bluuebunny/crossref_metadata_2025 huggingface dataset:
Remifentanil in paediatric anaesthetic practice
Authors: Marsh D. F. , Hodkinson B.
Published: February 2009

Remifentanil is a synthetic opioid, first introduced into clinical practice in 1996. Its unique pharmacokinetic profile has resulted in a gradual increase in its popularity in paediatric anaesthesia. It is an opioid of high potency and rapid clearance, consequently lacking problems of accumulation. These characteristics give it a high degree of predictability and it has become an attractive choice for a wide variety of anaesthetic challenges, from premature neonates to the elderly. Neonates and infants have a higher clearance than older children and, as a result, remifentanil has additional benefits in this group. Remifentanil can be described as the only consistently predictable opioid in paediatric practice.
Evaluation of tracheal tube introducers in simulated difficult intubation*
Authors: Janakiraman C. , Hodzovic I. , Reddy S. , Desai N. , Wilkes A. R. , Latto I. P.
Published: February 2009

In a randomised cross‐over study, 72 anaesthetists attempted to place Pro‐Breathe, new Portex, and Frova single‐use tracheal tube introducers and an Eschmann multiple‐use introducer in the trachea of a manikin set to simulate a grade 3 laryngeal view. Successful placement (proportion, 95% confidence interval) of either the Frova (78%, 67–86%) or the Eschmann introducer (64%, 52–74%) was significantly more likely (p < 0.0001) than with the Pro‐Breathe (4%, 1–12%) or the new Portex introducer (13%, 7–22%). The difference between the success rates for the Frova and the Eschmann introducers (p = 0.08) was not significant. A separate experiment revealed that the peak force that could be exerted by the Pro‐Breathe, new Portex and Frova single‐use introducers were three to six times greater than that which could be exerted by the Eschmann introducer (p < 0.0001). The single‐use introducers are more likely to cause tissue trauma during placement, particularly if held close to the tip.
The efficacy of a smoking cessation programme in patients undergoing elective surgery – a randomised clinical trial
Authors: Sadr Azodi O. , Lindström D. , Adami J. , Tønnesen H. , Nåsell H. , Gilljam H. , Wladis A.
Published: February 2009

It is known that smokers constitute an important risk group of patients undergoing surgery. It is unknown how smoking cessation intervention initiated 4 weeks prior to elective surgery affects the probability of permanent cessation. We randomly assigned 117 patients, scheduled to undergo elective orthopaedic and general surgery, to smoking cessation intervention and control group. The intervention group underwent a programme initiated, on average, 4 weeks prior to surgery with weekly meetings or telephone counselling and were provided with free nicotine replacement therapy (NRT). The control group received standard care. As a result, 20/55 (36%) patients the intervention group vs 1/62 (2%) in the control group became completely abstinent throughout the peri‐operative period (p < 0.001). After 1 year, those in the intervention group was most likely to be abstinent (18/55 (33%) vs 9/62 (15%) of the controls (p = 0.03). Level of nicotine dependence and obesity seemed to be a predictor of long‐term abstinence (p = 0.02).
Forces required to remove bougies from tracheal tubes*
Authors: Jackson G. N. B. , Bartlett R. , Yentis S. M.
Published: February 2009

Following a critical incident on our labour ward, we investigated the forces required to remove different bougies from different tracheal tubes and the effect of lubrication on ease of removal. Two studies were conducted: firstly examining the differences between six different bougies with a standard tracheal tube, and secondly examining the differences between four different tracheal tubes with a standard bougie. The forces varied amongst both the different bougies (p < 0.0001) and the different tracheal tubes (p < 0.0001). Removal was generally easier with lubrication but when corrected for multiple comparisons this did not reach statistical significance.
Interaction between prostaglandin D2 and chemoattractant receptor-homologous molecule expressed on Th2 cells mediates cytokine production by Th2 lymphocytes in response to activated mast cells
Authors: Xue L , Barrow A , Pettipher R
Published: February 2009

The mechanisms by which immunologically activated mast cells stimulate the production of proinflammatory cytokines by T helper type 2 (Th2) lymphocytes were investigated in a human cell culture system. Supernatants collected from cord blood-derived mast cells after treatment with immunoglobulin E (IgE)/anti-IgE contained an activity that stimulated the production of interleukin (IL)-4, IL-5 and IL-13 (both mRNA and protein) by Th2 lymphocytes. This activity was not detected in supernatants from unactivated mast cells and its production was inhibited by treatment of activated mast cells with the cyclo-oxygenase inhibitor diclofenac. The concentration of diclofenac used inhibited completely the production of prostaglandin D2 (PGD2) but did not inhibit the release of histamine or leukotriene C4. The effect of supernatants from activated mast cells was mimicked by exogenous PGD2 at concentrations similar to those detected in the cultures of activated mast cells, and addition of exogenous PGD2 to supernatants from diclofenac-treated mast cells restored their ability to stimulate Th2 cytokine production. The ability of the mast cell supernatants to stimulate production of Th2 cytokines was not affected by addition of diclofenac to the Th2 cells directly, indicating that the production, but not the action, of the factor was sensitive to diclofenac treatment. Inhibition of chemoattractant receptor-homologous molecule expressed on Th2 cells (CRTH2) abolished the effect of the mast cell supernatants on Th2 cytokine production. These data indicate that mast cells have the ability to stimulate Th2 cells to elaborate cytokines independently of T cell receptor activation or co-stimulation and this response is mediated by PGD2 acting upon CRTH2 expressed by Th2 cells.
The expression profile of functional regulatory T cells, CD4+CD25high+/forkhead box protein P3+, in patients with ulcerative colitis during active and quiescent disease
Authors: Kamikozuru K , Fukunaga K , Hirota S , Hida N , Ohda Y , Yoshida K , Yokoyama Y , Tozawa K , Kawa K , Iimuro M , Nagase K , Saniabadi A R , Nakamura S , Miwa H , Matsumoto T
Published: February 2009

