bluuebunny/crossref_metadata_2025 huggingface dataset:
Making context memories independent of the hippocampus
Authors: Lehmann Hugo , Sparks Fraser T. , Spanswick Simon C. , Hadikin Crystal , McDonald Robert J. , Sutherland Robert J.
Published: June 2009

We present evidence that certain learning parameters can make a memory, even a very recent one, become independent of the hippocampus. We confirm earlier findings that damage to the hippocampus causes severe retrograde amnesia for context memories, but we show that repeated learning sessions create a context memory that is not vulnerable to the damage. The findings demonstrate that memories normally dependent on the hippocampus are incrementally strengthened in other memory networks with additional learning. The latter provides a new account for patterns of hippocampal retrograde amnesia and how memories may become independent of the hippocampus.
Side-specific reward memories in honeybees
Authors: Gil Mariana , Menzel Randolf , De Marco Rodrigo J.
Published: June 2009

We report a hitherto unknown form of side-specific learning in honeybees. We trained bees individually by coupling gustatory and mechanical stimulation of each antenna with either increasing or decreasing volumes of sucrose solution offered to the animal's proboscis along successive learning trials. Next, we examined their proboscis extension response (PER) after stimulation of each antenna 1, 2, 3, and 24 h after training. The bees extended their proboscises earlier after stimulation of the antenna that had been coupled with increasing volumes than after stimulation of the antenna that had been coupled with decreasing volumes, thereby revealing short- and long-term side differences in the bees' PE reaction time. The bees' reaction time correlated well with the reaction time of the muscles M17. Long-term side differences in reaction time were prevented by repetitive antennal stimulation. Mechanosensory input was indispensable and sufficient for revealing side differences in reaction time. Such differences were specific to the gustatory input that the bees experienced during training. Our results show that side differences in the bees' PE reaction time depend upon the activation of side-specific reward memories. These memories are formed via the combined effect of a specific property of reward, i.e., that its magnitude increases or decreases over time, and side information seemingly relying on mechanosensory input. We present a learning procedure suitable to study reward learning in honeybees, which includes precise behavioral measures, physiological correlates of behavior, and within-animal controls. This procedure will prove fruitful in pharmacological and electrophysiological analyses of the neural substrates underlying reward memories in honeybees.
Generalization of conditioned fear along a dimension of increasing fear intensity
Authors: Dunsmoor Joseph E. , Mitroff Stephen R. , LaBar Kevin S.
Published: June 2009

The present study investigated the extent to which fear generalization in humans is determined by the amount of fear intensity in nonconditioned stimuli relative to a perceptually similar conditioned stimulus. Stimuli consisted of graded emotionally expressive faces of the same identity morphed between neutral and fearful endpoints. Two experimental groups underwent discriminative fear conditioning between a face stimulus of 55% fear intensity (conditioned stimulus, CS+), reinforced with an electric shock, and a second stimulus that was unreinforced (CS−). In Experiment 1 the CS− was a relatively neutral face stimulus, while in Experiment 2 the CS− was the most fear-intense stimulus. Before and following fear conditioning, skin conductance responses (SCR) were recorded to different morph values along the neutral-to-fear dimension. Both experimental groups showed gradients of generalization following fear conditioning that increased with the fear intensity of the stimulus. In Experiment 1 a peak shift in SCRs extended to the most fear-intense stimulus. In contrast, generalization to the most fear-intense stimulus was reduced in Experiment 2, suggesting that discriminative fear learning procedures can attenuate fear generalization. Together, the findings indicate that fear generalization is broadly tuned and sensitive to the amount of fear intensity in nonconditioned stimuli, but that fear generalization can come under stimulus control. These results reveal a novel form of fear generalization in humans that is not merely based on physical similarity to a conditioned exemplar, and may have implications for understanding generalization processes in anxiety disorders characterized by heightened sensitivity to nonthreatening stimuli.
Medication errors: problems and recommendations from a consensus meeting
Authors:   Members of EMERGE, the Erice Medication Errors Research Group, Agrawal Abha , Aronson Jeffrey K. , Britten Nicky , Ferner Robin E. , De Smet Peter A. , Fialová Daniela , Fitzgerald Richard J. , Likić Robert , Maxwell Simon R. , Meyboom Ronald H. , Minuz Pietro , Onder Graziano , Schachter Michael , Velo Giampaolo
Published: June 2009

Here we discuss 15 recommendations for reducing the risks of medication errors:

 1. Provision of sufficient undergraduate learning opportunities to make medical students safe prescribers.

 2. Provision of opportunities for students to practise skills that help to reduce errors.

 3. Education of students about common types of medication errors and how to avoid them.

 4. Education of prescribers in taking accurate drug histories.

 5. Assessment in medical schools of prescribing knowledge and skills and demonstration that newly qualified doctors are safe prescribers.

 6. European harmonization of prescribing and safety recommendations and regulatory measures, with regular feedback about rational drug use.

 7. Comprehensive assessment of elderly patients for declining function.

 8. Exploration of low‐dose regimens for elderly patients and preparation of special formulations as required.

 9. Training for all health‐care professionals in drug use, adverse effects, and medication errors in elderly people.

10. More involvement of pharmacists in clinical practice.

11. Introduction of integrated prescription forms and national implementation in individual countries.

12. Development of better monitoring systems for detecting medication errors, based on classification and analysis of spontaneous reports of previous reactions, and for investigating the possible role of medication errors when patients die.

