bluuebunny/crossref_metadata_2025 huggingface dataset:
A Delphi approach to define learning outcomes and assessment
Authors: Tonni I. , Oliver R.
Published: August 2012

Aim

The aim of this study was to use a Delphi process for curriculum revision facilitating staff collaboration and curriculum ‘alignment’ in the orthodontic specialist training programme in Cardiff.

Method

A 2‐round modified Delphi process was employed to achieve consensus amongst a heterogeneous panel with regard to the learning outcomes and assessment methods, which initially were defined according to formal directives and local initiatives. The panel comprised of nine staff members (five consultants, a professor, a reader, a lecturer and a student) who were working in the orthodontic department in Cardiff and involved in the process of curriculum revision.

Results

The response rate to the questionnaires was 77.8%. The staff members' consensus achieved in the Delphi process was 98.4% for the learning outcomes and assessment. The results of the Delphi process provided a list of outcomes and their appropriate assessment methods for the specialist orthodontist in Cardiff.

Discussion and Conclusion

The results show that the Delphi process was an efficient and cost‐effective technique to achieve consensus of opinion on the learning outcomes and the assessment methods for the specialist orthodontist as part of the process of curriculum revision in Cardiff.
Climate change and the optimal flowering time of annual plants in seasonal environments
Authors: Johansson Jacob , Bolmgren Kjell , Jonzén Niclas
Published: August 2012

Long‐term phenology monitoring has documented numerous examples of changing flowering dates during the last century. A pivotal question is whether these phenological responses are adaptive or not under directionally changing climatic conditions. We use a classic dynamic growth model for annual plants, based on optimal control theory, to find the fitness‐maximizing flowering time, defined as the switching time from vegetative to reproductive growth. In a typical scenario of global warming, with advanced growing season and increased productivity, optimal flowering time advances less than the start of the growing season. Interestingly, increased temporal spread in production over the season may either advance or delay the optimal flowering time depending on overall productivity or season length. We identify situations where large phenological changes are necessary for flowering time to remain optimal. Such changes also indicate changed selection pressures. In other situations, the model predicts advanced phenology on a calendar scale, but no selection for early flowering in relation to the start of the season. We also show that the optimum is more sensitive to increased productivity when productivity is low than when productivity is high. All our results are derived using a general, graphical method to calculate the optimal flowering time applicable for a large range of shapes of the seasonal production curve. The model can thus explain apparent maladaptation in phenological responses in a multitude of scenarios of climate change. We conclude that taking energy allocation trade‐offs and appropriate time scales into account is critical when interpreting phenological patterns.
Optimization of culture of mesenchymal stem cells: a comparison of conventional plate and microcarrier cultures
Authors: Chang J. , Lei H. , Liu Q. , Qin S. , Ma K. , Luo S. , Zhang X. , Huang W. , Zuo Z. , Fu H. , Xia Y.
Published: August 2012

Objectives

There has been increasing interest in mesenchymal stem cells (MSCs) because of their potential use for regenerative therapy; however, there is no well‐defined protocol for MSCs culture. This study compares techniques of conventional plate and microcarrier culturing of MSCs.

Methods and results

Here, different conditions for isolation and expansion of rat MSCs have been examined and it was found that plating density and plating time in primary culture played important roles for culture of these rat MSCs. When plated at 108/cm2 density for 72 h, in primary culture, recycling stem cells (RS cells) predominated, and characteristics of rat MSCs (including morphology, growth rate, phenotype and differentiation potentials) remained stable during expansion until passage 14. For subculture of the cells, it was found that their growth rate when incubated at 33 °C was higher than those incubated at 37 °C, and maximal increase was 10‐ and 6‐fold respectively. When cultured using microcarriers, at a density of 1 × 105/mg beads, growth kinetics, phenotype and differentiation potentials also remained constant for cells between passage 2nd and 14th; their maximal number increased 16‐fold.

Conclusions

Compared to conventional plate culture, culture using gelatine porous microcarrier Cultispher‐S was superior for large‐scale production of rat MSCs.
EGF signalling pathway regulates colon cancer stem cell proliferation and apoptosis
Authors: Feng Y. , Dai X. , Li X. , Wang H. , Liu J. , Zhang J. , Du Y. , Xia L.
Published: August 2012

Objectives

Cancer stem cells (CSCs) compose a subpopulation of cells within a tumour that can self‐renew and proliferate. Growth factors such as epidermal growth factor (EGF) and basic fibroblast growth factor (b‐FGF) promote cancer stem cell proliferation in many solid tumours. This study assesses whether EGF, bFGF and IGF signalling pathways are essential for colon CSC proliferation and self‐renewal.

Material and methods

Colon CSCs were cultured in serum‐free medium (SFM) with one of the following growth factors: EGF, bFGF or IGF. Characteristics of CSC gene expression were evaluated by real time PCR. Tumourigenicity of CSCs was determined using a xenograft model in vivo. Effects of EGF receptor inhibitors, Gefitinib and PD153035, on CSC proliferation, apoptosis and signalling were evaluated using fluorescence‐activated cell sorting and western blotting.

Results

Colon cancer cell HCT116 transformed to CSCs in SFM. Compared to other growth factors, EGF was essential to support proliferation of CSCs that expressed higher levels of progenitor genes (Musashi‐1, LGR5) and lower levels of differential genes (CK20). CSCs promoted more rapid tumour growth than regular cancer cells in xenografts. EGFR inhibitors suppressed proliferation and induced apoptosis of CSCs by inhibiting autophosphorylation of EGFR and downstream signalling proteins, such as Akt kinase, extracellular signal‐regulated kinase 1/2 (ERK 1/2).

