bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of Vegetative Compatibility Groups of Fusarium oxysporum from Eruca vesicaria and Diplotaxis tenuifolia
Authors: Catti A. , Pasquali M. , Ghiringhelli D. , Garibaldi A. , Gullino M. L.
Published: December 2006

From 2002 to 2004, wilted plants of different species of rocket (Eruca vesicaria and Diplotaxis spp.) were found for the first time in Europe, in greenhouse cultivations in Piedmont and Lombardy, northern Italy. The causal agent of the disease was found to be Fusarium oxysporum. Vegetative compatibility analysis was carried out on 46 isolates of the fungus, 41 of them obtained from wilted rocket (E. vesicaria and D. tenuifolia) and five reference strains, in order to increase the knowledge on the causal agent of recent epidemics of Fusarium wilt on rocket in Italy. The analysis showed the presence of two vegetative compatibility groups (VCGs) (VCG 0101 and VCG 0220) pathogenic on both kinds of rocket. The two VCG populations, which were classified as formae specialesconglutinans and raphani, respectively, are spread in the area of epidemics but are not related to the host species from which they were isolated (D. tenuifolia or E. vesicaria). This finding shows the heterogeneity of the causal agent of Fusarium wilt on rocket in Italy.
Occurrence and Latent Infection of Alternaria Rot of Pingguoli Pear (Pyrus bretschneideri Rehd. cv. Pingguoli) Fruits in Gansu, China
Authors: Li Y. C. , Bi Y. , An L. Z.
Published: December 2006

Alternaria rot of Pingguoli pear occurred after latent infection. Fruit surfaces were asymptomatic within 60 days storage under cold condition (0°C, RH 85–90%), but black‐grey hyphae could be seen in the lenticels or calyx tube of Pingguoli pear after 90 days of storage. The tissue collapsed and resulted in visible black spots as the hyphae spread over the fruit. Average incidence of Alternaria rot of fruits from an orchard in Gansu was 28.86% at 100 days of storage. The main fungus isolated from the Alternaria rot on stored Pingguoli pear was identified as Alternaria alternata (Fr. : Fr.) Keissl. This pathogen was able to initially infect the fruit via two pathways during the growing season, and then remain in a latent state. The fungus first colonized the styles at the full‐blossoming stage, and then grew into the carpel cavities progressively after 50 days from petal fall. The percentage latent infection of A. alternata was up to 45% in the carpel cavity until the harvest time. The fungus also attacked fruit surfaces and remained latent in the fruit peel during fruit development. The percentage of A. alternata latent infection at the calyx end, middle part and stem end of the fruit peel was 40%, 24% and 42.8%, respectively, at harvest time.
Inheritance of resistance to broomrape (Orobanche cumana Wallr.) race F in a sunflower line derived from wild sunflower species
Authors: Velasco L. , Pérez‐Vich B. , Jan C.C. , Fernández‐Martínez J.M.
Published: December 2006

Genetic resistance to broomrape (Orobanche cumana Wallr.) race F in sunflower line J1, derived from the wild perennial species Helianthusgrosseserratus Martens and Helianthus divaricatus L., has been reported to be controlled by dominant alleles at a single locus, Or6. However, deviations from this monogenic inheritance have been observed. The objective of the present study was to gain insight into the inheritance of resistance to broomrape race F in the sunflower line J1. F1, F2, F3 and BC generations from crosses between J1 and three susceptible lines, P21, NR5 and HA821 were evaluated. F1 hybrids showed both resistant (R) and moderately resistant (MR) plants, the latter having a maximum of five broomrape stalks per plant compared with >10 in the susceptible parents. This indicated incomplete dominance of the Or6 alleles. F2 plants were classified as R, MR or susceptible (more than five broomrape stalks per plant). Three different segregation ratios were observed: 3 : 1, 13 : 3 and 15 : 1 (R + MR : S), suggesting the presence of a second gene, Or7, whose expression was influenced by the environment. A digenic model was confirmed, based on the evaluation of F2:3 families.
Sources of resistance to broomrape (Orobanche crenata Forsk.) in narbon vetch
Authors: Nadal S. , Cubero J. I. , Moreno M. T.
Published: December 2006

Little is known about the levels of resistance to Orobanche crenata available in narbon vetch. A germplasm collection of 200 accessions of narbon vetch (Vicia narbonensis L.) originating from different countries was screened for resistance to crenate broomrape under field conditions. Thirteen accessions were selected for more detailed screening under controlled conditions and for additional field testing. Resistance to O. crenata was manifested by lower germination of broomrape seeds, reduced emergence of Orobanche shoots and fewer root attachments per narbon vetch plant. Differences in pod yield among narbon vetch accessions were also found in response to Orobanche infestation. Finally, eight accessions were selected and identified as new sources of narbon vetch resistant to broomrape.
ALTEREDl‐ARGININE/NITRIC OXIDE SYNTHASE/NITRIC OXIDE PATHWAY IN THE VASCULAR ADVENTITIA OF RATS WITH SEPSIS
Authors: Jia Yue Xia , Pan Chun Shui , Yang Jing Hui , Liu Xiu Hua , Yuan Wen Jun , Zhao Jing , Tang Chao Shu , Qi Yong Fen
Published: December 2006

In recent studies, the vascular adventitia has been established as an important source of inducible nitric oxide synthase (iNOS) and subsequent nitric oxide (NO) production, even more powerful than the media in response to certain inflammatory factors, such as lipopolysaccharide (LPS). The adventitia has an independentl‐arginine (l‐Arg)/NOS/NO pathway and is involved in the regulation of vascular function. In the present study, we explored the changes in and the pathophysiological significance of thel‐Arg/NOS/NO pathway in the adventitia of rats with sepsis.

Sepsis was induced by caecal ligation and puncture in order to observe changes inl‐Arg transport, NOS gene expression and activity and NO generation in the vascular adventitia to determine the mechanism of activation of thel‐Arg/NOS/NO pathway.

