bluuebunny/crossref_metadata_2025 huggingface dataset:
Acquired coagulation disorders: revisited using global coagulation/anticoagulation testing
Authors: Tripodi Armando , Chantarangkul Veena , Mannucci Pier M.
Published: July 2009

Acquired coagulation defects are characterized by a decrease of both pro‐ and anti‐coagulants. Because of this, we hypothesise that global tests, such as the prothrombin and partial thromboplastin times (PT and APTT), might be unsuitable for their investigation. Indeed, these tests are not good predictors of bleeding in acquired coagulopathies as they are in the congenital ones. This article discusses the possible reasons for this, using cirrhosis and the neonatal period as epitomes of acquired coagulation defects. Both display normal thrombin generation in the presence of thrombomodulin, in spite of prolonged PT and APTT. We surmise that, because of their design, the PT and APTT are responsive to thrombin generated as a function of pro‐coagulants, but much less to thrombin inhibited by the anti‐coagulants, especially protein C, which is activated to a limited extent in the absence of thrombomodulin. In conclusion, the PT and APTT can tell us whether or not a patient is deficient in one or more pro‐coagulants, but not whether this deficiency is counterbalanced by a parallel deficiency of anti‐coagulants. Thrombin generation assays are more suitable than PT and APTT for use in acquired coagulation defects.
Soil reflectance as a generic tool for assessing infiltration rate induced by structural crust for heterogeneous soils
Authors: Goldshleger N. , Ben‐Dor E. , Chudnovsky A. , Agassi M.
Published: July 2009

Raindrop energy disintegrates soil aggregates and rearranges soil particles to form a structural crust on the upper soil layer. The structural crust affects the physical properties of the soil, which can be observed by significant colour changes on the soil surface. Spectral differences observed in the structural crust are caused by rearrangement of the soil surface texture, mainly an increase in the clay fraction. Previous studies conducted on crusted soils using reflectance spectroscopy were limited to a certain soil type or area and seemed to be strongly dependent on the small range of soil types. In the current study, the influence of raindrop energy on the NIR‐SWIR spectral reflectance (1200–2400 nm) of heterogeneous soils was evaluated and used in combination with partial least squares (PLS) regression to construct a model that correlates the infiltration rate (IR) with its reflectance. Four soils from Israel and three soils from the USA were studied to provide a single data set. A relatively small root mean square error of cross‐validation (RMSECV) of 15.2% was found. A ratio of prediction to deviation (RPD) value of 1.98 indicates a promising generic model. Additionally, PLS models were run on different combinations of soil types (RPD values ranging between 2.4 and 3.2). For all models, whether all soils were run in one cross‐validation data set, or run for different combinations of soils, the best assessment of IR was achieved when using reduced wavelength range (selected wavelengths based on Martens’ significance test selection). These results allowed us to conclude that a generic approach aimed at assessing the structural crust for a variety of soils is feasible. A generic model using the suggested spectral approach has the potential to provide NIR‐SWIR spectral soil IR predictions with either a local or global data base of soils worldwide and may contribute to improved protection of crusted soils from erosion or water loss by runoff.
Century‐scale records of coral growth rates indicate that local stressors reduce coral thermal tolerance threshold
Authors: CARILLI JESSICA E. , NORRIS RICHARD D. , BLACK BRYAN , WALSH SHEILA M. , McFIELD MELANIE
Published: July 2009

Coral bleaching, during which corals lose their symbiotic dinoflagellates, appears to be increasing in frequency and geographic extent, and is typically associated with abnormally high water temperatures and solar irradiance. A key question in coral reef ecology is whether local stressors reduce the coral thermal tolerance threshold, leading to increased bleaching incidence. Using tree‐ring techniques, we produced master chronologies of growth rates in the dominant reef builder, massive Montastraea faveolata corals, over the past 75–150 years from the Mesoamerican Reef. Our records indicate that the 1998 mass bleaching event was unprecedented in the past century, despite evidence that water temperatures and solar irradiance in the region were as high or higher mid‐century than in more recent decades. We tested the influence on coral extension rate from the interactive effects of human populations and thermal stress, calculated here with degree‐heating‐months (DHM). We find that when the effects of chronic local stressors, represented by human population, are taken into account, recent reductions in extension rate are better explained than when DHM is used as the sole predictor. Therefore, the occurrence of mass bleaching on the Mesoamerican reef in 1998 appears to stem from reduced thermal tolerance due to the synergistic impacts of chronic local stressors.
Serrated polyps of the large intestine: a molecular study comparing sessile serrated adenomas and hyperplastic polyps
Authors: Sandmeier Dominique , Benhattar Jean , Martin Patricia , Bouzourene Hanifa
Published: July 2009

Aims:  To compare the molecular profile of a series of sessile serrated adenomas (SSAs) and hyperplastic polyps (HPs), in order to distinguish these lesions, SSAs having a potential role in the genesis of serrated adenocarcinomas through a serrated pathway in which methylation plays a key role.

Methods and results:  Twelve HPs and sixteen SSAs of the right and left colon were investigated for microsatellite instability, DNA mismatch repair genes, p53, p16, and β‐catenin expression, MLH1 and p16 (CDKN2A) gene methylation, and KRAS and BRAF mutations. Both SSAs and HPs were microsatellite stable. MLH1 and MSH2 protein silencing, aberrant cytoplasmic expression and methylation of p16 were found to be exclusive to right‐sided SSAs. The MLH1 promoter gene was frequently methylated in right‐sided SSAs in contrast with HPs. Abnormal p53 and β‐catenin expression was present in both SSAs and HPs. BRAF and KRAS mutation were mutually exclusive, but KRAS mutation was present only in left‐sided SSAs and HPs.

