bluuebunny/crossref_metadata_2025 huggingface dataset:
Response of mitochondria to light intensity in the leaves of sun and shade species
Authors: NOGUCHI KO , TAYLOR NICOLAS L. , MILLAR A. HARVEY , LAMBERS HANS , DAY DAVID A.
Published: June 2005

The present authors have shown previously that both respiration rates and in vivo activities of the alternative oxidase (AOX) of leaves of Alocasia odora, a shade species, are lower than those in sun species, thereby optimizing energy production under limited light conditions (Noguchi et al., Australian Journal of Plant Physiology 28, 27–35, 2001). In the present study, mitochondria isolated from A. odora leaves were examined in order to investigate the biochemical basis for the differences in respiratory parameters. Alocasia odora and spinach plants were cultivated under both high and low light intensities, mitochondria were isolated from their leaves, and their respiratory properties compared. Mitochondrial content of leaf extracts from the two species was estimated using fumarase activities and antibody detection of porin (the voltage‐dependent anion channel of the outer mitochondrial membrane). On a mitochondrial protein basis, spinach leaves showed higher capacities of the cytochrome pathway and cytochrome c oxidase (COX) than A. odora leaves. However, on a mitochondrial protein basis, A. odora showed higher capacities of AOX, which had a high affinity for ubiquinone when activated by pyruvate. Alocasia odora also had larger amounts of mitochondrial protein per leaf dry weight, even under severely shaded conditions, than spinach. Lower growth light intensity led to lower activities of most pathways and proteins tested in both species, especially glycine‐dependent oxygen uptake. In the low light environment, most of the AOX protein in A. odora leaves was in its inactive, oxidized dimer form, but was converted to its reduced active form when plants were grown under high light. This shift may prevent over‐reduction of the respiratory chain under photo‐oxidative conditions.
Salt tolerance in Eucalyptus spp.: identity and response of putative osmolytes
Authors: ADAMS MARK A. , RICHTER ANDREAS , HILL ALAN K. , COLMER TIMOTHY D.
Published: June 2005

In four species of salt‐tolerant eucalypts (Eucalyptus raveretiana, E. spathulata, E. sargentii and E. loxophleba), we found substantial concentrations of quercitol – a cyclitol known for its accumulation in seeds of Quercus. Quercitol was absent in old foliage of E. globulus, a species noted for greater susceptibility to salinity, and also absent in the moderately tolerant E. camaldulensis, but, relative to other species, both had higher foliar concentrations of inositol. Simple sugars and cyclitols accumulated to osmotically significant concentrations in all species. The osmotic potential of expressed sap was always less than that of the external ‘soil’ solution and increasing salinity produced predictable reductions in growth and increases in ion concentrations in foliage of saplings of four eucalypt species. The more salt‐tolerant species, E. spathulata, E. loxophleba and E. sargentii, were able to maintain well‐regulated leaf Na+ concentrations even at 300 mol m−3 NaCl. These more salt‐tolerant species also showed an apparent increase in net selectivity for K+ over Na+ as salinity increased, irrespective of the Na+ : Ca2+ ratio of the external medium (range 25 : 1 to 75 : 1; Ca2+ always ≥ 4.0 mol m−3). By contrast, E. globulus was unable to exclude Na+ when exposed to higher NaCl concentrations (e.g. 200 and 300 mol m−3). Carbon isotope signatures of foliage reflected imposed salinity but were not strongly enough correlated with growth to support previous suggestions that isotope discrimination be a means of evaluating salt tolerance. On the other hand, patterns of sugar and cyclitol accumulation should be further explored in eucalypts as traits contributing to salt tolerance, and with potential use as markers in breeding programmes.
Meeting the Demand for Innate and Adaptive Immunities During Evolution
Authors: Du Pasquier L.
Published: June 2005

An ideal immune system should provide each individual with rapid and efficient responses, a diverse repertoire of recognition and effector molecules and a certain flexibility to match the changing internal and external environment. It should be economic in cells and genes. Specific memory would be useful. It should not be autoreactive. These requirements, a mixture of innate and adaptive immunity features, are modulated in function of the dominant mode of selection for each species of metazoa during evolution (K or r). From sponges to man, a great diversity of receptors and effector mechanisms, some of them shared with plants, are articulated around conserved signalling cascades. Multiple attempts at combining innate and adaptive immunity somatic features can be observed as new somatic mechanisms provide individualized repertoires of receptors throughout metazoa, in agnathans, prochordates, echinoderms and mollusks. The adaptive immunity of vertebrates with lymphocytes and their specific receptors of the immunoglobulin superfamily, the major histocompatibility complex, developed from innate immunity evolutionary lines that can be traced back in earlier deuterostomes.
Interaction of Mucosal Microbiota with the Innate Immune System
Authors: Tlaskalova‐Hogenova H. , Tuckova L. , Mestecky J. , Kolinska J. , Rossmann P. , Stepankova R. , Kozakova H. , Hudcovic T. , Hrncir T. , Frolova L. , Kverka M.
Published: June 2005

Organisms live in continuos interaction with their environment; this interaction is of vital importance but at the same time can be life threatening. The largest and most important interface between the organism and its environment is represented by surfaces covered with epithelial cells. Of these surfaces, mucosae comprise in humans approximately 300 m2, and the skin covers approximately 1.8 m2 surface of the human body. Mucosal tissues contain two effector arms of the immune system, innate and adaptive, which operate in synergy. Interaction with commensal bacteria, which outnumber the nucleated cells of our body, occurs physiologically on epithelial surfaces; this interaction could pose the risk of inflammation. The mucosal immune system has developed a complex network of regulatory signalling cascades that is a prerequisite for proper activation but also for a timely inactivation of the pathway. As demonstrated in gnotobiotic animal models of human diseases, impaired regulation of mucosal responses to commensal bacteria plays an important role in the development of several inflammatory and autoimmune diseases.
Quadruple immunosuppression with basiliximab, tacrolimus, mycophenolate mofetil and prednisone is safe and effective for renal transplantation
Authors: Miura Masayoshi , Harada Hiroshi , Fukuzawa Nobuyuki , Iwami Daiki , Taniguchi Akihisa , Seki Toshimori , Togashi Masaki , Ogawa Yayoi , Satoh Hidetoshi , Hirano Tetsuo
Published: June 2005

Abstract:  Introduction:  Recent immunosuppression with tacrolimus and mycophenolate mofetil has improved the results of renal transplantation. In this study, we analyzed the effect and safety of basiliximab as an induction therapy.

