bluuebunny/crossref_metadata_2025 huggingface dataset:
A randomised, non‐crossover study of the GuardianCPV™ Laryngeal Mask versus the LMA Supreme™ in paralysed, anaesthetised female patients
Authors: Tiefenthaler W. , Eschertzhuber S. , Brimacombe J. , Fricke E. , Keller C. , Kaufmann M.
Published: April 2013

We investigated the hypothesis that the oropharyngeal leak pressure would differ between the GuardianCPV™ and the LMA Supreme™ in anaesthetised patients. We randomly assigned 120 patients to receive either the GuardianCPV or the LMA Supreme for airway management. Oropharyngeal leak pressure was measured during cuff inflation from 0 to 40 ml in 10‐ml steps. In addition, intracuff pressure, fibreoptic position of the airway and drain tube, device insertion success, ventilation success, blood staining and airway morbidity were determined. Mean (SD) oropharyngeal leak pressures for clinically acceptable cuff volumes of 20–40 ml were 31 (7) cmH2O for the GuardianCPV and 27 (7) cmH2O for the LMA Supreme (p < 0.0001); mean (SD) intracuff pressures were 68 (33) cmH2O and 88 (43) cmH2O (p < 0.0001), respectively. We found no differences in device insertion success, ventilation success, fibreoptic position of the airway and drain tube, blood staining or airway morbidity. We conclude that the oropharyngeal leak pressure is better for the GuardianCPV than for the LMA Supreme in anaesthetised patients.
Effect of anaesthetic technique on mortality following major lower extremity amputation: a propensity score‐matched observational study
Authors: Khan S. A. , Qianyi R. L. , Liu C. , Ng E. L. , Fook‐Chong S. , Tan M. G. E.
Published: April 2013

We investigated whether the type of anaesthesia affects mortality and length of stay after non‐traumatic major lower extremity amputations. A total of 1365 eligible patients who were operated on between 2002 and 2010 were included in the final analysis. Propensity score matching was used to produce 475 matched pairs of patients undergoing operation with either general or regional anaesthesia. We found that 30‐day mortality was significantly greater in the general anaesthesia group compared with the regional anaesthesia group, with an odds ratio (95% CI) of 1.5 (1.0–2.3) in the total matched population and 4.2 (1.3–13.4) in a high‐risk subgroup. The median (IQR [range]) length of postoperative hospital stay was significantly less in the patients of the high‐risk subgroup who had general anaesthesia at 15 (7–21 [1–101]) days compared with 25 days (10–37 [0–78]) for those who had regional anaesthesia (p = 0.027). The results of our study suggest that 30‐day mortality is significantly higher in patients undergoing major lower extremity amputations under general anaesthesia compared with regional anaesthesia.
Antipode to Terror: Spaces of Performative Politics
Authors: Mustafa Daanish , Brown Katherine E. , Tillotson Matthew
Published: April 2013

Focusing on Pakistan we address the human geography of politics and violence to argue that organized political violence is not only about death and destruction but also, more importantly, about the control of the public sphere, and vitally, the reorganization of space. To make this argument we also extend Arendt's thesis on totalitarianism and the human condition. Our argument is grounded in a review of the activities of Tehrik‐e‐Taliban, Pakistan's (TTP) during their brief control of the Swat valley in Pakistan. We argue that TTP's spectacular violence eliminates “worldliness”, plurality and life, so that spontaneous action is denied and the public sphere is destroyed through the universalization of terror. The practical implication of our argument is that, in significant contrast to state and military actions to date, productive measures to resist violence should protect the performance of politics in an extended public sphere.
Prevalence of pterygium in a population in Northern Japan: the Locomotive Syndrome and Health Outcome in Aizu Cohort Study
Authors: Tano Takatoshi , Ono Koichi , Hiratsuka Yoshimune , Otani Koji , Sekiguchi Miho , Konno Shinichi , Kikuchi Shinichi , Onishi Yoshihiro , Takegami Misa , Yamada Masakazu , Fukuhara Shunichi , Murakami Akira
Published: April 2013

Purpose:  The aim of the study was to determine the prevalence and risk factors for pterygium in a population aged 40–74 years in Fukushima Prefecture, Japan.

Methods:  Of 4185 citizens of the towns of Minamiaizu‐machi and Tadami‐machi, 2312 (55.2%) gave consent to an ocular examination during a health examination. Pterygium was diagnosed when a radially oriented fibrovascular lesion growing over the limbus into the cornea was observed. Eyes with a history of pterygium excision were also diagnosed with pterygium. Prevalence and factors associated with pterygium were investigated.

Results:  Of the 2312 subjects, 101 (4.4%; 95% confidence interval, 3.6–5.3%) had pterygium in at least 1 eye. The average age (±SD) of the subjects was 64.3 ± 8.0 years. Gender, age, outdoor job history and smoking history were examined as possible associated factors, but only age was found to be significantly associated with pterygium in logistic regression analysis.

Conclusion:  The prevalence of pterygium was 4.4% in the study population. This low rate may be due to the northern latitude of these towns. Age was associated with a risk of pterygium, but gender and outdoor job history were not associated with onset of pterygium in this study.
Retinal and choroidal intravascular spectral‐domain optical coherence tomography
Authors: Willerslev Anne , Li Xiao Q. , Cordtz Peter , Munch Inger C. , Larsen Michael
Published: April 2013

Purpose:  To examine retinal and choroidal blood vessels using spectral‐domain optical coherence tomography (SD‐OCT).

Methods:  Retrospective case series.

