bluuebunny/crossref_metadata_2025 huggingface dataset:
Tissue cohesion and the mechanics of cell rearrangement
Authors: David Robert , Luu Olivia , Damm Erich W. , Wen Jason W. H. , Nagel Martina , Winklbauer Rudolf
Published: September 2014

Morphogenetic processes often involve the rapid rearrangement of cells held together by mutual adhesion. The dynamic nature of this adhesion endows tissues with liquid-like properties, such that large-scale shape changes appear as tissue flows. Generally, the resistance to flow (tissue viscosity) is expected to depend on the cohesion of a tissue (how strongly its cells adhere to each other), but the exact relationship between these parameters is not known. Here, we analyse the link between cohesion and viscosity to uncover basic mechanical principles of cell rearrangement. We show that for vertebrate and invertebrate tissues, viscosity varies in proportion to cohesion over a 200-fold range of values. We demonstrate that this proportionality is predicted by a cell-based model of tissue viscosity. To do so, we analyse cell adhesion in Xenopus embryonic tissues and determine a number of parameters, including tissue surface tension (as a measure of cohesion), cell contact fluctuation and cortical tension. In the tissues studied, the ratio of surface tension to viscosity, which has the dimension of a velocity, is 1.8 µm/min. This characteristic velocity reflects the rate of cell-cell boundary contraction during rearrangement, and sets a limit to rearrangement rates. Moreover, we propose that, in these tissues, cell movement is maximally efficient. Our approach to cell rearrangement mechanics links adhesion to the resistance of a tissue to plastic deformation, identifies the characteristic velocity of the process, and provides a basis for the comparison of tissues with mechanical properties that may vary by orders of magnitude.
Adult neurogenesis: taking stock in Stockholm
Authors: Govindarajan Nambirajan , Kempermann Gerd
Published: September 2014

In May this year, Stockholm hosted a Keystone Symposium on Adult Neurogenesis, attracting scientists from around the world despite the lack of customary snow. The symposium offered an extraordinary program, covering diverse topics that ranged from the neural stem cell lineage and regulation of neurogenesis to functional aspects of neurogenesis in homeostasis and disease, and even computational modeling. This Meeting Review describes some of the exciting presentations and emerging themes from the symposium, which reveal how much this young field has matured.
Development of aDrosophila melanogasterspliceosensor system forin vivohigh-throughput screening in myotonic dystrophy type 1
Authors: García-Alcover Irma , Colonques-Bellmunt Jordi , Garijo Raquel , Tormo José R. , Artero Rubén , Álvarez-Abril Mari Carmen , López Castel Arturo , Pérez-Alonso Manuel
Published: September 2014

Alternative splicing of pre-mRNAs is an important mechanism that regulates cellular function in higher eukaryotes. A growing number of human genetic diseases involve splicing defects that are directly connected to their pathology. In myotonic dystrophy type 1 (DM1), several clinical manifestations have been proposed to be the consequence of tissue-specific missplicing of numerous genes. These events are triggered by an RNA gain-of-function and resultant deregulation of specific RNA-binding factors, such as the nuclear sequestration of muscleblind-like family factors (MBNL1-MBNL3). Thus, the identification of chemical modulators of splicing events could lead to the development of the first valid therapy for DM1 patients. To this end, we have generated and validated transgenic flies that contain a luciferase-reporter-based system that is coupled to the expression of MBNL1-reliant splicing (spliceosensor flies), to assess events that are deregulated in DM1 patients in a relevant disease tissue. We then developed an innovative 96-well plate screening platform to carry out in vivo high-throughput pharmacological screening (HTS) with the spliceosensor model. After a large-scale evaluation (>16,000 chemical entities), several reliable splicing modulators (hits) were identified. Hit validation steps recognized separate DM1-linked therapeutic traits for some of the hits, which corroborated the feasibility of the approach described herein to reveal promising drug candidates to correct missplicing in DM1. This powerful Drosophila-based screening tool might also be applied in other disease models displaying abnormal alternative splicing, thus offering myriad uses in drug discovery.
A systematic review of ultrasound-guided FNA of lesions in the head and neck—focusing on operator, sample inadequacy and presence of on-spot cytology service
Authors: Ganguly A , Burnside G , Nixon P
Published: September 2014

The objective of this review is to perform a systematic review of ultrasound-guided fine-needle aspiration (FNA) services for head and neck lesions with assessment of inadequacy rates and related variables such as the presence of immediate cytological assessment. A computer-based systematic search of articles in English language was performed using MEDLINE (1950 to date) from National Health Service evidence healthcare database and PubMed. Full texts of all relevant articles were obtained and scrutinized independently by two authors according to the stated inclusion and exclusion criteria. The primary search identified 932 articles, but only 78 met all the study criteria. The overall inadequacy rate was 9.3%, 16 studies had on-site evaluation by a cytopathologist/specialist clinician with a rate of 6.0%. In seven studies, a cytotechnician was available to either assess the sample or prepare the slides with an average inadequacy rate of 11.4%. In 1 study, the assessment was unclear, but the inadequacy rate for the remaining 54 studies, without immediate assessment, was 10.3%. The rate for the cytopathologist/specialist clinicians was significantly different to no on-site assessment but this was not found for assessment by cytotechnicians. The review suggests that the best results are obtained with a cytopathologist-led FNA service, where the pathologist reviews the specimen immediately, in relation to the clinical context, thereby deciding on adequacy and need for further biopsies. A systematic review looking at ultrasound-guided FNA of head and neck lesions has not been published previously.
A kinetic and thermodynamic framework for the Azoarcus group I ribozyme reaction
Authors: Gleitsman Kristin R. , Herschlag Daniel H.
Published: September 2014

