bluuebunny/crossref_metadata_2025 huggingface dataset:
Disability adjusted life years lost to dengue in Brazil
Authors: Luz P. M. , Grinsztejn B. , Galvani A. P.
Published: January 2009

Objectives  To assess the dengue burden in Brazil, and to compare it over three spatial scales: in the city of Rio de Janeiro, the state of Rio de Janeiro, and in Brazil overall.

Methods  We calculated disability adjusted life years (DALYs) lost to dengue per million individuals annually from 1986 through 2006. To calculate DALYs, we compiled data on the number of dengue cases by age, clinical syndrome and outcome. We evaluated the sensitivity of our results to multiplication factors used to adjust for inaccuracies in reporting using a Monte Carlo method.

Results  From 1986 through 2006, a mean of 56, 47 and 22 DALYs per million individuals annually were lost to dengue in the city of Rio de Janeiro, in the state of Rio de Janeiro and in Brazil, respectively. Over 80% of the dengue burden derived from dengue fever cases. The dengue burden was highest at the city‐level with a maximum single‐year estimate of 560 DALYs per million individuals for 2002.

Conclusions  Assessment of dengue burden requires consideration of all clinical syndromes over multiple years. Our results indicate that the dengue burden is as high as the burden of other major infectious diseases that afflict the Brazilian population, including malaria. These results may prompt policy makers to elevate the prioritization of dengue control, and allocate resources needed to curtail the increasing dengue burden.
Recombinant human hepatitis B vaccine initiating alopecia areata: testing the hypothesis using the C3H/HeJ mouse model
Authors: Sundberg John P. , Silva Kathleen A. , Zhang Weidong , Sundberg Beth A. , Edwards Kathryn , King Lloyd E. , Davis Robert L. , Black Steven
Published: January 2009

Untoward effects of human vaccines suggest that recombinant hepatitis B vaccine may induce alopecia areata (AA) in some patients. Similar untoward immunological effects may also account for AA‐like diseases in domestic species. In this study, the C3H/HeJ spontaneous adult onset AA mouse model was used to test the role, if any, of recombinant hepatitis B vaccine on the initiation or activation of AA. Initial experiments demonstrated no effect on induction of AA in young adult female C3H/HeJ mice (P = 0.5689). By contrast, older females, those at the age when AA first begins to appear in this strain, had a significant increase (P = 0.0264) in the time of onset of AA, suggesting that the vaccine may initiate disease in mice predisposed to AA. However, larger vaccine trials, which included diphtheria and tetanus toxoids as additional controls, did not support these initial result findings and suggest that AA associated with vaccination may be within the normal background levels of the given population.
Actinomyces meyeri cutaneous actinomycosis
Authors: Hermida María Daniela , Della Giovanna Patricia , Lapadula María , García Sandra , Cabrera Hugo Néstor
Published: January 2009

Actinomyces meyeri cutaneous actinomycosis is a very rare disease. It often results from contiguous dissemination of an underlying focus. We report a case of pulmonary actinomicosis with secondary cutaneous involvement which led to the diagnosis.

A 51‐year‐old man presented with an indurated, erythematous plaque on his right chest wall. He had been diagnosed with pneumoniae one month prior ago and received antibiotic treatment but symptoms persisted. Fibrobroncoscopy was normal and bronchoalveolar lavage samples were negative. The cutaneous plaque evolved with fistulization and drainage of serohematic material with white grains. Actinomyces meyeri was cultured from bacteriologic samples. Ceftriaxone and doxiciclin were administered for a total of 12 months with complete resolution of the clinical condition.
An outbreak of 268 cases of Paederus dermatitis in a toy‐building factory in central China
Authors: Huang Changzheng , Liu Yeqiang , Yang Jing , Tian Jin , Yang Lingyun , Zhang Jing , Li Yanqiu , Li Jiawen , Wang Chunsen , Tu Yating , Tao Juan
Published: January 2009

Objective  To evaluate the clinical features of and to identify the pathogen responsible for an outbreak of acute dermatitis in a toy‐building factory in Chibi city, central China.

Methods  Physical examinations were carried out on all the factory staff. Records were made. The factory district, its surrounding environment and the accommodation conditions were investigated. The insects collected in the area were identified by a parasitologist at the Department of Parasitology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan.

Results  Two hundred and sixty‐eight cases of Paederus dermatitis were diagnosed in a total of 316 staff at the toy‐building factory. The total incidence rate was 84.81%. The incidence rates in administrators and workers were 43.75% and 87%, respectively. The face and neck were the most common sites of involvement. The most common lesions consisted of linear erythema and papulopustules. In 71.27% of patients, more than one lesion was present.

Conclusion  This outbreak of acute dermatitis was diagnosed as Paederus dermatitis caused by Paederus fuscipes. The favorable environment, lighting, humidity, and poor accommodation may have been responsible for the outbreak. Increased public awareness of this condition may decrease the incidence of Paederus dermatitis.
Infectious balanoposthitis: management, clinical and laboratory features
Authors: Lisboa Carmen , Ferreira Alcina , Resende Carlos , Rodrigues Acácio Gonçalves
Published: January 2009

Background  Balanitis is defined as inflammation of the glans penis, often involving the prepuce (balanoposthitis). It is a common condition due to a wide variety of causes with infection being the most frequent and several microorganisms reported. The clinical aspect is often non specific. The management of balanoposthitis remains a clinical challenge.

Objective  To evaluate the prevalence of infectious balanitis, its management, clinical features, laboratory procedures and treatment options.

Subjects and methods  One hundred eighteen patients with infectious balanitis were evaluated between 1995 and 2004 and laboratory data were collected.

