bluuebunny/crossref_metadata_2025 huggingface dataset:
Massive macroglossia developing fast and immediately after endotracheal extubation
Authors: TOYAMA S. , HOYA K. , MATSUOKA K. , NUMAI T. , SHIMOYAMA M.
Published: November 2011

We report an unusual case of massive macroglossia that developed very rapidly after neurosurgery in the park bench position with neck flexion. A few minutes after endotracheal extubation, massive macroglossia was noticed with marked protrusion of the tongue from the oral cavity. The patient's hospital stay was prolonged due to difficulty in speaking and eating. Macroglossia is a rare complication; however, it may cause life‐threatening airway obstruction. It is important to be prepared for managing post‐operative macroglossia and keep in mind that it may develop rapidly, especially after prolonged surgery performed with sustained neck flexion. The patient should be informed of the risk of macroglossia and the associated problems prior to the operation.
Neutrophil inhibition contributes to cardioprotection by postconditioning
Authors: GRANFELDT A. , JIANG R. , WANG N.‐P. , MYKYTENKO J. , ELDAIF S. , DENEVE J. , ZHAO Z.‐Q. , GUYTON R. A. , TØNNESEN E. , VINTEN‐JOHANSEN J.
Published: November 2011

Background

Postconditioning (postcon) reduces infarct size, myocardial superoxide (•O2) generation, and neutrophil (PMN) accumulation. It is unknown whether inhibition of PMNs influence cardioprotection by postcon. The present study tested the following hypotheses: (1) myocardial salvage by postcon is modified by inhibition of PMNs and (2) postcon directly inhibits PMN •O2 generation.

Methods

For hypothesis 1, a deductive approach was used to determine infarct size in vivo with and without PMNs in rats, and for hypothesis 2, blood sampled from the anterior interventricular vein (AIV) in a canine model was used. Protocol 1: anesthetized rats, subjected to 30 min of coronary artery occlusion and 3 h of reperfusion, were randomized to control (n = 13), postcon (n = 13), PMN‐depletion: (n = 9), and postcon in PMN‐depleted rats (n = 9). Protocol 2: blood was sampled at baseline, 2 h and 24 h from the AIV, draining the area at risk (AAR) in anesthetized dogs with 60 min coronary occlusion ± postcon; whole blood was analyzed for •O2 by luminol‐enhanced chemiluminescence.

Results

Postcon and PMN depletion reduced infarct size (42.6 ± 2.1%, P < 0.05 vs. control, and 43.9 ± 3.0%, P < 0.05 vs. control, respectively) vs. control (58.8 ± 0.9%), with no further decrease with postcon in PMN‐depleted rats (37.2 ± 2.9%, P = 0.34 vs. postcon). PMN accumulation in AAR was less in postcon (21.2 ± 0.3%, P < 0.05 vs. control) and PMN‐depleted (9.4 ± 0.3%, P < 0.05 vs. control) vs. control (30.5 ± 1.2%), with a further decrease in the postcon + PMN depletion group (5.4 ± 0.6%, P < 0.05 vs. control). In dogs, •O2 release by PMNs increased at 2 h and 24 h of R, which was reduced to baseline levels by postcon.

Conclusions

These data imply PMN involvement in cardioprotection by postconditioning.
Isoflurane late preconditioning against myocardial stunning is associated with enhanced antioxidant defenses
Authors: CRYSTAL G. J. , MALIK G. , YOON S.‐H. , KIM S.‐J.
Published: November 2011

Background

We tested the hypothesis that an upregulation of antioxidant proteins [Cu‐Zn superoxide dismutase (SOD), Mn SOD, catalase, glutathione peroxidase, and glutathione peroxidase] plays a role in the delayed protection against myocardial stunning produced by isoflurane preconditioning (ISOPC). Findings were compared with late ischemic PC (IPC).

Methods

Fourteen mongrel dogs were chronically instrumented to measure coronary blood flow and myocardial wall thickening (WT) in conscious state. In Group 1, dogs underwent IPC, induced by a 10‐min coronary artery occlusion (CAO); after 24 h of reperfusion, they were subjected to a second 10‐min ischemia CAO‐reperfusion. In Group 2 (ISOPC), dogs inhaled one minimum alveolar concentration (MAC) ISO (1.4% in O2
) for 60 min, allowed to recover for 24 h, and then subjected to CAO ischemia‐reperfusion. Recovery of WT following the initial 10‐min CAO in Group 1 served as control response for both ISOPC and IPC. Expression and activity of antioxidant proteins were measured using Western blotting and spectrophotometric techniques, respectively.

Results

Two to three hours of reperfusion were required for recovery of WT following either ISOPC or IPC; in contrast, without PC, WT remained markedly reduced (30% below baseline) at this time point and required more than 6 h of reperfusion for recovery. Neither IPC nor ISOPC affected expression of Cu‐Zn SOD, Mn SOD, or catalase. However, ISOPC increased activity of Mn SOD (+40%), catalase (+39%), glutathione peroxidase (+37%), and glutathione reductase (+93%) (P < 0.05); IPC had similar effects.

