bluuebunny/crossref_metadata_2025 huggingface dataset:
Primary adenosquamous carcinoma of the jejunum
Authors: He Yong‐Tao , Wang Xiao‐Jie , Gong Jing , Chen Ni , Zhou Qiao
Published: September 2005

Adenosquamous carcinomas of the small intestine are extremely rare, with only three documented jejunal and three ileal cases being reported in the English‐language medical literature. Presented herein is a case of primary jejunal adenosquamous carcinoma in an 80‐year‐old woman. The jejunal carcinoma consisted predominantly of a squamous component throughout the tumor but peritoneal nodules carrying metastases from the adenocarcinoma element were noted, making it the first case of jejunal adenosquamous carcinoma with metastases from the adenocarcinoma component. The finding that metastases could arise from the minor component of a jejunal adenosquamous carcinoma indicates that an accurate diagnosis must be based upon thorough examination of both the primary and the metastases, not just mesenteric nodule biopsy alone. Histological foci of closely intermingled squamous and glandular components with apparent morphological transition were noted, indicating the pathogenetic possibility that the squamous component might arise by transformation from the glandular element. The squamous component was strongly positive with immunostaining for p63 (nuclear staining) and for cytokeratin 10/13 (cytoplasmic staining), while the adenocarcinoma element was negative. The immunohistochemical results suggest that p63 and cytokeratin 10/13 might be useful in identifying squamous differentiation in jejunal carcinoma.
Idiopathic chondrolysis of the hip: medium‐ to long‐term results
Authors: Korula Ravi Jacob , Jebaraj Isaac , David Kenny S.
Published: September 2005

Background:  Chondrolysis of the hip secondary to severe trauma, prolonged immobilization and slipped capital femoral epiphysis have been well documented. There have not been many reports, however, of idiopathic chondrolysis of the hip. We here present our experience with 21 hips with an average follow‐up of 23.4 months.

Methods:  Twenty patients (21 hips), with gross deformities of the hip who presented with fibrous ankylosis were treated over a 23‐year period. Average age at presentation was 13 years. None of the patients responded to a trial of conservative treatment (non‐steroidal anti‐inflammatory medications, traction and physiotherapy.)

Results:  Most of the preoperative deformities were corrected following arthrotomy, capsulectomy and skeletal traction. However, return of normal hip motion was not seen in any of the patients. Fibrous ankylosis in a functional position was seen to develop in two patients; one patient underwent hip arthrodesis, while another with bilateral involvement underwent excision arthroplasties.

Conclusions:  Circumferential capsulectomy with aggressive mobilization of the hip can correct the deformities associated with this condition, although long‐term results are uniformly disappointing with regard to return of hip joint motion in cases of late presentation.
Complications and outcomes of single‐stage bilateral total knee arthroplasty
Authors: Horne Geoffrey , Devane Peter , Adams Kathryn
Published: September 2005

Background:  A recent literature review by the senior authors of this study revealed that simultaneous bilateral knee arthroplasty is uncommon and controversial. Reported complications include myocardial infarction, deep venous thrombosis, pulmonary embolus, thromboembolic complications, pseudo‐obstruction, postoperative ileus and death. This present study was designed to identify complications of single‐stage bilateral total knee arthroplasty to compare with reports in the international literature.

Methods:  A retrospective study of 40 cases of simultaneous total knee arthroplasty carried out by the senior authors at Wellington over the last 10 years, examined details of surgery, anaesthesia, preoperative and postoperative management to identify the occurrence of complications. Thirty‐one patients completed an Oxford Knee Score, a EuroQuol‐5 Dimension (EQ‐5D) questionnaire and reported their experience of the bilateral procedure.

Results:  Complications reported in the international literature did not occur in the patients studied. Complications that did occur included urinary retention, wound infections and oedema of the limbs or knees. The mean Oxford Knee Score was 20.79. In 2003 the New Zealand national mean for primary total knee arthroplasty was 23.35. The EQ‐5D revealed high patient satisfaction and good functional status.

Conclusions:  While the outcomes and cost benefits of single stage bilateral replacement are established, the risk of complications remains. This study establishes the low complication rate associated with this procedure in the senior authors’ hands, and documents the high patient satisfaction. The study demonstrates that, in selected patients, simultaneous bilateral knee replacement surgery can be performed with good outcomes without a definite increase in perioperative risk.
Surgical management of invasive breast cancer: a 5‐year prospective study of treatment in the Australian Capital Territory and South‐Eastern New South Wales
Authors: Koshy Anil , Buckingham John M. , Zhang Yanping , Craft Paul , Dahlstrom Jane E. , Tait Members of the ACT and SE NSW Breast Cancer Treatment G Noel
Published: September 2005

Background:  Breast cancer is a major health problem in Australia. The aim of the present report is to evaluate the surgical management of invasive breast cancers in our region.

Methodology:  As part of a multidisciplinary quality assurance project, data were collected for the majority of breast cancers treated in our region between July 1997 and June 2002. Participants included surgeons, medical and radiation oncologists, pathologists and general practitioners.

