bluuebunny/crossref_metadata_2025 huggingface dataset:
P61 Producing a Safer Bone Allograft by Procesing Single Femoral Heads
Authors: Rooney P. , Mann J. , Eagle M. , Hogg P. , Kearney J.
Published: September 2006

Introduction  The majority of bone allografts in the UK are supplied as fresh‐frozen single femoral heads which still contain the donor's bone marrow and this donor bone marrow may actually be included in the grafting procedure. Due to the possibility of disease transmission, removal of marrow components from banked allograft femoral heads is desirable. In this study we have set out to develop a protocol to remove donor bone marrow from single femoral heads in a time period and in a manner such that it could be easily implemented into routine production.

Methods  A 12‐step protocol has been devised which involved sonication, rinsing, three centrifugation steps, a hydrogen peroxide wash, an ethanol wash and a total of five warm water washes at 56–59oC. At the end of the procedure, the bone was morcellised into a fine powder and used for residual values. The amount of soluble protein, double stranded DNA and haemoglobin removed at each step was measured using commercial kits and the percentage removed at each step was evaluated.

Results  The total time for the 12‐step protocol was less than 4 h. The protocol resulted in the removal of in excess of 99% of soluble protein, DNA and haemoglobin. Soluble protein and DNA exhibited similar patterns of removal, with the highest proportion of removal occurring at the first centrifugation step whereas haemoglobin removal was highest in the initial sonication wash.

Conclusion  The data presented here indicate that single femoral heads can be individually processed in a four‐hour time period with the resultant removal of the vast majority of bone marrow components. The cleaning protocol may be useful in reducing the possibility of disease transmission in allograft bone.
P64 NHS Cord Blood Bank: Microbiological Screening Results of Cord Blood Donations
Authors: Ellis J. , Biggs C. , Armitage S. , McDonald C. , Contreras M.
Published: September 2006

Following the world's first umbilical cord blood transplant performed by Gluckman et al in 1988, the NHS Cord Blood Bank (NHS‐CBB) was established in 1996 with the primary aim to redress the ethnic imbalance of donors represented on the British Bone Marrow Registry. The NHS‐CBB collects cord blood following delivery of the placenta at a stage where it is considered a waste product. This allows thorough decontamination of the umbilical cord prior to venepuncture. All processing is performed in a closed system or in a cleanroom environment. Microbiological screening of all cord blood units is performed on the final product for aerobic, anaerobic and fungal contaminants, prior to cryopreservation. Contamination rate for the first year of banking was 10.5%. This high rate initiated development and validation of a new cleaning protocol in conjunction with the National Bacteriology Laboratory (NBL). Following the introduction of this system in March 1997 contamination rates subsequently decreased to a median 0.8%. Species identification has elucidated that 54.4% of contaminants were skin flora. Regular quality monitoring of collection and processing indicates that the major source of contamination is at collection. In comparison, contamination of red blood cell collections within the NBS has been found to be approximately 0.08%. This difference may be explained by the inherent difficulties in decontaminating an entire umbilical cord attached to the suspended placenta, use of a wider bore needle and inclusion of the umbilical cord core sample into the collection bag. The NHS‐CBB has issued three bacteriology positive units for transplantation (2.4% of total units issued) with no adverse events reported. In line with current international cord blood banking standards, the CBB now discards all microbial positive donations. Collaboration with the NBL enables the CBB to monitor contamination rates, minimise contamination, thereby maximising efficiency and reduction of wastage.
The potential geographic distribution of the invasive weed Senna obtusifolia in Australia
Authors: DUNLOP E A , WILSON J C , MACKEY A P
Published: September 2006

Senna obtusifolia (sicklepod) is an invasive weed of northern Australia, where it significantly impacts agricultural productivity and alters natural ecosystem structure and function. Although currently restricted to northern regions, the potential for S. obtusifolia to spread south is not known. Using the eco‐climatic model CLIMEX, this study simulated the potential geographic distribution of S. obtusifolia in Australia under two scenarios. Model parameters for both scenarios were derived from the distribution of S. obtusifolia throughout North and Central America. The first scenario used these base model parameters to predict the distribution of S. obtusifolia in Australia, whilst the second model predicted the distribution of a cold susceptible S. obtusifolia ecotype that is reported to occur in the USA. Both models predicted the potential for an extensive S. obtusifolia distribution, with the first model indicating suitable climatic conditions occurring predominantly in coastal regions from the Northern Territory, to far north Queensland and into northern Victoria. The cold susceptible ecotype displayed a comparatively reduced distribution in the southern parts of Australia, where inappropriate temperatures, a lack of thermal accumulation and cold stress restrict the invasion south to the coastal regions of central New South Wales. The extent of the predicted distribution of both ecotypes of S. obtusifolia reinforces the need for strategic management at a national scale.
The implication of stubble tillage for weed population dynamics in organic farming
Authors: PEKRUN C , CLAUPEIN W
Published: September 2006

In practical farming, early and shallow stubble tillage is carried out post‐harvest to stimulate germination of freshly ripened crop and weed seeds, to kill the resulting seedlings and hence to reduce the input into the soil seedbank. Additionally, it aims at reducing perennial weeds by mechanical damage. In this paper, field experiments and laboratory studies are presented which show that stubble tillage can reduce perennial weeds. However, it had a variable effect on annual weeds. After 5 years of experimentation, no effect of stubble tillage was seen on the aboveground vegetation. In contrast, the soil seedbank of the control was roughly doubled where the stubble had been left uncultivated until autumn ploughing. These results indicate that practical experience which assumes that stubble tillage reduces annual weed populations may be correct, despite the fact that in other published studies stubble tillage exerted no control on annual weeds or had a variable effect. This will have practical application in organic arable production systems.
L/I‐10 Anesthetic management of pediatric living related liver and small bowel transplants
Authors: Campise‐Luther R.
Published: September 2006

Living related liver and small bowel transplants, in combination or staged, are now considered an acceptable therapy for children with short gut syndrome who do not tolerate parenteral nutrition and suffer from liver dysfunction and portal hypertension secondary to cholestasis.

