bluuebunny/crossref_metadata_2025 huggingface dataset:
Goblet cell carcinoid of the appendix: a specific type of carcinoma
Authors: Van Eeden S , Offerhaus G J A , Hart A A M , Boerrigter L , Nederlof P M , Porter E , Van Velthuysen M‐L F
Published: December 2007

Aims:  Goblet cell carcinoid is a poorly understood tumour of the appendix. The aim of this study was to determine whether it should be regarded as a separate entity or as a variant of classical carcinoid.

Methods and results:  The immunohistochemical expression pattern of 21 markers and the mutation status of KRas codon 12 were determined in 16 goblet cell carcinoids and compared with 14 classical carcinoids, 19 colonic adenocarcinomas and 10 appendiceal mucinous cystadeno (carcino)mas. The results were subjected to a stepwise linear discriminant analysis.

Goblet cell carcinoids were significantly different from the control groups. The most important markers for discriminating between the groups were CEA (classical carcinoid versus all others), KRas mutation (present in all mucinous cystadeno (carcino)mas), β‐catenin (goblet cell carcinoid versus left sided colonic adenocarcinoma) and chromogranin (goblet cell carcinoid versus right sided colonic adenocarcinoma). Expression of Math1 and HD5 was similar in goblet cell carcinoid and colonic adenocarcinoma but absent in classical carcinoid.

Conclusion:  The results suggest that goblet cell carcinoids should be regarded as a separate entity. The formerly used term ‘crypt cell carcinoma’ may be more appropriate because it reflects the more aggressive clinical behaviour of these tumours as well as their greater similarity to adenocarcinomas rather than to carcinoids.
The expression of Wilms’ tumour‐1 and Ca125 in invasive micropapillary carcinoma of the breast
Authors: Lee A H S , Paish E C , Marchio C , Sapino A , Schmitt F C , Ellis I O , Reis‐Filho J S
Published: December 2007

Aim:  Metastases from ovarian serous papillary carcinoma to the breast and primary invasive micropapillary carcinoma of the breast are histologically similar. The distinction is clinically important to ensure appropriate management. Wilms’ tumour‐1 (WT1) and Ca125 are frequently expressed in serous papillary carcinomas, and uncommonly in unselected mammary carcinomas. One previous study found Ca125 expression in 69% of invasive micropapillary carcinomas. The aim was to assess the frequency of expression of WT1 and Ca125 in invasive micropapillary carcinoma.

Methods and results:  Twenty‐five of 34 invasive micropapillary carcinomas showed no nuclear expression of WT1. The remaining nine tumours showed weak to moderate immunoreactivity in 1–10% of nuclei. Six of these nine tumours also contained ductal carcinoma in situ, which expressed WT1 in five of the six. Membranous or cytoplasmic expression of Ca125 was found in seven tumours.

Conclusion:  Nuclear WT1 expression is present in a minority of invasive micropapillary carcinomas and, when present, expression is focal. The frequency of expression of Ca125 was similar to the results in unselected mammary carcinoma. Thus, these markers are useful members of the immunohistochemical panel for the distinction of mammary invasive micropapillary carcinoma from ovarian serous papillary carcinoma.
Differential expression of matrix metalloproteinase (MMP)‐2, MMP‐9 and tissue inhibitor of metalloproteinase (TIMP)‐1 and TIMP‐2 in non‐melanoma skin cancer: implications for tumour progression
Authors: O’Grady A , Dunne C , O’Kelly P , Murphy G M , Leader M , Kay E
Published: December 2007

Aims:  To investigate the expression of matrix metalloproteinase (MMP)‐2, MMP‐9, and tissue inhibitor of metalloproteinase (TIMP)‐1 and TIMP‐2 in non‐melanoma skin cancer (NMSC) and to compare their expression between different tumour types and with clinicopathological factors.

Methods and results:  A study of 11 normal skin, 29 Bowen’s disease (BD), 40 squamous cell carcinoma (SCC) and 38 basal cell carcinoma (BCC) samples for MMP‐2, MMP‐9, TIMP‐1 and TIMP‐2 expression was carried out using immunohistochemistry and in situ hybridization. The expression of all metalloproteinases was greater in tumours than in normal skin. MMP‐2 and MMP‐9 expression was more extensive in the stroma of SCC than of BCC or BD. TIMP‐1 expression was greater in the stroma of BCC than of SCC or BD and TIMP‐2 expression was greater in the stroma of SCC than of BD. There was a correlation between increased metalloproteinase expression and depth of lesion (MMP‐2 and TIMP‐2), inflammation (MMP‐2, MMP‐9, TIMP‐1 and TIMP‐2) and microvessel density (MMP‐2, MMP‐9 and TIMP‐2).

Conclusions:  MMP‐2, MMP‐9, TIMP‐1 and TIMP‐2 play an important role in the pathogenesis of non‐melanoma skin cancer, but differ significantly in their expression levels between the tumour types examined. The immunoexpression of these proteins may be useful indicators of cutaneous cancer invasion and progression.
Evaluation of oestrogen receptor expression in breast cancer by quantification of mRNA
Authors: Potemski P , Pluciennik E , Bednarek A K , Kusinska R , Kubiak R , Kordek R
Published: December 2007

Aims:  cDNA microarrays have subclassified breast carcinomas into molecular subtypes with oestrogen receptor‐α (ER) gene expression as a main marker. The aim was to compare ER expression in 97 patients with operable breast cancer estimated by real‐time reverse transcriptase‐polymerase chain reaction (real‐time RT‐PCR) and by routine immunohistochemistry, and to determine which method was reliable for molecular subtyping in relation to basal‐type keratins and HER2 gene expression.

