bluuebunny/crossref_metadata_2025_split huggingface dataset:
A tertiary experience of vesico‐vaginal and urethro‐vaginal fistula repair: factors predicting success
Authors: Ockrim Jeremy L. , Greenwell Tamsin J. , Foley Charlotte L. , Wood Dan N. , Shah P. Julian R. 
Published: January 2009

OBJECTIVETo review the outcomes of all patients referred with vesico‐vaginal (V VF) and urethro‐vaginal (UVF) fistulae to a tertiary centre, and to investigate the patient, fistula and surgical factors relevant to success.PATIENTS AND METHODSWe reviewed retrospectively the case‐notes of 41 consecutive patients (32 with V VF; nine with UVF) treated between January 2000 and January 2006.RESULTSAll patients were tertiary referrals, eight after failed local repairs. Four patients were unsalvageable and had a supravesical diversion. In all there were 47 repairs (23 transvaginal; 24 transabdominal) on 37 patients by two specialist surgeons. The fistula was closed in 92%; five V VF and one UVF required a second procedure, and one V VF a third procedure. One patient with a V VF awaits a second attempt at repair. In one V VF (one attempt) and one UVF (three attempts) the procedure failed and the patient had a diversion. A transvaginal approach cured all 11 patients with a V VF and eight of nine with a UVF, whilst an abdominal approach used for larger/complex fistulae was successful in 18 of 24 (75%) attempts (P = 0.13). The major determinants of success were fistula size (>3 cm; P = 0.02) and the availability of tissue for interposition. V VF repairs using Martius/omental interposition were mostly successful, whilst abdominal repairs in which omentum was unavailable tended to fail (37.5% cure; P = 0.002).CONCLUSIONSDespite varied aetiology, V VF/UVF were repaired successfully in 92% of patients. Complex (V VF) fistulae were challenging and a quarter of these required more than one attempt. Failure of repair was more likely in larger fistulae (>3 cm) requiring an abdominal approach, if omental interposition was not possible. Good‐quality tissue interposition for complex fistula is essential for a successful outcome.
Long‐term effectiveness of diet‐plus‐exercise interventions vs. diet‐only interventions for weight loss: a meta‐analysis
Authors: Wu T. , Gao X. , Chen M. , Van Dam R. M. 
Published: January 2009

SummaryDiet and exercise are two of the commonest strategies to reduce weight. Whether a diet‐plus‐exercise intervention is more effective for weight loss than a diet‐only intervention in the long‐term has not been conclusively established. The objective of this study was to systemically review the effect of diet‐plus‐exercise interventions vs. diet‐only interventions on both long‐term and short‐term weight loss. Studies were retrieved by searching MEDLINE and Cochrane Library (1966 – June 2008). Studies were included if they were randomized controlled trials comparing the effect of diet‐plus‐exercise interventions vs. diet‐only interventions on weight loss for a minimum of 6 months among obese or overweight adults. Eighteen studies met our inclusion criteria. Data were independently extracted by two investigators using a standardized protocol. We found that the overall standardized mean differences between diet‐plus‐exercise interventions and diet‐only interventions at the end of follow‐up were −0.25 (95% confidence interval [CI]−0.36 to −0.14), with a P‐value for heterogeneity of 0.4. Because there were two outcome measurements, weight (kg) and body mass index (kg m−2), we also stratified the results by weight and body mass index outcome. The pooled weight loss was 1.14 kg (95% CI 0.21 to 2.07) or 0.50 kg m−2 (95% CI 0.21 to 0.79) greater for the diet‐plus‐exercise group than the diet‐only group. We did not detect significant heterogeneity in either stratum. Even in studies lasting 2 years or longer, diet‐plus‐exercise interventions provided significantly greater weight loss than diet‐only interventions. In summary, a combined diet‐plus‐exercise programme provided greater long‐term weight loss than a diet‐only programme. However, both diet‐only and diet‐plus‐exercise programmes are associated with partial weight regain, and future studies should explore better strategies to limit weight regain and achieve greater long‐term weight loss.
The Effects of Relative Income and Absolute Income on Happiness
Authors: Tao Hung‐Lin , Chiu Shih‐Yung 
Published: January 2009

