bluuebunny/crossref_metadata_2025 huggingface dataset:
Non‐N‐methyl‐d‐aspartate glutamate receptors in the lateral hypothalamus modulate cardiac baroreflex responses in conscious rats
Authors: Crestani Carlos C , Deolindo Milena V , Alves Fernando HF , Resstel Leonardo BM , Correa Fernando MA
Published: April 2009

In the present study, we investigated the effects of inhibition of the lateral hypothalamus (LH) neurotransmission with bilateral microinjection of CoCl2, a non‐selective blocker of neurotransmission, on modulation of cardiac baroreflex responses in conscious rats as well as the involvement of LH glutamatergic neurotransmission in this modulation.

Reflex bradycardiac and tachycardiac responses to blood pressure increases (following i.v. infusion of phenylephrine) or decreases (following i.v. infusion of sodium nitroprusside) were investigated in conscious male Wistar rats. Responses were evaluated before and after microinjection of 1 nmol/100 nL CoCl2, 2 nmol/100 nL 1,2,3,4‐tetrahydro‐6‐nitro‐2,3‐dioxobenzoquinoxaline‐7‐sulphonamide (NBQX; a selective non‐N‐methyl‐d‐aspartate (NMDA) glutamate receptor antagonist) or different doses (2, 4 or 8 nmol/100 nL) of the selective NMDA glutamate receptor antagonist LY235959.

Microinjection of CoCl2into the LH had no effect on the tachycardiac baroreflex response, but did evoke a decrease in the reflex bradycardia caused by increases in blood pressure. Microinjection of NBQX into the LH had a similar effect on reflex bradycardia as CoCl2, but had no effect on the tachycardiac response. Microinjection of increasing doses of LY235959 into the LH had no effect on the cardiac baroreflex response.

In conclusion, the data suggest that the LH has a tonic facilitatory influence on the parasympathetic component of the baroreflex. The results also indicate that this facilitatory influence is mediated by local LH glutamatergic neurotransmission through non‐NMDA glutamatergic receptors.
Longitudinal assessment of the effects of oestrogen on blood pressure and cardiovascular autonomic activity in female rats
Authors: El‐Mas Mahmoud M , Abdel‐Rahman Abdel A
Published: April 2009

Published data concerning the effects of ovarian hormones on haemodynamic variability are contradictory. For the first time, the present study used radiotelemetric haemodynamic monitoring to investigate the long‐term effects of chronic oestrogen depletion and repletion on cardiovascular autonomic control and arterial baroreflex sensitivity (BRS) in female rats.

Blood pressure (BP), heart rate (HR) and +dP/dtmax of arterial pressure (an estimate of myocardial contractility) were monitored in sham‐operated (SO), ovariectomized (OVX) and oestrogen‐replaced OVX rats (OVXE2) for 16 weeks. Cardiovascular autonomic control and baroreflexes were assessed by frequency domain analysis of interbeat intervals (IBI) and systolic BP (SBP).

Compared with SO rats, OVX rats exhibited no changes in BP, short‐lived decreases in HR and sustained reductions in +dP/dtmax of arterial pressure. The high‐ (HF; 0.75–3 Hz) and low‐frequency (LF; 0.25–0.75 Hz) components of spectral power of IBI were significantly decreased and increased, respectively, by ovariectomy. An increase in the IBILF/HF ratio in OVX rats suggests a shift in the cardiac sympathovagal balance towards sympathetic dominance. Index α, the spectral index of spontaneous BRS, was reduced by OVX.

Oestrogen replacement caused significant reductions in BP and HR and reversed OVX‐induced changes in +dP/dtmax of arterial pressure and cardiac autonomic activity. The LF oscillations of SBP were reduced in OVXE2 rats, suggesting a reduction in vascular sympathetic tone by oestrogen.

These findings highlight the importance of long‐term oestrogen therapy in rectifying the detrimental effects of depletion of ovarian hormones on the cardiovascular system and baroreflex.
p38 MITOGEN‐ACTIVATED PROTEIN KINASE (MAPK) IS ACTIVATED BY NORADRENALINE AND SERVES A CARDIOPROTECTIVE ROLE, WHEREAS ADRENALINE INDUCES p38 MAPK DEPHOSPHORYLATION
Authors: Tsang Michael YC , Rabkin Simon W
Published: April 2009

The aim of the present study was to investigate the role of p38 mitogen‐activated protein kinases (MAPK) in mediating the effect of noradrenaline (NA) on cardiomyocyte cell viability.

Cardiomyocytes from embryonic chick heart were treated with various concentrations of NA, phenylephrine or isoproterenol and p38 MAPK activation was determined by western blotting. Total cell death was assessed by the 3‐(4,5‐dimethyl‐2 thiazoyl)‐2,5‐diphenyl‐2H‐tetrazolium bromide assay. Apoptosis was determined by specific DNA fragmentation.

At 100 µmol/L, NA produced a significant increase in cell death that was associated with microscopic changes and DNA fragmentation indicative of apoptosis. The p38 MAPK inhibitor SB202190 (at 1 µmol/L beginning 1 h before NA), reduced NA‐induced p38 MAPK activation and significantly accentuated NA‐induced cell death. In contrast, the mitogen‐activated protein kinase kinase ERK1/2 inhibitor PD98059 (at 1 µmol/L beginning 1 h before NA) did not significantly alter NA‐induced cell death. These effects of NA were mediated, in part, through α‐adrenoceptor because phenylephrine (100 µmol/L), like NA, also induced p38 MAPK activation. However, 100 µmol/L isoproterenol produced a sustained dephosphorylation of p38 MAPK.