Determination of quantitative thermodynamic and kinetic frameworks for ribozymes derived from the Azoarcus group I intron and comparisons to their well-studied analogs from the Tetrahymena group I intron reveal similarities and differences between these RNAs. The guanosine (G) substrate binds to the Azoarcus and Tetrahymena ribozymes with similar equilibrium binding constants and similar very slow association rate constants. These and additional literature observations support a model in which the free ribozyme is not conformationally competent to bind G and in which the probability of assuming the binding-competent state is determined by tertiary interactions of peripheral elements. As proposed previously, the slow binding of guanosine may play a role in the specificity of group I intron self-splicing, and slow binding may be used analogously in other biological processes. The internal equilibrium between ribozyme-bound substrates and products is similar for these ribozymes, but the Azoarcus ribozyme does not display the coupling in the binding of substrates that is observed with the Tetrahymena ribozyme, suggesting that local preorganization of the active site and rearrangements within the active site upon substrate binding are different for these ribozymes. Our results also confirm the much greater tertiary binding energy of the 5′-splice site analog with the Azoarcus ribozyme, binding energy that presumably compensates for the fewer base-pairing interactions to allow the 5′-exon intermediate in self splicing to remain bound subsequent to 5′-exon cleavage and prior to exon ligation. Most generally, these frameworks provide a foundation for design and interpretation of experiments investigating fundamental properties of these and other structured RNAs.
Power analysis and sample size estimation for RNA-Seq differential expression
Authors: Ching Travers , Huang Sijia , Garmire Lana X.
Published: September 2014

It is crucial for researchers to optimize RNA-seq experimental designs for differential expression detection. Currently, the field lacks general methods to estimate power and sample size for RNA-Seq in complex experimental designs, under the assumption of the negative binomial distribution. We simulate RNA-Seq count data based on parameters estimated from six widely different public data sets (including cell line comparison, tissue comparison, and cancer data sets) and calculate the statistical power in paired and unpaired sample experiments. We comprehensively compare five differential expression analysis packages (DESeq, edgeR, DESeq2, sSeq, and EBSeq) and evaluate their performance by power, receiver operator characteristic (ROC) curves, and other metrics including areas under the curve (AUC), Matthews correlation coefficient (MCC), and F-measures. DESeq2 and edgeR tend to give the best performance in general. Increasing sample size or sequencing depth increases power; however, increasing sample size is more potent than sequencing depth to increase power, especially when the sequencing depth reaches 20 million reads. Long intergenic noncoding RNAs (lincRNA) yields lower power relative to the protein coding mRNAs, given their lower expression level in the same RNA-Seq experiment. On the other hand, paired-sample RNA-Seq significantly enhances the statistical power, confirming the importance of considering the multifactor experimental design. Finally, a local optimal power is achievable for a given budget constraint, and the dominant contributing factor is sample size rather than the sequencing depth. In conclusion, we provide a power analysis tool (http://www2.hawaii.edu/~lgarmire/RNASeqPowerCalculator.htm) that captures the dispersion in the data and can serve as a practical reference under the budget constraint of RNA-Seq experiments.
Deletion of L4 domains reveals insights into the importance of ribosomal protein extensions in eukaryotic ribosome assembly
Authors: Gamalinda Michael , Woolford John L.
Published: September 2014

Numerous ribosomal proteins have a striking bipartite architecture: a globular body positioned on the ribosomal exterior and an internal loop buried deep into the rRNA core. In eukaryotes, a significant number of conserved r-proteins have evolved extra amino- or carboxy-terminal tail sequences, which thread across the solvent-exposed surface. The biological importance of these extended domains remains to be established. In this study, we have investigated the universally conserved internal loop and the eukaryote-specific extensions of yeast L4. We show that in contrast to findings with bacterial L4, deleting the internal loop of yeast L4 causes severely impaired growth and reduced levels of large ribosomal subunits. We further report that while depleting the entire L4 protein blocks early assembly steps in yeast, deletion of only its extended internal loop affects later steps in assembly, revealing a second role for L4 during ribosome biogenesis. Surprisingly, deletion of the entire eukaryote-specific carboxy-terminal tail of L4 has no effect on viability, production of 60S subunits, or translation. These unexpected observations provide impetus to further investigate the functions of ribosomal protein extensions, especially eukaryote-specific examples, in ribosome assembly and function.
Structure and mechanism of E. coli RNA 2′,3′-cyclic phosphodiesterase
Authors: Remus Barbara S. , Jacewicz Agata , Shuman Stewart
Published: September 2014

