bluuebunny/crossref_metadata_2025 huggingface dataset:
How Safe Is Aggressive Statin Therapy?
Authors: Guthrie Robert M.
Published: February 2007

The most recent guidelines of the National Cholesterol Education Program recommend more aggressive low‐density lipoprotein cholesterol goals: <100 mg/dL for patients at moderate or high risk of cardiovascular disease, and <70 mg/dL for patients at very high risk. These lower goals are more likely to be achieved using the more powerful statins—atorvastatin, rosuvastatin, and simvastatin. Although statins are widely used, extensively studied, and known to have an excellent safety profile, the perception of many health care providers and patients is that safety concerns about the more efficacious statins, especially at high doses, limit their use. However, clinical data consistently support the view that adverse events are uncommon even when intensive therapy is used to reach aggressive low‐density lipoprotein cholesterol goals. Overall, the more potent statins have similar safety profiles. The benefits of aggressive statin treatment in reducing the risk of cardiovascular events appear to far outweigh any potential risks of adverse events.
Prediction of in vitro response to interferon‐α in renal cell carcinoma cell lines
Authors: Shimazui Toru , Ami Yoshihiro , Yoshikawa Kazuhiro , Uchida Kazuhiko , Kojima Takahiro , Oikawa Takehiro , Nakamura Kogenta , Honda Nobuaki , Hinotsu Shiro , Miyazaki Jun , Kunita Noriko , Akaza Hideyuki
Published: February 2007

We analyzed the correlation between interferon‐α (IFNα) response and gene expression profiles to predict IFNα sensitivity and identified key molecules regulating the IFNα response in renal cell carcinoma (RCC) cell lines. To classify eight RCC cell lines of the SKRC series into three subgroups according to IFNα sensitivity, that is, sensitive, resistant and intermediate group, responses to IFNα (300–3000 IU/mL) were quantified by WST‐1 assay. Microarray, followed by supervised hierarchical clustering analysis, was applied to selected genes according to IFNα sensitivity. In order to find alteration of expression profiles induced by IFNα, sequential microarray analyses were performed at 3, 6, and 12 h after IFNα treatment of RCC cell lines and mRNA expression level was confirmed using quantitative real time polymerase chain reaction. According to the sequential microarray analysis between IFNα‐sensitive and ‐resistant line, seven genes were selected as candidates for IFNα‐sensitivity‐related genes in RCC cell lines. Among these seven genes, we further developed a model to predict tumor inhibition with four genes, that is, adipose differentiation‐related protein, microphthalmia associated transcription factor, mitochondrial tumor suppressor 1, and troponin T1 using multiple linear regression analysis (coefficient = 0.948, P = 0.0291) and validated the model using other RCC cell lines including six primary cultured RCC cells. The expression levels of the combined selected genes may provide predictive information on the IFNα response in RCC. Furthermore, the IFNα response to RCC might be modulated by regulation of the expression level of these molecules. (Cancer Sci 2007; 98: 529–534)
MEK‐ERK is involved in SUMO‐1 foci formation on apoptosis
Authors: Utsubo‐Kuniyoshi Ryoko , Terui Yasuhito , Mishima Yuko , Rokudai Akiko , Mishima Yuji , Sugimura Natsuhiko , Kojima Kiyotsugu , Sonoda Yoshiko , Kasahara Tadashi , Hatake Kiyohiko
Published: February 2007

Small ubiquitin‐related modifier (SUMO) modification appears to regulate the activity, intracellular localization, and stability of the targeted proteins. To explore the relationship among sumoylation, antitumor reagent, and apoptosis, we treated green fluorescence protein (GFP)‐SUMO‐1‐overexpressed K562 cells (K562/GFP‐SUMO‐1) with mitoxantrone (MIT) as an antitumor reagent. By the treatment with MIT, GFP‐SUMO‐1 formed foci in nuclei. While by the treatment with a tumor promoter 12‐O‐tetradecanoylphorbol‐13‐acetate (TPA), GFP‐SUMO‐1 located homogeneously in nuclei. When K562/GFP‐SUMO‐1 cells were treated with TPA plus MIT, GFP‐SUMO‐1 foci became larger and apoptosis was induced more than with MIT alone. The apoptosis induced by TPA plus MIT was prevented by blockage of GFP‐SUMO‐1 foci by small interfering RNA (siRNA) against SUMO‐1. The formation of GFP‐SUMO‐1 foci was reduced by a MEK inhibitor U0126 or a nuclear export inhibitor leptomycin B, and endogenous SUMO‐1 foci were reduced in K562 cells expressing the dominant‐negative MEK1 mutant. These results suggest that the formation of SUMO‐1 foci is regulated by the MEK‐ERK pathway and may induce apoptosis. (Cancer Sci 2007; 98: 569–576)
Does the differential seedling mortality caused by slugs alter the foliar traits and subsequent susceptibility of hybrid willows to a generalist herbivore?
Authors: ALBRECTSEN BENEDICTE R. , GUTIERREZ LAURA , FRITZ ROBERT S. , FRITZ ROBERT D. , ORIANS COLIN M.
Published: February 2007

Abstract1. Many Salicaceae species naturally form hybrid swarms with parental and hybrid taxa that differ in secondary chemical profile and in resistance to herbivores. Theoretically, the differential mortality in the seedling stage can lead to changes in trait expression and alter subsequent interactions between plants and herbivores. This study examines whether herbivory by the generalist slugArion subfuscus, which causes extensive mortality in young willow seedlings, causes shifts in (a) the foliar chemistry of F2 willow hybrids (Salix sericeaandSalix eriocephala), and (b) the subsequent susceptibility to Japanese Beetles,Popillia japonica.

