bluuebunny/crossref_metadata_2025 huggingface dataset:
Bilateral recurrent laryngeal nerve neuropraxia following laryngeal mask insertion: a rare cause of serious upper airway morbidity
Authors: Sacks Mark D. , Marsh Deborach
Published: March 2003

We report the case of a 4‐year‐old boy who developed bilateral recurrent laryngeal nerve neuropraxia following a routine anaesthetic with a laryngeal mask airway. The possible mechanisms of injury and the ways that this rare but critical complication might be avoided are discussed.
Fibreoptic nasal intubation in children with anticipated and unanticipated difficult intubation
Authors: Blanco Gerardo , Melman Estela , Cuairan Vicente , Moyao Diana , Ortiz‐Monasterio Fernando
Published: March 2003

The establishment of a tracheal airway with direct laryngoscopy can be either a very difficult or an impossible task in children with congenital or acquired facial malformations. Out of 46 patients categorized as difficult tracheal intubation, fibreoptic laryngoscopy was used successfully in 44 children anaesthetized by mask with sevoflurane and oxygen or by an intravenous infusion of propofol and mask oxygenation. There were two failures (4.3%). One was due to excessive bleeding and secretions produced by the multiple attempts to intubate with direct laryngoscopy and the other failure in a patient with Pierre Robin syndrome and very small nasal passages that precluded the introduction of the endoscope. Fibreoptic laryngoscopy was successful in 37 cases (80.4%) on the first attempt to intubate and in seven (15.2%) on a second or third attempt. We conclude that fibreoptic laryngoscopy in anaesthetized children with difficult anticipated or unanticipated tracheal intubation in trained hands is a safe technique that can be lifesaving. Therefore, we urge all anaesthesia trainees to become proficient in fibreoptic tracheal intubation.
The correlation of bispectral index with endtidal sevoflurane concentration and haemodynamic parameters in preschoolers
Authors: MCCANN Mary Ellen , Bacsik Julianne , Davidson Andrew , Auble Susan , Sullivan Lorna , Laussen Peter
Published: March 2003

Background: Bispectral index (BIS) is a signal processing device that potentially is a pharmacodynamic measure of the effects of anaesthesia on the central nervous system.

Methods: In this prospective blinded study, we investigated the pharmacodynamic relationship between BIS, haemodynamic changes during anaesthesia and endtidal nonsteady state concentrations of sevoflurane in 30 children, mean age 3.3 ± 1.1 years, who were undergoing tonsillectomy and adenoidectomy. A standardized anaesthetic technique was used and included induction and maintenance with sevoflurane, nitrous oxide and oxygen. BIS, heart rate, mean arterial pressure (MAP) and endtidal sevoflurane (ETsevo) concentrations were continuously recorded and specifically noted at the time of intubation, placement of Dingman gag, incision of adenoid, adenoid out, incision of tonsil, tonsil one out, tonsil two out, last agent off, first spontaneous movement, first eye opening and extubation. The anaesthetist was blinded to BIS throughout the procedure.

Results: Using a Spearman correlation analysis, there was significant negative correlation between BIS and ETsevo concentrations (r=− 0.888, P < 0.01) and a pharmacodynamic relationship with EC50 (ETsevo at which BIS=50) of 1.48% (95% confidence interval 0.84–2.11). There was a weak negative correlation between sevoflurane and MAP (r=− 0.391, P < 0.01) but no significant correlation between sevoflurane and heart rate.

Conclusions: In preschool children undergoing sevoflurane anaesthesia for tonsillectomy and adenoidectomy, endtidal sevoflurane concentrations are more closely correlated with BIS than with MAP or heart rate.
Difficult paediatric intubation when fibreoptic laryngoscopy fails
Authors: Ng Agnes , Vas Lakshmi , Goel Sunita
Published: March 2003

Summary We report an unusual problem with fibreoptic bronchoscopy in an 8‐year‐old girl with Negar syndrome. She had a history of difficult airway since birth, and had undergone mandibular distraction for severe obstructive sleep apnoea when she was aged 2 years. Nagar syndrome is a Treacher–Collins like syndrome with normal intelligence, conductive bone deafness and problems with articulation. The patients have malar hypoplasia with down slanting palpebral fissures, high nasal bridge, micrognathia, absence of lower eyelashes, low set posteriorly rotated ears, preauricular tags, atresia of external ear canal, cleft palate, hypoplasia of thumb, with or without radius, and limited elbow extension. Protracted attempts with a fibreoptic bronchoscope failed to visualize the glottis, and this was only possible when the tube was guided to the larynx by blind nasal intubation. Apparently, the healing of the wounds for the mandibular distraction in the mandibular space on the inside of the rami of the mandible had caused differential fibrosis on either side of the hyoid, leading to a triplane distortion of the larynx with a left shift, clockwise rotation to a 2–8 o'clock direction and a slight tilt towards the left pharyngeal wall. The large epiglottis overlying this had precluded a view of the larynx. Finally, the older technique of breathguided intubation facilitated fibreoptic bronchoscopy to achieve tracheal intubation.
A comparison of two different doses of ketamine with midazolam and midazolam alone as oral preanaesthetic medication on recovery after sevoflurane anaesthesia in children
Authors: Trabold Benedikt , Rzepecki Angela , Sauer Kay , Hobbhahn Jonny
Published: March 2003

Summary Background: This investigation prospectively evaluated the effect of oral premedication of two different doses of ketamine with midazolam and midazolam alone on the recovery of children after sevoflurane anaesthesia.