2H (two-histidine) phosphoesterase enzymes are distributed widely in all domains of life and are implicated in diverse RNA and nucleotide transactions, including the transesterification and hydrolysis of cyclic phosphates. Here we report a biochemical and structural characterization of the Escherichia coli 2H protein YadP, which was identified originally as a reversible transesterifying “nuclease/ligase” at RNA 2′,5′-phosphodiesters. We find that YadP is an “end healing” cyclic phosphodiesterase (CPDase) enzyme that hydrolyzes an HORNA>p substrate with a 2′,3′-cyclic phosphodiester to a HORNAp product with a 2′-phosphomonoester terminus, without concomitant end joining. Thus we rename this enzyme ThpR (two-histidine 2′,3′-cyclic phosphodiesterase acting on RNA). The 2.0 Å crystal structure of ThpR in a product complex with 2′-AMP highlights the roles of extended histidine-containing motifs 43HxTxxF48 and 125HxTxxR130 in the CPDase reaction. His43-Nε makes a hydrogen bond with the ribose O3′ leaving group, thereby implicating His43 as a general acid catalyst. His125-Nε coordinates the O1P oxygen of the AMP 2′-phosphate (inferred from geometry to derive from the attacking water nucleophile), pointing to His125 as a general base catalyst. Arg130 makes bidentate contact with the AMP 2′-phosphate, suggesting a role in transition-state stabilization. Consistent with these inferences, changing His43, His125, or Arg130 to alanine effaced the CPDase activity of ThpR. Phe48 makes a π–π stack on the adenine nucleobase. Mutating Phe28 to alanine slowed the CPDase by an order of magnitude. The tertiary structure and extended active site motifs of ThpR are conserved in a subfamily of bacterial and archaeal 2H enzymes.
Preoperative low-dose ketamine has no preemptive analgesic effect in opioid-naïve patients undergoing colon surgery when nitrous oxide is used - a randomized study
Authors: Nistal-Nuño Beatriz , Freire-Vila Enrique , Castro-Seoane Francisco , Camba-Rodriguez Manuel
Published: September 2014

Background: The analgesic properties of ketamine are associated with its non-competitive antagonism of the N-methyl-D-aspartate receptor; these receptors exhibit an excitatory function on pain transmission and this binding seems to inhibit or reverse the central sensitization of pain. In the literature, the value of this anesthetic for preemptive analgesia in the control of postoperative pain is uncertain. The objective of this study was to ascertain whether preoperative low-dose ketamine reduces postoperative pain and morphine consumption in adults undergoing colon surgery.

Methods: In a double-blind, randomized trial, 48 patients were studied. Patients in the ketamine group received 0.5 mg/kg intravenous ketamine before surgical incision, while the control group received normal saline. The postoperative analgesia was achieved with a continuous infusion of morphine at 0.015 mg∙kgˉ¹∙hˉ¹ with the possibility of 0.02 mg/kg bolus every 10 min. Pain was assessed using the Visual Analog Scale (VAS), morphine consumption, and hemodynamic parameters at 0, 1, 2, 4, 8, 12, 16, and 24 hours postoperatively. We quantified times to rescue analgesic (Paracetamol), adverse effects and patient satisfaction.

Results: No significant differences were observed in VAS scores between groups (P>0.05), except at 4 hours postoperatively (P=0.040). There were no differences in cumulative consumption of morphine at any time point (P>0.05). We found no significant differences in incremental postoperative doses of morphine consumption in bolus, except at 12 h (P =0.013) and 24 h (P =0.002). The time to first required rescue analgesia was 70 ± 15.491 min in the ketamine group and 44 ± 19.494 min in the control (P>0.05). There were no differences in hemodynamic parameters or patient satisfaction (P>0.05).

Conclusions: Preoperative low-dose-ketamine did not show a preemptive analgesic effect or efficacy as an adjuvant for decreasing opioid requirements for postoperative pain in patients receiving intravenous analgesia with morphine after colon surgery.
Interdiction Games on Markovian PERT Networks
Authors: Gutin Eli , Kuhn Daniel , Wiesemann Wolfram
Published: September 2014

In a stochastic interdiction game a proliferator aims to minimize the expected duration of a nuclear weapons development project, and an interdictor endeavors to maximize the project duration by delaying some of the project tasks. We formulate static and dynamic versions of the interdictor’s decision problem where the interdiction plan is either precommitted or adapts to new information revealed over time, respectively. The static model gives rise to a stochastic program, whereas the dynamic model is formalized as a multiple optimal stopping problem in continuous time and with decision-dependent information. Under a memoryless probabilistic model for the task durations, we prove that the static model reduces to a mixed-integer linear program, whereas the dynamic model reduces to a finite Markov decision process in discrete time that can be solved via efficient value iteration. We then generalize the dynamic model to account for uncertainty in the outcomes of the interdiction actions. We also discuss a crashing game where the proliferator can use limited resources to expedite tasks so as to counterbalance the interdictor’s efforts. The resulting problem can be formulated as a robust Markov decision process.