Severe sepsis resulted in severe disturbance of haemodynamic features, with decreased mean arterial blood pressure, brachycardia and inhibited cardiac function (decreased left ventricular ±dP/dtmax). Left ventricular end‐diastolic pressure was elevated threefold (P < 0.01) under anaesthesia. Rats with sepsis showed severe glucopenia and lacticaemia. Plasma levels of the inflammatory factors macrophage chemoattractant protein‐1 and interleukin‐8 were increased five‐ and 29‐fold, respectively (P < 0.01).

In the adventitia of the thoracic and abdominal aortas, thel‐Arg/NO pathway was similarly characterized: the uptake of [3H]‐l‐Arg was Na+independent, with the peak occurring at approximately 40 min incubation. Total NOS activity was largely calcium independent (> 90%). The Vmaxofl‐Arg transport in the sepsis group was increased by 83.5% (P < 0.01), but the Kmvalue was not significantly different compared with controls.

The mRNA levels of cationic amino acid transporter (CAT)‐1 and CAT‐2B in the sepsis group were increased by 86 and 62%, respectively (bothP < 0.01). Inducible NOS activity was increased 2.8‐fold compared with controls (P < 0.01) and iNOS mRNA levels were elevated approximately sixfold (P < 0.01). The NO levels in the plasma and incubation media (incubation for 40 min) in the sepsis group were increased by 144 and 273%, respectively (bothP < 0.01).

The Arg/NOS/NO pathway was activated in the vascular adventitia of rats with sepsis shock. Thel‐Arg/NOS/NO pathway in the aortic adventitia may play an important role in the pathogenesis of sepsis and septic shock.
ROSIGLITAZONE MODULATES FASTING AND POST‐PRANDIAL PARAOXONASE 1 ACTIVITY IN TYPE 2 DIABETIC PATIENTS
Authors: Van Wijk Jeroen , Coll Blai , Cabezas Manuel Castro , Koning Eelco , Camps Jordi , Rabelink Ton , Mackness Bharti , Joven Jorge
Published: December 2006

In the present study, we have explored the effect of rosiglitazone on post‐prandial paraoxonase (PON)‐1, an enzyme with potent anti‐oxidant properties that may protect against atherosclerosis because increased post‐prandial lipaemia, although sometimes understated, is part of the diabetic dyslipidaemia.

A randomized, cross‐over, placebo‐controlled, double‐blind clinical trial was performed. Participants (19 type 2 diabetic patients on oral antihyperglycaemic agents) were randomly assigned to receive either placebo or rosiglitazone 4 mg twice daily for 8 weeks. After a 6 week wash‐out, the alternative treatment was implemented. Standardized 6 h oral fat‐loading tests were performed after each treatment period.

Patients assigned to rosiglitazone had increased fasting PON‐1 activity (from 331 ± 29 to 362 ± 32 U/L before treatment vs after treatment, respectively; P = 0.015), although the PON‐1 mass did not change (68.8 ± 21.1 vs 64.2 ± 25.4 mg/L before treatment vs after treatment, respectively). In addition, rosiglitazone significantly decreased fasting plasma peroxides compared with placebo (162 ± 25 vs 214 ± 28 mmol/L, respectively; P = 0.019). The post‐prandial fall in PON‐1 activity, expressed as area under the curve, was attenuated by rosiglitazone (−97 ± 14 vs−161 ± 24 Uh/L for rosiglitazone vs placebo, respectively; P = 0.02) and the increase in PON‐1 activity caused by rosiglitazone correlated with reductions in fasting plasma glucose (r = ‐0.42; P < 0.05), homeostatic model assessment index (r = ‐0.59; P < 0.01) and peroxides (r = ‐0.40; P = 0.07).

The present data indicate that rosiglitazone may convey increased protection against the oxidative modification that represents increased post‐prandial lipaemia.
GREEN TEA EXTRACT IMPEDES DYSLIPIDAEMIA AND DEVELOPMENT OF CARDIAC DYSFUNCTION IN STREPTOZOTOCIN‐DIABETIC RATS
Authors: Anandh Babu PV , Sabitha KE , Shyamaladevi CS
Published: December 2006

The efficacy of green tea extract (GTE) on serum and cardiac lipids was investigated in streptozotocin (STZ)‐diabetic rats.

Diabetes was induced in rats by a single intraperitoneal injection of STZ (60 mg/kg bodyweight). Six weeks after the induction of diabetes, GTE was administered orally for 4 weeks (300 mg/kg bodyweight daily). Bodyweight, heart weight, heart weight : bodyweight ratio, blood glucose, serum and cardiac lipids were determined in experimental rats.

In diabetic rats, there was a significant decrease in bodyweight with an increase in heart weight : bodyweight ratio and blood glucose. Diabetic rats had significantly increased serum levels of cholesterol, triglycerides, free fatty acids and low‐density lipoprotein–cholesterol (LDL‐C) and decreased levels of high‐density lipoprotein–cholesterol (HDL‐C). In the hearts of diabetic rats, there was a significant increase in cholesterol, triglycerides and free fatty acids levels, with an increase in lipoprotein lipase activity.

