bluuebunny/crossref_metadata_2025 huggingface dataset:
REGIONAL DIFFERENCES IN EXTRACELLULAR PURINE DEGRADATION IN THE PROSTATIC AND EPIDIDYMAL PORTIONS OF THE RAT VAS DEFERENS
Authors: Diniz Carmen , Fresco Paula , Gonçalves Jorge
Published: September 2005

1. The aim of the present study was to compare ecto‐nucleotidase activities in rat bisected vas deferens using 1,N6‐etheno(ε)‐nucleotides (ε‐ATP and ε‐AMP) as substrates. Degradation was estimated by measuring the disappearance of the substrate and the appearance of its metabolites using HPLC with fluorescence detection. Incubation of tissue preparations (prostatic or epididymal portions) with 300 nmol/L ε‐ATP at 37°C caused a partial disappearance of ε‐ATP and appearance of its metabolites (ε‐ADP, ε‐AMP and ε‐adenosine). Incubation at 25°C reduced ε‐ATP degradation more in the prostatic than in the epididymal portion.

2. Incubation of tissue preparations with ε‐AMP at 37°C resulted in the disappearance of ε‐AMP and the appearance of ε‐adenosine, which was more pronounced in the epididymal than in the prostatic portion. Incubation at 25°C reduced ε‐AMP degradation more in the epididymal than in the prostatic portion.

3. Decreasing pH from 7.4 to 6.5 enhanced ε‐AMP degradation only in the prostatic portion, whereas increasing pH from 7.4 to 8.5 enhanced ε‐AMP degradation in both portions, but more markedly in the epididymal portion. The alkaline phosphatase inhibitors levamisole (10 mmol/L) and β‐glycerophosphate (10 mmol/L) reduced ε‐AMP degradation only in the epididymal portion.

4. In conclusion, the results of the present study are compatible with the presence, in the bisected rat vas deferens, of an ecto‐nucleotidase system that is involved in the degradation of extracellular purines, which may differ between the epididymal and prostatic portions, with the epididymal portion presenting a different and higher capacity to form adenosine.
ACUTE EFFECTS OF CANDESARTAN ON RAT RENAL HAEMODYNAMICS AND PROXIMAL TUBULAR REABSORPTION
Authors: Hiranyachattada Siriphun , Saetew Siriwan , Harris Peter J
Published: September 2005

1. The effects of the specific angiotensin II receptor type I (AT1) antagonist candesartan on renal proximal tubular sodium transport were studied using lithium clearance. The effects of candesartan on mean arterial blood pressure (MABP), renal plasma flow (RPF), glomerular filtration rate (GFR) and sodium and potassium excretion were also investigated.

2. Male Wistar rats were anaesthetized with Inactin (thiobutabarbital sodium; Sigma, St Louis, MO, USA). Clearance markers (8% polyfructosan, 1% para‐aminohippuric acid and 4 mmol/l lithium chloride) were given into a jugular vein at the rate of 1.6 mL/h per 100 g bodyweight. Candesartan was given as bolus injection (0.01, 0.1, 0.2, 0.5 and 1.0 mg/kg) followed by 60 min continuous infusion at a rate of 0.5, 5, 10, 25 and 50 µg/min per kg, respectively.

3. The non‐depressor dose of candesartan (0.01 mg/kg) did not alter RPF or GFR, whereas diuresis, natriuresis and kaliuresis were observed. The higher doses of candesartan reduced MABP, RPF and GFR, although diuresis, natriuresis and kaliuresis were still observed.

4. Renal tubular sodium and water reabsorption were inhibited after intravenous administration of candesartan independently of an alteration in arterial pressure. Lithium clearance data indicate that the site of inhibition was in the proximal nephron segment.
EFFECTS OF ECONAZOLE ON Ca2+ LEVELS IN AND THE GROWTH OF HUMAN PROSTATE CANCER PC3 CELLS
Authors: Huang Jong‐Khing , Liu Chung‐Shin , Chou Chiang‐Ting , Liu Shiuh‐Inn , Hsu Shu‐Shong , Chang Hong‐Tai , Hsieh Ching‐Hong , Chang Chih‐Hung , Chen Wei‐Chuan , Jan Chung‐Ren
Published: September 2005

1. Econazole is used clinically as an antifungal drug with many different in vitro effects. However, the effects of econazole on prostate cancer cells are unknown. The effects of econazole on intracellular Ca2+ concentrations ([Ca2+]i) in and the proliferation of human PC3 prostate cancer cells was explored in the present study using fura‐2 and tetrazolium as fluorescent dyes.

2. At a concentration of 0.1 µmol/L, econazole started to increase [Ca2+]i in a concentration‐dependent manner. The econazole‐induced increase in [Ca2+]i was reduced by 48% by removal of extracellular Ca2+, suggesting that the econazole‐induced increase in [Ca2+]i was composed of extracellular Ca2+ influx and intracellular Ca2+.

3. This econazole‐induced Ca2+ influx was via an L‐type Ca2+ channel‐like pathway. In Ca2+‐free medium, 1 µmol/L thapsigargin, an inhibitor of the endoplasmic reticulum Ca2+‐ATPase, caused a monophasic increase in [Ca2+]i, after which the effect of econazole to increase [Ca2+]i was substantially inhibited. Conversely, pretreatment with 5 µmol/L econazole to deplete intracellular Ca2+ stores totally prevented thapsigargin from releasing more Ca2+.