This paper was accepted by Dimitris Bertsimas, optimization.
Have your say
Authors: Slaughter Sarah , Matthews Jenny
Published: September 2014

Standards must be maintained

Positive press for assistant practitioners
National Service Frameworks
Authors: Dunbar Amanda , Stewart Heather
Published: September 2014

In your day-to-day work you may have become aware of the existence of National Service Frameworks (NSFs). The purpose of this article is to explain what these are, why they have been developed and the implications to you in your practice.
Care for people with multiple sclerosis: guidance from the National Institute for Clinical Excellence
Authors: Porter Bernie
Published: September 2014

The National Institute for Clinical Excellence (NICE) produces guidelines for the management of a wide range of conditions. For many nurses involved in day-to-day care of patients it may seem that such guidelines appear from nowhere. It may also seem that they do not reflect what is considered best practice. With an increasing emphasis on evidence-based care, nurses need to be aware of the process followed in the production of such guidelines. It is hoped that by sharing this information the process will be demystified, that nurses will gain a better understanding of the methods used and that they will feel encouraged to join guideline development committees to influence care in their specialist arena.
Nutritional care of patients with motor neurone disease
Authors: Rio Alan , Ampong Mary Ann , Johnson Julia , Willey Emma , Leigh P Nigel
Published: September 2014

Nutritional research in patients with motor neurone disease has gathered pace from observations of inadequate dietary intakes and malnutrition to sophisticated techniques measuring daily energy expenditure. However, there is much to learn, particularly in defining the optimum time for gastrostomy and reducing early post-procedural mortality. The new percutaneous radiological gastrostomy technique appears to be as safe as percutaneous endoscopic gastrostomy but problems associated with tube failure prevent this method replacing the endoscopic option entirely. Nutritional management provided by multidisciplinary teams allows clinicians to work in partnership to provide patient-centred and coordinated care.
Legal and ethical dilemmas of disclosing genetic test results
Authors: Lynch Jane
Published: September 2014

Patients have a right to expect that information discovered in the course of their health care will not be shared without their consent.
Memory ability after subarachnoid haemorrhage: Relatives' and patients' statements in relation to test results
Authors: Berggren Elisabeth , Sidenvall Birgitta , Larsson Dennis
Published: September 2014

Aim

The aim of this study was to describe memory after a subarachnoid haemorrhage (SAH) from the perspective of relatives and patients in two cohorts and also to evaluate the application of relatives' statements as a tool in nursing care and rehabilitation, in order to support the patient.

Background

Cognitive sequelae due to SAH are a large disability and may influence the adjustment to daily life. Supporting patients and relatives requires knowledge concerning the patients' memory both from the perspective of patients and relatives.

Method

Eleven relatives and 11 patients (Cohort 1), 11 years after the onset of a SAH and 15 relatives and 15 patients (Cohort 2) 6 years after the onset of a SAH, participated in the study. Interview questions and memory tests were used to collect data.

Findings

Problems with memory, including meta-memory problems regarding relatives' statements, were common. Relatives and patients stated patients' memory in a similar manner. However, patients' statements concerning their memory corresponded in higher degree with memory test results, in comparison with relatives' statements.

Conclusions

Relatives' and patients' statements are useful as tools in nursing care and rehabilitation. However, from results showing meta-memory problems and that patients' statements concerning their memory corresponded better with memory test results (in comparison with relatives' statements), it is vital to offer patients memory tests in order to prevent complications in mutual family relationships.
New developments and opportunities for members
Authors: Preece Anne
Published: September 2014

Two exciting new developments are taking place which can offer BANN members the opportunity to share knowledge and skills with health professionals practising in other countries.
Research Roundup
Authors: Warner Richard
Published: September 2014

Richard Warner provides a synopsis and brief review of a selection of recently published research articles of interest to neuroscience nurses, highlighting the key points to keep you up to date. A full reference is provided for those who wish to read the research in more detail.
Nurses, infections, brains
Authors: Greener Mark
Published: September 2014

Mark Greener selects the latest clinical research
Slowing diabetic nephropathy
Authors: Morris David
Published: September 2014

Recognising the signs of renal damage caused by diabetes enables intervention to slow the condition's progress and minimise complications. David Morris writes
Demystifying constipation
Authors: Paul Siba Prosad , Routley Christine
Published: September 2014

Childhood constipation is a common reason for parents seeking help and advice. Siba Prosad Paul and Christine Routley provide an overview of managing the condition in the community
CKD-related anaemia: challenges and precautions using intravenous iron
Authors: Timmins Samantha
Published: September 2014

Intravenous iron is essential in the ongoing management of chronic kidney disease related anaemia and is increasingly being administered to patients in community settings. In this article, Samantha Timmins explains how the renal anaemia service at the Royal Devon and Exeter NHS Foundation Trust has overcome barriers to provide an efficient intravenous iron service for outpatients.
Contrast-induced acute kidney injury prevention in a renal unit
Authors: Chan Victoria , Gibson Matthew , Mohteshamzadeh Mobin
Published: September 2014

Contrast-induced acute kidney injury (CI-AKI) is generally uncommon. However, patients with risk factors such as pre-existing chronic kidney disease have a higher risk of developing this condition. In this article, Victoria Chan, Matthew Gibson and Mobin Mohteshamzadeh explain the effect of a prevention protocol, established at the Royal Berkshire Hospital, which aims to reduce the risk of the condition.
Patient-to-patient peer support in renal care: what, why and how?
Authors: Wood Eleri
Published: September 2014