These data show that NA‐induced p38 MAPK activation, through α‐adrenoceptor, has a protective role in cardiomyocytes to antagonize NA‐induced cell death. In contrast, β‐adrenoceptor stimulation produces dephosphorylation of p38 MAPK.
Pirfenidone inhibits carbon tetrachloride‐ and albumin complex‐induced liver fibrosis in rodents by preventing activation of hepatic stellate cells
Authors: Zhao Xin‐Yan , Zeng Xin , Li Xin‐Min , Wang Tai‐Ling , Wang Bao‐En
Published: April 2009

Pirfenidone (PFD; 5‐methyl‐1‐phenyl‐2(1H)‐pyridone) is an effective and novel agent with antifibrotic and anti‐inflammatory properties. In the present study, we investigated the antifibrotic effects of PFD on experimental liver fibrosis models in rodents and the possible underlying molecular mechanisms.

Liver fibrosis was induced by carbon tetrachloride (CCl4) in BALB/c mice. Pirfenidone (250 mg/kg) and silymarin (50 mg/kg) were given to different groups of rats by gastric gavage for 4 weeks. Pirfenidone significantly attenuated fibrosis severity, as determined by histopathological scores and hydroxyproline levels in liver tissue, by 49.8 and 44.9%, respectively, compared with the CCl4‐treated group. The antifibrotic effects of PFD were significantly greater than those of silymarin, as indicated by a decrease of 23.5 and 24.8% in histopathological scores and hydroxyproline levels, respectively.

Liver fibrosis was also induced by albumin antigen–antibody complex in Wistar rats, which were then treated with the same doses of PFD and silymarin for 8 weeks. Pirfenidone significantly reduced the degree of fibrosis compared with CCl4‐treated rats (by 45.0 and 51.0% as determined by histopathological scores and hydroxyproline levels in liver tissue, respectively). The antifibrotic effects of PFD were comparable to those of silymarin.

The effects of PFD on the expression of extracellular matrix‐associated genes in human hepatic stellate cells (the LX‐2 cell line) were measured by real‐time quantitative polymerase chain reaction. LX‐2 cells were treated with or without 100 μmol/L or 1 mmol/L PFD for 24 h. Pirfenidone significantly inhibited the expression of a‐smooth muscle actin and Type I collagen in 8 ng/mL transforming growth factor‐β1‐ or 5% fetal bovine serum‐activated LX‐2 cells in a dose‐dependent manner.

In conclusion, the results of the present study demonstrate that PFD is effective in ameliorating fibrogenesis induced by CCl4 in mice and by the albumin complex in rats. These effects were mediated mainly via inhibition of the activation of hepatic stellate cells, as well as antifibrotic actions (i.e. inhibition of collagen synthesis) of PFD.
A new method for assessing variability of 24 h blood pressure and its first application in 1526 elderly men
Authors: Duan Jun‐Li , Hao Chang‐Ning , Lu Wei , Han Li , Pan Zhi‐Hong , Gu Yi , Liu Pei‐Jing , Tao Rui , Shi Yi‐Qin , Du Ye‐Ye
Published: April 2009

Blood pressure variability (BPV) includes physiological and random variations in blood pressure (BP). Commonly used approaches, such as standard deviation (SD) and weighted standard deviation (wSD) methods, do not efficiently assess random variation in BP. In the present study, we propose a novel method to assess individual BP variations, extracting random variation in BP by eliminating physiological variation mathematically. This novel assessment method furthers our understanding of the relationship between BP variation and lacunar infarction (LACI).

In the present study, we analysed ambulatory blood pressure monitoring recordings taken from 1526 men aged 60–98 years of age. Individual curves were created using a mathematical method and the related BP variation calculated, namely the SD for individual BP variations. In addition, correlations between LACI and BP variations as determined by the classical SD method, wSD and our novel assessment method (SD′) were evaluated.

The results demonstrated that 24 h variations in systolic BP (SBP) were closely associated with LACI when the SD and wSD methods were used (P < 0.05), but the most significant correlations were observed when the SD′ method was used (P < 0.01). Furthermore, using SD′ yielded the lowest value of the parameter P among the three different methods used to analyse BPV. Using the SD′ method, a significant correlation was found between variations in SBP and the incidence of LACI (P < 0.05). It was found that the incidence of LACI increaesd by 2% with each 1 mmHg increase in SBP variation.

In conclusion, our novel assessment method enables mathematical removal of interference from physiological BP variation and the results show a better correlation with LACI. Thus, our novel method may be considered a simple index of 24 h BP variation that is superior to conventional SD and wSD methods.
Effects of the endocannabinoid transport inhibitors AM404 and UCM707 on diabetic neuropathy in rats
Authors: Hasanein Parisa , Soltani Nepton
Published: April 2009

Diabetic rats display increased pain responses following injection of formalin into the paw, suggesting the presence of hyperalgesia. In the present study, we investigated the efficacy of the systemic administration of the endocannabinoid transport inhibitors UCM707 and AM404 (1, 10 and 50 mg/kg, i.p.) on hyperalgesia during the formalin test in streptozocin (STZ)‐induced diabetic rats.

Nociceptive testing was performed in male adult Wistar rats 4 weeks after the onset of hyperglycaemia. At the end of the experiment, all rats were weighed and then underwent plasma glucose measurements.