Results:  Over the 5‐year period, 1069 invasive breast cancers were treated. Mastectomy (52%) was more common than breast conservation. For cancers less than 2 cm in diameter (61%), breast conservation was achieved in 62%. High nuclear grade cancers (27%) resulted in mastectomy in 60%. This treatment pattern was the same for patients living in urban and rural areas and in all age groups. Those patients requiring two or more operations (30%) to achieve surgical clearance still had a 33% rate of breast conservation. Over the last 5 years there has been an increase in sentinel node biopsies (16 sentinel node biopsies during 1998−1999; 64 during 2001−2002) and axillary dissections started to decrease. A small group has had no axillary node biopsy or dissection, mainly patients over 70 years of age. Multimodality treatments increased over the 5‐year period of our study with the use of postoperative radiotherapy increasing from 60% to 65% and chemotherapy from 36% to 55%.

Conclusions:  The project has mapped treatment trends for breast cancer in our region and documented the implementation of new treatment methods as well as the increasing use of multidisciplinary management, multimodality treatment and the implementation of best practice guidelines.
Is age at diagnosis an independent prognostic factor for survival following breast cancer?
Authors: Jayasinghe Upali W. , Taylor Richard , Boyages John
Published: September 2005

Background:  Previous studies of patients with breast cancer have examined age at diagnosis as a prognostic factor for survival with contradictory results. The current study examines the effect of age in conjunction with pathological tumour size, lymph node status and histological grade to clarify whether age at diagnosis is an independent factor for overall survival.

Methods:  This is a population‐based study that examines the survival of 393 women with a first diagnosis of breast cancer in 1992 in the Greater Western region of Sydney in New South Wales, Australia. Survival analysis was conducted using the Kaplan−Meier method. Relative risks associated with age at diagnosis, pathological tumour size, and number of positive lymph nodes and histological grade and adjusted for each other were computed using Cox proportional hazard regression. Patients’ ages were categorized as ‘younger’ (<40 years of age at diagnosis), ‘middle‐aged’ (40−69 years) or ‘older age’ (>69 years).

Results:  The 10‐year survival of women <40 years was 49%, which was significantly lower than ‘middle‐aged’ women (73%). For women with node‐negative breast cancer, younger women had a significantly (P = 0.011) poorer survival rate (68%) than middle‐aged (90%) or older women (80%). After adjusting for the effects of the pathological tumour size, the lymph node status and histological grade, women <40 years showed a higher risk of dying than older women. However, young women detected with a small (<20 mm) node‐negative tumour have a good prognosis.

Conclusions:  Age at diagnosis, tumour size and lymph node status were independent prognostic indicators for survival. Age at diagnosis should be considered as an important factor in making decisions about adjuvant therapy, irrespective of nodal status.
Safety and cost benefits of bilateral total knee replacement in an acute hospital
Authors: Stubbs Geoffrey , Pryke S. E. R. , Tewari Sandeep , Rogers Janine , Crowe Bethany , Bridgfoot Lynnet , Smith Natalie
Published: September 2005

Background:  Total knee arthroplasty of both knees under the one anaesthetic has become a common procedure. Benefits reported include a shorter overall hospital stay and reduced costs. The published studies come from university associated tertiary referral hospitals with well‐established research establishments and a vast experience of joint replacement. This study examines the experience of a small hospital to see if similar benefits can be achieved.

Methods:  A retrospective medical record review was performed of the synchronous bilateral knee replacements against a match group of bilateral staged knee replacements. Both groups were compared with a control group of unilateral knee replacements. A prospectively conducted review of the synchronous and staged bilateral knee replacement groups was then carried out to assess the clinical outcome in these two groups.

Results:  The incidence of surgical and medical complications was not statistically different in any group. The bed stay for bilateral surgery was increased by 2 days compared to unilateral surgery with a net saving of 6 days hospital stay for the patient group having both knees replaced at separate operations within 1 year. At an average of 2.5 years post surgery there was no statistically significant difference in outcome between those patients who had both knees replaced either synchronously or at staged intervals.

Conclusions:  Bilateral knee replacement is a good choice for patient and hospital. Bilateral surgery does not increase the risk of perioperative complications to the patient and reduces the overall cost to the hospital. There is no difference in short to medium term clinical outcome between patients who have had both knees replaced synchronously or at staged intervals. Results comparable in safety, as judged by complication rates and efficiency, as judged by length of stay can be achieved in a smaller metropolitan level 2 hospital environment.
Simultaneous branchial cleft and thyroid disorders may present a management challenge
Authors: Harding Jane L. , Veivers David , Sidhu Stan B. , Sywak Mark S. , Shun Albert , Delbridge Leigh W.
Published: September 2005

Background:  Cysts, sinuses or abscesses arising from second, third or fourth branchial cleft remnants may lie either within the body of, or in close proximity to the thyroid gland. Given their infrequent nature they may pose both diagnostic and management challenges for the treating surgeon when they occur in association with thyroid disorders.

Methods:  This is a case series. All patients with concomitant thyroid disorders and a branchial cleft anomaly treated in the University of Sydney Endocrine Surgical Unit in the 10‐year period 1994−2003 comprised the study group. Patient demographics, clinical presentation, imaging, surgical management, definitive histology and outcomes were documented.

Results:  Six patients were identified with an age range of 3−76 years and a male : female ratio of 1:5. Five branchial cleft anomalies were left sided, one was right sided. Two patients had second cleft anomalies, both of which were initially thought to represent metastatic lymph nodes in association with thyroid cancer. A further two patients had third cleft abnormalities presenting as suppurative thyroiditis. The final two patients had fourth cleft abnormalities causing intraoperative management problems.

