bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Basic Laparoscopic Skills Courses on Essential Knowledge of Equipment
Authors: van Hove P. Diederick , Verdaasdonk Emiel G. G. , van der Harst Erwin , Jansen Frank Willem , Dankelman Jenny , Stassen Laurents P. S.
Published: February 2012

Background. This study aims to evaluate the effect of laparoscopic skills courses on the knowledge of laparoscopic equipment. Methods. A knowledge test on laparoscopic equipment was developed, and participants of 3 separate basic laparoscopic skills courses in the Netherlands completed the test at the beginning and end of these courses. All lectures and demonstrations during the courses were recorded on video to assess the matching of its contents with the items in the test. As a reference, the test was also completed by a group of laparoscopic experts by e-mail. Results. In total, 36 participants (64.3%) completed both the pretest and posttest. Overall, the mean test score improved from 60.4% of the maximum possible score for the pretest to 68.4% for the posttest. There were no significant differences in test scores between the 3 separate courses. However, the actual content varied among the courses. The correspondence of the test items with the course content varied from 47% to 69%. Although 30% of the participants had already received training for laparoscopic equipment in their own hospital, 92.5% wanted to receive more training. 28 experts completed the test with a mean score of 75.7%, which was significantly better than the posttest score of the course participants. Conclusions. The laparoscopic skills courses evaluated in this study had a modest positive effect on the acquisition of knowledge about laparoscopic equipment. Variance exists among their contents.
The effects of transurethral resection of the prostate on morbidity and mortality in patients with nondialysis-requiring renal insufficiency
Authors: Akdemir Alp Ozgur , Oztekin Cetin Volkan , Doluoglu Omer Gokhan , Karabakan Mehmet , Ugurlu Ozgur , Cetinkaya Mesut
Published: February 2012

Objectives: To compare the prevalence of preoperative co-morbid factors and complications of transurethral resection of prostate (TUR-P) in patients with normal and non-dialysis requiring elevated serum creatinine levels.

Methods: The records of 357 consecutive patients with IPSS≥20, serum creatinine level ≤ 3 mg/dl, residual urine volume ≤ 300 ml and with no upper urinary tract dilatation or evidence of prostate cancer that underwent TUR-P were retrospectively evaluated. 60 patients who did not fulfill the inclusion criteria were excluded. The preoperative Na, K, creatinine levels and the early changes observed in these parameters after TUR-P of the patients with normal (Group1, n = 272) and elevated (Group2, n = 25) serum creatinine levels, as well as the preoperative baseline data and postoperative complications were compared.

Results: Preoperative PSA, serum urea, creatinine and K levels were significantly higher in group2. No significant differences were observed between early and late postoperative complications of the two groups. Co-morbid diseases were significantly more common in group2. No progression in renal failure or de novo need for hemodialysis was observed in group2.

Conclusions: TUR-P can be safely performed in BPH patients with mild serum creatinine elevations (1.6-3 mg/dl) and moderately increased prostate volumes without additional morbidity and mortality.
How Guilt and Pride Shape Subsequent Self-Control
Authors: Hofmann Wilhelm , Fisher Rachel R.
Published: February 2012

The present research utilized experience sampling data to investigate how guilt and pride experiences in response to self-control failure versus success affect future self-control when encountering the same type of temptation (thematic self-control). Guilt showed signs of a “mixed blessing” such that previous guilt led to an increase in subsequent self-regulatory goal importance and conflict awareness; however, accounting for these beneficial effects, guilt also had a detrimental residual effect on the successful inhibition of recurring temptation. Pride, in contrast, had uniformly positive effects on subsequent self-control in the form of increased goal importance, increased conflict, and increased likelihood to use self-control to resist temptation. These results contrasted in theoretically important ways from an analysis of short-term spillover effects of incidental guilt and pride on thematically unrelated subsequent self-control. Potential mechanisms and implications of these findings are discussed.
Suppressive Regulation of KSHV RTA with O-GlcNAcylation
Authors: Ko Ying-Chieh , Tsai Wan-Hua , Wang Pei-Wen , Wu I-Lin , Lin Shu-Yu , Chen Yu-Lian , Chen Jen-Yang , Lin Su-Fang
Published: February 2012

Background

The replication and transcription activator (RTA) of Kaposi's sarcoma-associated herpesvirus (KSHV) is a molecular switch that initiates a productive replication of latent KSHV genomes. KSHV RTA (K-RTA) is composed of 691 amino acids with high Ser and Thr content (17.7%), but to what extent these Ser and Thr are modified in vivo has not been explored.

Methods

By using tandem mass spectrometric analysis of affinity-purified FLAG tagged K-RTA, we sought to identify Ser and Thr residues that are post-translationally modified in K-RTA.

Results

We found that K-RTA is an O-GlcNAcylated protein and Thr-366/Thr-367 is the primary motif with O-GlcNAcylation in vivo. The biological significance of O-GlcNAc modified Thr-366 and Thr-367 was assessed by site-specific amino acid substitution. Replacement of Thr with Ala at amino acid 366 or 367 caused a modest enhancement of K-RTA transactivation activity in a luciferase reporter assay and a cell model for KSHV reactivation. By using co-immunoprecipitation coupled with western blot analysis, we showed that the capacity of K-RTA in associating with endogenous PARP1 was significantly reduced in the Thr-366/Thr-367 O-GlcNAc mutants. PARP1 is a documented negative regulator of K-RTA that can be ascribed by the attachment of large negatively charged polymer onto K-RTA via PARP1's poly (ADP-ribose) polymerase activity. In agreement, shRNA-mediated depletion of O-GlcNAc transferase (OGT) in KSHV infected cells augmented viral reactivation and virus production that was accompanied by diminished K-RTA and PARP1 complexes.

