bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and Validation of an Acute Kidney Injury Risk Index for Patients Undergoing General Surgery
Authors: Kheterpal Sachin , Tremper Kevin K. , Heung Michael , Rosenberg Andrew L. , Englesbe Michael , Shanks Amy M. , Campbell Darrell A.
Published: February 2009

Background

The authors sought to identify the incidence, risk factors, and mortality impact of acute kidney injury (AKI) after general surgery using a large and representative national clinical data set.

Methods

The 2005-2006 American College of Surgeons-National Surgical Quality Improvement Program participant use data file is a compilation of outcome data from general surgery procedures performed in 121 US medical centers. The primary outcome was AKI within 30 days, defined as an increase in serum creatinine of at least 2 mg/dl or acute renal failure necessitating dialysis. A variety of patient comorbidities and operative characteristics were evaluated as possible predictors of AKI. A logistic regression full model fit was used to create an AKI model and risk index. Thirty-day mortality among patients with and without AKI was compared.

Results

Of 152,244 operations reviewed, 75,952 met the inclusion criteria, and 762 (1.0%) were complicated by AKI. The authors identified 11 independent preoperative predictors: age 56 yr or older, male sex, emergency surgery, intraperitoneal surgery, diabetes mellitus necessitating oral therapy, diabetes mellitus necessitating insulin therapy, active congestive heart failure, ascites, hypertension, mild preoperative renal insufficiency, and moderate preoperative renal insufficiency. The c statistic for a simplified risk index was 0.80 in the derivation and validation cohorts. Class V patients (six or more risk factors) had a 9% incidence of AKI. Overall, patients experiencing AKI had an eightfold increase in 30-day mortality.

Conclusions

Approximately 1% of general surgery cases are complicated by AKI. The authors have developed a robust risk index based on easily identified preoperative comorbidities and patient characteristics.
Development of the Functional Recovery Index for Ambulatory Surgery and Anesthesia
Authors: Wong Jean , Tong Doris , De Silva Yoshani , Abrishami Amir , Chung Frances
Published: February 2009

Background

It is increasingly important to evaluate patients' recovery after ambulatory surgery. The authors developed the Functional Recovery Index (FRI) to assess postdischarge functional recovery for ambulatory surgical patients.

Methods

The scale development involved four phases: item generation, item selection, reliability, and validity testing. A draft questionnaire was tested and revised. Items were selected through testing endorsement frequency, factor analysis, and testing internal consistency. The interrater reliability was calculated. Construct validity was tested by multiple hypotheses on convergent validity, extreme groups, and discriminant validity. Responsiveness was assessed by measuring the FRI postoperatively and comparing minor versus more extensive surgery. The rate of response and the time for completion of the questionnaire were recorded.

Results

The final questionnaire had 14 items grouped under 3 factors. Each item was scored from 0 to 10, with 0 = no difficulty and 10 = extreme difficulty with the activity. The 3 factors were summated for a total score. Internal consistency for the 3 factors (pain and social activity, lower limb activity, and general physical activity) was as follows: Cronbach alpha = 0.90, 0.89, and 0.86, respectively. Interrater reliability was 0.99. Convergent validity for FRI versus verbal rating scale pain score was 0.76. Discriminant validity testing showed that the type of surgery was significant and that intermediate (beta = 0.138) and major surgery (beta = 0.337) were associated with higher FRI scores than minor surgery. The time to complete the questionnaires ranged between 4 min 10 s and 4 min 35 s.

Conclusions

The FRI had excellent reliability, good validity, responsiveness, and acceptability, indicating that this questionnaire will be a good instrument for assessing functional recovery of ambulatory surgical patients.
Anesthesiology Trainees Face Ethical, Practical, and Relational Challenges in Obtaining Informed Consent
Authors: Waisel David B. , Lamiani Giulia , Sandrock Norma J. , Pascucci Robert , Truog Robert D. , Meyer Elaine C.
Published: February 2009

Background

Categorizing difficulties anesthesiologists have in obtaining informed consent may influence education, performance, and research. This study investigated the trainees' perspectives and educational needs through a qualitative analysis of narratives.

Methods

The Program to Enhance Relational and Communication Skills-Anesthesia used professional actors to teach communication skills and relational abilities associated with informed consent. Before attending the program, participants wrote about a challenging informed consent experience. Narratives were analyzed by two researchers following the principles of grounded theory. The researchers independently read the narratives and marked key words and phrases to identify reoccurring challenges described by anesthesiologists. Through rereading of the narratives and discussion, the two researchers reached consensus on the challenges that arose and calculated their frequency.

Results

Analysis of the 39 narratives led to the identification of three types of challenges facing anesthesiologists in obtaining informed consent. Ethical challenges included patient wishes not honored, conflict between patient and family wishes and medical judgment, patient decision-making capacity, and upholding professional standards. Practical challenges included the amount of information to provide, communication barriers, and time limitations. Relational challenges included questions about trainee competence, mistrust associated with previous negative experiences, and misunderstandings between physician and patient or family.

