bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using simulation models to teach junior doctors how to insert chest tubes: a brief and effective teaching module
Authors: Hutton I. A. , Kenealy H. , Wong C. 
Published: February 2008

AbstractBackground:  Pleural procedures may cause serious complications when incorrectly carried out. There is a need to find effective methods for teaching how to insert a chest drain safely.Aim:  To assess the effectiveness of a programme for teaching chest tube insertion using a simulation model (SuperAnnie).Methods:  Groups of four to six junior doctors were enrolled in a 2‐h teaching session, covering both theoretical knowledge and practical chest tube insertion techniques using a simulation model. Before the teaching module, participants completed a questionnaire about their confidence and skill levels and were videotaped inserting a standard chest tube in the model. The assessments were repeated 1 month after the teaching module. The video clips were scored by two independent assessors using an 18‐point scoring system that was blinded to whether the taping was pre‐ or post‐teaching.Results:  Forty‐nine doctors completed the study. Baseline video assessment scores were low (median score 4 (maximum possible score 18), interquartile range (IQR) 2–7.5) and were not associated with past experience, the doctor’s self‐confidence level or their self‐assessed skill rating. After teaching, video assessment scores improved significantly (mean score 13, IQR 10.5–15). Doctors with the lowest baseline scores showed the most improvement. There were also improvements in doctors’ self‐confidence and self‐assessed skill levels, although there remained no association between these measures and video assessment scores.Conclusions:  A brief teaching module using a simulation model is effective in improving confidence and skill in chest tube insertion.
Prolonged seated immobility at work is a common risk factor for venous thromboembolism leading to hospital admission
Authors: Aldington S. , Pritchard A. , Perrin K. , James K. , Wijesinghe M. , Beasley R. 
Published: February 2008

AbstractThe role of seated immobility at work in the pathogenesis of venous thromboembolism (VTE) is uncertain. In this case series, 61 patients aged <65 years with a recent admission for deep venous thrombosis and/or pulmonary embolism completed an interviewer‐administered questionnaire to obtain information regarding risk factors. Prolonged seated immobility at work in the 4 weeks before the VTE event was defined as being seated at least 8 h in a 24‐h period and at least 3 h at a time without getting up, at least 10 h in a 24‐h period and at least 2 h at a time without getting up or at least 12 h in a 24‐h period and at least 1 h at a time without getting up. The most commonly identified risk factors were family history of VTE (21 of 61, 34%), seated immobility at work (21 of 61, 34%) and a thrombophilic state (19 of 61, 31%). We conclude that prolonged seated immobility at work may represent a common and important risk factor for VTE.
Insights into Yersinia pestis biofilm development: topology and co‐interaction of Hms inner membrane proteins involved in exopolysaccharide production
Authors: Bobrov Alexander G. , Kirillina Olga , Forman Stanislav , Mack Dietrich , Perry Robert D. 
Published: February 2008

SummaryPrimarily, three operons, hmsHFRS, hmsT and hmsP, are responsible for the development of a Yersinia pestis biofilm, which is essential for blockage‐dependent transmission of plague from fleas to mammals. Here, using specific antibodies, a polymeric β‐1,6‐N‐acetyl‐d‐glucosamine‐like polysaccharide was detected in the extracellular matrix of hmsHFRS‐dependent Y. pestis biofilm. The production of this exopolysaccharide (EPS) was controlled by diguanylate cyclase HmsT and EAL domain phosphodiesterase HmsP, acting as positive and negative regulators respectively. Cellular compartmentalization of soluble segments of Hms inner membrane proteins, including the putative glycosyltransferase domain of HmsR, the diguanylate cyclase/GGDEF domain of HmsT and the phosphodiesterase/EAL domain of HmsP, was determined by a combination of topology prediction algorithms and construction of C‐terminal translational fusions with β‐galactosidase and alkaline phosphatase. Multiple interactions of Hms inner membrane proteins were detected using bacterial cAMP based two‐hybrid system. Biochemical analyses confirmed some of these protein–protein interactions. Our results indicate that synthesis and regulation of the Y. pestis biofilm EPS occurs in the cytoplasm by a proposed Hms enzymatic complex.
Role for the Ankyrin eukaryotic‐like genes of Legionella pneumophila in parasitism of protozoan hosts and human macrophages
Authors: Habyarimana Fabien , Al‐khodor Souhaila , Kalia Awdhesh , Graham James E. , Price Christopher T. , Garcia Maria Teresa , Kwaik Yousef Abu 
Published: February 2008