Results:  Scans through retinal blood vessels in healthy subjects demonstrated vessel wall reflexes and a tri‐layer profile of the blood column on longitudinal scans and a figure‐of‐eight configuration on cross‐sectional scans. Intravascular reflectivity decreased with increasingly oblique angles of observation and was absent when blood flow was parallel to the line of sight. The high blood flow in the choroidal vessels in healthy subjects and the low flow in the retinal vessels in patients with ocular ischaemic syndrome and central retinal artery occlusion were both associated with lower reflectivity of the blood and an unstructured intravascular SD‐OCT profile.

Discussion:  This qualitative in vivo study found a characteristically structured SD‐OCT profile of the blood column in retinal vessels with normal blood flow. Both structure and total reflectivity faded when blood flow was lower or higher than normal or at oblique angles to the line of sight. In conclusion, SD‐OCT scans of the vessels in the posterior pole of the eye may assist the clinical assessment of gross abnormalities of ocular blood flow, e.g. in carotid artery stenosis.
Rates of visual field loss before and after trabeculectomy
Authors: Bertrand Valérie , Fieuws Steffen , Stalmans Ingeborg , Zeyen Thierry
Published: April 2013

Purpose:  To compare the rates of change in the visual field (VF) in patients with glaucoma before and after trabeculectomy.

Methods:  Of 52 eyes of 52 patients with different types of chronic glaucoma who underwent first trabeculectomy were evaluated retrospectively. Pre‐ and postoperative‐automated visual fields measured by the same technique were compared to detect differences in rates of change. Rates of VF loss before and after trabeculectomy were calculated using mean deviation (MD). Linear mixed models were used to compare the rates of change in the VF before and after trabeculectomy.

Results:  The mean follow‐up period pre‐ and post‐trabeculectomy was 3.9 years (min 0.9, max 10.7) and 3.8 years (min 2.0, max 8.0), respectively. The intraocular pressure (IOP) decreased from 18.1 mmHg (SD = 4.7) before trabeculectomy to 11.1 mmHg (SD = 2.9) at the last follow‐up after trabeculectomy. The rate of MD loss was reduced with 56% on average, from −0.36 dB/year before surgery to −0.16 dB/year after surgery (p = 0.15).

Conclusion:  Trabeculectomy considerably decreased the rates of change in the glaucomatous visual field.
The influence of background diabetic retinopathy in the second eye on rates of progression of diabetic retinopathy between 2005 and 2010
Authors: Scanlon Peter H. , Stratton Irene M. , Histed Mark , Chave Steve J. , Aldington Stephen J.
Published: April 2013

Purpose:  The Gloucestershire Diabetic Eye Screening Programme offers annual digital photographic screening for diabetic retinopathy to a countywide population of people with diabetes. This study was designed to investigate progression of diabetic retinopathy in this programme of the English NHS Diabetic Eye Screening Programme.

Methods:  Mydriatic digital retinal photographs of people with diabetes screened on at least 2 occasions between 2005 and 2010 were graded and included in this study if the classification at first screening was no DR (R0), background DR in one (R1a) or both eyes (R1b). Times to detection of referable diabetic retinopathy (RDR) comprising maculopathy (M1), preproliferative (R2) or proliferative retinopathy (R3) were analysed using survival models.

Results:  Data were available on 19 044 patients, 56% men, age at screening 66 (57–74) years (median, 25th, 75th centile). A total of 8.3% of those with R1a and 28.2% of those with R1b progressed to any RDR, hazard ratios 2.9 [2.5–3.3] and 11.3 [10.0–12.8]. Similarly 7.1% and 0.11% of those with R1a progressed to M1 and R3, hazard ratios 2.7 [2.3–3.2] and 1.6 [0.5–5.0], compared to 21.8% and 1.07% of those with R1b, hazard ratio 9.1 [7.8–10.4] and 15.0 [7.1–31.5].

Conclusions:  The risk of progression is significantly higher for those with background DR in both eyes than those with background retinopathy in only one or in neither eye.
An exploratory microdialysis study investigating the effect of repeated application of a diclofenac epolamine medicated plaster on prostaglandin concentrations in skeletal muscle after standardized physical exercise
Authors: Burian Angela , Frangione Valeria , Rovati Stefano , Mautone Giuseppe , Leuratti Chiara , Vaccani Angelo , Crevenna Richard , Keilani Mohammad , Burian Bernhard , Brunner Martin , Zeitlinger Markus
Published: April 2013

Aim

Muscle injuries and extensive exercise are associated with cyclo‐oxygenase dependent formation of inflammatory prostaglandins. Since the effect of topical administration of non‐steroidal anti‐inflammatory drugs (NSAIDs) on local cyclo‐oxygenase is unknown, the present exploratory, open label, non‐randomized study set out to measure exercise induced release of prostaglandins before and after epicutaneous administration of diclofenac.

Methods

Microdialysis was used to determine the local interstitial concentration of PGE2 and 8‐iso‐PGF2α as well as diclofenac concentrations in the vastus lateralis under rest, dynamic exercise and during recovery in 12 healthy subjects at baseline and after a treatment phase applying a total of seven plasters medicated with 180 mg of diclofenac epolamine over 4 days.