Conclusions

The ethical, practical, and relational challenges in obtaining informed consent colored trainees' views of patient care and affected their interactions with patients. Using participant narratives personalizes education and motivates participants. The richness of narratives may help anesthesiologists to appreciate the qualitative aspects of informed consent.
Effect of Nitrous Oxide Use on Long-term Neurologic and Neuropsychological Outcome in Patients Who Received Temporary Proximal Artery Occlusion during Cerebral Aneurysm Clipping Surgery
Authors: Pasternak Jeffrey J. , McGregor Diana G. , Lanier William L. , Schroeder Darrell R. , Rusy Deborah A. , Hindman Bradley , Clarke William , Torner James , Todd Michael M.
Published: February 2009

Background

The authors explored the relationship between nitrous oxide use and neurologic and neuropsychological outcome in a population of patients likely to experience intraoperative cerebral ischemia: those who had temporary cerebral arterial occlusion during aneurysm clipping surgery.

Methods

A post hoc analysis of a subset of the data from the Intraoperative Hypothermia for Aneurysm Surgery Trial was conducted. Only subjects who had temporary arterial occlusion during surgery were included in the analysis. Metrics of short-term and long-term (i.e., 3 months after surgery) outcome were evaluated via both univariate and multivariate logistic regression analysis. An odds ratio (OR) greater than 1.0 denotes a worse outcome in patients receiving nitrous oxide.

Results

The authors evaluated 441 patients, of which 199 received nitrous oxide. Patients receiving nitrous oxide had a greater risk of delayed ischemic neurologic deficits (i.e., the clinical manifestation of vasospasm) (OR, 1.78, 95% confidence interval [CI], 1.08-2.95; P = 0.025). However, at 3 months after surgery, there was no difference in any metric of gross neurologic outcome: Glasgow Outcome Score (OR, 0.67; CI, 0.44-1.03; P = 0.065), Rankin Score (OR, 0.74; CI, 0.47-1.16; P = 0.192), National Institutes of Health Stroke Scale (OR, 1.02; CI, 0.66-1.56; P = 0.937), or Barthel Index (OR, 0.69; CI, 0.38-1.25; P = 0.22). The risk of impairment on at least one test of neuropsychological function was reduced in those who received nitrous oxide (OR, 0.56; CI, 0.36-0.89; P = 0.013).

Conclusion

In this patient population, use of nitrous oxide was associated with an increased risk for the development of delayed ischemic neurologic deficits; however, there was no evidence of detriment to long-term gross neurologic or neuropsychological outcome.
Safety and Efficacy of Intensive Insulin Therapy in Critical Neurosurgical Patients
Authors: Bilotta Federico , Caramia Remo , Paoloni Francesca P. , Delfini Roberto , Rosa Giovanni
Published: February 2009

Background

Intensive insulin therapy to maintain blood glucose at or below 6.11 mM reduces morbidity and mortality after cardiac surgery and morbidity in medical intensive care unit (ICU) patients. The authors investigated the clinical safety and outcome effects of intensive insulin therapy compared to conventional insulin therapy in patients receiving postoperative intensive care after neurosurgical procedures.

Methods

In this prospective randomized controlled trial, 483 patients undergoing elective or emergency brain surgery were prospectively and randomly assigned either to intensive insulin therapy (241 patients), receiving insulin titrated to maintain blood glucose levels within the range of 4.44-6.11 mM, or to conventional insulin therapy (242 patients), receiving insulin to maintain blood glucose levels below 11.94 mM. Primary endpoint was incidence of hypoglycemia (defined as blood glucose < 2.78 mM). Efficacy measures included the length of ICU stay, infection rate, and 6 months follow-up Glasgow outcome scale score and overall survival.

Results

Hypoglycemia episodes were more frequent in patients receiving intensive insulin therapy, median (min-max): 8 (0-23) versus 3 (0-4); P < 0.0001. The length of stay in the ICU was shorter (6 vs. 8 days; P = 0.0001), and the infection rate was lower (25.7% vs. 39.3%; P = 0.0018). Glasgow outcome scale score and overall survival at 6 months were similar in the two groups.

Conclusions

Intensive insulin therapy in patients admitted to a postoperative neurosurgical ICU after brain surgery is associated with iatrogenic hypoglycemia, but it can also reduce the infection rate and shorten the ICU stay.
Strict Glucose Control Does Not Affect Mortality after Aneurysmal Subarachnoid Hemorrhage
Authors: Thiele Robert H. , Pouratian Nader , Zuo Zhiyi , Scalzo David C. , Dobbs Heather A. , Dumont Aaron S. , Kassell Neal F. , Nemergut Edward C.
Published: February 2009

Background

The effects of both hyperglycemia and hypoglycemia are deleterious to patients with neurologic injury.

Methods

On January 1, 2002, the neurointensive care unit at the University of Virginia Health System initiated a strict glucose control protocol (goal glucose < 120 mg/dl). The authors conducted an impact study to determine the effects of this protocol on patients presenting with aneurysmal subarachnoid hemorrhage.

Results

Among the 834 patients admitted between 1995 and 2007, the in-hospital mortality was 11.6%. The median admission glucose for survivors was lower (135 vs. 176 mg/dl); however, on multivariate analysis, increasing admission glucose was not associated with a statistically significant increase in the risk of death (P = 0.064). The median average glucose for survivors was also lower (116 vs. 135 mg/dl). This was significant on multivariate analysis (P < 0.001); however, the effect was small (odds ratio, 1.045). Implementation of the strict glucose protocol decreased median average glucose (121 vs. 116 mg/dl, P < 0.001) and decreased the incidence of hyperglycemia. Implementation of the protocol had no effect on in-hospital mortality (11.7% vs. 12.0%, P = 0.876 [univariate], P = 0.132 [multivariate]). Protocol implementation was associated with an increased incidence of hypoglycemia (P < 0.001). Hypoglycemia was associated with a substantially increased risk of death on multivariate analysis (P = 0.009; odds ratio = 3.818).

