bluuebunny/crossref_metadata_2025 huggingface dataset:
Activation of ERK1/2 occurs independently of KRAS or BRAF status in endometrial cancer and is associated with favorable prognosis
Authors: Mizumoto Yasunari , Kyo Satoru , Mori Noriko , Sakaguchi Junko , Ohno Satoshi , Maida Yoshiko , Hashimoto Manabu , Takakura Masahiro , Inoue Masaki
Published: March 2007

The extracellular‐regulated kinase (ERK) signaling pathway plays important roles in regulating the malignant potential of cancer cells in vitro. However, the effect of ERK signaling on the prognosis of human tumors is not clearly understood. The present study examined the expression of phosphorylated ERK1/2 (p‐ERK1/2) as a hallmark of ERK activation, in relation to KRAS and BRAF mutations, in 63 endometrial cancer specimens with endometrioid‐subtype, in order to clarify the prognostic value of p‐ERK1/2 expression. Immmunohistochemical analysis revealed that 40 tumors (63%) expressed p‐ERK1/2, with varying levels of expression. Total ERK1/2 expression was also evaluated in a subset of tumors; most cases expressed ERK1/2 constitutively but no correlation was observed with p‐ERK expression, indicating that p‐ERK1/2 staining was not due to ERK overexpression but to hyperactivation of ERK1/2. There was no statistically significant correlation between p‐ERK1/2 expression and clinicopathological features, including patient age, International Federation of Gynecology and Obstetrics stage, pathological grade, myometrial invasion and lymph node metastasis. Sequencing analysis indicated that 23% of patients had a mutation in exon 1 of KRAS, whereas none of the patients had a mutation in exons 11 or 15 of BRAF, which are reportedly hot spots for mutation in many tumor types. There was no significant correlation between KRAS or BRAF status and p‐ERK1/2 expression. Unexpectedly, patients with low p‐ERK1/2 expression had significantly lower relapse‐free survival (P = 0.041) and overall survival (P = 0.020). Multivariate Cox regression analysis indicated that p‐ERK1/2 expression was an independent prognostic indicator for overall survival (P = 0.047). These findings suggest that ERK activation occurs in a KRAS‐ and BRAF‐independent manner in endometrial cancer, and is associated with favorable prognosis. (Cancer Sci 2007; 98: 652–658)
Hormonal and morphological study of the pituitaries in reeler mice
Authors: Lombardero Matilde , Kovacs Kalman , Horvath Eva , Salazar Ignacio
Published: March 2007

Reelin is a neuronal glycoprotein that plays a crucial role in brain layer formation during prenatal development. The reeler mutant mouse lacks Reelin, leading to abnormalities in the neuronal layering of cerebral cortex and cerebellum, producing ataxia, tremor and abnormal locomotion. Reeler mice are reported to have growth retardation and most of them are sterile or unable to bring up their newborns. Since the brain is one of the main regulator of pituitary hormone secretion and no information was reported regarding pituitary function and structure in these mutant mice, we studied pituitary endocrine activity and morphology in reeler mice. Mice were classified in three groups as reeler homozygote (RHM), reeler heterozygote (RHT) or control (CO). Pituitary hormone blood levels were assessed by enzyme immunoassay (EIA) and immunoradiometric assay (IRMA). Animals and their pituitaries were weighted and pituitaries were studied by histology, immunohistochemistry and electron microscopy. Results showed statistically significant differences in body weight and in adrenocorticotropic hormone (ACTH) and luteinizing hormone (LH) blood levels between the three groups. In contrast, growth hormone (GH) blood levels showed a high individual variation and no decrease in reeler groups compared with CO. Morphological studies revealed no differences in pituitary cell types except that somatotrophs appeared to be slightly smaller in RHM and RHT. Although it seems that pituitary hypofunction is not responsible for growth retardation, more studies are needed to obtain a deeper insight into the endocrine status of these mutant mice to elucidate the cause of their low body weight and reproductive behaviour.
Oestrogenic Regulation of Pro‐Opiomelanocortin, Neuropeptide Y and Corticotrophin‐Releasing Hormone mRNAs in Mouse Hypothalamus
Authors: Pelletier G. , Li S. , Luu‐The V. , Labrie F.
Published: March 2007

It is well documented that oestrogen suppresses food intake by an action at the hypothalamic level. Using in situ hybridisation, we studied the effect of castration (CX) and short‐term administration of oestradiol (E2) in CX female mice for three neuropeptides involved in feeding behaviour: two anorexigenic peptides, (i) the pro‐opiomelanocortin (POMC)‐derived peptide α‐melanocyte‐stimulating hormone and (ii) corticotrophin‐releasing hormone (CRH), and the orexigenic peptide, (iii) neuropeptide Y (NPY). POMC‐expressing neurones were mostly laterally located in the arcuate nucleus. POMC mRNA expression was decreased following CX and a single injection of E2 induced an increase in mRNA levels at 12‐ and 24‐h time intervals. In the parvocellular area of the paraventricular nucleus, CRH mRNA levels were similarly decreased after CX and completely restored to normal levels at 12 and 24 h following E2 injection. On the other hand, the levels of NPY mRNA expressed in neurones located in the inner zone of the arcuate nucleus were increased by CX and decreased to the levels observed in intact animals by E2 injection (3–24 h). The present data suggest that oestrogen might exert an anorexigenic action by stimulating POMC and CRH mRNA expression and decreasing NPY mRNA expression in the hypothalamus.
Identification and comparison of marbofloxacin metabolites from the plasma of ball pythons (Python regius) and blue and gold macaws (Ara ararauna)
Authors: HUNTER R. P. , KOCH D. E. , COKE R. L. , CARPENTER J. W. , ISAZA R.
Published: March 2007

