bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental health inequalities and mental health nursing
Authors: ELLIOTT L. , MASTERS H.
Published: June 2009

Accessible summary

Current research clearly shows that mental health problems occur more frequently in some social groups than others. These inequalities in mental health affect people in many developed countries. For example, depression and anxiety are more common among poorer people than richer people. Depression is more common among women while suicide is more common among men. There are higher rates of certain mental health problems among ethnic minorities. People with long‐term mental health problems also have poorer physical health compared with those in the general population. These differences are thought to be determined by a person's economic, social and cultural position in society. There is additional evidence that mental health inequalities can be made worse by poor service provision or by people not using the existing services.

This paper examines what mental health nurses might do to address inequalities in mental health. It concludes that mental health nurses have a key role to play in helping to shape existing physical and mental health services so that these services are more accessible and helpful for those who use them. However, we also conclude that health services, including nursing, may not be powerful enough to tackle some of the underlying causes of mental health inequalities. One such cause is poverty, which needs extensive government action. We also think that these limitations are not clearly stated in current policy for mental health nurses and should be set out more clearly in policy and indeed training initiatives.

Reducing inequalities in health, including mental health, is of high priority in many national policies. However, it is not yet known how mental health nurses might respond to these policies. Using examples from the available evidence, we argue that the causes of mental health inequalities are complex and thought to arise from fundamental divisions in society. These divisions are formed by social relationships, which areinfluenced by deep social structures, such as the economy or culture. The extensive range of social determinants means that there is no single explanation of why inequalities in mental health might occur. It also suggests that these determinants may act synergistically to create pockets of inequity where health needs are most complex. This poses difficult challenges for mental health nurses who undoubtedly have a key role in addressing mental health inequalities, although their role is likely to be restricted to service redesign and delivery. Mental health nurses are unlikely to address some of the deeper structural determinants of mental health inequalities, such as poverty, which can only be tackled through government‐led reforms. Furthermore, we must be mindful of the possibility that services offered by mental nurses may have an uneven uptake across social classes, which in turn could serve to maintain or worsen mental health inequalities. Therefore, a key question for mental health nursing, policy and training is whether these limitations are clearly recognized.
Self‐help CBT for depression: opportunities for primary care mental health nurses?
Authors: WARRILOW A. E. , BEECH B.
Published: June 2009

Accessible summary

There is currently a big demand for effective and accessible treatments for common mental health problems, but waiting lists are often long.

The aim of this review is to discover whether self‐help cognitive behavioural therapy materials are effective in the treatment of depression.

It explores a possible role for mental health nurses within primary care to provide access to and low‐level support with, these materials.

A possible model for organizing such a service is suggested.

Mental health treatments that are effective and accessible to the general population are in high demand. Cognitive behavioural therapy (CBT) has been shown to be effective and is popular but such treatments are difficult to access especially within primary care, causing delay, frustration and suffering. One approach to meeting demand would be through the use of self‐help CBT materials that aim to address common mental health problems such as depression. The aim of this review is to discover whether self‐help CBT materials are effective in the treatment of depression and how mental health nurses within primary care can use their skills to provide access and low‐level support. Studies critiqued within this literature review indicate that self‐help CBT is effective for the treatment of depression. However, there is a lack of evidence that specifically considers self‐help CBT for the treatment of depression in primary care. This review addresses the question of how much nurse client contact is needed to provide adequate support for the facilitation of self‐help CBT in depression with primary care patients and recommends the use of a service delivery model. However, more research needs to be carried out on the application of self‐help CBT for depression in primary care.
Increase in serum haptoglobin and apolipoprotein M in patients with obstructive sleep apnoea
Authors: KIM JINKWAN , LEE SEUNGGWAN , IN KWANGHO , KIM JEHYEONG , YOU SEHWA , KANG KYUNGHO , SIM JAEJEONG , LEE SANGYEUB , YOON DAEWUI , LEE JUNGBOK , SHIN CHOL
Published: June 2009

Obstructive sleep apnoea (OSA) is a common syndrome, which is associated with a number of medical problems that impact morbidity and mortality. Although the precise mechanisms that underlie these associations are not fully understood, previous studies have suggested that patients with OSA show elevations of several biomarkers that are associated with cardiovascular risk. This study was undertaken to identify serum proteins associated with OSA by using a proteomics technique and to examine changes in identified protein levels after continuous positive airway pressure treatment. The study participants consisted of 40 male patients (aged 40–49 years) with severe OSA and 34 male control subjects matched for age and body mass index. All subjects underwent polysomnography. Using a proteomics approach, we identified nine proteins that were differentially expressed in patients with severe OSA and controls. Three of these nine proteins, haptoglobin, paraoxonase‐1 and apolipoprotein M, were quantified by using enzyme‐linked immunosorbent assays, kinetic assays and by using Western blotting. Multiple regression analysis showed that haptoglobin and apolipoprotein M levels are independently related to apnoea–hypopnoea index (P < 0.01). A further study is required to determine the nature of associations between these identified proteins and OSA in a large population.
The Plasmodium falciparum protein Pfg27 is dispensable for gametocyte and gamete production, but contributes to cell integrity during gametocytogenesis
Authors: Olivieri Anna , Camarda Grazia , Bertuccini Lucia , Van De Vegte‐Bolmer Marga , Luty Adrian J. F. , Sauerwein Robert , Alano Pietro
Published: June 2009