Results  Balanitis was diagnosed in 219 (10.7%) of the men that have attended the sexually transmitted disease (STD) Clinic. One hundred eighteen (53.9%) had clinically been assumed to suffer from infectious balanitis. In 75 (63.6%) patients the diagnosis was confirmed by culture studies. Candida albicans was isolated from 24 patients. Staphylococcus spp. and groups B and D Streptococci were the most frequently isolated bacteria. All men were uncircumcised. Ninety‐one (77.1%) of infectious balanitis patients were treated with antifungal agents. Twelve patients with infectious noncandida balanitis were treated with general antibiotic therapy. Fifty‐five (46.6%) patients had a follow‐up of 3 to 12 months during which recurrences were registered in 7 (12.7%) patients.

Conclusions  Infectious balanitis was a common condition, affecting 53.9 % of male STD clinic patients in this study. Candida spp. were the most frequently isolated microorganisms. The clinical aspect is of little value in predicting the infectious agent associated with balanoposthitis.
The importance of nasal provocation test in the diagnosis of natural rubber latex allergy
Authors: Ünsel M. , Mete N. , Ardeniz Ö. , Göksel S. , Ersoy R. , Sin A. , Gulbahar O. , Kokuludag A.
Published: January 2009

Background:  Most studies regarding natural rubber latex (NRL) allergy have concentrated on the prevalance using skin prick test (SPT) and specific IgE assay. The objective of this study is to examine the target organ (skin, nasal mucosa) responses in patients with positive SPT to NRL using the nasal provacation test (NPT) and glove use test (GUT).

Methods:  Four thousand four hundred and twenty patients presented to our polyclinic between July 2003 and January 2007 were evaluated. One thousand six hundred and ninety‐nine patients had positive SPT to one or more allergens (NRL and other inhaler allergens). Twenty‐nine patients with positive SPT to NRL comprised the NRL sensitive group (group 1). Thirty‐five randomized patients with positive SPT to an inhaler allergen other than NRL and negative NRL‐specific IgE comprised atopic control group (group 2). Thirty healthy individuals who had no allergic diseases and had negative SPT and NRL‐specific IgE comprised the healthy control group (group 3).

Results:  The lowest NRL allergen concentration leading to NPT positiveness was 0.05 μg/mL. NPT was negative in groups 2 and 3. NPT was found to have a sensitivity of 96%, specificity of 100%, negative predictive value of 98% and positive predictive value of 100%. GUT was found to have a sensitivity of 81%, specificity of 90%, negative predictive value of 75% and positive predictive value of 93%.

Conclusions:  Nasal provocation test was successfully used for the first time in the diagnosis of NRL allergy. NPT is a more sensitive method as compared to GUT.
OBESITY INDUCED RENAL OXIDATIVE STRESS CONTRIBUTES TO RENAL INJURY IN SALT‐SENSITIVE HYPERTENSION
Authors: Quigley Jeffrey E , Elmarakby Ahmed A , Knight Sarah F , Manhiani Marlina M , Stepp David W , Olearzcyk Jeffrey J , Imig John D
Published: January 2009

In the present study, we determined the role of hypertension, oxidative stress and inflammation on kidney damage in a rodent model of obesity and diabetes. Hypertension was induced in male obese (db/db) mice and lean (db/m) mice by implantation of deoxycorticosterone acetate (DOCA) pellets and mice were allowed to drink water containing 1% salt. Mice were divided into six groups as follows: obese and lean control, obese and lean 1% salt (salt) and obese and lean DOCA plus 1% salt (DOCA‐salt).

Blood pressure was significantly increased in lean and obese DOCA‐salt groups relative to their respective controls; however, there was no difference in blood pressure between the lean and obese control and salt groups. Urinary 8‐isoprostane was increased in obese control compared with lean control mice (1464 ± 267 vs 493 ± 53 pg/µmol creatinine, respectively) and this elevation was further increased in the obese DOCA‐salt treated mice (2430 ± 312 pg/µmol creatinine). Urinary monocyte chemoattractant protein‐1 excretion and CD68‐positive cells were also increased in both obese and lean DOCA‐salt groups compared with their respective controls. Furthermore, DOCA‐salt treatment increased collagen IV excretion in both obese and lean mice compared with controls, but there was no difference between obese and lean DOCA‐salt groups. Urinary albumin excretion was significantly increased in the obese compared with the lean DOCA‐salt mice (507 ± 160 vs 202 ± 48 µg/day, respectively).

These data suggest that obese DOCA‐salt hypertensive mice exhibit greater renal injury than lean DOCA‐salt hypertensive mice in a manner independent of blood pressure and that this renal injury is associated with obesity related pre‐existing renal oxidative stress.
Husserl and Heidegger: Exploring the disparity
Authors: McConnell‐Henry Tracy , Chapman Ysanne , Francis Karen
Published: January 2009

Introduced as an alternative to empirical science, phenomenology offers nursing an insightful means for understanding nursing phenomena specifically in relation to lived experiences. However, not all phenomenologies were created equal, a point which has left many a nursing researcher not only confused. Furthermore, this confusion might result in the choosing of a philosophical framework that is neither cognizant with the research question nor the epistemological lens through which the researcher operates. Drawing on common nursing examples to illustrate concepts, the authors closely examine and debate the disparities between Husserl's transcendental phenomenology and Heidegger's hermeneutic approach to phenomenology. The aim of the article is to demystify the dense language used and present the fundamental beliefs of each philosopher in a format that is accessible to novice phenomenologists.
Impact of prenatal diagnosis on choledochal cysts and the benefits of early excision
Authors: Foo Dominic CC , Wong Kenneth KY , Lan Lawrence CL , Tam Paul KH
Published: January 2009

Aim:  To evaluate the clinical outcomes of patients with prenatally diagnosed choledochal cysts compared with those diagnosed after birth and the optimal timing of definitive treatment.