Conclusion

ISOPC had powerful, delayed anti‐stunning effect that was associated with an enhancement of endogenous antioxidant defenses.
White Flank Spots Signal Feeding Dominance in Female Diamond Firetails, Stagonopleura guttata
Authors: Crowhurst Clare J. , Zanollo Valeria , Griggio Matteo , Robertson Jeremy , Kleindorfer Sonia
Published: November 2011

Plumage colour can be used as an honest signal to convey health and status, which has traditionally been examined in the sexual selection context of choosy females and elaborate males. We use a model avian system to study the role of plumage coloration in a social context such as inter‐ and intrasexual competition over food resources. The diamond firetail (Stagonopleura guttata) is an endemic Australian finch: females have more white flank spots than males, and white spot number was correlated with cell‐mediated immune response in females. We use two experimental designs to test the role of white flank spots for feeding dominance and dominance discrimination in a group‐living bird. The results from two‐choice trials and from single‐arena trials showed that female ornamentation was consistently important in social food contests, and males consistently responded to female spot number. Females with higher spot number fed first, in trials with males and/or females. Also, females preferred to feed next to test birds with low spot number, but males showed no preference for feeding next to birds with few or many spots. Finally, latency to feed was predicted by spot number: both males and females had longer latency to feed if test birds had more spots than the focal birds. We conclude that female, but not male, ornamentation was important for inter‐ and intrasexual food competition. This is one of the very few studies to show that the same plumage ornament can have a different function between the sexes as a signal of social status. Moreover, this study shows that white plumage can be a signal of dominance.
Young mothers' lived experiences prior to becoming pregnant in rural Victoria: A phenomenological study
Authors: Roberts Sarah , Graham Melissa , Barter‐Godfrey Sarah
Published: November 2011

Objective:  To explore the lived experiences and social context prior to becoming pregnant, of women who became mothers during adolescence in rural Victoria.

Design:  Qualitative interpretive phenomenological study using semistructured interviews.

Setting:  Rural community in North East Victoria, Australia.

Participants:  Four rural women who gave birth to a child between the ages of 15 and 19.

Results:  Five themes emerged from the data as being essential to the participants' experiences prior to pregnancy. These included feeling isolated; life change: transition into adulthood; support and understanding in sexual relationships; feeling dissatisfied; and overcoming adversity. Participants' provided practical recommendations to improve life for young people in rural areas through reflecting on their own experiences.

Conclusion:  These findings highlight the complex nature of rural young women's experiences leading up to pregnancy and suggest that early motherhood might be largely reflective of the social environment in which one lives prior to pregnancy. Providing somewhere safe to go, organised and appropriate social activities and increasing access to health services were identified as being pertinent to improving experiences for rural young people prior to pregnancy. Health professionals should consider the importance of supporting young women through non‐judgemental, approachable and accessible services.
Asian migrants' lived experience and acculturation to Western health care in rural Tasmania
Authors: Terry Daniel , Ali Mohammed , Lê Quynh
Published: November 2011

Objectives:  The study was designed to explore the lived experience of Asian migrants' health care‐seeking behaviour in Tasmania, to discern the acculturation process by which Asian migrants are enabled to use the health system and to identify strategies, which assist migrants to understand and use the health system better.

Methods:  Qualitative research was adopted. Semistructured interviews were conducted with 36 Asian migrants residing in North, South and North West Tasmania, which were recruited through purposive sampling.

Results:  Six main themes emerged from the interviews: the acculturation process, interactions with the health care system, access issues, culturally appropriate health care, positive health care in Tasmania and suggestions for improving health care.

Conclusions:  The findings indicated that Asian migrants' views affected their health care‐seeking behaviours because of the lack of information, poor communication, limited access and choices in Tasmania. Interestingly, those married to local Tasmanians had the shortest trajectory to health system acculturation. The study recommended developing health and well‐being for Asian migrants by increasing access to information regarding navigating the health system and improving access to and awareness of language services. In addition, ensuring adequate, appropriately written, culturally specific and congruent information should be available to assist migrants' transition into a new health care system. Lastly, greater cultural awareness within the health profession to meet the needs of culturally specific individuals and communities is required when they seek care.
Performance pressure: Simulated patients and high‐stakes examinations in a regional clinical school
Authors: Harvey Pam , Radomski Natalie
Published: November 2011

Objective:  To investigate the effects and challenges of being a simulated patient (SP) in a high‐stakes clinical examination context in a regional setting.

Design:  Mixed methods, using a written survey, focus groups, and a retrospective postal survey.

Setting:  A university clinical school in a Victorian regional city.

Participants:  Nineteen SP volunteers (from an existing database of 55 people) who had been involved in mid‐year, summative Objective Structured Clinical Examination (OSCE) role‐play performances.

Main outcome measures:  Challenges of the OSCE role‐play experience and the reported effects on SPs. The implications of these factors have an impact on the sustainability of SP programs in regional settings.

Results:  Physical and emotional effects like exhaustion were reported, as well as empathy and concern for the medical students. The retrospective postal survey indicated that the SPs had no long‐term negative effects from their high‐stakes examination experiences. Participants also reported that a level of decision making and improvisation was needed in the performance of their OSCE role plays.