4. The phospholipase C (PLC) inhibitor U73122 (2 µmol/L) abolished the increase in [Ca2+]i induced by 10 µmol/L ATP (a Ca2+ mobilizer that needs inositol 1,4,5‐trisphosphate).

5. Overnight incubation with 1–30 µmol/L econazole inhibited proliferation of PC3 cells in a concentration‐dependent manner.

6. These findings suggest that, in PC3 cells, econazole increases [Ca2+]i by stimulating Ca2+ influx into cells and Ca2+ release from the endoplasmic reticulum via a PLC‐independent mechanism. Econazole is cytotoxic at submicromolar concentrations.
IN VITRO INHIBITORY EFFECTS OF ATORVASTATIN ON CARDIAC FIBROBLASTS: IMPLICATIONS FOR VENTRICULAR REMODELLING
Authors: Martin Jennifer , Denver Rachel , Bailey Michael , Krum Henry
Published: September 2005

1. Hydroxy‐3‐methylglutaryl coenzyme A (HMG CoA) reductase inhibitors (statins) reduce mortality after myocardial infarction (MI). Although this may be predominantly due to their known anti‐ischaemic actions, these drugs are known to have other beneficial effects.

2. Because pathological deposition of extracellular matrix (ECM) material is a key component of remodelling after MI, we sought to determine whether atorvastatin could inhibit ECM production in vitro.

3. The addition of atorvastatin to rat cardiac fibroblasts stimulated with either transforming growth factor (TGF)‐β1 (TGF‐β1) or angiotensin (Ang) II reduced collagen synthesis in a dose‐dependent manner (3.7‐fold reduction (95% confidence interval (CI) 1.8–15; P < 0.01) and 5.3‐fold reduction (95% CI 1.8–7.7; P < 0.01), respectively, compared with stimulant alone). Similar observations were made in human cardiac fibroblast cell culture. Atorvastatin also dose‐dependently reduced TGF‐β1 and AngII‐induced increases in α(I)‐procollagen mRNA (P < 0.01 for both), as well as gene expression of the profibrotic peptide connective tissue growth factor.

4. Atorvastatin appears to directly inhibit collagen production by cardiac fibroblasts. This antifibrotic action may contribute to the antiremodelling effect of statins.
CARDIOVASCULAR ACTIONS OF THE VENOM FROM THE IRUKANDJI (CARUKIA BARNESI) JELLYFISH: EFFECTS IN HUMAN, RAT AND GUINEA‐PIG TISSUES IN VITRO AND IN PIGS IN VITRO
Authors: Winkel Kenneth D , Tibballs James , Molenaar Peter , Lambert Gavin , Coles Peter , Ross‐Smith Mark , Wiltshire Carolyn , Fenner Peter J , Gershwin Lisa‐Ann , Hawdon Gabrielle M , Wright Christine E , Angus James A
Published: September 2005

1. We have investigated the cardiovascular pharmacology of the crude venom extract (CVE) from the potentially lethal, very small carybdeid jellyfish Carukia barnesi, in rat, guinea‐pig and human isolated tissues and anaesthetized piglets.

2. In rat and guinea‐pig isolated right atria, CVE (0.1–10 µg/mL) caused tachycardia in the presence of atropine (1 µmol/L), a response almost completely abolished by pretreatment with tetrodotoxin (TTX; 0.1 µmol/L). In paced left atria from guinea‐pig or rat, CVE (0.1–3 µg/mL) caused a positive inotropic response in the presence of atropine (1 µmol/L).

3. In rat mesenteric small arteries, CVE (0.1–30 µg/mL) caused concentration‐dependent contractions that were unaffected by 0.1 µmol/L TTX, 0.3 µmol/L prazosin or 0.1 µmol/L ω‐conotoxin GVIA.

4. Neither the rat right atria tachycardic response nor the contraction of rat mesenteric arteries to CVE were affected by the presence of box jellyfish (Chironex fleckeri) antivenom (92.6 units/mL).

5. In human isolated driven right atrial trabeculae muscle strips, CVE (10 µg/mL) tended to cause an initial fall, followed by a more sustained increase, in contractile force. In the presence of atropine (1 µmol/L), CVE only caused a positive inotropic response. In separate experiments in the presence of propranolol (0.2 µmol/L), the negative inotropic effect of CVE was enhanced, whereas the positive inotropic response was markedly decreased.

6. In anaesthetized piglets, CVE (67 µg/kg, i.v.) caused sustained tachycardia and systemic and pulmonary hypertension. Venous blood samples demonstrated a marked elevation in circulating levels of noradrenaline and adrenaline.

7. We conclude that C. barnesi venom may contain a neural sodium channel activator (blocked by TTX) that, in isolated atrial tissue (and in vivo), causes the release of transmitter (and circulating) catecholamines. The venom may also contain a ‘direct’ vasoconstrictor component. These observations explain, at least in part, the clinical features of the potentially deadly Irukandji syndrome.
GLYCOGEN CONTENT AND CONTRACTILE RESPONSIVENESS TO T‐SYSTEM DEPOLARIZATION IN SKINNED MUSCLE FIBRES OF THE RAT
Authors: Goodman Craig , Blazev Ronnie , Stephenson Gabriela
Published: September 2005

1. Glycogen content (determined microfluorometrically), response capacity to transverse tubular (T) system depolarization and the relationship between these two parameters were examined in single, mechanically skinned fibres from rat extensor digitorum longus (EDL) muscle in the presence of high and constant concentrations of ATP and creatine phosphate.