Methods: In a randomized, double‐blind study, 79 children (aged 1–8 years, ASA physical status I or II) were assigned to receive one of three premedications in a volume of 0.5 ml·kg−1: group 1 received midazolam 0.5 mg·kg−1 (MD); group 2 received midazolam 0.5 mg·kg−1 with ketamine 1.8 mg·kg−1 (MK‐1); and group 3 received midazolam 0.5 mg·kg−1 with ketamine 3 mg·kg−1 (MK‐2). The reactions of the children during administration were noted. Anaesthesia was induced by facemask with incremental sevoflurane administration. All children received alfentanil (15 µg·kg−1). Tracheal intubation was facilitated by mivacurium (0.2 mg·kg−1). Anaesthesia was maintained with sevoflurane and an additional dose of alfentanil, if necessary. During recovery, the time interval between discontinuation of anaesthesia and arousal (spontaneous ventilation, extubation) were recorded.

Results: Emergence (spontaneous ventilation, extubation) and recovery times (discharge, Aldrete score=9) did not differ significantly between groups (P=0.24, P=0.59 and P=0.145, respectively).

Conclusions: The combination of midazolam and ketamine as oral preanaesthetic medication did not significantly affect the recovery time of children after sevoflurane anaesthesia.
A comparison of five techniques for detecting cardiac activity in infants
Authors: Inagawa Gaku , Morimura Naoto , Miwa Takaaki , Okuda Koji , Hirata Masako , Hiroki Koichi
Published: March 2003

Summary Background: The new guidelines for cardiopulmonary resuscitation recommend that laypersons should begin chest compressions without checking for a pulse because the pulse check has serious limitations in accuracy. We determined the efficacy of the most suitable method to search for cardiac activity in infants.

Methods: Twenty‐eight nurses tried to detect infants' cardiac activity and determined their heart rates with five different techniques: palpation of brachial pulse, carotid pulse, femoral pulse, apical impulse and auscultation of apical impulse with the naked ear (direct auscultation technique).

Results: The mean time interval required to find the pulse within 30 s in the auscultation, the apical, the brachial, the carotid and the femoral were 2.4 ± 1.2, 3.5 ± 2.7, 4.0 ± 2.7, 9.9 ± 7.0 and 9.1 ± 5.9 s, respectively. The required time was significantly shorter in the auscultation method than in the palpation of carotid and femoral pulses. The percentage and 95% confidence intervals (95% CI) of pulses identified within 10 s (= the number of the correct identified within 10 s/the number of all cases) in auscultation, apical, brachial, carotid and femoral palpations were 100.0% (95% CI 51.8, 100), 75.0% (95% CI 28.9, 89.3), 73.1% (95% CI 52.2, 88.4), 50.0% (95% CI 30.6, 69.4) and 42.9% (95% CI 24.5, 62.8), respectively. These values were greater in the auscultation method than in all the palpation methods.

Conclusions: The direct auscultation technique was more rapid and accurate than any other techniques to determine cardiac activity without instruments. It is suggested that direct a auscultation technique is also superior to the palpation of brachial artery in cardiopulmonary resuscitation in infants.
The use of porcine small intestinal submucosa in ten cases of feline corneal disease
Authors: Featherstone Heidi J. , Sansom Jane , Heinrich Christine L.
Published: March 2003

Porcine small intestinal submucosa (SIS) was used as a novel graft material in the management of 10 cases of feline corneal disease. Five cases had stromal ulceration associated with trauma, ocular foreign body and/or suspected infection and required a grafting procedure. Five cases had feline sequestra that were managed by a keratectomy prior to placement of SIS as a graft material. Eight eyes healed with minimal corneal scarring with a very good cosmetic and visual result. One eye with continued aqueous leakage in the immediate postoperative period required a conjunctival pedicle graft to reinforce the SIS graft site. One eye required enucleation 48 h following grafting due to progressive keratomalacia but the SIS material remained intact.
Diversity and function of male antennal glands in Cynipoidea (Hymenoptera)
Authors: Isidoro Nunzio , Bin Ferdinando , Romani Roberto
Published: March 2003

The functional anatomy of antennal glands located either on the 3rd or on the 3rd and 4th antennomeres in males of several species of cynipoids was investigated. SEM observations revealed variously modified antennomeres with elevated plates, tyloids and excavated areas. In all the cases, the antennomeres are equipped with cuticular pores, corresponding internally to cuticular ducts. TEM studies showed the presence of type III integumentary glands, as classified by Noirot & Quennedey. Each glandular unit is made up of an innermost secretory cell, producing the secretion, and an outermost canal cell, producing the evacuating duct. The secretion passes through the duct and reaches the cuticular pores, concentrated in a ventro‐lateral portion of the antennomere called the ‘release and spread structure’. Both in Cynipidae and in Eucoilinae (Figitidae), the courtship behaviour includes a pre‐copulatory phase characterized by intense antennal stroking. Bioassays in the eucoilins Leptopilina boulardi and L. heterotoma showed that these glands are the production site of a contact sex recognition pheromone, necessary for the female to accept the male.
Phylogenetic position of the Tenrecs (Mammalia: Tenrecidae) of Madagascar based on analysis of the complete mitochondrial genome sequence of Echinops telfairi
Authors: Mouchaty Suzette K. , Gullberg Anette , Janke Axel , Arnason Ulfur
Published: March 2003