Diabetes caused significant hyperalgesia during both phases of the formalin test. At 10 and 50 mg/kg, both UCM707 and AM404 reversed chemical hyperalgesia in diabetic rats. UCM707 (10 and 50 mg/kg) caused less intensive nociceptive behaviour during both phases of the test, whereas AM404 (10 and 50 mg/kg) only affected pain scores during Phase 1 of the formalin test. At 1 mg, neither drug had any effect on pain behaviour in control and diabetic groups compared with their respective controls. Neither UCM707 nor AM404 had any effect on bodyweight or plasma glucose levels of treated compared with non‐treated rats at any of the doses tested.

The results of the present study indicate that systemic administration of UCM707 and AM404 is effective in ameliorating chemical hyperalgesia in STZ‐diabetic rats. Thus, endocannabinoid transport inhibitors may have potential in the treatment of painful diabetic neuropathy.
Additive beneficial effects of amlodipine and atorvastatin in reversing advanced cardiac hypertrophy in elderly spontaneously hypertensive rats
Authors: Lu Jing‐Chao , Cui Wei , Zhang Hai‐Lin , Liu Fan , Han Mei , Liu De‐Min , Yin Hong‐Ning , Zhang Kai , Du Jun
Published: April 2009

Additive beneficial effects on cardiovascular disease have been reported for amlodipine and atorvastatin. However, it is still unclear whether the combination of amlodipine and atorvastatin has additive beneficial effects on the regression of advanced cardiac hypertrophy in hypertension. In the present study, the effects of the drug combination on advanced cardiac hypertrophy were investigated in elderly spontaneously hypertensive rats (SHR).

Elderly SHR (36 weeks old) were randomly allocated into four groups of 12: (i) a vehicle‐treated control group; (ii) an amlodipine (10 mg/kg per day)‐treated group; (iii) an atorvastatin (10 mg/kg per day)‐treated group; and (iv) a group treated with a combination of amlodipine and atorvastatin (both at 10 mg/kg per day). Drugs were administered by oral gavage every morning for a period of 12 weeks before hearts were harvested for analysis.

Combined administration of amlodipine and atorvastatin significantly suppressed cardiomyocyte hypertrophy, interstitial fibrosis and upregulation of hypertrophic and profibrotic genes, and also improved left ventricular diastolic dysfunction to a greater extent than did amlodipine monotherapy. Further beneficial effects of combination therapy on advanced cardiac hypertrophy were associated with a greater reduction of NADPH oxidase‐mediated increases in cardiac reactive oxygen species (ROS), rather than decreased blood pressure and serum cholesterol levels.

To elucidate the underlying molecular mechanisms, we examined cardiovascular NADPH oxidase subunits and found that amlodipine clearly attenuated the expression of p47phox and p40phox and slightly but significantly reduced p22phox and Rac‐1 levels in heart tissue. Combination treatment with amlodipine plus atorvastatin led to a further reduction in p22phox, p47phox and Rac‐1 protein levels compared with amlodipine alone.

In conclusion, combined amlodipine and atorvastatin treatment has a greater beneficial effect on advanced cardiac hypertrophy compared with amlodipine monotherapy. The benefits are likely to be related to the additive effects of the drugs on the suppression of NADPH oxidase‐mediated ROS generation.
Anticancer activity of Panax notoginseng extract 20(S)‐25‐OCH3‐PPD: Targetting β‐catenin signalling
Authors: Bi Xiuli , Zhao Yuqing , Fang Wenfeng , Yang Wancai
Published: April 2009

The Wnt/β‐catenin pathway plays a critical role in carcinogenesis and so agents that target Wnt/β‐catenin may have potential in cancer prevention and therapy. The aim of the present study was to evaluate the anticancer activity of the novel natural product dammarane‐type triterpene sapogenin (20(S)‐25‐OCH3‐PPD; PPD25) isolated from the leaves of Panax notoginseng.

The anticancer activity of PPD25 was evaluated in three colon cancer cell lines and in one lung cancer cell line. The effects of PPD25 to inhibit proliferation and to induce apoptosis were evaluated. In addition, the potential mechanisms underlying the effects of PPD25 were investigated.

It was found that the addition of 5 or 25 µmol/L PPD25 to the culture medium significantly inhibited cell proliferation and induced apoptosis in all four cancer cell lines. Mechanistic studies revealed that PPD25 significantly reduced the expression of β‐catenin, a key mediator in the Wnt pathway, as well as transcriptional targets of β‐catenin, namely c‐myc, cyclin D1, cdk4 and T cell factor (TCF)‐4. In addition, β‐catenin/TCF transcriptional activity was significantly suppressed by PPD25.

The data demonstrate that the PPD25 exerts its anticancer effect by targetting β‐catenin signalling, suggesting that PPD25 may have potential as a chemotherapeutic and/or chemopreventive agent for colon and lung cancer.
Local dynamic changes in confined extracellular environments within organs
Authors: Behrendorff Natasha , Shukla Alka , Schwiening Christof , Thorn Peter
Published: April 2009

Herein we review past work that has studied the composition of luminal fluid in organs, with a focus on measures of calcium and pH in the exocrine glands. This luminal environment is ‘external’ to the mammalian body and is not subject to the usual mechanisms of homeostatic control. Instead, it is controlled by the behaviour of the cells that line the lumen.

We discuss the likely possibility that rapid and local changes in calcium and pH occur within microdomains in the lumen. Further, we present preliminary evidence, using live cell imaging of intact pancreatic fragments, that supports the idea that pH changes do occur. Our evidence indicates that exocytosis of secretory granules in pancreatic acinar cells leads to a loss of protons from the granule and a subsequent local acidification of the lumen.

