bluuebunny/crossref_metadata_2025 huggingface dataset:
A study of airway management using the ProSeal LMA® laryngeal mask airway compared with the tracheal tube on postoperative analgesia requirements following gynaecological laparoscopic surgery
Authors: Hohlrieder M. , Brimacombe J. , Eschertzhuber S. , Ulmer H. , Keller C.
Published: August 2007

In a randomised double blind prospective study, we tested the hypothesis that postoperative pain is lower in patients who receive an ProSeal LMA™ laryngeal mask airway compared with a tracheal tube. One hundred consecutive female patients (ASA I–II, 18–75 years) undergoing laparoscopic gynaecological surgery were divided into two equal‐sized groups for airway management with the ProSeal LMA or tracheal tube. Anaesthesia management was identical for both groups and included induction of anaesthesia using propofol/fentanyl, and maintenance with propofol/remifentanil, muscle relaxation with rocuronium, positive pressure ventilation, gastric tube insertion, dexamethasone/tropisetron for anti‐emetic prophylaxis, and diclofenac for pain prophylaxis. All types of postoperative pain were treated using intravenous patient‐controlled analgesia (PCA) morphine. Patients and postoperative staff were unaware of the airway device used. Data were collected by a single blinded observer. We found that pain scores were lower for the ProSeal LMA at 2 h and 6 h but not at 24 h. Morphine requirements were lower for the ProSeal LMA by 30.4%, 30.6% and 23.3% at 2, 6 and 24 h, respectively. Nausea was less common with the ProSeal LMA than with the tracheal tube at 2 h and 6 h but not at 24 h. There were no differences in the frequency of vomiting, sore throat, dysphonia or dysphagia. We conclude that postoperative pain is lower for the ProSeal LMA than the tracheal tube in females undergoing gynaecological laparoscopic surgery.
Apnoeic spells following general anaesthesia in a patient with familial hemiplegic migraine
Authors: Willson J. , Kapur S.
Published: August 2007

Hemiplegic migraine is an unusual variant of migraine, characterised by a temporary hemiparesis or hemiplegia associated with headache. We report a patient with hemiplegic migraine who developed atypical migraine with apnoeic spells, aphasia and hemiparesis following general anaesthesia. We review the clinical features of hemiplegic migraine and the considerations for its anaesthetic management.
The utility of B‐type natriuretic peptide in predicting postoperative cardiac events and mortality in patients undergoing major emergency non‐cardiac surgery
Authors: Cuthbertson B. H. , Card G. , Croal B. L. , McNeilly J. , Hillis G. S.
Published: August 2007

B‐type natriuretic peptide (BNP) levels predict cardiovascular risk in several settings. We hypothesised that they would identify individuals at increased risk of complications and mortality following major emergency non‐cardiac surgery. Forty patients were studied with a primary end‐point of a new postoperative cardiac event, and/or development of significant ECG changes, and/or cardiac death. The main secondary outcome was all‐cause mortality at 6 months. Pre‐operative BNP levels were higher in 11 patients who suffered a new postoperative cardiac event (p = 0.001) and predicted this outcome with an area under the receiver operating characteristic curve of 0.85 (CI = 0.72–0.98, p = 0.001). A pre‐operative BNP value > 170 pg.ml−1 has a sensitivity of 82% and a specificity of 79% for the primary end‐point. In this small study, pre‐operative BNP levels identify patients undergoing major emergency non‐cardiac surgery who are at increased risk of early postoperative cardiac events. Larger studies are required to confirm these data.
Effects of normobaric hyperoxia on haemodynamic parameters of healthy full‐term parturients
Authors: Litchfield K. N. , Harten J. M. , Anderson K. J. , Kinsella J. , McGrady E. M.
Published: August 2007

Fifteen healthy, full‐term women with singleton pregnancies were exposed to an increased FIo2 of 0.4 and their haemodynamic responses measured with a non‐invasive transthoracic bio‐impedance monitor. There was a mean reduction in cardiac index from 3.18 to 3.03 l.min−1.m−2 (4.7%, p = 0.004). The mean indexed systemic vascular resistance increased from 2049 to 2178 dynes.cm−5.m−2 (5.7%, p = 0.005). There were no significant changes in stroke index, heart rate or mean arterial pressure. This study demonstrates that even a moderate increase in inspired oxygen fraction has significant effects on the cardiovascular system of the term parturient.
Comparison of the Airway Scope®, gum elastic bougie and fibreoptic bronchoscope in simulated difficult tracheal intubation: a manikin study
Authors: Koyama Y. , Inagawa G. , Miyashita T. , Kikuchi T. , Miura N. , Miki T. , Kurihara R. , Kamiya Y. , Goto T.
Published: August 2007

We compared the Airway Scope® with a gum elastic bougie and fibreoptic bronchoscope in a manikin with a simulated Cormack and Lehane Grade 3 laryngoscopic view. Twenty‐seven anaesthetists intubated the trachea of the manikin with these devices and the time required for intubation was measured. They were then asked to rate the subjective difficulty of intubation (1 = very easy; 5 = very difficult). Mean (SD) intubation times were 16.6 (11.2) s with the Airway Scope, 29.4 (10.9) s with the gum elastic bougie (p < 0.0001), and 30.6 (20.0) s with the fibreoptic bronchoscope (p < 0.0001). The median (range) difficulty was 2 (1–4) with the Airway Scope, 3 (2–4) with the gum elastic bougie (p < 0.001), and 2 (1–5) with the fibreoptic bronchoscope (p = 0.014). In Cormack and Lehane grade 3 laryngoscopic views, the Airway Scope may enable faster and easier tracheal intubation than does a Macintosh laryngoscope with a gum elastic bougie or a fibreoptic bronchoscope.
Bacterial contamination of anaesthetists' hands by personal mobile phone and fixed phone use in the operating theatre
Authors: Jeske H.‐C. , Tiefenthaler W. , Hohlrieder M. , Hinterberger G. , Benzer A.
Published: August 2007