13. Use of IT systems, when available, to provide methods of avoiding medication errors; standardization, proper evaluation, and certification of clinical information systems.

14. Nonjudgmental communication with patients about their concerns and elicitation of symptoms that they perceive to be adverse drug reactions.

15. Avoidance of defensive reactions if patients mention symptoms resulting from medication errors.
The pathophysiology of medication errors: how and where they arise
Authors: McDowell Sarah E. , Ferner Harriet S. , Ferner Robin E.
Published: June 2009

1. Errors arise when an action is intended but not performed; errors that arise from poor planning or inadequate knowledge are characterized as mistakes; those that arise from imperfect execution of well‐formulated plans are called slips when an erroneous act is committed and lapses when a correct act is omitted.

2. Some tasks are intrinsically prone to error. Examples are tasks that are unfamiliar to the operator or performed under pressure. Tasks that require the calculation of a dosage or dilution are especially susceptible to error.

3. The tasks of prescribing, preparation, and administration of medicines are complex, and are carried out within a complex system; errors can occur at each of many steps and the error rate for the overall process is therefore high.

4. The error rate increases when health‐care professionals are inexperienced, inattentive, rushed, distracted, fatigued, or depressed; orthopaedic surgeons and nurses may be more likely than other health‐care professionals to make medication errors.

5. Medication error rates in hospital are higher in paediatric departments and intensive care units than elsewhere.

6. Rates of medication errors may be higher in very young or very old patients.

7. Intravenous antibiotics are the drugs most commonly involved in medication errors in hospital; antiplatelet agents, diuretics, and non‐steroidal anti‐inflammatory drugs are most likely to account for ‘preventable admissions’.

8. Computers effectively reduce the rates of easily counted errors. It is not clear whether they can save lives lost through rare but dangerous errors in the medication process.
Medication errors: prescribing faults and prescription errors
Authors: Velo Giampaolo P. , Minuz Pietro
Published: June 2009

1. Medication errors are common in general practice and in hospitals. Both errors in the act of writing (prescription errors) and prescribing faults due to erroneous medical decisions can result in harm to patients.

2. Any step in the prescribing process can generate errors. Slips, lapses, or mistakes are sources of errors, as in unintended omissions in the transcription of drugs. Faults in dose selection, omitted transcription, and poor handwriting are common.

3. Inadequate knowledge or competence and incomplete information about clinical characteristics and previous treatment of individual patients can result in prescribing faults, including the use of potentially inappropriate medications.

4. An unsafe working environment, complex or undefined procedures, and inadequate communication among health‐care personnel, particularly between doctors and nurses, have been identified as important underlying factors that contribute to prescription errors and prescribing faults.

5. Active interventions aimed at reducing prescription errors and prescribing faults are strongly recommended. These should be focused on the education and training of prescribers and the use of on‐line aids. The complexity of the prescribing procedure should be reduced by introducing automated systems or uniform prescribing charts, in order to avoid transcription and omission errors. Feedback control systems and immediate review of prescriptions, which can be performed with the assistance of a hospital pharmacist, are also helpful. Audits should be performed periodically.
Medication errors: pharmacovigilance centres in detection and prevention
Authors: Bencheikh Rachida Soulaymani , Benabdallah Ghita
Published: June 2009

1. Detecting medication errors needs collaboration between various organizations, such as patient safety institutions, pharmacovigilance centres, and poison control centres. In order to evaluate the input of pharmacovigilance centres and poison control centres in detecting and evaluating medication errors a pilot project was initiated by the World Alliance for Patient Safety in collaboration with the Uppsala Monitoring Centre; the Moroccan pharmacovigilance centre acted as project coordinator. As part of this project, a questionnaire on detecting medication errors was circulated to pharmacovigilance centres and poison control centres around the world, in order to assess their ability to detect and analyse medication errors.

2. The results showed that through their databases pharmacovigilance centres can detect, identify, analyse, and classify medication errors and carry out root cause analysis, which is an important tool in preventing medication errors.

3. The duties of pharmacovigilance centres in preventing medication errors include informing health‐care professionals about the importance of reporting such errors and creating a culture of patient safety. Pharmacovigilance centres aim to prevent medication errors in collaboration with poison control centres. Such collaboration allows improved detection and improved preventive strategies. In addition, collaboration with regulatory authorities is important in finalizing decisions.

4. Collaboration between pharmacovigilance centres and poison control centres should be strengthened and bridges need to be built linking pharmacovigilance centres, poison control centres, and organizations dedicated to patient safety, in order to avoid duplication of workload.
Medication errors: prevention using information technology systems
Authors: Agrawal Abha
Published: June 2009

1. Given the high frequency of medication errors with resultant patient harm and cost, their prevention is a worldwide priority for health systems.

2. Systems that use information technology (IT), such as computerized physician order entry, automated dispensing, barcode medication administration, electronic medication reconciliation, and personal health records, are vital components of strategies to prevent medication errors, and a growing body of evidence calls for their widespread implementation.

3. However, important barriers, such as the high costs of such systems, must be addressed through economic incentives and government policies.