Material and methods:  Forty‐nine kidney recipients were given tacrolimus, mycophenolate mofetil and prednisone (non‐Bas group), and 31 recipients were given basiliximab as an induction therapy in addition to the triple immunosuppressants (Bas group). Graft function, incidence of acute rejection (AR), findings of protocol graft biopsy and adverse effects were compared.

Results:  Serum creatinine within 1 yr post‐transplant was comparable between the two groups. Incidence of biopsy‐proven AR within 6 months post‐transplant was less in the Bas group than in the non‐Bas group. Borderline change at 3 months post‐transplant was less in the Bas group when compared to the non‐Bas group. The frequency and severity of tubulitis were higher in the non‐Bas group than in the Bas group. The addition of basiliximab did not increase opportunistic infection, but reduced tacrolimus nephrotoxicity.

Conclusion:  The addition of basiliximab to the tacrolimus‐based triple immunosuppressive regimen enabled us to reduce the doses of immunosuppressants and tacrolimus nephrotoxicity without increasing early rejection or infection. This regimen is safe and effective for application during the early period after renal transplantation.
Renal graft loss with plasma cell‐rich acute rejection in cadaveric renal transplantation: a case report
Authors: Suzuki Taisei , Fukuzawa Junya , Furuya Shuichiroh , Yuzawa Kenji , Aita Kumi , Ohkohchi Nobuhiro , Nagata Michio
Published: June 2005

Abstract:  We reported a case of renal graft loss in cadaveric renal transplantation. An episode biopsy with renal dysfunction showed plasma cell predominant inflammatory infiltration in the interstitium without a finding of vascular or glomerular rejection, and was diagnosed as plasma cell‐rich acute rejection (PCAR). Despite intensive immunosuppressive therapy, the renal histology of repeated biopsies showed persistent plasma cell infiltration and the graft was finally lost. Immunohistological staining and immunoglobulin gene rearrangement studies to estimate the clonality of inflammatory cells revealed that the infiltrating plasma cells were polyclonal in origin. Epstein–Barr virus was not detected by in situ hybridization. From these results, we excluded the possibility of post‐transplant lymphoproliferative disorder (PTLD); however, a precise definition and differential diagnosis between PCAR and PTLD has not yet been fully determined. As therapeutic regimens for PCAR and PTLD are different, definite guidelines for diagnosis and treatments of PCAR need to be established.
Complement C4d deposition in transplanted kidneys: preliminary report on long‐term graft survival
Authors: Kawamura Nahoko , Tomita Makoto , Hasegawa Midori , Murakami Kazutaka , Nabeshima Kunihiro , Kushimoto Hiroko , Kasugai Masami , Takahashi Kazuo , Hiki Yoshiyuki , Kinukawa Tsuneo , Usuda Nobumitsu , Sugiyama Satoshi
Published: June 2005

Abstract:  The effects of antibody‐mediated rejection on long‐term graft survival have not been fully investigated. The aim of this study is to clarify the influence on long‐term survival of deposition of the complement split product C4d in allografts using polyclonal anti‐C4d antibody. Inclusion criteria were recipients who underwent graft biopsy during acute deterioration of graft function within the first 2 yr after transplantation. Patients whose graft did not survive more than 1 yr and who received graft from an human leucocyte antigen (HLA)‐identical sibling or an ABO‐incompatible donor were excluded. Among the 92 recipients investigated, 22 (23.9%) had peritubular capillary C4d deposition, 15 (16.3%) had glomerular capillary C4d deposition and seven (7.6%) had both peritubular and glomerular capillary C4d deposition. Twenty of these 22 patients revealed acute cellular rejection, including borderline changes. There was no significant relationship between pathological severity of acute rejection and presence or absence of peritubular capillary C4d deposition. Graft survival was inferior in patients with peritubular capillary C4d deposition to that in patients without C4d deposition (p = 0.0419). Graft survival in patients with glomerular C4d deposition did not differ from that in patients without C4d deposition. In conclusion, C4d deposition in peritubular capillaries has a substantial impact on long‐term graft survival.
Latent IgA deposition from donor kidney is the major risk factor for recurrent IgA nephropathy in renal transplantation
Authors: Moriyama Takahito , Nitta Kosaku , Suzuki Koichi , Honda Kazuho , Horita Shigeru , Uchida Keiko , Yumura Wako , Tanabe Kazunari , Toma Hiroshi , Nihei Hiroshi , Yamaguchi Yutaka
Published: June 2005

Abstract: Background: Previous studies have recognized risk factors for recurrent IgA nephropathy (r‐IgAN) in renal transplantation. However the clinical significance of latent IgA deposition from the donor kidney remains to be determined.