Regulatory T cells (Treg) have an essential role in maintaining immune tolerance in the gut. The functional CD4+ Treg express the transcription factor forkhead box protein 3 (FoxP3) or a CD25high in humans. Further, depletion of elevated granulocytes/monocytes by extracorporeal adsorption (GMA) induces immunomodulation in patients with ulcerative colitis (UC). We investigated the impact of GMA on Treg. Thirty-one UC patients, clinical activity index (CAI) 12·1 ± 2·97, refractory to conventional medications including intravenous corticosteroid and 13 healthy controls (HC), were included. Patients received five GMA sessions over 5 weeks. Biopsies from the rectal mucosa and blood samples at baseline and post-GMA were immunostained with anti-CD4/FoxP3 and anti-CD4/CD25 antibodies for immunohistochemistry and flow cytometry. Following GMA, 22 of 31 patients achieved remission (CAI ≤ 4, P < 0·01) and their endoscopic activity index decreased from 10·6 ± 2·32 to 4·75 ± 1·48 (P = 0·003). The circulating CD4+CD25high+ Treg level was low and increased markedly in responders (P < 0·02). In the nine non-responders, the baseline CD4+CD25high+ Treg level was about 50% of the level in the responders (P < 0·03) or in the HC (P < 0·01), and all nine had to undergo colectomy. Conversely, the number of CD4+/FoxP3+ mucosal Treg in GMA responders decreased significantly after the fifth GMA session compared with the baseline level (P < 0·05). It is believed that the CD4+ Treg has an essential role in the control of immune pathology in UC patients and a net influx of these cells from the circulation into the mucosa may proceed to suppress inflammation. GMA can impact the circulating as well as the mucosal levels of Treg.
The magnitude and selectivity of natural and multiple anthropogenic mortality causes in hunted brown bears
Authors: Bischof Richard , Swenson Jon E. , Yoccoz Nigel G. , Mysterud Atle , Gimenez Olivier
Published: February 2009

The population dynamic and evolutionary effects of harvesting are receiving growing attention among biologists. Cause‐specific estimates of mortality are necessary to determine and compare the magnitude and selectivity of hunting and other types of mortalities. In addition to the logistic and financial constraints on longitudinal studies, they are complicated by the fact that nonhunting mortality in managed populations usually consists of a mix of natural and human‐caused factors.

We used multistate capture–recapture (MCR) models to estimate cause‐specific survival of brown bears (Ursus arctos) in two subpopulations in Sweden over a 23‐year period. In our analysis, we distinguished between legal hunting and other sources of mortality, such as intraspecific predation, accidents, poaching, and damage control removals. We also tested whether a strong increase in harvest quotas after 1997 in one of the subpopulations affected vulnerability to legal hunting.

Although only a fraction of mortalities other than legal hunting could be considered natural, this group of causes showed a general pattern of demographic selectivity expected from natural mortality regimes in populations of long‐lived species, namely greater vulnerability of young animals. On the other hand, demographic effects on hunting vulnerability were weak and inconsistent. Our findings support the assumption that hunting and other mortalities were additive.

As expected, an increase in hunting pressure coincided with a correspondingly large increase in vulnerability to hunting in the affected subpopulation. Because even unbiased harvest can lead to selective pressures on life‐history traits, such as size at primiparity, increasing harvest quotas may not only affect population growth directly, but could also alter optimal life‐history strategies in brown bears and other carnivores.

Legal hunting is the most conveniently assessed and the most easily managed cause of mortality in many wild populations of large mammals. Although legal hunting is the single‐most important cause of mortality for brown bears in Sweden, the combined mortality from other causes is of considerable magnitude and additionally shows greater selectivity in terms of sex and age than legal hunting. Therefore, its role in population dynamics and evolution should not be underestimated.
Barriers to the self‐care of type 2 diabetes from both patients’ and providers’ perspectives: literature review
Authors: Pun Sandra PY , Coates Vivien , Benzie Iris FF
Published: February 2009

Aim.  To review systematically the literature about barriers to diabetes self‐care from both patients’ and healthcare providers’ perspectives.

Background.  Diabetes mellitus is a global health concern due to rapidly increasing prevalence. The healthcare costs for diabetes care and related complications are high. Tight glycaemic control achieved by intensive therapy has been shown to lower the risk of complications. Despite the provision of comprehensive management programmes, patients are often unable to achieve the desired outcomes. It is essential to understand the barriers to diabetes self‐care in order to promote successfully self‐care behaviours.

Methods.  A search of OVID Medline (R), CINAHL, Cochrane Library and British Nursing Index was carried out during 1986–2007 using keywords: Type 2 Diabetes Mellitus, self care, patient compliance, patient adherence and barriers to diabetes self care. Manual searching of relevant nursing journals and sourcing of secondary research extended the search.

