bluuebunny/crossref_metadata_2025 huggingface dataset:
Plumbing in the embryo: developmental defects of the urinary tracts
Authors: Uetani N , Bouchard M
Published: April 2009

Kidney and urinary tract malformations are among the most frequent developmental defects identified in newborns. Ranging from asymptomatic to neonatal lethal, these malformations represent an important clinical challenge. Recent progress in understanding the developmental origin of urinary tract defects in the mouse and other animal models suggests a new framework for the interpretation of these defects in humans. Gene inactivation studies in mice provided invaluable information on the formation of the Wolffian duct, a central component of embryonic renal development, on ureter and kidney induction as well as on distal ureter maturation. All three developmental processes are crucial for normal urinary tract morphogenesis. A failure to complete these developmental steps is responsible for a spectrum of kidney and urinary tract malformations including renal agenesis, renal dysplasia, vesicoureteral reflux, hydroureter, hydronephrosis and ureterocele. Surprisingly, distal ureter maturation, the process by which the ureter is displaced from the Wolffian duct to its final position within the bladder wall, has only recently been characterized at the morphological level. Anomalies in this process are emerging as a major source of urinary tract developmental defects. This review is aimed at bridging the current knowledge on the morphological and molecular events identified in the mouse, together with clinical observations of urinary tract malformation in humans.
Chronic ingestion ofPorphyromonas gingivalisinduces systemic nitric oxide response in mice
Authors: Nemec A. , Pavlica Z. , Crossley D. A. , Šentjurc M. , Jerin A. , Eržen D. , Vrecl M. , Majdič G. , Zdovc I. , Petelin M. , Skalerič U.
Published: April 2009

Introduction: Porphyromonas gingivalisinduces nitric oxide (NO) production in various cells, systemic NO elevation being expected in chronic oral challenge.

Methods: Groups of BALB/c mice were inoculated orally with either liveP. gingivalisATCC 33277 or sterile broth on days 0, 2 and 4, with or without later administration of the inducible nitric oxide synthase (iNOS) inhibitor 1400W. Plasma and tissues were harvested on day 42 for assays of tumor necrosis factor‐α (TNF‐α), nitrite and nitrate (NOx) and tissue NO, or histology and iNOS immunohistochemistry.

Results: No signs of gingivitis were observed, but plasma NOx was significantly elevated (P = 0.028) as was TNF‐α (P = 0.079) inP. gingivalis‐inoculated animals compared with controls, NOx being reduced when 1400W was used. NO production in organs showed a similar trend, with significant elevation in liver (P = 0.017) and kidneys (P = 0.027), whereas concomitant treatment of inoculated animals with 1400W caused significant reductions in NO in aorta (P = 0.008) and kidneys (P = 0.046). Sham‐inoculated 1400W‐treated animals had significantly increased plasma NOx (P = 0.004) and liver NO (P = 0.04). NOx in plasma correlated significantly with NO production in lungs (0.35,P = 0.032) and kidneys (0.47,P = 0.003). Immunohistochemistry demonstrated iNOS activity in many tissues in all groups.

Conclusion: Repeated oral administration ofP. gingivalisinduced systemic NO and NOx production in mice, probably by activating iNOS as suggested by the response to 1400W.
In vitro evaluation of yoghurt starter lactobacilli and Lactobacillus rhamnosus GG adhesion to saliva‐coated surfaces
Authors: Stamatova I. , Kari K. , Vladimirov S. , Meurman J. H.
Published: April 2009

Aim:  The aim of the study was to evaluate the adhesion of Lactobacillus delbrueckii subsp. bulgaricus and Lactobacillus rhamnosus strain GG to saliva‐coated surfaces in vitro.

Methods:  Fifteen radiolabeled dairy L. delbrueckii subsp. bulgaricus strains and L. rhamnosus GG were tested for their ability to adhere to saliva‐coated hydroxyapatite beads and polystyrene microtiter plates and the radioactivity was measured by liquid scintillation counter. The effects of lysozyme on the adhesion of lactobacilli and of pretreatment with lactobacilli on the adhesion of Streptococcus sanguinis were also assessed.

Results:  All strains tested adhered to saliva‐coated surfaces but with significantly different binding frequencies. The adhesion of the L. delbrueckii subsp. bulgaricus strains remained lower in comparison to L. rhamnosus strain GG. One L. delbrueckii subsp. bulgaricus strain showed binding frequency comparable to S. sanguinis. Lysozyme pretreatment of the samples significantly increased lactobacillus adhesion to saliva‐coated surfaces.

Conclusion:  The present results showed significant variations in the adhesion capacity of the Lactobacillus strains studied. Adhesion to oral surfaces is of primary importance for bacterial colonization in the mouth. Only one of the L. delbrueckii subsp. bulgaricus dairy starter culture strains investigated had a high adhesion percentage. This strain might then be considered for further investigations in the oral environment.
Increased trait‐like impulsivity and course of illness in bipolar disorder
Authors: Swann Alan C , Lijffijt Marijn , Lane Scott D , Steinberg Joel L , Moeller F Gerard
Published: April 2009

Background:  Impulsivity as a trait characteristic is increased in bipolar disorder and may be a core factor of the illness. We have investigated relationships between trait‐like impulsivity, measured by the Barratt Impulsiveness Scale (BIS‐11), and demographic and illness‐course characteristics of bipolar disorder.

Methods:  We studied 114 subjects with bipolar disorder and 71 healthy comparison subjects. Diagnoses were based on the Structured Clinical Interview for DSM‐IV. In addition to impulsivity, we examined age, education, gender, psychiatric symptoms, and characteristics related to course of illness. We used general linear mixed model analysis to evaluate the manner in which the variables contributed to BIS‐11 scores.