Conclusions:  HPs and SSAs may be related lesions. However, at least right‐sided SSAs differ from left‐sided SSAs and HPs in the occurrence of MLH1 and p16 methylation, supporting the hypothesis that SSAs could be precursors of serrated adenocarcinomas.
The routine use of histochemical stains in gastrointestinal pathology: a UK‐wide survey
Authors: Koenig Michael , Schofield John B , Warren Bryan F , Shepherd Neil A
Published: July 2009

Aims:  A survey was conducted into the routine use of special stains on gastrointestinal (GI) biopsy specimens in histopathology departments within the National Health Service. The aim was to compare the sole use of haematoxylin and eosin (H&E) staining with the use of H&E and special stains, according to the biopsy site.

Methods and results:  One hundred and sixty‐seven histopathology departments in the UK were contacted using an e‐mail questionnaire. Valid return rate was 55%. Sixty‐eight percent of departments employ H&E only for oesophageal biopsy specimens. Gastric specimens are stained using only H&E in 47% of departments and 53% use H&E combined with special stains. Duodenal, small and large bowel biopsy specimens are mostly stained with H&E.

Conclusions:  The results show that the routine use of special stains in GI pathology in the UK is highly variable, especially for oesophageal and gastric biopsy specimens. The literature indicates that special stains in GI specimens can enhance sensitivity and specificity for the detection of pathological abnormalities, especially metaplasia and infections. The diversity of staining practice highlights the need to provide robust and evidence‐based guidelines for the routine use of special stains to ensure universal best practice.
Genetic diversity of European cattle breeds highlights the conservation value of traditional unselected breeds with high effective population size
Authors: MEDUGORAC IVICA , MEDUGORAC ANA , RUSS INGOLF , VEIT‐KENSCH CLAUDIA E. , TABERLET PIERRE , LUNTZ BERNHARD , MIX HENRY M. , FÖRSTER MARTIN
Published: July 2009

In times of rapid global and unforeseeable environmental changes, there is an urgent need for a sustainable cattle breeding policy, based on a global view. Most of the indigenous breeds are specialized in a particular habitat or production system but are rapidly disappearing. Thus, they represent an important resource to meet present and future breeding objectives. Based on 105 microsatellites, we obtained thorough information on genetic diversity and population structure of 16 cattle breeds that cover a geographical area from the domestication centre near Anatolia, through the Balkan and alpine regions, to the North‐West of Europe. Breeds under strict artificial selection and indigenous breeds under traditional breeding schemes were included. The overall results showed that the genetic diversity is widespread in Buša breeds in the Anatolian and Balkan areas, when compared with the alpine and north‐western European breeds. Our results reflect long‐term evolutionary and short‐term breeding events very well. The regular pattern of allele frequency distribution in the entire cattle population studied clearly suggests conservation of rare alleles by conservation of preferably unselected traditional breeds with large effective population sizes. From a global and long‐term conservation genetics point of view, the native and highly variable breeds closer to the domestication centre could serve as valuable sources of genes for future needs, not only for cattle but also for other farm animals.
Long‐term natal site‐fidelity by immature lemon sharks (Negaprion brevirostris) at a subtropical island
Authors: CHAPMAN DEMIAN D. , BABCOCK ELIZABETH A. , GRUBER SAMUEL H. , DIBATTISTA JOSEPH D. , FRANKS BRYAN R. , KESSEL STEVEN A. , GUTTRIDGE TRISTAN , PIKITCH ELLEN K. , FELDHEIM KEVIN A.
Published: July 2009

Although many sharks begin their life confined in nursery habitats, it is unknown how rapidly they disperse away from their natal area once they leave the nursery. We examine this issue in immature lemon sharks (Negaprion brevirostris) from the time they leave the nursery (∼ age 3) at a subtropical island (Bimini, Bahamas), through to the onset of sexual maturity (∼ age 12). From 1995 to 2007 we tagged and genotyped a large fraction of the nursery‐bound sharks at this location (0–3 years of age, N = 1776 individuals). From 2003 to 2007 we sampled immature sharks aged from 3 to 11 years (N = 150) living around the island and used physical/genetic tag recaptures coupled with kinship analysis to determine whether or not each of these ‘large immature sharks’ was locally born. We show that many island‐born lemon sharks remain close to their natal area for long periods (years) after leaving the nursery; more than half of the sampled sharks up to 135 cm total length (∼6 years old) were locally born. The fraction of locally born sharks gradually declined with increasing shark size, indicating that dispersal is relatively slow and does not primarily occur after sharks reach a threshold size. Local conservation measures (e.g. localized fishery closures, marine protected areas) can therefore help protect island‐born lemon sharks even after they leave the nursery habitat.
Mating system variability in a mouthbrooding cichlid fish from a tropical lake
Authors: SEFC K. M. , HERMANN C. M. , KOBLMÜLLER S.
Published: July 2009