The anesthetic management of a pediatric living related liver and small bowel transplant is very challenging. Preoperatively, the focus is on the extensive preparation needed for these cases. Intraoperatively, fluid management requires maintenance of a delicate balance between low CVP to prevent venous congestion of the transplant and adequate blood pressure to maintain perfusion, especially during the reperfusion phase. Monitoring the coagulation status and platelets is important, in order to be able to react appropriately to uncontrollable bleeding; however, overcorrection, which can lead to hepatic or mesenteric artery thrombosis and graft failure, should not be risked. Temperature control is crucial in children independent of the surgical procedure, but poses a special challenge in light of large volume shifts, cold transplanted organs, and large surface area exposure. Fluctuation in glucose levels, acid‐base status, and electrolytes have to be anticipated and treated. Postoperatively, these children have to be monitored in the ICU and cared for in a similar manner as intraoperatively. The team has to be prepared for emergent reexploration for complications, e.g., bleeding, at any time.

These are some of the considerations that demonstrate the complexity of the anesthetic care of these children.

References:  Socol E. et al. Liver and intestinal transplantation in children; JPGN Vol. 35 (2) Supplement; Aug. 2002.

Gregory GA. Pediatric Anesthesia, 4th Edition, p. 541‐567, Churchill/Livingston 2002.

Borland LM. Anesthesia for organ transplantation in children. Int Anesthesiol Clin 23:173, 1985.
L/I‐13 Donor hepatectomy morbidity based on the Clavien scale
Authors: Kinkhabwala M. , Davidzon G. , Lapointe Rudow D. , Brown R. , Emond J.
Published: September 2006

Introduction and methods:  Reported rates of complications after donor hepatectomy vary widely. One reason may be lack of standardization of reporting. In order to assess 1‐year morbidity after donor hepatectomy based on the modified Clavien scale (MCS), which has been proposed as a quantitative scoring system for postsurgical complications, we conducted a retrospective review of 127 living donors at our center through December 2004 (minimum 1‐year follow‐up).

Results:  A total of 76 donors underwent right hepatectomy (RH); 51, left or lateral hepatectomy (LH). In all, 36% of donors experienced a complication as defined by the MCS: 27% of LH donors and 42% of RH donors. The distribution of complications is illustrated in the table below. The most common grade 1 complications were wound infection (7.8%) and ileus (7.1%); grade 2, psychiatric problems and urinary tract infection; grade 3, hernia/wound revision (11.8%). The rate of bile leak was 3.9%; heterologous transfusion, 1.6%. There was 1 aborted procedure. The mean length of stay was 6.3 days for LH donors and 7.2 days for RH donors (p=.02).

Conclusion:  Our data indicate that RH donors experience a higher severity of complications than LH donors, according to Clavien scoring, and the length of hospital stay for RH donors is longer. Systematic application of the MCS may permit large‐scale comparisons of reported complications and thus help improve results of donor hepatectomy.

*Clavien score
LH
RH
Total

0
37
44
81

I
 8
12
20

II
 3
 7
10

III
 3
14
16

IV
 0
 0
 0

Total
11
76
46

*Chi‐squared p = 0.046 comparing Clavien 0/I vs. II/III/IV.
L/I‐4 Living donor liver transplants with alemtuzumab induction and steroid‐free tacrolimus monotherapy
Authors: Tan H. , Tom K. , Thai N. , Marsh J. , Shaw‐Stiffel T. , Fontes P. , DeVera M. , Daily M. , Donaldson J. , Starzl T. , Marcos A.
Published: September 2006

Introduction:  Alemtuzumab (Campath‐1H) is a humanized anti‐CD52 monoclonal antibody that results in prolonged depletion of T and other immune cells.

Patients and methods:  Alemtuzumab (30 mg IV x1) was used for induction in 45 consecutive right lobe adult‐to‐adult living donor liver transplants (RLALDLTs) from 6/10/03 to 9/20/05 at the Starzl Transplantation Institute. Maintenance immunosuppression was with steroid‐free tacrolimus monotherapy, which was weaned when possible. The mean preoperative MELD score was 12.4 (6 to 25); mean follow‐up was 18.6 + 8.6 months.

Results:  Our 1‐year recipient and graft survival rates were 93.3% and 91.1%, and compare well to UNOS data (89.1%, 79.3%). The cumulative acute cellular rejection (ACR) incidence was 0% at 1 mos, 2.4% at 2 mos, 4.8% at 3 mos, 7.3% at 4 mos, 8.9% at 12 mos, and 11.1% at 18 mos. Preweaning ACR was 8.9% (n=4) and only 1 patient had post‐weaning ACR. Weaning was attempted in 38% (n=17) of recipients. At follow‐up, of the 39 living patients, 19 are maintained on daily tacrolimus monotherapy, 7 on qod tacrolimus monotherapy, and 7 on 3x/week tacrolimus monotherapy. The 18.6‐mos recipient and graft survival rates were 88.9% and 86.7%. The mean total bilirubin of our survivors is 0.83 (+ 0.51). There were minimal infectious complications, with no incidence of tissue‐invasive CMV disease, no PTLD, and no posttransplant insulin‐dependent diabetes.