Results:  All BIS‐11 subscale scores were higher in bipolar disorder than in comparison subjects. There were less consistent independent effects of education and age. Elevated BIS‐11 scores were associated with early onset, more frequent episodes of illness, and a history of suicide attempts. These relationships persisted when age, gender, and education were taken into account.

Discussion:  These results show that, after accounting for common confounding factors, trait‐like impulsivity was substantially higher in subjects with bipolar disorder than in nonbipolar comparison subjects, regardless of symptoms. Within subjects with bipolar disorder, high trait impulsivity was associated with a more severe course of illness.
Do positive emotions predict symptomatic change in bipolar disorder?
Authors: Gruber June , Culver Jenifer L , Johnson Sheri L , Nam Jennifer Y , Keller Kristine L , Ketter Terence A
Published: April 2009

Objectives: Bipolar disorder is associated with positive emotion disturbance, though it is less clear which specific positive emotions are affected.

Methods: The present study examined differences among distinct positive emotions in recovered bipolar disorder (BD) patients (n = 55) and nonclinical controls (NC) (n = 32) and whether they prospectively predicted symptom severity in patients with BD. At baseline, participants completed self‐report measures of several distinct trait positive emotions. Structured assessments of diagnosis and current mood symptoms were obtained for BD participants. At a six‐month follow‐up, a subset of BD participants’ (n = 39) symptoms were reassessed.

Results: BD participants reported lower joy, compassion, love, awe, and contentment compared to NC participants. BD and NC participants did not differ in pride or amusement. For BD participants, after controlling for baseline symptom severity, joy and amusement predicted increased mania severity, and compassion predicted decreased mania severity at the six‐month follow‐up. Furthermore, amusement predicted increased depression severity and pride predicted decreased severity of depression. Awe, love, and contentment did not predict symptom severity.

Conclusions: These results are consistent with a growing literature highlighting the importance of positive emotion in the course of bipolar disorder.
No altered dorsal anterior cingulate activation in bipolar II disorder patients during a Go/No‐go task: an fMRI study
Authors: Welander‐Vatn Audun S , Jensen Jimmy , Lycke Christine , Agartz Ingrid , Server Andres , Gadmar Øystein Bech , Melle Ingrid , Nakstad Per Hjalmar , Andreassen Ole A
Published: April 2009

Objectives:  It has been reported that one of the core features in patients with bipolar disorder II (BD II) is increased impulsivity. The aim of this study was to investigate whether patients with BD II showed decreased activation in the dorsal anterior cingulate cortex (dACC) as compared to healthy controls when performing a task sensitive to impulsivity.

Methods:  Twenty‐seven BD II patients and 28 healthy controls performed a Go/No‐go task during a functional magnetic resonance imaging (fMRI) session. Eleven of the patients were unmedicated, and possible group differences between medicated and unmedicated patients were also assessed.

Results:  The groups did not differ in behavioral performance on the Go/No‐go task.

Both BD II subjects and healthy controls demonstrated dACC activity during the task, and analyses revealed no statistically significant group differences. Medicated and unmedicated patients also did not differ in the degree of fMRI activation.

Conclusions:  These findings do not support the hypothesis of abnormal dACC activity during a Go/No‐go task in BD II patients.
Differential item functioning of DSM‐IV depressive symptoms in individuals with a history of mania versus those without: an item response theory analysis
Authors: Weinstock Lauren M , Strong David , Uebelacker Lisa A , Miller Ivan W
Published: April 2009

Objectives:  Although major depression is characteristic of both bipolar disorder and major depressive disorder, there is disagreement as to whether there are distinct features of depression that differentiate these two conditions. The primary aim of this study was to use methods based in item response theory to evaluate differences in DSM‐IV depression symptom endorsement in an epidemiological sample of individuals with a history of mania (i.e., bipolar depression) versus those without (i.e., unipolar depression).

Methods:  Clinical interview data were drawn from a subsample (n = 13,058) of individuals with bipolar or unipolar depression who had participated in the National Epidemiologic Survey on Alcohol and Related Conditions. Using these data, a two‐parameter item response model was used to estimate differential item functioning of DSM‐IV depressive symptoms between these two groups.

Results:  Differences in severity parameter estimates revealed that suicidal ideation and psychomotor disturbance were more likely to be endorsed across most levels of depression severity in bipolar versus unipolar depression. Differences in discrimination parameter estimates revealed that fatigue was significantly less discriminating in bipolar versus unipolar depression.

Conclusions:  Equating for level of depression symptom severity, study results revealed that suicidal ideation and psychomotor disturbance are endorsed more frequently in bipolar versus unipolar depression. Study data also suggested that fatigue may be endorsed more frequently in unipolar relative to bipolar samples at moderate (versus low or high) levels of depression symptom severity.
Referral and treatment patterns for complex regional pain syndrome in the Netherlands
Authors: DE MOS M. , HUYGEN F. J. P. M. , VAN DER HOEVEN‐BORGMAN M. , DIELEMAN J. P. , STRICKER B. H. CH. , STURKENBOOM M. C. J. M.
Published: April 2009

Background: Patients with complex regional pain syndrome (CRPS) are seen and treated by a variety of physicians. The present study aims to describe referral and treatment patterns for CRPS patients in the Netherlands.

Methods: Patients, who were selected (1996–2005) from an electronic general practice (GP) database (Integrated Primary Care Information Project), were invited for study participation, involving diagnosis verification (International Association for the Study of Pain criteria) and assessment of referrals and treatment through information retrieved from GP journals, patients' questionnaires, pharmacy dispensing lists and specialist letters if available.