In the human malaria parasite Plasmodium falciparum, gametocyte maturation is a process remarkably longer than in other malaria species, accompanied by expression of 2–300 sexual stage‐specific proteins. Disruption of several of their encoding genes so far showed that only the abundant protein Pfg27, produced at the onset of sexual differentiation, is essential for gametocyte production. In contrast with what has been previously described, here we show that P. falciparum pfg27 disruptant lines are able to undergo all stages of gametocyte maturation, and are able to mature into gametes. A fraction of Pfg27‐defective gametocytes show, however, distinct abnormalities in intra‐ and extra‐cellular membranous compartments, such as accumulation of parasitophorous vacuole‐derived vesicles in the erythrocyte cytoplasm, large intracellular vacuoles and discontinuities in their trilaminar cell membrane. This work revises current knowledge on the role of Pfg27, indicating that the protein is not required for parasite entry into sexual differentiation, and suggesting that it is instead involved in maintaining cell integrity in the uniquely long gametocytogenesis of P. falciparum.
Activation and repression of a σN‐dependent promoter naturally lacking upstream activation sequences
Authors: Porrúa Odil , García‐González Vicente , Santero Eduardo , Shingler Victoria , Govantes Fernando
Published: June 2009

The Pseudomonas sp. strain ADP protein AtzR is a LysR‐type transcriptional regulator required for activation of the atzDEF operon in response to nitrogen limitation and cyanuric acid. Transcription of atzR is directed by the σN‐dependent promoter PatzR, activated by NtrC and repressed by AtzR. Here we use in vivo and in vitro approaches to address the mechanisms of PatzR activation and repression. Activation by NtrC did not require any promoter sequences other than the σN recognition motif both in vivo and in vitro, suggesting that NtrC activates PatzR in an upstream activation sequences‐independent fashion. Regarding AtzR‐dependent autorepression, our in vitro transcription experiments show that the concentration of AtzR required for repression of the PatzR promoter in vitro correlates with AtzR affinity for its binding site. In addition, AtzR prevents transcription from PatzR when added to a preformed E‐σN–PatzR closed complex, but isomerization to an open complex prevents repression. Gel mobility shift and DNase I footprint assays indicate that DNA‐bound AtzR and E‐σN are mutually exclusive. Taken together, these results strongly support the notion that AtzR represses transcription from PatzR by competing with E‐σN for their overlapping binding sites. There are no previous reports of a similar mechanism for repression of σN‐dependent transcription.
4‐Nitrotryptophan is a substrate for the non‐ribosomal peptide synthetase TxtB in the thaxtomin A biosynthetic pathway
Authors: Johnson Evan G. , Krasnoff Stuart B. , Bignell Dawn R. D. , Chung Wen‐Chuan , Tao Tao , Parry Ronald J. , Loria Rosemary , Gibson Donna M.
Published: June 2009

Thaxtomin A, a cyclic dipeptide with a nitrated tryptophan moiety, is a phytotoxic pathogenicity determinant in scab‐causing Streptomyces species that inhibits cellulose synthesis by an unknown mechanism. Thaxtomin A is produced by the action of two non‐ribosomal peptide synthetase modules (TxtA and TxtB) and a complement of modifying enzymes, although the order of biosynthesis has not yet been determined. Analysis of a thaxtomin dual module knockout mutant and single module knockout mutants revealed that 4‐nitrotryptophan is an intermediate in thaxtomin A biosynthesis prior to backbone assembly. The 4‐nitrotryptophan represents a novel substrate for non‐ribosomal peptide synthetases. Through identification of N‐methyl‐4‐nitrotryptophan in a single module knockout and the use of adenylation domain specificity prediction software, TxtB was identified as the non‐ribosomal peptide synthetase module specific for 4‐nitrotryptophan.
Influence of intra‐oesophageal capsaicin instillation on heartburn induction and oesophageal sensitivity in man
Authors: Kindt S. , Vos R. , Blondeau K. , Tack J.
Published: June 2009

Abstract Heartburn is the most typical gastro‐oesophageal reflux disease (GERD) symptom. The transient receptor potential vanilloid receptor‐1 (TRPV1) is a candidate mediator of heartburn. Exposure of TRPV1to capsaicin is characterized byactivation, followed bydesensitization. Our aim was to investigate the effect of intra‐oesophageal capsaicin instillation on oesophageal symptom perception (activation) and on sensitivity to oesophageal acid perfusion and oesophageal balloon distention (desensitization). In a first protocol (n = 10), saline or capsaicin solution were instilled in the mid‐oesophagus and symptoms were rated at 5‐min intervals for 60 min. In a second study (n = 10), oesophageal 0.1 N hydrochloric acid perfusion was performed 60 min after pretreatment with saline, low or high dose capsaicin. In a third study (n = 10), sensitivity to oesophageal balloon distention was determined before and at 30‐min intervals up to 90 min after pretreatment with saline, low or high dose capsaicin. Areas under the curve (AUC) for symptom intensities under different conditions were calculated and compared with Kruskal–Wallis test. Oesophageal capsaicin instillation induced transient symptoms of retrosternal and epigastric burning in a dose‐dependent fashion. After oesophageal capsaicin or saline instillation, there was no difference in symptom pattern and intensities induced by oesophageal acid perfusion. After oesophageal capsaicin or saline instillation, sensitivity to oesophageal balloon distention and oesophageal compliance were not significantly altered. Oesophageal instillation of the TRPV1receptor agonist capsaicin induces symptoms of retrosternal and epigastric burning in a dose‐dependent fashion. Pretreatment with capsaicin does not desensitize the oesophagus to acid perfusion or to balloon distention.
Loss of intramuscular and submuscular interstitial cells of Cajal and associated enteric nerves is related to decreased gastric emptying in streptozotocin‐induced diabetes
Authors: Wang X‐y. , Huizinga J. D. , Diamond J. , Liu L. W. C.
Published: June 2009

