bluuebunny/crossref_metadata_2025 huggingface dataset:
Maternal risk factors associated with fetal death during antenatal care in low‐resource tertiary hospitals
Authors: OLADAPO Olufemi T. , ADEKANLE Daniel A. , DUROJAIYE Bankole O.
Published: August 2010

Background: Data on maternal characteristics that could predict antepartum fetal death in women receiving antenatal care in resource‐constrained settings are limited.

Aims: To identify maternal sociodemographic and clinical risk factors for antepartum fetal death among women receiving antenatal care in a developing country setting.

Methods: Case‐control analyses of risk factors in the occurrence of singleton fetal death before labour at two university hospitals in south‐west Nigeria over 4–5 years. A total of 46 cases and 184 controls were compared for 31 sociodemographic and clinical risk factors. Unconditional multivariate logistic regression analysis was applied to determine independent risk factors. Level of significance was set at P < 0.05.

Results: The incidence of antepartum fetal death among women receiving antenatal care was 10.8 per 1000 total births during the period. Significant risk factors at univariate level include proteinuria, pregnancy‐induced hypertension, pre‐existing hypertension, reduced weight gain per week, previous antepartum fetal death, antepartum haemorrhage, previous miscarriage, symphysiofundal height–gestational age disparity = 4 cm and perception of reduced fetal movements. The independent risk factors were proteinuria (adjusted OR 4.23, CI: 1.57–11.42), pregnancy‐induced hypertension (adjusted OR 8.24, CI: 3.01–22.51) and perceived reduction in fetal movements (adjusted OR 7.17, CI: 1.57–45.76).

Conclusions: The identified factors should serve as potential targets for antenatal interventions to prevent antepartum fetal death in these institutions. Awareness of these factors should stimulate appropriate risk assessment geared towards the prevention of antepartum fetal deaths by clinicians in these centres and centres in similar setting.
Predicting a failed induction
Authors: BECKMANN Michael
Published: August 2010

Background:  A failed induction usually refers to failure to progress to the active phase of labour; however, there is no consensus regarding when an induction has failed.

Aims:  To investigate the factors (particularly length of latent phase) that may influence mode of birth for women undergoing Syntocinon induction of labour.

Methods:  A retrospective analysis of 978 nulliparous women undergoing Syntocinon induction of labour following artificial or spontaneous rupture of membranes was performed.

Results:  As the length of the latent phase increased, the likelihood of birth by caesarean section increased significantly (P < 0.001). After ten hours of Syntocinon administration, the 8% of women not in the active phase of labour had approximately a 75% chance of being delivered by emergency caesarean section and after 12 h the chance was almost 90%. Multivariate analysis also suggested an association between birth by caesarean section and use of prostaglandin gel (P < 0.001) or mechanical methods of cervical priming (P = 0.004), maternal height < 155 cm (P = 0.020) and cervical dilation prior to commencement of Syntocinon (P = 0.018).

Conclusions:  It would seem reasonable to continue a Syntocinon infusion for at least ten hours in women undergoing induction who have yet to reach the active phase of labour ( 4 cm), and unclear benefit in continuing an induction beyond 12 h. The duration of latent phase is a helpful predictor of subsequent mode of birth.
Prediction of a caesarean delivery by labour and delivery nurses
Authors: SCHULTZ Carrie C. , WOOD Janine Y. , MAGANN Everett F. , CAMPBELL Lori A. , CHAUHAN Suneet P. , MORRISON John C.
Published: August 2010

The predictive accuracy of a nurse on labour and delivery to foretell the route of delivery is unknown. Registered nurses directly involved in managing women's labour predicted the route of delivery on 199 women between September 2005 and September 2006. The sensitivity to identify women who subsequently would deliver by caesarean was 26% (95% CI 13–42%); positive predictive value of 38% (20–39%) and likelihood ratio of 2.6 (1.3–7.5). Experience did not improve the predictive accuracy.
Self‐obtained vaginal swabs for PCR chlamydia testing: A practical alternative
Authors: ROSE Sally B. , LAWTON Beverley A. , BROMHEAD Collette , MACDONALD E. Jane , LUND Kim A.
Published: August 2010

This study shows that given a choice, New Zealand women at high risk for sexually transmitted infections (STI) opt to provide a self‐taken vaginal swab over a clinician‐taken sample for STI testing. Self‐obtained vaginal swabs have previously been shown to have equal sensitivity and specificity to endocervical swabs and greater sensitivity than urine for the detection of Chlamydia trachomatis by polymerase chain reaction (PCR). We suggest that self‐obtained vaginal swabs should be a readily available option offered to women for chlamydia testing by PCR in New Zealand.
Lifetime prevalence of cervical neoplasia in addicted and medical patients
Authors: REECE Albert
Published: August 2010

Background:  The prevalence and timing of cervical dysplasia among substance use disorder (SUD) patients is not well studied.

Methods:  A cross‐sectional pilot survey was undertaken among our primary practice female medical and SUD patients by patient recall of cervical screening history.