Conclusions

KSHV latent-lytic switch K-RTA is modified by cellular O-GlcNAcylation, which imposes a negative effect on K-RTA transactivation activity. This inhibitory effect involves OGT and PARP1, two nutritional sensors recently emerging as chromatin modifiers. Thus, we speculate that the activity of K-RTA on its target genes is continuously checked and modulated by OGT and PARP1 in response to cellular metabolic state.
Risk of new acute myocardial infarction hospitalization associated with use of oral and parenteral non-steroidal anti-inflammation drugs (NSAIDs): a case-crossover study of Taiwan's National Health Insurance claims database and review of current evidence
Authors: Shau Wen-Yi , Chen Hsi-Chieh , Chen Shu-Ting , Chou Hsu-Wen , Chang Chia-Hsuin , Kuo Chuei-Wen , Lai Mei-Shu
Published: February 2012

Background

Previous studies have documented the increased cardiovascular risk associated with the use of some nonsteroidal anti-inflammatory drugs (NSAIDs). Despite this, many old NSAIDs are still prescribed worldwide. Most of the studies to date have been focused on specific oral drugs or limited by the number of cases examined. We studied the risk of new acute myocardial infarction (AMI) hospitalization with current use of a variety of oral and parenteral NSAIDs in a nationwide population, and compared our results with existing evidence.

Methods

We conducted a case-crossover study using the Taiwan's National Health Insurance claim database, identifying patients with new AMI hospitalized in 2006. The 1-30 days and 91-120 days prior to the admission were defined as case and matched control period for each patient, respectively. Uses of NSAIDs during the respective periods were compared using conditional logistic regression and adjusted for use of co-medications.

Results

8354 new AMI hospitalization patients fulfilled the study criteria. 14 oral and 3 parenteral NSAIDs were selected based on drug utilization profile among 13.7 million NSAID users. The adjusted odds ratio, aOR (95% confidence interval), for risk of AMI and use of oral and parenteral non-selective NSAIDs were 1.42 (1.29, 1.56) and 3.35 (2.50, 4.47), respectively, and significantly greater for parenteral than oral drugs (p for interaction < 0.01). Ketorolac was associated with the highest AMI risk among both of oral and parenteral NSAIDs studied, the aORs were 2.02 (1.00, 4.09) and 4.27 (2.90, 6.29) respectively. Use of oral flurbiprofen, ibuprofen, sulindac, diclofenac, and parenteral ketoprofen were also significantly associated with increased AMI risk. The results of the present study were consistent with the majority of evidence from previous studies.

Conclusions

The collective evidence revealed the tendency of increased AMI risk with current use of some NSAIDs. A higher AMI risk associated with use of parenteral NSAIDs was observed in the present study. Ketorolac had the highest associated risk in both oral and parenteral NSAIDs studied. Though further investigation to confirm the association is warranted, prescribing physicians and the general public should be cautious about the potential risk of AMI when using NSAIDs.
Air column in esophagus and symptoms of gastroesophageal reflux disease
Authors: Moosavi Alijavad , Raji Hanieh , Teimoori Mojtaba , Ghourchian Shadi
Published: February 2012

Background

During imaging of the normal esophagus, air is often detected. The purpose of this study was to determine the correlation between the appearance of air bubbles on imaging and Gastroesophageal Reflux Disease (GERD) symptoms.

Methods

The cross-sectional imaging study was conducted at Rasole Akram Hospital, Tehran, Iran. A total of 44 patients underwent X-ray computed tomography (CT) scanning; the presence of air in the esophagus and visible on CT imaging was scrutinized.

Results

The average age of the subjects was 59 and the male to female ratio was 0.83. We found a significant relationship between the presence of GERD symptoms, the size of air bubbles and esophageal dilation (ED) on the CT scan.

Conclusions

Air bubbles in the esophagus may be seen frequently in CT scans, but their size and location can vary. The GERD symptoms can arise when a small diameter air column is present within the esophagus, especially in the middle and lower parts.
Service quality of private hospitals: The Iranian Patients' perspective
Authors: Zarei Asghar , Arab Mohammad , Froushani Abbas Rahimi , Rashidian Arash , Ghazi Tabatabaei S Mahmoud
Published: February 2012

Background

Highly competitive market in the private hospital industry has caused increasing pressure on them to provide services with higher quality. The aim of this study was to determine the different dimensions of the service quality in the private hospitals of Iran and evaluating the service quality from the patients' perspective.

Methods

A cross-sectional study was conducted between October and November 2010 in Tehran, Iran. The study sample was composed of 983 patients randomly selected from 8 private general hospitals. The study questionnaire was the SERVQUAL questionnaire, consisting of 21 items in service quality dimensions.

