bluuebunny/crossref_metadata_2025 huggingface dataset:
KEYSTONE ISLAND FLAP: AN ALTERNATIVE RECONSTRUCTIVE OPTION TO FREE FLAPS IN IRRADIATED TISSUE
Authors: Behan Felix , Sizeland Andrew , Porcedu Sandro , Somia Naveen , Wilson Jeremy
Published: May 2006

Background:  The Keystone Flap is an island flap that is very useful for repairing skin defects of the integument. Described as a keystone, this arc‐shaped flap in fact consists of a schematically designed, perforator‐based reconstructive unit which serendipitously resembles two conjoined VY flaps. This facilitates closure because of the multiple VY points at the extremes, where the surrounding tissue is advanced to close the defect while the flap size remains basically static.

Methods:  A consecutive series of nine cases involving the head and neck and inguinal regions were examined to show the use of the Keystone Flap in irradiated tissue for recurrent disease. They are described by using a combination of clinical illustrations and diagrams to explain the surgical technique.

Results:  The average age of the patients in the series is 74 years. A low complication rate and rapid wound healing with no significant flap necrosis was shown in this series. Additionally the short operation time is quite beneficial, particularly for the elderly.

Conclusion:  There is a low complication rate using Keystone flaps (this double VY is a clinical development from Diffenbach’s original work of 18481) and this technique is particularly useful in achieving wound healing especially after irradiation treatment. This surgical technique once mastered is easy to perform. Another bonus is that there is minimal use of postoperative analgesia. Additional XRT is well tolerated by the patients with minimal evidence of wound complications, while acheiving an acceptable aesthetic appearance.
TRIMODAL DEATH AND THE INJURIES OF SURVIVORS IN KRABI PROVINCE, THAILAND, POST‐TSUNAMI
Authors: Johnson Luke J. , Travis Angela R.
Published: May 2006

26 December 2004 is a date that changed the lives of incalculable numbers of persons the world over as a result of the Asian tsunami. Krabi Province was one of the more severely affected areas of Thailand, with many of the dead and injured being non‐Thai, persons who were holidaying during the peak tourist season. Some injury types were comparatively underrepresented, such as head, thoracic and abdominal trauma. Does the classic trimodal distribution of death following injury help explain the types of injuries seen in the survivors of the disaster? Data are incomplete at this point in time, but with time it may be found that the trimodal model displays the pattern of death in mass casualty disaster situations. This may aid in the development of specific strategies to deal with similar events in the future.
MINIMAL ACCESS COLONIC SURGERY: IS IT TRULY MINIMALLY INVASIVE?
Authors: Hill Andrew G. , Connolly Andrew B.
Published: May 2006

Laparoscopic colonic surgery has an established role in the management of both benign and malignant conditions. Proposed benefits from laparoscopic surgery include decreased pain, decreased metabolic disturbance to the patient and faster recovery. It is now generally accepted that pro‐inflammatory mediators, including cytokines, are to a great extent responsible for the metabolic changes associated with injury and surgery, and that these metabolic changes are related to postoperative recovery. Cytokine levels in the serum are decreased after major laparoscopic colorectal surgery compared with open surgery. However, the cytokine concentration in abdominal drain fluid is the same independent of the size of the incision and these concentrations are far higher than those found in the serum suggesting that the peritoneal would from the surgery itself is more important to metabolic events than the skin wound used to access the abdominal cavity to perform the operation. When looked at critically in programmes where patients are optimally managed perioperatively, there appears to be minimal metabolic benefit from performing a major colonic resection using minimal access surgery. Thus, it appears that the wound is critical when the operation involves only minor peritoneal disruption, such as in laparoscopic cholecystectomy, but when large peritoneal defects are created, such as in major colorectal surgery, then the skin wound becomes irrelevant to metabolism and hence recovery. Thus, minimal access does not necessarily equate to minimal invasion and the terms should not be used interchangeably in the context of laparoscopic colorectal surgery.
SURMOUNTING THE CHALLENGES OF SENTINEL LYMPH NODE BIOPSY FOR BREAST CANCER IN NON‐TERTIARY CENTRES AND COMMUNITY‐BASED PRACTICES
Authors: Tan Mona P.
Published: May 2006

Background:  Sentinel lymph node biopsy (SLNB), a procedure associated with low morbidity, has been shown to be an accurate technique for determining axillary lymph node status in breast cancer. It is now a standard of care in many tertiary oncology centres. The purpose of this study was to determine the feasibility of carrying out SLNB in non‐tertiary centres and community practices without full nuclear medicine facilities and lower patient volume.

Methods::  From November 2002 to February 2005, 50 women diagnosed with clinically node‐negative breast cancer underwent 52 sentinel lymph node procedures. Surgery was carried out in five hospitals with different access to nuclear medicine facilities. Lymphatic mapping was therefore carried out with blue dye only. Patients were divided into two groups: group 1 comprised those with invasive disease who went on to have an axillary clearance, and group 2 comprised those who underwent SLNB only for a negative node. Routine pathological examination was carried out for sentinel nodes.

Results::  There were 31 SLNB with axillary dissection and 21 SLNB only. The identification rate was 96.2%. Among those who had concomitant axillary dissection, there were no false‐negative results. The overall accuracy was 94%, sensitivity was 82% and specificity was 100%.