Methods and results:  Frozen tumour samples were analysed by real‐time RT‐PCR for the expression of ER, HER2, keratin 5 and keratin 17 genes. In a group of 27 tumours with a low level of ER mRNA (<1.00), there were eight ER+ cases as assessed by immunohistochemistry, and of 70 cases with a high level of ER mRNA (≥1.00), 26 were ER− by immunohistochemistry (P = 0.003). Lack of prognostic relevance of ER mRNA level was demonstrated, whereas assessment by immunohistochemistry was related to clinical outcome. Expression of basal keratins and HER2 genes differed significantly between ER+ and ER− tumours based on immunohistochemistry, but not on mRNA level.

Conclusions:  These results throw doubt on the assessment of ER mRNA as a key factor in the molecular distinction between breast tumours.
Immunohistochemical expression patterns of AP2α and AP2γ in the developing fetal human breast
Authors: Friedrichs N , Steiner S , Buettner R , Knoepfle G
Published: December 2007

Aims:  AP2α (TFAP2A) and AP2γ (TFAP2G) transcription factors have been implicated in the control of proliferation, differentiation and apoptosis of normal breast epithelium and in breast cancer. The aim of this study was to provide a comprehensive analysis of the expression patterns of TFAP2A and TFAP2G in the developing fetal breast anlage with other relevant markers.

Methods and results:  Sixty fetal and one infant human breast specimens from 14 weeks of gestational age to 5 months old were examined. The primary breast outgrowth/nipple showed TFAP2A expression by the basal cells (week 14), followed later by cytokeratin (CK) 5 co‐expression (week 17). Sprouting of the secondary outgrowths was characterized by HER‐2+ invading cells. Preliminary ductal buds were lined by TFAP2G/HER‐1‐expressing myoepithelial precursors (week 19). Maturation of TFAP2A/CK18+ epithelia and TFAP2G/smooth muscle actin‐positive myoepithelia proceeded in a distal‐to‐proximal manner beginning in the terminal end buds (week 22). CK5+ progenitor cells and CK5/TFAP2A or CK5/TFAP2G co‐expressing intermediary glandular or myoepithelial cells were found in the terminal end buds of neonatal fetal breast tissue.

Conclusions:  AP2 transcription factors may play decisive pacemaker roles in initiating and coordinating budding and branching processes during formation of the fetal breast anlage, possibly via modulation of an epidermal growth factor receptor.
Can multiscale models of species’ distribution be generalized from region to region? A case study of the koala
Authors: McAlpine C. A. , Rhodes J. R. , Bowen M. E. , Lunney D. , Callaghan J. G. , Mitchell D. L. , Possingham H. P.
Published: December 2007

While various studies have evaluated the habitat requirements for wildlife in fragmented forest landscapes at multiple spatial scales, few have considered whether there is regional variation in the most important factors. This is a conundrum for managers of any species with a broad geographical range: to what extent should studies in one region inform decisions in another?

We addressed this question using a case study of the koala,Phascolarctos cinereus, in three biogeographically different fragmented forested landscapes in eastern Australia. Mixed‐effect logistic models were applied to predict koala occurrence from explanatory variables captured at four spatial scales: the individual tree, the stand (<1 ha), the patch (1–100 ha) and the landscape (100–1000 ha).

We used model averaging to account for model and parameter uncertainty, and tested the cross‐regional discrimination ability of the models.

We discovered that multiscale models of koala distribution cannot be readily generalized from region to region, and that specific conservation actions for each region, rather than the entire geographical range, are more appropriate. We found a strong justification for adopting a hierarchical landscape approach to koala conservation across its range. However, cross‐regional differences in habitat relationships occurred within this hierarchy. Exceptions were landscape context, which showed a consistently strong effect and high rank in all regions, and the presence of individual preferred tree species of the genusEucalyptus, which showed modest consistency in its interaction with large‐diameter trees across the regions. In contrast, the remaining habitat variables, including patch size (a key management factor), showed moderate to strong cross‐regional variation attributed to the interaction of edaphic factors, landscape history and contemporary land‐use patterns.

Synthesis and applications. Adopting a uniform conservation programme over a large geographical area is attractive to policy‐makers and conservation planners. However, our study confirms the lack of generality of species distribution models over large areas. Consequently, we argue against adopting a uniform conservation programme for species with a large geographical range.
Modelling the habitat requirements of leopardPanthera pardusin west and central Asia
Authors: Gavashelishvili Alexander , Lukarevskiy Victor
Published: December 2007

Top predators are seen as keystone species of ecosystems. Knowledge of their habitat requirements is important for their conservation and the stability of the wildlife communities that depend on them. The goal of our study was to model the habitat of leopardPanthera pardusin west and central Asia, where it is endangered, and analyse the connectivity between different known populations in the Caucasus to enable more effective conservation management strategies to be implemented.

Presence and absence data for the species were evaluated from the Caucasus, Middle East and central Asia. Habitat variables related to climate, terrain, land cover and human disturbance were used to construct a predictive model of leopard habitat selection by employing a geographic information system (GIS) and logistic regression.

Our model suggested that leopards in west and central Asia avoid deserts, areas with long‐duration snow cover and areas that are near urban development. Our research also provides an algorithm for sample data management, which could be used in modelling habitats for similar species.

