bluuebunny/crossref_metadata_2025 huggingface dataset:
Three novel and six common mutations in 11 patients with methylmalonic acidemia
Authors: KOBAYASHI AZUSA , KAKINUMA HIROAKI , TAKAHASHI HIROAKI
Published: February 2006

Background: Patients with a defect in methylmalonyl‐coenzyme A mutase (MCM) are classified as having methylmalonic acidemia, which is divided into two subclasses: mut0 and mut−. Fifty‐five disease‐causing mutations have been identified. Although most are private mutations, only three (E117X, G717V, and N219Y) are reportedly common in Japanese, Black, and Caucasian populations, respectively. Here we identified mutations in 11 Japanese patients with MCM deficiency.

Methods: Mutational analysis was performed in 11 unrelated Japanese patients with MCM deficiency using polymerase chain reaction and direct sequencing.

Results: Three novel (L494X, R727X, and 449_461del) and six previously reported (R93H, E117X, N219Y, R369H, G648D and IVS2 + 5G>A) mutations were identified. The L494X mutation was found in three unrelated patients, and the R93H, E117X, R369H, G648D, and IVS2 + 5G>A mutations occurred more than once. Two of the patients were classified as mut− phenotype because of residual [14C]‐propionate incorporation in the presence of a high concentration of hydroxocobalamin. The two mut− patients were heterozygous for the G648D mutation and presented with lethargy and metabolic acidosis after 2 years of life. Their psychomotor development has been documented as normal. The patients with the R727X or 449_461del mutations clinically exhibited mut0 phenotype. Two patients with mut0 phenotype died in infancy. One presented early in the neonatal period; the other was symptomatic in the late infantile period.

Conclusions: The L494X, R93H, E117X, R369H, G648D, and IVS2 + 5G>A mutations are found in more than two unrelated families in the Japanese population. The short‐term outcome was generally poor in patients with mut0, and therefore alternative treatments should be considered.
CHANGES IN THE MANAGEMENT OF DUCTAL CARCINOMA IN SITU BEFORE THE RELEASE OF CLINICAL PRACTICE RECOMMENDATIONS IN AUSTRALIA: THE CASE IN VICTORIA
Authors: White Victoria , Pruden Myee , Giles Graham , Kitchen Paul , Collins John , Inglis Graeme , Hill David
Published: February 2006

Background:  This study examines changes in the management of ductal carcinoma in situ between 1995 and 1999 in the Australian State of Victoria. This period was before the release of Australian treatment recommendations.

Methods:  All new cases of ductal carcinoma in situ diagnosed between 1 April and 30 September in 1995 and 1999 were identified from the population cancer registry. Treating surgeons completed a questionnaire on the presentation and management of each case. In 1995, 64 out of 70 surgeons returned questionnaires for 137 cases (case response, 94%). In 1999, 68 surgeons treated 159 registered cases and 141 completed surveys were returned (case response, 89%).

Results:  More cases underwent an image‐guided biopsy in 1999 (54%) than in 1995 (34%). Breast‐conserving surgery (BCS) was used to treat 69% of cases in 1999 and 63% in 1995. The use of axillary procedures (clearance or sampling) for women treated by mastectomy decreased from 61% in 1995 to 30% in 1999. More patients treated with BCS had margins simply described as ‘clear’ in 1995 (49%) than in 1999 (21%). In 1995, only 7% of cases treated with BCS had radiotherapy, and this was 25% in 1999.

Conclusion:  In both 1999 and 1995, the majority of patients were treated by BCS, but only a minority received radiotherapy.
INDOCYANINE GREEN ELIMINATION: A COMPARISON OF THE LiMON AND SERIAL BLOOD SAMPLING METHODS
Authors: Purcell Roslyn , Kruger Peter , Jones Mark
Published: February 2006

Background:  Indocyanine green (ICG) elimination is a test widely used to evaluate hepatic functional reserve in patients being assessed for hepatic resection. This study compares a non‐invasive liver function monitoring system, the LiMON (Pulsion Medical Systems, Munich, Germany), with serial blood sampling methods.

Methods:  ICG elimination was measured by the LiMON, spectrophotometry and high‐performance liquid chromatography (HPLC) in 20 patients with hepatocellular carcinoma and cirrhosis as part of their preoperative work‐up.

Results:  The ICG 15‐min retention rates obtained by spectrophotometry and HPLC correlated well (correlation coefficient = 0.91), and there was good agreement between the tests (mean bias = 2.93, 95% confidence interval (CI) = 1.59–4.28). There was a reasonably strong correlation between results obtained with the LiMON and spectrophotometry (correlation coefficient = 0.81), and again there was good agreement between the tests (mean bias = 2.71, 95% CI = 0.19–5.22). On average, 15‐min retention rates measured by the LiMON were 2.71 lower than those measured with spectrophotometry.