Marbofloxacin is a veterinary only, synthetic, broad spectrum fluoroquinolone antimicrobial agent. In mammals, approximately 40% of the oral dose of marbofloxacin is excreted unchanged in the urine; the remaining is excreted via the bile as unchanged drug in the feces. The Vd ranges from 1.1 (cattle) to 1.3 (dog, goat, swine) L/kg. Because of extra‐label use of marbofloxacin in birds and reptiles, this study was designed to determine the profile of metabolites in plasma and compare the circulating metabolite profile between a reptile and an avian species. Six adult ball pythons (Python regius) and 10 blue and gold macaws (Ara ararauna) were used in this study. The macaws were dosed both i.v. and p.o. with a single 2.5 mg/kg administration where as the pythons received a single 10 mg/kg dose both i.v. and p.o. The metabolite profiles of marbofloxacin in the plasma of these species were determined using a high performance liquid chromatography system with a mass spectrometer for detection (LC/MS/MS). Mass spectra data generated from the snake and bird plasma samples were compared with previously reported LC/MS/MS mass spectral data. Evidence does not suggest differences due to route of administration (i.v. vs. p.o.) in either species. Four chromatographic peaks with resulting daughter spectrum were identified and represent 12 possible metabolite structures. All of the proposed metabolites, except for the N‐oxide, appear to be unique to macaws. The potential metabolites identified in macaws appear to be very different than those reported for chickens.
High salt stress in wheat leaves causes retardation of chlorophyll accumulation due to a limited rate of protochlorophyllide formation
Authors: Abdelkader Amal F. , Aronsson Henrik , Sundqvist Christer
Published: March 2007

When exposed to salt stress, leaves from dark‐grown wheat seedlings (Triticum aestivum, cv. Giza 168) showed reduced accumulation of chlorophyll during irradiation. To elucidate the mechanism behind salt‐influenced reduction of chlorophyll biosynthesis, we have investigated the effect of salt stress on the spectral forms of Pchlide, the phototransformation of Pchlide to Chlide, the Shibata shift, the regeneration of Pchlide and the accumulation of Pchlide from 5‐aminolevulinic acid (ALA). We found that the phototransformation of Pchlide to Chlide was not affected by salt stress. The blue shift (Shibata shift) of newly formed Chlide was delayed both after flash irradiation and in continuous light. The reformation of Pchlide in darkness after a flash irradiation or after a period of 3‐h irradiation was retarded in the salt‐treated leaves. However, after a 20‐h dark period, Pchlide was reformed even in salt‐treated leaves but the formation of short‐wavelength Pchlide was suppressed. Compared to controls, salt treatment also reduced the amount of Pchlide accumulated in leaves floated on ALA. The increase in the low temperature fluorescence emission spectrum at 735 nm, which occurred gradually during several hours of irradiation with continuous light in control leaves, was completely suppressed in salt‐treated leaves. It is concluded that salt stress inhibits chlorophyll accumulation partly by reducing the rate of porphyrin formation but, as discussed, also by a possible reduction in the formation of chlorophyll‐binding proteins.
Suppressing expression of a soluble acid invertase (BoINV2) in broccoli (Brassica oleracea) delays postharvest floret senescence and downregulates cysteine protease (BoCP5) transcription
Authors: Eason Jocelyn R. , Ryan Dacey J. , Watson Lyn M. , Pinkney Tatyana , Hedderley Duncan , Christey Mary C. , Braun Robert H. , Coupe Simon A.
Published: March 2007

We report on the production and selection of transgenic Brassica oleracea var. Italica lines with a downregulated soluble acid invertase (BoINV2). Explants of broccoli (cv. Triathlon) were transformed with an antisense construct of BoINV2 under the control of an Asparagus officinalis‐derived harvest‐induced promoter using Agrobacterium tumefaciens‐mediated transformation. BoINV2 is upregulated in wild‐type broccoli floret tissue after harvest. Transgenic broccoli lines showed reduced BoINV2 mRNA accumulation immediately after harvest compared with wild‐type. Downregulation of BoINV2 had no significant impact on the expression of a second broccoli acid invertase gene (BoINV1), but plants with downregulated BoINV2 also had lower expression of a senescence‐associated cysteine protease (BoCP5) compared with wild‐type. The total soluble sugar levels in floret tissue of antisense BoINV2 lines were greater than wild‐type tissue after harvest (up to 1.5 times higher). Soluble protein content of wild‐type tissue decreased from 48 h after harvest with an increase in protease activity. In comparison, two antisense BoINV2 lines retained at‐harvest levels of soluble protein until 72 and 96 h after harvest and had lower postharvest endoprotease activity compared with wild‐type. Antisense BoINV2 lines also had a slower rate of floret sepal chlorosis after harvest compared with wild‐type.
Detoxification of hydrogen peroxide maintains the water transport activity in figleaf gourd (Cucurbita ficifolia) root system exposed to low temperature
Authors: Rhee Ji‐Ye , Lee Seong‐Hee , Singh Adya Prasad , Chung Gap‐Chae , Ahn Sung‐Ju
Published: March 2007

