bluuebunny/crossref_metadata_2025 huggingface dataset:
Caring for older people with dementia in residential care: nursing students’ experiences
Authors: Robinson Andrew , Cubit Katrina
Published: May 2007

Title. Caring for older people with dementia in residential care: nursing students’ experiences

Aim. This paper is a report of selected findings from two projects aimed at improving nursing students’ experiences of caring for older people in elder care settings.

Background. With a growing number of older people the prevalence of dementia is rapidly increasing, such that it is now a primary reason for admission to residential care. This has implications for the preparation and support of nursing students on clinical placements as people with dementia represent a key focus of their nursing activities.

Method. Two projects were conducted in Tasmania between 2001 and 2005, involving 87 second year Bachelor of Nursing students who participated in 3‐week clinical placements in eight residential elder care facilities. During the placements, students and their mentors participated in a series of weekly focus group discussions to explore their experiences of caring for residents with dementia. Thematic analysis of the data was conducted.

Findings. Staff in the facilities struggled to support students effectively and often failed to recognize that students found residents’ behaviour disturbing. Despite having some theoretical understanding of dementia, students reported being unsure of how to respond to residents and often felt scared and intimidated.

Conclusion. Better preparation and support are needed for students on placements involving residents with dementia. Feasible strategies for more effective support include increased curriculum content about caring for people with dementia, and improved collaboration between university schools of nursing and settings for care of older people.
Comparative phylogeography and population structure of European Betula species, with particular focus on B. pendula and B. pubescens
Authors: Maliouchenko O. , Palmé A. E. , Buonamici A. , Vendramin G.G. , Lascoux M.
Published: May 2007

Aim  To compare the population genetic structures of the haplotype‐sharing species Betula pendula and B. pubescens and to draw phylogeographic inferences using chloroplast DNA markers. In particular, we tested whether B. pendula and B. pubescens exhibited the same or different phylogeographic structures.

Location  Western Europe and Russia.

Methods  In this study we used both chloroplast DNA polymerase chain reaction‐restriction fragment length polymorphism and microsatellites to genotype B. pendula, B. pubescens and, to a limited extent, B. nana, in 53 populations across Eurasia. A spatial amova (samova) was used to identify major clusters within each species.

Results  The low level of phylogeographic structure previously observed in B. pendula was confirmed, and the samova analysis retrieved only two major clusters. In contrast, seven clusters were observed in B. pubescens, although the overall level of population differentiation was similar to that of B. pendula.

Main conclusions  We detected a difference in the population genetic structure between the two species, despite extensive haplotype sharing. It is difficult to ascribe this finding to a single factor, but divergence in ecology between the two species may provide part of the explanation. For both species, the contribution of southern western populations to the recolonization after the Last Glacial Maximum seems to have been limited, and eastern and western European populations apparently had different histories.
Defining the Gonadotrophin‐Releasing Hormone Neuronal Network: Transgenic Approaches to Understanding Neurocircuitry
Authors: Campbell R. E.
Published: May 2007

The gonadotrophin‐releasing hormone (GnRH) neurones are the final downstream effector neurones driving the central regulation of reproductive function and fertility in all mammalian species. Although it is abundantly clear that successful fertility relies upon the communication of a variety signals regarding internal and external cues to the GnRH neuronal population, how this is achieved remains poorly understood. A range of technical limitations has posed significant hurdles to defining, with any certainty, the complexities of the synaptic neuronal network regulating GnRH neurones. However, recent advances in transgenic technology have opened up new avenues to reconsider questions aimed at understanding this critical network. This article addresses some of the latest advances that use transgenic mouse models as tools to understand the neuronal circuitry underpinning the regulation of the GnRH neurones. By incorporating standard morphological and viral tract tracing techniques with innovative transgenic tools, recent studies have uncovered previously unappreciated qualities of the GnRH neurone, including extensive dendritic lengths, numerous somal and dendritic spines and plasticity over pubertal development, along with beginning to define the primary and higher‐order afferents that make up the GnRH neuronal network.
Clinical evaluation of a new formulation of propofol in a medium‐chain and long‐chain triglycerides emulsion in dogs
Authors: REDONDO GARCÍA J. I.
Published: May 2007

Propofol formulated in a mixed medium‐chain and long‐chain triglycerides emulsion has been recently introduced for clinical use as an alternative to the conventional long‐chain triglycerides formulation. This prospective multicentric study evaluated the clinical effectiveness and the complications associated with the use of this new formulation of propofol in dogs.

Forty‐six Spanish veterinary clinics participated in this study. A total of 541 anaesthesias (118 ASA I, 290 ASA II, 101 ASA III and 32 ASA IV) performed for various diagnostic and therapeutic purposes were evaluated. The anaesthetic protocol was not controlled, with the exception that propofol had to be used at least for induction of anaesthesia. The induction dose of propofol and the incidence of anaesthetic complications throughout the procedure were recorded. A chi‐square test compared the incidence of complications according to the maintenance agent used (propofol vs. inhalatory anaesthesia), anaesthetic risk (ASA classification) and the reason for the anaesthesia.