2. The mean total glycogen content (tGlyc) in freshly dissected fibres was 58.1 ± 4.2 mmol glucosyl units/L fibre (n = 53).

3. A large proportion of tGlyc was retained in the skinned fibres (SFGlyc) after 2 and 30 min exposure to an aqueous relaxing solution (73.1 ± 2.8 and 64 ± 12.3%, respectively).

4. When fibres were incubated for 30 min in a high (30 µmol/L)‐Ca2+ solution, the proportion of SFGlyc was markedly lower (approximately 28%), which suggests that rat skinned fibres contain a Ca2+_sensitive glycogenolytic system.

5. In rat skinned fibres, T‐system depolarization‐induced Ca2+ release was not accompanied by a detectable loss of fibre glycogen and there was no correlation between response capacity and initial SFGlyc, indicating that other factors, unrelated to glycogen depletion, ultimately limited the capacity of rat skinned fibres to respond to T‐system depolarization.

6. It is concluded that rat mechanically skinned fibre preparations are well suited for studies of glycogenolysis at a cellular level and that, with further refinement of the depolarization protocol, they may be suitable for studies of the non‐metabolic role of glycogen in mammalian skeletal muscle contractility.
Do surgeons need to look after unwell patients? The role of medical emergency teams
Authors: Wong Kenneth , Levy Richard D.
Published: September 2005

Background:  Medical emergency teams (MET) have been shown to reduce in‐hospital morbidity and mortality of surgical patients. The present study reviews the experience with the use of MET in the care of critically unwell surgical patients.

Methods:  Data were prospectively collected on all patients in a general surgical unit of a tertiary referral centre meeting the criteria for activating a MET over a 6 month period. These data were retrospectively analysed with respect to surgical team and MET involvement in the care of these patients.

Results:  Over the 6 month study period, 22 patients qualified for a MET response based on criteria of physiological instability. A MET was activated for 13 of these patients (59%), with the remainder being managed by direct consultation with intensive care and medical staff. Forty‐six per cent of MET activations were outside of normal working hours. Respiratory distress including tachypnoea and desaturation was the most commonly identified physiological abnormality (13 patients), accounting for 62% of MET activations. A MET was activated by a surgical registrar in 46% of cases. Seventy‐seven per cent of MET activations were preceded by at least one registrar level assessment without resolution of the patient's clinical deterioration. The most common MET interventions were supplementation of oxygen therapy and initiation of pharmacotherapy (11 patients). The surgical team complemented the MET response by providing detailed information regarding the patient's surgical condition, premorbid status (13 patients), organized transfer to the operating theatre (three patients), initiated blood transfusions (two patients) and deciding to order abdominal computed tomography (two patients). Urgent surgical decision making was required in 23% of MET activations.

Conclusions:  Medical emergency team activations for critically unwell surgical patients are complemented by surgical team involvement in the decision making and management process. The MET may be underutilized in the management of unwell surgical patients.
Surgeon and hospital volume and the management of colorectal cancer patients in Australia
Authors: McGrath Daniel R. , Leong David C. , Gibberd Robert , Armstrong Bruce , Spigelman Allan D.
Published: September 2005

Background:  The evidence for a relationship between patient outcomes and clinician and hospital volume is increasing. The National Colorectal Cancer Care Survey was undertaken to determine the management patterns in Australia for individuals newly diagnosed with colorectal cancer in a 3 month period in the year 2000.

Methods:  All new cases of colorectal cancer registered at each Australian State Cancer Registry were entered into the survey. This generated a questionnaire that was sent to the treating surgeon. Chi‐squared tests and logistic regression analyses were used to determine levels of statistical significance.

Results:  Of 2383 surgical questionnaires generated, 2015 (85%) were completed. The majority (58%) of surgeons treated one or two patients with colorectal cancer over the 3 months of the survey. There was variation across surgeon cohorts for preoperative measures including the use of deep vein thrombosis prophylaxis. Patients seen by low volume surgeons were most likely to be given a permanent stoma (P < 0.0001). Patients with rectal cancer who were operated on by high volume surgeons were significantly more likely to receive a colonic pouch (P < 0.0001).

Conclusion:  This nationwide population‐based survey of the treatment of colorectal cancer patients suggests that the delivery of care by surgeons (the majority) who treat patients with rectal cancer infrequently should be evaluated.
Factors associated with morbitity in liver hydatid surgery
Authors: Manterola Carlos , Vial Manuel , Pineda Viviana , Sanhueza Antonio , Barroso Manuel
Published: September 2005

Background:  The purpose of the present paper was to determine the association between clinical evolutionary and laboratory variables with postoperative morbidity in patients surgically treated for liver hydatidosis (LH).

Methods:  A case−control nested cohort study was undertaken. Patients were studied and surgically treated in Hospital Regional of Temuco between 1994 and 2001. The morbidity variable registered with a minimum 12‐month follow‐up period was considered in a dichotomous way. The association with clinical, laboratory, evolutionary, and surgical variables was studied. Descriptive statistics, bivariate analysis using χ2 and Fisher's exact test for categorical variables; t‐test, anova, and Kruskal−Wallis for continuous variables; odds ratio calculations, and ordinal and multivariate logistic regression models were applied.

