bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in intravenous immunoglobulin prescribing patterns during a period of severe product shortages, 1995–2000
Authors: Pendergrast J. M. , Sher G. D. , Callum J. L.
Published: September 2005

Background and Objectives  Canadian consumption of intravenous immunoglobulin (IVIG) has increased dramatically since it was first marketed in the early 1980s, and Canada is now the world's largest per capita consumer. During the late 1990s, worldwide product shortages of IVIG occurred. This study was designed to identify the disease conditions for which IVIG was being prescribed in academic hospitals during this period, and to explore the effects that IVIG shortages had on prescribing patterns.

Materials and Methods  Blood bank and pharmacy records of IVIG distribution were collected retrospectively from four Toronto teaching hospitals for the period 1995–2000. These records were then cross‐referenced with patient medical records to determine the indication for IVIG administration.

Results  A total of 100 208 g of IVIG was prescribed to 429 patients over a 6‐year period. Most of the IVIG consumption was in patients with haematological (22%) or neurological (20%) conditions, in recipients of bone marrow transplants (19%) and in patients with infectious disease‐related conditions (including congenital and acquired hypogammoglobulinaemia, 18%). Dermatological conditions (7%) were the most rapidly growing indication for IVIG usage during the 6‐year period of review, increasing from 0% of annual IVIG usage in 1995 to 16% in 2000. Over 80% of the diseases treated were supported by published recommendations. After 1997 there was an abrupt decline in the annual number of patients treated, primarily owing to a decline in single‐use recipients. Annual consumption of IVIG, however, remained stable.

Conclusions  IVIG shortages were followed by a decrease in the number of single‐use recipients, who probably represented empirical use of IVIG; this had little effect on the total amount of IVIG distributed annually. Stricter adherence to currently available published recommendations may not be the optimal means of controlling IVIG use within an academic hospital setting. Rather, emphasis may be better placed on improving the evidence base upon which these recommendations are made, for example by conducting controlled prospective clinical trials.
Prediction of accuracy of estimated Mendelian sampling terms
Authors: Avendaño S. , Woolliams J.A. , Villanueva B.
Published: September 2005

This study describes a general framework for predicting the accuracy of Mendelian sampling terms when truncation selection is applied on best linear unbiased prediction (BLUP) estimated breeding values. A selection index approach is followed. The pseudo‐BLUP index is extended to include terms related to the Mendelian sampling term. Predicted accuracies are compared with those obtained through stochastic computer simulation. Good predictions for the accuracy of the Mendelian sampling term were obtained both at selection time and at convergence of long‐term contributions of selected candidates for a range of heritabilities and population structures. The prediction approach developed provides a key tool for obtaining predictions of genetic response from quadratic optimization that maximizes the rate of genetic progress while restricting the rate of inbreeding.
A fast algorithm for computing inbreeding coefficients in large populations
Authors: Sargolzaei M. , Iwaisaki H. , Colleau J.‐J.
Published: September 2005

Inbreeding coefficients of animals are required in many genetic analyses of livestock records. A modification of Colleau's indirect algorithm to compute inbreeding coefficients in large populations is presented. With overlapping generations, the modified algorithm evaluated all progeny of each sire simultaneously in one back and forth exploration of a reduced pedigree. Simulation for a relatively large number of generations, different number of sires, family sizes and mating designs showed that Colleau's algorithm was faster (from 1.2 to 143 times) than two other algorithms under comparison (Tier, modified Meuwissen and Luo), in all situations investigated. Modifying Colleau's algorithm considerably decreased computation time (from 50 to 89%), resulting in a very fast algorithm. The number of sires mostly affected computational efficiency of the modified algorithm, whereas family size and mating design had virtually no effect. In the updating situation, when only animals born in the last year were evaluated, given known inbreeding coefficients for the other, the modified algorithm was also fast compared with the other three algorithms. Memory requirements for the algorithms were also discussed.
Estimation of heritability for Tying‐up syndrome in the Thoroughbred racehorse by Gibbs sampling
Authors: Oki H. , Miyake T. , Hasegawa T. , Sasaki Y.
Published: September 2005

Tying‐up is a condition that primarily affects the muscles of horses. In this study, the heritability of the Tying‐up syndrome in the Thoroughbred racehorse was estimated by Bayesian analysis with Gibbs sampling based on the threshold model for binary traits. The data used were the clinical data in racehorses diagnosed by veterinarians of the Racehorse Clinics of Japan Racing Association from 2000 to 2003. The health status of the Tying‐up was treated as a binary trait. In the genetic analysis, the effect of changing the amount of the pedigree or inbreeding information on the estimation of heritability was investigated, too. The heritability estimates with non‐zero probability in the posterior densities were approximately 0.16–0.18 in minimum, suggesting that the heritability of the Tying‐up is not zero at least. The posterior density distributions of the heritability estimates were generally more pointed and sharp with using inbreeding coefficients than without using it, suggesting that more stable estimations were obtained when inbreeding coefficients were used. Among the different amounts of pedigree and inbreeding information, the heritabilities obtained with three or four generations of pedigree using inbreeding coefficients seems to be preferable, i.e. heritability of 0.42 or 0.43 for Tying‐up.
Prediction of inbreeding in commercial females maintained by rotational mating with partially isolated sire lines
Authors: Honda T. , Nomura T. , Mukai F.
Published: September 2005