Conclusions

The initiation of a tight glucose control regimen lowered average glucose levels but had no effect on overall in-hospital mortality.
Goal-directed Colloid Administration Improves the Microcirculation of Healthy and Perianastomotic Colon
Authors: Kimberger Oliver , Arnberger Michael , Brandt Sebastian , Plock Jan , Sigurdsson Gisli H. , Kurz Andrea , Hiltebrand Luzius
Published: February 2009

Background

The aim of this study was to compare the effects of goal-directed colloid fluid therapy with goal-directed crystalloid and restricted crystalloid fluid therapy on healthy and perianastomotic colon tissue in a pig model of colon anastomosis surgery.

Methods

Pigs (n = 27, 9 per group) were anesthetized and mechanically ventilated. A hand-sewn colon anastomosis was performed. The animals were subsequently randomized to one of the following treatments: R-RL group, 3 ml x kg(-1) x h(-1) Ringer lactate (RL); GD-RL group, 3 ml x kg(-1) x h(-1) RL + bolus 250 ml of RL; GD-C group, 3 ml x kg(-1) x h(-1) RL + bolus 250 ml of hydroxyethyl starch (HES 6%, 130/0.4). A fluid bolus was administered when mixed venous oxygen saturation dropped below 60%. Intestinal tissue oxygen tension and microcirculatory blood flow were measured continuously.

Results

After 4 h of treatment, tissue oxygen tension in healthy colon increased to 150 +/- 31% in group GD-C versus 123 +/- 40% in group GD-RL versus 94 +/- 23% in group R-RL (percent of postoperative baseline values, mean +/- SD; P < 0.01). Similarly perianastomotic tissue oxygen tension increased to 245 +/- 93% in the GD-C group versus 147 +/- 58% in the GD-RL group and 116 +/- 22% in the R-RL group (P < 0.01). Microcirculatory flow was higher in group GD-C in healthy colon.

Conclusions

Goal-directed colloid fluid therapy significantly increased microcirculatory blood flow and tissue oxygen tension in healthy and injured colon compared to goal-directed or restricted crystalloid fluid therapy.
Ventilator-associated Pneumonia or Endotracheal Tube-associated Pneumonia?
Authors: Pneumatikos Ioannis A. , Dragoumanis Christos K. , Bouros Demosthenes E. , Warner David S. , Warner Mark A.
Published: February 2009

Ventilator-associated pneumonia is the most common nosocomial infection in the intensive care unit, and it is associated with prolonged hospitalization, increased health care costs, and high attributable mortality. During the past several decades, numerous studies focused on the crucial role of the endotracheal tube (ETT) in the pathogenesis of ventilator-associated pneumonia. Tracheal intubation thwarts the cough reflex, compromises mucocilliary clearance, injures the tracheal epithelial surface, provides a direct conduit for rapid access of bacteria from upper into the lower respiratory tract, and allows the formation of biofilm on the ETT surface. The combination of these factors puts the mechanically ventilated patient at great jeopardy of developing ventilator-associated pneumonia. Many preventive strategies have arisen from this understanding: control of intracuff pressure, aspiration of subglottic secretions, decontamination of subglottic area, use of antiseptic impregnated ETTs, and elimination or prevention of the ETT biofilm formation. The authors review the role of ETT management for the prevention of the ventilator-associated pneumonia.
Methadone Pharmacokinetics Are Independent of Cytochrome P4503A (CYP3A) Activity and Gastrointestinal Drug Transport
Authors: Kharasch Evan D. , Hoffer Christine , Whittington Dale , Walker Alysa , Bedynek Pamela Sheffels
Published: February 2009

Background

Methadone clearance is highly variable, and drug interactions are problematic. Both have been attributed to CYP3A, but actual mechanisms are unknown. Drug interactions can provide such mechanistic information. Ritonavir/indinavir, one of the earliest protease inhibitor combinations, may inhibit CYP3A. We assessed ritonavir/indinavir effects on methadone pharmacokinetics and pharmacodynamics, intestinal and hepatic CYP3A activity, and intestinal transporters (P-glycoprotein) activity. CYP3A and transporters were assessed with alfentanil and fexofenadine, respectively.

Methods

Twelve healthy human immunodeficiency virus-negative volunteers underwent a sequential three-part crossover. On three consecutive days, they received oral alfentanil/fexofenadine, intravenous alfentanil, and intravenous plus oral (deuterium-labeled) methadone, repeated after acute (3 days) and steady-state (2 weeks) ritonavir/indinavir. Plasma and urine analytes were measured by mass spectrometry. Opioid effects were assessed by miosis.

Results

Alfentanil apparent oral clearance was inhibited more than 97% by both acute and steady-state ritonavir/indinavir, and systemic clearance was inhibited more than 90% due to diminished hepatic and intestinal extraction. Ritonavir/indinavir increased fexofenadine area under the plasma concentration-time curve four- to five-fold, suggesting significant inhibition of gastrointestinal P-glycoprotein. Ritonavir/indinavir slightly increased methadone N-demethylation, but it had no significant effects on methadone plasma concentrations or on systemic or apparent oral clearance, renal clearance, hepatic extraction or clearance, or bioavailability. Ritonavir/indinavir had no significant effects on methadone plasma concentration-effect relationships.

