bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is neuromyelitis optica associated with human leukocyte antigen?
Authors: Zéphir H , Fajardy I , Outteryck O , Blanc F , Roger N , Fleury M , Rudolf G , Marignier R , Vukusic S , Confavreux C , Vermersch P , de Seze J 
Published: March 2009

Background To establish whether or not multiple sclerosis (MS) and neuromyelitis optica (NMO) are different pathological entities, we wondered whether MS patients and NMO patients share the same pattern of human leukocyte antigen (HLA) predisposition. Objective To study a putative association between susceptibility to NMO and HLA class I or class II loci in Caucasians. Methods A total of 39 unrelated Caucasian patients with NMO and six patients at a high risk of converting to NMO were studied. DNA genotyping of HLA class I and class II loci was assessed and allelic frequencies were reported at a high-resolution level. A case-control study by comparing the allelic distribution in the NMO patients with that of a French Caucasian MS group and a French Caucasian healthy group was carried out. Results The frequencies of HLA-DQA1, DQB1, and HLA-DRB1 DR2 alleles in the NMO group were intermediate between the healthy control group and the MS group. The DPB1*0501 allele was not increased in the NMO group compared with the healthy control group. The distribution of HLA-DRB1 allele enabled to distinguish between NMO-IgG-positive patients and healthy controls ( P = 0.01). NMO-IgG-negative patients presented an HLA II pattern closer to that of the MS group ( P = 0.01). Conclusion In contrast to the reported results in Asian opticospinal MS, we found no association between the DPB1*0501 allele and NMO in our Caucasian patients. Moreover, we suggest that NMO-IgG-positive patients could represent a distinct NMO group in terms of their genetic susceptibility.
Axin expression in thymic stromal cells contributes to an age-related increase in thymic adiposity and is associated with reduced thymopoiesis independently of ghrelin signaling
Authors: Yang Hyunwon , Youm Yun-Hee , Sun Yuxiang , Rim Jong-Seop , Galbán Craig J , Vandanmagsar Bolormaa , Dixit Vishwa Deep 
Published: March 2009

AbstractThe adipocytes are the predominant cell types that constitute the bulk of the thymic microenvironment by the fifth decade of life in healthy humans. An age-related increase in thymic adiposity is associated with reduced thymopoiesis and compromised immune surveillance in the elderly. However, the mechanisms regulating the generation of intrathymic adipocytes during aging remain to be elucidated. Here, we report that the CD45– thymic stromal cells (TSCs) are amenable to adipogenesis. We identified that the Wnt inhibitor axin is expressed in the lymphoid as well as stromal cells of the thymus with increased expression in CD45– TSCs of older mice. Knockdown of axin by RNA interference in CD45– primary TSCs led to a marked reduction in adipogenesis with significantly lower expression of adipogenic transcripts peroxisome proliferator-activated receptor γ2 (PPAR), adipocyte fatty acid-binding protein (aP2), and perilipin. Age-related elevated axin expression was increased specifically in thymic fibroblasts and medullary thymic epithelial cells (TECs) but not in the cortical TEC or CD45+ cells. Consistent with a role of axin in promoting thymic adipogenesis, axin expression was also colocalized with lipid-expressing adipogenic cells in aging thymus. The prolongevity intervention, caloric restriction (CR), prevented the age-related increase in axin and the adipogenic cell in the thymus together with increase in thymic output. We have recently demonstrated that CR induces ghrelin, which can partially reverse thymic involution. Here, we show that axin expression is not affected by ablation of ghrelin receptors in aging mice, suggesting a ghrelin-independent mechanism for regulation of axin. Our data are consistent with the hypothesis that blocking the specific proadipogenic signals in the thymus may complement the present approaches to rejuvenate thymic function during aging.
Security Swipe Cards and Scanners are a Potential Reservoir for Hospital-Acquired Infection
Authors: Sultan MJ , Alm A , Hindmarsh A , Greatorex RA 
Published: March 2009