The administration of GTE to diabetic rats resulted in significant recovery in bodyweight, heart weight : bodyweight ratio and blood glucose levels. The administration of GTE reduced cholesterol, triglyceride, free fatty acid and LDL‐C levels, and increased HDL‐C levels, in the serum of diabetic rats. In addition, GTE decreased cholesterol, triglyceride, free fatty acids levels and lipoprotein lipase activity in the myocardium of diabetic rats. These beneficial effects of GTE are ascribed to its antihyperglycaemic and hypolipidaemic activity. In conclusion, green tea can reduce the risk of cardiovascular disease in diabetes with a significant improvement in lipid metabolism.
EXPRESSION OF HUMAN FACTOR IX GENE IN MURINE PLASMA THROUGH LENTIVIRAL VECTOR‐INFECTED HAEMATOPOIETIC STEM CELLS
Authors: Chen Haoming , Yao Hengmei , Huang Lu , Shen Qi , Jia William , Xue Jinglun
Published: December 2006

Haematopoietic stem cells (HSC) are an attractive target for gene therapy. Gene transfer to HSC can provide a potential cure for many inherited diseases. Moreover, recombinant lentiviral vectors can transfer genes efficiently to HSC. In the present study, we used the recombinant lentiviruses FUGW (Flip, ubiquitin promoter, GFP and WRE vector) and FUXW (Flip, ubiquitin promoter, F IX and WRE vector), which carry the enhanced green fluorescent protein (EGFP) and human factor IX (hFIX) gene, respectively, to infect HSC.

High titres of recombinant lentivirus were prepared from 293T cells by calcium phosphate‐mediated transient cotransfection. Murine mononuclear cells (MNC) separated from murine bone marrow and HSC separated by magnetic cell sorting were cultured in vitro. Cells they were infected by the recombinant lentiviruses FUGW and FUXW. The expression of EGFP was observed under a fluorescent microscope and was analysed by fluorescence‐activated cell sorting, whereas the expression of hFIX was detected by ELISA.

The results show that the lentiviral vectors can efficiently infect murine HSC in vitro and that transduction was more efficient following cytokine treatment with interleukin (IL)‐3, IL‐6 and stem cell factor.

Haematopoietic stem cells infected with lentivirus FUXW were transplanted into [60Co]‐irradiated non‐obese diabetic/severe combined immunodeficiency (NOD‐SCID) mice. The expression of hFIX in the blood plasma of the transplanted mice reached a peak of 44.9 ± 7.6 ng/mL on Day 7. An assay of transaminase levels and a histological study of the liver showed that there was no significant damage following HSC transplantation to mice.

The results of the present study suggest that transplantation of HSC results in the persistant expression of hFIX in mice, which may be useful in haemophilia B gene therapy.
TIME‐DEPENDENT TRANSITION FROM H2O2–EXTRACELLULAR SIGNAL‐REGULATED KINASE‐ TO O2−–NITRIC OXIDE‐DEPENDENT MECHANISMS IN THE STIMULATORY EFFECT OF LEPTIN ON RENAL Na+/K+‐ATPase IN THE RAT
Authors: Marciniak Andrzej , Borkowska Ewelina , Kȩdra Anna , Rychlik Monika , Beltowski Jerzy
Published: December 2006

Recent studies suggest that leptin, a peptide hormone secreted by white adipose tissue, is involved in the pathogenesis of arterial hypertension, in part by regulating renal sodium handling. Previously, we have demonstrated that in normal rats leptin has a time‐dependent effect on renal Na+/K+‐ATPase that drives tubular sodium reabsorption. Short‐term leptin infusion results in a transient decrease in Na+/K+‐ATPase activity, whereas prolonged administration stimulates the enzyme.

In the present study, we investigated whether these acute effects of leptin are preserved in rats with experimentally induced chronic hyperleptinaemia.

Hyperleptinaemia was induced by administration of exogenous leptin (0.25 mg/kg twice daily, s.c., for 7 days). Acute effects of leptin in anaesthetized control (normoleptinaemic) and hyperleptinaemic animals was investigated. Leptin was infused into the abdominal aorta proximally to the renal arteries for 0.5, 1, 2 or 3 h.

Leptin (1 µg/min per kg) had a time‐dependent effect on renal Na+/K+‐ATPase in both the control and hyperleptinaemic groups. The inhibitory effect observed after 0.5 h infusion was impaired in the hyperleptinaemic group. However, in both groups this effect was abolished by the Janus kinase inhibitor tyrphostin AG490 (100 nmol/min per kg), as well as by the phosphatidylinositol 3‐kinase inhibitors wortmannin (10 nmol/min per kg) and LY294002 (1 µmol/min per kg).

The stimulatory effect of leptin on Na+/K+‐ATPase activity was observed after 3 h of infusion and was of similar magnitude in control and hyperleptinaemic groups. In the control group, the stimulatory effect of leptin was abolished by the NADPH oxidase inhibitor apocynin (1 µmol/min per kg), the H2O2scavenger catalase (1 mg/min per kg) and the extracellular signal‐regulated kinase (ERK) inhibitor PD98059 (100 nmol/min per kg). In contrast, in the hyperleptinaemic group, the stimulatory effect of leptin was abolished by the cGMP analogue 8‐bromo‐cGMP (100 nmol/min per kg) and by the superoxide dismutase mimetic tempol (100 µmol/min per kg) but was not affected by catalase or PD98059.

Leptin increased urinary H2O2excretion and ERK phosphorylation in the renal tissue only in the control group.

The results suggest that the acute stimulatory effect of leptin on renal Na+/K+‐ATPase is mediated by divergent mechanisms depending on the chronic leptin level (i.e. by H2O2‐dependent stimulation of ERK in normoleptinaemic animals and by superoxide‐dependent impairment of the nitric oxide–cGMP pathway in hyperleptinaemic rats).
PROTECTIVE EFFECTS OF BENDAZAC LYSINE ON DIABETIC PERIPHERAL NEUROPATHY IN STREPTOZOTOCIN‐INDUCED DIABETIC RATS
Authors: Yu Jun‐Xian , Zhang Yin‐Di , Yin Xiao‐Xing , Shen Jian‐Ping , Qiu Jun , Yin Hong‐Lin , Jiang Shao‐Jun
Published: December 2006

Diabetic neuropathy is a many faceted complication of both type I and II diabetes. The aim of the present study was to investigate the effects of bendazac lysine (BDL), an anticataract drug, on experimental diabetic peripheral neuropathy (DPN) in rats.