The solution to the inbreeding problem for livestock breeds in commercial use is often complicated by hierarchical population structure, in which favourable genes are accumulated in the upper level of the hierarchy (breeding population) by artificial selection and the genetic progress achieved is transferred to the lower level through migration of males. When the breeding population is subdivided into several isolated lines, rotational mating with the lines has been shown to be quite an effective system to reduce the short‐ and long‐term inbreeding of commercial females in the lower level. In practice, however, some amount of migration should be allowed among the lines to reduce the rate of inbreeding in each line. In this study, we developed the recurrence equation for the inbreeding coefficient of the commercial females maintained by the rotational mating with partially isolated lines. Numerical computations were carried out to evaluate the effect of the migration on the efficiency of the rotational mating. It was shown that even with a small amount of migration among the lines, the inbreeding of commercial females is substantially inflated. However, when four or five lines are available, the inbreeding coefficient of commercial females can be suppressed to an acceptable level, irrespective of the effective size of line and the migration rate. Application of the mating system to the population of Japanese Black cattle was also examined.
Molecular cloning and characterization of bovine PRKAG3 gene: structure, expression and single nucleotide polymorphism detection
Authors: Yu S.L. , Kim J.E. , Chung H.J. , Jung K.C. , Lee Y.J. , Yoon D.H. , Lee S.H. , Choi I. , Bottema C.D.K. , Sang B.C. , Lee J.H.
Published: September 2005

The protein kinase adenosine monophosphate‐activated γ3‐subunit (PRKAG3) gene encodes a muscle‐specific isoform of the regulatory gamma‐subunit of adenosine monophosphate‐activated protein kinase, which plays a key role in regulating energy homeostasis in eucaryotes. It is well known that mutations in the PRKAG3 gene affect high glycogen content in the porcine skeletal muscle and, consequently, meat quality. The genomic structure and sequence of the bovine PRKAG3 were analysed from a Korean cattle BAC clone. The bovine PRKAG3 gene comprises 13 exons and spans approximately 6.8 kb on BTA2. From 5′ and 3′‐rapid amplification of cDNA ends experiments, the full‐length cDNA of bovine PRKAG3 has been identified, encoding a deduced protein of 465 amino acids. Two splice isoforms, generated by the alternative splicing of exon 2, were also identified. Northern blot analysis demonstrated that, similar to other species, the bovine PRKAG3 transcript was only expressed in skeletal muscle. Seven single nucleotide polymorphisms, including two previously identified variants, were detected in four Bos taurus cattle breeds. The bovine PRKAG3 gene described in this study may be involved in muscle‐related genetic diseases or meat quality traits in cattle.
Weight loss and hypernatremia in breast‐fed babies: Frequency in neonates with non‐hemolytic jaundice
Authors: Tarcan Aylin , Tiker Filiz , Vatandaş Nilgün Şalk , Haberal Ayşegül , Gürakan Berkan
Published: September 2005

Objective:  The aim of this study was to determine what proportion of newborns admitted with idiopathic non‐hemolytic hyperbilirubinemia exhibit severe weight loss and hypernatremia.

Methods:  The prospective study involved 115 infants >48 h old who were admitted with jaundice between July 2002 and July 2003, and had unconjugated bilirubin levels >12 mg/dL. Premature babies (gestational age <37 weeks) and those with hemolytic jaundice and other pathologic causes of non‐hemolytic jaundice were excluded. Postnatal age (days) at admission, bodyweight at admission, weight change since birth (percentage weight loss calculated at admission) and mode of feeding (breast‐feeding, formula feeding, mixed feeding) were recorded. Severe weight loss was defined in babies who showed >10% weight loss or had not regained enough to reach birthweight by postnatal day 10. Serum Na levels and breast‐milk Na levels were also measured.

Results:  Twenty‐eight (33%) of the 86 newborns with idiopathic hyperbilirubinemia in the study exhibited severe weight loss. Almost all the 86 babies were exclusively breast‐fed, and 10 babies (12%) had severe weight loss combined with hypernatremia. The group with severe weight loss and hypernatremia had higher breast‐milk Na levels than the other infants.

Conclusion:  The results indicate that a large proportion of babies with non‐hemolytic jaundice have severe weight loss, and that breast‐fed newborns with the combination of weight loss and hypernatremia may present with non‐hemolytic jaundice.
Can Australian general practitioners tackle childhood overweight/obesity? Methods and processes from the LEAP (Live, Eat and Play) randomized controlled trial
Authors: McCallum Zoë , Wake Melissa , Gerner Bibi , Harris Claire , Gibbons Kay , Gunn Jane , Waters Elizabeth , Baur Louise A
Published: September 2005

Background:  General practitioners (GPs) could make an important contribution to management of childhood overweight. However, there are no efficacy data to support this, and the feasibility of this approach is unknown.

Objectives:  To determine if GPs and families can be recruited to a randomized controlled trial (RCT), and if GPs can successfully deliver an intervention to families with overweight/obese 5‐ to 9‐year‐old children.

Methods:  A convenience sample of 34 GPs from 29 family medical practices attended training sessions on management of childhood overweight. Practice staff trained in child anthropometry conducted a cross‐sectional body mass index (BMI) survey of 5‐ to 9‐year‐old children attending these practices. The intervention focused on achievable goals in nutrition, physical activity and sedentary behaviour, and was delivered in four solution‐focused behaviour change consultations over 12 weeks.