INTRODUCTION Hospital-acquired infections complicate 10% of hospital admissions resulting in increased morbidity, mortality and cost to hospitals. Most hospitals issue doctors with plastic swipe cards that function as electronic keys to access clinical areas. The card is handled many times a day, often before direct patient contact. The aim of this study was to determine if swipe cards harbour potentially harmful bacteria. SUBJECTS AND METHODS On a single day, doctors working in the surgical directorate completed a questionnaire to determine their pattern of swipe card use. Cards were inoculated onto agar plates and incubated for 48 h under standard laboratory conditions, following which the number of colony forming units (CFUs) cultured from each card was determined. Representative colonies were sampled and sub-cultured for staphlococcal, enterococcal, coliform and pseudomonad species. Isolated bacterial pathogens were tested for antimicrobial sensitivity. Swipe-card scanners were swabbed for microbiological culture on the same day. RESULTS All cards were colonised with environmental bacteria (mean, 73 CFU). Of cards, 21% were contaminated with pathogenic bacteria including Staphylococcus aureus (5.1%), Pseudomonas putida (2.6%), and coliform species (12.8%). The pattern of card use did not significantly affect the amount of bacterial contamination, but infrequent use of the card and keeping the card in a pocket or wallet was associated with higher levels of contamination. Environmental bacteria were cultured from 88% of card scanners, the highest counts coming from scanners in main theatres and the day-surgery unit. CONCLUSIONS Doctors' swipe cards are contaminated with, and may therefore be a reservoir for, pathogenic bacteria implicated in hospital-acquired infection.
Referral Letters for 2-Week Wait Suspected Colorectal Cancer do not Allow a ‘Straight-to-Test’ Pathway
Authors: Aljarabah MM , Borley NR , Goodman AJ , Wheeler JMD 
Published: March 2009

INTRODUCTION Some clinicians have argued that 2-week wait suspected colorectal cancer patients can go ‘straight-to-test’ to facilitate time to diagnosis and treatment. The aim of this study was to evaluate whether the currently used referral letters are reliable enough to allow that pathway. PATIENTS AND METHODS General practitioner (GP) letters referring patients under the Two Week-Wait Rule for suspected colorectal cancer were prospectively reviewed over a 6-month period. Three examining consultants were asked to outline the tests they would perform having only read the letter, and then again after a clinical consultation with the patient. The outcome of these tests was tracked. RESULTS A total of 217 referral letters of patients referred under Two Week Wait Rule for suspected colorectal cancer were studied. Having just read the referral letter, the most frequently requested test was colonoscopy (148), then CT scan (48), barium enema (44), followed by gastroscopy (23) and flexible sigmoidoscopy in 15 patients (some patients would have had more than one test requested). After consultation with the patients, tests requested as guided by the GP letter were changed in 67 patients (31%), where 142 colonoscopies, 61 CT scans, 37 barium enemas, 23 flexible sigmoidoscopies and 19 gastroscopies were organised. The referral indication which had tests changed most often was definite palpable rectal mass (67%), while patients referred with definite palpable right-sided abdominal mass had their tests least often changed (9%). A total of 22 patients were found to have colorectal cancers (10%) and 30 patients were diagnosed with polyps (14%). Out of 142 colonoscopies performed, 19 (13%) showed some pathology beyond the sigmoid colon and of the 23 patients who had flexible sigmoidoscopy initially, only three went on to have colonoscopy subsequently. During the 6-month period of the study, only five breaches of the waiting time targets were recorded (1 to the 31-day target and 4 to the 62-day target). CONCLUSIONS A significant number of patients would have had tests changed after a clinical consultation. However, only a small number required further investigations having had a consultation prior to their initial investigations. We conclude that 2-week wait suspected colorectal cancer patients should be seen in the clinic first and should not proceed ‘straight-to-test’.
Clinical Impact of Tumour Involvement of the Anastomotic Doughnut in Oesophagogastric Cancer Surgery
Authors: Sillah K , Griffiths EA , Pritchard SA , Swindell R , West CM , Page R , Welch IM 
Published: March 2009