Patients and methods: Between 1992 and 1999, 0‐hour allograft biopsies were performed in 510 renal transplantation recipients at the Kidney Center of Tokyo Women's Medical University. Among these 510 patients, there were 49 whose primary disease was identified as IgAN. Among these 49 patients, 13 patients (26.5%) were diagnosed as having r‐IgAN based on renal biopsy. We compared risk factors of r‐IgAN, including IgA deposition, between the r‐IgAN and non‐r‐IgAN groups.

Results: We assessed factors previously reported to be risk factors for r‐IgAN, such as follow‐up period after transplantation, sex, ages of donors and recipients, donor type, ABO compatible or incompatible transplantation, number of HLA‐A, B, and DR mismatches, number of donors with HLA‐A2, B35, B46, and/or DR4, duration to end stage renal disease, duration of dialysis, and latent IgA deposition from donor kidneys. Latent IgA deposition was the only risk factor that differed significantly in frequency between patients with and without recurrence (38.5% in r‐IgAN group vs. 9.1% in non‐r‐IgAN group, p = 0.037). Other factors did not differ significantly between the two groups. Clinical factors, such as urinary protein excretion, urinary red blood cell sediment and serum creatinine, were significantly worse and the number of patients who required hemodialysis 5 yr after transplantation was significantly higher in the r‐IgAN group than in the non‐r‐IgAN group (38.5 vs. 5.6%, p = 0.001). Four of the five patients who required hemodialysis in the r‐IgAN group had latent IgA deposition from the donor kidney.

Conclusion: Our data suggest that 26.5% out of patients with primary IgAN will develop recurrence within 5 yr after transplantation. Latent IgA deposition from the donor kidney was one of the risk factors of r‐IgAN and it would lead to the development of r‐IgAN. Moreover, r‐IgAN will compromise graft survival, especially in cases with latent IgA deposition from the donor kidney.
Clinicopathological evaluation of renal allograft treated with anti‐CD25 monoclonal antibody
Authors: Okamoto Masahiko , Akioka Kiyokazu , Higuchi Atsushi , Kadotani Yayoi , Ushigome Hidetaka , Uryuhara Kenji , Kaihara Satoshi , Yoshimura Norio
Published: June 2005

Abstract:  Twenty‐seven living‐donor kidney recipients were treated with the antibody against CD25 as the induction immunosuppressive agent. They did not develop acute rejection within 1 month after transplantation, and mean serum creatinine level at 1 month was 1.0 ± 0.4 mg/dL. There were no findings of acute rejection or drug‐induced nephrotoxity in protocol biopsies at 1 month following transplantation. After 1 month had passed, acute rejection occurred in three cases. The pathological grade of acute rejection varied from borderline to grade III by Banff classification. The careful inspection is necessary to find out the occurrences of acute rejection more than 2 months after transplantation because immunological situation has been changing around this period.
Mixed venous oxygen desaturation during early mobilization after coronary artery bypass surgery
Authors: Kirkeby‐Garstad I. , Sellevold O. F. M. , Stenseth R. , Skogvoll E.
Published: June 2005

Background:  Early postoperative mobilization induces a marked reduction in mixed venous oxygen saturation (SvO2) after aortic valve replacement. We investigated whether a similar desaturation occurs among coronary artery bypass grafting (CABG) patients, and if the desaturation was related to the preoperative ejection fraction (EF).

Methods:  Thirty‐one CABG patients with a wide range in EF were included in an open observational study. We recorded hemodynamic and oxygenation variables during mobilization on postoperative day 1 and day 2 using a pulmonary artery catheter.

Results:  Patients with an EF ranging from 24 to 87% were mobilized without clinical problems. SvO2 at rest was 65.4 ± 4.9% (mean ± SD) on day 1 and 64.3 ± 5.8% on day 2 (NS). During mobilization, cardiac index and oxygen delivery were reduced while oxygen consumption was increased (P‐values: 0.000, 0.007 and 0.000, respectively). Consequently, oxygen extraction increased, resulting in a marked reduction in SvO2−42.9 ± 8.3% on day 1 and 47.4 ± 8.5% on day 2 (P = 0.025 between days). Several pre‐, intra‐ and postoperative factors were tested as possible predictors for SvO2 during mobilization. No factor contributed substantially.

Conclusion:  Patients with CABG exhibit a marked desaturation during early postoperative mobilization. Preoperative ejection fraction did not affect SvO2 during exercise. The clinical consequences and underlying mechanism require further investigation.
Xenon anaesthesia may preserve cardiovascular function in patients with heart failure
Authors: Baumert J.‐H. , Falter F. , Eletr D. , Hecker K. E. , Reyle‐Hahn M. , Rossaint R.
Published: June 2005

Background:  The hypothesis that xenon anaesthesia provided haemodynamic stability was tested in patients with heart failure in a prospective, randomized, single‐blind design.

Methods:  Twenty‐six patients scheduled for implantation of a cardioverter‐defibrillator (ICD) received xenon 60–65% in oxygen (xenon group, n = 12) or propofol 3 mg/kg/h (propofol group, n = 14), both combined with remifentanil 0.2 µg/kg/min. After induction of anaesthesia with etomidate and remifentanil, heart rate (HR), mean arterial pressure (MAP) and left ventricular ejection fraction (LVEF) were recorded. After 60 min of propofol or xenon anaesthesia, the same parameters were recorded.

Results:  While HR decreased in both groups, MAP was unchanged with xenon (73 vs. 76 mmHg) and decreased with propofol (from 78 to 64 mmHg, P < 0.02). LVEF was stable in both groups [32% vs. 37%, xenon (NS), and 30% vs. 34%, propofol (NS)]. Preload, as measured by end‐diastolic volume (EDV), did not change (66 vs. 63 ml with xenon; 79 vs. 81 ml with propofol, both NS). Afterload, as determined by end‐systolic pressure‐volume product (ESPV), decreased with propofol (6760 vs. 4920 ml mmHg) but not with xenon (4060 vs. 3780 ml mmHg, P < 0.01 between groups).