The figleaf gourd (Cucurbita ficifolia Bouché) root system has the ability to take up water and nutrients at low soil temperatures, and in the present paper, we attempt to reveal some of the molecular mechanisms behind this low‐temperature tolerance. Exposure of figleaf gourd root system to low temperature induced accumulation of H2O2 along the plasma membrane but not in the cytoplasm. H+‐ATPase (EC 3.6.1.35) activity of isolated root plasma membranes and root hydraulic conductivity (Lpr) were largely insensitive to externally applied H2O2. However, using bromocresol purple, it was shown that the acidification of the medium surrounding the root was strongly inhibited with low temperature‐ and H2O2‐treated roots. Addition of catalase (EC 1.11.1.6) to the root medium during low‐temperature exposure led to a recovery of H+‐efflux along the root surface and increased Lpr, demonstrating the importance of an H2O2 detoxification system in the root cells. Additional evidence for an increased Lpr was obtained by the Fenton reaction wherein a warming of the solution increased the activity of the detoxification system. All available evidence suggests that the ability of figleaf gourd root system to maintain a low level of H2O2 in the cytoplasm and to detoxify reactive oxygen species is related to the maintenance of water transport activity at low temperatures.
Development of a physical map for three Frankia strains and a partial genetic map for Frankia EuI1c
Authors: Rawnsley Tania , Tisa Louis S.
Published: March 2007

Physical maps for Frankia strains CcI3, EAN1pec and EuI1c chromosomes were constructed by the use of macrorestriction analysis and pulsed‐field gel electrophoresis (PFGE). The restriction enzymes AseI, PmeI, SwaI and SspI were used to cut the Frankia chromosome into a limited number of large fragments and for double digestions. The genomes sizes, as determined by the addition of the estimated fragment sizes, were 5430 ± 35 kb, 9101 ± 109 kb and 8105 ± 842 kb for strains CcI3, EAN1pec and EuI1c, respectively. A complete physical map was achieved by the analysis of PFGE for the single and double digestions and by two‐dimensional PFGE to determine doublets and overlapping fragments. For strain EuI1c, a partial genetic map was also constructed by positioning the 16S rRNA, glnII, glnA and hboO genes on the physical map. PFGE analysis of DNA with and without proteinase K treatment together with the other results suggested a circular genome.
Vigilance in Greater Flamingos Wintering in Southern Tunisia: Age‐Dependent Flock Size Effect
Authors: Boukhriss Jihen , Selmi Slaheddine , Béchet Arnaud , Nouira Saïd
Published: March 2007

Decrease in individual vigilance with flock size is a widely recognized pattern in group‐living species. However such a relationship may be affected by other factors, such as age and flock composition. For instance, because young animals generally lack experience and have higher nutritional needs than adults, they can be expected not only to be less vigilant than adults but also to decrease their vigilance level by a greater extent when flock size increases than adults do. We investigated this issue using data on greater flamingos wintering in the gulf of Gabès, in southern Tunisia. Flamingos tended to congregate in small single‐age flocks for feeding, but as flock size increased, flocks became mixed. We found that when flock size increased, young flamingos significantly decreased their vigilance time, while adult did not, suggesting an age‐dependent flock size effect on vigilance. However, when flock composition (single‐age vs. mixed) was taken into account, a more complex pattern was found. Within single‐age and small flocks, no difference was found between young flamingos and adult ones regarding their vigilance level and their response to increasing flock size. However, within mixed and large flocks, adult flamingos were more vigilant than young ones, while variation in flock size did not result in a significant change in vigilance. These results suggest that young birds relied on the presence of adults, and hence more experienced individuals in detecting dangers, to reduce their vigilance and to increase their foraging time in order to satisfy their higher nutritional requirements. They could also be interpreted as a possible consequence of increasing competition with flock size which constrained more nutritionally stressed young flamingos to increase their foraging time to the detriment of vigilance.
Starch‐like exopolysaccharide produced by the filamentous fungi Ophiostoma ulmi and O. novo‐ulmi
Authors: Jeng R. , Huang C. , Sain M. , Hubbes M. , Rodriguez A. , Saville B.
Published: March 2007

This paper describes the chemical and biochemical properties of exopolysaccharides (EPS) produced by Ophiostoma ulmi and O. novo‐ulmi isolates, the Dutch elm disease (DED) fungi. Some of EPS have been considered as pathogenicity factor in the DED complex. The selected isolates grow well and produce EPS in a medium containing various types of carbon and nitrogen sources. EPS obtained from potato dextrose broth (PDB) medium appeared to be opaque, firm and stained purple blue with iodine‐potassium iodide solution, whereas those from yeast extract (YE) medium were less opaque, jelly‐like and remained unchanged in iodine solution. The selected fungal isolates produced much higher molecular weight EPS from the medium containing YE than from PDB. The results of this study suggest that high molecular weight compounds produced by O. ulmi (W9) and O. novo‐ulmi (R136) are not involved in DED pathogenesis. Spectrometric analysis of acid‐digested EPS obtained from PDB and YE revealed the presence of a monomer similar to glucose used as a standard. Thin layer chromatography indicated that glucan‐1,4‐α‐glucosidase (glucoamylase) only hydrolyses EPS from PDB media and releases glucose. The results strongly indicate that isolates of O. ulmi and O. novo‐ulmi produce starch‐like EPS from PDB medium. The EPS obtained from YE medium lacked this characteristic. The biological significance and the potential use of these EPS are discussed.
The effects of calcium on stem lesions of silver birch seedlings
Authors: Lilja A. , Luoranen J. , Rikala R. , Heinonen R.
Published: March 2007