Conclusions

This study indicates that EGF signalling was essential for formation and maintenance of colon CSCs. Inhibition of the EGF signalling pathway may provide a useful strategy for treatment of colon cancer.
Korean mistletoe lectin regulates self‐renewal of placenta‐derived mesenchymal stem cells via autophagic mechanisms
Authors: Choi J. H. , Lyu S. Y. , Lee H. J. , Jung J. , Park W. B. , Kim G. J.
Published: August 2012

Objectives

The balance between survival and death is a key point for regulation of physiology of stem cells. Recently, applications of natural products to enhance efficiencies in culturing and differentiation of stem cells are increasing. Korean mistletoe lectin (Viscum album L. var. coloratum agglutinin, VCA) has been known to be toxic to some cancer cells, but it is still unclear whether VCA has a cytotoxic or indeed a proliferative effect on mesenchymal stem cells (MSCs). Here, we have compared effects of VCA in naïve placenta‐derived stem cells (PDSCs), immortalized PDSCs and cancer cells (HepG2), and analysed their mechanisms.

Materials and methods

MTT assay was performed to analyse effects of VCA on naïve PDSCs, immortalized PDSCs and HepG2. FACS, ROS, caspase‐3 assay, western blotting and immunofluorescence were performed to detect signalling events involved in self‐renewal of the above cell types.

Results

VCA had cancer cell‐specific toxicity to HepG2 cells even with low concentrations of VCA (1–5 pg/ml), toxicity was observed to immortalized PDSCs and HepG2s, while proliferation of naïve PDSCs was significantly increased (P < 0.05). ROS production by VCA treatment in naïve PDSCs was significantly lower compared to controls (P < 0.05). Furthermore, autophagy was activated in naïve PDSCs treated with VCA through increase in type II LC3 and decrease in phosphorylated mTOR.

Conclusions

VCA can promote MSC proliferation through an activated autophagic mechanism.
Estimating changes in mean population age using the death distributions of live‐captured medflies
Authors: CAREY JAMES R. , PAPADOPOULOS NIKOS T. , PAPANASTASIOU STELLA , DIAMANTIDIS ALEXANDROS , NAKAS CHRISTOS T.
Published: August 2012

1. A simple, low‐cost approach to estimating population ageing was introduced based on a modified version of the captive cohort method – a technique developed earlier (Careyet al.,Aging Cell,7, 426–437, 2008) in which information on the remaining lifespans of live‐captured medflies of unknown age is used to estimate the overall population age structure.

2. To test this approach approximately 1200 medflies near Volos, Greece were live captured from daily sampling over a 3‐month field season.

3. This simplified method reported: (i) an extraordinary post‐capture longevity of wild medflies in early season (>200 days in longest lived); (ii) a decrease of 50–75 days in the mean longevity from early‐season to late‐season flies; (iii) seasonality of frailty as indicated by the shorter‐lived flies in late autumn; (iv) cessation of fly emergence in late season as indicated by the absence of long‐lived individuals (indicating newly emerged at capture) sampled in the autumn; and (v) increase in mean age from about 20 days in early season to approximately 60 days in late season.

4. The applications of this simplified captive cohort method are discussed, including its use in the analysis of insect vector populations,Drosophilaecology and ageing in the wild, demographic toxicology, and age bias in sampling.
Larger wildflower plantings increase natural enemy density, diversity, and biological control of sentinel prey, without increasing herbivore density
Authors: BLAAUW BRETT R. , ISAACS RUFUS
Published: August 2012

1. An important means of conserving beneficial insects in resource‐limited habitats is to meet their ecological requirements, which may be achieved by providing areas containing flowering plants that bloom throughout the season, but little is known about the importance of wildflower plot size for supporting natural enemies or the biological control they provide.

2. Wildflowers were established in plots of sizes ranging from 1 to 100 m2, and found that natural enemy density, group richness, and diversity of natural enemy groups increased with plot size.

3. The density of insect herbivores was lower in all flower plots than in the control samples, whereas the diversity of herbivore groups was significantly higher in flower plots.

4. Comparing population growth of sentinel soybean aphids (Aphis glycines Matsumura) among plot sizes, aphid colonies were smaller as plot size increased.

5. Providing beneficial insects with flowering resources resulted in significantly more natural enemies and greater pest control than in smaller flower plots or mown grass areas.

6. These results indicate that the density, diversity, and function of natural enemies are sensitive to the size of wildflower plantings, even at relatively small scales. Therefore, larger wildflower plots are more suitable for the conservation of beneficial insects and their provision of natural pest control.
Semi‐field experiments investigating facilitation: arrival order decides the interrelationship between two saproxylic beetle species
Authors: VICTORSSON JONAS
Published: August 2012

1. Acanthocinus aedilis (Linnaeus) and Rhagium inquisitor (Linnaeus) both colonise the cambial layer in newly dead Scots pine Pinus sylvestris L. and thus are potential competitors.

2. Species interactions and in particular priority effects were investigated in an experiment with a replacement series design. Four pairs of adult beetles were released on each of 91 caged pine bolts (0.35 m long, 13 replicates). To test for priority effects, a 2‐week interval was used to separate the species.

