bluuebunny/crossref_metadata_2025 huggingface dataset:
Teaching and learning communication with children and young people: developing the qualifying social work curriculum in a changing policy context
Authors: Luckock Barry , Lefevre Michelle , Tanner Karen
Published: December 2006

Twenty years after survey evidence showed that UK social work students could complete their training without having learnt about or worked with children, new research suggests little has changed. There is still no guarantee that any student on qualification will have been taught about or assessed in communication skills with children and young people. This is despite the claim that the pre‐registration award provides teaching and assessment in core generic skills as a foundation for the development of specialist practice roles in agencies. In fact, as this paper shows, a common understanding of what counts as effective communication with children has yet to be consolidated in social work practice and research. This has impeded the process of curriculum development. Divergent expectations about what counts as social work communication with children in a changing policy context may be exacerbating long‐standing uncertainties about how genericism and specialism should be linked in professional education and training. In exploring these issues, this paper seeks to clear the way for the renewed effort that is now required if this aspect of curriculum development is to be effective.
Potentiating effects of nonactive/active vitamin D analogues and ketoconazole in parathyroid cells
Authors: Segersten Ulrika , Björklund Peyman , Hellman Per , Åkerström Göran , Westin Gunnar
Published: December 2006

Background and objective  1,25‐dihydroxyvitamin D3[1α,25(OH)2D3, calcitriol], and its less calcaemic synthetic analogues have therapeutic potential in several diseases, including hyperparathyroidism (HPT). We have suggested that non‐1α‐hydroxylated (nonactive) vitamin D analogues may present an alternative in tumour cells expressing 25‐hydroxyvitamin D3 1α‐hydroxylase (1α‐hydroxylase). The aim of this study was to investigate biological effects of a non‐1α‐hydroxylated vitamin D analogue in normal and tumour parathyroid cells.

Patients and methods  Effects of vitamin D analogues and ketoconazole on parathyroid hormone (PTH) secretion (radioimmunoassay) and PTH mRNA expression (reverse transcription‐polymerase chain reaction) were studied in primary bovine parathyroid cells. Proliferation of tumour cells isolated from HPT patients was determined by thymidine incorporation

Results  EB1285, non‐1α‐hydroxylated precursor of the vitamin D analogue EB1089, suppressed PTH secretion and PTH mRNA level as well as increased expression of 25‐hydroxyvitamin D3‐24‐hydroxylase (24‐hydroxylase) in bovine parathyroid cells. EB1285 also inhibited cell proliferation of parathyroid tumour cells from primary (pHPT) and secondary HPT (sHPT) patients. Combined treatment with the cytochrome P450‐dependent enzyme inhibitor ketoconazole and EB1285 or with active vitamin D compounds potentiated the suppressive effect on PTH secretion from bovine parathyroid cells. Ketaconazole alone displayed PTH suppression and increased 24‐hydroxylase expression.

Conclusion  The results support the idea that a non‐1α‐hydroxylated vitamin D analogue may elicit vitamin D receptor (VDR) effects in 1α‐hydroxylase expressing parathyroid tumour cells. Further studies are warranted to elucidate whether precursor vitamin D analogues as well as inhibitors of 24‐hydroxylase present therapeutic alternatives in patients suffering from HPT.
Aspects of the distribution and growth of bluemouth (Helicolenus dactylopterus, Delaroche 1809) since its invasion of the northern North Sea in 1991
Authors: MAMIE J. C. J. , BEARE D. J. , JONES E. G. , KIENZLE M. , DOBBY H. , HEATH M. R. , REID D. G.
Published: December 2006

Recent trends in the abundance, distribution and growth of bluemouth in Scottish waters are described. The observations are all based on an ecologically important time‐series database of trawl surveys conducted annually between 1925 and 2004 by Fisheries Research Services, Aberdeen. We examine the period 1985–2004 in detail. Bluemouth abundance has increased over the last decade both along the continental shelf west of Scotland and in the North Sea. In 1991 bluemouth appeared in the northern North Sea as a distinct cohort, with total lengths ranging between 6 and 8 cm. 1991 was a year of exceptional Atlantic inflow into the North Sea, and it is likely that the bluemouth used this water mass as a highway, entering from the north and west as small individuals. The fish from 1991 grew steadily and formed a distinct length mode that we track here until its disappearance in 2002. In the first few years following this influx, bluemouth were recorded all around the northern North Sea, but since 1997 numbers have declined and its distribution has shrunk into one of two International Council for the Exploration of the Sea (ICES) statistical rectangles (39F1 and 40F2) which are positioned in the central part of the North Sea. Since 1991 only one subsequent and relatively minor immigration of bluemouth into the North Sea has taken place, in 1998. The composition of the North Sea bluemouth population as a single cohort allows its spatial distribution, expansion and growth rate to be charted, discussed and described.
CD4+ Th1 cells promote CD8+ Tc1 cell survival, memory response, tumor localization and therapy by targeted delivery of interleukin 2 via acquired pMHC I complexes
Authors: Huang Hui , Hao Siguo , Li Fang , Ye Zhenmin , Yang Junbao , Xiang Jim
Published: December 2006