AbstractThe authors consider the absolute income effect and several relative income effects on happiness. The latter include both a longitudinal comparison, which consists of both upward and downward comparisons, and a parallel comparison with individuals of similar traits. It is found that the longitudinal comparison and parallel comparison exist simultaneously, although the downward comparison is insignificant. However, the symmetry of the upward comparison, downward comparison, and parallel comparison cannot be rejected. Because the absolute income effect and the relative income effects countervail, the effect of income growth on subjective well‐being is likely to be negligible.
Healthcare System Types: A Conceptual Framework for Comparison
Authors: Wendt Claus , Frisina Lorraine , Rothgang Heinz 
Published: January 2009

AbstractThis article addresses the need to establish a comprehensive conceptual framework for analysing healthcare systems and their transformations. It begins by offering an overview of the current state of the art in the field, pointing to the literature's absence of conceptual robustness in the definition of system types. By exploring the dimensions ‘financing’, ‘provision’ and ‘regulation’ of healthcare, the article then proceeds deductively in line with the ‘Weberian method of ideal‐types’ to establish a taxonomy of 27 healthcare systems, of which three can be identified as ‘ideal‐types’. When applying this concept, not only can differences between healthcare systems be analysed, but also changes over time. The article concludes by identifying three forms of healthcare system transformation.
Closed‐chamber transepidermal water loss measurement: microclimate, calibration and performance
Authors: Imhof R. E. , De Jesus M. E. P. , Xiao P. , Ciortea L. I. , Berg E. P. 
Published: January 2009

SynopsisThe importance of transepidermal water loss (TEWL) as a measure of the skin barrier is well recognized. Currently, the open‐chamber method is dominant, but it is increasingly challenged by newer closed‐chamber technologies. Whilst there is familiarity with open‐chamber characteristics, there is uncertainty about the capabilities of the challengers. The main issues are related to how microclimate affects TEWL measurements.The aim of this paper is to provide a framework for understanding the effects of microclimate on TEWL measurement. Part of the problem is that TEWL measurement is indirect. TEWL is the diffusion of condensed water through the stratum corneum (SC), whereas TEWL methods measure water vapour flux in the air above the SC. This vapour flux depends on (i) the rate of supply of water to the skin surface and (ii) the rate of evaporation of water from the skin surface. Rate (i) is a skin property (TEWL), rate (ii) is a microclimate property. The controlling rate for the combined process is the lower of the above two rates. Therefore, TEWL instruments measure TEWL only when TEWL is the rate‐limiting process.Another problem is that SC barrier property and SC hydration are affected by the microclimate adjacent to the skin surface. This is discussed insofar as it affects the measurement of TEWL. The conclusion is that such changes occur on a timescale that is long compared with TEWL measurement times.An important aspect of TEWL measurement is calibration. We present an analysis of the traditional wet‐cup method and a new droplet method that is traceable and has been independently verified by a standards laboratory.Finally, we review performance indicators of commercial closed‐chamber instruments with reference to open‐chamber instruments. The main findings are that TEWL readings correlate well, but there are significant differences in the other aspects of performance.
Long‐term changes in breeding phenology at two seabird colonies in the western North Sea
Authors: WANLESS SARAH , FREDERIKSEN MORTEN , WALTON JOHN , HARRIS MIKE P. 
Published: January 2009

There is compelling evidence that the breeding phenology of many species has changed substantially in recent decades. However, taxonomic and spatial variation in the direction and rate of change is still not well understood. We explored these issues by analysing a dataset containing information on first egg dates of 10 species of seabird at two major breeding colonies (86 km apart) in the western North Sea over a period of 35 years. Within a species, timing of breeding was positively correlated between the two colonies, suggesting that factors affecting the phenology of these species operated at a regional rather than a colony scale. Comparison of time trends among the species revealed contrasting patterns, with some showing no systematic change, others becoming earlier and others later. The clearest species groupings appeared to be among the terns with arrival and/or first egg dates becoming earlier in Arctic Terns Sterna paradisaea, Common Terns Sterna hirundo and Sandwich Terns Sterna sandvicensis, and among the auks (Common Guillemot Uria aalge, Razorbill Alca torda and Atlantic Puffin Fratercula arctica) and Black‐legged Kittiwake Rissa tridactyla where the trend was in the opposite direction towards later breeding. This general trend towards later breeding in the latter group of species contrasts with correlational evidence from many other organisms indicating that breeding phenology is advancing in response to climate change.
Wound healing essentials: Let there be oxygen
Authors: Sen Chandan K. 
Published: January 2009