Conclusions:  Branchial cleft remnants and anomalies are rare but may occur in association with thyroid disease. They may pose a diagnostic and management dilemma either preoperatively, when mistaken for metastatic thyroid cancer, or intraoperatively when mistaken for a thyroid nodule.
Long‐term outcome of postanal repair in the treatment of faecal incontinence
Authors: Abbas Saleh M. , Bissett Ian P. , Neill Mischell E. , Parry Bryan R.
Published: September 2005

Background:  Idiopathic faecal incontinence is a common debilitating problem; the results of surgical treatment are variable with only a small proportion of patients achieving full continence.

Objectives:  The aim of this study was to evaluate the long‐term outcome of postanal repair in idiopathic faecal incontinence.

Patients and methods:  Patients who had postanal repair in Auckland between 1994 and 2001 were identified and mailed faecal incontinence severity index (FISI) and faecal incontinence quality of life (FIQOL) questionnaires. Preoperative and postoperative incontinence scores were compared and postoperative quality of life scores were calculated.

Results:  Forty‐seven of the 66 patients who had undergone postanal repair from 1994 to 2001 completed the FIQOL questionnaire. FISI scores were complete on 44 patients. Comparison of preoperative and postoperative FISI scores revealed an improvement with mean scores of 34 and 23, respectively (P = 0.0001). Thirty (68%) patients had improved, including four who were fully continent. Fourteen patients were the same or worse.

Conclusions:  Postanal repair provides lasting benefit for the majority of patients with faecal incontinence.
Improvement in the emergency splinting of fractures after a simple educational exercise
Authors: Miller Nicholas J. K. , Wong Wicky C. F. , Ryan Damien P.
Published: September 2005

Background:  Splinting long bone fractures in the early stages of their management reduces pain, facilitates transport and helps prevent further soft tissue injury; but experience suggests that the rate of splinting is low. This study set out to quantify this rate and determine whether it could be improved with simple educational intervention.

Methods:  Radiographs ordered in the emergency department over an 8‐week control period were examined for fractures and presence of splints. The junior doctors responsible for these patients completed a questionnaire to assess how highly they rated early splinting. At the beginning of the next emergency term new junior doctors were given the same questionnaire followed by an information sheet relating to fracture management. The questionnaire was repeated after reading the information sheet to confirm comprehension. Radiographs performed over the following 8 weeks were examined.

Results:  Ninety‐six long bone fractures amenable to splinting were X‐rayed in the control period, and of these 15 were splinted (16%). After the intervention this rose to 28 out of 98 fractures (29%, P < 0.05). The intervention group prior to reading the information sheet ranked splinting in a similar manner to the control group (P > 0.20) but significantly higher afterwards (P < 0.01).

Conclusion:  The rate of splinting of long bone fractures in the early stages of their management is low, and junior doctors do not regard this as a priority. We have shown that a simple teaching session significantly improves this rate and suggest that similar training should be provided to all emergency staff.
Surgical management of colorectal cancer in south‐western Sydney 1997−2001: a prospective series of 1293 unselected cases from six public hospitals
Authors: Wong S. K. Cyril , Kneebone A. , Morgan Matthew , Henderson Christopher J. A. , Morgan Ann , Jalaludin Bin
Published: September 2005

Background:  The aim of the present study is to provide local data for the management of colorectal cancers in the south‐western Sydney health area from 1997 to 2001.

Methods:  The data were collected prospectively. Follow up was conducted in late 2001 and early 2002. Data were cross‐validated with hospital and area databases and with data from the New South Wales Registry of Births, Deaths and Marriages.

Results:  This was an unselected series of 1293 patients from 36 surgeons; 16.5% of patients presented as emergencies. Only 3% presented as a result of bowel cancer screening. Of the 1293 patients, 1270 received an operation. There were 598 elective colonic resections with the mortality rate of 1.2%, reoperation rate of 2.7% and anastomotic leak rate of 0.8%. For the 410 elective rectal resections, the rates were 2.9%, 2.7% and 1.2%, respectively. For the 290 emergency operations, the rates were much worse at 7.7%, 6.6% and 4.8%, respectively. The corrected overall 3‐year survival rate was 64%. For Dukes’ A, B, C and D, the figures were 94%, 87%, 61% and 7%, respectively.

Conclusions:  Colorectal cancer is a major cause of mortality and morbidity in our community. Very few bowel cancers were discovered at the asymptomatic stage. This paper strongly supports community bowel cancer screening and early diagnosis. The local database has provided a rich source of information to benchmark management and outcomes of bowel cancer patients treated in the South Western Sydney Area Health Service. An area‐wide computer network with online data input facilities at individual workplaces will improve data integrity and data collection efficiency.
Limy bile syndrome: review of seven cases
Authors: Ballas Konstantinos D. , Alatsakis Michael B. , Rafailidis Savas F. , Psarras Kiriakos , Sakadamis Athanassios K.
Published: September 2005

Background:  Milk of calcium bile or limy bile is a rare disorder in which the gall bladder is filled with a thick, paste‐like, radiopaque material.