Results

The result of factor analysis revealed 3 factors, explaining 69% of the total variance. The total mean score of patients' expectation and perception was 4.91(SD = 0.2) and 4.02(SD = 0.6), respectively. The highest expectation and perception related to the tangibles dimension and the lowest expectation and perception related to the empathy dimension. The differences between perception and expectation were significant (p < 0.001). There was a significant difference between the expectations scores based on gender, education level, and previous hospitalization in that same hospital. Also, there was a significant difference between the perception scores based on insurance coverage, average length of stay, and patients' health conditions on discharge.

Conclusion

The results showed that SERVQUAL is a valid, reliable, and flexible instrument to monitor and measure the quality of the services in private hospitals of Iran. Our findings clarified the importance of creating a strong relationship between patients and the hospital practitioners/personnel and the need for hospital staff to be responsive, credible, and empathetic when dealing with patients.
Carbon black nanoparticle instillation induces sustained inflammation and genotoxicity in mouse lung and liver
Authors: Bourdon Julie A , Saber Anne T , Jacobsen Nicklas R , Jensen Keld A , Madsen Anne M , Lamson Jacob S , Wallin Håkan , Møller Peter , Loft Steffen , Yauk Carole L , Vogel Ulla B
Published: February 2012

Background

Widespread occupational exposure to carbon black nanoparticles (CBNPs) raises concerns over their safety. CBNPs are genotoxic in vitro but less is known about their genotoxicity in various organs in vivo.

Methods

We investigated inflammatory and acute phase responses, DNA strand breaks (SB) and oxidatively damaged DNA in C57BL/6 mice 1, 3 and 28 days after a single instillation of 0.018, 0.054 or 0.162 mg Printex 90 CBNPs, alongside sham controls. Bronchoalveolar lavage (BAL) fluid was analyzed for cellular composition. SB in BAL cells, whole lung and liver were assessed using the alkaline comet assay. Formamidopyrimidine DNA glycosylase (FPG) sensitive sites were assessed as an indicator of oxidatively damaged DNA. Pulmonary and hepatic acute phase response was evaluated by Saa3 mRNA real-time quantitative PCR.

Results

Inflammation was strongest 1 and 3 days post-exposure, and remained elevated for the two highest doses (i.e., 0.054 and 0.162 mg) 28 days post-exposure (P < 0.001). SB were detected in lung at all doses on post-exposure day 1 (P < 0.001) and remained elevated at the two highest doses until day 28 (P < 0.05). BAL cell DNA SB were elevated relative to controls at least at the highest dose on all post-exposure days (P < 0.05). The level of FPG sensitive sites in lung was increased throughout with significant increases occurring on post-exposure days 1 and 3, in comparison to controls (P < 0.001-0.05). SB in liver were detected on post-exposure days 1 (P < 0.001) and 28 (P < 0.001). Polymorphonuclear (PMN) cell counts in BAL correlated strongly with FPG sensitive sites in lung (r = 0.88, P < 0.001), whereas no such correlation was observed with SB (r = 0.52, P = 0.08). CBNP increased the expression of Saa3 mRNA in lung tissue on day 1 (all doses), 3 (all doses) and 28 (0.054 and 0.162 mg), but not in liver.

Conclusions

Deposition of CBNPs in lung induces inflammatory and genotoxic effects in mouse lung that persist considerably after the initial exposure. Our results demonstrate that CBNPs may cause genotoxicity both in the primary exposed tissue, lung and BAL cells, and in a secondary tissue, the liver.
Deregulation of apoptosis-related genes is associated with PRV1 overexpression and JAK2 V617F allele burden in Essential Thrombocythemia and Myelofibrosis
Authors: Tognon Raquel , Gasparotto Elainy PL , Neves Renata P , Nunes Natália S , Ferreira Aline F , Palma Patrícia VB , Kashima Simone , Covas Dimas T , Santana Mary , Souto Elizabeth X , Zanichelli Maria Aparecida , Simões Belinda P , de Souza Ana Maria , Castro Fabíola A
Published: February 2012

Background

Essential Thrombocythemia (ET) and Primary Myelofibrosis (PMF) are Chronic Myeloproliferative Neoplasms (MPN) characterized by clonal myeloproliferation/myeloaccumulation without cell maturation impairment. The JAK2 V617F mutation and PRV1 gene overexpression may contribute to MPN physiopathology. We hypothesized that deregulation of the apoptotic machinery may also play a role in the pathogenesis of ET and PMF. In this study we evaluated the apoptosis-related gene and protein expression of BCL2 family members in bone marrow CD34+ hematopoietic stem cells (HSC) and peripheral blood leukocytes from ET and PMF patients. We also tested whether the gene expression results were correlated with JAK2 V617F allele burden percentage, PRV1 overexpression, and clinical and laboratory parameters.

Results

By real time PCR assay, we observed that A1, MCL1, BIK and BID, as well as A1, BCLW and BAK gene expression were increased in ET and PMF CD34+ cells respectively, while pro-apoptotic BAX and anti-apoptotic BCL2 mRNA levels were found to be lower in ET and PMF CD34+ cells respectively, in relation to controls. In patients' leukocytes, we detected an upregulation of anti-apoptotic genes A1, BCL2, BCL-X

L
and BCLW. In contrast, pro-apoptotic BID and BIM

EL
expression were downregulated in ET leukocytes. Increased BCL-XL protein expression in PMF leukocytes and decreased BID protein expression in ET leukocytes were observed by Western Blot. In ET leukocytes, we found a correlation between JAK2 V617F allele burden and BAX, BIK and BAD gene expression and between A1, BAX and BIK and PRV1 gene expression. A negative correlation between PRV1 gene expression and platelet count was observed, as well as a positive correlation between PRV1 gene expression and splenomegaly.