Conclusion:  With propofol, MAP is reduced and LVEF is not increased in spite of reduced afterload. In contrast, MAP and LVEF are maintained with xenon.
Effects of phosphodiesterase‐III inhibitors on sevoflurane‐induced impairment of rat diaphragmatic function
Authors: Uesugi T. , Mikawa K. , Nishina K. , Kodama S‐I. , Obara H.
Published: June 2005

Background:  Volatile anesthetics are known to cause diaphragmatic dysfunction using a whole body model. The first aim of the current study was to compare the impairing effect of halothane and sevoflurane on diaphragmatic contractile functions under unfatigued and fatigued conditions. The second purpose was to determine whether phosphodiesterase‐III inhibitors can attenuate sevoflurane‐potentiated reduction of contractility after fatigue.

Methods:  Using rat‐isolated muscle strips, diaphragmatic twitch characteristics and tetanic contractions were measured before and after muscle fatigue, which was induced by repetitive tetanic contraction with or without exposure to halothane (1–3 MAC) or sevoflurane (1–3 MAC). Diaphragmatic functions were further assessed with exposure to 3 MAC sevoflurane in the presence and absence of milrinone, or olprinone. Cyclic adenosine monophosphate (cAMP) concentrations in the fatigued diaphragm were also measured.

Results:  Halothane (1–3 MAC) or sevoflurane (1–2 MAC) did not induce a direct inotropic effect under unfatigued and fatigued conditions. Sevoflurane at 3 MAC enhanced fatigue‐induced impairment of twitch and tetanic tensions. Clinically relevant concentrations of olprinone improved the sevoflurane‐induced potentiation of diaphragmatic dysfunction following fatigue, accompanied by restoration of diaphragmatic cAMP levels, although milrinone failed to do so.

Conclusion:  Our findings suggest that sevoflurane has a greater decreasing effect on diaphragmatic contractility after fatigue than halothane, and that the clinical dose of olprinone surmounts the disadvantage of sevoflurane in various conditions where diaphragmatic fatigue is predisposed.
Palmar skin conductance compared to a developed stress score and to noxious and awakening stimuli on patients in anaesthesia
Authors: Storm H. , Shafiei M. , Myre K. , Ræder J.
Published: June 2005

Background:  The number of fluctuations in the skin conductance per s (NFSC) as a measure of the sympathetic nervous system may be a tool for monitoring physiological stress during surgery and general anaesthesia. The purpose of this study was to find the sensitivity and specificity of the NFSC when compared to a peroperative clinical stress score. Moreover, different patterns of skin conductance responses were compared with the BIS score to find out if the mean level of skin conductance (SC) and NFSC monitoring could differentiate between awakening and noxious stimuli.

Methods:  Fourteen patients were studied during stressful or non‐stressful registration periods. During each registration period, the NFSC was compared to a five‐point clinical stress score (CSS) (systolic blood pressure >130 mmHg, cough, tears, EMG in the forehead >50 or movements) and BIS score.

Results:  The NFSC and the CSS both indicated physiological stress at 12 registrations and no stress at 186 registrations. The NFSC indicated physiological stress without signs of clinical stress (CSS = 0) in 28 registrations, whereas signs of clinical stress (CSS > 0) were indicated on two occasions without signs of stress in the NFSC. The sensitivity of the NFSC when compared to the CSS was 86% and the specificity was 86%. Moreover, in all situations (n = 16) where NFSC indicated stress and the BIS score >50, the SC increased. This was different from situations (n = 13) where NFSC indicated stress and the BIS score <50, then the SC did not increase (P < 0.001).

Conclusion:  The NFSC is sensitive to clinical stress during surgical stimulation. Moreover, the combined use of SC and NFSC may have a potential to differentiate between situations of stress due to inadequate hypnotic effect vs. inadequate analgesic effect.
Plasma propofol concentrations during orthotopic liver transplantation
Authors: Wu J. , Zhu S. M. , He H. L. , Weng X. C. , Huang S. Q. , Chen Y. Z.
Published: June 2005

Objective:  The aim of this study was to investigate the changes in plasma concentrations of propofol in three phases (the paleohepatic, anhepatic, and neohepatic phases) during orthotopic liver transplantation (OLT) using target‐controlled infusion (TCI).

Methods:  Ten patients undergoing OLT without venovenous bypass were studied (age 29–53 years, weight 56–79 kg). After intubation, a non‐hypnotic target concentration of propofol 0.5 µg ml−1 using a Diprifusor® pump (Zeneca Pharmaceuticals, Macclesfield, UK) was administered as a supplement anesthesia throughout the procedure. Plasma samples were obtained in each phase for propofol assay, respectively. Performance parameters for the Diprifusor® system in each phase, the percentage median performance error (MDPE), the percentage median absolute performance error (MDAPE), and the percentage median absolute constancy error (MDACE) were evaluated.

Results:  In all patients, measured plasma propofol concentrations were several times higher than Diprifusor® values in each phase during the procedure. In nine patients, propofol concentrations in the anhepatic phase were higher than those in the paleohepatic or neohepatic phase (P < 0.05). There were no significant differences between the paleohepatic and neohepatic phases. Interindividual variation of the plasma propofol concentrations was significant (P < 0.05). Percentage median performance error of Diprifusor® in each phase, as well as MDAPE, was large (>300%) and was significantly higher in the anhepatic phase (P < 0.01), whereas MDACE was relatively small and there was no significant difference between phases.