Conclusions:  Our study reveals the complexity and demands on SPs in performing in high‐stakes clinical examinations. The results highlight that SP roles involve more than the transfer of scripted information. SPs should be considered as members of the examination team when preparing and implementing high‐stakes examinations to assist in maintaining standardised performance during and across OSCE role plays. Relationships between SPs and educational institutes need to be nurtured to ensure that the ability to continue high‐stakes OSCEs in a regional setting is maintained.
Travelling all over the countryside: Travel‐related burden and financial difficulties reported by cancer patients in New South Wales and Victoria
Authors: Zucca Alison , Boyes Allison , Newling Graham , Hall Alix , Girgis Afaf
Published: November 2011

Objective:  To describe travel burden and travel‐related financial burden experienced by cancer patients over the first year after diagnosis.

Design, setting, participants:  Population‐based longitudinal cohort of recent adult cancer patients diagnosed with the eight most incident cancers recruited from New South Wales and Victorian Cancer Registries. Self‐report survey data were collected at 6 and 12 months after diagnosis from 1410 participants (city: n = 890; regional/remote: n = 520).

Main outcome measures:  Travel time to cancer treatment, living away from home for treatment, travel‐related treatment decisions, extent of financial issues, unmet need for financial help.

Results:  During the first 12 months after diagnosis, outer regional/remote residents had the greatest travel burden; 61% (n = 79) travelled at least 2 hours one way to receive treatment, and 49% (n = 66) lived away from home to receive treatment. Strongest associates of travel burden were living in regional/remote areas (odds ratio (OR) = 18.9–135.7), having received surgery (OR = 6.7) or radiotherapy (OR = 3.6). Between 6 and 12 months after diagnosis, 2% (n = 24) of patients declined cancer treatment because of the time it would take to get to treatment. Patients who travelled more than 2 hours or lived away for treatment reported significantly greater financial difficulties (38%; 40%) than those who did not (12%; 14%), even after adjusting for covariates.

Conclusions:  Travel burden is greatest for rural patients, and is associated with greater financial burden. Appropriate and adequate provision of travel and accommodation assistance schemes remains paramount to achieving equitable delivery of cancer services.
Factors influencing the selection of rural practice locations for early career pharmacists in Victoria
Authors: Fleming Cristen A. , Spark M. Joy
Published: November 2011

Objective:  To identify factors influencing the choice of practice location for early career pharmacists working and living in Victoria.

Design:  Survey.

Setting:  Victorian pharmacies.

Participants:  Pharmacists living in Victoria in April 2009, who had registered with the Pharmacy Board of Victoria after 1 October 2004, stratified into major city and rural areas.

Main outcome measures:  Questionnaire responses analysed via descriptive statistics, chi‐square and direct logistic regression.

Results:  Early career pharmacists were more likely to practice in a rural location if they had undertaken a rural internship, had a spouse or partner with a non‐metropolitan background and were not practicing in a hospital pharmacy. Pharmacists who had lived in a rural area during their childhood and had studied pharmacy at a rural university were four times more likely to have undertaken a rural internship than those that studied at a major city university.

Conclusions:  The strongest indicator for future practice location was a pharmacist's internship location. Childhood location and pharmacy education location were indicators of internship location. Pharmacists with a rural childhood location, especially those who study at rural universities, are more likely to work in rural areas.
Urban–rural influences on suicidality: Gaps in the existing literature and recommendations for future research
Authors: Handley Tonelle E. , Inder Kerry J. , Kelly Brian J. , Attia John R. , Kay‐Lambkin Frances J.
Published: November 2011

Suicide is a major public health issue of particular concern among rural populations, which experience a consistently higher suicide rate than urban areas. Although extensive research efforts have been directed towards understanding suicidality and related factors, there is a continued lack of clinically useful factors to target preventive measures, particularly among some regional and demographic groups. This suggests limitations in the conceptualisation of this important construct. A review of the literature was undertaken, using a snowballing and saturation approach. Literature was considered relevant if it addressed the research question ‘what are the current limitations in research on urban/rural influences on suicidality?’ Findings were used to develop a set of guidelines to inform future research. A number of gaps in existing research relevant to limitations in rural suicide research were identified: inconsistencies in terminology; a focus on high‐end suicidal behaviours; a disproportionate focus on urban populations; a dominance of cross‐sectional research; and a high use of clinical samples. These limitations are discussed in terms of their implications for rural suicidality, and are used to support the development of recommendations for future research, with a focus on encouraging consistency and standardisation. A number of limitations can be identified in existing research on suicide. Targeting these specific areas can be an important step in addressing the current gaps in knowledge relating to rural suicide prevention.
Can tertiary prevention of hepatocellular carcinoma be achieved by nucleos(t)ide analogs therapy of hepatitis B?
Authors: Chien Rong‐Nan
Published: November 2011

See article in J. Gastroenterol. Hepatol. 2011; 26: 1380–1388.
Phagocytic properties in tumor astrocytes
Authors: Persson Annette , Englund Elisabet
Published: November 2011