Conclusions

Our results suggest the participation of intrinsic apoptosis pathway in the MPN physiopathology. In addition, PRV1 and JAK2 V617F allele burden were linked to deregulation of the apoptotic machinery.
What factors affect the carriage of epinephrine auto‐injectors by teenagers?
Authors: Macadam Clare , Barnett Julie , Roberts Graham , Stiefel Gary , King Rosemary , Erlewyn‐Lajeunesse Michel , Holloway Judith A , Lucas Jane S
Published: February 2012

Background

Teenagers with allergies are at particular risk of severe and fatal reactions, but epinephrine auto‐injectors are not always carried as prescribed. We investigated barriers to carriage.

Methods

Patients aged 12‐18 years old under a specialist allergy clinic, who had previously been prescribed an auto‐injector were invited to participate. Semi‐structured interviews explored the factors that positively or negatively impacted on carriage.

Results

Twenty teenagers with food or venom allergies were interviewed. Only two patients had used their auto‐injector in the community, although several had been treated for severe reactions in hospital. Most teenagers made complex risk assessments to determine whether to carry the auto‐injector. Most but not all decisions were rational and were at least partially informed by knowledge. Factors affecting carriage included location, who else would be present, the attitudes of others and physical features of the auto‐injector. Teenagers made frequent risk assessments when deciding whether to carry their auto‐injectors, and generally wanted to remain safe. Their decisions were complex, multi‐faceted and highly individualised.

Conclusions

Rather than aiming for 100% carriage of auto‐injectors, which remains an ambitious ideal, personalised education packages should aim to empower teenagers to make and act upon informed risk assessments.
Phenotypic characterization and 16S rDNA identification of culturable non-obligate halophilic bacterial communities from a hypersaline lake, La Sal del Rey, in extreme South Texas (USA)
Authors: Phillips Kristen , Zaidan Frederic , Elizondo Omar R , Lowe Kristine L
Published: February 2012

Background

La Sal del Rey ("the King's Salt") is one of several naturally-occurring salt lakes in Hidalgo County, Texas and is part of the Lower Rio Grande Valley National Wildlife Refuge. The research objective was to isolate and characterize halophilic microorganisms from La Sal del Rey. Water samples were collected from the lake and a small creek that feeds into the lake. Soil samples were collected from land adjacent to the water sample locations. Sample salinity was determined using a refractometer. Samples were diluted and cultured on a synthetic saline medium to grow halophilic bacteria. The density of halophiles was estimated by viable plate counts. A collection of isolates was selected, gram-stained, tested for catalase, and characterized using API 20E®test strips. Isolates were putatively identified by sequencing the 16S rDNA. Carbon source utilization by the microbial community from each sample site was examined using EcoPlate™ assays and the carbon utilization total activity of the community was determined.

Results

Results showed that salinity ranged from 4 parts per thousand (ppt) at the lake water source to 420 ppt in water samples taken just along the lake shore. The density of halophilic bacteria in water samples ranged from 1.2 × 102- 5.2 × 103colony forming units per ml (cfu ml-1) whereas the density in soil samples ranged from 4.0 × 105- 2.5 × 106colony forming units per gram (cfu g-1). In general, as salinity increased the density of the bacterial community decreased. Microbial communities from water and soil samples were able to utilize 12 - 31 carbon substrates. The greatest number of substrates utilized was by water-borne communities compared to soil-based communities, especially at lower salinities. The majority of bacteria isolated were gram-negative, catalase-positive, rods. Biochemical profiles constructed from API 20E®test strips showed that bacterial isolates from low-salinity water samples (4 ppt) showed the greatest phenotypic diversity with regards to the types and number of positive tests from the strip. Isolates taken from water samples at the highest salinity (420 ppt) tended to be less diverse and have only a limited number of positive tests. Sequencing of 16S DNA displayed the presence of members of bacterial generaBacillus,Halomonas,Pseudomonas,Exiguobacteriumand others. The genusBacilluswas most commonly identified. None of the isolates were members of the Archaea probably due to dilution of salts in the samples.

Conclusions

The La Sal del Rey ecosystem supports a robust and diverse bacterial community despite the high salinity of the lake and soil. However, salinity does appear to a limiting factor with regards to the density and diversity of the bacterial communities that inhabit the lake and surrounding area.
Platelet-activating factor receptor plays a role in the pathogenesis of graft-versus-host disease by regulating leukocyte recruitment, tissue injury, and lethality
Authors: Castor Marina G M , Rezende Bárbara M , Resende Carolina B , Bernardes Priscila T T , Cisalpino Daniel , Vieira Angélica T , Souza Danielle G , Silva Tarcília A , Teixeira Mauro M , Pinho Vanessa
Published: February 2012

