bluuebunny/crossref_metadata_2025 huggingface dataset:
Massive amplification of rolling-circle transposons in the lineage of the bat
Myotis lucifugus
Authors: Pritham Ellen J. , Feschotte Cédric
Published: February 2007

Rolling-circle (RC) transposons, or
Helitrons
, are a newly recognized group of eukaryotic transposable elements abundant in the genomes of plants, invertebrates, and zebrafish. We provide evidence for the colonization of a mammalian genome by
Helitrons
, which has not been reported previously. We identified and characterized two families of
Helitrons
in the little brown bat
Myotis lucifugus
. The consensus sequence for the first family,
HeliBat1
, displays the hallmarks of an autonomous
Helitron
, including coding capacity for an ≈1,500-aa protein with an RC replication motif and a region related to the SF1 superfamily of DNA helicases. The
HeliBatN1
family is a nonautonomous
Helitron
family that is only distantly related to
HeliBat1
. The two
HeliBat
families have attained high copy numbers (≈15,000 and > 100,000 copies, respectively) and make up at least ≈3% of the
M. lucifugus
genome. Sequence divergence and cross-species analyses indicate that both
HeliBat
families have amplified within the last ≈30–36 million years and are restricted to the lineage of vesper bats. We could not detect the presence of
Helitrons
in any other order of placental mammals, despite the broad representation of these taxa in the databases. We describe an instance of
HeliBat
-mediated transduction of a host gene fragment that was subsequently dispersed in ≈1,000 copies throughout the
M. lucifugus
genome. Given the demonstrated propensity of RC transposons to mediate the duplication and shuffling of host genes in bacteria and maize, it is tempting to speculate that the massive amplification of
Helitrons
in vesper bats has influenced the evolutionary trajectory of these mammals.
Needlestick Injuries to the Feet of Japanese Healthcare Workers: A Culture-Specific Exposure Risk
Authors: Yoshikawa Toru , Kidouchi Kiyoshi , Kimura Satoshi , Okubo Takashi , Perry Jane , Jagger Janine
Published: February 2007

A comparison of needlestick injury surveillance data from Japan and the United States revealed a higher proportion of foot injuries to Japanese healthcare workers (HCWs), compared with US HCWs. This study investigates the underlying factors that contribute to this difference and proposes evidence-based prevention strategies to address the risk, including the use of safety-engineered needle devices, point-of-use disposal containers for sharp instruments and devices, and closed-toe footwear.
Physical manipulation of calcium oscillations facilitates osteodifferentiation of human mesenchymal stem cells
Authors: Sun Shan , Liu Yaoming , Lipsky Samantha , Cho† Michael
Published: February 2007

The role of cytosolic calcium oscillation has long been recognized in the regulation of cellular and molecular interactions. Information embedded in calcium oscillation can provide molecular cues for cell behavior such as cell differentiation. Although calcium dynamics are versatile and likely to depend on the cell type, the calcium dynamics in human mesenchymal stem cells (hMSCs) and its role in differentiation are yet to be fully elucidated. In the present study we characterized the calcium oscillation profiles in hMSCs before and after subjecting the cells to the osteoinductive factors. Our findings indicate that the calcium spikes decreased rapidly with osteodifferentiation to a level observed in terminally differentiated human osteoblasts. In addition, the calcium oscillations appear to serve as a bidirectional signal during hMSC differentiation. While an altered calcium oscillation pattern may be an indicator for hMSC differentiation, it is also likely to be involved in directing hMSC differentiation. Treatment of hMSCs with a noninvasive electrical stimulation, for example, not only altered the calcium oscillations but also facilitated osteodifferentiation. Regulation of calcium oscillation by external physical stimulation could amplify hMSC differentiation into a tissue‐specific lineage and may offer an alternate biotechnology to harness the unique properties of stem cells.—Sun, S., Liu, Y., Lipsky, S., Cho, M. Physical manipulation of calcium oscillations facilitates osteo‐differentiation of human mesenchymal stem cells. FASEB J. 21, 1472–1480 (2007)
Alternative splicing in intron 13 of the human eNOS gene: a potential mechanism for regulating eNOS activity
Authors: Lorenz Mario , Hewing Bernd , Hui Jingyi , Zepp Angela , Baumann Gert , Bindereif Albrecht , Stangl Verena , Stangl Karl
Published: February 2007

NO, the product of endothelial NOS (eNOS), is a major regulator of vascular homeostasis and a critical factor in preventing cardiovascular diseases. We previously established a positive correlation between the number of variable CA repeats in intron 13 of human eNOS and the risk of coronary artery disease, and demonstrated that these polymorphic CA repeats function as a length‐dependent splicing enhancer. By 5′‐RACE polymerase chain reaction (PCR), we detected three splice variants containing novel 3′ splice sites within intron 13—termed eNOS13A, eNOS13B, and eNOS13C—which share the first 13 exons of human eNOS and the same polyadenylation site at the end of the novel exon. When translated, all these splice variants would result in truncated proteins lacking eNOS activity. Coexpression of full‐length eNOS with eNOS13A diminished eNOS enzyme activity in COS‐7 cells by formation of heterodimers. The splice variants were expressed in endothelial cells and various human tissues. Finally, we demonstrate, using minigene transfection, that the expression of the eNOS13A splice variant is increased with high CA repeat numbers in intron 13. These data suggest a new mechanism for the regulation of eNOS activity and NO production in the cardiovascular system by truncated, dominant‐negative splice variants of human eNOS.—Lorenz M., Hewing B., Hui J., Zepp A., Baumann G., Bindereif A., Stangl V., Stangl K. Alternative splicing in intron 13 of the human eNOS gene: A potential mechanism for regulating eNOS activity FASEB J. 21, 1556–1564 (2007)
The Social Norm of Tipping: A Review1
Authors: Azar Ofer H.
Published: February 2007