Conclusion:  In patients being assessed for suitability of hepatic resection, the LiMON provides results similar to those obtained by serial blood sampling methods. This is important as techniques of carrying out ICG elimination vary widely between institutions and results are frequently incorporated into scoring systems that are used to determine surgical decisions.
OPERATION SUMATRA ASSIST: SURGERY FOR SURVIVORS OF THE TSUNAMI DISASTER IN INDONESIA
Authors: Chambers Anthony J. , Campion Michael J. , Courtenay Brett G. , Crozier John A. , New Charles H.
Published: February 2006

The tsunami of 26 December 2004 was one of the deadliest natural disasters recorded, with the Indonesian province of Aceh being the most devastated region. As part of the Australian Government's response to the disaster, the Australian Defence Force deployed personnel from the Sydney‐based 1st Health Support Battalion to Banda Aceh, the capital of the province. This unit joined with medical personnel from the New Zealand Defence Force to form the ANZAC field hospital. The mission of this unit as part of Operation Sumatra Assist was to provide medical and surgical care to the people of Aceh during the critical stages of rebuilding of the tsunami‐devastated region. Surgical teams of the ANZAC field hospital were some of the first to provide definitive surgical care to the critically injured survivors of the disaster. During the first 4 weeks of the deployment, 173 surgical procedures were carried out for 71 patients in this facility. Thirty patients underwent 119 procedures (69% of total) for injuries sustained in the tsunami. Most of these patients required debridements, dressing changes and wound management procedures for the management of severe soft tissue infections. Three amputations were carried out. The remaining 41 patients underwent 54 procedures (31%) for emergent surgical conditions unrelated to the disaster.
COST, DEMOGRAPHICS AND INJURY PROFILE OF ADULT PEDESTRIAN TRAUMA IN INNER SYDNEY
Authors: Small Timothy J. , Sheedy Joanne M. , Grabs Anthony J.
Published: February 2006

Background:  Pedestrian accidents are associated with substantial morbidity, mortality and cost; however, there has been very little published work on this topic in Australasia over recent years. The objective of this study was to examine the demographics, injury profile, outcomes and cost of pedestrian versus motor vehicle accidents in a central city hospital in Sydney.

Methods:  Consecutive pedestrians injured by motor vehicles and admitted as inpatients during the years 2002–2004 were identified from our prospective trauma registry. A retrospective review included patient profiles (age, sex, time of injury and blood alcohol), injury pattern, cost, morbidity and mortality.

Results:  A total of 180 patients (64% men and 36% women) with a mean age of 46 and mean injury severity score of 14.1 were identified. Two peak injury periods were observed: one between 17.00 and 18.00 hours (P < 0.01) and the other between 20.00 and 22.00 hours (P < 0.01). Significantly more injuries occurred on Friday (P < 0.01) and during autumn months (P < 0.05). Musculoskeletal (34.3%), head (31.8%) and external (20.2%) injuries predominated. Forty‐nine per cent of patients tested positive for consuming alcohol, with an average blood alcohol concentration (BAC) of 0.22%. Alcohol consumption was associated with a worse outcome in terms of hospital and intensive care unit stay, morbidity and mortality. The average length of stay was 13.4 days costing $A16320 per admission. Sixteen patients died (mortality rate of 8.9%), with the highest rate in the elderly group (22.7%) (P < 0.001).

Conclusions:  Pedestrian accidents in inner Sydney are common with injuries predominating in intoxicated adult males. Mortality was higher in the elderly group. Injuries to the head and lower extremities predominate. Hospital stays are lengthy, resulting in a high cost for each admission.
GOVERNANCE AND INNOVATION: EXPERIENCE WITH A POLICY ON THE INTRODUCTION OF NEW INTERVENTIONAL PROCEDURES
Authors: Spigelman Allan D.
Published: February 2006

Background:  Changing consumer expectations, particularly in the area of informed consent, coupled with a history of an unanticipated rise in adverse events following the introduction of some new interventional procedures, have produced a need for the more formal evaluation of such procedures before their introduction into a health‐care facility. Moreover, a need exists to ensure that the outcomes of such procedures are monitored. Descriptions of such formal evaluation processes were lacking before 2000. The experience of a large regional health service with the implementation of a brief but comprehensive evaluation process for the introduction of new interventional procedures is described.

Methods:  A policy outlining the approval and monitoring processes, including a simple, 15‐point checklist, was developed in consultation with clinicians and managers and was implemented in 2000. The experience with this policy between January 2001 and December 2004 (inclusive) is described.

Results:  Twenty‐nine applications for the introduction of new procedures, from a range of clinical disciplines, were submitted and approved. Some required significant modification, particularly in the areas of clinical risk description and other data required to facilitate the provision of informed consent.

Conclusions:  Innovation can be protected and encouraged by processes that allow for appropriate scrutiny of the benefits and requirements for the successful introduction of new interventional procedures. The approach described has since been used as the basis for the New South Wales Health Department statewide policy on this matter and as a model policy by the Royal Australasian College of Surgeons.
PALLIATIVE GASTRECTOMY IN ADVANCED GASTRIC CANCER: IS IT WORTHWHILE?
Authors: Samarasam Inian , Chandran B. Sudhakar , Sitaram V , Perakath Benjamin , Nair Aravindan , Mathew George
Published: February 2006

Background:  Gastric cancer remains one of the leading causes of cancer‐related deaths. Many patients present late, and therefore, resections are often palliative in nature. The aim of this study was to assess the feasibility of resectional operation and the survival advantage of surgical resection in advanced gastric cancer. The effectiveness of palliation and the quality of life following operation for gastric cancer were assessed.

Methods:  One hundred and fifty‐one patients who underwent operation for gastric cancer at a tertiary centre in South India during a 5‐year period between 1999 and 2003, were included in this study. Four sites of tumour spread were used as indicators of incurability in these patients. These were unresectable primary tumour or macroscopic residual primary tumour (T+), unresectable lymph nodal metastasis (L+), unresectable liver metastasis (H+) and peritoneal metastasis (P+). The resectability rate and survival were assessed in relation to these four factors.