Methods:  Retrospective review of all patients who underwent primary choledochal cyst excision and Roux‐en‐Y hepaticojejunostomy from 1996 to 2006 at a single institution.

Results:  A total of 45 patients were included. Ten (22.2%) of the patients had prior prenatal diagnosis. The mean age at operation for this group was 4.4 months and mean follow up was 55.9 months. There was no operative complication or late morbidity. For the post‐natal diagnosis group, the mean age at operation was 5.7 years (P < 0.000) and mean follow up period was 69 months. The most common presentation in this group was abdominal pain (31.4%), followed by pancreatitis (28.6%) and symptoms of cholestasis (25.7%). Early post‐operative morbidities occurred in two (5.7%) patients. On long‐term follow up, two (5.7%) further patients in the post‐natal group developed complications.

Conclusion:  Prenatal diagnosis of choledochal cysts results in earlier definitive surgery. More adverse complications were seen in those who had surgery at an older age. We therefore recommend early excision of choledochal cysts.
Asthma and protracted bronchitis: Who fares better during an acute respiratory infection?
Authors: Petsky Helen L , Acworth Jason P , Clark Ronald , Thearle Donna M , Masters Ian B , Chang Anne B
Published: January 2009

Aim:  Acute respiratory infections (ARI) are common in children, and symptoms range from days to weeks. The aim of this study was to determine if children with asthma have more severe ARI episodes compared with children with protracted bronchitis and controls.

Methods:  Parents prospectively scored their child's next ARI using the Canadian acute respiratory illness and flu scale (CARIFS) and a validated cough diary (on days 1–7, 10 and 14 of illness). Children were age‐ and season‐matched.

Results:  On days 10 and 14 of illness, children with protracted bronchitis had significantly higher median CARIFS when compared with children with asthma and healthy controls. On day 14, the median CARIFS were: asthma = 4.1 (interquartile range (IQR) 4.0), protracted bronchitis = 19.6 (IQR 25.8) and controls = 4.1 (IQR 5.25). The median cough score was significantly different between groups on days 1, 7, 10 and 14 (P < 0.001). A significantly higher proportion of children with protracted bronchitis (63%) were still coughing at day 14 in comparison with children with asthma (24%) and healthy controls (26%).

Conclusion:  Children with protracted bronchitis had the most severe ARI symptoms and higher percentage of respiratory morbidity at day 14 in comparison with children with asthma and healthy controls.
Macular polypoidal choroidal vasculopathy with a remote lesion
Authors: Tsujikawa Akitaka , Nakanishi Hideo , Ojima Yumiko , Iwama Daisuke , Tamura Hiroshi , Otani Atsushi , Yoshimura Nagahisa
Published: January 2009

Abstract

Purpose:  To report cases of the macular type of polypoidal choroidal vasculopathy with a remote lesion.

Methods:  We report six patients (seven eyes) with polypoidal choroidal vasculopathy who had macular and remote lesions. These eyes were examined with angiography and tomography.

Results:  All seven eyes showed an exudative macular lesion beneath the fovea. In addition, all eyes showed remote polypoidal lesions that were not connected to the macular lesions; the remote lesion was detected outside of the vascular arcade in five eyes, superotemporally beside the optic disc in one eye and on the nasal side of the optic disc in one eye. Indocyanine green angiography, fluorescein angiography and optical coherence tomography failed to reveal any sign of a branching vascular network or choroidal neovascularization that connected the macular lesion with the more remote lesion. At the initial visit, visual acuity in the seven eyes ranged from 6/150 to 6/9 (median, 6/15). Four eyes underwent photodynamic therapy to the exudative macular lesion. During 27.6 ± 14.3 months of follow up, no worsening was detected in any of the remote lesions. Median visual acuity was 6/60 at the final visit.

Conclusions:  Some patients with macular polypoidal choroidal vasculopathy also have a remote lesion, although the remote lesion seems to have only a minor effect on visual outcome.
Changes of aqueous vascular endothelial growth factor and interleukin‐6 after intravitreal triamcinolone for branch retinal vein occlusion
Authors: Park Sung P , Ahn Jae K
Published: January 2009

Abstract

Background:  To investigate sequential changes of aqueous vascular endothelial growth factor (VEGF) and interleukin (IL)‐6 in macular oedema secondary to branch retinal vein occlusion after single intravitreal injection of triamcinolone acetonide (IVTA).

Methods:  We recruited 10 healthy controls and 30 patients at Chonnam National University Hospital, Gwangju, Korea. Aqueous and plasma levels of VEGF and IL‐6 were measured by enzyme‐linked immunosorbent assay at the time of IVTA and 3 months later. Non‐response to IVTA was defined as showing persistent macular oedema based on a reduction of central macular thickness by less than 20% from baseline measurements by optical coherence tomography and vision improvement by less than 0.3 logMAR. Fluorescein angiography was performed 6 months after IVTA. We compared aqueous levels of VEGF and IL‐6 between responders and non‐responders.

Results:  The aqueous levels of VEGF and IL‐6 were significantly higher in 12 non‐responders than in 18 responders at baseline measurements (511 ± 245 pg/mL vs. 230 ± 108 pg/mL, P < 0.001; 38 ± 31 pg/mL vs. 16 ± 13 pg/mL, P < 0.001, respectively). Aqueous levels of VEGF were still higher in non‐responders (312 ± 64 pg/mL) 3 months after IVTA, and aqueous levels of VEGF in responders returned to normal (86 ± 21 pg/mL, P < 0.001). Aqueous levels of IL‐6 normalized in all patients 3 months after IVTA. Fluorescein angiography revealed that non‐responders showed higher frequencies of macular ischaemia and ischaemic branch retinal vein occlusion.