Abstract  Interstitial cells of Cajal (ICC) are associated with afferent innervation and peristalsis of the stomach suggestive of a key role in the pathophysiology of gastroparesis. We studied changes in the density and ultrastructure of ICC and enteric nerves in the streptozotocin‐induced diabetes mellitus (STZ‐DM) in Wistar rats using immunohistochemistry and electron microscopy. Gastric emptying was studied in vivo by single‐photon emission computed tomography. In the STZ‐DM antrum, a marked reduction was observed in the density of the intramuscular ICC (ICC‐IM) and ICC located at the submucosal border of the circular muscle layer of the antrum (ICC‐SM). The surviving ICC showed lamellar bodies and partial vacuolation of the cytoplasm content, loss of connections between ICC‐IM and nerves; it appeared that injured ICC‐IM developed into fibroblast‐like ICC. ICC associated with Auerbach’s plexus (ICC‐AP) in the antrum and ICC in the fundus were not affected significantly except for a loss of connections with nerve structures. Marked reduction in nerve tissue (Protein Gene Product‐9.5 positivity) was also restricted to the muscle layers including nitrergic nerves (neuronal nitric oxide synthase positivity). In vivo assessed gastric emptying was markedly reduced in STZ‐DM rats. Our data demonstrate in the STZ‐DM rat stomach a decreased density of ICC limited to the antrum and to ICC‐IM and ICC‐SM, and structural degeneration in ICC‐IM and associated nerves with a special emphasis on loss of synaptic connections, accompanied by a decrease in gastric emptying. Hence, in this model of gastroparetic diabetes, regional injury to subsets of ICC and nerves are associated with gastric motor dysfunction.
Time‐course of recovery of gastric emptying and motility in rats with experimental spinal cord injury
Authors: Qualls‐creekmore E. , Tong M. , Holmes G. M.
Published: June 2009

Abstract  We have shown recently that spinal cord injury (SCI) decreases basal gastric contractions 3 days after injury. In the present study we used the [13C]‐octanoic acid breath test and gastric strain gauges with the aim to investigate the time‐course of recovery from postinjury gastric stasis in rats that underwent experimental SCI at the level of the third thoracic (T3) vertebra. Following verification of the [13C]‐breath test sensitivity in uninjured rats, we conducted our experiments in rats that underwent T3‐ spinal contusion injury (T3‐CI), T3‐spinal transection (T3‐TX) or laminectomy (control) surgery at 3 days, 1, 3 or 6 weeks postinjury. Our data show that compared to rats that underwent laminectomy, rats that received SCI showed a significant reduction in the cumulative per cent [13C] recovery. Although more marked in T3‐TX rats, the delayed gastric emptying in T3‐CI and T3‐TX rats was comparable in the 3 days to 3 weeks period postinjury. At 6 weeks postinjury, the gastric emptying in T3‐CI rats recovered to baseline values. Conversely animals in the T3‐TX group still show a significantly reduced gastric emptying. Interestingly, the almost complete functional recovery observed in T3‐CI rats using the [13C]‐breath test was not reflected by analysis of spontaneous gastric contractions after SCI. These data indicate that T3‐SCI produces a significant reduction in gastric emptying independent of injury severity (T3‐CI vs T3‐TX) that persists for at least 3 weeks after injury. However, 6 weeks postinjury T3‐CI, but not T3‐TX, rats begin to demonstrate functional recovery of gastric emptying.
Activation of protease‐activated receptor‐4 inhibits the intrinsic excitability of colonic dorsal root ganglia neurons
Authors: Karanjia R. , Spreadbury I. , Bautista‐cruz F. , Tsang M. E. , Vanner S.
Published: June 2009

Abstract  The antinociceptive mechanism underlying protease‐activated receptor‐4 (PAR4) activation was studied in Fast Blue‐labelled dorsal root ganglia (DRG) neurons from mouse colon which expressed transcript for PAR4. Whole cell perforated patch clamp recordings were obtained from these neurons and the effects on neuronal excitability of PAR4 activating peptides (AP) and reverse peptides (RP) were examined. A 3‐min application of PAR4‐AP (100 μmol L−1) markedly suppressed the number of action potential discharged at twice rheobase for up to 60 min. PAR4‐RP had no effect. PAR4 application suppresses the excitatory effects of PAR2. These findings demonstrated that activation of PAR4 on colonic DRG neurons suppresses their excitability, suggesting these receptors could provide important targets for modifying pain in colonic GI disorders such as IBS and IBD.
IRREGULAR TRICHOME BRANCH 2 (ITB2) encodes a putative aminophospholipid translocase that regulates trichome branch elongation in Arabidopsis
Authors: Zhang Xiaoguo , Oppenheimer David G.
Published: June 2009

The P4 ATPase family in Arabidopsis consists of 12 members that encode putative aminophospholipid translocases (ALA1–12). Until recently, no mutations in these genes have been shown to cause a visible phenotype, although reduced expression of ALA1 in transgenic plants expressing an antisense construct has been shown to result in reduced plant size when plants were grown under cold conditions. During a genetic screen for mutations that affect trichome shape, we isolated several alleles of the irregular trichome branch 2 (itb2) mutation. Subsequent positional cloning of this locus showed that ITB2 encoded ALA3. Phenotypic and genetic analyses of multiple itb2 alleles, including the T‐DNA insertion alleles, showed that the loss of ITB2/ALA3 function leads to aberrant trichome expansion, reduced primary root growth and longer root hairs. We also found that itb2/ala3 mutant pollen does not grow as well as wild‐type pollen, leading to severe segregation distortion. Our results suggest that aminophospholipid translocases play an important role in the polar growth of plant cells, which is consistent with the proposed role of ALA3 in membrane trafficking. Furthermore, itb2/ala3 mutants provide a convenient visible phenotype for further genetic analysis of the ALA family in Arabidopsis.
Lipid microdomain polarization is required for NADPH oxidase‐dependent ROS signaling in Picea meyeri pollen tube tip growth
Authors: Liu Peng , Li Rui‐Li , Zhang Liang , Wang Qin‐Li , Niehaus Karsten , Baluška František , Šamaj Jozef , Lin Jin‐Xing
Published: June 2009