Conclusion::  Consistent results in non‐tertiary centres can be achieved with adequate attention to appropriate preceptorship and meticulous technique. Women who elect to have surgical treatment for breast cancer in these hospitals need not be denied the benefits of SLNB.
OUTCOME ANALYSIS OF PATIENTS WITH CRANIOFACIAL RESECTION: HONG KONG EXPERIENCE
Authors: Wong Ling Yuen , Lam Lai Kun , Fan Yiu Wah , Yuen Anthony P. W. , Wei William I.
Published: May 2006

Background:  The aim of this study was to evaluate the clinical outcome of patients who underwent craniofacial resection for tumour in the anterior skull base at the University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong between January 1993 and June 2003.

Methods:  A retrospective review was conducted. The duration of follow up ranged from 1.7 to 119 months (median, 41.8 months). The setting was a tertiary referral centre. Thirty‐nine patients, 23 males and 16 females, aged 8–79 years were included. Thirty‐four patients had malignant tumour and five patients had benign pathology. The tumour pathology was diversified. Nineteen patients had no treatment before the surgery, and the remaining 20 patients had received surgery, radiotherapy or combined treatment before resection. Patients were given postoperative irradiation and/or chemotherapy depending on the pathology of the tumour and the extent of the disease and clearance at the time of surgery.

Results:  There was no operative mortality. Complications occurred in 10 patients and among them, three required reoperation. The other complications were managed successfully with conservative measures. The 5‐year actuarial disease‐free survival for patients with benign and malignant pathology was 100 and 77.6%, respectively. For patients with malignant pathology, 5‐year actuarial disease‐free survival was 90% when the resection margin was negative at surgery. However, the survival dropped to 53.6% when the resection margin was involved macroscopically.

Conclusion:  Craniofacial resection was an appropriate surgical approach with acceptable morbidity in selected patients with tumour located at the anterior skull base. Complete excision of malignant tumour could achieve 90% 5‐year disease‐free actuarial survival.
SURGICAL PROCEDURES FOR MELANOMA IN PUBLIC AND PRIVATE NEW SOUTH WALES HOSPITALS, 2001–2002
Authors: Barton Michael B. , Gabriel Gabriel S. , Frommer Michael S. , Holt Phoebe E. , Thompson John F.
Published: May 2006

Background:  Evidence suggests that there is considerable variation in the types of procedures used to treat cancer. This variation may result in suboptimal or cost‐ineffective care. The present study examined the variation in surgical treatment of melanoma before the establishment of a Melanoma Network that could promote more uniform high‐quality care in New South Wales (NSW). The variations in the use of surgical procedures for melanoma by NSW Area Health Service of patient residence were examined.

Methods:  Data in the Health Information Exchange of NSW Health collected on procedures carried out on patients with a diagnosis of melanoma in NSW public and private hospitals from 1 July 2001 to 30 June 2002 were examined. Data were aggregated by Area Health Services of patient residence. These data were compared with the numbers of new cases of melanoma notified to the NSW Central Cancer Registry in the same areas in 2001–2002. Excision of skin lesions, skin grafting and numbers and types of lymph node procedures were examined.

Results:  During the study period, the Central Cancer Registry reported that there were 3085 notifications of melanoma, whereas hospital inpatient data recorded that 6864 procedures were carried out for patients with a melanoma diagnosis in NSW public and private hospitals. Sixty‐seven per cent of procedures were carried out in private hospitals. A total of 852 skin grafting procedures were recorded. Of these, 60% were carried out in private hospitals. The average proportion of skin grafts associated with excisions in NSW was 30% (range, 0–53%). Eight hundred and fifty‐eight lymph node procedures were recorded for 747 NSW residents. These were biopsies, excisions or both. Forty per cent were carried out in private hospitals. The average proportion of new cases of melanoma associated with a lymph node procedure in NSW was 28% (range, 0–47%).

Conclusion:  Most of the inpatient procedures for patients with melanoma were carried out in private hospitals. The proportions of new cases that underwent skin grafting after excision, or underwent lymph node dissection, varied more than fivefold from one Area Health Service to another. This may indicate variations in casemix, variations in clinical practice or both.
COMPLETION THYROIDECTOMY FOR MALIGNANCY AFTER INITIAL MINIMAL ACCESS THYROID SURGERY
Authors: Yeh Michael W. , Sidhu Stan B. , Sywak Mark , Edhouse Pamela , Delbridge Leigh W.
Published: May 2006

Background:  Minimal access thyroid surgery (MATS), carried out through a lateral 2.5‐cm incision, provides excellent clinical and cosmetic outcomes when carried out for small (<3 cm), single nodules. However, if the final pathology shows thyroid malignancy and a completion thyroidectomy is required, the small lateral incision requires conversion to a standard collar incision and the second operation must be carried out in the presence of previous lateral dissection. The aim of this study is to determine if there is any demonstrable disadvantage to completion thyroidectomy for malignancy after MATS when compared with the same procedure after conventional hemithyroidectomy.

Methods:  This retrospective cohort study examined all patients undergoing completion thyroidectomy for malignancy in the University of Sydney Endocrine Surgical Unit from January 2002 to January 2005. Outcome measures were complication rates, final scar length and patient’s self‐assessment of scar appearance.