Results: One hundred and two patients were included. Sixty‐one percent had presented first at the GP, while 80% subsequently consulted one or more medical specialists, most frequently an anesthetist (55% of the cases) or a specialist in rehabilitation medicine (41%). Over 90% of the patients received oral or topical pharmacotherapy, 45% received intravenous therapy, 89% received non‐invasive therapy (i.e. physiotherapy) and 18% received nerve blocks. Analgesics and free radical scavengers were administered early during CRPS, while vasodilating drugs and drugs against neuropathic pain (antidepressants and anti‐epileptics) were administered later on. Pharmacotherapy was usually initiated by a medical specialist.

Conclusion: The Dutch treatment guidelines, issued in 2006, recommend free radical scavenger prescription (plus physiotherapy) as the initial treatment step for CRPS. Until 2005 only half of the patients received a scavenger within 3 months after disease onset, and the majority presents first at the GP, in particular GPs may be encouraged to initiate treatment with scavengers, while waiting for the results of further specialist consultation.
Evaluation of easily applicable pain measurement tools for the assessment of pain in demented patients
Authors: PESONEN A. , KAUPPILA T. , TARKKILA P. , SUTELA A. , NIINISTÖ L. , ROSENBERG P. H.
Published: April 2009

Background and objectives: Difficulties in communication and lack of suitable pain scales may lead to undertreatment of pain in cognitively impaired patients. We performed a study in this type of patients and evaluated the usefulness of four simple pain scales.

Patients and methods: We studied 41 hospitalized elderly (76–95 years) who suffered from pain with an acute component. Cognitive function was assessed with the mini‐mental state examination (MMSE) and the degree of depression was assessed on the geriatric depression scale (GDS). Pain intensity was assessed at rest and after a pain‐provoking movement three times at 2‐week intervals by repeating the test at a 10‐min interval at each test session. The pain scales were the 50 cm red wedge scale (RWS), the seven‐point faces pain scale (FPS), the 10 cm visual analogue scale (VAS) and the five‐point verbal rating scale (VRS).

Results: In group MMSE≥24, patients were able to use all four scales rather successfully. In the other groups (MMSE 17–23, 11–16 and ≤10), only the use of VRS was successful to a reasonable degree (64–85% on average). GDS scores did not correlate with the pain scores, with the exception of pain scores on FPS during movement (P<0.01). The estimations of intensity and frequency of pain performed by nurses failed to correlate with the patient's own pain intensity estimations.

Conclusion: Scoring of pain with RWS, FPS and VAS seems to be feasible in elderly patients with a normal cognitive dysfunction. In our study VRS appeared to be applicable in the elderly with a clear cognitive dysfunction, i.e., with MMSE<17.
Signs of critical illness polyneuropathy and myopathy can be seen early in the ICU course
Authors: AHLBECK K. , FREDRIKSSON K. , ROOYACKERS O. , MÅBÄCK G. , REMAHL S. , ANSVED T. , ERIKSSON L. , RADELL P.
Published: April 2009

Background: Critical illness polyneuropathy and myopathy (CIPNM) is recognized as a common condition that develops in the intensive care unit (ICU). It may lead to a prolonged hospital stay with subsequent increased ICU and hospital costs. Knowledge of predisposing factors is insufficient and the temporal pattern of CIPNM has not been well described earlier. This study investigated patients with critical illness in need of prolonged mechanical ventilation, describing comprehensively the time course of changes in muscle and nerve neurophysiology, histology and mitochondrial oxidative function.

Methods: Ten intensive care patients were investigated 4, 14 and 28 days after the start of mechanical ventilation. Laboratory tests, neurophysiological examination, muscle biopsies and clinical examinations were performed. Neurophysiological criteria for CIPNM were noted and measurements for mitochondrial content, mitochondrial respiratory enzymes and markers of oxidative stress were performed.

Results: While all patients showed pathologic changes in neurophysiologic measurements, only patients with sepsis and steroid treatment (5/5) fulfilled the CIPNM criteria. The presence of CIPNM did not affect the outcome, and the temporal pattern of CIPNM was not uniform. All CIP changes occurred early in ICU care, while myopathy changes appeared somewhat later. Citrate synthase was decreased between days 4 and 14, and mitochondrial superoxide dismutase was increased.

Conclusion: With comprehensive examination over time, signs of CIPNM can be seen early in ICU course, and appear more likely to occur in patients with sepsis and corticosteroid treatment.
Effects of sevoflurane on cognitive deficit, motor function, and histopathology after cerebral ischemia in rats
Authors: EBERSPÄCHER E. , ECKEL B. , ENGELHARD K. , MÜLLER K. , HOFFMAN W. E. , BLOBNER M. , WERNER C.
Published: April 2009

Background: The volatile anesthetic sevoflurane exhibits neuroprotective properties when assessed for motor function and histopathology after cerebral ischemia in rats. Damage of hippocampal neurons after ischemia relates to a number of cognitive deficits that are not revealed by testing animals for motor function. Therefore, the present study evaluates cognitive and behavioral function as well as hippocampal damage in rats subjected to cerebral ischemia under sevoflurane compared with fentanyl/nitrous oxide (N2O)/O2 anesthesia.

Methods: Thirty‐four rats were trained for 10 days using a hole‐board test to detect changes in cognitive and behavioral function. Rats were randomly assigned to the following groups: (A) sham/fentanyl/N2O/O2 (n=7); (B) ischemia/fentanyl/N2O/O2 (n=10); (C) sham/2.0 vol% sevoflurane in O2/air (n=7); and (D) ischemia/2.0 vol% sevoflurane in O2/air (n=10). Cerebral ischemia was produced by unilateral common carotid artery occlusion combined with hemorrhagic hypotension (mean arterial blood pressure 40 mmHg for 45 min). Temperature, arterial blood gases, and pH were maintained constant. Cerebral blood flow was measured using laser‐Doppler flowmetry. After surgery, cognitive and behavioral function was re‐evaluated for 10 days. On day 11, the brains were removed for histopathologic evaluation (hematoxylin/eosin‐staining).

