bluuebunny/crossref_metadata_2025 huggingface dataset:
Three-dimensional pressure- and shear-driven flow phenomena in a circular recess of a hydrostatic rotary table
Authors: Shen Feng , Chen Cong-Lian , Liu Zhao-Miao
Published: June 2013

The three-dimensional pressure- and shear-driven flow phenomena in a circular recess of hydrostatic rotary table in heavy-duty computer numerical control machines is very complicated and has not been fully explored. Navier–Stokes equations have been applied through the whole flow region using a finite volume approach to explore this complicated flow phenomena, including the influences of feeding Reynolds number ( Rei), sliding Reynolds number ( Res) and the recess geometry on flow behaviors. A test rig based on a particle image velocimetry was built to compare experimental and numerical results, finding a good agreement for stationary cases. The results show that the flow patterns in the recess are very complex and four three-dimensional vortices exist at Rei = 448 and Res = 74.6. Four flow states are defined according to the structure of the vortices. Different sectional profiles of the streamlines and velocity vector fields are examined to reveal the mechanism of pressure- and shear-driven flow interactions. The results of influences of recess geometry on flow states and pressure patterns are intended to contribute to represent a database in view of the hydrostatic rotary table theoretical modeling.
A critical discourse approach to the analysis of values in political discourse: The example of freedom in President Bush’s State of the Union addresses (2001–2008)
Authors: Sowińska Agnieszka
Published: June 2013

This article aims to show how critical discourse studies (CDS) can contribute to the analysis of values in political discourse. It is argued that although valuation is fundamental to CDS, the concept of value is often taken for granted by critical discourse practitioners. The article discusses the main assumptions relating to value and evaluation in CDS and introduces a number of pragmalinguistic tools for the exploration of values in political discourse: metaphor, assertion-based patterns and thesis–antithesis in the service of axiological proximisation. The analysis of the concept of freedom based on President Bush’s State of the Union addresses (2001–2008) demonstrates how the Bush administration exploited this fundamental value of the American nation.
Phenethyl isothiocyanate triggers apoptosis in human malignant melanoma A375.S2 cells through reactive oxygen species and the mitochondria-dependent pathways
Authors: Huang S-H , Hsu M-H , Hsu S-C , Yang J-S , Huang W-W , Huang A-C , Hsiao Y-P , Yu C-C , Chung J-G
Published: June 2013

We have reported previously that phenethyl isothiocyanate (PEITC) induces apoptosis in human osteosarcoma U-2 OS cells. Cytotoxic activity of PEITC towards other cancer cells such as human malignant melanoma and skin cancer cells has not been reported. In this study, the anticancer activity of PEITC towards human malignant melanoma cancer A375.S2 cells was investigated. To determine the mechanisms of PEITC inhibition of cell growth, the following end points were determined in A375.S2 cells: cell morphological changes, cell cycle arrest, DNA damage and fragmentation assays and morphological assessment of nuclear change, reactive oxygen species (ROS) and Ca2+ generations, mitochondrial membrane potential disruption, and nitric oxide and 10- N-nonyl acridine orange productions, expression and activation of caspase-3 and -9, B-cell lymphoma 2 (Bcl-2)-associated X protein (Bax), Bcl-2, poly (adenosine diphosphate-ribose) polymerase, and cytochrome c release, apoptosis-inducing factor and endonuclease G. PEITC induced morphological changes in time- and dose-dependent manner. PEITC induced G2/M phase arrest and induced apoptosis via endoplasmic reticulum stress-mediated mitochondria-dependent pathway. Western blot analysis showed that PEITC promoted Bax expression and inhibited Bcl-2 expression associated with the disintegration of the outer mitochondrial membrane causing cytochrome c release, and activation of caspase-9 and -3 cascade leading to apoptosis. We conclude that PEITC-triggered apoptotic death in A375.S2 cells occurs through ROS-mediated mitochondria-dependent pathways.
Drivers of cost and health-related quality of life in patients with systemic lupus erythematosus (SLE): a Swedish nationwide study based on patient reports
Authors: Bexelius C , Wachtmeister K , Skare P , Jönsson L , Vollenhoven R van
Published: June 2013

The objective of this paper is to investigate drivers of cost and health-related quality of life (HRQoL) related to disease activity and fatigue among patients with systemic lupus erythematous (SLE).

A questionnaire was sent to members of a patient organization with a self-reported diagnosis of SLE, requesting information on demographics and disease characteristics, medications, resource utilization, informal care, loss of productivity, fatigue and HRQoL in relation to SLE. Mean annual costs per patient were estimated from a societal perspective. HRQoL was measured through EQ-5D and fatigue was measured through a 10 cm VAS scale. Patient-reported disease activity was measured through the Systemic Lupus Activity Questionnaire (SLAQ) and corticosteroid dose. Drivers of costs and HRQoL were analyzed through regression analysis.

A total of 339 patients out of 737 returned the questionnaire. Mean age was 55; 94% were female. The mean HRQoL measured through the five-item EQ-5D instrument was 0.64 and total costs were estimated at €22,594 (direct costs €7818; indirect costs €14,776). Disease activity, fatigue and corticosteroid doses had a statistically significant impact on costs and HRQoL.