The patients premedicated withα2agonists needed lower doses (mean ± SD, 2.9 ± 1.3 mg/kg i.v.) than the animals premedicated with phenothiazines (3.9 ± 1.4 mg/kg i.v.) or benzodiazepines (4.0 ± 1.4 mg/kg i.v.). The most frequent complications were difficult endotracheal intubation (1.3%), postinduction apnoea (11.3%), cyanosis (0.6%), bradypnoea (2.6%), tachypnoea (2.8%), bradycardia (2%), tachycardia (2.6%), hypotension (0.2%), shock (0.2%), vomiting (4.6%), epileptiform seizures (2.8%), premature awakening (7.4%) and delayed recovery (0.9%). There were no cases of pain on injection or aspiration pneumonia. Three dogs died (0.55%), one during induction and two during recovery from anaesthesia. This study demonstrates that the new formulation of propofol is an useful and effective drug to induce general anaesthesia in dogs.
Pharmacokinetics of ruminally dosed sodium [36Cl]chlorate in beef cattle
Authors: OLIVER C. E. , CRAIGMILL A. L. , CATON J. S. , ANDERSON R. C. , SMITH D. J.
Published: May 2007

The recently recognized potential of sodium chlorate as a possible preharvest food safety tool for pathogen reduction in meat animals has spurred interest in the pharmacokinetics of intraruminally dosed chlorate. Six Loala cattle were assigned (one heifer and one steer per treatment) to one of three intraruminal doses of radiolabeled sodium [36Cl]chlorate (21, 42, or 63 mg/kg body weight) administered in four equal aliquots over a 24‐h period. Blood and serum were collected (29 samples in 48 h). Total radioactive residues were measured and the radioactive moieties were speciated. Chlorate appeared rapidly in blood and serum after dosing. For animals administered a dose of 42 or 63 mg/kg, the half‐life of absorption was estimated at 0.6–0.9 h. Serum chlorate concentrations progressively increased with aliquot administration until peaking at 6–21 parts per million at 26 h. Between aliquot administrations, serum chlorate levels typically peaked in 3.5 h or less. The half‐life of chlorate elimination ranged between 6.9 and 11 h, depending on the dose. Ultimately, absorption of chlorate removes it from its desired site of action, the lower gastrointestinal tract, thereby reducing its efficacy. Further research is needed to develop a chlorate formulation that will allow passage to the lower gastrointestinal tract.
North‐eastward subduction followed by slab detachment to explain ophiolite obduction and Early Miocene volcanism in Northland, New Zealand
Authors: Schellart W.P.
Published: May 2007

Oligocene–Miocene models for northern New Zealand, involving south‐westward subduction to explain Early Miocene Northland volcanism, do not fit within the regional Southwest Pacific tectonic framework. A new model is proposed, which comprises a north‐east‐dipping South Loyalty basin slab that retreated south‐westward in the Eocene–earliest Miocene and was continuous with the north‐east‐dipping subduction zone of New Caledonia. In the latest Oligocene, the trench reached the Northland passive margin, which was pulled it into the mantle by the slab, resulting in obduction of the Northland allochthon. During and after obduction, the slab detached from the unsubductable continental lithosphere, inducing widespread calc‐alkaline volcanism in Northland. The new model further explains contemporaneous arc volcanism along the Northland Plateau Seamount Chain and sinking of the Northland basement, followed by uplift and extension in Northland.
Epstein–Barr virus DNA load and seroconversion in pediatric renal transplantation with tacrolimus immunosuppression
Authors: Suzuki Toshiaki , Ikezumi Yohei , Okubo Soichiro , Uchiyama Makoto , Takahashi Kota , Shiraga Hiroshi , Hattori Motoshi
Published: May 2007

Abstract:  EBV infection is one of major complications arising in pediatric patients who have undergone renal transplantation. A strong correlation between the grade of immunosuppression and the development of PTLD, one of the most severe EBV‐associated diseases, has been recognized. In this study, we monitored the serologic profile in conjunction with peripheral blood EBV‐DNA load of 32 children who underwent renal transplantation with tacrolimus as an immunosuppressant. Six patients were EBV‐seronegative (EBV−) before the transplantation, and the mean DNA load in the EBV− group was significantly higher than that in the EBV‐seropositive (EBV+) group. Seroconversion occurred in five of these patients in a mean period of 22 weeks after the transplantation. The EBV‐DNA load in the EBV+ group was maintained at a low level for a year, whereas it increased rapidly to over 1 × 105 copies/mL in two patients in the EBV− group three to seven months after the transplantation, which corresponds to the timing of seroconversion, and one of them developed PTLD. These observations suggest that the close monitoring of the EBV‐DNA load, along with longitudinal observation of seroconversion, is essential in pediatric renal transplantation, particularly for younger children who are more likely to be EVB−.
Adaptive switch from infanticide to parental care: how do beetles time their behaviour?
Authors: OLDEKOP J. A. , SMISETH P. T. , PIGGINS H. D. , MOORE A. J.
Published: May 2007

AbstractIn species where parents may commit infanticide, temporal kin recognition can help ensure parents kill unrelated young but care for their own offspring. This is not true recognition, but rather depends on accurate timing of the arrival of young and a behavioural switch from killing to caring for offspring. Mistakes have clear fitness consequences; how do species that use temporal kin recognition ensure accurate timing? We manipulated photic cues and show that the switch from infanticide to parental care in the burying beetleNicrophorus vespilloidesdepends on day‐length inputs. Extending the light period after carcass discovery influenced timing of both oviposition and the cessation of infanticide. Manipulation of the light : dark cycle after oviposition also influenced timing of the switch to parental care. The timing mechanism is therefore sensitive to photic cues and access to a carcass and is not triggered by oviposition. The behavioural switch is directly related to the timing mechanism rather than changes in reproductive physiology. Given the conserved nature and extensive homology of genetic influences on biological timing, we speculate that the molecular mechanisms regulating circadian behaviour may have been co‐opted to allow beetles to determine how much time has passed after carcass discovery even though this is over 50 h.
Benefits and challenges of providing transitional rehabilitation services to people with spinal cord injury from regional, rural and remote locations
Authors: Booth Susan , Kendall Melissa
Published: May 2007

Objective:  To identify the factors influencing participation and outline the benefits and challenges of providing transitional rehabilitation for people with spinal cord injury (SCI) from rural and regional locations.