Synthesis and applications. This model provides a tool to improve search effectiveness for leopard in the Caucasus, Middle East and central Asia as well as for the conservation and management of the species. The model can predict the probable distribution of leopards and the corridors between various known populations. Connectivity patterns can be used to facilitate corridor planning for leopard conservation, especially in the Caucasus, where the leopard is a top priority conservation species. Also, as top predators are often associated with high biodiversity, the leopard habitat model could help to identify biodiversity hotspots. The protection of biodiversity hotspots is seen as the most effective way to conserve biodiversity globally.
Mutations in two global regulators lower individual mortality in Escherichia coli
Authors: Fontaine Fanette , Stewart Eric J. , Lindner Ariel B. , Taddei François
Published: December 2007

There has been considerable investigation into the survival of bacterial cells under stress conditions, but little is known about the causes of mortality in the absence of exogenous stress. That there is a basal frequency of cell death in such populations may reflect that it is either impossible to avoid all lethal events, or alternatively, that it is too costly. Here, through a genetic screen in the model organism Escherichia coli, we identify two mutants with lower frequencies of mortality: rssB and fliA. Intriguingly, these two genes both affect the levels of different sigma factors within the cell. The rssB mutant displays enhanced resistance to multiple external stresses, possibly indicating that the cell gains its increased vitality through elevated resistance to spontaneous, endogenous stresses. The loss of fliA does not result in elevated stress resistance; rather, its survival is apparently due to a decreased physical stress linked to the insertion of the flagellum through the membrane and energy saved through the loss of the motor proteins. The identification of these two mutants implies that reducing mortality is not impossible; rather, due to its cost, it is subject to trade‐offs with other traits that contribute to the competitive success of the organism.
The large subunit of Leishmania topoisomerase I functions as the ‘molecular steer’ in type IB topoisomerase
Authors: BoseDasgupta Somdeb , Ganguly Agneyo , Das Benu Brata , Roy Amit , Khalkho Neeta V. M. , Majumder Hemanta K.
Published: December 2007

Kinetoplastid topoisomerase IB is an unusual bisubunit enzyme where reconstitution of the large (LdTOPIL or L) and small (LdTOPIS or S) subunits shows functional activity. It is yet to be deciphered whether one subunit or both navigate the heterodimer to its cellular DNA targets. Tethering a specific DNA‐binding protein to topoisomerase I alters its site specificity. The chimeric constructs UMSBP–LdTOPIL/S or U–L/S (fusion of UMSBP to the N‐terminus of L and reconstituted with S) and LdTOPIL/UMSBP–LdTOPIS or L/U–S (fusion of UMSBP to the N‐terminus of S and reconstituted with L) exhibit relaxation activity. Only U–L/S shows altered site specificity and enhanced DNA‐binding affinity for the universal minicircle sequence (UMS) containing substrate. This proves that L alone serves as the ‘molecular steer’ for this heterodimer. Reconstituted U–L/S also induces cleavage close to UMS and causes minicircle linearization. The differential properties of the reconstituted chimeras U–L/S and L/U–S reveal the structural and functional asymmetry between the heterodimer. Therefore this study helps in a better understanding of the mechanistic details underlying topoisomerization by this bi‐subunit enzyme.
LeuX tRNA‐dependent and ‐independent mechanisms of Escherichia coli pathogenesis in acute cystitis
Authors: Hannan Thomas J. , Mysorekar Indira U. , Chen Swaine L. , Walker Jennifer N. , Jones Jennifer M. , Pinkner Jerome S. , Hultgren Scott J. , Seed Patrick C.
Published: December 2007

Uropathogenic Escherichia coli (UPEC) contain multiple horizontally acquired pathogenicity‐associated islands (PAI) implicated in the pathogenesis of urinary tract infection. In a murine model of cystitis, type 1 pili‐mediated bladder epithelial invasion and intracellular proliferation are key events associated with UPEC virulence. In this study, we examined the mechanisms by which a conserved PAI contributes to UPEC pathogenesis in acute cystitis. In the human UPEC strain UTI89, spontaneous excision of PAI IIUTI89 disrupts the adjacent leuX tRNA locus. Loss of wild‐type leuX‐encoded tRNA5Leu significantly delayed, but did not eliminate, FimB recombinase‐mediated phase variation of type 1 pili. FimX, an additional FimB‐like, leuX‐independent recombinase, was also found to mediate type 1 pili phase variation. However, whereas FimX activity is relatively slow in vitro, it is rapid in vivo as a non‐piliated strain lacking the other fim recombinases rapidly expressed type 1 pili upon experimental infection. Finally, we found that disruption of leuX, but not loss of PAI IIUTI89 genes, reduced bladder epithelial invasion and intracellular proliferation, independent of type 1 piliation. These findings indicate that the predominant mechanism for preservation of PAI IIUTI89 during the establishment of acute cystitis is maintenance of wild‐type leuX, and not PAI IIUTI89 gene content.
The disulphide isomerase DsbC cooperates with the oxidase DsbA in a DsbD‐independent manner
Authors: Vertommen Didier , Depuydt Matthieu , Pan Jonathan , Leverrier Pauline , Knoops Laurent , Szikora Jean‐Pierre , Messens Joris , Bardwell James C. A. , Collet Jean‐Francois
Published: December 2007