Diabetes was induced in rats by intraperitoneal injection of 75 mg/kg streptozotocin (STZ) dissolved in 0.1 mol/L citrate buffer (pH 4.4). Bendazac lysine was administered to rats at doses of 50, 100 and 200 mg/kg twice a day for 12 weeks.

Diabetic rats without treatment showed hypopraxia, polydipsia, polyuria, slow weight gain, cataract, increased tail‐flick threshold temperature, decreased motor nerve conduction velocity (nd induced pathological morphological changes of myelinated nerve fibres. All these symptoms were ameliorated in diabetic rats treated with BDL. Bendazac lysine ameliorated the blood glucose concentration, glycosylated haemoglobin levels and insulin levels in the plasma of diabetic rats, reduced aldose reductase activity in erythrocytes and advanced glycation end‐products in both nerves and serum and increase the activity of glutathione peroxidase in the nerves and Na+/K+‐ATPase in the nerves and erythrocytes.

Bendazac lysine exerts its protective effects against the progression of diabetic peripheral neuropathy in STZ‐diabetic rats through multiple mechanisms and is a potential drug for the prevention of deterioration in DPN.
COMPARISON BETWEEN GASTRIC SCINTIGRAPHY AND THE [13C]‐ACETATE BREATH TEST WITH WAGNER–NELSON ANALYSIS IN HUMANS
Authors: Sanaka Masaki , Urita Yoshihisa , Sugimoto Motonobu , Yamamoto Takatsugu , Kuyama Yasushi
Published: December 2006

The [13C]‐acetate breath test (ABT) quantifies gastric emptying as the half [13CO2]‐excretion time (T1/2b), but T1/2b differs from the scintigraphic half‐emptying time (T1/2s). The aims of the present study were to accurately determine the half‐emptying time by ABT with Wagner–Nelson analysis (T1/2WN), to compare T1/2WN with T1/2s and to validate the Wagner–Nelson strategy in ABT.

For a comparative study, eight volunteers simultaneously underwent ABT and scintigraphy. Anterior images were acquired and breath samples were collected every 15 min for 4.0 h after ingestion of a 200 kcal liquid meal labelled with 37 MBq [99mTc]‐colloidal sulphur and 100 mg [13C]‐acetate. For the validation experiment, another six volunteers underwent ABT, on two randomized occasions, using the 200 kcal liquid meal with 100 mg [13C]‐acetate. On either of the two occasions, a gel‐forming agent was stirred into the meal to intentionally delay gastric emptying by increasing meal viscosity. Breath samples were collected at regular 15 min intervals for 4 h post ingestion.

The Wagner–Nelson equation for ABT is F(t) = (Abreath(t) + C(t)/0.65)/Abreath(∞), where F(t) is a fractional dose of the [13C] label emptied, C(t) is the [13CO2] excretion (% dose/h), Abreath(t) is the area under the C(t) curve (% dose) and Abreath(∞) is the ultimate [13CO2] recovery in breath (% dose). The percentage gastric retention was estimated as 100 × (1 − F(t)). The time plots of scintigraphic activity and 100 × (1 − F(t)) were fitted to y(t) = 100 × e−K×t, K values were estimated mathematically for each plot by regression analysis and T1/2s and T1/2WN were calculated as (ln2)/K. The time versus pulmonary [13CO2] excretion plots were fitted to z(t) = m × k × β × e−kt(1 − e−k×t)β−1, where m, k and β are constants; T1/2b was calculated as –(ln(1 − 2−1/β)]/k.

Values of T1/2WN were closer to T1/2s than T1/2b, although T1/2WN and T1/2b yielded significant under‐ and overestimation of T1/2s, respectively. The high viscosity meal significantly prolonged T1/2WN and T1/2b; T1/2WN could detect the delayed transit of the viscous meal more sensitively than T1/2b.

The Wagner–Nelson method improves the accuracy of the ABT.
Nurses’ perceptions of multidisciplinary team work in acute health‐care
Authors: Atwal Anita , Caldwell Kay
Published: December 2006

Multidisciplinary teamwork is viewed as one of the key processes through which care is managed in the British National Health Service, and yet is often viewed as one of the most problematic. Working in a multidisciplinary team requires many skills, which involves understanding not only one’s own role but also the role of other professionals. The aim of this study was to explore nurses’ perceptions of multidisciplinary teamwork in acute health‐care. Nineteen nurses were interviewed using the critical incident approach to obtain their perceptions of multidisciplinary teamwork. Direct observation was conducted to record interactions between nurses and health‐care professionals in multidisciplinary teams. In total, 14 meetings were attended in elder care and orthopaedics and seven in acute medicine. The findings of this study identified three barriers that hindered teamwork: (i) differing perceptions of teamwork; (ii) different levels of skills acquisitions to function as a team member; and (iii) the dominance of medical power that influenced interaction in teams. Thus, education establishments and nursing managers need to ensure that the acquisition of team‐playing skills is an integral part of continued professional development.
Clinical differentiation of atypical pneumonia using Japanese guidelines
Authors: ISHIDA Tadashi , MIYASHITA Naoyuki , NAKAHAMA Chikara
Published: December 2006

Background and objective:  Atypical pneumonia occupies an important position in community‐acquired pneumonia. The aim of this study was to examine whether making a diagnosis of atypical pneumonia is possible based upon the Japanese Respiratory Society guidelines.

Methods:  The data from three prospective studies were reviewed. A total of 285 patients with mycoplasmal pneumonia or chlamydial pneumonia and 515 patients with pneumococcal pneumonia or Haemophilus influenzae pneumonia were assessed to determine whether these pneumonias met the diagnostic criteria for atypical pneumonia used in the Japanese Respiratory Society guidelines. The criteria were: (i) age less than 60 years; (ii) no or only minor underlying diseases; (iii) persistent cough; (iv) limited chest auscultatory findings; (v) no sputum, or no identified aetiological agent by rapid diagnosis; and (vi) a peripheral white blood cell count below 10 000/µL.