The cooperative role of CD4+ helper T (Th) cells has been reported for CD8+ cytotoxic T (Tc) cells in tumor eradication. However, its molecular mechanisms have not been well elucidated. We have recently demonstrated that CD4+ Th cells can acquire major histocompatibility complex/peptide I (pMHC I) complexes and costimulatory molecules by dendritic cell (DC) activation, and further stimulate naïve CD8+ T cell proliferation and activation. In this study, we used CD4+ Th1 and CD8+ Tc1 cells derived from ovalbumin (OVA)‐specific T cell receptor (TCR) transgenic OT II and OT I mice to study CD4+ Th1 cell's help effects on active CD8+ Tc1 cells and the molecular mechanisms involved in CD8+ Tc1‐cell immunotherapy of OVA‐expressing EG7 tumors. Our data showed that CD4+ Th1 cells with acquired pMHC I by OVA‐pulsed DC (DCOVA) stimulation are capable of prolonging survival and reducing apoptosis formation of active CD8+ Tc1 cells in vitro, and promoting CD8+ Tc1 cell tumor localization and memory responses in vivo by 3‐folds. A combined adoptive T‐cell therapy of CD8+ Tc1 with CD4+ Th1 cells resulted in regression of well‐established EG7 tumors (5 mm in diameter) in all 10/10 mice. The CD4+ Th1’s help effect is mediated via the helper cytokine IL‐2 specifically targeted to CD8+ Tc1 cells in vivo by acquired pMHC I complexes. Taken together, these results will have important implications for designing adoptive T‐cell immunotherapy protocols in treatment of solid tumors.
Blood monocytes, myeloid dendritic cells and the cytokines interleukin (IL)‐7 and IL‐15 maintain human CD4+ T memory cells with mixed helper/regulatory function*
Authors: McKinlay Adam , Radford Kristen , Kato Masato , Field Ken , Gardiner Damien , Khalil Dalia , Burnell Fiona , Hart Derek , Vuckovic Slavica
Published: December 2006

The number and function of human T cells in the periphery are regulated by homeostatic signals received from antigen‐presenting cells (APCs) and the common gamma chain (γc) cytokines interleukin (IL)‐7 and IL‐15. We found that, in the absence of introduced antigen, blood monocytes or myeloid dendritic cells (MDCs) in the presence of IL‐7 and IL‐15 (IL‐7/IL‐15) can regulate CD4+ T memory (Tm) cell numbers by polyclonal cell proliferation. The dynamics of CD4+ Tm cell proliferation, in the presence of IL‐7/IL‐15, was dependent on contact with MDCs and to a lesser extent on contact with monocytes. IL‐7/IL‐15 either alone or combined with monocytes or MDCs enhanced the proportion of CD4+ Tm cells with activated and effector phenotype and diminished the helper function of CD4+ Tm cells. These CD4+ Tm cells, preconditioned with IL‐7/IL‐15 alone or with monocytes or MDCs and IL‐7/IL‐15, reduced T cell‐dependent immunoglobulin M (IgM) and IgG responses. This appeared to be a contact‐dependent effect involving a reduction in antibody‐producing CD27+ B memory cells, but contact‐independent suppression by soluble factors also contributed to the antibody‐producing capacity of CD27+ B memory cells. These results indicate that blood monocytes, MDCs and the cytokines IL‐7/IL‐15 contribute to homeostasis of CD4+ Tm cells by regulating their number, activation state and helper/suppressor (regulatory) function. In healthy individuals, this mode of regulating CD4+ Tm cell homeostasis may provide a basis for the control of autoimmune responses.
Interferon‐β therapy reduces CD4+ and CD8+ T‐cell reactivity in multiple sclerosis
Authors: Zafranskaya Marina , Oschmann Patrick , Engel Rosel , Weishaupt Andreas , Van Noort Johannes M. , Jomaa Hassan , Eberl Matthias
Published: December 2006

Therapy with interferon‐β (IFN‐β) has well‐established clinical effects in multiple sclerosis (MS), albeit the immunomodulatory mechanisms are not fully understood. We assessed the prevalence and functional capacity of CD4+ and CD8+ T cells in healthy donors, and in untreated and IFN‐β‐treated MS patients, in response to myelin oligodendrocyte glycoprotein (MOG). The proportion of CD45RO+ memory T cells was higher in MS patients than in healthy donors, but returned to normal values upon therapy with IFN‐β. While CD45RO+ CD4+ T cells from all three groups responded to MOG in vitro, untreated patients showed augmented proliferative responses compared to healthy individuals and IFN‐β treatment reduced this elevated reactivity back to the values observed in healthy donors. Similarly, the response of CD45RO+ CD8+ T cells to MOG was strongest in untreated patients and decreased to normal values upon immunotherapy. Overall, the frequency of peripheral CD45RO+ memory T cells ex vivo correlated with the strength of the cellular in vitro response to MOG in untreated patients but not in healthy donors or IFN‐β‐treated patients. Compared with healthy individuals, responding CD4+ and CD8+ cells were skewed towards a type 1 cytokine phenotype in untreated patients, but towards a type 2 phenotype under IFN‐β therapy. Our data suggest that the beneficial effect of IFN‐β in MS might be the result of the suppression or depletion of autoreactive, pro‐inflammatory memory T cells in the periphery. Assessment of T‐cell subsets and their reactivity to MOG may represent an important diagnostic tool for monitoring successful immunotherapy in MS.
Structure of the Lipopolysaccharide Side Chain of Pseudomonas syringae pv. tabaci Strain NCPPB 79 (=CFBP 1615), in Relation to O‐serogroup
Authors: Spitali M. , Smith A. R. W.
Published: December 2006

The lipopolysaccharide (LPS) side chain from Pseudomonas syringae pv. tabaci strain NCPPB 79 (=CFBP 1615) contained l‐ and d‐rhamnose, and GlcNAc. Using methylation analysis, periodate oxidation, Smith degradation and 1H‐ and 13C‐nuclear magnetic resonance spectroscopy, the repeat unit was found to have the structure:

This structure is correlated with a previously proposed serogrouping system. The involvement of LPS generally in plant disease is briefly discussed.
Occurrence of Toxic Hexadepsipeptides in Preharvest Maize Ear Rot Infected by Fusarium poae in Poland
Authors: Chełkowski J. , Ritieni A. , Wiśniewska H. , Mulè G. , Logrieco A.
Published: December 2006

Twenty‐seven preharvest maize ears affected by Fusarium poae rot (disease score 36–100%) were selected in 1998 and 1999 in Poland and examined for the occurrence of toxic hexadepsipeptides: beauvericin (BEA), enniatin A, enniatin B and enniatin B1. The identification of F. poae was confirmed by sequence analysis of variable internal transcribed spacer regions and compared with NCBI gene bank DNA sequences. Chemical analyses were performed by HPLC‐MS. In 27 ears infected by F. poae were detected: BEA (trace to 46 μg/g) in 18 samples, enniatin A (trace to 37 μg/g) in nine samples, enniatin B (trace to 47 μg/g) in 15 samples and enniatin B1 (trace to 25 μg/g) in 12 samples. When 20 strains of F. poae isolated from these samples were cultured on rice, all produced BEA (1.9–75 μg/g), three enniatin A (1.8–2 μg/g), 12 enniatin B (1.1–5.1 μg/g) and eight enniatin B1 (1.2–5.2 μg/g). Occurrence and quantification of enniatin A, enniatin B and enniatin B1 and their co‐occurrence with BEA in maize kernels is reported for the first time.
Virulence Frequences of Puccinia triticina in Germany and the European Regions of the Russian Federation
Authors: Lind V. , Gultyaeva E.
Published: December 2006

From 2001 to 2003, leaf rust was collected in different regions of Germany and the Russian Federation to generate single spore isolates and to study the structure of the pathogen populations by analyses of virulence. The virulence of isolates was tested with 38 near‐isogenic lines each carrying a different resistance gene. The analyses of variance revealed significant effects for the frequency of virulent isolates, the regions and most interactions with years and regions, but no significance was found for the effects of years. In Germany, an increase of virulence frequencies was detected for Lr1 and Lr2a while a decrease was found for Lr3a, Lr3bg and Lr3ka. Such clear trends did not occur in Russia which may be due to the great agroclimatic differences between regions. The variance of the frequency of virulent isolates was used to estimate adequate sample sizes for the analysis of regional populations of leaf rust. This procedure resulted in more reliable information about the dynamic processes within the pathogen populations. In 2002 and 2003, all pathotypes in Germany had a combined virulence to Lr1, Lr2a, Lr2b, Lr15, Lr17 and Lr20 supplemented by a few other genes. The complexity of virulence was lower in the most frequent pathotypes. In Russia virulence to the alleles at locus Lr3 was very common. Using detached leaf segments in Germany and Russia it turned out that the most virulent pathotypes carry 34 and 32 virulence genes, respectively. Virulence to Lr9, Lr19, Lr24 and Lr38 was rare or even absent. The use of major genes, not overcome by corresponding virulent pathotypes, may contribute to more durable types of resistance in case they are combined with genes having different effects, e.g. adult plant resistance.
Natural Infection by Tospoviruses of Cucurbitaceous and Fabaceous Vegetable Crops in India
Authors: Jain R. K. , Bag S. , Umamaheswaran K. , Mandal B.
Published: December 2006

Natural infection of tospoviruses on three cucurbitaceous (Cucumis sativus, cucumber; Luffa acutangula, ridge gourd; Citrullus lanatus, watermelon) and three fabaceous (Vigna unguiculata, cowpea; Phaseolus vulgaris, French bean; Dolichos lablab, sem) vegetable crops in India was identified on the basis of nucleocapsid protein (NP) gene characteristics. The complete NP gene of the cowpea isolate from Kerala and the sem isolate from Tamil Nadu was 831 nucleotides long, encoding a protein of 276 amino acids. For other Tospovirus isolates from cucumber, French bean, ridge gourd and watermelon, the partial NP gene (291 nt) was sequenced. Comparative NP gene sequence analyses revealed that fabaceous isolates shared maximum identity both at the nucleotide (92–97%) and amino acid (93–97%) levels with the corresponding region of Groundnut bud necrosis virus (GBNV), whereas cucurbitaceous isolates shared maximum identity both at nucleotide (93–99%) and amino acid (95–98%) levels with the corresponding region of Watermelon bud necrosis virus (WBNV), results suggesting that the Tospovirus isolates infecting fabaceous hosts should be regarded as strain of GBNV, whereas those infecting cucurbitaceous hosts as a strain of WBNV. Nucleocapsid protein gene was conserved both in GBNV and WBNV isolates originating from different hosts and locations.
Effect of Seed Treatment with Rhizobium leguminosarum on Pythium Damping‐off, Seedling Height, Root Nodulation, Root Biomass, Shoot Biomass, and Seed Yield of Pea and Lentil
Authors: Huang H. C. , Erickson R. S.
Published: December 2006