Following hand disinfection, 40 anaesthetists working in the operating room (OR) were asked to use their personal in‐hospital mobile phone for a short phone call. After use of the cell phone, bacterial contamination of the physicians' hands was found in 38/40 physicians (4/40 with human pathogen bacteria). After repeating the same investigation with fixed phones in the OR anteroom 33/40 physicians showed bacterial contamination (4/40 with human pathogen bacteria). The benefit of using mobile phones in the OR should be weighed against the risk for unperceived contamination. The use of mobile phones may have more serious hygiene consequences, because, unlike fixed phones, mobile phones are often used in the OR close to the patient.
Peri‐operative respiratory failure in a cirrhotic patient: a misleading diagnosis
Authors: Busani S. , Rinaldi L. , Barbieri E. , Drago A. , Barbieri A. , Girardis M.
Published: August 2007

Patients with chronic liver disease may present with different degrees of respiratory dysfunction whose differential diagnosis is important before elective surgery. We report the case of a misleading diagnosis of peri‐operative respiratory failure in a cirrhotic patient who underwent mastectomy. Intra‐operative respiratory failure was ascribed by the anaesthetic team to pulmonary embolism and after the operation this diagnosis was still suspected. Despite postoperative heparin treatment, pulmonary gas exchange remained severely impaired. On the hypothesis of a right to left shunt, we performed transoesophageal echocardiography with a bubble test and confirmed hepatopulmonary syndrome. We administered anticoagulant therapy to the patient following surgery, increasing the risk of haemorrhage. We also continued orotracheal intubation and mechanical ventilation longer than was needed. Respiratory symptoms in a patient with liver disease should not be underestimated and up to 20% of these patients may have hepatopulmonary syndrome.
An evaluation of the TruView EVO2 laryngoscope
Authors: Li J. B. , Xiong Y. C. , Wang X. L. , Fan X. H. , Li Y. , Xu H. , Ma Y. , Deng X. M.
Published: August 2007

The TruView EVO2 laryngoscope was compared with the traditional Macintosh laryngoscope in 200 patients who required tracheal intubation for elective surgery. Mallampati score determined prior to laryngoscopy was significantly related to the view of the glottis during laryngoscopy for both laryngoscopes. The view of the larynx was better with the TruView EVO2 laryngoscope than with the Macintosh laryngoscope in patients with a Cormack and Lehane grade greater than 1 (p < 0.01). The mean time to intubate was significantly shorter with the Macintosh laryngoscope (34 s) than with the TruView laryngoscope (51 s) (p < 0.01).
Ischaemic complications of Glypressin in liver disease: a case series
Authors: Donnellan Fergal , Cullen Garret , Hegarty John E. , McCormick P. Aiden
Published: August 2007

Aim To report three cases of extensive skin necrosis in cirrhotic patients treated with the vasoconstrictor agent terlipressin (Glypressin).

Methods We identified three patients who developed skin necrosis and determined any factors, which put them at an increased risk of doing so.

Results Two patients were obese and developed extensive abdominal wall skin necrosis. The third patient had lower limb chronic venous insufficency and developed extensive necrosis of both lower limbs.

Conclusions With increasing clinical use of terlipressin and an increasing incidence of obesity and non‐alcoholic fatty liver disease‐related cirrhosis, the incidence of these serious complications is likely to rise. Earlier recognition and treatment may lead to improved outcome.
Nonsteroidal anti‐inflammatory drug use and the risk of severe skin and soft tissue complications in patients with varicella or zoster disease
Authors: Mikaeloff Yann , Kezouh Abbas , Suissa Samy
Published: August 2007

What is already known about this subject

• Three previous epidemiological studies found an increased risk of severe skin and soft tissue infectious complications associated with exposure to NSAIDs in children with varicella.

• In vitro studies demonstrated that decreases in defences against infections induced by NSAIDs could be due to impairment of neutrophil blood cell function.

What this study adds

• The use of NSAIDs is associated with an increased risk of severe skin and soft tissue complication of varicella in children.

• The use of NSAIDs is also associated with a small increased risk of such complications in zoster disease in adults and the elderly.

• This study supports the limited prescription of NSAIDs in VZV infection.

Aims To assess the risk of severe skin and soft tissue complications associated with the use of nonsteroidal anti‐inflammatory drugs (NSAIDs) in treating patients with varicella zoster virus infection.

Methods The design was a nested case‐control study, with matching for age and practice. The setting was primary care in the United Kingdom (United Kingdom's General Practice Research Database). Two population‐based cohorts of all patients with a primary varicella (n = 140 111) or zoster (n = 108 257) diagnosis during 1994–2005 were followed up for 2 months after diagnosis. Main outcome measures of severe skin or soft tissue complications (mostly cellulitis and abscess) associated with current NSAID or paracetamol use were estimated, and adjusted for potential confounding factors, including sex, drug use, and comorbidity.