Results.  A total of 16 original research papers using various methods including survey, descriptive correlational, sequential explanatory mixed‐method and qualitative exploratory design were reviewed. In total, over 8900 patients and 4550 healthcare providers were recruited from over 28 countries in these studies. Major barriers identified included psychosocial, socioeconomic, physical, environmental and cultural factors.

Conclusions.  Healthcare providers can enhance patient empowerment and participation with family support to achieve feasible targets. Better health care delivery systems and reforms that improve affordability, accessibility, and efficiency of care are essential for helping both providers and patients to meet desirable standards of diabetes care.

Relevance to clinical practice.  Understanding barriers to diabetes self‐care is the first step in facilitating providers to identify their role in enabling patients to overcome these barriers. Healthcare providers can develop strategies to clarify and individualise treatment guidelines, implement continuing education, improve communication skills, and help motivate patients to achieve desired behavioral changes.
A chance at survival: gene expression noise and phenotypic diversification strategies
Authors: Fraser Dawn , Kærn Mads
Published: February 2009

Phenotypic diversification plays a central role in evolution and provides species with a capacity to survive environmental adversity. The profound impact of random molecular events on the shaping of life is well accepted in the context of chance mutations and genetic drift; however, the evolution of the regulatory networks encoding microorganismal stress response and survival strategies might also have been significantly influenced by gene expression noise. This likelihood has inspired numerous investigations to characterize the sources of phenotypic diversity within isogenic populations, and to explore their direct and potential biological implications. Here, we discuss different scenarios where gene expression noise might bestow a selective advantage under stress, highlighting a potentially fundamental role of stochastic mechanisms in the evolution of microbial survival strategies.
Obesity, adipokines and asthma
Authors: Jartti T. , Saarikoski L. , Jartti L. , Lisinen I. , Jula A. , Huupponen R. , Viikari J. , Raitakari O. T.
Published: February 2009

Background:  The prevalence of asthma and obesity is increasing concomitantly, but many aspects of this link are unclear. Our objective was to examine whether obesity is associated with asthma in three time points of life, and whether immunomodulatory adipokines, leptin and adiponectin are linked to overweight‐associated asthma.

Methods:  We studied the association between obesity and asthma at ages 3–18 years [mean (SD), 10 years (5), n = 3582, year 1980], 9–24 years [16 years (5), n = 2764, 1986] and 24–39 years [32 years (5), n = 2620, 2001] in a prospective cohort study and further tested for associations with serum leptin and adiponectin concentrations. Data on allergy status, smoking and other laboratory values (serum insulin, plasma C‐reactive protein and serum lipid values) were also analyzed.

Results:  Allergy and parental asthma were significantly associated with asthma at all ages. At ages 24–39 years, but not earlier, body mass index (BMI) (odds ratio, OR 1.05; P = 0.019) and female gender (OR 1.56; P = 0.031) were independently associated with asthma. Increase in BMI was also associated with incident asthma during adulthood (OR 1.08; P = 0.030). Levels of leptin, adiponectin or any other obesity‐related biomarker were not independently associated with asthma.

Conclusions:  Asthma is linked with obesity in adults, but our results do not support a significant role for leptin, adiponectin or any other obesity‐related biomarker studied in this association. Other factors should be sought for better understanding the connection between obesity and asthma.
Long‐term outcomes of donation after cardiac death liver allografts from a single center
Authors: Nguyen Justin H. , Bonatti Hugo , Dickson Rolland C. , Hewitt Winston R. , Grewal Hani P. , Willingham Darrin L. , Harnois Denise M. , Schmitt Timothy M. , Machicao Victor I. , Ghabril Marwan S. , Keaveny Andrew P. , Aranda‐Michel Jaime , Satyanarayana Raj , Rosser Barry G. , Hinder Ronald A. , Steers Jeffery L. , Hughes Christopher B.
Published: February 2009

Abstract:  Organ shortage continues to be a major challenge in transplantation. Recent experience with controlled non‐heart‐beating or donation after cardiac death (DCD) are encouraging. However, long‐term outcomes of DCD liver allografts are limited. In this study, we present outcomes of 19 DCD liver allografts with follow‐up >4.5 years. During 1998–2001, 19 (4.1%) liver transplants (LT) with DCD allografts were performed at our center. Conventional heart‐beating donors included 234 standard criteria donors (SCD) and 214 extended criteria donors (ECD). We found that DCD allografts had equivalent rates of primary non‐function and biliary complications as compared with SCD and ECD. The overall one‐, two‐, and five‐yr DCD graft and patient survival was 73.7%, 68.4%, and 63.2%, and 89.5%, 89.5%, and 89.5%, respectively. DCD graft survival was similar to graft survival of SCD and ECD in non hepatitis C virus (HCV) recipients (p > 0.370). In contrast, DCD graft survival was significantly reduced in HCV recipients (p = 0.007). In conclusion, DCD liver allografts are durable and have acceptable long‐term outcomes. Further research is required to assess the impact of HCV on DCD allograft survival.
The impact of functioning pancreas–kidney transplantation and pancreas alone transplantation on the lipid metabolism of statin‐naïve diabetic patients
Authors: Lauria Márcio W , Figueiró José Maria , Machado Lucas José Campos , Sanches Marcelo D. , Lana Ângela Maria Quintão , Ribeiro‐Oliveira Jr Antônio
Published: February 2009

Abstract: Objective:  To compare the lipid profile (total cholesterol – TC, triglycerides – TG, high density lipoprotein cholesterol – HDL‐c, low density lipoprotein cholesterol – LDL‐c and non‐HDL cholesterol – NHDL‐c) of patients with functioning pancreas–kidney transplantation (PKT) or pancreas transplantation alone (PTA) after one (T1) and two yr (T2) following their pre‐transplantation data (T0).