Results:  One hundred and fifty‐three SUD patients were compared with 77 general medical patients younger than 45 years old. The substances abused in this population have previously been described. There was no difference in the mean number of Pap smears (mean ± SEM 6.30 ± 0.55 vs 5.68 ± 0.70, respectively) or the time since last screening (2.93 ± 0.29 vs 1.60 ± 0.26 years). Limiting the analysis to patients younger than 45 years effectively controlled for the difference in ages between SUD and medical patients (29.94 ± 0.52 and 30.21 ± 1.04 years). Significant differences in cytological abnormalities (OR = 5.88, CI 1.92–23.92; P = 0.0005), cervical intraepithelial neoplasia (CIN) (OR = 14.4, CI 2.20–602.92, P = 0.001) and high‐grade CIN‐cancer (P = 0.002) were noted. When diagnoses were scored and charted, the trend of the lines of best fit in the two groups was significantly different (P < 0.00001). There were five and two cancers noted in the two groups. There were two and ten hysterectomies performed in the two groups which were for two and one indications of cancer, respectively. In the addicted group invasive cancer was diagnosed at 23‐, 23‐, 34‐ and 37‐years olds.

Conclusion:  SUD patients have a very high rate of abnormalities on cervical screening including precancerous lesions and these changes occurred at significantly younger ages. The possibility of some form of cancer promotion merits further investigation.
Blindness after confinement
Authors: LAWSON Gerald W.
Published: August 2010

Four days after an elective caesarean section, a patient went blind within a few hours, associated with a sudden rise in blood pressure. The blindness, initially thought to be caused by a cerebral infarct, was ultimately diagnosed as a result of posterior reversible leuco‐encephalopathy syndrome. This rare syndrome is reviewed.
Models of antenatal care and obstetric outcomes in Sydney South West
Authors: BAI Jun , GYANESHWAR Rajanishwar , BAUMAN Adrian
Published: August 2010

Objectives:  To assess obstetric outcomes of different models of antenatal care.

Methods:  The study was historical cohort analysis of population birth data of 67 675 singleton births delivered in all public hospitals in Sydney South‐west. Maternal and neonatal outcomes were compared for different models of antenatal care received. The care was provided within the hospitals in doctor's clinic, midwives’ clinic, birth centre, or by a team of midwives in the caseload midwifery. In the non‐hospital settings, the care was provided by private obstetricians or by the general practitioner (GP) as part of the GP Shared Care program. The data for those women who received no antenatal care were also analysed.

Results:  This study provided information that the obstetric outcomes were very similar regardless of whether a woman received her antenatal care in the midwives’ clinic, the birth centre, under the GP Shared Care program or in the doctor's clinic in Sydney South‐west hospitals.

Conclusions:  This study provides evidence for the view that different models of maternity care can be provided with good outcomes.
Successful but limited use of external cephalic version in Auckland
Authors: WISE Michelle R. , SADLER Lynn , ANSELL David
Published: August 2010

Background: External cephalic version (ECV) can effectively reduce the chance of non‐cephalic presentation at birth and reduce caesarean section rate for breech presentation at term. It is recommended in New Zealand to offer ECV to all eligible women with breech presentation at term.

Aim: This study aims to determine the ECV success rate at our hospital, factors that predict ECV success, and perinatal outcomes for women who had ECV, and to estimate the ECV attempt rate at our hospital.

Methods: A prospective audit was performed of all women with singleton non‐cephalic presentation ≥ 36 weeks who attended the ECV clinic at National Women's Health in Auckland from July 2002 to January 2006.

Results: Two hundred and fifty five women presented for ECV during the study period, and the ECV success rate was 59%. The strongest predictor of ECV success was an unengaged presenting part. Women with successful ECV had a vaginal birth rate of 67%. Three women needed to have an ECV attempt in order to prevent one caesarean section. We estimated that 26% of women with term breech presentation had an ECV attempt.

Conclusions: ECV at National Women's Health is effective at reducing beech presentation at term and at restoring a caesarean section rate equivalent to that of cephalic singleton pregnancy at term. However, the low rate of referral should be addressed.
A prospective study of outcomes five years after hysterectomy in premenopausal women
Authors: FARQUHAR Cynthia Margaret , SADLER Lynn , STEWART Alistair W.
Published: August 2010

Aims: To prospectively collect data five years after hysterectomy and compare with data of women who had not undergone hysterectomy.

Methods: A prospective cohort study of five years of premenopausal women with and with out hysterectomy was undertaken. Multivariate analytical methods were used to control for differences between groups.

Results: Comparing the prehysterectomy and five years post‐hysterectomy data, pelvic pain, abdominal pain, urinary frequency and depression scores were reduced five years following hysterectomy. Women in the non‐hysterectomy group were more likely to describe their health as good or very good (74%) than women in the hysterectomy group (56%) (P = 0.03).

Conclusions: The long‐term health of women who undergo hysterectomy is not noticeably different from a group of women who do not undergo hysterectomy. In women undergoing hysterectomy, pelvic pain, urinary frequency and depression scores are reduced five years after hysterectomy compared to prehysterectomy.
Induction of labour: A comparison between controlled‐release dinoprostone vaginal pessary (Cervidil®) and dinoprostone intravaginal gel (Prostin E2®)
Authors: KHO Ee Min , SADLER Lynn , McCOWAN Lesley
Published: August 2010

Background: There are various prostaglandin preparations available for inducing labour. Controlled‐release dinoprostone vaginal pessary is used in a number of centres in Australia and New Zealand.

Aims: To compare the efficacy and safety of controlled‐release dinoprostone vaginal pessary (Cervidil®) with dinoprostone intravaginal gel (Prostin E2®) for induction of labour.