Results:  A total of 106 patients underwent MATS during the study period, 11 of whom required completion thyroidectomy for malignancy. During the same period, 42 patients required completion thyroidectomy for malignancy after previous conventional hemithyroidectomy. There was no difference in complication rates between the two groups. The two complications in the study consisted of one case of flap oedema (control) and one case of keloid scar (MATS). Mean final incision length, scar appearance and patient’s satisfaction with scar did not differ between the two groups.

Conclusion:  There is no demonstrable disadvantage when completion thyroidectomy for malignancy is required after MATS.
PROSPECTIVE AUDIT OF LAPAROSCOPIC CHOLECYSTECTOMY EXPERIENCE AT A SECONDARY REFERRAL CENTRE IN SOUTH AUSTRALIA
Authors: Tan Jeremy T. H. , Suyapto Dion R. , Neo Eu L. , Leong Paul S. K.
Published: May 2006

Backgrouond:  Laparoscopic cholecystectomy is now the gold standard procedure for symptomatic gallstone disease. Nevertheless, there are still several controversies such as the need for routine intraoperative cholangiogram (IOC), the indications for and results of early laparoscopic cholecystectomy in the setting of acute cholecystitis and the use of endoscopic retrograde cholangiopancreatography versus laparoscopic common bile duct (CBD) exploration for intraoperatively detected choledocholithiasis. The aim of this study was to investigate some of these controversies.

Methods:  All laparoscopic cholecystectomies carried out at our institution, a secondary referral centre in Adelaide, South Australia, over a 9‐month period were prospectively audited. Data were collected regarding indications for surgery, rate of conversion to open operation, use of IOC, rate of choledocholithiasis and complication rate.

Results:  There were 202 patients, of whom 152 were women and 50 men. Age range was 15–83 years. Sixty‐one per cent of emergency operations were for acute cholecystitis. The conversion rate for emergency operations was 20.6% and for elective procedures was 4.2% (P = 0.003).One hundred and eighty‐four patients had an IOC performed. Twelve of these patients had choledocholithiasis. Six of these 12 patients had both normal preoperative ultrasound and liver function tests. Four of the patients went on to postoperative endoscopic retrograde cholangiopancreatography, four had successful laparoscopic CBD exploration, two had open CBD exploration and two had their distal CBD filling defects flushed away with normal saline. There was no morbidity associated with performance of the IOC. There were three patients with postoperative bile leak and one with a bile duct injury.

Conclusion:  Selective IOC would miss a proportion of patients with choledocholithiasis. Early laparoscopic cholecystectomy for acute cholecystitis is associated with a higher conversion rate than elective laparoscopic cholecystectomy. Overall complication rate is low, with 95% of patients having no complications. Laparoscopic CBD exploration is feasible with a reasonable success rate. This can all be achieved at a secondary referral centre staffed by general surgeons.
IS THERE STILL A ROLE FOR THE CLASSICAL COX‐MAZE III?
Authors: Yap Cheng‐Hon , Prior David , Kenny James , Zimmet Adam , Chao Victor , Mooney Donald , Yii Michael
Published: May 2006

Background:  The incidence of surgery for atrial fibrillation (AF) is rising, paralleled by an increase in the types of lesion sets and energy sources used. These alternate energy sources have simplified the surgery at the expense of increased cost of consumables. The classical Cox‐Maze III is the gold standard therapy with a proven efficacy in curing AF. Our complete experience with this procedure is presented.

Methods:  All 28 patients undergoing the classical Cox‐Maze III procedure at our institution underwent preoperative assessment and were followed prospectively.

Results:  Twenty‐eight patients underwent the Cox‐Maze III procedure between January 2001 and May 2003. Their mean age was 65 years (range, 44–80 years). Twenty‐five patients had concomitant cardiac procedures. Mean duration of AF was 8.3 years. Permanent AF was present in 82%. Mean follow‐up time was 15 ± 8 months (range, 4–30 months). There were no perioperative or late deaths, or thromboembolic events. Sixty‐one per cent had early (<3 months) atrial arrhythmia. Freedom from AF at most recent clinical follow up was 93%. Freedom from late atrial arrhythmia was 82%. Freedom from late AF or atrial flutter by pacemaker interrogation or Holter assessment was 77%. Anti‐arrhythmic medication use was reduced. New York Heart Association class improved from an average of 2.8 preoperatively to 1.3 postoperatively.

Conclusion:  The result of the present study shows the safety and efficacy of the classical Cox‐Maze III procedure. With the advantage of proven long‐term efficacy, demonstrable safety and avoidance of costly technology, the Cox‐Maze III should not be discounted as a treatment option in patients because of its perceived complexity.
ADVANCES IN THE ADJUVANT TREATMENT OF COLORECTAL CANCER
Authors: Nordman Ina C. , Iyer Shoba , Joshua Anthony M. , Clarke Stephen J.
Published: May 2006

Background:  There have been numerous advances in the adjuvant therapy of colon cancer in the last two decades.

Methods:  This review outlines the historical perspectives of adjuvant treatment as well as current and emerging standards of care.