Design:  Grounded Theory analysis of service records and policy documents.

Setting:  One transitional rehabilitation service for people with SCI.

Participants:  Service records of 40 individuals with SCI from non‐metropolitan locations who participated in transitional rehabilitation and 29 individuals with SCI who declined transitional rehabilitation over a two‐year period.

Interventions:  Home‐based transitional rehabilitation programs offered by a multidisciplinary team including physiotherapy, occupational therapy, nursing and social work.

Measures:  Participation was measured using the percentage of people from non‐metropolitan locations who decline transitional rehabilitation. The benefits and challenges of transitional rehabilitation were identified using open, axial and selective coding of service records.

Results:  People with SCI from non‐metropolitan areas were underrepresented among transitional rehabilitation participants, with 69% of those declining transitional rehabilitation coming from regional or rural areas. The study identified five functions of transitional rehabilitation that presented both benefits and challenges of this model in assisting people from non‐metropolitan locations. These included: (1) the identification, education, coordination and funding of local care providers; (2) family involvement in rehabilitation; (3) contact with social and community supports; (4) specialist support to problem‐solve discharge needs; and (5) skill acquisition and transfer in a community environment.

Conclusions:  The transitional rehabilitation model offers many advantages over traditional hospital‐based rehabilitation but still faces challenges in offering an equitable model for people with SCI from non‐metropolitan locations.
Tumor necrosis factor signaling in hepatocyte apoptosis
Authors: Hatano Etsuro
Published: May 2007

Death receptor‐mediated hepatocyte apoptosis is implicated in a wide range of liver diseases including viral hepatitis, alcoholic hepatitis, ischemia/reperfusion injury, fulminant hepatic failure, cholestatic liver injury, and cancer. Our aim was to clarify the protective pathway in death receptor‐mediated hepatocyte apoptosis and the significance of apoptosis in liver injury. In vitro: AdIκBsr plus tumor necrosis factor (TNF)‐α/Jo2 rapidly induced apoptosis in mouse hepatocyte, whereas TNF‐α/Jo2 alone produced little cytotoxicity. The combination of the mitochondrial permeability transition (MPT) inhibitors, cyclosporine A and trifluoperazine, protected AdIκBsr‐infected hepatocytes from TNF‐α‐ but not Fas‐mediated apoptosis. The TNF‐α and Jo2 induced iNOS through NF‐κB. Nitric oxide donor (S‐nitroso‐N‐acetylpenicillamine) inhibited Bid cleavage, the MPT, and caspase activation and reduced TNF‐α‐ and Fas‐mediated cell killing. Inhibition of PI3K by LY294002 and a dominant‐negative Akt, which attenuated NF‐κB activation by TNF‐α or Jo2, sensitized hepatocytes to TNF‐ or Jo2. In vivo: apoptosis as well as necrosis may play an important role in hepatic ischemia/reperfusion injury. Adenoviral gene transfer of myrAkt could inhibit apoptotic cell death and subsequent hepatic ischemia/reperfusion injury in the rat, through Bad not NF‐κB. Bile acids cause liver injury during cholestasis by inducing hepatocyte apoptosis. Hepatocyte apoptosis has a major role in hepatic injury by bile duct ligation. At least, early hepatic injury by bile duct ligation involved Fas‐mediated and Bcl‐xL insensitive apoptotic pathway. In conclusion, the role of apoptosis in various liver diseases may suggest possible treatments.
Ischemic preconditioning in liver pathophysiology
Authors: Arai Masahiro , Tejima Kazuaki , Ikeda Hitoshi , Tomiya Tomoaki , Yanase Mikio , Inoue Yukiko , Nagashima Kayo , Nishikawa Takako , Watanabe Naoko , Omata Masao , Fujiwara Kenji
Published: May 2007

Brief periods of tissue ischemia produced tissue resistance to prolonged ischemia and reperfusion, a phenomenon called ischemic preconditioning. The mechanisms of ischemic preconditioning were examined in a rat warm ischemia–reperfusion model as well as the effect of ischemic preconditioning on liver regeneration. Ischemic preconditioning decreased liver injury after warm ischemia–reperfusion, which was reversed by Kupffer cell depletion. Ischemic preconditioning stimulated Kupffer cells to produce reactive oxygen species. Scavengers of reactive oxygen species reversed the effect of ischemic preconditioning, and pretreatment with sublethal dose of hydrogen peroxide mimicked ischemic preconditioning effect. Rat livers were preconditioned by ischemia and subjected to 70% partial hepatectomy. Liver regeneration was then evaluated serially. Ischemic preconditioning promoted liver regeneration, which was reversed by adenosine A2 receptor antagonism and mimicked by adenosine A2 receptor agonism. Promotion of liver regeneration by ischemic preconditioning and adenosine A2 receptor agonism were reversed by Kupffer cell depletion. In conclusion, ischemic preconditioning stimulates Kupffer cells to produce reactive oxygen species, leading to hepatocyte protection against warm ischemia–reperfusion injury; and ischemic preconditioning promoted liver regeneration via adenosine A2 receptor pathway in Kupffer cells.
Hepatitis C virus contributes to hepatocarcinogenesis by modulating metabolic and intracellular signaling pathways
Authors: Koike Kazuhiko
Published: May 2007