Results:  The resectability rate decreased as the number of sites of tumour spread increased. The overall survival was significantly better in the subgroup of patients who had a resectional operation (total gastrectomy or subtotal gastrectomy), as opposed to the subgroup who had non‐resectional operation (exploratory laparotomy or laparotomy with gastrojejunostomy) (P = 0.0003). This survival advantage of resectional operation disappeared when more than two sites of tumour spread were present. The quality of life was significantly better when a resection operation was carried out.

Conclusion:  In advanced gastric cancer, palliative resection has a survival advantage if the tumour spread is restricted to two or less sites. Patients who undergo resectional operation have better palliation of symptoms and their postoperative quality of life is significantly better.
THE READABILITY OF ORIGINAL ARTICLES IN SURGICAL JOURNALS
Authors: Hall John C.
Published: February 2006

Background:  Readability indices have been developed based on sentence length and the use of long words. One such measure is the Reading Ease Scale developed by Rudolf Flesch. Texts that are easy to read have high scores: texts with scores below 30 are similar to legal contracts. This study uses Flesch scores to evaluate the readability of surgical journals.

Methods:  Flesch scores were calculated for articles published in the Archives of Surgery, the British Journal of Surgery, and the ANZ Journal of Surgery. The first 30 original articles published in each journal in 2005 were selected for study. Excluded from study were editorials, reviews and case reports.

Results:  The overall median score was 15.1 (0.0–29.1). The median scores for each of the journals were 12.4 (Archives of Surgery), 14.4 (British Journal of Surgery), and 18.6 (ANZ Journal of Surgery). There was only a minor link between Flesch scores and the use of surgical terms.

Conclusion:  Original articles published in surgical journals contain too many long sentences and complex words. Readability indices are useful tools because they promote the use of simple English. It is realistic for authors to aim for Flesch scores above 30 when creating manuscripts.
PARTIAL ORCHIDECTOMY FOR MALIGNANCY WITH CONSIDERATION OF CARCINOMA IN SITU
Authors: Hughes Peter D.
Published: February 2006

Background:  This article reports partial orchidectomy for malignant tumour in a solitary testis and discusses the common occurrence of carcinoma in situ (CIS) in the non‐tumour part of a testis containing malignant tumour, or in 5% of the contralateral testis when malignant tumour is found in one testis.

Method:  Ultrasound of the testis gave the appearance of a 21‐mm germ cell tumour in the lower pole of a solitary testis in a 20‐year‐old man. Chest X‐ray was clear, and blood testis tumour markers were negative. Semen was collected and stored under liquid nitrogen freezing. The testis was explored through a groin incision and then the palpable tumour together with a margin of normal‐looking testis was excised.

Results:  Histology showed embryonal carcinoma with no CIS in the adjacent normal testis tissue that had been excised with the tumour. At 93 months postoperatively, computed tomography scans of the chest and abdomen were negative, as were blood testis tumour markers, and the patient is potent. Ultrasound shows a testis of normal size and consistency.

Conclusion:  Partial orchidectomy was practical in this case, but CIS is common in the non‐tumour part of any testis containing germ cell tumour and should be searched for histologically. In a man with two testes, one containing a germ cell tumour, CIS is found in 5% of the contralateral testes. Testis CIS leads to invasive carcinoma within 5 years in 50% of cases. When CIS is present, local radiation therapy is recommended by Heidenreich et al.; this retains potency but destroys fertility. Some are treating with chemotherapy CIS or germ cell primary tumours other than teratoma, in an attempt to preserve both potency and fertility.
Crude extract of the cyanobacterium, Hapalosiphon sp., causes a cessation of root elongation and cell division in several plant species
Authors: SANEVAS NUTTHA , SUNOHARA YUKARI , MATSUMOTO HIROSHI
Published: February 2006

The phytotoxic activities of the crude extract from the cyanobacterium, Hapalosiphon sp., on the initial growth and root cell division of several plant species were investigated. Although the germination percentages of the plants were not affected by the extract, their root and shoot growth were remarkably suppressed, depending on the extract concentrations. Roots were more sensitive to the extract than shoots and the sensitivity, determined by the I50 concentrations between the susceptible and tolerant species, differed by 5 and 11 times in dicotyledonous and monocotyledonous plants, respectively. The mitotic index for wheat (Triticum aestivum L. cv. Norin 61) root cells was not affected, but the mitotic index for onion (Allium cepa L. cv. Raputa II) was reduced with the increasing concentration of the extract. In the onion root meristem, the number of cells in prophase, metaphase, anaphase, and telophase were decreased significantly with 6 g DW L−1 (g dry weight of algae L−1). This suggests that the extract might inhibit the processes regulating the entry of cells into mitosis.
Reduced herbicide doses in field crops: A review
Authors: BLACKSHAW ROBERT E. , O'DONOVAN JOHN T. , HARKER K. NEIL , CLAYTON GEORGE W. , STOUGAARD ROBERT N.
Published: February 2006