2. In 2001, two populations of F2 seedlings were generated: those that survived slug herbivory (80–90% of seedlings placed in the field were killed by the slugs) were designated as S‐plants, whereas C‐plants (controls) experienced no mortality.

3. Common garden experiments with cuttings from these populations, in 2001 and 2002, revealed extensive variation in the phenolic chemistry of F2 hybrids, but revealed no significant difference between S‐ and C‐plants, although the levels of foliar nutrients, proteins and nitrogen tended to be higher in S‐plants.

4. Concentrations of salicortin and 2′‐cinnamoylsalicortin explained 55 and 38% of the the variation in leaf damage caused by Japanese beetles, and secondary chemistry was highly correlated within replicate clones (salicortinR2= 0.85, 2‐cinnamoylsalicortinR2= 0.77, condensed tanninsR2= 0.68).

5. Interestingly, Japanese beetle damage and condensed tannins were positively correlated within the S‐plants, but not in the C‐plants, suggesting that slugs had selected for plants with a positive relationship between tannins andP. japonicadamage. This is unlikely to be a consequence of a preference for tannins, but is suggested to be related to the elevated nutrient levels in the S‐plants, perhaps in combination with the complex‐binding properties of tannins.

6. The damage was highly correlated within replicate clones and a model choice analysis suggested that Japanese beetle damage may be explained by four factors: concentrations of salicortin, condensed tannins, and nitrogen, as well as the specific leaf area (thick leaves were damaged less).
The extended Moran effect and large‐scale synchronous fluctuations in the size of great tit and blue tit populations
Authors: SÆTHER BERNT‐ERIK , ENGEN STEINAR , GRØTAN VIDAR , FIEDLER WOLFGANG , MATTHYSEN ERIK , VISSER MARCEL E. , WRIGHT JONATHAN , MØLLER ANDERS PAPE , ADRIAENSEN FRANK , VAN BALEN HANS , BALMER DAWN , MAINWARING MARK C. , MCCLEERY ROBIN H. , PAMPUS MIRIAM , WINKEL WOLFGANG
Published: February 2007

Synchronous fluctuations of geographically separated populations are in general explained by the Moran effect, i.e. a common influence on the local population dynamics of environmental variables that are correlated in space. Empirical support for such a Moran effect has been difficult to provide, mainly due to problems separating out effects of local population dynamics, demographic stochasticity and dispersal that also influence the spatial scaling of population processes. Here we generalize the Moran effect by decomposing the spatial autocorrelation function for fluctuations in the size of great tit Parus major and blue tit Cyanistes caeruleus populations into components due to spatial correlations in the environmental noise, local differences in the strength of density regulation and the effects of demographic stochasticity.

Differences between localities in the strength of density dependence and nonlinearity in the density regulation had a small effect on population synchrony, whereas demographic stochasticity reduced the effects of the spatial correlation in environmental noise on the spatial correlations in population size by 21·7% and 23·3% in the great tit and blue tit, respectively.

Different environmental variables, such as beech mast and climate, induce a common environmental forcing on the dynamics of central European great and blue tit populations. This generates synchronous fluctuations in the size of populations located several hundred kilometres apart.

Although these environmental variables were autocorrelated over large areas, their contribution to the spatial synchrony in the population fluctuations differed, dependent on the spatial scaling of their effects on the local population dynamics. We also demonstrate that this effect can lead to the paradoxical result that a common environmental variable can induce spatial desynchronization of the population fluctuations.

This demonstrates that a proper understanding of the ecological consequences of environmental changes, especially those that occur simultaneously over large areas, will require information about the spatial scaling of their effects on local population dynamics.
Increased catecholamines and heart rate in children with low birth weight: perinatal contributions to sympathoadrenal overactivity
Authors: Johansson S. , Norman M. , Legnevall L. , Dalmaz Y. , Lagercrantz H. , Vanpée M.
Published: February 2007

Background.  Low birth weight is associated with cardiovascular disease. The underlying mechanisms are unknown. We hypothesized that perinatal stress alters autonomic regulation of the cardiovascular system. In this study, catecholamines, heart rate (HR) and blood pressure (BP) were measured in healthy children with low birth weight.

Methods.  This clinical study included 105 children (mean age 9.6 years) in three groups; born at term with normal birth weight (controls, n = 37), born at term but small for gestational age (SGA, n = 29) and born preterm (Preterm, n = 39). Dopamine, adrenaline and noradrenaline were determined in urine. HR and BP were measured at rest, during an orthostatic test and after a mathematical mental stress test.

Results.  Children in the Preterm and SGA groups excreted higher levels of catecholamines when compared with controls. HR (mean [SD] values) were higher at rest and after mental stress in Preterm (at rest 76 [9] and after mental stress 82 [12] min−1) and in SGA (79 [8] and 82 [10]) when compared with controls (70 [9] and 75 [9]). HR correlated with urinary catecholamines (r = 0.24–0.27, P < 0.05). Blood pressures measured at rest, during orthostatic testing and after mental stress did not differ between the groups.