The polarization of sterol‐enriched lipid microdomains has been linked to morphogenesis and cell movement in diverse cell types. Recent biochemical evidence has confirmed the presence of lipid microdomains in plant cells; however, direct evidence for a functional link between these microdomains and plant cell growth is still lacking. Here, we reported the involvement of lipid microdomains in NADPH oxidase (NOX)‐dependent reactive oxygen species (ROS) signaling in Picea meyeri pollen tube growth. Staining with di‐4‐ANEPPDHQ or filipin revealed that sterol‐enriched microdomains were polarized to the growing tip of the pollen tube. Sterol sequestration with filipin disrupted membrane microdomain polarization, depressed tip‐based ROS formation, dissipated tip‐focused cytosolic Ca2+ gradient and thereby arrested tip growth. NOX clustered at the growing tip, and corresponded with the ordered membrane domains. Immunoblot analysis and native gel assays demonstrated that NOX was partially associated with detergent‐resistant membranes and, furthermore, that NOX in a sterol‐dependent fashion depends on membrane microdomains for its enzymatic activity. In addition, in vivo time‐lapse imaging revealed the coexistence of a steep tip‐high apical ROS gradient and subapical ROS production, highlighting the reported signaling role for ROS in polar cell growth. Our results suggest that the polarization of lipid microdomains to the apical plasma membrane, and the inclusion of NOX into these domains, contribute, at least in part, to the ability to grow in a highly polarized manner to form pollen tubes.
Plasma membrane‐associated proline‐rich extensin‐like receptor kinase 4, a novel regulator of Ca2+ signalling, is required for abscisic acid responses in Arabidopsis thaliana
Authors: Bai Ling , Zhang Guozeng , Zhou Yun , Zhang Zhaopei , Wang Wei , Du Yanyan , Wu Zhongyi , Song Chun‐Peng
Published: June 2009

Plant roots respond to environmental stresses or the exogenous plant hormone abscisic acid (ABA) by undergoing marked physiological and morphological changes. We show here that PERK4, a gene that encodes a member of the Arabidopsis thaliana proline‐rich extensin‐like receptor kinase family, plays an important role in ABA responses. Mutation of PERK4 by T‐DNA insertion decreased sensitivity to ABA with respect to seed germination, seedling growth and primary root tip growth. The effect on root growth was due to enhanced cell elongation rather than cell division. The cytosolic free calcium concentration and Ca2+ channel currents were lower in perk4 root cells than in wild‐type cells in the presence of ABA. Root growth was similar in wild‐type and perk4 plants after the application of a Ca2+ channel blocker. PERK4 localised to the plasma membrane, and was shown to be an ABA‐ and Ca2+‐activated protein kinase. Our data suggest that the receptor‐like kinase encoded by PERK4 functions at an early stage of ABA signalling to inhibit root cell elongation by perturbing Ca2+ homeostasis.
A role for circadian evening elements in cold‐regulated gene expression in Arabidopsis
Authors: Mikkelsen Michael D. , Thomashow Michael F.
Published: June 2009

The plant transcriptome is dramatically altered in response to low temperature. The cis‐acting DNA regulatory elements and trans‐acting factors that regulate the majority of cold‐regulated genes are unknown. Previous bioinformatic analysis has indicated that the promoters of cold‐induced genes are enriched in the Evening Element (EE), AAAATATCT, a DNA regulatory element that has a role in circadian‐regulated gene expression. Here we tested the role of EE and EE‐like (EEL) elements in cold‐induced expression of two Arabidopsis genes, CONSTANS‐like 1 (COL1; At5g54470) and a gene encoding a 27‐kDa protein of unknown function that we designated COLD‐REGULATED GENE 27 (COR27; At5g42900). Mutational analysis indicated that the EE/EEL elements were required for cold induction of COL1 and COR27, and that their action was amplified through coupling with ABA response element (ABRE)‐like (ABREL) motifs. An artificial promoter consisting solely of four EE motifs interspersed with three ABREL motifs was sufficient to impart cold‐induced gene expression. Both COL1 and COR27 were found to be regulated by the circadian clock at warm growth temperatures and cold‐induction of COR27 was gated by the clock. These results suggest that cold‐ and clock‐regulated gene expression are integrated through regulatory proteins that bind to EE and EEL elements supported by transcription factors acting at ABREL sequences. Bioinformatic analysis indicated that the coupling of EE and EEL motifs with ABREL motifs is highly enriched in cold‐induced genes and thus may constitute a DNA regulatory element pair with a significant role in configuring the low‐temperature transcriptome.
High intestinal IgA associates with reduced risk of IgE‐associated allergic diseases
Authors: Kukkonen Kaarina , Kuitunen Mikael , Haahtela Tari , Korpela Riitta , Poussa Tuija , Savilahti Erkki
Published: June 2009