PAF is a potent lipid mediator involved in several manifestations of acute inflammation, including leukocyte influx, leukocyte interaction with endothelium, and production of inflammatory cytokines. The present study evaluated the relevance of PAFR for the pathogenesis of acute GVHD using a model of adoptive transfer of splenocytes from WT or PAFR−/− C57BL/6J to B6D2F1 mice. Mice, which received PAFR−/− splenocytes or treatment with the PAFR antagonist, showed reduced clinical signs of disease and no mortality. In GVHD mice receiving PAFR−/− splenocytes, there was deceased bacterial translocation and tissue injury. Furthermore, production of proinflammatory cytokines and chemokines (TNF-α, IFN-γ, CCL2, CCL3, and CCL5) and accumulation of CD8+ cells in intestine and liver were reduced in mice transplanted with the PAFR−/− splenocyte. Mechanistically, an absence or pharmacological blockade of PAFR was associated with decreased rolling and adhesion of leukocytes to the mesenteric microcirculation, as assessed by intravital microscopy. Despite decreased GVHD, there was maintained GVL activity when PAFR−/− leukocytes were transferred into WT mice. In conclusion, PAFR on donor leukocytes plays a critical role in GVHD by mediating leukocyte influx and cytokine production in target tissues. PAFR antagonist may potentially be useful in the treatment of GVHD in bone marrow-transplanted patients.
The metalloproteinase inhibitor Reck is essential for zebrafish DRG development
Authors: Prendergast Andrew , Linbo Tor H. , Swarts Tanya , Ungos Josette M. , McGraw Hillary F. , Krispin Shlomo , Weinstein Brant M. , Raible David W.
Published: February 2012

The neural crest is a migratory, multipotent cell lineage that contributes to myriad tissues, including sensory neurons and glia of the dorsal root ganglia (DRG). To identify genes affecting cell fate specification in neural crest, we performed a forward genetic screen for mutations causing DRG deficiencies in zebrafish. This screen yielded a mutant lacking all DRG, which we named sensory deprived (sdp). We identified a total of four alleles of sdp, all of which possess lesions in the gene coding for reversion-inducing cysteine-rich protein containing Kazal motifs (Reck). Reck is an inhibitor of metalloproteinases previously shown to regulate cell motility. We found reck function to be both necessary for DRG formation and sufficient to rescue the sdp phenotype. reck is expressed in neural crest cells and is required in a cell-autonomous fashion for appropriate sensory neuron formation. In the absence of reck function, sensory neuron precursors fail to migrate to the position of the DRG, suggesting that this molecule is crucial for proper migration and differentiation.
Molecular mechanism underlying the regulatory specificity of aDrosophilahomeodomain protein that specifies myoblast identity
Authors: Busser Brian W. , Shokri Leila , Jaeger Savina A. , Gisselbrecht Stephen S. , Singhania Aditi , Berger Michael F. , Zhou Bo , Bulyk Martha L. , Michelson Alan M.
Published: February 2012

A subfamily of Drosophila homeodomain (HD) transcription factors (TFs) controls the identities of individual muscle founder cells (FCs). However, the molecular mechanisms by which these TFs generate unique FC genetic programs remain unknown. To investigate this problem, we first applied genome-wide mRNA expression profiling to identify genes that are activated or repressed by the muscle HD TFs Slouch (Slou) and Muscle segment homeobox (Msh). Next, we used protein-binding microarrays to define the sequences that are bound by Slou, Msh and other HD TFs that have mesodermal expression. These studies revealed that a large class of HDs, including Slou and Msh, predominantly recognize TAAT core sequences but that each HD also binds to unique sites that deviate from this canonical motif. To understand better the regulatory specificity of an individual FC identity HD, we evaluated the functions of atypical binding sites that are preferentially bound by Slou relative to other HDs within muscle enhancers that are either activated or repressed by this TF. These studies showed that Slou regulates the activities of particular myoblast enhancers through Slou-preferred sequences, whereas swapping these sequences for sites that are capable of binding to multiple HD family members does not support the normal regulatory functions of Slou. Moreover, atypical Slou-binding sites are overrepresented in putative enhancers associated with additional Slou-responsive FC genes. Collectively, these studies provide new insights into the roles of individual HD TFs in determining cellular identity, and suggest that the diversity of HD binding preferences can confer regulatory specificity.
Value of the US BI-RADS final assessment following mastectomy: BI-RADS 4 and 5 lesions
Authors: Gweon Hye Mi , Son Eun Ju , Youk Ji Hyun , Kim Jeong-Ah , Chung Jin
Published: February 2012

Background

Clinical examination is not entirely sufficient for evaluation of the postoperative site for follow-up of patients with mastectomy. A few studies have reported that postoperative follow-up US evaluation allows early detection and proper management of local tumor recurrence.

Purpose

To evaluate the diagnostic performance of the American College of Radiology (ACR) ultrasonographic (US) Breast Imaging Reporting and Data System (BI-RADS) categories 4 and 5 breast lesions at the mastectomy site.

Material and Methods

Our institutional review board approved this study and waived the need for informed consent. We retrospectively reviewed the consecutive post-mastectomy US exams for palpable and non-palpable lesions in the post-mastectomy chest wall that were categorized as BI-RADS 4 (subcategorized 4a, 4b, and 4c) or 5 between January 2007 and April 2010. The positive predictive value (PPV) for final assessment was evaluated.

Results

From 2681 post-mastectomy US examinations, we obtained a study population of 50 patients with 50 lesions (20 palpable, 30 non-palpable). There were nine (45%) malignancies among the palpable lesions and six (20%) malignancies among the non-palpable lesions. The palpability showed no significant correlation with malignancy in overall subcategorization ( P >0.05). The PPVs of categories 4 and 5 were 14.3% for category 4a, 62.5% for category 4b, 100% for category 4c, and 100% for category 5.