Results In patients with varicella, there were 386 cases of severe skin or soft tissue complications (rate 2.8 per 1000) during the 2 month follow‐up period (mean age 10.7 years). The rate of complications associated with exposure to NSAIDs was increased (rate ratio 4.9; 95% CI 2.1, 11.4). In patients with zoster disease, there were 681 cases of severe skin or soft tissue complications (rate 6.3 per 1000) during the 2 month follow‐up (mean age 60.9 years). The rate ratio of complications associated with exposure to NSAIDs was 1.6 (95% CI 1.1, 2.4). In both conditions, there was no increased risk of complication associated with a current exposure to paracetamol.

Conclusions The use of NSAIDs is associated with an elevated risk of severe skin and soft tissue complications of varicella zoster virus infection, mostly in children with varicella.
Effect of homeopathy on analgesic intake following knee ligament reconstruction: a phase III monocentre randomized placebo controlled study
Authors: Paris A. , Gonnet N. , Chaussard C. , Belon P. , Rocourt F. , Saragaglia D. , Cracowski J. L.
Published: August 2007

What is already known about this subject

• The efficacy of homeopathy is still under debate and a recent meta‐analysis recommended further randomized double‐blind clinical trials to identify any clinical situation in which homeopathy might be effective.

What this study adds

• The complex of homeopathy tested in this study (Arnica montana 5 CH, Bryonia alba 5 CH, Hypericum perforatum 5 CH and Ruta graveolens 3 DH) is not superior to placebo in reducing 24 h morphine consumption after knee ligament reconstruction.

Aims The efficacy of homeopathy is still under debate. The objective of this study was to assess the efficacy of homeopathic treatment (Arnica montana 5 CH, Bryonia alba 5 CH, Hypericum perforatum 5 CH and Ruta graveolens 3 DH) on cumulated morphine intake delivered by PCA over 24 h after knee ligament reconstruction.

Methods This was an add‐on randomized controlled study with three parallel groups: a double‐blind homeopathic or placebo arm and an open‐label noninterventional control arm. Eligible patients were 18–60 years old candidates for surgery of the anterior cruciate ligament. Treatment was administered the evening before surgery and continued for 3 days. The primary end‐point was cumulated morphine intake delivered by PCA during the first 24 h inferior or superior/equal to 10 mg day−1.

Results One hundred and fifty‐eight patients were randomized (66 in the placebo arm, 67 in the homeopathic arm and 25 in the noninterventional group). There was no difference between the treated and the placebo group for primary end‐point (mean (95% CI) 48% (35.8, 56.3), and 56% (43.7, 68.3), required less than 10 mg day−1 of morphine in each group, respectively). The homeopathy treatment had no effect on morphine intake between 24 and 72 h or on the visual analogue pain scale, or on quality of life assessed by the SF‐36 questionnaire. In addition, these parameters were not different in patients enrolled in the open‐label noninterventional control arm.

Conclusions The complex of homeopathy tested in this study was not superior to placebo in reducing 24 h morphine consumption after knee ligament reconstruction.
Plant traits relate to whole‐community litter quality and decomposition following land use change
Authors: QUESTED H. , ERIKSSON O. , FORTUNEL C. , GARNIER E.
Published: August 2007

Given the speed and extent of changes in vegetation as a result of human activity, there is a need to investigate ways in which individual species’ impacts on ecosystem processes can be generalized and scaled‐up to the community level.

We focus on linking community functional parameters (mean of the traits of the plants in the community, weighted using four different methods) with litter chemistry and decomposition, in a chronosequence of currently managed and abandoned semi‐natural grasslands in southern Sweden.

Changes in plant community composition with age since abandonment were reflected in community functional parameters: as expected, aggregated specific leaf area (SLA) declined, and aggregated leaf dry matter content (LDMC) and leaf carbon : nitrogen ratio (C : N) increased with plot age.

Several litter chemistry indices were closely linked with plant traits at the community level; in particular, community aggregated LDMC was correlated with the lignin and fibre content of the community litter.

Aggregated LDMC stood out as the trait most closely linked to community litter decomposition. This relationship was consistent across all three incubation periods (by which time up toc.70% mass loss had occurred) and as strong as that between the best single chemical index of litter quality (lignin : N ratio) and litter mass loss.

Mass loss of whole community litter, incubated in its plot of origin, was related to mass loss of the same litter incubated under standard conditions, but not to decomposition of a standard substrate, indicating dominant substrate quality control over decomposition.

This study demonstrates the potential of the traits of living plants as a tool to link changes in species composition with ecosystem processes at the community level.
Fracture strength of bovine incisors after intra‐radicular treatment with MTA in an experimental immature tooth model
Authors: Bortoluzzi E. A. , Souza E. M. , Reis J. M. S. N. , Esberard R. M. , Tanomaru‐Filho M.
Published: August 2007

Aim  To evaluate, using an experimental immature tooth model, the fracture resistance of bovine incisors submitted to different reinforcement treatments with mineral trioxide aggregate (MTA).