Intraspecific variability in mating behaviour and disparities between social and reproductive behaviour add complexity to the description of animal mating systems. A previously published field study on a population of the maternally mouthbrooding cichlid fish Ctenochromis horei in the north of Lake Tanganyika suggested mate monopolization by the most dominant male. In the present study, genetic reconstructions of paternity in a population in the south of the lake provided no evidence for male mate monopolization, as none of the inferred sires had offspring in more than one brood. The ability to reconstruct sire genotypes from offspring alleles was confirmed by computer simulations. Multiple paternity occurred in several broods and was significantly more frequent in the sample taken in the rainy season than in the dry season sample (100% of broods vs. 14%, respectively; P = 0.005). The data suggest geographical and temporal variation in the mating behaviour of C. horei despite its continuous year‐round reproduction, invariable brood care behaviour and habitat‐specific distribution in the relatively constant and confined environment of a tropical lake. Moreover, our data show that inferences on the distribution of male reproductive success, if based on each geographical or temporal data set alone, would fail to describe the potential for sexual selection in this species.
Factors influencing time to smear conversion in patients with smear‐positive pulmonary tuberculosis
Authors: WANG Jann‐Yuan , LEE Li‐Na , YU Chong‐Jen , CHIEN Yin‐Ju , YANG Pan‐Chyr ,   The Tami Group
Published: July 2009

Background and objective:  Persistent smear‐positivity in patients with pulmonary tuberculosis has been shown to predict an unfavourable outcome. This study was conducted to identify the factors influencing time to sputum smear conversion.

Methods:  From July 2003 to June 2007, all patients with smear‐positive and culture‐confirmed pulmonary tuberculosis, who had attended a medical centre and a local teaching hospital, were identified. Factors that might have influenced time to smear conversion were investigated using time‐to‐event analysis.

Results:  Altogether 305 patients (mean age: 58.6 years) were studied. Diabetes mellitus was the most common underlying comorbidity. Eight patients (2.6%) had AIDS. After 2 months of treatment, 34 (11.1%) patients remained smear‐ and culture‐positive. Cox proportional hazard regression analysis indicated that the presence of a cavity on CXR, smear grading and the first 2‐month treatment regimen were independent factors influencing the time to sputum smear conversion. Among patients who had received isoniazid in the first 2 months of treatment, the time to sputum smear conversion in the 24 patients whose isolate showed isoniazid resistance was not different from that in the 236 patients whose isolate was isoniazid‐susceptible (hazard ratio 1.061; 95% CI: 0.697–1.616).

Conclusions:  This analysis revealed that 11.1% of tuberculosis patients remained smear‐positive after 2 months of treatment. Patients with cavitation, higher smear grading and those who had not used isoniazid, rifampicin, ethambutol and pyrazinamide continuously in the initial treatment phase had a longer time to sputum smear conversion.
Urinary collecting system invasion in renal cell carcinoma: Incidence and long‐term prognosis
Authors: Schrader Andres Jan , Rustemeier Julia , Varga Zoltan , Hegele Axel , Olbert Peter Jochen , Frohme Carsten , Hofmann Rainer
Published: July 2009

Objectives:  Current data on the prognostic impact of urinary collecting system (UCS) invasion by renal cell carcinoma (RCC) are highly conflicting. The aim of the present study was to assess incidence and long‐term prognosis of RCC patients with and without UCS involvement.

Methods:  We evaluated 780 patients who had undergone renal surgery between 1990 and 2005. The mean follow‐up was 5.44 years.

Results:  Sixty‐seven patients (8.6%) demonstrated UCS invasion. These patients had a significant increase in the likelihood of cancer‐related death (hazard ratio [HR] 1.9, 95% confidence interval: 1.4–2.7; P = 0.001). Their median 5‐year tumor‐specific survival rate was 61%, as opposed to 79% for patients without UCS invasion (P = 0.001). UCS invasion was significantly associated with tumor stage, grade, clinical symptoms, lymph node and visceral metastasis at diagnosis, but not with age, gender, histologic subtype or body mass index. However, by means of multivariate analysis, UCS invasion was disqualified as an individual prognostic marker for RCC.

Conclusion:  We do not advocate the inclusion of UCS invasion into upcoming Tumor‐Nodes‐Metastasis staging systems. In contrast, future research should focus on the prognostic role of novel molecular tumor markers and/or specific immunological characteristics of RCC patients.
A perspective on the evolving science and practice of ecological restoration in Australia
Authors: McDonald Tein , Williams Jann
Published: July 2009

Summary  This brief review of the science and practice of ecological restoration and rehabilitation in Australia shows that, from small isolated efforts in the first half of the 20th century, substantial numbers of programmes are steadily emerging from natural area, agricultural landscape, mining and aquatic management sectors. With support from numerous research programmes in the last two decades, restoration and rehabilitation work is increasing in scale and ecological rigour; and researchers and practitioners are increasingly engaging with the international restoration discourse. Future improvements in prioritization, goal‐setting, monitoring, evaluation and communication are, however, still needed to improve Australia’s capacity to meet its increasingly serious environmental challenges and do its bit to reduce and halt global degradation.
Paddock trees, parrots and agricultural production: An urgent need for large‐scale, long‐term restoration in south‐eastern Australia
Authors: Manning Adrian D. , Lindenmayer David B.
Published: July 2009