Farmers are becoming increasingly interested in more comprehensive weed management programs that reduce weed populations over time and in the use of reduced herbicide doses that lower their production costs. Research indicates that there is good potential to reduce the number of herbicide applications and utilize lower herbicide doses within competitive cropping systems. Diverse crop rotations, competitive cultivars, higher crop seed rates, reduced row spacing, specific fertilizer placement, and cover crops have been identified as integral components of competitive cropping systems. This review paper explores the potential for successful use of reduced herbicide doses within competitive cropping systems that have a multiyear approach to weed management. The utilization of decision support systems or new methods of assessing active weed growth are discussed in light of further enhancing the successful use of reduced herbicide doses and advising farmers on when (and when not) they might be a viable option.
Effects of lodging of Echinochloa crus‐galli L. on the herbicidal efficacy of MTB‐951, a mycoherbicide using Drechslera monoceras (Drechsler) Subram. et Jain (= Exserohilum monoceras [Drechsler] Leonard et Suggs)
Authors: HIRASE KANGETSU , NISHIDA MAKOTO , SHINMI TATSUO
Published: February 2006

MTB‐951 is a plant pathogen (Drechslera monoceras), which was isolated from native Echinochloa spp. in Japan. The conidia of this pathogen were used as the herbicidal active ingredient to control Echinochloa crus‐galli L. The herbicidal efficacy of MTB‐951 on E. crus‐galli was drastically increased with an increasing water depth of between 1 and 10 cm. The efficacy also was increased when shoots were lodged by pushing down on them with a stainless steel net so that all parts of the weed were submerged. These results suggest that the contact area of the leaf surface of E. crus‐galli with water is important for infection and that lodging the shoots of E. crus‐galli might be effective in increasing the herbicidal efficacy. In order to find other methods to lodge the weed, we investigated several materials, of which diisononyl phthalate (DINP) was found to be the most effective. Using this material as a model, the effect of lodging on the herbicidal efficacy of MTB‐951 was examined. The lodging ratio (ratio of the number of the plants lodged on the water surface to that of the total plants) was increased with an increased amount of DINP, between 0.5 and 8 kg ha−1. The herbicidal efficacy of MTB‐951 also was increased by DINP and a positive correlation was observed between the lodging ratio and herbicidal efficacy. These results indicate that lodging, which can increase the contact area between the leaf surface and water, enhances the herbicidal efficacy of MTB‐951.
Uprooting and shearing resistances in the seedlings of four weedy species
Authors: TOUKURA YUJI , DEVEE ENKHEE , HONGO AKIO
Published: February 2006

For mechanical weeding, the uprooting force of whole seedlings and the shearing force of basal stems were measured in two grass weeds (Setaria faberi and Echinochloa crus‐galli var. crus‐galli) and two broad‐leaved weeds (Chenopodium album and Amaranthus patulus), using balance‐type equipment and a pair of scissors, respectively. Seedlings were grown in plastic pots. Uprooting and shearing experiments were carried out on the 11th, 16th, 21st, and 26th days after sowing. The uprooting force, the shearing force required to fracture the specimen, plant dry matter weight and cross‐sectional area exponentially increased as seedlings grew, but the uprooting stress and shearing toughness maintained similar values after the 2nd sampling time, except for the 3rd and 4th sampling times in C. album. The increases in uprooting force and the shearing force required to fracture the specimen were supported by an expansion of the cross‐sectional area of stems of the broad‐leaved weeds or pseudostems of grass weeds. The higher values of uprooting stress and shearing toughness in C. album were related to an increased area of lignified organs in the basal stems. There was a significant correlation between uprooting and shearing forces. The shearing force was always higher than the uprooting force, so that most seedlings were uprooted and not fractured at the basal stems or pseudostems. The mean ratio of uprooting force to root dry matter weight after the 2nd sampling time suggested a high uprooting resistance at an extremely low amount of root dry matter weight.
Growth and reproduction of Hypochoeris radicata L.
Authors: DOI MICHIKO , ITO MISAKO , AULD BRUCE A.
Published: February 2006

Hypochoeris radicata L. (Asteraceae) is a perennial, native to Europe, and is widespread in several countries. The objective of the present study was to reveal the life history characteristics of H. radicata by focusing on its reproductive strategy. Flowering, seed‐setting, and vegetative propagation of the species were observed in pots. Reproductive propagation of the species also was investigated in natural populations. The light and temperature requirements for seed germination were examined. The species germinated in temperatures ranging from 10–30°C, both in light and dark. With plants grown in pots, reproductive growth started when the rosette diameter reached ≈ 14–16 cm. Flowering was not day length‐related, but it possibly was related to temperature. In natural populations, the flowering and seed‐setting periods continued for > 6 months. Vegetative propagation occasionally occurred in plants with three or more shoots by the crown splitting below ground level.
Residual phytotoxic activity of pethoxamid in soil and its concentration in soil water under different soil moisture conditions
Authors: DHAREESANK ARM , KOBAYASHI KATSUICHIRO , USUI KENJI
Published: February 2006