Conclusions:  IL‐6‐independent VEGF secretion may contribute to persistent macular oedema associated with ischaemic BRVO after IVTA.
Lifestyle factors and colorectal cancer risk (1): systematic review and meta‐analysis of associations with body mass index
Authors: Harriss D. J. , Atkinson G. , George K. , Tim Cable N. , Reilly T. , Haboubi N. , Zwahlen M. , Egger M. , Renehan A. G. ,   the C‐CLEAR group
Published: January 2009

Objective  Excess body weight, defined by body mass index (BMI), may increase the risk of colorectal cancer. As a prerequisite to the determination of lifestyle attributable risks, we undertook a systematic review and meta‐analysis of prospective observational studies to quantify colorectal cancer risk associated with increased BMI and explore for differences by gender, sub‐site and study characteristics.

Method  We searched MEDLINE and EMBASE (to December 2007), and other sources, selecting reports based on strict inclusion criteria. Random‐effects meta‐analyses and meta‐regressions of study‐specific incremental estimates were performed to determine the risk ratio (RR) and 95% confidence intervals (CIs) associated with a 5 kg/m2 increase in BMI.

Results  We analysed 29 datasets from 28 articles, including 67 361 incident cases. Higher BMI was associated with colon (RR 1.24, 95% CIs: 1.20–1.28) and rectal (1.09, 1.05–1.14) cancers in men, and with colon cancer (1.09, 1.04–1.12) in women. Associations were stronger in men than in women for colon (P < 0.001) and rectal (P = 0.005) cancers. Associations were generally consistent across geographic populations. Study characteristics and adjustments accounted for only moderate variations of associations.

Conclusion  Increasing BMI is associated with a modest increased risk of developing colon and rectal cancers, but this modest risk may translate to large attributable proportions in high‐prevalence obese populations. Inter‐gender differences point to potentially important mechanistic differences, which merit further research.
Lifestyle factors and colorectal cancer risk (2): a systematic review and meta‐analysis of associations with leisure‐time physical activity
Authors: Harriss D. J. , Atkinson G. , Batterham A. , George K. , Tim Cable N. , Reilly T. , Haboubi N. , Renehan A. G. ,   The Colorectal Cancer, Lifestyle, Exercise And Research Group
Published: January 2009

Objective  Increased physical activity may decrease the risk of colorectal cancer. As a prerequisite to the determination of lifestyle attributable risks, we performed a systematic review and meta‐analysis of prospective observational studies to quantify gender‐specific risk associated with increased leisure‐time physical activity (LT‐PA).

Method  We searched MEDLINE and EMBASE (to December 2007), and other sources, selecting reports based on strict inclusion criteria. We used random‐effects meta‐analyses to estimate summary risk ratios (RR) and 95% confidence intervals (95% CI) for uppermost vs lowermost categories of physical activity. To investigate dose–response, we explored risks ratios as a function of cumulative percentiles of physical activity distribution.

Results  Fifteen datasets from 14 articles, including 7873 incident cases, were identified. For colon cancer, there were inverse associations with LT‐PA for men (RR: 0.80; 95% CI: 0.67–0.96) and women (0.86; 0.76–0.98). LT‐PA did not influence risk of rectal cancer. The dose–response analysis was consistent with linear pattern reductions in risk of colon cancer in both genders. There was evidence of moderate between‐study heterogeneity but summary estimates were broadly consistent across potential confounding factors.

Conclusion  Increased LT‐PA is associated with a modest reduction in colon but not rectal cancer risk; a risk reduction, which previously may have been overstated. LT‐PA only interventions in public health cancer prevention strategies are unlikely to impact substantially on colorectal cancer incidences.
The evolution of analgesia in an ‘accelerated’ recovery programme for resectional laparoscopic colorectal surgery with anastomosis
Authors: Zafar N. , Davies R. , Greenslade G. L. , Dixon A. R.
Published: January 2009

Objective  The study set out to analyse the outcomes of an evolving accelerated recovery programme after laparoscopic colorectal resection (LCR).

Method  The results of a prospective electronic database (March 2000 – April 2008) were analysed.

Results  There were 353 consecutive patients undergoing ‘three port’ high anterior resection (AR) (237 without covering stoma) and 166 a right hemicolectomy (RHC). One hundred thirty‐eight had postoperative analgesia using paracetamol IV and oral analgesia (IVP); 27 (16.3%) received additional parenteral morphine and were excluded. Patient controlled morphine analgesia (PCA) was used in 138. Transversus abdominis plane (TAP) blocks, supplemented by IV paracetamol and oral analgesia were used in the last 50 patients.

The time to the resumption of diet was significantly reduced with TAP analgesia (median 12 h) and IVP (median 12 h) compared with PCA median (36 h) (χ2 = 143; 4df: P < 0.001). The postoperative hospital stay was significantly reduced with TAP analgisia (median 2 days) and IVP (median 3 days) compared with PCA (median 5 days); χ2 = 73; 2df: P < 0.001. Seventeen (34%) TAP and nine (6.5%) IVP patients were discharged within 24 h of surgery compared with no patient in the PCA group. Ninety‐three per cent of PCA, 35% IVP and 10% TAP patients were discharged in more than 3 days. The movement towards ‘accelerated recovery’ was not associated with any increased risk of urinary retention, return to theatre, readmission and/or 30 day mortality.