The phylogenetic position of the lesser hedgehog tenrec, Echinops telfairi, was studied on the basis of analysis of the concatenated sequences of 12 mitochondrial protein‐coding genes. In addition to the tenrec, the analysis included two other representatives of the insectivore order Lipotyphla, the hedgehog and the mole. The eutherian tree was rooted with three non‐eutherian mammalian taxa. The analysis joined the tenrec, the African elephant (order Proboscidea) and the aardvark (order Tubulidentata) on a common branch. The three lipotyphlan taxa, the tenrec (Tenrecidae), the mole (Talpidae) and the hedgehog (Erinaceidae) were dispersed in the eutherian tree, demonstrating lipotyphlan polyphyly.
Phylogeny and jaw evolution in Gnathostomulida, with a cladistic analysis of the genera
Authors: Sørensen Martin V.
Published: March 2003

Sørensen, M. V. (2002). Phylogeny and jaw evolution in Gnathostomulida, with a cladistic analysis of the genera.— Zoologica Scripta,31, 461–480.

The relationships between the genera in Gnathostomulida were investigated in a computerized cladistic analysis. The data matrix comprised 55 morphological characters of sensory structures, the reproductive systems, and the hard mouthparts. The cladistic analysis produced four almost identical most parsimonious trees. The four trees differed by having different topologies within the family Gnathostomulidae. Based on the obtained trees, the following was concluded: (1) Filospermoidea and Bursovaginoidea are both monophyletic; (2) Scleroperalia is paraphyletic; (3) all known families except Onychognathiidae (Sterrer 1972) are monophyletic; (4) Onychognathiidae emend. comprises the generaNanognathia, Onychognathia, Rastrognathia, Valvognathia and Vampyrognathia; (5) Paucidentulidae and Onychognathiidae emend. branch off in the lower part of Bursovaginoidea; (6) the following two clades are monophyletic and appear as sister groups: Problognathiidae−Gnathostomulidae−Austrognathiidae and Gnathostomariidae−Goannagnathia−Mesognathariidae−Clausognathiidae−Agnathiellidae. Based on the character optimization it was suggested that the gnathostomulid jaw evolved from a relatively simple ancestral jaw belonging to the compact type or the open lamellar type. The fused lamellar type evolved from the open lamellar type. The ancestral dentarium resembled the arc type and evolved along two different evolutionary paths into the basket type and the row type.
The Nemertodermatida are basal bilaterians and not members of the Platyhelminthes
Authors: Jondelius Ulf , Ruiz‐Trillo Iñaki , Baguñà Jaume , Riutort Marta
Published: March 2003

Recent hypotheses on metazoan phylogeny have recognized three main clades of bilaterian animals: Deuterostomia, Ecdysozoa and Lophotrochozoa. The acoelomate and ‘pseudocoelomate’ metazoans, including the Platyhelminthes, long considered basal bilaterians, have been referred to positions within these clades by many authors. However, a recent study based on ribosomal DNA placed the flatworm group Acoela as the sister group of all other extant bilaterian lineages. Unexpectedly, the nemertodermatid flatworms, usually considered the sister group of the Acoela together forming the Acoelomorpha, were grouped separately from the Acoela with the rest of the Platyhelminthes (the Rhabditophora) within the Lophotrochozoa. To re‐evaluate and clarify the phylogenetic position of the Nemertodermatida, new sequence data from 18S ribosomal DNA and mitochondrial genes of nemertodermatid and other bilaterian species were analysed with parsimony and maximum likelihood methods. The analyses strongly support a basal position within the Bilateria for the Nemertodermatida as a sister group to all other bilaterian taxa except the Acoela. Despite the basal position of both Nemertodermatida and Acoela, the clade Acoelomorpha was not retrieved. These results imply that the last common ancestor of bilaterian metazoans was a small, benthic, direct developer without segments, coelomic cavities, nephrida or a true brain. The name Nephrozoa is proposed for the ancestor of all bilaterians excluding the Nemertodermatida and the Acoela, and its descendants.
Semantic equivalence of the Nursing Phenomena Classification of ICNP®: Alpha Version in Brazilian Portuguese
Authors: Nóbrega M. M. Lima da , De Gutierrez M. G. Rivero
Published: March 2003

This study presents the results obtained in the first phase of research carried out to adapt the Nursing Phenomena Classification of ICNP® Alpha to the Brazilian context. This phase intended to attain semantic equivalence of the terms of this classification through the use of the back‐translation technique, with some modifications. From the results obtained, it may be stated that the semantic adaptation of the classification attained a rate of agreement of 98% for the titles and the definitions of nursing phenomena. The 2% of terms that did not reach an acceptable rate of agreement are related to coping, in the following phenomena: coping; defensive coping; coping: disabling; ineffective coping specific: rape‐trauma, death, divorce; compromised health coping; and inadequate family coping. From this result, it may be concluded that the Nursing Phenomena Classification was translated in a semantically correct form.