Results

At baseline PGE2 concentrations were 1169 ± 780 pg ml−1 at rest and 1287 ± 459 pg ml−1 during dynamic exercise and increased to 2005 ± 1126 pg ml−1 during recovery. After treatment average PGE2 concentrations were 997 ± 588 pg ml−1 at rest and 1339 ± 892 pg ml−1 during exercise. In contrast with the baseline phase no increase in PGE2 concentrations was recorded during the recovery period after treatment (PGE2 1134 ± 874 pg ml−1). 8‐iso‐PGF2α was neither affected by exercise nor by treatment with diclofenac. Local and systemic concentrations of diclofenac were highly variable but comparable with previous clinical pharmacokinetic studies.

Conclusions

We can hypothesize an effect of topical diclofenac epolamine plaster on limiting the increase of local concentrations of the pro‐inflammatory prostaglandin PGE2 induced in the muscle of healthy human subjects following standardized physical exercise. No effect of diclofenac treatment on 8‐iso‐PGF2α concentrations was observed, mainly since isoprostane is produced by a free radical‐catalyzed lipid peroxidation mechanism independent of cyclo‐oxygenases.
The importance of family functioning, mental health and social and emotional well‐being on child oral health
Authors: Renzaho A. M. N. , de Silva‐Sanigorski A.
Published: April 2013

Objective

To examine the strength of associations between child oral health and aspects of the home environment (child behaviour, parental psychological distress and family functioning) in a large sample of 1‐ to 12‐year‐old Australian children.

Methods

The current study used data from the 2006 Victorian Child Health and Wellbeing Study. Data were obtained on 4590 primary carers. Measures of the family environment included the level of family functioning, parental psychological distress, child's emotion and behavioural problems and the family structure.

Results

The odds of children having good oral health status were lower with increasing parental psychological distress and poor family functioning across all age groups, and lower with increasing child mental health or conduct problems among children aged 4 years or older. Socioeconomic factors were also related to child oral health status, but this was significant only among children aged 4–7 years, with the odds of children having good oral health status 68% higher in households with a yearly income ≥AUD$ 60 000 compared with households with income <$20 000 (P < 0.05).

Conclusion

In order to address inequities in the experience of poor oral health, solutions that encompass social, economic and psychosocial dimensions will be required. Integrating intervention strategies that promote oral, healthy family functioning and the mental health of parents and children into existing systems reaching vulnerable community members may improve child oral health outcomes and reduce the unequal distribution of oral disease across the social gradient.
A qualitative study exploring the psychosocial value of weekend camping experiences for children and adolescents with complex heart defects
Authors: Desai P. P. , Sutton L. J. , Staley M. D. , Hannon D. W.
Published: April 2013

Background

Children living with complex heart defects (CHD) are likely to have ongoing social, emotional, physical, and health concerns, and are in need of additional psychosocial support. Summer camps can provide therapeutic benefits. Little research exists regarding the value of shorter camping experiences from the perspectives of children with CHD. The aim of our study was to explore what children and adolescents with CHD considered meaningful when attending a therapeutic camping weekend in the company of peers with similar medical diagnoses.

Methods

Engaging a phenomenological approach we used participant generated photography and reflective semi‐structured interviews to explore participants' lived experience and value derived from their weekend camping experiences. The study was completed with thirteen participants ranging in age from 9 to 16 years. Interviews were recorded and transcribed verbatim. Data were analysed using Van Manen's guidelines.

Results

Three themes reflecting the camp experiences were generated from the data. Meaningful experiences spanned three outcomes which had some overlapping influences: (i) Developing relationships and feeling accepted by peers and counsellors at camp; (ii) Enjoying and learning during the weekend; and (iii) Experiencing the natural and human‐built therapeutic environmental features of camp. The camping programme features, inputs, and processes as identified by the participants in contributing to these outcomes are described.

Conclusion

This qualitative study showed that children living with complex CHD valued the opportunity for participating in weekend camping experiences in the company of peers with similar heart defects. Findings contribute to a better understanding of what programme features and processes were considered meaningful. Given the scarcity of resources to devote to such social support activities, the findings may help professionals to plan effective interventions to maximize benefits during a shorter camping experience.
Another Way Family Can Get in the Head and Under the Skin: The Neurobiology of Helping the Family
Authors: Fuligni Andrew J. , Telzer Eva H.
Published: April 2013

Families can be both challenging and meaningful. Advances in technology have allowed us to gain insight into the impact of family stress on biological and neurological development, but these tools also can be used to understand more deeply the social and cultural meaning of family experiences in the developing child. In this article, we describe a program of research examining the psychological, immunological, and neural correlates of children helping their families. Although difficult at times, such help can provide a sense of belonging and role fulfillment that may shape the neurobiology of the developing child.
Environmental‐Scale Map Use in Middle Childhood: Links to Spatial Skills, Strategies, and Gender
Authors: Liben Lynn S. , Myers Lauren J. , Christensen Adam E. , Bower Corinne A.
Published: April 2013

Researchers have shown that young children solve mapping tasks in small spaces, but have rarely tested children's performance in large, unfamiliar environments. In the current research, children (9–10 years; N = 40) explored an unfamiliar campus and marked flags' locations on a map. As hypothesized, better performance was predicted by higher spatial‐test scores, greater spontaneous use of map–space coordinating strategies, and participant sex (favoring boys). Data supported some but not all hypotheses about the roles of specific spatial skills for mapping performance. Data patterns were similar on a computer mapping task that displayed environmental‐scale videos of walks through a park. Patterns of children's mapping errors suggested both idiosyncratic and common mapping strategies that should be addressed in future research and educational interventions.
Developmental Changes in Executive Functioning
Authors: Lee Kerry , Bull Rebecca , Ho Ringo M. H.
Published: April 2013

