bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunological Approaches Against Human Chorionic Gonadotropin for Control of Fertility and Therapy of Advanced‐Stage Cancers Expressing hCG/Subunits
Authors: Talwar Gursaran P. , Gupta Jagdish C. , Shankar Neha V.
Published: April 2011

Citation Talwar GP, Gupta JC, Shankar NV. Immunological approaches against human chorionic gonadotropin for control of fertility and therapy of advanced‐stage cancers expressing hCG/subunits. Am J Reprod Immunol 2011; 66: 26–39

The year 2011 marks the 84th year of the discovery of human chorionic gonadotropin (hCG) by Ascheim and Zondek. Originally considered and employed as a reliable diagnostic index for pregnancy, the multiple roles of hCG as an initiator and sustainer of pregnancy are now recognized. Besides pregnancy, the expression of hCG or its subunits is observed in a number of cancers of diverse type, in particular at advanced stage. Cancers expressing hCG/subunits have poor prognosis and adverse survival. Thus, immunological approaches against hCG have applications for control of fertility and for treatment of terminal cancers. Various mechanisms by which hCG exercises its action are discussed. These include its role as autocrine growth promoter, inhibitor of apoptosis, promotor of angiogenesis, invasiveness, and protection against rejection by the immune system. The article reviews various vaccines developed for control of fertility and for therapy of advanced‐stage cancers expressing ectopically hCG/subunits. Also reviewed are the recombinant fully humanized and chimeric antibodies usable for emergency contraception, as vacation contraceptive, and as therapeutic antibodies for treatment of cancers.
Contraceptive Vaccines Based on the Zona Pellucida Glycoproteins for Dogs and Other Wildlife Population Management
Authors: Gupta Satish K. , Srinivasan Villuppanoor A. , Suman Pankaj , Rajan Sriraman , Nagendrakumar Singanallur B. , Gupta Neha , Shrestha Abhinav , Joshi Pooja , Panda Amulya K.
Published: April 2011

Citation Gupta SK, Srinivasan VA, Suman P, Rajan S, Nagendrakumar SB, Gupta N, Shrestha A, Joshi P, Panda AK. Contraceptive vaccines based on the zona pellucida glycoproteins for dogs and other wildlife population management. Am J Reprod Immunol 2011; 66: 51–62

Zona pellucida (ZP) glycoproteins, by virtue of their critical role in fertilization, have been proposed as candidate antigens for the development of contraceptive vaccines. In this review, the potential of a ZP‐based contraceptive vaccine for the management of wildlife population, with special reference to street dogs, is discussed. Immunization of various animal species, including female dogs, with native porcine ZP led to inhibition of fertility, which was associated with the ovarian dysfunction. Immunization of female dogs with Escherichia coli‐expressed recombinant dog ZP glycoprotein‐3 (ZP3) either coupled to diphtheria toxoid or expressed as fusion protein with ‘promiscuous’ T non‐B‐cell epitope of tetanus toxoid also led to inhibition of fertility. To improve the contraceptive efficacy of ZP‐based contraceptive vaccine, various groups are working on improving the immunogen, use of DNA vaccine as prime‐boost strategy, and delivering the zona proteins/peptides presented on either virus‐like particles or entrapped in microsphere. Host‐specific live vectors such as ectromelia virus and cytomegalovirus have also been used to deliver mouse ZP3 in mice. Various studies show the enormous potential of the ZP‐based vaccine for the management of wildlife population, where permanent sterilization may be desirable.
Contraceptive Vaccines for the Humane Control of Community Cat Populations
Authors: Levy Julie K.
Published: April 2011

Citation Levy JK. Contraceptive vaccines for the humane control of community cat populations. Am J Reprod Immunol 2011; 66: 63–70

Free‐roaming unowned stray and feral cats exist throughout the world, creating concerns regarding their welfare as well as their impact on the environment and on public health. Millions of healthy cats are culled each year in an attempt to control their numbers. Surgical sterilization followed by return to the environment is an effective non‐lethal population control method but is limited in scope because of expense and logistical impediments. Immunocontraception has the potential to be a more practical and cost‐effective method of control. This is a review of current research in immunocontraception in domestic cats. Functional characteristics of an ideal immunocontraceptive for community cats would include a wide margin of safety for target animals and the environment, rapid onset and long duration of activity following a single treatment in males and females of all ages, and sex hormone inhibition. In addition, product characteristics should include stability and ease of use under field conditions, efficient manufacturing process, and low cost to the user. Two reproductive antigens, zona pellucida and GnRH, have been identified as possible targets for fertility control in cats. Zona pellucida, which is used successfully in multiple wildlife species, has achieved little success in cats. In contrast, immunization against GnRH has resulted in long‐term contraception in both male and female cats following a single dose. GnRH is an ideal contraceptive target because it regulates pituitary and gonadal hormone responses in both males and females, thus suppressing nuisance behaviors associated with sex hormones in addition to preventing pregnancy. The responsiveness of cats to fertility control via GnRH suppression should encourage researchers and cat control stakeholders to continue efforts to optimize vaccines that induce multiyear contraception following a single dose in a high proportion of treated cats.
Ulceroglandular tularemia
Authors: Potz‐Biedermann Christiane , Schwendemann Lena , Schröppel Klaus , Sönnichsen Karsten , Schmidt Diethard , Schaller Martin
Published: April 2011