Readers can access the entire text of the ICNP® Beta Version by visiting http://www.icn.ch/icnpupdate.htm. Other information about the ICNP® and its development can be found at
http://www.icn.ch/icnp.htm.
A client‐centred model: discharge planning in Juvenile Justice Centres in New South Wales, Australia
Authors: Jarvis L. A. , Beale B , Martin K
Published: March 2003

Health care delivered in Juvenile Justice Centres in New South Wales, Australia, leads to improvement in the health status of detainees while in custody but this declines on discharge and is contributed to by a breakdown in continuity of care. In an effort to halt this decline in health status, a model of interdisciplinary discharge planning is proposed to address the interface between Juvenile Justice Centres and adult correctional facilities and the community. Key features of the process are: collaboration through the development of links by establishment of a community liaison co‐ordinator position; open and continuous communication between service providers; continuous involvement of detainees and their significant others; and ongoing support to detainees once discharged. Evaluation of the discharge‐planning process ensures that the process is appropriate to meet the needs of this specific and diverse population of young people and supplies feedback to all service providers. The trusting relationship that is developed between detainees and registered nurses within centres leaves nurses ideally placed to co‐ordinate the discharge‐planning process.
Sowing the seeds of public health nursing–1920–39
Authors: Kalnins Irene
Published: March 2003

The Florence Nightingale International Foundation and the Florence Nightingale International Courses played an important role in the development of public health nursing leadership in Europe and remain an outstanding example of international collaboration. Through the International Courses 203 nurses from 40 countries were prepared to organize and implement systems of public health nursing where none had previously existed; another 97 nurses were prepared for leadership as administrators and teachers. Below, how the courses started and their impact as viewed by nursing leaders of that era.
Autonomy and professional responsibility in care for persons with intellectual disabilities
Authors: Meininger Herman P.
Published: March 2003

Abstract The meaning of autonomy in the context of care for persons with intellectual disabilities is clarified by a sketch of different views of the autos implied in autonomy. The dominating concept of autonomy is largely orientated toward realization of the self into a sovereign individual and toward an emancipation that is aimed at freedom of choice and self determination. The concept of professional responsibility connected to this concept of autonomy has a technical‐instrumental and contractual character. In an alternative view of the self as a ‘story’, authenticity and personal identity of both caregiver and care‐receiver and their mutual relation are of central importance. Professional responsibility then takes on a dialogical character. This dialogical character includes, limits and transcends the valuable elements of the dominating concept of autonomy.
Modern nursing and modern physics: does quantum theory contain useful insights for nursing practice and healthcare management?
Authors: Hastings John
Published: March 2003

In recent years, a number of articles have appeared in the nursing literature proposing that the branch of modern physics known as quantum theory offers insights that may be useful in nursing practice and healthcare management. This paper critiques this literature in the light of key concepts in quantum theory. The conclusion is that quantum theory has been misunderstood and misapplied within the nursing journals. Quantum theory is essentially mathematical and is based on quantitative experimentation. To successfully apply this theory to nursing practice, nurses will have to equip themselves with the necessary mathematical and experimental skills.
Artificially damaged hairs: preparation and application for the study of preventive ingredients
Authors: Kon R. , Nakamura A. , Takeuchi K.
Published: March 2003

Synopsis

We have developed a method for preparing artificially damaged hairs, similar to those generally observed in permed hair. Moreover, we have established two models of hair for testing preventive ingredients. A model for scale lift was prepared using alkaline protease digestion following lyophilization. A model for splitting, was prepared by successive extraction of the cortical protein, re‐oxidation, and lyophilization. The practical application of these models was confirmed through the evaluation of the preventive effect of a polymer or peptides.

Nous avons dévelopé une méthode pour préparer artificiellement des cheveux endommagés, qui étaient observés en générale pour les cheveux permanents. De plus, nous avons établi deux modèles de cheveux pour prévenir l'effet des éléments préventifs. Le premier, c'est le modèle de 'scale lift' qui a été preparé en utilisant Ia digestion de la protèse alcaline suivi par la lyophilisation. Le seconde, c'est le modèle de 'splitting' qui a été préparé en utilisant successivement l'extraction de la protéine corticale, la ré‐oxydation et la lyophilisation. La valeur pratique de ces modèle a été estimée par l'évaluation de l'effet préventif d'un polymère et des peptides.
The influence of a cream containing 20% glycerin and its vehicle on skin barrier properties
Authors: Lodén M , Wessman W
Published: March 2003

Synopsis

Glycerin is widely used in cosmetics and well as in pharmaceutical formulations, mainly as humectant. In vitro studies have shown glycerin to prevent crystallization of stratum corneum model lipid mixture at low room humidity. Whether this may affect the skin barrier function during repeated application of glycerin in a cream base to normal skin is not known. Therefore, the influence of a cream containing 20% glycerin was compared with its placebo cream in a bilateral, double‐blind study on 17 healthy volunteers. The effect was evaluated as influence on hydration with a corneometer and on skin barrier function. Skin barrier function was assessed as permeability to water with an evaporimeter (transepidermal water loss; TEWL) and as sensitivity to an irritating surfactant by measuring the biological response (measured as TEWL and skin blood flow).

Ten days treatment of normal skin with 20% glycerin significantly increased skin corneometer values, indicating an increased hydration. However, our study failed to show an influence of glycerin on human skin, in terms of TEWL and skin sensitivity to SLS‐induced irritation.