Although early studies of executive functioning in children supported Miyake et al.'s (2000) three‐factor model, more recent findings supported a variety of undifferentiated or two‐factor structures. Using a cohort‐sequential design, this study examined whether there were age‐related differences in the structure of executive functioning among 6‐ to 15‐year‐olds (N = 688). Children were tested annually on tasks designed to measure updating and working memory, inhibition, and switch efficiency. There was substantial task‐based variation in developmental patterns on the various tasks. Confirmatory factor analyses and tests for longitudinal factorial invariance showed that data from the 5‐ to 13‐year‐olds conformed to a two‐factor structure. For the 15‐year‐olds, a well‐separated three‐factor structure was found.
Maintaining a Social‐Emotional Intervention and Its Benefits for Institutionalized Children
Authors: McCall Robert B. , Groark Christina J. , Fish Larry , Muhamedrahimov Rifkat J. , Palmov Oleg I. , Nikiforova Natalia V.
Published: April 2013

This article reports the maintenance of one of the largest interventions conducted in St. Petersburg (Russian Federation) orphanages for children birth to 4 years using regular caregiving staff. One orphanage received training plus structural changes, another training only, and a third business as usual. The intervention produced substantial differences between these institutions on the Home Observation for Measurement of the Environment (HOME) Inventory and on the Battelle Developmental Inventory scores for children. These institutional differences in HOME scores (N = 298) and Battelle scores for children (N = 357) departing the institutions for families in St. Petersburg and the United States were maintained for at least 6 years after the intervention project. This result may be associated with certain features of the intervention and activities conducted during the follow‐up interval.
Hyperprolactinaemia associated with increased thyroid volume and autoimmune thyroiditis in patients with prolactinoma
Authors: Sayki Arslan Muyesser , Sahin Mustafa , Topaloglu Oya , Tutal Esra , Karakose Melia , Gungunes Askin , Cakal Erman , Ozbek Mustafa , Delibasi Tuncay
Published: April 2013

Objective

The aim of this investigation was to evaluate the effects of hyperprolactinaemia on thyroid function, volume and nodularity in patients with prolactinoma.

Context

Hyperprolactinaemia has been associated with various autoimmune diseases; however, the data on the correlation between the level of prolactin (PRL) and thyroid disorders have not been adequately clarified.

Design

Case–control study.

Patients

Forty‐eight subjects with new diagnosis of hyperprolactinaemia (group 1) and 39 subjects undergoing treatment for prolactinoma (group 2) were recruited from our outpatient clinic. Fifty‐two healthy subjects were included as a control group (group 3).

Measurements

The serum PRL, thyroid‐stimulating hormone (TSH), thyroxine (free T4), thyroidal microsome (anti‐TPO) and antithyroglobulin antibodies (TgAb) levels were evaluated, and ultrasonographic thyroid volume was calculated.

Results

The frequencies of positive anti‐TPO and TgAb were significantly higher in group 1 than in groups 2 and 3 (P = 0·008). Also, the percentage of patients with thyroid heterogeneity were significantly higher in groups 1 and 2 than in group 3 (P < 0·05). The percentage of patients with thyroid nodules were higher in group 1 than in groups 2 and 3 (p1–2 = 0·03, p1–3 = 0·05 and p2–3 = 0·637). The mean thyroid volume was significantly higher in group 1 (P = 0·001), and a positive correlation was found between thyroid volume and the level of PRL (r = 0·616; P = 0·0001). Prolactin had a significant effect on the total volume according to stepwise multiple linear regression analysis (adjusted R2 is 0·268; P < 0·0001).

Conclusions

Patients with hyperprolactinaemia have significantly increased thyroid volume, thyroid autoimmunity and nodule prevalence.
Testing new susceptibility genes in the cohort of apparently sporadic phaeochromocytoma/paraganglioma patients with clinical characteristics of hereditary syndromes
Authors: Pęczkowska Mariola , Kowalska Aldona , Sygut Jacek , Waligórski Dariusz , Malinoc Angelica , Janaszek‐Sitkowska Hanna , Prejbisz Aleksander , Januszewicz Andrzej , Neumann Hartmut P. H.
Published: April 2013

Background

Phaeochromocytoma (PCC) and paraganglioma (PGL) can occur sporadically or as a part of familial cancer syndromes. Red flags of hereditary syndromes are young age and multifocal tumours. We hypothesized that such patients are candidates for further molecular diagnosis in case of normal results in ‘classical’ genes.

Material and methods

We selected patients with PCC/PGL under the age of 40 and/or with multiple tumours. First, we tested the genes RET, VHL, NF1, SDHB, SDHC and SDHD. Patients without mutations in these genes were tested for mutations in MAX, TMEM127 and SDHAF2.

Results

In 153 patients included, mutations were detected in the classical genes in 72 patients (47%) [RET‐22 (14%), VHL‐13 (9%), NF1‐3 (2%), SDHB‐13 (9%), SDHC‐3 (2%), SDHD‐16 (11%), SDHB large deletions– 2 (1%)]. One patient with MAXc.223C>T (p.R75X) mutation was detected. It was a male with bilateral, metachronous phaeochromocytomas diagnosed in 36 and 40 years of age. Remarkably, he showed in the period before the MAX gene was detected, a RET p. Y791F variant. During 10‐year follow‐up, we did not find any thyroid abnormalities. LOH examination of tumour tissue showed somatic loss of the wild‐type allele of MAX.