Methods:  Fifty‐three type 1 diabetic patients underwent pancreas transplantation (42 PKT and 11 PTA) remaining euglycemic after transplantation were evaluated before and one and two yr after the procedures. They were using predominantly tacrolimus‐mycophenolate mofetil‐based immunosuppression and low glucocorticoid dose with systemic venous drainage of the pancreatic graft. None of them used hypolipidemic agents for economical reasons. Lipids were reported as means ± standard error of the mean. Data obtained in T0 were compared with T1 and T2 using ANOVA followed by Student’s t‐test.

Results:  TC, LDL‐c, NHDL‐c and TG were lower in T1 and T2 when compared with T0 (p < 0.05) in PKT, while no change was observed for HDL‐c (p > 0.05). PTA group showed no significant changes in lipids.

Conclusion:  In spite of the known side effects of tacrolimus‐based immunosuppression to lipids, our study with a statin‐naïve sample showed improvements (PKT) or stabilization (PTA) in the serum lipid profile after pancreas transplantation.
Long‐term survival after kidney transplantation in an HIV‐positive patient
Authors: Roefs Anne , Van Der Ende Marchina , IJzermans Jan , Weimar Willem , Van Gelder Teun
Published: February 2009

Abstract:  Only a decade ago, human immunodeficiency virus (HIV)‐seropositivity was considered an absolute contraindication for organ transplantation. With the currently available experience, it is no longer justified to deny HIV‐positive patients access to transplantation. To the best of our knowledge, we here present the longest surviving HIV‐positive patient after renal transplantation. The follow‐up period after renal transplantation in this HIV‐positive female is now 13 yr and she is in good general condition with excellent renal function. Throughout her post‐transplant follow‐up, we encountered a number of problems that are illustrative of the HIV‐positive patient.
IL13 variants are associated with total serum IgE and early sensitization to food allergens in children with atopic dermatitis
Authors: Zitnik Simona Eva , Rüschendorf Franz , Müller Sebastian , Sengler Claudia , Lee Young‐Ae , Griffioen Rupino W. , Meglio Paolo , Wahn Ulrich , Witt Heiko , Nickel Renate
Published: February 2009

Increased total and specific serum immunoglobulin E (IgE) levels are common characteristics of atopic diseases and their basal production is proposed to be under strong genetic control. Interleukin 13 (IL13) variants have been consistently associated with total serum IgE levels in white populations with a strongest association in non‐atopics. The aim of this study was to test the IL13 p.R130Q and c.1‐1111C>T variants in children with atopic dermatitis (AD) for associations with total serum IgE and early sensitization to common food and inhalant allergens and with asthma. We included 453 children with AD [participants of the Early Treatment of the Atopic Child (ETAC) study] that were followed from the age of 12–24 months for 3 yr. Total and specific IgE were determined at four time points. We genotyped the IL13 p.R130Q and c.1‐1111C>T variants by melting curve analysis. In children up to 4 yr of age, the 130Q allele was related to slightly higher total IgE levels compared to heterozygotes and 130R homozygotes. More importantly, both IL13 variants were significantly associated with sensitization to food allergens, with most significant results for sensitization to egg (p = 0.0001). Although early sensitization to hen’s egg represents a strong risk factor for subsequent sensitization to inhalant allergens and asthma, the investigated IL13 variants were not associated with these phenotypes at the age of 48–60 months. In summary IL13 variants contribute to elevated levels of total serum IgE in young atopic children and are strongly associated with sensitization to food allergens, particularly to hen’s egg. These findings suggest that IL13 variants play a major role not only in non‐cognate but also in allergen specific IgE synthesis.
Factors associated with maternal dietary intake, feeding and weaning practices, and the development of food hypersensitivity in the infant
Authors: Venter Carina , Pereira Brett , Voigt Kerstin , Grundy Jane , Clayton C. Bernie , Higgins Bernie , Arshad S. Hasan , Dean Taraneh
Published: February 2009

Maternal diet during pregnancy and breastfeeding, as well as infant feeding and weaning practices, may play a role in the development of sensitization to food and food hypersensitivity (FHS) and need further investigation. Pregnant women were recruited at 12 wk pregnancy. Information regarding family history of allergy was obtained by means of a questionnaire. A food frequency questionnaire was completed at 36 wk gestation. Information regarding feeding practices and reported symptoms of atopy was obtained during the infants’ first 3 yr of life. Children were also skin‐prick tested at 1, 2 and 3 yr to a pre‐defined panel of food allergens. Food challenges were conducted where possible. Maternal dietary intake during pregnancy, and breast‐feeding duration did not influence the development of sensitization to food allergens or FHS, but weaning age (≥16 wk) did for sensitization at 1 yr (p = 0.03), FHS by 1 yr (p = 0.02), sensitization at 3 yr (p = 0.01) and FHS by 3 yr (p = 0.02). In contrast, children who were not exposed to a certain food allergen before the age of 3–6 months were less likely to become sensitized or develop FHS. Women with a family history of allergic disease were more likely to breastfeed exclusively at 3 months (p = 0.008) and avoid peanuts from the infant’s diet at 6 months (p = 0.03). Maternal dietary intake during pregnancy, and breast‐feeding duration did not appear to influence the development of sensitization to food allergens or FHS. Weaning age may affect sensitization to foods and development of FHS. A history of allergic disease has very little impact on maternal dietary, feeding, and weaning practices.
The influence of parental educational level on the development of atopic sensitization, wheezing and eczema during the first year of life
Authors: Dom Sandra , Droste Jos H. J. , Sariachvili Manana A. , Hagendorens Margo M. , Bridts Chris H. , Stevens Wim J. , Desager Kristine N. , Wieringa Marjan H. , Weyler Joost J.
Published: February 2009