Methods: Retrospective cohort study of 969 women who were induced using either 10‐mg controlled‐released dinoprostone vaginal pessary (n = 507) or intravaginal dinoprostone gel (n = 462) at National Women's Health, Auckland City Hospital. Study outcomes included induction to delivery interval, mode of delivery, rate of oxytocin augmentation and incidence of uterine hyperstimulation.

Results: Induction to vaginal birth interval was longer among nullipara receiving the pessary compared to those receiving intravaginal gel (21.5 vs 17.8 h, P = 0.004). There was no difference in rates of oxytocin augmentation or in mode of birth between pessary and gel groups. There was a trend to more uterine hyperstimulation among women induced with the pessary compared with those induced with intravaginal gel (22 (4.5%) vs 11 (2.4%) relative risk (RR) 1.9 (0.9–3.9)). Hyperstimulation associated with an abnormal fetal heart pattern (14 (2.9%) vs 2 (0.4%), RR 6.5 (1.5–28.9)) or treated with tocolytics (9 (1.8%) vs 1 (0.2%), RR 8.4 (1.1–66)) was more common in women who received the pessary.

Conclusion: Use of dinoprostone vaginal pessaries did not shorten time to delivery or improve any other birth outcome measured compared to dinoprostone intravaginal gel. Clinically significant hyperstimulation appeared more common following use of the pessary. Large randomised controlled trials are needed to confirm or refute these findings.
Obstetric management following traumatic tetraplegia: Case series and literature review
Authors: SKOWRONSKI Emma , HARTMAN Keith
Published: August 2010

Objective: Pregnancy in tetraplegia is a rare event, with only sporadic cases reported. This case series describes seven pregnancies in five tetraplegic women, all with spinal cord injuries in the region of C6.

Design: Retrospective case series.

Setting: Sydney, Australia.

Population: All tetraplegic women presenting to the obstetric service of a university teaching hospital, which also provides a regional spinal injury service, between 1981 and 2006.

Methods: Hospital records of all patients were examined and information extracted regarding demographics, pregnancies and their complications, labour and delivery and neonatal data.

Main outcome measures: Course, complications, management and outcomes of pregnancy in tetraplegic women.

Results: Mean age at the time of injury was 22 years, and, at the time of pregnancy, 33 years. All patients suffered recurrent, and sometimes severe, urinary tract infections and episodes of autonomic dysreflexia during pregnancy. Frequent and sometimes lengthy hospital admissions were required for these and other reasons. Only two pregnancies required caesarean section and all entered labour spontaneously, at a mean of 37.9 weeks of gestation. Episodes of autonomic dysreflexia were aggressively managed using pre‐emptive epidural anaesthesia and sublingual nifedipine. All pregnancies resulted in normal, near‐term babies with no serious perinatal problems.

Conclusions: Pregnancy and childbirth in tetraplegic women can be undertaken safely, usually with spontaneous onset of labour and vaginal delivery. However, hospitalisation for intercurrent problems is common. Management requires a multidisciplinary approach and is best undertaken in major centres with both obstetric and spinal cord injuries medical expertise.
Verbal Artistry: A Case for Education
Authors: Henne Richard B.
Published: August 2010

This article expands our understanding of how language‐minoritized children's communicative competence interrelates with schooling. It features a verbal performance by a young Native American girl. A case is made for greater empirical specification of the real extent of children's non‐school‐sanctioned communicative competence. The case disrupts Euro‐Western ideologies of language and corresponding instructional policies and practices that pervade U.S. schooling. It also offers productive ways of reframing and reforming language loss in language contact situations. [ethnography of communication, verbal art, language ideologies, language policy and planning, Indigenous language education, Lakota]
Literacy, Knowledge Production, and Grassroots Civil Society: Constructing Critical Responses to Neoliberal Dominance
Authors: Mein Erika
Published: August 2010

Within the context of neoliberal globalization, portrayals of “literacy” and “knowledge” are increasingly emphasized for their instrumental value for individuals and markets. At the same time, locally situated movements have emerged to challenge, resist, and transform these representations. This article examines a grassroots movement in Mexico, the Feria Pedagógica (Pedagogical Fair), as one such site of contestation. Grounded in nonmainstream notions of “civil society,” this movement represents an alternative educational space where literacy practices are tied to the construction of counterhegemonic identities and epistemologies.[literacy, civil society, social movements, popular education, Mexico]
How Infants Learn About the Visual World
Authors: Johnson Scott P.
Published: August 2010

The visual world of adults consists of objects at various distances, partly occluding one another, substantial and stable across space and time. The visual world of young infants, in contrast, is often fragmented and unstable, consisting not of coherent objects but rather surfaces that move in unpredictable ways. Evidence from computational modeling and from experiments with human infants highlights three kinds of learning that contribute to infants’ knowledge of the visual world: learning via association, learning via active assembly, and learning via visual‐manual exploration. Infants acquire knowledge by observing objects move in and out of sight, forming associations of these different views. In addition, the infant’s own self‐produced behavior—oculomotor patterns and manual experience, in particular—is an important means by which infants discover and construct their visual world.
From Perceptual Categories to Concepts: What Develops?
Authors: Sloutsky Vladimir M.
Published: August 2010