Conclusions

Inhibition of both hepatic and intestinal CYP3A activity is responsible for ritonavir/indinavir drug interactions. Methadone disposition was unchanged, despite profound inhibition of CYP3A activity, suggesting little or no role for CYP3A in clinical methadone metabolism and clearance. Methadone bioavailability was unchanged, despite inhibition of gastrointestinal P-glycoprotein activity, suggesting that this transporter does not limit methadone intestinal absorption.
Risk Associated with Preoperative Anemia in Noncardiac Surgery
Authors: Beattie W Scott , Karkouti Keyvan , Wijeysundera Duminda N. , Tait Gordon
Published: February 2009

Background

Preoperative anemia is an important risk factor for perioperative red blood cell transfusions and has been shown to be independently associated with adverse outcomes after noncardiac surgery. The objective of this observational study was to measure the prevalence of preoperative anemia and assess the relationship between preoperative anemia and postoperative mortality.

Methods

Data were retrospectively collected on 7,759 consecutive noncardiac surgical patients at the University Health Network between 2003 and 2006. Preoperative anemia was defined as a hemoglobin concentration less than 12.0 g/dl for women and less than 13.0 g/dl for men. The unadjusted and adjusted relationship between preoperative anemia and mortality was assessed using logistic regression and propensity analyses.

Results

Preoperative anemia was common and equal between genders (39.5% for men and 39.9% for women) and was associated with a nearly five-fold increase in the odds of postoperative mortality. After adjustment for major confounders using logistic regression, anemia was still associated with increased mortality (odds ratio, 2.36; 95% confidence interval, 1.57-3.41). This relationship was unchanged after elimination of patients with severe anemia and patients who received transfusions. In a propensity-matched cohort of patients, anemia was associated with increased mortality (odds ratio, 2.29; 95% confidence interval, 1.45-3.63).

Conclusions

Anemia is a common condition in surgical patients and is independently associated with increased mortality. Although anemia increases mortality independent of transfusion, it is associated with increased requirement for transfusion, which is also associated with increased mortality. Treatment of preoperative anemia should be the focus of investigations for the reduction of perioperative risk.
Cancer epigenomics: Implications of DNA methylation in personalized cancer therapy
Authors: Toyota Minoru , Suzuki Hiromu , Yamashita Toshiharu , Hirata Koichi , Imai Kohzoh , Tokino Takashi , Shinomura Yasuhisa
Published: February 2009

Genetic alterations in cancer can provide information for predicting a tumor's sensitivity to chemotherapeutic drugs. But although such information is certainly useful, the relatively low frequency of mutations seen in many cancers limits the utility of pharmacogenomics in large numbers of cancer patients, necessitating consideration of other approaches. Epigenetic changes such as DNA methylation are a hallmark of human cancers. Methylation of genes involved in DNA repair and maintaining genome integrity (e.g. MGMT, hMLH1, WRN, and FANCF), and cell‐cycle checkpoint genes (e.g. CHFR and 14‐3‐3 σ, CDK10, and p73), all reportedly influence the sensitivity to chemotherapeutic drugs, suggesting that DNA methylation could serve as a molecular marker for predicting the responsiveness of tumors to chemotherapy. However, the comprehensive study of pharmacoepigenomics awaits the advent of genome‐wide analysis of DNA methylation using microarrays and next‐generation sequencers. (Cancer Sci 2009; 100: 787–791)
Glypican 3‐expressing gastric carcinoma: Distinct subgroup unifying hepatoid, clear‐cell, and α‐fetoprotein‐producing gastric carcinomas
Authors: Ushiku Tetsuo , Uozaki Hiroshi , Shinozaki Aya , Ota Satoshi , Matsuzaka Keisuke , Nomura Sachiyo , Kaminishi Michio , Aburatani Hiroyuki , Kodama Tatsuhiko , Fukayama Masashi
Published: February 2009

Gypican‐3 (GPC3) has been recognized as an oncofetal protein in hepatic neoplasms and yolk sac tumors. To characterize a distinct subgroup of gastric carcinoma (GC) expressing GPC3 (GPC3‐GC), primary and metastatic GC tissues were evaluated by immunohistochemistry with special focus on their related entities: hepatoid, clear‐cell, and α‐fetoprotein‐producing GC. GPC3‐GC was defined as focal GPC3‐GC when 10–49% of neoplastic cells were positive, and as diffuse GPC3‐GC when more than 50% of cells were positive. Among 926 GC cases, 101 (11%) were GPC3‐GC, of which 45 were diffuse and 56 were focal GPC3‐GC. Specific histological patterns, such as the hepatoid and clear‐cell patterns, were frequently observed in diffuse GPC3‐GC (38 and 49%, respectively) and in focal GPC3‐GC (4 and 25%, respectively), whereas these patterns were extremely rare in GPC3‐negative GC. Immunoreactive α‐fetoprotein was only identified in GPC3‐GC (38% of diffuse and 14% of focal GPC3‐GC). Both diffuse and focal GPC3‐GC showed nodal metastasis more frequently (67 and 55%, respectively) than GPC3‐negative GC (34%), and the diffuse GPC3‐GC had significantly more T2–4 and M1 stage cases. GPC3 immunostaining was present in 57 out of 61 nodal metastases (93%) and in all four liver metastases examined. Importantly, diffuse GPC3 expression was observed in the liver metastasis, even if the primary tumor was focal GPC3‐GC. GPC3‐GC is a distinctive group of GC, which unifies hepatoid, clear‐cell, and α‐fetoprotein‐producing GC. GPC3 is expected to be a target of forthcoming immunotherapy for a patient bearing this specific type of GC. (Cancer Sci 2009; 100: 626–632)
From tumor lymphangiogenesis to lymphvascular niche
Authors: Hirakawa Satoshi
Published: February 2009