Summary  Scattered trees, or ‘paddock trees’, are keystone structures, which provide multiple ecological values. However, they are in decline in many places. This has serious implications for species that use them, such as the vulnerable Superb Parrot (Polytelis swainsonii) of south‐eastern Australia. We outline three key aspects of the ecology, biology and distribution of the species that illustrate the implications of scattered tree decline. These are that (i) it depends on trees; (ii) it lives across agricultural landscapes; and (iii) it uses scattered tree landscapes dynamically in response to climate variation. We outline the dual challenge of maintaining populations of both scattered trees and the Superb Parrot over large scales and over the long term. Without urgent restoration action, a narrow bottleneck (where there are few mature trees) will make the long‐term future of the Superb Parrot precarious in these landscapes. We outline a vision for future landscapes that addresses this challenge, including the development of a form of Australian ‘wood‐pasture’. We suggest some ways that might be implemented at two scales. At the farm scale, we suggest (i) protecting what remnant vegetation we currently have; (ii) recruiting future large, old trees; (iii) sequentially setting aside land to ensure whole‐of‐farm tree regeneration; (iv) use of incentives to encourage restoration actions; and (v) using a revolving land fund to purchase and reorganize farms into economically and ecologically sustainable units. At the landscape scale, we suggest (i) the need for coordination of long‐term landscape restoration plans; (ii) the possible collaborative management of adjacent farms to ensure economic and ecological sustainability. We conclude that addressing the large‐scale and long‐term challenges of restoring scattered trees in landscapes occupied by the Superb Parrot could restore lost or diminished ecological services. This challenge illustrates the need for action at both the farm and the landscape scale that is planned over the short, medium and long term.
Peri‐operative management of anti‐platelet agents
Authors: Hermiz Samer , Larsen Peter , Galletly Duncan C. , Harding Scott A.
Published: July 2009

Background:  Increasing numbers of patients treated with anti‐platelet agents are presenting for non‐cardiac surgery. We examined the peri‐operative management of anti‐platelet therapy in patients undergoing elective non‐cardiac surgery and the process by which patients received instructions.

Methods:  We interviewed and collected outcome data on 213 consecutive patients aged ≥45 years presenting for elective non‐cardiac surgery at our institution over a 6‐week period regarding the peri‐operative management of anti‐platelet and warfarin therapy.

Results:  Anti‐platelet therapy was prescribed in 22.5% and warfarin in 5.2% of the study subjects. Aspirin was stopped peri‐operatively in 55.3%, while clopidogrel was stopped in the sole patient treated with this. The frequency of anti‐platelet agent discontinuation was similar for major and minor surgery. Warfarin was discontinued prior to surgery in all cases. Only 54.2% of those treated with anti‐platelet therapy recalled being given instruction regarding pre‐operative management of their anti‐platelet therapy compared with 90.9% of patients treated with warfarin (P= 0.04). In the absence of instructions, a number of patients made their own decision to stop their aspirin pre‐operatively. Post‐operatively, only 37% recalled receiving instructions regarding restarting anti‐platelet therapy. As a result, three patients failed to do so. In contrast, all those treated with warfarin received clear post‐operative instructions.

Conclusion:  Peri‐operative anti‐platelet management and communication with patients appears to be sub‐optimal. There is a need for standardized processes whereby informed decisions regarding peri‐operative anti‐platelet therapy are made and communicated clearly to the patients.
Quality of clinical notes for vascular surgery admissions: A CRABEL score review
Authors: Suh Jun , Roake Justin A. , Lewis David R.
Published: July 2009

Aim:  To compare the quality of patient notes between acute and elective admissions in vascular surgery.

Method:  Patient notes from the 50 most recent acute and elective admissions on a vascular surgical unit were reviewed using the CRABEL score. Points for quality of record keeping were awarded in four categories: Initial Clerking, Subsequent Entries, Consent and Discharge Summary. Total scores were calculated as a percentage. One hundred per cent represents the minimum quality standard expected. Overall CRABEL scores were compared for differences in the quality of note keeping between acute and elective admissions. Further analysis identified areas that need improvement.

Results:  The mean CRABEL score for acute admissions was 79.2% (77.0–81.3, 95% C.I.) compared to 81.3% (78.8–83.8, 95% C.I.) for elective admissions (t‐test P= n.s.). When the individual categories were analysed no statistically significant difference was observed between the two groups for ‘Subsequent Entries’ and ‘Consent’ sections (t‐test p= n.s.). ‘Initial Clerking’ category scored significantly better for elective 16.3 out of 20 (15.7–16.9, 95% C.I.) admissions compared to acute admissions 14.6 out of 20 (13.9–15.3, 95% C.I.), (t‐test P= 0.00063). ‘Discharge Summary’ section also scored significantly better for elective admissions 9.9 out of 10 (9.9–10.0, 95% C.I.) compared to acute admissions 9.6 out of 10 (9.3–9.9, 95% C.I.), (t‐test P= 0.040).

Conclusion:  There was no statistically significant difference in the overall quality of written patient notes between acute and elective admissions, however ‘Initial Clerking’ and ‘Discharge Summary’ were better documented for elective admissions. Both acute and elective admissions were observed to have substandard quality of record keeping.
Whole‐genome microarray analyses of Synechococcus–Vibrio interactions
Authors: Tai Vera , Paulsen Ian T. , Phillippy Katherine , Johnson D. Aaron , Palenik Brian
Published: July 2009

Microbes live in diverse communities yet their physiologies are typically studied in axenic culture. To begin to address this dichotomy, whole‐genome microarray analyses were used and revealed that several major metabolic pathways were affected in Synechococcus sp. WH8102, a model phototroph, when grown with Vibrio parahaemolyticus, a model heterotroph. In co‐cultures with V. parahaemolyticus, although phosphate was not depleted, Synechococcus sp. WH8102 may have experienced phosphate stress since the expression of phosphate acquisition genes increased and alkaline phosphatase activity was higher than in monocultures. Expression of cell wall synthesis genes and the components of a zinc transporter were also upregulated. In contrast, a ferric uptake regulation (Fur) family gene was downregulated as were genes that encode proteins rich in iron or involved in detoxifying oxygen radicals. Nitrogen use may also have been affected in co‐cultures as the gene expression changes share similarities with ammonia‐grown Synechococcus. This study demonstrates the multiple impacts that interspecific microbial interactions can have on the physiology of a major primary producer and the importance of investigating microbial physiology from a community perspective.
Bacterial, archaeal and eukaryal community structures throughout soil horizons of harvested and naturally disturbed forest stands
Authors: Hartmann Martin , Lee Sangwon , Hallam Steven J. , Mohn William W.
Published: July 2009