Results:  General practitioners were recruited from across the sociodemographic spectrum. All attended at least two of the three education sessions and were retained throughout the trial. Practice staff weighed and measured 2112 children in the BMI survey, of whom 28% were overweight/obese (17.5% overweight, 10.5% obese), with children drawn from all sociodemographic quintiles. Of the eligible overweight/obese children, 163 (40%) were recruited and retained in the LEAP RCT; 96% of intervention families attended at least their first consultation.

Conclusions:  Many families are willing to tackle childhood overweight with their GP. In addition, GPs and families can participate successfully in the careful trials that are needed to determine whether an individualized, family‐based primary care approach is beneficial, harmful or ineffective.
Early case conferences shorten length of stay in children admitted to hospital with suspected child abuse
Authors: Smith J Anne S , Efron Daryl
Published: September 2005

Objective:  To compare the outcomes of two models for the management of children admitted to hospital with suspected child abuse: routine early case conferencing versus standard evaluation.

Methods:  Between March 2001 and February 2002 professionals from the Royal Children's Hospital, Melbourne, Victoria Police and Child Protection services collaborated on a randomized controlled study involving children admitted to hospital with suspected child abuse. The intervention group (n = 13) received a case conference within 24 h of the child's admission to hospital. The control group (n = 12) were managed according to standard procedures whereby each organization conducted their own evaluation (and a case conference might or might not have been held). Patients were followed for 3 months with data collected from all three professional groups.

Results:  The process of evaluation, the eventual diagnosis of child abuse and the confidence with which professionals made this diagnosis was not significantly different between the groups. Case conferences were judged to be useful regardless of their timing. Mean length of stay in the intervention group was significantly less than in controls (42.4 h vs 99.7 h, P = 0.01).

Conclusion:  Early case conferences appear to shorten the period of time children spend in hospital when child abuse is suspected. This has significant implications for reducing costs for all organizations involved in the evaluation of suspected child abuse.
Volume‐targeted ventilation and arterial carbon dioxide in neonates
Authors: Dawson Catherine , Davies Mark William
Published: September 2005

Objectives: To review the arterial carbon dioxide tensions (PaCO2) in newborn infants ventilated using synchronized intermittent mandatory ventilation (SIMV) in volume guarantee mode (using the Dräger Babylog 8000+) with a unit policy targeting tidal volumes of approximately 4 mL/kg.

Methods: Data on ventilator settings and arterial PaCO2 levels were collected on all arterial blood gases (ABG; n = 288) from 50 neonates (<33 weeks gestational age) ventilated using the Dräger Babylog 8000+ ventilator (Dräger Medizintechnik GmbH, Lübeck, Germany) in SIMV plus volume guarantee mode. Data were analysed for all blood gases done on the entire cohort in the first 48 h of life and a subanalysis was done on the first gas for each infant (n = 38) ventilated using volume guarantee from admission to the nursery. The number of ABG showing severe hypocapnoea (PaCO2 < 25 mmHg) and/or severe hypercapnoea (PaCO2 > 65 mmHg) were determined.

Results: The mean (SD) PaCO2 during the first 48 h was 46.6 (9.0) mmHg. The mean (SD) PaCO2 on the first blood gas of those infants commenced on volume guarantee from admission was 45.1 (12.5) mmHg. Severe hypo‐ or hypercapnoea occurred in 8% of infants at the time of their first blood gas measurement, and in <4% of blood gas measurements in the first 48 h.

Conclusions: Infants ventilated with volume guarantee ventilation targeting approximately 4 mL/kg (range: 2.9–5.1) have acceptable PaCO2 levels at the first blood gas measurement and during the first 48 h of life; and avoid severe hypo‐ or hypercapnoea over 90% of the time.
Surgical biopsy in lymphoma*
Authors: Eaton Michael , Fox Richard
Published: September 2005

The term ‘lymphoma’ describes malignant lymphoproliferative diseases that originate from B‐ and T‐cells in the lymphatic system. The majority of lymphomas arise from lymph nodes, while some may originate in extranodal sites. Lymphoma is a common cancer, affecting approximately 4000 people in Australia per year, and constituting 4% of newly diagnosed cancers. Lymphoma is primarily a disease of adults, and is the sixth most common cancer in men, after prostate, colorectal, lung, melanoma and bladder, and the fifth most common cancer in women, after breast, colorectal, melanoma and lung1.
Clinical outcomes of deep atypical lipomas (well‐differentiated lipoma‐like liposarcomas) of the extremities
Authors: Sommerville Scott M. M. , Patton James T. , Luscombe Jon C. , Mangham D. Chas , Grimer Robert J.
Published: September 2005

Aim:  Controversy exists with regard to the nomenclature, treatment and outcome of a group of well‐differentiated lipomatous tumours sometimes labelled as atypical lipomas. The purpose of the present paper is to attempt to clarify these controversies by reporting our experience with this lesion.

Methods:  The clinical features and follow up of 61 patients with the diagnosis of deep atypical lipoma and a minimum two‐year follow up were examined.

Results:  All patients were treated by marginal excision alone. A local recurrence was seen in five patients (8%). Three recurred once and two recurred twice. No patient had a metastasis or died as a result of the tumour. No lesion dedifferentiated.