The relationship between the residual phytotoxic activity of pethoxamid (2‐chloro‐N‐[2‐ethoxyethyl]‐N‐[2‐methyl‐1‐phenyl‐1‐propenyl] acetamide) on rice (Oryza sativa cv. Kiyohatamochi) seedlings and its behavior in soil was investigated under different moisture conditions. The phytotoxic activity of pethoxamid on the shoot growth of rice seedlings in soil was higher in 80% soil moisture content than in 70% and 60% soil moisture contents. The phytotoxic activity in soil in 70% and 80% soil moisture conditions decreased with the increasing time after application, but the phytotoxic activity was slight in 50% soil moisture conditions at any given time after application. The residues of pethoxamid in soil water, the amount adsorbed on soil solid, and the amount in total soil was reduced with the time after application in a similar manner among these soil moisture conditions. The residual phytotoxic activity of pethoxamid on the shoot growth of rice seedlings in soil was more highly correlated with the concentration in soil water than with the amounts adsorbed on soil solid and in total soil. The partition coefficients between the amounts of pethoxamid adsorbed on soil solid and its concentration in soil water were similar among the soils with different moisture conditions at each day, and the partition coefficient increased with the time after application. These results suggested that the residual phytotoxic activity of pethoxamid in soil depends on the decreasing concentration of pethoxamid in soil water with time, except in low soil‐moisture conditions, which were insufficient for seedling growth.
T‐stress solutions for two‐dimensional crack problems in anisotropic elasticity using the boundary element method
Authors: SHAH P. D. , TAN C. L. , WANG X.
Published: February 2006

The importance of a two‐parameter approach in the fracture mechanics analysis of many cracked components is increasingly being recognized in engineering industry. In addition to the stress intensity factor, the T stress is the second parameter considered in fracture assessments. In this paper, the path‐independent mutual M‐integral method to evaluate the T stress is extended to treat plane, generally anisotropic cracked bodies. It is implemented into the boundary element method for two‐dimensional elasticity. Examples are presented to demonstrate the veracity of the formulations developed and its applicability. The numerical solutions obtained show that material anisotropy can have a significant effect on the T stress for a given cracked geometry.
Acute pancreatitis after anesthesia with propofol in a child with glycogen storage disease type IA
Authors: BUSTAMANTE SERGIO E. , APPACHI ELUMALAI
Published: February 2006

Glycogen storage disorder type 1A (GSD 1A) is an inherited disorder of glycogen metabolism characterized by fasting hypoglycemia, lactic acidosis, hyperuricemia, and hyperlipidemia. These children have a higher risk of developing pancreatitis because of hypertriglyceridemia. Drug‐induced pancreatitis accounts for a small proportion of cases of pancreatitis. The mechanism of drug‐induced pancreatitis include hypersensitivity, direct toxic injury or indirectly by inducing hypertriglyceridemia. Propofol is often the drug of choice for induction of anesthesia in ambulatory surgical procedures. There are various reports in the literature describing pancreatitis induced by propofol. We present a 4‐year‐old girl with GSD 1A, who required tonsillectomy and adenoidectomy under general anesthesia. She developed acute pancreatitis in the postoperative period. Propofol was used as a general anesthetic and the postoperative incidence of pancreatitis is discussed.
Use of the Esophageal Doppler Machine to help guide the intraoperative management of two children with pheochromocytoma
Authors: HACK HENRIK
Published: February 2006

The anesthetic management of pheochromocytoma has been based upon the intraoperative control of blood pressure and fluid balance following adequate preoperative preparation. This can be difficult, especially in the presence of significant comorbidity such as cardiac or renal dysfunction. Two cases of children with pheochromocytoma are reported where the introperative management of fluid balance and blood pressure control were guided by measurement of changes in descending aortic blood flow using an esophageal Doppler probe. The advantages of such a technique compared with more invasive monitors are discussed.
Pharmacokinetic–pharmacodynamic relationship of rocuronium under stable nitrous oxide–fentanyl or nitrous oxide–sevoflurane anesthesia in children
Authors: WOLOSZCZUK‐GEBICKA BOGUMILA , WYSKA ELZBIETA , GRABOWSKI TOMASZ , ŚWIERCZEWSKA ANNA , SAWICKA RENATA
Published: February 2006

Background:  The aim of this study was to compare pharmacokinetics and pharmacokinetic–pharmacodynamic (PK–PD) relationship of rocuronium in children anesthetized with nitrous oxide (N2O) and fentanyl or with N2O and sevoflurane.

Methods:  Twenty‐four children (3–11 years old, ASA PS I or II) were randomized to receive N2O/O2–fentanyl or N2O/O2–sevoflurane (one MAC) anesthesia. Neuromuscular transmission was monitored electromyographically. Initial bolus dose of rocuronium, 0.6 mg·kg−1 was followed by continuous infusion, targeting at steady‐state 95% T1 depression. Neuromuscular transmission was allowed to recover spontaneously. Plasma samples were collected at the moment of discontinuation of infusion, and 10, 20, 30, 50, 60 and 75 min afterwards. Concentrations of rocuronium were measured using high‐performance liquid chromatography with electrochemical detection (HPLC‐EC). Rocuronium PK was described by a two‐compartment model and PD parameters were estimated using effect compartment and sigmoidal Emax models.

Results:  No differences in rocuronium PK parameters were observed between study groups. Clearance was 3.91 ± 2.07 and 3.62 ± 0.80 ml·min−1·kg−1 in sevoflurane and fentanyl groups, respectively (P < 0.65). Effect compartment concentrations corresponding to 50% inhibition of T1 (EC50) were 1.41 ± 0.45 and 2.32 ± 1.00 μg·ml−1 (P < 0.02), and rate constants for equilibration between plasma and effect compartment (ke0) values were 0.10 ± 0.04 and 0.24 ± 0.14 min−1 (P < 0.009) in sevoflurane and fentanyl groups, respectively.