These changes in luminal composition are placed in the context of diseases of the pancreas, such as cystic fibrosis and pancreatitis, both of which are known to result in perturbations of luminal fluid composition.
Increased frequency of distinct TSC2 allelic variants in focal cortical dysplasias with balloon cells and mineralization
Authors: Schönberger Anna , Niehusmann Pitt , Urbach Horst , Majores Michael , Grote Alexander , Holthausen Hans , Blümcke Ingmar , Deckert Martina , Becker Albert J.
Published: April 2009

Focal cortical dysplasias with balloon cells (FCDIIb) usually present with characteristic imaging and molecular features, that is, a transmantle sign on fluid‐attenuated inversion recovery MRI and abundance of allelic variants of the tuberous sclerosis gene 1 (TSC1). Recently, we observed several mineralized lesions (n = 5) lacking this MRI pattern and which surprisingly turned out as FCDIIb upon neuropathological examination. These mineralized FCDIIb revealed an increased frequency of TSC2 allelic variants but not TSC1 (intron 31: 60% vs. 11% in controls; P = 0.0164, exon 41: 40% vs. 6.5% in controls; P = 0.0441). Mineralized FCDIIb have a favorable postsurgical outcome and need consideration in the presurgical differential diagnosis of calcified lesions associated with pharmacoresistant focal epilepsies.
Genetic association of BDNF val66met and GSK‐3β‐50T/C polymorphisms with tardive dyskinesia
Authors: Park Sung Woo , Lee Jung Goo , Kong Bo Geum , Lee Sun Jung , Lee Chan Hong , Kim Jeong Ik , Kim Young Hoon
Published: April 2009

Aims:  Neurodegenerative processes may be involved in the pathogenesis of tardive dyskinesia (TD), and a growing body of evidence suggests that brain‐derived neurotrophic factor (BDNF) plays a role in both the antipsychotic effects and the pathogenesis of TD. BDNF and glycogen synthase kinase (GSK)‐3β are important in neuronal survival, and thus abnormal regulation of BDNF and GSK‐3β may contribute to TD pathophysiology. This study investigated the relationship between two polymorphisms, val66met in the BDNF coding region and ‐50T/C in the GSK‐3β promoter, and susceptibility to TD among a matched sample of patients having schizophrenia with TD (n = 83), patients with schizophrenia without TD (n = 78), and normal control subjects (n = 93).

Methods:  All subjects were Korean. The BDNF val66met and GSK‐3β‐50T/C genotypes were determined by polymerase chain reaction and restriction fragment length polymorphism analyses.

Results:  Polymerase chain reaction analysis revealed no significant difference in the occurrence of the polymorphisms among the TD, non‐TD, and control subjects, but a significant interaction was observed among the groups possessing BDNF val allele in compound genotypes (P = 0.001). We found that the schizophrenic subjects with the C/C GSK‐3β genotype, who carry the val allele of the BDNF gene, are expected to have a decreased risk of developing neuroleptic‐induced tardive dyskinesia (P < 0.001).

Conclusions:  Our results demonstrate that the GSK‐3β C/C genotype with the BDNF val allele is associated with patients having schizophrenia without TD. This study also suggests that the BDNF and GSK‐3β gene polymorphisms work in combination, but not individually, in predisposing patients with schizophrenia to TD.
Pharmacokinetics and efficacy of a direct switch from conventional depot to risperidone long‐acting injection in Chinese patients with schizophrenic and schizoaffective disorders
Authors: Lai Ying‐Ching , Huang Ming‐Chyi , Chen Chun‐Hsin , Tsai Chang‐Jer , Pan Chun‐Hung , Chiu Chih‐Chiang
Published: April 2009

Aims:  This 12‐week open‐label study was designed to investigate the pharmacokinetics and efficacy of a direct switch from a conventional depot to long‐acting injectable risperidone in patients with schizophrenia and schizoaffective disorder.

Methods:  Men or women from 18 to 65 years old with a diagnosis of schizophrenia or schizoaffective disorder were eligible for participation if they had been treated with conventional depot for at least 8 weeks before study entry. Intramuscular long‐acting risperidone was administered starting from 25 mg, with the dose flexibly adjusted every two weeks for 12 weeks from week 4.

Results:  Of the 25 patients enrolled in this study, 21 completed at least one post‐baseline assessment and were thus included in the analysis. The mean serum concentration of risperidone plus 9‐hydroxyrisperidone was 29.1 ng/mL at the 12th week after switching, with an average injection dose of 31.25 mg long‐acting risperidone every two weeks. The levels of active moiety of risperidone seemed to be higher in Chinese patients compared to those in Caucasian patients. Positive and Negative Syndrome Scale total scores (from 67.5 to 56.4; P = 0.002), scores for negative symptoms (P = 0.006) and general symptoms (P = 0.001) were improved significantly 12 weeks after the switch. Mean Extrapyramidal Symptom Rating Scale scores were improved significantly from 20.1 to 5.5 (P < 0.001). Significantly decreased levels of cholesterol and triglyceride were found at the 12th week. The levels of fasting glucose, low‐density lipoprotein, high‐density lipoprotein and bodyweight remained unchanged.

Conclusions:  These findings suggest that switching from conventional depot to long‐acting risperidone is feasible with the advantage of symptom reduction and side‐effect profile decrement.
Prediction for developmental delay on Neonatal Oral Motor Assessment Scale in preterm infants without brain lesion
Authors: Tsai Sen‐Wei , Chen Chao‐Huei , Lin Ming‐Chih
Published: April 2009

Background:  Preterm infants often have difficulty in achieving a coordinated sucking pattern. To analyze the correlation between preterm infants with disorganized sucking and future development, weekly studies were performed of 27 preterm infants from initiation of bottle feeding until a normal sucking pattern was recognized.