Tipping in U.S. restaurants alone amounts to $27 billion annually. Tipping is also common in other occupations and countries, making tipping a significant economic activity. The literature on tipping is spread over various disciplines: mainly psychology, economics, hospitality, and tourism. This survey article integrates the research conducted on tipping to allow an overview of the literature. In addition to summarizing and synthesizing the research on tipping, the article includes original ideas and suggests topics for future research.
Exercise, Lipids, and Lipoproteins in Older Adults: A Meta‐Analysis
Authors: Kelley George A. , Kelley Kristi S. , Tran Zung V.
Published: February 2007

The authors used the meta‐analytic approach to examine the effects of aerobic exercise on lipids and lipoproteins in adults 50 years of age and older. Twenty‐eight outcomes representing 1427 subjects (806 exercise, 621 control) were available for pooling. Random‐effects modeling yielded statistically significant improvements of 1.1%, 5.6%, 2.5%, and 7.1%, respectively, for total cholesterol (mean ± SEM in mg/dL, −3.3±1.7; 95% confidence interval [CI], −6.5 to −0.02; p=0.05), high‐density lipoprotein cholesterol (2.5±1.0; 95% CI, 0.7–4.4; p=0.01), low‐density lipoprotein cholesterol (−3.9±1.9; 95% CI, −7.7 to −0.08; p=0.05), ratio of total cholesterol to high‐density lipoprotein cholesterol (−0.8±0.2; 95% CI, −1.2 to −0.4; p<0.001), but not triglycerides (−7.0±3.6; 95% CI, −14.0 to 0.1; p=0.06). After conducting sensitivity analyses, only the improvements in high‐density lipoprotein cholesterol and the ratio of total cholesterol to high‐density lipoprotein cholesterol remained statistically significant (p<0.05 for both). It was concluded that aerobic exercise increases high‐density lipoprotein cholesterol and decreases the ratio of total cholesterol to high‐density lipoprotein cholesterol in older adults.
Atrial Fibrillation Following Cardiac Surgery: A Retrospective Cohort Series
Authors: Scherr Kimberly , Jensen Louise , Smith Heather , Kozak Cori‐Lynn
Published: February 2007

Atrial fibrillation (AF) is a common postoperative complication of cardiac surgery, yet the prevention and treatment of postoperative AF remains controversial and varies among practitioners. The purpose of this study was to document the incidence and time of onset of postoperative AF in a cardiac surgical cohort, examine risk factors implicated in the occurrence of postoperative AF, and assess effectiveness of current treatment strategies implemented for postoperative AF. A retrospective health record review was conducted on 1078 adults following cardiac surgery. Data on demographic, preoperative, perioperative, and postoperative risk factors for postoperative AF, documented episodes of AF, and clinical outcomes were recorded. Overall incidence of postoperative AF was 39.6%: 57.6% after cardiac valve surgery, 69.3% after combined coronary artery bypass graft and valve surgery, and 33% after bypass graft surgery alone. The peak onset of postoperative AF occurred on the second postoperative day. Advancing age, history of AF, combined cardiac valve and coronary artery bypass graft surgery, and high Mg+2 levels on the third postoperative day were significant predictors of postoperative AF in this cohort. Length of hospitalization increased with the presence of postoperative AF. Findings corroborate that multiple factors play a role in the development of AF following cardiac surgery.
Repaired Tetralogy of Fallot in the Adult
Authors: McRae Marion E.
Published: February 2007

The majority of persons living with tetralogy of Fallot are now adults and may face a number of long‐term cardiac problems that necessitate reoperation. These problems include pulmonary regurgitation, tricuspid regurgitation, ventricular tachycardia, atrial flutter and/or fibrillation, pulmonary artery branch stenoses, right ventricular aneurysms, right ventricular outflow tract obstruction, residual ventricular septal defects, and coronary artery disease. Management approaches to these potential problems are discussed. Issues related to genetics, pregnancy, infective endocarditis, insurability, and employment are also reviewed with specific reference to the individual with repaired tetralogy of Fallot.
Using Impedance Cardiography to Assess Left Ventricular Systolic Function via Postural Change in Patients With Heart Failure
Authors: DeMarzo Arthur P. , Calvin James E. , Kelly Russell F. , Stamos Thomas D.
Published: February 2007

For the diagnosis and management of heart failure, it would be useful to have a simple point‐of‐care test for assessing ventricular function that could be performed by a nurse. An impedance cardiography (ICG) parameter called systolic amplitude (SA) can serve as an indicator of left ventricular systolic function (LVSF). This study tested the hypothesis that patients with normal LVSF should have a significant increase in SA in response to an increase in end‐diastolic volume caused by postural change from sitting upright to supine, while patients with depressed LVSF associated with heart failure should have a minimal increase or a decrease in SA from upright to supine. ICG data were obtained in 12 patients without heart disease and with normal LVSF and 18 patients with clinically diagnosed heart failure. Consistent with the hypothesis, patients with normal LVSF had a significant increase in SA from upright to supine, whereas heart failure patients had a minimal increase or a decrease in SA from upright to supine. This ICG procedure may be useful for monitoring the trend of patient response to titration ofβblockers and other medications. ICG potentially could be used to detect worsening LVSF and provide a means of measurement for adjusting treatment.
End‐of‐Life Issues in Elderly Patients With Acute Coronary Syndrome: The Role of the Cardiovascular Nurse
Authors: Handberg Eileen
Published: February 2007