Conclusions:  Models used by Diprifusor® are not suitable for liver transplantation patients. A further study should be performed in order to determine all pharmacokinetic parameters of propofol in these patients.
Effects of sevoflurane and desflurane on cytokine response during tympanoplasty surgery
Authors: Koksal G. M. , Sayilgan C. , Gungor G. , Oz H. , Sen O. , Uzun H. , Aydin S.
Published: June 2005

Background:  This study was devised to compare the effects of sevoflurane and desflurane anaesthesia on the cytokine response.

Methods:  Sixty ASA I–II patients, scheduled for tympanoplasty, were randomly allocated to be anaesthetized with either sevoflurane or desflurane at maintenance inspiratory concentrations of 1–1.5 MAC of either agent. Blood samples were taken for plasma tumour necrosis factor α (TNFα), interleukin 1β and interleukin‐6 assay before induction of anaesthesia, before surgery, and at the end of surgery. Alveolar cells were obtained after induction of anaesthesia and at the end of surgery.

Results:  Plasma TNFα was greater with desflurane than sevoflurane both before surgery (45.1 ± 3.5 pg ml−1 for desflurane vs. 23.2 ± 2.5 pg ml−1 for sevoflurane, P < 0.01) and (62.0 ± 5.3 pg ml−1 vs. 35.5 ± 4.6 pg ml−1, P < 0.001). Interleukin 1β was similarly greater with desflurane than sevoflurane before (39.3 ± 4.0 pg ml−1 vs. 17.4 ± 3.0 pg ml−1; P < 0.01) and after surgery (46.0 ± 3.4 pg ml−1 vs. 23.3 ± 3.2 pg ml−1, P < 0.001). There were similar results for interleukin 6 before (42.3 ± 3.5 pg mls−1. 29.0 ± 2.6 pg ml−1, P < 0.001) and after surgery (86.0 ± 4.5 pg ml−1 vs. 45.9 ± 6.3 pg ml−1, P < 0.001). Alveolar cell TNFα concentrations after surgery were also greater with desflurane than sevoflurane (96.3 ± 12.4 pg ml−1 vs. 64.8 ± 10.1 pg ml−1, P < 0.001), as were interleukin 1β (75.4 ± 6.2 pg ml−1 vs. 32.0 ± 8.3 pg ml−1, P < 0.001) and interleukin 6 concentrations (540.1 ± 65.3 pg ml−1 vs. 363.6 ± 29.2 pg ml−1, P < 0.001).

Conclusion:  Desflurane appears to cause a greater systemic and intrapulmonary pro‐inflammatory response than sevoflurane during anaesthesia for ear surgery.
Effects of ephedrine on intubating conditions following priming with rocuronium
Authors: Leykin Y. , Pellis T. , Lucca M. , Gullo A.
Published: June 2005

Background:  Onset of action of muscle relaxants is influenced by cardiac output and muscle blood flow. Ephedrine reduces the onset time of rocuronium. Onset is also shortened by priming. Accordingly, we hypothesized that priming combined with ephedrine is superior to either technique used separately.

Methods:  Four groups of randomly allocated patients (n = 31), ASA I – II, were induced with propofol 2.5 mg kg−1. In groups I and II, 0.04 mg kg−1 of rocuronium was followed by a 3‐min priming interval. Induction was followed by an intubation dose of 0.04 mg kg−1. Then a 30‐s intubation was attempted. In groups III and IV the same sequence was repeated except for sham priming and an intubation dose of 0.44 mg kg−1. In groups I and II, ephedrine (210 µg kg−1) was injected before propofol. In groups II and V, an equivalent volume of normal saline was injected. Jaw relaxation, vocal cord position, and diaphragmatic response were used to assess intubating conditions.

Results:  All patients of group I were intubated 30 s after the intubating dose and within a 20‐s interval compared with 74% of patients in groups II and III, and 84% of patients in group IV. Intubating conditions were graded good to excellent in all patients in group I compared with 42% of those in group II, 35% in group III and 52% in group IV (P < 0.01 vs. group I). During the priming interval, no adverse effects were observed or reported.

Conclusions:  Ephedrine in combination with propofol significantly improved clinical intubating conditions at 30 s following priming with rocuronium compared with priming with ephedrine without priming.
Comparison of the effects of isoflurane and sevoflurane on protein tyrosine phosphorylation‐mediated vascular contraction
Authors: Yu J. , Mizumoto K. , Kakutani T. , Hasegawa A. , Ogawa K. , Hatano Y.
Published: June 2005

Background:  Isoflurane induces greater effects on vasodilation and decreasing blood pressure than sevoflurane. Tyrosine kinase‐catalyzed protein tyrosine phosphorylation plays an important role in regulating vascular smooth muscle contraction. The aim of the present study was to compare the effects of isoflurane and sevoflurane on tyrosine phosphorylation‐mediated vascular constriction, by assessing the degree of sodium orthovanadate (Na3VO4, tyrosine phosphatase inhibitor)‐induced contraction and protein tyrosine phosphorylation of rat aortic smooth muscle.

Methods:  Na3VO4‐induced contraction and protein tyrosine phosphorylation of rat aortic smooth muscle were measured in the presence of genistein, a tyrosine kinase inhibitor, and different concentrations of isoflurane and sevoflurane, using isometric force measurement and Western blot, respectively.

Results:  Na3VO4 (10−4 M) induced sustained contraction and tyrosine phosphorylation of substrates that were both markedly attenuated in the presence of genistein (5 × 10−5 M). Isoflurane and sevoflurane dose‐dependently (1, 2, 3 MAC) attenuated the Na3VO4‐induced contraction (P < 0.05–0.005, n = 8), with a greater degree of inhibition by isoflurane than sevoflurane at 2 MAC (P < 0.01) and 3 MAC (P < 0.05). Both anesthetics also attenuated the total band density of the Na3VO4‐induced, tyrosine‐phosphorylated substrates in a concentration‐dependent manner (P < 0.05–0.005, n = 4), with much greater attenuation by isoflurane than sevoflurane at 1 and 2 MAC (P < 0.05), respectively.