Conclusion

Analysis of the MAX gene should be performed in selected patients, especially those with bilateral adrenal phaeochromocytoma in whom mutations of the classical genes are absent. Our study provides with further support that Y791F RET is a polymorphism.
Modification of xenogenic bone substitute materials – effects on the early healing cascade in vitro
Authors: Kämmerer Peer W. , Schiegnitz Eik , Alshihri Abdulmonem , Draenert Florian G. , Wagner Wilfried
Published: April 2013

Introduction

Initial platelet activation with subsequent cytokine release at the defect site plays a crucial role in tissue integration. The aim of this study was to evaluate the influence of topographic and biomimetic collagen modifications of a xenogenic bone substitute material (BSM) on in vitro platelet activation and cytokine release.

Material and Methods

Three types of xenogenic BSM were used. Two BSM with different levels of granularity (large granule BSM [XBSM/L], small granule BSM [XBSM/S]) and a BSM with collagen (XBSM/C). All three samples were incubated with platelet concentrate of four healthy volunteers at room temperature for 15 min. For all groups, highly thrombogenic collagen type 1 served as a reference and an additional preparation with platelet concentrate only (without XBSM) served as control. Platelet count and cytokine release of VEGF, PDGF, TGF‐β, and IGF into the supernatant were measured.

Results

Compared with the control group, XBSM/C showed an increase in platelets consumption (mean 41,000 ± 26,000/ml vs. 471,000 ± 38,000/ml), cytokine release of VEGF (mean 46.8 ± 7.2 pg/ml vs. 18.8 ± 2.7 pg/ml), and PDGF (mean 18,350 ± 795 pg/ml vs. 2726 ± 410 pg/ml) but not IGF (194,728 ± 51,608 pg/ml vs. 1,333,911 ± 35,314 pg/ml). There was also an increase in cytokine release of TGF‐ß in XBSM/C compared with XBSM/S (77,188 ± 27,413 pg/ml vs. 38,648 ± 13,191 pg/ml), but no such difference when compared with XBSM/L (77,188 ± 27,413 pg/ml vs. 53,309 ± 29,430 pg/ml). XBSM/L showed higher platelets consumption (301,000 ± 45,000 vs. 415,000 ± 98,000) and a higher cytokine release of PDGF (3511 ± 247 pg/ml vs. 3165 ± 78 pg/ml) compared with XBSM/S. There was no distinct difference in the levels of VEGF, TGF‐ß, and IGF between XBSM/L and XBSM/S.

Conclusions

Topographic as well as biomimetic modifications of the xenogenic BSM showed an increased platelet activation and cytokine release in vitro. This effect on the intrinsic healing cascade could result in comparable enhanced soft‐ and hard‐tissue regeneration in vivo.
EXPLORING A SUBGRAPH MATCHING APPROACH FOR EXTRACTING BIOLOGICAL EVENTS FROM LITERATURE
Authors: Liu Haibin , Kešelj Vlado , Blouin Christian
Published: April 2013

An important task in biological information extraction is to identify descriptions of biological relations and events involving genes or proteins. In this work, we propose a graph‐based approach to automatically learn rules for detecting biological events in the life science literature. The event rules are learned by identifying the key contextual dependencies from full parsing of annotated text. The detection is performed by searching for isomorphism between event rules and the dependency graphs of complete sentences. When applying our approach to the data sets of the Task 1 of the BioNLP‐ST 2009, we achieved a 40.71% F‐score in detecting biological events across nine event types. Our 56.32% precision is comparable with the state‐of‐the‐art systems. The approach may also be generalized to extract events from other domains where training data are available because it requires neither manual intervention nor external domain‐specific resources. The subgraph matching algorithm we developed is released under the new BSD license and can be downloaded from http://esmalgorithm.sourceforge.net.
Covered self‐expandable metal stent deployment promises safe neoadjuvant chemoradiation therapy in patients with borderline resectable pancreatic head cancer
Authors: Kubota Kensuke , Sato Takamitsu , Watanabe Seitaro , Hosono Kunihiro , Kobayashi Noritoshi , Mori Ryutaro , Taniguchi Koichi , Matsuyama Ryusei , Endo Itaru , Nakajima Atsushi
Published: April 2013

Background

Patients with borderline resectable pancreatic head cancer (BRPHC) have been treated with neoadjuvant chemoradiation therapy (NACRT) using metallic stents. The aim of the present study was to evaluate the efficacy and complications of covered self‐expanding metallic stents (CSEMS) during the NACRT and surgical period.

Patients and Methods

We reviewed the outcomes of patients with BRPHC, then divided them chronologically into three groups as follows. Group A: upfront surgery with plastic stent (PS) deployment; group B: PS deployment plus neoadjuvant chemotherapy (NAC) and/or NACRT; group C: CSEMS deployment plus NAC/NACRT. Patients were categorized as borderline resectable based on National Comprehensive Cancer Network Guidelines, 2010. Days to reintervention (DR), reintervention rate, and the rate of R0 and complications were studied. Safe margin‐negative resection (R0) surgery was defined as R0 surgery without reintervention during the NACRT period and no postoperative complications.

Results

DR were as follows. Groups A, B and C were 32, 55 and 97 days, respectively (P < 0.05). R0 surgery obtained in groups A, B and C was 53% (9/17), 100% (17/17) and 93% (14/15), respectively. CSEMS did not interfere with surgery. Safe R0 surgery obtained in groups B and C was 11% (2/19) and 67% (10/15), respectively (P < 0.05). Multivariate analysis showed that the odds ratio for safe R0 surgery was 16.210 (95% CI 2.457–106.962, P = 0.003) for CSEMS placement.