Results:  Although previous regimens included a variety of equivalent schedules of 5‐fluorouracil and folinic acid, integration of newer drugs such as oxaliplatin are offering significant improvements in disease‐free survival. The use of targeted agents such as bevacuzimab creates the potential to further increase cure rates in the adjuvant setting. The current low rate of referral of eligible patients for chemotherapy in Australia is also discussed.

Conclusion:  Adjuvant therapy for colon cancer is making major strides as we attempt to cure more patients.
USE OF ETHYLENEDIAMINETETRAACETIC ACID FOR IN VIVO STRIPPING OF COLUMNAR MUCOSA: PILOT STUDY IN AN EXPERIMENTAL MODEL
Authors: France Michael , Drew Paul A. , Ruszkiewicz Andrew , Jamieson Glyn G. , Watson David I.
Published: May 2006

Background:  Barrett’s oesophagus is an important clinical problem that can lead to oesophageal adenocarcinoma. A variety of mucosal ablation strategies are now being applied in an attempt to prevent this, although they all can cause complications. Animal experiments that suggest that ethylenediaminetetraacetic acid (EDTA) could be a novel agent for ablation of Barrett’s oesophagus are reported in this article.

Methods:  Dark Agouti rats were used in all experiments. To determine the feasibility of using EDTA to strip intestinal type mucosa, segments of the small intestine were exposed in vitro to EDTA at various concentrations with or without agitation. The conditions required for EDTA to strip mucosa from a vascularized loop of small bowel were then optimized in vivo. Cannulated small bowel loops were irrigated with different concentrations of EDTA with or without pulsation of the irrigation solution. The effect of similar treatments on the normal mucosa of the rat oesophagus was then determined. Mucosal healing after EDTA stripping was studied in an isolated small bowel loop survival model.

Results:  Ethylenediaminetetraacetic acid with agitation or pulsation resulted in stripping of the intestinal columnar mucosa in vitro and in vivo. The extent was influenced by the concentration of EDTA and duration of exposure. Squamous epithelium was relatively resistant to stripping. In the survival model the small bowel mucosa regenerated without stricture formation.

Conclusion:  Small bowel columnar mucosa can be removed by EDTA in vivo without stricture formation. A refinement of this approach could be applicable to the ablation of Barrett’s oesophagus.
TRACHEOBRONCHIAL INJURIES FROM BLUNT TRAUMA
Authors: Wong Edward H. N. , Knight Simon
Published: May 2006

Tracheobronchial injuries from trauma can be life threatening. We present a case report of a 23‐year‐old man who suffered a left main bronchus transection after a motorbike accident. The diagnostic and management issues surrounding tracheobronchial injuries are reviewed. Early diagnosis and treatment lead to the best outcome, with almost complete return of pulmonary function.
TUBERCULOUS DACTYLITIS
Authors: Keith Prue P. A. , Gong Andrew
Published: May 2006

Tuberculous dactylitis is a rare condition and a diagnostic challenge. Tissue biopsies can be negative for microscopy and culture. Polymerase chain reaction and DNA probes for mycobacterium tuberculosis can provide an earlier diagnosis. Surgery and antimicrobial therapy remain the mainstay of management.
Experience of dying: concerns of dying patients and of carers
Authors: Terry W. , Olson L. G. , Wilss L. , Boulton‐Lewis G.
Published: May 2006

Background: Terminally ill patients frequently express concerns about what dying will be like: how their bodies may change as disease progresses, how medication may alter the effect of these changes and whether and how their preferences will be respected as they become more ill.

Methods: Thirty‐six patients admitted to a hospice were interviewed and 18 carers of patients of the Palliative Care service, who had died participated in focus groups. Thirty‐three patients had advanced malignant disease, 13 were women; their mean age was 68 years (range 44–92 years).

Results: The areas of concern consistently identified by patients were (i) privacy and autonomy, principally in regard to families, (ii) a lack of information about physical changes and medication use as death approached and (iii) the desire to shorten life, which was expressed by all patients. Carers recalled problems accessing services and support and had needed more help with practical issues such as medication timing and dose. They believed that not enough information about the patients’ illnesses had been given to them and they were insistent that carers should have information against the wishes of patients.

Conclusion: Some of the patients’ and carers’ concerns can be readily addressed. Others, particularly access to confidential information, cannot be addressed without a realignment of professional ethical standards and community expectations. The patients’ discussions of their desire to shorten life may have implications for the debate on euthanasia and physician‐assisted suicide.
Management of metastatic gastrointestinal stromal tumour in the Glivec era: a practical case‐based approach
Authors: Harrison M. L. , Goldstein D.
Published: May 2006

Gastrointestinal stromal tumour is now recognized as a distinct pathological malignancy and has received much attention over the last few years. Despite almost universal resistance to chemotherapy, a novel therapy, Imatinib, which targets the KIT receptor, has changed the natural history of this disease. We have audited the first 26 consecutive patients with gastrointestinal stromal tumour treated over 4 years at a single institution. A practical guide to the management of common toxicities and drug resistance is reported with a review of the published reports. Many of the strategies used are likely to be widely applicable to the use of targeted therapies in other malignancies.
Management of iron deficiency in patients admitted to hospital: time for a rethink of treatment principles
Authors: Ahmad I. , Gibson P. R.
Published: May 2006

Background: Iron deficiency is very common in patients admitted to hospital. Its management is changing with new insights into iron absorption and therapeutic options.