Conclusion:  We believe the term atypical lipoma is appropriate for these tumours, as they appear not to have any metastatic potential, merely a propensity to recur locally. The chance of dedifferentiation is small and radiotherapy may play a role in its causation. We suggest that a simple marginal resection (shelling‐out) is adequate treatment for these lesions. Radiotherapy should not be used.
Abdominal trauma: a disease in evolution
Authors: Smith Jason , Caldwell Erica , D’Amours Scott , Jalaludin Bin , Sugrue Michael
Published: September 2005

Background:  The last decade has seen many changes in the way we investigate and manage abdominal injuries. This study assessed the pattern of abdominal injury and its investigation in patients admitted to a major trauma centre.

Methods:  A retrospective registry review of all adult trauma patients admitted to Liverpool Hospital between January 1996 and December 2003 was undertaken. All adult trauma patients were included, identifying mechanism of injury, injury severity score, abbreviated injury score for the abdomen, investigations and intervention. The study period was divided (period 1 from 1996 to 1999, period 2 from 2000 to 2003) and the two periods compared to assess change.

Results:  The study involved 1224 patients with abdominal injuries. Of these, 969 (79%) were a result of blunt trauma. The main causes were road accidents (61%), interpersonal violence (24%) and falls (7%). Penetrating injury increased from 16% to 25% between the two periods. There were 1274 intra‐abdominal injuries, made up of 607 solid organ (liver (n = 220, 36%), spleen (n = 195, 32%), renal (n = 144, 24%) ), 291 hollow viscus (small bowel (n = 160, 55%), large bowel (n = 104, 36%) ) and 168 vascular. Four hundred and thirty‐six (36%) patients underwent laparotomy, 65% for blunt trauma. Between the two periods there was a 46% decrease in the use of diagnostic peritoneal lavage, with a 40% increase in computed tomography and 325% increase in focused assessment with sonography for trauma.

Conclusions:  This study defined abdominal injury pattern and identified a significant shift in mechanism of injury and abdominal investigation at a major trauma centre during an 8‐year study period. Abdominal trauma is indeed a disease in evolution.
The Auburn Elective Surgery Pilot Project
Authors: Singh N. , Brooke‐Cowden G. L. , Whitehurst Catherine , Smith Deborah , Senior John
Published: September 2005

Background:  The aim of this project was to increase rates of day surgery, reduce elective surgical waiting lists, give patients a guaranteed date of surgery and improve operating theatre utilization. The guiding principle behind the project was to treat the administration of elective surgery as a separate business unit, distinct from emergency surgery.

Methods:  Elective surgical referrals for admission from throughout the Western Sydney Health Area Service were pooled. The procedure for surgical admissions was altered in three areas: (i) the use of a new booking and waiting list system administered by a dedicated nurse coordinator who generated the lists for surgery; (ii) restructuring the elective surgical operating sessions; and (iii) planning post‐discharge care at the time of operation using model clinical pathways.

Results and conclusions:  During the project period, the number of the selected surgical procedures performed doubled. Fifty‐seven per cent of patients were discharged on the day of surgery. Surgeons took less time to perform procedures. By the end of the trial period, waiting lists for the selected procedures were eliminated. Operating costs as evaluated by the Centre for Health Economics Research and Evaluation were reduced by 25%. The administrative changes to surgical admissions resulted in improved cost and patient throughput for elective surgical admissions with no adverse patient outcomes.
Central nervous system interleukin‐8 production following neck of femur fracture
Authors: Chuang Danny , Power Sharleen E. , Dunbar P. Rod , Hill Andrew G.
Published: September 2005

Aim:  To establish a proinflammatory cytokine profile of the cerebrospinal fluid (CSF) following trauma.

Background:  Trauma is associated with a postinjury syndrome consisting of loss of weight and nitrogen, pyrexia, anorexia and fatigue. It has been proposed that cytokines are pathophysiologically involved in this syndrome but the site of action of these is unclear. Previous work in head injury models, supported by animal work, has suggested that one important site of action is the central nervous system (CNS).

Methods:  Women who had sustained neck of femur fractures were enrolled (trauma group). CSF was collected at the time of spinal anaesthetic. Women undergoing elective lower limb surgery were recruited as controls. CSF and serum were assayed for Interleukin (IL) 1, 2, 4, 6, 8, 10, 12, interferon gamma, and tumour necrosis factor by cytometric bead array.

Results:  In the trauma group, IL‐8 was elevated in the CSF but not in the serum, while IL‐6 was elevated in the serum but not in the CSF. IL‐1β, associated with elevated IL‐12, was also detected in the serum of three of 11 trauma patients but none of the nine controls. No other cytokines were consistently detected.

Conclusions:  This study raises the possibility that IL‐8, acting in the CNS, plays a role in the postinjury syndrome. It is unclear as to the mechanism by which CNS IL‐8 is produced in trauma but a physiological role is supported by the known ability of the CNS to produce IL‐8 and the presence of receptors for its action in the CNS.
Remifentanil versus fentanyl for short‐term analgesia‐based sedation in mechanically ventilated postoperative children
Authors: AKINCI SEDA BANU , KANBAK MERAL , GULER AYGUN , AYPAR ULKU
Published: September 2005

Background : Analgesia‐based sedation techniques are becoming more established in the intensive care unit (ICU) setting. The aim of this study was to compare remifentanil and fentanyl infusions for postoperative analgesia in pediatric ICU patients.

Methods : After receiving ethical committee approval, a prospective randomized, double‐blind study was performed. Twenty‐two postoperative orthopedic surgery patients received either remifentanil 0.1 μg·kg−1·min−1 or fentanyl 0.025 μg·kg−1·min−1 infusions diluted to the same volume. Analgesic infusion was titrated to predefined levels of analgesia [behavioral pain scale (BPS) score of 3]. Propofol was added if sedation was unsatisfactory after BPS score 3 had been achieved.