Disturbances caused by timber harvesting have critical long‐term effects on the forest soil microbiota and alter fundamental ecosystem services provided by these communities. This study assessed the effects of organic matter removal and soil compaction on microbial community structures in different soil horizons 13 years after timber harvesting at the long‐term soil productivity site at Skulow Lake, British Columbia. A harvested stand was compared with an unmanaged forest stand. Ribosomal intergenic spacer profiles of bacteria, archaea and eukarya indicated significantly different community structures in the upper three soil horizons of the two stands, with differences decreasing with depth. Large‐scale sequencing of the ribosomal intergenic spacers coupled to small‐subunit ribosomal RNA genes allowed taxonomic identification of major microbial phylotypes affected by harvesting or varying among soil horizons. Actinobacteria and Gemmatimonadetes were the predominant phylotypes in the bacterial profiles, with the relative abundance of these groups highest in the unmanaged stand, particularly in the deeper soil horizons. Predominant eukaryal phylotypes were mainly assigned to known mycorrhizal and saprotrophic species of Basidiomycetes and Ascomycetes. Harvesting affected Basidiomycetes to a minor degree but had stronger effects on some Ascomycetes. Archaeal profiles had low diversity with only a few predominant crenarchaeal phylotypes whose abundance appeared to increase with depth. Detection of these effects 13 years after harvesting may indicate a long‐term change in processes mediated by the microbial community with important consequences for forest productivity. These effects warrant more comprehensive investigation of the effects of harvesting on the structure of forest soil microbial communities and the functional consequences.
Molecular taxonomy and phylogeny of the Geodiidae (Porifera, Demospongiae, Astrophorida) – combining phylogenetic and Linnaean classification
Authors: Cárdenas Paco , Rapp Hans Tore , Schander Christoffer , Tendal Ole S.
Published: July 2009

Cárdenas, P., Rapp, H. T., Schander, C. & Tendal, O. S. (2009). Molecular taxonomy and phylogeny of the Geodiidae (Porifera, Demospongiae, Astrophorida) – combining phylogenetic and Linnaean classification.—Zoologica Scripta, 39, 89–106.

According to the fossil records, the Geodiidae represents one of the oldest families of demosponges (Phylum Porifera). There are approximately 220 described extant species, geographically and bathymetrically widely distributed around the world. Species of this family all share a two‐layered cortex with ball‐shaped spicules called ‘sterrasters’ in the endocortex. However, molecular studies have questioned the monophyly of the group. Moreover, the evolutionary history and the intrafamily relationships of the Geodiidae are not fully resolved. Using a partial sequence of the cytochrome c oxidase subunit 1 (COI) gene and a partial sequence of the 28S rDNA gene (D1–D2 domains), we present the first molecular phylogeny focusing on this group. The congruent results from the two gene fragments suggest that (i) the Geodiidae is monophyletic, (ii) the Erylinae/Geodinae subdivision sensuSollas, 1888 is valid and that (iii) Isops and Sidonops are junior synonyms of Geodia. The synonymization of Isops and Sidonops implies that the oscule/pore morphology as a diagnostic character should be abandoned. Geodia hentscheli nom. nov. has been given for Geodia mesotriaena (Hentschel, 1929). This study served as the basis for a revised phylogenetic classification of the Geodiidae. Well‐supported clades led to the establishment of clade names following the PhyloCode. The Geodinae clade is strongly supported and notably composed of Depressiogeodia, Cydonium and Geodia. A morphological synapomorphy of Geodinae is the presence of euasters in the ectocortex. The Erylinae (Erylus, Penares, Caminus and Pachymatisma) form a strongly supported monophyletic group with three morphological synapomorphies: (i) loss of anatriaenes and protriaenes, (ii) microrhabds (or spherules) in the ectocortex and (iii) short‐shafted triaenes. The Erylus monophyly is ambiguous. Erylus species are distributed in three well‐supported clades. Finally, spicule homology in the cortex of the Geodiidae is discussed.
p53 expression in patients with advanced urothelial cancer of the urinary bladder
Authors: Shariat Shahrokh F. , Bolenz Christian , Karakiewicz Pierre I. , Fradet Yves , Ashfaq Raheela , Bastian Patrick J. , Nielsen Matthew E. , Capitanio Umberto , Jeldres Claudio , Rigaud Jérôme , Müller Stefan C. , Lerner Seth P. , Montorsi Francesco , Sagalowsky Arthur I. , Cote Richard J. , Lotan Yair
Published: July 2009

Study Type – Prognosis (inception cohort)  Level of Evidence 1b

OBJECTIVE

To test whether assessing p53 expression could improve the ability to predict disease recurrence and disease‐specific survival in a multi‐institutional cohort of patients with advanced urothelial carcinoma of the urinary bladder (UCB).

PATIENTS AND METHODS

The study comprised 692 patients with pT3–4 N0 or pTany N+ UCB treated with radical cystectomy and lymphadenectomy. The predictive accuracy (PA) was quantified using the 200 bootstrap‐corrected concordance index. The base model comprised age, gender, stage, grade, lymphovascular invasion, number of lymph nodes removed, number of lymph nodes positive, concomitant carcinoma in situ, and adjuvant chemotherapy.