Summary Legionella pneumophila is a ubiquitous organism in the aquatic environment where it is capable of invasion and intracellular proliferation within various protozoan species and is also capable of causing pneumonia in humans. In silico analysis showed that the three sequenced L. pneumophila genomes each contained a common multigene family of 11 ankyrin (ank) genes encoding proteins with ∼30–35 amino acid tandem Ankyrin repeats that are involved in protein–protein interactions in eukaryotic cells. To examine whether the ank genes are involved in tropism of protozoan hosts, we have constructed isogenic mutants of L. pneumophila in ten of the ank genes. Among the mutants, the ΔankH and ΔankJ mutants exhibit significant defects in robust intracellular replication within A. polyphaga, Hartmanella vermiformis and Tetrahymena pyriformis. A similar defect is also exhibited in human macrophages. Most of the ank genes are upregulated by L. pneumophila upon growth transition into the post‐exponential phase in vitro and within Acanthamoeba polyphaga, and this upregulation is mediated, at least in part, by RpoS. Single‐cell analyses have shown that upon co‐infection of the wild‐type strain with the ankH or ankJ mutant, the replication defect of the mutant is rescued within communal phagosomes harbouring the wild‐type strain, similar to dot/icm mutants. Therefore, at least two of the L. pneumophila eukaryotic‐like Ank proteins play a role in intracellular replication of L. pneumophila within amoeba, ciliated protozoa and human macrophages. The Ank proteins may not be involved in host tropism in the aquatic environment. Many of the L. pneumophila eukaryotic‐like ank genes are triggered upon growth transition into post‐exponential phase in vitro as well as within A. polyphaga. Our data suggest a role for AnkH and AnkJ in modulation of phagosome biogenesis by L. pneumophila independent of evasion of lysosomal fusion and recruitment of the rough endoplasmic reticulum.
Relation of microvessel density with microvascular invasion, metastasis and prognosis in renal cell carcinoma
Authors: Yildiz Esin , Ayan Semih , Goze Fahrettin , Gokce Gokhan , Gultekin Emin Y. 
Published: February 2008

OBJECTIVETo clarify the significance of microvessel density (MVD) in a retrospective investigation the relationship between the pattern of MVD (reflecting angiogenesis), and tumour stage, grade, size, and occurrence of microvessel invasion (MVI), metastasis, and cancer‐specific survival (CSS) in patients who had surgery for renal cell carcinoma (RCC).PATIENTS AND METHODSVessels were labelled in sections of formalin‐fixed, paraffin‐embedded tissues from 54 RCCs by CD34 immunohistochemistry. The mean MVD, expressed as the number of vessels per 10 high‐power fields (HPF, ×400) were measured for each case. In addition, all pathological slides were reviewed for the presence and absence of MVI. The prognostic value of MVD and MVI was then evaluated, and correlated with the usual prognostic variables, tumour metastasis and CSS.RESULTSIn a univariate analysis of CSS, the MDV tended to be lower as stage increased from pT1 to pT3, and as grade increased from G1 to G4, although it was statistically significant only for stage (P < 0.001 and 0.050, respectively). The mean MVD was higher in 42 nonmetastatic than in 12 metastatic tumours, and in 33 tumours associated with MVI than in 21 with no MVI (P < 0.001). The mean MVD was also lower and significantly different for 28 large than 26 small tumours (P = 0.005). The survival rate of patients with tumours that were small, low‐stage, of higher MVD, with no MVI and metastasis was significantly higher than that of patients with large, high‐stage, low MVD, with MVI and metastatic tumours (all P < 0.001). MVI was significantly more common with a decreasing trend in MVD and the presence of metastasis (Spearman rank correlation rs = −0.68, P = 0.01, and rs = 0.39, P = 0.01, respectively). Independent prognostic factors in a multivariate analysis were: in all patients with RCC, tumour stage (P = 0.013) and metastasis (P = 0.028); in those with low MVD, MVI (P = 0.004) and metastases (P = 0.016); in those with no MVI, stage (P = 0.020); in those with MVI, MVD (P = 0.001); in those with no metastases, stage (P = 0.045); and in those with metastases, MVD (P < 0.001). No independent predictor was identified in patients with high MVD. In patients with no metastases there was a significantly shorter median CSS time in RCCs with low MVD and with MVI (P = 0.004 for both). Similarly, patients who had grade 3–4 tumours, vs those with lower MVD and with MVI, had a significantly shorter median CSS (P = 0.020 for MVD, and 0.01 for MVI).CONCLUSIONSThis study suggested that MVD in RCC was inversely associated with MVI, tumour metastasis, patient survival and tumour diameter and stage, from the usual prognostic variables, but MVD was not an independent prognostic factor in multivariate analysis for all patients with RCC. Low MVD and the presence of MVI appears to be a marker for identifying patients with an adverse prognosis.
Introduction of an enhanced recovery protocol for radical cystectomy
Authors: Arumainayagam Nimalan , McGrath John , Jefferson Kieran P. , Gillatt David A. 
Published: February 2008