Conclusions:  Disposition of rocuronium was similar under stable N2O–fentanyl and N2O–sevoflurane anesthesia. Sevoflurane reduced rocuronium requirements as well as decreased EC50 relevant to inhibition of T1 and rocuronium transfer to effect compartment. Therefore, the potentiating effect of sevoflurane seems to be mainly of PD origin, probably due to an increased sensitivity of the neuromuscular junction.
Comparison of cuffed and uncuffed preformed oral pediatric tracheal tubes
Authors: WEISS MARKUS , BERNET VERA , STUTZ KATHARINA , DULLENKOPF ALEXANDER , MAINO PAOLO
Published: February 2006

Background : In preformed cuffed tracheal tubes the position of the cuff within the airway is given by its distance to the tube bend placed at the lower teeth. The aim of this study was to compare the design of cuffed and uncuffed preformed pediatric oral tracheal tubes with regard to anatomical landmarks.

Methods : Complete series of cuffed and uncuffed preformed oral pediatric tracheal tubes sized from internal diameter 3.0–7.0 mm if available were ordered from five different manufacturers. The distance from the bend to the distal tube tip and to the upper border of the cuff were measured and compared with anatomical airway landmarks in the developing child.

Results : Between cuffed and uncuffed tracheal preformed tubes up to 37 mm differences in the bend‐to‐tracheal tube tip distances were found for given age groups. Thus uncuffed preformed tracheal tubes were more at risk for inadvertent endobronchial intubation than cuffed preformed tracheal tubes. Comparison of bend‐to‐upper border of the cuff distances with teeth‐to‐vocal cord distances calculated from anatomical data revealed that several of the tracheal tube cuffs become positioned within the subglottic larynx or even within the vocal cords when inserted according to the bend.

Conclusions : There is a need for improvement in cuffed preformed pediatric tracheal tubes, namely a standard bend‐to‐tracheal tube tip distance to allow a safe insertion depth, a short cuff placed on the tube shaft as distally as possible and an intubation depth mark to verify a proper position of the cuff in the trachea.
A comparative study of hemodynamic responses to orotracheal intubation with fiberoptic bronchoscope and laryngoscope in children
Authors: XUE F.S. , ZHANG G.H. , SUN H.T. , LI C.W. , LI P. , LIU K.P. , XU Y.C. , LIU Y. , LIU J.
Published: February 2006

Background : The purposes of this study were to further identify the hemodynamic responses to orotracheal intubation in children, using a fiberoptic bronchoscope (FOB) and a direct laryngoscope (DLS), and to validate whether the FOB can attenuate the hemodynamic response to orotracheal intubation compared with the DLS.

Methods : Forty‐three children, ASA PS I–II scheduled for elective plastic surgery under general anesthesia requiring orotracheal intubation were randomly allocated to either the DLS group (n = 20) or the FOB group (n = 23). Noninvasive systolic blood pressure (SBP) and heart rate (HR) were recorded before (baseline values) and after anesthesia induction (postinduction values), at intubation and every minute for the first 5 min after intubation. The maximal values of SBP and HR during the observation were also recorded. The product of HR and SBP [rate pressure product (RPP)] at each time point was calculated.

Results : In the DLS group, SBP, HR, and RPP at intubation and 1 min after intubation were significantly higher than postinduction values, but did not exceed baseline values. In the FOB group, SBP, HR, and RPP at intubation increased significantly compared with baseline and postinduction values. In the two groups, the maximal values of SBP, HR, and RPP during the observation were significantly higher than baseline values. Except for the HR at intubation, there were no significant differences in other hemodynamic parameters during the observation and the time required to reach maximal values of SBP, HR, and RPP between the two groups.

Conclusions : Orotracheal intubation using FOB and DLS in children may cause similar increases in SBP and HR. Compared with the DLS, the FOB had no advantage in attenuating the hemodynamic responses to orotracheal intubation.
Impact of a nurse practitioner‐assisted preoperative assessment program on quality
Authors: VARUGHESE ANNA M. , BYCZKOWSKI TERRI L. , WITTKUGEL ERIC P. , KOTAGAL UMA , DEAN KURTH C.
Published: February 2006

Background : The anesthesia manpower shortage in the last few years in the US has limited many hospital pediatric surgical services. We sought to meet an increasing surgical caseload, while providing safe, timely and patient‐centered care by instituting a nurse practitioner‐assisted preoperative evaluation (NPAPE) program. The strategic goal of this program was to shift anesthesiologists from the preanesthesia clinic to the operating room (OR), while maintaining the quality of preoperative care. Our study sought to evaluate the quality of the NPAPE program.

Methods : One thousand five hundred and nine children aged 1 month–18 years, 463 parents, 25 anesthesiologists and 20 preoperative clinic nurses were studied. Indicators of quality were incidence of respiratory complications (apnea/hypopnea, laryngospasm, bronchospasm, and supplemental oxygen use in postanesthesia care unit), patient preoperative preparation time and parent and staff (anesthesiologists and preoperative clinic nurse) satisfaction. These indicators were recorded for 1 week every 3 months for 1 year. The first week (baseline) was an anesthesiologist‐only preoperative assessment (three anesthesiologists performing approximately 120 evaluations per day). The subsequent four data collection weeks at 3, 6, 9, and 12 months were nurse practitioner (NP)‐aided preoperative assessments (one anesthesiologist with six NPs performing approximately 120 evaluations per day).