RESULTS

p53 expression was altered in 341 (49.3%) patients. In multivariable analyses, p53 expression was independently associated with disease recurrence (hazard ratio, 1.66; P < 0.001) and cancer‐specific mortality (hazard ratio 1.65, P < 0.001). Overall, adding p53 did not significantly improve the PA of the base model (recurrence +0.7%, P = 0.085, and cancer‐specific mortality +1.2%, P = 0.050). In the subgroups of pT3N0 (280) and pT4N0 (83) patients, p53 slightly improved the PA of the base model by a statistically significant degree (recurrence +1.7% and +3.6%, respectively; cancer‐specific mortality +1.9% and +3.5%, respectively; all P < 0.001). In 329 patients with pTany N+ disease p53 status did not improve the PA of the base model.

CONCLUSION

While assessing p53 expression has limited utility in patients with lymph node‐positive UCB, it marginally improves prognostication in patients with advanced non‐metastatic UCB. Integration of p53 into a panel of biomarkers might be necessary to capture a more accurate picture of the biological potential of advanced UCB.
Young Diabetics: Memories, Current Lifestyles and Attitudes
Authors: Mok J. Y. K. , Laing I. A. , Farquhar J. W.
Published: July 2009

Eighty‐six subjects aged 22.3 ± 2.3 years (mean ± S.D.), who attended one clinic as diabetic children, filled in a questionnaire designed to evaluate their present health and lifestyles, as well as discover their childhood memories. About two‐thirds (66.3%) had unhappy recollections particularly of such irritating routines as urine testing, injections, and special food programmes. Only 6% complained that future complications were not discussed with the child at the appropriate time, but with the exception of blindness, childhood knowledge of diabetic complications was poor.

Around two‐thirds (66.4%) left school with some examination result; 44.2% went into further education, while 19.8% entered into a trade. These attainments were comparable to those of local school leavers. As young diabetic adults, 62.8% were employed; 22.1% were students or housewives with no other occupations.
Evaluation of Visidex II—A New Strip for Blood Glucose Measurement
Authors: Hutchison A. S. , Boal Ann B. , MacCuish A. C.
Published: July 2009

We have evaluated a new blood glucose test‐strip (Visidex II, Ames), which does not require washing with water after contact with blood. Visidex II showed a significant negative bias when compared with a similar diagnostic strip (BM 20–800, Boehringer) and with the Beckman II glucose analyser (p<0.001 in both cases), and a poorer correlation with either method than BM strips with the Beckman II. A significant number (6.3%) of Visidex strips in this study were unreadable due to removal of the colour pads on blotting, and some difficulty was reported by patients in reading values around 6–8 mmol/l. Visidex II can safely be stored in the refrigerator and developed strips may be stable longer than BM strips. A significant error in reading was noted if the incubation time was varied by ± 5 seconds. Further experience and perhaps some modifications may be necessary before Visidex II can be recommended for widespread use.
Prevalence of Morning Hyperglycaemia: Determinants of Fasting Blood Glucose Concentrations in Insulin‐treated Diabetics
Authors: Francis A. J. , Home P. D. , Walford S. , Alberti K. G. M. M. , Mann N. , Reeves W. G.
Published: July 2009

A rise in blood glucose concentration at the end of the night, and consequent morning hyperglycaemia, are well recognized events in some diabetic patients. In 94 patients on twice daily insulin injections we have examined the prevalence and extent of morning hyperglycaemia, and its relation to control, insulin therapy, and insulin antibody levels. Blood glucose reached the highest level of the day before or after breakfast in 83% of patients, and in 50% this value was 2 mmol/l greater than any other time of day. Patients with higher fasting concentrations did not have worse blood glucose control over the rest of the day. No correlation was found between fasting blood glucose concentrations and the evening dose of intermediate acting insulin or the level of insulin antibodies. No consistent change in fasting blood glucose concentrations occurred with changes in antibody levels in patients switched between pork and beef insulin. Morning hyperglycaemia was as common with both insulin species.

Pre‐ and post‐breakfast hyperglycaemia is common and significant in insulin‐treated diabetic patients. It is not directly related to diabetic control at other times of the day, and is independent of insulin species and insulin antibody levels.
Prevalence of Hypertension in White, Black and Asian Diabetics in a District Hospital Diabetic Clinic
Authors: Pacy P. J. , Dodson P. M. , Beevers M. , Fletcher R. F. , Taylor K. G.
Published: July 2009

In a District General Hospital Diabetic Clinic 40.0% of a random sample of diabetics under the age of 65 years of age were hypertensive. Black patients (48.9%) had greater (p < 0.05) prevalence of hypertension than Whites (37.5%) and Asians (35.4%). Hypertension was more prevalent in females (49.1%) than males (33.0%) (p < 0.001) in each ethnic group except Asians, and patients not receiving insulin had greater prevalence (45.6%) than those on insulin (30.7%) (p < 0.001), except black diabetics where the reverse was found. There was a positive relationship between age and systolic (p < 0.00001) and diastolic blood pressure (p < 0.00001) and a negative association between duration of diabetes and diastolic blood pressure (p < 0.004) on multiple regression analysis but no relationship was noted between blood pressure and either weight or blood glucose.

Forty‐six percent of all hypertensives were receiving conventional anti‐hypertensive drug therapy; 38.7% were normotensive with similar results in each ethnic group and between the sexes. Isolated systolic hypertension was the commonest form of hypertension (48.3%) with isolated diastolic hypertension (4.9%) the rarest. These findings were observed regardless of the ethnic group or gender.