Conclusion:  The results of the present study demonstrate that isoflurane exhibits a greater degree of inhibition on the Na3VO4‐stimulated contraction and protein tyrosine phosphorylation of rat aortic smooth muscle compared with sevoflurane. These findings suggest that isoflurane depresses the protein tyrosine phosphorylation‐mediated contraction of vascular smooth muscle to a greater degree than sevoflurane.
Characterization of inhibition of platelet function by paracetamol and its interaction with diclofenac in vitro
Authors: Munsterhjelm E. , Niemi T. T. , Ylikorkala O. , Silvanto M. , Rosenberg P. H.
Published: June 2005

Background:  Paracetamol (acetaminophen) is an effective analgesic and a weak inhibitor of cyclo‐oxygenase (COX). Clinically paracetamol is often used together with traditional NSAIDs, which are strong inhibitors of COX. We studied binding of paracetamol to COX and its action on platelet function together with diclofenac.

Methods:  Blood was collected from healthy donors and platelet function was assessed by photometric aggregometry, a platelet function analyser (PFA‐100™, Dade Behring, Deerfield, IL) and by measuring the release of thromboxane B2 (TxB2), the stable metabolite of thromboxane A2, after addition of paracetamol (10–80 µg ml−1). A concentration‐inhibition relationship was established and the inhibition coefficient (Ki) demonstrating 50% binding to COX was determined using a Schild‐plot. Interaction of paracetamol (5–20 µg ml−1) and diclofenac (0.1–0.8 µg ml−1) was determined and an isobolographic analysis was performed.

Results:  Paracetamol added to platelet‐rich plasma (PRP) caused a concentration‐dependent inhibition of platelet function. Photometric aggregometry and TxB2 release was significantly inhibited by paracetamol from 10 µg ml−1 onwards. The PFA‐100™ closure time was significantly prolonged by paracetamol at a high concentration only. Ki was 15.2 µg ml−1 with a 95% confidence interval of 11.8–18.6 µg ml−1. Inhibition of aggregation by diclofenac was augmented by paracetamol. Isobolographic analysis showed synergism.

Conclusions:  The 95% confidence interval of Ki equals the antipyretic plasma concentration of paracetamol, i.e. 10–20 µg ml−1. High doses of paracetamol and a combination of diclofenac and paracetamol cause platelet inhibition and thus may increase risk of surgical bleeding.
Effect of low‐dose N‐acetyl‐cysteine infusion on tourniquet‐induced ischaemia‐reperfusion injury in arthroscopic knee surgery
Authors: Saricaoglu F. , Dal D. , Salman A. E. , Atay Ö. A. , Doral M. N. , Salman M. A. , Kilinç K. , Aypar Ü.
Published: June 2005

Background:  Temporary occlusion of blood flow is used during arthroscopic knee surgery in order to provide a bloodless surgical field. The resulting ischaemia‐reperfusion causes lipid peroxidation, which contributes to tissue injury. The aim of the study was to investigate the effect of low‐dose n‐acetyl cysteine (NAC) infusion on oxidative stress by determining malondialdehyde (MDA) levels during arthroscopic knee surgery.

Methods:  Thirty patients, ASA I – II, undergoing arthroscopic knee debridement under a tourniquet were divided into NAC and control groups. Anaesthesia was induced with propofol, fentanyl and vecuronium bromide and maintained with desflurane in an equal parts O2‐N2O mixture. In the NAC group, an infusion of NAC, 5 mg kg−1.h−1, was started after intubation, and continued until extubation. An equal volume of saline was infused to the control group. Duration of ischaemia, anaesthesia time, total dose of NAC infused were also recorded. Venous blood and synovial membrane tissue samples were obtained 10 min after the onset of NAC infusion but before tourniquet inflation (t1), after 30 min of ischaemia (t2), and after 5 min of reperfusion following tourniquet release (t3).

Results:  Plasma MDA levels were significantly lower in the NAC group on reperfusion. There were no differences between the groups in tissue MDA levels at ischaemia and reperfusion times.

Conclusion:  Low‐dose n‐acetyl cysteine infusion attenuates lipid peroxidation and ischaemia‐reperfusion injury in arthroscopic knee surgery requiring tourniquet application.
Remifentanil patient‐controlled analgesia following cardiac surgery
Authors: Krishnan K. , Elliot S. C. , Berridge J. C. , Mallick A.
Published: June 2005

Background:  Remifentanil is increasingly used as a component of cardiac anaesthesia. Following cardiac surgery remifentanil is often substituted for alternative opioids on the intensive care unit. We were interested to evaluate postoperative continuation of remifentanil in the form of remifentanil patient control analgesia (RPCA) for those patients who received intraoperative remifentanil. The objectives of this study were to assess the safety, efficacy and feasibility of the RPCA.

Methods:  Ten patients who received an intravenous infusion of remifentanil perioperatively for coronary artery bypass graft surgery (CABG) had their remifentanil infusion converted to RPCA following extubation on the intensive care unit. Remifentanil patient control analgesia delivered an initial background infusion consistent with the infusion rate at extubation and with a bolus facility of 50 µg administered over 5 min followed by a 5‐min lockout. Data collection included sedation and pain scores, respiratory rate, arterial blood gases, number of successful/unsuccessful attempts and the background infusion rate for each subject over a period of 12 h following extubation.