Discussion:  This study represents the largest series to date of RLALDLT recipients undergoing alemtuzumab induction and steroid‐free tacrolimus monotherapy, and confirms the short‐term safety and efficacy of this approach.
L/I‐6 Late retransplants using living donors: case‐control outcome analysis
Authors: Sainz‐Barriga M. , Ricciardi S. , Carbotta G. , Cesana A. , Berrevoet F. , De Gendt S. , De Hemptinne B. , Troisi R.
Published: September 2006

Background:  Survival after retransplants (ReLTs) is inferior to that after primary liver transplantation. Adult‐to‐adult living donor liver transplants (AALDLTs) are an emerging method to treat patients with end‐stage liver disease. The aim of this study is to analyze outcomes of ReLTs as compared with those achieved with deceased donors (ReDDLTs) and living liver donors (ReLDLTs), by determining variables affecting allograft and patient survival.

Methods:  From January 2000 through November 2005, 23 (8%) of 288 LTs were late ReLTs (>6 months). Recipients were divided into 2 groups: ReDDLTs (n=14) and ReLDLTs (n=9). The overall M/F ratio was 16/7 (mean age, 49 years). Secondary biliary cirrhosis and HCV recurrence were the main indications for ReLTs.

Results:  Both groups were comparable for MELD and Child status (CTP) at the time of their ReLTs, with the exception of higher median serum creatinine levels in the ReDDLT group. Waiting list time from decision to retransplant was 48±80 days in the ReLDLT group and 199±207 days in the ReDDLT group (p=0.006). Living donor morbidity consisted of 1 biliary leak and 1 incisional hernia. According to univariate analysis, recipient BMI, vascular thrombosis at ReLT, and creatinine levels were independent predictors of graft survival, whereas CTP score ≥ 10 was the only predictor of mortality after late ReLT. Our 1‐ and 3‐year patient survival rates in ReDDLT vs. ReLDLT recipients were 79% and 79% vs. 89% and 89% (p = 0.33); our 1‐ and 3‐year graft survival rates were 79% and 79% vs. 67% and 67% (p=0.25).

Conclusions:  Our results suggest that the severity of graft failure based on CTP increases the risk of death after ReLTs, whereas renal insufficiency and previous vascular thrombosis are predisposing factors for early graft loss. Late ReLTs with a living donor graft allow ReLTs to take place in due time, with acceptable donor morbidity and without hampering the deceased donor liver pool. However, better patient selection is warranted.
L/I‐9 Adult living donor liver transplants: Niguarda experience in Milan
Authors: Giacomoni A. , Lauterio A. , Slim A. , Mangoni I. , Aseni P. , Pirotta V. , Boati S. , De Carlis L.
Published: September 2006

Introduction: Adult living donor liver transplants (ALDLTs) have emerged as an option in the last few years.

Materials and methods:  From March 2001 through February 2006, we performed 27 ALDLTs. Liver volume, vascular, and biliary anatomy were assessed by CT scan and magnetic resonance cholangiography. The graft‐to‐recipient weight ratio was always above 0.8. The recipients were United Network for Organ Sharing (UNOS) status 2B or 3. The transplant was carried out grafting segments V‐VIII to the recipient without the MHV. In the recipient we have never used a venous‐venous bypass.

Results:  With a mean follow‐up of 675 days (range, 8 to 1,804 days), 23 out of the 27 patients are alive. Three have undergone a retransplant: 2 as a consequence of an arterial thrombosis and 1 because of small‐for‐size‐syndrome.

These data show an overall patient and graft survival rate of 85% and 74%. Four deaths were caused by massive pulmonary bleeding due to Rendù‐Osler syndrome, systemic aspergillosis, sepsis, and cardiac arrhythmia. Fourteen biliary complications (51.85%) occurred in 11 recipients (40.74%); 3 of these patients developed 2 consecutive and different biliary complications. All the donors are alive and well.

Conclusion:  An expert surgical team and proper selection of both donor and recipient are mandatory. Overall results of ALDLTs are very satisfactory, even if we have to take into account a high rate of biliary complications.
Bayes factor for testing the genetic background of quantitative threshold traits
Authors: Casellas J. , Piedrafita J.
Published: September 2006

The recent development of the Bayes factor methodology to test between nested competing models has allowed to evaluate the genetic component of continuous traits through a methodology based on the reparameterization of a variance component model in terms of intra‐class correlation. In this study, we present a modification of that procedure to compare between threshold models that only differ in a bounded variable. An extra data‐augmentation step is required to sample liability, an underlying continuous variable related with phenotypic records through an adequate number of thresholds. In this context, we describe a procedure to sample from a truncated multivariate normal distribution with non‐null covariances between records, taking as starting point the Cholesky factorization and the inclusion of linear restrictions. The method was tested by computer simulations with satisfactory results.
Effects of interleukin‐10 gene polymorphism on the development of gastric cancer and peptic ulcer in Japanese subjects
Authors: Sugimoto Mitsushige , Furuta Takahisa , Shirai Naohito , Nakamura Akiko , Kajimura Masayoshi , Sugimura Haruhiko , Hishida Akira
Published: September 2006

Background:  Anti‐inflammatory cytokines play an important role in downregulation of inflammation and the prevention of neoplastic disorders. Genetic variations of anti‐inflammatory cytokines are assumed to influence such responses. The aim of the present study was to clarify the association between the IL‐10 polymorphism, one of the representative anti‐inflammatory cytokines, and susceptibility to gastric cancer and peptic ulcer in Japan.