3. The interrelationship in simultaneous coexistence was positive for A. aedilis and negative for R. inquisitor (+,−). Acanthocinus aedilis produced 161% more offspring per female in coexistence than alone. Rhagium inquisitor had lower offspring quality in coexistence where its larvae weighed 39% less than in one‐species bolts.

4. The interrelationship depended on arrival order. When A. aedilis had priority the interaction was again advantageous to A. aedilis (+,−) but when R. inquisitor had priority no species interaction occurred (0,0). Both species therefore fared better when having priority.

5. Facilitation in cerambycids is novel and the facilitative effect on A. aedilis could be oviposition incitement or resource enhancement by R. inquisitor.
Are patterns in the taxonomic, biological and ecological traits of water beetles congruent in Mediterranean ecosystems?
Authors: PICAZO FÉLIX , MILLÁN ANDRÉS , DOLÉDEC SYLVAIN
Published: August 2012

1. Coleoptera species show considerable diversity in life histories and ecological strategies, which makes possible their wide distribution in freshwater habitats, including highly stressed ones such as saline or temporary waterbodies. Explaining how particular combinations of traits allow species to occupy distinctive habitats is a central question in ecology.

2. A total of 212 sites, sampled over a wide range of inland aquatic habitats in the south‐eastern Iberian Peninsula, yielded 272 species belonging to 68 genera and 11 families. The affinities of genera for 11 biological and 11 ecological traits, gathered from literature and the authors’ own expertise, were used to assess the degree of congruence between taxonomic, biological and ecological traits.

3. Taxonomic richness was significantly related to the number of both biological and ecological trait categories, with the richest families also showing the highest functional and ecological diversity. A fuzzy correspondence analysis performed on the abundance‐weighed array of biological traits separated genera according to categories of diet, feeding habits, respiration, reproduction and locomotion. A similar analysis of ecological traits revealed that preferences related to longitudinal distribution (headwater to mouth), local habitat and current velocity best discriminated genera. At the family level, there was a distinctive functional grouping of genera based on biological traits. Only Elmidae showed noticeable homogeneity across genera for both biological and ecological traits.

4. Co‐inertia analysis demonstrated a significant match between biological and ecological traits (Rv‐correlation = 0.35, P < 0.001). Elmidae genera displayed the highest concordance, whereas Hydraenidae demonstrated the lowest.

5. These results indicate that the predominance of habitat filtering processes in headwater streams yields biological trait conservatism (as shown by Elmidae genera), as well as trait convergence for some specific traits (for instance, respiration) among certain Dytiscidae genera and other typical rheophilic taxa, whereas other biotic factors, such as competition among species, appear more prominent in less stressed habitats. Further knowledge of traits, especially regarding physiological capabilities, is needed to better understand water beetle life history strategies.
Use of a morphology‐based functional approach to model phytoplankton community succession in a shallow subtropical lake
Authors: SEGURA ANGEL M. , KRUK CARLA , CALLIARI DANILO , FORT HUGO
Published: August 2012

1. We use morphology‐based functional groups (MBFGs) of phytoplankton to predict ecological performance of groups with a mechanistic model. We evaluate MBFGs’ performance in relation to hypothetical examples of succession and compare it with empirical data for a shallow subtropical hypertrophic lake (Lake Rodó, Uruguay).

2. Our model predicts a trade‐off between maximum growth rate (μmax) and competitive ability (Tilman’s R*) for most MBFGs. The model predicts that phytoplankton succession will proceed from groups with high surface/volume, high μmax and without specialised structures (opportunists) towards the dominance of large colonial or filamentous algae with lower μmax and specialised traits (gleaners). These predictions are generally congruent with empirical data for Lake Rodó.

3. The MBFG classification explained ecological performance of phytoplankton community dynamics while reducing system dimensionality. Despite species aggregation, MBFGs can resolve the occurrence of potentially noxious groups and thus is a promising tool for understanding and managing ponds and lakes.
Holland Sleep Disorders Questionnaire: a new sleep disorders questionnaire based on the International Classification of Sleep Disorders‐2
Authors: KERKHOF GERARD A. , GEUKE MONIQUE E. H. , BROUWER ANNA , RIJSMAN ROSELYNE M. , SCHIMSHEIMER ROB JAN , VAN KASTEEL VIVIANE
Published: August 2012

The primary objectives of this study were to construct a self‐assessment questionnaire for sleep disorders based on the International Classification of Sleep Disorders‐2, and to evaluate the questionnaire’s psychometric properties with respect to its total score and the individual scores for each of the six sleep disorders. In total, 1269 patients, clinically diagnosed with a sleep disorder, and 412 subjects without sleep complaints were enrolled into this study. Principal components analysis confirmed that the Holland Sleep Disorders Questionnaire differentially represented the six symptom clusters associated with International Classification of Sleep Disorders‐2 classifications. The Holland Sleep Disorders Questionnaire’s total score distinguished patients with a clinically diagnosed sleep disorder from individuals without sleep complaints, with area under the receiver operating curve P(A) of 0.95. The internal reliability coefficient alpha was 0.90 and, applying the Youden criterion as cutoff score, the overall accuracy was 88% (κ: 0.75). Subsequently, the six diagnostic groups of sleep‐disordered patients could be differentiated reliably, with P(A) values ranging between 0.69 and 0.95, alpha coefficients ranging between 0.73 and 0.81 and an overall percentage of 85% correctly classified patients (κ = 0.80), indicating a substantial to excellent agreement between the primary diagnoses and the Holland Sleep Disorders Questionnaire classifications.
Phlebotomine sandflies and the spreading of leishmaniases and other diseases of public health concern
Authors: MAROLI M. , FELICIANGELI M. D. , BICHAUD L. , CHARREL R. N. , GRADONI L.
Published: August 2012