Persistent infection with hepatitis C virus (HCV) is a major risk factor for development of hepatocellular carcinoma (HCC). However, it remains controversial in the pathogenesis of HCC associated with HCV as to whether the virus plays a direct or an indirect role. The studies using transgenic mouse models, in which the core protein of HCV has an oncogenic potential, indicate that HCV is directly involved in hepatocarcinogenesis, albeit other factors such as continued cell death and regeneration associated with inflammation would also play a role. The downstream events of the core protein are segregated into two components. One is the augmented production of oxidative stress along with the activation of scavenging system, including catalase and glutathione, in the putative pre‐neoplastic stage with steatosis in the liver. Thus, oxidative stress production in the absence of inflammation by the core protein would partly contribute to the development of HCC. The generation of oxidative stress is estimated to originate from mitochondrial dysfunction in hepatocytes by HCV infection. The other component is the alteration of intracellular signaling cascade of mitogen‐activated protein kinase and activating factor (AP)‐1, leading to the activation of cell cycle control. The combination of these pathways, collective with HCV‐associated alterations in lipid and glucose metabolism, would lead to the frequent development of HCC in persistent HCV infection. These results suggest that there would be a mechanism for hepatocarcinogenesis in persistent HCV infection that is distinct from those for the other cancers. Similar to the pathogenesis of other cancers, the accumulation of a set of genetic aberrations may also be necessary for a multistage development of HCC. However, HCV core protein, to which an oncogenic potential is ascribed, may allow some of the multiple steps to be bypassed in hepatocarcinogenesis. Therefore unlike for other cancers, HCV infection may be able to cause HCC in the absence of a complete set of genetic aberrations. Such a scenario, ‘non‐Vogelstein‐type’ carcinogenesis, would explain the rare feature of hepatocarcinogenesis in HCV infection, the extraordinarily high incidence and the multicentric nature of HCC development.
Cost of hospitalizing asthma patients in a regional hospital in Thailand
Authors: CHUESAKOOLVANICH Kittisak
Published: May 2007

Background and objective:  The hospitalization of asthma patients accounts for substantial costs in any health‐care system. However, the utilization of medical resources and the cost of hospitalizing asthma patients in Thailand have never been evaluated. This study aimed to evaluate the utilization of health‐care resources and itemize the cost of hospitalizing asthma patients in a regional hospital in north‐east Thailand.

Methods:  A cross‐sectional, retrospective study was conducted at Surin Hospital, a 697‐bed, regional hospital in north‐east Thailand. The study included 183 adults (≥15 years of age) who were admitted with acute asthma. Demographic data, resource‐utilization parameters and itemized costs were recorded.

Results:  The average hospital cost was TH5809.3 ± 6587.4 (US$134.5 ± 152.5) per patient (range, TH740–57 980 or US$17.1–1342.1). Medications were the primary hospital expense (47.2%), followed by hospital charges (13.5%), nursing care (13.0%) and respiratory therapy (12.2%). Fifteen per cent of patients accounted for 45% of total hospital costs. Significant predictors of increased total hospital cost were: (i) age ≥60 years; (ii) presence of comorbid conditions; (iii) admission to the intensive care unit; and/or (iv) prolonged hospital stay.

Conclusion:  Despite the low unit costs for inpatient care in Thailand, the cost of hospitalizing asthma patients (especially the elderly) constitutes a substantial burden to the health‐care system.
Pneumoconiosis and liver cirrhosis are not risk factors for tuberculosis in patients with pulmonary infection
Authors: WU Huang‐Pin , PAN Yu‐Huei , HUA Chung‐Ching , SHIEH Wen‐Bin , JIANG Bor‐Yiing , YU Teng‐Jen
Published: May 2007

Background and objective:  It is unclear whether patients with liver cirrhosis and coal miners with pneumoconiosis are at increased risk of developing pulmonary tuberculosis (TB). Furthermore, little is known of the likelihood of pneumonia in patients with bronchiectasis, haemodialysis, diabetes mellitus or advanced lung cancer being due to TB. To answer these questions, patients with these clinical comorbidities were analysed.

Methods:  The study was retrospective and included 264 TB patients, 478 non‐TB pneumonia patients, and as negative controls, 438 subjects without pneumonia. The parameters analysed were age, gender and the presence of pneumoconiosis, bronchiectasis, liver cirrhosis, haemodialysis, diabetes mellitus and advanced lung cancer.

Results:  Male gender was the only significant factor increasing the risk of pulmonary TB. When compared with non‐TB pneumonia and control patients, the odds ratios were 1.862 and 2.182, respectively. Patients with liver cirrhosis did not show an increased risk of pulmonary TB after regression analysis. Pneumoconiosis resulted in a 2.260 (P = 0.003) odds ratio for pulmonary TB, compared with the controls. However, there was no difference in pneumoconiosis between TB and non‐TB pneumonia patients. Patients with bronchiectasis, lung cancer and those receiving haemodialysis had a lower risk for pulmonary TB in lower respiratory tract infection, with odds ratios of 0.342, 0.311 and 0.182, respectively.