Methods:  The IL‐10‐1082 (A/G)/‐819 (T/C)/‐592 (A/C) polymorphisms were assessed in Helicobacter pylori‐positive patients with gastritis only (n = 162), gastric ulcers (n = 110), duodenal ulcers (n = 94), or gastric cancers (n = 105), and H. pylori‐negative controls (n = 168) by allele specific primer–polymerase chain reaction methods.

Results:  The carriage of IL‐10‐592 C (age and sex‐adjusted odds ratio [OR]: 1.851, 95% confidence interval [CI]: 1.018–3.380) and IL‐10‐819 C (adjusted OR: 1.868, 95%CI: 1.023–3.411) allele were associated with an increased risk for gastric cancer development, not gastric ulcer and duodenal ulcer. The IL‐10‐1082 polymorphism had no association with development of gastric cancer and peptic ulcers. The presence of the ATA/GCC haplotype of IL‐10‐1082/‐819/‐592 polymorphism significantly increased the risk of gastric cancer development (adjusted OR: 2.805, 95%CI: 1.258–6.254) compared with presence of the ATA/ATA haplotype.

Conclusions:  The IL‐10‐1082/‐819/‐592 genotype status and haplotype were associated with an increased risk for gastric cancer development, not peptic ulcer, in Japan. The genotyping test of this anti‐inflammatory cytokine would be useful for the detection of individuals with higher risk of gastric cancer development.
Hepatitis C virus (HCV) viremia in HIV‐infected patients without HCV antibodies detectable by third‐generation enzyme immunoassay
Authors: Hadlich Everton , Álvares‐Da‐Silva Mário Reis , Molin Rafaela Komorowski Dal , Zenker Raquel , Goldani Luciano Zubaran
Published: September 2006

Background:  The detection of hepatitis C virus antibody (anti‐HCV) by enzyme immunoassay to screen HCV infection in HIV‐1‐infected individuals may yield false negative results, especially in patients with advanced immunossupression. In such cases, a diagnosis would be possible only by use of a viral RNA detection technique. Third‐generation anti‐HCV enzyme immunoassays seem to have superior performance compared to second‐generation immunoassays in this context.

Methods:  A cross‐sectional study was conducted to ascertain the presence of HCV by polymerase chain reaction (PCR) in 61 HIV‐1‐infected patients with CD4+ cell counts <200 cells/mm3, and no detectable HCV antibodies by a third‐generation enzyme immunoassay.

Results:  Six (10%) of 61 patients tested HCV‐RNA positive by PCR assay. There was one patient who seroconverted during observation. Hence, there were five patients with HCV viremia without detectable antibodies to HCV throughout the study, which represents 8.2% (95% confidence interval: 2.8–18.4) of 61 HIV‐1‐infected patients. All five carriers of HCV viremia had CD4 counts <100 cells/mm3 and were diagnosed with an opportunistic disease at some stage.

Conclusions:  The HCV viremia and no detectable HCV antibodies by third‐generation immunoassay were found only in individuals with a CD4 count of <100 cells/mm3. Molecular assays to detect HCV‐RNA should be considered as an important tool to diagnose hepatitis C in HIV‐1‐infected patients with advanced immunossupression.
Pharmacokinetic profile of once daily intravenous tobramycin in children with cystic fibrosis
Authors: Massie John , Cranswick Noel
Published: September 2006

Aim:  Once‐daily tobramycin in patients with cystic fibrosis (CF) is a more convenient dosing regimen than thrice daily dosing. There are limited data on the pharmacokinetic (PK) profile for once‐daily tobramycin in patients with CF. The aim of this study was to define the PK parameters for once‐daily tobramycin in children with CF and develop an algorithm for therapeutic drug monitoring dosing.

Methods:  CF patients admitted to hospital were commenced on once‐daily intravenous tobramycin (12 mg/kg/day) and ticarcillin/clavulinic acid. Serum tobramycin levels were taken at 30 min, 2–4 h and 12 h post dose. Data points for the PK model included: age, sex, weight, tobramycin dose, time of tobramycin doses and levels, tobramycin levels. WinNonMix was used to obtain the PK parameters.

Results:  Forty‐four children with 86 admissions who were aged 9 months−20 years were included. A one‐compartment intravenous infusion model with first order elimination kinetics produced the best model. Population parameters were: volume of distribution (Vd) = 0.267 L/kg (95% confidence interval (CL) 0.260–0.272), clearance (CL) 0.103 L/kg/h (95% CI 0.098–0.107) and half‐life (t1/2) 1.82 (95% CI 1.77–1.88) h. Once the population model was established post hoc analysis was used to calculate individual subject predictions. Plots of individual prediction curves agreed well with observed values.