In this study, we tested the hypothesis that decreased liming of growth medium has a role in the increase of stem lesions and top dying caused by Phytophthora cactorum in containerized silver birch seedlings (Betula pendula) in Finnish forest nurseries. The effect of limestone dose rates on growth and the nutrient status was also monitored. An index based on severity of symptom expression was used to compare the effect of different liming treatments on P. cactorum infection. Limestone amended into the sphagnum peat growth medium increased the amount of calcium in the seedling stems. Liming did not significantly decrease the disease severity although index values in most cases decreased with the increased limestone dose rates. In general, the lesions were restricted after out‐planting and the mortality of seedlings was low. Only inoculated seedlings on which the lesions had spread around the stem in the nursery died. Phytophthora cactorum appears to be a nursery pathogen, as it did not survive under conditions present in the field. Four years after out‐planting, the tallest birches were those grown in sphagnum peat amended with the highest limestone dose of 8 kg m−3.
Effects of associated fungi Sclerophoma pythiophila and Cenangium ferruginosum on Gremmeniella abietina dieback in Spain
Authors: Santamaría O. , Tejerina L. , Pajares J. A. , Diez J. J.
Published: March 2007

The interactions between Gremmeniella abietina and either Sclerophoma pythiophila or Cenangium ferruginosum, fungi frequently isolated from diseased twigs along with G. abietina, were studied under laboratory (dual cultures) and greenhouse conditions (double‐inoculations). Virulence of each species was also evaluated in greenhouse experiments by means of single‐inoculations. In vitro interactions were assessed on Petri dishes containing malt agar with pine needle extract, and greenhouse experiments were performed on 1‐year‐old Pinus halepensis seedlings. In vitro growth of G. abietina was inhibited by both fungi when grown in dual culture. In single‐inoculations, G. abietina caused the greatest necrosis length on P. halepensis seedlings, followed by S. pythiophila, whereas C. ferruginosum did not cause significant necrosis. In double‐inoculations, C. ferruginosum was able to reduce the length of necrosis caused by G. abietina on the P. halepensis seedlings. In contrast, necrosis length was greater in seedlings inoculated with both S. pythiophila and G. abietina than in those inoculated with G. abietina alone. Therefore, S. pythiophila seems to play a role in disease expression caused by G. abietina on P. halepensis in Spain.
Water stress and insect defoliation promote the colonization of Quercus cerris by the fungus Biscogniauxia mediterranea
Authors: Capretti P. , Battisti A.
Published: March 2007

The effects of water stress and defoliation by Lymantria dispar on the successful infection of the fungal pathogen Biscogniauxia mediterranea in seedlings of the Turkey oak (Quercus cerris) were studied under controlled conditions. Seedlings were inoculated by spraying with a spore suspension of Biscogniauxia mediterranea and were subjected to different levels of water stress, insect defoliation, and combinations of the two factors. The leaf water potential was periodically assessed throughout the experiment. The fungus was isolated exclusively from seedlings deprived of water, and insect defoliation increased significantly the proportion of fungus isolation when the water stress was moderate. Thus insect defoliation seems to promote fungal colonization in case of moderate water stress.
Effect of heavy metal pollution of forest soil on radial growth of Scots pine
Authors: Fedorkov A.
Published: March 2007

A field experiment with artificial soil contamination by the heavy metals copper and nickel was established in Kola Peninsula, northern Russia. To study the effect of soil contamination by heavy metals without SO2 air pollution on the Scots pine trees growth the experiment was located outside the range of forest damage due to emissions from a copper–nickel smelter. Retardation in tree diameter growth over 15 years after contamination with 20 kg of metallurgical dust per 100 m2 plot was 54%, 10 kg 27%, 5 kg 16% and 2.5 kg 7%, respectively, compared with growth in control plots. Thus, decreasing Scots pine growth due to heavy metal pollution was demonstrated.
Advances in the serological diagnosis of invasive Aspergillus infections in patients with haematological disorders
Authors: Maertens Johan , Theunissen Koen , Lodewyck Tom , Lagrou Katrien , Eldere Johan Van
Published: March 2007

A reliable diagnosis of invasive aspergillosis in patients with haematological malignancies is seldom achieved antemortem. Conventional laboratory diagnostic methods are insensitive and time‐consuming, resulting in late diagnosis and treatment and contributing to unacceptably high mortality. As a result, routine antifungal prophylaxis and early empirical treatment have been recommended. However, overtreatment associated with these strategies results in increased toxicity and cost. The use of sensitive and rapid non‐culture‐based diagnostic assays, such as detection of Aspergillus antigens (galactomannan, β‐d‐glucan) or detection of genomic DNA sequences may allow a shift in emphasis from empirical to pre‐emptive therapy, especially when substantiated by suggestive radiological findings. These new tools may be used to confirm a presumed diagnosis of invasive aspergillosis, or, when used to screen high‐risk patients, may identify an infection at the early stage of disease. The excellent negative predictive value of these assays should convince clinicians to withhold antifungal therapy in persistently febrile neutropenic patients with no other signs of fungal infection. On the other hand, consecutive positive results in a high‐risk population should at least trigger a complete diagnostic work‐up. This review will focus on the diagnostic utility as well as on the pitfalls of serial screening for the presence of circulating fungal antigens in haematology patients.
Anidulafungin – state of affairs from a clinical perspective
Authors: Vehreschild Jörg J. , Kümmerle Tim , Karthaus Meinolf , Cornely Oliver A.
Published: March 2007