An increasing number of patients with the zoonosis tularemia have been reported in the last few years in Europe. Tularemia can be divided into different forms depending on its appearance. Tularemia must be considered in the differential diagnosis of diseases that present with an ulcer and regional lymphadenopathy. The diagnosis can be confirmed by culturing Francisella tularensis. With effective antibiotic intervention, the prognosis is favorable. Typically tularemia develops after outdoor activities; it is generally transferred by blood‐sucking arthropods from infected wild animals to humans.
Psoriasin: key molecule of the cutaneous barrier?
Authors: Gläser Regine , Köten Bente , Wittersheim Maike , Harder Jürgen
Published: April 2011

Psoriasin (S100 A7) was discovered two decades ago as a protein abundantly expressed in psoriatic keratinocytes. Even though much scientific research has been carried out on the characterization of psoriasin, only recent studies point to an important role of psoriasin as an antimicrobial and immunomodulatory protein in skin and other epithelia. In this review, we provide an overview of the major findings in psoriasin research and discuss novel studies highlighting the role of psoriasin as an important effector molecule of the cutaneous barrier.
Heat tolerance and the effects of shade on the behavior of Simmental bulls on pasture
Authors: TITTO Cristiane Gonçalves , TITTO Evaldo Antonio Lencioni , TITTO Rafael Martins , MOURÃO Gerson Barreto
Published: April 2011

The objectives were to assess the degree of thermolysis capacity as a characteristic of heat tolerance of the Simmental beef cattle and evaluate the effects of shade and shade type (artificial: AS, trees: TS, or no shade: NS) on daily behavior patterns during summer. Black globe temperature (BGT) was different under the two types of shade (P < 0.05) and was lower under the TS (P < 0.01) and under AS (P > 0.01) than average BGT in the sun. Animals when in AS used more intensely the shade (P = 0.002) mostly lying down under it (10.00–14.00 hours), while time standing was similar (P = 0.107) between TS and NS. Bulls without shade (NS) spent significantly more time at the water trough and most part of the day standing idle (72.4%, 10.1 h/14 h). TS bulls spent more time grazing/standing (P < 0.001). The Simmental bulls that were in TS and AS spent more time ruminating than bulls that stay without shade (NS). The availability of shade changes grazing, rumination and idling behavior of cattle in response to environmental conditions. Shade provided by trees can be more efficient than artificial shading as cattle spent more time grazing when tree shade was available. Thermolysis capacity can be used to select heat‐tolerant animals.
THE DEWEY‐HUTCHINS DEBATE: A DISPUTE OVER MORAL TELEOLOGY
Authors: Johnston James Scott
Published: April 2011

In this essay, James Scott Johnston claims that a dispute over moral teleology lies at the basis of the debate between John Dewey and Robert M. Hutchins. This debate has very often been cast in terms of perennialism, classicism, or realism versus progressivism, experimentalism, or pragmatism. Unfortunately, casting the debate in these terms threatens to leave the reader with the impression that Dewey and Hutchins were simply talking past each other, that one was wrongheaded while the other correct, or that they held incommensurable ideological standpoints. Such an understanding obscures a deeper conflict that divided these two men and overlooks the depth of the differences in their moral outlooks. Johnston argues that both thinkers knew very well what morally significant principles and practices were at stake in the debate and, further, that this awareness, rather than the question of which foundation for education was better for students, informed their responses to one another.
KANT'S CONCEPTION OF RESPECT AND AFRICAN AMERICAN EDUCATION RIGHTS
Authors: Bynum Gregory Lewis
Published: April 2011

Immanuel Kant envisioned a kind of respect in which one recognizes each human (1) as being not fully comprehensible by any human understanding, (2) as being an end in him‐ or herself, and (3) as being a potential source of moral law. In this essay, Gregory Lewis Bynum uses this conception of respect as a lens with which to examine African American education rights on three levels: the individual level (the level of individual persons' moral experience and moral significance), the community level (the level of the formation and sustaining of social groups that have value for humanity), and the global level (the level of a universal community of humanity). Bynum's goal in this examination is to strengthen our practical understanding of African Americans' right to education defined, in accordance with international human rights documents, as the right to an education that supports the full development of the human personality in a manner that respects students' “cultural identity, language, and values.”
EDUCATION, FAIR COMPETITION, AND CONCERN FOR THE WORST OFF
Authors: Giesinger Johannes
Published: April 2011

In this essay, Johannes Giesinger comments on the current philosophical debate on educational justice. He observes that while authors like Elizabeth Anderson and Debra Satz develop a so‐called adequacy view of educational justice, Harry Brighouse and Adam Swift defend an egalitarian principle. Giesinger focuses his analysis on the main objection that is formulated, from an egalitarian perspective, against the adequacy view: that it neglects the problem of securing fair opportunities in the competition for social rewards. Giesinger meets this objection by expressing two basic theses: First, he argues that Brighouse and Swift themselves fail to give an adequate account of fair competition; and, second, he shows that the adequacy view provides the theoretical resources to face this problem.
THE PROVENANCES OF ECONOMIC THEORY'S IMPACT ON EDUCATION: FRENCH EDUCATIONAL THOUGHT AT THE END OF THE ANCIEN RÉGIME
Authors: Gilead Tal
Published: April 2011