Results: Cognitive testing revealed deficits in declarative and working memory in ischemic rats anesthetized with fentanyl/N2O. Rats anesthetized with sevoflurane during ischemia showed a significantly better outcome. Hippocampal damage was significantly worse with fentanyl/N2O.

Conclusion: The present data add to previous investigations showing that sevoflurane prevents a deficit in cognitive function and histopathological damage induced by cerebral ischemia in rats.
A Scandinavian survey of drug administration through inhalation, suctioning and recruitment maneuvers in mechanically ventilated patients
Authors: GRIVANS C. , LINDGREN S. , ÅNEMAN A. , STENQVIST O. , LUNDIN S.
Published: April 2009

Background: The aim was to describe current practices for drug administration through inhalation, endotracheal suctioning and lung recruitment maneuvers in mechanically ventilated patients in Scandinavian intensive care units (ICUs).

Methods: We invited 161 ICUs to participate in a web‐based survey regarding (1) their routine standards and (2) current treatment of ventilated patients during the past 24 h. In order to characterize the patients, the lowest PaO2 with the corresponding highest FiO2, and the highest PaO2 with the corresponding lowest FiO2 during the 24‐h study period were recorded.

Results: Eighty‐seven ICUs answered and reported 186 patients. Positive end‐expiratory pressure (PEEP) levels (cmH2O) were 5–9 in 65% and >10 in 31% of the patients. Forty percent of the patients had heated humidification and 50% received inhalation of drugs. Endotracheal suctioning was performed >7 times during the study period in 40% of the patients, of which 23% had closed suction systems. Twenty percent of the patients underwent recruitment maneuvers. The most common recruitment maneuver was to increase PEEP and gradually increase the inspiratory pressure. Twenty‐six percent of the calculated PaO2/FiO2 ratios varied >13 kPa for the same patient.

Conclusion: Frequent use of drug administration through inhalation and endotracheal suctioning predispose to derecruitment of the lungs, possibly resulting in the large variations in PaO2/FiO2 ratios observed during the 24‐h study period. Recruitment maneuvers were performed only in one‐fifth of the patients during the day of the survey.
Endotoxin‐like reaction following once‐daily gentamicin
Authors: ALY E. E. , SIVASUBRAMANIAM S. K. , BHATTI T. H. , SANAKA R.
Published: April 2009

An endotoxin‐like reaction is a host response to an agent that induces the release of endogenous pyrogens, including cytokines. The typical reaction that is associated with gentamicin is fever and chills, rigor, shivering, tachycardia with hypertension or hypotension, respiratory symptoms and muscle cramps. We report a case of a 92‐year‐old patient who developed an endotoxin‐like reaction in the post‐operative recovery unit following 200 mg of gentamicin. The reported side effect is not included in the drug sheet or in the British National Formulary. No similar incidents were reported in the UK. We discuss the clinical picture of this rare event, along with a review of the literature and recommendations.
Isoflurane attenuates pulmonary interleukin‐1β and systemic tumor necrosis factor‐α following mechanical ventilation in healthy mice
Authors: VANEKER M. , SANTOSA J. P. , HEUNKS L. M. , HALBERTSMA F. J. , SNIJDELAAR D. G. , VAN EGMOND J. , VAN DEN BRINK I. A. , VAN DE POL F. M. , VAN DER HOEVEN J. G. , SCHEFFER G. J.
Published: April 2009

Background: Mechanical ventilation (MV) induces an inflammatory response in healthy lungs. The resulting pro‐inflammatory state is a risk factor for ventilator‐induced lung injury and peripheral organ dysfunction. Isoflurane is known to have protective immunological effects on different organ systems. We tested the hypothesis that the MV‐induced inflammatory response in healthy lungs is reduced by isoflurane.

Methods: Healthy C57BL6 mice (n=34) were mechanically ventilated (tidal volume, 8 ml/kg; positive end‐expiratory pressure, 4 cmH2O; and fraction of inspired oxygen, 0.4) for 4 h under general anesthesia using a mix of ketamine, medetomidine and atropine (KMA). Animals were divided into four groups: (1) Unventilated control group; (2) MV group using KMA anesthesia; (3) MV group using KMA with 0.25 MAC isoflurane; (4) MV group using KMA with 0.75 MAC isoflurane. Cytokine levels were measured in lung homogenate and plasma. Leukocytes were counted in lung tissue.

Results: Lung homogenates: MV increased pro‐inflammatory cytokines. In mice receiving KMA+ isoflurane 0.75 MAC, no significant increase in interleukin (IL)‐1β was found compared with non‐ventilated control mice.

Plasma: MV induced a systemic pro‐inflammatory response. In mice anesthetized with KMA+ isoflurane (both 0.25 and 0.75 MAC), no significant increase in tumor necrosis factor (TNF)‐α was found compared with non‐ventilated control mice.

Conclusions: The present study is the first to show that isoflurane attenuates the pulmonary IL‐1β and systemic TNF‐α response following MV in healthy mice.
Quality of cardiopulmonary resuscitation on manikins: on the floor and in the bed
Authors: JÄNTTI H. , SILFVAST T. , TURPEINEN A. , KIVINIEMI V. , UUSARO A.
Published: April 2009

Background: In general, in‐hospital resuscitation is performed in a bed and out‐of‐hospital resuscitation on the floor. The surface under the patient may affect the cardiopulmonary resuscitation (CPR) quality; therefore, we evaluated CPR quality (the percentage of chest compressions of correct depth) and rescuer's fatigue (the mean compression depth minute by minute) when CPR is performed on a manikin on the floor or in the bed.