Aims: The aims of this study were to develop guidelines for the correction of iron deficiency in patients admitted to hospital and to compare these with current practice.

Methods: Based on current published evidence, guidelines were developed. All patients in whom iron deficiency was detected during hospital admission over a 2.5 year period were retrospectively studied. Their management was compared with that of the guidelines developed.

Results: Three clinical scenarios were identified—(A) urgent attention to haemoglobin required: blood transfusion followed by i.v. iron recommended, (B) Semiurgent iron repletion: i.v. iron recommended and (C) non‐urgent iron repletion: oral or i.v. repletion recommended. A total of 119 patients was identified, age 18–99 (median 77) years, 29% men, and haemoglobin 33–130 (87) g/L. Of 66 given blood transfusion, 17 had subsequent i.v. iron, 25 oral iron and 24 no other form of iron repletion. Of the other 53, nine had i.v. iron, 32 oral iron and 12 had no treatment. Fifty‐five per cent of patients were managed according to the proposed guidelines and this occurred less frequently (9%) in those presenting with cardiovascular problems than in those with anaemia, gastrointestinal bleeding or other medical problems (all >60%; P < 0.0001, Fisher's exact test).

Conclusion: Current management is haphazard, with underutilization of i.v. iron and failure to initiate any regimen for iron repletion being common. It may be time for a change in approach to repletion of iron in ill patients.
Patient reporting and doctor recognition of dyspnoea in a comprehensive cancer centre
Authors: Hayes A. W. , Philip J. , Spruyt O. W.
Published: May 2006

The aim of this study was to examine different aspects of dyspnoea in an Australian acute cancer care population, specifically prevalence, recognition, reporting, symptom control methods and prognostic significance. Patients and treating hospital medical officer were concurrently asked to evaluate the experience of dyspnoea. The prevalence of dyspnoea was 33%, with discrepancies observed between patient and doctor reporting of the presence of dyspnoea (P = 0.021), as well as its intensity and distress. Symptomatic methods for the relief of cancer‐related dyspnoea are underused, particularly opioids. The medical underestimation of dyspnoea is consistent with previous studies and potentially detracts from effective management of this symptom.
Ecological persistence interrupted in Caribbean coral reefs
Authors: Pandolfi John M. , Jackson Jeremy B.C.
Published: May 2006

The recent mass mortality of Caribbean reef corals dramatically altered reef community structure and begs the question of the past stability and persistence of coral assemblages before human disturbance began. We report within habitat stability in coral community composition in the Pleistocene fossil record of Barbados for at least 95 000 years despite marked variability in global sea level and climate. Results were consistent for surveys of both common and rare taxa. Comparison of Pleistocene and modern community structure shows that Recent human impacts have changed coral community structure in ways not observed in the preceding 220 000 years.
Heavy use of prophylactic antibiotics in aquaculture: a growing problem for human and animal health and for the environment
Authors: Cabello Felipe C.
Published: May 2006

The accelerated growth of finfish aquaculture has resulted in a series of developments detrimental to the environment and human health. The latter is illustrated by the widespread and unrestricted use of prophylactic antibiotics in this industry, especially in developing countries, to forestall bacterial infections resulting from sanitary shortcomings in fish rearing. The use of a wide variety of antibiotics in large amounts, including non‐biodegradable antibiotics useful in human medicine, ensures that they remain in the aquatic environment, exerting their selective pressure for long periods of time. This process has resulted in the emergence of antibiotic‐resistant bacteria in aquaculture environments, in the increase of antibiotic resistance in fish pathogens, in the transfer of these resistance determinants to bacteria of land animals and to human pathogens, and in alterations of the bacterial flora both in sediments and in the water column. The use of large amounts of antibiotics that have to be mixed with fish food also creates problems for industrial health and increases the opportunities for the presence of residual antibiotics in fish meat and fish products. Thus, it appears that global efforts are needed to promote more judicious use of prophylactic antibiotics in aquaculture as accumulating evidence indicates that unrestricted use is detrimental to fish, terrestrial animals, and human health and the environment.
Gene expression of Escherichia coli in continuous culture during adaptation to artificial sunlight
Authors: Berney Michael , Weilenmann Hans‐Ulrich , Egli Thomas
Published: May 2006

Escherichia coli growing in continuous culture under continuous UVA irradiation exhibits growth inhibition with a subsequent adaptation to the stress. Transcriptome analysis was performed during transient growth inhibition and in the UVA light‐adapted growth state. The results indicate that UVA light induces stringent response and an additional response that includes the upregulation of the synthesis of valine, isoleucine, leucine, phenylalanine, histidine and glutamate. The induction of several SOS response‐genes strongly points to DNA damage as a result of UVA exposure. The involvement of oxidative stress was observed with the induction of ahpCF. Taken together it supports the hypothesis of the production of reactive oxygen species by UVA light. In the UVA‐adapted cell population strong repression of the acid tolerance response was found. We identified the enzyme chorismate mutase as a possible chromophore for UVA light‐inactivation and found strong repression of the pyrBI operon and the gene mgtA encoding for an ATP‐dependent Mg2+ transporter. Furthermore, our results indicate that the role of RpoS may not be as important in the adaptation of E. coli to UVA light as it was implicated by previous results with starved cells, but that RpoS might be of crucial importance for the resistance under transient light exposure.
The role of endothelial dysfunction in the pathophysiology of erectile dysfunction in diabetes and in determining response to treatment
Authors: Pegge N. C. , Twomey A. M. , Vaughton K. , Gravenor M. B. , Ramsey M. W. , Price D. E.
Published: May 2006