Results:  The data from nine male and one female patient were analyzed by using SPSS11 for Windows. During the study period the patients achieved adequate pain control and made more RPCA attempts at lower background infusion rates. No episodes of apnoea, SpO2 less than 95% or a rise in PaCO2 greater than 6.5 kPa were observed.

Conclusion:  Remifentanil patient control analgesia with a background infusion was effective and safe for postoperative pain relief in this group of spontaneously breathing ICU patients following cardiac surgery.
Cerebral state index during anaesthetic induction: a comparative study with propofol or nitrous oxide
Authors: Anderson R. E. , Barr G. , Jakobsson J. G.
Published: June 2005

Background:  Confidently predicting the depth of anaesthesia for the individual patient and independently of drug(s) type using EEG‐based monitors has proven difficult. This open, randomized, explorative study of day surgical patients evaluates the ability of the Cerebral State Monitor™ (Danmeter AB, Odense, Denmark) of anaesthetic depth to identify loss of response (LOR) using either propofol or N20 for induction.

Methods:  In this open, randomized study, day surgical patients (n=10 in each group) were studied using the Cerebral State Index Monitor™. After baseline measurements, induction to LOR was achieved with either repeated 30‐mg boluses of propofol every second minute or with N20 (after premedication 5 min before with 30 mg propofol) increased every other minute in 15% increments (max. 75%). Sedation level was evaluated every other minute using the Observer's Assessment of Alertness/Sedation scale

Results:  Baseline values were 91 (82–98) and 94 (82–100) for N20 and propofol patients, respectively. During induction CSI™ decreased with increasing sedation in patients given propofol (P<0.001) but not in patients given nitrous oxide. Median value at LOR was 56 (40–76) and 95 (87–100) for the propofol and nitrous oxide group of patients, respectively.

Conclusion:  The Cerebral State Index™ behaves as other depth of anaesthesia monitors with a progressive decrease during propofol induction but loss of consciousness with N20 results in no change in CSI™.
Prevention of catheter‐related bloodstream infections: An appraisal of developments in designing an infection‐resistant ‘dream dialysis‐catheter’ (Review Article)
Authors: SAXENA ANIL K , PANHOTRA BODH R
Published: June 2005

SUMMARY:  With the increasing number of elderly, diabetics and debilitated patients being accepted for haemodialysis (HD), the use of central venous catheters (CVCs) as vascular access has become more widespread, with an inevitable inherent risk of catheter‐related bloodstream infections (CRBSI) and ensuing mortality. No reliable plans for the effective management of CRBSI without actually sacrificing vascular access sites are presently available. Therefore, the onus really falls on renal physicians to make effective use of the established supportive guiding principles, practices, policies and programs to prevent CRBSI among HD patients. A huge body of research in polymer industry has aimed at alterations of physical, chemical, biological and immunological properties of CVCs to prevent the bacterial colonization of catheters. Developing an infection‐resistant dialysis catheter has been an elusive dream. This article analyses the current state‐of‐the‐art strategies aimed at preventing CRBSI and also reviews the progress made to date, in the direction of development of a ‘bioactive’ thrombosis and infection‐resistant dialysis catheter.
Epstein–Barr virus‐related primary central nervous system lymphoma after cadaveric renal transplantation improved by treatment with high‐dose methotrexate followed by irradiation (Case Report)
Authors: HIGUCHI MAKOTO , HATA TAKENORI , FURUYA SHINO , HOSAKA SHIGETOSHI , KAMIJO YUJI , KIYOSAWA KENDO , ISHIZUKA OSAMU , NISHIZAWA OSAMU , HORA KAZUHIKO
Published: June 2005

SUMMARY:  A 57‐year‐old man was admitted to hospital because of motor aphasia on 16 September 2000. He had an approximate 2‐year history of haemodialysis treatment, since April 1997, and had received a cadaveric renal transplantation in July 1999. Computed tomography and magnetic resonance imaging (MRI) revealed a mass with ringed enhancement in the left temporal‐parietal lobe. Primary central nervous system (CNS) lymphoma (diffuse large B cell type) was diagnosed based on an open brain tumour biopsy. Epstein–Barr virus early RNA (EBER) in situ hybridization showed positive signals in the nuclei of the CNS lymphoma cells. A dose reduction of immunosuppressant and three series of high‐dose methotrexate (MTX) therapy with leucovorine rescue followed by irradiation (whole brain irradiation, 30 Gy; partial brain tumour irradiation, 20 Gy) were carried out for his primary CNS lymphoma. The patient is currently in good condition (September 2004) with no enlargement of the lymphoma, as examined by MRI every 3 months, and preserved renal function.
Future of home haemodialysis in Australia and New Zealand (Review Article)
Authors: LYNN KELVIN L , BUTTIMORE ADRIAN L
Published: June 2005

SUMMARY:  Maintenance haemodialysis (HD) was pioneered in Seattle and rapidly became home‐based. When dialysis treatment began in Australia and New Zealand, home haemodialysis (HHD) became the predominant form of dialysis. When compared with in‐centre conventional dialysis, HHD is associated with superior survival and quality of life and is cheaper. There is currently significant interest in increasing the frequency and duration of dialysis and in providing more flexible dialysis regimens for patients. If the likely benefits of these treatment changes are to be fully realized HHD and self care HD services will need to expand. Dialysis units in Australia and New Zealand are better equipped than most to respond to this challenge.
Impact of rHuEPO therapy initiation on soluble adhesion molecule levels in haemodialysis patients
Authors: KAHRAMAN SERKAN , YILMAZ RAHMI , KIRKPANTUR ALPER , GENCTOY GULTEKIN , ARICI MUSTAFA , ALTUN BULENT , ERDEM YUNUS , YASAVUL UNAL , TURGAN CETIN
Published: June 2005

Background:  Increased levels of soluble adhesion molecules have been reported in haemodialysis (HD) patients. Recent studies have shown that recombinant human erythropoietin (rHuEPO) elicits proliferation and migration of endothelial cells and modifies endothelial function. The present study was design to explore the effects of rHuEPO on serum levels of soluble adhesion molecules in HD patients.