Conclusion  Laparoscopic surgery utilizing IV paracetamol and TAP blocks for postoperative analgesia aids safe effective ‘accelerated recovery’ in an unselected patient population undergoing right hemicolectomy and high anterior resection. Routine epidural anaesthesia is unnecessary for LCR. Morphine PCA is associated with delayed recovery.
Understanding the anatomy of lymphatic drainage and the use of blue‐dye mapping to determine the extent of lymphadenectomy in rectal cancer surgery: unresolved issues
Authors: Bell S. , Sasaki J. , Sinclair G. , Chapuis P. H. , Bokey E. L.
Published: January 2009

Objective  This paper reviews the literature on the pathways of lymphatic drainage of the rectum and their significance in radical cancer surgery.

Method  This paper reviews some of the seminal works on the lymphatic drainage of the rectum and its surgical implications when operating on patients with rectal cancer. Publications were searched via Medline, sourced from reference lists and by cross referencing with the most widely cited papers.

Results  The classical European description of the anatomy of the lymphatic drainage of the rectum is presented. Early lymphatic mapping techniques and the role of newer technologies in lymphatic mapping, including sentinel lymph node mapping are discussed. The differing philosophies between Western practice, of dissection in the plane of the fascia propria and the Japanese wider pelvic lymphadenectomy are discussed.

Conclusions  A clear understanding of the regional lymphatic drainage of the rectum and precise anatomical mobilisation of the rectum is the surgical cornerstone to excellent locoregional control of rectal cancer. The success of the differing Western and Japanese philosophies on the degree of pelvic lymphadenectomy suggests a possible role for ‘selective wide pelvic lymphadectomy’. Mapping lateral lymphatic drainage pathways could augment the selection process for radiotherapy.
The use of symptoms to predict colorectal cancer site. Can we reduce the pressure on our endoscopy services?
Authors: Kent A. J. , Woolf D. , McCue J. , Greenfield S. M.
Published: January 2009

Objective  Our objective was to determine the value of gastrointestinal symptoms and signs in predicting the site of colorectal cancer (CRC). These symptoms can subsequently be used in determining first‐line investigation with either sigmoidoscopy or colonoscopy.

Method  We interrogated the endoscopic and CRC databases (‘Infoflex’), for patients diagnosed with CRC between April 2005 and March 2006 inclusive. These patients were cross‐referenced with the pathology database and patient records. Information gathered from these databases include: age, gender, symptoms, site of cancer, histology, Duke’s grading, blood parameters, diagnostic tool and treatment.

Results  One hundred fifty‐three patients were diagnosed with CRC between April 2005 and March 2006. One hundred twenty‐six were initially seen in the out‐patient department, of whom 38 (29%) were right‐sided (proximal to the splenic flexure), and 88 (70%) were left‐sided (splenic flexure and beyond). Change in bowel habit (diarrhoea and constipation) and rectal bleeding were significantly associated with left‐sided cancers (P < 0.0024 and P < 0.0001, respectively). Haemoglobin (P < 0.0001) and mean corpuscular volume (P < 0.0001) were significantly lower in right‐sided cancers. Weight loss, pain and obstruction were not associated with cancer site. C‐reactive protein, albumin and carcinoembryonic antigen are not predictive of cancer site, Duke’s stage or influenced by patient age or gender.

Discussion  Symptoms can accurately predict site of cancer, allowing investigations to be tailored accordingly. We would recommend that patients with altered bowel habit and/or rectal bleeding, and no other symptoms, risk factors or anaemia, can be investigated with a flexible sigmoidoscopy to confirm or refute a diagnosis of colorectal cancer.
Multiple synchronous colonic anastomoses: are they safe?
Authors: Holubar S. D. , Wolff B. G. , Poola V. P. , Soop M.
Published: January 2009

Objective  To evaluate short‐term outcomes after construction of synchronous colonic anastomoses without fecal diversion.

Method  Using a prospective procedural database, all adult general surgery patients who underwent two synchronous segmental colon resections and anastomoses without ostomy at our institution from 1992–2007 were identified. Demographics, operative techniques, and 30‐day outcomes are reported. Results are number (percent) of patients or median (interquartile range).

Results  Over 15 years, 69 patients underwent double colonic anastomoses [40 males, age 63 (45–76) years, BMI 25.3 (22.9–28.7) kg/m2]. Multiple colonic anastomoses were performed in one of every 201 colectomies during the study period (0.5%). The operation was an emergency in two (3%) cases; most cases were clean‐contaminated 56 (81%). Ten (17%) cases were laparoscopic‐assisted with a 44% conversion rate. Length of stay was seven (5–10) days. Overall 30‐day morbidity was 36% including nine (13%) surgical site infections, two (2.9%) intra‐abdominal abscesses requiring percutaneous drainage, and one (1.4%) wound dehiscence. There were no anastomotic leaks or fistulas, and two patients (2.9%) died within 30 days from pulmonary sepsis and complications from a distal anastomotic hemorrhage, respectively.

Conclusions  Synchronous colon anastomoses without fecal diversion do not appear to be associated with an increased risk of complications and can be safely constructed in selected patients.
Combined surgery in pelvic organ prolapse is safe and effective
Authors: Riansuwan W. , Hull T. L. , Bast J. , Hammel J. P.
Published: January 2009

Objective  In women, rectal prolapse is often accompanied by other signs of generalized pelvic floor weakness including uterine and bladder prolapse. The purpose of this study was to compare whether there are differences in outcomes of rectal prolapse surgery between women having combined pelvic organ prolapse (POP) surgery with a urologist or urogynecologist (CS) vs those having abdominal rectal prolapse surgery alone (RP).