Although in the majority of cases hypertension was mild these data confirm the importance of routine blood pressure measurement in diabetic patients.
Different Glycaemic Responses to Pasta, Bread, and Potatoes in Diabetic Patients
Authors: Parillo M. , Giacco R. , Riccardi G. , Pacioni D. , Rivellese A.
Published: July 2009

To evaluate whether the same amount of carbohydrate (CHO) in different foods gives different glycaemic responses when consumed in the context of a real meal, seven diabetic patients were given in a random order and on alternate days three test meals of identical composition. Each meal consisted of a fixed part to which a 50 g CHO portion of either bread (90 g) or spaghetti (65 g) or potatoes (285 g) was added. The glycaemic response was significantly higher after ingestion of bread than after the spaghetti meal both at 2 (5.9±0.8 vs 4.3±0.7 mmol/lxhour, p<0.05) and at 5 hours (16.5±3.6 vs 9.8±2.3 mmol/lxhour, p<0.05). The glycaemic response to the potato meal was similar to that for bread at 2 hours (6.2±1.2 mmol/lxhour, p<0.05 vs spaghetti) and intermediate between the two other test meals at 5 hours (14.6±4.3 mmol/lxhour). Meal planning for diabetic patients should be based not only on the biochemical properties but also on the glycaemic response to the food.
Delayed Diagnosis of Non‐insulin‐dependent Diabetes is Associated with Greater Metabolic and Clinical Abnormality
Authors: Hillson R. M. , Hockaday T. D. R. , Newton D. J. , Pim B.
Published: July 2009

Seventy‐seven per cent of 235 newly diagnosed and untreated patients with diabetes mellitus were polysymptomatic at their first visit to hospital. The larger the number of typical symptoms, the greater was the duration of the longest lasting one (p<0.001). Symptom duration was positively correlated with pre‐treatment fasting plasma glucose (p<0.05), but this was more strongly linked to the number of symptoms (p<0.001). In those patients diagnosed because of symptoms typical of diabetes mellitus, mean fasting glucose was higher than when symptoms were elicited retrospectively in patients in whom glycosuria had been found unexpectedly. Weight loss at diagnosis (from ‘highest remembered’) was positively correlated with fasting plasma glucose (p<0.001).

One hundred and thirty‐two patients had fundal colour photography 7 or 8 years after diagnosis. The mean pre‐diagnosis duration of symptoms was 2± S.D.17 months in 80 without retinopathy compared to 8±6 months for 52 with retinopathy (p<0.001). The severity of retinopathy was also positively associated with symptom duration, as was failure to attend for these ocular reviews. Prolonged symptoms pre‐diagnosis were associated with increased risk of death during the first 5 years post‐diagnosis among those with a normal electrocardiogram (ECG) initially (p<0.003), but was unrelated to ECG abnormality then or during the next 5 years.

These findings accord with (but offer no proof of) the inherently plausible expectation that both morbidity and mortality would be lessened by earlier diagnosis of non‐insulin‐dependent diabetes mellitus.
Factitious Diabetic Instability
Authors: O'Brien I. A. D. , Lewin I. G. , Frier B. M. , Rodman H. , Genuth S. , Corrall R. J. M.
Published: July 2009

Factitious diabetic instability is described in four patients. In three the predominant problem was recurrent hypoglycaemia. The fourth presented with apparent insulin resistance and episodes of ketoacidosis. The methods used to make the diagnosis are described, and the factors which contribute to this type of diabetic instability are discussed.
Screening for Early Diabetic Nephropathy: Which Sample to Detect Microalbuminuria?
Authors: Gatling W. , Knight C. , Hill R. D.
Published: July 2009

In a study to monitor the acceptability of using a timed overnight urine collection to measure microalbuminuria in a large diabetic population, it was found that only 184 (69.4%) of 265 diabetics returned the urine collection to the hospital laboratory. Three proposals for an initial screening test to predict high risk microalbuminuria were analysed

Proposal I: a random urinary albumin concentration (RAC) >25 μg/ml predicts an overnight albumin excretion rate (AER) >30 μg/min. In 159 diabetics, the sensitivity of this screening test was 56%, specificity 81%, and predictive value 15%.

Proposal II: an albumin concentration >20 μg/ml in an early morning urine sample predicts an overnight AER >30 μg/min. In 175 diabetics, the sensitivity of this screening test was 86%, specificity 97%, and predictive value 71%.

Proposal III: an albumin/creatinine ratio (albumin mg/l creatinine mmol/l) >3.5 in an early morning urine sample predicts an overnight AER >30 μg/minute. In 171 diabetics, the sensitivity of this screening test was 100%, specificity 95%, and predictive value 64%.