Field experiments were conducted in 2004 and 2005 to determine the effects of seed treatment with Rhizobium leguminosarum bv. viceae on damping‐off, seedling height, root nodule mass, root biomass, shoot biomass and seed yield of pea and lentil in a field naturally infested with Pythium spp. Compared with the untreated controls, treatment of pea seeds with R. leguminosarum bv. viceae strains R12, R20 or R21 significantly (P < 0.05) reduced incidence of damping‐off, promoted seedling growth and increased root nodule mass, root biomass and shoot biomass. Seed treatments with R12 or R21 also resulted in a significant (P < 0.05) increase in seed yield of pea. The strain R21 was most effective among the four strains of R. leguminosarum bv. viceae tested in peas. Although, the level of disease control by strain R21 was similar to seed treatment with the fungicide ThiramTM, R21 was more effective in enhancing root nodule production and promoting plant growth. For lentil, treatment of seeds with R. leguminosarum bv. viceae strains R12 or R21 significantly (P < 0.05) reduced incidence of damping‐off compared with the untreated control. All of the four strains of R. leguminosarum bv. viceae tested increased lentil seedling height, root nodule mass and shoot biomass, and all except R20 increased root biomass. Seed yield was higher for the treatments of R12 and R21. The strain R12 was most effective among the four strains of R. leguminosarum bv. viceae tested in lentil. Although, strain R12 was as effective as ThiramTM for control of damping‐off of lentil, it was more effective than ThiramTM for the production of root nodules and promotion of plant growth. The study concludes that seed treatment with R. leguminosarum bv. viceae is effective in control of Pythium damping‐off of pea and lentil and that the efficacy of control is strain specific, strain R21 for control of the disease on pea and strain R12 for control of the disease on lentil.
Inhabitancy and Colonization on Healthy Rice Plants by Glomerella cingulata
Authors: Yoshida S. , Tsukiboshi T. , Arie T. , Shinohara H. , Koitabashi M. , Tsushima S.
Published: December 2006

An omnivorous phytopathogenic fungus, Glomerella cingulata, was isolated from rice plants in Japan. We evaluated the effect of the fungus as an inoculum source for anthracnose to other plants. Leaf sheaths of rice plants were monitored in mid‐June and mid‐July for 2 years to evaluate the quantitative inhabitancy of G. cingulata in the fungal community. The pathogenicity of G. cingulata to 20 plant leaves was elucidated. A hygromycin B‐resistant green fluorescent protein (GFP) mutant of the fungus was used to observe fungal infection and development processes on rice plants. Glomerella cingulata was detected on rice sheaths in mid‐June at a low frequency, but was not detected in mid‐July. The fungus has a broad pathogenic spectrum, whereas development of the GFP mutant in tissues of rice plants was limited. Thus, the effect of G. cingulata inhabiting rice plants as a source of inoculum for other crops is likely to be low, although the fungal potential to infect various plants was ascertained.
Virulence and the Production of Endo‐1,4‐β‐glucanase by Isolates of Alternaria alternata Involved in the Moldy‐core Disease of Apples
Authors: Reuveni M. , Sheglov N. , Eshel D. , Prusky D. , Ben‐Arie R.
Published: December 2006

Alternaria alternata, is the predominant fungal pathogen responsible for moldy‐core in apple cultivars of the Red Delicious group. Here we report on the association between virulence of natural isolates of A. alternata, their production of endo‐1,4‐β‐glucanase (EG) and moldy‐core development in apple fruits. Based on decay development following wound inoculations of mature fruits, three of 150 isolates, collected in three orchards in northern Israel and representing low, moderate and high virulence, were selected and designated Rm44, Er30 and Sh42, respectively. All three isolates secreted EG when grown on enzyme‐inducing medium (EIM) containing commercial cellulose or apple cell walls and this production was related to their degree of virulence. Polyacrylamide gel electrophoresis (PAGE) revealed quantitative differences between the three isolates, relative to their virulence. When fungal extracts were run in native gels, a single band with a molecular mass of 23 kDa showing EG activity was produced by the high‐ (Sh42) and the medium‐virulence (Er30) isolate but not by the low‐virulence (Rm44) isolate. A commercial cellulase preparation (containing endo‐ and exo‐1,4‐β‐glucanase) placed on pricked fruit led to the formation of symptoms similar to those developing on A. alternata‐inoculated fruits within 2–4 days. Inoculation of bloom clusters at full bloom with the highly virulent isolate (Sh42) of A. alternata resulted in a significantly higher infection in fruits (58%) than in those inoculated with the low‐virulence isolate (Rm44) (30%). Our results suggest that the moldy‐core symptoms caused by A. alternata in apple, could be related to the ability of the fungus to produce EG in developing lesions.
Culturally diverse patient–nurse interactions on acute care wards
Authors: Cioffi Jane
Published: December 2006

The nurse–patient interaction is central to providing nursing care. This qualitative study explores nurses’ and culturally diverse patients’ experiences within nurse–patient relationships in acute care wards. Eight nurses and their respective patients volunteered to join the study and were interviewed. The three themes identified in relationships between nurses and culturally diverse patients were shared tension, perceived difference and held awareness. It is concluded from the study that relationships between nurses and culturally diverse patients in acute care wards during short episodes of hospitalization are not easy for nurses and need to receive deeper consideration as to how they can be developed more effectively. It is recommended that educational support be provided to develop more effective interactions between nurses and patients with research being carried out to investigate factors that can strengthen culturally diverse patient–nurse interactions in acute care settings.
Searching for value: The influence of policy and reform on nurses’ sense of value in long‐term aged care in Australia
Authors: Venturato Lorraine , Kellett Ursula , Windsor Carol
Published: December 2006

Contemporary literature on long‐term aged care focuses heavily on issues associated with the recruitment and retention of nursing staff, such as job satisfaction and attitudes towards caring for older people. This paper aims to highlight one aspect of a larger study of registered nurses’ experiences in long‐term aged care in Australia and the influence that government policy and reform has in shaping that experience. This insight into aspects of nurses’ everyday experience also contributes to a broader understanding of job satisfaction in long‐term care. Findings from this study suggest that registered nurses experience tension in their search for value in their practice, which incorporates professional, political and social mediators of value and worth. These issues are discussed in relation to the impact of policy and reform on nurses’ sense of value in long‐term aged care and highlight the need for sensitive policy initiatives that support issues of value in nursing practice.
The study of nursing documentation complexities
Authors: Cheevakasemsook Aree , Chapman Ysanne , Francis Karen , Davies Carmel
Published: December 2006