End‐of‐life care and cardiovascular disease are concepts that do not have the same synergy as end‐of‐life care and cancer. Cardiovascular care is predominantly perceived by patients and practitioners as a curative discipline. However, with the aging of the population and the prevalence of cardiovascular heart disease, it will continue to be the leading cause of death for adults in the United States. Clinical treatment options and issues surrounding end‐of‐life care need to be addressed with elderly patients and their families. The purpose of this article is to discuss the role of the cardiovascular nurse in the care of the elderly patient with acute coronary syndrome.
Effect of Uncertainty on Depression in Patients With Newly Diagnosed Atrial Fibrillation
Authors: Kang Younhee
Published: February 2007

This cross‐sectional survey study aimed to determine the effects of uncertainty on depression through the appraisal within the “uncertainty in illness” model. In 81 subjects with atrial fibrillation, individuals with greater symptom severity perceived more uncertainty. Uncertainty was appraised as a danger rather than an opportunity. While the appraisal of opportunity had a negative relationship with depression, the appraisal of danger was positively associated with depression. The indirect effect of uncertainty on depression through appraisal was supported by the empirical data on patients with atrial fibrillation. Helping patients to correctly interpret symptoms and to understand the effectiveness of treatment may modify and reduce their uncertainty so that uncertainty leading to worse health outcomes may be reduced.
Protective effects of citrus nobiletin and auraptene in transgenic rats developing adenocarcinoma of the prostate (TRAP) and human prostate carcinoma cells
Authors: Tang MingXi , Ogawa Kumiko , Asamoto Makoto , Hokaiwado Naomi , Seeni Azman , Suzuki Shugo , Takahashi Satoru , Tanaka Takuji , Ichikawa Kazuhito , Shirai Tomoyuki
Published: February 2007

Dietary phytochemicals, including nobiletin and auraptene, have been shown to exert inhibiting effects in several chemically induced carcinogenesis models. We here investigated the influence of nobiletin and auraptene on prostate carcinogenesis using transgenic rats developing adenocarcinoma of the prostate (TRAP) bearing the SV40 T antigen transgene under control of the probasin promoter and human prostate cancer cells. Starting at 5 weeks of age, male TRAP rats received powder diet containing 500 p.p.m. nobiletin or auraptene, or the basal diet for 15 weeks and then were sacrificed for analysis of serum testosterone levels and histological changes. The body and relative prostate weights and serum testosterone levels did not differ among the groups. Since all animals developed prostate carcinomas, these were semiquantitatively measured and expressed as relative areas of prostate epithelial cells. Nobiletin caused significant reduction in the ventral (P < 0.01), lateral (P < 0.001) and dorsal (P < 0.05) prostate lobes, while decreasing high grade lesions (P < 0.05) in the ventral and lateral lobes. Feeding of auraptene also effectively reduced the epithelial component (P < 0.05) and high grade lesions (P < 0.05), in the lateral prostate. A further experiment demonstrated that growth of androgen sensitive LNCaP and androgen insensitive DU145 and PC3 human prostate cancer cells, was suppressed by both nobiletin and to a lesser extent auraptene in a dose‐dependent manner, with significant increase in apoptosis. In conclusion, these compounds, particularly nobiletin, may be valuable for prostate cancer prevention. (Cancer Sci 2007; 98: 471–477)
Irbesartan reduces common carotid artery intima‐media thickness in hypertensive patients when compared with atenolol: the Swedish Irbesartan Left Ventricular Hypertrophy Investigation versus Atenolol (SILVHIA) study
Authors: Mörtsell D. , Malmqvist K. , Held C. , Kahan T.
Published: February 2007

Background and purpose.  Angiotensin II promotes cell growth and has been implicated in the development and maintenance of left ventricular (LV) hypertrophy and of structural vascular changes. We wished to examine whether an angiotensin receptor blocker (ARB) would influence structural vascular changes beyond the effects of blood pressure reduction.

Methods.  Hypertensive patients with LV hypertrophy (age 55 ± 9 years, blood pressure 162 ± 19/104 ± 8 mmHg, LV mass index 148 ± 31 g m−2; mean ± SD) were randomized double‐blind to the ARB irbesartan (n = 52) or the beta1 receptor blocker atenolol (n = 56) for 48 weeks. Ultrasonography of the left and right common carotid artery (CCA) and echocardiography were performed at week 0 and 48.

Results.  With similar reductions in blood pressure, CCA intima‐media thickness (IMT) was reduced by irbesartan (from 0.92 ± 0.14 by 0.01 ± 0.10 mm, NS), whereas it was increased by atenolol (from 0.94 ± 0.21 by 0.03 ± 0.12 mm, P = 0.018; P = 0.002 between groups). CCA lumen diameter was less reduced by irbesartan than by atenolol. Thus, CCA intima‐media area was reduced by irbesartan (from 21.3 ± 5.0 by 0.90 ± 2.45 mm2, P = 0.034) but not by atenolol (from 21.3 ± 6.1 by 0.18 ± 2.71 mm2, NS; P = 0.037 between groups). Changes in CCA IMT or area did not relate to changes in LV mass.