Results:  All items of the criteria proved to be valid except for ‘age’ in patients with Chlamydophila pneumoniae pneumonia using multiple regression analysis. The sensitivity and specificity for atypical pneumonia were 77.0% and 93.0% based on four or more of the criteria respectively.

Conclusion:  Pure atypical pneumonia can be differentiated to some degree by clinical symptoms and laboratory findings. It is important to differentiate and treat bacterial pneumonia and atypical pneumonia in regions such as Japan, where Streptococcus pneumoniae resistance to macrolides is high. Treatment covering the two types of pneumonia should be considered in elderly patients and those with underlying respiratory disease.
Early switch to oral antibiotics and early discharge guidelines in the management of community‐acquired pneumonia
Authors: LEE Richard Wai Wing , LINDSTROM Steven Terence
Published: December 2006

Background and objective:  The major cost of managing community‐acquired pneumonia (CAP) relates to the duration i.v. antibiotic use and length of hospital stay (LOS). Guidelines on early switch to oral antibiotics and early discharge from hospital may help to achieve a unified approach to managing CAP. The aim of this study was to assess the benefits and safety of these guidelines in an Australian respiratory medicine unit.

Methods:  This prospective study included consecutive patients admitted with a diagnosis of CAP over a 6‐month period. Early switch to oral antibiotics and early discharge guidelines were implemented one month prior to the evaluation period. Comparison was made to a retrospective control group admitted before the guidelines were implemented. Data collection included patient demographics, clinical and outcome parameters, duration of i.v. antibiotics and LOS. Thirty‐day outcomes on patient safety and satisfaction were collected from the prospective group.

Results:  One hundred and twenty‐five patients in the prospective group were compared to 100 patients in the controls. Baseline characteristics were similar between the comparison groups. Both the mean duration of i.v. antibiotics used (3.38 ± 0.22 vs. 3.99 ± 0.28 days, P = 0.03) and LOS (7.62 ± 0.60 vs. 8.36 ± 0.55 days, P = 0.04) were significantly shorter in the prospective group. Thirty‐day readmission rate was 6% and patient self‐reported overall satisfaction was 93.9% in those who were followed up.

Conclusions:  The use of early switch and early discharge guidelines for CAP reduced the duration of i.v. antibiotics and LOS while maintaining high levels of safety and patient satisfaction.
Open‐label, randomized comparison trial of long‐term outcomes of levofloxacin versus standard antibiotic therapy in acute exacerbations of chronic obstructive pulmonary disease
Authors: RUIZ‐GONZÁLEZ Agustin , GIMÉNEZ Antonio , GÓMEZ‐ARBONÉS Xavier , SOLER‐GONZÁLEZ Jorge , SÁNCHEZ Virginia , FALGUERA Miquel , PORCEL Jose M.
Published: December 2006

Background and objective:  This study investigated whether treating acute exacerbations of COPD (AE‐COPD) with levofloxacin modifies the long‐term outcome of COPD patients in comparison with standard antibiotic regimens.

Methods:  A 6‐month open‐label clinical trial of AE‐COPD patients compared the outcomes of treating with levofloxacin versus standard therapy (clarithromycin, cefuroxime, or amoxicillin/clavulanate) at recommended doses for 10 days. Several variables were analysed: pulse oximetry, FEV1, health‐related quality of life, infection‐free interval, number of exacerbations, hospitalizations due to an exacerbation and mortality.

Results:  Of the 116 patients initially enrolled, completion or withdrawal information was available for 50 patients in the levofloxacin arm and 52 in the standard therapy arm. At the end of the study, there were no differences in mortality (17.8% vs. 22.9%, P = 0.53), number of exacerbations (33 vs. 41, P = 0.40), pulse oximetry (median 91.71% vs. 92.46%, P = 0.18), FEV1 (median 51.31% vs. 47.14%, P = 0.30), health‐related quality of life (median 8.63 vs. 10.75, P = 0.94) and infection‐free interval (median 112 vs. 101 days, P = 0.72), for the levofloxacin and standard therapy, respectively. However, 12 out of 33 (33.6%) exacerbations treated with levofloxacin required in‐hospital management versus 27 out of 41 (65.8%) treated with standard therapy (P = 0.02).

Conclusion:  This preliminary study suggests that 10‐day treatment of AE‐COPD with levofloxacin is associated with a reduction in hospitalizations compared with standard antibiotics despite there being no significant benefit in other outcome variables.
Follow up and surveillance of the patient with lung cancer: What do you do after surgery?
Authors: ALBERTS W. Michael
Published: December 2006

Abstract:  Of the new cases of lung cancer discovered each year, it has been estimated that 50–55% have localized disease and are thus candidates for potentially curative treatment. Some of these patients will refuse surgery or will have co‐morbidities that preclude surgery. The remainder will undergo an attempted curative resection. A common clinical question arises in these patients: how should this patient be followed after surgery? Post‐treatment surveillance is indicated to monitor for recurrence of the original tumor and for the development of a metachronous tumor. The appropriate protocol is controversial and current recommendations are primarily expert opinion or consensus‐based and await further study. A suggested clinically reasonable and cost‐effective surveillance approach would include a history, physical examination and an imaging study (either chest radiograph or CT) every 6 months for 2 years and then annually. Patients should be counselled on symptom recognition and advised to contact their physician should such symptoms appear.
Monoclonal antibody 7F9 recognizes rat protein homologous to human carboxypeptidase‐M in developing and adult rat lung
Authors: FUJIWARA Naoyuki , IKEDA Mitsunobu , HIRABAYASHI Susumu , MORI Hiroki , SHIRASAWA Madoka , KANSAKU Ai , SUNAMORI Makoto , HATA Yutaka
Published: December 2006

Background and objective:  The purpose of this study was to obtain an antibody that would be useful for investigating the yet unclear molecular mechanism underlying the differentiation of lung alveolar type I and II cells.