Methodology  An immature tooth model was created by sectioning the coronal and apical portions of 40 bovine incisors 8 mm above and 12 mm below the cementoenamel junction. The root canals were irrigated with 1.0% sodium hypochlorite. They were enlarged both coronally and apically using number 703 carbide burs (ISO: 500–104‐168‐007‐021) and their internal diameter was standardized to 2.1 mm. The specimens were assigned to four groups (n = 10): GI‐control (without filling); GII‐apical MTA plug + filling with gutta‐percha and endodontic sealer; GIII‐filling with MTA; GIV‐apical MTA plug + filling with MTA + metallic post (Reforpost I). A polyether impression material was used to simulate the periodontal ligament. The specimens were submitted to a compressive load at a crosshead speed of 0.5 mm min−1 in a servo‐hydraulic universal testing machine (MTS 810) applied at 45° to the long axis of the tooth until failure. Data were submitted to statistical analysis by the Kruskal–Wallis test at 5% significance level.

Results  GIV presented the highest fracture resistance (32.7N) and differed significantly from the other groups (P < 0.05). No statistically difference was found between GII (16.6N) and GIII (23.4N) (P > 0.05). GIII had a significantly higher fracture resistance than GI (P < 0.05).

Conclusions  The use of MTA + metallic post as an intra‐radicular reinforcement treatment increased the resistance to fracture of weakened bovine teeth in an experimental immature tooth model.
Nonexercise activity thermogenesis – liberating the life‐force
Authors: Levine J. A.
Published: August 2007

Obesity occurs when energy intake exceeds energy expenditure over a protracted period of time. The energy expenditure associated with everyday activity is called NEAT (Nonexercise activity thermogenesis). NEAT varies between two people of similar size by 2000 kcal day−1 because of people’s different occupations and leisure‐time activities. Data support the central hypothesis that NEAT is pivotal in the regulation of human energy expenditure and body weight regulation and that NEAT is important for understanding the cause and effective treatment for obesity.
Numerical study of sediment transport above rippled beds under the action of combined waves and currents
Authors: LI MING , O'CONNOR BRIAN A.
Published: August 2007

To study sediment suspension above ripples under the combined action of waves and currents, a three‐dimensional numerical model has been developed based on the use of FLUENT software, and an external sediment transport model. The computer model has been tested against laboratory measurements involving oscillatory wave motion, as well as cases of co‐linear waves with following and opposing currents, with satisfactory results. Compared with the situation in which only waves are present (called waves‐alone cases), the effects from the steady current on both vortex shedding and sediment suspension above ripples have clearly been revealed by the model results. In particular, the vortices generated in combined waves and currents tend to stay low in the trough area of the ripple and are ejected earlier than those in the waves‐alone case at both the ripple crest and trough, which leads to concentration peaks at different phases and with different magnitudes. The model was also applied to a field case from a multi‐barred, dissipative beach at Egmond‐an‐Zee, in the Netherlands, to investigate the influences of a long‐shore current on cross‐shore sediment transport. The model results show reasonable overall agreement with the field measurements, as well as the important effects of the three dimensional flow structure on the sediment entrainment process close to the ripple surface, which is very difficult to observe in such detail in field studies.
Plasma levels of endothelin‐1 after a pulmonary embolism of bone marrow fat
Authors: Krebs J. , Ferguson S. J. , Nuss K. , Leskosek B. , Hoerstrup S. P. , Goss B. G. , Shaw S. , Aebli Nikolaus
Published: August 2007

Background:  During orthopedic surgery, embolization of bone marrow fat can lead to potentially fatal, intra‐operative cardiovascular deterioration. Vasoactive mediators may also be released from the bone marrow and contribute to these changes. Increased plasma levels of endothelin‐1 (ET‐1) have been observed after pulmonary air and thrombo‐embolism. The role of ET‐1 in the development of acute cardiovascular deterioration as a result of bone marrow fat embolization during vertebroplasty was therefore investigated.

Methods:  Bone cement was injected into three lumbar vertebrae of six sheep in order to force bone marrow fat into the circulation. Invasive blood pressures and heart rate were recorded continuously until 60 min after the last injection. Cardiac output, arterial and mixed venous blood gas parameters and plasma ET‐1 concentrations were measured at selected time points. Post‐mortem, lung biopsies were taken for analysis of intravascular fat.

Results:  Cement injections resulted in a sudden (within 1 min) and severe increase in pulmonary arterial pressure (>100%). Plasma concentrations of ET‐1 started to increase after the second injection, but no significant changes were observed. Intravascular fat and bone marrow cells were present in all lung lobes.

Conclusion:  Cement injections into vertebral bodies elicited fat embolism resulting in subsequent cardiovascular changes that were characterized by an increase in pulmonary arterial pressure. Cardiovascular complications as a result of bone marrow fat embolism should thus be considered in patients undergoing vertebroplasty. No significant changes in ET‐1 plasma values were observed. Thus, ET‐1 did not contribute to the acute cardiovascular changes after fat embolism.
Effects of thoracic epidural anaesthesia on pulmonary venous admixture and oxygenation during one‐lung ventilation
Authors: ÖZcan P. E. , ŞEntürk M. , Sungur Ulke Z. , Toker A. , Dilege Ş. , Ozden E. , ÇAmci E.
Published: August 2007

Background:  In this clinical randomized study, the effects of four anaesthesia techniques during one‐lung ventilation [total intravenous anesthesia (TIVA) with or without thoracic epidural anaesthesia (TEA) (G‐TIVA‐TEA and G‐TIVA), isoflurane anaesthesia with or without TEA (G‐ISO‐TEA and G‐ISO)] on pulmonary venous admixture (Qs/Qt) and oxygenation (OLV) were investigated.