This study demonstrates that Swedish patients with SLE have low HRQoL and incur high societal costs and that are both associated with and most likely driven by disease activity, fatigue and corticosteroid use.
A case of toxic epidermal necrolysis-like skin lesions with systemic lupus erythematosus and review of the literature
Authors: Cetin G Yildirim , Sayar H , Ozkan F , Kurtulus S , Kesici F , Sayarlıoglu M
Published: June 2013

Objective

Subepidermal bullous lesions and toxic epidermal necrolysis-like (TEN-like) lesions can occur in patients with systemic lupus erythematosus (SLE). In this report, we describe a case of a patient previously diagnosed with SLE who experienced TEN-like skin lesions with unusual subacute progression in the context of the current literature.

Methods

We present a recent case of TEN-like lupus erythematosus and review of studies published in English identifying SLE cases mimicking TEN, accessed via PubMed and Google Scholar databases. The keywords used in the search were: TEN, SLE, TEN-like SLE, and TEN-like lesions. The search covered all articles from January 1980 to November 2011.

Results

A 52-year-old male presented with fatigue, weakness, and weight loss (23 kg in two months). Skin redness started across nose and cheeks six months before admission. Bilateral pleural effusions were observed in a thorax tomography taken in the referral hospital two months prior to admission. Because of articular involvement, antinuclear antibody (ANA), and anti-dsDNA positivity, the patient was diagnosed with SLE. We initiated a punch skin biopsy, and the findings were consistent with Stevens-Johnson syndrome. There was marked basal layer necrosis in the epidermis, and there was predominantly lymphohistiocytic infiltrate in the dermis. A total of 22 cases, including our case, with TEN-like lupus erythematosus were reported in the literature. In addition, cutaneous lupus had positive ANAs in 18 of 22 patients (81.8%). The patients were aged 12 to 76 years; 21 cases were women and only one patient was male.

Discussion

Skin involvement, including the rare variant of TEN-like acute cutaneous SLE, is very common among SLE patients. The acute syndrome of pan-epidermolysis or apoptotic pan-epidermolysis may become a useful designation when considering a clinical diagnosis of drug-induced TEN or SLE. Further studies are required to verify our findings.
Erythrocyte sedimentation rate is a predictor of renal and overall SLE disease activity
Authors: Stojan G , Fang H , Magder L , Petri M
Published: June 2013

Objective

Our aim was to assess whether erythrocyte sedimentation rate (ESR) levels correlate with the level of disease activity at each visit and whether a change in ESR could be useful in predicting changes in disease activity.

Methods

Thousands of visits in a prospective systemic lupus erythematosus (SLE) cohort were analyzed to assess the association of ESR and level of disease activity. We explored whether ESR was cross-sectionally associated with disease activity, whether changes in ESR were associated with changes in disease activity, and whether changes in ESR predicted future changes in disease activity. Visits when patients had cancer, infection, pregnancy or were in renal failure were excluded.

Results

After adjusting for confounding factors, mild (25–50 mm/h), moderate (51–75 mm/h), and marked (>75 mm/h) elevations in ESR levels at a given visit correlated with the SELENA-SLEDAI, the Physician Global Assessment (PGA), fatigue, renal, joint, rash, serositis, hematological visual analogue scale (VAS), hematuria and proteinuria ( p < 0.0001) levels at that visit. A change in ESR between two visits was highly correlated with a concurrent change in PGA, renal, fatigue and joint VAS ( p < 0.0001). There was no statistically significant correlation between change in ESR between two visits and change in disease activity at a future visit. The subgroup analysis of patients who do not have anti-dsDNA and low complement levels as a feature of their disease showed ESR to be positively associated with SLEDAI, PGA, renal and joint VAS at that visit ( p < 0.0001), but there were few significant associations between changes in ESR and changes in disease activity.

Conclusion

ESR is associated with disease activity in SLE measured by the SELENA-SLEDAI, the PGA, and with organ-specific activity including serositis, rash, joint, renal and hematological VAS. Grouping baseline ESR into four levels does associate with both global and organ-specific disease activity. A change in ESR between two visits was highly correlated with a change in PGA, renal, fatigue and joint VAS. In patients without anti-dsDNA and low complement levels, ESR was positively associated with SLEDAI, PGA, renal and joint VAS at the same visit. Until more specific biomarkers are validated, serial ESR does have some utility in following disease activity in SLE.
What are you looking at? Visitors’ perspectives on CCTV in the night-time economy
Authors: Brands Jelle , Schwanen Tim , van Aalst Irina
Published: June 2013