Methods:  Monoclonal antibodies were raised against membrane proteins from embryonal day 18.5 rat lungs and characterized by immunoblotting on rat lung lysates at various developmental stages to select an appropriate clone. The antigen of the selected antibody was purified by serial column chromatography and immunoprecipitation and identified by mass spectrometry.

Results:  7F9 antibody recognizes a 65‐kDa protein that is expressed most prominently from embryonal day 20.5 to postnatal day 1. This protein was identified as a rat protein that is similar to 5730456K23Rik protein. The protein is homologous to human carboxypeptidase‐M. Although human carboxypeptidase‐M is known as a marker of type I cells, the expression of this rat protein was detected in columnar epithelial cells expressing type II cell markers, SP‐C and a lamellar body protein ABCA3, in developing lung. Its expression was detected in alveolar cells lacking T1α, a type I cell marker protein, in adult lung. It was also expressed in RLE‐6TN cells derived from type II cells. The expression in RLE‐6TN cells was down‐regulated by transforming growth factor‐β1 and up‐regulated by Wnt3a.

Conclusions:  7F9 antibody detects a protein in rat lung cells expressing type II markers. The antibody is a useful tool for studying signalling triggered by transforming growth factor‐β1 and Wnt3a in rat type II cells.
Efficacy of azithromycin administration in prevention of respiratory tract infection after bronchoscopic biopsy: A randomized, controlled trial
Authors: KANAZAWA Hiroshi
Published: December 2006

Background and objective:  Respiratory tract infection is a serious complication associated with bronchoscopic biopsy. This study attempted to examine its incidence and determine an efficacious therapy for preventing such infections.

Methods:  Nine hundred and thirty patients who underwent bronchoscopic biopsy in Osaka City University Hospital outpatient clinic were enrolled in the study. All patients were randomly assigned to receive a 3‐day course of azithromycin (500 mg/day), cefcapene pivoxil hydrochloride (300 mg/day) or no antibiotics. The primary outcome was the incidence of respiratory tract infection after bronchoscopic biopsy among the three groups.

Results:  In the no‐treatment group, nine of the 310 patients (2.9%) had respiratory tract infection after bronchoscopic biopsy. All patients with infection had abnormal bronchoscopic findings. Of the patients with respiratory tract infection, 60% were in the no‐treatment group, 26.7% in the cefcapene group and 13.3% in the azithromycin group. Although not statistically significant, the incidence in the azithromycin group (0.7%) was lower than in the no‐treatment group (P = 0.06). Among the patients with abnormal bronchoscopic findings, the incidence in the azithromycin group was significantly lower than that in the no‐treatment group (3.0% vs. 14.8%; P = 0.02). Moreover, maximum C‐reactive protein values also appeared to be lower in the azithromycin group than in the no‐treatment group and the cefcapene group.

Conclusions:  A 3‐day course of azithromycin administration is well tolerated and effective in preventing infection post bronchoscopy.
Effect of inhaled budesonide on oropharyngeal, Gram‐negative bacilli colonization in asthma patients
Authors: TALAY Fahrettin , KARABAY Oguz , YILMAZ Fahrettin , KOCOGLU Esra
Published: December 2006

Background and Objective:  The effect of inhaled budesonide on oropharyngeal Gram‐negative bacilli colonization (OGNBC) in asthmatic patients was investigated.

Methods:  Oropharyngeal cultures were obtained from asthmatic patients attending the hospital respiratory outpatient clinic, at baseline and 1 month after treatment with 800 µg/day of inhaled budesonide. Cultures were evaluated for OGNBC and compared with those of healthy controls.

Results:  A total of 148 cultures (74 from asthma patients, 74 from healthy controls) were evaluated. Six cultures (8.1%) from healthy controls, eight cultures (10.8%) from asthma patients obtained before treatment and 20 cultures (27.0%) obtained after treatment were positive for OGNBC (P < 0.05). Gender, age, presence of atopy and the degree of illness were not found to be related to the presence of OGNBC in and healthy control cultures. In the cultures obtained from the patients after treatment, OGNBC was higher in patients >50 years and in those with FEV1 < 70% (P < 0.05). Nine (18.8%) of 48 patients <50 years compare with 11 (42.3%) of the 26 patients >50 revealed OGNBC (P < 0.05). OGNBC were observed in 18.9% of the patients with FEV1 = 70% and in 47.6% of those with FEV1 < 70% (P < 0.05).

Conclusions:  The increased rate of OGNBC in asthma patients treated with inhaled budesonide was found to be related to increased age and lower level of FEV1. Further studies with larger numbers of patients are required for the interpretation of this colonization in the course of lower respiratory infections in these patients.
Using discrete choice experiments to investigate subject preferences for preventive asthma medication
Authors: LANCSAR Emily J. , HALL Jane P. , KING Madeleine , KENNY Patricia , LOUVIERE Jordan J. , FIEBIG Denzil G. , HOSSAIN Ishrat , THIEN Francis C.K. , REDDEL Helen K. , JENKINS Christine R.
Published: December 2006

Background and objective:  Long‐term adherence to inhaled corticosteroids is poor despite the crucial role of preventer medications in achieving good asthma outcomes. This study was undertaken to explore patient preferences in relation to their current inhaled corticosteroid medication, a hypothetical preventer or no medication.

Methods:  A discrete choice experiment was conducted in 57 adults with mild–moderate asthma and airway hyper‐responsiveness, who were using inhaled corticosteroid ≤500 µg/day (beclomethasone equivalent). In the discrete choice experiment, subjects evaluated 16 hypothetical scenarios made up of 10 attributes that described the process and outcomes of taking asthma medication, with two to four levels for each attribute. For each scenario, subjects chose between the hypothetical medication, the medication they were currently taking and no asthma medication. A random parameter multinomial logit model was estimated to quantify subject preferences for the aspects of taking asthma medication and the influence of attributes on medication decisions.