Today, the influence of economic thought on educational theory is evident. It seems to weaken, however, the further we travel back in history. In this article, Tal Gilead examines the historical origins of this influence. He shows that it first emerged in French educational thought during the second half of the eighteenth century. Through analyzing a number of books on educational theory from this period, Gilead demonstrates the educational impact of two innovative economic ideas: first, the idea that wealth stems from the product of the land, and, second, the idea that the wealth of the nation is positively correlated with that of the individuals composing it. Gilead argues that these economic ideas contributed to the emergence and spread of progressive notions regarding the scope, nature, and aims of educational provision. He especially stresses the role that these economic ideas played in transforming contemporary attitudes toward the education of the poor.
Structural basis for substrate recognition by Erwinia chrysanthemi GH30 glucuronoxylanase
Authors: Urbániková Ľubica , Vršanská Mária , Mørkeberg Krogh Kristian B. R. , Hoff Tine , Biely Peter
Published: April 2011

Xylanase A from the phytopathogenic bacterium Erwinia chrysanthemi is classified as a glycoside hydrolase family 30 enzyme (previously in family 5) and is specialized for degradation of glucuronoxylan. The recombinant enzyme was crystallized with the aldotetraouronic acid β‐d‐xylopyranosyl‐(1→4)‐[4‐O‐methyl‐α‐d‐glucuronosyl‐(1→2)]‐β‐d‐xylopyranosyl‐(1→4)‐d‐xylose as a ligand. The crystal structure of the enzyme–ligand complex was solved at 1.39 Å resolution. The ligand xylotriose moiety occupies subsites −1, −2 and −3, whereas the methyl glucuronic acid residue attached to the middle xylopyranosyl residue of xylotriose is bound to the enzyme through hydrogen bonds to five amino acids and by the ionic interaction of the methyl glucuronic acid carboxylate with the positively charged guanidinium group of Arg293. The interaction of the enzyme with the methyl glucuronic acid residue appears to be indispensable for proper distortion of the xylan chain and its effective hydrolysis. Such a distortion does not occur with linear β‐1,4‐xylooligosaccharides, which are hydrolyzed by the enzyme at a negligible rate.

Database
 Structural and experimental data are available in the Protein Data Bank database under accession number 2y24 [45].
Structure and function of active chromatin and DNase I hypersensitive sites
Authors: Cockerill Peter N.
Published: April 2011

Chromatin is by its very nature a repressive environment which restricts the recruitment of transcription factors and acts as a barrier to polymerases. Therefore the complex process of gene activation must operate at two levels. In the first instance, localized chromatin decondensation and nucleosome displacement is required to make DNA accessible. Second, sequence‐specific transcription factors need to recruit chromatin modifiers and remodellers to create a chromatin environment that permits the passage of polymerases. In this review I will discuss the chromatin structural changes that occur at active gene loci and at regulatory elements that exist as DNase I hypersensitive sites.
Formulation of a DIMTEST Effect Size Measure (DESM) and Evaluation of the DESM Estimator Bias
Authors: Seo Minhee , Roussos Louis A.
Published: April 2011

DIMTEST is a widely used and studied method for testing the hypothesis of test unidimensionality as represented by local item independence. However, DIMTEST does not report the amount of multidimensionality that exists in data when rejecting its null. To provide more information regarding the degree to which data depart from unidimensionality, a DIMTEST‐based Effect Size Measure (DESM) was formulated. In addition to detailing the development of the DESM estimate, the current study describes the theoretical formulation of a DESM parameter. To evaluate the efficacy of the DESM estimator according to test length, sample size, and correlations between dimensions, Monte Carlo simulations were conducted. The results of the simulation study indicated that the DESM estimator converged to its parameter as test length increased, and, as desired, its expected value did not increase with sample size (unlike the DIMTEST statistic in the case of multidimensionality). Also as desired, the standard error of DESM decreased as sample size increased.
Rock Weathering Processes in Antarctica: A Comparison of Some Recent Studies with Those from the Northern Hemisphere
Authors: ELLIOTT CHRISTINE
Published: April 2011

A review of some recent studies on rock weathering in Antarctica has revealed that Antarctic weathering research has a significant contribution to make to the ongoing debate about rock weathering in cold climates. Largely conducted in the field rather than the laboratory as in the Northern Hemisphere, it demonstrates that whilst all weathering processes can occur in Antarctica this is highly localised and dependent on the particular micro‐environment. Freeze‐thaw, for example, is not the most dominant process in many parts of Antarctica. The right combination of rock temperature and moisture can mean that salt, insolation, hydration or even chemical weathering can predominate.
Stroke Unit Care: Does Ischemic Stroke Subtype Matter?
Authors: Saposnik Gustavo , Hassan Khalid A. , Selchen Daniel , Fang Jiming , Kapral Moira K. , Smith Eric E. ,   on behalf of the Investigators of the Registry of the Canadian Stroke Network for the Stroke Outcome Research Canada (SORCan - http://www.sorcan.ca) working group
Published: April 2011

Background

Stroke unit care improves outcomes following ischemic stroke. However, it is not known whether all ischemic stroke subtypes benefit equally from stroke unit admission.

Objective

To determine whether the benefit of stroke unit admission is similar among all ischemic stroke subtypes.

Design, setting and patients

Prospective cohort study including patients admitted with an acute ischemic stroke between July 2003 and September 2007 to stroke centers participating institutions in the Registry of the Canadian Stroke Network. Ischemic stroke subtype information was determined according to the modified Trial of Org 10 172 in Acute Stroke Treatment criteria and categorized as small vessel disease (lacunar), large artery atherosclerotic disease, cardioembolic, or other (including both other determined and undetermined causes).