Patients with kidney disease can often learn and gain support from their fellow patients, and peer support is becoming an increasing area of practice in health care. In the first of a series of articles on the topic, Eleri Wood outlines what it is, why it is recommended and how it can be implemented.
Re-establishing the patient's place at the heart of end-of-life care
Authors: Mendes Aysha
Published: September 2014

The Liverpool Care Pathway has been recently phased out in favour of new priorities of care. In this new regular column, Aysha Mendes delves into the rapidly evolving world of end-of-life care and explores what it all means for renal nurses who are caring for patients with end-stage renal disease.
Secure a flourising future
Authors: Hart Karen
Published: September 2014

Do you need to hone your business skills and develop a new focus on sustainability? If so, the Childcare Business Adviser's Programme could be for you. The first in a CPD series by Karen Hart.
Support their resilience
Authors: Hempsall James
Published: September 2014

As the free entitlement increases to meet its new target of reaching 40 per cent of this age group, James Hempsall kicks off a new series examining how to provide an environment which enables twos to flourish.
Wandering in the wild
Authors: Garner Lynne
Published: September 2014

This first article in a series on travelling looks at land-based methods. The following activities will help you take children on an exciting adventure to explore their surroundings on foot, by car or by train.
We're in it together
Authors: White Hilary
Published: September 2014

Pumpkin Soup by Helen Cooper provides a useful tool to look at relationships. Hilary White presents activity ideas based on the book and aimed at developing group working and task sharing.
London Fashion Week
Authors: Cruikshank Sarah
Published: September 2014

Sarah Cruikshank takes advantage of the 30th anniversary of London Fashion Week to present clothes and textile inspired activities, including fastening and unfastening, and seasonal clothing.
Adjuvant therapy decisions based on magnetic resonance imaging of extramural venous invasion and other prognostic factors in colorectal cancer
Authors: Chand M , Swift RI , Chau I , Heald RJ , Tekkis PP , Brown G
Published: September 2014

Introduction

There remains a lack of high quality randomised trial evidence for the use of adjuvant chemotherapy in stage II rectal cancer, particularly in the presence of high risk features such as extramural venous invasion (EMVI). The aim of this study was to explore this issue through a survey of colorectal surgeons and gastrointestinal oncologists.

Methods

An electronic survey was sent to a group of colorectal surgeons who were members of the Association of Coloproctology of Great Britain and Ireland. The survey was also sent to a group of gastrointestinal oncologists through the Pelican Cancer Foundation. Reminder emails were sent at 4 and 12 weeks.

Results

A total of 142 surgeons (54% response rate) and 99 oncologists (68% response rate) responded to the survey. The majority in both groups of clinicians thought EMVI was an important consideration in adjuvant treatment decision making and commented routinely on this in their multidisciplinary team meeting. Although both would consider treating patients on the basis of EMVI detected by magnetic resonance imaging, oncologists were more selective. Both surgeons and oncologists were prepared to offer patients with EMVI adjuvant chemotherapy but there was lack of consensus on the benefit.

Conclusions

This survey reinforces the evolution in thinking with regard to adjuvant therapy in stage II disease. Factors such as EMVI should be given due consideration and the prognostic information we offer patients must be more accurate. Historical data may not accurately reflect today’s practice and it may be time to consider an appropriately designed trial to address this contentious issue.
A rare case of acute intestinal obstruction due to bowel entrapment in migrated onlay polypropylene mesh
Authors: Tiwari SK , Lal Pawanindra
Published: September 2014

Onlay mesh hernioplasty is the gold standard technique in the management of inguinal hernias. We report a rare case of intraperitoneal mesh migration with bowel entrapment causing acute intestinal obstruction in an elderly patient.
Parathyroid adenoma in third pharyngeal pouch cyst as a rare case of primary hyperparathyroidism
Authors: Salido S , Gómez-Ramírez J , Bravo JM , Martín-Pérez E , Fernández-Díaz G , Nova JL Múñoz de , Auza J , Larrañaga E
Published: September 2014

The primitive thymus and inferior parathyroid derive from the third branchial cleft. During embryonic development, these structures descend, reaching their final localisation. Third branchial cleft anomalies present usually as a fistula, abscess or cyst. However, there are no reports on parathyroid adenomas in the literature other than as a morphological possibility.

We describe the case of a 47-year-old man, who had been diagnosed with arterial hypertension and who presented with a cervical mass at the edge of the lower third of the sternocleidomastoid muscle. On ultrasonography, the mass had a cystic walled appearance. Laboratory analysis only revealed an intact parathyroid hormone level of 140.5pg/ml. Sestamibi imaging showed a probable parathyroid adenoma in the anterior mediastinum. During surgery, a tract running from beyond the superior thyroid pedicle to the superior mediastinum was dissected and removed. In the inferior end of the tract, a brown mass was visible. Pathological examination revealed a thymus cyst surrounding a parathyroid adenoma. The primal alteration was the lack of division between the thymus and inferior parathyroid gland, and the prompt prevention of their development. In the case of our patient, a parathyroid adenoma had grown by chance.
The acute management of haemorrhoids
Authors: Hardy A , Cohen CRG
Published: September 2014

Introduction

Although the acute thrombosis and strangulation of haemorrhoids is a common condition, there is no consensus as to its most effective treatment.