Results:  The cohort was composed of 202 patients surgically treated for LH, 112 women (55.5%) and 90 men (44.5%), with an average age of 45.2 years. Average morbidity of the series, with a median follow‐up period of 53 months, was 16.4%. Six variables were significantly associated in the bivariate analysis (age, haematocrit, total leucocyte count, alkaline phosphatase, history of previous surgery for LH and existence of biliary communications), but only two achieved statistical significance in the multivariate model (age and history of previous surgery for LH; P = 0.017 and 0.018; and odds ratio of 1.0 and 4.1, respectively).

Conclusions:  In surgical decision making for patients with LH, the history of previous surgery for LH must be considered as a risk factor for postoperative morbidity.
Diagnostic value of routine drain tip culture in primary joint arthroplasty
Authors: Weinrauch Patrick
Published: September 2005

Background:  Closed suction drainage after joint arthroplasty is common practice in many institutions. The purpose of this study was to determine the correlation between routine drain tip culture and the diagnosis of superficial or deep postoperative wound infection after primary knee and hip replacement.

Methods:  Over a 12‐month period, drain tips were retrieved and cultured in all patients who underwent unilateral primary total knee or hip replacement with the use of closed suction drainage. A total of 393 cultures was performed in 387 patients (145 hip replacements, 242 knee replacements). Patients were followed for an average of 8.9 months after surgery to assess for postoperative wound infection.

Results:  Three patients had a positive drain tip culture, none of which were diagnosed with superficial or deep infection. Four patients (1%) were diagnosed with deep infection, 16 (4.1%) with superficial infection. No patient with either superficial or deep infection had a positive drain tip culture after their index procedure. The sensitivity of routine drain tip culture for the diagnosis of postoperative infection in primary joint replacement was 0% and specificity was 99.2%.

Conclusions:  These data do not support the practice of routine drain tip culture after primary hip or knee replacement for the diagnosis of postoperative infection.
National Breast Cancer Audit: establishing a web‐based data system
Authors: Boult Margaret , Cuncins‐Hearn Astrid , Tyson Sarah , Kollias Jim , Babidge Wendy , Maddern Guy
Published: September 2005

Background:  An audit of surgical treatment of early breast cancer was introduced nationally in 1999. In August 2002, the Australian Safety and Efficacy Register of New Interventional Procedures − Surgical, under the auspices of the Royal Australasian College of Surgeons, assumed responsibility for managing this audit. This article provides an update of audit activities, now known formally as the National Breast Cancer Audit (NBCA), including a description of the new governance structure and the development of a secure online surgical audit system.

Methods:  Major changes have taken place in the design and governance of the NBCA during the last two years. Two committees have been established to oversee the audit. A clinical advisory committee comprises experts from a number of fields including breast surgery, oncology, government, and from peak breast cancer and consumer bodies. A technical advisory committee oversees many of the technical issues that have arisen with the development of an online data entry system. The online system of data entry was developed and launched to surgeons in May 2004.

Results:  There are now 28 000 cases of primary breast surgery in the audit. Around 250 surgeons are currently participating, an increase of over 50 surgeons since May 2004. Surgeons can review their data using the online system and compare their own results by generating reports which graph their own results against national aggregate data.

Conclusions:  There has been a significant increase in the volume of data received since the launch of the secure online system. The governing committees are working towards creating a clinical audit which will provide an improved data entry system and better reporting for all participating surgeons. The NBCA can also serve as a template on which to base other surgical audits.
Paediatric trauma at an adult trauma centre
Authors: Holland Andrew J. A. , Jackson Alicia M. , Joseph Anthony P.
Published: September 2005

Background:  Trauma in children remains the commonest cause of mortality. The majority of injured children who reach hospital survive, indicating that additional more sensitive outcome measures should be utilized to evaluate paediatric trauma care, including morbidity and missed injury rates. Limited contemporary data have been presented reviewing the care of injured children at an adult trauma centre (ATC).

Methods:  A review was undertaken of injured children who warranted activation of the trauma team, treated within the emergency department of an ATC (Royal North Shore Hospital) situated in the Lower North Shore area of Sydney. Data were collected prospectively and patients followed through to death or discharge from the ATC or another institution to which they had been transferred.

Results:  A total of 93 children were admitted to the ATC between January 1999 and April 2002. Mean age was 9 years 3 months (range 5 weeks−15 years 9 months) and 70% were male. The median injury severity score was 15 (range 1−75) and there were three deaths. Forty‐two children were transferred to a paediatric trauma centre (PTC), including three children who had been transferred to the ATC from another hospital. There was one missed injury and one iatrogenic urethral injury.

Conclusions:  The majority of children with trauma were treated safely and appropriately at the ATC. The missed injury rate was < 1% and there were no adverse long‐term sequelae of initial treatment. Three secondary transfers could have been avoided by more appropriate coordination of the initial referral to a PTC.
Evolution of methodological standards in surgical trials
Authors: Ellis Carleen , Hall Jane. L. , Khalil Alizan , Hall John C.
Published: September 2005

Background:  The Consolidated Standards of Reporting Trials (CONSORT) Statement outlines acceptable ways of performing and reporting clinical trials. The objective of the present study was to identify evolving patterns in the methodological standards of surgical trials.

Methods:  Compliance with 12 key standards from the CONSORT statement were evaluated in 490 trials published in either the ANZ Journal of Surgery or the British Journal of Surgery between January 1969 and December 2003.