Results : There were no differences in groups regarding demographics, tracheal extubation times, and pain scores of the patients. After cessation of the opioid infusion, the sedation scores and the heart rates were always higher in the remifentanil group compared with the fentanyl group. The incidences of nausea, vomiting, apnea, desaturation, reintubation within 24 h and constipation were also similar between the two groups.

Conclusions : We conclude that a remifentanil infusion provides clinically comparable analgesia with a fentanyl infusion in mechanically ventilated postoperative pediatric patients. These two drugs are suitable for short‐term analgesia‐based sedation in pediatric postoperative ICU patients.
Tracheoesophageal fistula and associated congenital heart disease: implications for anesthetic management and survival
Authors: DIAZ LAURA K. , AKPEK ELIF A. , DINAVAHI RADHIKA , ANDROPOULOS DEAN B.
Published: September 2005

Background : Infants with tracheoesophageal fistula (TEF) and/or esophageal atresia (EA) frequently have other associated congenital anomalies which can have a significant impact on their anesthetic care and survival to discharge.

Methods : A medical record review and retrospective data analysis were performed in a university affiliated children's hospital of all infants undergoing TEF/EA repair between January 1998 and July 2004. The incidence of intraoperative complications during the TEF repair and overall survival to hospital discharge was compared in two groups of infants: 26 patients with TEF/EA and coexisting congenital heart disease (CHD), and 27 patients with TEF/EA and no CHD.

Results : The overall incidence of intraoperative critical events during repair of TEF/EA was significantly higher in infants with associated cardiac pathology (P = 0.003). Six of 53 infants died during hospitalization (overall mortality, 11.3%) and all had associated cardiac pathology. In comparison with nonductal‐dependent lesions, the presence of a ductal‐dependent cardiac lesion appeared to significantly increase patient mortality (57% vs. 10%, P = 0.028).

Conclusions : Low birth weight (<1500 g) and associated cardiac pathology were found to be independent predictors of mortality in infants undergoing surgery for TEF/EA repair. The presence of a ductal‐dependent cardiac lesion further increased the risk of morbidity and mortality, in addition to necessitating special anesthesia considerations.
Detection of cultured and uncultured Burkholderia cepacia complex bacteria naturally occurring in the maize rhizosphere
Authors: Pirone Luisa , Chiarini Luigi , Dalmastri Claudia , Bevivino Annamaria , Tabacchioni Silvia
Published: September 2005

The species composition of a Burkholderia cepacia complex population naturally occurring in the maize rhizosphere was investigated by using both culture‐dependent and culture‐independent methods. B. cepacia complex isolates were recovered from maize root slurry on the two selective media Pseudomonas cepacia azelaic acid tryptamine (PCAT) and trypan blue tetracycline (TB‐T) and subjected to identification by a combination of restriction fragment length polymorphism (RFLP) analysis and species‐specific polymerase chain reaction (PCR) tests of the recA gene. DNA extracted directly from root slurry was examined by means of nested PCR to amplify recA gene with species‐specific B. cepacia complex primers and to obtain a library of PCR amplified recA genes. Using the culture‐dependent method the species Burkholderia cepacia, Burkholderia cenocepacia, Burkholderia ambifaria and Burkholderia pyrrocinia were identified, whereas using the culture‐independent method also the species Burkholderia vietnamiensis was detected. The latter method also allowed us to highlight a higher diversity within the B. cenocepacia species. In fact, by using the culture‐independent method the species B. cenocepacia recA lineages IIIA and IIID besides B. cenocepacia recA lineage IIIB were detected. Moreover, higher heterogeneity of recA RFLP patterns was observed among clones assigned to the species B. cenocepacia than among B. cenocepacia isolates from selective media.
The active methanotrophic community in hydromorphic soils changes in response to changing methane concentration
Authors: Knief Claudia , Kolb Steffen , Bodelier Paul L. E. , Lipski André , Dunfield Peter F.
Published: September 2005

Methanotrophic communities were studied in several periodically water‐saturated gleyic soils. When sampled, each soil had an oxic upper layer and consumed methane from the atmosphere (at 1.75 ppmv). In most gleyic soils the Km(app) values for methane were between 70 and 800 ppmv. These are higher than most values observed in dry upland soils, but lower than those measured in wetlands. Based on cultivation‐independent retrieval of the pmoA‐gene and quantification of partial pmoA gene sequences, type II (Alphaproteobacteria) methanotrophs of the genus Methylocystis spp. were abundant (> 107pmoA target molecules per gram of dry soil). Type I (Gammaproteobacteria) methanotrophs related to the genera Methylobacter and Methylocaldum/Methylococcus were detected in some soils. Six pmoA sequence types not closely related to sequences from cultivated methanotrophs were detected as well, indicating that diverse uncultivated methanotrophs were present. Three Gleysols were incubated under different mixing ratios of 13C‐labelled methane to examine 13C incorporation into phospholipid fatty acids (PLFAs). Phospholipid fatty acids typical of type II methanotrophs, 16:0 and 18:1ω7c, were labelled with 13C in all soils after incubation under an atmosphere containing 30 ppmv of methane. Incubation under 500 ppmv of methane resulted in labelling of additional PLFAs besides 16:0 and 18:1ω7c, suggesting that the composition of the active methanotrophic community changed in response to increased methane supply. In two soils, 16:1 PLFAs typical of type I methanotrophs were strongly labelled after incubation under the high methane mixing ratio only. Type II methanotrophs are most likely responsible for atmospheric methane uptake in these soils, while type I methanotrophs become active when methane is produced in the soil.
Sequence analysis of three plasmids harboured in Rhodococcus erythropolis strain PR4
Authors: Sekine Mitsuo , Tanikawa Satoshi , Omata Seiha , Saito Mika , Fujisawa Takatomo , Tsukatani Naofumi , Tajima Takahisa , Sekigawa Tomohiro , Kosugi Hiroki , Matsuo Yasunori , Nishiko Rika , Imamura Kohsuke , Ito Mio , Narita Hitomi , Tago Shinichi , Fujita Nobuyuki , Harayama Shigeaki
Published: September 2005