Résumé

La glycérine est largement utilisée dans les formulations cosmétiques aussi bien que pharmaceutiques, principalement en tant qu’humectant. Des tests in vitro ont montré que la glycérine empèche la cristallization de la structure lipidique du Stratum Corneumà humidité ambiante basse. La question de savoir si ceci peut affecter la fonction barrière de la peau durant des applications répetées d’une crème pour peau normale contenant de la glycérine n’a pas été demontrée. Par conséquent, une crème contenant 20% de glycérine a été comparée avec son placebo dans un test bilatéral en double aveugle sur 17 volontaires en bonne santé. L’effet hydratant de la glycérine a étéévalué avec l’aide d’un cornéomètre, son influence sur la fonction barrière de la peau avec l’aide d’un évaporimètre (mesurant la Perte Trans‐Epidermal en eau) et son effet protecteur après irritation á l’aide d’un agent de surface par la réponse biologique de la peau (mesure de la PTEL et du flux sanguin).

Dix jours de traitement sur une peau normale avec une crème contenant 20% de glycérine ont augmenté les mesures du cornéomètre de manière significative, indiquant une augmentation de l’hydration de la peau. Cependant notre étude n’a pas pu démontré l’influence de la glycérine sur la peau en terme de PTEL et la réduction du potentiel irritant du Sodium Lauryl Sulphate.
Identification and quantitative analysis of kojic acid and arbutine in skin‐whitening cosmetics
Authors: Masse M.‐O. , Duvallet V. , Borremans M. , Goeyens L.
Published: March 2003

Synopsis

After testing several chromatographic systems described in the literature, the optimal operating conditions were retained to develop a simple and rapid method grouping TLC and HPLC/UV for separation, identification and dosage of kojic acid (CAS RN 501‐30‐4) or arbutine (CAS RN 497‐76‐7) in skin‐whitening cosmetic products. The screening is carried out by TLC on cellulose plate and by TLC on silicagel plate with UV indicator and polar mobile solvent. Regarding identification and quantitative determination by HPLC/UV, the best results were obtained by direct phase chromatography, using a polar stationary phase greffed with diol groups and a polar buffered mobile phase at PH 2,5.

Intralaboratory prevalidation tests were carried out on the HPLC method: detection limit, linearity and intralaboratory repeatability of standard curves and repeatability of samples quantitative determination.
Quantification of glycolic acid in cosmetic products using reversed phase high performance liquid chromatography
Authors: Couch L. H. , Howard P. C.
Published: March 2003

Synopsis

Many cosmetics contain keratolytic hydroxy acids to correct the effects of photoageing on human skin. Although methods exist for quantifying the α‐hydroxy acid, glycolic acid in aqueous media, accurate methods for quantification in mixed hydrophobic and aqueous cosmetic creams and lotions are lacking. Glycolic acid was extracted from cosmetics using aqueous tetrahydrofuran (THF), separated with strong‐anion exchange cartridges, and quantified by high performance liquid chromatography (HPLC) with UV–VIS detection without the paired‐ion reagents. In a recovery experiment, the mean accuracy of the method was 100.6%. The dynamic range of the method allows for the detection of glycolic acid at concentrations used in over‐the‐counter cosmetics.
Can excess iron increase the risk for coronary heart disease and cancer?
Authors: Kelly Colette
Published: March 2003

Summary
It has been hypothesised that high iron stores increase the risk of diseases such as coronary heart disease and cancer. In summary, in spite of the theoretical possibilities that high exposure to either dietary or systemic iron might increase heart disease or cancer risk, the evidence suggests that this is not the case in healthy individuals. However, some questions remain unanswered including the risk of colon cancer in individuals with high dietary iron intakes (either via a high intake of red meat, fortified foods or frequent supplement use). It is probable that much of the non‐haem iron will remain unabsorbed, which potentially may damage the colonic  mucosa  and  increase  the  risk  of  large  bowel  cancer.  Furthermore,  the  risk of cardiovascular disease and cancer in individuals who carry a mutation of HFE, the gene for haemochromatosis, many of whom may be asymptomatic, may be greater than the general population, particulary when dietary iron intake is high. This paper summarises the basis of iron metabolism and examines the theoretical reasons for an association between iron and cardiovascular disease (CVD; includes coronary disease, vascular disease & myocardial infarction) and cancer. It also revisits the studies designed to investigate the role of iron in CVD and cancer.
HAPPY mapping in a plant genome: reconstruction and analysis of a high‐resolution physical map of a 1.9 Mbp region ofArabidopsis thalianachromosome 4
Authors: Thangavelu Madan , James Allan B. , Bankier Alan , Bryan Glenn J. , Dear Paul H. , Waugh Robbie
Published: March 2003

HAPPY mapping is anin vitroapproach for defining the order and spacing of DNA markers directly on native genomic DNA. This cloning‐free technique is based on analysing the segregation of markers amplified from high molecular weight genomic DNA which has been broken randomly and ‘segregated’ by limiting dilution into subhaploid samples. It is a uniquely versatile tool, allowing for the construction of genome maps with flexible ranges and resolutions. Moreover, it is applicable to plant genomes, for which many of the techniques pioneered in animal genomes are inapplicable or inappropriate. We report here its demonstration in a plant genome by reconstructing the physical map of a 1.9 Mbp region around the FCA locus ofArabidopsis thaliana.The resulting map, spanning around 10% of chromosome 4, is in excellent agreement with the DNA sequence and has a mean marker spacing of 16 kbp. We argue that HAPPY maps of any required resolution can be made immediately and with relatively little effort for most plant species and, furthermore, that such maps can greatly aid the construction of regional or genome‐wide physical maps.
Clinical aspects of obesity in childhood and adolescence
Authors: Kiess W. , Galler A. , Reich A. , Müller G. , Kapellen T. , Deutscher J. , Raile K. , Kratzsch J.
Published: March 2003