In glioblastoma multiforme (GBM), the pathophysiological events preceding and promoting an uncontrolled and remarkable growth is largely unknown. Studies on gliomas and macrophage expression have shown high levels of phagocytic cells, that is, microglial cells. It has also been demonstrated that human astrocytic cells and rat glioma cells are capable of phagocytosis. The purpose of this study was to investigate a potential phagocytic property in human GBM cells in tumor biopsies from surgery. With an immunhistochemical double staining using macrophage markers (CD68 and CD163) and human telomerase reverse transcriptase (hTERT) as a marker for neoplastic cells, we found high levels of double positive cells in human GBM. In hematoxylin‐erythrosin stained sections, we also identified fragmented cell components in the cytoplasm of tumor cells. In our judgement, many neoplastic cells in GBM are also positive for macrophage markers. We suggest that human astroglial tumor cells may have phagocytic properties or phagocyte‐like properties. This may represent a latent capacity of self‐defence, evoked under certain circumstances. It is likely that these properties substantially help the tumors thrive and expand.
Primary lateral sclerosis: Upper‐motor‐predominant amyotrophic lateral sclerosis with frontotemporal lobar degeneration – immunohistochemical and biochemical analyses of TDP‐43
Authors: Kosaka Takayuki , Fu Yong‐Juan , Shiga Atsushi , Ishidaira Haruka , Tan Chun‐Feng , Tani Takashi , Koike Ryoko , Onodera Osamu , Nishizawa Masatoyo , Kakita Akiyoshi , Takahashi Hitoshi
Published: November 2011

Primary lateral sclerosis (PLS) is clinically defined as a disorder selectively affecting the upper motor neuron (UMN) system. However, recently it has also been considered that PLS is heterogeneous in its clinical presentation. To elucidate the association of PLS, or disorders mimicking PLS, with 43‐kDa TAR DNA‐binding protein (TDP‐43) abnormality, we examined two adult patients with motor neuron disease, which clinically was limited almost entirely to the UMN system, and was followed by progressive frontotemporal atrophy. In the present study, the distribution and severity, and biochemical profile of phosphorylated TDP‐43 (pTDP‐43) in the brains and spinal cords were examined immunohistochemically and biochemically. Pathologically, in both cases, frontotemporal lobar degeneration with ubiquitin inclusions (FTLD‐U) was evident, with the most severe degeneration in the motor cortex. An important feature in both cases was the presence of Bunina bodies and/or ubiquitin inclusions, albeit very rarely, in the well preserved lower motor neurons. The amygdala and neostriatum were also affected. pTDP‐43 immunohistochemistry revealed the presence of many positively stained neuronal cytoplamic inclusions (NCIs) and dystrophic neurites/neuropil threads in the affected frontotemporal cortex and subcortical gray matter. By contrast, such pTDP‐43 lesions, including NCIs, were observed in only a few lower motor neurons. pTDP‐43 immunoblotting revealed that fragments of ∼25‐kDa were present in the cortices, but not in the spinal cord in both cases. Genetically, neither of the patients had any mutation in theTDP‐43gene. In conclusion, we consider that although PLS may be a clinically significant disease entity, at autopsy, the majority of such clinical cases would present as upper‐motor‐predominant amyotrophic lateral sclerosis with FTLD‐TDP.
Invariant natural killer T cells in chronic obstructive pulmonary disease
Authors: CHI SU YOUNG , BAN HEE JUNG , KWON YONG SOO , OH IN JAE , KIM KYU SIK , KIM YU IL , KIM YOUNG CHUL , LIM SUNG CHUL
Published: November 2011

Background and objective:  Invariant natural killer T (iNKT) cells may play an important role in regulating the innate and acquired immune systems in chronic obstructive pulmonary disease (COPD). However, there is little information regarding the potential role of iNKT cells in the pathogenesis of COPD. To investigate whether iNKT cells have an important role in COPD, the frequency of iNKT cells in peripheral blood of patients with COPD was analysed.

Methods:  This was a comparative study of 28 patients with COPD and 19 age‐matched healthy control subjects. Blood iNKT cells were stained with 6B11 mAb, anti‐T cell receptor Vα24 mAb, anti‐T cell receptor Vβ11 mAb or α‐galactosylceramide‐loaded CD1d‐tetramer, and analysed by flow cytometry.

Results:  The frequency of CD4+ 6B11+ iNKT, CD4+ Vα24+ iNKT, CD4+ Vβ11+ iNKT and CD3+ 6B11+ iNKT cells was significantly lower in peripheral blood of patients with COPD than in that of healthy control subjects. The frequency of CD4+ 6B11+ iNKT cells was significantly lower in patients with exacerbations of COPD compared with those with stable COPD.

Conclusions:  The frequency of iNKT was decreased in peripheral blood of patients with COPD. These results strongly suggest that iNKT cells may play an important role in the pathogenesis of COPD.
Axon–axon interactions in neuronal circuit assembly: lessons from olfactory map formation
Authors: Imai Takeshi , Sakano Hitoshi
Published: November 2011

During the development of the nervous system, neurons often connect axons and dendrites over long distances, which are navigated by chemical cues. During the past few decades, studies on axon guidance have focused on chemical cues provided by the axonal target or intermediate target. However, recent studies have shed light on the roles and mechanisms underlying axon–axon interactions during neuronal circuit assembly. The roles of axon–axon interactions are best exemplified in recent studies on olfactory map formation in vertebrates. Pioneer–follower interaction is essential for the axonal pathfinding process. Pre‐target axon sorting establishes the anterior–posterior map order. The temporal order of axonal projection is converted to dorsal–ventral topography with the aid of secreted molecules provided by early‐arriving axons. An activity‐dependent process to form a discrete map also depends on axon sorting. Thus, an emerging principle of olfactory map formation is the ‘self‐organisation’ of axons rather than the ‘lock and key’ matching between axons and targets. In this review, we discuss how axon–axon interactions contribute to neuronal circuit assembly.
Forward signaling by EphB1/EphB2 interacting with ephrin‐B ligands at the optic chiasm is required to form the ipsilateral projection
Authors: Chenaux George , Henkemeyer Mark
Published: November 2011