Conclusion:  This study has established an algorithm for routine monitoring of once‐daily tobramycin in children with CF. Satisfactory serum levels of tobramycin were obtained with a dose of 12 mg/kg/day and a regimen algorithm that uses only one measurement to monitor the plasma concentration is suggested.
Safety and efficacy of blood glucose management practices at a diabetes camp
Authors: Gunasekera Hasantha , Ambler Geoffrey
Published: September 2006

Aim:  Camps are an important part of diabetic management in children yet data on the safety and efficacy of camps are limited. We assessed the safety and efficacy of blood glucose management guidelines at summer camps for diabetic children.

Methods:  Consistent management guidelines were implemented during 10 consecutive diabetes camps held in the same facility between 1998 and 2002. Using the entire sample of campers aged 9–13 years, we analysed insulin dosage alterations, the frequency of hypoglycaemia (<4 mmol/L), hyperglycaemia (>15 mmol/L) and ketosis and evaluated our overnight management guidelines. The effects of sex, year, age, insulin regimen and duration of diagnosis on hypoglycaemia frequency were determined.

Results:  Mean insulin doses decreased 19.2% (95% confidence interval 16.9–21.6%) by the last day of camp (day 6) relative to the day prior to camp. Mean blood glucose levels were 11.4 mmol/L before breakfast and the main evening meal, 11.3 mmol/L before bed, 10.8 mmol/L at midnight and 9.4 mmol/L at 3 am. Of the 10 839 readings analysed, 984 (9.1%) were below 4 mmol/L (0.5 per camper/day) with no clinical grade 3 (seizure or coma) hypoglycaemia. Hypoglycaemia frequency was independent of sex, year, age, insulin regimen and duration of diagnosis (all P > 0.05). There were 2570 (23.7%) readings above 15 mmol/L (1.4 per camper/day) but only 42 (0.4%) were associated with significant ketosis.

Conclusion:  Children at diabetes camps experience considerable blood glucose variability; however, the careful application of monitoring and management guidelines can avoid serious adverse events.
Electrical coupling underlies theta rhythm in freely moving cats
Authors: Gołębiewski Henryk , Eckersdorf Barbara , Konopacki Jan
Published: September 2006

The role of gap junction coupling in the generation of theta rhythms in freely moving cats was investigated in a present study. Two gap junction blockers, carbenoxolone and quinine, were administered intraperitoneally and intrahippocampally; both gap junction blockers abolished or diminished (respectively) hippocampal formation theta. The inhibitory effect developed approximately 30 min after drug administration. This effect was found to be reversible. Our results provide the first direct in vivo evidence for the contribution of gap junction communication in mechanisms of neural synchrony, underlying the production of theta in in vivo conditions.
Heterogeneity in low voltage‐activated Ca2+ channel‐evoked Ca2+ responses within neurons of the thalamic paraventricular nucleus
Authors: Richter Trevor A. , Kolaj Miloslav , Renaud Leo P.
Published: September 2006

Low voltage‐activated Ca2+ channels (LVA or T‐type Ca2+ channels) are crucial to burst firing and oscillations in thalamocortical relay cells and are exhibited by neurons in the paraventricular nucleus of thalamus (PVT), a dorsal midline nucleus deemed important in the neural representation of motivational behaviours. We used a functional approach (whole‐cell patch‐clamp electrophysiology combined with confocal laser scanning microscopy) to analyse the spatial distribution of LVA Ca2+ channel‐evoked Ca2+ transients in PVT neurons. We observed that the magnitude of LVA Ca2+ channel‐evoked Ca2+ transients was significantly greater in proximal dendrites (located up to 20 µm from the soma) than in the soma. In addition, the magnitudes of these Ca2+ transients varied significantly not only among different dendrites of the same cell but also within individual dendrites. These findings suggest that LVA Ca2+ channels are expressed (i) predominantly on the proximal dendrites and (ii) heterogeneously within individual dendrites of PVT neurons. The spatial characteristics of dendritic LVA Ca2+ channels in PVT neurons suggest that these channels may regulate burst firing by modulating dendritic afferent inputs.
Changes of spine density and dendritic complexity in the prefrontal cortex in offspring of mothers exposed to stress during pregnancy
Authors: Murmu Meena Sriti , Salomon Shiri , Biala Yaarit , Weinstock Marta , Braun Katharina , Bock Jörg
Published: September 2006

Both chronic stress in adulthood and episodes of stress in the early postnatal period have been shown to interfere with neuronal development in limbic prefrontal cortical regions. The present study in rats showed for the first time that the development of layer II/III pyramidal neurons in the dorsal anterior cingulate (ACd) and orbitofrontal cortex (OFC) is significantly affected in offspring of mothers exposed to stress during pregnancy. In prenatally stressed (PS) male rat pups the ACd and OFC showed significantly lower spine densities on the apical dendrite (ACd, −20%; OFC, −25%), on basal dendrites reduced spine densities where found only in the OFC (−20% in PS males). Moreover, in both cortical areas a significant reduction of dendritic length was observed in PS males compared to control offspring, which was confined to the apical dendrites (ACd, −30%, OFC, −26%). Sholl analysis revealed that these alterations were accompanied by a significantly reduced complexity of the dendritic trees in both cortical regions. PS females displayed reductions of dendritic spine densities in the ACd and OFC on both the basal (ACd, −21%; OFC, −20%) and apical dendrites (ACd, −21%; OFC, −21%), however, in contrast to the findings in PS males, no dendritic atrophy was detected in the PS females. These findings demonstrate that gestational stress leads to significant alterations of prefrontal neuronal structure in the offspring of the stressed mothers in a sex‐specific manner.
Consumer impact of an interactive decision aid for rectal cancer patients offered adjuvant therapy
Authors: Butow P. N. , Solomon M. , Young J. M. , Whelan T. , Salkeld G. , Wilson K. , Harrison J. D. , Hruby G. , Mansour O. , Kennedy N. , Tattersall M. H. N.
Published: September 2006