Conclusions.  The favourable effects by irbesartan on CCA IMT with an outward vascular remodelling suggest that angiotensin II mediates structural vascular changes, beyond the effects of blood pressure. This may be important in the prevention of cerebrovascular events.
Generation of Autoreactive CTL by Tumour Vaccines Containing Foreign T Helper Epitopes
Authors: Steinaa L. , Rasmussen P. B. , Rygaard J. , Mouritsen S. , Gautam A.
Published: February 2007

The aim of this study was to evaluate the effect of including a foreign T helper cell epitope in vaccines designed for generation of CTL against self‐antigens and for inhibition of tumour growth. Two different vaccine designs were composed, a minimal epitope vaccine and a modified full length self‐antigen, both based on OVA containing either a colinearily synthesized or an inserted Th‐epitope, respectively. These vaccines were used for immunization of tolerant OVA transgenic mice (RIP‐OVAlow) and non‐tolerant C57BL/6 mice. First, it was shown that transgenic mice were tolerant to OVA in the CD4 compartment. Secondly, only the vaccines containing the foreign Th‐epitope and not the wild‐type constructs were able to induce self‐reactive CTL in the transgenic mice. Thirdly, these self‐reactive CTL induced by the Th‐epitope modified constructs also inhibited tumour growth in the OVA transgenic mice. Overall, these results demonstrate that inclusion of a foreign Th‐epitope circumvents the tolerance in this OVA transgenic strain. In addition, these results show the importance of including strong T‐cell help in cancer vaccines.
Correlation of IL‐1alpha and IL‐4 Gene Polymorphisms and Clinical Parameters in Idiopathic Pulmonary Fibrosis
Authors: Vasakova M. , Striz I. , Slavcev A. , Jandova S. , Dutka J. , Terl M. , Kolesar L. , Sulc J.
Published: February 2007

Idiopathic pulmonary fibrosis (IPF) is a serious disease characterized with progressive scarring of the lungs in which a genetic background is supposed. We have tested correlation of promotor regions of IL‐1alpha and IL‐4 gene polymorphisms with clinical parameters in IPF.

We investigated the group of 30 patients with IPF. The correlations of vital capacity (VC) and diffusing capacity for carbon monoxide (DLCO), bronchoalveolar lavage (BAL) fluid cell counts and high resolution computed tomography (HRCT) alveolar and interstitial scores with different genotypes of IL‐4 at (−1098), (−590) and (−33) positions and IL‐1 alpha at (−889) position were tested. The PCR method was used for genotyping.

The carriers of CT genotype at IL‐1 alpha (−889) position had higher VC at the time of diagnosis. The CC genotype at this position was more frequent in patients with higher counts of HLADR+ T lymphocytes in BAL. The GT genotype at IL‐4 (−1098) position correlated with higher counts of CD4+ T lymphocytes, and inversely the TT genotype with higher counts of CD8+ T lymphocytes in BAL fluid. According to dynamic changes of HRCT score the CT genotype at IL‐4 (−33) was more frequent in patients with progressive disease compared to that with stable disease.

We assume from our data that the gene polymorphisms of the promotor region of IL‐4 at position (−1098) and (−33) and IL‐1 alpha at position (−889) are likely to play a pathogenic role in IPF and in modification of its clinical presentation and severity.
Donor‐transmitted toxoplasmosis in liver transplant recipients: a case report and literature review
Authors: Assi M.A. , Rosenblatt J.E. , Marshall W.F.
Published: February 2007

Abstract: Transmission of toxoplasmosis via liver transplantation is extremely uncommon. Here we report the case of a 52‐year‐old male liver transplant recipient who on day 32 post transplant developed pneumonia followed by respiratory failure. Donor‐transmitted toxoplasmosis was confirmed as the etiology by both serologic and molecular testing. We also review all previously published cases of toxoplasmosis in the English‐language adult liver transplant literature.
Pasteurella multocida septic shock following liver transplantation treated with drotrecogin alfa (activated)
Authors: Al‐Sabah S. , Goldberg P. , Qureshi S.T.
Published: February 2007

Abstract: Severe sepsis and progression to septic shock in solid organ transplant recipients is associated with a high mortality. We describe a fulminant case of septic shock in a liver transplant recipient caused by Pasteurella multocida, a gram‐negative coccobacillus most commonly associated with domestic cats and dogs. P. multocida is a rare cause of bacteremia and has not been reported as a cause of septic shock following liver transplantation. In addition to standard therapy, the patient was managed with drotrecogin alfa (activated) recombinant activated protein C (APC), an evidence‐based agent that has been shown to significantly improve outcome in severe sepsis in the non‐transplant population. The known risk factors, clinical course, and outcomes of severe infection associated with P. multocida are also briefly reviewed. This case illustrates the need for transplant recipients and their healthcare providers to carefully consider the risk of severe infection associated with domestic animal exposure.
Immmunohistochemical Study of the Blood and Lymphatic Vasculature and the Innervation of Mouse Gut and Gut‐Associated Lymphoid Tissue
Authors: Ma B. , Von Wasielewski R. , Lindenmaier W. , Dittmar K. E. J.
Published: February 2007