Methods:  A total of 27 preterm infants without brain lesion participated in the present study. Neonatal Oral Motor Assessment Scale (NOMAS) was utilized to evaluate the sucking pattern. Infants who were initially assessed as having disorganized sucking on NOMAS and regained a normal sucking pattern by 37 weeks old were assigned to group I; infants with a persistent disorganized sucking pattern after 37 weeks were assigned to group II. The mental (MDI) and psychomotor (PDI) developmental indices of Bayley Scales of Infant Development, second edition were used for follow‐up tests to demonstrate neurodevelopment at 6 months and 12 months of corrected age.

Results:  At 6 months follow up, subjects in group I had a significantly higher PDI score than group II infants (P= 0.04). At 12 months follow up, group I subjects had a significantly higher score on MDI (P= 0.03) and PDI (P= 0.04). There was also a higher rate for development delay in group II at 6 months (P= 0.05).

Conclusion:  NOMAS‐based assessment for neonatal feeding performance could be a helpful tool to predict neurodevelopmental outcome at 6 and 12 months. Close follow up and early intervention may be necessary for infants who present with a disorganized sucking pattern after 37 weeks post‐conceptional age.
Maternal smoking during pregnancy and offspring obesity: Meta‐analysis
Authors: Ino Toshihiro
Published: April 2009

Background:  Recent reports have suggested that maternal smoking may increase the risk of development of obesity in the unborn child in later life, but relatively few cohort studies have been done on the relationship between maternal smoking during pregnancy and future development of metabolic syndrome.

Methods:  A systematic review and meta‐analysis of observational studies reporting effect estimates and 95% confidence intervals (95%CI) was conducted on the association between maternal smoking during pregnancy and obesity of future offspring.

Results:  Seventeen papers were identified from 444 English‐language papers (key word search: maternal smoking and obesity) in PubMed. All papers showed a positive association between maternal smoking during pregnancy and childhood obesity. The meta‐analysis, using the DerSimonian–Laird method, found the association to be statistically significant. In association with maternal smoking during pregnancy and body mass index with more than 95%CI in the offspring aged 3–33 years, the pooled odds ratio calculated from 16 of these 17 studies was 1.64 (95%CI: 1.42–1.90). After adjustment for publication bias, the pooled adjusted odds ratio was 1.52 (95%CI: 1.36–1.70). In addition, confounders of maternal obesity, low social status, low birthweight and not being breast‐fed seemed to be risk factors for offspring obesity.

Conclusion:  Maternal smoking during pregnancy may cause future obesity and metabolic syndrome.
BT01 LAP BAND –“IS IT A DURABLE BARIATRIC PROCEDURE?” THE WESLEY BRISBANE EXPERIENCE
Authors: Patel B. M. , Bowden B. K. , Duncombe J. E. , Fielding G. A.
Published: April 2009

Introduction:   The Wesley Private Hospital has been a world leading centre for bariatric surgery in Brisbane, Australia. We have been involved with laparoscopic adjustable gastric band surgery since 1996. Since that time we have performed over 3000 primary lap band procedures. In this study we hoped to ascertain the long term durability of the procedure over an eight year follow up period.

Methods and Materials:   We have conducted a retrospective analysis of all patients who underwent LAGB surgery at our institute from 1st January 2000 to 31st December 2000. The end points were related to the outcomes in terms of weight loss and complications.

Results:   158 patients underwent LAGB surgery during the above period. There were 135 females and 23 males in this study. The age ranged from 13–69 years. Mean age of 41 years. The mean weight on presentation was 127 kg. The current mean weight is 104 kg. 80% follow‐up rate over eight years. There was no mortality in our series.

Conclusion:   LAGB surgery has proven durability over an eight year period in our series with a minimum of morbidity and no mortality.
BT05 MODERN MANAGEMENT OF COLONIC DIVERTICULITIS IN THE OBESE
Authors: White S.
Published: April 2009

Colonic diverticulitis is a dietary disorder of the ageing Western population associated with a low intake of oral fibre. Symptoms develop in only 10% of patients and overall only 1% of patients experience a complication. CT scan is the investigation of choice, although CT fails to predict clinical outcomes in many cases. Uncomplicated diverticulitis is reliably managed by antibiotics in the great majority of cases. So much so that enthusiasm for elective surgical resection after two documented attacks is waning, particularly in the high risk patient i.e. obese. Complicated diverticulitis (abscess, peritonitis, fistulae, stricture or bleeding) that fails conservative management is traditionally treated by open Hartmann's rectosigmoidectomy. Alternatives to laparoscopy are particularly helpful in the obese where large incisions cause significant problems with pain management, patient mobilisation and wound breakdown with hernia. Endoscopic management of acute diverticular bleeding and stricture with obstruction is well described. Radiological management of diverticular abscess is widely available Laparoscopic washout for purulent peritonitis is new whilst laparoscopic resection for faecal peritonitis is proven. Technical aspects of colonic diverticular surgery in the obese will be discussed and our experiences with laparoscopic, colonoscopic and radiological management complicated diverticulitis will be presented.
BT06 HERNIA REPAIR IN THE MORBIDLY OBESE
Authors: McCallum M.
Published: April 2009

The basic message is DON'T.

Groin Hernia:   There is evidence that groin herniae in males are very safe to watch. Elective hernia repair therefore should be carefully considered. The risk of infection, of recurrence and of non surgical complications is high. Watchful waiting may well be the best option. In case of emergency a policy of “primum non nocere” may be the best option.

Incisional Hernia:   Weight reduction prior to surgery results in fewer complications and happier surgeons! If operation is necessary in an emergency situation “Live to fight another day” may be the best motto.