Phlebotomine sandflies transmit pathogens that affect humans and animals worldwide. We review the roles of phlebotomines in the spreading of leishmaniases, sandfly fever, summer meningitis, vesicular stomatitis, Chandipura virus encephalitis and Carrión's disease. Among over 800 species of sandfly recorded, 98 are proven or suspected vectors of human leishmaniases; these include 42Phlebotomusspecies in the Old World and 56Lutzomyiaspecies in the New World (all: Diptera: Psychodidae). Based on incrimination criteria, we provide an updated list of proven or suspected vector species by endemic country where data are available. Increases in sandfly diffusion and density resulting from increases in breeding sites and blood sources, and the interruption of vector control activities contribute to the spreading of leishmaniasis in the settings of human migration, deforestation, urbanization and conflict. In addition, climatic changes can be expected to affect the density and dispersion of sandflies. Phlebovirus infections and diseases are present in large areas of the Old World, especially in the Mediterranean subregion, in which virus diversity has proven to be higher than initially suspected. Vesiculovirus diseases are important to livestock and humans in the southeastern U.S.A. and Latin America, and represent emerging human threats in parts of India. Carrión's disease, formerly restricted to regions of elevated altitude in Peru, Ecuador and Colombia, has shown recent expansion to non‐endemic areas of the Amazon basin.
Experimental evidence for distinct costs of pathogenesis and immunity against a natural pathogen in a wild bird
Authors: Bonneaud Camille , Balenger Susan L. , Hill Geoffrey E. , Russell Andrew F.
Published: August 2012

Protective immunity is expected to evolve when the costs of mounting an immune response are less than those of harbouring pathogens. Estimating the costs of immunity vs. pathogenesis in natural systems is challenging, however, because they are typically closely linked. Here we attempt to disentangle the relative cost of each using experimental infections in a natural host–parasite system in which hosts (house finches, Carpodacus mexicanus) differ in resistance to a bacterium (Mycoplasma gallisepticum, MG), depending on whether they originate from co‐evolved or unexposed populations. Experimental infection with a 2007‐strain of MG caused finches from co‐evolved populations to lose significantly more mass relative to controls, than those from unexposed populations. In addition, infected co‐evolved finches that lost the most mass harboured the least amounts of MG, whereas the reverse was true in finches from unexposed populations. Finally, within co‐evolved populations, individuals that displayed transcriptional evidence of higher protective immune activity, as indicated by changes in the expression of candidate immune and immune‐related genes in a direction consistent with increased resistance to MG, showed greater mass loss and lower MG load. Thus, mass loss appeared to reflect the costs of immunity vs. pathogenesis in co‐evolved and unexposed populations, respectively. Our results suggest that resistance can evolve even when the short‐term energetic costs of protective immunity exceed those of pathogenesis, providing the longer‐term fitness costs of infection are sufficiently high.
Lignification of cell walls of infected cells in Casuarina glauca nodules that depend on symplastic sugar supply is accompanied by reduction of plasmodesmata number and narrowing of plasmodesmata
Authors: Schubert Maria , Koteyeva Nouria K. , Zdyb Anna , Santos Patricia , Voitsekhovskaja Olga V. , Demchenko Kirill N. , Pawlowski Katharina
Published: August 2012

The oxygen protection system for the bacterial nitrogen‐fixing enzyme complex nitrogenase in actinorhizal nodules of Casuarina glauca resembles that of legume nodules: infected cells contain large amounts of the oxygen‐binding protein hemoglobin and are surrounded by an oxygen diffusion barrier. However, while in legume nodules infected cells are located in the central tissue, actinorhizal nodules are composed of modified lateral roots with infected cells in the expanded cortex. Since an oxygen diffusion barrier around the entire cortex would also block oxygen access to the central vascular system where it is required to provide energy for transport processes, here each individual infected cell is surrounded with an oxygen diffusion barrier. In order to assess the effect of these oxygen diffusion barriers on oxygen supply for energy production for transport processes, apoplastic and symplastic sugar transport pathways in C. glauca nodules were examined. The results support the idea that sugar transport to and within the nodule cortex relies to a large extent on the less energy‐demanding symplastic mechanism. This is in line with the assumption that oxygen access to the nodule vascular system is substantially restricted. In spite of this dependence on symplastic transport processes to supply sugars to infected cells, plasmodesmal connections between infected cells, and to a lesser degree with uninfected cells, were reduced during the differentiation of infected cells.
Influence of the Cumulus and Gonadotropins on the Metabolic Profile of Porcine Cumulus–Oocyte Complexes During In Vitro Maturation
Authors: Alvarez GM , Dalvit GC , Cetica PD
Published: August 2012