Conclusions.  Preterm birth and fetal growth restriction are associated with increased sympathoadrenal activity in childhood, as indicated by stress‐induced increases in HR and urinary catecholamines. These findings suggest that the cardiovascular control is differently programmed in these children with possibly higher risk of developing hypertension in adulthood.
Modulation of environmental responses of plants by circadian clocks
Authors: HOTTA CARLOS T. , GARDNER MICHAEL J. , HUBBARD KATHARINE E. , BAEK SEONG JIN , DALCHAU NEIL , SUHITA DONTAMALA , DODD ANTONY N. , WEBB ALEX A. R.
Published: February 2007

Circadian clocks are signalling networks that enhance an organism's relationship with the rhythmic environment. The plant circadian clock modulates a wide range of physiological and biochemical events, such as stomatal and organ movements, photosynthesis and induction of flowering. Environmental signals regulate the phase and period of the plant circadian clock, which results in an approximate synchronization of clock outputs with external events. One of the consequences of circadian control is that stimuli of the same strength applied at different times of the day can result in responses of different intensities. This is known as ‘gating’. Gating of a signal may allow plants to better process and react to the wide range and intensities of environmental signals to which they are constantly subjected. Light signalling, stomatal movements and low‐temperature responses are examples of signalling pathways that are gated by the circadian clock. In this review, we describe the many levels at which the circadian clock interacts with responses to the environment. We discuss how environmental rhythms of temperature and light intensity entrain the circadian clock, how photoperiodism may be regulated by the relationship between environmental rhythms and the phasing of clock outputs, and how gating modulates the sensitivity of the clock and other responses to environmental and physiological signals. Finally, we describe evidence that the circadian clock can increase plant fitness.
Gene Gun‐delivered pGM‐CSF Adjuvant Induces Enhanced Emigration of two Dendritic Cell Subsets from the Skin
Authors: Matthews K. , Bailey S. L. , Gossner A. G. , Watkins C. , Dalziel R. G. , Hopkins J.
Published: February 2007

Two subsets of sheep afferent lymph dendritic cells (DC) are defined by the differential expression of CD172a and CD45RA. The majority (∼70%) of CD172a+ subset is CD45RA/CD11c+/CD207+/TLR4+. The CD172a− DC are CD45RA+/CD207− and express low levels of CD11c and CD86. Real‐time RT‐PCR showed that CD172+ DC produce IL‐1β and IL‐10 and high levels of IL‐18 but almost no IL‐12p40; CD172a− DC express IL‐12p40 but no IL‐10 and low levels of IL‐1β and IL‐18. Gene gun‐delivered granulocyte‐macrophage colony‐stimulating factor (pGM‐CSF) caused an early rise in the output of CD172a+ DC, changes to DC phenotype and significant increases in the levels of expression cytokine transcripts. However, pGM‐CSF did not affect any qualitative changes to cytokine expression, CD172a+ DC remained IL‐10+/IL‐12p40− and the CD172− DC remained IL‐10−/IL‐12p40+.
Iron Ions and Haeme Modulate the Binding Properties of Complement Subcomponent C1q and of Immunoglobulins
Authors: Dimitrov J. D. , Roumenina L. T. , Doltchinkova V. R. , Vassilev T. L.
Published: February 2007

The complement system and circulating antibodies play a major role in the defence against infection. They act at the sites of inflammation, where the harsh microenvironment and the oxidative stress lead to the release of free iron ions and haeme. The aim of this study was to analyse the consequences of the exposure of C1q and immunoglobulins to iron ions or haeme. The changes in target recognition by C1q and in the rheumatoid factor activity of the immunoglobulins were investigated. The exposure of C1q to ferrous ions increased its binding to IgG and to IgM. In contrast, haeme inhibited C1q binding to all studied targets, especially to IgG1 and C‐reactive protein. Thus, the haeme released as a result of tissue damage and oxidative stress may act as a negative feedback regulator of an inappropriate complement triggering as seen in ischaemia‐reperfusion tissue injury. The results also show that iron ions and haeme were able to reveal rheumatoid factor activity of IgG. The modulation of the C1q‐target binding as well as the revealing of rheumatoid factor activity of IgG by exposure to redox‐active agents released at the sites of inflammation may have important consequences for the understanding of the immunopathological mechanisms of inflammatory and autoimmune diseases.
Phenotypic and Functional Differences between Lymphocytes from NALT and Nasal Passages of Mice
Authors: Rodríguez‐Monroy M. A. , Rojas‐Hernández S. , Moreno‐Fierros Leticia
Published: February 2007

Nasal‐associated lymphoid tissue (NALT) and nasal passages (NP) are considered as inductive and effector sites, respectively. The differences among lymphocyte populations of these nasal compartments have not been clearly established. The aim of this work was to contribute to the characterization of NALT and NP lymphocytes in mice. We isolated lymphocytes from both compartments, determined the frequencies of B220+ cells as well as CD8+, CD4+ T cells; and analysed the expression of CD69 and CD25. Besides we analysed the proportion of T cells producing IL‐2, IL‐4, IL‐5, IL‐10, IFN‐γ and TNF‐α. We found differences between NALT and NP. Two populations of B cells, B220+hi and B220+low were clearly distinguished only in NP, but not in NALT. Both hi and low B220+ cells expressed CD19, but only a fraction of the B220+low population, expressed the plasma cell marker CD138+. More B than T lymphocytes, as well as higher frequencies of CD4+ than CD8+ T cells were found in both compartments. A small fraction of NK cells (CD3−DX5+) along with a significant proportion of double negative CD4−CD8−CD3+DX5− T cells was detected in both nasal tissues. Furthermore, as expected for a mucosal effector site, NP contained major proportions of B220+, T CD4+ and T CD8+ cells expressing CD25 and CD69 in comparison to NALT. Likewise, the proportion of T cells spontaneously producing IL‐2, IFN‐γ, and IL‐4, was higher in NP than in NALT. These data provide further evidence indicating that distinctive phenotypic and functional features exist in the lymphocyte populations residing at NALT and NP.
Paradoxical worsening of tuberculosis in a heart–lung transplant recipient
Authors: Place S. , Knoop C. , Remmelink M. , Baldassarre S. , Van Vooren J.‐P. , Jacobs F. , Mascart F. , Estenne M.
Published: February 2007

Abstract: We report on a heart–lung transplant recipient who presented with pulmonary tuberculosis (TB) 2.5 months after transplantation and then developed a paradoxical reaction after 4 months of adequate anti‐TB treatment. She eventually recovered with anti‐TB and high‐dose steroid treatments.