The blood and lymphatic vascular system of the gut plays an important role in tissue fluid homeostasis, nutrient absorption and immune surveillance. To obtain a better understanding of the anatomic basis of these functions, the blood and lymphatic vasculature of the lower segment of mouse gut and several constituents of gut‐associated lymphoid tissue (GALT) including Peyer's patch, specialized lymphoid nodules in the caecum, small lymphoid aggregates and lymphoid nodules in the colon were studied by using confocal microscopy. Additionally, the innervation and nerve/immune cell interactions in the gut and Peyer's patch were investigated by using cell surface marker PGP9.5 and Glial fibrillary acidic protein (GFAP). In the gut and Peyer's patch, the nerves have contact with B cell, T cell and B220CD3 double‐positive cells. Dendritic cells, the most important antigen‐presenting cells, were closely apposed to some nerves. Some dendritic cells formed membrane–membrane contact with nerve terminals and neuron cell body. Many fine nerve fibres, which are indirectly detected by GFAP, have contact with dendritic cells and other immune cells in the Peyer's patch. Furthermore, the expression of Muscarinic Acetylcholine receptor (subtype M2) was characterized on dendritic cells and other cell population. These findings are expected to provide a route to understand the anatomic basis of neuron‐immune regulation/cross‐talk and probably neuroinvasion of prion pathogens in the gut and GALT.
Effect of Sperm Cryopreservation on the European Eel Sperm Viability and Spermatozoa Morphology
Authors: Asturiano JF , Marco‐Jiménez F , Peñaranda DS , Garzón DL , Pérez L , Vicente JS , Jover M
Published: February 2007

Contents

The main objective of the present work was to study the effect of cryopreservation of European eel sperm both on the sperm viability and the spermatozoa head morphology. Spermatozoa morphology was evaluated with computer‐assisted morphology analysis after collection in fresh samples, after adding the freezing medium containing dimethyl sulfoxide as cryoprotectant and, finally, after the cryopreservation process and thawing. Cell viability was assessed, in both fresh and thawed samples, by Hoechst 33258 staining. Computer‐assisted sperm analysis (CASA) was used to determine the percentage of motile cells and to measure motility parameters in sperm samples. A significant decrease of head perimeter (12.56%) and area (17.90%) was detected from spermatozoa in fresh to thawed samples, indicating that cells do not recover the original size after the cryopreservation process. CASA was used to measure the percentage of motile cells (51.9%) and spermatozoa motility parameters such as curvilinear, straight line and angular path velocities, as well as beating cross frequency. This technique was employed in the fresh sperm samples but proteins present at the freezing medium (L‐α‐phosphatidylcholine) made impossible to use this last technique in thawed samples. When sperm viability was assessed by Hoechst staining, a significant decrease of approximately 15% (73.10 vs 58.26%) of alive spermatozoa was registered from fresh to thawed samples. The percentage of motile cells measured by CASA in fresh samples (51.9%) was lower than the percentage of alive cells determined by Hoechst stainning, suggesting the existence of different batches of spermatozoa in different stages of development, even during the eight to tenth weeks of treatment, when the highest sperm quality was found.
The Embryonic Pregnancy Signal Oestradiol Influences Gene Expression at the Level of Translational Initiation in Porcine Endometrial Cells
Authors: Wollenhaupt K , Brüssow K‐P , Tiemann U , Tomek W
Published: February 2007

Contents

In the pig, conceptus‐derived oestrogens (days 11 and 12 of pregnancy) seem to be a critical component of the signalling mechanism for maternal recognition of pregnancy. Embryonic oestrogens can mediate effects on endometrial function by interactions with epithelial and stromal oestrogen receptors (ER). Recent data demonstrate that cell membrane ER interacts with the phosphatidylinositol 3‐kinase/Akt pathway in several types of cells. The protein kinase Akt is involved in the control of cell growth, survival and proliferation. One distinct function of the Akt signalling cascade is its ability to phosphorylate the eukaryotic initiation factor‐4E (eIF‐4E)‐binding protein 1 (4E‐BP1). This phosphorylation suppresses the inhibitory effect of 4E‐BP1 on the translation initiation factor eIF4E and in such a way potentially stimulates gene expression at the level of translational initiation. The aim of the present study was to examine if embryonic oestradiol (E2) transmits its effect by such a mechanism. Endometrial cells of cyclic gilts (day 13 of the oestrous cycle, n = 4) were cultured and supplemented with vehicle (control), E2(50 and 100 pm/l) or with the selective ER modulator raloxifen (10 and 1000 nm/l), and incubated for 24 h. The cell viability was detected by MTT assay, the abundance and phosphorylation of Akt, 4E‐BP1 and ERαwas analysed by Western blotting. Incubation with E2or raloxifen did not alter endometrial cell viability. The phosphorylation of Akt at Ser473seems to be increased by E2(p < 0.05) and decreased by raloxifen (p > 0.05). Raloxifen (1000 nm/l) induced a band shift in 4E‐BP1 to the highest electrophoretic mobility which reflects a decrease in phosphorylation (p < 0.05), whereas an influence of E2on 4E‐BP1 phosphorylation could not be detected. The decrease (p < 0.05) of the abundance of the 80 kDa ERαform both by E2and raloxifen indicates that the E2‐stimulated Akt phosphorylation and the inhibition of 4E‐BP1 phosphorylation by raloxifen is an E2ER‐transmitted process. Therefore, embryonic oestrogens can potentially transmit their effect by influencing signalling cascades which modulate gene expression at the level of translational initiation.
Lacrimal sac volume measurement during eyelid closure and opening
Authors: Amrith Shantha , Goh Poh Sun , Wang Shih‐Chang
Published: February 2007

Abstract

Background:  Jones’ theory of tear drainage suggests that the lacrimal sac fills when the eyelids are closed and empties when the eyelids are opened. This study was undertaken to see if there is any change in the volume of the lacrimal sac during eyelid closure and opening using images obtained from magnetic resonance dacryocystography using a topical magnetic resonance contrast agent.