Method  Charts were reviewed to collect perioperative data on those having surgery from 1995 to 2001. Phone surveys were conducted to obtain Cleveland Clinic Foundation (CCF) Incontinence score, Knowles‐Eccersley‐Scott‐Symptom (KESS) Constipation Score, Short Form 36 (SF‐36) quality of life score and recurrence rate. Appropriate statistical analysis was performed.

Results  Ninety‐four operations were performed (23 CS and 71 RP). Forty‐six (49%) could be contacted by phone. Mean follow‐up was similar in both groups (CS 4.1 vs RP 3.6 years; P = 0.796). There were no significant differences between both groups regarding age, American Society of Anesthesiology classification Score, complications, length of hospital stay, CCF Incontinence score, KESS Constipation Score, SF‐36 Score and recurrence rate of rectal prolapse. The operative time (CS 226 vs RP 122 min; P < 0.001) and blood loss (CS 377 vs RP 183 ml; P < 0.001) were significantly increased in the CS group.

Conclusion  Combined surgery for POP is safe and effective when considering outcomes of rectal prolapse surgery. Therefore surgeons should not hesitate to address all pelvic floor issues during the same operation by working in partnership with the anterior pelvic floor colleagues.
Assessment of urodynamic and detrusor contractility variables in patients with overactive bladder syndrome treated with botulinum toxin‐A: is incomplete bladder emptying predictable?
Authors: Sahai Arun , Sangster Philippa , Kalsi Vinay , Khan Mohammad S. , Fowler Clare J. , Dasgupta Prokar
Published: January 2009

OBJECTIVE

To assess whether incomplete bladder emptying and the need for clean intermittent self‐catheterization (CISC) is predictable, by analysing urodynamic and detrusor contractility variables in patients treated with botulinum toxin‐A (BTX‐A) for refractory idiopathic detrusor overactivity (IDO).

PATIENTS AND METHODS

Sixty‐seven patients (mean age 50.3) with IDO, from two centres, had bladder injections of 200 U BTX‐A. Patients with difficulty in emptying their bladder and/or persistent overactive bladder symptoms, with postvoid residual volumes (PVR) of >150 mL after treatment were started on CISC. Urodynamics were conducted at baseline, 4 and 12–16 weeks after injection with BTX‐A. Detrusor contractility was assessed using the projected isovolumetric pressure (PIP1) in women and bladder contractility index (BCI) in men.

RESULTS

There were improvements in the mean maximum cystometric capacity, bladder compliance and maximum detrusor pressures during filling cystometry after BTX‐A injections. The PVR was significantly increased at 4 but not at 12 weeks. Nineteen patients required CISC and when compared with those not needing CISC their pretreatment maximum flow rate (15 vs 22 mL/s, P = 0.003), PIP1 (43 vs 58, P = 0.02) and BCI (113 vs 180, P = 0.001) were lower. Receiver operator characteristic curve analysis suggested that a PIP1 of ≤50 in women (sensitivity 0.83; specificity 0.70; area under the curve 0.822) and BCI ≤120 (sensitivity 0.7; specificity 0.79; area 0.879) might predict the need for CISC.

CONCLUSION

The maximum flow rate, PIP1 and BCI were significantly lower in patients who required CISC after BTX‐A treatment than in those who did not. A PIP1 of ≤50 in women and a BCI of ≤120 might be predictive of a need for CISC in this setting, and might help when counselling patients.
Radiotherapy to bone metastases from renal cell carcinoma with or without zoledronate
Authors: Kijima Toshiki , Fujii Yasuhisa , Suyama Taisuke , Okubo Yuhei , Yamamoto Shinya , Masuda Hitoshi , Yonese Junji , Fukui Iwao
Published: January 2009

OBJECTIVE

To investigate the rate of objective response and the skeletal‐related event (SRE)‐free survival after combined therapy with radiotherapy (RT) and zoledronate in patients with bone metastases from renal cell carcinoma (RCC).

PATIENTS AND METHODS

In all, 23 patients with RCC metastatic to bone were included in this retrospective study, of whom 13 had RT to bone metastases with no bisphosphonate therapy between 2000 and 2006, while the remaining 10 had combined therapy with RT and zoledronate (RT + Z) in 2006 and 2007. Significant calcifications of osteolytic metastases and/or shrinkage of bone lesions, as measured by computed tomography, were defined as a partial response. SREs were defined as any of pathological fracture, spinal cord compression, bone surgery, or additional RT to the bone.

RESULTS

In the RT + Z group, six patients had a partial response, showing evidence of calcification of their osteolytic bone metastases, while in the RT group, only one patient did (P = 0.019). One patient in the RT + Z group had an SRE, while 10 in the RT group had SREs (P = 0.003). The median SRE‐free survival time was not reached in the RT + Z group, but in the RT group it was 18.7 months (P = 0.046).

CONCLUSION

Combined therapy as RT + Z achieved a higher objective response rate (six of 10) and prolonged SRE‐free survival than RT alone in patients with bone metastases from RCC.
Lymphangiogenesis occurs in upper tract urothelial carcinoma and correlates with lymphatic tumour dissemination and poor prognosis
Authors: Bolenz Christian , Fernández Mario I. , Trojan Lutz , Hoffmann Katja , Herrmann Edwin , Steidler Annette , Weiss Christel , Ströbel Philipp , Alken Peter , Michel Maurice Stephan
Published: January 2009

OBJECTIVE

To describe the lymphatic vessel density and to determine the functional and prognostic significance of tumoral lymphatic vessels in upper tract urothelial carcinoma (UTUC).