In urban policy discourses across Western Europe, video surveillance is often considered an important tool to increase the safety of consumers in city-centre areas in general, and in nightlife districts in particular. However, the question of whether closed-circuit television (CCTV) actually promotes experiences of safety is neither straightforward nor resolved. Although this topic has received substantial attention in the academic literature, relatively little research has been conducted on how users of public spaces perceive CCTV whilst in the midst of situations. By directly confronting study participants in the presence of CCTV cameras, we explore nightlife district visitors’ perceptions and understandings of CCTV in situ, in relation to safety when out at night in Utrecht and Rotterdam, the Netherlands. Potential differences regarding gender and ethnicity are also considered. We found, first, that our study participants’ awareness of CCTV during the practice of ‘going out’ was a continuum rather than a dichotomy (aware or unaware) and that fuller awareness of CCTV is related to greater personal safety. Second, we observed a large gap between the policy discourses surrounding CCTV and the understanding of nightlife district visitors regarding how CCTV works. It is suggested that one way of aligning visitors’ understanding and policy discourses is to shift the latter from a focus on ensuring safety towards offering assistance. For the delivery of such assistance in practice, CCTV needs to be integrated further with other forms of policing and surveillance, especially those forms that are compatible with a spatiotemporal logic of embodiment and situatedness.
Development of robust control law for active buffeting load alleviation of smart fin structures
Authors: Chen Yong , Ulker Fatma D , Wickramasinghe Viresh , Zimcik David G
Published: June 2013

Aerodynamic buffeting load can lead to premature fatigue damage of aircraft vertical fin structures. This article presents a robust control law development strategy for active buffeting load alleviation of a smart fin structure. The impact of aerodynamic loads on the modeling uncertainties of the smart fin was investigated through extensive wind tunnel tests. Test results revealed that the airflow introduced higher damping ratio and caused frequency shift to the vibration modes. These aerodynamic effects may adversely affect the performance and robustness of active control laws. Based on the observations, the structured singular value synthesis technique was used to develop a robust control law for the smart fin using a truncated baseline dynamic model. A parametric uncertainty block was introduced to account for the changes in the modal parameters of the baseline dynamic model due to the aerodynamic effects. An additive uncertainty block was included to account for the unmodeled higher-order vibration modes as well as the modeling errors in the low frequency range. The robust performance of the control law was demonstrated through simulations as well as extensive closed-loop control experiments in the wind tunnel using various free airstreams and vortical airflows. This provided a verified control law design strategy for active buffeting alleviation applications.
Reshaping Child Welfare’s Response to Trauma
Authors: Ai Amy L. , Foster Lovie J. Jackson , Pecora Peter J. , Delaney Nancy , Rodriguez Wenceslao
Published: June 2013

Growing evidence has linked early trauma with severe psychiatric consequences. Posttraumatic stress disorder (PTSD) is a potentially debilitating mental health condition found among some youth in foster care and foster care alumni. However, the current child welfare practice response has not met the demands in both assessment and intervention. This critical review aims to use the evidence to reshape the child welfare response to trauma in children and adolescents. We begin with research on the psychiatric consequences of child maltreatment and issues related to diagnostic assessment for PTSD. Next, we compare major foster care/alumni studies showing considerably higher rates of PTSD among young foster care recipients and alumni than among nationally comparable groups. To inform practice on childhood trauma, we then summarize current evidence-based interventions showing effectiveness with PTSD. Finally, we address new dimensions, such as gene–environment research, posttraumatic growth, and implications for reshaping child welfare practice and foster care.
Palliative Care Consultation Trajectories
Authors: Kozlov Elissa , Carpenter Brian D. , Thorsten Michael , Heiland Mark , Agarwal Anupam
Published: June 2013

Background:

Palliative care consultations teams (PCCTs) promote comprehensive health but only if the PCCT can influence actual care. The purpose of this study is to document the types of recommendations made by a PCCT, determine the rates at which recommendations are implemented, and identify the factors related to implementation.

Results:

The mean number of recommendations per patient was 1.44 (standard deviation = 1.81), and 57% of the recommendations were implemented. Discharge and goals of care recommendations were significantly more likely to be implemented than recommendations for pain, symptom management, and consultation of other services.

Conclusions:

Although PCCTs may have suggestions about how to guide care, many of those recommendations are not implemented. Future research is needed to understand how to maximize the impact of PCCTs.
Plasticity in the Injured Brain
Authors: Overman Justine J. , Carmichael S. Thomas
Published: June 2013

Changes in brain circuits occur within specific paradigms of action in the adult brain. These paradigms include changes in behavioral activity patterns, alterations in environmental experience, and direct brain injury. Each of these paradigms can produce axonal sprouting, dendritic morphology changes, and alterations in synaptic connectivity. Activity-, experience-, and injury-dependent plasticity alter neuronal network function and behavioral output, and in the case of brain injury, may produce neurological recovery. The molecular substrate for adult neuronal plasticity overlaps in these three paradigms in key signaling pathways. These common pathways for adult plasticity suggest common mechanisms for activity-, experience-, and injury-dependent plasticity. These common pathways may also interact to enhance or impede each other during adult recovery of function after injury. This review focuses on common molecular changes evoked during the process of adult neuronal plasticity, with a focus on neural repair in stroke.
Wrangling Space
Authors: Henson Donna F.
Published: June 2013

A ruminative storying and restorying of a life lived in the consequences of space and time, this layered, “disorganized” narrative explores distance in its many and varied forms. Questioning the narrative principle of coherence, the writing plays in the space between presence and absence, distance and desire. Here and there. A psychography of sorts, the resultant piece attempts to make meaning of those interactional accidents of proximity that leave us loved, loving, leaving, or left. And also, and so very inevitably, bruised by the incidental and tedious trauma of it all. In wrangling this space, I seek to embrace the small moments that leave us changed in small ways; those fragments of experience that resist the imposition of coherence, that defy storying, that live on the edge of our narrative world.
Construct Validity and Diagnostic Utility of the Cognitive Assessment System for ADHD
Authors: Canivez Gary L. , Gaboury Allison R.
Published: June 2013