Methods:  Seven patients with limy bile syndrome were treated in our department from 1980 to 2003. There were five women and two men, and their age ranged from 30 to 64 years. A retrospective analysis of clinical symptoms, diagnostic work‐up, treatment approach and operative findings was performed.

Results:  All patients presented with intermittent right upper abdominal quadrant pain. Three of the seven patients (42.85%) presented with complications like acute cholecystitis (two of seven patients) and obstructive jaundice (one of seven patients). Diagnosis was based on clinical findings, plain abdominal X‐rays, ultrasonography and computed tomography scanning. Surgery was the treatment of choice and cholecystectomy alone or in combination with common bile duct exploration and drainage (if needed) was performed.

Conclusion:  The clinical aspect of the disease is similar to that of biliary lithiasis and the diagnosis is easily made by the characteristic spontaneous opacification of the gall bladder on plain abdominal X‐rays. Complications such as acute cholecystitis, pancreatitis or obstructive jaundice can also be present. Although some cases of conservative pharmaceutical treatment as well as cases of spontaneous disappearance of limy bile have been reported, surgical treatment remains the treatment of choice.
Contribution of investigations to the diagnosis of bilateral vas aplasia
Authors: Kumar Rajeev , Thulkar Sanjay , Kumar Virender , Jagannathan N. R. , Gupta Narmada P.
Published: September 2005

Background:  Bilaterally absent vas deferens is a surgically uncorrectable cause of male infertility. It is usually diagnosed clinically. We evaluate the role of semen analysis and radiological imaging in providing objective evidence of vas aplasia.

Methods:  Twenty consecutive patients with clinically suspected bilateral vas aplasia were enrolled for this prospective study. They were investigated on the basis of an algorithm till corroborative evidence for vas aplasia was obtained. This successively included a semen analysis on at least two occasions, transrectal ultrasonogram (TRUS), pelvic magnetic resonance imaging (MRI) and scrotal exploration. The contribution of each investigation to confirming the diagnosis was evaluated.

Results:  Seventeen patients (85%) had a low volume ejaculate while all 20 had azoospermia and semen fructose levels below normal. Semen pH was non‐acidic in 75% of cases and thus was not contributory to the diagnosis. TRUS and MRI were non‐contributory in 30% and 50% of evaluations, respectively. The clinical diagnosis was found to be correct in all patients.

Conclusions:  Vas aplasia is a clinical diagnosis. Low volume ejaculate with azoospermia and low or absent semen fructose is sufficient corroborative evidence and no further investigations are required for this diagnosis.
Incidental gall bladder carcinoma: does the surgical approach influence the outcome?
Authors: Cucinotta Eugenio , Lorenzini Cesare , Melita Giuseppinella , Iapichino Giuliano , Currò Giuseppe
Published: September 2005

Background:  The aim of the study was to evaluate the outcome in patients with unsuspected gall bladder carcinoma diagnosed after cholecystectomy, comparing the laparoscopic approach with open surgery.

Methods:  A retrospective study was done of 16 patients who were diagnosed with unsuspected gall bladder carcinoma out of the 2850 who had undergone cholecystectomy for symptomatic cholelithiasis at our institution between 1990 and 2004. Eight cases (seven women and one man, mean age 63 (range 49−75 years) ) were diagnosed after laparoscopic cholecystectomy (group A) and eight cases (six women and two men, mean age 63 (range 50−79 years) ) after open cholecystectomy (group B). We evaluated the outcome in the two groups correlating the cumulative survival rates with tumour stage and surgical technique.

Results:  In group A, three patients had port‐site recurrence (1 pT1a and 2 pT1b tumours) after 6, 7 and 9 months, one had intraperitoneal dissemination (pT2) after 3 months, and four had no recurrence (1 pTis, 2 pT1a and 1 pT1b). In group B, five patients had recurrences (4 pT1b and 1 pT2) after an average of 8 months (range 5−11) and three had no recurrence (1 pTis and 2 pT1a). Survival rate was statistically correlated with tumour stage but not with the surgical approach used to perform cholecystectomy.

Conclusions:  The surgical approach used for cholecystectomy would seem not to influence the outcome in patients with unsuspected gall bladder carcinoma. The tumour stage is the most important prognostic factor.
Rate of return to work and driving following arthroscopic subacromial decompression
Authors: McClelland Damian , Paxinos Anastasios , Dodenhoff Ronald M.
Published: September 2005

Background:  The aim of the present paper was to evaluate the return to work and return to driving of a cohort of patients undergoing arthroscopic subacromial decompressions ± arthroscopic acromioclavicular joint excision.

Methods:  Arthroscopic subacromial decompressions ± arthroscopic acromioclavicular joint excision were performed in 68 patients between February 2000 and November 2000. All patients had symptoms of subacromial impingement ± acromioclavicular joint arthrosis for more than 6 months that had not settled with conservative treatment. All had positive local anaesthetic injection tests. All patients were followed up at 3 weeks and 3 months postoperatively. Their Constant−Murley score was measured preoperatively and at 3 weeks and 3 months postoperatively. Patients were asked to record when they had returned to work and when they had returned to driving.

