bluuebunny/crossref_metadata_2025_split huggingface dataset:
Patient frailty: the elephant in the operating room
Authors: Hubbard R. E. , Story D. A. 
Published: December 2013

SummaryFor most surgeons and many anaesthetists, patient frailty is currently the ‘elephant in the (operating) room’: it is easy to spot, but is often ignored. In this paper, we discuss different approaches to the measurement of frailty and review the evidence regarding the effect of frailty on peri‐operative outcomes. We explore the limitations of ‘eyeballing’ patients to quantify frailty, and consider why the frail older patient, challenged by seemingly minor insults in the postoperative period, may suffer falls or delirium. Frailty represents a state of increased vulnerability to stressors, and older inpatients are exposed to multiple stressors in the peri‐operative setting. Quantifying frailty is likely to increase the precision of peri‐operative risk assessment. The Frailty Index derived from Comprehensive Geriatric Assessment is a simple and robust way to quantify frailty, but is yet to be systematically investigated in the pre‐operative setting. Furthermore, the optimal care for frail patients and the reversibility of frailty with prehabilitation are fertile areas for future research.
Emergency surgery: the big three – abdominal aortic aneurysm, laparotomy and hip fracture
Authors: Stoneham M. , Murray D. , Foss N. 
Published: December 2013

SummaryNational reports recommended that peri‐operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high‐risk procedures undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely to rise as the population ages, this review summarises the evidence on which such guidance is based, and provides information about how anaesthetists might participate in audit and research aimed at improving local and national outcomes for these most vulnerable of patients.
Conceptualising the role of information and communication technologies in the design of higher education teaching models used in the UK
Authors: Caird Sally , Lane Andy 
Published: December 2013

AbstractDespite the widespread availability of information and communication technologies (ICTs) and some research into specific pedagogical practices using them, there has been little research on the role of these technologies in shaping broader pedagogical approaches in higher education (HE). Increased experimentation in using ICTs raises questions about their pedagogical role in teaching, learning and assessment provision, and in creating innovative pedagogies. An accepted approach is needed to compare the different ways ICTs and rich media are used in HE teaching models. Within the SusTEACH HE sustainability research project this was needed to support the carbon‐based environmental assessment of HE courses using ICTs. Building on a review of learning design theories and models, and ICTs used for pedagogical purposes, this paper considers several approaches to conceptualising the role of ICTs in HE courses, leading to the development of the Teaching Models Rating Tool designed to examine the role of ICTs in course provision. This tool characterises courses as using Face‐to‐Face Teaching Models, Distance Teaching Models, ICT‐Enhanced Blended Teaching Models or Online Teaching Models. Whilst this tool was designed to support research on sustainable HE teaching models in the UK, it has wider applications to support comparative assessments of pedagogical and economic impacts. Further developments will be informed by the complex and evolving role of ICTs in HE teaching models.
A role for PPARα in the medial prefrontal cortex in formalin‐evoked nociceptive responding in rats
Authors: Okine B N , Rea K , Olango W M , Price J , Herdman S , Madasu M K , Roche M , Finn D P 
Published: December 2013