Conclusion:  Physicians should first consider non‐TB bacterial infection rather than Mycobacterium tuberculosis infection in pneumonia in patients with bronchiectasis, lung cancer or those receiving haemodialysis.
Peripheral T‐cell lymphoma with diffuse pulmonary infiltration and an increase in serum KL‐6 level
Authors: FUJISAWA Tomoyuki , SUDA Takafumi , MATSUURA Shun , ENOMOTO Noriyuki , TAKESHITA Kaori , OHNISHI Kazunori , CHIDA Kingo
Published: May 2007

Abstract:  Peripheral T‐cell lymphoma is a subtype of non‐Hodgkin’s lymphoma. A case of peripheral T‐cell lymphoma showing diffuse pulmonary involvement together with a marked increase in the level of serum KL‐6 is presented. CXR and CT revealed reticular and ground‐glass opacities, which mimicked interstitial pneumonia. Immunopathological findings and an analysis of T‐cell receptor gene rearrangements of the lung biopsy specimen led to a definite diagnosis of peripheral T‐cell lymphoma. In addition, the extensive proliferation of type II pneumocytes, which stained strongly positive for anti‐KL‐6 antibody suggested that the pneumocytes were the source of serum KL‐6.
Elevated α‐defensin levels in plasma of patients with pulmonary sarcoidosis
Authors: ASHITANI Jun‐ichi , MATSUMOTO Nobuhiro , NAKAZATO Masamitsu
Published: May 2007

Background and objectives:  Pathogens such as mycobacteria and proprionibacterium have been implicated in the pathogenesis of sarcoidosis. α‐Defensins (DF) are naturally occurring antimicrobial peptides. The aim of the present study was to assess whether DF are increased in the airway and/or systemic circulation in patients with pulmonary sarcoidosis and whether DF levels are related to sarcoidosis disease activity.

Methods:  DF levels in plasma and BAL fluid (BALF) were measured in 30 patients with pulmonary sarcoidosis and in 10 controls. Plasma and BALF DF levels were compared according to disease activity. Molecular forms were analysed using reverse‐phase (RP) HPLC to confirm plasma and BALF DF kinetics in pulmonary sarcoidosis.

Results:  DF concentrations in plasma and BALF were higher in patients with pulmonary sarcoidosis than in the controls. Plasma DF levels correlated with lysozyme but not with angiotensin‐converting enzyme. These levels were high in patients in whom more organs were involved, whereas BALF DF levels were higher in patients at stage II or III than with those at sarcoidosis I. RP‐HPLC showed high plasma levels of pro‐defensins, DF precursors from the bone marrow, in sarcoidosis, although DF in peripheral neutrophils and BALF were the mature type.

Conclusions:  High plasma DF concentrations resulted from bone marrow stimulation and seemed to be associated with disease activity, whereas BALF DF were released from accumulated neutrophils in the lungs and may contribute to parenchymal involvement in sarcoidosis.
Routine culture for Mycobacterium tuberculosis from bronchoscopy in Taiwan
Authors: YANG Chih‐Jen , CHEN Tun‐Chieh , HUNG Jen‐Yu , LU Po‐Liang , SHEU Chau‐Chyun , TSAI Jong‐Rung , CHONG Inn‐Wen , HWANG Jhi‐Jhu , HUANG Ming‐Shyan
Published: May 2007

Background and objective:  The value of routine culture for mycobacterium from bronchoscopic washings and the cost‐effectiveness is still uncertain in countries where tuberculosis is endemic. This study examined the epidemiology of positive cultures for M. tuberculosis obtained by bronchoscopy to determine the health benefit and cost of a policy of routine culture and smear.

Methods:  All positive cultures for Mycobacterium tuberculosis in bronchial washings and the corresponding CXR features were analysed.

Results:  The incidence of tuberculosis in routine bronchoscopy was 3.71%, and in patients who presented with typical tuberculosis features on CXR was 6.5%. Up to 10.6% of culture‐proven pulmonary tuberculosis relied on bronchoscopy for diagnosis. The total cost of routine mycobacterium culture and acid‐fast bacillus smear during the 2‐year period was approximately USD 24 800.

Conclusion:  Routine mycobacterium culture and acid‐fast staining from bronchoscopic specimens appears to be valuable in countries where tuberculosis is prevalent.
Sarcoidosis in Singapore: Epidemiology, clinical presentation and ethnic differences
Authors: ANANTHAM Devanand , ONG Sin Jen , CHUAH Khoon Leong , FOOK‐CHONG Stephanie , Hsu Ann , ENG Philip
Published: May 2007

Background and objectives:  The aim of this study is to better understand the epidemiological and clinical features of patients with sarcoidosis in Singapore and to ascertain if ethnic differences exist.

Methods:  A review of hospital medical records from June 1998 to May 2004 to identify patients with sarcoidosis.

Results:  There were 59 patients with sarcoidosis identified (19 Chinese, 29 Asian Indian and 11 Malay). The estimated annual incidence of sarcoidosis in Singapore was 0.56 per 100 000. There was a significant difference between the observed and expected disease frequency in Chinese (32.2% vs 78.7%) and Indians (49.2% vs 6.0%, P < 0.005). A bimodal distribution of age at diagnosis was seen with peaks in the 30–39 years and 50–59 years age groups; 38.9% of cases were over the age of 50. Chinese patients were more likely to be asymptomatic (57.9%, P = 0.015) and less likely to have impaired spirometry (P = 0.013). Pulmonary sarcoid presented largely as stage 0 or stage 1 disease (74.4%). Overall mean spirometry was unimpaired and prognosis was good with 79.2% showing no radiological deterioration. There were no significant differences in organ involvement or treatment between ethnic groups.