Results:  Only one non‐manual worker did not return to work within 6 weeks. Eighty‐five per cent of manual workers returned to manual work within 3 months. Fifty‐one patients held driving licences. The average time to return to driving was 28.9 days. Average preoperative Constant−Murley scores were 47.5 (20−67). At 3 weeks postoperation average Constant−Murley scores were 66.8 (40−92), and at 3 months 76.5 (48−99).
Comparison of blue dye and isotope with blue dye alone in breast sentinel node biopsy
Authors: Syme David B. Y. , Collins John P. , Mann G. Bruce
Published: September 2005

Background:  Sentinel lymph node biopsy (SNB) is rapidly gaining acceptance as an alternative to axillary dissection (AD) in patients with early breast cancer. Debate continues regarding the optimum technique for sentinel node (SN) mapping. We have used our series of 364 SNBs to compare two different techniques.

Methods:  A retrospective review of patients undergoing SNB by surgeons in our breast service. Overall results were analysed, with particular attention to those having blue dye alone and those having blue dye in combination with radio‐labelled colloid. SNs were analysed using haematoxylin−eosin and immunohistochemical staining.

Results:  SN identification rates were similar: 96% for dye alone and 89% for dye and colloid in combination. Twenty‐one per cent of SN mapped with dye alone contained metastases, compared to 30% with dye and colloid in combination. The false‐negative rate was correspondingly higher in the dye alone group (21 vs 2.8%).

Conclusion:  SNB using dye and colloid in combination was significantly superior to dye alone in this series. We advocate using both dye and colloid for intraoperative SN mapping.
Fate of the infrapatellar branch of the saphenous nerve post total knee arthroplasty
Authors: Mistry Dinshaw , O'Meeghan Christopher
Published: September 2005

Background:  The infrapatellar branch of the saphenous nerve is a known cause of morbidity following knee surgery. The incidence of sensory changes following total knee arthroplasty, and its effect on patient satisfaction with arthroplasty surgery remain undocumented. Our aim was to document the incidence of infrapatellar nerve palsy following total knee arthroplasty and its effect on patient satisfaction.

Methods:  Between 1 January 2002 and 31 December 2003 all patients attending outpatients clinic for primary total knee joint arthroplasty were prospectively tested for sensory defects. Patients were then assessed postoperatively and satisfaction was measured using the British Orthopaedic Satisfaction Score and a visual analogue scale.

Results:  Thirty‐one patients satisfied inclusion criteria of which 21 agreed to participate. One patient was excluded later in the study leaving 20 patients. Seventy per cent of patients had sensory changes in the area supplied by the infrapatellar branch of the saphenous nerve. Patient satisfaction scores did not correlate to the presence of a sensory deficit. Two patients stated that the sensory deficit was a significant factor in their dissatisfaction with their arthroplasty surgery.

Conclusions:  Sensory changes due to damage to the infrapatellar branch of the saphenous nerve during total knee joint arthroplasty is a common occurrence and can interfere with patient satisfaction. Patients should be informed of this risk in the preoperative discussion.
Is a cystogram necessary after radical prostatectomy?
Authors: Ischia Joseph J. , Lindsay Stephen
Published: September 2005

Background:  Improvements in the surgical technique of radical prostatectomy have allowed the length of postoperative catheterization to be reduced dramatically over the past 20 years. Today, many surgeons perform a cystogram to ensure the anastomosis is watertight before an ‘early’ (day 7 or less) trial of void (TOV). We aim to show that achieving an intraoperative watertight anastomosis may preclude the need for routine cystogram prior to TOV.

Methods:  Between 31 May 1999 and 29 February 2004, we performed a prospective study of 68 consecutive patients who underwent radical prostatectomy by a single surgeon. We tested the vesicourethral anastomosis for watertightness intraoperatively by instilling 250 mL of normal saline in to the bladder and compared this with evidence of extravasation on the cystogram on day 7.

Results:  Fifty‐four (79.4%) of the 68 patients had a watertight anastomosis intraoperatively. All men had a cystogram on day 7 (6−9 days). Sixty (88.2%) of these cystograms showed no evidence of extravasation. Three men (4.4%) who had evidence of a leak on their cystogram had achieved a watertight anastomosis intraoperatively. However, one of these men had suffered a postoperative septicaemia which may have jeopardized the anastomosis. Only two (2.9%) of the 68 patients had unsuspected extravasation at their day 7 cystogram. Therefore, 97.1% of patients (95% Confidence Interval: 95.1%−99.2%) could be suitably managed by our proposed protocol.

Conclusion:  Achieving an intraoperative watertight anastomosis is a very good predictor of a watertight cystogram on day 7. It seems feasible to avoid routine cystograms prior to TOV in the absence of other postoperative complications.
Allelopathic studies of common wheat (Triticum aestivum L.)
Authors: MA YONGQING
Published: September 2005

Wheat (Triticum aestivum L.) is a common name for cereal grasses of a genus of the grass family, cultivated for food since prehistoric times by the people of the temperate zones and now the most important grain crop of those regions. It has allelopathic potential if used as a cover crop for weed control in various cropping systems. Research results indicate that, among modern varieties, there is a variable resistance potential against weeds. Numerous allelochemicals have been identified in wheat, mainly belonging to the categories of phenolic acids, hydroxamic acids and short‐chain fatty acids. Some researchers conceived that wheat allelopathy is genetically controlled, but systematic research on gene behaviors is lacking. The negative effects of wheat on other crops under different agricultural production systems have been reported. Research is needed to determine the genetic control of wheat allelopathy prior to the development of allelopathic wheat varieties. Further research is needed to conduct in vitro studies to isolate, identify and quantify allelochemicals from living wheat plants at different growth stages. Also, the relationship between heritages of modern varieties and the allelopathic characteristics of wheat during their evolution and selection by humans is still unclear. There is also a lack of research on the modern varieties as to whether the allelopathic potential can be genetically transferred to the next generation. In the future, more models and assessment systems must be developed to illuminate the essence of allelopathy and the genomes of wheat with allelopathic traits should be constructed to make available allelopathic bioinformation on wheat.
The Economics of School Quality
Authors: Hanushek Eric A.
Published: September 2005