ABSTRACTThe state of wound oxygenation is a key determinant of healing outcomes. From a diagnostic standpoint, measurements of wound oxygenation are commonly used to guide treatment planning such as amputation decision. In preventive applications, optimizing wound perfusion and providing supplemental O2 in the perioperative period reduces the incidence of postoperative infections. Correction of wound pO2 may, by itself, trigger some healing responses. Importantly, approaches to correct wound pO2 favorably influence outcomes of other therapies such as responsiveness to growth factors and acceptance of grafts. Chronic ischemic wounds are essentially hypoxic. Primarily based on the tumor literature, hypoxia is generally viewed as being angiogenic. This is true with the condition that hypoxia be acute and mild to modest in magnitude. Extreme near‐anoxic hypoxia, as commonly noted in problem wounds, is not compatible with tissue repair. Adequate wound tissue oxygenation is required but may not be sufficient to favorably influence healing outcomes. Success in wound care may be improved by a personalized health care approach. The key lies in our ability to specifically identify the key limitations of a given wound and in developing a multifaceted strategy to specifically address those limitations. In considering approaches to oxygenate the wound tissue it is important to recognize that both too little as well as too much may impede the healing process. Oxygen dosing based on the specific need of a wound therefore seems prudent. Therapeutic approaches targeting the oxygen sensing and redox signaling pathways are promising.
Microcirculation in mixed arterial/venous ulcers and the surrounding skin: Clinical study using a laser Doppler perfusion imager and capillary microscopy
Authors: Ambrozy Ewald , Waczulikova Iveta , Willfort‐Ehringer Andrea , Ehringer Herbert , Koppensteiner Renate , Gschwandtner Michael E. 
Published: January 2009

ABSTRACTTo treat mixed skin ulcers effectively, it is important to investigate skin microcirculation in greater detail. Therefore, we used laser Doppler perfusion imaging and capillary microscopy for assessing both subpapillary and nutritive microcirculation in four defined regions of the skin in 17 patients with mixed ulcers caused by a combination of peripheral arterial occlusive disease and chronic venous insufficiency. Laser Doppler area flux was significantly higher in the ulcer areas than in the areas without granulation tissue and those in intact skin. The flux in the scars was higher than that in the intact skin or in the ulcer areas without granulation tissue. Capillary density in the intact skin was higher than the densities in nongranulation tissue areas, granulation areas, and scar areas (p<0.001 for all comparisons). To conclude, the ulcer areas without granulation tissue did not show a healing tendency due to poor subpapillary and nutritive perfusion; the granulation tissue exhibited high subpapillary perfusion as a sign of healing. In the scars, sufficient blood supply could be detected in both layers as a sign of an almost complete healing process. Blood supply in the intact skin is, however, already affected by distorted microcirculation in the ulcers.
Aging influences wound healing in patients with chronic lower extremity wounds treated in a specialized wound care center
Authors: Wicke Corinna , Bachinger Andreas , Coerper Stephan , Beckert Stefan , Witte Maria B. , Königsrainer Alfred 
Published: January 2009

ABSTRACTWith the dramatic increase in the aging population, the study and care of wounds in the elderly have become priority topics for both researchers and clinicians. The effects of aging on wound healing in humans have remained controversial. The study was a 5‐year epidemiological evaluation of standardized data collected regularly during patients' visits at a specialized Wound Care Center with the aim to determine the key factors influencing the healing of chronic lower extremity wounds. In this analysis of 1,158 chronic wounds, the frequency of wound closure was statistically significantly lower in older patients compared with younger patients. The share of closed wounds decreased by nearly 25% in the elderly patients (≥70 years). The relationship between the patient's age and the proportion of wound closure was nonlinear. The effect of aging on the frequency of wound closure of chronic wounds became clinically apparent after age 60. The chronicity of the wounds was illustrated by their recurrent nature, their long duration, the presence of multiple wounds, and the frequency of concurrent infection. Comorbidity was documented by the coprevalence of up to three underlying diseases related to impaired wound healing. The present study clearly showed that aging affects chronic wound healing negatively.
Delayed reepithelialization and basement membrane regeneration after wounding in mice lacking CXCR3
Authors: Yates Cecelia C. , Whaley Diana , Hooda Shveta , Hebda Patricia A. , Bodnar Richard J. , Wells Alan 
Published: January 2009