Objective: The Das–Naglieri Cognitive Assessment System (CAS) is a test of cognitive abilities based on the Planning, Attention, Simultaneous, and Successive Theory (PASS). Studies of CAS performance by children with ADHD typically show lowest performance on Planning and deficits on Attention, but normal Simultaneous and Successive processing. Such distinct group differences studies support construct validity and are necessary, but not sufficient, for establishing diagnostic utility. Method: Students meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria for ADHD ( n = 20) and matched controls ( n = 20) were assessed with the CAS to examine distinct group differences and diagnostic utility of CAS in correctly classifying the individuals from both groups. Results: CAS PASS scores were significantly related to ADHD characteristics demonstrating both distinct group differences (with medium to large effect sizes) and diagnostic utility (with medium effect sizes). Conclusion: Support was observed for CAS PASS score characteristics previously observed among students with ADHD, and this is the first study to report on the diagnostic utility of CAS PASS scores. Given the small sample, additional large-scale studies and cross-validation is needed. (J. of Att. Dis. 2016; 20(6) 519-529)
Communication-overlap techniques for improved strong scaling of gyrokinetic Eulerian code beyond 100k cores on the K-computer
Authors: Idomura Yasuhiro , Nakata Motoki , Yamada Susumu , Machida Masahiko , Imamura Toshiyuki , Watanabe Tomohiko , Nunami Masanori , Inoue Hikaru , Tsutsumi Shigenobu , Miyoshi Ikuo , Shida Naoyuki
Published: June 2013

Plasma turbulence research based on five-dimensional (5D) gyrokinetic simulations is one of the most critical and demanding issues in fusion science. To pioneer new physics regimes both in problem sizes and in timescales, an improvement of strong scaling is essential. Overlap of computations and communications using non-blocking MPI communication schemes is a promising approach to improving strong scaling, but it often fails on practical applications with conventional MPI libraries. In this work, this classical issue is resolved by developing communication-overlap techniques with additional MPI support for non-blocking communication routines and with heterogeneous OpenMP threads, which work even on conventional MPI libraries and network hardware. These techniques dramatically improved the parallel efficiency of a gyrokinetic toroidal 5D Eulerian code GT5D on the K-computer, which has a dedicated network, and on the Helios system which has a commodity network. On the K-computer, excellent strong scaling was achieved beyond 100k cores whilst keeping a sustained performance of [Formula: see text]10% ([Formula: see text]307 TFlops using 196,608 cores), and simulations for next-generation large-scale fusion experiments are significantly accelerated. This performance is 16[Formula: see text] sped up compared with the maximum performance reported at the 2011 International Conference for High Performance Computing, Networking, Storage and Analysis ([Formula: see text]19 TFlops using 16,384 cores of the BX900 cluster) (Idomura, 2011).
Electrophysiological markers and predictors of the disease course in primary progressive multiple sclerosis
Authors: Schlaeger Regina , D’Souza Marcus , Schindler Christian , Grize Leticia , Kappos Ludwig , Fuhr Peter
Published: June 2013

Background:

Currently no valid surrogate marker exists for primary progressive multiple sclerosis (PPMS).

Objective:

Our aim was to prospectively investigate multimodal evoked potentials (EPs) as markers and predictors of the disease course in PPMS.

Methods:

Twenty-two PPMS patients were prospectively examined with visual, somatosensory and motor EPs and Expanded Disability Status Scale (EDSS) assessments at baseline (T0) and at six-month intervals over three years. Spearman rank correlation was used to determine the relationship between EP measures and EDSS. The relationship between disease evolution and a numerical score derived from z-transformed EP-latencies ( s-EP-Q) and baseline characteristics was further assessed using multivariable linear regression analysis.

Results:

s-EP-Q correlated with EDSS score at all points in time in cross-sectional comparison (0.53≤rs ≤0.68; 0.0007≤p≤0.0232) and also longitudinally by trend ( rs=0.46, p=0.0740). The s-EP-QT0 correlated with the EDSS score at year 3 (T6) ( rs=0.77, p<0.0001). The s-EP-Q changes became statistically significant six months before corresponding changes were seen in the EDSS score. EDSST6 as predicted by EDSST6= −1.027+0.037* age+0.217* s-EP-QT0 + 0.695* EDSST0 correlated with the observed values ( rs=0.92, p<0.0001).

Conclusions:

Multimodal EPs correlate well with disability in PPMS, and allow some prediction of the disease course over three years. These findings support a role of EPs as surrogate markers in clinical trials in PPMS.
Balance deficit with opened or closed eyes reveals involvement of different structures of the central nervous system in multiple sclerosis
Authors: Prosperini Luca , Petsas Nikolaos , Raz Eytan , Sbardella Emilia , Tona Francesca , Mancinelli Chiara Rosa , Pozzilli Carlo , Pantano Patrizia
Published: June 2013

Objective:

To evaluate whether balance deficit in patients with multiple sclerosis (MS), as assessed with eyes opened (EO) and closed (EC), is associated with damage of different structures of the central nervous system (CNS).