Metastasis in sentinel lymph nodes indicates the initial spread of tumors from a primary site. The recent discovery of tumor‐associated growth of lymphatic vessels clarified that tumor lymphangiogenesis actively promotes enhanced draining/sentinel lymph node metastasis. Studies of experimental carcinogenesis have further established that tumors continue to induce lymphangiogenesis in metastatic foci such as draining lymph nodes. Lymphangiogenesis within draining lymph nodes probably contributes to enhanced distant lymph node and distant organ metastases. Lymph node lymphangiogenesis has recently been identified in several human malignancies, such as cutaneous malignant melanoma. Tumor‐associated lymphangiogenesis thus has potential significance not only at the primary site, but also in lymph nodes. Primary tumors induce new lymphatic vessel growth in draining lymph nodes before metastasis. The remarkable enlargement of sinusoidal lymphatic endothelium might facilitate tumor cell transport to the lymph nodes, and potentially contribute to the migration, residence, and/or survival of metastatic tumor cancer stem cells by inducing a specific tumor microenvironment. Therefore, the novel concept of ‘lymphvascular niche’ is proposed herein to explain lymphatic network expansion. This concept might help to improve understanding of the molecular mechanism of lymph node metastasis, and change therapeutic approaches to treating cancer metastasis. (Cancer Sci 2009; 100: 983–989)
Both CD133+ and CD133− subpopulations of A549 and H446 cells contain cancer‐initiating cells
Authors: Meng Xiangjiao , Li Ming , Wang Xiuwen , Wang Yawei , Ma Daoxin
Published: February 2009

Tumors have been known to contain a small population of cancer stem cells that initiate tumor growth and promote tumor spreading. CD133 alone or in combination with other markers is currently being used for identification and isolation of the putative cancer stem cell population from malignant tumors. To determine whether the CD133+ cells constitute the stem cell populations of lung cancer cells A549 and H446, CD133+ and CD133− subpopulations were sorted from A549 and H446 cells by magnetic cell separation and characterized for their in vitro stem cell‐like properties. Interestingly, both the CD133+ and CD133− cells displayed similar abilities of colony formation, self‐renewal, proliferation, differentiation, and invasion, as well as resistance to chemotherapy drugs. Furthermore, colony formation assays showed that more than 40% of cells in both the CD133+ cells and CD133− subpopulations could form large colonies capable of regenerating the unsorted populations and forming tumors in nude mice. These results suggest that CD133 alone cannot be used as a stem cell marker for the lung cancer cells A549 and H446, and both the CD133+ and CD133− subpopulations contain similar numbers of cancer stem cells. (Cancer Sci 2009; 100: 1040–1046)
Human immature dental pulp stem cells’ contribution to developing mouse embryos: production of human/mouse preterm chimaeras
Authors: Siqueira da Fonseca S. A. , Abdelmassih S. , De Mello Cintra Lavagnolli T. , Serafim R. C. , Clemente Santos E. J. , Mota Mendes C. , De Souza Pereira V. , Ambrosio C. E. , Miglino M. A. , Visintin J. A. , Abdelmassih R. , Kerkis A. , Kerkis I.
Published: February 2009

Objectives:  In this study, we aimed at determining whether human immature dental pulp stem cells (hIDPSC) would be able to contribute to different cell types in mouse blastocysts without damaging them. Also, we analysed whether these blastocysts would progress further into embryogenesis when implanted to the uterus of foster mice, and develop human/mouse chimaera with retention of hIDPSC derivates and their differentiation.

Materials and Methods:  hIDPSC and mouse blastocysts were used in this study. Fluorescence staining of hIDPSC and injection into mouse blastocysts, was performed. Histology, immunohistochemistry, fluorescence in situ hybridization and confocal microscopy were carried out.

Results and Conclusion:  hIDPSC showed biological compatibility with the mouse host environment and could survive, proliferate and contribute to the inner cell mass as well as to the trophoblast cell layer after introduction into early mouse embryos (n = 28), which achieved the hatching stage following 24 and 48 h in culture. When transferred to foster mice (n = 5), these blastocysts with hIDPSC (n = 57) yielded embryos (n = 3) and foetuses (n = 6); demonstrating presence of human cells in various organs, such as brain, liver, intestine and hearts, of the human/mouse chimaeras. We verified whether hIDPSC would also be able to differentiate into specific cell types in the mouse environment. Contribution of hIDPSC in at least two types of tissues (muscles and epithelial), was confirmed. We showed that hIDPSC survived, proliferated and differentiated in mouse developing blastocysts and were capable of producing human/mouse chimaeras.
Do the determinants of physical activity change by physical activity level?
Authors: Kim Hyun Kyung , Kim Mi Ja , Park Chang Gi , Kim Hyeon Ok
Published: February 2009

Title.  Do the determinants of physical activity change by physical activity level?