ABSTRACTWound healing is a complex, orchestrated series of biological events that is controlled by extracellular components that communicate between cell types to re‐establish lost tissue. We have found that signaling by ELR‐negative CXC chemokines through their common CXCR3 receptor is critical for dermal maturation during the resolving phase. In addition there needs to be complete maturation of the epidermis and regeneration of a delineating basement membrane for proper functioning. The role of this ligand–receptor system appears confounding as one ligand, CXCL4/(PF4), is present during the initial dissolution and two others, CXCL10/(IP‐10) and CXCL11/(IP‐9/I‐TAC), are expressed by keratinocytes in the later regenerative and resolving phases during which the basement membrane is re‐established. We examined CXCR3 signaling role in healing using a mouse lacking this receptor, as all three ligands act solely via the common receptor. Reepithelialization was delayed in CXCR3‐deficient mice in both full and partial‐thickness excisional wounds. Even at 90 days postwounding, the epidermis of these mice appeared less mature with lower levels of E‐cadherin and cytokeratin 18. The underlying basement membrane, a product of both dermal fibroblasts and epidermal keratinocytes, was not fully established with persistent diffuse expression of the matrix components laminin 5, collagen IV, and collagen VII throughout the wound bed. These results suggest that CXCR3 and its ligands play an important role in the re‐establishment of the basement membrane and epidermis. These studies further establish the emerging signaling network that involves the CXCR3 chemokine receptor and its ligands as a key regulator of wound repair.
Effect of estrogen and progesterone on macrophage activation during wound healing
Authors: Routley Claire E. , Ashcroft Gillian S. 
Published: January 2009

ABSTRACTAge‐related impaired wound healing leads to substantial morbidity and mortality along with a large financial burden to health services. There is accumulating evidence that the tissue damage associated with chronic wounds is initiated and propagated by an inappropriately excessive inflammatory response. Research on age‐related impaired wound healing suggests that the decline in sex steroid hormones with age may have a substantial influence on the inflammatory response in vivo. Topical and systemic estrogen treatments have shown an increased rate of healing by reducing inflammation, however the underlying mechanisms are little understood. In vitro studies also suggest progesterone may play a role in modulating inflammation. Macrophages are essential mediators of inflammation and wound healing. Macrophages can be activated in a classical or alternative manner in parallel with the TH1/TH2 dichotomy, respectively. Using a murine incisional wound healing model this study was carried out to investigate the roles of estrogen and progesterone on macrophage activation during the wound healing response. Our findings suggest with a reduction of steroid hormones following ovariectomy, alternatively activated macrophage markers (Fizz1 and Ym1) were reduced, with this effect being reversed with the administration of estrogen or progesterone; suggesting that with the reduction of steroid hormones macrophages are activated in a classical manner, promoting inflammation, whereas estrogen or progesterone are contributing toward macrophage activation in an alternative manner, driving wound repair, angiogenesis, and remodeling.
Characterizing omental adhesions by culturing cells isolated from a novel in vivo adhesion model
Authors: Gómez‐Gil Verónica , Pascual Gemma , García‐Honduvilla Natalio , Rodríguez Marta , Buján Julia , Bellón Juan M. 
Published: January 2009