People are remarkably smart: They use language, possess complex motor skills, make nontrivial inferences, develop and use scientific theories, make laws, and adapt to complex dynamic environments. Much of this knowledge requires concepts and this study focuses on how people acquire concepts. It is argued that conceptual development progresses from simple perceptual grouping to highly abstract scientific concepts. This proposal of conceptual development has four parts. First, it is argued that categories in the world have different structure. Second, there might be different learning systems (subserved by different brain mechanisms) that evolved to learn categories of differing structures. Third, these systems exhibit differential maturational course, which affects how categories of different structures are learned in the course of development. And finally, an interaction of these components may result in the developmental transition from perceptual groupings to more abstract concepts. This study reviews a large body of empirical evidence supporting this proposal.
Knowledge as Process: Contextually Cued Attention and Early Word Learning
Authors: Smith Linda B. , Colunga Eliana , Yoshida Hanako
Published: August 2010

Learning depends on attention. The processes that cue attention in the moment dynamically integrate learned regularities and immediate contextual cues. This paper reviews the extensive literature on cued attention and attentional learning in the adult literature and proposes that these fundamental processes are likely significant mechanisms of change in cognitive development. The value of this idea is illustrated using phenomena in children's novel word learning.
Domain‐Creating Constraints
Authors: Goldstone Robert L. , Landy David
Published: August 2010

The contributions to this special issue on cognitive development collectively propose ways in which learning involves developing constraints that shape subsequent learning. A learning system must be constrained to learn efficiently, but some of these constraints are themselves learnable. To know how something will behave, a learner must know what kind of thing it is. Although this has led previous researchers to argue for domain‐specific constraints that are tied to different kinds/domains, an exciting possibility is that kinds/domains themselves can be learned. General cognitive constraints, when combined with rich inputs, can establish domains, rather than these domains necessarily preexisting prior to learning. Knowledge is structured and richly differentiated, but its “skeleton” must not always be preestablished.Instead, the skeleton may be adapted to fit patterns of co‐occurrence, task requirements, and goals. Finally, we argue that for models of development to demonstrate genuine cognitive novelty, it will be helpful for them to move beyond highly preprocessed and symbolic encodings that limit flexibility. We consider two physical models that learn to make tone discriminations. They are mechanistic models that preserve rich spatial, perceptual, dynamic, and concrete information, allowing them to form surprising new classes of hypotheses and encodings.
Preterm appropriate for gestational age infants: size at birth explains subsequent growth
Authors: Funkquist E‐L , Tuvemo T , Jonsson B , Serenius F , Nyqvist KH
Published: August 2010

Aim:  The aim was to evaluate growth and breastfeeding up to 18 months corrected age (CA) among preterm appropriate for gestational age (AGA) infants whose mothers initiated breastfeeding during the infants’ hospital stay.

Methods:  One hundred and twenty‐seven preterm AGA infants with a median birth weight of 2320 (769–3250) g and gestational age 34.29 (25.00–35.86) weeks were evaluated up to a CA of 18 months. A retrospective, descriptive and comparative design was used. Data were obtained by chart review of hospital medical records and a questionnaire completed by the mothers.

Results:  The changes in standard deviation scores (SDS) during the infants’ hospital stay were −0.9 for weight, −0.3 for length and −0.5 for head circumference (HC). Infants with higher SDS at birth showed more negative changes from birth to discharge. Median increments in SDS from discharge to a CA of 2 months were as high as, or higher than, the loss from birth to discharge.

Conclusion:  Preterm AGA infants with higher SDS for weight, length and HC at birth are at higher risk of inadequate growth during their hospital stay.
Difficulties in the Diagnosis of Mental Illness in Elderly Mentally Handicapped Patients
Authors: Shah A.
Published: August 2010

The increased life expectancy of mentally handicapped individuals, significant psychiatric morbidity in this population and the contemporary policy of community care is likely to result in increased referrals of elderly mentally handicapped patients with mental illness to psychogeriatric services. This will have implications for the organisation of services. Difficulties in the diagnosis of mental illness in a small series of elderly mentally handicapped patients are described. Techniques for improving diagnostic accuracy are discussed.
Prescribed Exercise In The Elderly: The Impact On Energy Expenditure For Selected Activities
Authors: Mitchell R.A. , Imperial E. , Kelleher P. , Brunker P. , Gass G.
Published: August 2010

The purpose of this study was to report on the average daily energy expenditure on selected daily activities by elderly persons and to determine whether a non‐supervised exercise program influences the amount of energy expended on these activities. A total of 164 non‐institutionalised volunteers with a mean age of 68±4.6 years of age maintained a diary of daily activities (household, gardening, maintenance, sport, miscellaneous) for a period of twelve months. Subjects were randomly assigned to either a prescribed or non‐prescribed exercise program. The reliability of the resulting data was established as being between 0.87 and 0.97. There were significant differences between the exercisers and non‐exercisers on energy expended, with the former group having higher mean scores on all activities. Associated with the already documented increase in fitness associated with prescribed regular exercise, we conclude that such exercise has a significant influence on the amount of energy that elderly persons used on common daily activities.
Baby Boomers Meet The Third Age
Authors: Mason R. , Randell S.
Published: August 2010

Recent trends in adult and community education (ACE) in Australia have implications for the University of the Third Age (U3A), even though the way the U3A operates isolates it from some of these external pressures. Issues include: funding constraints and government priorities, the change from empowerment to instrumentalism, with an emphasis on education for employment, accreditation and articulation, and an increasing perception of ACE as a market commodity. These developments challenge U3As to develop a curriculum of enrichment, more rigour in their programs and new education formats as they face increased competition from other adult education providers. In addition, U3As may well engage in some introspection as well as reflection about what might be the evolving needs of an increasingly better educated older generation.
Independence and self‐provision in old age: how realistic are these goals?
Authors: Ranzijn Rob , Patrickson Margaret , Carson Ed , Le Sueur Eddie
Published: August 2010

Objectives:  The aim of the present paper was to examine the relationship between perceived choices in work and retirement in middle age and financial security and confidence about the future in old age.