Anidulafungin is the most recent development in the echinocandin class antifungals. Like other echinocandins, it inhibits 1,3‐β‐d‐glucan synthesis, thus achieving fungicidal activity against many Candida spp. including those resistant to fluconazole as well as fungistatic activity against some clinically important filamentous fungi, especially Aspergillus spp. The drug is well tolerated, even in patients with renal or hepatic impairment. It has a low drug–drug interaction profile as it does not significantly interfere with the cytochrome P450 pathway. Anidulafungin has been approved for treatment of candidaemia, intra‐abdominal abscesses, peritonitis and oesophageal candidiasis. Trials have shown non‐inferiority of anidulafungin to fluconazole in the treatment of invasive and non‐invasive candidiasis. After promising results from animal models, the role of anidulafungin in the treatment of invasive aspergillosis and other filamentous fungi is yet to be cleared. Currently, anidulafungin offers another alternative in the treatment of Candida infections, especially in patients where avoidance of drug–drug interactions is needed. Future investigations may elucidate how anidulafungin performs clinically in comparison with the other echinocandins.
Zygomycosis – current epidemiological aspects
Authors: Glöckner Andreas , Vehreschild Jörg J. , Cornely Oliver A.
Published: March 2007

Zygomycoses are very rare invasive fungal infections (IFI). They primarily occur in the immunocompromised patients and are associated with a high mortality. During the last years, a rising incidence of zygomycosis in patients undergoing allogeneic haematopoietic stem cell transplantation (HSCT) has been reported, which is probably a part of the trend in the incidence of mould infections that has been going on for decades. Difficulty in diagnosis, especially concerning the differentiation of zygomycosis from the far more common aspergillosis, additionally hampers a reliable assessment of the incidence of zygomycosis. In patients undergoing allogeneic HSCT, changes in the frequency, severity and management of Graft‐versus‐Host‐Disease (GvHD) also favour mould infections, among them zygomycosis. In centres employing voriconazole for prophylaxis of IFI since its approval for treatment in 2001, incidence of aspergillosis has markedly dropped. The assumption that the frequency of zygomycosis has increased since the introduction of voriconazole is not found in prospective trials and therefore needs verification, especially when considering the long ongoing trends in fungal incidence. Currently recruiting multicentre trials on primary prophylaxis of IFI will have to show the preventive effectiveness of antifungals with mould activity and the incidence of zygomycosis under prospectively controlled conditions.
ROUTINE LEVEL VI LYMPH NODE DISSECTION FOR PAPILLARY THYROID CANCER: SURGICAL TECHNIQUE
Authors: Grodski Simon , Cornford Lachlan , Sywak Mark , Sidhu Stan , Delbridge Leigh
Published: March 2007

Total thyroidectomy is the treatment of choice for clinically significant papillary thyroid cancer (PTC); however, 10–15% develop palpable local recurrence in the cervical lymph nodes. Metastases in the cervical lymph nodes account for 75% of loco‐regional recurrence and up to 50% of these patients eventually die of their disease. It is generally accepted that surgical excision of grossly involved lymph node disease should be carried out. The role of routine lymph node dissection, however, is greeted with far more controversy. Regional lymph node metastases have been shown to be associated with more frequent tumour recurrence. Not only is recurrence associated with increased disease‐related mortality, but recent data have shown that the presence of involved lymph nodes is associated with adverse survival. Additionally, there have been significant changes to the way patients are managed after treatment for PTC in recent years. Surveillance previously relied on clinical assessment and radioiodine scans whereas now the use of serum thyroglobulin and high‐resolution ultrasound are the standard as evidenced by recommendations by the American Thyroid Association. These techniques have greater sensitivity and subsequently lymph node metastases are being detected earlier and more frequently. This has led to a paradigm shift in the aims of treatment of PTC, from a focus on survival data to a focus on disease‐free status. Routine central neck lymph node dissection can be carried out with no increased morbidity and can achieve lower 6‐month stimulated thyroglobulin levels when compared with total thyroidectomy alone. Routine ipsilateral level VI lymph node dissection in addition to total thyroidectomy should be carried out for the management of clinically significant PTC.
SURGICAL APPLICATIONS OF CYANOACRYLATE ADHESIVES: A REVIEW OF TOXICITY
Authors: Leggat Peter A. , Smith Derek R. , Kedjarune Ureporn
Published: March 2007

Cyanoacrylate (CA) and its homologues have a variety of medical and commercial applications as biological adhesives and sealants. Homologues of CA are being widely promoted in surgery as a tissue adhesive to replace traditional suturing techniques. Potential benefits of using CA adhesives include better cosmetic results, more rapid wound closure, and perhaps most significantly, the potential for significant reductions in percutaneous injuries from suture needles, which would in turn also reduce the risk of transmission of infectious diseases. Nevertheless, certain concerns have been raised regarding the potential toxicity of CA within patients, as well as among health professionals who are occupationally exposed when using CA compounds. Reported toxicity of CA in the workplace may result in dermatological, allergic and respiratory conditions. To help reduce the occupational burden, therefore, medical staff using CA adhesives should avoid direct contact with the compound and use appropriate personal protective measures at all times. Maintaining higher levels of humidity, optimizing room ventilation and using special air conditioning filters in surgical suites and operating theatres may also be useful in minimizing the exposure to volatile CA adhesives.
ANALYSIS OF 82 CASES OF RETROPERITONEAL SCHWANNOMA
Authors: Li Qiang , Gao Chuntao , Juzi Jonathan T. , Hao Xishan
Published: March 2007

Background:  The aim of the study was to improve the diagnosis and treatment of retroperitoneal schwannoma by analysing clinical manifestations and postoperative course of this rare disease.