Methods

A PubMed search was undertaken for papers describing the aetiology and treatment of the acute complications of haemorrhoids.

Results

The anatomy and treatments for strangulated internal haemorrhoids and thrombosed perianal varices are discussed. Studies of the effectiveness and complications of conservative and operative treatments are reviewed.

Conclusions

Ambiguities exist in the terminology used to describe the two separate pathologies that make up the acute complications of haemorrhoids. These complications have traditionally been treated conservatively. There is evidence that early operative intervention for strangulated internal haemorrhoids is safe and effective. A suggested algorithm for treatment is given, based on the published literature.
Diagnostic dilemma of gastric intramural air
Authors: Misro A , Sheth H
Published: September 2014

Emphysematous gastritis and gastric emphysema remain the two most important differential diagnoses of intramural gastric air bubbles, both differing vastly in their clinical presentation, radiographic findings, management and prognosis. This report discusses a case of gastric emphysema along with the importance of reaching an accurate clinical diagnosis early in the disease course.
Cutaneous basal cell carcinoma with endobronchial metastasis
Authors: Sadr AH , de Kerviler S , Kang N
Published: September 2014

Although basal cell carcinoma is a very common malignancy, metastasis from this tumour is extremely rare. For this reason, many plastic surgeons, dermatologists and physicians dealing with skin malignancies consider this as a locally invasive malignancy. We present a rare case of metastatic basal cell carcinoma manifested as a bronchial tumour. This case highlights the fact that despite basal cell carcinoma’s local invasive potential, the possibility of distant metastasis still exists and clinicians should therefore be cautious about interpreting extracutaneous symptoms. Chest physicians should always consider the possibility of this rare tumour in the lungs in patients with a history of large basal cell carcinomas in the head and neck region.
Hypopharyngeal fistula complicating difficult thyroidectomy for invasive papillary cancer
Authors: Rabie M Ezzedien
Published: September 2014

Thyroidectomy is associated with certain known complications, including recurrent laryngeal or superior laryngeal nerve injury and hypocalcaemia due to hypoparathyroidism. Other much rarer complications include oesophageal injury with oesophageal fistula formation. In this report, we describe the clinical course of a patient with an invasive papillary thyroid carcinoma who underwent total thyroidectomy and developed hypopharyngeal fistula in the immediate postoperative period, a complication that has never been reported previously following thyroidectomy. Under conservative treatment, the fistula closed within two weeks and the patient was referred, in good condition, to the oncologist for completion of therapy.
A rare case of obstructive right atrial lipoma
Authors: Habertheuer A , Andreas M , Wiedemann D , Rath C , Kocher A
Published: September 2014

Benign cardiac tumours are rare and cardiac lipomas account only for a small fraction among those. Most of these tumours differ in terms of clinical manifestation, diagnosis, morphology and size, and are therefore not diagnosed easily unless they become symptomatic. We report the case of a 71-year-old Caucasian woman with recurrent episodes of shortness of breath presenting with an acute exacerbation of dyspnoea and hypertensive crisis. Diagnosis of a right atrial lipoma with a coexisting patent foramen ovale was established on echocardiography and computed tomography, and the patient was evaluated for elective surgery. Comprising the entire free wall of the right atrium, the tumour was removed during open heart surgery on cardiopulmonary bypass. The right atrium and the orifices of both the superior and inferior vena cava were reconstructed with bovine pericardium. No evidence of tumour relapse was observed during successive follow-up visits.
The morbidity of negative appendicectomy
Authors: Lee M , Paavana T , Mazari F , Wilson TR
Published: September 2014

Introduction

The increased use of diagnostic laparoscopy for management of right iliac fossa pain may have lowered the threshold for removing normal appendices, particularly as there is a perception that this practice carries little additional morbidity. The aim of this retrospective audit was to determine the negative appendicectomy rate after laparoscopic appendicectomy (LA) in our busy district hospital, and to compare the relative incidence and severity of complications after removal of an inflamed or non-inflamed appendix.

Methods

Adult patients who underwent LA in 2011–2012 were identified from theatre registers. Histology results were reviewed to differentiate between inflamed and normal appendices. Postoperative complications and events following discharge were identified via electronic patient records. Complication severity was stratified using the Clavien–Dindo classification.

Results

Over 2 years, 467 LAs were performed, of which 143 (30.6%) were for normal appendices. Significantly more negative appendicectomies were performed in women (43%) than in men (17%) (p<0.0001). Complications were seen in 62 patients (13.3%). There was no significant difference between the complication rates for those who had an inflamed (16.6%) or non-inflamed (11.9%) appendix (p=0.141). Similarly, there was no difference in the severity of complications between these groups. Reoperation or invasive intervention was required after four negative appendicectomies (2.8%).

Conclusions

LA carries a similar morbidity regardless of whether the appendix is inflamed. Negative appendicectomy should not be undertaken routinely during laparoscopy for right iliac fossa pain.
Patient reported outcome measures in male incontinence surgery
Authors: Tran MGB , Yip J , Uveili K , Biers SM , Thiruchelvam N
Published: September 2014

Introduction

Patient reported outcome measures (PROMs) were used to evaluate outcomes of the artificial urinary sphincter (AUS) and the AdVance™ (American Medical Systems, Minnetonka, MN, US) male sling system (AVMS) for the symptomatic management of male stress urinary incontinence.