This study aimed to explore complexities in nursing documentation and related factors. Nursing documentation has been one of the most important functions of nurses since the time of Florence Nightingale because it serves multiple and diverse purposes. Current health‐care systems require that documentation ensures continuity of care, furnishes legal evidence of the process of care and supports evaluation of quality of patient care. However, nursing documentation has not served such objectives because of its complexities. This study explores nursing documentation complexities and related factors through both qualitative and quantitative methodologies. The study used multiple methods of inquiry: in‐depth interviewing; participant observation; nominal group processing; focus group meetings; time and motion study of nursing activities; and auditing of completeness of nursing documentation. Complexities in nursing documentation include three aspects: disruption, incompleteness and inappropriate charting. Related factors that influenced documentation comprised: limited nurses’ competence, motivation and confidence; ineffective nursing procedures; and inadequate nursing audit, supervision and staff development. These findings suggest that complexities in nursing documentation require extensive resolution and implicitly dictate strategies for nurse managers and nurses to take part in solving these complicated obstacles.
Influenza and rhinovirus infections among health‐care workers
Authors: BELLEI Nancy , CARRARO Emerson , PEROSA Ana Helena Sitta , BENFICA Daniela , GRANATO Celso Fransisco Hernandes
Published: December 2006

Background and objective:  Health‐care workers (HCWs) are at higher risk of acquisition and transmission of respiratory virus infections. Nosocomial transmission of influenza has been documented but whether this is so for other respiratory viruses has not been assessed.

Methods:  Epidemiological, clinical and viral laboratory surveillance was carried out on HCWs presenting with acute respiratory infection in a university hospital.

Results:  Over a 2‐year period, 203 subjects were recruited: rhinovirus was the most frequently detected virus (37.7% in flu negative samples) and influenza A/B was positive in only 12.3% of subjects. Only 19.7% of HCWs were immunized against influenza. High detection of rhinovirus occurred even during the peak of the influenza season and half of the infected subjects reported an influenza‐like illness.

Conclusion:  Rhinovirus infection occurred frequently in this study population and probably contributes to influenza misdiagnosis. Educational interventions about different viruses causing respiratory symptoms and an increase in standards of infection control besides influenza immunization among HCWs is needed.
Association between the IL‐4 promoter polymorphisms and asthma or severity of hyperresponsiveness in Taiwanese
Authors: CHIANG Chi‐Huei , TANG Ying‐Chuan , LIN Ming‐Wei , CHUNG Ming‐Yi
Published: December 2006

Background and objectives:  Recent family‐based studies have revealed a linkage between human chromosome 5q31 and asthma, elevated serum IgE levels and airway hyperresponsiveness (AHR). Among the candidate genes in this region is the gene encoding IL‐4. This gene could be a candidate gene for asthma. The aim of this prospective case‐control study was to assess the frequency of polymorphisms in the IL‐4 gene promoter among asthmatic patients from Taiwan.

Methods:  The study consisted of 167 patients with asthma and 111 healthy subjects. PCR amplification followed by Bsm F1 restriction digestion were used to assign genotypes at the IL‐4 promoter C‐589T locus. Pulmonary function tests, methacholine challenge tests, total IgE, specific IgE antibodies against common inhalant allergens and total eosinophil counts were assessed in asthmatic patients.

Results:  The T allele frequency for the C‐589T IL‐4 gene promoter in asthma patients was higher than for normal subjects (P < 0.0001). The frequency discrepancy was found to be even higher for asthmatic patients with severe AHR (P < 0.05). There were no significant differences for the T allele frequency among asthmatic patients with the various other phenotypes such as high versus normal total eosinophil, high versus normal total IgE and high versus normal levels of specific IgE against mite, cockroach or cat dander, or dog dander.

Conclusions:  Polymorphism in the promoter of the IL‐4 gene is associated with asthma and is a disease modifier in terms of the severity of AHR.
Effects of bronchodilators on dynamic hyperinflation following hyperventilation in patients with COPD
Authors: FUJIMOTO Keisaku , YOSHIIKE Fumiaki , YASUO Masanori , KITAGUCHI Yoshiaki , URUSHIHATA Kazuhisa , KUBO Keishi , HONDA Takayuki
Published: December 2006

Background and objective:  The present study was performed to examine the occurrence of dynamic hyperinflation following hyperventilation in COPD patients and former smokers without COPD, and the efficacy of short‐acting anticholinergic agents (SAAC) and β2‐agonists (SABA) for lung hyperinflation following metronome‐paced hyperventilation in COPD.

Methods:  Fifty‐nine patients with COPD, 20 ex‐smokers without COPD and 20 healthy subjects who had never smoked were examined for dynamic hyperinflation by metronome‐paced hyperventilation with respiratory rate increasing from 20 to 30 and 40 tidal breaths/min. Dynamic hyperinflation was evaluated as the decrease in inspiratory capacity (IC) following hyperventilation, and the effects of SAAC and SABA on dynamic hyperinflation were assessed.

Results:  COPD patients showed a significant increase in end‐expiratory lung volume and a decrease in IC following hyperventilation, and ex‐smokers without COPD also showed mild but significant dynamic hyperinflation. Multiple stepwise linear regression analysis revealed that the carbon monoxide transfer coefficient (DLco/VA) and RV/TLC were significant and independent determinants of dynamic hyperinflation in COPD. Treatment with SAAC and SABA significantly increased IC at each respiratory rate, independently of the increases in FEV1. Furthermore, SABA significantly inhibited the decrease in IC due to hyperventilation.