In Escherichia coli, DsbA introduces disulphide bonds into secreted proteins. DsbA is recycled by DsbB, which generates disulphides from quinone reduction. DsbA is not known to have any proofreading activity and can form incorrect disulphides in proteins with multiple cysteines. These incorrect disulphides are thought to be corrected by a protein disulphide isomerase, DsbC, which is kept in the reduced and active configuration by DsbD. The DsbC/DsbD isomerization pathway is considered to be isolated from the DsbA/DsbB pathway. We show that the DsbC and DsbA pathways are more intimately connected than previously thought. dsbA‐dsbC‐ mutants have a number of phenotypes not exhibited by either dsbA‐, dsbC‐ or dsbA‐dsbD‐ mutations: they exhibit an increased permeability of the outer membrane, are resistant to the lambdoid phage Φ80, and are unable to assemble the maltoporin LamB. Using differential two‐dimensional liquid chromatographic tandem mass spectrometry/mass spectrometry analysis, we estimated the abundance of about 130 secreted proteins in various dsb‐ strains. dsbA‐dsbC‐ mutants exhibit unique changes at the protein level that are not exhibited by dsbA‐dsbD‐ mutants. Our data indicate that DsbC can assist DsbA in a DsbD‐independent manner to oxidatively fold envelope proteins. The view that DsbC's function is limited to the disulphide isomerization pathway should therefore be reinterpreted.
The Gup1 homologue of Trypanosoma brucei is a GPI glycosylphosphatidylinositol remodelase
Authors: Jaquenoud Malika , Pagac Martin , Signorell Aita , Benghezal Mohammed , Jelk Jennifer , Bütikofer Peter , Conzelmann Andreas
Published: December 2007

Glycosylphosphatidylinositol (GPI) lipids of Trypanosoma brucei undergo lipid remodelling, whereby longer fatty acids on the glycerol are replaced by myristate (C14:0). A similar process occurs on GPI proteins of Saccharomyces cerevisiae where Per1p first deacylates, Gup1p subsequently reacylates the anchor lipid, thus replacing a shorter fatty acid by C26:0. Heterologous expression of the GUP1 homologue of T. brucei in gup1Δ yeast cells partially normalizes the gup1Δ phenotype and restores the transfer of labelled fatty acids from Coenzyme A to lyso‐GPI proteins in a newly developed microsomal assay. In this assay, the Gup1p from T. brucei (tbGup1p) strongly prefers C14:0 and C12:0 over C16:0 and C18:0, whereas yeast Gup1p strongly prefers C16:0 and C18:0. This acyl specificity of tbGup1p closely matches the reported specificity of the reacylation of free lyso‐GPI lipids in microsomes of T. brucei. Depletion of tbGup1p in trypanosomes by RNAi drastically reduces the rate of myristate incorporation into the sn‐2 position of lyso‐GPI lipids. Thus, tbGup1p is involved in the addition of myristate to sn‐2 during GPI remodelling in T. brucei and can account for the fatty acid specificity of this process. tbGup1p can act on GPI proteins as well as on GPI lipids.
Expression of helminth genes in Leishmania: an experimental transfection system to test immunological function
Authors: MAIZELS R. M. , GOMEZ‐ESCOBAR N. , PRIETO‐LAFUENTE L. , MURRAY J. , AEBISCHER T.
Published: December 2007

Functional analysis of genes from parasitic helminths requires, at the present time, heterologous expression. We have adapted the well‐characterized system of transfection in Leishmania protozoal parasites, as a means of analysing the effect of single filarial genes on the mammalian immune system. For example, testing the function of the Brugia malayi abundant larval transcript (ALT) gene‐transfected Leishmania mexicana were found to be significantly more virulent in macrophages in vitro. The course of infection in vivo is also aggravated by expression of the ALT gene. Examples are also given of transgenes which reduced in vitro growth within macrophages, as well as others which exert no effect on the protozoal parasitism. Thus, Leishmania transfection provides a tractable system to analyse helminth gene function within the context of the host immune system.
Cytokine expression in the brains of Toxocara canis‐infected mice
Authors: HAMILTON C. M. , BRANDES S. , HOLLAND C. V. , PINELLI E.
Published: December 2007

Toxocara canis can infect a number of hosts including mice and humans. In the murine host, larvae exhibit a predilection for the central nervous system, resulting in an increasing number of parasites migrating to the brain as infection progresses. Previous studies have shown that larval burdens vary between individual outbred mice receiving the same inocula, suggesting a role for immunity in the establishment of cerebral infection. Although the systemic immune response to T. canis has been widely reported, there has been no investigation of the cerebral immune response. The aim of the present study was to characterize the cerebral immune response in two inbred strains of T. canis‐infected mice (BALB/c and NIH) at several time points post‐infection (p.i.). Relative quantification of gene expression in the brains of these mice showed increased expression of IL‐5, IL‐10, IFN‐γ and inducible nitric oxide synthase (iNOS). This response was detected as early as 3 days p.i., persisting up to 97 days p.i., and was more pronounced in BALB/c‐infected mice. These results have implications for the role of these cytokines and iNOS in the cerebral establishment of T. canis, and in the cerebral pathology reported during infection.
Detection and characterization of Streptomyces causing potato common scab in Western Europe
Authors: Flores‐González R. , Velasco I. , Montes F.
Published: December 2007