Contents

The aim of this work was to examine the influence of the cumulus and gonadotropins on the metabolic profile of porcine cumulus oocyte complexes (COCs) during in vitro maturation. Immature COCs were assigned to morphological classes A1 (with a dense cumulus), A2 (with a translucent cumulus), B1 (with the corona radiata), B2 (with only some remaining cumulus cells) and matured with or without gonadotropins. Glycolysis and ammonia production were higher in the A class COCs; gonadotropins increased both, especially in the A1 COCs (p < 0.05). The A class COCs had the highest initial protein contents and at the end of in vitro maturation. Furthermore, hormonal stimulation induced a similar increase in protein contents of both A classes (p < 0.05). The neutral lipid content and reactive oxygen species (ROS) levels were similar in the immature oocytes of the COCs of all classes. A reduction was seen in both these variables when maturation proceeded either in the presence or absence of gonadotropins. The cumulus type surrounding the oocyte is related to the metabolism of carbohydrates and amino acids by the COC during in vitro maturation under gonadotropic stimulation. Oocyte lipolytic activity and ROS production appear to be independent of the surrounding cumulus and the presence of gonadotropins.
Effect of intrathecal administration of E‐series prostaglandin 1 receptor antagonist in a cyclophosphamide‐induced cystitis rat model
Authors: Wada Naoki , Matsumoto Seiji , Kita Masafumi , Watanabe Masaki , Hashizume Kazumi , Kakizaki Hidehiro
Published: August 2012

Objectives:  To investigate the effect of intrathecal administration of E‐series prostaglandin 1 antagonist in cyclophosphamide‐induced murine cystitis.

Methods:  Female Wistar rats were used for this experimental study. Intrathecal administration of E‐series prostaglandin 1 antagonist (ONO‐8711; 0.5, 5 and 50 µg) in sham controls and rats with cystitis induced by a single intraperitoneal injection of cyclophosphamide (300 mg/kg) was assessed by evaluating micturition pressure and intercontraction interval using a conscious‐filling cystometry at 48 h after cyclophosphamide or saline injection. In both groups, prostaglandin E2 concentrations and the expression of E‐series prostaglandin 1 receptor in the spinal cord were measured by enzyme‐linked immunosorbent assay and reverse transcription polymerase chain reaction, respectively.

Results:  Rats with cyclophosphamide‐induced cystitis showed a shorter intercontraction interval compared with controls, where the cumulative intrathecal administration of ONO‐8711 did not significantly change micturition pressure or intercontraction interval compared with the baseline. In rats with cyclophosphamide‐induced cystitis, each dose of ONO‐8711 significantly increased the intercontraction interval compared with the baseline (46% increase at 50 µg intrathecally). Polymerase chain reaction revealed the expression of E‐series prostaglandin 1 receptor in the spinal cord of both sham and cyclophosphamide‐induced cystitis rats. In rats with cyclophosphamide‐induced cystitis, PGE2 concentration in the dorsal horn of the L5‐6 spinal cord was significantly higher than that in controls (3.55 ± 1.24 vs 0.99 ± 0.06 pg/mg tissue).

Conclusions:  In rats with cyclophosphamide‐induced cystitis, urinary frequency seems to be caused by prostaglandin E2 acting on E‐series prostaglandin 1 receptor at the level of the spinal cord. Blockade of the spinal E‐series prostaglandin 1 receptor by ONO‐8711 might have a therapeutic potential in the control of interstitial cystitis/bladder pain syndrome.
Synchronous presentation of acute pancreatitis and splenomegaly with intussusceptions in Peutz‐Jeghers syndrome
Authors: Li Yang , Liu Wentian , Zhou Lu , Zheng Zhongqing , Liu Wenge
Published: August 2012

Peutz‐Jeghers syndrome (PJS) is a rare, autosomal dominant inherited disorder characterized by gastrointestinal hamartomatous polyps and pigmented mucocutaneous lesions. Intussusceptions and gastrointestinal tract bleeding are frequent complications of PJS caused by larger polyps, but acute pancreatitis and splenomegaly are very rare. Previously, surgical intervention was the only curative modality despite the associated complications. In recent years, double‐balloon enteroscopy (DBE) has become the alternative method as the ideal treatment. We report the case of a 20‐year‐old woman diagnosed with PJS, as she suffered from 4‐day nausea and vomiting with acute abdominal pain, and clinically manifested acute pancreatitis, splenomegaly and duodenojejunal intussusceptions secondary to a huge proximal jejunal polyp (10 cm × 2 cm). We removed the polyp via DBE and found that the acute pancreatitis, splenomegaly and duodenojejunal intussusceptions were simultaneously ameliorated 2 days after treatment. Currently, the patient has been symptom free for 3 months after polypectomy. Acute pancreatitis, splenomegaly and intussusceptions can synchronously occur in PJS patients, and polypectomy via DBE is the effective treatment alternative to surgical intervention for this disease, thereby obviating some complications associated with the latter.
Human papillomavirus infection and the risk of cervical cancer in Japan
Authors: Matsumoto Koji , Yoshikawa Hiroyuki
Published: August 2012

Infection with a high‐risk human papillomavirus (HPV) is established as a major risk factor for cervical cancer. In Japan, eight HPV genotypes (16, 18, 31, 33, 35, 45, 52 and 58) confer a much higher risk of cervical cancer and its immediate premalignant lesions (cervical intraepithelial neoplasia grade 3 [CIN 3]) than do other high‐risk and the low‐risk HPV types. However, only a small fraction of infected women develop CIN 3 or invasive cervical cancer, suggesting the involvement of additional cofactors in cervical carcinogenesis. A multicenter prospective cohort study of Japanese women with low‐grade cervical abnormalities has demonstrated that tobacco smoking is significantly associated with an increased risk of persistent low‐grade cervical lesions, while the presence of human leukocyte antigen Class II DRB1*1302 protects against progression to CIN 3. Understanding the epidemiology of HPV infections and cervical cancer may improve prevention and lead to novel clinical management strategies for cervical precursor lesions. Viral and host factors that affect the risk of cervical cancer are discussed in this review.
Expression of endothelial nitric oxide synthase in the uterus of patients with leiomyoma or adenomyosis
Authors: Oh Na‐Jung , Ryu Ki‐Young , Jung Cha‐Nam , Yi Sang Yeop , Kim Se‐Ryun
Published: August 2012

Aim:  To confirm the difference in the expression of endothelial nitric oxide synthase in the normal endometrium and myometrium of women who have leiomyoma or adenomyosis compared with controls, and its correlation with the pathogenesis of menorrhagia or dysmenorrhea in patients with uterine leiomyoma.