The level of fatness of a child at which morbidity acutely and/or later in life increases is determined on an acturial basis. Direct measurements of body fat content, e.g. hydrodensitometry, bioimpedance, or DEXA, are useful tools in scientific studies. However, body mass index (BMI) is easy to calculate and is generally accepted now to be used to define obesity in children and adolescents clinically. An increased risk of death from cardiovascular disease in adults has been found in subjects whose BMI had been greater than the 75th percentile as adolescents. Childhood obesity seems to substantially increase the risk of subsequent morbidity whether or not obesity persists into adulthood. The genetic basis of childhood obesity has been elucidated to some extent through the discovery of leptin, the ob gene product, and the increasing knowledge on the role of neuropeptides such as POMC, neuropeptide Y (NPY) and the melanocyte concentrating hormone receptors (for example, MC4R). Environmental/exogenous factors largely contribute to the development of a high degree of body fatness early in life. Twin studies suggest that approximately 50% of the tendency toward obesity is inherited. There are numerous disorders including a number of endocrine disorders (Cushing's syndrome, hypothyroidism, etc.) and genetic syndromes (Prader‐Labhard–Willi syndrome, Bardet Biedl syndrome, etc.) that can present with obesity. A simple diagnostic algorithm allows for the differentiation between primary or secondary obesity. Among the most common sequelae of primary childhood obesity are hypertension, dyslipidemia, back pain and psychosocial problems. Therapeutic strategies include psychological and family therapy, lifestyle/behaviour modification and nutrition education. The role of regular exercise and exercise programmes is emphasized. Surgical procedures and drugs used in adult obesity are still not generally recommended in children and adolescents with obesity. As obesity is the most common chronic disorder in industrialized societies, its impact on individual lives as well as on health economics has to be recognized more widely. This review is aimed towards defining the clinical problem of childhood obesity on the basis of current knowledge and towards outlining future research areas in the field of energy homoeostasis and food intake in relation to child health. Finally, one should aim to increase public awareness of the ever increasing health burden and economic dimension of the childhood obesity epidemic that is present around the globe.
A review of the literature of Bardet–Biedl disease and report of three cases associated with metabolic syndrome and diagnosed after the age of fifty
Authors: Iannello S. , Bosco P. , Cavaleri A. , Camuto M. , Milazzo P. , Belfiore F.
Published: March 2003

Bardet–Biedl syndrome (BBS) is a genetic autosomal‐recessive disease (formerly grouped with Laurence–Moon–Biedl syndrome but considered today as a separate entity) characterized by abdominal obesity, mental retardation, dysphormic extremities (syndactyly, brachydactyly or polydactyly), retinal dystrophy or pigmentary retinopathy, hypogonadism or hypogenitalism (limited to male patients) and kidney structural abnormalities or functional impairment. The expression and severity of the various clinical BBS features show inter‐ and intrafamilial variability. This study focuses on three cases of familial BBS – two sisters and one brother (66, 64 and 51 years of age, respectively) – with the main cardinal findings of the disease plus a classic ‘metabolic syndrome’ (characterized by abdominal obesity, atherogenic dyslipidaemia, raised blood pressure, insulin resistance with or without glucose intolerance, and prothrombotic risk and proinflammatory states). One female patient (not affected by reproductive dysfunction) had three healthy offspring, while the other two patients were unmarried. Another severely affected brother died at 70 years of age; two other brothers are lean but affected by nephropathy, retinopathy, slight mental retardation, polydactyly, hypertension and thrombotic diseases, and had healthy offspring. BBS is a rather rare but severe syndrome that is often mis‐ or undiagnosed. Ophthalmologists, endocrinologists and nephrologists should be aware of BBS because of its adverse prognosis – early onset of blindness, associated findings of metabolic syndrome and increased vascular risk, and severe renal impairment (the most frequent cause of reduced survival and death early in life).
Adult Stem Cell Plasticity and Methods of Detection
Authors: Almeida‐Porada Graça , Porada Christopher , Zanjani Esmail D.
Published: March 2003

The ability to selectively produce one or more differentiated cell types at will from totipotent stem cells would be of profound clinical importance, as it would enable the specific replacement of damaged/dysfunctional cell types within the body, potentially curing numerous diseases. Until recently, it was thought that the only cells that possessed sufficient immaturity to be capable of giving rise to more than one tissue type in vitro and in vivo were the embryonic stem cells. However, recent studies have now provided compelling evidence that the adult bone marrow, brain and skeletal muscle contain stem cells that possess the remarkable ability to trans‐differentiate and give rise to progeny of alternate embryologic derivations. These recent findings have shattered the existing dogma that the stages of embryologic development are irreversible. In this review, we present a brief summary of the most significant findings in the field of stem cell plasticity, emphasizing studies involving the hematopoietic system, discussing the models used thus far, and finishing with our findings on human stem cell plasticity using the fetal sheep model.
Philadelphia chromosome‐positive acute lymphoblastic leukemia– current concepts and future perspectives
Authors: Faderl Stefan , Garcia‐Manero Guillermo , Thomas Deborah A. , Kantarjian Hagop M.
Published: March 2003