A PCR‐based diagnostic method was developed for direct detection from tuber lesions of pathogenic Streptomyces causing common scab of potato. Primers were designed to amplify a fragment of the txtAB (txtA and txtB) genes, which are pathogenicity determinants in the main pathogenic Streptomyces species. The method was evaluated on 84 naturally infected potato samples, comprising 19 potato cultivars, harvested in the years from 2000 to 2004 in the Netherlands, the UK, France, Germany and Spain. Pathogenic Streptomyces in tuber lesions were detected by PCR in 70 samples and were also successfully isolated from these 70 samples. All pathogenic isolates showed the basic general phenotypic traits of the S. scabiei phenetic cluster. RFLP analysis of amplified rRNA sequences, together with carbon source utilization and repetitive BOX profiles, allowed most isolates to be assigned to S. europaeiscabiei, which emerged as the main cause of potato common scab in Western Europe.
Pathology of cortical invasion by Plasmodiophora brassicae in clubroot resistant and susceptible Brassica oleracea hosts
Authors: Donald E. C. , Jaudzems G. , Porter I. J.
Published: December 2007

The differences in physiological response of Brassica oleracea to infection and growth of Plasmodiophora brassicae in infected tissue were studied in clubroot resistant and susceptible hosts, grown in sand solution culture artificially inoculated with spores of P. brassicae (108 spores mL−1). Primary (root hair) and secondary (cortical) stages of P. brassicae occurred in both resistant and susceptible hosts. Symptoms of cortical invasion by P. brassicae in resistant and susceptible hosts included cell wall breaks, presence of vesicles or inclusion bodies within the cell walls, cell wall thickening in association with plasmodesmata and enlarged and/or disorganized host nuclei. The main difference between the resistant and susceptible host reaction was the absence of degradation of the secondary thickening and cell walls of the xylem in the resistant host. This study supports the existence of an amoeboid form of the pathogen in addition to the recognized two‐phase life history of P. brassicae. Furthermore, it suggests that resistance in B. oleracea does not prevent the development of this amoeboid form. A reduced number of cell wall breakages suggests movement of the amoeboid form, may have been restricted but not prevented in the resistant host.
Diversity and distribution of Ralstonia solanacearum strains in Guatemala and rare occurrence of tomato fruit infection
Authors: Sanchez Perez A. , Mejia L. , Fegan M. , Allen C.
Published: December 2007

Fifty‐nine Ralstonia solanacearum isolates from diverse crops and regions were collected and characterized to determine the distribution and diversity of this soilborne pathogen in Guatemala. Three distinct types were present: a phylotype I, sequevar 14 strain, probably originating from Asia, infecting tomatoes and aubergines at moderate elevations; a phylotype II, sequevar 6 strain of American origin causing Moko disease in lowland banana plantations; and a phylotype II, sequevar 1 (race 3 biovar 2) strain causing brown rot on potatoes, Southern wilt of Pelargonium spp. and bacterial wilt of greenhouse tomatoes at high elevations. These data on strain diversity will inform effective regional efforts to breed for wilt resistance. A sensitive enrichment method did not detect the pathogen in fruits from naturally infected commercial tomato plants in Guatemalan fields and greenhouses, although it was detected in 6% of fruits from a wilt‐resistant hybrid. Low numbers of R. solanacearum cells were also infrequently detected in fruits from plants artificially inoculated in the growth chamber with either race 3 biovar 2 or a phylotype II tomato strain.
A quality audit of the service delivered by the NSW Neonatal and Paediatric Transport Service
Authors: Browning Carmo Kathryn A , Williams Katrina , West Maureen , Berry Andrew
Published: December 2007

Aim:  To discover areas of NSW Neonatal and Paediatric Transport Service's (NETS) work with which the parents, referring and receiving doctors are dissatisfied and respond to them.

Methods:  An anonymous survey of referring doctors, parents of patients transported by NETS and receiving hospital doctors between July and December 2005.

Results:  Referring doctors: Fifty‐seven per cent of the 288 (30% response rate) doctors who responded were paediatricians and 43% worked in rural settings. Over 90% responded positively about communication with the NETS team at referral and retrieval. Useful feedback included the need to be more time efficient in phone communication and during stabilisation of the child and to improve feedback about management and patient outcomes. Parents: Forty‐seven per cent of 152 responses (15% response rate) came from rural families. The majority (>98%) of parents felt that the NETS team were helpful and supportive of them. Parents reported being able to travel with their child 60% of the time and of those who could not, 95% could explain why. Receiving doctors: Ninety‐three per cent of 218 responses (42% response rate) thought that the referral was appropriate, that the NETS teams carried out their advice correctly (98%) and that the child's needs were reported accurately by the team (90%). In a minority of retrievals important concerns were raised about ventilation, sedation, patient assessment and management.

Conclusion:  Most retrievals happen in a way that referring consultants, parents and receiving consultants find appropriate. Important suggestions for improvement in service delivery and some areas of risk to patient safety have been identified. Processes for overcoming these situations are being developed and implemented.
Randomised controlled trial of intravenous maintenance fluids
Authors: Yung Michael , Keeley Steve
Published: December 2007

Aim: Traditional paediatric intravenous maintenance fluids are prescribed using hypotonic fluids and the weight‐based 4:2:1 formula for administration rate. However, this may cause hyponatraemia in sick and post‐operative children. We studied the effect of two types of intravenous maintenance fluid and two administration rates on plasma sodium concentration in intensive care patients.

Methods: A Factorial‐design, double‐blind, randomised controlled trial was used. We randomised 50 children with normal electrolytes without hypoglycaemia who needed intravenous maintenance fluids for >12 h to 0.9% saline (normal saline) or 4% dextrose and 0.18% saline (dextrose saline), at either the traditional maintenance fluid rate or 2/3 of that rate. The main outcome measure was change in plasma sodium from admission to 12–24 h later.