Methods:  In 100 patients (four groups, 25 patients in each) undergoing thoracotomy, a thoracic epidural catheter was inserted pre‐operatively. In G‐TIVA‐TEA and G‐ISO‐TEA, bupivacaine 0.1% + 0.1 mg/ml morphine was administered intra‐operatively (10 ml of first bolus + 7 ml/h infusion). Propofol infusion or isoflurane concentration was adjusted to keep a bispectral index (BIS) of between 40 and 50 in all groups. FiO2 was 0.8 during OLV and 0.5 before and after OLV. Partial arterial and central venous oxygen pressures (PaO2 and PvO2), arterial and venous oxygen saturations and Qs/Qt values were recorded before, during and after OLV.

Results:  During OLV, PaO2 was significantly higher and Qs/QT significantly lower in G‐TIVA‐TEA and G‐TIVA compared with G‐ISO‐TEA and G‐ISO (PaO2: 188 ± 36; 201 ± 39; 159 ± 33; 173 ± 42 mmHg, respectively; Qs/Qt: 31.2 ± 7.4; 28.2 ± 7; 36.7 ± 7.1; 33.7 ± 7.7%, respectively). No statistical changes were observed in patients with TEA compared with without TEA in any measurement.

Conclusion:  During OLV, TEA does not significantly affect the oxygenation and Qs/Qt and can be used safely regardless of whether TIVA or inhalation techniques are used.
Levosimendan improves the initial outcome of cardiopulmonary resuscitation in a swine model of cardiac arrest
Authors: Koudouna E. , Xanthos T. , Bassiakou E. , Goulas S. , Lelovas P. , Papadimitriou D. , Tsirikos N. , Papadimitriou L.
Published: August 2007

Background:  Cardiac arrest remains the leading cause of death in Western societies. Advanced Life Support guidelines propose epinephrine (adrenaline) for its treatment. The aim of this study was to assess whether a calcium sensitizer agent, such as levosimendan, administered in combination with epinephrine during cardiopulmonary resuscitation, would improve the initial resuscitation success.

Methods:  Ventricular fibrillation was induced in 20 Landrace/Large‐White piglets, and left untreated for 8 min. Resuscitation was then attempted with precordial compressions, mechanical ventilation and electrical defibrillation. The animals were randomized into two groups (10 animals each): animals in Group A received saline as placebo (10 ml dilution, bolus) + epinephrine (0.02 mg/kg), and animals in Group B received levosimendan (0.012 mg/kg/10 ml dilution, bolus) + epinephrine (0.02 mg/kg) during cardiopulmonary resuscitation. Electrical defibrillation was attempted after 10 min of ventricular fibrillation.

Results:  Four animals in Group A showed restoration of spontaneous circulation and 10 in Group B (P = 0.011). The coronary perfusion pressure, saturation of peripheral oxygenation and brain regional oxygen saturation were significantly higher during cardiopulmonary resuscitation in Group B.

Conclusions:  A calcium sensitizer agent, when administered during cardiopulmonary resuscitation, significantly improves initial resuscitation success and increases coronary perfusion pressure during cardiopulmonary resuscitation.
Disturbances in melatonin and core body temperature circadian rhythms after minimal invasive surgery
Authors: Gögenur I. , Middleton B. , Kristiansen V. B. , Skene D. J. , Rosenberg J.
Published: August 2007

Background:  Sleep disturbances, fatigue and reduced general well‐being frequently occur after minimal invasive surgery. The circadian rhythms of melatonin and core body temperature are central to the regulation of normal sleep. The aim of this study was to assess changes in these circadian rhythms after laparoscopic cholecystectomy.

Methods:  Twelve women were studied before and after laparoscopic cholecystectomy. The major urinary melatonin metabolite, 6‐sulphatoxymelatonin (aMT6s), and the core body temperature were measured for 1 day before and 1 day after surgery. The basal and maximum secretion of aMT6s were determined, as well as the timing and amplitude of aMT6s and the temperature rhythm. The patients’ rest–activity and calculated sleep parameters were assessed by actigraphy.

Results:  A significant delay in the timing of aMT6s rhythm was observed after surgery [median (range) peak time of aMT6s: after surgery, 05:49 h (02:57–08:23 h); before surgery, 04:32 h (02:18–06:49 h); P≤ 0.05]. The amplitude of the aMT6s rhythm was also significantly decreased after surgery [after surgery, 7.1 ng aMT6s/mg creatinine (1–15.9 ng); before surgery, 13.2 ng aMT6s/mg creatinine (2.9–22.7 ng); P≤ 0.005]. There was almost a12‐h phase delay of the core body temperature rhythm after surgery [peak time: before surgery, 17:39 h (15:17–22:06 h); after surgery, 05:14 h (03:24–21:43 h); P≤ 0.01].