PATIENTS AND METHODS

The study included 65 patients who had a radical nephroureterectomy (RNU) for UTUC between 1997 and 2004. All pathological slides were re‐evaluated by one reference pathologist and clinical data were reviewed. Lymphatic endothelial cells (LECs) were stained immunohistochemically using D2‐40. The lymphatic vessel density (LVD) was described in representative intratumoral (ITLVD), peritumoral (PTLVD) and non‐tumoral (NTLVD) areas. Random samples were selected for double‐immunostaining with D2‐40 and CD‐34 (to distinguish blood and lymphatic vessels) and the proliferation marker Ki‐67 to detect lymphangiogenesis. The primary outcome measures were disease‐specific survival (DSS) and disease recurrence (urothelial and/or distant).

RESULTS

The median (interquartile range) PTLVD was 4.0 (3.0–6.3), and significantly higher than that for ITLVD, of 0.3 (0–1.7) (P < 0.001), and NTLVD, of 3 (2.0–3.7) (P < 0.001). Both a higher ITLVD and PTLVD, the presence of lymphovascular invasion (LVI) (each P < 0.001) and a high tumour grade (P = 0.004) were associated with reduced DSS on univariate analysis. A higher PTLVD (P = 0.028) and the presence of LVI (P = 0.020) independently predicted reduced DSS on multivariate analysis. IT and PT lymphatic vessels showed proliferating LECs in all analysed samples.

CONCLUSION

Lymphangiogenesis is present in UTUC, as shown by a significantly increased PTLVD and proliferating LECs. Our findings suggest functional relevance of PT lymphatic vessels during lymphatic tumour spread. PTLVD is a potential novel prognostic factor for DSS in UTUC, and further prospective studies will be needed to determine the effect of its routine evaluation on clinical outcomes of this malignancy.
A tertiary experience of vesico‐vaginal and urethro‐vaginal fistula repair: factors predicting success
Authors: Ockrim Jeremy L. , Greenwell Tamsin J. , Foley Charlotte L. , Wood Dan N. , Shah P. Julian R.
Published: January 2009

OBJECTIVE

To review the outcomes of all patients referred with vesico‐vaginal (V VF) and urethro‐vaginal (UVF) fistulae to a tertiary centre, and to investigate the patient, fistula and surgical factors relevant to success.

PATIENTS AND METHODS

We reviewed retrospectively the case‐notes of 41 consecutive patients (32 with V VF; nine with UVF) treated between January 2000 and January 2006.

RESULTS

All patients were tertiary referrals, eight after failed local repairs. Four patients were unsalvageable and had a supravesical diversion. In all there were 47 repairs (23 transvaginal; 24 transabdominal) on 37 patients by two specialist surgeons. The fistula was closed in 92%; five V VF and one UVF required a second procedure, and one V VF a third procedure. One patient with a V VF awaits a second attempt at repair. In one V VF (one attempt) and one UVF (three attempts) the procedure failed and the patient had a diversion. A transvaginal approach cured all 11 patients with a V VF and eight of nine with a UVF, whilst an abdominal approach used for larger/complex fistulae was successful in 18 of 24 (75%) attempts (P = 0.13). The major determinants of success were fistula size (>3 cm; P = 0.02) and the availability of tissue for interposition. V VF repairs using Martius/omental interposition were mostly successful, whilst abdominal repairs in which omentum was unavailable tended to fail (37.5% cure; P = 0.002).

CONCLUSIONS

Despite varied aetiology, V VF/UVF were repaired successfully in 92% of patients. Complex (V VF) fistulae were challenging and a quarter of these required more than one attempt. Failure of repair was more likely in larger fistulae (>3 cm) requiring an abdominal approach, if omental interposition was not possible. Good‐quality tissue interposition for complex fistula is essential for a successful outcome.
Long‐term effectiveness of diet‐plus‐exercise interventions vs. diet‐only interventions for weight loss: a meta‐analysis
Authors: Wu T. , Gao X. , Chen M. , Van Dam R. M.
Published: January 2009

Diet and exercise are two of the commonest strategies to reduce weight. Whether a diet‐plus‐exercise intervention is more effective for weight loss than a diet‐only intervention in the long‐term has not been conclusively established. The objective of this study was to systemically review the effect of diet‐plus‐exercise interventions vs. diet‐only interventions on both long‐term and short‐term weight loss. Studies were retrieved by searching MEDLINE and Cochrane Library (1966 – June 2008). Studies were included if they were randomized controlled trials comparing the effect of diet‐plus‐exercise interventions vs. diet‐only interventions on weight loss for a minimum of 6 months among obese or overweight adults. Eighteen studies met our inclusion criteria. Data were independently extracted by two investigators using a standardized protocol. We found that the overall standardized mean differences between diet‐plus‐exercise interventions and diet‐only interventions at the end of follow‐up were −0.25 (95% confidence interval [CI]−0.36 to −0.14), with a P‐value for heterogeneity of 0.4. Because there were two outcome measurements, weight (kg) and body mass index (kg m−2), we also stratified the results by weight and body mass index outcome. The pooled weight loss was 1.14 kg (95% CI 0.21 to 2.07) or 0.50 kg m−2 (95% CI 0.21 to 0.79) greater for the diet‐plus‐exercise group than the diet‐only group. We did not detect significant heterogeneity in either stratum. Even in studies lasting 2 years or longer, diet‐plus‐exercise interventions provided significantly greater weight loss than diet‐only interventions. In summary, a combined diet‐plus‐exercise programme provided greater long‐term weight loss than a diet‐only programme. However, both diet‐only and diet‐plus‐exercise programmes are associated with partial weight regain, and future studies should explore better strategies to limit weight regain and achieve greater long‐term weight loss.
Role of personal endorsement of outgroup members' distinctive values and need for cognitive closure in attitude towards the outgroup
Authors: Guan Yanjun , Bond Michael Harris , Huang Zheng , Zhang Zhiyong , Deng Hong , Hu Tian , Gao Haiyan
Published: January 2009