Background and PurposeThe nuclear hormone receptor, PPARα, and its endogenous ligands, are involved in pain modulation. PPARα is expressed in the medial prefrontal cortex (mPFC), a key brain region involved in both the cognitive‐affective component of pain and in descending modulation of pain. However, the role of PPARα in the mPFC in pain responding has not been investigated. Here, we investigated the effects of pharmacological modulation of PPARα in the rat mPFC on formalin‐evoked nociceptive behaviour and the impact of formalin‐induced nociception on components of PPARα signalling in the mPFC.Experimental ApproachThe effects of intra‐mPFC microinjection of a PPARα agonist (GW7647) or a PPARα antagonist (GW6471) on formalin‐evoked nociceptive behaviour in rats were studied. Quantitative real‐time PCR and LC‐MS/MS were used to study the effects of intraplantar injection of formalin on PPARα mRNA expression and levels of endogenous ligands, respectively, in the mPFC.Key ResultsIntra‐mPFC administration of GW6471, but not GW7647, resulted in delayed onset of the early second phase of formalin‐evoked nociceptive behaviour. Furthermore, formalin‐evoked nociceptive behaviour was associated with significant reductions in mPFC levels of endogenous PPARα ligands (N‐palmitoylethanolamide and N‐oleoylethanolamide) and a 70% reduction in PPARα mRNA but not protein expression.Conclusions and ImplicationsThese data suggest that endogenous ligands may act at PPARα in the mPFC to play a facilitatory/permissive role in second phase formalin‐evoked nociceptive behaviour in rats.Linked ArticlesThis article is part of a themed section on Cannabinoids 2013. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2014.171.issue‐6
Genetic variants of immunoglobulin γ and κ chains influence humoral immunity to the cancer-testis antigen XAGE-1b (GAGED2a) in patients with non-small cell lung cancer
Authors: Pandey J P , Namboodiri A M , Ohue Y , Oka M , Nakayama E 
Published: December 2013

SummaryGM (γ marker) allotypes, genetic variants of immunoglobulin γ chains, have been reported to be associated strongly with susceptibility to lung cancer, but the mechanism(s) underlying this association is not known. One mechanism could involve their contribution to humoral immunity to lung tumour-associated antigens. In this study, we aimed to determine whether particular GM and KM (κ marker) allotypes were associated with antibody responsiveness to XAGE-1b, a highly immunogenic lung tumour-associated cancer-testis antigen. Sera from 89 patients with non-small cell lung cancer (NSCLC) were allotyped for eight GM and two KM determinants and characterized for antibodies to a synthetic XAGE-1b protein. The distribution of various GM phenotypes was significantly different between XAGE-1b antibody-positive and -negative patients (P = 0·023), as well as in the subgroup of XAGE-1b antigen-positive advanced NSCLC (P = 0·007). None of the patients with the GM 1,17 21 phenotype was positive for the XAGE-1b antibody. In patients with antigen-positive advanced disease, the prevalence of GM 1,2,17 21 was significantly higher in the antibody-positive group than in those who lacked the XAGE-1b antibody (P = 0·026). This phenotype also interacted with a particular KM phenotype: subjects with GM 1,2,17 21 and KM 3,3 phenotypes were almost four times (odds ratio = 3·8) as likely to be positive for the XAGE-1b antibody as the subjects who lacked these phenotypes. This is the first report presenting evidence for the involvement of immunoglobulin allotypes in immunity to a cancer-testis antigen, which has important implications for XAGE-1b-based immunotherapeutic interventions in lung adenocarcinoma.
The influence of the periodontal biotype on peri‐implant tissues around immediate implants with and without xenografts. Clinical and micro‐computerized tomographic study in small Beagle dogs
Authors: Maia Luciana P. , Reino Danilo M. , Muglia Valdir A. , de Souza Sérgio L. S. , Palioto Daniela B. , Novaes Arthur B. 
Published: December 2013

AbstractObjectiveSoft tissues and buccal bone plate remodeling after immediate implantation in sockets with thin buccal bone, using the flapless approach with or without bone graft into the buccal gap, was compared between sites with thin and normal gingiva.Material and methodsEight dogs had the gingiva of one side of the mandible thinned, the mandibular premolars were extracted without flaps, and 4 implants were installed in each side, positioned 1.5 mm from the buccal bone. The sites were randomly assigned into: TG (test group) = thin gingiva; TG + GM (TG with grafting material); CG (control group) = normal gingiva; and CG + GM (CG with grafting material). Buccal bone thickness (BBT), thickness of keratinized tissue (TKT), alveolar thickness (AT), gingival recession (GR), and probing depth (PD) were clinically evaluated. Within 12 weeks the dogs were sacrificed and the samples were analyzed by micro‐computerized tomography.ResultsA thin BBT was observed in all the dogs. The presurgical procedures reduced TKT in the test group, with minimal changes of the AT. There were no statistically significant differences among the groups for the clinical parameters and the tomographic analysis showed similar linear and tri‐dimensional bone reduction in all the groups.ConclusionThe thickness of the buccal bone was a fundamental factor in buccal bone plate resorption, even with flapless implantation. The decrease in gingival thickness or the addition of a biomaterial in the gap did not influence the results.
Lotus petal perforator flap for reconstruction of an extended chronic presacral defect after radiotherapy and rectal cancer resection
Authors: van der Meer J. G. , Moerman E. , van de Kar A. L. , Vermaas M. , Gerhards M. F. 
Published: December 2013