Main outcome measures

The primary outcome measure was all-cause mortality at 30 days after stroke. Secondary outcomes were seven-day mortality and death or institutionalization at discharge.

Results

Among 6223 eligible patients with ischemic stroke admitted to regional stroke centers in Ontario, the mean age was 72 years and 52·4% were male. Overall 30-day mortality was 12·2%. The 30-day risk-adjusted mortality was lower for stroke unit care across all stroke subtypes (for lacunar stroke 3·0% vs. 5·3%; for large artery disease 7·5% vs. 14·5%; for cardioembolic 15·3% vs. 23·3%; and for other causes 8·9% vs. 15·9%). In multivariable analysis, after controlling for age, gender, medical comorbidities, and stroke severity, there was a significant reduction in stroke mortality associated with stroke unit admission in all stroke subtypes (odds ratio (95% confidence interval) for lacunar stroke 0·48 (0·27–0·88), for large artery atherosclerotic disease 0·39 (0·27–0·56), for cardioembolic 0·46 (0·36–0·59), and for other causes 0·45 (0·29–0·70)). The results remained similar after a sensitivity analysis excluding patients receiving palliative care, and a secondary analysis including 3215 patients with missing Trial of Org 10 172 in Acute Stroke Treatment classification.

Conclusion

This study provides ‘real-world’ evidence that all ischemic stroke subtypes do benefit from a stroke unit admission regardless of the etiology. There is no justification for withholding access to stroke unit care based on stroke subtype.
Older adults’ knowledge of pressure ulcer prevention: a prospective quasi‐experimental study
Authors: Hartigan Irene , Murphy Siobhan , Hickey Mary
Published: April 2011

hartigan i., murphy s. & hickey m. (2011) Older adults’ knowledge of pressure ulcer prevention: a prospective quasi‐experimental study. International Journal of Older People Nursing7, 208–218  doi: 10.1111/j.1748‐3743.2011.00274.x

Aim.  To test an evidence base patient education leaflet to evaluate older adults’ knowledge of pressure ulcers and prevention strategies.

Background.  The increasing population of older adults living in the community managing chronic health conditions are at risk of pressure ulcer development. Education leaflets are a useful adjunct to reinforce healthcare professional’s verbal information to promote healthy lifestyles choices. However, little is known of the effectives of pressure ulcer prevention educational leaflets for older adults.

Methods.  A quasi‐experimental uncontrolled pre‐test, post‐test study of participants’ knowledge of pressure ulcer and preventative strategies was conducted. Community dwelling older adults (n = 75) were recruited to this study. Older adult’s knowledge was measured pre‐ and postdistribution of an education intervention. A risk assessment scale was recorded to identify whether this cohort of older adults were actually at risk of developing pressure ulcers.

Conclusion.  The results indicate that an education leaflet enhanced patients’ knowledge relating to pressure ulceration. Printed education materials increase knowledge and understanding which may lend to older adults adopting healthy behaviours.

Implications for practice.  An education leaflet can help older adults and their carers to be more empowered as active participants in reducing the incidence of pressure ulceration.
Identifying and handling abused older clients in community care: the perspectives of nurse managers
Authors: Sandmoe Astrid , Kirkevold Marit
Published: April 2011

sandmoe a. & kirkevold m. (2013) Identifying and handling abused older clients in community care: the perspectives of nurse managers.International Journal of Older People Nursing8, 83–92  doi: 10.1111/j.1748‐3743.2011.00279.x

Background. Abuse of older people can lead to an increased need for health care services, and early identification of and intervention with abused, older clients should be a priority.

Objectives. To gain knowledge about how nurse managers and their staff identify and handle abused older clients.

Design. Qualitative study.

Methods. Fifty‐two participants were interviewed, the text transcribed and analysed using manifest qualitative content analysis.

Findings and discussion. The identification and handling of older victims depended on individual nurses and the involvement of the participants and are based on clinical experience and less on knowledge through professional training and education. The participants emphasised the need for an individualised approach to older victims suspected of abuse. The important role of the nurse managers in the handling of abuse is discussed as well as the need for support of the nurse managers and the staff in community care by increased interdisciplinary collaboration to handle complex cases.

Conclusion. The identification and handling of abused older clients are a challenging issue for community care, and more knowledge and support are needed.

Implications for practice. The concept of elder abuse must be clarified, and strategies for its identification and intervention must be developed.
June 2001: 61 year old woman with confusion and obtundation
Authors: Barron J. , Lownie S. P. , Lee D. H. , Hammond R. R.
Published: April 2011

Cases of the Month, April–June, 2001

The April Case of the Month (COM). The contributors report a case of a 70 year‐old woman with recurrent meningiomas, one of which showed rhabdoid and lipomatous differentiation. Histopathological study of the first and second previous resections showed only typical meningothelial meningioma. On the third craniotomy, a new tumor specimen showed an admixture of classic meningothelial meningioma with lipomatous and rhabdoid foci. Immunohisto‐chemical studies showed diffuse reactivity for epithelial membrane antigen and vimentin, as well as focal positivity for desmin and smooth muscle actin in the areas with rhabdoid features and S100 protein in the lipomatous foci. The presence of these three different and concomitant histological patterns only in the third surgical resection might support a meta‐plastic origin and, also, corroborates the concept that rhabdoid features are suggestive of an aggressive behavior.