Several studies have investigated the association between socioeconomic status and the occurrence of allergies. Nevertheless, the results remain contradictory. The aim of this study was to evaluate the associations between parental education and the occurrence of atopic sensitization, recurrent wheezing and eczema during the first year of life, differentiating between atopic and non‐atopic disorders based on specific serum IgE. We conducted an aetiological study in 690 children, based on a prospective birth cohort project in which environmental and health information was gathered using questionnaires. At the age of 1 yr a blood sample was taken for quantification of specific IgE. Adjusted odds ratios and 95% confidence intervals were computed as measures of association between the outcomes and parental education. Parental educational level was positively associated with the occurrence of atopic sensitization (OR: 2.1; 95% CI: 1.0–4.4) and eczema (OR: 1.9; 95% CI: 1.1–3.4), but negatively with the occurrence of recurrent wheezing (OR: 0.4; 95% CI: 0.2–0.8) in the first year of life. Atopic recurrent wheezing was positively associated with the education of the parents, whereas non‐atopic recurrent wheezing was negatively associated. When maternal and paternal education were considered separately, only maternal education had a significant influence. Our results suggest that aspects associated with a high maternal educational level may play an important role in the development of atopic disorders.
PTGDR is not a major candidate gene for asthma and atopy in Chinese children
Authors: Leung Ting Fan , Li Chung Yi , Kong Alice P. S. , Chan Iris H. S. , Ng Maggie C. Y. , Chan Michael H. M. , So Wing Yee , Wong Gary W. K. , Lam Christopher W. K. , Chan Juliana C. N.
Published: February 2009

Airway sensitization requires the expression of prostanoid DP receptor in mice. Recent studies reported that polymorphisms in the gene encoding prostanoid DP receptor (PTGDR) were associated with asthma in White people and Black people, but this association could not be replicated among Latinos and Koreans. This study investigated the association between asthma‐related traits and six single nucleotide polymorphisms (SNPs) of PTGDR in Chinese children, consisted of 308 asthmatics and 368 non‐allergic controls. Plasma total and aeroallergen‐specific immunoglobulin E were measured by immunoassays. PTGDR SNPs were determined by multiplex SNaPshot™ genotyping. All polymorphic markers followed Hardy–Weinberg equilibrium except G1044A in the controls (p = 0.021). The linkage disequilibrium (LD) scores for these SNPs were moderate to high, and in particular, T‐549C and C‐441T were in strong LD. Significant interethnic variations in PTGDR alleles and haplotypes (up to 41%) were found in our subjects when compared with White people or Latinos. Asthma diagnosis, atopy and aeroallergen sensitization did not differ among children with different PTGDR genotypes (p > 0.15 for all). Linear regression showed weakly significant associations between T‐197C and G1044A of PTGDR and spirometric variables. PTGDR haplotypes were not associated with asthma and atopy phenotypes (p > 0.09 for all). Our results do not support PTGDR to be a major candidate gene for asthma traits in Chinese children.
Physiological responses of intertidal marine brown algae to nitrogen deprivation and resupply of nitrate and ammonium
Authors: Young Erica B. , Berges John A. , Dring Matthew J.
Published: February 2009

Intertidal macroalgae Fucus and Laminaria experience seasonally fluctuating inorganic N supply. This study examined the effects of long‐term N deprivation, recovery following N resupply, and effects of elevated ammonium and nitrate exposure on N acquisition in intertidal algae using manipulations of N supply in tank culture. Over 15 weeks of N deprivation, internal N and nitrate reductase activity (NRA) declined, but maximum quantum yield of PSII was unaffected in Fucus serratus and Fucus vesiculosus. Low NRA was maintained despite no external nitrate availability and depletion of internal pools, suggesting a constitutive NRA, insensitive to N supply. Nitrate resupplied to N‐starved thalli was rapidly taken up and internal nitrate pools and NRA increased. Exposure to elevated (50 μM) nitrate over 4 days stimulated nitrate uptake and NRA in Laminaria digitata and F. serratus. Exposure to elevated ammonium suppressed NRA in L. digitata but not in F. serratus. This novel insensitivity of NRA to ammonium in Fucus contrasts with regulation of NRA in other algae and higher plants. Ammonium suppression of NRA in L. digitata was not via inhibition of nitrate uptake and was independent of nitrate availability. L. digitata showed a higher capacity for internal nitrate storage when exposed to elevated ambient nitrate, but NRA was lower than in Fucus. All species maintained nitrate assimilation capacity in excess of nitrate uptake capacity. N uptake and storage strategies of these intertidal macroalgae are adaptive to life in fluctuating N supply, and distinct regulation of N metabolism in Fucus vs Laminaria may relate to position in the intertidal zone.
Microbial communities in roots of Pinus sylvestris seedlings with damping‐off symptoms in two forest nurseries as determined by ITS1/2 rDNA sequencing
Authors: Kwaśna H. , Bateman G. L.
Published: February 2009