If operation cannot be delayed, the choice between open and laparoscopic surgery is difficult. Laparoscopic perhaps gives lesser pain but is more difficult. Open surgery is not easy and is associated with all the complications that operating in morbidly patients is associated with.

Each case must be assessed and decisions made. Whatever decision is made, there is a large risk of complications, and the surgical procedure therefore must reflect the urgency of the situation.
BT07P AN EMERGING TECHNIQUE IN BARIATRIC SURGERY, IN AN UNUSUAL PATIENT COHORT
Authors: Macgregor D. E. , Hopkins G. , Radford‐Smith G.
Published: April 2009

This reports on a pilot study of the use of sleeve gastrectomy in morbidly obese patients with inflammatory bowel disease.

Background:   The management of obesity is an increasingly important issue in health care. Bariatric surgery is now well established as the only modality which can effect significant, sustained weight loss and thus control of subsequent complications. With increasing experience of the Bariatric Unit at the Royal Brisbane and Women's Hospital we are looking at special cases in obesity surgery.

Sleeve Gastrectomy and IBD:   Sleeve gastrectomy (SG) is a laparoscopic surgical technique which is increasing in application. It is effective for weight reduction and early studies show low morbidity and mortality. The technique involves stapled resection of much of the greater curve of the stomach, leaving a remnant gastric tube.

In comparison to other bariatric surgery techniques we feel sleeve gastrectomy is particularly useful in obese patients with IBD. Whilst morbid obesity is an infrequent issue in the inflammatory bowel disease patient cohort, the surgical management presents particular issues for customary techniques. SG does not require implantation of foreign material, open surgery or surgery upon the small bowel.

Furthermore this cohort has specific issues where obesity may impact upon their IBD, resulting in specific indications for bariatric surgery.

We report on the outcomes from our early experience.
BS01 WHAT NEXT FOR BREAST CANCER GENE TESTING?
Authors: Gattas M. R.
Published: April 2009

In 1994 and 1995 the BRCA1 and BRCA2 genes were first discovered. These breakthroughs quickly lead to the clinical testing of these genes in families with multiple cases of breast and ovarian cancer. Whilst different centres apply different criteria for clinical testing, only approximately 20% of high risk families are found to harbour a mutation in one or other of these genes. Despite intense efforts by the research community, there has been no BRCA3 gene uncovered, nor is there likely to be any other high penetrant breast cancer to be found. More recent research efforts have uncovered more moderate and low risk breast cancer susceptibility genes. It remains to be seen if there is any clinical utility in testing for these low penetrant genes in years to come.

More promising are the trials of new drugs called PARP inhibitors that may offer specific advantages in treating breast and ovarian cancer in women who are germline carriers of BRCA gene mutations. Molecular genetics will no doubt continue to shed light on the biology of breast cancer in productive ways in years to come.
BS13P AN AGGRESSIVE STROMAL SARCOMA OF THE BREAST: A CASE REPORT AND ROLE OF RADIOTHERAPY
Authors: Imisairi A. H.
Published: April 2009

Introduction:   Primary breast sarcoma is very rare and aggressive that comprises 0.5–1% of all breast neoplasms. Most of the series include both stromal and cystosarcoma phylloides and only few reports based on primary stromal sarcoma of the breast solely. The mode of treatment is still uncertain and the role of radiotherapy remains questionable.

Case Report:   We report a case of a stromal sarcoma of the breast in a 62 year‐old woman who was referred to our centre because of rapidly enlarging mass of the right breast for 6 months. The mass was 16 × 15 × 15 cm in size, fungating with overlying skin ulceration. A tru cut biopsy revealed malignant lesion most probably stromal sarcoma or malignant phylloides. Mastectomy of the right breast with axillary clearance with split skin graft was performed and pathologic examination demonstrated primary stromal sarcoma of the right breast with involvement of the pectoralis major. No axillary lymph nodes involvement was noted. The patient was subsequently undergone 20 courses of radiotherapy to the right chest wall. CT scan of the thorax and abdomen 6 months after that were normal and it was repeated yearly for 3 consecutive years which revealed no evidence of distant metastasis.

Conclusion:   The aggressiveness of breast stromal sarcoma mandates adequate surgical resection to achieve local control. Despite radiotherapy shows good respond in this case, its role is still debatable and more series need to be reviewed to justify the indication.
BS02 SENTINEL NODE BIOPSY FOR LOCALLY RECURRENT BREAST CANCER
Authors: Spillane A. J.
Published: April 2009

Purpose:   Sentinel node biopsy (SNB) is standard of care for node negative, early breast cancer. There is debate as to the role of SNB in cases presenting with locally recurrent cancer or new ipsilateral cancer after breast conservation surgery or mastectomy in patients who have had a prior axillary dissection or prior SNB. The role of re‐operative SNB is evolving as is its place in staging and management.

Methodology:   Illustrative case histories and English language literature review.

Results:   High rates of ipsilateral axillary lymphatic drainage still occur in patients where only prior SNB has been performed in the axilla. When prior axillary dissection has been performed there is approximately 33–38% chance of demonstrating axillary sentinel nodes and a 28–58% chance of demonstrating non‐ipsilateral axillary / extra‐axillary drainage. The more extensive the axillary intervention the greater the chance of extra‐axillary lymphatic drainage. Common sites of non‐ipsilateral axillary lymphatic drainage include – internal mammary nodes and the contralateral axilla. Less common sites include intramammary lymph nodes both in the ipsilateral and the contralateral breast, interpectoral nodes and supraclavicular nodes. Information from the redo SNB alters management in the majority of cases. Re‐operative SNB has been reported after prior mastectomy but there is very little data available.