Methods: Forty‐four simulated cardiac arrest scenarios of 10 min were treated by intensive care unit (ICU) nurses in pairs using a 30 : 2 chest compression‐to‐ventilation ratio. The rescuer who performed the compressions was changed every 2 min. CPR was randomly performed either on the floor or in the bed without a backboard; in both settings, participants kneeled beside the manikin.

Results: A total number of 1060 chest compressions, 44% with correct depth, were performed on the floor; 1068 chest compressions were performed in the bed, and 58% of these were the correct depth. These differences were not significant between groups. The mean compression depth during the scenario was 44.9±6.2 mm (mean±SD) on the floor and 43.0±5.9 mm in the bed (P=0.3). The mean chest compression depth decreased over time on both surfaces (P<0.001), indicating rescuer fatigue, but this change was not different between the groups (P=0.305).

Conclusions: ICU nurses perform chest compression as effectively on the floor as in the bed. The mean chest compression depth decreases over time, but the surface had no significant effect.
The combined neuroprotective effects of lidocaine and dexmedetomidine after transient forebrain ischemia in rats
Authors: GOYAGI T. , NISHIKAWA T. , TOBE Y. , MASAKI Y.
Published: April 2009

Background: We investigated whether coadministration of lidocaine and dexmedetomidine would reduce brain injury following transient forebrain ischemia in rats to a greater extent than either drug alone.

Methods: Adult male Sprague–Dawleyrats were anesthetized with halothane to maintain normocapnia and normoxia. Rats received subcutaneous injection of saline 1 ml/kg, lidocaine 10 mg/kg, dexmedetomidine 3 μg/kg, or lidocaine 10 mg/kg plus dexmedetomidine 3 μg/kg. Thirty minutes after the drug injection, forebrain ischemia was induced by hemorrhagic hypotension and occlusion of the bilateral carotid arteries, and was confirmed by isoelectric EEG. At the end of 10‐min ischemia, rats were reperfused. The same dose of drugs was administered 3, 24, and 48 h after ischemia. Neurological examination was done at 1, 2, and 7 days after ischemia. Seven days after ischemia, the brain was stained with hematoxylin and eosin. We counted ischemic cells in the CA1 hippocampal region, striatum, and cerebral cortex. We also measured extracellular glutamate and norepinephrine concentration in hippocampal CA1 in the four groups.

Results: As compared with saline‐treated rats, rats receiving dexmedetomidine plus lidocaine showed less than neurological deficit scores at 2 and 7 days after ischemia, and had less ischemic cells in the CA1 region. However, administration of dexmedetomidine plus lidocaine did not alter the area under the glutamate concentration curve and norepinephrine concentration during ischemia in the CA1 region, compared with saline‐treated rats.

Conclusions: Our results suggest coadministration of lidocaine and dexmedetomidine improves the neurological outcome without alteration of glutamate and norepinephrine concentrations during forebrain ischemia in rats.
An inquiry into the relationship between ABO blood group and thrombotic thrombocytopenic purpura
Authors: Staropoli J. F. , Stowell C. P. , Tuncer H. H. , Marques M. B.
Published: April 2009

Background and Objectives  ABO blood group accounts for up to 40% of the variability in plasma von Willebrand factor (VWF) levels, which vary in the rank order AB > B > A > O > Bombay. This may be due in part to the influence of ABO‐associated oligosaccharides on the proteolysis of VWF by the metalloprotease ADAMTS13, which is markedly deficient in thrombotic thrombocytopenic purpura (TTP). Using ABO blood group as a surrogate for baseline VWF levels as well as susceptibility to proteolysis by ADAMST13, we set out to determine whether ABO blood group influences the clinical course of TTP.

Methods  We conducted a retrospective analysis of the clinical course of 76 patients with primary, sporadic TTP treated at two institutions over the past 10 years.

Results  We found no significant differences between group O and non‐O patients with respect to presenting platelet count and lactate dehydrogenase concentration, maximum serum creatinine concentration, and total number of therapeutic plasma exchanges per episode.

Conclusions  Substrate‐related contributors to the highly variable phenotype and clinical course of TTP warrant further investigation.
The preliminary experimental and clinical study of the relationship between the pigment gallstone and intestinal mucosal barrier
Authors: Su Yang , Wu Shuodong , Fan Ying , Jin Junzhe , Zhang Zhenhai
Published: April 2009

Aims:  To investigate the relations between the formation of pigment gallstone and the function of the intestinal mucosal barrier, as well as the underlying mechanism.

Methods:  Eighty guinea pigs were randomly divided into three groups in which they were respectively given normal diet, gallstone‐causing diet, and gallstone‐formation diet with a supplementary intestinal mucosal protection compound known as glutamine. The model of pigment gallstone was established after 8 weeks of dietary administration. Indices about the function of the intestinal mucosal barrier and bacterial translocation were measured. Clinical cases were divided into three groups: control, cholesterol gallstone, and pigment gallstone, where the levels of plasma diamine oxidase (DAO), plasma endotoxin and the excretion rates of technetium 99m‐diethylene triamine pentaacetic acid (99mTC‐DTPA) in the urine of each group were measured.