Methods:  Fifty‐one hysterectomized patients were divided into three groups: (i) patients with leiomyoma (n = 24); (ii) those with adenomyosis (n = 19); and (iii) the control group (n = 8). The expression of endothelial nitric oxide synthase was confirmed on immunohistochemistry and analyzed using an evaluation nomogram.

Results:  The expression of endothelial nitric oxide synthase was significantly higher in the leiomyoma group and the adenomyosis group as compared with the control group. In the subgroup analysis of leiomyoma depending on symptoms (menorrhagia or dysmenorrhea or both), the expression of endothelial nitric oxide synthase was significantly higher in the symptomatic subgroup than the asymptomatic subgroup (endometrium P = 0.0029, myometrium P = 0.0276).

Conclusions:  Based on the findings that the expression of endothelial nitric oxide synthase was significantly higher in the uterus with leiomyoma or adenomyosis, it can therefore be inferred that nitric oxide might have a pathological effect on the uterus with the above diseases. In particular, it is also presumed that endothelial nitric oxide synthase is closely associated with menorrhagia and dysmenorrhea.
Immunohistochemical expression of the proliferative marker Ki67 in hydatidiform moles and its diagnostic value in the progression to gestational trophoblastic neoplasia
Authors: Hasanzadeh Malihe , Sharifi Nourieh , Esmaieli Habibollah , Daloee Mahdi Sharife , Tabari Azadeh
Published: August 2012

Aim:  Considering that Ki‐67 is a proliferative marker in molar pregnancies and the possible progression of these kinds of pregnancies to gestational trophoblastic neoplasia (GTN), we decided to evaluate the rate of expression of this marker in patients with uneventful hydatidiform moles and GTN. Moreover, we determined the predictive value of this factor for the progression of molar pregnancies to GTN.

Methods:  In two groups of patients, including 30 patients with uneventful molar pregnancies and 30 patients with GTN, an immunohistochemical staining technique using the Envision method was performed. To evaluate nuclear immunoreactivity of trophoblastic cells for Ki67 on paraffin sections obtained from molar pregnancy products, the percentage of the stained cells was used. Semi‐quantitative evaluation was also performed. Data were analyzed using Mann–Whitney tests and receiver operating characteristic curve analysis.

Results:  The expression of Ki67 in cytotrophoblastic and syncytiotrophoblastic cells of patients with GTN was significantly more than for patients with an uneventful molar pregnancy (P < 0.05). We considered a 12.5% cut‐off value for Ki67 in cytotrophoblastic cells and a sensitivity of 90%, specificity 93%, positive predictive value of 93.1% and negative predictive value of 90.3% were obtained. Similarly, considering a cut‐off value of 6% for Ki67 in syncytiotrophoblastic cells, results of 90% were obtained for all diagnostic indices.

Conclusion:  Our findings suggest that expression of the Ki67 oncogene in trophoblastic cells in patients with GTN are found far more frequently than in patients with an uneventful molar pregnancy, and demonstrate a high predictive value of progression to GTN.
Intravenous iron sucrose versus oral iron in treatment of iron deficiency anemia in pregnancy: A randomized clinical trial
Authors: Kochhar Puneet Kaur , Kaundal Asmita , Ghosh Pranay
Published: August 2012

Aim:  Iron deficiency is a leading cause of anemia in pregnancy. The present study aimed to compare the efficacy of oral and intravenous iron therapy in improving iron deficiency anemia in pregnancy and restoring iron stores, compare the obstetric outcome in the two groups and evaluate the safety of intravenous iron sucrose.

Material and Methods:  This was a prospective study, where 100 anemic antenatal women with hemoglobin 7–9 g/dL, mean corpuscular volume <85 fL and serum ferritin <15 ng/mL, were randomized into two groups. In group A (n = 50), the women received 200 mg tablets of ferrous sulphate, each containing 60 mg elemental iron, three times a day for 4 weeks. In group B (n = 50), iron sucrose was given in divided doses of 200 mg each on alternate days by slow intravenous infusion. Primary outcome measure was treatment efficacy, assessed by measurement of hemoglobin, red blood cell indices and reticulocytes on days 7, 14, 21, and 30 and at delivery, and of ferritin on day 30 and at delivery. Any side‐effects of treatment and the neonatal outcome were studied as secondary outcome measures.

Results:  There was a statistically significant difference in increase of hemoglobin levels (3.1 g/dL in group A vs 5.1 g/dL in group B; P = 0.002) and ferritin levels between the two groups on day 30 (P = 0.005). The adverse effects from iron treatment were mild but more prominent in group A. Neonatal outcome was comparable in the two groups.