Results: Fifty patients (37 surgical) were enrolled. Plasma sodium fell in all groups: mean fall 2.3 (standard deviation 4.0) mmol/L. Fluid type (P = 0.0063) but not rate (P = 0.12) was significantly associated with fall in plasma sodium. Dextrose saline produced a greater fall in plasma sodium than normal saline: difference 3.0, 95% confidence interval 0.8–5.1 mmol/L. Full maintenance rate produced a greater fall in plasma sodium than restricted rate, but the difference was small and non‐significant: 1.6 (−0.7, 3.9) mmol/L. Fluid type, but not rate, remained significant after adjustment for surgical status. One patient, receiving normal saline at restricted rate, developed asymptomatic hypoglycaemia.

Conclusion: Sick and post‐operative children given dextrose saline at traditional maintenance rates are at risk of hyponatraemia.
Prevalence and behavioural correlates of enuresis in young children
Authors: Erdogan Ayten , Akkurt Hanife , Boettjer Nazan K , Yurtseven Eray , Can Gunay , Kiran Sibel
Published: December 2007

Objectives:  Previous studies based on clinical samples report that enuresis in children is associated with behavioural problems and reduced self‐esteem, but the relationship between behavioural problems and enuresis remains controversial. This population‐based study investigated the prevalence and behavioural correlates of enuresis in a group of preparatory school children.

Methods:  This cross‐sectional survey involved 356 parents and their children aged 5–7 years, all residents of Istanbul, Turkey. Parents completed the Child Behaviour Checklist and socio‐demographic data form (response rate: 90%). Fifty‐three children with enuresis were compared with 303 non‐symptomatic children. Differences in the mean scores and the percentages of children falling beyond pre‐selected clinical thresholds were compared between the groups.

Results:  The prevalence of enuresis was 14.9%, and enuresis was more frequent among boys. Children with enuresis were reported by their parents to have greater social problems and higher total problem scores than control children (P = 0.019, P = 0.048, respectively). However, there were no differences in the percentages of children falling beyond pre‐selected clinical thresholds between the groups.

Conclusions:  Children with enuresis had higher mean scores for total and social behavioural problems than controls; however, clinically relevant behavioural problems did not show differences between the groups. Given the inconsistent research findings across studies, longitudinal research and outcome studies could help determine whether there is a causal relationship between psychopathology and enuresis.
Parental experiences and preferences which influence subsequent use of post‐discharge health services for children born very preterm
Authors: Pritchard Margo A , Colditz Paul B , Beller Elaine M ,   for the Queensland Optimising Preterm Infant Outcomes Group
Published: December 2007

Aim:  Parents are ultimately responsible for organising and accessing health services for their children. How parents experience those services are likely to influence subsequent use. Understanding parental preference for service provision can inform compliance strategies with recommended child health recommendations. The aim of this study was to explore parental experiences and preferences which influence subsequent use of post‐discharge health services for children born preterm with a birthweight ≤1250 g.

Methods:  Focus groups consisted of randomly selected families recruited from a population‐based cross‐sectional cohort study of 2‐, 4‐ and 7‐year‐old children corrected age for prematurity. Parents were asked to consider which aspects of childhood health service delivery influenced subsequent use. Transcripts were analysed and themes constructed. SWOT analysis evaluated health service practices by systematically mapping parents' accounts of the perceived strengths (S), weaknesses (W), opportunities (O) and threats (T) of services in relation to subsequent use.

Results:  Fifteen parents participated in three groups (by children's age). Three dominant themes emerged and included (i) assistance with accessing appropriate services; (ii) provision of consistent information and comprehensive child health records; and (iii) support of parental self‐efficacy in the health care of their child.

Conclusion:  Primary health carers are ideally suited to co‐ordinate and provide continuity to improve parental involvement and compliance with health promoting recommendations for their preterm children. This approach may improve interagency co‐operation and access to services enabling early identification and intervention. Adopting these strategies may be effective in optimising child health follow‐up strategies and improve uptake of recommended intervention and prevention programmes.
Circulatory disturbances during the first postnatal 24 hours in extremely premature infants 25 weeks or less of gestation with histological fetal inflammation
Authors: Furukawa Seishi , Sameshima Hiroshi , Ikenoue Tsuyomu
Published: December 2007

Aim:  To investigate the effect of pre‐existing fetal inflammation on hemodynamics during the first postnatal 24 h in extremely premature infants ≤25 weeks of gestation.

Methods:  We defined fetal inflammation as the infiltration of neutrophils into the chorionic plate vessels or umbilical cord vessels on histological examination. In 41 infants born between 22 and 25 weeks of gestation, 23 displayed fetal inflammation and 18 displayed no fetal inflammation. Circulatory indices including blood pressure, heart rate, average urine flow, catecholamine index, ejection fraction of the left ventricle, and volume load for 24 h were compared between the two groups, as well as the incidence of intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), and death. The comparisons were made with repeated measure anova and with Fisher's exact test, or unpaired t‐test. Probability values <0.05 were considered significant.

Results:  Infants with and without fetal inflammation had similar birthweights and gestational age. There was no significant difference in incidence of PVL and death. However, infants with fetal inflammation had a significantly higher incidence of IVH ≥3 than infants with no fetal inflammation (49% vs 17%) (P = 0.04). Infants with fetal inflammation had significantly higher heart rate (P = 0.005), catecholamine index (P = 0.019) and volume load (P = 0.021).