Methods:  A qualitative study of 30 middle‐aged adults in Adelaide and Whyalla in South Australia, either presently employed, unemployed or retired, were interviewed about their work histories, the factors in their work changes, their perceived options concerning future work and retirement, and their anticipated financial security and sources of income in retirement.

Results:  In general, participants with a history of continuous stable employment believed they were in a good financial situation and were confident about their future, but many of the participants had a history of precarious employment, no financial security, and expected to rely primarily on government support in their old age.

Conclusion:  A substantial proportion of older adults may not be able to provide for themselves in later life without public policies which are more interventionist.
A randomised controlled trial of an exercise intervention to reduce functional decline and health service utilisation in the hospitalised elderly
Authors: Jones Catherine T , Lowe Adrian J , MacGregor Lachlan , Brand Caroline A , Tweddle Nicole , Russell David M
Published: August 2010

Objective:  Functional decline is experienced by up to 50% of older hospitalised patients and is associated with increased institutionalisation, mortality and length of stay (LOS). We aimed to determine the effectiveness of an exercise program in reducing functional decline and health service utilisation in older inpatients.

Methods:  A single‐blinded randomised controlled trial was conducted in a tertiary metropolitan hospital involving 180 acute general medical patients aged ≥ 65 years. In addition to usual physiotherapy care, the intervention group performed an exercise program for 30 minutes, twice daily, with supervision and assistance. Change in physical function was measured by the modified Barthel index (mBI). Analysis was done on an intention‐to‐treat basis.

Results:  When admission mBI scores were low, there was a greater improvement in mBI scores in the intervention group compared with the control group. The intervention group had a shorter total LOS (Hazard ratio (HR) 1.46 (95%CI 1.04–2.05); P = 0.026).
Food insecurity among older Australians: prevalence, correlates and well‐being
Authors: Temple Jeromey B
Published: August 2010

Objectives:  The purpose of this study is to examine (i) the prevalence of food insecurity among older persons, (ii) the characteristics of the food insecure and (iii) the association between food insecurity and well‐being.

Methods:  The 2001 National Health Survey is used to measure the prevalence of food insecurity. Multivariate analysis is conducted using rare events logistic regression.

Results:  Almost 3% of Australians aged 55 years and over, and 7% of those aged under 55 are estimated to be food insecure. Lone males and females are more likely to experience food insecurity when compared to couples. Low‐income earners and those with multiple long‐term conditions are at a heightened risk of food insecurity. The probability of food insecurity decreases with age. Persons who are food insecure perform poorly against self‐reported measures of well‐being.

Conclusions:  Although the prevalence of food insecurity is low, a definite social gradient exists in those at risk.
Acid suppression in the elderly
Authors: Manoharan Thenmozhi , Dārzi?š Pēteris
Published: August 2010

Objective:  To determine the proportion of older inpatients in whom acid suppression with proton pump inhibitors (PPI) and histamine antagonists (H2A) are clearly justified.

Methods:  A retrospective review of the records of 100 inpatients aged 80 years or older discharged from a public hospital or its associated private hospital who were prescribed PPI or H2A on discharge. Evidence that acid suppression was indicated was sought via review of inpatient medical records and of hospital pharmacy records.

Results:  On discharge, PPIs were prescribed for 90 patients and 10 received H2A. In 52 patients, the prescriptions were clearly justified. In 34 patients, acid suppression was possibly justified and in 14 cases, justification for acid suppression therapy could not be found.

Conclusions:  Approximately a half of all acid suppression therapy in older people discharged from hospital did not have a clear indication documented and may not be justified.
Exogenous oxidative stress induces Ca2+ release in the yeast Saccharomyces cerevisiae
Authors: Popa Claudia‐Valentina , Dumitru Ioana , Ruta Lavinia L. , Danet Andrei F. , Farcasanu Ileana C.
Published: August 2010