Conclusions:  Following laparoscopic cholecystectomy, there was a delay in the timing of the aMT6s rhythm and a decreased evening decline in the temperature rhythm.
Laminar organization of spinal dorsal horn neurones activated by C‐ vs. A‐heat nociceptors and their descending control from the periaqueductal grey in the rat
Authors: Koutsikou Stella , Parry Dilys M. , MacMillan Frankie M. , Lumb Bridget M.
Published: August 2007

The periaqueductal grey can differentially control A‐ vs. C‐nociceptor‐evoked spinal reflexes and deep spinal dorsal horn neuronal responses. However, little is known about the control of A‐ vs. C‐fibre inputs to lamina I and the lateral spinal nucleus, and how this correlates with the control of deeper laminae. To address this, the laminar distributions of neurones expressing Fos‐like immunoreactivity were determined following preferential activation of A‐ or C‐heat nociceptors, using fast or slow rates of skin heating, respectively, in the absence or presence of descending control evoked from the periaqueductal grey. In lamina I, numbers of Fos‐positive neurones following both fast and slow rates of skin heating were reduced significantly following activation in the ventrolateral and dorsolateral/lateral periaqueductal grey. In contrast, in the deep dorsal horn (laminae III–VI), activation in both the ventrolateral and dorsolateral/lateral periaqueductal grey significantly reduced the numbers of Fos‐positive neurones evoked by C‐ but not A‐nociceptor stimulation. C‐ but not A‐heat nociceptor activation evoked Fos bilaterally in the lateral spinal nucleus. Stimulation in the ventrolateral but not the dorsolateral/lateral periaqueductal grey significantly increased the numbers of Fos‐positive neurones evoked by A‐ and C‐nociceptor stimulation bilaterally in the lateral spinal nucleus. These data have demonstrated differences in the descending control of the superficial vs. the deep dorsal horn and lateral spinal nucleus with respect to the processing of A‐ and C‐fibre‐evoked events. The data are discussed in relation to the roles of A‐ and C‐nociceptors in acute and chronic pain.
Enhanced affective brain representations of chocolate in cravers vs. non‐cravers
Authors: Rolls Edmund T. , McCabe Ciara
Published: August 2007

To examine the neural circuitry involved in food craving, in making food particularly appetitive and thus in driving wanting and eating, we used fMRI to measure the response to the flavour of chocolate, the sight of chocolate and their combination in cravers vs. non‐cravers. Statistical parametric mapping (SPM) analyses showed that the sight of chocolate produced more activation in chocolate cravers than non‐cravers in the medial orbitofrontal cortex and ventral striatum. For cravers vs. non‐cravers, a combination of a picture of chocolate with chocolate in the mouth produced a greater effect than the sum of the components (i.e. supralinearity) in the medial orbitofrontal cortex and pregenual cingulate cortex. Furthermore, the pleasantness ratings of the chocolate and chocolate‐related stimuli had higher positive correlations with the fMRI blood oxygenation level‐dependent signals in the pregenual cingulate cortex and medial orbitofrontal cortex in the cravers than in the non‐cravers. To our knowledge, this is the first study to show that there are differences between cravers and non‐cravers in their responses to the sensory components of a craved food in the orbitofrontal cortex, ventral striatum and pregenual cingulate cortex, and that in some of these regions the differences are related to the subjective pleasantness of the craved foods. Understanding individual differences in brain responses to very pleasant foods helps in the understanding of the mechanisms that drive the liking for specific foods and thus intake of those foods.
Evaluation of a radiographer‐provided barium enema service
Authors: Law R. L. , Titcomb D. R. , Carter H. , Longstaff A. J. , Slack N. , Dixon A. R.
Published: August 2007

Aim  Radiographers performed and reported 5516 double contrast barium enemas (RDCBEs) over 4 years to October 2001. This study was undertaken to assess the accuracy of RDCBE and the sensitivity for diagnosing colorectal cancer (CRC).

Method  A total of 224 consecutive outpatient RDCBEs were reported; normal (C1), diverticulosis (C2), diverticulosis with filling defect (C3), diverticulosis & other pathology (C4) and abnormal (C5). RDCBEs were then reported by a radiologist (AL, NS) and the two reports compared. Of 450 CRCs, 153 had undergone DCBE; 152 RDCBEs. Reports were analysed to establish concurrence between radiographer and radiologist and final CRC diagnosis.

Results  By category: C1 – 37%, C2 – 31%, C3 – 21%, C4 – 11%, C5 – 0%. C4s included polyps (50%), cancer (12.5%), disrupted anastomosis (8%) and colitis (4%). There was no discrepancy between RDCBE and radiologist reports. Radiology and CRC diagnosis agreed in 145 of 152 DCBEs. There were three exclusions: DCBEs occurred outside the study period (2), one only with raised possibility of malignancy. Of eight remaining RDCBEs, seven were false negatives and one false positive. Sensitivity score for RDCBE was 94.5%. Double reporting by a radiologist did not improve sensitivity.

Conclusion  RDCBEs are as accurate as those performed by radiologists and have a very high sensitivity for CRC. In a time of ever increasing demands for complex staging investigations for CRC and interventional radiology, the ACPGBI needs to reconsider its guidelines on radiographers not only performing but also reporting DCBE.
Was It Something I Ate? Implementation of the FDA Seafood HACCP Program
Authors: Alberini Anna , Lichtenberg Erik , Mancini Dominic , Galinato Gregmar I.
Published: August 2007

We develop a theoretical model of enforcement and compliance under HACCP regulation and use the FDA's seafood inspection records to examine: (1) if the FDA has targeted its inspections under HACCP regulation; (2) the effects of inspections on compliance with HACCP and plant sanitation standards; and (3) the relationship between compliance with HACCP and preexisting sanitation standards. There is some evidence of targeting based on product risk, but not on past compliance performance. The threat of an inspection increases the likelihood of compliance, but only for sanitation inspections, not for HACCP. HACCP compliance does not improve compliance with sanitation standards.
Domestic Support and Border Measures for Processed Horticultural Products
Authors: Rickard Bradley J. , Sumner Daniel A.
Published: August 2007