4. This paper provides a review of the current state of IT systems in preventing medication errors.
Subfossil Cladocera in relation to contemporary environmental variables in 54 Pan‐European lakes
Authors: BJERRING RIKKE , BECARES ELOY , DECLERCK STEVEN , GROSS ELISABETH M. , HANSSON LARS‐ANDERS , KAIRESALO TIMO , NYKÄNEN MIRVA , HALKIEWICZ ANNA , KORNIJÓW RYSZARD , CONDE‐PORCUNA JOSÉ M. , SEFERLIS MILTIADIS , NÕGES TIINA , MOSS BRIAN , AMSINCK SUSANNE LILDAL , ODGAARD BENT VAD , JEPPESEN ERIK
Published: June 2009

1. Changes in cladoceran subfossils in the surface sediments of 54 shallow lakes were studied along a European latitude gradient (36–68°N). Multivariate methods, such as regression trees and ordination, were applied to explore the relationships between cladoceran taxa distribution and contemporary environmental variables, with special focus on the impact of climate.

2. Multivariate regression tree analysis showed distinct differences in cladoceran community structure and lake characteristics along the latitude gradient, identifying three groups: (i) northern lakes characterised by low annual mean temperature, conductivity, nutrient concentrations and fish abundance, (ii) southern, macrophyte rich, warm water lakes with high conductivity and high fish abundance and (iii) Mid‐European lakes at intermediate latitudes with intermediate conductivities, trophic state and temperatures.

3. Large‐sized, pelagic species dominated a group of seven northern lakes with low conductivity, where acid‐tolerant species were also occasionally abundant. Small‐sized, benthic‐associated species dominated a group of five warm water lakes with high conductivity. Cladoceran communities generally showed low species‐specific preferences for habitat and environmental conditions in the Mid‐European group of lakes. Taxon richness was low in the southern‐most, high‐conductivity lakes as well as in the two northern‐most sub‐arctic lakes.

4. The proportion of cladoceran resting eggs relative to body shields was high in the northern lakes, and linearly (negatively) related to both temperature and Chl a, indicating that both cold climate (short growing season) and low food availability induce high ephippia production.

5. Latitude and, implicitly, temperature were strongly correlated with conductivity and nutrient concentrations, highlighting the difficulties of disentangling a direct climate signal from indirect effects of climate, such as changes in fish community structure and human‐related impacts, when a latitude gradient is used as a climate proxy. Future studies should focus on the interrelationships between latitude and gradients in nutrient concentration and conductivity.
Predator–prey relationships in a changing environment: the case of the sparrowhawk and its avian prey community in a rural area
Authors: Millon Alexandre , Nielsen Jan Tøttrup , Bretagnolle Vincent , Møller Anders Pape
Published: June 2009

1.  Changes in community composition are expected to entail cascading effects at different trophic levels within a food web. However, empirical evidence on the impact of changes in prey communities on the population dynamics of generalist predators, and on the extent of possible feedback processes, remains scarce.

2.
 We analysed the dynamics of a generalist predator, the European sparrowhawk Accipiter nisus L., in a rural area of Northern Denmark. Over a 20‐year period, the diet of the predator has been thoroughly assessed (>30 000 identified prey items) and quantitative information about its avian prey community, based on standard breeding bird surveys, has revealed significant trends for several passerine species, although the overall prey biomass available remained stable.

3.
 The growth rate of the sparrowhawk breeding population was negatively related to the previous sparrowhawk density and to winter temperature, but was positively related to available prey biomass. Contrary to expectations for a generalist predator, sparrowhawks seemed to be predominantly sensitive to changes in the cumulative abundance of their two main prey species, the skylark Alauda arvensis L. and the blackbird Turdus merula L., but less so to changes in the wider prey community.

4.  In demographic terms, the two‐phase sparrowhawk dynamic recorded here (a recovery following an initial decrease) was mainly driven by recruitment of yearling females into the breeding population rather than by variation in the apparent survival of breeding females.

5.
 Our findings emphasize that changes in the composition of a prey community, affected by environmental changes, impacted population dynamics of a generalist predator. Finally, we found conditions that might enable apparent competition between blackbirds and song thrushes Turdus philomelos L. to occur. High blackbird abundance, maintaining sparrowhawks at a relatively high density may, in turn, push song thrushes into a predator pit.
Heterogeneous selection on a heritable temperament trait in a variable environment
Authors: Quinn John L. , Patrick Samantha C. , Bouwhuis Sandra , Wilkin Teddy A. , Sheldon Ben C.
Published: June 2009

1.
 Temperament traits increasingly provide a focus for investigating the evolutionary ecology of behavioural variation. Here, we examine the underlying causes and selective consequences of individual variation in the temperament trait ‘exploration behaviour in a novel environment’ (EB, based on an 8‐min assay) in a free‐ranging population of a passerine bird, the great tit Parus major.

2.
 First, we conducted a quantitative genetic analysis on EB using a restricted maximum likelihood‐based animal model with a long‐term pedigree. Although repeatability was relatively high, EB was only moderately heritable and permanent environment (VPE) effects contributed as much to phenotypic variance as additive genetic effects.