Results:  There has been an irregular but progressive improvement in the methodological standards of published trials. The criteria with the greatest improvement related to estimation of sample size, randomization, concealment of the allocated intervention, baseline comparisons, and the method of expressing outcomes. Compliance rates were <50% for three criteria during the last decade of the review, that is, concealment of the allocated intervention, blindness of assessment, and the method of expressing outcomes.

Conclusion:  The results of surgical trials need to be interpreted with care.
Diagnosis and surgical management of popliteal artery entrapment syndrome
Authors: Goh Brian K. P. , Tay Kiang‐Hiong , Tan Seck‐Guan
Published: September 2005

Background:  The purpose of the present study was to report the authors’ experience of surgically treating eight limbs in six patients for popliteal artery entrapment syndrome (PAES), over a 10‐year period.

Methods:  From 1995 to 2004, six patients (eight limbs) underwent surgery for PAES at a single institution. The patients’ data were collected retrospectively from the case records and operative notes.

Results:  There were six patients with a mean age of 34 years (range, 27−38 years) at diagnosis and five of them were male. Two patients were found to have bilateral involvement. Both patients had symptoms involving both limbs and underwent bilateral surgery. Intermittent claudication was the most frequent presenting symptom (seven of eight limbs). All the patients had Delaney's type III PAES. Popliteal artery release was performed in all eight limbs and this was combined with a vein patch or a reversed long saphenous vein bypass graft in four limbs because the arteries in these four limbs were diseased or occluded. At a median follow up of 15 months (range, 40 days−9 years), five (seven limbs) of the six patients (eight limbs) were cured of their symptoms. One patient who presented late with rest pain and dusky toes underwent popliteal artery release, endarterectomy and a vein patch repair for an occluded popliteal artery. However, her limb could not be salvaged and her affected limb had to be amputated.

Conclusion:  Popliteal artery entrapment syndrome is a rare but important cause of peripheral vascular insufficiency especially in young patients. Early diagnosis and surgical intervention is imperative for good operative outcome and to prevent limb loss.
Use of two‐point discrimination as a nerve repair assessment tool: preliminary report
Authors: Shooter David
Published: September 2005

Background:  Two‐point discrimination, static and dynamic, has long been used as an assessment tool for tactile gnosis, and to assess recovery after repair of a peripheral nerve. While use of a bent paperclip with a specified intertip distance as the assessment device has been described, no research has been performed on the accuracy of setting this distance by hand and eye alone. The aim of the present study was to demonstrate this accuracy.

Methods:  Five orthopaedic registrars, four residents and three clinic nurses performed static and dynamic two‐point discrimination testing on each other. They set the tip distance by hand and eye by bending a paperclip such that the distance between the two ends was their best approximation of 5 mm and then 10 mm. The testing was repeated after 7 days, n = 264 for each tip distance.

Results:  Two‐sample t‐tests showed no significant difference (P > 0.53−0.93) between tip distance setting performed by registrars, nurses and residents; while single sample t‐test showed a statistically significant difference (P < 0.0001) between the attempted tip distance and the overall mean tip distance achieved at 5 mm and 10 mm.

Conclusion:  Statistical analysis showed that the single sample t‐test could be discarded. Static and dynamic two‐point discrimination testing with a paperclip set by hand and eye is therefore an accurate and reproducible test capable of being administered by both medical and non‐medical staff, and is suitable for inclusion in a peripheral nerve repair testing protocol.
TRAM flap delay: an extraperitoneal laparoscopic technique
Authors: Ebrahimi Ardalan , Cosman Peter , Widdowson Peter , Crampton Nicholas
Published: September 2005

Although the transverse rectus abdominis musculocutaneous (TRAM) flap is the gold standard in autogenous breast reconstruction, it is less reliable in patients at high risk of ischaemic compromise. A preliminary delay procedure involving ligation of the deep inferior epigastric vessels has been shown to augment flap vascularity and improve outcome in those high risk patients undergoing unipedicled TRAM flap reconstruction. Despite previous description of a transperitoneal laparoscopic technique, surgical delay generally continues to be performed as an open procedure. This may reflect apprehension over the transperitoneal approach with its attendant risk of injury to intra‐abdominal organs and vessels as well as adhesion formation. In this paper we describe an extraperitoneal laparoscopic technique for TRAM flap delay. Access to the deep inferior epigastric vessels is obtained using an extraperitoneal approach similar to that used for total extraperitoneal laparoscopic inguinal hernia repair and the vessels are easily identified and ligated using a single working port. While further study is required to evaluate the safety and efficacy of this technique, we report this as an alternative to the known open procedure which may be particularly useful for bilateral TRAM flap delay with the potential for reduced operative time, postoperative pain and scarring by avoiding bilateral inguinal incisions.
Unusual complications of laparoscopic totally extraperitoneal inguinal hernia repair
Authors: Lo Cheng Hean , Trotter Dean , Grossberg Peter
Published: September 2005

Although complications of laparoscopic totally extraperitoneal inguinal hernia repairs are well documented, the development of pneumothorax, pneumomediastinum and subcutaneous emphysema is rarely reported. The authors’ experience with a 23‐year‐old man who developed intraoperative bilateral pneumothoraces and cervical subcutaneous emphysema during a laparoscopic totally extraperitoneal inguinal hernia repair prompted a MEDLINE literature review. Seven similar cases were found in which the patients developed pneumothorax, pneumomediastinum and/or subcutaneous emphysema following laparoscopic hernioplasty. An intercostal catheter was inserted in two out of the seven patients only. Numerous hypotheses were proposed for the development of these complications. Several authors felt that the duration of the procedure and preperitoneal insufflation pressures are related to the development of these complications. These potentially lethal complications must be diagnosed and managed promptly.
Transfer of intubated patients with traumatic brain injury to Auckland City Hospital
Authors: Lind Christopher R. P. , Heppner Peter A. , Robins Toby M. , Mee Edward W.
Published: September 2005

Background:  Delays in patient transfer to definitive neurosurgical care after traumatic brain injury are important in determining neurological outcome. The efficiency of interhospital transfer of patients to Auckland City Hospital (ACH) was analysed and compared with international standards.