Methods. Using sequential bronchoalveolar lavages, we assessed the inflammatory response in the lung and investigated the alveolar immune response against a Mycobacterium tuberculosis antigen.

Results. The paradoxical reaction was characterized by a massive infiltration of the alveolar space by M. tuberculosis antigen‐specific CD4+ T cells and by the presence of a CD4−CD8− T lymphocyte subpopulation bearing phenotypic markers (CD16+/56+) classically associated with NK cells.

Conclusion. This case report illustrates that even solid organ transplant recipients receiving intense triple‐drug immune suppression may be able to develop a paradoxical reaction during TB treatment. Transplant physicians should be aware of this phenomenon in order to differentiate it from treatment failure.
Early Embryonic Development of the Camel Lumbar Spinal Cord Segment
Authors: Elmonem M. E. A. , Mohamed S. A. , Aly K. H.
Published: February 2007

The lumbar spinal cord segment of the one‐humped camel (Camelus dromedarius) embryos at 2.4‐ to 28‐cm crown vertebral rump length (CVRL) was examined. Major changes are occurring in the organization of the lumbar spinal cord segment at this early developmental period. At first, the spinal cord is flattened from side to side but with increase in gestational age it becomes flattened dorsoventrally. The size and shape of the lumen changes in indifferent stage of development. These changes may be in relation to the decrease of ependymal layer and increase of the mantel layer during the developmental stages. The lumen of the spinal cord is a wide spindle in shape at 2.4‐cm CVRL, diamond in shape at 5.5‐cm CVRL and narrow oval in shape at 28‐cm CVRL. It occupies about the whole, half and one‐seventh of the total height of the spinal cord at 2.4‐, 5.5‐ and 28‐cm CVRL, respectively. At the 2.4–2.7 CVRL, the spinal cord is formed of six plates: roof, floor, two alar and two basal plates. The present investigation indicates that the distribution of the ependymal, mantle and marginal layers differs in the various developmental stages of the camel embryos. The majority of the cross section of the spinal cord consists at first of ependymal and mantle layers, and a thin outer rim of the marginal layer. With the advancement of age, the ependymal layer diminishes in size, while the mantle and marginal layers increase in size forming the future grey and white matters, respectively.
Immunohistolocalization and Gene Expression of the Secretory Carbonic Anhydrase Isozymes (CA‐VI) in Canine Oral Mucosa, Salivary Glands and Oesophagus
Authors: Kasuya T. , Shibata S. , Kaseda M. , Ichihara N. , Nishita T. , Murakami M. , Asari M.
Published: February 2007

The immunohistolocalization of secretory carbonic anhydrase isoenzymes (CA‐VI) in canine salivary glands, parotid, submandibular, sublingual and zygomatic glands, oral and oesophageal mucosa was studied using a specific antiserum against a canine CA‐VI. In addition, the gene expression of CA‐VI from the same tissue was studied using a real‐time reverse‐transcriptase polymerase chain reaction. In all salivary glands and oesophageal gland, immunostaining intensely localized CA‐VI antiserum throughout the cytoplasm of serous acinar cells, including serous demilune and ductal epithelial cells. In contrast, no immunoreaction localized CA‐VI in the mucous acinar cells of the gland. CA‐VI gene transcripts were also detected in the same areas. The physiological significance of secretory CA‐VI in the oral and oesophageal cavity is thought to play a highly specialized role in the maintenance of bicarbonate level in saliva and to protect mucosa from acid injury. It is shown that the major sites of the CA‐VI secretion in dogs were in serous (demilune) secretory cells in all four major salivary glands and oesophageal glands in particular.
Sperm distribution in the reproductive tract of sows after intrauterine insemination
Authors: Sumransap P , Tummaruk P , Kunavongkrit A
Published: February 2007

Contents

The purpose of the present study was to compare the number of spermatozoa obtained from different parts of the oviducts and the uterine horns of sows after intrauterine insemination (IUI) and conventional artificial insemination (AI), 24 h after insemination. Twelve crossbred (Landrace × Yorkshire) multiparous sows were used in the experiment. The sows were examined for standing oestrus using a back pressure test and were examined every 4 h after standing oestrus by real‐time B‐mode ultrasonography to estimate the time of ovulation. The sows were allocated to two groups, group I sows (n = 6) were inseminated by a conventional AI technique with 3 × 109 motile spermatozoa in 100 ml of extended semen, and group II sows (n = 6) were inseminated by an IUI technique using 1 × 109 motile spermatozoa in 50 ml of extended semen. A single dose of AI or IUI was given using the same boar, 8–10 h before the expected time of ovulation during the second oestrus after weaning. Twenty four hours after insemination, the sows were ovario‐hysterectomized. The oviducts and the uterine horns were removed and divided into seven parts, the cranial, middle and caudal uterine horns, the utero‐tubal junction (UTJ), the cranial and caudal isthmus, and the ampulla. All parts of the reproductive tract were flushed and the spermatozoa were counted using a haemocytometer. The results revealed that the spermatozoa were found in both the oviducts and the uterine horns in all animals. The number of flushed spermatozoa in the UTJ of groups I and II, was 142 500 and 131 167 (p > 0.05), and in the caudal isthmus was 1411 and 1280 (p > 0.05), respectively. The proportion of spermatozoa in different parts of the reproductive tract in relation to the total number of spermatozoa within the tract was not significantly different between groups I and II (p > 0.05). It could be concluded that IUI, with a three‐time reduction in the number of spermatozoa used resulted in the same number of spermatozoa to be deposited in the sperm reservoir around ovulation time.
Does routine gowning reduce nosocomial infection and mortality rates in a neonatal nursery? A Singapore experience
Authors: Tan Soek Gek , Lim Siok Hong , Malathi I
Published: February 2007