OBJECTIVETo describe and assess an enhanced recovery protocol (ERP) for the peri‐operative management of patients undergoing radical cystectomy (RC), which was started at our institution on 1 October 2005, as RC is associated with increased morbidity and longer inpatient stays than other major urological procedures.PATIENTS AND METHODSAn ERP was introduced in our institution that focused on reduced bowel preparation, and standardized feeding and analgesic regimens. In all, 112 consecutive patients were compared, i.e. 56 before implementing the ERP and 56 since introducing the ERP. The primary outcome measures were duration of total inpatient stay and interval from surgery to discharge, and the morbidity and mortality. Data were analysed retrospectively from cancer network and hospital records.RESULTSThe demographics of the two groups showed no significant difference in age, gender distribution, American Society of Anesthesiologists grade, or type of urinary diversion. Re‐admission, mortality and morbidity rates showed no statistically significant difference between the groups. The median (interquartile range) duration of hospital stay was 17 (15–23) days in the no‐ERP group, and 13 (11–17) days in the ERP group (significantly different, P < 0.001, Wilcoxon rank‐sum test). The median duration of recovery after RC was 15 (13–21) days in the no‐ERP group and 12 (10–15) days in the ERP group (significantly different, P = 0.001, Wilcoxon rank‐sum test).CONCLUSIONThe introduction of an ERP was associated with significantly reduced hospital stay, with no deleterious effect on morbidity or mortality.
Methylation of the TPEF‐ and PAX6‐promoters is increased in early bladder cancer and in normal mucosa adjacent to pTa tumours
Authors: Hellwinkel Olaf J.C. , Kedia Merab , Isbarn Hendrik , Budäus Lars , Friedrich Martin G. 
Published: February 2008

OBJECTIVETo evaluate CpG island methylation patterns of cancer‐associated genes for their applicability as molecular biomarkers for the detection of superficial bladder cancer and for the discrimination of invasive from noninvasive tumours.PATIENTS AND METHODSWe analysed the methylation status of CpG islands in the promoter region of the cancer‐associated genes GSTP1, DAPK, MDR1, TPEF, PAX6, and TSLC1 in primary papillary bladder cancer specimens from 39 patients (pT1 10, pTis one, pTa 20, pT2 five). Tumour‐adjacent normal mucosa served as the control. The DNAs were bisulphite‐treated and submitted to methylation‐specific real‐time polymerase chain reactions.RESULTSOnly TPEF and PAX6 had substantial CpG island methylation percentages. The TPEF‐ and PAX6‐promoters also had significantly higher methylation rates in tumour tissue compared with the normal tumour‐adjacent tissue. Interestingly, the methylation rates of the TPEF‐ and the PAX6‐promoter were higher in adjacent normal tissues from bladders with pTa then in those with pT1 tumours.CONCLUSIONOur results shed a critical light on the hypothesis that CpG island hypermethylation of the GSTP1‐, DAPK‐, MDR1‐ and TSLC1‐promoter could represent molecular biomarkers for bladder cancer diagnosis and detection. However, methylated PAX6‐ or TPEF‐promoters could represent biomarkers for this disease. Additional studies are needed to evaluate whether methylation rates of these genes in normal bladder tissues are applicable as accessory markers for the tumour state or its invasive behaviour.
Real‐time virtual ultrasonographic radiofrequency ablation of renal cell carcinoma
Authors: Ukimura Osamu , Mitterberger Michael , Okihara Koji , Miki Tsuneharu , Pinggera Germar M. , Neururer Richard , Peschel Reinhard , Aigner Friedrich , Gradl Johann , Bartsch Georg , Colleselli Daniela , Strasser Hannes , Pallwein Leo , Frauscher Ferdinand 
Published: February 2008