3.  We then asked whether heterogeneous selection acted on EB at various temporal and spatial scales. Using estimates of lifetime reproductive success, we found evidence of weak negative directional selection acting on EB amongst females which was driven by selection through recruitment, but not fecundity, in one of the four breeding years. There was no evidence of any selection on EB through survival.

4.  Heterogeneous selection on EB within seasons was also observed amongst males through fecundity along two fine‐scale environmental gradients – local breeding density and habitat quality; we are unaware of any previous equivalent demonstrations.

5.
 All of these analyses were repeated on a second measure of exploration behaviour (EB2, measured during a 2‐min assay) to facilitate comparison with other studies. EB and EB2 were strongly correlated to one another at the genetic level, but were only moderately correlated at the phenotypic level and VPE was undetected in EB2. Selection on EB2 was similar to that on EB; we conclude that both traits are broadly equivalent from an evolutionary perspective.

6.
 Our analyses suggest that to the extent that the temperament trait ‘exploration behaviour’ is subject to natural selection in this population, this selection is highly context dependent and most evident along two environmental gradients. Furthermore, the strong VPE effect detected suggests that understanding the causes and consequences of variation in this trait will require studies firmly embedded in an environmental context.
Blocking of fetal K antigens on cord red blood cells by maternal anti‐K
Authors: Lee E. , Redman M. , Owen I.
Published: June 2009

summary.

A 26‐year‐old Caucasian female in her second pregnancy grouped as A, D+ R1R1 K− with anti‐K (titre: 256) at booking. Her partner was typed as K1 positive. Baby was born with Hb 23.1 g/dl. Cord samples were referred to our laboratory for investigation and were found to be DAT 5+, IgG and anti‐K was eluted from the red cells. Cord samples typed as A, R1r K− by DiaMed DiaClon Rh subgroups & K card. We report a case of false negative K1 phenotyping due to blocking with maternal anti‐K.
Dengue virus antibodies in blood donors from an endemic area
Authors: Rodríguez Rodríguez D. , Garza Rodríguez M. , Chavarria A. M. , Ramos‐Jiménez J. , Rivera M. A. , Taméz R. C. , Farfan‐Ale J. , Rivas‐Estilla A. M.
Published: June 2009

summary.

We evaluated the incidence of anti‐Dengue virus (DENV) antibodies and dengue viremia in a region of Mexico with a high prevalence of dengue. DENV is the most important arthropod‐borne virus in terms of human morbidity and mortality in America We tested 800 blood donors from a tertiary care teaching hospital that provides care in Northeast Mexico, to identify anti‐DENV IgM and IgG antibodies by enzyme‐linked immunosorbent assay (ELISA) and DENV genome by reverse transcription polymerase chain reaction (RT‐PCR). In addition, routine tests for donors including Brucella, Hepatitis C virus (HCV), Venereal Disease Research Laboratory (VDRL), HIV‐1 and HBsAg identification were performed. We found that 59% of donors were reactive for anti‐DENV IgG and none of them had reported recent DENV infection; however, 16 (2%) were reactive for anti‐DENV IgM antibodies. None of them were viremic at the time of donation. Routine tests showed that the prevalence of anti‐Brucella was 0.71%, anti‐HCV 0.71%, anti‐HIV‐1‐2 0.14%, HBsAg 0.14% and VDRL test 0.57%. Although DENV transmission by blood transfusion had not been confirmed in Mexico, the finding of a high prevalence of anti‐DENV IgM‐positive donors with asymptomatic manifestations and the recent viremia reported in blood donors suggests that this route of transmission might be possible.
Identification of the etiologies of chronic urticaria in children: A prospective study of 94 patients
Authors: Jirapongsananuruk Orathai , Pongpreuksa Sureerat , Sangacharoenkit Preeda , Visitsunthorn Nualanong , Vichyanond Pakit
Published: June 2009

Jirapongsananuruk O, Pongpreuksa S, Sangacharoenkit P, Visitsunthorn N, Vichyanond P. Identification of the etiologies of chronic urticaria in children: A prospective study of 94 patients. Pediatr Allergy Immunol 2010: 21: 508–514. © 2009 John Wiley & Sons A/S

The etiologies of chronic urticaria (CU) in childhood remains incompletely understood because of limited data in children. The objective of this study was to examine some of the possible etiologies of CU in children by focusing on the functional autoantibody to FcεRIα and IgE, thyroid autoimmunity, urticarial vasculitis, parasitic infestation and food allergy. Children 4–15 yr of age with CU were investigated for complete blood count, erythrocyte sedimentation rate (ESR), antinuclear antibody (ANA), CH50, free‐T4 (FT4), thyroid stimulating hormone (TSH), anti‐thyroglobulin and anti‐microsomal antibody, autologous serum skin test (ASST), skin prick tests (SPT) for foods, food challenges, and stool examination for parasites. Ninety‐four children who met the criteria for CU were recruited. Patients with physical urticaria were excluded. Eosinophilia and elevated ESR were found in 23% and 13%, respectively. High ANA titers were found in 2%. None of these patients had clinical features of urticarial vasculitis, abnormal CH50 level, abnormal TSH and FT4. Anti‐thyroglobulin and anti‐microsomal antibodies were not detected. Positive ASST was found in 38%. There were no differences in medication requirement and CU remission between patients with positive and negative ASST. Parasites were found in 5% without clinical correlation. SPT to foods was positive in 35%. Positive food challenges were found in six/nine patients with positive history of food allergy and two/seven patients with negative history. Food avoidance was beneficial to the subgroup of patients with positive history of food allergy only.
Indigenous hepatitis E virus infection of a plasma donor in Germany
Authors: Adlhoch C. , Kaiser M. , Pauli G. , Koch J. , Meisel H.
Published: June 2009

Background  Although Europe is supposed to be non‐endemic for hepatitis E virus (HEV), locally acquired human cases are registered, and a relatively high prevalence for anti‐HEV was found in blood donors in some European countries. Transfusion–transmitted infections by contaminated blood products were reported in Japan and sporadically in Europe.