Results:  In the pigment gallstone group, the level of plasma DAO and endotoxin, the excretory ratio of lactulose and mannitol in urine, the bacterial translocation ratio in the celiac lymph nodes and the activities of β‐glucuronidase increased comparing to the control group. The gallstone‐formation rate for the intestinal mucosal protection group (GLN) decreased, and other indices, except the activity of β‐glucuronidase, were all lower than that of gallstone‐formation group. In the clinical experiment, the levels of plasma DAO and endotoxin, as well as the excretory rate of 99mTC‐DTPA in urine were higher in the patients with gallstones than that in the control group.

Conclusions:  The formation of pigment gallstone was related to the abnormal function of the intestinal mucosal barrier. The abnormality in the function of the intestinal mucosal barrier probably induced the formation of gallstone by a bacterial translocation mechanism.
Predictors of microscopic portal vein invasion by hepatocellular carcinoma: Measurement of portal perfusion defect area ratio
Authors: Shirabe Ken , Kajiyama Kiyoshi , Abe Tomoyuki , Sakamoto Shigeru , Fukuya Tatsuro , Akazawa Kohei , Morita Kazutoyo , Maehara Yoshihiko
Published: April 2009

Objective:  Microscopic portal vein invasion (PVI) by cancer cells is a poor prognostic factor after hepatic resection for hepatocellular carcinoma (HCC). The aim of this study is to predict PVI preoperatively in patients with HCC.

Methods:  We studied 46 hepatectomized patients who had HCC without any portal venous invasion detected during preoperative radiographic evaluation. We defined the portal perfusion defect area ratio (PPDAR) as the following: the quotient of the maximal portal perfusion defect area, on computed tomography during arterio‐portography (CTAP) is divided by the maximal tumor area on magnetic resonance imaging (MRI) or CT.

Results:  The median PPDAR was 1.3 (mean 1.4 ± 1.1; ranged from 0.7 to 5.8). The incidence of PVI was 4.5% in patients with a PPDAR <1.3, 35.7% in those with a PPDAR of 1.3–1.6, 70% in those with a PPDAR ≥1.6 (P = 0.0005). When analyzing the preoperative value of different cut‐off points for the PPDAR, the lowest P‐value by Fisher's exact test was achieved when the PPDAR threshold was 1.6 (P = 0.0012). The sensitivity was 58%, and specificity was 91% with this cut‐off value. On univariate analyses, factors that significantly correlated with PVI were PPDAR (P = 0.0012), serum levels of des‐gamma‐carboxy prothrombin (P = 0.033), and tumor size (P = 0.0126). On multivariate analysis, PPDAR was the only significant independent predictor of PVI.

Conclusion:  Our study shows that PPDAR is a new concept, which is useful in predicting PVI and that a value ≥1.6 is predictive of PVI.
Antidepressant effect detected on proton magnetic resonance spectroscopy in drug‐naïve female patients with first‐episode major depression
Authors: Kaymak Semra Ulusoy , Demir Başaran , Oğuz Kader Karlı , Şentürk Senem , Uluğ Berna
Published: April 2009

Aim:  Recent neuroimaging studies support functional and structural alterations in the dorsolateral prefrontal cortex (DLPFC), particularly on the left side in patients with major depressive disorders (MDD). The aim of the present study was to examine the biochemical characteristics of left DLPFC as measured on proton (1H) magnetic resonance spectroscopy (MRS) in patients with drug‐naïve first‐episode MDD and a healthy control group. A second aim was to assess the effect of antidepressant treatment on the metabolites of DLPFC.

Methods:  Short‐echo single‐voxel 1H‐MRS was done for the left DLPFC in 17 female drug‐free MDD patients (mean age ± SD, 30.9 ± 6.9 years) and 13 matched control subjects (mean age ± SD, 29.1 ± 6.2 years) and was repeated at 8 weeks following antidepressant treatment.

Results:  Comparison of baseline values indicated that there were no significant differences in any of the metabolite ratios (N‐acetyl aspartate/creatine [NAA/Cr], myoinositol [Ino]/Cr, and choline [Cho]/Cr) between patients and controls. Significant differences were detected between pre‐ and post‐treatment Ino/Cr ratios (0.67 ± 0.13, 0.58 ± 0.22, P = 0.032, respectively), although there was no difference in NAA/Cr and Cho/Cr ratios.

Conclusion:  Although no significant metabolic alterations exist in female patients with drug‐naïve first‐episode MDD as evaluated on 1H‐MRS, an increase in Ino/Cr was observed following 8‐week antidepressant treatment. These findings give rise to the possibility that non‐neuronal cells, particularly glial cells that are probably damaged, play a role in the action of antidepressant treatment.
A two‐year follow‐up study of chronic fatigue syndrome comorbid with psychiatric disorders
Authors: Matsuda Yasunori , Matsui Tokuzo , Kataoka Kouhei , Fukada Ryosuke , Fukuda Sanae , Kuratsune Hirohiko , Tajima Seiki , Yamaguti Kouzi , Kato Yukiko Hakariya , Kiriike Nobuo
Published: April 2009

Aims:  Chronic fatigue syndrome patients often have comorbid psychiatric disorders such as major depressive disorders and anxiety disorders. However, the outcomes of chronic fatigue syndrome and the comorbid psychiatric disorders and the interactions between them are unknown. Therefore, a two‐year prospective follow‐up study was carried out on chronic fatigue syndrome patients with comorbid psychiatric disorders.

Methods:  A total of 155 patients who met the Japanese case definition of chronic fatigue syndrome were enrolled in this study. Comorbid psychiatric disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria. Patients with comorbid psychiatric disorders received psychiatric treatment in addition to medical therapy for chronic fatigue syndrome. Seventy patients participated in a follow‐up interview approximately 24 months later.