Methods:  A retrospective analysis of 82 patients with retroperitoneal schwannoma between January 1951 and September 2004 was carried out.

Results:  The patients were 38 (46%) men and 44 (54%) women between the ages of 6 months and 70 years. The interval between clinical manifestation and diagnosis ranged from 10 days to 2 years. The main symptoms were abdominal distension (30.5%) and abdominal pain (20.7%). Only in 13 patients (15.9%) a correct preoperative diagnosis was made by either ultrasound‐guided biopsy, computed tomography scanning or magnetic resonance imaging. All patients received operative therapy. Sixty patients (73.2%) underwent a total resection; 13 patients (15.9%) subtotal resection, but 9 patients (11.0%) had only an examination and a biopsy. Two patients (2.4%) had multiple schwannomas and two others had a simultaneous malignancy (adenocarcinoma of the ascending colon and squamous‐cell carcinoma of the lung, respectively). Most of the retroperitoneal schwannomas were close to the spine. Pathological results showed 81 (98.8%) were benign schwannoma and 1 (1.2%) was a malignant one. The tumour size ranged from 3 to 22 cm. One benign schwannoma recurred 3 years after the operation. The patient with malignant schwannoma died 18 months after the operation because of metastasized disease.

Conclusion:  Most of the retroperitoneal schwannomas are benign. It is difficult to make an accurate preoperative diagnosis. However, with the preoperative assessment of ultrasound‐guided fine‐needle aspiration, computed tomography and magnetic resonance imaging, the accuracy of diagnosis could definitely be improved. Treatment depends solely on surgery. Malignant schwannomas are insensitive to chemotherapy and radiation, resulting in poor prognosis.
A PILOT STUDY OF PREOPERATIVE AND POSTOPERATIVE CHEMOTHERAPY IN PATIENTS WITH OPERABLE GASTRIC CANCER: AUSTRALASIAN GASTROINTESTINAL TRIALS GROUP STUDY 9601
Authors: Findlay Michael , Storey David , Gebski Val , Hargreaves Carol , Cullingford Graham , Boyer Michael , Trotter James , Archer Stephen , Davidson Andrew , Johnston Peter , Yuen Jennifer , Dhillon Haryana , Della‐Fiorentina Stephen , Richardson Gary , Truskett Philip , Goldstein David ,   The AGITG
Published: March 2007

Background:  With poor cure rates in gastric cancer using surgery alone, the safety, efficacy and feasibility of preoperative and postoperative chemotherapy was investigated.

Methods:  Patients with advanced but operable gastric or cardio‐oesophageal adenocarcinoma were staged using endoscopy, computed tomography scan and laparoscopy. If considered potentially resectable, they received chemotherapy (epirubicin, cisplatin and 5‐fluorouracil) for 9 weeks before and after surgery.

Results:  Of 59 participants entered, two were found to have metastatic disease and were excluded from the analysis. Of the participants, 10 were women and 47 men; their median age was 58 years (range 27–83 years) and median performance status 0 (range 0–1). Two of the 57 participants commencing chemotherapy did not undergo surgery (one sudden death, one new liver metastases). Grade 3 and 4 preoperative and postoperative toxicity rates were, respectively, neutropenia 22 and 18%, emesis 12 and 14% and other non‐haematological toxicity <10 and <10%. Of the 55 who underwent surgery, 40 had apparently curative resections (clear or positive microscopic margins), 2 died after surgery (anastomotic leak, sepsis) and 16 had postoperative complications. Of these, 27 participants commenced postoperative chemotherapy and 21 completed it. Median progression‐free survival and overall survival were 19.6 and 22 months, respectively.

Conclusion:  Epirubicin, cisplatin and protracted venous infusion of 5‐fluorouracil chemotherapy was well‐tolerated in the preoperative setting and did not appear to increase complication rates of surgery for advanced and operable stomach cancer. These findings demonstrate the feasibility of this strategy in the Australasian clinical setting and are in keeping with the results of a recently reported randomized trial, which demonstrated a significant survival advantage using this chemotherapy regimen.
LAPAROSCOPIC ASSISTED COLECTOMY: EXPERIENCE FROM A RURAL CENTRE
Authors: Guo Ding Y. , Eteuati Jimmy , Hung Nguyen M. , Lloyd David , Ragg Joe L
Published: March 2007

Background:  This study presents an audit of the first 50 elective laparoscopic assisted colorectal resections carried out at the Launceston General Hospital, Tasmania, particularly in comparison with the 33 elective open resections carried out in the same 18‐month period.

Methods:  This was a retrospective review and analysis of prospectively recorded data on an intention‐to‐treat basis using non‐parametric methods.