The present study was designed to examine the role of the perceived culture of the outgroup and the perceiver's cognitive style on the intergroup process. We conducted a survey among mainland Chinese college students to discover the role of their personal endorsement of Hong Kong Chinese's distinctive values and need for cognitive closure in predicting their attitude towards the Hong Kong Chinese outgroup. Results showed that mainland Chinese who gave a higher endorsement of Hong Kong Chinese values were more likely to show a positive attitude towards Hong Kong Chinese, especially for people with a higher need for cognitive closure. These results were discussed in terms of the function of shared social reality on the formation of positive intergroup attitude. Future directions for intergroup research were proposed based on these findings.
The Effects of Relative Income and Absolute Income on Happiness
Authors: Tao Hung‐Lin , Chiu Shih‐Yung
Published: January 2009

The authors consider the absolute income effect and several relative income effects on happiness. The latter include both a longitudinal comparison, which consists of both upward and downward comparisons, and a parallel comparison with individuals of similar traits. It is found that the longitudinal comparison and parallel comparison exist simultaneously, although the downward comparison is insignificant. However, the symmetry of the upward comparison, downward comparison, and parallel comparison cannot be rejected. Because the absolute income effect and the relative income effects countervail, the effect of income growth on subjective well‐being is likely to be negligible.
Healthcare System Types: A Conceptual Framework for Comparison
Authors: Wendt Claus , Frisina Lorraine , Rothgang Heinz
Published: January 2009

This article addresses the need to establish a comprehensive conceptual framework for analysing healthcare systems and their transformations. It begins by offering an overview of the current state of the art in the field, pointing to the literature's absence of conceptual robustness in the definition of system types. By exploring the dimensions ‘financing’, ‘provision’ and ‘regulation’ of healthcare, the article then proceeds deductively in line with the ‘Weberian method of ideal‐types’ to establish a taxonomy of 27 healthcare systems, of which three can be identified as ‘ideal‐types’. When applying this concept, not only can differences between healthcare systems be analysed, but also changes over time. The article concludes by identifying three forms of healthcare system transformation.
Closed‐chamber transepidermal water loss measurement: microclimate, calibration and performance
Authors: Imhof R. E. , De Jesus M. E. P. , Xiao P. , Ciortea L. I. , Berg E. P.
Published: January 2009

Synopsis

The importance of transepidermal water loss (TEWL) as a measure of the skin barrier is well recognized. Currently, the open‐chamber method is dominant, but it is increasingly challenged by newer closed‐chamber technologies. Whilst there is familiarity with open‐chamber characteristics, there is uncertainty about the capabilities of the challengers. The main issues are related to how microclimate affects TEWL measurements.

The aim of this paper is to provide a framework for understanding the effects of microclimate on TEWL measurement. Part of the problem is that TEWL measurement is indirect. TEWL is the diffusion of condensed water through the stratum corneum (SC), whereas TEWL methods measure water vapour flux in the air above the SC. This vapour flux depends on (i) the rate of supply of water to the skin surface and (ii) the rate of evaporation of water from the skin surface. Rate (i) is a skin property (TEWL), rate (ii) is a microclimate property. The controlling rate for the combined process is the lower of the above two rates. Therefore, TEWL instruments measure TEWL only when TEWL is the rate‐limiting process.

Another problem is that SC barrier property and SC hydration are affected by the microclimate adjacent to the skin surface. This is discussed insofar as it affects the measurement of TEWL. The conclusion is that such changes occur on a timescale that is long compared with TEWL measurement times.

An important aspect of TEWL measurement is calibration. We present an analysis of the traditional wet‐cup method and a new droplet method that is traceable and has been independently verified by a standards laboratory.

Finally, we review performance indicators of commercial closed‐chamber instruments with reference to open‐chamber instruments. The main findings are that TEWL readings correlate well, but there are significant differences in the other aspects of performance.
Long‐term changes in breeding phenology at two seabird colonies in the western North Sea
Authors: WANLESS SARAH , FREDERIKSEN MORTEN , WALTON JOHN , HARRIS MIKE P.
Published: January 2009

There is compelling evidence that the breeding phenology of many species has changed substantially in recent decades. However, taxonomic and spatial variation in the direction and rate of change is still not well understood. We explored these issues by analysing a dataset containing information on first egg dates of 10 species of seabird at two major breeding colonies (86 km apart) in the western North Sea over a period of 35 years. Within a species, timing of breeding was positively correlated between the two colonies, suggesting that factors affecting the phenology of these species operated at a regional rather than a colony scale. Comparison of time trends among the species revealed contrasting patterns, with some showing no systematic change, others becoming earlier and others later. The clearest species groupings appeared to be among the terns with arrival and/or first egg dates becoming earlier in Arctic Terns Sterna paradisaea, Common Terns Sterna hirundo and Sandwich Terns Sterna sandvicensis, and among the auks (Common Guillemot Uria aalge, Razorbill Alca torda and Atlantic Puffin Fratercula arctica) and Black‐legged Kittiwake Rissa tridactyla where the trend was in the opposite direction towards later breeding. This general trend towards later breeding in the latter group of species contrasts with correlational evidence from many other organisms indicating that breeding phenology is advancing in response to climate change.