OBJECTIVETo evaluate the usefulness of real‐time virtual ultrasonography (RVS) as a new navigational tool for percutaneous radiofrequency ablation (RFA) of solid renal cell carcinoma (RCC).PATIENTS AND METHODSTen patients with 13 RCCs were treated with percutaneous RFA using RVS, which displays ultrasonograms and corresponding multiplanar reconstruction images of computed tomography in parallel.RESULTSRVS allowed excellent anatomical visualization and precise navigation of RFA for RCC. All patients were treated successfully in one session with percutaneous RVS RFA. There were no significant complications, and none of the patients had a local tumour recurrence during the follow‐up.CONCLUSIONRVS for RFA of solid RCC is a new and promising alternative imaging method.
Pharmacological characterization of a novel investigational antimuscarinic drug, fesoterodine, in vitro and in vivo
Authors: Ney Peter , Pandita Raj Kumar , Newgreen Donald T. , Breidenbach Alexander , Stöhr Thomas , Andersson Karl‐Erik 
Published: February 2008

OBJECTIVETo investigate the primary pharmacology of fesoterodine (a novel antimuscarinic drug developed for treating overactive bladder) and SPM 7605 (its active metabolite, considered to be the main pharmacologically active principle of fesoterodine in man) against human muscarinic receptor subtypes, and to investigate in vitro and in vivo functional activity of these agents on the rat bladder compared with existing standard agents.MATERIALS AND METHODSThe displacement of radioligand binding by fesoterodine, SPM 7605 and standard agents in membrane preparations of Chinese hamster ovary (CHO) cells expressing the different human muscarinic receptors (M1–M5) was characterized. Agonistic and antagonistic activities were studied using different CHO cell lines stably expressing the human recombinant muscarinic receptor subtypes. The effects of fesoterodine and SPM 7605 on isolated bladder strips contracted by carbachol or electrical field stimulation (EFS) were investigated. In vivo the effects of fesoterodine and SPM 7605 on micturition variables were assessed using continuous cystometry in conscious female Sprague‐Dawley rats, and compared to those of oxybutynin and atropine.RESULTS In vitro SPM 7605 potently inhibited radioligand binding at all five human muscarinic receptor subtypes with equal affinity across all five. Fesoterodine had a similar balanced selectivity profile but was less potent than SPM 7605. Both substances were competitive antagonists of cholinergic agonist‐stimulated responses in human M1‐M5 cell lines and had a similar potency and selectivity profile to the radioligand‐binding studies. In rat bladder strips, fesoterodine and SPM 7605 caused a rightward shift of the concentration‐response curve for carbachol with no depression of the maximum, and concentration‐dependently reduced contractions induced by EFS. The potency of both drugs was similar to that of atropine and oxybutynin. In the presence of the esterase inhibitor neostigmine, the concentration‐response curve of fesoterodine was shifted to the right, suggesting that part of the activity was caused by metabolism to SPM 7605 by tissue enzymes. In vivo, low doses (0.01 mg/kg) of fesoterodine and SPM 7605 reduced micturition pressure and increased intercontraction intervals and bladder capacity, but did not affect residual volume.CONCLUSIONSFesoterodine and its active metabolite, SPM 7605, are nonsubtype selective, competitive antagonists of human muscarinic receptors, but SPM 7605 has greater potency than the parent compound. Pharmacodynamic studies in the rat bladder in vitro confirm the competitive muscarinic antagonist profile of these agents in a native tissue preparation, and in vivo studies in the rat showed effects on bladder function consistent with a muscarinic antagonist profile.
Laser‐capture microdissection in prostate cancer research: establishment and validation of a powerful tool for the assessment of tumour–stroma interactions
Authors: Shukla Chitranjan J. , Pennington Caroline J. , Riddick Antony C.P. , Sethia Krishna K. , Ball Richard Y. , Edwards Dylan R.W. 
Published: February 2008

OBJECTIVESTo describe our experience with the optimization and validation of laser‐capture microdissection (LCM) for biomarker analysis in prostate tissues. As LCM allows the separation of benign and malignant epithelial structures and stromal elements, it not only allows identification of the source of the biomarker, but might also accentuate gene or protein expression changes by reducing contamination by other cellular elements.MATERIALS AND METHODSIn all, 19 fresh‐frozen prostate tissue samples were subjected to LCM, with the cDNA being analysed using quantitative polymerase chain reaction for several genes, to identify the optimum number of cells for capture, as well as gene markers assessing for the purity of the captured cells. The localization was further confirmed by in situ hybridization.RESULTSProstate‐specific antigen (PSA) and cytokeratin 8, were expressed solely by epithelial cells, whereas hepatocyte growth factor (HGF) and tissue inhibitor of metalloproteinases‐3 (TIMP3) were expressed only by stromal cells, and the levels of transcripts of these genes were unaltered between benign and malignant tissues.CONCLUSIONSThese data suggest that PSA, cytokeratin 8, HGF and TIMP3 are reliable gene markers of purity of epithelial and stromal compartments for LCM of prostate tumours. Although this technique is not new and is increasingly used in laboratories, it needs optimization and stringent validation criteria before data analysis. This applies to all tissue types subjected to LCM.
Female sexual dysfunction: a new urogynaecological research field
Authors: Dalpiaz Orietta , Kerschbaumer Andrea , Mitterberger Michael , Pinggera Germar M. , Colleselli Daniela , Bartsch Georg , Strasser Hannes 
Published: February 2008