Methods:

Fifty patients with MS and 20 healthy controls (HCs) underwent static posturography to calculate the body’s center of pressure displacement (COP path) with EO and EC. They were scanned using a 3.0T magnet to obtain PD/T2 and 3D-T1-weighted images of the brain and spinal cord. We determined the mid-sagittal cerebellum area (MSCA) and upper cervical cord cross-sectional area (UCCA). We also measured the patients’ lesion volumes (T2-LVs) on the whole brain and at different infratentorial levels.

Results:

MS patients had wider COP paths with both EO and EC ( p < 0.001), and lower values in both MSCA ( p = 0.01) and UCCA ( p = 0.008) than HCs. The COP path with EO was associated with MSCA (Beta = − 0.58; p = 0.004) and T2-LV on middle cerebellar peduncles (Beta = 0.59; p = 0.002). The COP path with EC was associated with UCCA (Beta= − 22.74; p = 0.003) and brainstem T2-LV (Beta = 0.52; p = 0.01).

Conclusions:

Balance deficit in MS was related to atrophy of both the cerebellum and spinal cord, but the extent of COP path under the two different conditions (EO or EC) implied different patterns of damage in the CNS.
Networked multilingualism: Some language practices on Facebook and their implications
Authors: Androutsopoulos Jannis
Published: June 2013

Integrating research on multilingualism and computer-mediated communication, this paper proposes the term ‘networked multilingualism’ and presents findings from a case study to explore its implications for the theorising of multilingualism. Networked multilingualism is a cover term for multilingual practices that are shaped by two interrelated processes: being networked, i.e. digitally connected to other individuals and groups, and being in the network, i.e. embedded in the global mediascape of the web. It encompasses everything language users do with the entire range of linguistic resources within three sets of constraints: mediation of written language by digital technologies, access to network resources, and orientation to networked audiences. The empirical part of the paper discusses the Facebook language practices of a small group of Greek-background secondary school students in a German city. Data collection follows an online ethnography approach, which combines systematic observation of online activities, collection and linguistic analysis of screen data, and data elicited through direct contact with users. Focusing on four weeks of discourse on profile walls, the analysis examines the participants’ linguistic repertoires, their language choices for genres of self-presentation and dialogic exchange, and the performance of multilingual talk online. The findings suggest that the students’ networked multilingual practices are individualised, genre-shaped, and based on wide and stratified repertoires.
The intersection of African American English and Black American Sign Language
Authors: Lucas Ceil , Bayley Robert , McCaskill Carolyn , Hill Joseph
Published: June 2013

This article reports on the intersection of African American English (AAE) and a variety of American Sign Language (ASL) used by Black signers and known as Black ASL. Based on an extensive videotaped corpus collected from 96 African American signers in the southern United States, we explore the conditions that led to the development of a separate African American variety and document its features. Starting in 1869, 17 states and the District of Columbia had separate schools or departments for Black Deaf children within already-established schools. The last school to desegregate was in Louisiana, in 1978. We filmed Black signers in six of the 17 states, in free conversation and interviews, and we also elicited lexical items. Signers were divided into two groups, those over 55 who attended segregated schools and signers under 35 who attended integrated schools. Of the eight linguistic features investigated, two result from the contact of Black ASL with spoken English: the mouthing of English words and the incorporation of African American words and phrases. Older signers who attended segregated schools mouth very little, while younger signers who attended integrated schools mouth as frequently as young white signers. The young Black signers also spontaneously produce and discuss words and phrases from AAE that have made their way into Black ASL, such as “Stop trippin’!”, “My bad”, and “Girl, please.” The presence of these AAE features in Black ASL shows the effects of attendance in mainstreaming programs starting in the mid-1970s, including contact with hearing AAE speakers, and an increased focus on the learning of spoken English.
Poor health-related quality of life in the Swedish general population: The association with disease and lifestyle factors
Authors: Djärv Therese , Wikman Anna , Johar Asif , Lagergren Pernilla
Published: June 2013

Aim: Poor health-related quality of life (HRQoL) is associated with increased use of healthcare services, but it remains unclear which individuals have a heightened risk in the general population. Methods: A Swedish population-based cross-sectional survey was conducted in 2008. Predefined risk characteristics including sex, age, educational level, marital status, body mass index, diseases, physical activity, and tobacco smoking were collected by a self-report questionnaire. Five aspects of the EORTC QLQ-C30 were used to assess HRQoL: physical, role, emotional, social, and cognitive function. Participants were defined as having “poor HRQoL” if they scored ≥10 points (scale 0–100) lower than the mean score of the total sample. To assess the characteristics of individuals with poor HRQoL, classification and regression tree (CART) analysis was performed. Results: A total of 4910 (70.5% participation rate) randomly selected individuals participated in the study. The CART analysis showed that for each of the five functional aspects of HRQoL, the most important covariate HRQoL was the number of reported diseases, while the second strongest covariate was physical inactivity. Conclusion: This large population-based study indicates that a higher number of diseases and physical inactivity are the most important covariates of poor HRQoL in the Swedish general population.
Risk and causes of death between 40 and 70 years of age in the Nordic countries 1951–2010
Authors: Vollset Stein Emil
Published: June 2013