The Ca2+‐dependent response to oxidative stress caused by H2O2 or tert‐butylhydroperoxide (tBOOH) was investigated in Saccharomyces cerevisiae cells expressing transgenic cytosolic aequorin, a Ca2+‐dependent photoprotein. Both H2O2 and tBOOH induced an immediate and short‐duration cytosolic Ca2+ increase that depended on the concentration of the stressors. Sublethal doses of H2O2 induced Ca2+ entry into the cytosol from both extracellular and vacuolar sources, whereas lethal H2O2 shock mobilized predominantly the vacuolar Ca2+. Sublethal and lethal tBOOH shocks induced mainly the influx of external Ca2+, accompanied by a more modest vacuolar contribution. Ca2+ transport across the plasma membrane did not necessarily involve the activity of the Cch1p/Mid1p channel, whereas the release of vacuolar Ca2+ into the cytosol required the vacuolar channel Yvc1p. In mutants lacking the Ca2+ transporters, H2O2 or tBOOH sensitivity correlated with cytosolic Ca2+ overload. Thus, it appears that under H2O2‐induced or tBOOH‐induced oxidative stress, Ca2+ mediates the cytotoxic effect of the stressors and not the adaptation process.
NtKTI1, a Kunitz trypsin inhibitor with antifungal activity fromNicotiana tabacum, plays an important role in tobacco’s defense response
Authors: Huang Hao , Qi Sheng‐Dong , Qi Fang , Wu Chang‐Ai , Yang Guo‐Dong , Zheng Cheng‐Chao
Published: August 2010

A cDNA library from tobacco inoculated withRhizoctonia solaniwas constructed, and several cDNA fragments were identified by differential hybridization screening. One cDNA clone that was dramatically repressed,NtKTI1, was confirmed as a member of the Kunitz plant proteinase inhibitor family. RT‐PCR analysis revealed thatNtKTI1was constitutively expressed throughout the whole plant and preferentially expressed in the roots and stems. Furthermore, RT‐PCR analysis showed thatNtKTI1expression was repressed afterR. solaniinoculation, mechanical wounding and salicylic acid treatment, but was unaffected by methyl jasmonate, abscisic acid and NaCl treatment.In vitroassays showed that NtKTI1 exerted prominent antifungal activity towardsR. solaniand moderate antifungal activity againstRhizopus nigricansandPhytophthora parasiticavar.nicotianae. Bioassays of transgenic tobacco demonstrated that overexpression ofNtKTI1enhanced significantly the resistance of tobacco againstR. solani, and the antisense lines exhibited higher susceptibility than control lines towards the phytopathogen. Taken together, these studies suggest that NtKTI1 may be a functional Kunitz trypsin inhibitor with antifungal activity against several important phytopathogens in the tobacco defense response.
Retrospective review of pemetrexed with or without platinum in malignant mesothelioma: The Australian ‘Special Access Scheme’ experience
Authors: BURGE ME , JOSHUA AM , McNEIL CM , HUI R , BOYER MJ , ABRAHAM R
Published: August 2010

Background:  Pemetrexed and cisplatin have recently been shown to significantly improve survival compared with cisplatin alone. However, there are only limited data reflecting teaching hospital experience outside a clinical trial. Pemetrexed has only been available in Australia on a restricted basis since 2002. We reviewed our experience of patients treated on the Australian ‘Special Access Scheme’ at three major thoracic oncology units.

Methods:  Charts were reviewed for all patients enrolled on the scheme. Data was extracted on age, World Health Organization (WHO) performance status, histology, prior therapy, time from diagnosis to starting pemetrexed, chemotherapy (pemetrexed alone or with a platinum), cycle number, response rate, actuarial progression‐free and overall survival. Doses were cisplatin 75 mg/m2 or carboplatin AUC = 5 and pemetrexed 500 mg/m2 every 21 days.

Results:  52 patients (32 male and 20 female) were reviewed. Median age was 58 years and 88% were WHO 0–1. Histology included 54% epithelial, 17% biphasic (epithelial and sarcomatoid) and 21% undefined. The median time from diagnosis to administration of pemetrexed was 145 days. Sixty‐five percent had minimal surgical intervention with video assisted thoracoscopy, pleurodesis and biopsy, while 19% had received prior palliative radiation. Seventy‐one percent were chemotherapy naïve, the remaining 29% having received previous platinum and/or gemcitabine regimens. Twenty‐three percent had pemetrexed alone, 35% in combination with carboplatin and 42% with cisplatin. The median number of cycles was 4 (range 1–13). The response rate was 33%. No toxicity was observed in 20% grade 3–4 toxicity in 10% (majority nausea/vomiting). The median progression‐free and overall survival times from starting pemetrexed were 184 days and 298 days, respectively.

Conclusions:  Pemetrexed‐based regimens are safe and effective in a community setting in malignant mesothelioma.
Management of malignant pleural mesothelioma
Authors: NOWAK Anna K , BYDDER Sean
Published: August 2010

Malignant mesothelioma is a highly fatal malignancy that may become more prevalent in the Asia–Pacific region over the next decades. We review clinical aspects of this disease, including presentation, diagnosis, staging and management. A small proportion of patients will be suitable for aggressive trimodality therapy (extra‐pleural pneumonectomy, chemotherapy and radiotherapy) with the aim of cure or achieving prolonged palliation. However, most patients will present with advanced disease and so are only suitable for palliation. We review palliative therapy with an emphasis on the practical aspects of chemotherapy as well as palliative procedures such as pleurodesis. The future direction of clinical research in mesothelioma is discussed.
Development and evaluation of a brief, peer‐led communication skills training program for cancer clinicians
Authors: SUTHERLAND Georgina , HEGARTY Suzanne , WHITE Victoria , COFFIN Janine , JEFFORD Michael
Published: August 2010

Aim:  To develop a brief, peer‐led communication skills training program for cancer clinicians working in the state of Victoria in response to mounting evidence of the detrimental effects of poor doctor–patient communication. The first workshop module developed by The Cancer Council Victoria for the Victorian Cancer Clinicians Communication Program (VCCCP) focused on delivering bad news to patients and their families.