The May COM. A 32‐year‐old woman with a history of previous mastoid surgery presented with bilateral extremity weakness and ambulatory instability. MRI revealed a dural‐based mass completely encircling the upper cervical spinal cord. Workup was significant for an abnormally elevated c‐ANCA, positive at a dilution Of 1:128. A portion of the lesion was removed by a posterior surgical approach to decompress the cervical cord. Histologic examination of the dura showed a dense granulomatous infiltrate with vasculitis and giant cells; coupled with the positive c‐ANCA, the Process was felt to be most consistent with Wegener's granulomatosis. Wegener's granulomatosis infrequently involves the dura or meninges and has not previously been reported to affect dura of the cervical cord. Symptomatic improvement followed surgical decompression and high‐dose corticosteroid therapy, with resultant resolution of an elevated c‐ANCA titer.

The June COM. A 61 year old female presents with a three week history of increasing confusion, lethargy and headache. A neurological exam revealed dis‐orientation, mild expressive aphasia, bilateral papilledema, and a right pronator drift. She had a craniotomy and resection of tumor. The tumor histologically was consistent with a solitary fibrous tumor displaying malignant features of hypercellularity, marked nuclear atypia, high mitotic activity, and a high proliferation index.

This case is unique as the first malignant variant of solitary fibrous tumor to be reported intracranially.
Modification to reporting of qualitative fluorescent spot test results improves detection of glucose‐6‐phosphate dehydrogenase (G6PD)‐deficient heterozygote female newborns
Authors: NADARAJAN V. , SHANMUGAM H. , STHANESHWAR P. , JAYARANEE S. , SULTAN K. S. , ANG C. , ARUMUGAM S.
Published: April 2011

Introduction:  The glucose‐6‐phosphate dehydrogenase (G6PD) fluorescent spot test (FST) is a useful screening test for G6PD deficiency, but is unable to detect heterozygote G6PD‐deficient females. We sought to identify whether reporting intermediate fluorescence in addition to absent and bright fluorescence on FST would improve identification of mildly deficient female heterozygotes.

Methods:  A total of 1266 cord blood samples (705 male, 561 female) were screened for G6PD deficiency using FST (in‐house method) and a quantitative enzyme assay. Fluorescence intensity of the FST was graded as either absent, intermediate or normal. Samples identified as showing absent or intermediate fluorescence on FST were analysed for the presence of G6PD mutations using TaqMan@SNP genotyping assays and direct nucleotide sequencing.

Results:  Of the 1266 samples, 87 samples were found to be intermediate or deficient by FST (49 deficient, 38 intermediate). Of the 49 deficient samples, 48 had G6PD enzyme activity of ≤ 9.5 U/g Hb and one sample had normal enzyme activity. All 38 intermediate samples were from females. Of these, 21 had G6PD activity of between 20% and 60%, and 17 samples showed normal G6PD activity. Twenty‐seven of the 38 samples were available for mutation analysis of which 13 had normal G6PD activity. Eleven of the 13 samples with normal G6PD activity had identifiable G6PD mutations.

Conclusion:  Glucose‐6‐phosphate dehydrogenase heterozygote females cannot be identified by FST if fluorescence is reported as absent or present. Distinguishing samples with intermediate fluorescence from absent and bright fluorescence improves detection of heterozygote females with mild G6PD deficiency. Mutational studies confirmed that 85% of intermediate samples with normal enzyme activity had identifiable G6PD mutations.
Paediatric CT imaging trends in Australia
Authors: Brady Zoe , Cain Timothy M , Johnston Peter N
Published: April 2011

Introduction: The use of CT has rapidly increased since its introduction. Although an important medical tool for diagnosis and treatment, CT is recognised as being among the highest contributors to population radiation exposure. As the risks associated with exposure are higher for children than for adults, this study assessed the impact of paediatric CT in Australia by analysing imaging trends.

Methods: CT imaging trends were derived from Medicare data. Comparable data from a dedicated paediatric hospital (Royal Children's Hospital Melbourne (RCH)) were analysed to determine the validity of utilising Medicare statistics in the younger age groups. The resulting trends reflect the situation for paediatric CT imaging in Australia.

Results: In 2009, 2.1 million CT services were billed to Medicare in Australia for children and adults. The average annual growth in the number of CT services provided since 1994 was 8.5%, compared with population growth of 1.4%. Comparison of RCH and Medicare data revealed that only one third of paediatric CT imaging is captured by Medicare. Combining the data sets showed that over the last 20 years, there has been an average annual increase of 5.1% in the CT imaging rate for 0 to 18‐year‐olds. However, in recent years, growth in the imaging rate for 11 to 18‐year‐olds has slowed, while for 5 to 10‐year‐olds the imaging rate has declined.

Conclusions: The significant growth in CT services is attributable to increased demand from the adult demographic. Conversely, increases in the imaging rate for paediatric patients have slowed overall. In fact, for some age groups the rate has fallen.
Extracolonic findings at CT colonography: A review of 258 consecutive cases
Authors: Sutherland Tom , Coyle Elizabeth , Lui Belinda , Lee Wai‐Kit
Published: April 2011

Introduction: Computed tomographic colonography (CTC) is a non‐invasive method of examining the colon and is used for colorectal polyp and mass diagnosis. As the entire abdomen is examined, incidental extracolonic pathologies can be diagnosed. The types of extracolonic findings (ECFs) and their frequency have not been explored in an Australian setting.