AbstractAimAs a result of their extent and complexity, pelvic wounds after surgery for anorectal malignancy often require a multidisciplinary approach to accomplish closure. This report describes a successful reconstruction using the lotus petal perforator flap.MethodThis flap is based on perforators of the internal pudendal artery and was partially depithelialized for plugging the defect.ResultsWound healing was achieved after 12 days.ConclusionThe lotus petal flap is a relatively simple and successful choice for reconstruction of an extended chronic presacral defect after radiotherapy and rectal cancer resection.
Early Effect of Essential Hypertension on the Left Ventricular Twist‐Displacement Loop by Two‐Dimensional Ultrasound Speckle Tracking Imaging
Authors: Qin Chuan , David Meggo‐Quiroz L. , Nanda Navin C. , Wang Xinfang , Xie Mingxing 
Published: December 2013

ObjectiveTo investigate two‐dimensional (2D) ultrasound speckle tracking imaging (STI) in the evaluation of the early changes in the left ventricular (LV) twist‐displacement loop in patients with hypertension (EH).MethodsSixty‐five EH patients with left ventricular normal geometry (LVN) – including 33 cases with non‐left atrial enlargement (NLAE) and 32 cases with left atrial enlargement (LAE) – along with 45 healthy individuals were enrolled in this study. Basal and apical 2D LV short‐axis images were acquired and analyzed to obtain the LV rotation (LVrot) and LV radial displacement. Once the LV twist and LV radial displacement were calculated, an LV twist‐displacement loop was constructed. Group comparisons between peak twist (Ptw), twist at mitral valve opening (MVOtw), untwisting rate (Utw R), systolic radial displacement (SD), systolic slope (SS), isovolumic relaxation radial displacement (IVRD) and isovolumic relaxation slope (IVRS) were performed.Results(1) The Ptw and MVOTw were greater in the NLAE and LAE groups when compared to the normal group while the UTw R was lower in likewise comparison. (2) The LV twist was correlated to the radial displacement in systole and in the isovolumic relaxation period. The SS and IVRS were greater in the NLAE and LAE groups when compared to the normal group.ConclusionsThe LV twist‐displacement loop can be reconstructed noninvasively by 2D ultrasound STI. EH affects the systolic and early diastolic component of the twist‐displacement loop by increasing the LV twist and decreasing the LV untwisting respectively impairing LV relaxation. The assessment of the LV twist‐displacement loop may be useful in the evaluation of early features of LV dysfunction in EH patients.
Utility of Speckle Tracking Echocardiography to Characterize Dysfunctional Myocardium in Patients with Ischemic Cardiomyopathy Referred for Cardiac Resynchronization Therapy
Authors: Kydd Anna C. , Khan Fakhar , Gopalan Deepa , Ring Liam , Rana Bushra S. , Virdee Mohan S. , Dutka David P. 
Published: December 2013

BackgroundAssessment of transmural scar at the site of latest mechanical activation is relevant to maximize outcomes in cardiac resynchronization therapy (CRT). Few studies have assessed the ability of speckle tracking echocardiography (STE)‐derived short‐axis strain to identify segmental myocardial scar, defined by contrast‐enhanced cardiac magnetic resonance imaging (CMR), in patients referred for CRT.MethodsA total of 26 patients with ischemic cardiomyopathy who underwent preprocedure echocardiography and CMR were studied. Extent of transmural scar was assessed using contrast‐enhanced CMR and corresponding peak segmental radial and circumferential strains were derived using two‐dimensional (2D) STE. Total left ventricle (LV) scar volume was compared with parameters of global strain. CRT response was defined as >15% reduction in LV end systolic volume (LVESV) at 6 months.ResultsSpeckle tracking short‐axis strain analysis was technically possible in over 90% of LV segments. Applying a segmental radial strain cutoff value of 10% distinguished segments with >50% scar area with a high negative predictive value (98%). Global longitudinal strain <−5% predicted CRT response.ConclusionsTwo‐dimensional STE offers potential to characterize dysfunctional myocardium and define segmental scar offering an integrated imaging approach to guide LV lead placement for CRT.
The Shadow Within: A Colossal Left Atrium
Authors: Varghese Mithun J. , Hussain Tajammul , George Paul V. , Pati Purendra K. , Jose Jacob V. 
Published: December 2013