Conclusions:  These findings suggest that lung hyperinflation following hyperventilation may be a useful method for detecting dynamic hyperinflation observed not only in patients with COPD but also in ex‐smokers without COPD, and both SAAC and SABA are effective in reducing dynamic hyperinflation in COPD.
Serum progastrin‐releasing peptide levels followed by whole‐body positron emission tomography detects early recurrence of small‐cell lung cancer
Authors: YAMAGUCHI Hiroyuki , SODA Hiroshi , KITAZAKI Takeshi , NAKANO Hirofumi , FUJINO Satoru , NAKAMURA Yoichi , KOHNO Shigeru
Published: December 2006

Abstract:  A 65‐year‐old male smoker with severe COPD was diagnosed with limited‐stage small‐cell lung cancer. After receiving cisplatin/irinotecan, serum progastrin‐releasing peptide (ProGRP) levels decreased to within the reference values and the lesions were markedly reduced in size. A whole‐body 18F‐fluorodeoxyglucose PET (FDG‐PET) scan confirmed complete remission. During follow up, serum ProGRP levels increased, and a whole‐body FDG‐PET scan detected recurrence at the hilar lymph node that had been negative on CT. Complete remission was again achieved with second‐line chemotherapy (cisplatin/etoposide) and local irradiation to the hilar lymph node. Monitoring serum ProGRP levels, followed by whole‐body FDG‐PET when indicated, may improve the clinical management of patients with small‐cell lung cancer after initial complete remission.
Increase in soluble CD138 in bronchoalveolar lavage fluid of multicentric Castleman’s disease
Authors: HASEGAWA Masaru , BETSUYAKU Tomoko , YOSHIDA Nobuya , NASUHARA Yasuyuki , KINOSHITA Ichiro , OHTA Satoshi , ITOH Tomoo , PARK Pyong Woo , NISHIMURA Masaharu
Published: December 2006

Abstract:  Multicentric Castleman’s disease (MCD) is a rare and often incurable lymphoproliferative disorder. It is typically a systemic illness, but occasionally manifests primarily as a pulmonary parenchymal disease with massive infiltration of CD138 (syndecan‐1)‐positive plasma cells. This is the first report to demonstrate a marked elevation of soluble CD138, despite the absence of plasma cells, in BAL fluid in an MCD patient with pulmonary involvement. This finding suggests that the quantitative measurement of soluble CD138 in BAL fluid may reflect plasma cell infiltration and disease activity in the lungs of patients with MCD.
Delayed presentation of amniotic fluid embolism: Lessons from a case diagnosed at autopsy
Authors: MALHOTRA Puneet , AGARWAL Ritesh , AWASTHI Anshu , DAS Ashim , BEHERA Digamber
Published: December 2006

Abstract:  Amniotic fluid embolism (AFE) syndrome, a catastrophic cause of respiratory failure typically occurs during labour, or soon after delivery. Systemic hypotension is the most prominent haemodynamic alteration documented in patients with AFE, a consequence principally of severe left‐sided heart failure. A 22‐year‐old female was admitted to the respiratory intensive care unit with severe eclampsia and acute respiratory failure 4 h following delivery. Her blood pressure was elevated (systolic 150–180 mm Hg, diastolic 90–110 mm Hg) throughout the admission. She succumbed in spite of therapy for eclampsia and mechanical ventilation. Autopsy revealed large numbers of polygonal, anucleate foetal squames and mucin in the pulmonary vasculature typical of AFE while changes of eclampsia were found in the liver and kidneys. It appears that AFE syndrome can have a delayed presentation, as late as 4 h after delivery and haemodynamic collapse may not be mandatory if the patient has coexisting systemic hypertension secondary to severe eclampsia.
Thymic and pulmonary mucosa‐associated lymphoid tissue lymphomas in a patient with Sjögren’s syndrome and literature review
Authors: SUNADA Koichi , HASEGAWA Yuichi , KODAMA Takahide , ANAMI Yoichi , SATOH Hiroaki , OHTSUKA Morio , SEKIZAWA Kiyohisa
Published: December 2006

Abstract:  Mucosa‐associated lymphoid tissue lymphoma (MALToma) has been reported in several organs. Among MALTomas, thymic and pulmonary MALTomas are rare. The present report describes a patient with Sjögren’s syndrome who presented thymic and pulmonary MALTomas. Although the exact pathogenetic relationship between these two tumours is uncertain, it is likely that the underlying immune dysregulation related to Sjögren’s syndrome contributed to the occurrence and the unusual manifestation of MALTomas in this patient.
Prevalence of symptomatic large pleural effusions first diagnosed more than 30 days after coronary artery bypass graft surgery
Authors: PENG Ming‐Cheng , HOU Charles Jia‐Yin , LI Jiun‐Yi , HU Po‐Yuan , CHEN Chun‐Yen
Published: December 2006

Background and objective:  Symptomatic large pleural effusions (>25% of hemithorax) are sometimes diagnosed after coronary artery bypass graft surgery (CABG). Their incidence and outcome have not been fully described. This study aims to discuss the prevalence and the clinical course in patients diagnosed with symptomatic newly developed large pleural effusions at least 30 days after CABG.

Methods:  A retrospective study of 410 patients who underwent CABG over a three and a half year period was undertaken. The type of surgery, timing of occurrence of effusion after CABG, amount and characteristics of the pleural effusion, left ventricular dimension and ejection fraction were obtained from medical records and cardiac surgery databases.