Rhodococcus erythropolis strain PR4 has been isolated as an alkane‐degrading bacterium. The strain harbours one linear plasmid, pREL1 (271 577 bp) and two circular plasmids, pREC1 (104 014 bp) and pREC2 (3637 bp), all with some sequence similarities to other Rhodococcus plasmids. For pREL1, pREC1 and pREC2, 298, 102 and 3 open reading frames, respectively, were predicted. Linear plasmid pREL1 has several regions homologous to plasmid pBD2 found in R. erythropolis BD2. Sequence analysis of pREL1 and pBD2 identified common metal‐resistance genes on both, but pREL1 also encodes alkane‐degradation genes not found on pBD2, with enzyme constituents some of which are quite different from those of other organisms. The alkane hydroxylase consisted of a cytochrome P450 monooxygenase, a 2Fe‐2S ferredoxin, and a ferredoxin reductase. The ferredoxin reductase amino acid sequence resembles the AlkT (rubredoxin reductase) sequence. A zinc‐containing alcohol dehydrogenase further oxydizes alkanols, alkane oxidation products catalysed by alkane hydroxylase. Of the circular plasmids, the pREC1 sequence is partially similar to the sequence of pREAT701, the virulence plasmid found in Rhodococcus equi. pREC1 has no pREAT701 virulence genes and encodes genes for β‐oxidation of fatty acids. Thus, joint actions of enzymes encoded by pREL1 and pREC1 may enable efficient mineralization of alkanes.
Diabetes and dyslipidaemia
Authors: Schwartz Sherwyn L.
Published: September 2005

The risk of developing cardiovascular disease (CVD) is higher and the prognosis poorer for diabetic than for non‐diabetic individuals. Diabetic dyslipidaemia is characterized by hypertriglyceridaemia, low levels of high‐density lipoprotein cholesterol (HDL‐C) and the presence of small, dense low‐density lipoprotein (LDL) particles. Increased physical activity and weight loss are the first steps in managing diabetic dyslipidaemia. A secondary goal is to achieve non‐HDL‐C targets with cholesterol‐lowering therapy. Improved glycaemic control, the first priority in managing hypertriglyceridaemia, can also aid in lowering levels of LDL‐C. Lipid‐lowering therapy should be initiated if lifestyle changes and glycaemic control fail to reduce LDL‐C levels to <100 mg/dl (5.5 mmol/l), regardless of the status of CVD, coronary heart disease or peripheral vascular disease, and to reduce triglyceride levels of ≥150 mg/dl (8.3 mmol/l). Many diabetic patients may need oral hypoglycaemic agents or insulin to achieve adequate glycaemic control. Intensive insulin therapy can provide tight glycaemic control and reduce elevated triglyceride levels.
The immunotherapy of prostate and bladder cancer
Authors: Totterman Thomas H. , Loskog Angelica , Essand Magnus
Published: September 2005

The role of the immune system in controlling the growth of tumour cells is highly complex and has been extensively debated. It is well documented that the immune system controls virally induced cancers, and there is evidence for a role of specific immunity in other types of tumours. The greater understanding of the regulation and optimization of adoptive, specific immune responses, and the better characterization of tumour‐associated antigens indicate the way for active specific vaccination and cell therapy in urological tumours. Currently, bacille Calmette Guerin immunotherapy is established for localized bladder cancer and many experimental immunotherapies are under evaluation. Here we review some timely aspects of tumour immunology, and describe the current status and development of immunotherapy in prostate and bladder cancer.
Intravesical bacillus Calmette‐Guèrin therapy: experience with a reduced dwell‐time in patients with pronounced side‐effects
Authors: Andius Patrik , Fehrling Marianne , Holmäng Sten
Published: September 2005

OBJECTIVE

To report the side‐effects after a reduction in the dwell‐time in patients who had pronounced symptoms after intravesical bacillus Calmette‐Guèrin (BCG) treatment, as side‐effects such as fever, haematuria, and frequency are common and sometimes severe after BCG treatment in patients with bladder cancer.

PATIENTS AND METHODS

The dwell‐time was reduced to ≤ 30 min in 51 patients who had pronounced side‐effects after the preceding BCG instillation. All patients self‐reported side‐effects after each instillation in a questionnaire.

RESULTS

After reducing the BCG dwell‐time, fever, chills, dysuria and the overall time‐to‐recovery were significantly reduced but frequency and haematuria were not influenced. Patients with carcinoma in situ had significantly less dysuria than patients with papillary tumours. There was no difference in the treatment results between patients who had a normal dwell‐time and a reduced dwell‐time, determined at the first and second follow‐up cystoscopy.