INTRODUCTION Published colorectal cancer surgery data suggest no role for the analysis of the anastomotic doughnuts following anterior resection. The usefulness of routine histological analysis of the upper gastrointestinal doughnut is not clear. Our study assessed the impact of cancer involvement of the doughnut on clinical practice. Factors associated with doughnut involvement and the effect on patients' survival were also analysed. PATIENTS AND METHODS The clinicopathological details of 462 patients who underwent potentially curative oesophagogastrectomy for cancer with a stapled anastomosis between 1994 and 2006 in two specialist centres were retrospectively analysed. Univariate, multivariate and survival analyses were carried out. RESULTS Approximately 5% of doughnuts (22 of 462) were histologically involved with cancer. Microscopic involvement of the proximal resection margin, local lymph node metastasis and lymphatic invasion within the main resected specimen were independently associated with doughnut involvement (all P < 0.05). However, these three factors taken together failed to predict doughnut involvement. Doughnut involvement was an independent adverse prognostic factor for overall survival (P = 0.0013). CONCLUSIONS In contrast to findings in colorectal surgery, doughnut involvement with cancer appears to have useful prognostic information following oesophagogastrectomy. Routine histological analysis of upper gastrointestinal doughnuts is justified. Doughnut involvement could potentially strengthen the indications for adjuvant therapy in the future.
Improving Operation Notes to Meet British Orthopaedic Association Guidelines
Authors: Morgan David , Fisher Noel , Ahmad Aman , Alam Fazle 
Published: March 2009

INTRODUCTION Operation notes are an important part of medical records for clinical, academic and medicolegal reasons. This study audited the quality of operative note keeping for total knee replacements against the standards set by the British Orthopaedic Association (BOA). PATIENTS AND METHODS A prospective review of all patients undergoing total knee replacement at a district general hospital over 8 months. Data recorded were compared with those required by the BOA good-practice guidelines. Change in practice was implemented and the audit cycle completed. Data were statistically analysed. RESULTS A total of 129 operation notes were reviewed. There was a significant improvement in the mean number of data points recorded from 9.6 to 13.1. The least well recorded data were diagnosis, description of findings, alignment and postoperative flexion range. All had a significant improvement except description of findings. The operating surgeon writing the note improved from 56% to 67%. Detailed postoperative instructions also improved in quality. CONCLUSIONS Surgeon education and the use of a checklist produce better quality total knee replacement operation notes in line with BOA guidelines. Further improvements may be made by making the data points part of the operation note itself.
Do Scoring Systems Help in Predicting Survival Following Ruptured Abdominal Aortic Aneurysm Surgery?
Authors: Gatt Marcel , Goldsmith Paul , Martinez Marcos , Barandiaran Jesus , Grover Kartikae , El-Barghouti Naif , Perry Eugene P 
Published: March 2009

INTRODUCTIONThe aim of this study was to assess the value of the Hardman Index and the Glasgow Aneurysm Score in predicting postoperative mortality in patients with ruptured abdominal aortic aneurysm (rAAA), and to assess the correlation between the two.PATIENTS AND METHODSPatients admitted with rAAA were identified from a hospital database. Hospital records were reviewed and a retrospective Hardman Index and Glasgow Aneurysm Score was calculated. Poor postoperative prognosis was considered at a Glasgow Aneurysm Score > 95 or a Hardman Index ≥ 3.RESULTSA total of 96 patients with a median age of 77.5 years (interquartile range, 71–83 years) and a male:female ratio of 2:1 were identified. Of these, 37 patients were not offered surgery and this was associated with 100% mortality. Of the 59 operated patients, 36 (61%) patients died postoperatively. Operated patients had a median Glasgow Aneurysm Score of 91 (interquartile range, 77–101) and a Hardman Index of 2 (interquartile range, 1–2). In this group, a Glasgow Aneurysm Score > 95 or a Hardman Index ≥ 3 was not associated with mortality (P = 0.10 and P = 0.79, respectively). Correlation between the scoring systems was poor (+0.42 τb).CONCLUSIONSThe scoring systems assessed did not help predict the outcome of rAAA surgery, and correlated poorly with each other. They do not aid clinical judgement.
Sending NHS Patients for Operations Abroad: Is the Holiday Over?
Authors: Hanna Sammy A , Saksena Joyti , Legge Stella , Ware Howard E 
Published: March 2009