A methodological molecular procedure, which included extraction and cloning of the ITS1/2 rDNA of root‐associated organisms with subsequent transformation and sequencing of representative clones, was effective for detection, discrimination and determination of the frequency of the main damping‐off pathogens in roots of Pinus sylvestris seedlings growing in different forest‐tree nursery soils and exhibiting different rates of disease progress. Roots exhibiting slower damping‐off progression were colonized by Fusarium oxysporum, Neonectria radicicola (Ascomycota) and Pythium spp. (Oomycota), which comprised 50% of the microbial community. Roots exhibiting faster damping‐off progression were dominated by Thanatephorus cucumeris (Basidiomycota), which comprised 80% of the microbial community. The microbial community was more diverse in roots with slower damping‐off progression (14 species) than in roots with faster disease progression (seven species).
PCR‐RFLP markers identify three lineages of the North American and European populations of Phytophthora ramorum
Authors: Elliott M. , Sumampong G. , Varga A. , Shamoun S. F. , James D. , Masri S. , Brière S. C. , Grünwald N. J.
Published: February 2009

Phytophthora ramorum, the cause of sudden oak death and ramorum blight, has three major clonal lineages and two mating types. Molecular tests currently available for detecting P. ramorum do not distinguish between clonal lineages and mating type is determined by cultural methods on a limited number of samples. In some molecular diagnostic tests, cross‐reaction with other closely related species such as P. hibernalis, P. foliorum or P. lateralis can occur. Regions in the mitochondrial gene Cox1 are different among P. ramorum lineages and mitochondrial genotyping of the North American and European populations seems to be sufficient to differentiate between mating types, because the EU1 lineage is mostly A1 and both NA1 and NA2 lineages are A2. In our study, we were able to identify P. ramorum isolates according to lineage using polymerase chain reaction‐restriction fragment‐length polymorphism (PCR‐RFLP) of the Cox1 gene, first by using ApoI to separate P. ramorum from other species and EU1 from North American populations, and then AvaI to distinguish between NA1 and NA2 genotypes. However, P. foliorum had the same restriction profile as P. ramorum NA1 isolates.
Detection of quantitative trait loci (QTL) associated with resistance to whitebacked planthopper (Sogatella furcifera) in rice (Oryza sativa)
Authors: Geethanjali S. , Kadirvel P. , Gunathilagaraj K. , Maheswaran M.
Published: February 2009

Whitebacked planthopper (WBPH) is an important insect pest of rice. In this study, we report quantitative trait loci (QTL) associated with resistance to WBPH using a doubled‐haploid (DH) mapping population derived from the cross IR64/Azucena. We evaluated a set of 91 DH lines using various screening tests which measure seedling resistance, antibiosis and tolerance to WBPH. QTL analysis involving a RFLP map of 175 markers detected a significant QTL on chromosome 7 (RG511‐RG477) associated with seedling resistance to WBPH. In addition, QTL analysis involving available defence related candidate genes as markers on a sub set of 60 DH lines showed significant association of genomic regions on chromosome 1 (W1‐pMRF1), 2 (XLRfrI7‐RG157) and 7 (RG711‐CDO418) with resistance to WBPH. Several suggestive QTL were detected on chromosomes 2, 3, 6, 7, 8 and 11 showing the possibility of their association with resistance to WBPH. The phenotypic contribution of the QTL ranged from 8.4% to 32.1%. Some of the WBPH resistance QTL detected in this study showed similar map positions with the QTL reported for resistance to brown planthopper (BPH) in the same mapping population. These results would be useful for attempts to trace the genes associated with resistance to planthoppers in rice.
Detection of QTLs for bread‐making quality in wheat using a recombinant inbred line population
Authors: Li Y. , Song Y. , Zhou R. , Branlard G. , Jia J.
Published: February 2009

Whereas gluten fraction accounts for 30–60% of the variation in wheat bread‐making quality, there remains substantial variation determined by non‐gluten factors. The objective of this study was to detect new loci for wheat quality. The genetics of sodium dodecyl sulphate‐sedimentation volume (Ssd), grain hardness (GH), grain protein content, wet gluten content (WGC) and water absorption (Abs) in a set of 198 recombinant inbred lines derived from two commercial varieties was studied by quantitative trait loci (QTL) analysis. A genetic map based on 255 marker loci, consisting of 250 simple sequence repeat markers and five glutenin loci, Glu‐A1, Glu‐B1, Glu‐D1, Glu‐B3 and Glu‐D3, was constructed. A total of 73 QTLs were detected for all traits. A major QTL for GH was detected on chromosome 1B and its relative contribution to phenotypic variation was 27.7%. A major QTL for Abs on chromosome 5D explained more than 30% of the phenotypic variation. Variations in Ssd were explained by four kinds of genes. Some QTLs for correlated traits mapped to the same regions forming QTL clusters or indicated pleiotropic effects.
Assessment and measurement of health literacy: An integrative review of the literature
Authors: Mancuso Josephine M.
Published: February 2009

Research linking health literacy to health knowledge, health behaviors, health outcomes, health disparity, health status, and increasing health‐care costs is prevalent around the globe. Given the importance of health literacy, it is prudent to examine the tools available to assure that patients are health‐literate. This article provides an integrative review in order to investigate what has been developed to evaluate health literacy in the health‐care setting. The research questions considered include: (i) Which instruments or screening tools are available to assess or measure health literacy in the clinical setting?; and (ii) What are the psychometric properties, advantages, and limitations of the identified tools? A number of databases are utilized to locate research specific to this topic. The research is analyzed, the findings are summarized, and the limitations are mentioned. The implications, recommendations, and the need for future research are discussed.
Premature menopause: Exploring the experience through online communication
Authors: Halliday Lesley , Boughton Maureen
Published: February 2009