Kukkonen K, Kuitunen M, Haahtela T, Korpela R, Poussa T, Savilahti E. High intestinal IgA associates with reduced risk of IgE‐associated allergic diseases. Pediatr Allergy Immunol 2010: 21: 67–73. © 2009 John Wiley & Sons A/S

Development of oral tolerance and its stimulation by probiotics are still incomprehensible. Microbial stimulation of the gut may induce a subtle inflammation and induce secretion of mucosal IgA, which participates in antigen elimination. In a cohort of allergy‐prone infants receiving probiotics and prebiotics or placebo we studied intestinal IgA and inflammation in the development of eczema, food allergy, asthma, and rhinitis (allergic diseases). We performed a nested unmatched case–control study of 237 infants participating in a randomized double‐blind placebo‐controlled allergy‐prevention trial using a combination of four probiotic strains pre‐natally and during 6 months form birth. We measured faecal IgA, α1‐antitrypsin (α1‐AT), tumour necrosis factor‐alpha (TNF‐α), and calprotectin at the age of 3 and 6 months. By age 2 yr, 124 infants had developed allergic disease or IgE‐sensitization (cases) and 113 had not (controls). In infants with high faecal IgA concentration at the age of 6 months, the risk of having any allergic disease before the age of 2 yr tended to reduce [odds ratio (OR: 0.52)] and the risk for any IgE‐associated (atopic) disease reduced significantly (OR: 0.49). High faecal calprotectin at the age of 6 months associated also with lower risk for IgE‐associated diseases up to age 2 yr (OR: 0.49). All faecal inflammation markers (α1‐AT, TNF‐α, and calprotectin) correlated positively with faecal IgA (p < 0.001). Probiotics tended to augment faecal IgA (p = 0.085) and significantly increased faecal α1‐AT (p = 0.001). High intestinal IgA in early life associates with minimal intestinal inflammation and indicates reduced risk for IgE‐associated allergic diseases.
Indications for combined liver and kidney transplantation in children
Authors: Chava Srinivas P. , Singh Balbir , Pal Sujoy , Dhawan Anil , Heaton Nigel D.
Published: June 2009

Abstract:  A significant number of patients awaiting liver transplantation have associated renal failure and renal dysfunction is associated with increased morbidity and mortality after LT. There has been a recent increase in the number of CLKT in adults. The common indications for CLKT in children are different from those of adults and include metabolic diseases affecting the kidney with or without liver dysfunction and congenital developmental abnormalities affecting both organs. The results are generally encouraging among these groups of patients. Early evaluation and listing of patients before they become severely ill or have major systemic manifestations of their metabolic problem are important.
Preemptive therapy is not adequate for prevention of cytomegalovirus disease in pancreas–kidney transplant recipients
Authors: López‐Medrano F. , Rueda B. , Lizasoain M. , Juan R. San , Folgueira D. , Andrés A. , Morales J. M. , Jiménez C. , Meneu J. C. , Aguado J. M.
Published: June 2009

Background. Cytomegalovirus (CMV) remains the most common viral infection after pancreas–kidney transplantation (PKT). Comparative studies about CMV prophylaxis in PKT have not been developed.

Methods. We analyzed CMV disease in a cohort of 84 PKT recipients. All received intravenous ganciclovir during treatment with anti‐thymocyte globulin and later one of the following options for pre‐transplant CMV‐seropositive recipients: (a) no prophylaxis (n=10 patients), (b) preemptive therapy (PT) (n=13), or (c) continuous prophylaxis (CP) for 12 weeks (n=29). Pre‐transplant CMV‐seronegative recipients received CP (n=21).

Results. Eleven patients were excluded because of organ explantation in the first 15 days. Incidence of CMV disease in seropositive recipients was 30% under no prophylaxis, 23% under PT, and 6.9% under CP. Incidence of CMV disease under CP was 33.3% in seronegative recipients. Six of 9 episodes of CMV disease under CP occurred after finishing prophylaxis. Under CP, the incidence of CMV disease was significantly higher in seronegative than in seropositive recipients (P<0.05).

Conclusion. According to the results of our study, for CMV‐seropositive PKT recipients, CP is a better strategy than PT. For CMV‐seronegative recipients, 3 months of CP is an inadequate strategy.
Phosphodiesterase inhibition by naloxone augments the inotropic actions of β‐adrenergic stimulation
Authors: PARK W. K. , CHANG C. H. , CHAE J. E. , KIM M. H. , CHO Y. L. , AHN D. S.
Published: June 2009

Background: In a shock state, naloxone generates the cardiovascular pressor effect by displacing the endogenous opiate‐like peptide β‐endorphin, resulting in restoration of the normal response to catecholamines. In addition to this opioid antagonistic effect, the non‐opiate receptor‐mediated effect has also been proposed. The aim of this study was to define the mechanism of non‐opiate receptor‐mediated action of naloxone.

Methods: In guinea‐pig ventricular tissues, cumulative concentration–response curves for isoproterenol as well as for forskolin and 3‐isobutylmethylxanthine (IBMX) were obtained by increasing the concentration stepwise. To assess the effect on the phosphodiesterase (PDE), the effects of naloxone on contractile forces induced by isoproterenol (0.05 μM) in the presence of IBMX, cilostamide (a PDE III inhibitor), or rolipram (a PDE IV inhibitor) were observed. Naloxone‐induced changes in cAMP production by isoproterenol both in the absence and in the presence of IBMX were measured. Naloxone‐induced changes in cAMP production by forskolin in the presence of IBMX were also measured.