Objective  There is increasing interest in the use of decision aids (DAs) to facilitate patient involvement in clinical decisions. This study explored the views of patients with colorectal cancer and participants in a community bowel screening service regarding an interactive DA concerning adjuvant treatment for rectal cancer, and the impact of the aid on knowledge, anxiety, attitudes and preferences for treatment options.

Method  Fourteen patients with colorectal cancer participated in four focus groups. Eighty‐nine participants in a community bowel screening service completed a questionnaire before and 1 week after viewing the DA. Thirty were randomly selected to participate in a telephone interview to obtain qualitative feedback about the DA.

Results  Focus group participants reported using information to evaluate their doctor's care and expertise, or to prepare themselves for future symptoms and side‐effects. Most supported the use of a DA and preferred pie charts to convey risk information. Within the community sample, anxiety remained stable and knowledge increased after exposure to the DA. Almost all participants found the DA useful and easy to understand, and felt it would make the process of decision making easier.

Conclusion  A DA regarding adjuvant therapy for rectal cancer appears to be valued and to produce positive outcomes. A randomized controlled trial of this intervention is now required.
Curative resection for low rectal adenocarcinoma: abdomino‐perineal vs anterior resection
Authors: Okaro A. C. , Worthington T. , Stebbing J. F. , Broughton M. , Caffarey S. , Marks C. G.
Published: September 2006

Objective  Local recurrence after abdomino‐perineal excision of the rectum for tumours has been reported to occur in up to a third of patients in contrast to 4% after restorative anterior resection.

Method  Low rectal tumours were defined as tumours within 8 cm of the anal verge and were treated by either stapled low anterior resection (SLAR) or abdomino‐perineal excision of the rectum (APER). One hundred and seventy‐eight patients with tumours in the lower third of the rectum (30% of 591 rectal cancers) underwent surgical resection between 1980 and 2001. Data were collected prospectively; 68 (38%) had SLAR and 110 (62%) had APER with median follow up of approximately 12 years; 54 SLAR (79%) and 76 APER (69%) had curative procedures on clinical and pathological criteria.

Results  Local and distant recurrence occurred in seven (13%) and eight (15%) patients in the SLAR group and six (8%) and 14 (18%) patients in the APER group, respectively. Overall 5‐year survival was 63% and 60% in the SLAR and APER groups, respectively

Conclusion  For rectal cancers within 8 cm of the anal verge, both procedures achieved equivalent results measured by low local recurrence rates and overall survival.
Evacuation proctography – should it be part of the assessment of all patients with faecal incontinence?
Authors: Dench J. E. , Gooneratne M. , Hickey F. , Williams N. S. , Lunniss P. J. , Scott M.
Published: September 2006

Introduction:  Evacuation Proctography (EP) is rarely incorporated into the assessment of patients with faecal incontinence (FI). Continence‐restoring surgery (e.g. sphincteroplasty, ESGN) may result in the worsening or unmasking of a pre‐existing rectal evacuatory disorder (RED), or precipitate a new‐onset RED. This study compared the incidence of RED, diagnosed on EP, between patients with FI, with or without symptoms of RED.

Method:  A retrospective study of 250 patients with FI (mean age 53 years; range 21–83 years, F = 213), +/­ symptoms of RED, referred for comprehensive physiological investigation. Proctographic diagnoses were classified as: normal;functional i.e. no clear anatomical cause (e.g. pelvic floor dyssynergia); mechanical (e.g. rectocoele, intussusception; deemed to obstruct evacuation) or mechanicaland functional.

Results:  Seventy‐three patients (29%) had isolated FI; the remaining 177 (71%) had FI combined with symptoms of RED.

 Proctographic results.

Diagnosis
FI (%)
FI & RED (%)

Normal
22 (30)
36 (20)

Abnormal

 Mechanical
33 (45)
99 (56)

 Functional
16 (22)
24 (14)

 Mechanical & Functional
2 (3)
18 (10)

Normal vs abnormal: P = 0.10, 2, df = 1.

Conclusion:  There is no significant difference in the incidence of proctographic abnormalities between those patients who do, and those who do not volunteer symptoms of RED. Seventy percent of patients with FI, who deny symptoms of RED, have evidence of abnormal evacuation on proctography. Within the limitations of a retrospective study, these data suggest that proctography should be routinely performed in patients with FI.
A comparison of segmental vs subtotal/total colectomy for colonic Crohn's disease: a meta‐analysis
Authors: Purkayastha S. , Tekkis P. P. , Lanitis S. , Athanasiou T. , Heriot A. G. , Darzi A. W. , Orchard T. R. , Nicholls R. J.
Published: September 2006

Purpose:  To evaluate differences in short‐ and long‐term outcomes of patients with colonic Crohn's disease (CD) undergoing either subtotal/total colectomy with ileorectal anastomosis (IRA) or segmental colectomy(SC).

