause of wound contamination. Pulsed lavage with normal saline is as effective as lavage with chlorhexidine.
The Use of the Harmonic Scalpel in Thyroidectomy: ‘Beyond the Learning Curve’
Authors: Foreman E , Aspinall S , Bliss RD , Lennard TWJ
Published: March 2009

INTRODUCTION

Safe and effective haemostasis in surgery is clearly essential, and in the neck where risks of airway compromise are also present any new technology that purports to offer advantages must be rigorously evaluated. We describe our experience with the use of the Harmonic Scalpel [Ethicon UK] in thyroidectomy.

PATIENTS AND METHODS

A retrospective clinical review of 183 patients undergoing hemi or total thyroidectomies from 12 months prior to using the harmonic scalpel (2003; n = 77) and 12 months ‘beyond the learning curve’ (2006; n = 106).

RESULTS

The results demonstrate that, once past the learning curve, the use of the harmonic scalpel during thyroidectomy significantly reduces operative time and postoperative hypocalcaemia, and is as safe as conventional surgery with regard to voice change and bleeding.

CONCLUSIONS

The harmonic scalpel is as safe as conventional methods of haemostasis and operations using this technique are quicker once the need to have repetitive ‘clip, cut and tie’ routines is avoided.
Buccal Mucosal Grafts for Urethroplasty: Comparison of Postoperative Oral and Perineal Morbidity
Authors: Abdel-Galil Khalid , Eardley Ian , Loukota Richard
Published: March 2009

INTRODUCTION

A prospective study of postoperative oral and perineal pain experienced by a group of patients undergoing buccal mucosal graft harvest for urethral reconstruction.

PATIENTS AND METHODS

A consecutive group of 24 male patients undergoing buccal mucosa graft harvest for urethral recon8truction of stricture disease was prospectively studied between June 2006 and December 2008. All patients were examined pre-operatively and entered into the study prospectively. After surgery, all patients were reviewed at 24 h and 48 h. On both occasions, they were asked to complete a proforma containing visual analogue pain scales for both the oral donor site as well as the perineum.

RESULTS

A statistically significant higher level of pain was experienced from the perineum than the oral donor site on both the first and second postoperative days.

CONCLUSIONS

Comparative analysis of visual analogue pain scale scores between oral donor site and perineum showed that patients experience significantly more pain from the latter postoperatively.
Audit of Clinical Coding of Major Head and Neck Operations
Authors: Mitra Indu , Malik Tass , Homer Jarrod J , Loughran Sean
Published: March 2009

INTRODUCTION

Within the NHS, operations are coded using the Office of Population Censuses and Surveys (OPCS) classification system. These codes, together with diagnostic codes, are used to generate Healthcare Resource Group (HRG) codes, which correlate to a payment bracket. The aim of this study was to determine whether allocated procedure codes for major head and neck operations were correct and reflective of the work undertaken. HRG codes generated were assessed to determine accuracy of remuneration.

PATIENTS AND METHODS

The coding of consecutive major head and neck operations undertaken in a tertiary referral centre over a retrospective 3-month period were assessed. Procedure codes were initially ascribed by professional hospital coders. Operations were then recoded by the surgical trainee in liaison with the head of clinical coding. The initial and revised procedure codes were compared and used to generate HRG codes, to determine whether the payment banding had altered.

RESULTS

A total of 34 cases were reviewed. The number of procedure codes generated initially by the clinical coders was 99, whereas the revised codes generated 146. Of the original codes, 47 of 99 (47.4%) were incorrect. In 19 of the 34 cases reviewed (55.9%), the HRG code remained unchanged, thus resulting in the correct payment. Six cases were never coded, equating to £15,300 loss of payment.

CONCLUSIONS

These results highlight the inadequacy of this system to reward hospitals for the work carried out within the NHS in a fair and consistent manner. The current coding system was found to be complicated, ambiguous and inaccurate, resulting in loss of remuneration.
Congenital Choledochal Malformation: Not Just a Problem for Children
Authors: Dabbas Natalie , Davenport Mark
Published: March 2009

Choledochal cysts remain relatively uncommon in Western Europe and the US, although they are appreciably more common in Asia. Their aetiology remains obscure although abnormalities of the pancreaticobiliary junction may be the primary pathology in some, with biliary dilatation following reflux of activated pancreatic secretions. Most anomalies will present in childhood with obstructive jaundice or abdominal pain; a proportion may only present for the first time during adulthood, and some of these will show malignant transformation. The classical triad of pain, jaundice and a palpable mass is, however, not common. Complete cyst excision, where possible, and biliary reconstruction remain the aims for most types although there is still some controversy about the type of reconstruction. Laparoscopic reconstruction is possible but is still very much an advanced technique. The risk of long-term problems post-surgery is significant. Whether this is due to recurrent pancreatitis secondary to the retained common channel and/or a distal stump, or due to the development of biliary tract malignancy is still a cause for concern and indicates the need for adequate, prolonged follow-up.
Colombo–Taunton Surgical Trainee Exchange Programme
Authors: Pournaras DJ , Abayajeewa K , Chester JF
Published: March 2009

Disillusioned with Modernising Medical Careers (MMC) my consultant suggested that I spend some time undertaking trauma surgery in Colombo, Sri Lanka. He was surprised that I agreed immediately without asking for how long! Six months later, having secured some study leave, I was on my way to Colombo...
Setting up a BSS course in Jordan
Authors: Issa Fadi , Goodacre Tim , Uraiqat Major Ahmed , Smith Frank CT
Published: March 2009

One of the great privileges of being part of the surgical community is the opportunity to interact with surgeons abroad, whose surgical environment differs greatly from our own. In these situations, it is fascinating to witness the universal applicability of basic surgical techniques that we often take for granted. As organisations with strong links throughout the world, the royal colleges of surgeons have long had a commitment to furthering surgical education outside the UK.