Methods: A retrospective review of all CTC examinations performed in an Australian tertiary hospital between February 2004 and July 2009 were reviewed to extract patient demographic data, reason for referral, presence of colonic polyps and masses, presence of other colonic and extracolonic pathologies. Statistical significance was determined using a Student's t‐test or Fisher's exact test where appropriate.

Results: Two hundred fifty‐eight CTC examinations were performed and an ECF was present in 70.1% and were more common with increasing age (P ≤ 0.01), but were not related to gender, or source of referral or the presence of colonic findings. Major ECFs were diagnosed in 8.9% of patients.

Conclusions: ECFs are more frequent with increasing age and although they are common, only a minority are of high significance.
Low‐osmolar monomeric versus iso‐osmolar dimeric contrast media: An intra‐individual comparison in CT angiography using an animal model
Authors: Behrendt Florian F , Pietsch Hubertus , Jost Gregor , Keil Sebastian , Mottaghy Felix M , Günther Rolf W , Mahnken Andreas H
Published: April 2011

Introduction: The aim of this study was to compare intra‐individual contrast enhancement in multidetector‐row computed tomography using the low‐osmolar monomeric iopromide 300 and the iso‐osmolar dimeric iodixanol 320.

Methods: Repeated computed tomography scanning of the chest of five pigs was performed under standardised conditions using iopromide 300 (300 mg I/mL) and iodixanol 320 (320 mg I/mL) with an identical iodine delivery rate of 1.5 g I/sec and a total iodine dose of 300 mg/kg body weight. Time‐enhancement curves were computed, and pulmonary and aortic peak enhancement, time‐to‐peak and plateau time above 300 Hounsfield units (HU) were analysed.

Results: Intra‐individual comparison revealed no statistically significant differences in contrast enhancement between the iopromide 300 and iodixanol 320 in the pulmonary artery and the aorta (620 vs 552 HU; P = 0.13). There was no significant difference between the two CM in the plateau time at the pulmonary artery and the aorta (P = 0.75 and P = 0.24, respectively). Aortic peak time was significantly earlier with iopromide 300 than with iodixanol 320 (P = 0.004).

Conclusions: Low‐osmolar monomeric and iso‐osmolar dimeric CM provide a similar and suitable vascular contrast enhancement.
Computed tomography characteristics of hepatic and splenic abscesses associated with melioidosis: A 7‐year study
Authors: Apisarnthanarak Piyaporn , Thairatananon Atita , Muangsomboon Kobkun , Lu David SK , Mundy Linda M , Apisarnthanarak Anucha
Published: April 2011

Purpose: This study aimed to characterise the CT findings associated with hepatic and splenic melioid abscesses.

Methods: Patients with CT evidence of hepatic and/or splenic abscesses were retrospectively evaluated for clinical evidence of melioidosis over a 7‐year period. After blinded review of the CT characteristics of intra‐abdominal abscesses (IAA), we conducted a stratified analysis of patients with and without melioid IAA.

Results: Among 49 patients with CT evidence of hepatic and/or splenic IAA, the mean age was 50.2 years, 22 (44.9%) were women and eight (16.3%) had laboratory confirmation of melioidosis. For the 113 IAA, 33 were melioid abscesses (15 liver and 18 spleen) and 80 were non‐melioid abscesses (69 liver and 11 spleen). Splenic IAA were more common in the melioid group (P = 0.001) and smaller in diameter than the hepatic IAA (P < 0.001). Melioid IAA were smaller than non‐melioid IAA (P < 0.001) and the CT necklace sign was the strongest predictor for melioid IAA (odds ratio = 24.6, P = 0.006) with 100% specificity. Other significant predictors for melioidosis were concurrent hepatic and splenic involvement (P = 0.009), multiple abscesses (P = 0.015) and residence in an endemic area (P = 0.047). By multivariate analysis, concurrent hepatic and splenic involvement was the sole predictor of melioidosis (adjusted odds ratio = 11.3, 95% confidence interval = 1.6–77.5, P = 0.014).

Conclusion: The CT necklace sign, along with concurrent hepatic and splenic IAA, were highly suggestive of melioidosis in persons from Central Thailand.
Constructive interference in steady‐state/FIESTA‐C clinical applications in neuroimaging
Authors: Kulkami Makarand
Published: April 2011

High spatial resolution is one of the major problems in neuroimaging, particularly in cranial and spinal nerve imaging. Constructive interference in steady‐state/fast imaging employing steady‐state acquisition with phase cycling is a robust sequence in imaging the cranial and spinal nerve pathologies. This pictorial review is a concise article about the applications of this sequence in neuroimaging with clinical examples.
The utility of PET/CT in staging and assessment of treatment response of nasopharyngeal cancer
Authors: Law Alastair , Peters Lester J , Dutu Gaelle , Rischin Danny , Lau Eddie , Drummond Elizabeth , Corry June
Published: April 2011

Introduction: The aim of this study was to evaluate the impact of positron emission tomography/computerised tomography (PET/CT) as an adjunct to conventional imaging (CI) in the management of nasopharyngeal cancer (NPC) both for initial staging and assessment of post‐treatment response.