Conclusion

The ACR US BI-RADS categorization of 4a, 4b, 4c, and 5 for breast lesions at the mastectomy site is a feasible method for predicting local recurrence. All lesions should be managed according to US characteristics during evaluation of local recurrence at the mastectomy site, regardless of palpability.
Cannabis misinterpretation and misadventure in a coroner's court
Authors: Tormey William Patrick
Published: February 2012

A 37-year-old, one-pack-per-day tobacco smoker collapsed and died at home. At autopsy, he had an occluded left anterior descending coronary artery. Δ9-Tetrahydrocannabinol-carboxylic acid was found in his urine but no cannabinoids were detected in his blood. Misadventure was the inquest verdict on the basis of the urinary cannabis, with acute myocardial infarction as the primary cause and cannabis as the secondary cause of death. Such a conclusion is a misinterpretation of the evidence when the time duration for cannabis as a trigger for myocardial infarction is at most two hours. The absence of cannabis in the blood likely places the time since inhalation at more than two hours. The role of tobacco smoking as a trigger was ignored. Cotinine, the biochemical marker of tobacco smoke, should be added to the standard toxicological screen in the guidelines on autopsy practice of the Royal College of Pathologists.
Development of an obstetric medicine email discussion list
Authors: Carson Michael P
Published: February 2012

Background

The Clinical Forum on the North American Society of Obstetric Medicine (NASOM) website was underutilized. From 2006 to 2007 there were 16 Clinical Forum posts with 12 responses, and none were added after 2007. This report describes the development of an email discussion list using an information ‘push’ format to facilitate discussion among Obstetric Medicine physicians.

Methods

An email list of North American and International SOM members was compiled and distributed. Email list usage was tallied and a survey was sent to list members.

Results

The email discussion list had 18 discussions in the first year with 79 responses, and membership grew from 96 to 209 members from five continents. There have been 44 discussion topics over three years. Common topics related to haematology, thrombosis and cardiac issues. Ninety-one percent felt that the list improved communication among members.

Conclusion

The frequent usage, large number of responses and survey results suggest that the email list successfully improved communication among SOM members.
Phleboliths from venous malformations of the head and neck
Authors: Eivazi B , Fasunla A J , Güldner C , Masberg P , Werner J A , Teymoortash A
Published: February 2012

Objectives/Hypothesis

Phleboliths in venous malformations (VM) of the head and neck are often observed and may cause significant symptoms. Only a few articles refer to the morphology and composition of the phleboliths in VM. The objective of this study was to analyse and to demonstrate their composition and morphology.

Methods

Patients with VM presenting to a vascular anomalies centre during a three-year period were identified. The incidence of phleboliths was analysed followed by morphological and structural analysis with cone beam tomography and X-ray diffraction.

Results

Phleboliths were identified in 28/98 patients with VM of the head and neck. Seven patients underwent conventional surgery to reduce the volume of the VM or to remove the phleboliths, which were localized in the cheek (3 cases), submandibular region (2 cases), infrahyoidal neck or upper eyelid (1 case each). The structural analysis showed that more advanced lamination and an increasing radiopacity of the cortex was observed in larger phleboliths. X-ray powder diffraction analysis revealed that the main constituent in the pulverized phleboliths was carbonate-fluorohydroxylapatite.

Conclusion

This study shows in a vivid way that phleboliths from VM of the head and neck area show a laminar structure and consist of apatite, without any indication of differences in their chemical composition. Treatment of localized intravascular coagulopathy in VM might be able to prevent the formation and the progression of phleboliths. Hypothetically, another option might be lithotripsy.
Right axillosubclavian vein thrombosis resolved by percutaneous rheolytic thrombectomy in a patient with a recurrent gastrointestinal stromal tumour undergoing imatinib mesylate treatment
Authors: Chiang M-H , Su C-S , Lai H-C , Lee W-L , Ting C-T , Chan S-W , Liu T-J
Published: February 2012

The manifestation and management of spontaneous axillosubclavian vein thrombosis in patients with gastrointestinal stromal tumour (GIST) undergoing oral chemotherapy have never been described. We report a patient with a recurrent GIST who was receiving maintenance imatinib yet developed a right axillosubclavian vein thrombotic occlusion. The occluded vein was unresponsive to systemic anticoagulation but was reopened by percutaneous rheolytic thrombectomy and has shown good long-term patency. Thus, for patients with recurrent GIST undergoing imatinib therapy, axillosubclavian vein thrombosis might manifest as a complication and could be managed with rheolytic thrombectomy, which thoroughly removes intravascular thrombus and effectively revascularizes the thrombosed vessel uneventfully.
The primordial follicle reserve is not renewed after chemical or γ-irradiation mediated depletion
Authors: Kerr J B , Brogan L , Myers M , Hutt K J , Mladenovska T , Ricardo S , Hamza K , Scott C L , Strasser A , Findlay J K
Published: February 2012