It is concluded that an albumin/creatinine ratio performed on an early morning urine sample brought to the diabetic clinic would be a useful initial screening test to detect an overnight AER >30 μg/min.
Osteopenia and Metatarsal Fractures in Diabetic Neuropathy
Authors: Cundy T. F. , Edmonds M. E. , Watkins P. J.
Published: July 2009

Radiographs of the hands and feet of 19 diabetic patients with severe neuropathy were compared to those of 22 control patients without neuropathy. The two groups were matched for age, sex, and duration of diabetes. Cortical bone mass, measured by x‐ray morphometry, was significantly lower in both the hands (p<0.002) and the feet (p<0.001) of those with neuropathy. The osteopenia was worse in the feet than the hands and also worse in women. Serum alkaline phosphatase levels were also significantly higher in the neuropathy group (p<0.005). Metatarsal fractures were a frequent finding in the neuropathic patients, but were not seen in controls. The presence of metatarsal fractures was strongly associated with the subsequent development of diabetic osteopathy (p<0.001). We conclude that cortical bone mass in the feet and hands is reduced in severe diabetic neuropathy. This may contribute to the predisposition to metatarsal fracture and diabetic osteopathy.
Fasting Blood Glucose and Risk of Coronary Heart Disease, Stroke, and All‐cause Mortality: A 17‐year Follow‐up Study of Men Born in 1913
Authors: Ohlson L.‐O. , Svärdsudd K. , Welin L. , Eriksson H. , Wilhelmsen L. , Tibblin G. , Larsson B.
Published: July 2009

This report concerns the relationship between baseline levels of fasting blood glucose (FBC) in non‐diabetics and the subsequent 17‐year incidence of coronary heart disease (CHD), stroke and all‐cause mortality. In 1963, 973 men aged 50 years were recruited from a general Swedish urban population for a prospective study of risk factors for CHD. Eight hundred and fifty‐five (88%) men agreed to participate and have been observed for 17 years. The 832 men who had no history of myocardial infarction, stroke, diabetes mellitus or who had a fasting blood glucose below 7.0 mmol/l at baseline were selected for this analysis. CHD occurred in 106 men, 35 developed a stroke and 137 died during follow‐up. When quintiles and deciles of the FBG distribution were considered, no trend of 17‐year incidence of CHD, stroke or death was apparent. However, for men with an FBG above the 95th percentile (>5.7 mmol/l) a non‐significant trend towards increasing risk was indicated.
Glycosylated Haemoglobin Levels in Patients Referred for Oral Glucose Tolerance Tests
Authors: John W. G. , Richardson R. W.
Published: July 2009

Oral glucose tolerance tests (OGTTs) were performed on 127 patients, and the results interpreted according to the WHO criteria. Glycosylated haemoglobin (GHb), assayed by affinity chromatography, was measured on the fasting blood specimen. All patients classified as diabetic were found to have GHb results greater than 9.9%. There was no overlap with the normal group, all of whom had GHb results less than 8.8%. In the diabetic patients, GHb showed good correlations with both fasting and 2‐hour post‐glucose blood glucoses. By contrast the non‐diabetic group showed only poor correlations between GHb and the fasting and the 2‐hour blood glucose concentrations. Overall, the best correlation was found between GHb and the mean of the five blood glucose results obtained during the OGTT.
The Personal Meaning of Having Diabetes: Implications for Patient Behaviour and Education or Kicking the Bucket Theory
Authors: Anderson Robert M.
Published: July 2009

Most diabetes educators (physicians, nurses, nutritionists) lack the time and expertise to become familiar with theories of human behaviour even though they may be relevant to the education of their patients. As a result, the current practice of diabetes patient education reflects, in many instances, an extension of the information transfer approach found in most schools. This approach is based on the idea that lack of knowledge and skills accounts for the major portion of the poor self‐care behaviour observed in some diabetic patients. The emphasis on information transfer is probably partially attributable to the fact that it is easier to measure and evaluate. This approach is too narrow a view of behaviour or learning and fails to meet the needs of diabetes patient educators and their clients. The idea that the behaviour of patients with diabetes will be strongly influenced by their view of diabetes is explored. Diabetes educators need to become skilled designers of patient education programmes which facilitate changes in the personal meaning of diabetes. Researchers should test the utility of seeing disease‐related behaviour and education as a process, at least in part, concerned with the personal meaning of diabetes.
The Prevention and Reversibility of Tissue Non‐enzymatic Glycosylation in Diabetes
Authors: McLennan S. , Yue D. K. , Marsh M. , Swanson B. , Delbridge L. , Reeve T. , Turtle J. R.
Published: July 2009

The time course of non‐enzymatic glycosylation (NEG) of liver, kidney, tail collagen, and haemoglobin was studied in diabetic rats. Increased NEG of liver, kidney, and collagen was detectable within 4 weeks of diabetes. The abnormal NEG of liver, kidney, and haemoglobin present after 4 weeks of untreated diabetes could be normalized by 4–8 weeks of intensive insulin therapy given by continuous subcutaneous infusion. However, the same treatment was ineffective in reversing the abnormal NEG and thermal stability of tail collagen. The differences in the development and reversibility of these tissue changes may be due to different tissue turnover rates. Insulin therapy, given from the onset of diabetes, was effective in preventing the development of collagen abnormalities. This suggests that early and vigorous treatment of diabetes is necessary to prevent collagen changes which are potentially irreversible.
Progression of Impaired Glucose Tolerance to Diabetes Mellitus in Patients with Primary Glaucoma and Ocular Hypertension
Authors: Clark C. V. , Mapstone R.
Published: July 2009

In 375 patients aged 68.5 ± 9.4 years (mean ± 1 SD) with primary glaucoma, subdivided by irido‐corneal angle configuration into closed‐angle glaucoma (123 cases), ocular hypertension (186 cases), and open‐angle glaucoma (66 cases), diabetic status was determined by standard 75 g oral glucose tolerance tests. In 63 patients with impaired glucose tolerance who were retested one year later, 16% had progressed to diabetes mellitus. The results confirm a significant association between non‐insulin dependent diabetes mellitus and primary glaucoma which may result from autonomic dysfunction in parasympathetic tone causing anterior chamber angle closure.