A 1 year prospective study on routine gowning before entering a neonatal unit was conducted in a maternity hospital in Singapore. This study was done based on previous work by Donowitz, Haque and Chagla and Agbayani et al., as there have been no known studies done in Singapore. The aim of the study was to test the hypothesis that routine gowning before entering a neonatal nursery does not reduce nosocomial infection and mortality rate. A total of 212 neonates from the neonatal intensive care unit (NICU) and 1694 neonates from the neonatal special care unit (NSCU) were studied. Neonates admitted during the 1 year study were assigned to the gowning (control) and no routine gowning (trial) group on every alternate 2 months. The hospital infection control nurse provided data on nosocomial infection. The overall nosocomial infection rate in the NICU was 24% (25 of 104 admissions) during gowning periods compared to 16.6% (18 of 108 admissions) when plastic aprons were not worn before entry. In the NSCU, the overall infection rate was 1.5% (12 of 800 admissions) during gowning periods compared to 2.1% (19 of 894 admissions) when no gown was worn before entry. Results of the study found no significant differences in the incidences of nosocomial infection and mortality in the neonates. The cost of gowns used during the no routine gowning periods was S$2012.8 compared to S$3708 used during the routine gowning procedure. The investigators recommend that routine gowning before entering a neonatal unit is not essential and cost effective for the purpose of reducing infection. Rather the focus should be on adequate handwashing by all hospital personnel and visitors before handling neonates.
The role of the nurse in food service: A literature review and recommendations
Authors: Kowanko Inge
Published: February 2007

Kowanko I. International Journal of Nursing Practice 1997; 3: 73–78

The role of the nurse in food service: A literature review and recommendations

In the current economic climate increasing numbers of hospitals are outsourcing arrangements for food preparation and service. There is debate among health professionals about the most appropriate role, if any, of nurses in feeding patients. This paper reports on a comprehensive review of the literature over the last 30 years pertaining to patient nutrition and food service in hospital. It is apparent that many patients are admitted in a malnourished state and that deterioration of nutritional status frequently occurs during hospitalization. At the same time there is evidence that appropriate and prompt attention to patient nutrition by nurses and other health professionals has a positive influence on patient outcome and hospital costs. The implications for nursing are discussed.
Changing handover practices: One private hospital’s experiences
Authors: McKenna Lisa , Walsh Kerryn
Published: February 2007

McKenna L, Walsh K. International Journal of Nursing Practice 1997; 3: 128–132

Changing handover practices: One private hospital’s experiences

The handover practice has long been an important component of clinical nursing practice allowing nurses to exchange relevant client information from one shift to the next and ensure continuity of patient care. Traditional approaches have seen nursing handovers taking place in a room away from general ward activity. Oncoming nursing staff receive the information verbally from nurses on the previous shift about all patients within the ward or unit. This practice has been proven over time to present difficulties and consequently, many hospitals are choosing to adopt models that better address current needs. This analysis describes the creative approaches taken by one private hospital in modifying handover practices with the view to reduce time and increase overall efficiency and effectiveness, whilst ensuring that staff and ward requirements are considered. The study highlights how action research principles can be applied to introduce change into the clinical practice environment.
A therapeutic programme for people with dementia
Authors: Gibb Heather , Morris Clare T , Gleisberg Juergen
Published: February 2007

Gibb H, Morris CT, Gleisberg J. International Journal of Nursing Practice 1997; 3: 191–199

A therapeutic programme for people with dementia

A programme involving Tai Chi and structured reminiscence was trialed with nine people suffering from moderately advanced dementia. The analysis reported here aimed to examine stories the people told with a view to understanding the purpose of story telling in their lives. Themes derived from the narrative data had a strong evaluative quality, ranging from simple evocative expressions to more cognitive complex insights or treasures. The study indicated a major aim in story telling as being able to generate life values, both for the enrichment of identification of self, and to pass on or leave for today’s youth. Findings here further substantiate Luke and Freiden’s view that old age has its own cognitive and spiritual goals to achieve. There is strong evidence that people with moderate dementia still aim to participate in that endeavour.
Disaster relief work: Nurses and others in bushfire territory
Authors: M Helen
Published: February 2007