EphB receptor tyrosine kinases direct axonal pathfinding through interactions with ephrin‐B proteins following axon–cell contact. As EphB:ephrin‐B binding leads to bidirectional signals, the contributions of signaling into the Eph‐expressing cell (forward signaling) or the ephrin‐expressing cell (reverse signaling) cannot be assigned using traditional protein null alleles. To determine if EphB1 is functioning solely as a receptor during axon pathfinding, a new knock‐in mutant mouse was created, EphB1T‐lacZ, which expresses an intracellular‐truncated EphB1‐β‐gal fusion protein from the endogenous locus. As in the EphB1−/− protein null animals, the EphB1T‐lacZ/T‐lacZ homozygotes fail to form the ipsilateral projecting subpopulation of retinal ganglion cell axons. This indicates that reverse signaling through the extracellular domain of EphB1 is not required for proper axon pathfinding of retinal axons at the optic chiasm. Further analysis of other EphB and ephrin‐B mutant mice shows that EphB1 is the preferred receptor of ephrin‐B2 and, to a lesser degree, ephrin‐B1 in mediating axon guidance at the optic chiasm despite the coexpression of EphB2 in the same ipsilaterally projecting retinal axons.
Transcriptional control of differentiation and neurogenesis in autonomic ganglia
Authors: Rohrer Hermann
Published: November 2011

Autonomic neuron development is controlled by a network of transcription factors, which is induced by bone morphogenetic protein signalling in neural crest progenitor cells. This network intersects with a transcriptional program in migratory neural crest cells that pre‐specifies autonomic neuron precursor cells. Recent findings demonstrate that the transcription factors acting in the initial specification and differentiation of sympathetic neurons are also important for the proliferation of progenitors and immature neurons during neurogenesis. Elimination of Phox2b, Hand2 and Gata3 in differentiated neurons affects the expression of subtype‐specific and/or generic neuronal properties or neuron survival. Taken together, transcription factors previously shown to act in initial neuron specification and differentiation display a much broader spectrum of functions, including control of neurogenesis and the maintenance of subtype characteristics and survival of mature neurons.
Cell‐autonomous and cell‐to‐cell signalling events in normal and altered neuronal migration
Authors: Manent Jean‐Bernard , Beguin Shirley , Ganay Thibault , Represa Alfonso
Published: November 2011

The cerebral cortex is a complex six‐layered structure that contains an important diversity of neurons, and has rich local and extrinsic connectivity. Among the mechanisms governing the cerebral cortex construction, neuronal migration is perhaps the most crucial as it ensures the timely formation of specific and selective neuronal circuits. Here, we review the main extrinsic and extrinsic factors involved in regulating neuronal migration in the cortex and describe some environmental factors interfering with their actions.
What can we get from ‘barrels’: the rodent barrel cortex as a model for studying the establishment of neural circuits
Authors: Wu Chia‐Shan , Ballester Rosado Carlos J. , Lu Hui‐Chen
Published: November 2011

Sensory inputs triggered by external stimuli are projected into discrete arrays of neuronal modules in the primary sensory cortex. This whisker‐to‐barrel pathway has gained in popularity as a model system for studying the development of cortical circuits and sensory processing because its clear patterns facilitate the identification of genetically modified mice with whisker map deficits and make possible coordinated in vitro and in vivo electrophysiological studies. Numerous whisker map determinants have been identified in the past two decades. In this review, we summarize what have we learned from the detailed studies conducted in various mutant mice with cortical whisker map deficits. We will specifically focus on the anatomical and functional establishment of the somatosensory thalamocortical circuits.
Decoding the transcriptional basis for GABAergic interneuron diversity in the mouse neocortex
Authors: Anastasiades Paul G. , Butt Simon J. B.
Published: November 2011

The locally projecting GABAergic interneurons of the mammalian cerebral cortex are a highly heterogeneous population, whose malfunction or deficit has been implicated in a wide range of neurological disorders. However, the low incidence of the various distinct interneuron populations within the neocortex, combined with the lack of molecular or physiological markers specific to these subtypes, have hampered investigations into their function in the normal and dysfunctional brain. A number of research groups have begun to elucidate the developmental genetic mechanism that underpins this diversity in the mouse neocortex, spurred on by the knowledge that the temporal and spatial origin of an interneuron in the embryonic brain is predictive of its eventual intrinsic properties in the mature cortex. In this review we highlight a number of recent findings that strengthen our understanding of the transcription factor code that is at the heart of generating this diversity. Further understanding of this code will enable selective observation, targeting and manipulation of interneuron subtypes across both in vitro and in vivo systems.
Predictive factors of PACU stay after herniorraphy in infant: a classification and regression tree analysis
Authors: Silins Vilnis , Julien Florence , Brasher Christopher , Nivoche Yves , Mantz Jean , Dahmani Souhayl
Published: November 2011

Introduction:  Herniorraphy is a common surgical intervention in infants, particularly in those born prematurely. Prematurity and perioperative sedation have been shown to be risk factors for postoperative apnea. However, their influence upon PACU stay duration has not been evaluated. The goal of this study was to investigate predictive factors for PACU stay in infants undergoing herniorraphy.