Conclusion

CSEMS should be considered to relieve symptomatic biliary obstruction in patients with BRPHC receiving NACRT in view of the high attainability rate of safe R0 surgery compared to that with PS deployment.
Use of transnasal endoscopy for screening of esophageal squamous cell carcinoma in high‐risk patients: Yield rate, completion rate, and safety
Authors: Wang Chih‐Hsien , Lee Yi‐Chia , Wang Cheng‐Ping , Chen Chien‐Chuan , Ko Jenq‐Yuh , Han Ming‐Lun , Chen Tseng‐Cheng , Lou Pei‐Jen , Yang Tsung‐Lin , Hsiao Tzu‐Yu , Wu Ming‐Shiang , Wang Hsiu‐Po , Tseng Ping‐Huei
Published: April 2013

Background

Patients with head and neck squamous cell carcinoma are at high risk for synchronous and/or metachronous esophageal cancer. The present study aimed to evaluate the feasibility and safety of unsedated transnasal endoscopy (TNE) for screening these high‐risk patients.

Patients and Methods

Consecutive high‐risk patients including patients with suspicious or diagnosed head and neck cancer or patients with alarming symptoms received screening TNE. All endoscopic procedures, including sequential conventional white‐light, narrow‐band imaging, and Lugol chromoendoscopy, were done without sedation. All suspicious lesions in the esophagus were biopsied for histological evaluation. The completion rate, procedure time, and significant adverse events of all endoscopic procedures were recorded and analyzed.

Results

From May 2007 to August 2011, a total of 500 TNE were carried out in 441 high‐risk patients. Among them, 294 patients (66.7%) had diagnosed head and neck squamous cellcarcinoma, and most were hypopharyngeal cancer (n = 186). Esophageal squamous cell carcinomas and high‐grade intraepithelial neoplasms were detected in 10.1% and 7.3%, respectively, of the cases. Completion rate of TNE in head and neck cancer was 96.7%; tumor obstruction and stenosis of anastomosis site were the main reasons for incomplete procedures. Mean duration of the endoscopic procedure was 14.6 min. One patient had post‐endoscopic epistaxis while another patient had post‐biopsy hemoptysis, both of whom were treated conservatively. No procedure‐related mortality or significant morbidity occurred.

Conclusion

Unsedated TNE is safe and feasible for screening synchronous or metachronous esophageal neoplasms in high‐risk patients, especially those with head and neck cancer.
Polysaccharide hemostatic system for hemostasis management in colorectal endoscopic mucosal resection
Authors: Huang Rui , Pan Yanglin , Hui Na , Guo Xuegang , Zhang Linhui , Wang Xiangping , Zhang Rongchun , Luo Hui , Zhou Xiong , Tao Qin , Liu Zhiguo , Wu Kaichun
Published: April 2013

Background

A new polysaccharide hemostatic system (EndoClotTM) was recently developed for bleeding control in gastrointestinal tract endoscopy; however, its efficacy and safety is not yet well established in colorectal endoscopic mucosal resection (EMR). The aim of the present study was to observe the bleeding control effect after EMR in the colorectum.

Patients and Methods

EndoClotTM was applied immediately to mucosal defects after resection whether or not there was post‐resection bleeding. Bleeding was monitored post‐procedurally by clinical findings including positive stool occult blood test and by second‐look endoscopy. Hemostasis, rebleeding rates and treatment‐related complications were observed.

Results

In total, 82 patients were enrolled, totaling 181 lesions. Among them, 20 lesions in 18 cases showed bleeding immediately after the procedure. Among them, two lesions were treated by combined hot biopsy forceps, and complete hemostasis was achieved in all cases without surgery. It took 1.1 min (0.4–2.1) tocarry out hemostasis treatment. Rebleeding with positive stool test and colonoscopy recurred in three of 18 patients with immediate post‐procedural bleeding. In patients without immediate post‐procedural bleeding, three patients were confirmed with delayed bleeding. No major adverse events of treatment or procedure‐related serious adverse events were reported during a 30‐day follow up. Colonoscopy was done in selected patients at 30 days and full recovery of mucosal defect was achieved in all cases.

Conclusion

Polysaccharide hemostatic system effectively achieves hemostasis in controlling and preventing EMR‐related bleeding with the advantage of simple application; thus it might be a useful alternative in treating bleeding endoscopically.
Clinical feasibility of a new through‐the‐scope fully covered esophageal self‐expandable metallic stent: An in vivo animal study
Authors: Cheon Young Koog , Lee Tae Yoon , Sung In Kyung , Shim Chan Sup
Published: April 2013

Background

Most delivery devices used for esophageal stents for obstructing esophageal cancer have a diameter of 5–8 mm, a size that is too large to pass through the endoscopic working channel. The conventional esophageal stent requires multiple endoscopic procedures for implantation. The purpose of the present study was to evaluate the clinical feasibility of a newly developed fully covered, self‐expanding, through‐the‐scope (TTS) esophageal stent in a porcine model.

Methods

Eight mini pigs were used. Each animal underwent placement of a fully covered TTS stent (Hanarostent® Esophagus TTS) and the upper part of the stent was fixed by suturing with nylon. Fluoroscopy was carried out every week to assess migration of the stent. Follow‐up endoscopy was done every month for 3 months to evaluate the status of the membrane, stent mesh, grade of tissue hyperplasia, and mucosal changes at both ends of the stent.

Results

All stents were successfully and easily deployed, and were placed without any distortion in the stent or without rupture of the membrane. In two cases, stent migration was observed after 8 weeks. No case of membrane disruption, stent mesh disruption or tissue hyperplasia at either end of the stent was found at the completion of the study.