Aim.  The paper reports on a study to describe the determinants of physical activity according to physical activity level among rural women in Korea.

Background.  The benefits of physical activity for promoting health and preventing illness are well known, and gender and regional disparities in physical activity have been reported. Although the number of women who perform physical activity has increased, many still do not meet the recommended levels to gain health benefits.

Method.  A cross‐sectional descriptive study was conducted using a structured questionnaire. A convenience sample of 245 women living in a rural area of Korea was recruited during 2004. Self‐efficacy, benefits, barriers and sociodemographics were examined in relation to three levels of physical activity: inactive, insufficiently active and active. Descriptive statistics and multinomial logistic regression were used for data analysis.

Result.  Perceived self‐efficacy, benefits and barriers were statistically significant determinants only when the insufficiently active group was compared with the inactive group. Sociodemographic factors related to work and family roles statistically significantly explained the physical activity levels of rural women.

Conclusion.  Nursing interventions to increase self‐efficacy and benefits, or decrease perceived barriers could be effective for initiating physical activity for inactive women, whereas the same may not apply for insufficiently active women. Insufficiently active women may have false confidence that their physical activity will help them gain health benefits. Reducing the burdens of work and family roles of rural women might improve their physical activity levels.
Moral distress questionnaire for clinical nurses: instrument development
Authors: Eizenberg Michal Mashiach , Desivilya Helena Syna , Hirschfeld Miriam J.
Published: February 2009

Title.  Moral distress questionnaire for clinical nurses: instrument development.

Aim.  This paper is a report of a study to develop and test the psychometric properties of a culture‐sensitive moral distress questionnaire among nurses employed in a variety of work settings.

Background.  In the course of the last decade, there has been increased interest in capturing healthcare professionals’ experiences of stress associated with ethical dilemmas. Ethical issues emerge in grey areas and are often blurred, and have thus received insufficient attention.

Method.  The study comprised two phases: a qualitative phase to elicit the culture‐specific themes and a quantitative phase, comprising the design of a 15‐item questionnaire. The questionnaire was then completed by a convenience sample of 179 nurses from a variety of work settings. The data were collected in 2006.

Results.  Factor analysis resulted in three factors representing moral distress: (1) problems caused by work relationships among staff; (2) problems due to lack of resources; and (3) problems caused by time pressure. With regard to the construct validity of the questionnaire, differences between community and hospital nurses were tested, and a statistically significant difference was found between them in two among the three factors (relationships and time). The stability of the measures was examined by test‐retest reliability and revealed statistically significant results.

Conclusions.  The instrument exhibits acceptable reliability and validity in the Israeli cultural context. Further research is needed to evaluate the measure in other cultural settings.
Mental health nurses’ attitudes towards severe perinatal mental illness
Authors: McConachie Susan , Whitford Heather
Published: February 2009

Title.  Mental health nurses’ attitudes towards severe perinatal mental illness.

Aim.  This paper reports on a study exploring the experiences and attitudes of generic mental health nurses towards care of women with severe mental illness during the perinatal period.

Background.  Severe mental disorder in the perinatal period is a global public health concern. However, there are concerns that mental health nurses other than dedicated perinatal mental health teams may lack knowledge, skills and experience in caring for such disorders, because of their low prevalence.

Methods.  Sixteen generic Registered Mental Nurses working in public adult mental health services participated in three focus groups during 2007.

Findings.  Participants did not perceive any difference between symptoms during perinatal and non‐perinatal periods. There were mixed attitudes towards caring for women with severe mental illness in the perinatal period. Fear and anxiety was expressed by the nurses when caring or feeling responsible for the babies of clients. Lack of communication between professional groups and decreased clinical decision‐making following the introduction of the Edinburgh Post Natal Depression Scale caused frustration. Confidence was displayed when working with known and trusted colleagues.

Conclusion.  Generic mental health nurses would benefit from more education on perinatal mental health and there may be a need for them to be supported by specialist perinatal mental health practitioners.
Self‐efficacy with application to adolescent smoking cessation: a concept analysis
Authors: Heale Roberta , Griffin Mary T.Q.
Published: February 2009

Title.  Self‐efficacy with application to adolescent smoking cessation: a concept analysis.

Aim.  This paper is a report of a concept analysis of adolescent smoking cessation self‐efficacy.

Background.  Smoking cessation is a key preventive care/health promotion strategy offered by nurses worldwide. Most programming is tailored to adults although the reasons for smoking, along with coping strategies, resources and developmental stage, differ in adolescence. Understanding of the concept of self‐efficacy as it relates to the adolescent population will assist nurses in addressing smoking cessation behaviours with this population.

Data sources.  The CINAHL and Proquest Nursing databases were searched for papers published between 1977 and 2007 using the keywords self‐efficacy, adolescents and smoking cessation. The Walker and Avant method of concept analysis was applied.

Findings.  Adolescent smoking cessation self‐efficacy is the confidence, perceived capacity and perceived ability that the teen possesses to quit smoking. Identified antecedents include developmental stage, past life support, emotional support, coping strategies, resources and emotional status. Consequences are smoking cessation: positive or negative. Empirical measures are identified.