Method:  Comparative studies from 1988 to 2002, of subtotal/total colectomy and IRA vs SC, were used. The study end points included surgical and overall recurrence, time to recurrence, postoperative morbidity and incidence of permanent stoma. Meta‐analytical tools were used to evaluate the study outcomes.

Results:  Six studies, consisting of a total of 488 patients (223‐IRA and 265‐SC) were included. Meta‐analysis suggested no significant difference between IRA and SC in recurrence of CD. Time to recurrence was longer in the IRA group by 4.4 years (95%CI, 3.1–5.8), P < 0.001. There was no difference in postoperative complications (OR = 1.4, 95%CI, 0.16–12.74) or the need for a permanent stoma between the two groups (OR = 2.75, 95%CI, 0.78–9.71). Patients with two or more colonic segments involved were associated with lower re‐operation rate in the IRA group, a difference which did not reach statistical significance (P = 0.177).

Conclusions:  Both procedures were equally effective as treatment options for colonic CD, however, patients in the SC group exhibited recurrence earlier than those in the IRA group. The choice of operation is dependent on the extent of colonic disease, with a trend towards better outcomes with IRA for two or more colonic segments involved.
A Competence‐Based Model of Initiatives for Innovations
Authors: Talke Katrin , Salomo Sören , Mensel Nils
Published: September 2006

The initiation of the innovation process has recently produced increased interest among the new product development scholars. While most extant research has focused on the management of opportunity recognition, of the development of new product concepts and of concept selection, little research has examined the initiative emergence process. With this article the authors intend to shed some light on the starting point of initiative formation by outlining a structured and comprehensive concept of the initiative emergence process; investigating individual competences facilitating initiative emergence, including task‐related, action‐related and cognitive competences; and developing a competence‐based model for helping explain the occurrence of initiatives. For future research, the authors develop propositions on the impact that different competency constellations have on initiatives along their emergence process, and on factors that determine how to support competences for initiatives adequately.
Preference Utilisation and Tariff Reduction in EU Imports from ACP Countries
Authors: Manchin Miriam
Published: September 2006

Despite the long relationship between the European Union and the African, Caribbean and Pacific (ACP) countries aimed at encouraging their exports while stimulating growth and investment, the ACP states still face difficulties in integrating into the world economy. This paper examines the non‐least developed ACP countries preferential trade with the EU using data on EU member states’ imports eligible for preferences under the Cotonou agreement for the period 2001 at the 8‐digit level. Using data on tariffs and preferential quota applicable on each 8‐digit product for the year 2001 ad‐valorem tariff rates were calculated. The paper also investigates the existence of a threshold in the offered duty reduction under which traders have no incentives to ask for preferences since the costs of obtaining these exceeds their benefits. Our results showed that the higher the value of preferences offered, the higher the probability that preferences are requested. Using endogenous threshold estimation techniques we also provided evidence that there exists a minimum value of preferences needed for traders to request preferences. More specifically, if the difference between preferential and third country tariff rates are lower than 4 per cent, there are no incentives for traders to request preferences since the costs of obtaining the preferences are expected to be higher than the benefits from obtaining the preferences. Our results additionally indicate that country specificities also play an important role in the decision whether requesting preferences or not and how much to import.
PROSECUTING MILITARY LEADERS FOR WAR CRIMES
Authors: MAY LARRY
Published: September 2006

Abstract:This article argues in favor of holding leaders responsible for international crimes but also worries quite a bit about what would be a fair standard ofmens reafor these leaders. Section 1 sets out the key facts of the case and the basis of the International Criminal Tribunal for Yugoslavia Trial Chamber's conviction of General Tihomir Blaskic. Section 2 presents the basis of the ICTY Appeals Court's overruling of the Trial Chamber's decision. Section 3 focuses on the issue of mens rea concerning those who command others to commit such crimes as the taking of hostages and the use of human shields. Section 4 sets out a limited argument in favor of negligence as a type of mens rea in international criminal law. Finally, section 5 discusses the relevance of the idea of the theory of joint criminal liability in such cases.
COLLECTIVE ACTION AND THE PECULIAR EVIL OF GENOCIDE
Authors: WRINGE BILL
Published: September 2006

Abstract: There is a common intuition that genocide is qualitatively distinct from, and much worse than, mass murder. If we concentrate on the most obvious differences between genocidal killing and other cases of mass murder it is difficult to see why this should be the case. I argue that many cases of genocide involve not merely individual evil but a form of collective action manifesting a collective evil will. It is this that explains the moral distinctiveness of genocide. My view contrasts with one put forward by Claudia Card, though we both agree that the notion of “social death” plays a significant role here.
COMPENSATION AND REPARATION AS FORMS OF COMPENSATORY JUSTICE
Authors: KHATCHADOURIAN HAIG
Published: September 2006

Abstract: Compensation and reparation are two parts or forms of compensatory or corrective justice. This essay aims, first, to distinguish, define, and analyze these two forms as against distributive and penal justice; and, second, to provide a moral justification of a system or social practice of compensation and of reparation, drawing on the ideas of Aristotle, William Blackstone, Bernard Boxill, John Rawls, and James Sterba. Then, by applying the results of the analysis to the first genocide of the twentieth century, the Armenian genocide, it illustrates certain difficulties in realizing reparative justice when the wrongful injury is perpetrated by a sovereign state, and it emphasizes the paramount importance in such cases of the acknowledgment of wrong by the perpetrator.
Performativity and helping professions: social theory, power and practice
Authors: Powell Jason L. , Gilbert Tony
Published: September 2006