Conclusion

Our findings indicate that the new fully covered self‐expanding TTS esophageal stent is easy and simple to implant, and no significant distortion of mesh or disruption of membrane was observed.
Diffusion‐weighted imaging changes in cerebral watershed distribution following neonatal encephalopathy are not invariably associated with an adverse outcome
Authors: Harteman Johanna C , Groenendaal Floris , Toet Mona C , Benders Manon Jnl , Van Haastert Ingrid C , Nievelstein Rutger Aj , Koopman‐Esseboom Corine , de Vries Linda S
Published: April 2013

Aim

Patterns of injury in term‐born infants with neonatal encephalopathy following hypoxia–ischaemia are seen earlier and are more conspicuous on diffusion‐weighted magnetic resonance imaging (DW‐MRI) than on conventional imaging. Although the prognostic value of DW‐MRI in infants with basal ganglia and thalamic damage has been established, data in infants in whom there is extensive injury in a watershed distribution are limited. The aim of this study was to assess cognitive and functional motor outcome in a cohort of infants with changes in a predominantly watershed distribution injury on neonatal cerebral MRI, including DWI.

Method

DW‐MRI findings in infants with neonatal encephalopathy following hypoxia–ischaemia were evaluated retrospectively. Twenty‐two infants in whom DWI changes exhibited a predominantly watershed distribution were enrolled in the study (10 males, 12 females; mean birthweight 3337g, 2830–3900g; mean gestational age 40.5wks, 37.9–42.1wks). Follow‐up MRI data at the age of 3 months (n=15) and over the age of 18 months (n=7) were analysed. In survivors, neurodevelopmental outcome was assessed with the Griffiths Mental Development Scales at the age of at least 18 months. Amplitude‐integrated electroencephalography was used to score background patterns and the occurrence of epileptiform activity.

Results

DW‐MRI revealed abnormalities that were bilateral in all infants and symmetrical in 10. The posterior regions were more severely affected in five infants and the anterior regions in three. Watershed injury occurred in isolation in 10 out of 22 infants and was associated with involvement of the basal ganglia and thalami in the other 12, of whom seven died. Cystic evolution, seen on MRI at age 3 months, occurred in three of the 15 surviving infants. Neurodevelopmental assessment of the surviving infants was performed at a median age of 35 months (range 18–48mo). Of the five survivors with basal ganglia and thalamic involvement, two developed cerebral palsy, one had a developmental quotient of less than 85, and two had a normal outcome. Of the 10 infants with isolated watershed injury, nine had an early normal motor and cognitive outcome. In all infants with a favourable outcome, background recovery was seen on amplitude integrated EEG within 48 hours after birth.

Conclusion

Extensive DWI changes in a watershed distribution in term‐born neonates are not invariably associated with adverse sequelae, even in the presence of cystic evolution. Associated lesions of the basal ganglia and thalami are a better predictor of adverse sequelae than the extent and severity of the watershed abnormalities seen on DW‐MRI.
Every picture does not (always) tell a story
Authors: Stoodley Neil
Published: April 2013

This commentary is on the original article by Harteman et al. on pages 642–653 of this issue.
Left Atrial Volume as Predictor of Valve Replacement and Cardiovascular Events in Patients with Asymptomatic Mild to Moderate Aortic Stenosis
Authors: Dalsgaard Morten , Egstrup Kenneth , Wachtell Kristian , Cramariuc Dana , Kjaergaard Jesper , Gerdts Eva , Hassager Christian
Published: April 2013

Background

Left atrial (LA) size is known to increase with chronically increased left ventricular (LV) filling pressure. We hypothesized that LA volume was predictive of aortic valve replacement (AVR) and cardiovascular events in a large cohort of patients with asymptomatic mild to moderate aortic valve stenosis.

Methods

Transthoracic echocardiography was performed in 1,758 patients in the Simvastatin and Ezetemibe in Aortic Stenosis study. LA volume was measured in the apical four‐chamber view in 1,503 patients (85%). The relation of LA volume to AVR or a combined endpoint of cardiovascular events (AVR, congestive heart failure due to aortic stenosis or death from cardiovascular causes) was evaluated.

Results

AVR was performed in 415 (28%) patients, whereas 505 (34%) reached the combined endpoint. A significant but weak association of increased LA volume and risk of the combined endpoint was found (log‐rank test: P = 0.02), but this relation did not reach any significance in a multivariate model adjusting for age, gender, aortic valve area index, LV ejection fraction, LV hypertrophy, hypertension, and mitral regurgitation. LA volume was not predictive of AVR (log‐rank test: P = 0.3).

Conclusion

In asymptomatic patients with mild to moderate Aortic valve stenosis (AS), LA volume was not predictive of the combined endpoint of Aortic valve replacement, development of heart failure or cardiac death. AVA and presence of LV hypertrophy were the only predictors of events in multivariate analysis.
A Sinus Venosus Atrial Septal Defect Is Diagnosed by Echocardiography with an Unusual Bubble Study
Authors: Dorosz Jennifer L. , Fonseca Brian M. , Kay Joseph D. , Graham Brian B. , Salcedo Ernesto E. , Quaife Robert A.
Published: April 2013