Recent national concerns about student performance on PISA tests and similar assessments appear warranted because of the direct relationship between student cognitive skills and both individual earnings and national growth. The evidence on the impacts of school quality indicates very large economic effects. Available research shows, however, that improving school quality is difficult and not closely related to spending levels. One approach supported by research is improving teacher quality, which can yield sizable gains in student performance. Instituting appropriate policies to alter the teacher force will necessarily take significant time.
Educational Attainment and Family Background
Authors: Aakvik Arild , Vaage Kjell , Salvanes Kjell G.
Published: September 2005

This paper analyses the effect of aspects of family background, such as family income and parental education, on the educational attainment of persons born from 1967 to 1972. Family income is measured at different periods of a child’s life to separate long-term versus short-term effects of family income on educational choices.We find that permanent income matters to a certain degree, and that family income when the child is 0-6 years old is an important explanatory variable for educational attainment later in a child’s life. We find that short-term credit constraints have only a small effect on educational attainment. Long-term factors, such as permanent family income and parental education, are much more important for educational attainment than are short-term credit constraints. Public interventions to alleviate the effects of family background should thus also be targeted at a child’s early years, the shaping period for the cognitive and non-cognitive skills important later in life.
The effects of antipsychotics on β‐catenin, glycogen synthase kinase‐3 and dishevelled in the ventral midbrain of rats
Authors: Alimohamad H. , Sutton L. , Mouyal J. , Rajakumar N. , Rushlow W. J.
Published: September 2005

Protein kinase B and glycogen synthase kinase‐3 have been identified as susceptibility genes for schizophrenia and altered protein and mRNA levels have been detected in the brains of schizophrenics post‐mortem. Recently, we reported that haloperidol, clozapine and risperidone alter glycogen synthase kinase‐3 and β‐catenin protein expression and glycogen synthase kinase‐3 phosphorylation levels in the rat prefrontal cortex and striatum. In the current study, β‐catenin, adenomatous polyposis coli, Wnt1, dishevelled and glycogen synthase kinase‐3 were examined in the ventral midbrain and hippocampus using western blotting. In addition, β‐catenin and GSK‐3 were examined in the substantia nigra and ventral tegmental area using confocal and fluorescence microscopy. The results indicate that repeated antipsychotic administration results in significant elevations in glycogen synthase kinase‐3, β‐catenin and dishevelled‐3 protein levels in the ventral midbrain and hippocampus. Raclopride causes similar changes in β‐catenin and GSK‐3 in the ventral midbrain, suggesting that D2 dopamine receptor antagonism mediated the changes observed following antipsychotic administration. In contrast, amphetamine, a drug capable of inducing psychotic episodes, had the opposite effect on β‐catenin and GSK‐3 in the ventral midbrain. Collectively, the results suggest that antipsychotics may exert their beneficial effects through modifications to proteins that are associated with the canonical Wnt pathway.
Induction and attenuation of neuronal apoptosis by proteasome inhibitors in murine cortical cell cultures
Authors: Suh Jaehong , Lee Young Ae , Gwag Byoung Joo
Published: September 2005

Evidence has accumulated showing that pharmacological inhibition of proteasome activity can both induce and prevent neuronal apoptosis. We tested the hypothesis that these paradoxical effects of proteasome inhibitors depend on the degree of reduced proteasome activity and investigated underlying mechanisms. Murine cortical cell cultures exposed to 0.1 µm MG132 underwent widespread neuronal apoptosis and showed partial inhibition of proteasome activity down to 30–50%. Interestingly, administration of 1–10 µm MG132 almost completely blocked proteasome activity but resulted in reduced neuronal apoptosis. Similar results were produced in cortical cultures exposed to other proteasome inhibitors, proteasome inhibitor I and lactacystin. Administration of 0.1 µm MG132 led to activation of a mitochondria‐dependent apoptotic signaling cascade involving cytochrome c, caspase‐9, caspase‐3 and degradation of tau protein; such activation was markedly reduced with 10 µm MG132. High doses of MG132 prevented the degradation of inhibitor of apoptosis proteins (IAPs) cIAP and X chromosome‐linked IAP, suggesting that complete blockade of proteasome activity interferes with progression of apoptosis. In support of this, addition of high doses of proteasome inhibitors attenuated apoptosis of cortical neurons deprived of serum. Taken together, the present results indicate that inhibition of proteasome activity can induce or prevent neuronal cell apoptosis through regulation of mitochondria‐mediated apoptotic pathways and IAPs.
Suppression of protein kinase Cε mediates 17β‐estradiol‐induced neuroprotection in an immortalized hippocampal cell line
Authors: Jung Marianna E. , Watson David G. , Simpkins James W.
Published: September 2005