INTRODUCTION The UK Department of Health, in its attempt to help NHS trusts reduce long elective waiting lists, set up the overseas commissioning scheme in 2002. This allowed hospitals to send their patients abroad for their surgery. In theory, this was a win-win situation, where pressures upon surgeons were reduced, and trusts could reach UK Government targets and avoid breaches. At our hospital, a significant number of patients, who had undergone a total joint replacement abroad, were discharged after only one postoperative review and often had very little physiotherapy. A few presented to our clinic with more serious problems. PATIENTS AND METHODS This is a retrospective review of two matched groups of patients (22 each), all of whom underwent a total knee replacement in 2003. The first group (abroad, Belgium) included 10 males and 12 females with a mean age of 74.5 years and a mean follow-up of 37 months. The second group (local institution) included 10 males and 12 females with a mean age of 71.4 years and a mean follow-up of 34 months. All patients were evaluated using the Oxford Knee Score (OKS), Knee Society Score (KSS), and SF-12 systems. RESULTS OKS and KSS were similar in the two groups. However, SF-12 figures revealed a statistically significant difference in both the physical (PCS) and mental components (MCS). Belgium group – mean PCS 40, mean MCS 48: local group – mean PCS 47, mean MCS 57; P < 0.05. CONCLUSIONS The results demonstrate that, although the majority of patients operated upon abroad got comparable functional results to patients operated locally, they often felt dissatisfied with the overall experience of travelling for their operation. Furthermore, the issues of ‘patient ownership’ and long-term follow-up need to be fully addressed in order to safeguard the high standard of care we should offer our patients.
Primary Total Knee Replacement: Is Suction a Portal of Infection?
Authors: Budnar Vijaya M , Amirfeyz Rouin , Ng Michael , Bannister Gordon C , Blom Ashley W 
Published: March 2009

INTRODUCTION Pulsed lavage during a total knee replacement usually leaves a pool of fluid on the surgical drapes. It is common practice to suck away this fluid using the same suction device used intra-operatively. This could be a cause of direct wound contamination. We hypothesised that bacteria contaminate fluid that collects around the foot in total knee replacement surgery and that suction equipment could be a portal of contamination. We also hypothesised that bacterial count in the fluid is lower if chlorhexidine, rather than saline, is used in the pulsed lavage. PATIENTS AND METHODS Forty patients undergoing primary total knee replacement were divided into two groups. The first group had pulsed lavage with normal saline and the second with 0.05% chlorhexidine. RESULTS At the end of the operation, 20 ml of fluid, pooled on the surgical drapes was aspirated and cultured for bacterial growth. None of the fluid samples showed bacterial growth. CONCLUSIONS Suction device used peri-operatively during knee replacement is unlikely to be a cause of wound contamination. Pulsed lavage with normal saline is as effective as lavage with chlorhexidine.
The Use of the Harmonic Scalpel in Thyroidectomy: ‘Beyond the Learning Curve’
Authors: Foreman E , Aspinall S , Bliss RD , Lennard TWJ 
Published: March 2009

INTRODUCTION Safe and effective haemostasis in surgery is clearly essential, and in the neck where risks of airway compromise are also present any new technology that purports to offer advantages must be rigorously evaluated. We describe our experience with the use of the Harmonic Scalpel [Ethicon UK] in thyroidectomy. PATIENTS AND METHODS A retrospective clinical review of 183 patients undergoing hemi or total thyroidectomies from 12 months prior to using the harmonic scalpel (2003; n = 77) and 12 months ‘beyond the learning curve’ (2006; n = 106). RESULTS The results demonstrate that, once past the learning curve, the use of the harmonic scalpel during thyroidectomy significantly reduces operative time and postoperative hypocalcaemia, and is as safe as conventional surgery with regard to voice change and bleeding. CONCLUSIONS The harmonic scalpel is as safe as conventional methods of haemostasis and operations using this technique are quicker once the need to have repetitive ‘clip, cut and tie’ routines is avoided.
Buccal Mucosal Grafts for Urethroplasty: Comparison of Postoperative Oral and Perineal Morbidity
Authors: Abdel-Galil Khalid , Eardley Ian , Loukota Richard 
Published: March 2009

INTRODUCTION A prospective study of postoperative oral and perineal pain experienced by a group of patients undergoing buccal mucosal graft harvest for urethral reconstruction. PATIENTS AND METHODS A consecutive group of 24 male patients undergoing buccal mucosa graft harvest for urethral recon8truction of stricture disease was prospectively studied between June 2006 and December 2008. All patients were examined pre-operatively and entered into the study prospectively. After surgery, all patients were reviewed at 24 h and 48 h. On both occasions, they were asked to complete a proforma containing visual analogue pain scales for both the oral donor site as well as the perineum. RESULTS A statistically significant higher level of pain was experienced from the perineum than the oral donor site on both the first and second postoperative days. CONCLUSIONS Comparative analysis of visual analogue pain scale scores between oral donor site and perineum showed that patients experience significantly more pain from the latter postoperatively.
Audit of Clinical Coding of Major Head and Neck Operations
Authors: Mitra Indu , Malik Tass , Homer Jarrod J , Loughran Sean 
Published: March 2009