Results:  Of the 70 patients with chronic fatigue syndrome, 33 patients were diagnosed as having comorbid psychiatric disorders including 18 major depressive disorders. Sixteen patients with psychiatric disorders and eight patients with major depressive disorders did not fulfill the criteria of any psychiatric disorders at the follow up. As for chronic fatigue syndrome, nine out of the 70 patients had recovered at the follow up. There is no significant influence of comorbid psychiatric disorders on the outcome of chronic fatigue syndrome.

Conclusions:  Chronic fatigue syndrome patients have a relatively high prevalence of comorbid psychiatric disorders, especially major depressive disorders. The outcomes of chronic fatigue syndrome and psychiatric disorders are independent. Therefore treatment of comorbid psychiatric disorders is necessary in addition to the medical treatment given for chronic fatigue syndrome.
Sacral nerve stimulation in faecal incontinence: position statement based on a collective experience
Authors: Leroi A. M. , Damon H. , Faucheron J. L. , Lehur P. A. , Siproudhis L. , Slim K. , Barbieux J. P. , Barth X. , Borie F. , Bresler L. , Desfourneaux V. , Goudet P. , Huten N. , Lebreton G. , Mathieu P. , Meurette G. , Mathonnet M. , Mion F. , Orsoni P. , Parc Y. , Portier G. , Rullier E. , Sielezneff I. , Zerbib F. , Michot F. ,   Club NEMO
Published: April 2009

Objective  Since the first paper published by Matzel et al., in 1995, on the efficacy of sacral nerve stimulation (SNS) in patients with faecal incontinence, the indications, the contraindications, the stimulation technique and follow up of implanted patients have changed. The aim of this article was to provide a consensus opinion on the management of patients with faecal incontinence treated with SNS.

Method  Recommendations were based on a critical review of the literature when available and on expert opinions in areas with insufficient evidence.

Results  We have reviewed the indications and contraindications, proposed an algorithm for patient management showing the place of SNS. The temporary test technique, the implantation technique, the patient follow up and the approach in case of treatment failure were discussed.

Conclusion  We hope not only to provide a guide on patient management to clinical practitioners interested in SNS but also to harmonize our practices.
An exploratory study of the effect of using high‐mix biphasic insulin aspart in people with type 2 diabetes
Authors: Dashora U. , Ashwell S. G. , Home P. D.
Published: April 2009

Objective:  To compare blood glucose control when using biphasic insulin aspart (BIAsp) three times a day (using 70/30 high‐mix before breakfast and lunch), with biphasic human insulin (BHI, 30/70) twice daily in adults with type 2 diabetes already treated with insulin.

Research design and methods:  In a 60‐day, open‐label, crossover study, people with insulin‐treated type 2 diabetes [n = 38, baseline haemoglobin A1c 8.3 ± 0.9 (s.d.) %] were randomized to BIAsp three times a day before meals, as BIAsp 70 (70% insulin aspart and 30% protamine‐complexed insulin aspart) before breakfast and lunch and BIAsp 30 (30/70 free and protamine‐complexed insulin aspart) before dinner, or to human premix insulin (BHI) 30/70 twice a day before meals. A 24‐h in‐patient plasma glucose profile was performed at the end of each 30‐day treatment period. The total daily insulin dose of BIAsp regimen was 110% of BHI and the doses were not changed during the study.

Results:  There was no difference between BIAsp and BHI in geometric weighted average serum glucose over 24 h [7.3 vs. 7.7 mmol/l, BIAsp/BHI ratio 0.95 (95% CI 0.88–1.02), not significant (NS)], but daytime geometric weighted average glucose concentration was significantly lower with the BIAsp regimen than with BHI [8.3 vs. 9.2 mmol/l, BIAsp/BHI ratio 0.90 (0.84–0.98), p = 0.014]. The mealtime serum glucose excursion was also lower with BIAsp than with BHI with statistically significant differences at lunchtime [difference −4.9 (−7.0 to −2.7) mmol/l, p = 0.000); the difference in glucose excursions above 7.0 mmol/l was also significant [−5.8 (−8.3 to −3.2) mmol/l, p = 0.000). The proportion of participants experiencing confirmed hypoglycaemic episodes was similar between regimens (42 vs. 43%, NS).

Conclusions:  An insulin regimen using high‐mix BIAsp (BIAsp 70) before breakfast and lunch and BIAsp 30 before dinner can achieve lower blood glucose levels during the day through reduced mealtime glucose excursions in particular at lunchtime than a twice‐daily premix regimen.
The long‐term natural history of overactive bladder symptoms due to idiopathic detrusor overactivity in women
Authors: Garnett Stephen , Swithinbank Lucy , Ellis‐Jones Julie , Abrams Paul
Published: April 2009

OBJECTIVES

To assess the long‐term natural history of overactive bladder (OAB) symptoms due to idiopathic detrusor overactivity (IDO) in women.

PATIENTS AND METHODS

Original urodynamic traces were reviewed and women who were referred with OAB symptoms and found to have IDO on investigation in our urodynamic unit ≥10 years previously were invited for a repeat urodynamic and symptomatic assessment.

RESULTS

In all, 174 women were identified and invited to participate; 53 had repeat urodynamics, another 32 attended the unit for symptom assessment and a further 23 completed postal questionnaires. There were no significant symptomatic or urodynamic differences between these groups at baseline. Of the 53 who had repeat urodynamics, 46 (88%) had persistent symptomatic IDO.