Conclusion:  Histological evidence of fetal inflammation in extremely premature infants is associated with circulatory disturbances over the first 24 h of life and increases in the incidence of IVH ≥3.
Mouse model for allogeneic immune reaction against fetus recapitulates human pre‐eclampsia
Authors: Nishizawa Haruki , Hasegawa Kiyoshi , Suzuki Machiko , Achiwa Yumiko , Kato Takema , Saito Kuniaki , Kurahashi Hiroki , Udagawa Yasuhiro
Published: December 2007

Aim:  We have previously demonstrated that mRNA expression and enzyme activity levels of placental indoleamine 2,3‐dioxygenase (IDO), which degrades L‐tryptophan and blocks the proliferation of T cells, are significantly low in patients with severe pre‐eclampsia. From this observation, we hypothesized that induction of maternal allogeneic immune reaction by reduced IDO activity is one of the causes of pre‐eclampsia.

Methods:  To examine this hypothesis, we administered an IDO inhibitor to pregnant female mice carrying allogeneic concepti. Since administration of an IDO inhibitor to pregnant mice starting at E4.5 is already reported to cause allogeneic fetal rejection, we modified the regimen and started the administration at E6.5 when the fetus and placenta have already been established.

Results:  Pregnant mice treated with an IDO inhibitor developed high blood pressure and proteinuria in addition to local circulation impairment in the placenta, which is analogous to the lesions that are characteristic of human pre‐eclampsia. In contrast, pregnant mice carrying syngeneic concepti did not manifest such symptoms.

Conclusions:  Our findings reveal a pivotal role for IDO activity in the etiology of pre‐eclampsia. These data also lend support to the current hypothesis that pre‐eclampsia is one of the possible manifestations of a maternal immunological reaction against an allogeneic fetus.
Adolescent primiparas: Changes in obstetrical risk between 1983–1987 and 1999–2005
Authors: Zeck Willibald , Walcher Wolfgang , Tamussino Karl , Lang Uwe
Published: December 2007

Aims:  Teenage pregnancies have always been considered at increased risk for obstetric complications. Deliveries in adolescent primiparas in the 5‐year time periods 1983–1987 and 1999–2005 were compared against each other, the general population and against primiparas aged 20–29 years in order to reveal trends and differences in obstetric outcome.

Methods:  A total of 186 primiparas delivering at an age of 17 or less between October 1999 and October 2005 were compared with 353 adolescent primiparas delivered between 1983 and 1987. Type of delivery and complications such as low birthweight, pre‐eclampsia, breech presentation and third stage complications were studied.

Results:  The percentage of adolescents in the overall obstetric population decreased. The cesarean section rate remained the same in the adolescents while increasing in the general population. Rates of low birthweight and operative vaginal delivery increased in the adolescent group and overall. Third stage complications (abnormally adherent or incomplete placentas) decreased in both groups. There were no intrauterine fetal deaths in adolescent pregnancies in either time period. Other obstetric variables were unchanged in the adolescent as well as in the general population between 1999 and 2005. When comparing the adolescents' outcome with the outcome of the 20–29‐year‐old primiparas between 1999 and 2005, it was noted that the rates of abstracted obstetric variables were higher in the population of the 20–29‐year‐olds.

Conclusions:  The obstetric outcome of adolescent pregnancies has remained favorable over the last 18 years. We do not consider adolescence as an obstetrical risk. We suggest that adolescent pregnancy is more a public health issue than a clinical problem.
Positive rates for rubella antibody in pregnant women and benefit of post‐partum vaccination in a Japanese perinatal center
Authors: Okuda Mika , Yamanaka Michiko , Takahashi Tsuneo , Ishikawa Hiroshi , Endoh Masaya , Hirahara Fumiki
Published: December 2007

Aim:  This study of pregnant women was undertaken to clarify their immune status for rubella and to evaluate the efficacy of, and adverse reaction to, post‐partum rubella vaccination.

Methods:  We determined the levels of both rubella antibody by hemagglutination inhibition test and IgM antibody by enzyme‐linked immunosorbent assay in the first gestational trimester and surveyed the positive rates for rubella antibody in pregnant women at our perinatal center; we recommended post‐partum vaccination for women with poor immune status. We also evaluated the effectiveness of the vaccine and any adverse reaction.

Results:  Among 2741 pregnant women, 185 cases (6.7%) were seronegative for rubella virus. This rate was especially high (12.4%) in the population who had opted out of the vaccination because of a change in Japanese government policy. A total of 30 cases (1.1%) were positive or false‐positive for IgM antibody, but no congenital rubella syndrome (CRS) developed. The seropositive rate was 93.3% in total, but this figure includes those who required post‐partum vaccination (558 cases or 20.3%) because their titers were 16× or lower. Among 145 cases who received post‐partum rubella vaccine, no severe adverse reaction was detected, and in all 37 cases with hemagglutination inhibition antibody titers of 8× or lower, the efficacy rate was 100%.

Conclusions:  It is necessary to appropriately evaluate the CRS risk. Also, we need to emphasize the importance and safety of post‐partum rubella vaccination in Japan.
Abnormal glucose tolerance in polycystic ovary syndrome
Authors: Bhattacharya Sudhindra M.
Published: December 2007

Aim:  To investigate the incidence of abnormal glucose tolerance (AGT) in women with polycystic ovary syndrome (PCOS), and the reliability of fasting plasma glucose level (FPG) as a screening test for this metabolic abnormality.

Methods:  Two hundred and three women (62 adolescents and 141 adults) diagnosed with PCOS underwent estimation of FPG and 2‐h plasma glucose after ingestion of 75 g of glucose on an empty stomach. In each case, body mass index (BMI) was calculated from height and weight measurements.