Results:  With respect to case selection, patients in the laparoscopic group were younger (median = 63 years (range 19–98 years) vs 69 years (33–93 years), P = 0.0392) and more patients had benign pathology (22/50, 44% vs 4/33, 12%, P = 0.002). There was no significant difference in sex or American Society of Anesthesiologists status (P = 0.499 and 0.517, respectively). There were more left‐sided than right‐sided resections (28/50, 56% vs 14/33, 42%, P = 0.118), along with more total colectomies in the laparoscopic group (7 vs 2). Operation times in the laparoscopic group were longer (197.5 min (87–452 min) vs 144 min (70–260 min), P = 0.0002) and no significant reduction was recorded over the study period (P = 0.50). There were five conversions from laparoscopic to open procedure (a 10% incidence). Compared with the open colectomy group, patients who underwent laparoscopic resections required less parenteral analgesia (2 days (1–5 days) vs 3 days (0–6 days), P < 0.0001). They had earlier first flatus (3 days (1–7 days) vs 4 days (1–6 days), P = 0.0069) and bowel movement (3 days (1–7 days) vs 4 days (2–9 days), P = 0.0021), tolerated solid diet earlier (3 days (1–9 days) vs 4 days (1–30 days), P = 0.0001) and had shorter hospital stay (5 days (3–12 days) vs 7 days (4–37 days), P = 0.0009). Less major perioperative complications were recorded for the laparoscopic group (2/50 vs 4/33, P = 0.162), but very little difference was found with respect to minor complications (17/50 vs 10/33, P = 0.725). For carcinoma resections, there were no positive resection margins. In the laparoscopic group, tumour size was smaller (3.25 cm (1–7 cm) vs 5 cm (2–15 cm), P = 0.0014) and less lymph nodes were harvested (6 (2–16) vs 8 (3–23), P = 0.101).

Conclusion:  Laparoscopic colectomy allowed early postoperative recovery and shorter hospital stay. This was at the expense of a longer operation. It can be taken up by relatively laparoscopically naive surgeons without extra major morbidity/mortality associated with the learning curve. It is technically feasible and safe in small centres.
GASTRIC ANTRAL PATCH OESOPHAGOPLASTY FOR IATROGENIC TRACHEO‐OESOPHAGEAL FISTULA
Authors: Talbot Michael L. , Hugh Thomas B. , Spratt Phillip
Published: March 2007

Acquired tracheo‐oesophageal fistula is a devastating condition, usually occurring as a late manifestation of oesophageal or other thoracic malignancies. In these cases palliation by placement of an oesophageal stent is the preferred option, but management of a large non‐malignant fistula is more complex. In many patients in whom primary repair of the defects is not possible oesophagectomy may be seen as the best treatment. We present a case of a large tracheo‐oesophageal fistula repaired with a gastric antral patch oesophagoplasty and intercostal muscle flap.
GIANT FUNCTIONING PARATHYROID CYST PRESENTING AS A RETROSTERNAL GOITRE
Authors: McKay Gary D , Ng Thomas H , Morgan Gary J , Chen Roger C
Published: March 2007

Parathyroid cysts are rare and even more rarely cause a neck mass resembling a goitre. Such large parathyroid cysts may involve the mediastinum, growing to a sufficient size to produce symptoms related to obstruction, and if functioning, primary hyperparathyroidism. Parathyroid cysts should be considered in the list of differential diagnoses of anterior neck masses to allow for appropriate preoperative investigation to avoid unnecessary confusion at the time of operation. We report a case where a functioning parathyroid cyst presented as a retrosternal goitre to emphasize the potential pitfalls associated with their diagnosis and management.
Audit of acute admissions of chronic obstructive pulmonary disease: inpatient management and outcome
Authors: Chang C. L. , Sullivan G. D. , Karalus N. C. , Hancox R. J. , McLachlan J. D. , Mills G. D.
Published: March 2007

Background: Despite the publication of several management guidelines for exacerbations of chronic obstructive pulmonary disease (COPD), there is little information on standards of care in clinical practice. The aim of this audit was to examine the assessment, management and outcome of COPD admissions to a secondary and tertiary referring New Zealand hospital during two different seasons. Compliance to current recommendations was examined and compared with the available international published work.

Methods: All COPD‐related admissions to Waikato Hospital during the months of May and October 2004 were reviewed. Ninety‐four cases (from 84 patients) were audited.

Results: General characteristics, clinical features and lung function tests were similar to that of other cohorts. Twenty‐three per cent of the admissions were Maori and the mean age of Maori admissions were significantly less than that of the non‐Maori admissions (57 and 72 years, respectively; P = 0.0001). The geometric mean length of stay was 3.4 days, which is significantly less than most other reported hospital lengths of stays related to exacerbations of COPD. Fifty‐five per cent of the cohort was admitted more than once to the hospital for COPD in the 12 months before the index admission. Thirteen per cent of all admissions received assisted ventilation. Overall 30‐day mortality was 8% and the 12‐month mortality was 31%. Decreased body mass index was a risk factor for death as was an increased CURB‐65 (confusion, urea, respiratory rate, blood pressure age) score – a simple bedside assessment score, which has previously been used to predict mortality in patients with community‐acquired pneumonia.

Conclusion: This audit documented the general characteristics, assessment, management and outcome of the COPD admissions to a secondary New Zealand hospital. Further investigations into factors contributing to shorter length of stay and predictors of mortality are needed.
Effects of vitamin E treatment on peroxisome proliferator‐activated receptor‐α expression and insulin resistance in patients with non‐alcoholic steatohepatitis: results of a pilot study
Authors: Yakaryilmaz F , Guliter S , Savas B , Erdem O , Ersoy R , Erden E , Akyol G , Bozkaya H , Ozenirler S
Published: March 2007

Background: Insulin resistance (IR) is commonly associated with non‐alcoholic steatohepatitis (NASH). Peroxisome proliferator‐activated receptor‐α (PPAR‐α) may also play a role in the pathogenesis of NASH. A pivotal role in NASH pathogenesis depends on the hypothesis of increased oxidative stress. The aim of our study was to evaluate the effects of supplemental oral vitamin E, a potent antioxidant, on liver functions, PPAR‐α expression and IR in patients with NASH.