Conclusion:  Sarcoidosis in Singapore is rare and the incidence differs between ethnic groups. Chinese appear to have a lower incidence and a less symptomatic presentation; Indians have a higher incidence and poorer clinical course.
Late‐onset post‐traumatic Phaeoacremonium parasiticum endophthalmitis
Authors: Huynh Tu Khai , Lee Lawrence R , Ellis David
Published: May 2007

Abstract

This is the first documented case of Phaeoacremonium parasiticum endophthalmitis to the authors' knowledge. P. parasiticum has been described in the literature causing various skin, subcutaneous and joint infections and one case of infective endocarditis, but has never been documented as an ocular infectious agent. The most likely source of inoculation in this case was a penetrating injury caused by a stick 5 years prior to the presentation. An enucleation was avoided through treatment with intravitreal antibiotics and amphotericin and oral voriconazole, and the patient's vision stabilized at 6/18. Microbiological studies were delayed but confirmed the mould's sensitivity to amphotericin B and voriconazole.
Psychosocial barriers to active surveillance for the management of early prostate cancer and a strategy for increased acceptance
Authors: Pickles Tom , Ruether J. Dean , Weir Lorna , Carlson Linda , Jakulj Fabijana ,   the SCRN Communication Team
Published: May 2007

OBJECTIVES

To review the psychosocial needs of men undergoing active surveillance (AS, the monitoring of early prostate cancer, with curative intervention only if the disease significantly progresses) for prostate cancer, and barriers to its uptake.

METHODS

The introduction of screening for prostate‐specific antigen (PSA) has led to more men diagnosed with early and nonlife‐threatening forms of prostate cancer; about half of men diagnosed as a result of PSA testing have cancers that would never cause symptoms if left untreated and yet up to 90% of such men receive curative therapy, then living with the toxicity of treatment but with no benefit. Thus AS is increasingly being promoted, but if such a strategy is to succeed, the psychosocial barriers that discourage men from adopting AS must be addressed. We reviewed and assessed reports on this topic, published in English since 1994.

RESULTS

There is relatively little research on AS, as most published reports refer to watchful waiting (which is a palliative management approach). Men with prostate cancer generally have lower levels of psychological disturbance than for other cancers, but the psychosocial issues identified include anxiety in response to no intervention, uncertainty related to loss of control, and lack of patient education and support, particularly around the time of initial treatment planning. Approaches that were identified to improve uptake of AS include increased education and improved communication, interventions to reduce anxiety and uncertainty, and the empowerment of patients by the development of a sense of control and meaning. Physicians attitudes are influential and the education of physicians about AS as an appropriate option is to be encouraged. Peer‐support groups were also identified as being of particular value.

CONCLUSIONS

There are several strategies that should be developed if AS is to become more widely adopted. Increased education and good communication can alleviate anxiety and uncertainty, as can interventions for cognitive re‐framing. Inviting patients to become active participants in their management might enhance the patients’ sense of control, and the involvement of peer‐support groups might be beneficial.
Elastin expression and elastic fibre width in the anterior vaginal wall of postmenopausal women with and without prolapse
Authors: Karam Jose A. , Vazquez Dolores V. , Lin Victor K. , Zimmern Philippe E.
Published: May 2007

OBJECTIVES

To compare elastin expression and elastic fibre width in the anterior vaginal wall of postmenopausal women with and with no bladder prolapse.

PATIENTS AND METHODS

Full‐thickness specimens were obtained from the upper lateral anterior vaginal wall of women having a large cystocele repaired (stage III or IV; prolapse group, 33) and the same location in patients with no prolapse having radical cystectomy (control group, 10). The percentage of elastin‐positive tissue and elastic fibre width were measured by immunohistochemistry on 6 µm thick tissue sections from 10 random field readings per sample using image analysis software. The examiner was unaware of sample identity and the patients’ clinical history.

RESULTS

The age was comparable between the control and prolapse groups (median 70.5 years), and the parity, vaginal deliveries, hormone replacement use, cigarette smokers and body mass index were no different between the groups. Immunohistochemical staining and morphometric analysis indicated that elastin expression in the prolapse group was 10.6%, vs 14.4% in the control group (P = 0.049). The median width of elastic fibres was 0.9 µm in the prolapse and 1.8 µm in the control groups (P < 0.001). Elastin expression and elastic fibre width appeared to be stable with increasing age in the prolapse group.

CONCLUSIONS

In this case‐control study investigating elastin changes in postmenopausal women with prolapse, the elastin expression and fibre width were significantly lower in the vaginal wall of patients with a large cystocele than in controls of a similar age.
Robotic Anderson‐Hynes pyeloplasty: 5‐year experience of one centre
Authors: Schwentner Christian , Pelzer Alexandre , Neururer Richard , Springer Brigitte , Horninger Wolfgang , Bartsch Georg , Peschel Reinhard
Published: May 2007

OBJECTIVE

To present our 5‐year experience with robotically assisted laparoscopic pyeloplasty (RALP), as LP has been shown to have similar success rates as open surgery, but standard LP requires high operative skills and a correspondingly long period of training, limiting its widespread availability, and RALP is easier and quicker to learn due to facilitated intracorporeal suturing.