Drawing on Judith Butler's conception of ‘performativity’, we would argue that the notion has important implications for contemporary debates in international social welfare over agency, subjection and ‘resistance’. Professional social workers embedded in discursive institutions function according to particular expectations around performativity. In addition, this organisational context is complex with multiple demands. In light of technologies of surveillance and control in contemporary social work, performativity offers a response to the pressing need to expand notions of worker opposition beyond traditional forms of organised dissent towards the production of subjective space.
Increase of Plasma Fibrinogen Levels and Variability with Age in a Sample of Middle Aged Healthy Men
Authors: Drenos F. , Miller G. J. , Humphries S. E.
Published: September 2006

According to predictions from the current theoretical models for ageing the heterogeneity of the population is increasing with increasing age. Although the direct observation of such changes in humans is extremely difficult, supporting evidence should be identifiable in key biomarkers associated with health and mortality. Using data from the Northwick Park Heart Study II of 3052 healthy middle‐aged men (mean 56 years of age, range 49–69 years), with 5 annual measures of CHD risk factors, ageing effects were tested for plasma fibrinogen, cholesterol and triglycerides. Fibrinogen levels increased with age (p < 0.0001), while cholesterol showed a decrease, and triglycerides did not show any change with age. There was a significant increase in the variance of fibrinogen with age (p < 0.0007) but not for cholesterol or triglycerides. The raising effect on fibrinogen levels associated with the A allele of the FIBB−455G>A promoter variant also decreased with age (p = 0.005). The age‐associated changes observed in the fibrinogen variability and the association of phenotype to genotype are discussed in light of the evolutionary theory, and their implications are considered.
Biomechanics of the vertebrae and associated osteoderms of the Early Permian amphibian Cacops aspidephorus
Authors: Dilkes D. , Brown L. E.
Published: September 2006

Two series of osteoderms associated with the anterior three‐quarters of the presacral vertebral column of the Early Permian temnospondylous amphibian Cacops aspidephorus have important implications for biomechanics of the axial skeleton. An internal series consists of an osteoderm fused to the distal tip of each neural spine. Lying dorsal to the internal series and overlapping each internal osteoderm is a second external series. The orientation of the zygapophyseal facets implies modest lateral flexion with limited coupled axial rotation of the column. However, the osteoderms restricted any possible lateral flexion through their inverted V‐shape, strongly angled overlap between each external osteoderm and its neighbouring internal osteoderms, and the presence of a midsagittal flange on the ventral surface of each external osteoderm that fits into grooves on the anterior and posterior edges of the neighbouring internal osteoderms. This configuration allowed vertical flexion of the vertebral column with little lateral flexion. The rod‐like nature of osteoderms with the anterior three‐quarters of the presacral vertebrae suggests a restricted form of forward movement for Cacops unlike that of other early tetrapods.
Chronic Low Back Pain in Older Adults: What Physicians Know, What They Think They Know, and What They Should Be Taught
Authors: Cayea Danelle , Perera Subashan , Weiner Debra K.
Published: September 2006

Chronic low back pain (CLBP) is a common and debilitating problem in older adults. Little exists in the literature about primary care physicians' (PCPs') knowledge of and confidence in managing this problem. A self‐administered survey was mailed to PCPs in western Pennsylvania to measure knowledge of the evaluation and treatment of common contributors to CLBP in older adults, confidence in diagnosing these contributors through physical examination, and the association between confidence levels and knowledge. The survey combined items with an ordinal scale on which PCPs ranked their confidence in detecting various contributors to CLBP (e.g., fibromyalgia) using physical examination and patient vignettes followed by multiple choice questions designed to assess knowledge. One hundred fifty‐three of 634 surveys were returned (24.1%). Overall, the majority of PCPs did not feel “very confident” in their ability to diagnose any of the contributors of CLBP listed (most items <40%). PCPs felt most confident in detecting scoliosis and least confident detecting myofascial pain of the piriformis muscle. There was a wide range in the number of respondents answering all questions related to a particular topic correctly (3.9% for sacroiliac joint syndrome to 70.4% for hip osteoarthritis). There was no relationship between knowledge scores and confidence ratings (P>.05 for all comparisons). The results point to a need for more PCP education about CLBP in older adults. It also suggests that accurate needs assessment should not rely on physician confidence ratings alone.
A Java Applet for Exploring the New Higher Level Classification of Eukaryotes with Emphasis on the Taxonomy of Protists
Authors: WOLF MATTHIAS , SEIBEL PHILIPP N. , DANDEKAR THOMAS , LYNN DENIS H.
Published: September 2006

ABSTRACT. We have converted the hierarchically organized new higher level classification of eukaryotes with emphasis on the taxonomy of protists proposed by Adl et al. into an interactive and dynamic Java applet. The current version of the applet can be accessed via http://phylogenetics.bioapps.biozentrum.uni‐wuerzburg.de/etv. We use the layout from a Degree‐of‐Interest tree (DOITree) that effectively displays all the taxonomic information as well as the phylogenetic relationships described in the original article by Adl et al. The tree was made using the Prefuse Toolkit for interactive information visualization. All browsers capable of using Java applets will be able to view the tree. The applet is freely available for scientists, teachers, and students.