Philadelphia chromosome (Ph)‐positive acute lymphoblastic leukemia (ALL) is diagnosed rarely in children, but constitutes the most frequent cytogenetic abnormality in adults with ALL. In contrast to chronic myeloid leukemia (CML), patients with Ph‐positive ALL usually demonstrate expression of a truncated version of the BCR‐ABL protein called p190bcr–abl. Irrespective of age and breakpoint location, Ph‐positive ALL carries a poor prognosis. Although remission rates are identical to those of Ph‐negative ALL, relapse is almost universal and long‐term survival remains rare. Given the poor outcome with current chemotherapy consolidation programs, stem cell transplantation is usually recommended for these patients in first remission or as soon as feasible. Even with transplantation the impact on outcome is limited and new therapeutic concepts are urgently needed. One of the most promising developments in recent years has been the introduction of the tyrosine kinase inhibitors such as STI571. An overview of current treatment modalities in Ph‐positive ALL will be provided and the rationale for new therapies will be discussed.
Recent approaches in acute lymphoblastic leukemia in adults
Authors: Gökbuget Nicola , Hoelzer Dieter
Published: March 2003

In the last decades outcome of adult acute lymphoblastic leukemia (ALL) has improved considerably. In large multicenter studies remission rates range from 75% to 89%, and long‐term leukemia‐free survival (LFS) from 28% to 39%. Major progress has also been made regarding better characterization of subtypes of ALL. Complete diagnostic procedures are essential to identify these subtypes which have significant differences in clinical and laboratory features and prognosis. LFS of > 50% can be expected in favorable subtypes such as T‐ALL or mature B‐ALL, while LFS of < 20% is expected in Ph/BCR‐ABL positive ALL. Prognostic factors can be used for risk stratification and selection of treatment strategies can be adapted to the subtype and relapse risk. This includes measurement of minimal residual disease (MRD) to evaluate individualized treatment strategies adapted to the molecular response. Several new approaches for improvement in chemotherapy and stem cell transplantation (SCT) are under investigation. They include the use of intensified anthracyclines, asparaginase, cyclophosphamide or high‐dose cytarabine during induction and intensive rotational chemotherapy during consolidation. Also SCT – mainly from sibling donors – is now part of standard treatment of de novo ALL, although it remains open whether indications should be based on prognostic factors or whether SCT should be offered to all patients with sibling donor. However, substantial progress can only be achieved by new, experimental strategies. These include new approaches for SCT, such as nonmyeloablative SCT, measurement of MRD, causal treatment with molecular targeting, e.g. with kinase inhibitors, and antibody therapy.
Detection and quantification of HIV‐1 specific CD4 helper and CD8 cytotoxic cells: their role in HIV‐1‐infected individuals and vaccine recipients
Authors: Imami N , Hardy G , Pires A , Burton C , Sullivan A , Gotch F
Published: March 2003

There is a strong link between virus specific CD8 T‐cell function and the efficiency of regulatory CD4 helper T cells. Controlling viraemia in HIV‐1‐infected individuals requires the maintenance of strong CD4 and CD8 T‐cell responses. These responses should be elicited by prophylactic vaccination and by postexposure immunotherapy. This review will examine the methods that are available for the detection and quantification of HIV‐1 specific CD4 and CD8 T‐cell responses. We will also discuss the methods that should be used to identify these responses in HIV‐1‐infected individuals, seropositive recipients of immunotherapy and seronegative vaccinees. Finally, we will give examples of how responses observed in vitro relate to those known to occur in vivo.
Prevalence, risk factors and outcome of hyperlactataemia in HIV‐infected patients*
Authors: Hocqueloux L , Alberti C , Feugeas J‐P , Lafaurie M , Lukasiewicz E , Bagnard G , Carel O , Erlich D , Molina J‐M
Published: March 2003

Objective

We describe the prevalence, risk factors and outcome of hyperlactataemia (HL) in a cohort of 140 HIV‐infected patients.

Patients and methods

Patients were enrolled consecutively within a 3‐month period (July to September 1999) and followed until 31 October 2000. One hundred and forty HIV‐infected patients had venous plasma lactate levels measured. HL was defined at baseline by two consecutive lactate levels > 2.1 mmol/L (upper limit of normal). We compared baseline demographic characteristics, immuno‐virological parameters, antiretroviral therapy and outcome between patients with HL (cases) or without HL (controls). We described the clinical features of patients with HL.

Results

Among 129 patients included in the analysis, HL was found in 11 patients (8.5%), all of whom were receiving nucleoside reverse transcriptase inhibitors (NRTIs). Cases were more likely than controls to receive didanosine or stavudine (82% vs. 19%, P= 2.7 × 10−6 and 82% vs. 48%, P= 0.03, respectively). Only 4/11 cases (36%) had symptoms consistent with HL. After a median follow‐up of 15 months, lactate level returned to normal in all three patients who discontinued NRTIs, but in only 2/8 patients who did not (P = 0.06). Only one case experienced lactic acidosis and died during follow‐up. Mortality rate was similar in cases and controls.