ABSTRACTAlthough it has been established that postoperative adhesions in the peritoneal cavity are the consequence of injury to the peritoneum, there is much controversy over the nature of the cells giving rise to this neotissue. Here, we establish a novel adhesiogenic model in the rabbit to analyze the phenotype and proliferation in vitro of cells comprising adhesion tissue seven days postsurgery. Adhesion‐free omentum tissue was used as control. Cells derived from adhesions and from the control omentum were subcultured and characterized through immunofluorescence and Western blotting procedures to determine markers of cell differentiation and pluripotential, and viability and proliferation assays. Our findings indicate the existence of a mesenchymal population in the omentum revealed by markers of pluripotent cells with high angiogenic capacity. This population seems to be responsible for the adhesions formed in response to mesothelial damage. Depending on the local environment, mesenchymal cells are capable of in vivo differentiation towards at least two different cell phenotypes rendering two types of adhesions with clearly differentiated characteristics. One type of adhesion shows a highly vascularized adipose morphology containing cells differentiating into a vascular lineage. The other adhesions are fibrous with large amounts of collagen and comprised mainly of myofibroblasts conferring less compliance to this tissue.
Prostaglandin E1 prevents liver failure after excessive hepatectomy in the rat by up‐regulating Cyclin C, Cyclin D1, and Bclxl
Authors: Ishibe Atsushi , Togo Shinji , Kumamoto Takafumi , Watanabe Kazuteru , Takahashi Takuji , Shimizu Tetsuya , Makino Hirochika , Matsuo Kenichi , Kubota Toru , Nagashima Yoji , Shimada Hiroshi 
Published: January 2009

ABSTRACTProstaglandin E1 (PGE1) has wide‐ranging effects on cytoprotection and may play a role in preventing liver failure following excessive hepatectomy. We examined the effect of PGE1 on hepatocyte apoptosis and liver regeneration after 95% hepatectomy in a rat model. PGE1 or vehicle was intravenously administered 30 minutes before and during hepatectomy. The extent of hepatocyte injury was evaluated by serum alanine aminotransferase and aspartate aminotransferase levels. To evaluate hepatocyte apoptosis and liver regeneration, terminal deoxynucleotidyl transferase dUTP nick end labeling staining and Ki67 labeling were performed. The expression levels of Bcl‐xL, Bcl‐2, Bax, Cyclin C, Cyclin D1, Cyclin E, p21, transforming growth factor‐β, plasminogen activator inhibitor‐1, and glyceraldehyde‐2‐phosphate dehydrogenase mRNA were also examined by reverse transcription‐polymerase chain reaction. Survival was improved in the PGE1 group (26.6%), whereas all rats in the vehicle group died within 60 hours. PGE1 significantly suppressed the release of alanine aminotransferase and aspartate aminotransferase at 12 hours postoperatively. Pretreatment with PGE1 significantly increased the Ki67‐positive cell count and decreased the terminal deoxynucleotidyl transferase dUTP nick end labeling positive cell count after hepatectomy, and also significantly increased the expression levels of Bcl‐xL, Cyclin C, and Cyclin D1. Our results suggest that pretreatment with PGE1 may increase survival following hepatectomy by salvaging the remaining liver tissue, which it does by inhibiting apoptosis and stimulating hepatocyte proliferation.
Tyrosine phosphorylation of EGF‐R and PDGF‐R proteins during acute cutaneous wound healing process in mice
Authors: Gope Mohan L. , Gope Rajalakshmi 
Published: January 2009

ABSTRACTThe effect of topical application of epidermal growth factor (EGF) and platelet‐derived growth factors (PDGFs) on the levels of EGF‐R and PDGF‐R proteins and their tyrosine phosphorylation were analyzed during an acute cutaneous wound healing process in mice. The growth factor‐treated wounds had optimum levels of receptor proteins as early as day 1 compared with the control, which had only a basal level. Analysis of the tyrosine phosphorylation of the receptor proteins in control and growth factor‐treated wounds indicated that they were phosphorylated until day 5 after wounding. Only the mature forms of α‐PDGF‐R and β‐PDGF‐R proteins were phosphorylated and not their precursors. Our results show that rapid attainment of maximum levels of growth factor receptor proteins and their tyrosine phosphorylation as early as day 1 and the maintenance of the same until day 3 appear to aid faster and better wound healing. Topical application of PDGF‐AA alone did not facilitate the wound healing process and it also antagonized the EGF‐medicated wound healing when applied premixed with EGF or within 30 minutes after EGF application. Under these conditions, the receptor proteins were not phosphorylated. Thus, an increased and sustained level of EGF‐R and PDGF‐R proteins and their tyrosine phosphorylation appear to accelerate the wound healing process.