Methods

All male patients with stress urinary incontinence referred to our specialist clinic over a two-year period completed the ICIQ-UI SF (International Consultation on Incontinence Questionnaire on Urinary Incontinence Short Form) and the ICIQ-MLUTS LF (International Consultation on Incontinence Questionnaire on Male Lower Urinary Tract Symptoms Long Form) at consultation as well as at subsequent follow-up appointments. The Wilcoxon signed-rank test for non-parametric paired data was used for pre and postoperative comparisons. The chi-squared test was used for categorical variables.

Results

Thirty-seven patients (forty surgical cases) completed a preoperative and at least one follow-up questionnaire. There was a statistically significant improvement in PROMs postoperatively, regardless of mode of surgery (p<0.01). Analysis of the ICIQ-MLUTS LF showed that patients with higher preoperative scores (>25) had greater improvement with an AUS than with the AVMS (p<0.01).

Conclusions

This prospective study shows that completion and collection of PROMs as part of routine clinical practice is achievable and useful in the assessment of male stress incontinence surgery. PROMs are important instruments to assess effectiveness of healthcare intervention and they are useful adjuncts in surgical studies.
Using a tightRope® to treat a complex fracture of the trapezium
Authors: Shenouda ME , Mohan A , Sarkhel T
Published: September 2014

We present the case of a 23-year-old man with a combined scaphoid fracture and comminuted trapezium fracture, treated surgically with percutaneous fixation of the scaphoid fracture and concomitant Arthrex Mini TightRope® stabilisation of base of thumb metacarpal to base of index finger metacarpal. The patient made a good functional recovery, returning to usual activities within six weeks. We suggest that this technique could be used to treat complex trapezium fractures that cannot be reconstructed with surgery.
Outcomes of a metal-on-metal total hip replacement system
Authors: Matharu GS , Theivendran K , Pynsent PB , Jeys L , Pearson AM , Dunlop DJ
Published: September 2014

Introduction

High short-term failure rates have been reported for a variety of metal-on-metal (MoM) total hip replacements (THRs) owing to adverse reactions to metal debris (ARMD). This has led to the withdrawal of certain poorly performing THRs. This study analysed the outcomes of a MoM THR system.

Methods

Between 2004 and 2010, 578 uncemented MoM THRs (511 patients, mean age: 60.0 years) were implanted at one specialist centre. The THR system used consisted of the Corail®stem, Pinnacle®cup, Ultamet®liner and Articul/eze®femoral head (all DePuy, Leeds, UK). All patients were recalled for clinical review with imaging performed as necessary.

Results

The mean follow-up duration was 5.0 years (range: 1.0–9.1 years). Overall, 39 hips (6.7%) in 38 patients (all 36mm femoral head size) underwent revision at a mean time of 3.5 years (range: 0.01–8.3 years) from the index THR with 30 revisions (77%) performed in women. The cumulative eight-year survival rate for all THRs was 88.9% (95% confidence interval [CI]: 78.5–93.4%), with no difference (p=0.053) between male (95.2%, 95% CI: 84.2–98.7%) and female patients (85.3%, 95% CI: 70.2–92.1%) at eight years. Seventeen revisions (44%) were performed for ARMD. There was no significant difference in absolute postoperative Oxford hip scores between men and women (p=0.608). The mean acetabular inclination in unrevised THRs was 44.0°. Forty-seven non-revised THRs (8.7%) had blood metal ion concentrations above recommended thresholds (seven had periprosthetic effusions).

Conclusions

Although this MoM THR system has not failed as dramatically as other similar designs, we recommend against continued use and advise regular clinical surveillance to identify ARMD early.
Delayed diagnosis in metastatic lesions of the foot
Authors: Evans S , Ramasamy A , Jeys L , Grimer R
Published: September 2014

Introduction

Pedal acrometastases are a rare complication of disseminated malignancy. To date, there is little in the literature documenting their clinical course.

Methods

Our large orthopaedic oncology database was used to review the clinical course of symptomatic pedal acrometastases.

Results

A total of 15 cases of pedal acrometastases were identified from 2,595 patients with metastases. The median age at presentation was 64.5 years (range: 14–83 years) and the median length of foot symptoms (predominantly pain and swelling) prior to diagnosis of metastasis was 16 weeks (range: 6–104 weeks). The median survival following diagnosis was 4.6 months (range: 2.3–104.5 months).