Results:  Subjects consistently made choices in favour of being able to do strenuous and sporting activities with or without reliever, experiencing no side‐effects and never having to monitor their peak flow. Frequency of collecting prescriptions, frequency of taking the medication, its route of administration and the strength of the doctor recommendation about the medication were not significant determinants of choice.

Conclusions:  The results of this study suggest that patients prefer a preventer that confers capacity to maximize physical activity, has no side‐effects and does not require daily peak flow monitoring.
Influence of isolation from the sea on spatial patterns of macroinfauna in intermittently closed/open coastal lakes in New South Wales
Authors: DYE ARTHUR H.
Published: December 2006

Abstract  Intermittently open/closed coastal lakes and lagoons are susceptible to contamination and nutrient‐enrichment. Although many of them are considered to be degraded, our understanding of their ecology and the effects of anthropogenic activity is limited. This study of coastal lakes in New South Wales compared the density and distribution of macrobenthos in localities that differed in their degree of isolation from the sea, that is, open versus closed lakes and mouths versus inner reaches. Lakes kept open artificially (to improve water quality and reduce flooding), were also compared with naturally open or closed lakes. Densities of macrobenthos were usually greater in the mouths of open than of closed lakes, but the opposite was true in inner reaches. While isolated localities differed more between lakes than did mouths, small‐scale variability was greater in the latter. Spatial patterns were less temporally consistent in inner reaches than in mouths. Differences in densities and spatial variability between mouths and inner reaches were influenced primarily by whether a lake was open or closed and secondarily by manipulation of the mouth. While, for example, densities in open manipulated systems were usually greater in the mouths, but smaller in the inner reaches, the effect of manipulation was less obvious in closed lakes. Differences in density between types of lakes were not clearly related to physical factors although, within lakes, benthos generally correlated negatively with salinity and positively with median particle‐size, silt and organic content. The effects of factors that modify the degree of isolation of coastal lakes are discussed and it is concluded that current levels of isolation do not appear to affect macrobenthos adversely. Nevertheless, increased isolation, which is likely as a result of climatic change, may well do so, particularly in lakes already stressed by human impacts.
REOPERATIVE PARATHYROID SURGERY: THE IMPORTANCE OF ECTOPIC LOCATION AND MULTIGLAND DISEASE
Authors: Gough Ian
Published: December 2006

Background:  Despite the availability of expert surgeons and preoperative imaging investigations, some patients require reoperation for persistent or recurrent hyperparathyroidisms.

Method:  Fifty consecutive patients were reviewed.

Results:  There were 28 persistent cases (24 primary, 4 secondary) and 22 recurrent cases (15 primary, 7 secondary) and 98% had successful surgical treatment. Multigland disease was present in 24 of 39 (62%) of primary cases, 11 of 24 persistent and 13 of 15 recurrent (P < 0.02). Four patients in the recurrent primary group had multiple endocrine neoplasia type 1, whereas the other 20 primary patients had sporadic multigland disease. Multigland disease was present in all secondary cases and was a very important factor in this entire series of patients (70%). Regrowth of a remnant of a gland biopsied or partially resected at an earlier operation was the cause of recurrence in 12 of 15 primary and 2 of 7 secondary cases (P < 0.05). The site of missed glands in persistent disease was ectopic in 60%. Ectopic glands were found in the following sites: intrathyroidal 10 (8 inferior and 2 superior), intrathymic 9, posterior mediastinum 4, base of skull 2, carotid sheath 1 and supernumerary 5. Investigations to locate missing glands were positive in 28 of 43 sestamibi scans (65%), 14 of 34 ultrasound scans (41%), 10 of 24 computed tomography scans (42%) and 11 of 13 selective venous sampling tests (85%).

Conclusion:  Some persistent cases are unavoidable because of ectopic locations and some recurrences are inevitable because of multigland disease.
MAGNIFICATION CHROMO‐COLONOSCOPY
Authors: Togashi Kazutomo , Konishi Fumio
Published: December 2006

Chromoscopic colonoscopy using indigo carmine is indispensable for the accurate detection of flat neoplastic lesions. In particular, the dye spray technique facilitates the detection of both flat hyperplastic polyps and highly dysplastic lesions. However, magnification chromo‐colonoscopy discriminates adenomas from hyperplastic polyps with greater accuracy than conventional methods by showing distinct and visible pit patterns. A pit pattern represents crypt orifices, which reflect the underlying histological structures and colonoscopists can make histological predictions by observing the pit patterns without obtaining biopsy specimens. The pit patterns are classified as types I, II, IIIL, IIIs, IV and V based on histological characterization of normal mucosa, hyperplastic polyp, polypoid adenoma, flat adenoma, tubulo‐villous adenoma and cancerous tissue, respectively. In previous reports, overall accuracy ranged from 80 to 95%. In addition, magnification chromo‐colonoscopy is useful for the diagnosis of early cancer associated with substantial invasion of the submucosa, in which type V pits are subclassified as types V‐I and V‐N. The presence of type V‐N pits is significant in correlation to cancer with substantial invasion of the submucosa. Magnification chromo‐colonoscopy is useful in clinical decision‐making when deciding whether endoscopic resection or bowel resection is the appropriate initial procedure to treat lesions.
SELECTION OF PRIMARY HIP AND KNEE ARTHROPLASTIES FOR PUBLIC HOSPITALS IN WESTERN AUSTRALIA: A CLINICAL EVIDENCE APPROACH
Authors: Kop Alan M. , Swarts Eric
Published: December 2006

Background:  The Australian Joint Registry records that there are approximately 84 hip stem designs, 71 acetabular designs and 45 knee systems in common use in Australia, giving the surgeon an extensive and often bewildering choices.