Reports indicate that germ-line stem cells present in adult mice can rapidly generate new oocytes and contribute to the primordial follicle reserve following conditions of ovotoxic stress. We further investigated the hypothesis that adult mice have the capacity to generate new oocytes by monitoring primordial follicle numbers throughout postnatal life and following depletion of the primordial follicle reserve by exposure to doxorubicin (DXR), trichostatin A (TSA), or whole-body γ-irradiation. We show that primordial follicle number remains stable in adult C57BL/6 mice between the ages of 25 and 100 days. However, within 2 days of treatment with DXR or TSA, primordial follicle numbers had declined to 65 and 51% respectively (P<0.05–0.01 when compared to untreated controls), with no restoration of follicle numbers evident after 7 days for either treatment. Furthermore, ovaries from mice subjected to sterilizing doses of γ-irradiation (0.45 or 4.5 Gy) revealed complete ablation of all primordial follicles 5 days after treatment, with no indication of follicular renewal. We conclude that neo-folliculogenesis does not occur following chemical or γ-irradiation mediated depletion of the primordial follicle reserve.
Future Directions in the Evaluation and Management of Neonatal Sepsis
Authors: Bhatti Micah , Chu Alison , Hageman Joseph R. , Schreiber Michael , Alexander Kenneth
Published: February 2012

Although sepsis is one of the important etiologies of illness in hospitalized infants, it is often difficult to determine if an infant is truly infected and, moreover, how to treat these infections. To address the first issue, researchers have begun to examine techniques to shorten the amount of time it takes to culture and identify organisms. On the clinical side, the development of biomarkers may help physicians to better identify infants who are likely ill from infection versus those infants who are unstable from other processes. The ability to distinguish between these cohorts will help to curtail excessive use of empirical antibiotics. Even if infants are determined to truly have infection on the basis of a positive culture, it is becoming more challenging to appropriately treat causative organisms, as multidrug resistance becomes more prevalent. Furthermore, it becomes more important to evaluate strategies to prevent these infections before they occur.
Antibiotic Therapy and Early Onset Sepsis
Authors: Falciglia Gustave , Hageman Joseph R. , Schreiber Michael , Alexander Kenneth
Published: February 2012

Early onset sepsis in the newborn infant continues to be an important clinical problem for neonatologists everywhere in the world. Different routes of transmission, changes in causative agents, and potential antibiotic resistance all influence the choice of antibiotic therapy. Group B Streptococcus and Escherichia coli continue to be the major pathogens dictating antibiotic therapy in the United States. Ampicillin and gentamicin are the antibiotics used by most for empirical therapy; cephalosporins are used in certain clinical situations. In this review, we address the reasons for these choices while highlighting clinically relevant aspects of the antibiotics commonly used in the treatment of early onset sepsis in the newborn.
Community-level renewable energy planning in sensitive areas
Authors: Clark Andrew J. , Roddy Dermot J.
Published: February 2012

This paper looks at medium-scale renewable energy systems suitable for community-level developments, exploring the impact of the planning system on the scope for deployment and identifying ways of keeping schemes within limits that are likely to be acceptable. It pays particular attention to environmentally sensitive locations such as areas of outstanding natural beauty. The findings, which are generally applicable in a UK environment, are exemplified and demonstrated by means of a case study based on an area of outstanding natural beauty in north east England in which there is local community interest in sustainability matters generally. Systems considered include air source heat pumps, biomass heating, wind energy, solar photovoltaic and anaerobic digestion.
Subcooled flow boiling heat transfer of ethanol aqueous solutions in vertical annulus space
Authors: Sarafraz M.M. , Peyghambarzadeh S.M. , Vaeli N.
Published: February 2012

The subcooled flow boiling heat-transfer characteristics of water and ethanol
solutions in a vertical annulus have been investigated up to heat flux
132kW/m2. The variations in the effects of heat flux and fluid velocity, and
concentration of ethanol on the observed heat-transfer coefficients over a
range of ethanol concentrations implied an enhanced contribution of nucleate
boiling heat transfer in flow boiling, where both forced convection and
nucleate boiling heat transfer occurred. Increasing the ethanol concentration
led to a significant deterioration in the observed heat-transfer coefficient
because of a mixture effect, that resulted in a local rise in the saturation
temperature of ethanol/water solution at the vapor-liquid interface. The
reduction in the heat-transfer coefficient with increasing ethanol
concentration is also attributed to changes in the fluid properties (for
example, viscosity and heat capacity) of tested solutions with different
ethanol content. The experimental data were compared with some
well-established existing correlations. Results of comparisons indicate
existing correlations are unable to obtain the acceptable values. Therefore a
modified correlation based on Gnielinski correlation has been proposed that
predicts the heat transfer coefficient for ethanol/water solution with
uncertainty about 8% that is the least in comparison to other well-known
existing correlations.
Optimization of gradual hemolysis for isolation of hemoglobin from bovine erythrocytes
Authors: Pravilovic Radoslava , Mojsilovic Slavko , Kostic Ivana , Ilic Vesna , Bugarski Diana , Djordjevic Verica , Bugarski Branko
Published: February 2012