Methods:  This is a prospective non‐randomized comparative study in a tertiary hospital setting. Magnetic resonance dacryocystography scans were performed on five volunteers using 0.5% topical gadolinium‐DTPA (MagneVist, Schering AG, Berlin, Germany) as a contrast agent. A T1‐weighted magnetic resonance imaging scan with 2‐mm contiguous coronal cuts was performed after localizing the lacrimal sac and instilling the contrast agent. The scans were performed with eyelids closed and opened. Volumes of 10 lacrimal sacs of five volunteers were calculated using pixel calibration and computer graphics.

Results:  No statistical difference in size of the lacrimal sacs was demonstrable between when the eyes were opened and when they were shut.

Conclusion:  The present study could not demonstrate any volume change in the sac between eyelid closure and opening. Magnetic resonance imaging dacryocystography measures sac volume at two static end‐points, so it cannot show any transient volume change that might occur during blinking. Various factors that may be affecting tear flow through the nasolacrimal system are discussed.
EFFECT OF RE‐STERILIZATION OF SURGICAL SUTURES BY ETHYLENE OXIDE
Authors: Nagaraja Prem Anand , Shetty Devi
Published: February 2007

Background:  Surgical suture packs are opened (and external packaging removed) on the operating table prior to surgery. Some of these suture packs may not be used in the surgery for reasons of inappropriateness or change in the surgical technique or following accidental contact with a non‐sterile surface. These unused sutures with their foil packs still unopened are sometimes re‐sterilized using ethylene oxide to allow for reuse. This re‐sterilization of unopened suture packs can be contentious, due to legislation and health regulations in developed countries. The purpose of the present paper was to measure the effect of such repeated gas sterilization on sutures.

Methods:  The knot tensile strength was measured for new sterile sutures and ethylene oxide re‐sterilized sutures. The tests were conducted on two available brands of sutures, including both absorbable and non‐absorbable synthetic sutures.

Results:  No statistically significant difference was observed in the tensile strengths between the two sets of sutures, before and after re‐sterilization. Some foil packs showed slight crimping after re‐sterilization, but remained intact. No humidity was observed inside the foil packs.

Conclusions:  Re‐sterilization of unused suture foil packs can be carried out without loss of tensile strength.
INTRAOPERATIVE NEUROLOGICAL CHANGES IN 1665 REGIONAL ANAESTHETIC CAROTID ENDARTERECTOMIES PREDICTS POSTOPERATIVE STROKE
Authors: Mayer Raoul C. , Bingley John , Westcott Mark J. , Deshpande Arvind , Davies Micheal J. , Lovelock Mark E. , Vidovich John , Doyle John , Denton Micheal J. , Gurry John F.
Published: February 2007

Background:  To maximize the benefit of carotid endarterectomy (CEA) in stroke prevention its complication rate must be minimized. The purpose of this study was to report the outcomes of a large series of CEA carried out under regional anaesthesia with selective shunting, with particular emphasis on identifying predictors for perioperative stroke and mortality.

Methods:  Between 1987 and 2003 the data for 1665 consecutive regional anaesthetic CEA carried out in 1495 patients were collected prospectively; awake neurological testing facilitated selective shunting. Preoperative data, intraoperative events and postoperative in‐hospital complications were recorded and analysed.

Results:  There were 38 non‐fatal strokes (2.3%) and 10 deaths (0.6%), giving a combined stroke and mortality rate of 2.9%. Only patients who needed shunting were found to have significantly higher rate of postoperative stroke and mortality (7.0 vs 1.9%, P < 0.001). Patient characteristics, comorbidities, indication for operation (P = 0.34) and the degree of stenosis of the contralateral carotid artery (P = 0.65) were not found to be predictive of perioperative stroke or mortality, although the latter two were found to be predictive of the need for shunting (P < 0.001 and P = 0.002).

Conclusion:  Regional anaesthetic CEA is a safe and effective technique with excellent morbidity and mortality rates. The technique can be undertaken safely regardless of the indication for endarterectomy or the status of the contralateral carotid artery. Patients who developed intraoperative neurological changes requiring shunting are identified as high risk for perioperative stroke or mortality and should therefore be carefully monitored postoperatively.
NATIONAL BREAST CANCER AUDIT: DUCTAL CARCINOMA IN SITU MANAGEMENT IN AUSTRALIA AND NEW ZEALAND
Authors: Cuncins‐Hearn Astrid , Boult Margaret , Babidge Wendy , Zorbas Helen , Villanueva Elmer , Evans Alison , Oliver David , Kollias James , Reeve Tom , Maddern Guy
Published: February 2007

Background:  Ductal carcinoma in situ (DCIS) is a significant issue in Australia and New Zealand with rising incidence because of the implementation of mammographic screening. Current information on its natural history is unable to accurately predict progression to invasive cancer. In 2003, the National Breast Cancer Centre in Australia published recommendations for DCIS. In Australia and New Zealand, the National Breast Cancer Audit collects information on DCIS cases. This article will examine these recommendations and provide information from the audit on current DCIS management.

Methods:  Three thousand six hundred and twenty‐nine cases of DCIS were entered by 274 breast surgeons between January 1998 and December 2004. Data items in the National Breast Cancer Audit database that were covered in the National Breast Cancer Centre recommendations were reviewed. Information was available on the following: diagnostic biopsy rates for all cases and mammographically positive cases and rates of breast conserving surgery (BCS), clear margins following BCS, postoperative radiotherapy following BCS for groups at high risk of recurrence as well as axillary procedures and tamoxifen prescription.