Aims: Use time trends in cause-specific middle-age death risk to study differences in mortality patterns among the Nordic countries. Methods: Middle-age (40–69 years) death risk and its decomposition into cause-specific death risks were computed. Results: In 1952, middle-age death risk was highest in Finland and lowest in Norway. For men, the death risk at the age of 40–69 years stagnated or increased during the first 20–30 years after 1950. From 1970–1980 until present time, there has been a strong decrease in male middle-age death risk. For women, there was a strong decreasing trend during the whole study period with the exception of Denmark. For 20 years from the late 1970s, the death risk at 40–69 years increased for Danish women followed by a sharp decrease from the mid-1990s. The main driver of the initial upward trend in men and downward trends in both men and women were changing death risks from circulatory disease. The upward trend in Danish women was driven by increased death risk from non-circulatory diseases that also gave an untoward trend in Danish men. Middle-age death risks converged after 1990 for Danish and Finnish men at a higher level than in the three other countries. In 2010, middle-age death risk in Finnish women, who had the highest level in 1952, converged with Norway, Sweden and Iceland at a risk much below Danish women. Conclusions: Trends in risk and causes of middle-age death from 1951–2010 showed important variation among the five Nordic countries and between men and women.
Prevalence of adolescents who perceive their parents to have alcohol problems: A Swedish national survey using a web panel
Authors: Elgán Tobias H , Leifman Håkan
Published: June 2013

Aims: The primary aim is to estimate the prevalence of Swedish adolescents who perceive their parent(s) to have alcohol problems. Additional research questions pertain to the prevalence of adolescents who think someone close to them drinks too much alcohol and if this has hurt them or caused them problems. Methods: A cross-sectional design was employed using a web-based survey targeted to 1000 Swedish 16–19-year-olds randomly selected from a web panel. The questionnaire included the CAST-6 scale, used to assess whether or not participants perceived their parents’ alcohol consumption as problematic, and questions relating to whether or not they think someone close to them drinks too much and if this has caused them problems. Data was weighted using a post-stratification procedure. Results: The proportion of adolescents classified as having parents with alcohol problems was 20.1%. Further, 44.0% reported that they think someone close to them drinks too much alcohol and 9.6% that this has hurt them or caused them problems. Conclusions: These results indicate that the problem is widespread. Our findings are similar to previous research where a more indirect methodology has been adopted, using either psychiatric interviews or self-reported alcohol consumption of adults, to estimate the magnitude of the problem.
Cementless Total Hip Arthroplasty with Large Diameter Metal-on-Metal Heads: Short-Term Survivorship of 8059 Hips from the Finnish Arthroplasty Register
Authors: Mokka J. , Mäkelä K. T. , Virolainen P. , Remes V. , Pulkkinen P. , Eskelinen A.
Published: June 2013

Background and Aims:

Population-based register data from the National Joint Register of Australia and England and Wales have revealed that the mid-term outcome of cementless large diameter head metal-on-metal total hip arthroplasty is inferior to that of conventional cemented metal-on-polyethylene total hip arthroplasty. The aim of this study was to compare the results of cementless large diameter head metal-on-metal total hip arthroplasty with conventional cemented arthroplasty in Finland. The second aim of this study was to compare the cementless large diameter head metal-on-metal models with each other.

Material and Methods:

Based on the data extracted from the Finnish Arthroplasty Register, the risk of revision of 8059 cementless large diameter head metal-on-metal total hip arthroplasties performed during 2002–2009 was analyzed using Cox regression model. The revision risk of these hips was compared to that of 16,978 cemented metal-on-polyethylene total hip arthroplasties performed during the same time period.

Results:

In the Cox regression analysis, there was no difference in revision risks between cementless large diameter head metal-on-metal total hip arthroplasty and cemented metal-on-polyethylene total hip arthroplasty (relative risk = 0.90, confidence interval = 0.74–1.10, p = 0.3). However, in female patients aged 55 years or above, cementless large diameter head metal-on-metal total hip replacements showed a significantly increased risk of revision as compared to cemented total hip replacements (relative risk = 1.33, confidence interval = 1.04–1.70). Compared to the reference implant in this study (cementless Synergy stem combined with Birmingham Hip Resurfacing [BHR] cup), the CementLess Spotorno (CLS) stem combined with Durom cup had a 2.9-fold (95% confidence interval = 1.17–6.90) increased risk of revision.

Conclusions:

We found that cementless large diameter head metal-on-metal total hip arthroplasty had short-term survivorship compared with cemented total hip arthroplasty at a nation-wide level. However, in female patients aged 55 years or above, cementless large diameter head metal-on-metal total hip arthroplasty showed inferior results. Furthermore, implant design had an influence on revision rates. Longer follow-up time is needed to assess the success of large diameter head metal-on-metal total hip arthroplasty.
Should We Abandon Wire-Guided Localization for Nonpalpable Breast Cancer? A Plea for Wire-Guided Localization
Authors: de Roos M. A. J. , Welvaart W. N. , Ong K. H.
Published: June 2013

Background and Aims:

To evaluate wire-guided localization for nonpalpable breast cancer regarding procedure and surgery-related outcome in a nonteaching community hospital in the Netherlands.