Methods: All NPC cases referred to the Peter MacCallum Centre for Metabolic Imaging between January 2002 and December 2007 were identified.

In patients undergoing initial staging, any differences between the pre‐PET/CT management plan based on CI and that following performance of the PET/CT scan were noted. Clinical impact was scored using the Centre's published criteria: 'high' if PET/CT changed the primary treatment modality or intent, ‘medium’ if treatment modality was unchanged but the radiotherapy technique or dose was altered, and ‘low’ if there was no change in treatment modality or intent.

Patients undergoing PET/CT following definitive treatment were scored according to whether or not they achieved a complete metabolic response.

Results: Forty‐eight patients underwent a staging PET/CT. The clinical impact was high in 8%, medium in 25% and low in 66% of patients. Twenty‐one patients were scanned for post‐treatment response. PET/CT was less frequently equivocal than MRI (3 vs 8/21). A complete metabolic response on PET/CT was associated with a 93% negative predictive value for subsequent recurrence.

Conclusion: PET/CT is a valuable staging tool for the detection of occult metastatic disease and defining the extent of neck nodal disease. Post‐treatment, a complete metabolic response on PET/CT has a very high negative predictive value with fewer equivocal results than MRI.
Treatment of regional cutaneous nodular metastases from melanoma using high‐dose rate mould brachytherapy
Authors: Chaudhuri Anupam , De‐Groot Charles , Seel Matthew , Jolly Mike , Cameron Tina
Published: April 2011

Introduction: The involvement of a wide body surface area by regional cutaneous nodular metastases (RCNM) from melanoma poses a significant therapeutic challenge. We report our experience from Waikato Hospital, Hamilton, New Zealand in successfully treating this condition with high‐dose rate (HDR) surface mould brachytherapy (BT).

Methods: We analysed six patients who had surgery and then developed RCNM, which was treated in our department by HDR mould BT using Iridium 192. Five out of six patients were treated with a dose of 30 Gy in five fractions to wide field with a further 6 Gy boost to tumour nodules. Our first patient received a higher dose of 36 Gy in six fractions followed by 6 Gy boost to tumour nodules.

Results: All patients experienced a complete response (CR). Median follow up was 23 months and side effects were minimal, only Radiation Therapy Oncology Group (RTOG) grade I/II early and late toxicity. To date, no in‐field recurrence has been observed. Two patients died from metastatic disease at 33 and 34 months of follow up.

Conclusion: There was a CR in all cases without in‐field recurrence. To our knowledge, this is the first reported experience in treating skin melanoma with a BT surface mould. We recommend that BT surface mould should be considered when treating patients with RCNM.
Larynx preservation with primary non‐surgical treatment for loco‐regionally advanced larynx cancer
Authors: Corry June , Rischin Danny , Cotton Sue , D'Costa Ieta , Chua Margaret , Vallance Neil , Lyons Bernard , Kleid Stephen , Sizeland Andrew , Peters Lester J
Published: April 2011

Introduction: The objective of this paper was to review the results of primary non‐surgical treatment with the aim of larynx preservation for loco‐regionally advanced larynx cancer (LALC).

Methods: All patients with LALC presenting between January 2002 and December 2006 who were selected for primary non‐surgical treatment were included in this study.

Results: There were 60 patients, 48% with stage III and 52% with stage IV disease. The median follow‐up of living patients was 41 months. Larynx preservation with local disease control was achieved in 83% and 77% of patients at 3 and 5 years, respectively. Failure‐free survival at 3 and 5 years was 66% and 59%, respectively, and overall survival was 67% and 45%, respectively. All patients with larynx preservation had a functional voice. Two patients became feeding tube dependant. Thirty‐nine percent of all deaths were unrelated to LALC.

Conclusions: Primary non‐surgical treatment achieves high rates of larynx preservation with a low rate of severe complications but overall survival remains disappointing.
Use of prechemotherapy positron emission tomography‐CT imaging, acquired in the treatment position, to help plan involved nodal radiotherapy for a patient with diffuse large B‐cell lymphoma
Authors: David Steven P , Rees Heather S , MacManus Michael P
Published: April 2011

Fused positron emission tomography/computed tomography (PET‐CT) images are increasingly being used to assist radiation oncologists in the definition of treatment volumes for patients with metabolically active tumours. This is the first report in which baseline fluorodeoxyglucose‐PET‐CT images were acquired in the treatment position in a case of diffuse large B‐cell lymphoma and incorporated directly into the radiotherapy treatment planning process. It highlights the potential benefits of using combined 3‐D functional and structural imaging for the design of radiation target volumes in patients with aggressive lymphomas that are managed with combined chemo and radiotherapy.
Outcomes of Locking Plates in Proximal Humeral Fractures: A Systematic Review
Authors: Dheerendra Sujay K. , Khan Wasim S. , Barber Julie , Goddard Nicholas J. , Ahrens Philip M.
Published: April 2011