Materials and Methods  Several samples from a plasma donor were screened with a highly sensitive quantitative HEV real‐time polymerase chain reaction and the full‐length genome was generated. Serology was performed with two different commercially available ELISA kits.

Results  The full‐length genome sequence of human HEV was identified using samples from a plasma donor with acute self‐limiting hepatitis. Plasma donated 2 weeks before onset of elevated liver enzyme levels was already positive for HEV RNA (104 copies/ml). High viraemia (106 copies/ml) correlated with the detection of anti‐HEV IgM in the first blood sample with increased alanine transaminase levels. Phylogenetic analyses grouped the isolate within genotype 3, subtype 3f.

Conclusion  The sequence analyses and the epidemiological data revealed that the plasma donor was most probably infected with a swine HEV. This case supports the ongoing discussion of an obligatory HEV nucleic acid testing of blood products for special recipient risk groups.
Statin therapy and carotid endarterectomy: a review of trends in New South Wales, 1990–2004
Authors: Robinson David A. , Ghaly Benjamin , Hayen Andrew , Lusby Robert J.
Published: June 2009

Background:  The number of patients requiring carotid endarterectomy in our hospitals had been noted to be declining. Hence, our aim was to look at the numbers of carotid interventions in our State to see whether this trend was more pervasive and to look at trends in statin prescriptions over the same time‐course.

Methods:  We queried the New South Wales Department of Health Inpatients Statistics Collection database to determine the number of carotid interventions between 1 July 1990 and 30 June 2004. We also collected data on statin prescriptions from the Health Insurance Commission of the Australian Department of Health and Ageing. The trends in carotid interventions were examined using negative binomial regression.

Results:  The rate of carotid interventions increased by 9.8% between 1990 and 1991 and 1997 and 1998 and then declined from 1998 to 1999 through 2003 to 2004 by 6.8%. We noted a similar trend in octogenarians, although the peak was somewhat earlier. The prescription of statins was found to have increased eightfold between 1992 and 2003.

Conclusion:  The rate of carotid intervention has declined significantly from a peak in the late 1990s. This peak was at least partly accounted for by North American Symptomatic Carotid Endarterectomy Trial and Advances in Computer Sciences and Technology, studies that were conducted largely before the advent of statins. The number of persons in the community on statins has increased enormously since that time. We ponder over the influence of statins on the natural history of carotid artery disease and the implication this has for future trials of carotid intervention in asymptomatic patients.
Combined biliary and gastric bypass procedures as effective palliation for unresectable malignant disease
Authors: Mann Christopher D. , Thomasset Sarah C. , Johnson Nicholas A. , Garcea Guiseppe , Neal Christopher P. , Dennison Ashley R. , Berry David P.
Published: June 2009

Background:  Although endoscopic treatment of jaundice is increasingly used in the palliation of unresectable malignant disease, surgical bypass still has a role to play in this setting. This study aimed to reappraise the short‐term and long‐term results of combined biliary/gastric bypass (hepaticojejunostomy and gastrojejunostomy) as palliation for unresectable malignant disease.

Methods:  All patients undergoing simultaneous biliary and gastric bypass procedures for unresectable malignant disease between August 2000 and January 2006 were identified and outcomes reviewed.

Results:  One hundred and two patients underwent open surgical biliary drainage procedures for palliation of malignant disease. Underlying malignant disease included pancreatic carcinoma (n = 88), duodenal adenocarcinoma (n = 6) and distal cholangiocarcinoma (n = 3). Thirty‐one of the patients underwent a planned palliative bypass procedure, the remainder being carried out after unresectable disease was identified at laparotomy. Postoperative mortality and morbidity rates were higher in the group undergoing planned bypass. During follow up, two patients developed recurrent jaundice that required transhepatic stenting and two patients developed late gastric outlet obstruction requiring refashioning of the gastrojejunostomy.

Conclusion:  Combined surgical biliary and gastric bypass achieved effective palliation of jaundice and gastric outlet obstruction until death in >95% of patients in this series. It remains first‐line therapy in patients identified as having unresectable disease at laparotomy.
Serum‐mediated osteogenic effect in traumatic brain‐injured patients
Authors: Gautschi Oliver P. , Cadosch Dieter , Frey Sönke P. , Skirving Allan P. , Filgueira Luis , Zellweger René
Published: June 2009

Background:  Patients with a traumatic brain injury (TBI) and bone fractures often show an enhanced fracture healing, as well as an increased incidence of heterotopic ossifications (HO). It has been suggested that unknown osteoinductive factors may be released by the injured brain into the systemic blood circulation and act peripherally on the affected tissues. The aim of this study was to investigate whether serum from TBI patients is osteoinductive.