Conclusions:   Lymphatic mapping is possible in the majority of ipsilateral local recurrent and new primary breast cancer patients. Re‐operative SNB is technically feasible in the majority of cases where lymphatic drainage is demonstrated. When performed the results change management in the majority of cases.
BS05 PAPILLARY LESION ON PERCUTANEOUS BREAST NEEDLE BIOPSY – IS SURGICAL EXCISION NECESSARY?
Authors: Law M. T. , Bennett I. C.
Published: April 2009

Purpose:   Malignancy is encountered in 15–24% of papillary lesions identified on percutaneous breast needle biopsies (FNA and core). We aim to determine the incidence of malignancy in our clinic and to identify features which may help differentiate benign from malignant lesions, avoiding the need for routine excisional biopsy.

Method:   Retrospective review of all needle biopsies showing papillary lesions between 2006 and 2007 at the Wesley Breast Clinic. Correlations of Clinico‐radiological features and definitive histology were tested using Chi Square test with clinical significance defined as p < 0.05.

Results:   127 biopsies were performed on 102 patients. 47% were screen detected. 100 patients underwent surgery, 2 were managed conservatively. Malignancy rate on definitive histology was 18% with most showing invasive disease (12/18). Atypical or malignant core biopsy findings (p < 0.05), high ultrasound BIRADS score (p = 0.0021), and being post‐menopausal (p < 0.05) were found to be strong predictors of malignancy. Of the 2 conservatively treated patients, no clinico‐radiological changes were identified over a 9–12 months follow‐up period.

Conclusion:   The incidence of malignancy in our institution is comparable with world literature. Although our series did not identify a low risk group where conservative management is suitable, patients demonstrating strong predictors of malignancy stated above should certainly not be considered for such approach. Use of new techniques such as immunohistochemistry to improve core biopsy accuracy may lead to identification of a true benign group.
BS08 CLINICIAN – PERFORMED ULTRASOUND: AN INVALUABLE TOOL FOR SURGEONS IN THE ASSESSMENT AND MANAGEMENT OF BREAST LUMPS
Authors: Smith T. J.
Published: April 2009

Purpose:   To review the use of clinician‐performed ultrasound in assessing patients presenting with breast lumps.

Methodology:   1000 consecutive cases of breast lumps presenting to single surgeon where office ultrasound was used at the initial consultation to facilitate diagnosis and treatment. The cases were prospectively audited.

Results:   Ultrasound is shown to play a valuable role in identifying a discrete lesion and accurately documenting its’ dimensions and characteristics. Ultrasound can readily distinguish between cystic and solid lumps and frequently allows for further characterisation of solid lumps as probably benign or malignant. This information can influence further clinical decision‐making. Ultrasound guided needle aspiration of cysts and percutaneous needle biopsy of solid lesions can be performed expeditiously at the initial consultation thereby saving time and reducing costs. Ultrasound can subsequently be used for accurate follow‐up and documentation of lesions that are managed non‐operatively.

Conclusion:   The use of ultrasound by the surgeon streamlines patient care. Practical issues relating to the implementation of breast ultrasound, training and access to suitable equipment will be addressed.
BS09 STAGING AND MANAGING THE AXILLA IN EARLY BREAST CANCER – GUIDELINES FOR BEST PRACTICE
Authors: O'brien J. , Wilcoxon H. , Pearce A. , Luxford K. , Nelson A. , Zorbas H.
Published: April 2009

Purpose:   Evidence‐based guidelines assist clinicians to integrate research into practice. National Breast and Ovarian Cancer Centre (NBOCC) has systematically reviewed current evidence and developed recommendations for staging and managing the axilla in early breast cancer (EBC). NBOCC guidelines for sentinel node biopsy (SNB) were presented at RACS in 2008, supporting SNB as an alternative to axillary dissection (AD) in suitable women with EBC. However, guidelines for non‐SNB‐based axillary management are also required.

Methodology:   A multidisciplinary working group including consumers oversaw the systematic review addressing: AD versus 4‐node sampling in axillary staging; AD versus non‐surgical methods in axillary staging; the optimal extent of AD; the prognostic significance of the number of nodes retrieved and the proportion of involved nodes identified at AD; long‐term outcomes of AD; and axillary irradiation (with or without AD) following breast surgery. Evaluation of the evidence informed the development of guideline recommendations by the working group.

Results:   Eleven randomised trials were identified, however the majority of evidence was from non‐randomised trials. Imaging alone is not recommended for routine staging, and for most patients, surgical staging of the axilla is required. For women undergoing AD, level I or II AD is recommended. For women in whom axillary dissection is contraindicated, radiotherapy of the axilla is recommended. Implications and further recommendations for clinical practice will be discussed.

Conclusion:   Guidance for clinical practice is vital where evidence is inconsistent. Axilla management in EBC is once such area, emphasising the importance of new NBOCC guidelines.
BA01 AUDIT OF WAIKATO REGIONAL BURNS CENTRE: BIOBRANE INFECTION RATES
Authors: Nichols K. G. , Moaveni Z. , Mcewan C. , Alkadhi A. , Mcewan W. , Alkadhi A.
Published: April 2009

Purpose:   To review the Burns Service within Waikato Regional Burns Unit (WRBU) and specifically the use and infection rates of Biobrane (TM).

Methods:   Retrospective audit of hospital database and clinical records from January 2003 to July 2008. Data collection included age, sex, ethnicity, percentage burn, site and thickness of burn, time to transfer to regional burns centre, time to theatre for application of Biobrane, antibiotic or topical silver treatment, re‐admission, total number of operations and overall cost of admission. Biobrane infection, causative organism and treatment.