Material and Methods:  This study is a retrospective analysis of perioperative data in infants <6 months of age undergoing herniorraphy during the period November 2007–November 2009. Collected data included age, gestational age at birth, post‐conceptional age, weight, weight at birth, type of anesthesia (spinal vs general), perioperative administration of opioids and paracetamol, duration of surgery, duration of PACU stay, and apnea in PACU. Data analysis used classification and regression trees (CART) with a 10‐fold cross‐validation.

Results:  Two hundred and ninety‐six patients were included in the analysis. Five parameters were found to predict the duration of PACU stay: a post‐conceptional age below 45 weeks, prematurity, general anesthesia, postoperative opioid administration, and the use of intraoperative regional analgesia. CRT method allows constructing a decision tree with eight terminal nodes. The percentage of explained variability of the model and the cross‐validation were 79.7% and 76.6%, respectively.

Discussion:  Our study allows construction of an accurate predictive tree for PACU stay during herniorraphy in infants <6 months. Parameters found to influence the duration of PACU stay were related to anesthesia techniques and perinatal outcomes.
Perioperative management of the child on long‐term opioids
Authors: Geary Tim , Negus Anna , Anderson Brian J. , Zernikow Boris
Published: November 2011

The strategies used to manage children exposed to long‐term opioids are extrapolated from adult literature. Opioid consumption during the perioperative period is more than three times that observed in patients not taking chronic opioids. A sparing use of opioids in the perioperative period results in both poor pain management and withdrawal phenomena. The child’s pre‐existing opioid requirement should be maintained, and acute pain associated with operative procedures should be managed with additional analgesia. This usually comprises short‐acting opioids, regional or local anesthesia, and adjuvant therapies. Long‐acting opioids, transdermal opioid patches, and implantable pumps can be used to maintain the regular opioid requirement. Intravenous infusion, nurse controlled analgesia, patient‐controlled analgesia, or oral formulations are invaluable for supplemental requirements postoperatively. Effective management requires more than simply increasing opioid dose during this time. Collaboration of the child, family, and all teams involved is necessary. While chronic pain or palliative care teams and other staff experienced with the care of children suffering chronic pain may have helpful input, many pediatric hospitals do not have chronic pain teams, and many patients receiving long‐term opioids are not palliative. Acute pain services are appropriate to deal with those on long‐term opioids in the perioperative setting and do so successfully in many centers. Staff caring for such children in the perioperative period should be aware of the challenges these children face and be educated before surgery about strategies for postoperative management and discharge planning.
Sealed Orifice Laparoscopic or Endoscopic (SOLE) Surgery: technology and technique convergence for next‐step colorectal surgery
Authors: Cahill R. A. , Hompes R. , Cunningham C. , Mortensen N. J.
Published: November 2011

The new avenue of minimally invasive surgery, referred to as single‐incision/access laparoscopy, is often presented as an alternative to standard multiport approaches, whereas in fact it is more usefully perceived as a complementary modality. The emergence of the technique can be of greater use both to patients and to the colorectal specialty if its principles can be merged into next‐stage evolution by synergy with more conventional practice. In particular, rather than device specificity, what is needed is convergence of capability that can be applied by the same surgeon in differing scenarios depending on the individualized patient and disease characteristics. We detail here the global applicability of a simple access device construct that allows the provision of simple and complex single‐port laparoscopy as well as contributing to multiport laparoscopic and transanal resections in a manner that is reliable, reproducible, ergonomical and economical.
Laparoscopic low anterior resection and transanal pull‐through for low rectal cancer: a Natural Orifice Specimen Extraction (NOSE) technique
Authors: D’Hoore A. , Wolthuis A. M.
Published: November 2011

Ultralow anterior resection with coloanal anastomosis has been proven to be oncologically sound and the majority of patients will have acceptable functional outcome. Here we describe a technique that combines laparoscopic ultralow total mesorectal excision with an intersphincteric dissection in order to allow the mobilized rectum and descending colon to be extracted via the muscular anal canal and so avoid any further abdominal incision other than laparoscopic port sites. We believe this novel approach to have significant clinical potential in selected patients.
Transrectal Natural Orifice Translumenal Endoscopic Surgery (NOTES) for colorectal resection
Authors: Rieder E. , Whiteford M. H.
Published: November 2011

Natural orifice translumenal endoscopic surgery (NOTES) is a new surgical paradigm involving performance of intra‐abdominal surgery via a natural orifice and thereafter peritoneal access through an intentionally created hole in a hollow viscus. The vast majority of research in this rapidly evolving field had involved access via an oral or vaginal route. Access via a transanal route, other than the obvious concern over contamination, has many appealing attributes. In addition, transanal surgery has long been a common procedure lending a valuable clinical experience to the foundation of this field of research. Examples of preclinical and clinical research on transanal NOTES colorectal resections are here presented and discussed.
Totally transrectal endoscopic Total Mesorectal Excision (TME)
Authors: Lacy A. M. , Adelsdorfer C.
Published: November 2011