Results: Naloxone (30 μM) produced a leftward shift of the isoproterenol concentration–response curve (0.01–2 μM) without changing the maximal response. Forskolin (0.5–10 μM) produced a concentration‐dependent increase in contractile forces. Naloxone increased the maximal inotropic response of forskolin. Naloxone showed no effect on the IBMX concentration–response curve. In the presence of IBMX (200 μM), naloxone did not alter the contractions evoked by isoproterenol or forskolin. Whereas naloxone increased contractile forces significantly (approximately 25%) more than that of isoproterenol in the presence of rolipram, no alteration of contractile forces in the cilostamide‐incubated muscles was observed. Naloxone caused a concentration‐related increase of cAMP in the absence of IBMX, but caused no change in its presence.

Conclusions: The enhancement of myocardial contractility by naloxone in the presence of stimulation of adenylyl cyclase activity appears to be mediated by inhibition of PDE, specifically PDE III.
Photoplethysmography and nociception
Authors: KORHONEN I. , YLI‐HANKALA A.
Published: June 2009

Photoplethysmography (PPG), i.e. pulse oximetric wave, is a non‐invasive technique that is used in anaesthesia monitoring primarily to monitor blood oxygenation. The PPG waveform resembles that of the arterial blood pressure but instead of pressure it is related to the volume changes in the measurement site and hence contains information related to the peripheral blood circulation, including skin vasomotion, which is controlled by the sympathetic nervous system. Because of this link, skin vasomotor response and PPG amplitude response have been associated with nociception under general anaesthesia. Recently, there has been interest in monitoring nociception during general anaesthesia. In many of the published studies, PPG waveform information has been included. The focus of this topical review is to provide an overview on the information embedded in the PPG waveform especially in the context of the autonomic nervous system and analgesia monitoring.
The occurrence of intra‐operative hypotension varies between hospitals: observational analysis of more than 147,000 anaesthesia
Authors: TAFFÉ P. , SICARD N. , PITTET V. , PICHARD S. , BURNAND B. ,   for the ADS study group
Published: June 2009

Background: Hypotension, a common intra‐operative incident, bears an important potential for morbidity. It is most often manageable and sometimes preventable, which renders its study important. Therefore, we aimed at examining hospital variations in the occurrence of intra‐operative hypotension and its predictors. As secondary endpoints, we determined to what extent hypotension relates to the risk of post‐operative incidents and death.

Methods: We used the Anaesthesia Databank Switzerland, built on routinely and prospectively collected data on all anaesthesias in 21 hospitals. The three outcomes were assessed using multi‐level logistic regression models.

Results: Among 147,573 anaesthesias, hypotension ranged from 0.6% to 5.2% in participating hospitals, and from 0.3% up to 12% in different surgical specialties. Most (73.4%) were minor single events. Age, ASA status, combined general and regional anaesthesia techniques, duration of surgery and hospitalization were significantly associated with hypotension. Although significantly associated, the emergency status of the surgery had a weaker effect. Hospitals' odds ratios for hypotension varied between 0.12 and 2.50 (P≤0.001), even after adjusting for patient and anaesthesia factors, and for type of surgery. At least one post‐operative incident occurred in 9.7% of the procedures, including 0.03% deaths. Intra‐operative hypotension was associated with a higher risk of post‐operative incidents and death.

Conclusion: Wide variations remain in the occurrence of hypotension among hospitals after adjustment for risk factors. Although differential reporting from hospitals may exist, variations in anaesthesia techniques and blood pressure maintenance may also have contributed. Intra‐operative hypotension is associated with morbidities and sometimes death, and constant vigilance must thus be advocated.
Does 1 or 2 g paracetamol added to ketoprofen enhance analgesia in adult tonsillectomy patients?
Authors: SALONEN A. , SILVOLA J. , KOKKI H.
Published: June 2009

Background: We have evaluated whether co‐administration of intravenous (i.v.) paracetamol could enhance the analgesic efficacy of ketoprofen (a non‐steroidal anti‐inflammatory drug or NSAID) in patients undergoing a tonsillectomy.

Methods: This prospective, randomized, double‐blinded and placebo‐controlled add‐on study with three parallel groups included 114 patients, aged 16–50 years, and scheduled for elective tonsillectomy. All patients were given ketoprofen 1 mg/kg i.v. after surgery, followed 5 min later by paracetamol 1 or 2 g i.v., or normal saline as a placebo. The primary outcome measure was the proportion of patients requiring oxycodone for rescue analgesia over the first 6 h (pain score >30/100 mm at rest or >50/100 mm during swallowing) after surgery.

Results: No difference was detected in the proportion of patients receiving oxycodone (31/37 in the paracetamol 1 g group, 29/39 in the paracetamol 2 g group and 30/38 in the ketoprofen‐alone group) between the three groups. However, significantly less doses of rescue analgesia were provided in the paracetamol groups than in the ketoprofen‐alone group (P=0.005); among those who required rescue analgesia, 27% less oxycodone was required in the paracetamol 1 g group (80 doses, P=0.023) and 38% less in the paracetamol 2 g group (64 doses, P=0.002) than in the ketoprofen‐alone group (106 doses).

Conclusion: Combining paracetamol i.v. with ketoprofen at the end of tonsillectomy did not reduce the proportion of the patients requiring rescue analgesia, but the number of opioid doses was less in the add‐on groups.
Different apoptosis ratios and gene expressions in two human cell lines after sevoflurane anaesthesia
Authors: KVOLIK S. , DOBROSEVIC B. , MARCZI S. , PRLIC L. , GLAVAS‐OBROVAC L.
Published: June 2009

Background: The aim of this study was to determine the effect of a single exposure of carcinoma cells (Caco‐2 and HEp‐2) to an anaesthetic gas mixture containing sevoflurane 3%, applied for a period of either 1 or 2 h, on the induction of apoptosis, propapototic gene expression and sphingomyelinase activity.