Cox H M. International Journal of Nursing Practice 1997; 3: 218–223

Disaster relief work: Nurses and others in bushfire territory

This paper describes one aspect of a study into the experiences in long‐term healing of a community following the 1983 Ash Wednesday bushfire. Forty participants were interviewed, of whom 26 were residents and 14 disaster relief workers. The paper concentrates on the experiences of the latter, describing how they came to understand the bushfire affected the community and how they managed disaster work. For novices it was a profoundly difficult experience, for which they received little help and had to manage with whatever skill they drew on in their ‘normal’ working lives, mixed with a good deal of intuition. The paper suggests that health workers in vulnerable areas require preparation for a likely disaster; that ‘outsiders’ need to deal through existing community groups and individuals to gain access to those in need of their skills, and that they also require preparation for helping ‘insiders’ who are themselves victims of the catastrophe.
Amniotic membrane transplantation for ocular surface reconstruction: indications and outcomes
Authors: Maharajan V Senthil , Shanmuganathan Vijay , Currie Alison , Hopkinson Andrew , Powell‐Richards April , Dua Harminder S
Published: February 2007

Abstract

Background:  The amniotic membrane is a useful tool in the management of several ocular surface diseases. Despite numerous studies, standardization of the use of the membrane and of outcome measures is lacking. Herein, the authors’ results of amniotic membrane transplantation (AMT) in ocular surface reconstruction against defined outcome measures are reported.

Methods:  A retrospective case study of 74 consecutive procedures (58 patients) performed against predefined outcome measures. The cases were divided into three groups. Group A AMT in the presence of stem cell loss (32 procedures), Group B AMT without stem cell loss (24 procedures) and Group C AMT for conjunctival reconstruction (18 procedures). The outcomes were evaluated against defined criteria based on the purpose (patch or graft) and objective for use of the membrane. Results were analysed by defining the outcomes as success, partial success or failure.

Results:  Unequivocal success of the procedure was observed in 22% in Group A, 62.5% in Group B and 50% in Group C. AMT was significantly more successful in the presence of functioning stem cells (P = 0.01). In Group A acute and subacute cases (less than 3 months) needed more procedures compared with chronic cases (P = 0.02). In Group C, results were comparatively worse when AMT was used in progressive cicatrizing conditions.

Conclusion:  Use of AMT can be associated with a significant number of failures. It provides a useful alternative for specific indications where its use should be encouraged. It is important to define criteria for success in order to accurately evaluate efficacy.
Comparison of acute structural and histopathological changes of the porcine ciliary processes after endoscopic cyclophotocoagulation and transscleral cyclophotocoagulation
Authors: Pantcheva Mina B , Kahook Malik Y , Schuman Joel S , Rubin Marc W , Noecker Robert J
Published: February 2007

Abstract

Background:  The objective of this study is to investigate the acute histological effects of transscleral cyclophotocoagulation and endoscopic cyclophotocoagulation on the ciliary body and other structures of porcine eyes compared with untreated controls.

Methods:  Transscleral cyclophotocoagulation and endoscopic cyclophotocoagulation were performed on porcine eyes. Detailed histological evaluations were performed with light and scanning electron microscopy of treated eyes and compared with untreated controls.

Results:  Histological changes were observed with both light and scanning electron microscopy for all treated tissues. Tissue treated with transscleral cyclophotocoagulation showed pronounced tissue disruption of the ciliary body muscle and stroma, ciliary processes, and both pigmented and non‐pigmented ciliary epithelium. Endoscopic cyclophotocoagulation‐treated tissue exhibited pronounced contraction of the cilliary processes with disruption of the ciliary body epithelium, with less architectural disorginization and sparing of the ciliary body muscle. The sclera was not affected by either laser treatment.

Conclusion:  The endoscopic cyclophotocoagulation treatment caused less damage to the ciliary body compared with the transscleral cyclophotocoagulation when evaluated by light and scanning electron microscopy. Compared with transscleral cyclophotocoagulation, endoscopic cyclophotocoagulation appears to be a more selective form of cyclophotocoagulation resulting in less tissue disruption while achieving the goal of destroying ciliary body epithelium.
MINIMALLY INVASIVE PARATHYROIDECTOMY: AN AUDIT OF A CHANGE IN CLINICAL PRACTICE
Authors: Yew Ming K. , Thompson Ivan J.
Published: February 2007

Background:  Minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism is gaining acceptance as a useful tool in the armamentarium of the endocrine surgeon.

Methods:  We undertook an audit of 154 consecutive cases of parathyroidectomy carried out through bilateral neck exploration as well as a minimally invasive approach.

Results:  Bilateral neck exploration had a 100% single operation cure rate. MIP had a 90% cure rate. Sestamibi localization had a positive predictive value of 99% for identifying an abnormal parathyroid gland. However, it performed poorly in the presence of multiglandular disease, resulting in these patients being at risk of having persistent hyperparathyroidism and therefore requiring a second operation.

Conclusion:  Our results with bilateral neck exploration are favourable compared with other large series. However, we have reported a 10% reoperation rate with MIP. Although not ideal, we are confident that, as a result of improvements based on this audit and with increasing experience, the cure rate will improve to reach international benchmarks. As such we feel that this strategy is a pragmatic way to offer MIP to patients in our region.
AIRWAY STENTS IN MANAGEMENT OF TRACHEAL STENOSIS: HAVE WE IMPROVED?
Authors: Wu Ching‐Yang , Liu Yun‐Hen , Hsieh Ming‐Ju , Wu Yi‐Chen , Lu Ming‐Shian , Ko Po‐Jen , Liu Hui‐Ping
Published: February 2007

Background:  Airway stenting is an alternative approach for relieving airway stenosis when lesions are inappropriate for single‐stage reconstruction. The aim of this study was to present our experience using airway stent in the management of patients with tracheal stenosis.