Conclusion:  Intravenous administration of iron sucrose is a safe treatment for correction of anemia in pregnancy, without serious side‐effects.
Natural history of primary precursor B lymphoblastic lymphoma of the ovary: Report of a rare case
Authors: Yadav Rajni , Sharma Mehar Chand , Karak Asis Kumar , Agarwal Nutan , Kumar Rajive , Kumar Lalit
Published: August 2012

The involvement of the ovaries in lymphomatous processes is a relatively rare phenomenon. Secondary involvement as a part of systemic disease is common as compared to de novo primary lymphoma. Mostly, primary ovarian lymphomas are diffuse large B cell type, whereas the precursor lymphoblastic lymphomas are extremely rare and only four cases have been reported previously. We herein describe a case of primary precursor B lymphoblastic lymphoma involving both ovaries in a 28‐year‐old woman which was detected incidentally and spread into the blood after 7 months; consequently she succumbed to the disease.
Complement factors are secreted in human follicular fluid by granulosa cells and are possible oocyte maturation factors
Authors: Yoo Sang Wook , Bolbot Tetyana , Koulova Anna , Sneeringer Rita , Humm Kathrin , Dagon Yossi , Usheva Anny
Published: August 2012

Aims:  In this study, we identify components of the complement system present in human follicular fluid that affect oocyte development and maturation.

Material and Methods:  Using bottom‐up liquid chromatography/mass spectrometry/mass spectrometry, we identified complement factors as consistently present in human follicular fluid from 15 different subjects.

Results:  According to our gene‐chip data, these complement factors are actively produced by granulosa cells.

Conclusions:  By applying the computational Ingenuity Pathway Analysis software and database we have identified complement pathways that play a role in oocyte maturation and follicular development.
Partial trisomy of the long arm of chromosome 1: Prenatal diagnosis, clinical evaluation and cytogenetic findings. Case report and review of the literature
Authors: Cambosu Francesca , Capobianco Giampiero , Fogu Giuseppina , Bandiera Pasquale , Pirino Alessio , Moro Maria Antonietta , Sanna Raimonda , Soro Giovanna , Dessole Margherita , Montella Andrea
Published: August 2012

Partial trisomy of the long arm of chromosome 1 is a relatively rare cytogenetic anomaly. Its phenotype has still not been completely defined, because of the cytogenetic heterogeneity of the cases so far described. We report a prenatal case of partial 1q trisomy associated with partial monosomy 4q, secondary to balanced maternal translocation t(1;4). The trisomic segment extended from 1q31.1 to qter and the monosomy 4q was from 4q35.2 to qter. The phenotypic anomalies found by post‐mortem and autopsy examinations were compared with those of similar cases reported in the literature. We performed standard cytogenetics and fluorescence in situ hybridization. Cerebral ventriculomegaly, present in our case, seemed to be a constant feature in partial 1q trisomies, so this cerebral malformation could be considered as the main echographic marker for this chromosomal imbalance and trisomy 1q should be added to the list of chromosomal abnormalities associated with ventriculomegaly.
Does microalbuminuria at mid‐pregnancy predict development of subsequent pre‐eclampsia?
Authors: Singh Renu , Tandon Indu , Deo Sujata , Natu Shankar Madhav
Published: August 2012

Aim:  The aim of this study was to evaluate microalbuminuria at mid‐pregnancy, using the albumin‐to‐creatinine ratio (ACR), as a predictor of pre‐eclampsia.

Material and Methods:  This prospective observational study was carried out on 144 normotensive women, aged < 35 years, body mass index < 25 kg/m2, and live singleton pregnancy between 24 and 28 weeks. In all, the ACR was measured in spot random urine samples. Normoalbuminuria was an ACR of <30 mg/g, whereas microalbuminuria was an ACR of 30–299 mg/g creatinine. All were followed till delivery. Primary outcome was the development of pre‐eclampsia. The secondary outcome measures were preterm births and neonatal birthweight. Statistical analysis was done with Fisher's exact and t‐tests.

Results:  Of all, 77.1% (111/144) had normoalbuminuria and 22.9% (33/144) had microalbuminuria. Of 33 microalbuminuric women, the mean blood pressure was significantly higher in those who subsequently developed pre‐eclampsia (P < 0.001). The mean ACR (mg/g) in this cohort was 60.6 ± 29.4. The mean ACR (mg/g) in women who subsequently developed pre‐eclampsia was significantly higher than in women who remained normotensive (P = 0.003). Of 33 microalbuminuric women, 12 (36.4%) developed pre‐eclampsia, and eight (24.2%) had preterm births. The mean birthweight (kg ± standard deviation) was significantly lower in the microalbuminuria group (2.45 ± 0.6) as compared to the normoalbuminuria group (2.8 ± 0.37), P < 0.001.

Conclusion:  Microalbuminuria in mid‐pregnancy may be a significant predictor of development of subsequent pre‐eclampsia, preterm birth and low‐birthweight babies.
Preincisional infiltration and intraperitoneal instillation of levobupivacaine 0.25% for management of early postoperative pain following laparoscopic ovarian drilling
Authors: Ismail Mohamed Taha , Hassanin Maher Z. , Elshmaa Nagat S.
Published: August 2012

Aim:  To assess the effectiveness of combined preincisional local infiltration (at trocar sites) and intraperitoneal instillation of levobupivacaine 0.25% for the management of early postoperative pain following laparoscopic ovarian drilling.