Methods:  Sixty‐one consecutive patients were classified into four groups: TBI and long‐bone fracture (group I, n = 12), isolated severe TBI (group II, n = 21), isolated long‐bone fracture (group III, n = 19) and controls (group IV, n = 9). Blood samples were collected at 6, 24, 72 and 168 h post‐injury. The osteogenic potential was determined by measuring the in vitro proliferation rate of the human fetal osteoblastic cell line hFOB1.19, and primary human osteoblasts. Additionally, serum induced osteoblastic differentiation was assessed by measuring the mRNA expression of specific osteoblastic markers, including alkaline phosphatase, runt‐related transcription factor 2, cathepsin K and serine protease 7.

Results:  The sera of group I induced a higher mean proliferation rate of primary human osteoblasts at all time points of sampling than group III (P < 0.05). Group I had a higher mean proliferation rate of hFOB1.19 cells than all other groups at 6, 24 and 72 h post‐injury (P < 0.05). The expression of alkaline phosphatase, cathepsin K and runt‐related transcription factor 2 mRNA was increased in group I compared with group III and serine protease 7 was exclusively expressed in group I.

Conclusion:  The study results strongly support a humoral mechanism in enhanced fracture healing and the induction of HO after TBI. Increased proliferation of osteoblastic cells and an accelerated differentiation of osteoprogenitor cells may be responsible for increased osteogenesis in TBI.
Needlescopic versus laparoscopic cholecystectomy: a meta‐analysis
Authors: Sajid Muhammad S. , Khan Munir A. , Ray Kausik , Cheek Elizabeth , Baig Mirza K.
Published: June 2009

Background:  To systematically analyse clinical trials on needlescopic (NC) versus laparoscopic cholecystectomy (LC) that evaluated the effectiveness of both procedures for the management of cholelithiasis.

Methods:  A systematic review of the literature was undertaken. Clinical trials on NC versus LC were selected according to specific criteria and analyzed to generate summative data expressed in standardized mean difference.

Results:  Sixteen trials on NC versus LC encompassing 1549 patients were retrieved from electronic databases. Only six randomized controlled trials on 317 patients qualified for the meta‐analysis according to inclusion criteria. NC was associated with longer operative time and higher conversion rate as compared with LC. There was statistically significant heterogeneity among trials. Intraoperative complications, postoperative complications and total stay in hospital were not significantly different. NC was superior to LC in terms of less post‐operative pain and better cosmetic outcomes.

Conclusion:  NC is a safe and effective procedure for the management of gallstone disease. NC is as effective as LC for perioperative complications and total stay in hospital. NC is superior to LC for less post‐operative pain and better cosmetic results. NC is associated with longer operative time and higher conversion rate.
Gastric fundic gland polyps: a clinico‐pathological study from North West Tasmania
Authors: Samarasam Inian , Roberts‐Thomson James , Brockwell Derek
Published: June 2009

Background:  Fundic gland polyps (FGPs) of the stomach were originally described in association with familial polyposis syndromes. It is now known that the majority of these polyps occur in the sporadic setting and are incidentally seen in up to 1.9% of routine upper gastrointestinal endoscopes. The aim of this study was to look at the clinico‐pathological features of the FGPs and to analyse their relationship to Helicobacter pylori infection, proton pump inhibitor treatment, colonic polyps and malignancy.

Methods:  A search of the histopathology records for a period of 10 years from 1997 to 2006 identified 120 patients with a histologically confirmed diagnosis of FGPs. The clinical history, upper gastrointestinal endoscopy findings, histopathology and colonoscopy findings were recorded from the medical records and analysed.

Results:  FGPs were seen in 3.2% of patients undergoing routine upper gastrointestinal endoscopes. There was a definite association with long‐term proton pump inhibitor treatment. There was a strikingly low incidence of H. pylori infection in the study population. Although there was no dysplasia or malignancy in any of these polyps, one patient had concomitant adenocarcinoma of the stomach. In the subgroup of patients who also had colonoscopy during the study period, 19% had associated colonic polyps and 6% had associated colonic malignancies.

Conclusions:  Every new patient diagnosed with FGPs should have a thorough clinico‐pathological study to see if the polyps are part of a sporadic or syndromic setting. A long‐term follow‐up study of patients with FGPs and its association with colonic polyps may be warranted.
Use of the harmonic scalpel in thyroidectomy
Authors: Parker David J. , Krupa Katherine , Esler Rachel , Vujovic Peter , Bennett Ian C.
Published: June 2009

Thyroidectomy is a surgical procedure that requires meticulous dissection, safe anatomical exposure and effective haemostasis. Use of the harmonic scalpel in thyroidectomy may assist in achieving these goals, particularly in respect to enabling efficient haemostatic coagulation and division of small vessels. This report demonstrates the results of utilizing the harmonic scalpel in a series of 88 prospective thyroidectomies in patients under the care of two surgeons over a 2‐year period recording a number of parameters, including operative times and post‐operative complications. These data were compared with a retrospective cohort of 57 patients who underwent thyroidectomies by the same two surgeons prior to the introduction of the harmonic scalpel. The results of this study show that the use of the harmonic scalpel decreased surgical operating time by 20 min (22.5%) for a hemithyroidectomy and 13.5 min (12%) for a total thyroidectomy. Harmonic scalpel use was not associated with an increased complication rate and has been demonstrated to be a very efficient and safe tool in assisting with the conduct of a thyroidectomy.
Complete pathologic response after preoperative rectal cancer chemoradiotherapy
Authors: Ciccocioppo Anthony , Stephens Jacqueline H. , Hewett Peter J. , Rieger Nicholas A.
Published: June 2009

Background:  Following preoperative treatment of rectal cancer with chemoradiotherapy (CRT), a complete pathological response (CPR) can be seen in the surgical specimen. The aim of this study was to assess the outcome of these patients as compared with those who did not have a complete response.