Methods:  This study retrospectively reviewed 45 patients who underwent airway stenting during a 2‐year period. Between June 2002 and August 2004, 45 patients underwent rigid bronchoscopy for tracheal stenosis using an Ultraflex stent (Microvasive; Boston Scientific, Boston, MA, USA), Hood stent (Hood Laboratories, Pembroke, MA, USA) and Montgomery T‐tube (Boston Medical, Westborough, MA, USA). Clinical improvement, intraoperative, early and late postoperative complications were evaluated.

Results:  Ultraflex stent was used in 14 patients, Hood stent in 9 and Montgomery T‐tube in 22. The overall clinical improvement was 95.5%. Four per cent of the patients (2/45) had intraoperative complications, 8.8% (4/45) had early postoperative complications and 51% (23/45) had late postoperative complications. No significant difference was determined between stent type and complication rates.

Conclusion:  Rigid bronchoscopic insertion of airway stents for tracheal stenosis is a safe and effective procedure. No difference exists between stent type and clinical improvement, intraoperative and early and late postoperative complications.
MANDIBULAR FRACTURES IN FAR NORTH QUEENSLAND: AN ETHNIC COMPARISON
Authors: Oberdan William , Finn Brian
Published: February 2007

Background:  No previous published Australian study on the epidemiology of mandibular fractures has comprehensively shown the differences existing between indigenous and nonindigenous populations. Cairns Base Hospital, which services both the metropolitan city of Cairns and remote regions of Far North Queensland, provides the perfect environment for investigating such differences.

Methods:  A retrospective study of all patients presenting to Cairns Base Hospital with mandibular fractures over the 3‐year period between January 1999 and January 2002 was undertaken.

Results:  A total of 444 mandibular fractures occurred in 276 patients. The indigenous population of 7.6% in Cairns (17.9% in Far North Queensland) represented 49% of all patients. Assaults (74%) were the principal cause. The second most common mechanism was sporting injuries (17%), followed by motor vehicle accidents (5%) and falls (4%). In the indigenous female population, 93% arose from assaults, of which 57% were documented as domestic violence. The nonindigenous population had a defined peak in the third decade of life, with fractures in 47% of men and 38% of women occurring then. However, the indigenous group had a sustained peak between 11 and 40 years of age, with 94% of fractures occurring within this period. The male to female ratio was 6:1 in nonindigenous (3:1 indigenous). The side of predilection was L:R = 1:1 in nonindigenous (L:R = 3:1 indigenous). Recurrent mandibular trauma was documented in 4% of nonindigenous (18% of indigenous). Within the nonindigenous, all women and 90% men sought medical attention within 2 days of injury. In contrast, 38% indigenous men and 20% indigenous women delayed their initial presentation for 3 days or more (P < 0.001).

Conclusion:  Clinically and statistically significant differences exist between the two ethnic groups. It is proposed that these differences are possible indicators that high rates of interpersonal violence exist in a community.
RISKS AND CONSEQUENCES OF INCIDENTAL PARATHYROIDECTOMY DURING THYROID RESECTION
Authors: Sippel Rebecca S. , ÖZgül ÖMer , Hartig Gregory K. , Mack Eberhard A. , Chen Herbert
Published: February 2007

Background:  Inadvertent removal of the parathyroid glands during elective thyroid surgery occurs more frequently in certain high‐risk patients and can lead to symptomatic hypocalcaemia.

Methods:  A case–control study was carried out at a tertiary referral, academic medical centre between May 1994 and August 2001. Five hundred and thirteen patients underwent thyroid resection. Pathology reports were reviewed to identify patients who had the inadvertent removal of a parathyroid gland during their thyroid surgery. Thirty‐three (6.4%) patients had inadvertent resection of a parathyroid gland. The outcomes of these 33 patients (INCIDENTAL) were compared with the other 480 patients who did not have resection of parathyroid tissue (NO INCIDENTAL).

Results:  Risk factors for inadvertent parathyroid resection included younger age (P = 0.003), bilateral thyroid resection (P = 0.001) and malignant pathology (P = 0.002). Factors that did not increase the risk of incidental parathyroidectomy included gland weight, sex, presence of a goitre, previous neck exploration and concurrent lymph node dissection. In the INCIDENTAL group 24% had a postoperative calcium levels less than 7.0 mg/dL (P = 0.001). Symptomatic hypocalcaemia developed in 12% of INCIDENTAL patients, compared to 4% in the NO INCIDENTAL group (P = 0.06).

Conclusion:  Incidental removal of parathyroid tissue occurred in 6.4% of thyroid resections. Younger patients undergoing a total or subtotal thyroidectomy for malignancy were at the highest risk. These patients had lower postoperative calcium levels, but the majority (88%) experienced no clinical consequences.
RECTUS SHEATH CATHETERS FOR CONTINUOUS ANALGESIA AFTER UPPER ABDOMINAL SURGERY
Authors: Cornish Philip , Deacon Alf
Published: February 2007

The segmental nerves T6–T11 pass through and innervate the rectus abdominis muscle and overlying skin. The arcuate lines compartmentalize the rectus, but they are deficient posteriorly and hence a catheter tunnelled into the posterior sheath can be used to achieve an effective continuous analgesic block. Volume is important to fill the compartment. It is a simple surgical procedure that has several advantages and appears a viable alternative to epidural analgesia.
Histamine release from the administration of suxamethonium and atracurium in adolescents
Authors: GOUDSOUZIAN N.G. , GELB C.
Published: February 2007