Materials and Methods:  This is a prospective randomized controlled observer‐blinded study. The study included 106 infertile patients with the diagnosis of polycystic ovary syndrome (PCOS) who were scheduled to undergo diagnostic laparoscopy and laparoscopic ovarian drilling (LOD) during the period from November 2009 to February 2012 at TAIBA Hospital in Kuwait. Patients were randomly allocated to two groups of 53 patients each. Group I comprised patients who received preincisional local infiltration and intraperitoneal instillation levobupivacaine 0.25%. Patients in group II received equal volumes of normal saline 0.9% (NS) at the same sites. The primary outcome measures were visual analog scale pain scores and postoperative analgesic consumption.

Results:  Postoperative average VAS pain scores, i.m. pethidine consumption and i.v. paracetamol consumption during the first 24 h were highly significantly lower in the levobupivacaine group compared to the NS group (P < 0.01). This technique was also associated with significantly higher overall patient satisfaction, shorter hospital stay and more rapid resumption of normal activity (P < 0.01) without any significant adverse events.

Conclusion:  The combination of preincisional local infiltration and intraperitoneal instillation of levobupivacaine 0.25% was found to substantially reduce postoperative pain and the consumption of postoperative analgesics during the first 24 h; and shorten hospital stay and time to resume normal activities after LOD. It was also associated with a very high overall patient satisfaction without any significant adverse events.
Vaginal delivery following single incision sling (TVT‐Secur) for female stress urinary incontinence
Authors: Tommaselli Giovanni A. , Di Carlo Costantino , Formisano Carmen , Fabozzi Annamaria , Nappi Carmine
Published: August 2012

In recent years, surgical treatment of stress urinary incontinence has become minimally invasive owing to the introduction of the transobturator route first and then single incision devices for positioning of mid‐urethral slings. Although a number of case reports in the literature describe pregnancies successfully terminated both by vaginal delivery and cesarean section following mid‐urethral sling positioning, there is still no definitive consensus on which is the preferred mode of delivery in these patients. We report a case of spontaneous vaginal delivery at term in a 41‐year‐old multiparous woman two years after the positioning of a single incision sling (TVT‐Secur). The patient remained continent throughout the gestation and in the following 24 months. This case seems to further support the concept that sling procedures for stress urinary incontinence do not represent an absolute contraindication to spontaneous vaginal delivery, although the preferred mode of delivery must be assessed on an individual basis.
Fetal growth restriction and reversed middle cerebral artery end‐diastolic flow with subchorionic placental lake
Authors: Kawakita Tetsuya , Sasaki Hiromasa , Hirabuki Shinya , Asamoto Akihiro
Published: August 2012

Fetal growth restriction (FGR) is frequently associated with uteroplacental insufficiency. Placental lakes are avillous spaces filled with maternal venous blood that usually do not compromise the pregnancy outcome; however, a few reports describe FGR in association with placental lakes. Reversed middle cerebral artery (MCA) end‐diastolic flow is a rare event and a potential indicator of poor fetal outcome due to placental insufficiency. We report a case of severe FGR associated with a huge subchorionic placental lake concomitant with reversed MCA end‐diastolic flow. We also conducted a literature review.
Fetomaternal hemorrhage with intraplacental chorioangioma
Authors: Kawano Ryosuke , Takemoto Shuji , Shimamatsu Kazuhide , Hori Daizo , Kamura Toshiharu
Published: August 2012

A 37‐year‐old Asian woman, gravid 0 para 0, was admitted to our hospital at 34 weeks and 5 days of her pregnancy for management of preeclampsia. A few days after admission, she recognized diminished fetal movement, and a non‐stress test revealed a non‐reassuring fetal heart rate pattern with decreased variability. A female baby weighing 1840 g was delivered by emergency cesarean section with Apgar scores of 5 and 5 at 1 and 5 min, respectively. Significant neonatal anemia with a hemoglobin level of 4.3 g/dL was observed. The elevated level of hemoglobin F (HbF) in the maternal blood accounted for 4.6% (normal ≦ 0.5%), and was indicative of the presence of fetomaternal hemorrhage (FMH). Microscopic examination of the placenta revealed chorioangioma. We report here a rare case of FMH with intraplacental chorioangioma, and discuss the relationship between these two pathologies.
Low titers of measles antibodies in Japanese pregnant women: A single‐center study
Authors: Kanda Eriko , Yamaguchi Koushi , Hanaoka Masachi , Matsui Hideo , Sago Haruhiko , Kubo Takahiko
Published: August 2012

Aim: Measles during pregnancy has deleterious effects on both perinatal and maternal outcomes. In Japan, local epidemics of measles and cases of measles during pregnancy are still being reported; therefore, the seroprevalence of antibodies to measles is suspected to be still not sufficient. The aim of this study was to analyze the seroprevalence of antibodies to measles in Japanese pregnant women and estimate the percentage of these women who require vaccination or revaccination against measles.

Material and Methods: We analyzed the seroprevalence of immunity to measles by the neutralization test in 10 349 pregnant women in the first trimester managed at the National Center for Child Health and Development between February 2004 and December 2010. The neutralization test titers were interpreted as follows: ≧1:8, seropositive; = 4, low‐positive; ≦4, seronegative.

Results: Of the total number of pregnant women tested, 7408 (71.6%) were seropositive, 1864 (18.0%) were low‐positive, and 1079 (10.4%) were seronegative for measles antibodies, respectively.

Conclusion: Our results revealed that 28% of our pregnant population was seronegative or low‐positive for measles antibodies, and thought to require revaccination or vaccination. Screening for measles immunity might be advisable for women of childbearing age.