INTRODUCTION Within the NHS, operations are coded using the Office of Population Censuses and Surveys (OPCS) classification system. These codes, together with diagnostic codes, are used to generate Healthcare Resource Group (HRG) codes, which correlate to a payment bracket. The aim of this study was to determine whether allocated procedure codes for major head and neck operations were correct and reflective of the work undertaken. HRG codes generated were assessed to determine accuracy of remuneration. PATIENTS AND METHODS The coding of consecutive major head and neck operations undertaken in a tertiary referral centre over a retrospective 3-month period were assessed. Procedure codes were initially ascribed by professional hospital coders. Operations were then recoded by the surgical trainee in liaison with the head of clinical coding. The initial and revised procedure codes were compared and used to generate HRG codes, to determine whether the payment banding had altered. RESULTS A total of 34 cases were reviewed. The number of procedure codes generated initially by the clinical coders was 99, whereas the revised codes generated 146. Of the original codes, 47 of 99 (47.4%) were incorrect. In 19 of the 34 cases reviewed (55.9%), the HRG code remained unchanged, thus resulting in the correct payment. Six cases were never coded, equating to £15,300 loss of payment. CONCLUSIONS These results highlight the inadequacy of this system to reward hospitals for the work carried out within the NHS in a fair and consistent manner. The current coding system was found to be complicated, ambiguous and inaccurate, resulting in loss of remuneration.
A New Principle for Measurement of Cobalamin and Corrinoids, Used for Studies of Cobalamin Analogs on Serum Haptocorrin
Authors: Hardlei Tore Forsingdal , Nexo Ebba 
Published: March 2009

AbstractBackground: Transcobalamin (TC) and haptocorrin (HC) are serum corrinoid–binding proteins. We developed new methods for measurement of the corrinoids bound to HC and TC.Methods: TC (n = 10) or HC (n = 138) was immunoprecipitated, and corrinoids were released by enzymatic degradation [subtilisin Carlsberg (EC 3.4.21.62)] of the binding proteins. Binding of the released corrinoids to added unsaturated TC (apoTC) or HC (apoHC) created holoTC (as measure of cobalamins) and holoHC (as measure of corrinoids). holoTC and holoHC were measured by use of ELISA. The amounts of analogs were calculated as the difference between corrinoids and cobalamins. Corrinoids extracted from HC were separated with HPLC after addition of potassium cyanide (n = 3).Results: The corrinoid- and cobalamin-specific assays had a positive linear relation between analyte concentration and assay signal, detection limits of 8 and 4 pmol/L, and imprecision values (CV) of ≤10% and ≤13% for concentrations between 45–200 and 12–115 pmol/L, respectively. No analogs were bound to serum TC, whereas the mean (95% reference range) for analogs present on HC was 245 (100–380) pmol/L. On HPLC a substantial amount of the analogs showed elution patterns similar to those of dicyanocobinamide.Conclusions: Our methods for measurement of unmodified corrinoids in serum demonstrate that HC carries cobalamin analogs not recognized by TC, and that on HPLC a substantial part of these analogs elute similarly to cobinamide.
Media events and European visions: Czech Republic in the 2007 Eurovision Song Contest
Authors: Štětka Václav 
Published: March 2009

Abstract
In this article, the author deals with the relationship between the supposed socio-integrative role of media events, as defined by Dayan and Katz, and the processes of European integration and identity building. He focuses specifically on the Eurovision Song Contest and the way it has been historically promoted as a tool for raising European consciousness, as well as on the difficulties with maintaining this role in the context of the growing number of participating countries. These issues are further explored through an empirical analysis of the 2007 Eurovision Song Contest in the Czech Republic, which was a debuting country that year. This case study shows that the event was largely unsuccessful and met both with a lack of audience interest as well as with media criticism and even disdain. It also demonstrates how, in light of the Czech musical representative's failure in the ESC, the Czech media scene adopted a nationalist-defensive stance and created an image of a moral victory over decadent Europe.