Methods: Nine patients with biopsy‐proven NASH were given oral vitamin E 800 mg daily for 24 weeks. Liver functions, lipid parameters, IR index with homeostatic metabolic assessment and liver histology and PPAR‐α staining index in biopsy specimens were detected before and after the treatment.

Results: Seven patients (78%) had IR initially. After 6 months of therapy in nine patients, fasting insulin improved (P = 0.01), but serum cholesterol, triglyceride, fasting blood glucose levels and body mass index remained unchanged. Aspartate aminotransferase and alanine aminotransferase levels decreased (P = 0.01 and P = 0.01, respectively). IR index with homeostatic metabolic assessment resistance improved (P = 0.01), but PPAR‐α staining index did not change (P = 0.37). Although the histological grade of steatosis decreased (P = 0.01), necroinflammation and fibrosis remained unchanged. In seven patients with IR, however, necroinflammation and PPAR‐α staining index were improved (P = 0.04 and P = 0.02).

Conclusion: Vitamin E treatment, in addition to its previously shown beneficial effect by suppressing oxidative stress, may also achieve improvement by reducing IR and PPAR‐α expression in NASH.
Efficacy of aprepitant in management of chemotherapy‐induced nausea and vomiting
Authors: Osorio‐Sanchez J. A. A. , Karapetis C. , Koczwara B.
Published: March 2007

Background: Chemotherapy‐induced nausea and vomiting (CINV) is an important cause of distress for cancer patients. We have evaluated the effectiveness and safety of a new antiemetic aprepitant in improving management of CINV refractory to standard antiemetic therapy in the general oncology setting.

Methods: Retrospective chart review of all patients who received aprepitant from 1 January 2004 to 31 May 2005.

Results: Twenty‐six patients received oral aprepitant in addition to 5‐hydroxytryptamine blocker and corticosteroid. Eighty‐five per cent of the patients were women. Median age was 49 years. More than half patients had early‐stage cancers. Majority received anthracycline‐based chemotherapy for breast cancer. Fourteen (54%) patients received aprepitant during cycle 2, seven patients (27%) started aprepitant during cycle 4 and one (4%) during cycle 5. Side‐effects observed included constipation (27%), fatigue (27%) and diarrhoea (8%). Six (23%) patients did not complete chemotherapy. Two of these had persistent nausea and vomiting, and four experienced diarrhoea, febrile neutropenia and other chemotherapy‐related events. Three patients (12%) were hospitalized prior to starting aprepitant because of CINV, and one patient was hospitalized because of CINV while receiving aprepitant. Only six (23%) patients would have been eligible for aprepitant under the reimbursement scheme available at the time.

Conclusion: The addition of aprepitant was associated with improved control of nausea and vomiting and reduction in hospitalization in patients receiving chemotherapy.
Opinions, attitudes and practices of Australian neurologists with regard to epilepsy and driving
Authors: Beran R. G. , Ainley L. A. E. , Beran M. E.
Published: March 2007

Introduction: Austroads Guidelines for fitness to drive were promulgated in 2003. Epilepsy was one of the conditions included and this paper reports results of a survey of Australian neurologists regarding opinions and practices relevant to the guidelines.

Methods: The survey was developed, piloted and Human Research Ethics Committee approved. Members of the Australian Association of Neurologists received three mailings and results were analysed.

Results: Almost 70% of 236 surveyed indicated assessment of epilepsy and driving with <9% not doing so – establishing ∼77% response for eligible neurologists. Most questions achieved 90% response. Almost 90% respondents assessed epilepsy and 70% found the guidelines helpful. Seventy‐seven per cent endorsed doctor assessors although half discounted General Practitioners as insufficiently knowledgeable and half advocated that only neurologists evaluate potential drivers with epilepsy. Most respondents supported reporting recalcitrant patients; yet only <30% did so. Three‐quarters favoured licences carrying a warning to self‐report and two‐thirds felt that product information should identify driving implications. Although many questions attracted expected responses, the surprise was the large undecided numbers, which were greater than expected. Neurologists were more lenient than prescribed by the guidelines with neither consensus for controlled epilepsy nor mandatory driving restrictions.

Conclusion: Respondents supplied predictable answers regarding ideal circumstances; yet most did not report recalcitrant patients. Most claimed to adhere to the guidelines and yet advocated more lenient driving restrictions that may allow preventable accidents. There was agreement between neurologists and guidelines for more rigourous restrictions for commercial drivers although again neurologists were more lenient. There is need for prospective research on epilepsy and driving.
Social information and emigration: lessons from immigrants
Authors: Cote J. , Clobert J.
Published: March 2007

‘Should I stay or should I go?’ is a fundamental question facing any candidate for emigration, as emigrating without outside information has major costs. Most studies on this topic have concentrated on risk‐reducing strategies (e.g. exploration) developed after leaving the natal habitat. The idea that information might be acquired before leaving has not been investigated. Immigrants carrying information about their origins could provide such information to potential emigrants in their initial habitat. We manipulated the density of common lizard (Lacerta vivipara) populations, to investigate whether immigrants originating from these populations transmitted such information to the population they joined. Emigration of the residents of this new population clearly depended on the origin of the immigrant. Immigrants are therefore a source of information, in this case about surrounding population densities, and may have a major effect on dispersal and species persistence in a fragmented habitat.