Mini‐AbstractA 32‐year‐old male with rheumatic heart disease presented with atrial fibrillation and severe mitral regurgitation. His chest radiograph showed cardiomegaly and the distinctive shadow within shadow appearance of a distended left atrium (LA); echocardiogram revealed an LA dimension of 15.2 × 12.8 cm and cardiac magnetic resonance imaging disclosed a calculated LA volume of 1950 mL, representing one of the largest reported LA sizes in the current literature.
Nocturnal resource defence in aphid‐tending ants of northern Patagonia
Authors: LESCANO MARÍA N. , FARJI‐BRENER ALEJANDRO G. , GIANOLI ERNESTO 
Published: December 2013

Interspecific competition plays a key role in the organisation of ant communities. In ant–plant interactions, individual host plants are usually occupied by a single ant colony, and co‐occurring ant species compete for hosts. Here indirect evidence of competition between three dominant ant species that tend aphids on two biennial thistles in northern Patagonia is described, and a novel defensive behaviour in temperate ant assemblages is reported.
This study has found that: (i) dominant ant species were not spatially segregated, thus enhancing the probability of fights and invasions of host plants; (ii) ant species did not show preferences for a thistle species or for any plant characteristic, and thus all plants have similar chances of being colonised by all dominant ant species; (iii) the resident ant species remained on the same plant during the whole plant life cycle, monopolising plant resources (aphids); and (iv) all dominant species, whose nests are on the ground, assigned some ants to stay on the host plant during the night, when the low temperatures typical of this temperate environment greatly reduce foraging activities. When these ‘nocturnal guards’ were experimentally removed from the host plant, other ants from the same colony rapidly appeared showing aggressive behaviours.
Taking all these findings together, it is suggested that interspecific competition influences the distribution of ants on their host plants and involves nocturnal defensive behaviours despite unfavourable thermal conditions. This illustrates how habitat features, such as the short life cycle of thistles and the low night‐time temperatures that reduce ant foraging and thus make plants more vulnerable to invasion, might affect the distribution and behaviour of ants.
Biotic and abiotic regulation of a low‐density stream‐dwelling brown trout (Salmo truttaL.) population: effects on juvenile survival and growth
Authors: Richard Alexandre , Cattanéo Franck , Rubin Jean‐François 
Published: December 2013

AbstractThe effects of biotic (density‐dependent) and environmental (flow and temperature) factors on the apparent survival, mean length and size variation of a low‐density brown trout population in the juvenile stage, that is, from their first summer (0+) to the end of the second year (1+), were determined. Apparent survival was negatively related to the age class density during the three periods (first summer, first winter and second summer). A significant interaction between the mean flow and 0+ density highlighted a gradient towards strong density dependence acting on fish loss (i.e., mortality or migration) with decreasing summer flow. Conversely, no density dependence was reported at higher mean flows. The mean length was determined by density‐dependent and density‐independent (temperature and flow) factors throughout the study period. The negative relationship between fish length and intracohort density was highly significant during the three periods. The yearling (1+) density was negatively related to 0+ fish length measured after the first summer, suggesting intercohort effects. A positive effect of temperature on fish length was observed. Mean length after the summer seasons (0+ and 1+ fish) was also positively related to mean flow. Fish size variation around the mean measured with the coefficient of variation (CV) increased with increasing 0+ densities, both at the end of the first summer and the first winter. Results suggested that density‐dependent and density‐independent factors acted jointly on apparent survival and growth with a predominance of biotic processes. We discussed the potential implications of density‐dependent regulations on growth and survival for population resilience after catastrophic events.
Gender differences in suicidal behaviour in patients with first‐episode psychosis
Authors: Austad Gudrun , Joa Inge , Johannessen Jan Olav , Larsen Tor Ketil 
Published: December 2013