Results:  Close adherence was found in diagnostic biopsy, BCS and clear margin rates. Some high‐risk groups received radiotherapy, although women with ‘close’ margins did not in 33% of cases. Axillary procedures were conducted in 23% of cases and most (81%) patients were not prescribed tamoxifen.

Conclusion:  There was predominantly close adherence to recommendations with three possible areas of improvement: fewer axillary procedures, an appraisal of radiotherapy practice following BCS and more investigation into tamoxifen prescription practices for DCIS.
Intervertebral epidural anaesthesia in paediatric surgery: success rate and adverse effects in 650 consecutive procedures
Authors: DALENS B. , CHRYSOSTOME Y.
Published: February 2007

The success rate and occurrence of adverse effects are reported in a retrospective study of 650 (99 sacral, 468 lumbar, 76 thoracic and seven cervical) paediatric epidurals performed, mostly (91%) under light general anaesthesia, by several anaesthetists. Seventeen‐gauge Tuohy and 20‐gauge (Potts‐Cournand® and Tuohy) needles were used. Anaesthetic solutions used were 1% lignocaine, 0.5% bupivacaine and a mixture of equal volumes of 0.5% bupivacaine with either 1% lignocaine or 1% etidocaine, all containing 1:200 000 adrenaline. The epidural space was identified by loss‐of‐resistance technique (LORT) with normal saline, air or CO2. Up to five attempts were occasionally necessary. LORT using fluid resulted in more subarachnoidal penetrations than the LORT using air (P < 0.05) which was easy and reliable but produced patchy anaesthesia (‘painful gaps') in 4.2% of patients. CO2‐LORT was as easy and reliable as air‐LORT and did not result in painful gaps. Lateral and mid‐line insertion routes were equally suitable whatever the level of approach. Twenty‐gauge needles, especially Tuohy needles, resulted in significantly less dural punctures in young children. The spread of the local anaesthetic correlated with the volume injected and the height of the epidural approach. Epidural anaesthesia had little haemodynamic effects. Administration of epidural morphine improved the duration of postoperative pain relief but undesirable effects occurred in up to 50% of patients. Low doses of naloxone (2–5 μg?kg−1.h−1) counteracted most adverse effects, avoiding urinary retention and delayed apnoea. Anaesthetists and residents without experience in paediatric anaesthesia had a good success rate in performing the techniques (under supervision of an experienced anaesthetist). At the same time, experience in regional anaesthesia would significantly boost the confidence of the anaesthetist in managing such cases. The authors recommend using CO2 instead of air in the LORT.
Propofol in paediatric anaesthesia
Authors: MORTON N.S. , JOHNSTON G. , WHITE M. , MARSH B.J.
Published: February 2007

Propofol has been used in paediatric anaesthesia since 1985 and an increasing body of evidence has shown that it is a safe, effective induction agent which has dose‐related side‐effects comparable with other agents. Pain on injection can be ameliorated by the use of antecubital veins or by pre‐mixing an adequate amount of lignocaine with propofol immediately prior to administration. The pharmacokinetics of propofol are different in children with their larger central compartment volume and clearance reflected in higher dose requirements for induction and maintenance of anaesthesia. This has important implications when propofol is given for sedation or anaesthesia by continuous infusion.
Anaesthesia for primary repair of cleft lip and cleft palate: a review of 244 procedures
Authors: DOYLE E. , HUDSON I.
Published: February 2007

The peri‐operative course of 194 patients undergoing 244 procedures for primary repair of cleft lip and palate over an 8‐year‐period was studied. A marked increase in the extent of intra‐operative monitoring was noted during this period. The Pierre Robin syndrome was the most common associated abnormality and was found in 17% of patients in this series. There were no deaths. A total of 101 procedures were undertaken in infants with cleft lip of whom 10% received an intra‐operative blood transfusion. Post‐operative opiate analgesics were administered following 97% of these procedures and profound respiratory depression was observed in three children. The use of lignocaine and noradrenaline did not significantly reduce the operative blood loss. A post‐operative pyrexial illness was significantly associated with the presence of a positive pre‐operative nasal and throat swab and this could be significantly reduced by pre‐operative antibiotic treatment. A total of 143 children underwent repair of cleft palate and of these 16.8% received an operative blood transfusion. An elective tracheostomy was required in one patient because of unsuccessful attempts at endotracheal intubation. One patient developed a respiratory arrest after two doses of diamorphine peri‐operatively. The use of lignocaine and noradrenaline significantly reduced the operative blood loss. The presence of a positive bacteriological nose or throat swab did not influence the development of a post‐operative pyrexia which could however be significantly reduced by the use of pre‐operative antibiotics.
Location of the paravertebral space in children and adolescents in relation to surface anatomy assessed by computed tomography
Authors: P. A. LÖNNQVIST MD, DEAA  , U. HESSER MD
Published: February 2007

A series of 52 thoracic and/or upper abdominal computer tomography scans were reviewed in order to determine the optimal puncture site and depth for performing paravertebral blocks in the mid‐thoracic region in children and adolescents. Both the lateral distance from the spinous process to the paravertebral space (SP‐PVS distance) and the depth from the skin to the paravertebral space (S‐PVS depth) correlated well (r values 0.86–0.95) to all patient related parameters (age, height, weight and body surface area). Since patient weight is usually readily obtainable and correlates well with both SP‐PVS distances (r= 0.89; SP‐PVS distance (mm) = 0.12 x body weight (kg) + 10.2) and S‐PVS depth (r= 0.95; S‐PVS depth (mm) = 0.48 x body weight (kg) + 18.7) this parameter might provide the best and easiest prediction of the location of the paravertebral space when performing paravertebral blocks in children and adolescents.
Stability of the laryngeal mask airway during marked extension of the head
Authors: GOUDSOUZIAN N.G. , CLEVELAND R.
Published: February 2007