Methods:  The ACH Department of Critical Care Medicine database for the year 2002 was reviewed, with supplementary information obtained from transfer organizations, hospital notes, radiology archives, and operative logbooks.

Results:  Thirty‐four adult patients with traumatic brain injury and no special reasons for delayed transfer were transported intubated from other hospitals in the North Island of New Zealand. The median time from injury to arrival at ACH was 6.5 h. It took a median 4.4 h for patients to get from initial computed tomographic imaging to ACH. For those requiring evacuation of haematomas, the mean time from arrival at ACH to the start of the operation was 1.4 h. Only 33% of patients from other metropolitan Auckland hospitals, and none from hospitals outside the city, arrived within 4 h from the time of injury.

Conclusion:  Transfer times for brain trauma patients are currently longer than recommended for optimal neurological outcome. Referring hospitals and transfer organizations should review their systems to identify areas for improvement. Direct admission to theatre needs to be expedited within ACH when required. Triage of all trauma patients in metropolitan Auckland with a Glasgow Coma Scale score of less than 14 to ACH would be likely to improve time to treatment. A mobile acute neurosurgical service based in Auckland that would support general surgeons initiating acute decompressive cranial operations would be likely to reduce time to surgery and improve outcomes for patients admitted to hospitals outside Auckland. The development of a mobile acute neurosurgery service which would complete decompressive procedures started by general surgeons would likely improve trauma outcomes for patients injured outside Auckland.
Critical Dialogues: Habermasian Social Theory and International Relations
Authors: Anievas Alexander
Published: September 2005

The works of Jürgen Habermas have been a theoretical inspiration for many students of international relations (IR). To date, however, the majority of critical IR approaches drawing from the Habermasian perspective have done so on purely philosophical grounds. This article will thus explore the utility of the social-theoretical aspects of Habermas's work for critical inquiries into world politics. To this end, it will examine four main elements of his work: the theory of communicative action; public sphere; lifeworld/system architecture; and discourse ethics. It will be argued that adopting the Habermasian conceptual apparatus provides a social-theoretical route to explaining the contradictory and often paradoxical nature of international relations in the epoch of ‘globalisation’. While various constructivist approaches to IR have recently offered more socially-oriented applications of Habermas's theoretical framework, the majority of these studies have done so from predominately non-critical standpoints. This article will thus seek to explore the utility of Habermas's work in offering a critical social theory of world politics.
Europeanisation and Foreign and Security Policy – Undermining or Rescuing the Nation State?
Authors: Major Claudia
Published: September 2005

The article aims to explore the utility of Europeanisation as a concept to grasp the interactions between national and European levels. The article illustrates how the EU impacts on the national level of policy, polity and the politics of Member States and assesses how the role of nation states within the European political system has changed as a result. First, the existing definitions of Europeanisation are critically assessed, contextualised and delimited. Initially developed for communitised policy areas in the first pillar, Europeanisation is defined as an interactive, ongoing and mutually constitutive process of ‘Europeanising’ and ‘Europeanised’ countries, linking national and European levels. Defining Europeanisation as ‘domestic change’, the article then discusses mechanisms, objects and forms, as well as the criteria and conditions of change. The article subsequently seeks to clarify the validity of the Europeanisation concept in capturing the increasing interwovenness of national and European spheres in intergovernmental policy fields situated in the second pillar of the EU, that is, foreign and security policy. Inherent methodological challenges, mainly due to the deficient delimitation of Europeanisation and the intergovernmental character of this policy field are discussed as well as the particularities of its applicability in this unique policy area.
Are Moderators Moderate?: Testing the ‘Anchoring and Adjustment’ Hypothesis in the Context of Marking Politics Exams
Authors: Garry John , McCool M. Alan , O'Neill Shane
Published: September 2005

On the basis of an experiment we confirm the hypothesis – derived from the ‘anchoring and adjustment’ heuristic – that the difference that a moderator makes to the grade awarded by a first marker is less than the difference between the grades awarded by two independent (or ‘double-blind’) markers. We suggest that double-blind marking is therefore more objective and reliable than moderator-based marking, although the former clearly has significantly higher administrative costs than the latter.
Microsatellite isolation from four avian species comparing two isolation techniques
Authors: GREGORY SEAN M. , QUINN JAMES S.
Published: September 2005

Microsatellites are continuing to increase in popularity for genetic studies. A major drawback, however, is they often need to be isolated de novo. The traditional method (shotgun cloning) generally results in thousands of recombinant clones, which are then screened by Southern hybridization. Results are typically around 2% positive for mammals, but less than 0.4% for birds. Shotgun cloning is therefore generally not an effective method for isolating microsatellites from avian genomes. Several alternative methods have been developed, but the decision as to which method to use is often arbitrary. Here we present results for two microsatellite isolation techniques from four avian species.
Isolation and characterization of highly polymorphic microsatellite loci for the garden tiger mothArctia caja(Lepidoptera: Arctiidae)
Authors: ANDERSON SARAH J. , DAWSON DEBORAH A. , FREELAND JOANNA R.
Published: September 2005