Material and Methods:

A consecutive series of 117 patients who were treated with breast-conserving surgery after wire-guided localization for nonpalpable breast cancer between January 2006 and December 2010 was retrospectively analyzed. The patients’ digital records were reviewed for patient, radiological, histological, and surgical characteristics. In order to quantify the excess resected tissue, a calculated resection ratio was determined by dividing the total resection volume by the optimal resection volume. The optimal resection volume was defined as a spherical tumor volume with an added 1.0 cm margin. The total resection volume was defined as the corresponding ellipsoid.

Results:

There were no procedure-related complications. There were two postoperative hemorrhages. Margins were clear in 92.3% of the cases after the first surgical procedure. Eight (6.8%) patients required two operations and one (0.9%) patient required three operations in order to obtain negative margins. Breast conservation was possible in 113 (96.6%) patients. The median calculated resection ratio was 1.87 (range 0.47–14.92).

Conclusions:

This study proves that it is possible to obtain excellent results performing breast-conserving surgery for nonpalpable breast cancer regarding margin status, total amount of operations, and the ratio between tumor and resected tissue volume using wire-guided localization as a localization tool.
Clinical and Proctoscopic Evaluation of Topical Formalin Application in the Treatment of Chronic Radiation Proctitis
Authors: Eriksen P. L. , Tougaard R. S. , Tøttrup A.
Published: June 2013

Background and Aims:

Chronic radiation proctitis is a disease associated with radiotherapy of cancer in the pelvic region. The main symptom is rectal bleeding. Several treatment modalities have been attempted, but few have demonstrated satisfactory effects. We present our experience with formalin applied locally to the rectal mucosa in the treatment of chronic radiation proctitis. Furthermore, we assess possible complications, the gravest suggested being cancer. Previous studies on the subject have reported good results, but often with a somewhat vaguely defined follow-up. Our evaluation of the treatment was based on both subjective symptoms and proctoscopic findings.

Material and Methods:

A small study (N = 11) was conducted retrospectively. All patients treated for chronic radiation proctitis with formalin in our clinic were identified, and data concerning effect and complications were collected by studying the patients’ records, with a questionnaire and a follow-up interview and proctoscopy.

Results:

The study showed a marked decrease in bleeding and objective signs of proctitis in all patients. Complete cessation of bleeding was achieved in five patients. Possible complications to the treatment detected in our study were the following: anorectal pain, tenesmus, incontinence, diarrhea, and mucous rectal discharge. No signs of neoplasia were found.

Conclusions:

The formalin treatment had a very good effect on chronic radiation proctitis. Possible complications were detected. Except in the case of anorectal pain, these are all of a questionable nature and can possibly be attributed to chronic radiation proctitis itself rather than the formalin treatment. Further study is warranted to confirm long-term effects of the formalin and to exclude possible complications, especially secondary anorectal cancer.
Hyperbilirubinemia as a Predictor for Appendiceal Perforation: A Systematic Review
Authors: Burcharth J. , Pommergaard H. C. , Rosenberg J. , Gögenur I.
Published: June 2013

Background and Aims:

Delayed or wrong diagnosis in patients with appendicitis can result in perforation and consequently increased morbidity and mortality. Serum bilirubin may be a useful marker for appendiceal perforation. The purpose of this systematic review was to evaluate studies investigating elevated serum bilirubin as a predictor for appendiceal perforation.

Material and Methods:

Medline, Embase, and Cochrane databases were searched for studies evaluating elevated bilirubin in the diagnosis of perforated appendicitis. Study selection criteria included English language papers evaluating serum bilirubin as a marker of appendiceal perforation in humans. A total of 189 abstracts were screened for eligibility, of which five clinical studies were included in this study.

Results:

Bilirubin was significantly higher in patients with appendiceal perforation compared with patients with appendicitis without perforation. Elevated serum bilirubin had a sensitivity ranging from 0.38 to 0.77 and a specificity ranging from 0.70 to 0.87 in predicting appendiceal perforation.

Conclusions:

Elevated serum bilirubin for determining the risk of perforation in appendicitis has low sensitivity but higher specificity. This measure can therefore be used as a supplement in the diagnostic process.
Perioperative Complications after Cemented or Uncemented Hemiarthroplasty in Hip Fracture Patients
Authors: Yli-Kyyny T. , Ojanperä J. , Venesmaa P. , Kettunen J. , Miettinen H. , Salo J. , Kröger H.
Published: June 2013

Background and Aims:

Both cemented and uncemented hemiarthroplasties are acceptable methods for treating displaced femoral neck fractures. Cemented hemiarthroplasty has traditionally been recommended as being more safe and reliable. However, the cementing process carries a risk of fat embolism and cardiovascular problems. This study attempted to determine whether these complications can be avoided when using a modern uncemented stem.