Background  Erectile dysfunction (ED) in diabetes is related to autonomic neuropathy and endothelial dysfunction. We studied the relative importance of these factors in diabetic and non‐diabetic men with ED and determined if they predict responses to treatment with sildenafil.

Methods  Thirty‐three men, aged 35–65 years, with ED (20 diabetic, 13 non‐diabetic), 15 of whom were sildenafil responders and 18 non‐responders, were compared with 30 age and risk‐matched control subjects (15 diabetic, 15 non‐diabetic). Subjects with ED completed the International Index of Erectile Function (IIEF) questionnaire. Endothelial function was assessed by changes in brachio‐radial and femoro‐tibial arterial pulse‐wave velocity (pulse‐wave velocity) during reactive hyperaemia, expressed as percentage endothelium‐dependent dilatation. Autonomic function was assessed by heart rate variation during expiration and inspiration (E/I ratio) and during the valsalva manoeuvre.

Results  The respective changes in pulse‐wave velocity, in the arm and leg [mean (sd)] were 0.71 (6.5)% and 3.5 (6.4)% in the impotent diabetic men, 0.7 (7.6)% and 2.4 (5.9)% in the non‐diabetic impotent men, −0.68 (5.7)% and −1.31 (7.2)% in the non‐impotent diabetic men and 7.7 (3.7)% and 7.6 (3.4)% in the control subjects. There was a significant interaction between ED and diabetic status such that there was significantly impaired vascular response in the diabetic group (both with and without ED) and in the non‐diabetic group with ED compared with the non‐diabetic control group (P = 0.01 and P = 0.001 for brachio‐radial and femoro‐tibial measures, respectively). The E/I ratios of the diabetic men were significantly lower than those of the control subjects [1.17 (0.14) vs. 1.33 (0.16), P < 0.02), but there were no differences in the measures of autonomic neuropathy between the groups with ED and those with normal erectile function. Amongst diabetic men, the initial IIEF scores (maximum score 30, low score indicates more severe ED) were significantly higher in sildenafil‐responders than non‐responders [16.3 (8.4), vs. 6.8 (7 1), P < 0.02]. The rate of sildenafil response was not significantly affected by the measures of endothelial or autonomic function.

Conclusions  ED in both diabetic and non‐diabetic men is characterized by marked endothelial dysfunction in comparison with non‐diabetic control subjects. Response to sildenafil is not predicted by either endothelial function or autonomic function, but in diabetic men appears to be related to the initial degree of erectile dysfunction.
Relationship between common functional polymorphisms of the p22phox gene (−930A > G and +242C > T) and nephropathy as a result of Type 2 diabetes in a Chinese population
Authors: Lim S. C. , Goh S. K. , Lai Y. R. , Tee W. W. , Koh A. , Xu X. H. , Wu Y. S. , Yap E. , Subramaniam T. , Sum C. F.
Published: May 2006

Objective  Genetic determinants are important in diabetic nephropathy (DN). Oxidative stress has also emerged as an important pathogenic factor in DN and vascular NADH oxidase is a major source of reactive oxygen species (ROS). Previous small studies reported a strong but contradictory association between functional genetic variation of p22phox, an important subcomponent of NADH oxidase, and DN. We investigated the association between two common functional single nucleotide polymorphisms (SNPs) (−930 A > G and +242 C > T) and DN in a much larger group of Chinese patients with Type 2 diabetes mellitus (T2DM).

Research design and methods  Case‐control study of Chinese subjects with long‐standing T2DM (> 10 years). Cases (n = 306) were subjects with a spot urinary albumin : creatinine ratio (ACR) of > 113 mg/mmol or elevated serum creatinine. Control subjects (n = 306) had ACR < 3.3 mg/mmol and normal serum creatinine. Genotyping was carried out by standard PCR and restriction fragment length polymorphism analysis.

Results  Gender distribution, age, duration of diabetes and HbA1c were similar in cases and control subjects. Distribution of genotypes in the control subjects for both SNPs was consistent with the Hardy–Weinberg equilibrium. Distribution of genotypes did not differ significantly between cases and control subjects for both polymorphisms—+2424C > T: cases CC 84.6%, CT 15.0%, TT 0.4% and control subjects CC 87.6%, CT 11.8%, TT 0.6% (P = 0.45); −930 A > G: cases AA 40.5%, AG 41.8%, GG 17.7% and control subjects AA 38.2%, AG 49.0%, GG 12.8% (P = 0.12). Distribution of alleles was also similar—+2424 C > T: cases C 92.2%, T 7.8% and control subjects C 93.5%, T 6.5% (P = 0.66); −930 A > G cases A 61.4%, G 38.6% and control subjects A 62.7%, G 37.3% (P = 0.38). We estimated that our study has approximately 80% power to detect a relative risk of 1.65 (for +242 C > T) and 1.35 (for −930 A > G) conferred by the minor allele, respectively.