A set of microsatellite markers was isolated fromArctia caja, a species that has been declining in UK for several decades. As has been found with other Lepidoptera species, this proved to be a difficult task. Eight enriched libraries identified 103 positive clones, and these yielded only seven polymorphic microsatellites. Allelic diversity ranged from 10 to 23 alleles per locus in a population of 30 individuals. Significant heterozygosity deficits were shown by three of these loci, presumably due to null alleles. The remaining four loci were in Hardy–Weinberg equilibrium and will be used to investigate the population genetic structure ofA. caja.
Development and characterization of novel tetra‐ and dinucleotide microsatellite markers for the French Polynesia black‐lipped pearl oyster, Pinctada margaritifera
Authors: HERBINGER C. M. , SMITH C.‐A. , LANGY S.
Published: September 2005

Ten microsatellite loci were developed for the black‐lipped pearl oyster Pinctada margaritifera with a magnetic bead enrichment protocol. These tetra‐ and dinucleotide markers were polymorphic, with 10 to 43 alleles observed in 97 individuals from two Tuamotu atoll populations. Most loci revealed significant genic differentiation between the two populations and also exhibited some degree of heterozygote deficiencies, probably due to the presence of null alleles. These loci should be very useful to describe genetic structure, genetic variability and reproductive success in the various aquaculture and wild populations of pearl oyster in French Polynesia.
Development of microsatellite markers in the toxic dinoflagellate Alexandrium catenella (Dinophyceae)
Authors: NAGAI S. , SEKINO M. , MATSUYAMA Y. , ITAKURA S.
Published: September 2005

The outbreak of paralytic shellfish poisoning caused by the toxic dinoflagellate Alexandrium catenella (Dinophyceae) is a worldwide concern from the economic and food hygiene point of view. To assess the dispersal mechanism, a population genetic study using highly polymorphic genetic markers is one of the crucial approaches. We isolated 12 polymorphic microsatellites from this species. These loci provide one class of highly variable genetic marker as the number of alleles ranged from three to 12 and the estimate of gene diversity was from 0.248 to 0.897 across the 12 microsatellites; we consider that these loci have a potential to detail the genetic structure and gene flow among A. catenella populations.
An evaluation of allowing for mismatches as a way to manage genotyping errors in parentage assignment by exclusion
Authors: VANDEPUTTE M. , MAUGER S. , DUPONT‐NIVET M.
Published: September 2005

In parentage assignment by exclusion, using multiple and very polymorphic loci, genotyping errors are a major cause of non‐assignment. Using stochastic simulations, we tested the possibility to allow for mismatches at one or more allele as a way to recover assignment power. This was very efficient provided the set of loci used had a high assignment power (> 99%) and the error rate was not too high (below 3–4%). In these cases, most of the theoretical assignment power could be recovered. We also showed the efficiency of the method in a practical experiment with rainbow trout.
Democracy, Islam and Dialogue: The Case of Turkey
Authors: Kanra Bora
Published: September 2005

The November 2002 general elections in Turkey produced an Islamic-leaning government, supported by one of the biggest majorities, bringing the relationship between Islam and democracy under scrutiny. This paper examines the nature of this relationship and the current political situation in Turkey. It argues that Turkey's long-running aspiration for democratization has now a reasonable chance of success. This argument is supported by the findings of a Q study, conducted in Turkey during the 2002 election campaign, indicating strong support for dialogue, particularly within the Turkish Muslim community. Yet, it will also argue that turning this possibility into a success depends on the implementation of the right deliberative framework. Habermas's discourse theory of democracy provides the essentials for this. However, particularly in the context of a divided society, like Turkey, it has to be complemented with a better emphasis on deliberation as a social learning process, as in Dryzek's theory of discursive democracy.
Lessons Learned, Lessons Forgotten: The Swedish Referendum on EMU of September 2003
Authors: Aylott Nicholas
Published: September 2005

Sweden's referendum on whether to join EMU produced an emphatic No. The murder of one of the Yes side's leading representatives thus appeared not to have affected the result. Cleavages exposed in the referendum on EU membership nine years previously were even more apparent this time; yet No-voters were also to found across the political, regional and social spectrums. As well as describing the campaign and explaining the outcome, this article focuses on the campaign strategies adopted by parties and other actors. Lessons from previous campaigns had been learned by the opponents of EMU, but largely forgotten by its supporters.
Prevention of hepatitis B virus infection from hepatitis B core antibody‐positive donor graft using hepatitis B immune globulin and lamivudine in living donor liver transplantation
Authors: Suehiro Taketoshi , Shimada Mitsuo , Kishikawa Keiji , Shimura Tatsuo , Soejima Yuji , Yoshizumi Tomoharu , Hashimoto Kohji , Mochida Yasushi , Maehara Yoshihiko , Kuwano Hiroyuki
Published: September 2005

Abstract: Background: Hepatic grafts from hepatitis B surface antigen‐negative and anti‐core antibody (HBcAb)‐positive donors have been shown to transmit hepatitis B virus (HBV) infection. Recently, it has been reported that combined hepatitis B immune globulin (HBIG) and lamivudine therapy is effective in the prevention of hepatitis B recurrence after living donor liver transplantation (LDLT). In this report, we assessed the efficacy of combined HBIG and lamivudine therapy in preventing HBV transmission by graft with HBcAb‐positive donors.