Results : The incidence of respiratory complications, patient preoperative preparation time, and levels of parental satisfaction did not differ significantly between anesthesiologist‐only and NP‐aided assessments. However, anesthesiologist and preoperative clinic nurse satisfaction increased significantly postimplementation of the program.

Conclusions : Our study revealed that within a year of its implementation, the NPAPE program maintained patient safety, timeliness, and a high level of parent satisfaction as well as increased staff satisfaction, while shifting two anesthesiologists to the OR. A NP‐assisted preoperative evaluation program can offer operational advantages without compromising care.
Monitored anesthesia care with a combination of ketamine and dexmedetomidine during magnetic resonance imaging in three children with trisomy 21 and obstructive sleep apnea
Authors: LUSCRI NATHAN , TOBIAS JOSEPH D.
Published: February 2006

We present a series of three children with trisomy 21 and obstructive sleep apnea who required sedation during magnetic resonance imaging of the upper airway. In an effort to provide effective sedation with limited effects on cardiovascular and ventilatory function, sedation was provided by a combination of ketamine and dexmedetomidine. Sedation was initiated with a bolus dose of ketamine (1 mg·kg−1) and dexmedetomidine (1 μg·kg−1) and maintained by a continuous infusion of dexmedetomidine (1 μg·kg−1·h−1). One patient required a repeat of the bolus doses of ketamine and dexmedetomidine and an increase of the dexmedetomidine infusion to 2 μg·kg−1· h−1. Effective sedation was provided for all three patients. We noted no clinically significant hemodynamic or respiratory effects. No central apnea was noted although there was a brief episode of upper airway obstruction in one patient which responded to repositioning of the airway. All three patients developed some degree of hypercarbia with maximum PEco2 values of 6.4, 6.9, and 6.8 kPa (49, 53, and 52 mmHg), respectively. To date, this is the first report regarding the use of this combination in pediatric patients. Given the preliminary success noted in our three patients, prospective trials evaluating the efficacy of a dexmedetomidine–ketamine combination appears warranted.
Airway management of three cases of congenital cervical teratoma
Authors: HULLETT BRUCE J. , SHINE NEVILLE P. , CHAMBERS NEIL A.
Published: February 2006

Cervical teratomas are rare congenital tumors derived from all three germ cell layers. The vast majority are histologically benign, but the significant size they may attain can potentiate life‐threatening upper airway obstruction. All cases require the specialist airway skills of the pediatric anesthetist. This may be planned, in the case of antenatally diagnosed lesions, when the pediatric anesthetist is part of a multidisciplinary team involved in an EX utero Intrapartum Treatment (EXIT) or Operation On Placental Support (OOPS) procedure, or when a neonate is undergoing elective excision in the early neonatal period as definitive treatment. Alternatively the anesthetist may be called upon urgently to secure a compromised airway immediately postpartum when no antenatal diagnosis has been made. Furthermore, after elective surgical excision, airway compromise is possible, which may again require anesthetic intervention. The aim of this study is to report the authors’ experience in managing the airway in three cases of congenital cervical teratoma in the study institution over the last 24 months. These cases highlight the possible airway scenarios that may confront the anesthetist in the immediate postpartum, elective surgery and postoperative stages and the variety of techniques that may be employed in order to overcome the potential difficulties encountered.
Association of oculocardiac reflex and postoperative nausea and vomiting in strabismus surgery in children anesthetized with halothane and nitrous oxide
Authors: KARANOVIC NENAD , CAREV MLADEN , UJEVIC ANTE , KARDUM GORAN , DOGAS ZORAN
Published: February 2006

Background: Postoperative nausea and vomiting (PONV) occurs frequently after strabismus surgery. The controversy still exists regarding the association of PONV and the oculocardiac reflex (OCR). A recent study has proven that rocuronium attenuates OCR. If these two occurrences are dependent, it is expected that with the diminution of OCR, occurrence of PONV will also be reduced. The goal of this randomized, controlled study was to prove an association between OCR and PONV by attenuating OCR with 0.4 mg·kg−1of rocuronium and subsequently diminishing PONV if these occurrences are associated.

Methods: A total of 119 ASA 1 children, aged between 3 and 10, undergoing surgery of the medial rectus muscle, were randomly assigned to two groups. In group R (n = 59), 0.4 mg·kg−1of rocuronium was administered i.v. before intubation. Group C (controls,n = 60) received no muscle relaxant. The anesthesia was induced and maintained with halothane and N2O/O2(50/50%). Chi‐squared test, Fisher's exact test,t‐test, andanovawere used for statistical analysis;P‐value <0.05 was considered statistically significant.

Results: There were no differences between groups regarding patients’ characteristics as well as endtidal halothane and duration of surgery and anesthesia. The occurrence of OCR was different between groups (R: 16/59, 27.1%, C: 28/60, 46.7%;P = 0.027), but not the occurrence of PONV (R: 27/59, 45.8%, C: 28/60, 46.7%;P = 0.921). There was an equal number of patients with PONV and bradycardias in both groups (R: 4/27 vs C: 4/28;P = 0.858), whereas there was different, but statistically insignificant distribution of patients (R: 3/27 vs C: 10/28;P = 0.086) with PONV and arrhythmias other than bradycardia. However, simultaneous occurrence of total OCR and PONV in the 24‐h period was not different between the two groups (P = 0.964).