CONCLUSION

Reducing the BCG dwell‐time to ≤ 30 min could be an alternative to a dose reduction in patients who experience pronounced side‐effects after BCG instillations. The long‐term outcome after reducing dwell‐time and after dose reduction has not been studied and warrants further investigation.
Does information provided to men before a urodynamic study affect their expectation of pain?
Authors: Greenstein Alexander , Bar‐Yosef Yuval , Chen Juza , Matzkin Haim
Published: September 2005

OBJECTIVE

To evaluate the effect of a routine explanation provided to men on their expectation of pain associated with a urodynamic study (UDS).

PATIENTS AND METHODS

The purpose of UDS is to reproduce patient's symptoms during the urine storage and voiding phases, and thus understand the causes of the patient's symptoms. UDS may cause discomfort and pain, mainly from the urethral instrumentation; the fear of pain related to UDS may affect the patients’ behaviour and the information provided by them, and thus may alter the conclusions drawn from the study. Routinely as with any other invasive procedures, patients are provided with an explanation about the UDS. Sixty‐three men referred for UDS in an outpatient clinic, who had not had previous UDS, were included (mean age 56.4 years, range 25–89). Of these patients, 15 had had previous instrumentation of the urethra (urethral catheterization, cystoscopy), and 14 had had a prostatectomy. One urologist provided a detailed explanation of the different stages of the UDS. Use of an anaesthetic gel, and instrumentation of the urethra and anus by an experienced urologist, were emphasized. Pain was assessed using a visual analogue pain scale three times, to provide an expected pain score (EPS) on entering the examination room, after the explanation, and the actual pain felt during the UDS.

RESULTS

The mean EPS before the explanation was 4.2, significantly higher (5.17) after the explanation (P = 0.02) and the actual pain scored during the UDS was 3.76, lower than both the previous EPS. In patients who had had previous instrumentation of the urethra, the EPS after the explanation was significantly higher, at 6.06 (P < 0.05). Pain scores were not significantly different in patients after prostatectomy.

CONCLUSIONS

The routine guidance provided to male patients undergoing UDS enhances their expectations of pain, especially in those who have had previous instrumentation of the urethra. As the fear of pain may alter the information provided by the patient, different strategies of providing patients with information about UDS should be devised.
Clinical observations of the effect of antidiuretic hormone on nocturia in elderly men
Authors: Ho Dong‐Ru , Lin Wei‐Yu , Wu Ching‐Fang , Shee Jia‐Jen , Huang Yun‐Ching , Chen Chih‐Shou
Published: September 2005

OBJECTIVE

To evaluate the effect of desmopressin on nocturia, based on patients’ subjective scoring of nocturia, as desmopressin is widely used to treat nocturnal enuresis and nocturnal polyuria.

PATIENTS AND METHODS

We investigated a specific subgroup of 28 men with benign prostate obstruction and nocturia who were treated with desmopressin. Patients with nocturnal polyuria were excluded. All the patients were refractory to treatment with antimuscarinics or anticholinergics, e.g. oxybutynin, tolterodine, and propantheline bromide. We assessed the effect of desmopressin using a quantitative nocturia score and analysed its synergistic effect with α‐blockers.

RESULTS

The mean frequency of nocturia was 6.1 before desmopressin and most (86%) patients had an improvement in nocturia within 1–12 weeks of treatment with desmopressin. There was a 43% reduction in nocturia after using desmopressin (P < 0.001). The correlation coefficient between the number of nocturnal voids and the reduction in nocturia after treatment with desmopressin was 0.756, indicating that the more severe the nocturia, the more effective was desmopressin.

CONCLUSIONS

Desmopressin is effective for refractory nocturia in elderly men with no nocturnal polyuria, and has limited side‐effects.
Cholinergic treatment: what are the early neuropathological targets?
Authors: Riepe M. W.
Published: September 2005

Defining the regions of the brain displaying the neuropathological lesions that cause Alzheimer's disease (AD) will facilitate deeper investigation into their pathophysiology. In addition, this would allow the effects of AD treatment to be specifically monitored in those regions. Cognitive decline in AD begins with failings of episodic memory and spatial orientation in patients with very mild AD. Clinical and experimental data show that the brain regions primarily involved in memory impairment early in AD are the hippocampus and the medial temporal lobe. Is it possible to prevent the development of pathophysiology in these regions? The neuroprotective effect of cholinesterase inhibitors has been demonstrated in a number of different models, including protection of cortical neurons in models of oxygen‐glucose deprivation and glutamate‐induced toxicity, and protection against the effects of hippocampal mitochondrial dysfunction in transgenic mouse models of AD. These preclinical data are supported by extensive clinical data indicating that maximum benefit is gained through early initiation of treatment with donepezil and suggest that the benefits afforded by donepezil may extend beyond those of a purely symptomatic treatment.
Alzheimer's disease: the benefits of early treatment
Authors: Gauthier S. G.
Published: September 2005

The purpose of this review was to summarize research on the clinical benefits of early treatment for Alzheimer's disease via a focused discussion of data on donepezil. Well‐controlled clinical trials demonstrate that donepezil is effective in stabilizing or slowing progressive decline in cognition, function, and behavior. Several studies reveal statistically significant and clinically meaningful advantages to initiating treatment early in the course of the disease. Benefits of donepezil treatment include behavioral stabilization and preserved independence, in addition to slowed cognitive decline. Epidemiologic studies and evidence from histopathology underlie a rationale for treating patients who are cognitively impaired but do not have dementia. Clinical trials in such patients indicate that treating patients with mild cognitive impairment (MCI) may delay the onset of Alzheimer's dementia. Substantial evidence favors initiating treatment early in the course of dementia and reinforces the necessity to assess behavior and activities of daily living to accurately evaluate treatment response. Results of early studies of donepezil in MCI are promising and suggest directions for further research.
A population‐based study of the prenatal diagnosis of congenital malformation over 16 years
Authors: Richmond Sam , Atkins John
Published: September 2005

Objective  A population‐based study of the trends in accuracy over time of prenatal diagnosis of congenital malformations.