Conclusion

HL is associated with NRTI use, in particular didanosine and stavudine, and discontinuation of NRTIs seems to be associated with rapid resolution of HL. Lactic acidosis remains rare and the long‐term outcome of patients with HL does not seem to be poorer than controls.
Familial mastocytosis associated with neurosensory deafness
Authors: Trevisan Giusto , Pauluzzi Paolo , Gatti Alessandro , Semeraro Argeo
Published: March 2003

Mastocytosis is a disease characterized by excessive accumulation of mast cells in different tissues and symptoms caused by the release of mast cell mediators. The skin is frequently directly involved in mastocytosis. The disease is rarely seen in other members of the subjects’ family; only 49 cases of familial mastocytosis have been reported. Familial mastocytosis associated with hearing loss may represent a newly described inherited entity. We describe a brother and sister exhibiting skin mastocytosis and neurosensory deafness, associated with a history of hearing loss in their father’s family. The appearance of the mast cell disease in two siblings, who presented with similar clinical features represents a familial form of mastocytosis; the association with an inherited form of deafness may constitute a new syndrome. Our patients show several features similar to some previously reported cases but different insofar that additional congenital defects and mental retardation are absent.
Effects of lithium carbonate (Li2CO3) on in‐vitro‐cultured normal human skin explants
Authors: Wolf Ronni , D’Avino Mariarosaria , De Angelis Francesca , Ruocco Eleonora , Lombardi Maria Luisa
Published: March 2003

The early morphological changes induced by lithium carbonate, a well‐known psoriasis‐provoking drug, were studied on cultured skin.

Normal human skin from patients undergoing mastectomy was cultured in the presence of 3 m m, 6 m
m and 10 m
m of Li2CO3 for 4 days. The morphological changes were then evaluated by three observers in a blind manner and their reports were matched and collated.

The cultured skin in the presence of Li2CO3 showed cell crowding of keratinocytes in the lower part of the epidermis, indicating epidermal hyperplasia. Another striking finding was intercellular oedema and vacuolar alteration with formation of small cavities in the upper dermis. There was no evidence of parakeratosis or any other histological characteristic of psoriasis, except hyperproliferation of the epidermis.

Based on our knowledge of mechanisms of lithium action, we proposed two competitive explanations for its action on the epidermis: i) that lithium acts directly on dividing cells of the epidermis; and ii) that it acts indirectly by altering epidermal barrier function.

Although we lack definite proof, we suggest that the observed morphological changes, in particular the non‐specific stimulus to epidermal proliferation, are the primary events which initiate the process that will ultimately lead to the development of psoriatis in a predisposed patient.
The role of HLA antigens in the development of paracoccidioidomycosis
Authors: Fernanda Reis Gavazzoni Dias Maria , Carlos Pereira Antônio , Pereira Angela , Alves Monica S R
Published: March 2003

Background Paracoccidioidomycosis is a systemic granulomatous disease that involves primarily the lungs and may disseminate to other organs and systems. It is caused by Paracoccidioides brasiliensis, a fungus that exhibits reversible thermal dimorphism and whose natural habitat is presently unknown. There are two main clinical forms: the acute (subacute) juvenile form and the chronic adult form. The former runs a more rapid course and is more severe than the latter. This mycosis is found throughout Latin America. Brazil accounts for 80% of reported cases. Presumably P. brasiliensis thrives in humid and hot places, especially near forests or farms. The infection is endemic in certain areas, especially in Brazil, Colombia and Venezuela, where nearly 100% of the population show cutaneous paracoccidioidina positive skin tests, indicating previous contact with the fungus, although a small percentage show clinical manifestations of the disease.

Methods We compared the expression of HLA class I antigens in a healthy group (control) and in a group of patients with paracoccidioidomycosis (chronic adult form) using the Terasaki lymphocytotoxicity test modified by Amos for HLA antigen analysis.

Aims To discover indications of whether or not individual susceptibility to P. brasiliensis might depend on some specific immunological defect.

Results There is no evidence of association between a specific HLA antigen and paracoccidioidomycosis in the subjects studied. Further investigations are recommended.
Acute Crohn’s colitis with lobular panniculitis – metastatic Crohn’s?
Authors: Yosipovitch Gil , Hodak Emmilia , Feinmesser Maora , David Michael
Published: March 2003

One of the common lesions in Crohn’s colitis is erythema nodosum, a septal panniculitis that may appear before diagnosis or in conjunction with flare up. We report a case of Crohn’s colitis where the presenting sign was neutrophilic lobular panniculitis with few granulomas. The possibility that this case represents a forme fruste of metastatic Crohn’s is suggested. As skin biopsies are not usually performed by gastroenterologists in erythema nodosum‐like skin lesions in Crohn’s patients it may well be that the incidence of lobular panniculitis is higher than reported in the literature.
Circle hairs: a clinical curiosity
Authors: Contreras‐Ruiz J , Duran‐McKinster C , Tamayo‐Sanchez L , Orozco‐Covarrubias L , Ruiz‐Maldonado R
Published: March 2003

A case of circle hairs is reported and the literature on the subject reviewed. Differential diagnoses are discussed as well as some theories on the nature of circle hairs.