Methods: Apoptosis was determined by flow cytometry. p53, caspase 3 and CYP2E1 gene expression was determined using reverse transcriptase polymerase chain reaction. Activities of acid (aSMase) and neutral sphingomyelinases (nSMase) were measured using methyl‐14C sphingomyeline, and for de novo ceramide and lipid synthesis [3H] palmitic acid was used. All results were compared with controls and analysed by Mann–Whitney and Kruskal–Wallis tests.

Results: In the treated Caco‐2 cells, the apoptotic ratio increased 24 h after anaesthesia (16.9%; P=0.04). The expression of both p53 and caspase‐3 genes increased in Caco‐2 and decreased in HEp‐2 cells. The CYP2E1 gene expression was observed only in the Caco‐2 cells. In control cells, the catalytic activity of aSMase was 2.3 times higher than that of nSMase activity. Decreased aSMase and nSMase activities were observed in Caco‐2 cells 24 h after exposition. aSMase activity was halved (54.2%; P=0.06) in HEp‐2 cells 24 h after anaesthesia. De novo ceramide synthesis correlated with SMase activity in Caco‐2 cells.

Conclusion: Sevoflurane anaesthesia induces late apoptosis in the colonic and laryngeal cancer cells investigated. Although the results obtained may indicate that an anaesthetic gas mixture containing sevoflurane induces p53‐dependent apoptosis in the Caco‐2 cells, the mechanism of apoptosis induction is unclear and remains to be elucidated.
Adding Gabapentin to a multimodal regimen does not reduce acute pain, opioid consumption or chronic pain after total hip arthroplasty
Authors: CLARKE H. , PEREIRA S. , KENNEDY D. , ANDRION J. , MITSAKAKIS N. , GOLLISH J. , KATZ J. , KAY J.
Published: June 2009

Background: Gabapentin (GPN) is effective in reducing post‐operative pain and opioid consumption, but its effects with regional anesthesia for total hip arthroplasty (THA) are not known. We designed this study to determine whether (1) gabapentin administration reduces pain and opioid use after THA using a multimodal analgesic regimen including spinal anesthesia; (2) pre‐operative administration of gabapentin is more effective than post‐operative administration.

Methods: After REB approval and informed consent, 126 patients were enrolled in a double‐blinded, randomized‐controlled study. Patients received acetaminophen 1 g per os (p.o.), celecoxib 400 mg p.o. and dexamethasone 8 mg intravenously, 1–2 h pre‐operatively. Patients were randomly assigned to one of three treatment groups (G1: Placebo/Placebo; G2: GPN/Placebo; G3: Placebo/GPN). Patients received gabapentin 600 mg (G2) or placebo (G1 and G3) 2 h before surgery. All patients had spinal anesthesia [15 mg (3cc) of 0.5% hypobaric bupivacaine with 10 μg of fentanyl]. In the post‐anesthetic care unit, patients received gabapentin 600 mg (G3) or placebo (G1 and G2). On the ward, patients received acetaminophen 1000 mg p.o. q6h, celecoxib 200 mg p.o. q12h and a morphine PCA device. Patients were interviewed 6 months post‐surgery to determine the incidence and severity of chronic post‐surgical pain.

Results: Mean±SD cumulative morphine (mg) consumption (G1=49.4±24.8, G2=47.2±30.1 and G3=56.1±38.2) at 48 h and pain scores at 12, 24, 36 and 48 h post‐surgery were not significantly different among the groups [G1 (n=38), G2 (n=38) and G3 (n=38)]. Side effect profiles were similar across groups. Six months after surgery, the number of patients who reported chronic post‐surgical pain (G1=10, G2=12 and G3=9) and the severity of the pain (G1=4.2±2.9, G2=4.1±2.2 and G3=4.9±2.2) did not differ significantly among the groups (P>0.05).

Conclusions: A single 600 mg dose of gabapentin given pre‐operatively or post‐operatively does not reduce morphine consumption or pain scores in hospital or at 6 months after hip arthroplasty within the context of spinal anesthesia and a robust multimodal analgesia regimen.
Low‐flow anaesthesia at a fixed flow rate
Authors: CHERIAN A. , BADHE A.
Published: June 2009

Aims and Objectives: This study attempts to assess the safety of low‐flow anaesthesia (LFA) at fixed flow rates with particular reference to the incidence of a decline in FiO2 below safe levels of 0.3 and to determine whether LFA can be used safely in the absence of an FiO2 monitor.

Methods: A total of 100 patients undergoing procedures under general anaesthesia at fresh gas flows of 300 ml/min of O2 and 300 ml/min of N2O were monitored while maintaining the dial setting of isoflurane at 1.5% for 2 h. The changes in gas composition were analysed and even a single recording of FiO2 of <0.3 was considered sufficient to render the technique unsafe in the absence of gas monitors.

Results: The lowest recorded value of FiO2 was 31% (v/v%). There was no incidence of adverse events necessitating the conversion from low flows to conventional flows.

Conclusions: We conclude that low flows of 300 ml/min of N2O and 300 ml/min of oxygen can be used safely for a period of 2 h without the use of monitors for gas analysis of oxygen and agent in adult patients weighing between 40 and 75 kgs.
The investigation of bronchospasm during induction of anaesthesia
Authors: FISHER M. M. , RAMAKRISHNAN N. , DOIG G. , ROSE M. , BALDO B.
Published: June 2009

Background: The aim of this study was to ascertain whether anaesthetic induction‐related anaphylactic bronchospasm could be distinguished from other types of bronchospasm by clinical features and response to treatment. Such features could then be used to identify a group of patients in whom skin testing is indicated.