Associate EditorMichael G. WyllieEditorial BoardIan Eardley, UKJean Fourcroy, USASidney Glina, BrazilJulia Heiman, USAChris McMahon, AustraliaBob Millar, UKAlvaro Morales, CanadaMichael Perelman, USAMarcel Waldinger, NetherlandsOBJECTIVETo critically review published data on the urogynaecological aspects of female sexual dysfunction (FSD), as FSD is a developing multidisciplinary issue associated with several biological, medical and psychological factors.METHODSThe reported prevalence of FSD is 19–50% and women with lower urinary tract symptoms or urinary incontinence (UI) not only complain of a deteriorating of quality of life but also of sexual life with an incidence as high as 26–47%. Furthermore, urogynaecological surgery represents an important but underestimated cause of FSD. Different databases (Pub Medical, Medline, serial titles, the Cochrane library and the NLM gateway database) were searched for the keywords ‘sexuality; sexual function; urinary incontinence; pelvic organ prolapse; questionnaire; symptom severity; epidemiology; quality of life; instruments; sexual health; vagina; vaginal surgery; pelvic surgery’.RESULTSThere is a lack of a standardized instrument for assessing FSD. Recent studies investigate the impact of UI on sexual function, but the pathophysiology has not been elucidated. Vaginal or pelvic surgery does not affect overall sexual satisfaction.CONCLUSIONSOur investigation highlights the need for studies to assess the anatomical, physiological and sensory mechanisms related to FSD. Specific questionnaire are needed to quantify the problem. In the definition, symptoms assessment and preoperative counselling is important, to make a distinction between overall sexual function and individual parameters, such as psychosocial context. Only in this way, will it be possible to identify new therapeutic targets. A definition of success in urogyneacological terms should include aspects of quality of life and quality of sexual life. Immediate research in this field is needed.
A four‐step technique of robotic right adrenalectomy: initial experience
Authors: Krane L. Spencer , Shrivastava Alok , Eun Dan , Narra Vinod , Bhandari Mahendra , Menon Mani 
Published: February 2008

OBJECTIVETo report a safe, quick and reproducible technique of robotically assisted right adrenalectomy (RRA), developed by assessing the surgical anatomy of the right adrenal gland, its vascularity, and the surrounding structures, through a high definition, magnified three‐dimensional view of the operating field provided by the da Vinci® surgical system (Intuitive Surgical, Sunnyville CA, USA).PATIENTS AND METHODSFour patients had RRA between January and July 2007 at the Vattikuti Urology Institute, for varied indications. We extensively reviewed published anatomical and surgical reports of the anatomy of the region to plan the surgical steps for RRA, careful reconfirming recognized anatomical facts and their probable significance. The surgical steps involved: (i) complete division of the hepatocolic ligament; (ii) definition of the right adreno‐caval junction (ACJ); (iii) division of the right adrenal vein; (iv) dissection and removal of the adrenal gland circumferentially. The surgery was digitally recorded and reviewed.RESULTSAll the adrenalectomies were done transperitoneally through five ports, replicating predetermined surgical steps. There were no anaesthesia or surgery related events and no patient required conversion to open surgery. All the patients had an uneventful recovery and were discharged home 0–3 days after RRA. With increasing experience it was possible to reach the ACJ with minimal peripheral dissection. From a lateral approach, we visualized the adrenal vein travelling along the anterior portion of the gland before terminating at the inferior vena cava and the retrocaval location of the medial edge of the adrenal gland. The right adrenal vein (singular or duplicate) was the only surgically significant vessel, as the other vessels encountered were controlled with bipolar diathermy.CONCLUSIONSRobotic assistance facilitated microdissection of fine anatomical planes around the right adrenal gland and provided direct access to the crucial ACJ. This technique permits ligation of the adrenal vein as an initial step, with no need to handle the adrenal gland. In the initial experience with four patients this technique was reproducible, regardless of indication or anatomical variance.