Results:  AGT was found in 16.3% of cases (33/203). AGT was found in 9.7% of adolescent cases (6/62) and 19.1% of adults (27/141) (P = 0.03). Women with abnormal glucose tolerance had higher BMI than those with normal glucose tolerance in the two subgroups (not statistically significant). Difference in BMI between adults and adolescents with normal glucose tolerance was statistically significant, but not in cases with AGT.

Conclusion:  AGT was found in 16.3% of women with PCOS (19.1% of adults and 9.7% of adolescents). BMI alone is not a significant contributory factor causing deterioration of glucose tolerance as a woman with PCOS matures. Other clinical parameters of obesity such as upper body obesity need to be studied. All women with PCOS should undergo periodic screening for abnormal glucose tolerance. Fasting plasma glucose is a poor screening test to detect abnormal glucose tolerance.
Surgical adhesives and tubal sterilization: An experimental study
Authors: Rivoire Henri C. , Fagundes Djalma J.
Published: December 2007

Aim:  Our aim was to assess the application of three currently used surgical adhesives in the tubal lumen of rabbits, to promote sterilization, using a transvaginal approach.

Methods:  Fifty‐seven female albino New Zealand rabbits (114 uterine tubes), which became pregnant and delivered before the experiment, were divided into four groups: GS (sham‐24 tubes), GEFIBRI (0.25 mL of fibrin adhesive in 30 tubes), GE‐GRF (0.25 mL of resorcin adhesive in 30 tubes) and GEBUTYL (0.25 mL of n‐butyl‐2‐cyanoacrylate adhesive in 30 tubes). The animals were mated with proven fertile males after the experiment and observed over 30, 90 and 180 days. Pregnancy and patency were macroscopically evaluated. The tubal diameter, tubal mucosa, myosalpinx, total optical density and inflammatory process were microscopically evaluated. The statistical analysis was performed by McNemar and Wilcoxon tests for the subgroups, and Fisher's exact test and Kruskal–Wallis test for the groups, the differences identified by Dunn's multiple comparisons test (P = 5%).

Results:  GS showed patency and pregnancies in all subgroups. GEFIBRI showed patency and pregnancies in all subgroups. GE‐GRF did not show patency or pregnancies, but was associated with severe inflammatory process and tubal morphology alterations. GEBUTYL did not show patency, pregnancies or morphological tubal mucosa alterations.

Conclusions:  The n‐butyl‐2‐cyanoacrylate adhesive effectively promoted tubal obstruction, did not cause tubal morphological alterations, nor did it impair the rabbit pregnancy. The fibrin adhesive failed to cause the occlusion. The GRF adhesive, in spite of producing tubal occlusion, caused severe uterine tubes damage.
Trichomonas vaginalis infection: Risk indicators among women attending for routine gynecologic examination
Authors: Verteramo Rosita , Calzolari Ettore , Degener Anna Marta , Masciangelo Raffaele , Patella Alfredo
Published: December 2007

Objectives:  Trichomonas vaginalis is one of the most common agents of sexually transmitted disease, but trichomoniasis is still considered as an infection of minor importance. The aim of this study was to investigate the risk indicators for trichomoniasis in women attending for routine gynecologic examination.

Methods:  The study was conducted comparing demographic and behavioral characteristics in two groups of 122 women with T. vaginalis infection and 853 uninfected women.

Results:  Univariate analysis showed a significant increase of T. vaginalis infection among women with older age and multiple sexual partners. In multiple logistic regression analysis, the higher number of lifetime partners and older age remained significantly associated with T. vaginalis infection.

Conclusions:  This study suggests that T. vaginalis infection might be mainly related to lifestyle risk factors. Therefore, in our opinion, the diagnosis and treatment of this disease should be encouraged on routine gynecologic examination.
Use of oral glucose tolerance test in early pregnancy to predict late‐onset gestational diabetes mellitus in high‐risk women
Authors: Phaloprakarn Chadakarn , Tangjitgamol Siriwan
Published: December 2007

Aim:  To evaluate if any single plasma glucose level from the four values of the normal 100‐g oral glucose tolerance test (OGTT) in early pregnancy (≤20 weeks of gestation) could predict gestational diabetes mellitus (GDM) diagnosed from a second OGTT in late pregnancy (28–32 weeks).

Methods:  Glucose levels of pregnant women at high‐risk for GDM, who had had a normal early OGTT, and who underwent the second test in late pregnancy, were studied. Each of the four plasma glucose values of the early OGTT was determined for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). The receiver operating characteristic curves of these four OGTT values were then constructed to find the optimal value to predict late‐onset GDM.

Results:  Of 193 pregnant women who had had a normal early OGTT, 154 also had a normal OGTT in late pregnancy while 39 had an abnormal test and were diagnosed with GDM. Among the four glucose values of the early OGTT, the 1‐h value yielded the best diagnostic performance to predict late‐onset GDM. The sensitivity, specificity, PPV, NPV, and area under the curve achieved from its optimal cutoff level of ≥155 mg/dL (8.6 mmol/L) were 89.7%, 64.3%, 38.9%, 96.1%, and 0.77, respectively.

Conclusions:  A 1‐h glucose value ≥155 mg/dL at the early OGTT yielded the best diagnostic performance. However, the low specificity and PPV rendered it suboptimal to predict late‐onset GDM. Nevertheless, a considerable number of high‐risk women could avoid the second OGTT in late pregnancy due to its high sensitivity and NPV.