Methods:  Soluble serum levels of E‐selectin (sE‐selectin), intracellular adhesion molecule‐1 (sICAM‐1) and vascular cell adhesion molecule‐1 (sVCAM‐1) were measured by ELISA in 29 rHuEPO naïve HD patients (20 males, 9 females) and 10 control subjects at baseline and second month. The HD patients with a haemoglobin level lower than 10.0 mg/dL (n = 19) were administered rHuEPO therapy and other HD patients (n = 10) were followed as a placebo group.

Results:  Serum levels of soluble adhesion molecules were significantly higher in HD patients compared with the control group. A significant rise from the baseline in sE‐selectin levels (77 ± 70 vs 100 ± 86 ng/mL, P < 0.05) was observed 2 months after rHuEPO initiation, while sICAM‐1 and sVCAM‐1 levels decreased (271 ± 261 vs 197 ± 89 and 1043 ± 243 vs 990 ± 236 ng/mL, respectively, P < 0.05).

Conclusions:  The present data indicate that rHuEPO could have an important action on serum levels of soluble adhesion molecules in HD patients. rHuEPO might modify the expression of adhesion molecules from endothelial cells either. However, the exact mechanism responsible for the serum elevation of these molecules in HD patients is yet to be fully elucidated.
Serum and peripheral blood mononuclear cells infectious burden: Correlation to inflammation and atherosclerosis in haemodialysis patients
Authors: TSIRPANLIS GEORGE , CHATZIPANAGIOTOU STYLIANOS , IOANNIDIS ANASTASIOS , BOUFIDOU FOTINI , MOUTAFIS SPYROS , NICOLAOU CHRYSOULA
Published: June 2005

Background:  Infectious agents may be implicated in the inflammatory atherosclerotic process. Not only specific microorganisms but also the infectious burden, defined as the number of pathogens to which a patient is exposed, has been associated with atherosclerosis. In the present study, the infectious burden, determined directly (by identification of viable pathogens in peripheral blood mononuclear cells (PBMC)) and indirectly (by serum antibodies detection) is correlated to the inflammatory and atherosclerotic status in haemodialysis (HD) patients, a population at high risk for cardiovascular disease.

Methods:  The viable forms of four microorganisms (Chlamydia pneumoniae, herpes virus 1 and 2 and cytomegalovirus) were identified in patients PBMC by cell cultures and subsequent polymerase chain reaction. Serum IgG against the above pathogens and Helicobacter pylori were also determined. Inflammation was assessed by measurement of C‐reactive protein (CRP), serum amyloid A (SAA), three pro‐ and one anti‐inflammatory cytokines and four adhesion molecules. Atherosclerosis was defined by a scoring system using medical history data.

Results:  The number of viable pathogens identified in PBMC in the 122 HD patients included in the study were zero in 22.1% of them, one in 33.6%, two in 43.4% and three in one patient. The number of IgG antibodies determined was one in 6.6% of patients, two in 32%, three in 48.4% and four in 13.1%. Seropositivity was not significantly different between patients with or without the respective viable pathogen identified in PBMC. Atherosclerosis was present in 40.2% of patients, and CRP, SAA and interleukin‐6 were all increased in these patients. Neither inflammatory indexes nor atherosclerosis were significantly different in patients with a higher number of viable pathogens detected in PBMC or in those with a higher antibodies number.

Conclusions:  The direct infectious burden determination (the number of viable pathogens in PBMC) does not coincide with the serum (by IgG detection) infectious burden. Although inflammation correlates to atherosclerosis, neither PBMC nor the serum infectious burden is associated with these two entities in the inflamed and atherosclerotic HD patients.
Diabetic end‐stage renal disease in the indigenous population of the Commonwealth of the Northern Mariana Islands
Authors: ABIDI SYED M , NEGRETE HILMER O , ZAHID IMRAN , BENNETT PETER H , NELSON ROBERT G
Published: June 2005

SUMMARY: The number of cases of treated end‐stage renal disease (ESRD) attributable to type 2 diabetes and survival after the onset of renal replacement therapy was examined in the Commonwealth of the Northern Mariana Islands (CNMI). All Chamorros and Carolinians to receive renal replacement therapy for ESRD between January 1982 and December 2002 were identified. Changes in survival over time were examined by dividing the study into three equal periods. Of 180 new cases of ESRD, 137 (76%; 101 Chamorros, 36 Carolinians) were attributed to diabetes. Ninety‐nine subjects, 80% of whom had diabetic ESRD, began renal replacement therapy in the last 7 years of the study compared with 81 (72% with diabetic ESRD) in the previous 14 years. All 137 of the diabetic subjects received haemodialysis. During the 21‐year study period, 79 of the diabetic subjects receiving dialysis died. The median survival after the onset of haemodialysis was 37 months in the first time period (1982–1988), 47 months in the second period (1989–1995) and 67 months in the third period (1996–2002). The death rate in the first period was 4.3 times (95% CI, 2.1–8.9) as high and the second period was 2.9 times (95% CI, 1.5–5.8) as high as the most recent period, after adjustment for age, sex and ethnicity in a proportional‐hazards analysis. The number of diabetic patients in CNMI who are receiving renal replacement therapy is rising rapidly. Considerable improvement in survival after the onset of haemodialysis has occurred over the past 21 years.