The position of the laryngeal mask airway (LMA) was ascertained in a two‐year‐old child by computerized tomographic images during slight flexion and marked extension of the head. No change of the quality of the airway was noted and there was no evidence of obstruction or dislocation of the LMA on the scans.
Continuous rectus sheath block analgesia for an infant with bronchopulmonary dysplasia
Authors: CORNISH P. , ANDERSON B. , CHAMBERS C.
Published: February 2007

A 12‐month infant with severe bronchopulmonary dysplasia and gastro‐oesophageal reflux presented for a Nissen fundoplication under general anaesthesia. Post‐operative pain was successfully managed with a continuous rectus sheath infusion of bupivacaine 0.25% 0.1 ml·kg−1·h−1 through an indwelling catheter which facilitated a rapid return to pre‐operative respiratory function.
Experiences with a reference directory for the perioperative care of children with rare diseases
Authors: ABEL M. , DIEFENBACH C.
Published: February 2007

A computerized reference data bank for the anaesthetic management and postoperative care of children with syndromes and rare disorders was established two years ago. It contains data on some 2000 syndromes and rare diseases. Updating of the directory is done by regular review of the literature and dialogue with the users. Between January 1991 and January 1993 this interdisciplinary service received 169 telephone, fax or postal calls for advisory service from physicians of all specialities connected with the field of operative paediatrics. The consultations concerned 79 patients with dysmorphias, 58 infants with metabolic disorders and 32 patients with complex or unclassified syndromes. About 58% of the patients were aged under three years. Although the structure of the data bank allows for an advisory service tailored to the individual needs, only 63% of the consultations could be given based upon published anaesthetic experiences of similiar cases. In the absence of anaesthetic case reports, advice for the other cases had to derived from the principles of general paediatric anaesthesia practice. In only 48 of the consultations (28%) was the user's experience reported and could then be stored in the directory.
Post‐operative analgesia with caudal epidural sufentanil
Authors: SEIXAS BAPTISTA JOSÉ , CELESTE DIAS M.
Published: February 2007

The effectiveness of post‐operative analgesia and the frequency of side effects of caudal epidural sufentanil with bupivacaine plus adrenaline was compared with bupivacaine plus adrenaline alone and morphine with bupivacaine plus adrenaline. One hundred and four children scheduled for subdiaphragmatic surgery were studied and divided in three groups. The results showed that epidural sufentanil with bupivacaine provided better analgesia than bupivacaine alone with fewer side effects compared with the group who received morphine and bupivacaine.
Is adenoidectomy in children safer with laryngeal mask airway or with tracheal intubation?
Authors: DUBREUIL MARC , CROS ANNE MARIE , BOUDEY CHRISTIAN , ESTEBEN DOMINIQUE , MILACIC MARTINE
Published: February 2007

Adenoidectomy in paediatric outpatient surgery is assumed to require tracheal intubation (TT). The laryngeal mask airway (LMA) commonly used for general paediatric surgery has never been previously studied for adenoidectomy. We therefore prospectively compared in a randomized manner, the incidence of complications with TT and LMA in 56 children undergoing adenoidectomy. Preoperative, intraoperative and the lowest SPO2 values after removal of either TT or LMA were recorded. The respiratory complications, cough, stridor and/or laryngospasm, were recorded intraoperatively and after removal of the airway device. The oxygen saturation levels were significantly higher in the laryngeal mask airway group both intraoperatively and after removal of the respiratory device (P<0.05). The incidence of respiratory complications was lower in the LMA group. In conclusion we have shown that the laryngeal mask airway with a flexometallic tube is a satisfactory alternative to tracheal intubation for outpatient paediatric adenoidectomy.
Hyperactivity following Vallergan premedication
Authors: THORPE C.M.
Published: February 2007

A child developed signs of hyperactivity following Vallergan (trimeprazine) premedication. Possible causes for this are discussed, and the current opinions on hyperactivity reviewed.
Recovery times following induction of anaesthesia with propofol, methohexitone, enflurane or thiopentone in children
Authors: SHARPLES A. , SHAW E.A. , MEAKIN G.
Published: February 2007

We have measured the times to early recovery in forty children aged 3‐14 years in whom anaesthesia was induced by intravenous propofol, methohexitone, thiopentone or inhalation of enflurane. Maintenance anaesthesia consisted of inhalation of nitrous oxide, oxygen and enflurane via a face mask. Early recovery, assessed by the Steward recovery score, was significantly faster after propofol, methohexitone or inhalation of enflurane compared with thiopentone (P < 0.01). There were no significant differences in recovery times between propofol, methohexitone or enflurane. We conclude that the use of propofol to induce anaesthesia does not hasten recovery in children undergoing short day‐case procedures compared with methohexitone or inhalation of enflurane.
Long‐term patient‐controlled analgesia in terminal care
Authors: DOYLE E. , MORTON N.S.
Published: February 2007

A case of prolonged use of patient‐controlled analgesia in terminal care is described. The patient was able to self‐administer large doses of morphine as required to maintain comfort and a reasonable sleep pattern without undue nausea, vomiting or sedation.