A systematic review of the clinical and radiological outcomes of locking plates in proximal humeral fractures in the current English literature was performed using Medline, CINAHL, AMED and EMBASE electronic databases to July 2009 via Ovid. There were 1266 proximal humeral fractures included in the review. The mean age of the patients was 61.7 years and there were 70.3% women. Based on the Neer classification, the review included 27% two-part, 39.5% three-part and 23.6% four-part fractures. At final follow-up, the Constant score was in the range 59 to 80, and the Disabilities of the Arm, Shoulder and Hand scores were in the range 15.2 to 51.8. The most frequent postoperative complication described was intra-articular screw perforation in 8.5% of fractures. Other complications included avascular necrosis (5.1%), subacromial impingement (3.1%), loss of reduction (3.7%) and implant failure (3.15%). Unplanned secondary surgical procedures were undertaken in 14.2% of cases. This systematic review has demonstrated that locking plate systems are suitable for stabilizing proximal humeral fractures. The current evidence base presents a number of methodological weaknesses and randomized controlled trials at independent centres reporting long-term results are required to compare locking plate systems with alternative fixation techniques used in the treatment of proximal humeral fractures.
Ten Questions on the Surgical Management of Complex Intra-Articular Fractures of the Distal Humerus
Authors: Amirfeyz Rouin , Hughes Andrew , Stanley David
Published: April 2011

Intra-articular fractures of the distal humerus are complex uncommon injuries. The management of these fractures has developed significantly over the last four decades with research into conservative and operative management, as well as biomechanical studies testing various methods of fixation. There is still a debate over the most appropriate method of surgical fixation, although most trauma surgeons agree that, when it is possible to internally fix, the goal of treatment must be accurate anatomic restoration and stable fixation to allow early range of motion.
An Interesting Cause of Acute Elbow Pain
Authors: Smith Elizabeth J.
Published: April 2011

This case report describes the case of a 59-year-old man who presented to the fracture clinic with an acutely swollen and painful elbow with a reduced range of movement. An X-ray demonstrated fracture of an olecranon exostosis.
Falling from the Tightrope: Double versus Single Tightropes in Patients with Acromioclavicular Joint Dislocations: Technique and Complications
Authors: Tsiouri Chrysi , Pan Yong-Wei , Mok Daniel
Published: April 2011

Background

We welcomed the innovative arthroscopic stabilization of the acromioclavicular joint dislocations with the Tightrope as it seemed promising regarding results and rehabilitation however our results were not satisfactory.

Materials and Methods

We clinically and radiographically reviewed the first thirty one consecutive patients treated with this method and analysed their scores in search of correlations between results and patient, injury or surgery factors.

Results

We had 19% failure rate that was not statistically correlated with any factors.

Conclusion

We believe the Tightrope alone is not adequate to stabilize the acromioclavicular joint as it does not address the acromioclavicular ligament and the instability at the anteroposterior plane.
Two-Screw, Arthroscopic Fixation of Os Acromiale Compared to a Similar, Open Procedure Incorporating a Tension Band: A Laboratory Study
Authors: Kummer Frederick J. , Van Gelderen Jeffrey , Meislin Robert J.
Published: April 2011

Background

A common treatment for symptomatic os acromiale is open fixation using two lag screws with a tension band. In several patients, we have used two screws alone inserted arthroscopically and posited that they would achieve equivalent fixation stability.

Methods

Twelve matched pairs of cadaver acromions had a simulated non-union created and were fixed with two cannulated lag screws. Six pairs used a Fiberwire (Arthrex, Naples, FL, USA) tension band in one of each pair; the other six pairs similarly used a stainless steel wire tension band. Specimens were mechanically loaded in a variety of modes to determine fixation stability.

Results

Neither of the tension band constructs demonstrated significantly stiffer or stronger fixations in the testing modes than the screws alone.

Conclusion

An arthroscopic fixation of os acromiale with two screws appears justified.
Stemless Shoulder Replacement, the Best of Both Worlds: A Personal View
Authors: Bunker Tim
Published: April 2011

Two decades of rapid advances in basic knowledge, industrial technology and surgical skill have made shoulder replacement a predictable, safe and successful operation. This article looks to pass on some of these advances in our understanding of anatomy, pathology, surgical approaches and releases. It looks at contentious issues such as the hemi versus total shoulder debate, the stemmed, surface and stemless debate, the issues of DVT prophylaxis and prophylaxis against infection. Finally the article makes the plea that shoulders are different from hips and knees and that long term results depend more upon cuff function than prosthetic failure.
Restoration of Medial Hinge in Acute Complex Proximal Humeral Fractures using Intra-Medullary Strut Allograft
Authors: Karthik Karuppaiah , Khunda Aiman , Kamath Vijay , Rangan Amar
Published: April 2011

Background

Proximal humerus fractures with medial column comminution/collapse often pose management dilemmas to the treating surgeon. Medial column mechanical support of these fractures plays a significant role in the ultimate stability of fixation until healing.

Methods

Twelve patients (four men and eight women) with unstable proximal humerus fractures were taken up for study. The fractures were stabilized with intramedullary strut allograft and locking plate (PHILOS) by a deltoid splitting approach. The outcome was assessed clinically by Oxford Shoulder Score and radiologically by measuring the head shaft angle at follow-up.

Results

The mean age of the patients was 65 years (range 54 years to 72 years) with the dominant arm affected in nine. All fractures progressed to union at an average of 4 months and 15 days (3 months to 11 months). At final follow-up (average 29.7 months), all patients had good functional outcome, with an average Oxford Shoulder Score of 19.2 (12 to 32). The average loss of head shaft angle was 6° (0° to 8°).

Conclusion

The technique has potential technical advantages in the management of proximal humeral fractures with medial column comminution/collapse. The rate of union has been encouraging and we recommend it as a method of treatment.