Methods: We retrospectively studied data from 183 patients referred to an anaesthetic allergy clinic because of bronchospasm during induction. For the analysis, the patients were divided into two groups depending on whether there was evidence suggesting immunological anaphylaxis.

Results: When the patients in whom intradermal tests were positive were compared with those in whom intradermal tests were negative, the skin test‐positive patients had significantly more severe reactions, and they were more commonly associated with other clinical signs. Mast cell tryptase (MCT) was an excellent discriminator between reactions likely to be allergic and those unlikely to be allergic.

Conclusions: Anaphylactic bronchospasm related to induction of anaesthesia is more likely to be severe than bronchospasm due to non‐immune causes. An allergic cause is more likely if there are associated features of anaphylaxis (skin changes, hypotension, angioedema) or elevated MCT. Patients with any of these features should undergo immuno‐allergolical investigation.
The addition of fentanyl to 1.5 mg/ml ropivacaine has no advantage for paediatric epidural analgesia
Authors: CHO J. E. , KIM J. Y. , HONG J. Y. , KIL H. K.
Published: June 2009

Background: Epidural opioids are frequently combined with local anaesthetics for an additive antinociceptive effect. We investigated the efficacy of epidural fentanyl to 1.25 or 1.5 mg/ml ropivacaine for post‐operative epidural analgesia in children.

Methods: One hundred and eight children undergoing hypospadias repair were randomized to receive 1.25 mg/ml ropivacaine (R1.25 group), 1.25 mg/ml ropivacaine with 0.2 mcg/kg/h of fentanyl (R1.25F group), 1.5 mg/ml ropivacaine (R1.5 group) or 1.5 mg/ml ropivacaine with 0.2 mcg/kg/h of fentanyl (R1.5F group) for post‐operative epidural analgesia. The epidural catheter was threaded caudally through the L4‐5 interspace. The face, legs, activity, cry, consolability (FLACC) score was assessed at every hour and at FLACC score >4, an epidural bolus of 0.5 ml/kg of ropivacaine 1.5 mg/ml was given as the rescue analgesia. The incidence of side effects such as hypoxia, sedation, pruritus, nausea and/or vomiting was recorded.

Results: The need for rescue analgesia was higher in the R1.25 group compared with that in the other three groups (all P<0.05). The incidence of side effects was higher in the R1.5F group compared with that in the R1.25 and R1.5 groups (both P=0.010).

Conclusion: The addition of 0.2 mcg/kg/h fentanyl to 1.5 mg/ml ropivacaine increased the incidence of side effects without improvement of analgesia in infants and children undergoing hypospadias repair. The use of plain 1.25 mg/ml ropivacaine increased the need for rescue analgesia and this could be compensated by addition of fentanyl.
The use of cord blood for transfusion purposes: current status
Authors: Khodabux C. M. , Brand A.
Published: June 2009

Although the use of umbilical cord blood (UCB) for transfusion purposes has been proposed decades ago, the employ is still limited. In this article we review studies evaluating UCB collection efficiency and sterility, examine processing and storage of UCB‐derived red blood cells (RBC) and discuss clinical studies in which UCB was used for transfusion purposes.

Efforts to provide preterm newborns with autologous RBC derived from UCB have not been very successful. UCB collected after full‐term deliveries can however easily be processed into RBC products and could be used autologous in case surgery of the neonate is indicated early after birth, or for allogeneic small volume paediatric transfusions. To harvest enough UCB volume, immediate clamping of the umbilical cord is commonly used as standard practice. Although delayed cord clamping has shown to improve the iron status in full‐term infants; for small‐for‐gestational‐age infants this has not been demonstrated. In addition, an increased need for phototherapy after delayed clamping exists. Altogether, we could find no disencouraging evidence to collect UCB, which could be processed into an easily available RBC product for paediatric transfusion in resource‐restricted countries.
Simultaneous genotyping of human platelet antigen‐1 to 17w by polymerase chain reaction sequence‐based typing
Authors: Xu X. , Zhu F. , Ying Y. , Tao S. , Liu Y. , Hong X. , Yan L.
Published: June 2009

Background and Objectives  Genotyping for human platelet antigen (HPA) systems is required in the investigation of patients with suspected HPA antibodies and for the provision of compatible blood products from HPA‐typed donors. Here, we set up a polymerase chain reaction sequence‐based typing method for simultaneous genotyping of HPA‐1 to 17w (PCR‐SBT).

Materials and methods  The specific primers for HPA‐1 to 17w were designed by primer premier 5·0 software. The PCR amplification conditions were optimized. Amplification products were purified by enzyme digestion and sequenced by a BigDye Terminator Cycle Sequencing kit.

Results  We used two standard DNA samples and 16 reference samples, including six with HPA gene mutations, for the HPA‐1 to 17w analysis by the PCR‐SBT and obtained 100% correct genotypes in these samples. The genotype and allele frequencies of HPA‐1 to 17w were analysed from 112 Han Chinese persons. Thirteen new single nucleotide polymorphisms and one microsatellite were found in the sequenced regions, in which two nucleotide polymorphisms of ITGB3 gene could cause amino acid alteration of Val419Met and Glu628Lys on the mature glycoprotein, respectively.

Conclusions  The PCR‐SBT method is reliable and accurate for HPA genotyping, suitable for routine HPA analysis, and can screen large numbers of donors. We identified 14 new polymorphisms, two of which led to amino acid changes.