CONCLUSIONS

OAB symptoms have a significant effect on the quality of life of those affected. OAB symptoms due to IDO in women are persistent, lasting for ≥10 years in 88% of this study population. This information might affect the treatment choices made by patients and their doctors in the management of this condition.
Surgical management of adrenal cysts: single‐institution experience
Authors: El‐Hefnawy Ahmed S. , El Garba Muftah , Osman Yasser , Eraky Ibrahim , El Mekresh Mohsen , Ibrahim El‐housseiny
Published: April 2009

OBJECTIVES

To assess the safety and efficacy of different surgical procedures used for managing benign adrenal cysts.

PATIENTS AND METHODS

The files of 245 patients presenting with adrenal masses was reviewed retrospectively; all had a thorough history taken and a physical examination. The radiological evaluation included abdominal plain X‐rays, grey‐scale abdominal ultrasonography and computed tomography with contrast medium. According to their clinical situation, patients had surgical open, laparoscopic intervention or were managed conservatively. The short‐ and long‐term outcome of the open and laparoscopic techniques were evaluated.

RESULTS

Twenty‐six (11%) patients presented with adrenal cysts; the mean (sd, range) age at the time of presentation for adults was 41.4  (15, 17–82) years, while a 1‐month female neonate and 1‐year‐old boy presented with an adrenal cyst. The mean (sd, range) size of the cysts was 10 (3.5, 5–18) cm. Surgical intervention was the treatment of choice in 21 patients; 11 (42%) had open adrenalectomy, while 10 (38%) had laparoscopic intervention. Both groups were comparable in the term of cyst size and operative time, while the laparoscopically managed group had a shorter hospital stay. Five patients were followed with no surgical intervention. At a mean follow‐up of 90 months all patients were symptom free, with no radiological evidence of recurrence.

CONCLUSIONS

Laparoscopic adrenalectomy is a safe and effective treatment for benign adrenal cysts. Compared with open techniques it has the advantages of a shorter hospital stay, less blood loss and enhanced cosmesis. Unlike aspiration of cyst contents, the recurrence of adrenal cysts after surgical removal is unlikely.
Differences among patients undergoing perineal or retropubic radical prostatectomy in pain and perioperative variables: a prospective study
Authors: Paiva Cristiano S. , Andreoni Cássio , Cunha Graziella P. , Khalil Walid , Ortiz Valdemar
Published: April 2009

OBJECTIVE

To compare pain in the first 24 h, the perioperative variables and the histopathological results among patients who had perineal (PRP) and retropubic radical prostatectomy (RRP), in a randomized trial.

PATIENTS AND METHODS

Patients with localized prostate cancer were accrued after selection using inclusion and exclusion criteria; they were prospectively randomized into four different groups: P1 (PRP with general anaesthesia), P2 (RPP with general plus epidural anaesthesia), R1 (RRP with general anaesthesia), and R2 (RRP with general plus epidural anaesthesia) and data collected for age, body mass index, prostate weight, serum prostate‐specific antigen level, Gleason score and clinical stage. Pain after RP was evaluated using numerical and oral scales, and by morphine intake delivered by a patient‐controlled analgesia pump. Perioperative features assessed prospectively were operating time, intraoperative bleeding, time to diet, time to ambulation, hospital stay and complications. Immediate oncological results were assessed based on histopathological evaluation, e.g. Gleason score, tumour volume, prostate volume, surgical margins and final pathological stage.

RESULTS

Between October 2004 and October 2007 80 patients were accrued (mean age 63 years, range 42–80). The groups were similar for preoperative data, but group R1 had larger prostates (P = 0.001). For postoperative pain, group R1 had a significantly greater intensity of pain, based on the visual analogue scales, and greater morphine intake during the first 24 h than the other three groups. Groups P1 and P2 had significantly less bleeding (511 and 612 mL) than groups R1 and R2 (926 and 1165 mL; P < 0.001), regardless of both prostate size and anaesthesia. Complications occurred in 27.5% and 25% (not significant) of patients after PRP and RRP, respectively. There were no differences in positive surgical margin rate and histopathological evaluation among the groups.

CONCLUSIONS

Patients who had RRP with general anaesthesia had a greater intensity of pain and higher morphine intake than the other groups. Men who had PRP had significantly less bleeding and shorter hospital stay than those having RRP.
Beneath the veil: plant growth form influences the strength of species richness–productivity relationships in forests
Authors: Oberle Brad , Grace James B. , Chase Jonathan M.
Published: April 2009

Aim  Species richness has been observed to increase with productivity at large spatial scales, though the strength of this relationship varies among functional groups. In forests, canopy trees shade understorey plants, and for this reason we hypothesize that species richness of canopy trees will depend on macroclimate, while species richness of shorter growth forms will additionally be affected by shading from the canopy. In this study we test for differences in species richness–productivity relationships (SRPRs) among growth forms (canopy trees, shrubs, herbaceous species) in small forest plots.

Location  We analysed 231 plots ranging from 34.0° to 48.3° N latitude and from 75.0° to 124.2° W longitude in the United States.

Methods  We analysed data collected by the USDA Forest Inventory and Analysis program for plant species richness partitioned into different growth forms, in small plots. We used actual evapotranspiration as a macroclimatic estimate of regional productivity and calculated the area of light‐blocking tissue in the immediate area surrounding plots for an estimate of the intensity of local shading. We estimated and compared SRPRs for different partitions of the species richness dataset using generalized linear models and we incorporated the possible indirect effects of shading using a structural equation model.

Results  Canopy tree species richness increased strongly with regional productivity, while local shading primarily explained the variation in herbaceous plant richness. Shrub species richness was related to both regional productivity and local shading.

Main conclusions  The relationship between total forest plant species richness and productivity at large scales belies strong effects of local interactions. Counter to the pattern for overall richness, we found that understorey herbaceous plant species richness does not respond to regional productivity gradients, and instead is strongly influenced by canopy density, while shrub species richness is under multivariate control.