Conclusions  In contrast with previous small studies, our data suggest that these SNPs do not confer significantly increased susceptibility to DN secondary to T2DM in Chinese subjects.
Very long chain n‐3 polyunsaturated fatty acids in the food chain in the UK and the potential of animal‐derived foods to increase intake
Authors: Givens D. I. , Gibbs R. A.
Published: May 2006

Summary  The very long chain (VLC) n‐3 polyunsaturated fatty acids (PUFA), particularly eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are widely recognised to have beneficial effects on human health. However, recommended intakes of VLC n‐3 PUFA (450 mg/day) are not being met by the diet in the majority of the population mainly because of low consumption of oil‐rich fish. Current mean intake of VLC n‐3 PUFA by adults is estimated to be about 282 mg/day with EPA and DHA contributing about 244 mg/day. Furthermore, the fact that only about 27% of adults eat any oil‐rich fish (excluding canned tuna) and knowledge of the poor conversion of α‐linolenic acid to EPA and DHA in vivo, particularly in men, leads to the need to review current dietary sources of these fatty acids. Animal‐derived foods are likely to have an important function in increasing intake and studies have shown that feeding fish oils to animals can increase the EPA and DHA content of the resulting food products. This paper highlights the importance of examining current and projected consumption trends of meat and other animal products when exploring the potential impact of enriched foods by means of altering animal diets. When related to current food consumption data, potential dietary intakes of EPA+DHA from foods derived from animals fed enriched diets are calculated to be about 231 mg/day. If widely consumed, such foods could have a significant impact on progression of conditions such as cardiovascular disease. Consideration is also given to the sources of VLC n‐3 PUFA in animal diets, with the sustainability of fish oil being questioned and the need to investigate the use of alternative dietary sources such as those of algal origin.
Whole grains uncovered
Authors: Seal C. J. , Jones A. R. , Whitney A. D.
Published: May 2006

Summary  A number of population‐based studies have demonstrated potential health benefits of consuming more wholegrain foods. Although the evidence is not yet supported by large‐scale intervention studies, it is sufficiently strong to have spawned a number of health claims in the USA and in several European countries including the UK, and health professionals have promoted their health benefits. Despite the scientific, industrial and media interest, consumption of wholegrain foods remains very low, and public awareness is limited. With the exception of breakfast cereals and breads, penetration of wholegrain foods in the market place is low. Areas of confusion both within the scientific community and for the consumer include defining what is meant by the term ‘whole grain’ and interpreting the names used for processed grains used in the ingredient list on foods. These must be clearly established before trends in wholegrain consumption can be properly quantified and clear food‐based guidelines can be developed.
Conjugated linoleic acid and human health‐related outcomes
Authors: Yaqoob P. , Tricon S. , Williams C. M. , Grimble R. F. , Burdge G. C. , Calder P. C.
Published: May 2006

Summary  There has been increasing interest in health benefits of conjugated linoleic acid (CLA) based on findings with laboratory animals. Some human studies have also suggested health benefits of CLA, but because of the mixes used these could not be readily associated with a particular isomer of CLA. A recent study examined the separate effects of near‐pure cis‐9,trans‐11 CLA (c9,t11 CLA) or trans‐10,cis‐12 CLA (t10,c12 CLA) on health‐related outcomes in healthy young males. The CLA isomers were provided in capsules and at three doses (up to about 2.5 g/day) each for 8 weeks. Both c9,t11 and t10,c12 CLA were incorporated in a dose–response fashion into blood lipids and cells. At the doses and durations used, neither isomer of CLA affected bodyweight, body mass index or body composition, insulin sensitivity, immune function or markers of inflammation. However, at the doses and durations used, c9,t11 and t10,c12 CLA had opposing effects on blood lipid concentrations. Altered dairy cow‐feeding practices were used to produce c9,t11 CLA‐rich milk and, from this ultra heat‐treated milk, cheese and butter were produced. The milk and the dairy products made from it had ninefold higher contents of c9,t11 CLA, higher contents of n‐3 fatty acids and lower contents of total fat and of saturated fatty acids. They also contained much higher contents of trans‐vaccenic acid (tVA). The modified dairy products were used in a 6‐week controlled dietary intervention study in healthy middle‐aged males. c9,t11 CLA and tVA were incorporated from dairy products into blood lipids and cells. Consumption of the CLA‐rich (and tVA‐rich) dairy products did not affect bodyweight or body mass index, insulin sensitivity or inflammatory markers. However, there were some detrimental effects on blood lipids. These effects may be due to tVA rather than to c9,t11 CLA, as they are consistent with the effects of trans fatty acids and not consistent with the effects of c9,t11 CLA identified in the earlier study with c9,t11 CLA in capsules.
Firm Performance, Governance Structure, and Top Management Turnover in a Transitional Economy*
Authors: Firth Michael , Fung Peter M. Y. , Rui Oliver M.
Published: May 2006