Design  A prospective study of all congenital malformations.

Setting  The counties of Cleveland, Durham, North Cumbria, Northumberland and Tyne and Wear.

Population  All 573,471 babies born to residents at 24 weeks of gestation or more, and all terminations for fetal abnormality, occurring between 1985 and 2000.

Methods  An analysis of all congenital anomalies whether antenatally detected or diagnosed before one year of age to examine the accuracy of prenatal diagnosis and its trends over four consecutive four‐year periods.

Main outcome measures  The proportion of cases where a diagnosis before birth was correctly made, wrongly made or not made in a range of important structural malformations.

Results  There was a substantial improvement in the accuracy of prenatal diagnosis of all conditions reported here. However, the extent to which different conditions were diagnosed varied widely. It now exceeds 90% for anencephaly and for abdominal wall defects but is still less than 70% for diaphragmatic hernia, bladder outlet obstruction and many major skeletal defects. Termination of pregnancy for fetal malformation rose from 23 to 47 per 10,000 registrable births.

Conclusion  This large prospective study provides data on the accuracy of prenatal diagnosis of a number of malformations in a geographically defined population under service conditions. Diagnostic accuracy has improved over time but may well be lower than many clinicians assume for some important conditions and may not match public expectations.
Two‐year neurodevelopmental outcome in children conceived by intracytoplasmic sperm injection: prospective cohort study
Authors: Agarwal Pratibha , Loh Sheila Kia Ee , Lim Sok Bee , Sriram Bhavani , Daniel Mary Lourdes , Yeo Seow Heong , Heng Derrick
Published: September 2005

Objective  Primary outcome was to compare neurodevelopmental outcome at two years in intracytoplasmic sperm injection (ICSI) conceived children versus matched controls. Secondary outcome was to determine incidence of major congenital malformations and study perinatal outcome.

Design  Prospective cohort study.

Setting  Tertiary care perinatal centre over a period of 13 months.

Population  Seventy‐six ICSI conceived children and 261 matched controls selected by matching for maternal age, sex, date of delivery, race, plurality and parity.

Methods  Mental Development Index (MDI) and Psychometric Development Index (PDI) of the Bayley's Scale of Development (BSID‐II) and Vineland Adaptive Behaviour Scale (VABS) were used to assess the neurodevelopmental and functional outcome. The congenital malformations were classified according to ICD‐9 code.

Main outcome measures  Primary outcome measure—neurodevelopmental and functional outcomes. Secondary outcome measure—congenital malformations and perinatal outcomes.

Results  Neurodevelopmental and functional outcome were comparable in both groups. The mean MDI score was 92 [16] versus 90 [14] in the study and control groups respectively. Fourteen (18.4%) in the ICSI group had MDI <85 compared with 87 (33%) controls (P= 0.002). On linear regression the MDI was independently affected by plurality (P= 0.001), maternal education and socio‐economic status (P= 0.01). The study group had a lower gestation (36 [3] vs 37.1 [2] weeks; P= 0.005) and a higher incidence of prematurity <34 weeks [19 (25%)] vs [31 (12%)] P= 0.012]. Six (7.9%) of the ICSI babies and seven (2.7%) of the controls had a major congenital malformation (P= 0.05).

Conclusions  Children born by ICSI pregnancies did not have an adverse neurodevelopmental outcome. The incidence of major congenital malformations in ICSI needs further evaluation.
Randomised controlled trial comparing efficacy of same day administration of mifepristone and misoprostol for termination of pregnancy with the standard 36‐ to 48‐hour protocol
Authors: Guest Jacqueline , Chien Patrick , Thomson Margaret , Kosseim Marie Louise
Published: September 2005

Hypothesis  That a 6‐hour drug administration interval has similar efficacy and greater patient satisfaction as a 36‐ to 48‐hour interval.

Sample  Four hundred and fifty patients.

Methods  A two‐arm parallel design unblended randomised controlled trial in a single hospital. Eligible women up to 63 days of gestation will be invited to participate. Those willing will be randomised to either the experimental group (6 hours administration of misoprostol) or the control group (36–48 hours administration of misoprostol). All participants will take 200 mg mifepristone orally. At the time determined by study group allocation 800 μg misoprostol will be given intravaginally together with 100 mg diclofenac pr. Antibiotic prophylaxis as per the usual protocol will be given to each group. The control group will remain in hospital for 6 hours as per current policy and the study group will return home in 1 to 3 hours.

Main outcome measure  Complete medical abortion without need for further misoprostol or surgical evacuation.

Secondary outcomes  Duration of bleeding, side effects and acceptability based on questionnaire.

Funding Source  None.