Methods:  The workshops consisted of four‐and‐a‐half hour interactive sessions co‐facilitated by an oncology clinician and clinical psychologist. Data on the participants' psychosocial beliefs about patient care, confidence and practice behavior were collected via self‐administered questionnaires before the workshop and 6 weeks after it. Evaluations on the structure and content of the sessions were collected immediately after the workshop.

Results:  Data were collected from 11 programs involving a total of 93 cancer clinicians. The results showed a high level of participant satisfaction with the broad aims of the workshop components, in particular the performance of the facilitators and the role‐play sessions. Pre‐ and post‐workshop data showed significant improvements over time on items relating to clinician confidence. Despite little change in subjective reports of clinical behavior and beliefs about psychosocial care, most participants reported changes in the way they delivered bad news since attending the VCCCP workshops.

Conclusion:  The Cancer Council Victoria responded to the needs of cancer clinicians working in the state and established a program that appears acceptable to clinicians who choose to participate.
Long‐term experience of residual symptoms following treatment for localized prostate cancer: An Australian sample
Authors: WOOTTEN Addie C , BURNEY Sue , FRYDENBERG Mark , FOROUDI Farshad , NG Kim T , COLEMAN Grahame
Published: August 2010

Aim:  To assess the degree of residual urinary and sexual dysfunction experienced by patients treated for localized prostate cancer with radical prostatectomy (RP), external beam radiotherapy (EBRT) or EBRT plus hormone therapy (EBRT/HT) in an Australian sample.

Methods:  This was a cross‐sectional survey of 150 patients who had undergone treatment for localized prostate cancer a mean of 4.93 years prior to the study. It was part of a larger study investigating the psychological adjustment of patients and their partners. Fifty‐five patients had undergone RP, 67 patients had undergone EBRT and 28 patients had undergone EBRT/HT for localized prostate cancer. The patients completed the University of California Los Angeles‐prostate cancer index to determine the level of residual sexual and urinary dysfunction and bother as well as their socio‐demographic characteristics.

Results:  In the RP group, 34.5% of patients reported urinary leakage every day. Only one RP patient (1.8%) reported this as a significant problem. Inability to achieve an erection was reported by 41.8% of the RP group, 34.3% of the EBRT group and 46.4% of the EBRT/HT group. ancova indicated a significant difference in mean urinary function scores across treatment groups. The RP group showed significantly worse urinary function compared to the other treatment groups; however, this was not perceived to be a significant problem by most of the survivors. Age was significantly associated with sexual function.

Conclusion:  Patients treated for localized prostate cancer face a high probability of living with long‐term residual symptoms. The results of this study suggest that urinary and sexual dysfunction is still evident, even in patients treated more than 4 years ago. The findings are consistent with a growing body of research indicating that patients in the later stages of surviving cancer face significant quality of life issues.
The management of periapical lesions in endodontically treated teeth
Authors: Yan Marcus T.
Published: August 2010

When root canal therapy is done according to accepted clinical principles and under aseptic conditions, the success rate is generally high. However, it has also been reported that 16% to 64.5% of endodontically treated teeth are associated with periapical radiolucent lesions. There are great variations among clinicians when suggesting treatment of these failed endodontic cases. This article will discuss factors influencing treatment decisions on these particular cases, and the pros and cons of nonsurgical retreatment versus surgical retreatment. The advancement of modern endodontic microsurgery will also be discussed.
Determination of root canal curvatures before and after canal preparation (part II): A method based on numeric calculus
Authors: Sonntag D. , Stachniss‐Carp S. , Stachniss C. , Stachniss V.
Published: August 2010

The aim of this paper is to present a new method based on numeric calculus to provide data on any type of root canal curvature at any point of the long axis of the canal. Twenty severely curved, simulated root canals were prepared with rotary FlexMaster® and Profile® instruments in the crown‐down technique and manually in the step‐back technique. The inner and outer curvatures were registered in a system of coordinates before and after preparation in increments of 0.5 mm. Using an equalising function, the curvatures were first represented in graphic and algebraic form. The maximum and the mean curvature as well as the length of the arc from the apical foramen to the point of maximum curvature were determined mathematically. An increase in maximum curvature was registered for all four shaping systems investigated. The radius of the inner curvature decreased by 0.5–1.2 mm in the manual systems as a result of the preparation. The Profile® system displayed the smallest changes in radius (−0.9 mm) even with the outer curvature, and manual preparation with stainless steel files the most pronounced change (−1.8 mm). The point of maximum curvature at the inner curvature was displaced by 1.6 mm to the apical foramen through manual preparation with Ni‐Ti files. At the outer curvature, the maximum displacement (1.8 mm) recorded was also the result of preparation with Ni‐Ti hand files, while a displacement of only 0.3 mm to the apical foramen was recorded with the other systems. The method offers a means of determining curvatures precisely without random specification of reference points. The method is also capable of registering only minor changes in curvature in the two‐dimensional long axis of the canal.
SEM evaluation of neodentinal bridging after direct pulp protection with mineral trioxide aggregate
Authors: Asgary Saeed , Parirokh Masoud , Eghbal Mohammad Jafar , Ghoddusi Jamileh , Eskandarizadeh Ali
Published: August 2010