Methods:  Since the 1990s, there have been several attempts to rationalize the supply of the products of primary hip and knee arthroplasties to the public hospitals in Western Australia. To continue and improve the rationalization process, the recently awarded ‘whole of health’ tender was based on a thorough clinical and laboratory evaluation process. The method included commercial analysis by Health Supply Western Australia, clinical evaluation by a committee comprised of senior surgeons and technical assessment by biomedical engineers and scientists. The evaluation process was subdivided into qualitative criteria; being the commercial aspects of the tender (50%) and a fitness for purpose assessment comprising clinically based evidence (40%) and laboratory assessment of product quality (10%).

Result:  The tendering process concluded with the recommendation of 12 hip and 5 knee systems.

Conclusions:  A comprehensive method primarily based on clinical evidence was used to assess arthroplasty products tendered to Western Australia public hospitals. Generally, there was good compliance with the commercial aspects of the tender. In contrast, however, clinically based evidence assessment of many arthroplasty devices was difficult because of a distinct lack of quality published work. Inadequate quality control of several devices is also of concern. Evaluation of key performance indicators, including cost savings, acceptance by surgeons, tender compliance and revision rates, will determine the success of the tender.
EXPERIENCE OF ENDOSCOPIC ULTRASOUND IN AN AUSTRALIAN TERTIARY HOSPITAL
Authors: Kalade Andrius V. , Desmond Paul V. , Chen Robert Y.
Published: December 2006

Background:  There is minimal prospective data on endoscopic ultrasound (EUS) experience in Australia. This study aimed to review the recent EUS experience of a single Australian tertiary hospital.

Methods:  Data of all EUS carried out at St Vincent’s Hospital, Melbourne, Australia were prospectively collected from August 2002 to September 2005. Patient demographics, indications, anatomical sites of EUS and fine‐needle aspiration (FNA) were extracted from the database. A subset of 231 patients were involved in a prospective study to assess the clinical effect of EUS: with accuracy and outcomes data derived from surgical histology and pre‐EUS and post‐EUS questionnaires.

Results:  Five hundred and sixty‐one procedures were carried out for 526 patients. Men comprised 57% (n = 300). Mean age was 60 years (range, 19–92 years). The indications were (i) oesophageal 30.7% (n = 172); (ii) pancreaticobiliary 29.6% (n = 166); (iii) mediastinal and lung 20.7% (n = 116); (iv) gastric 15.9% (n = 89); and (v) duodenal 3.2% (n = 18). Endoscopic ultrasound‐guided FNA was carried out in 30.3% procedures (170/561). Overall EUS accuracy was 84% (55/67 patients) and EUS‐guided FNA accuracy was 88% (28/32 patients). There were no major complications.

Conclusions:  This is the largest reported Australian experience of EUS to date. Overall EUS was accurate, safe with no major complications or mortality and had useful outcomes. The role, expertise and accessibility of EUS in the Australian clinical setting are anticipated to continue to increase.
NEW SURGICAL CONSULTANTS: IS THERE A LEARNING CURVE?
Authors: Sywak Mark S. , Yeh Michael W. , Sidhu Stan B. , Barraclough Bruce H. , Delbridge Leigh W.
Published: December 2006

The purpose of this study was to determine whether newly established surgeons who have completed dedicated post‐fellowship training are able to achieve surgical outcomes comparable to their more experienced peers. A cross‐sectional study of consecutive patients undergoing total thyroidectomy (TT) or completion thyroidectomy was carried out. Outcomes measured included unplanned return to the operating theatre, postoperative infection, permanent recurrent laryngeal nerve (RLN) injury and permanent hypoparathyroidism. Outcomes were categorized according to whether surgery was carried out by an established surgeon (ES) or a newly appointed surgeon (NAS). Eight hundred and nine TT and completion thyroidectomy procedures were carried out in the period January 2002 to December 2004. Of these, 515 (64%) were carried out by ES and 294 (36%) were carried out by NAS. The overall rate of permanent hypoparathyroidism and RLN injury was 1.4% (12/809) and 0.6% (5/809), respectively. The rate of permanent hypoparathyroidism was not significantly different between the two categories of surgeon (ES 1.35% vs NAS 1.7%; P = 0.7). The incidence of permanent RLN injury was not different between the two groups (ES 0.8% vs NAS 0.3%; P = 0.4). For NAS, the rate of permanent RLN injury for the first two years of independent practice did not differ significantly from 3 to 4 years of practice (0/123 vs 1/171; P = 0.4). Indications for surgery between the two groups were similar, with ES carrying out TT for benign goitre in 42% and cancer in 28%, and NAS 44 and 32%, respectively. Surgical outcomes for the newly established endocrine surgeon following subspecialty training are equivalent to those achieved by more experienced surgeons.
ADRENALINE‐INDUCED DIGITAL ISCHAEMIA REVERSED WITH PHENTOLAMINE
Authors: Molony Darren
Published: December 2006

Adrenaline autoinjectors are widely prescribed for self‐treatment of anaphylactic syndromes. Accidental misfire into digits can cause prolonged significant ischaemia with serious outcomes. Phentolamine is a readily available treatment, which is easily and safely given in the emergency setting.
EXPERIENCE WITH THE USE OF VACUUM DRESSINGS IN THE MANAGEMENT OF ACUTE ENTEROCUTANEOUS FISTULAS
Authors: Woodfield John C. , Parry Bryan R. , Bissett Ian P. , McKee Maree
Published: December 2006

High‐output enterocutaneous fistulas involving an open abdominal wound are a difficult management problem. We report our experience on the use of vacuum dressings. The potential benefits, problems and new recommendations for the use of vacuum dressings in the management of enterocutaneous fistulas are discussed.