Although estrogens are neuroprotective in a variety of neuroprotection models, the precise underlying mechanisms are currently not well understood. Here, we examined the role of protein kinase C (PKC) in mediating estrogen‐induced neuroprotection in the HT‐22 immortalized hippocampal cell line. The neuroprotection model utilized calcein fluorescence to quantitate cell viability following glutamate insults. 17β‐Estradiol (βE2) protected HT‐22 cells when treatment was initiated before or after the glutamate insult. The inhibition of PKC by bis‐indolylmaleimide mimicked and enhanced βE2‐induced neuroprotection. In contrast, the inhibition of specific PKC isozymes (α and β) by Go6976, inhibition of 1‐phosphatidylinositol 3 kinase by wortmannin, or inhibition of protein kinase A by H‐89, did not alter cell viability, suggesting a specific involvement of PKC in an isozyme‐dependent manner. We further examined whether estrogen interacts with PKC in a PKC isozyme‐specific manner. Protein levels and activity of PKC isozymes (α, δ, ε, and ζ) were assessed by western blot analysis and radiolabeled phosphorylation assays respectively. Among the isozymes tested, βE2 altered only PKCε; it reduced the activity and membrane translocation of PKCε in a manner that correlated with its protection against glutamate toxicity. Furthermore, βE2 reversed the increased activity of membrane PKCε induced by glutamate. These data suggest that the neuroprotective effects of estrogens are mediated in part by inhibition of PKCε activity and membrane translocation.
Isolation and characterization of twelve polymorphic microsatellite markers for the invasive ascidian Styela clava (Tunicata)
Authors: DUPONT L. , VIARD F. , BISHOP J. D. D.
Published: September 2005

The invasive solitary ascidian Styela clava has spread extensively along European coasts since its first occurrence in the early 1950s. In order to characterize spatial and temporal patterns of genetic change during its establishment and subsequent spread, we developed 12 species‐specific loci from an enriched microsatellite library. Polymorphism was explored in one native and two introduced populations (N = 31 ± 1). Number of alleles per locus varied from two to 13 (mean = 7). The average expected heterozygosity within populations ranged from 0.539 to 0.580.
Micro‐Phylogeographic and Demographic History of Portuguese Male Lineages
Authors: Beleza Sandra , Gusmão Leonor , Lopes Alexandra , Alves Cíntia , Gomes Iva , Giouzeli Maria , Calafell Francesc , Carracedo Angel , Amorim António
Published: September 2005

The clinal pattern observed for the distribution of Y‐chromosome lineages in Europe is not always reflected at a geographically smaller scale. Six hundred and sixty‐three male samples from the 18 administrative districts of Portugal were typed for 25 Y‐chromosome biallelic and 15 microsatellite markers, in order to assess the degree of substructuring of male lineage distribution. Haplogroup frequency distributions, Analysis of Molecular Variance (AMOVA) and genetic distance analyses at both Y‐SNP and Y‐STR levels revealed a general genetic homogeneity of Portuguese sub‐populations. The traditional division of the country in north, central and south, which is usually considered in studies addressing questions of the genetic variation distribution in Portugal, was not reflected in the Y‐haplotype distribution. Instead, just one sub–region (Alentejo) stood out due to the presence of high diversity levels and a higher number of different lineages, at higher frequencies than in other regions. These results are reconciled with the historical evidence available, assuming that from prehistorical times down to the end of the medieval period this region harboured the most diverse groups of people and, because of economic depression, remained relatively isolated from recent homogenisation movements. The finding of a broadly homogeneous background for the Portuguese population has vast repercussions in forensic, epidemiological and association studies.
Catheter Ablation of Regular Atrial Arrhythmia Following Surgical Treatment of Permanent Atrial Fibrillation
Authors: DENEKE THOMAS , KHARGI KRISHNA , GREWE PETER H. , CALCUM BERND , LACZKOVICS AXEL , KEYHAN‐FALSAFI ALI , MÜGGE ANDREAS , LAWO THOMAS , LEMKE BERND
Published: September 2005

Introduction: Surgical treatment of atrial fibrillation (AF) is gaining widespread acceptance. However, therapeutic modalities for secondary regular atrial tachycardia are still empiric.

Methods and Results: After linear atrial cooled‐tip radiofrequency ablation (SICTRA) during cardio‐surgical procedures to cure permanent AF, patients with regular atrial tachycardia were identified. Invasive electrophysiology including electroanatomic mapping was performed. Catheter ablation was directed to suppress atrial arrhythmia depending on activation mapping findings. Follow‐up was performed after 3 months and then after every 6 months. Of 238 patients, 12 (5.0%) were identified with regular secondary arrhythmias (12 ± 7 months after surgery) including 9 (3.8%) with persistent forms originating from the right atrium (RA) in six (66%) (isthmus‐dependent macroreentry in 4, incisional macroreentry in 1, and RA ectopy in 1). All patients with RA origin of the tachycardia were successfully ablated. Two patients had left atrial (LA)‐macroreentry circling around the mitral valve indicating insufficiency of the intraoperative ablation procedure: one patient was successfully ablated within the LA isthmus, in the other patient no complete conduction block could be induced. One patient had LA‐macroreentry degenerating into AF, and ablation was not performed.