AbstractAimPrior research shows contradictory gender patterns in suicidal behaviour among patients with first‐episode psychosis. The aim of this study was to investigate gender differences in the prevalence of suicidal behaviour (suicidal ideation, suicide plans and suicide attempts) and to delineate risk factors for suicidal behaviour among consecutively included male and female patients with first‐episode psychosis in the TIPS II early detection study.MethodsPatients with first‐episode psychosis (n = 246) from a hospital catchment area with a system for early detection were assessed and compared on baseline sociodemographical and clinical variables according to gender. Current (past 1 month) and lifetime prevalence of suicidal behaviour were assessed.ResultsCurrent and lifetime rates of suicidal behaviour were high (50.8% and 65.9%, respectively) and higher among females (lifetime: 78.3 %, past month: 64.2 %) versus males (lifetime: 56.4 %, past month: 40.7 %). Depressive symptoms and female gender were associated with both lifetime and current risk for suicidal behaviour. Lifetime prevalence was also associated with a longer duration of untreated psychosis and young age after controlling for other risk factors.ConclusionsSuicidal behaviour was frequent among patients with first‐episode psychosis, with a higher prevalence of suicidal behaviour in females. Depressive symptoms and female gender were significantly associated with suicidal behaviour.
Mechanisms underlying the basal forebrain enhancement of top‐down and bottom‐up attention
Authors: Avery Michael C. , Dutt Nikil , Krichmar Jeffrey L. 
Published: December 2013

AbstractBoth attentional signals from frontal cortex and neuromodulatory signals from basal forebrain (BF) have been shown to influence information processing in the primary visual cortex (V1). These two systems exert complementary effects on their targets, including increasing firing rates and decreasing interneuronal correlations. Interestingly, experimental research suggests that the cholinergic system is important for increasing V1's sensitivity to both sensory and attentional information. To see how the BF and top‐down attention act together to modulate sensory input, we developed a spiking neural network model of V1 and thalamus that incorporated cholinergic neuromodulation and top‐down attention. In our model, activation of the BF had a broad effect that decreases the efficacy of top‐down projections and increased the reliance of bottom‐up sensory input. In contrast, we demonstrated how local release of acetylcholine in the visual cortex, which was triggered through top‐down gluatmatergic projections, could enhance top‐down attention with high spatial specificity. Our model matched experimental data showing that the BF and top‐down attention decrease interneuronal correlations and increase between‐trial reliability. We found that decreases in correlations were primarily between excitatory–inhibitory pairs rather than excitatory–excitatory pairs and suggest that excitatory–inhibitory decorrelation is necessary for maintaining low levels of excitatory–excitatory correlations. Increased inhibitory drive via release of acetylcholine in V1 may then act as a buffer, absorbing increases in excitatory–excitatory correlations that occur with attention and BF stimulation. These findings will lead to a better understanding of the mechanisms underyling the BF's interactions with attention signals and influences on correlations.
Predicting the process of extinction in experimental microcosms and accounting for interspecific interactions in single‐species time series
Authors: Ferguson Jake M. , Ponciano José M. 
Published: December 2013

AbstractPredicting population extinction risk is a fundamental application of ecological theory to the practice of conservation biology. Here, we compared the prediction performance of a wide array of stochastic, population dynamics models against direct observations of the extinction process from an extensive experimental data set. By varying a series of biological and statistical assumptions in the proposed models, we were able to identify the assumptions that affected predictions about population extinction. We also show how certain autocorrelation structures can emerge due to interspecific interactions, and that accounting for the stochastic effect of these interactions can improve predictions of the extinction process. We conclude that it is possible to account for the stochastic effects of community interactions on extinction when using single‐species time series.