abstract  Recent research has argued that political and regulatory environments have a significant impact on corporate governance systems. In particular, countries with poor investor protection laws and weak law enforcement have low levels of corporate governance that manifests itself in substandard financial performance, management entrenchment, and the expropriation of minority shareholders. One implication of this research is that China will have poor corporate governance and entrenched managers as its legal system is relatively underdeveloped and inefficient. However, using data on top management turnover in China's listed firms, our results refute the prediction of entrenched management. We find evidence of very high turnover of company chairmen and there are many cases that we interpret to be forced departures. Our results show that chairman turnover is related to a firm's profitability but not to its stock returns. Turnover‐performance sensitivity is higher if legal entities are major shareholders but the proportion of non‐executive directors perversely affects it. We find no evidence that profitability improves after a change in chairman and this suggests that a firm's governance structure is ineffective as it is unable to recruit suitable replacements that can turn around its financial performance.
‘It Was Such a Handy Term’: Management Fashions and Pragmatic Ambiguity*
Authors: Giroux Hélène
Published: May 2006

abstract This article builds on constructs that authors have labelledstrategic ambiguity,interpretative viability,umbrella constructs, andboundary objects, and suggests that these constructs all articulate a central concern for collective action and the role of ambiguity therein. It characterizes aspragmatic ambiguitythe condition of admitting more than one course of action, and elucidates and operationalizes this new construct. Drawing on the sociology of translation (Callon, 1986;Latour, 1987),[1]it argues that pragmatic ambiguity is both the result and the resource of a collective process ofintéressementoccurring during the rise in popularity of a new management approach.

FollowingBenders and van Veen (2001), the article posits that pragmatic ambiguity increases during the rise of a management fashion. It provides empirical evidence in support of this claim by means of a longitudinal analysis of quality management (QM) concepts as articulated by several authors both before and during the Quality Movement of the 1980s and 1990s. The analyses of QM texts show that concepts became vaguer, more ambiguous, and more general as the Quality Movement gained momentum, suggesting the presence of a positive feedback loop between pragmatic ambiguity and popularity. In addition, the data illustrate how pragmatic ambiguity was achieved and sustained textually, and how it was supported by a variety of social, linguistic and rhetorical factors.
MAXIMS AND THICK ETHICAL CONCEPTS
Authors: Moore A. W.
Published: May 2006

I begin with Kant’s notion of a maxim and consider the role which this notion plays in Kant’s formulations of the fundamental categorical imperative. This raises the question of what a maxim is, and why there is not the same requirement for resolutions of other kinds to be universalizable. Drawing on Bernard Williams’ notion of a thick ethical concept, I proffer an answer to this question which is intended neither in a spirit of simple exegesis nor as a straightforward exercise in moral philosophy but as something that is poised somewhere between the two. My aim is to provide a kind of rational reconstruction of Kant. In the final section of the essay, I argue that this reconstruction, while it manages to salvage something distinctively Kantian, also does justice to the relativism involved in what J. L. Mackie calls ‘people’s adherence to and participation in different ways of life’.
A CRITIQUE OF FREGE ON COMMON NOUNS
Authors: Ben‐Yami Hanoch
Published: May 2006

Frege analyzed the grammatical subject‐term ‘S’ in quantified subject‐predicate sentences, ‘q S are P’, as being logically predicative. This is in contrast to Aristotelian Logic, according to which it is a logical subject‐term, like the proper name ‘a’ in ‘a is P’– albeit a plural one, designating many particulars. I show that Frege’s arguments for his analysis are unsound, and explain how he was misled to his position by the mathematical concept of function. If common nouns in this grammatical subject position are indeed logical subject‐terms, this should require a thorough reevaluation of the adequacy of Frege’s predicate calculus as a tool for the analysis of the logic and semantics of natural language.
ACTIONS, HABITS AND CONSTITUTION
Authors: Pollard Bill
Published: May 2006

In this paper I offer a critique of the view made popular by Davidson that rationalization is a species of causal explanation, and propose instead that in many cases the explanatory relation is constitutive. Given Davidson’s conception of rationalization, which allows that a huge range of states gathered under the heading ‘pro attitude’ could rationalize an action, I argue that whilst the causal thesis may have some merit for some such ‘attitudes’, it has none for others. The problematic ‘attitudes’ are those which can be attributed to the agent only on the basis of her history of doing a certain sort of thing. In other words, they are among the agent’s habits. I argue that such temporally extended states cannot be the causes of any present occurrence. Instead, I suggest we should think of the present action as partly constituting the state in question, and give a corresponding interpretation of the explanatory relation. Such explanations invite us to abandon a conception of agency narrowly based on psychology, in favour of an enriched one which takes an agent’s habits to partly constitute the agent.
Review of Three Recently Published Studies on the Mandaeans
Authors: GARDNER IAIN
Published: May 2006

This review deals with three major studies of the Mandaeans all published in 2002. Although each of the works utilizes earlier material, and indeed Drower's work dates back to 1937, their collective appearance marks something of a resurgence for Mandaean studies in the anglophone world. The review links these works to recent rapid changes for the Mandaeans, and indeed the development of substantial diaspora communities in Australia and elsewhere. The author also makes brief comment on the difficult questions of Mandaean identity and origin, and their relationship with Manichaeism.