During follow‐up (9 ± 4 months), no recurrences of atrial tachycardias were documented after successful ablation.

Conclusions: Persistent regular “secondary” arrhythmia occurred in 3.8% (9/238) of patients after SICTRA to treat permanent AF. Predominantly (67%; 6/9), the arrhythmia was located in the RA mostly incorporating the RA‐isthmus. Catheter ablation was highly effective for RA tachycardia (100%). In three cases (33%), LA‐macroreentry was documented and catheter ablation was successful in only one patient (overall success 78%).
Mapping of Atrial Activation During Sustained Atrial Fibrillation in Dogs with Rapid Ventricular Pacing Induced Heart Failure: Evidence for a Role of Driver Regions
Authors: RYU KYUNGMOO , SHROFF SUNIL C. , SAHADEVAN JAYAKUMAR , MARTOVITZ NICHOLE L. , KHRESTIAN CELEEN M. , STAMBLER BRUCE S.
Published: September 2005

Introduction: Dogs with rapid ventricular pacing (RVP)‐induced congestive heart failure (CHF) have inducible atrial tachycardia, flutter, and fibrillation (AF). We tested the hypothesis that rapid atrial activation in multiple regions and at different rates is responsible for sustained AF in this CHF model.

Methods and Results: We studied 12 episodes of sustained (>10 minutes) AF induced in 12 dogs with CHF produced by 3–6 weeks of RVP at 230 beats/minute. High‐density mapping of AF was performed using 382 unipolar atrial electrograms recorded simultaneously from epicardial electrodes on the right (RA) and left atria (LA) and Bachmann's bundle. AF mechanisms were based on Fast Fourier Transform (FFT) analysis and activation sequence mapping. A driver was defined as a rapid stable activation region with a single dominant frequency peak in FFT analysis. During AF, three FFT and activation patterns were seen: (1) a single LA driver (7.8 ± 1.1 Hz) near the pulmonary veins (PVs) with irregular activation in the rest of the atria (n = 4); (2) simultaneous, multisite, biatrial drivers at differing frequencies (LA vs RA dominant frequency gradient: 1.3 ± 0.8 Hz) near the PVs (8.4 ± 0.3 Hz) and high RA (8.5 ± 1.5 Hz) (n = 7); and (3) biatrial irregular activation with multiple and/or broadband frequency peaks without a dominant frequency. (LA: 7.1–11.4 Hz; RA: 5.9–7.7 Hz) (n = 1). Atrial drivers had either a focal activation pattern or were due to a macroreentrant circuit around the PVs.

Conclusions: In this CHF model, FFT analysis and activation sequence mapping demonstrate that sustained AF is characterized by single and multiple, stable LA and RA drivers with predominant sources in the PVs and high RA causing fibrillatory conduction.
Acceleration‐Dependent Left Bundle Branch Block with Severe Left Ventricular Dyssynchrony Results in Acute Heart Failure: Are There More Patients Who Benefit from Cardiac Resynchronization Therapy?
Authors: ZEPPENFELD KATJA , SCHALIJ MARTIN J. , BLEEKER GABE B. , HOLMAN EDUARD R. , BAX JEROEN J.
Published: September 2005

Cardiac resynchronization therapy (CRT) has been proposed to improve hemodynamics in patients with heart failure and left bundle branch block (LBBB) by resynchronization of left ventricular (LV) dyssynchrony.

The current report concerns a patient with narrow QRS complex without LV dyssynchrony who experienced an acute exacerbation of heart failure following exercise. Careful analysis revealed that an increase of heart rate induced acceleration‐dependent LBBB with severe LV dyssynchrony and mitral regurgitation followed by acute heart failure and hemodynamic collapse. CRT prevented these adverse reactions.

Accordingly, optimal evaluation for CRT may include testing for LV dyssynchrony during exercise.
Electrophysiological Basis and Genetics of Brugada Syndrome
Authors: GRANT AUGUSTUS O.
Published: September 2005

Brugada syndrome is a primary arrhythmic syndrome arising in the structurally normal heart. Any proposed mechanism should account for the major features of the syndrome: localization of the ST segment and T‐wave changes to the right precordial leads, association of conduction slowing at several levels, precipitation or aggravation of the major ECG changes by sodium channel‐blocking drugs and the occurrence of ventricular fibrillation. Heterogeneity of repolarization across the ventricle wall plays a major role. Any agency that shifts the net current gradient during phase I outward would exaggerate the normal heterogeneity of repolarization and result in the ST segment and T‐wave changes characteristic of the syndrome. When the outward current shift is marked, premature repolarization may occur in epicardial zone and the resulting gradient may precipitate reentry. The syndrome is inherited as an autosomal dominant. However, 75% of clinically affected individuals are males. In 20% of cases, the syndrome is associated with mutations of the cardiac sodium channel gene SCN5A. The mutations result in a loss‐of‐function as a result of the synthesis of a non‐functional protein, altered protein trafficking, or change in gating. Agencies that reduce the sodium current may precipitate the characteristic ECG changes, for example, sodium channel blockers and membrane depolarization by hyperkalemia. Sympathetic stimulation may reverse the ECG changes and reduce arrhythmia recurrence. By its nonspecific potassium channel blocking action, quinidine may also reduce arrhythmia recurrence. We still do not know the basis for defect in the majority of patients with Brugada syndrome.