Surgical treatment has been in constant evolution in the search for minimizing incisions regardless of the complexity of the operation. Natural Orifice Translumenal Endoscopic Surgery (NOTES) represents this progression of surgery to less invasive procedures. Transanal endoscopic microsurgery (TEM) is an ideal NOTES platform to access the peritoneal cavity endoscopically through the anus and specifically to allow colorectal resections be performed through smaller, or indeed without, abdominal incisions. Transanal rectosigmoidectomy with total mesorectal excision (TME) using TEM is a feasible and oncologically safe option. Such use of currently available combined hybrid laparoendoscopic systems provides a safe platform to define future clinical applications and advantages of NOTES. Furthermore, it stimulates the active development of technologies that will support and enable it.
Safe Sigmoid Access for Natural Orifice Transluminal Endoscopic Surgery (NOTES)
Authors: Feussner H. , Fiolka A. , Schneider A. , Gillen S. , Kranzfelder M. , Friess H. , Wilhelm D.
Published: November 2011

One of the main challenges in transluminal surgery is sterile and safe access. For many interventions, a transanal approach would be ideal but it is considered too risky because of contamination and the danger of secondary leakage. A new safe and sterile transanal access was developed, combining four basic principles: (i) the creation of a decontaminating hydroperitoneum, (ii) the use of an overtube, (iii) defining the entry point with ultrasound and (iv) dedicated closure technique. Applicability and reliability was first proven in extensive animal experiments. Feasibility of the concept in humans was subsequently demonstrated in cadavers.
Current clinical status of sentinel lymph nodes in colon and proximal rectal cancer
Authors: Bembenek A.
Published: November 2011

The postoperative report of the lymph node status of colorectal cancer in clinical practice is not a given fact. Among other factors, it is dependent on the experience and technique of the surgeon as well as the pathologist. Therefore a method like sentinel lymph node biopsy (SLNB) that identifies and provides for analysis the lymph node at highest risk for tumour involvement would be highly beneficial. Unlike in breast cancer or melanoma, SLNB is more difficult to apply in colorectal cancer and is still not ready for clinical routine application for these tumor entities. However, careful patient selection and expertise of the involved specialists can improve the quality and results of SLNB in colorectal cancer. Especially in the early stage cancer patients, SLNB may be helpful to identify the earliest signs of lymphatic dissemination (thereby upstaging the patient) or to encourage a limited extent of resection.
Near infrared fluorescence lymphatic laparoscopy of the colon and mesocolon
Authors: Ankersmit M. , van der Pas M. H. G. M. , van Dam D. A. , Meijerink W. J. H. J.
Published: November 2011

During surgery, a surgeon relies on the vision of his eyes and the touch of his hands. While laparoscopic surgery for colon cancer has proven to be safe and effective, it still remains a technically difficult procedure. Although it is associated with reduced haptic feedback, by enforcing the power of visual guidance, the loss of this feedback can be (partly) compensated for. Here we describe how the use of near‐infrared dyes and fluorescence laparoscopy could help improve tumour staging and therefore lead to better selection of patients for postoperative adjuvant chemotherapy. More controversially, and analogous to melanoma and breast cancer surgery with sentinel node biopsy, we speculate that local resection with SLN harvesting in early colon cancer might change the therapeutic and surgical strategy in colon cancer.
The Norwegian minke whale DNA register: a data base monitoring commercial harvest and trade of whale products
Authors: Glover Kevin A , Haug Tore , Øien Nils , Walløe Lars , Lindblom Lotta , Seliussen Bjørghild B , Skaug Hans J
Published: November 2011

The application of genetics for the management of natural resources is expanding, and within this field, DNA registers will play an increasing role. The Norwegian minke whale DNA register, established in 1996, was designed primarily as a control system to detect any attempts at illegal trade of products derived from other stocks of minke whale, or other whale species, under cover of the legal Norwegian harvest originating from the Northeast Atlantic. The register contains genetic data for 7644 of 7751 whales landed in the period 1997–2010. Profiles are established from sequencing part of the mtDNA control region, analysis of 10 STRs and a sex‐determining marker. Probabilities of genotypes matching between two randomly selected whales are 6.0−04 and 3.0−08 for five and eight of the STR loci, respectively. This permits verification of traded whale products via match to the register. The register has also been used in a number of ad hoc scientific studies resulting through the accumulation of genetic, demographic and biological data. Here, we review the register’s logistics, specifications and evaluate the potential to apply similar registers to control the exploitation of other marine species.
Iterative Bias Correction of the Cross‐Validation Criterion
Authors: YANAGIHARA HIROKAZU , FUJISAWA HIRONORI
Published: November 2011

Abstract.  The cross‐validation (CV) criterion is known to be asecond‐order unbiased estimator of the risk function measuring the discrepancy between the candidate model and the true model, as well as the generalized information criterion (GIC) and the extended information criterion (EIC). In the present article, we show that the 2kth‐order unbiased estimator can be obtained using a linear combination from the leave‐one‐out CV criterion to the leave‐k‐out CV criterion. The proposed scheme is unique in that a bias smaller than that of a jackknife method can be obtained without any analytic calculation, that is, it is not necessary to obtain the explicit form of several terms in an asymptotic expansion of the bias. Furthermore, the proposed criterion can be regarded as a finite correction of a bias‐corrected CV criterion by using scalar coefficients in a bias‐corrected EIC obtained by the bootstrap iteration.
Does Incorporation Improve Firm Performance?
Authors: Li Xiao Mei , Yueh Linda
Published: November 2011