Methods:  A retrospective study of the outcome of patients managed with preoperative CRT for their rectal cancer was conducted.

Results:  Between November 1998 and July 2004, there were 530 new presentations of rectal cancer at The Queen Elizabeth and Royal Adelaide hospitals. Forty of these patients (7.5%) were treated with long‐course preoperative CRT. After resection, a CPR was seen in seven patients (17.5%). These patients were all disease free at January 2006 after a median follow‐up of 6.0 years (range 1.42–7.02 years). One patient had died from non‐tumour‐/surgery‐related causes. Tumour recurrence, but not mortality, in this group was superior to the comparison group of patients without a CPR.

Conclusions:  None of our patients who had a CPR after preoperative CRT have recurred or died from their disease.
Epidemiology of post‐injury multiple organ failure in an Australian trauma system
Authors: Dewar David C. , Mackay Peter , Balogh Zsolt
Published: June 2009

Background:  The epidemiology of post‐injury multiple organ failure (MOF) is reported internationally to have gone through changes over the last 15 years. The purpose of this study is to describe the epidemiology of post‐injury MOF in Australia.

Methods:  A 12‐month prospective epidemiological study was performed at the John Hunter Hospital (Level‐1 Trauma Centre). Demographics, injury severity (ISS), physiological parameters, MOF status and outcome data were prospectively collected on all trauma patients who met inclusion criteria (ICU admission; ISS > 15; age > 18, head Abbreviated Injury Scale (AIS) <3 and survival >48 h). MOF was prospectively defined by the Denver MOF score greater than 3 points. Data are presented as % or Mean+/−SEM. Univariate statistical comparison was performed (Student t‐test, X2 test), P < 0.05 was considered significant.

Results:  Twenty‐nine patients met inclusion criteria (Age 40+/−4, ISS 29+/−3, Male 62%), five patients developed MOF. The incidence of MOF among trauma patients admitted to ICU was 2% (5/204) and 17% (5/29) in the high‐risk cohort. The maximum average MOF score was 6.3 +/−1, with the average duration of MOF 5+/−2 days. Two patients had respiratory and cardiac failure, two patients had failure of respiratory, cardiac and hepatic systems, while one patient had failure of respiratory, hepatic and renal systems. One MOF patient died, all non MOF patients survived. MOF patients had longer ICU stays (20+/−4 versus 7+/−0.8 P= 0.01), tended to be older (60+/−11 versus 35+/−4 p=0.07). None of the previously described independent predictors (ISS, base deficit, lactate, transfusions) were different when the MOF patients were compared with the non‐MOF patients.

Conclusion:  The incidence of MOF in Australia is consistent with the international data. In Australia MOF continues to cause significant late mortality and morbidity in trauma patients. MOF patients have longer ICU stay than high‐risk non MOF patients, and use significant resources. Our preliminary data challenges the timeliness of the 10‐year‐old independent predictors of post‐injury MOF. The epidemiology, the clinical presentation and the independent predictors of post‐injury MOF require larger scale reassessment for the Australian context.
Noise‐induced increase in human auditory evoked neuromagnetic fields
Authors: Alain Claude , Quan Jessica , McDonald Kelly , Van Roon Patricia
Published: June 2009

Noise is usually detrimental to auditory perception. However, recent psychophysical studies have shown that low levels of broadband noise may improve signal detection. Here, we measured auditory evoked fields (AEFs) while participants listened passively to low‐pitched and high‐pitched tones (Experiment 1) or complex sounds that included a tuned or a mistuned component that yielded the perception of concurrent sound objects (Experiment 2). In both experiments, stimuli were embedded in low or intermediate levels of Gaussian noise or presented without background noise. For each participant, the AEFs were modeled with a pair of dipoles in the superior temporal plane, and the effects of noise were examined on the resulting source waveforms. In both experiments, the N1m was larger when the stimuli were embedded in low background noise than in the no‐noise control condition. Complex sounds with a mistuned component generated an object‐related negativity that was larger in the low‐noise condition. The results show that low‐level background noise facilitates AEFs associated with sound onset and can be beneficial for sorting out concurrent sound objects. We suggest that noise‐induced increases in transient evoked responses may be mediated via efferent feedback connections between the auditory cortex and lower auditory centers.
Wide‐ranging frequency preferences of auditory midbrain neurons: Roles of membrane time constant and synaptic properties
Authors: Yang Sungchil , Lin Wenyu , Feng Albert S.
Published: June 2009