The authors explored the experience of premature menopause by analyzing 1350 posted messages by 98 women, with unique usernames, to an online discussion board over a 90 day period between December 2005 and March 2006. Four particularly problematic aspects emerged that related to the following themes: legitimizing the symptoms, the impact of diagnosis (“losing me”), treatment (“regaining me”), and feeling alone. It appeared that premature menopause, regardless of the cause, was a largely negative experience, compounded by the often lengthy process of confirming a diagnosis based on ambiguous and often vague symptoms, the scarcity of suitable information about the condition, and the subjective lack of perceived support that the women received. Furthermore, a feeling of being different, through the lack of menstruation and fertility choices, often led to relationship problems and generally a loss of well‐being. Women with premature menopause would benefit from the development of tailored information and support that addresses these problematic aspects of the condition.
Physicians' perceptions of protocol‐directed weaning in an intensive care unit in Norway
Authors: Hansen Britt Sætre , Severinsson Elisabeth
Published: February 2009

The aim of this paper is to identify physicians' perceptions of protocol‐directed weaning from mechanical ventilation in an intensive care unit in Norway. Errors occur in the absence of procedures, plans, and a team culture. Standardized weaning protocols, or pathways, offer a systematic approach. The focus group method was used. Four themes emerged: (i) acceptance, where the participants perceived the protocol as having a positive influence on the weaning process, although some barriers were identified, such as its failure to facilitate the “difficult‐to‐wean” patient; (ii) indignant responses, which gave the impression that the protocol was prescribed for the benefit of the nurses; (iii) ambivalence was evident in the two different approaches to the weaning process when problems occurred, which were “directing” and “collaborating”; and (iv) continuity and professional competence were perceived as important aspects of the weaning process. An unclear pattern of responsibility and poor interprofessional collaboration and communication were reported.
Presumed circle area ratio of the prostate in a community‐based group of men
Authors: St Sauver Jennifer L. , Jacobson Debra J. , McGree Michaela E. , Girman Cynthia J. , Nehra Ajay , Lieber Michael M. , Jacobsen Steven J.
Published: February 2009

OBJECTIVE

To determine the normal values for the presumed circle area ratio (PCAR) in a group of community‐based men, and to determine whether PCAR is associated with specific urological outcomes.

PATIENTS AND METHODS

The study was a cross‐sectional analysis among 328 Caucasian men (94% participation) residing in Olmsted County, Minnesota, USA. The PCAR was measured during prostatic ultrasonography. Lower urinary tract symptoms (LUTS) were measured using the American Urologic Association Symptom Index. The peak urinary flow rate was measured by a uroflowmeter, and the postvoid residual volume (PVR) was assessed using the BladderScanTM BVM 6500 (Verathon, Bothell, WA, USA). Correlations between PCAR and presence of LUTS, peak urinary flow rate, and PVR were determined using Spearman correlation coefficients. Unadjusted and adjusted odds ratios (ORs) were calculated using logistic regression to determine the associations between PCAR thresholds and categorical urological outcomes.

RESULTS

The median (interquartile range) PCAR was 0.85 (0.81–0.88). After adjusting for age and total prostate volume, men who had PCARs of >0.90 were more likely to have elevated overall and obstructive symptom scores (OR 2.95, 95% confidence interval 1.39–6.25, and 3.47, 1.63–7.39, respectively).

CONCLUSION

PCAR might add further information beyond total prostate volume when predicting the development of obstructive LUTS.
Decrease of urinary nerve growth factor levels after antimuscarinic therapy in patients with overactive bladder
Authors: Liu Hsin‐Tzu , Chancellor Michael B. , Kuo Hann‐Chorng
Published: February 2009

OBJECTIVE

To determine urinary nerve growth factor (NGF) levels in patients with overactive bladder (OAB) and after treatment with antimuscarinics.

PATIENTS AND METHODS

Urinary NGF levels were measured in 38 ‘normal’ controls and 70 patients with OAB. Patients were treated with tolterodine 4 mg once daily. Urinary NGF levels were measured by enzyme‐linked immunosorbent assay method and normalized by urinary creatinine levels (NGF/Cr). The urinary NGF/Cr levels and urgency severity scale (USS) were compared at baseline, 1, 2 and 3 months after antimuscarinics, and 1 month after discontinuing treatment.

RESULTS

The urinary NGF/Cr level was very low in normal controls with a mean (sem) of 0.005 (0.003). Patients with OAB had significantly higher baseline urinary NGF/Cr levels than the controls. Urinary NGF/Cr levels were significantly reduced at 3 months in 50 responders (1.10 [0.26] before vs 0.41 [0.09] after, P = 0.008) but not in the 20 non‐responders (1.38 [0.54] before vs 1.30 [0.46] after, P = 0.879). However, after discontinuing antimuscarinic treatment for 1 month, the urinary NGF/Cr level was elevated in 23 responders at 0.83 (0.33) and in five non‐responders at 2.72 (1.41). The USS scores significantly changed with the change of urinary NGF/Cr levels in responders at different time points. The voided volume increased but maximum urinary flow rate and postvoid residual volume did not increase in responders after 3‐months of antimuscarinic treatment. The limitation of this study was the lack of a control arm for comparison.