PATIENTS AND METHODS

In all, 92 patients had transperitoneal RALP for pelvi‐ureteric junction obstruction (PUJO) using the daVinci system (Intuitive Surgical, Sunnyvale, CA, USA). A transperitoneal dismembered Anderson‐Hynes procedure was used in all cases. Three robotic ports and one assistant port were used in all cases while a JJ stent was left indwelling for 6 weeks. Both primary PUJO (including horseshoe kidneys in 80 cases) and secondary (in 12 cases) were considered eligible. The follow‐up included ultrasonography, excretory urography and renal scintigraphy.

RESULTS

The mean follow‐up was 39.1 months; PUJO was successfully resolved in 89 patients (96.7%) while three required additional procedures. Haemorrhage into the collecting system and urine extravasation occurring early after surgery were the causes of failure. The mean (range) operative duration, including the set‐up of the robot, was 108.34 (72–215) min; the mean duration of docking and surgery significantly decreased with experience (P < 0.001). The mean hospital stay was 4.57 days. Split renal function improved from 37.6% to 41.9%. No cases of secondary PUJO were recorded during extended follow‐up.

CONCLUSIONS

RALP using the daVinci system is safe and effective, achieving similar long‐term success rates to open surgery. The three‐dimensional versatility of the robot enables the surgeon to recapitulate the open procedure. The results were durable with no cases of late complications, corroborating the accuracy of robot‐assisted intracorporeal suturing and the subsequent quality of the pelvi‐ureteric anastomosis. Moreover, the robotic approach was easy and quick to learn for both the surgical and the technical staff. Therefore, RALP is our preferred technique to treat PUJO.
Evidence for distinct effects of GH and IGF‐I in the metabolic syndrome
Authors: Maison P. , Balkau B. , Souberbielle J.‐C. , Cunin P. , Vol S. , Macquin‐Mavier I. , Eschwège E. ,   the D. E. S. I. R. Study Group
Published: May 2007

Aims  The metabolic syndrome is a cluster of cardiovascular risk factors which include central obesity, dyslipidaemia, glucose intolerance and hypertension. These risk factors are common in patients with growth hormone (GH) deficiency, suggesting a role for the somatotropic axis in the development of metabolic syndrome.

Methods  We used factor analysis to investigate the relationships linking serum levels of GH and insulin‐like growth factor I (IGF‐I) to metabolic syndrome variables (high‐density lipoprotein cholesterol, triglycerides, fasting glucose, blood pressure and waist circumference). We studied 359 men and 388 women from the Data from an Epidemiological Study on the Insulin Resistance syndrome (DESIR). Their age range was 30–64 years.

Results  Three independent latent factors explained 61% of the total variance in women and four factors explained 73% in men. In both men and women, IGF‐I showed a strong positive correlation with the lipid factor and a negative correlation with the obesity/glucose factor. In women, GH showed a strong negative correlation with the obesity/glucose factor but not the lipid factor. In men, GH was unrelated to the lipid and obesity/glucose factors. The blood pressure factor was not related to GH or IGF‐I. In contrast with IGF‐I, GH was significantly lower in women with metabolic syndrome (1575 ± 449 pg/ml) than in the other women (2121 ± 520 pg/ml, P = 0.002). No significant difference was observed in men for GH or IGF‐I.

Conclusion  Our results support a link between the somatotropic axis and several features of the metabolic syndrome, and suggest distinct effects of GH and IGF‐I on these parameters.
Nutrition and alcoholic liver disease
Authors: Everitt H. , Patel V. B. , Tewfik I.
Published: May 2007

Summary  Mounting interest in the potential value of nutritional therapy in the treatment of alcoholic liver disease (ALD) has arisen as a result of the growing body of evidence implicating nutritional intervention as a key player in ameliorating ALD. This review will focus on the involvement of nutrition in the pathogenesis of ALD, with extended focus on the role of micronutrients in the intervention or prevention of ALD. Oxidative damage is a major pathway in the initiation of ALD, and as such, many micronutrients have protective roles owing to their antioxidant properties. This can be either a direct action by scavenging free radicals or an indirect one elicited by increasing the synthesis or recycling of glutathione, the main intracellular antioxidant molecule. Micronutrients should be consumed as part of an energy‐sufficient (at least 1400 kcal/day), macronutrient‐based diet, as ALD progresses more quickly in people who have substituted a normal diet with alcohol, as opposed to those who drink alcohol in addition to their daily diet. Discontinuing alcohol consumption will enhance recovery, although this is not always possible with alcohol‐addicted patients. In conclusion, an energy‐sufficient diet high in vitamins and minerals will help protect against the formation and progression of ALD. However, alcohol abstinence is the recommended course of action to aid any recovery.
Nutritional management of stroke: from current evidence to conjecture
Authors: Ray S. , Rana P. , Rajput M. , Haleem M. A.
Published: May 2007

Summary  Stroke is a leading cause of death and adult disability in the Western world. Diet is an important consideration as there is evidence that around half of stroke patients are undernourished on admission to hospital and their nutritional status often declines during the hospital stay. Undernutrition is associated with both increased morbidity and mortality. There have been many studies that have looked at various aspects of feeding in stroke patients, and guidelines are available for clinicians and healthcare workers involved in the care of stroke patients. The present paper aims to review current evidence underpinning guidelines on nutritional management of stroke patients, identify potential barriers to implementation and highlight areas for future research.
Headache in German Children and Adolescents: A Population-Based Epidemiological Study
Authors: Kröner-Herwig B , Heinrich M , Morris L
Published: May 2007