Periodicity is a fundamental sound attribute. Its coding has been the subject of intensive research, most of which has focused on investigating how the periodicity of sounds is processed through the synaptic machinery in the brain. The extent to which the intrinsic properties of cells play in periodicity coding, particularly in the creation of selectivity to periodic signals, is not well understood. We performed in vitro whole‐cell patch recordings in the frog torus semicircularis to investigate each neuron’s intrinsic membrane properties as well as responses to sinusoidal current injected through the electrode and periodic stimulation of the ascending afferent. We found that: (i) toral neurons were heterogeneous, showing diverse biophysical phenotypes having distinct membrane characteristics, including membrane time constants (τ) and ionic channel compositions (Ih, Ikir, Ikv and INaP); (ii) a neuron’s τ was tightly correlated with its current‐evoked frequency preference (FP; range: 0.05–50 Hz); (iii) application of blockers for Ih, Ikir and Ikv (but not INaP) shifted the τ as well as the cell’s current‐evoked FP, suggesting that these ion channels contribute to the cell’s FP through regulation of τ; (iv) a neuron’s τ was also correlated with its afferent‐evoked FP (range: 10–300 pulses/s); and (v) the range of afferent‐evoked FP was approximately one order higher than the range of current‐evoked FPs, suggesting that both the cell’s intrinsic membrane and synaptic properties contribute to determining the afferent‐evoked cell‐specific FP (whose range matched those of cell‐specific responses to sound stimulation, e.g. selectivity to amplitude modulation rate).
Neuropathic pain in spinal cord injury: significance of clinical and electrophysiological measures
Authors: Wydenkeller Susanne , Maurizio Stefano , Dietz Volker , Halder Pascal
Published: June 2009

A large percentage of spinal cord‐injured subjects suffer from neuropathic pain below the level of the lesion (bNP). The neural mechanisms underlying this condition are not clear. The aim of this study was to elucidate the general effects of spinal deafferentiation and of bNP on electroencephalographic (EEG) activity. In addition, the relationship between the presence of bNP and impaired function of the spinothalamic tract was studied. Measurements were performed in complete and incomplete spinal cord‐injured subjects with and without bNP as well as in a healthy control group. Spinothalamic tract function, assessed by contact heat evoked potentials, did not differ between subjects with and without bNP; nevertheless, it was impaired in 94% of subjects suffering from bNP. In the EEG recordings, the degree of deafferentiation was reflected in a slowing of EEG peak frequency in the 6–12‐Hz band. Taking into account this unspecific effect, spinal cord‐injured subjects with bNP showed significantly slower EEG activity than subjects without bNP. A discrimination analysis in the subjects with spinothalamic tract dysfunction correctly classified 84% of subjects as belonging to either the group with bNP or the group without bNP, according to their EEG peak frequency. These findings could be helpful for both the development of an objective diagnosis of bNP and for testing the effectiveness of new therapeutic agents.
Perceptual influence on bimanual coordination: an fMRI study
Authors: Müller Katharina , Kleiser Raimund , Mechsner Franz , Seitz Rüdiger J.
Published: June 2009

In bimanual coordination subjects typically show a spontaneous preference for movement symmetry. While there is experimental evidence for the principle of muscle homology, recent evidence suggested that bimanual coordination may be mediated as perceptual goals (Mechsner et al., 2001). To explore this controversy we performed a fMRI study in 11 healthy, right‐handed subjects using bimanual index finger abductions and adductions in a congruous condition, i.e. both palms down, and incongruous conditions with either the left or right palm up. Our fMRI data showed a widespread bihemispheric network mediating proprioceptive coordination of the two hands with significant differences mainly for a perceptual dissociation: in the incongruous conditions with the one palm up there was a BOLD signal increase in a bilateral frontoparietal network involving the motor and premotor cortical areas, particularly in the right palm‐up condition. These results accord with the notion that perceptual cues play an important role in the control of bilateral hand movements.
Attentional modulation of adaptation in V4
Authors: Hudson Andrew E. , Schiff Nicholas D. , Victor Jonathan D. , Purpura Keith P.
Published: June 2009

Adaptation and visual attention are two processes that alter neural responses to luminance contrast. Rapid contrast adaptation changes response size and dynamics at all stages of visual processing, while visual attention has been shown to modulate both contrast gain and response gain in macaque extrastriate visual cortex. Because attention aims to enhance behaviorally relevant sensory responses while adaptation acts to attenuate neural activity, the question we asked is, how does attention alter adaptation? We present here single‐unit recordings from V4 of two rhesus macaques performing a cued target detection task. The study was designed to characterize the effects of attention on the size and dynamics of a sequence of responses produced by a series of flashed oriented gratings parametric in luminance contrast. We found that the effect of attention on the response dynamics of V4 neurons is inconsistent with a mechanism that only alters the effective stimulus contrast, or only rescales the gain of the response. Instead, the action of attention modifies contrast gain early in the task, and modifies both response gain and contrast gain later in the task. We also show that responses to attended stimuli are more closely locked to the stimulus cycle than unattended responses, and that attended responses show less of the phase lag produced by adaptation than unattended responses. The phase advance generated by attention of the adapted responses suggests that the attentional gain control operates in some ways like a contrast gain control utilizing a neural measure of contrast to influence dynamics.