Since the 1990s, China has made a significant effort to transform its state‐owned enterprises into shareholding companies and allow its private firms to become incorporated. This corporatization policy has been used to restructure state‐owned enterprises as well as govern a growing and diverse set of firms in a marketizing economy. The intent of these reforms is that, as has been found in other economies, incorporation should improve firm performance through granting previously state‐owned and private firms the various legal forms that provide better protection of property rights and limited liability protection, among others. The findings are that incorporation improves firm performance separately from privatization and listing on stock markets. Even with an under‐developed legal system and imperfect capital markets, incorporation generates a productivity improvement which bodes well for the emerging corporate sector in China.
Diagnosing Development Bottlenecks: China and India*
Authors: Li Wei , Mengistae Taye , Xu Lixin Colin
Published: November 2011

Beginning with lower income level in 1980, China's 2006 per capita GDP stands more than twice that of India's. We investigate the role of business environment in explaining China's productivity advantage using recent firm‐level survey data. We find that China has better infrastructure, more skilled workers and more labour‐hiring flexibility than India, but worse access to finance and a higher regulatory burden. Infrastructure appears to be a key constraint for India: it lags significantly behind China, yet it has important indirect effects for the effectiveness of labour flexibility. Labour flexibility also appears to be a major constraint for India, as evident in the predominance of small firms, the importance of firm size in accounting for India's disadvantage in productivity and the complementarity of proxies of labour flexibility with infrastructure and access to finance. Interestingly, regulatory uncertainty has adverse effects in India but not in China. Our empirical analysis suggests that it is important to consider country‐specific growth bottlenecks and the indirect effects of policy reforms.
Does Financial Repression Inhibit or Facilitate Economic Growth? A Case Study of Chinese Reform Experience*
Authors: Huang Yiping , Wang Xun
Published: November 2011

This article examines the impact of financial repression on economic growth during China's reform period. The aggregate financial repression index suggests that China's financial liberalization has been steady but gradual. Empirical estimation confirms that, on average, repressive policies helped economic growth, thanks probably to the prudent liberalization approach. But the impact turned from positive in the 1980s and the 1990s to negative in the 2000s, suggesting rising efficiency losses in recent years. Specifically, we find that lending to the state sector, interest rate regulation and capital account control were the main factors constraining China's economic growth in recent years.
Deep Brain Stimulation in Pantothenate Kinase Associated Neurodegeneration: challenges for the future
Authors: Pauls K. A. M. , Timmermann L.
Published: November 2011

Click here to view the accompanying paper in this issue.
An alternative approach for Mohs surgery using a combination of a flexible blade and the traditional scalpel
Authors: Gurgen J. , Judy D. , Witfill K. , Miller R.
Published: November 2011

Background  Mohs surgery is a specialized surgical and pathological technique used for the removal of high‐risk neoplasms. Previous reports show the ability of using a flexible blade for Mohs surgery.

Method  We utilized a technique combining the traditional #15 blade and scalpel with a flexible blade to perform excisions for Mohs surgery.

Discussion  The use of the flexible blade alone in Mohs may yield jagged tissue peripheral edges after cutting on the cryostat. The classic technique with a scalpel excision often results in a deeper cut than desired, resulting in a larger defect. We modified both the traditional Mohs technique and the flexible blade by combining both. We have performed this method in approximately over 100 cases on the scalp, face and ears, preserving tissue, minimizing bleeding and avoiding alopecia.
The distribution of fibrillin‐2 and LTBP‐2, and their co‐localisation with fibrillin‐1 in adult bovine tail disc
Authors: Li Bing , Urban Jill P. G. , Yu Jing
Published: November 2011

We investigated the distribution of fibrillin‐2 and LTBP‐2 (latent TGF‐β binding protein‐2) in the intervertebral disc of the adult bovine tail. The association of fibrillin‐2 and of LTBP‐2 with fibrillin‐1 was examined by dual immunofluorescence staining. Both fibrillin‐2 and LTBP‐2 were found extensively distributed in all regions of the disc with the organisation of the network varying significantly region to region. In the outer annulus fibrosus (OAF) both fibrillin‐2 and LTBP‐2 co‐localised with fibrillin‐1 forming fibres running parallel to the collagen fibres of the lamellae with the microfibrillar network staining densely in between the adjacent lamellae and also at the boundaries of the collagen bundle compartments. In the inner annulus fibrosus (IAF) and nucleus pulposus (NP), co‐localised fibrillin‐1,2 and LTBP‐2 formed a chondron‐like structure around the cell. By contrast, the inter‐territorial matrix of the IAF and NP contained a dense network of fibrillin‐2 but only sparse/filamentous fibres of fibrillin‐1 and LTBP‐2. Dual immunostaining revealed that in this region, fibrillin‐2 was highly colocalised with elastin. The LTBP‐2 network co‐localised well with that of fibrillin‐1 in all regions and indeed is reported to bind strongly to fibrillin‐1. However, interestingly LTBP‐2 but not fibrillin‐1 or fibrillin‐2 was removed by hyaluronidase but not collagenase pre‐digestion. Our results suggest that fibrillin‐2 and LTBP‐2 could play an important role in disc function.