In this work, we describe an optimized procedure based on gradual hemolysis
for the isolation of hemoglobin derived from bovine slaughterhouse
erythrocytes in a membrane bioreactor. The membrane bioreactor system
provided high yields of hemoglobin (mainly oxyhemoglobin derivate) and its
separation from the empty erythrocyte membranes (ghosts). Ten different
concentrations of hypotonic media were assessed from the aspect of the extent
of hemolysis, hematocrit values of the erythrocyte suspensions, cell swelling
and membrane deformations induced by decreased salt concentration. Effective
gradual osmotic hemolysis with an extent of hemolysis of 83% was performed
using 35 mM Na-phosphate/NaCl buffer of pH 7.2-7.4. Under these conditions
most of the cell membranes presented the appearance of the normal ghosts
under phase contrast microscope. The results show that isolation process
yielded predominantly to oxyhemoglobin. Kinetic studies showed that maximal
concentration of hemoglobin was reached after 40 min, but the process cycle
at which recovery of 83% was achieved lasted for 90 min.
Investigation of cement based composites made with recycled rubber aggregate
Authors: Jevtic Dragica , Zakic Dimitrije , Savic Aleksandar
Published: February 2012

The results of experimental investigations performed on cement based
composites made with addition of recycled rubber as a partial replacement of
natural river aggregate are presented in this paper. Different properties of
cement based mortar were analyzed, both in fresh and in hardened state.
Tested properties in the fresh state included: density, consistency and
volume of entrained air. In the hardened state, the following properties
were tested: density, mechanical properties (compressive and flexural
strength), modulus of elasticity, adhesion to concrete substrate, water
absorption, freeze-thaw resistance and ultrasonic pulse velocity. The
obtained results indicate that recycled rubber can be successfully applied
as a partial replacement of natural river aggregate in cement based
composites, in accordance with the sustainable development concept. The
investigation showed that physical-mechanical properties of cementituous
composites depend to a great extent on the percentage of replacement of
natural river aggregate with recycled rubber, especially when the density,
strength, adhesion and freeze-thaw resistance are concerned. The best
results were obtained in the freeze-thaw resistance of such composites.
Audit Committee Compensation, Fairness, and the Resolution of Accounting Disagreements
Authors: Bierstaker James L. , Cohen Jeffrey R. , DeZoort F. Todd , Hermanson Dana R.
Published: February 2012

An emerging body of research examines the relation of incentive-based audit committee compensation with accounting outcomes (e.g., Archambeault et al. 2008; Magilke et al. 2009). We extend this literature by examining the effects of audit committee compensation and perceived fairness to shareholders on actual public company audit committee members' judgments in accounting disagreements. Fifty-six highly experienced public company audit committee members participated in an experiment involving an accounting disagreement between management and the external auditor, with three types of audit committee compensation (i.e., cash only, cash and short-term stock options, or cash and long-term stock options) manipulated between subjects. We further measured the participants' perceptions of the fairness to shareholders if the auditor's adjustment is not recorded. We find evidence that audit committee members are more likely to support the auditor in an accounting disagreement when audit committee compensation includes long-term stock options and when members perceive that the failure to record the auditor's adjustment is less fair to shareholders. Moreover, we find that the relation between long-term incentive compensation and support for the auditor is fully mediated by a sense of fairness to shareholders. We offer implications and suggestions for future research.
The Joint Influence of the Extent and Nature of Audit Evidence, Materiality Thresholds, and Misstatement Type on Achieved Audit Risk
Authors: Budescu David V. , Peecher Mark E. , Solomon Ira
Published: February 2012

We use simulation to investigate the joint effects of materiality, evidence extent, evidence nature, and misstatement type on achieved audit risk, i.e., the risk of undetected material financial statement misstatement due to error or fraud. Our primary results are fourfold. First, contrary to conventional audit wisdom, we show that elevating the extent of testing decreases achieved audit risk only under certain conditions and may well increase it. Second, reducing materiality (attempting to perform a more precise audit) can either enhance or jeopardize audit effectiveness. Third, learning about the quality of the internal controls over financial reporting not only can help the auditor to perform an integrated audit, but also helps the auditor to reach better judgments about the extent to which and how evidence from the auditee organization's management and/or information systems may be distorted as a result of misstatement, reducing the risk that the auditor would be misled by such evidence. Fourth, when financial statements are biased intentionally due to fraud, it is especially important for the external auditor to supplement more traditional audit tests with tests that produce evidence that is less likely to be biased by management. Auditors who do not understand these four results run a heightened risk of compromising audit effectiveness.
Impression Management in Sustainability Reports: An Empirical Investigation of the Use of Graphs
Authors: Cho Charles H. , Michelon Giovanna , Patten Dennis M.
Published: February 2012

The purpose of this paper is to investigate whether firms use graphs in their sustainability reports in order to present a more favorable view of their social and environmental performance. Further, because prior research indicates that companies use social and environmental disclosure as a tool to reduce their exposure to social and political pressures (the legitimacy argument), we also examine whether differences in the extent of impression management are associated with differences in social and environmental performance. Based on an analysis of graphs in sustainability reports for a sample of 77 U.S. companies for 2006, we find considerable evidence of favorable selectivity bias in the choice of items graphed, and moderate evidence that where distortion in graphing occurs, it also has a favorable bias. Our results regarding the relation between impression management and performance are mixed. Whereas we find that graphs of social items in sustainability reports for companies with worse social performance exhibit more impression management, no significant relation between environmental performance and impression management in the use of environmental graphs is found. Overall, our results provide additional evidence that corporate sustainability reporting, as it currently exists, appears to be more about fostering positive public relations than providing a meaningful accounting of the social and environmental impacts of the firm.