Conclusion.  Levels of self‐efficacy have been shown to be an important consideration in the approach of nurses to smoking cessation counselling with the adolescent client. The theoretical definition for this concept will provide the basis for nurses to design appropriate interventions for use in smoking cessation programmes targeted to adolescents. This definition identifies the key attributes of this concept that should be addressed when caring for this population.
Context‐dependent flight speed: evidence for energetically optimal flight speed in the bat Pipistrellus kuhlii?
Authors: Grodzinski Uri , Spiegel Orr , Korine Carmi , Holderied Marc W.
Published: February 2009

Understanding the causes and consequences of animal flight speed has long been a challenge in biology. Aerodynamic theory is used to predict the most economical flight speeds, minimizing energy expenditure either per distance (maximal range speed, Vmr) or per time (minimal power speed, Vmp). When foraging in flight, flight speed also affects prey encounter and energy intake rates. According to optimal flight speed theory, such effects may shift the energetically optimal foraging speed to above Vmp.

Therefore, we predicted that if energetic considerations indeed have a substantial effect on flight speed of aerial‐hawking bats, they will use high speed (close to Vmr) to commute from their daily roost to the foraging sites, while a slower speed (but still above Vmp) will be preferred during foraging. To test these predictions, echolocation calls of commuting and foraging Pipistrellus kuhlii were recorded and their flight tracks were reconstructed using an acoustic flight path tracking system.

Confirming our qualitative prediction, commuting flight was found to be significantly faster than foraging flight (9·3 vs. 6·7 m s−1), even when controlling for its lower tortuosity.

In order to examine our quantitative prediction, we compared observed flight speeds with Vmp and Vmr values generated for the study population using two alternative aerodynamic models, based on mass and wing morphology variables measured from bats we captured while commuting. The Vmp and Vmr values generated by one of the models were much lower than our measured flight speed. According to the other model used, however, measured foraging flight was faster than Vmp and commuting flight slightly slower than Vmr, which is in agreement with the predictions of optimal flight speed theory.

Thus, the second aerodynamic model we used seems to be a reasonable predictor of the different flight speeds used by the bats while foraging and while commuting. This supports the hypothesis that bats fly at a context‐dependent, energetically optimal flight speed.
A liver slice culture‐based ex vivo assay to predict the outcome of antiviral therapy for chronic hepatitis C
Authors: Chang M.‐L. , Sung K.‐F. , Sheen I.‐S. , Lin S.‐M. , Yeh C.‐T.
Published: February 2009

Summary.  A liver slice culture‐based, ex vivo drug suppression assay was developed as a pre‐therapeutic predictor for the outcome of antiviral therapy. To investigate its clinical application, 106 consecutive patients with chronic hepatitis C virus (HCV) infection were evaluated. Ex vivo drug suppression assay was performed before administrating a standard course of peginterferon plus ribavirin combination therapy. Stepwise logistic regression model was used to estimate sustained virological response (SVR) on the presence of various clinicopathological parameters. Suppression of HCV replication in the ex vivo assay was present in 32 patients, 29 (90.6%) of whom achieved SVR. Stepwise logistic regression analysis indicated that the presence of interferon suppression effect in the ex vivo assay (odds ratio [OR], 5.552; 95% confidence interval [CI], 1.114–27.673; P = 0.036), genotype 1 (OR; 0.045, 95% CI, 0.008–0.259; P = 0.001), HCV‐RNA level (OR, 0.739; 95% CI, 0.617–0.885; P = 0.001), the presence of fatty metamorphosis (OR, 0.205; 95% CI, 0.053–0.793; P = 0.022), and albumin (OR, 9.687; 95% CI, 2.237–41.940; P = 0.002) were independent determinants of SVR. Categorical analysis revealed that 17 of 17 (100%) patients with genotype non‐1 and positive ex vivo suppression test achieved SVR, while 20 of 40 (50%) with genotype 1 and negative ex vivo suppression test achieved SVR. In conclusion, the ex vivo drug suppression assay may serve as an independent pre‐therapeutic predictor for the SVR in interferon‐based antiviral therapy.
Hybridization between escaped domestic and wild American mink (Neovison vison)
Authors: KIDD A. G. , BOWMAN J. , LESBARRÈRES D. , SCHULTE‐HOSTEDDE A. I.
Published: February 2009

The release of domesticated organisms into natural populations may adversely affect these populations through predation, resource competition, and the introduction of disease. Additionally, the potential for hybridization between wild and domestic conspecifics is of great concern because it can alter the evolutionary integrity of the affected populations. Wild American mink (Neovison vison) populations may be threatened not only by competition for resources with domestic mink originating from farms, but by breeding with such escapees. Using 10 microsatellite loci, we genotyped mink from Ontario, Canada, sampled from two farms, two putatively mixed populations in regions surrounding the mink farms, and two wild populations with no recent history of mink farming. Using individual‐based Bayesian population assignment, we identified four population clusters, including one wild, and three domestic populations. The latter were not clustered by farm but rather by distinct line‐bred colour phases. Population clustering also identified domestic and hybrid mink in the free‐ranging populations. Nearly two‐thirds of the mink sampled in the two putatively mixed populations (78% and 43%) were either farm escapees or descendants of escapees. Principal components analysis of allele frequencies supported our Bayesian assignment results. The power of our assignment test was assessed using simulated hybrid genotypes which suggested that our overall correct classification rate was 96.2%. The overwhelming presence of domestic animals and their hybridization with mink in natural populations is of great concern for the future sustainability of wild mink populations.
Discovery of a large clonal patch of a social amoeba: implications for social evolution
Authors: GILBERT OWEN M , QUELLER DAVID C , STRASSMANN JOAN E
Published: February 2009