The purpose of this study was to observe the basic morphology and determine the chemical composition of neodentinal bridges adjacent white mineral trioxide aggregate (WMTA) when used as a direct pulp capping material. The experimental procedures were performed on six intact dogs’ teeth. The pulps were exposed and cavities were filled with WMTA. After 2 weeks, neodentinal bridge formation was evaluated by scanning electron microscope (SEM) of cross‐sections of the specimens and electron probe microanalysis (EPMA) of the pulpal surfaces. Results of SEM observation showed that the most characteristic reaction of pulp cells was the intimate connection of cell processes and secreted extracellular fibres with the crystals of the pulp capping material. Results of EPMA indicated that the mineralisation of neodentinal bridge formation occurred progressively from the periphery to the central area. Based on these results, it appears that WMTA has the potential to be used as a direct pulp capping material during vital pulp therapy.
Radiographic and rheological properties of a new endodontic sealer
Authors: Gambarini Gianluca , Testarelli Luca , Pongione Giancarlo , Gerosa Robero , Gagliani Massimo
Published: August 2010

A new dual‐cured resin sealer has recently been proposed as an innovative endodontic filling material. Being a new endodontic material, no in vitro research has been published yet on Real Seal's (RS) physical properties. Therefore, the aim of the present study was to evaluate and compare radiopacity and rheological properties of the RS sealer with those of currently available endodontic sealers (Roeko Seal Automix and Bioseal). All tests strictly followed American National Standards Institute/American Dental Association (ANSI/ADA) specification No. 57, which indicates test methods and establishes minimal requirements of flow, film thickness and radiopacity of endodontic sealers. Results showed that significant differences were found among sealers in the different test methods. However, RS showed values complying with ANSI/ADA specification No. 57 requirements in all tests. Hence, the new RS sealer exhibited radiographic and rheological properties suitable for clinical use.
Unusual anatomy of mandibular premolars
Authors: De Almeida‐Gomes Fábio , De Sousa Bruno Carvalho , Dos Santos Roberto Alves
Published: August 2010

Mandibular premolars usually have a single root and canal; however, during clinical and radiographic evaluation as part of endodontic treatment it must be noted that variations in anatomical configuration are not uncommon. These teeth may require special canal preparation and filling techniques. This article discusses the treatment recommendations for unusual anatomical configurations in two different mandibular premolars and reports the treatment carried out on these teeth.
Healing of large periapical lesion: A non‐surgical endodontic treatment approach
Authors: Saatchi Masoud
Published: August 2010

A patient with a large periapical lesion around the apices of her mandibular incisors is presented. During the conservative non‐surgical endodontic treatment, sodium hypochlorite was used for irrigation, and calcium hydroxide was used for the intra‐canal dressing. Periapical healing was observed 1 month after obturation and continued in the 12‐month recall. This report confirms that the large size of a periapical lesion does not mandate its surgical removal, and that even cyst‐like periapical lesions heal following a conservative endodontic therapy.
Modulation of Tau Phosphorylation by the Kinase PKR: Implications in Alzheimer's Disease
Authors: Bose Anindita , Mouton‐Liger François , Paquet Claire , Mazot Pierre , Vigny Marc , Gray Françoise , Hugon Jacques
Published: August 2010

Double‐stranded RNA dependent kinase (PKR) is a pro‐apoptotic kinase that controls protein translation. Previous studies revealed that activated PKR is increased in brains with Alzheimer's disease (AD). Glycogen Synthase Kinase Aβ (GSK‐3β) is responsible for tau phosphorylation and controls several cellular functions also including apoptosis. The goal of this work was to determine if PKR could concurrently trigger GSK‐3β activation, tau phosphorylation and apoptosis. In AD brains, both activated kinases co‐localize with phosphorylated tau in neurons. In SH‐SY5Y cell cultures, tunicamycin and Aβ1‐42 activate PKR, GSK‐3β and induce tau phosphorylation and all these processes are attenuated by PKR inhibitors or PKR siRNA. Our results demonstrate that neuronal PKR co‐localizes with GSK‐3β and tau in AD brains and is able to modulate GSK‐3β activation, tau phosphorylation and apoptosis in neuroblastoma cells exposed to tunicamycin or Aβ. PKR could represent a crucial signaling point relaying stress signals to neuronal pathways leading to cellular degeneration in AD.
The use of opioids in fibromyalgia
Authors: NGIAN Gene‐Siew , GUYMER Emma K. , LITTLEJOHN Geoffrey O.
Published: August 2010

Fibromyalgia syndrome (FMS) is a chronic disorder of widespread pain with high personal and societal burdens. Although targeted pharmacotherapies have become available in recent years, it remains a challenging condition to treat. Despite no randomized controlled trials addressing the short‐ or long‐term use of opioids in FMS, their use remains prevalent. In this article we discuss the role of opioids and other analgesics in the management of FMS, with particular focus on problems associated with their use. We review aspects of the pathophysiology of FMS and consider how specific factors may contribute to the lack of efficacy of opioids in this condition. Finally, we discuss drugs with combined opioid and anti‐opioid action and their roles in FMS. There is insufficient evidence to recommend the routine use of opioids in FMS. As well as having a significant adverse effect profile, their inefficacy may be due to their inability to target the pathophysiologic processes involved in this central sensitization syndrome.