Cutaneous reactions and plasma histamine levels were evaluated in 30 adolescents subsequent to the administration of suxamethonium 1.5 mg kg−1 or atracurium 0.6 mg kg−1. Plasma histamine levels were measured by the radio‐enzymatic assay using histamine N‐methyl transferase. In the atracurium group, the change in plasma histamine level was significant at the 2 min mark, but was not significant in the suxamethonium group. About 60% of the patients in each group developed a cutaneous reaction. Erythematous cutaneous reactions following atracurium were frequently associated with a mild increase in plasma histamine levels, whereas the rashes induced by suxamethonium in adolescents were not associated with changes in plasma histamine.
Am I blind? The fear of a 4‐year‐old boy after total intravenous anaesthesia with propofol
Authors: SCHAEFER H.‐G. , MARSCH S.C.U.
Published: February 2007

A transient inability to open the eyes after total intravenous anaesthesia with propofol is described in a 4‐year‐old child. The possible mechanisms of the production of this complication are discussed.
Heart transplantation in children: anaesthetic considerations
Authors: BOLDT J. , ZICKMANN B. , NETZ H. , DAPPER F. , HEMPELMANN G.
Published: February 2007

Heart transplantation (HTX) is a relatively new therapy that is gaining popularity for the treatment of end‐stage myocardial failure in adults. This report focuses on our anaesthetic experiences in management of heart transplantation in children. Ten patients ranging in age from 5 days to 5 years and in weight from 3 to 16 kg were studied. Transplantation was successful in six cases (60%), two children died intra‐operatively, most likely due to an acute right heart failure, one patient died in the post‐operative period, and one child died after 2 months due to pulmonary emboli. Catecholamines were administered to eight of the patients before induction of anaesthesia. Inotropic support during and after weaning off cardiopulmonary bypass was necessary in all cases using either dobutamine and/or adrenaline. Phosphodiesterase inhibitor, enoximone, was administered in five patients. Prostaglandin E1 was used in four patients to reduce afterload of the right ventricle. Cardiac transplantation offers a challenge for the anaesthetist in the pre‐bypass period as well as in the weaning and early post‐bypass period. Experience is necessary to optimize anaesthetic management of these children.
Lactated Ringer with 1% dextrose: an appropriate solution for peri‐operative fluid therapy in children
Authors: DUBOIS M.C. , GOUYET L. , MURAT I. , SAINT‐MAURICE C.
Published: February 2007

Peri‐operative blood glucose, total protein, and electrolytes values were measured in children (3–120 months) scheduled for minor surgery and randomly assigned to three groups according to the type of fluids administered during anaesthesia: children of RL group (n= 27) received lactated Ringer, those of RLD1 group (n= 25), 1% dextrose in lactated Ringer, and those in RLD2.5 group (n= 27), 2.5% dextrose in 0.4 N saline (50% D5, 50% RL) (63 mmol·l‐1). Infusion rate was set according to children's age and weight. Fluids were infused throughout the study with volumetric infusion pumps. Blood samples were obtained at induction (T0), at the end of surgery (T1), 30 and 60 min later (T2, T3). Pre‐operative blood values were within the normal ranges except for high total protein values in all groups of children and for asymptomatic hypoglycaemia (2.3 and 2.5 mmol·l‐1) in two children. Blood glucose increased significantly in the three groups post‐operatively (P < 0.001), and this increase was related to the amount of glucose infused. Glucose values differed significantly between groups at T1 and T2, while blood glucose values were back to the normal ranges at T2 and T3 in the RL group. Sodium values remained unchanged post‐operatively in both RL and RLD1 groups, while a significant decrease was observed in the RLD2.5 group (P < 0.001). Total protein decreased in the three groups post‐operatively (P < 0.001) towards normal values. These data suggest that RLD1 is appropriate for peri‐operative fluid therapy in children. Its administration at the infusion rate used in this study, resulted in moderate post‐operative hyperglycaemia while avoiding the risk of peri‐operative hypoglycaemia, maintaining a constant extracellular fluid composition and correcting pre‐operative fluid deficit.
Continuous infusion of alfentanil in infants undergoing inguinal herniorraphy
Authors: GRONERT B.J. , DAVIS P.J. , COOK D.R.
Published: February 2007

We evaluated the safety and efficacy of continuous alfentanil infusions in 37 full‐term infants aged 4 to 52 weeks undergoing inguinal herniorraphy as outpatients. The infants were randomly assigned to one of two groups. In all patients anaesthesia was induced with halothane, nitrous oxide and oxygen by mask, then atropine and atracurium were administered intravenously. In the alfentanil group, anaesthesia was maintained with nitrous oxide, oxygen and alfentanil (100 μg·kg‐1) followed by a 2.0 μg·kg‐1·min‐1 continuous infusion whereas in the control group anaesthesia was maintained with nitrous oxide, oxygen, and halothane (1.5%). There were no differences between the groups with respect to intra‐operative values of blood pressure and heart rate, post‐operative values of oxygen saturation as measured by pulse oximetry and respiratory rate, or post‐operative incidence of vomiting and use of pain medication. Sedation lasted longer post‐operatively in the alfentanil group, delaying oral intake but not prolonging hospitalization time. This study affirms that intravenous anaesthesia with alfentanil is safe and effective in infants.
Caudal anaesthesia in a patient with Hurler syndrome (mucopolysaccharidosis type I)
Authors: WALBERGH E.J. , COLES P.G.
Published: February 2007

Children with any of the mucopolysaccharidoses are at a high risk of developing significant morbidity and mortality when a general anaesthetic is administered. This case report describes the use of a caudal epidural technique for the repair of bilateral inguinal herniae in a 10‐month‐old infant with Hurler syndrome (mucopolysaccharidosis type I).