Results:  The records of 356 patients 1 month post CABG were available for evaluation. The initial diagnosis of a newly developed symptomatic large pleural effusions was made in 11 patients (3.1%) at least 30 days after CABG. Eight had a pleural effusion predominantly on the left side and three on the right. Patients were further divided into two groups: those who had effusions diagnosed between 30 and 90 days post CABG (group 1) and those diagnosed more than 90 days post‐CABG (group 2). The pleural fluid LDH levels were higher in patients in group 1 (1262.0 ± 921.3 U/L vs. 117.5 ± 35.1 U/L, P = 0.02). Patients in group 2 had evidence of cardiac impairment compared with those in group 1, as evidenced by a lower ejection fraction (68.8 ± 6.0% vs. 52.0 ± 10.6% in groups 1 and 2, respectively, P = 0.01) and higher left ventricular end‐diastolic dimension (45.2 ± 6.0 mm vs. 55.3 ± 8.4 mm in groups 1 and 2, respectively, P = 0.05).

Conclusions:  The incidence of symptomatic newly developed large pleural effusions first diagnosed at more than 30 days post CABG was 3.1%. Those who were diagnosed between 30 and 90 days post CABG tended to have exudative effusions, whereas those diagnosed more than 90 days post CABG often had left ventricular impairment and transudative effusions. Most of these effusions settled with conservative management and did not recur.
Sputum bacteriology in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease in Taiwan with an emphasis on Klebsiella pneumoniae and Pseudomonas aeruginosa
Authors: LIN Sheng‐Hsiang , KUO Ping‐Hung , HSUEH Po‐Ren , YANG Pan‐Chyr , KUO Sow‐Hsong
Published: December 2006

Background and objective:  Bacterial infection is one of the major causes of acute exacerbation of COPD (AECOPD). This study was undertaken to investigate the microbiology of AECOPD.

Methods:  Medical records from 494 episodes of AECOPD in patients admitted to the National Taiwan University Hospital from January 2000 to June 2004 were reviewed. Severity of COPD was classified according to the 2003 Global Initiative for Chronic Obstructive Lung Disease guideline.

Results:  Potential pathogenic microorganisms were isolated from patients in 328 (66.4%) episodes of AECOPD. The predominant bacteria were Klebsiella pneumoniae (19.6%), Pseudomonas aeruginosa (16.8%) and Haemophilus influenzae (7.5%), followed by Acinetobacter baumannii (6.9%), Enterobacter species (6.1%) and Staphylococcus aureus (6.1%). The incidence of Streptococcus pneumoniae was 2.4%. Spirometry results obtained within 1 year of the exacerbation were available in 186 cases. K. pneumoniae was more frequently isolated in stage I COPD (39.1%) than stage II (16.6%), III (13.8%) and IV (9.4%). No glucose non‐fermentative Gram‐negative bacilli were isolated in stage I patients. Multivariate logistic regression analysis revealed that P. aeruginosa (odds ratio (OR) 3.19; 95% confidence interval (CI): 1.21–8.38), intubation (OR 14.81; 95% CI: 5.08–43.12) and age (OR 1.1; 95% CI: 1.03–1.17) were independent risk factors for mortality.

Conclusions:  Klebsiella pneumoniae and P. aeruginosa are the most common sputum pathogens in hospitalized patients with AECOPD in Taiwan, with the former being more commonly isolated from mild COPD and the latter associated with poor clinical outcome. These results should be considered when deciding which antibiotics should initially be used to treat patients with AECOPD.
Use of QuantiFERON®‐TB Gold to investigate tuberculosis contacts in a high school
Authors: HIGUCHI Kazue , HARADA Nobuyuki , MORI Toru , SEKIYA Yukie
Published: December 2006

Background and objective:  QuantiFERON®‐TB Gold (QFT‐G) was employed in a contact investigation in a high school to evaluate its performance in adolescents.

Methods:  Students of the same school grade as the index case were screened with tuberculin skin test (TST) and CXR examination as an initial contact investigation. QFT‐G was performed for students demonstrating a positive TST (erythema larger than 30 mm).

Results:  Of 349 students whose TST was completed, 95 had positive TST responses, although the distribution of TST responses was similar for both high and low exposure groups. In contrast, only four of the 88 TST‐positive students tested with QFT‐G were positive by this test, and three of these were from the high exposure group. Chemoprophylaxis was provided to only those four QFT‐G‐positive students. Follow up of the 91 students who were TST‐positive, but QFT‐G‐negative (or not tested), for more than 3.5 years revealed that none have developed active tuberculosis.

Conclusions:  QFT‐G appears more specific than TST as contacts with positive TST and negative QFT‐G responses were not offered prophylaxis and none developed tuberculosis during 3.5 years of follow up. The replacement of TST with QFT‐G, or perhaps combined use of TST and QFT‐G, may be more useful in diagnosing true infection and thus reducing the number of subjects indicated for chemoprophylaxis.
SURGICAL MANAGEMENT OF BREAST CANCER IN A SMALL PERIPHERAL NEW ZEALAND HOSPITAL
Authors: Lee Don Wai Gin , Vallance Stephen
Published: December 2006

Background:  Peripheral hospitals are perceived to be at a disadvantage in providing treatment for breast cancer, especially with regard to breast conservative surgery (BCS) because of the requirement of adjuvant radiotherapy. Wairau Hospital is a 100‐bed peripheral hospital in New Zealand with no on‐site radiotherapy unit.

Methods:  A retrospective audit of the surgical management of breast cancer between 1998 and 2002 was carried out.

Results:  One hundred and fifty‐seven presentations during the audit period. Despite the lack of tertiary resources, we report an overall BCS rate of 58.6%, consistent with the appropriate New Zealand guidelines. Of screen‐detected cancers, 81.6% underwent BCS. Only five patients requested mastectomy and of those undergoing BCS, five patients refused subsequent adjuvant radiotherapy. This was because of frailty from age and comorbidities and the inconvenience of travel.