Material and Methods:

We retrospectively compared 222 hip fracture patients treated with hemiarthroplasty in our hospital. A total of 100 of these patients were treated with a hydroxyapatite-coated uncemented hemiendoprosthesis (Bi-Metric BFx) and 122 patients with a cemented hemiendoprosthesis (Lubinus SPII). Information on mortality and complications during the first 18.7 months was retrieved from patient files.

Results and Conclusions:

Nine perioperative fat-embolic events were found in the cemented group and none in the uncemented group. During the initial hospital treatment, there were five deaths (4.1%) in the cemented group and one death (1%) in the uncemented group. There were significantly more perioperative fractures in the uncemented versus cemented group (7% versus 0.8%). We conclude that uncemented hemiarthroplasty is associated with more perioperative fractures than cemented hemiarthroplasty. However, perioperative cardiovascular disturbances may be less frequent with uncemented hemiarthroplasty, and early mortality may be lower with uncemented hemiarthroplasty.
“Enteroatmospheric Fistulae”—Gastrointestinal Openings in the Open Abdomen: A Review and Recent Proposal of a Surgical Technique
Authors: Marinis A. , Gkiokas G. , Argyra E. , Fragulidis G. , Polymeneas G. , Voros D.
Published: June 2013

The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with. It is in fact not a true fistula because it neither has a fistula tract nor is covered by a well-vascularized tissue. The mortality of enteroatmospheric fistulae was as high as 70% in past decades but is currently approximately 40% due to advanced modern intensive care and improved surgical techniques. Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging. Intensive care support of organs and systems is vital in order to manage the severely septic patient and the associated multiple organ failure syndrome. Many of the principles applied to classic enterocutaneous fistulae are used as well. Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access for excision of the involved loop are reviewed in this report. Additionally, we describe our recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs.
Adenomas with Adenocarcinoma: A Study Evaluating the Risk Of Residual Cancer And Lymph Node Metastasis
Authors: Steigen S. E. , Isaksen V. , Skjæveland A. , Vonen B.
Published: June 2013

Background and Aims:

The increasing number of cases with colorectal adenomas with adenocarcinoma necessitates renewed evaluation of classification systems and risk factors. The aim for this retrospective study was to evaluate the potential risk of residual cancer and lymph node metastasis in patients with colorectal adenomas with adenocarcinoma.

Material and Methods:

An investigation of adenomas with adenocarcinoma in 74 patients was performed on histological slides and compared with clinical characteristics. A total of 44 of the samples were from macroscopically and microscopically completely resected lesions, and cancer at extended surgery was compared with pathology reports, classifications, and histopathological features.

Results:

In all, 26 cases of adenomas with adenocarcinoma in the rectum and rectosigmoid were among women and 11 in men while 22 men as opposed to 15 women had primary lesions in colon, giving a significant association between gender and localization ( p = 0.01). For macroscopically and microscopically fully resected lesions, Haggitt classification or submucosal invasion did not correlate with cancer at extended surgery. The lack of information on resection margins in the primary pathology reports was found to correlate significantly with residual cancer at extended surgery ( p < 0.001) with residual cancer in 3 out of the 10 cases with no information, 1 out of the 5 where the resection margins were uncertain, 1 out of the 4 where the resection margins were not free, and none of the 25 cases when the resection margins were reported as free. In colon, 1 case out of the 6 with extended surgery (16.7%) was diagnosed with residual cancer compared with 4 out of the 10 (40%) from rectum.

Conclusions:

Haggitt or submucosal classifications were not found to be predictors for residual cancer in the remaining bowel tissue or lymph node metastasis. The only significant factor indicating increased risk of residual cancer was the lack of information on resection margins in the pathology report. Surgeons should therefore be alert when adenomas with adenocarcinomas are not confirmed as microscopically free in the pathology report.
Large-Diameter (30–35 mm) Pneumatic Balloon Dilatation of The Pylorus In Patients With Gastric Outlet Obstruction Symptoms After Esophagectomy
Authors: Ericson J. , Sunde B. , Lindblad M. , Nilsson M. , Lundell L. , Tsai J. A.
Published: June 2013

Background and Aims:

Functional gastric outlet obstruction is a common problem after esophagectomy. The aim of this study was to evaluate the safety and efficacy of treating this group of patients with pneumatic dilatation of the pyloric sphincter region using a large-diameter (30–35 mm) balloon.

Material and Methods:

A review of all patients who had undergone pneumatic dilatation of the pylorus sphincter because of gastric outlet obstruction symptoms after esophagectomy at the Karolinska University Hospital from 2006–2011 was completed. Main outcomes were recordings of nausea, regurgitation and bloating.

Results:

A total of 13 patients received pneumatic dilatation after an esophagectomy. The median time between esophagectomy and the first dilatation was 100 days, and the patients underwent a total of 21 dilatations (1–3 per patient) to a final median diameter of 30 mm. No procedure-related complications occurred. The median follow-up time was 205 days, and nausea and regurgitation improved significantly (p < 0.001, Fisher’s test).

Conclusions:

Pneumatic dilatation of the pylorus using a large-diameter pneumatic balloon seems to be a safe and effective method for treating symptoms suggestive of gastric outlet obstruction after esophagectomy. To document its true effectiveness, a randomized and sham-controlled study is needed.