Studies of genetic population structures of clonally reproducing macro‐organisms have revealed large areas where only one clone is found. These areas, referred to as clonal patches, have not been shown to occur in free‐living microbes until now. In free‐living microbes, high genetic diversity at local scales is usually maintained by high rates of dispersal. We report, however, a highly dense, 12‐m clonal patch of the social amoeba Dictyostelium discoideum in a cattle pasture located in a Texas Gulf Coast prairie. We confirm the presence of only one clone by the analysis of 65 samples and amplification of 10 polymorphic microsatellite loci. Samplings of additional cattle pastures nearby showed higher clonal diversity, but with a density of D. discoideum isolates lower than in the clonal patch. These findings show that high rates of microbial dispersal do not always produce genetic diversity at local scales, contrary to the findings of previous studies. The existence of clonal patches may be particularly important for microbial social evolution.
Estimating connectivity in marine populations: an empirical evaluation of assignment tests and parentage analysis under different gene flow scenarios
Authors: SAENZ‐AGUDELO P. , JONES G. P. , THORROLD S. R. , PLANES S.
Published: February 2009

The application of spatially explicit models of population dynamics to fisheries management and the design marine reserve network systems has been limited due to a lack of empirical estimates of larval dispersal. Here we compared assignment tests and parentage analysis for examining larval retention and connectivity under two different gene flow scenarios using panda clownfish (Amphiprion polymnus) in Papua New Guinea. A metapopulation of panda clownfish in Bootless Bay with little or no genetic differentiation among five spatially discrete locations separated by 2–6 km provided the high gene flow scenario. The low gene flow scenario compared the Bootless Bay metapopulation with a genetically distinct population (FST = 0.1) located at Schumann Island, New Britain, 1500 km to the northeast. We used assignment tests and parentage analysis based on microsatellite DNA data to identify natal origins of 177 juveniles in Bootless Bay and 73 juveniles at Schumann Island. At low rates of gene flow, assignment tests correctly classified juveniles to their source population. On the other hand, parentage analysis led to an overestimate of self‐recruitment within the two populations due to the significant deviation from panmixia when both populations were pooled. At high gene flow (within Bootless Bay), assignment tests underestimated self‐recruitment and connectivity among subpopulations, and grossly overestimated self‐recruitment within the overall metapopulation. However, the assignment tests did identify immigrants from distant (genetically distinct) populations. Parentage analysis clearly provided the most accurate estimates of connectivity in situations of high gene flow.
Allergic contact dermatitis in 136 children patch tested between 2000 and 2006
Authors: Hammonds L. Mark , Hall Virginia C. , Yiannias James A.
Published: February 2009

Background  Allergic contact dermatitis is often under‐recognized in the pediatric population but it may affect greater than 20% of this age group.

Methods  We conducted a retrospective review of the Mayo Rochester, Jacksonville and Arizona patch test database of all children 18 or younger over a 7‐year period (January 1, 2000–December 31, 2006).

Results  One‐hundred thirty‐six children were patch tested from age 3 to 18. Females constituted 66% of those tested and males 34%. Eighty percent of the children were equally distributed between age groups 11–15 and 16–18, with the remainder being 10 years or younger. Sixty‐one percent of the children tested positive to at least one allergen. Fifty‐three percent of these reactions were deemed to be of current relevance, 31% questionable relevance, 5% past relevance, and 10% not relevant. Males younger than 10 were most likely to have a positive patch test. However, the percent of positive tests in males decreased with increasing age. Females younger than age 10 were less likely to have a positive test than older females. The most common allergens were nickel, cobalt, gold, and thimerosal.

Conclusion  In children suspected to have allergic contact dermatitis, 61% were confirmed to have a positive reaction to at least one allergen. The utility of patch testing children whose clinical presentation is suggestive for allergic contact dermatitis is high.
Treatment of cellulite with LPG endermologie
Authors: Tülin Güleç A.
Published: February 2009

Background  LPG endermologie is a FDA‐approved massage system in use worldwide for cellulite treatment that lacks clinical study.

Objective  To determine the efficacy and safety of LPG endermologie in treating cellulite.

Methods  Thirty‐three healthy women (cellulite grades, 1–3 based on the 4‐stage Nurnberger–Muller scale) had LPG treatments twice weekly for a total of 15 sessions. Clinical evaluation was performed by digital photography for cellulite grade assessment, and perimetric measurements of eight body sites for the evaluation of body contours.

Results  Significant differences were found regarding mean cellulite grades before and after treatment. However, improved cellulite appearance occurred in only 5 women (15%). All patients showed a significant circumference loss at every measured body site. Weight losers had significantly greater loss of total and average body circumference than weight gainers.

Limitations  Relatively small sample size and lack of more‐objective methods for assessing treatment success.

Conclusion  LPG endermologie is a well‐tolerated and effective method for reducing the diameter of body circumference, however, it is mildly effective in reducing the cellulite grade and so, improving its orange‐peel appearance.