The aim of the present study was to assess the distribution and characteristics of headache in children aged 7-14 years in Lower Saxony (Germany). For the survey, 8800 households with children were randomly drawn from community registers. Parents received comprehensive questionnaires regarding various aspects of their child's headache history and general health by mail. The response rate was 63.5%. The 6-month prevalence of paediatric headache was 53.2% and increased with age (39% at 7 years to 63% at age 14). Overall, recurrent headache (≥/week) was experienced by 6.5% of the total sample and was significantly more common among older girls (≥11 years) than their male counterparts. Boys and girls did not differ markedly from one another regarding headache occurrence and frequency until the age of 11. Mean age of headache onset was 7.5 years, with onset occurring at a significantly younger age among boys than among girls. In accordance with International Classification of Headache Disorders-II criteria, migraine was diagnosed in 7.5% and tension-type headache in 18.5% of the cases, hence a large proportion of the children had unclassifiable headache. Of the headache disorders, migraine was rated the most disabling, with the highest average intensity, highest frequency, duration of headache often exceeding 2 h and more frequent use of medication. In general, aura symptoms were rare except for visual disturbances (17%). Paediatric headache was strongly associated with other health problems, including other pain symptoms. Paediatric headache was also associated with a history of parental headache.
The story of an ambivalent relationship: Sigmund Freud and Eugen Bleuler
Authors: Falzeder Ernst
Published: May 2007

Abstract:  This paper1 examines the short‐lived flirtation between psychoanalysis and academia and psychiatry in Europe and the reasons for, and consequences of, the fact that their paths diverged. It is argued that Bleuler's break with the psychoanalytic movement is a crucial and, until now, largely underestimated turning point. Bleuler's separation from the psychoanalytic movement was probably more important for the course it has since taken than those of Adler, Stekel, or even Jung. Bleuler's analysis by correspondence by Freud, and its failure, was of paramount importance for the future relationship between Freud and Bleuler, and for Bleuler's assessment of psychoanalysis.
Highly accurate SNP genotyping from historical and low‐quality samples
Authors: MORIN PHILLIP A. , MCCARTHY MELISSA
Published: May 2007

Historical and other poor‐quality samples are often necessary for population genetics, conservation, and forensics studies. Although there is a long history of using mtDNA from such samples, obtaining and genotyping nuclear loci have been considered difficult and error‐prone at best, and impossible at worst. The primary issues are the amount of nuclear DNA available for genotyping, and the degradation of the DNA into small fragments. Single nucleotide polymorphisms offer potential advantages for assaying nuclear variation in historical and poor‐quality samples, because the amplified fragments can be very small, varying little or not at all in size between alleles, and can be amplified efficiently by polymerase chain reaction (PCR). We present a method for highly multiplexed PCR of SNP loci, followed by dual‐fluorescence genotyping that is very effective for genotyping poor‐quality samples, and can potentially use very little template DNA, regardless of the number of loci to be genotyped. We genotyped 19 SNP loci from DNA extracted from modern and historical bowhead whale tissue, bone and baleen samples. The PCR failure rate was < 1.5%, and the genotyping error rate was 0.1% when DNA samples contained > 10 copies/µL of a 51‐bp nuclear sequence. Among samples with ≤ 10 copies/µL DNA, samples could still be genotyped confidently with appropriate levels of replication from independent multiplex PCRs.
NEUTRON ACTIVATION ANALYSIS AT THE BRITISH MUSEUM, LONDON
Authors: HUGHES M. J.
Published: May 2007

Neutron activation analysis was used at the British Museum from 1978 until 2002 for provenance studies on ceramics and marble. Significant numbers of the items analysed were of high quality and value, and careful sampling was necessary to avoid damage to the object. An in‐house British Museum Standard Pottery was established and inter‐calibrated with a number of standards used by other archaeometry laboratories. The results of the projects have been published in many papers, and the databases established will be of use to future scholars interested in the ceramic groups represented. Projects on Greek and Near Eastern pottery have been undertaken. Relatively large numbers of north European medieval and post‐medieval pottery samples were analysed, as well as the tin‐glazed ceramics of Spain and Italy. Classical marble has also formed the subject of another project and a database of quarry material has been established.
INAA OF ARCHAEOLOGICAL SAMPLES AT THE UNIVERSITY OF MANCHESTER
Authors: NEWTON G. W. A. , BOURRIAU J. , FRENCH E. B. , PRAG A. J. N. W.
Published: May 2007

INAA at Manchester began almost by chance, and amid scepticism, with a request for help from the university's Department of Archaeology in the early 1970s. Over the years, the method of selecting pottery to be sampled was refined from the simple assumption that sherds found at a site were typical of those made there, to a greater focus on kiln sites and wasters. An important element in Manchester's approach was that this was a teaching department: in the quarter‐century during which the laboratory practised INAA over 6000 samples were analysed in a wide range of projects by postdoctoral researchers, Ph.D. students and even final‐year undergraduates. Although there were sometimes problems of comprehension on both sides, close collaboration with archaeologists encouraged methodological comparisons, and often INAA was seen as an additional weapon in the archaeologists’ arsenal as much as a developing scientific technique. The university's place as the inventor of the computer encouraged the development of statistical programs, which in turn facilitated ready collaboration and exchange of information with other laboratories, such as those at Bonn and Berkeley.