In horticultural markets, trade barriers often apply to the processed products whereas domestic support applies to farm‐produced raw commodities. Here we assess the effects of such trade barriers and domestic support by simulating the effects of policy reform on global processing tomato markets, which are faced with modest processed product tariffs and high domestic support in the European Union (EU). Both protection and EU subsidy drive down world welfare, but we find that reducing import tariffs for tomato products would yield greater effects on markets and larger welfare impacts outside Europe than would reductions in EU domestic support.
Farmers' Health Insurance and Access to Health Care
Authors: Zheng Xiaoyong , Zimmer David M.
Published: August 2007

We estimate farmers' health care consumption given their insurance status, explicitly taking into account the possible endogeneity of insurance. Data come from the 1996–2001 waves of the Medical Expenditure Panel Survey conducted by the Agency for Healthcare Research and Quality. Results show that farmers have problems accessing affordable health insurance coverage, and these access problems lead to an overall reduction in the utilization of health care services by uninsured farmers. After controlling for selection, we observe quantitatively large and statistically significant direct effects of uninsurance on the utilization of health care services.
Identification and Analysis of Genomic Regions with Large Between‐Population Differentiation in Humans
Authors: Myles S. , Tang K. , Somel M. , Green R. E. , Kelso J. , Stoneking M.
Published: August 2007

The primary aim of genetic association and linkage studies is to identify genetic variants that contribute to phenotypic variation within human populations. Since the overwhelming majority of human genetic variation is found within populations, these methods are expected to be effective and can likely be extrapolated from one human population to another. However, they may lack power in detecting the genetic variants that contribute to phenotypes that differ greatly between human populations. Phenotypes that show large differences between populations are expected to be associated with genomic regions exhibiting large allele frequency differences between populations. Thus, from genome‐wide polymorphism data genomic regions with large allele frequency differences between populations can be identified, and evaluated as candidates for large between‐population phenotypic differences. Here we use allele frequency data from ∼1.5 million SNPs from three human populations, and present an algorithm that identifies genomic regions containing SNPs with extreme Fst. We demonstrate that our candidate regions have reduced heterozygosity in Europeans and Chinese relative to African‐Americans, and are likely enriched with genes that have experienced positive natural selection. We identify genes that are likely responsible for phenotypes known to differ dramatically between human populations and present several candidates worthy of future investigation. Our list of high Fst genomic regions is a first step in identifying the genetic variants that contribute to large phenotypic differences between populations, many of which have likely experienced positive natural selection. Our approach based on between population differences can compliment traditional within population linkage and association studies to uncover novel genotype‐phenotype relationships.
Autism in adults: symptom patterns and early childhood predictors. Use of the DISCO in a community sample followed from childhood
Authors: Billstedt Eva , Carina Gillberg I. , Gillberg Christopher
Published: August 2007

Background:  Few studies have looked at the very long‐term outcome of individuals with autism who were diagnosed in childhood.

Methods:  A longitudinal, prospective, community‐based follow‐up study of adults who had received the diagnosis of autism (classic and atypical) in childhood (n = 105) was conducted. A structured interview (the Diagnostic Interview for Social and COmmunication disorders – the DISCO) was used in order to evaluate symptoms and symptom patterns 13–22 years after original diagnosis. Childhood measures, including IQ‐level at time of childhood diagnosis and communicative speech registered before age 5 years, were studied in relation to the presence of autism symptoms at follow‐up.

Results:  The classical and atypical autism groups were fairly homogeneously impaired in terms of symptoms in the social interaction category whereas other common childhood autism symptoms, including maladaptive and stereotyped behaviours, were more variable in the study group at follow‐up. Odd responses to sensory stimuli were still extremely common. Speech before 5 years of age, IQ, gender, diagnosed medical disorder and onset of epilepsy before 5 years were variables that correlated to outcome on the DISCO algorithm for autistic spectrum disorders (Wing & Gould, 1979) concerning style and quality of social interaction, communication style and pattern of self‐chosen activities.

Conclusions:  Social interaction problems were still present in the vast majority of adults with autism/atypical autism, but behavioural impairments were much more variable in adulthood. Almost all cases were reported to show persistent perceptual problems. Certain childhood measures were found to prospectively predict adult social interaction style, communication type, and pattern of self‐chosen activities, which still met diagnostic criteria for autism/atypical autism in adulthood.
Across the continuum of attention skills: a twin study of the SWAN ADHD rating scale
Authors: Polderman Tinca J.C. , Derks Eske M. , Hudziak Jim J. , Verhulst Frank C. , Posthuma Daniëlle , Boomsma Dorret I.
Published: August 2007

Introduction:  Most behavior checklists for attention problems or attention deficit/hyperactivity disorder (ADHD) such as the Child Behavior Checklist (CBCL) have a narrow range of scores, focusing on the extent to which problems are present. It has been proposed that measuring attention on a continuum, from positive attention skills to attention problems, will add value to our understanding of ADHD and related problems. The Strengths and Weaknesses of ADHD symptoms and Normal behavior scale (SWAN) is such a scale. Items of the SWAN are scored on a seven‐point scale, with in the middle ‘average behavior’ and on the extremes ‘far below average’ and ‘far above average’.