Results:   WRBU admitted 830 patients (236 female and 594 male). A total of 124 patients (37 female and 87 male, average age 15.2 years) required application of Biobrane. Five patients were referred onto National Burns Centre. Mean length of stay 11.4 days (Median 6 days, range 1–68 days), percentage burn 15.6% (range 1–80%), transfer time 5 hours and time to theatre for application of Biobrane 13.5 hours (range 3.5 to >48 hours). Overall infection rate for Biobrane was 19.3% (23 from 119 patients). The main causative organisms were Staphylococcus aureus and Pseudomonas. Statistical analysis did not reveal a statistical significance (p = 0.05) in site, percentage or depth of burn, antibiotic cover or silver dressings and time to theatre for application. Re‐admission was statistically significant for infected Biobrane patients (n = 6, p = 0.04).

Conclusion:   Biobrane infection rates of 19.3% in this audit are far higher than has been reported. This discrepancy may be due to the inclusion and exclusion criteria used in clinical trails. Biobrane remains a useful adjunct but the high risk of infection in our population may require stricter guidelines.
BA04 OPERATIVE REQUIREMENTS OF SEVERE BURN PATIENTS: IMPLICATIONS FOR A DISASTER MANAGEMENT PLAN
Authors: Phua Y. S. , She R. W. , Moazzam A.
Published: April 2009

Purpose:   To determine the operative requirements of patients with severe burns and to develop a disaster management plan for our centre.

Methodology:   A retrospective review was undertaken of 46 patients with burns of more than 20% admitted to the Middlemore Hospital National Burn Centre from June 2006 to October 2008. The main outcome measures were length of inpatient stay, number of operative procedures, and total operating time. The impact of burn severity and other clinical factors on these outcome measures was analysed.

Results:   The mean length of hospital stay for the 38 survivors was 51.4 days. Overall 197.6 visits to theatre per year were required (79.3 operative procedures and 118.3 changes of dressing per year). This equated to 0.14 operative procedures and 36.7 operating minutes per percentage burn. Operative procedure time was greatest in the first week. Patients with burns more than 50% required a longer length of stay and greater number of operative procedures though had a higher overall mortality. Resource utilization was also higher in older patients and those with airway burns without a improvement in survival.

Conclusion:   With the high operative requirements of a major burn, a policy on triage in a mass burn casualty is required. While theatre time for changes of dressing can be eliminated in a disaster setting, theatre time requirements in the first week are largely unaffected. Limited intervention is recommended for burns over 50% in a disaster setting, taking into account age and concomitant injuries.
BA05 A REVIEW OF BLOOD TRANSFUSION PRACTICES IN BURNS PATIENTS ATTENDING THE NATIONAL BURNS CENTRE, NEW ZEALAND
Authors: Guiney A.‐M. , Stapelberg F. H. , She R. W. , Moazzam A.
Published: April 2009

Purpose:   Blood loss and high rates of transfusion in the intensive care unit and burn centre is an area of ongoing concern. Many studies report that patients receiving red blood cell transfusions in the ICU/burn centre setting are more likely to experience complications.

Blood use brings the risk of infection, adverse reaction and immunosuppression and more recently evidence for tumour progression.

The purpose of this study was to review blood transfusion practices in burns patients attending the national burn centre over a 2 year period and to assess transfusion policies over this timeframe.

Methodology:   A retrospective chart review from 2006 to 2008 was performed. All patients with >10% total body surface area burns who underwent surgery were included in the study. Variables examined were packed red blood cells transfused during and after surgery, preoperative and postoperative haemoglobin and cross‐match to transfusion ratios.

Results:   Of the 146 patients reviewed, 79 required multiple transfusions which were administered in the majority of cases via a traditional red blood cell transfusion approach. There was a high cross‐match to transfusion ratio.

Conclusion:   A traditional blood transfusion policy is administered in this unit however in those patients that were treated using a more restrictive policy, a lower haemoglobin was well tolerated. There is scope for the implementation of a more restrictive transfusion policy.
BA07P PAEDIATRIC TREADMILL INJURIES IN NSW: AN INCREASING PROBLEM
Authors: Kim L. , Maze D. , Adams S. , Giutronich S. , Holland A.
Published: April 2009

Purpose:   The steady growth in popularity of home treadmills during the past decade poses a potential hazard to infants and children. Despite increasing awareness of this problem, treadmill‐related injuries in the paediatric age group continue to be a concern. The aim of the study was to determine if there has been any change in the incidence of treadmill‐related injury in comparison to previous studies.

Methodology:   Medical records of all children with treadmill‐related injuries from the two tertiary paediatric hospitals between January 2007 and December 2008 in NSW, Australia were reviewed. Data collected include patient details, events surrounding the mechanism of injury, site of the burn and need for surgical intervention.

Results:   A total of 65 children sustained treadmill‐related injuries, 43 of whom were male. There were 17 cases in 2007 and 48 in 2008. The mean age of injury at the time of incident was 3.7 years (range 18 months–14 years). The most common site occurred in fingers/hand (75%) followed by arm/forearms (9%) and torso (8%). 22% required surgical intervention. One patient required two procedures. The most common injury event was when the treadmill was in use by an adult and the child approached unnoticed from behind.

Conclusion:   There has been an exponential increase in the incidence of treadmill‐related injuries in NSW, which parallels with a report from Queensland. The data suggest the need for national legislative changes in addition to increased public education to reduce the impact of this mechanism of injury.