Conclusions: Rocuronium (0.4 mg·kg−1) attenuates the occurrence of OCR, but with the reduced occurrence of OCR we were not able to attenuate the occurrence of PONV, therefore the association of OCR and PONV in strabismus surgery in children anesthetized with halothane and nitrous oxide remains unclear, and if there is a link between the two, it could be related to arrhythmias and not bradycardia.
Minimum viable population sizes and global extinction risk are unrelated
Authors: Brook Barry W. , Traill Lochran W. , Bradshaw Corey J. A.
Published: February 2006

Theoretical and empirical work has shown that once reduced in size and geographical range, species face a considerably elevated risk of extinction. We predict minimum viable population sizes (MVP) for 1198 species based on long‐term time‐series data and model‐averaged population dynamics simulations. The median MVP estimate was 1377 individuals (90% probability of persistence over 100 years) but the overall distribution was wide and strongly positively skewed. Factors commonly cited as correlating with extinction risk failed to predict MVP but were able to predict successfully the probability of World Conservation Union Listing. MVPs were most strongly related to local environmental variation rather than a species’ intrinsic ecological and life history attributes. Further, the large variation in MVP across species is unrelated to (or at least dwarfed by) the anthropogenic threats that drive the global biodiversity crisis by causing once‐abundant species to decline.
Ecosystem allometry: the scaling of nutrient stocks and primary productivity across plant communities
Authors: Kerkhoff Andrew J. , Enquist Brian J.
Published: February 2006

A principal challenge in ecology is to integrate physiological function (e.g. photosynthesis) across a collection of individuals (e.g. plants of different species) to understand the functioning of the entire ensemble (e.g. primary productivity). The control that organism size exerts over physiological and ecological function suggests that allometry could be a powerful tool for scaling ecological processes across levels of organization. Here we use individual plant allometries to predict how nutrient content and productivity scale with total plant biomass (phytomass) in whole plant communities. As predicted by our model, net primary productivity as well as whole community nitrogen and phosphorus content all scale allometrically with phytomass across diverse plant communities, from tropical forest to arctic tundra. Importantly, productivity data deviate quantitatively from the theoretically derived prediction, and nutrient productivity (production per unit nutrient) of terrestrial plant communities decreases systematically with increasing total phytomass. These results are consistent with the existence of pronounced competitive size hierarchies. The previously undocumented generality of these ‘ecosystem allometries’ and their basis in the structure and function of individual plants will likely provide a useful quantitative framework for research linking plant traits to ecosystem processes.
Predator disease out‐break modulates top‐down, bottom‐up and climatic effects on herbivore population dynamics
Authors: Wilmers Christopher C. , Post Eric , Peterson Rolf O. , Vucetich John A.
Published: February 2006

Human‐introduced disease and climatic change are increasingly perturbing natural ecosystems worldwide, but scientists know very little about how they interact to affect ecological dynamics. An outbreak of canine parvovirus (CPV) in the wolf population on Isle Royale allowed us to test the transient effects of an introduced pathogen and global climatic variation on the dynamics of a three‐level food chain. Following the introduction of CPV, wolf numbers plummeted, precipitating a switch from top‐down to bottom‐up regulation of the moose population; consequently, the influence of climate on moose population growth rate doubled. This demonstrates that synergistic interactions between pathogens and climate can lead to shifts in trophic control, and suggests that predators in this system may play an important role in dampening the effects of climate change on the dynamics of their prey.
Parent birds assess nest predation risk and adjust their reproductive strategies
Authors: Fontaine J. J. , Martin T. E.
Published: February 2006

Avian life history theory has long assumed that nest predation plays a minor role in shaping reproductive strategies. Yet, this assumption remains conspicuously untested by broad experiments that alter environmental risk of nest predation, despite the fact that nest predation is a major source of reproductive failure. Here, we examined whether parents can assess experimentally reduced nest predation risk and alter their reproductive strategies. We experimentally reduced nest predation risk and show that in safer environments parents increased investment in young through increased egg size, clutch mass, and the rate they fed nestlings. Parents also increased investment in female condition by increasing the rates that males fed incubating females at the nest, and decreasing the time that females spent incubating. These results demonstrate that birds can assess nest predation risk at large and that nest predation plays a key role in the expression of avian reproductive strategies.
Contamination routes of Clostridium botulinum in the honey production environment
Authors: Nevas Mari , Lindström Miia , Hörman Ari , Keto‐Timonen Riikka , Korkeala Hannu
Published: February 2006

Factors influencing Clostridium botulinum contamination in the honey production environment were evaluated in a 3‐year survey. A number of 1168 samples from 100 apiaries and related facilities were analysed for the presence of C. botulinum types A, B, E and F, using multiplex polymerase chain reaction targeted to botA, botB, botE and botF genes. Production methods and environmental factors were registered using a questionnaire and by personal observation. Clostridium botulinum was shown to be a common finding throughout the whole honey production chain, and the type most frequently detected was group I type B. In a pulsed‐field gel electrophoresis (PFGE) analysis of 202 group I type B isolates, only six different PFGE profiles were observed, of which two clearly distinct profiles predominated. This may indicate the existence of at least two different genetic lineages. The high prevalence of C. botulinum in soil and in samples associated with beeswax suggests the accumulation of soil‐derived botulinal spores in wax. Additionally, according to Spearman’s rank order correlation and multivariate analysis, production hygiene‐dependent factors have a significant influence on the contamination, and thus the number and frequency of C. botulinum spores in honey could possibly be diminished by increasing hygienic level in honey production.