Method:  The SWAN and the CBCL were completed by mothers of respectively 560 and 469 12‐year‐old twin pairs. The SWAN consists of nine DSM‐IV items for Attention Deficit (AD) and nine DSM‐IV items for Hyperactivity/Impulsivity (HI). The CBCL Attention Problem (AP) scale consists of 11 items, which are rated on a three‐point scale.

Results:  Children who had a score of zero on the CBCL AP scale can be further differentiated using the SWAN, with variation seen between the average behavior and far above average range. In addition, SWAN scores were normally distributed, rather than kurtotic or skewed as is often seen with other behavioral checklists. The CBCL AP scale and the SWAN‐HI and AD scale were strongly influenced by genetic factors (73%, 90% and 82%, respectively). However, there were striking differences in genetic architecture: variation in CBCL AP scores is in large part explained by non‐additive genetic influences. Variation in SWAN scores is explained by additive genetic influences only.

Conclusion:  Ratings on the SWAN cover the continuum from positive attention skills to attention and hyperactivity problems that define ADHD. Instruments such as the SWAN offer clinicians and researchers the opportunity to examine variation in both strengths and weaknesses in attention skills.
Risk for schizophrenia in intercountry adoptees: a Danish population‐based cohort study
Authors: Cantor‐Graae Elizabeth , Pedersen Carsten Bøcker
Published: August 2007

Background:  Increasing numbers of intercountry adoptees are reaching adulthood, the age of onset for most serious mental disorders. Little is known about the development of schizophrenia in intercountry adoptees, a group with potentially increased vulnerability. The aim of this study was to investigate the risk of developing schizophrenia in adoptees and in non‐adoptees.

Methods:  Utilising data from the Danish Civil Registration System, we established a population‐based cohort of 1.06 million persons resident in Denmark before the age of 15, whose legal mother lived in Denmark at the child's birth. Intercountry adoptees were identified as children born abroad. Record linkage provided information on psychiatric admissions.

Results:  Intercountry adoptees had an increased relative risk (RR) (RR = 2.90, 95% CI 2.41–3.50) of developing schizophrenia compared to native Danes. The increased risk was independent of age at onset and age at, or region of, adoption, and was not attributable to mental illness in a foster parent, the foster parent's age, or to urbanisation. The foster mother's own biological offspring had also an increased risk of developing schizophrenia (1.92, 95% CI 1.23–3.02).

Conclusions:  Young adult intercountry adoptees are at increased risk for schizophrenia. Although the underlying cause is unknown, a complex interplay of factors presumably may be involved, including heredity, adversity prior to adoption, and post‐adoption adjustment difficulties during upbringing.
Potassium leaching from cut grassland and from urine patches
Authors: Kayser M. , Müller J. , Isselstein J.
Published: August 2007

In grassland farming, especially on coarse‐textured soils, K can be a critical element. On these soils, the actual K management as well as fertilizer history to a large extent determine the leaching of K. The effects of four fertilizer regimes on the nutrient balances and leaching of K from grassland grown on a sandy soil were investigated. The swards differed in the source and level of N input and K fertilizer: no fertilizer N + 166 kg K ha−1 year−1 (Control), 320 kg inorganic N ha−1 + 300 kg K ha−1 year−1 (MIN 320), 320 kg N + 425 kg K ha−1 year−1 in form of cattle slurry (SLR 320) and a grass–clover sward + 166 kg K ha−1 year−1 (WCL 0) without any inorganic N input. In a second experimental phase, cores from these swards were used in a mini‐lysimeter study on the fate of K from urine patches. On cut grassland after 6 years K input minus removal in herbage resulted in average K surpluses per year of 47, 39, 56 and 159 kg K ha−1 for the Control, MIN 320, WCL 0 and SLR 320, respectively. Related leaching losses per year averaged 7.5, 5, 15 and 25 kg K ha−1. Losses of urinary‐K through leaching were 2.2–4.5 and 5.7–8.4% of the K supplied in summer and autumn applications, respectively. Plant and soil were the major sinks for K from fertilizer or urine. High levels of exchangeable K in the soil and/or large and late fertilizer or urine applications stimulated leaching of K.
Neuroprotective Effects of Propofol in Acute Cerebral Injury
Authors: Adembri Chiara , Venturi Luna , Pellegrini‐Giampietro Domenico E.
Published: August 2007

Propofol (2,6‐diisopropylphenol) is one of the most popular agents used for induction of anesthesia and long‐term sedation, owing to its favorable pharmacokinetic profile, which ensures a rapid recovery even after prolonged administration. A neuroprotective effect, beyond that related to the decrease in cerebral metabolic rate for oxygen, has been shown to be present in many in vitro and in vivo established experimental models of mild/moderate acute cerebral ischemia. Experimental studies on traumatic brain injury are limited and less encouraging. Despite the experimental results and the positive effects on cerebral physiology (propofol reduces cerebral blood flow but maintains coupling with cerebral metabolic rate for oxygen and decreases intracranial pressure, allowing optimal intraoperative conditions during neurosurgical operations), no clinical study has yet indicated that propofol may be superior to other anesthetics in improving the neurological outcome following acute cerebral injury. Therefore, propofol cannot be indicated as an established clinical neuroprotectant per se, but it might play an important role in the so‐called multimodal neuroprotection, a global strategy for the treatment of acute injury of the brain that includes preservation of cerebral perfusion, temperature control, prevention of infections, and tight glycemic control.