Mini‐Abstract

A 68‐year‐old man underwent echocardiogram with agitated saline for a presumed diagnosis of primary pulmonary hypertension. Surprisingly, the bubbles from the agitated saline enter the left heart before filling the right side, leading to a diagnosis of Eisenmeger's syndrome from a sinus venosus atrial septal defect. Because of high right‐sided pressure, the bubbles preferentially travel from the superior vena cava through the defect to the right superior pulmonary vein and left atrium, rather than the right side. This diagnosis was later confirmed on cardiac MRI.
THE ROLE OF MONITORING OF CORRUPTION IN A SIMPLE ENDOGENOUS GROWTH MODEL
Authors: COPPIER RAFFAELLA , COSTANTINI MAURO , PIGA GUSTAVO
Published: April 2013

This article analyzes the relationship between economic growth and the monitoring of corruption. In our theoretical model, we derive a nonlinear relationship between the level of monitoring and economic growth, as well as between corruption and economic growth. At low monitoring levels, the economy experiences widespread corruption and medium growth rates, whereas no corruption occurs at intermediate monitoring levels, but low growth rates are recorded. At high monitoring levels, no corruption takes place and high growth rates are observed. The model is estimated using a dynamic panel data approach for Italy. Empirical results support the theoretical model. (JEL C33, D73, K42)
The density dilemma: limitations on juvenile production in threatened salmon populations
Authors: Walters Annika W. , Copeland Timothy , Venditti David A.
Published: April 2013

Density‐dependent processes have repeatedly been shown to have a central role in salmonid population dynamics, but are often assumed to be negligible for populations at low abundances relative to historical records. Density dependence has been observed in overall spring/summer Snake River Chinook salmonOncorhynchus tshawytschaproduction, but it is not clear how patterns observed at the aggregate level relate to individual populations within the basin. We used a Bayesian hierarchical modelling approach to explore the degree of density dependence in juvenile production for nine Idaho populations. Our results indicate that density dependence is ubiquitous, although its strength varies between populations. We also investigated the processes driving the population‐level pattern and found density‐dependent growth and mortality present for both common life‐history strategies, but no evidence of density‐dependent movement. Overwinter mortality, spatial clustering of redds and limited resource availability were identified as potentially important limiting factors contributing to density dependence. The ubiquity of density dependence for these threatened populations is alarming as stability at present low abundance levels suggests recovery may be difficult without major changes. We conclude that density dependence at the population level is common and must be considered in demographic analysis and management.
Phenotypic plasticity in habitat use and growth of the European eel (Anguilla anguilla) in transitional waters in the Mediterranean area
Authors: Capoccioni Fabrizio , Lin Dai‐Yu , Iizuka Yoshiyuki , Tzeng Wann‐Nian , Ciccotti Eleonora
Published: April 2013

Lagoons and estuaries are transitional waters (TW), saline in character but substantially influenced by freshwater (FW) flows and the most productive habitat after upwelling areas. The European eel, Anguilla anguilla, is a typical inhabitant of these habitats and a target of important lagoon fisheries since ancient times. Notwithstanding this, in the Mediterranean region, where the numerous coastal lagoons are the most eligible habitat for this species, eel habitat use and growth, which display a high inter‐individual variability, are poorly studied. To gain knowledge about the migratory behaviour and the relative growth history of this species in TW in the Mediterranean area, the otolith Sr/Ca ratios of 56 individuals were analysed. The study sampling sites were two typical coastal lagoon environments, Caprolace lagoon and Lesina lagoon, located, respectively on the Tyrrhenian and the Adriatic coast of Italy, and the Tiber River (TR) estuary, in Central Italy. Otolith Sr/Ca profiles revealed that in all the sites, the resident contingent is substantial, while the proportion of nomad eels, or habitat inter‐shifter, was different among sites. Mean annual grow rate of resident eels is higher in productive environments (TR and lagoon of Lesina), while in Caprolace lagoon, an oligotrophic lagoon, resident eels grow slower. The observed patterns of habitat use and growth seem linked to local ecological conditions: facultative movements of eels with a nomadic behaviour seem affected by food availability rather than by the salinity gradient. This consideration supports the hypothesis that the facultative catadromous migration of European eel in Mediterranean TW, and the trophic shifts that this species exhibits, depend primarily on the productivity of the environment rather than on its salinity gradient.
Pseudomonas syringae pv. aesculi: foliar infection of Aesculus species and temperature–growth relationships
Authors: Mullett M. S. , Webber J. F.
Published: April 2013

Since 2001, the incidence of bleeding canker of horse chestnut (Aesculus hippocastanum) has increased markedly in western Europe. The causal agent, the bacterium Pseudomonas syringae pv. aesculi, originally isolated from foliar lesions on Indian horse chestnut (Aesculus indica) in India, is a bark killing pathogen on A. hippocastanum. In this study, P. syringae pv. aesculi was found as a foliar epiphyte on both A. hippocastanum and A. indica trees growing in the UK. When Aesculus leaves were challenged with cell suspensions (109 CFU ml−1) of Pseudomonas syringae pv. aesculi, a high level of asymptomatic infection occurred in all the species tested. The degree of re‐isolation of the bacterium after surface sterilization of leaves ranged from 33% (A. pavia) to 84 and 97% for A. hippocastanum and A. chinensis, respectively. The studies suggest both epiphytic and intrafoliar populations of P. syringae pv. aesculi could play a role in the incidence and spread of bleeding canker of horse chestnut. Growth–temperature responses of P. syringae pv. aesculi indicated a minimum of approximately −4°C and a maximum of approximately 35°C, with an optimum of approximately 25°C. These findings show that P. syringae pv. aesculi is not restricted to bark lesions but is likely to be widespread in the environment. It is also capable of causing foliar infection of several Aesculus species and could persist under extremes of weather in the UK.