Conclusions

This study suggests that 0.58% of all osseous metastases involve the foot, and that symptoms of foot pain and swelling are often misdiagnosed, leading to delays in treatment. A high index of suspicion is required to diagnose pedal acrometastases early, thereby allowing early treatment so that the patient’s quality of life can be maintained prior to death.
3D printing in prosthodontics
Authors: Hems Edward , Knott Nigel J
Published: September 2014

A technological revolution in dentistry is creating new paradigms of innovation that were unimaginable only a decade ago. A bull has entered the antique china shop and is running rampant among long-established manufacturing practices dependent upon expensive human skills and craftsmanship. Adventurous dental technophiles and their patients are beginning to enjoy a new world of peerless technical excellence with prodigious potential. The digitisation of dental processes, which includes 3D printing (or rapid prototyping) is beginning to deliver real firepower in dental surgeries.
Dental careers: changes, choices and challenges
Authors: Nayee Shalini , Calvert Alice P , Gallagher Jennifer E
Published: September 2014

Dentists in the United Kingdom have a wide range of career choices available, with opportunities in primary care, community/salaried/public dental services, hospital and academia. This luxury of choice is often touted as desirable but is the multitude of career pathways, in combination with frequently changing recruitment processes, structures and systems, a source of confusion? If you’re at the start of your career (or could do with an update), read on for a straightforward explanation of the dizzying world of dental careers.
Dentistry for osteoporosis and cancer patients
Authors: Moore Amelia E , Jasani Mukundrai Kris
Published: September 2014

Bisphosphonates (BPs) and similarly acting bone antiresorptive agents such as denosumab are becoming the principal if not sole therapeutic agents for the preventative treatment against fracture occurrence in osteoporosis (OP) patients. BPs are also increasingly used in the treatment of severely painful and potentially life-shortening bone complications, including fracture occurrence, in cancer patients. Are we seeing not only a rapid expansion of research focused on the prevention and treatment of osteonecrosis of the jaw (ONJ) but also the emergence of a new sub-specialty focusing on the diagnosis, prevention and treatment of ONJ?
Do you want to be a rich dentist or a good dentist?
Authors: Simmons Gerald
Published: September 2014

American healthcare often polarises opinon, particularly in the UK and Europe. Is it polarising dentists at home as well?
Policy spotlight
Authors: Wrigley Catherine
Published: September 2014

Welcome to our new, regular feature that aims to provide key political news in relation to dentistry and an update of the Faculty’s policy activities. You can find out more in the new policy and public affairs section on the FDS website.
New Automated Single-Cell Technique for Segmentation and Quantitation of Lipid Droplets
Authors: Dejgaard Selma Y. , Presley John F.
Published: September 2014

Lipid droplets are the major organelle for intracellular storage of triglycerides and cholesterol esters. Various methods have been attempted for automated quantitation of fluorescently stained lipid droplets using either thresholding or watershed methods. We find that thresholding methods deal poorly with clusters of lipid droplets, whereas watershed methods require a smoothing step that must be optimized to remove image noise. We describe here a novel three-stage hybrid method for automated segmentation and quantitation of lipid droplets. In this method, objects are initially identified by thresholding. They are then tested for circularity to distinguish single lipid droplets from clusters. Clusters are subjected to a secondary watershed segmentation. We provide a characterization of this method in simulated images. Additionally, we apply this method to images of fixed cells containing stained lipid droplets and GFP-tagged proteins to provide a proof-of-principle that this method can be used for colocalization studies. The circularity measure can additionally prove useful for the identification of inappropriate segmentation in an automated way; for example, of non-cellular material. We will make the programs and source code available to the community under the Gnu Public License. We believe this technique will be of interest to cell biologists for light microscopic studies of lipid droplet biology.
Media and culture: Movement across the decades
Authors: Rowe David
Published: September 2014

Over the last decade there have been well-documented, far-reaching changes to the media environment as digitalization – among other forces and processes – has substantially altered media production, consumption and use. A notable consequence of this shift has been the intensified co-dependency of the media and (especially ‘live’) sport, and the continuing expansion of the ‘media sports cultural complex’. The developing phenomenon of social media now figures prominently across the cultural sphere (including the ‘zone’ of media and sport), but it is necessary to question some ostensibly over-optimistic or premature claims about its lasting significance as a vehicle for human liberation. Thus, in considering a broad research agenda in this domain for the next decade, the centrality of political economy, media history, and anti-technological determinism are emphasized as necessary components of any workable analytical engagement with questions of power, media and cultural politics.
Countersymbols and the Constitution of Resistance in American Fundamentalism, 1919–1922
Authors: Edwards Jonathan J.
Published: September 2014

Christian fundamentalism is a doctrinal system and an argumentative frame, but it also functions as a “countermovement” whose members advocate resistance from a purported place of ecclesial and political marginalization. This article explores the roots of early fundamentalist resistance rhetoric as it manifested through a series of “countersymbols”—oppositional condensation symbols that invoke the corruption of an idealized community by its other to rhetorically justify resistance as necessary response.
Extending the dominion of effective control – Its applicability to mood choice in Spanish and Portuguese
Authors: Vesterinen Rainer
Published: September 2014

Within the model of Cognitive Grammar, the concept of dominion is fundamental to the analysis of the conceptualizer's attitude toward an event or a proposition. However, the concept has, first and foremost, been understood in epistemic terms, whereas there has been less concern with the conceptualizer's efforts to influence and manipulate the course of events in the world. This being so, the present paper shows that the conceptualizer's dominion of effective control is relevant in a number of linguistic contexts. The analysis provides evidence for this particular feature in factive contexts, deontic contexts, contexts of volition and causation, and in adverbial clauses of purpose, manner and condition. The analysis further shows that the conceptualizer's dominion of effective control is capable of providing a conceptually grounded explanation for the occurrence of the Spanish and the Portuguese subjunctive mood in these grammatical contexts.