Methods: We studied 22 patients who had undergone LDLT with allografts from HBcAb‐positive living donors at Gunma University Hospital and Kyushu University Hospital. Long‐term combined HBIG and lamivudine therapy were administrated to all recipients. Serum samples from the donor and recipient were tested for HBcAb, HBV DNA, and hepatitis B surface antibody. Liver biopsies from grafts were tested for HBV DNA.

Results: All recipients were HBcAb negative before LDLT. All of the donor livers were HBV DNA positive at the time of LDLT. All of the recipients had HBsAb titers greater than 300 mIU/ml 4 weeks after LDLT, and remained 100 mIU/ml thereafter. None of the recipients have become infected with HBV with a follow‐up of 25–86 months.

Conclusions: Perioperative combined HBIG and lamivudine therapy can prevent HBV infection in recipients who receive liver grafts from HBcAb‐positive donors.
Tumor necrosis factor gene polymorphisms and clearance or progression of hepatitis B virus infection
Authors: Niro Grazia Anna , Fontana Rosanna , Gioffreda Domenica , Valvano Maria Rosa , Lacobellis Angelo , Facciorusso Domenico , Andriulli Angelo
Published: September 2005

Abstract: Objectives: We evaluated the influence of tumor necrosis factor‐α (TNF‐α) promoter gene polymorphisms on clearance of hepatitis B virus (HBV) and outcome of HBV chronic hepatitis.

Methods: Four TNF‐α promoter polymorphisms (T‐1031C, C‐863A, G‐308A, and G‐238A) were evaluated by direct sequencing in 184 chronic HBV carriers hepatitis B surface antigen (HBsAg) positive and 96 controls with documented sero‐clearance (HBsAg negativity, positivity for anti‐HBs and anti‐HBc IgG). Frequencies of single‐nucleotide polymorphisms (SNPs) and haplotypes in the control group were compared with those of the chronic carrier group and with clinically defined subgroups of the latter: asymptomatic carriers, patients with compensated hepatitis, decompensated cirrhotics, and patients with hepatocellular carcinoma. Furthermore, subgroups of chronic carriers were compared among them.

Results: In the chronic carrier group, the −308G allele was more frequent in those with a family history of HBV infection (96% vs 88% of those with non‐familial transmission). The G/G genotype at position −308 was found in all chronic carriers with decompensated cirrhosis but in only 78% of controls (P=0.01) and was more frequent in decompensated cirrhotics than in the other subgroups. The distribution of TNF‐α gene polymorphisms in the carrier group was not significantly different from that in the sero‐clearance control group. TNF‐α SNPs at positions −1031/−863 and −863/−238 were in linkage disequilibrium. The TCGG haplotype (−T1031, −C863, −G308, −G238) was significantly associated with end‐stage liver disease.

Conclusion: The TNF‐α promoter polymorphisms do not appear to be determinant of HBV sero‐clearance in southern Italians. The genotype −308G/G and haplotype TCGG are associated with an unfavorable prognosis in patients with chronic HBV infection.
Reengineering transfusion and cellular therapy processes hospitalwide: ensuring the safe utilization of blood products
Authors: Brooks Jay P.
Published: September 2005

Efforts to make blood transfusion as safe as possible have focused on making the blood in the bag as disease‐free as possible. The results have been dramatic, and the costs have been correspondingly high. Although blood services will have to continue to deal with emerging pathogens, efforts to reduce the transfusion of infectious agents presently posing a risk will require high incremental costs and result in only improvements of a small magnitude.

The other aspect of safe blood transfusion, the actual transfusion process performed primarily in hospitals, has been accorded considerably less interest. We should turn our attention to enhancing overall blood safety by focusing on improving the process of blood transfusion. Errors involving patient, specimen, and blood product identification put transfused patients at risk, increasing the mortality risk for some. Solutions that could improve the transfusion process are discussed as a focus of this article.
Navigating the information technology highway: computer solutions to reduce errors and enhance patient safety
Authors: Koshy Ranie
Published: September 2005

Standardized, seamless, integrated information technology in the health‐care environment used with other industry tools can markedly decrease preventable errors or adverse events and increase patient safety. According to an Institute of Medicine (IOM) report released in 1999, preventable errors have caused between 44,000 and 98,000 deaths per year. Following the report, President Bill Clinton requested that the Agency of Healthcare Research and Quality, a government agency, look into the issue and fund, at the local or state level, processes that can reduce errors. Funding subsequently was made available for research that utilizes best practice tools in clinical practice to increase patient safety.

The Joint Commission on Accreditation of Healthcare Organization has placed a great deal of emphasis on strategies to reduce patient identification errors. Fragmented systems tout the individual as well as enhanced safety applications. These applications, however, are related to prevention in specific conditions and in specific health‐care settings. Systems are not integrated with common reference data and common terminology aggregated at a regional or national level to provide access to patient safety risks for timely interventions before errors and adverse events occur. Standardized integrated patient care information systems are not available either on a regional or on a national level.

This article examines tangible options to increase patient safety through improved state‐of‐the‐art tools that can be incorporated into the health‐care system to prevent errors.