Conclusion:  High rates of BCS are possible in peripheral hospitals. We postulate that intensive support and a visiting outpatient oncological service help empower patients to seek BCS if appropriate. A strong partnership between surgical, radiological and oncological services is also vital.
LOCALIZATION AND SURGICAL TREATMENT OF THE PANCREATIC INSULINOMAS
Authors: Chung Jun C. , Choi Seong H. , Jo Sung H. , Heo Jin S. , Choi Dong W. , Kim Yong I.
Published: December 2006

Objectives:  Insulinomas are rare tumours that originate from the islet cells of the pancreas. The aims of this study were to gain an understanding of the clinical features of insulinomas and to establish the diagnostic and therapeutic strategies.

Methods:  A review was carried out in 20 patients with insulinoma surgically treated in our institution over the last 10 years. Presenting symptoms, biochemical studies, preoperative and intraoperative localization studies, operative management and complications were analysed.

Results:  The male‐to‐female ratio was 8:12, with a mean age of 46.4 years. Each patient suffered from significant neuroglycopenic symptoms, usually manifested by dizziness, sweating, headache and confusion. The preoperative median serum levels of glucose, insulin and C‐peptide at the termination of the fast were 37.5 mg/dL, 23.5 μU/mL, 5.6 ng/mL, respectively. Preoperative tumour localization was achieved by means of ultrasonography (US), computed tomography, selective angiography or intra‐arterial calcium injection with hepatic venous sampling, and sensitivities of these examinations were 81.8, 73.7, 94.1 and 100%, respectively. Intraoperative localization was carried out by a combination of manual palpation and intraoperative US with retrospective sensitivities of 80 and 100%, respectively. Enucleation was carried out in 16 patients and distal pancreatectomy in 4. The mortality and morbidity rates were 0 and 10%, respectively. One patient developed late diabetes mellitus type 1 after distal pancreatectomy.

Conclusions:  We conclude that the diagnosis of insulinoma can be made on the basis of the results of a supervised fast, careful palpation with intraoperative US is essential for intraoperative detection of insulinomas and surgical resection is the best choice for treatment of benign insulinomas.
CONCEPTS OF SEROMA FORMATION AND PREVENTION IN BREAST CANCER SURGERY
Authors: Agrawal Amit , Ayantunde Abraham Abiodun , Cheung Kwok Leung
Published: December 2006

Background:  Seroma formation is the commonest early sequel to breast cancer surgery especially when axillary dissection is undertaken. It is associated with significant morbidity and financial burden. The main pathophysiology of seroma is still poorly understood and remains controversial. The optimal ways to reduce the incidence of seroma formation are unknown. The aim of this paper is to review the concepts of pathophysiology of seroma formation following mastectomy and breast‐conserving surgery for cancer. The various techniques in practice to reduce its incidence and treatment are outlined.

Method:  MEDLINE search of published work on the subject with respect to its pathophysiology, prevention and treatment was carried out. Manual retrieval of relevant articles in the reference lists of the original papers from the MEDLINE was then carried out.

Result:  The pathophysiology and mechanism of seroma formation in breast cancer surgery remains controversial and not fully understood. Methods of prevention and treatment of seroma remain varied and inconclusive.

Conclusion:  Evidence suggests an increase in the incidence of seroma because of thermal trauma from electrocautery dissection, but this is indispensable for surgical haemostasis. Obliteration of dead space by various flap apposition techniques has been shown to be advantageous in reducing incidence and volume of seroma. Low‐pressure suction drainage reduces seroma volume and duration of drainage leading to earlier drain removal. Preventive measures have to be tailored according to individual patient and operative factors.
EXTENDED MEDIAL GASTROCNEMIUS MYOCUTANEOUS FLAP IN REPAIR OF THE QUADRICEPS EXTENSION MECHANISM
Authors: Warrier Satish K. , Mah Eldon , Morrison Wayne A.
Published: December 2006

The gastrocnemius muscle is versatile in flap repair of defects from anterior knee to lower leg. We describe a case of extensor reconstruction using an extended medial gastrocnemius myocutaneous flap. A medial gastrocnemius flap was raised distal to its musculotendinous insertion. At its point of rotation, it was anchored to the anterior periosteum of the tibia, hence obliterating dead space and recreating the extensor mechanism of the knee. The patient had no flap loss and was able to ambulate independently. He showed no extensor lag. Our flap is unique in that it is the only medial gastrocnemius flap that has shown no extensor lag as well as complete flexion of the knee following a disrupted entire quadriceps mechanism. It is also the first myocutaneous gastrocnemius flap that has been described for this purpose.
THE GORDON GORDON‐TAYLOR MEMORIAL LECTURE: SURGICAL GIANTS AND GIANTS AMONG SURGEONS – THE CASE OF ABRAHAM COLLES
Authors: Little Miles
Published: December 2006

Sir Gordon Gordon‐Taylor was a surgical giant and a giant among surgeons. There’s a distinction between the two. Surgical giants are technical geniuses who pave the way for others and set the standards against which others can measure their performance. Giants among surgeons contribute other things to the science and practice of surgery and sometimes to fields outside surgery. By these measures, Abraham Colles was not a surgical giant. He thought, wrote and taught about his interests. He enhanced the reputation of Irish surgery. In retrospect, his science and his ethics seem flawed by modern standards, but by the measures of his own time he was a model investigator and a man of outstanding moral probity. He is remembered for the eponymous Colles’s fracture and for Colles’s fascia and ligament. He held the Chair of Anatomy and Surgery in Dublin for 32 years and drew the admiration and affection of his contemporaries, colleagues and students. He was a giant among surgeons, and his name deserves commemoration.