CONCLUSIONS

Changes in the urinary NGF levels were associated with the changes of the USS scores after antimuscarinic treatment and discontinued medication. The urinary NGF level could be a potential biomarker for evaluating therapeutic results of antimuscarinics therapy.
Cancer‐specific survival after radical cystectomy and standardized extended lymphadenectomy for node‐positive bladder cancer: prediction by lymph node positivity and density
Authors: Wiesner Christoph , Salzer Alice , Thomas Christian , Gellermann‐Schultes Claudia , Gillitzer Rolf , Hampel Christian , Thüroff Joachim W.
Published: February 2009

OBJECTIVE

To investigate the associations between different overall or topographically restricted lymph node (LN) variables and cancer‐specific survival (CSS) after radical cystectomy (RC) and extended LN dissection (LND) with curative intent in patients with LN‐positive bladder cancer.

PATIENTS AND METHODS

Between 2001 and 2006, 152 patients had RC with standardized extended LND for bladder cancer with curative intent. Patients with positive LNs were stratified according to the median of the LN variables (LNs removed, number of positive LNs, LN density). CSS was related to overall and topographically restricted LN variables, e.g. different levels of LND, and relationships were tested by univariate and multivariate analyses. Level 1 LND comprised the regions of the external and internal iliac LNs and of the obturator LNs, level 2 the templates of common iliac and presacral LNs, and level 3 the para‐aortic and paracaval LNs up to the inferior mesenteric artery. The mean (range) follow‐up was 22 (1–84) months.

RESULTS

LN metastases were diagnosed in 46 of the 152 patients (30%) with extended LND. In these 46 patients, the median number of removed LNs was 33 (level 1, 15.5; level 2, 9.0; level 3, 7.0), the median number of positive LNs was 3 (1.5, 0.5 and 0.0, respectively) and the median LN density was 0.11 (0.10, 0.02 and 0.0, respectively). The CSS was 76% at 1 year and 23% at 3 years. There were significant correlations between the 3‐year CSS and the overall LN density (≤0.11 vs >0.11; 34% vs 8%, P = 0.008), and the total number of positive LNs (≤3 vs >3; 33% vs 8%; P = 0.05). Overall LN density (hazard ratio 0.33, 95% confidence interval 0.15–0.72; P = 0.006) was an independent predictor for CSS in multivariate analysis.

CONCLUSIONS

Overall LN density is an independent predictor of survival after RC and extended LND with curative intent. Evaluation of topographically restricted LN positivity and density for different regions and levels of LND does not improve the prediction of CSS compared with overall LN positivity and density. A low incidence of level 3 LN positivity questions the clinical relevance of removing para‐aortic and paracaval LNs. However, our data need to be confirmed by a prospective randomized trial.
Magnetic resonance imaging in the prediction of biochemical recurrence of prostate cancer after radical prostatectomy
Authors: Fuchsjäger Michael H. , Shukla‐Dave Amita , Hricak Hedvig , Wang Liang , Touijer Karim , Donohue John F. , Eastham James A. , Kattan Michael W.
Published: February 2009

OBJECTIVE

To investigate whether magnetic resonance imaging (MRI) findings, when converted into a scoring system, can predict the biochemical recurrence of prostate cancer after radical prostatectomy (RP).

PATIENTS AND METHODS

Between January 2000 and October 2004, 610 patients with biopsy‐confirmed prostate cancer had MRI before RP, with whole‐mount step‐sectioning of the pathology sample. MRI findings were retrospectively scored on a seven‐point scale based on Tumour‐Node‐Mestastasis staging (1, no tumour seen, to 7, lymph node metastasis). MRI scores were added to published 5‐ and 10‐year clinical preoperative nomograms for predicting recurrence. The predictive accuracy of MRI was quantified as the differences in bootstrap‐corrected concordance indices of the models with and without MRI.

RESULTS

As of August 2007, 64 (10.5%) patients had a biochemical recurrence. MRI scores were associated with recurrence (P < 0.001) with hazard ratios of 1.76 and 1.81 in the 5‐ and 10‐year models, respectively. Actual recurrence rates by MRI score were: 1, 0%; 2, 4.5%; 3, 9%; 4, 24.1%; 5, 33.3%; 6, 69.2%; 7, 100%. When MRI was added, the concordance indices of the 5‐ and 10‐year models increased, from 0.762 to 0.776 (P = 0.081) and 0.773 to 0.788 (P = 0.107), respectively; the improvement was not significant.

CONCLUSION

The MRI scoring system devised was a strong predictor of biochemical recurrence after RP. Although MRI did not provide added prognostic value to standard clinical nomograms, in centres where MRI is used routinely, it might increase the confidence of the clinician in assessing the risk of recurrence by contributing supporting data.
Bridging gaps in risk discourse: home care case management and client choices
Authors: Ceci Christine , Purkis Mary Ellen
Published: February 2009

This paper examines, and problematises, a well‐entrenched conceptualisation of how home care case management practice works – that is, that case managers offer alternatives, and clients make choices. This understanding of practice is reinforced by organisational policy that states that clients have the right to live at risk if that is their choice. Analysis of data from a field study of home care practice in a western Canadian city, drawing predominantly on case managers’ accounts of actual practice situations, underscores the limitations of such a view, and suggests that conceptualising such practices as ongoing and fragile negotiations between freedom and security offers a more useful frame for thinking through the distance and difference between current home care policy and practice and what people might actually need.