bluuebunny/crossref_metadata_2025 huggingface dataset:
Morphological and behavioural characteristics of a gynandromorph of the desert locust, Schistocerca gregaria
Authors: MAENO KOUTARO , TANAKA SEIJI
Published: May 2007

Abstract Morphological and behavioural characteristics are investigated for a gynandromorph of the desert locust, Schistocerca gregaria, appearing under isolated rearing conditions in the laboratory. It has both male and female external reproductive organs bilaterally. The body size and dimensions are similar to a normal male. Morphometric traits (fore wing length/maximum head width ratio and fore wing length/hind femur length ratio) of the gynandromorph are typical for the values of solitarious locusts. When the gynandromorph is placed into an arena holding ten sexually mature gregarious females, it shows a distinct male behaviour: it jumps on a female and tries to mate with her. When kept together with males, males recognize this gynandromorph as a female because some of them try to mount, although no successful copulation is observed. The results suggest that the gynandromorph might have had a female‐specific pheromone. Dissection reveals that the gynandromorph has no testis but abnormal ovaries containing vitellogenic oocytes. These observations indicate that the gynandromorph obtained has a mixture of male and female morphological characteristics and behaves like a male but is recognized as a female by conspecific males.
mRNA metabolism of flowering‐time regulators in wild‐type Arabidopsis revealed by a nuclear cap binding protein mutant, abh1
Authors: Kuhn Josef M. , Breton Ghislain , Schroeder Julian I.
Published: May 2007

The precise regulation of RNA metabolism has crucial roles in numerous developmental and physiological processes such as the induction of flowering in plants. Here we report the identification of processes associated with mRNA metabolism of flowering‐time regulators in wild‐type Arabidopsis plants, which were revealed by an early flowering mutation, abh1, in an Arabidopsis nuclear mRNA cap‐binding protein. By using abh1 as an enhancer of mRNA metabolism events, we identify non‐coding polyadenylated cis natural antisense transcripts (cis‐NATs) at the CONSTANS locus in wild‐type plants. Our analyses also reveal a regulatory function of FLC intron 1 during transcript maturation in wild type. Moreover, transcripts encoding the FLM MADS box transcription factor are subject to premature intronic polyadenylation in wild type. In each case, abh1 showed altered patterns in RNA metabolism in these events compared with wild type. Together, abh1 enhances steps in the RNA metabolism that allowed us to identify novel molecular events of three key flowering‐time regulators in wild‐type plants, delivering important insights for further dissecting RNA‐based mechanisms regulating flowering time in Arabidopsis.
Two novel AP2/ERF domain proteins interact with cis‐element VWRE for wound‐induced expression of the Tobacco tpoxN1 gene
Authors: Sasaki Katsutomo , Mitsuhara Ichiro , Seo Shigemi , Ito Hiroyuki , Matsui Hirokazu , Ohashi Yuko
Published: May 2007

The vascular system‐specific and wound‐responsive cis‐element (VWRE) has been identified as a novel cis‐element for wound‐induced and vascular system‐specific expression of the tobacco peroxidase gene, tpoxN1. Here we isolated two independent clones that encode VWRE binding proteins by yeast one‐hybrid screening. As the gene products have an AP2/ERF (APETALA2/ethylene‐responsive factor) domain, and the transcripts were accumulated transiently after wounding, we named them wound‐responsive AP2/ERF‐like factor 1 (WRAF1) and WRAF2. The AP2/ERF domains of the two WRAFs share 97% homology, and are classified into the ERF subfamily B‐4. Gel mobility shift analysis indicated that WRAFs specifically bind VWRE, which contains no known cis‐elements for other AP2/ERF proteins. The binding activity of the WRAFs was found to be localized in the AP2/ERF domain. The WRAFs transactivated a promoter containing four tandem repeats of the VWRE, but not that of the mutated VWRE. Overexpression of the WRAF genes led to constitutive expression of the potential target gene, tpoxN1, in unwounded transgenic plants. These results indicate that the novel transcription factors WRAF1 and WRAF2 bind the VWRE as positive regulators for the expression of the tpoxN1 gene.
A physical map of the highly heterozygous Populus genome: integration with the genome sequence and genetic map and analysis of haplotype variation
Authors: Kelleher Colin T. , Chiu Readman , Shin Heesun , Bosdet Ian E. , Krzywinski Martin I. , Fjell Chris D. , Wilkin Jennifer , Yin TongMing , DiFazio Stephen P. , Ali Johar , Asano Jennifer K. , Chan Susanna , Cloutier Alison , Girn Noreen , Leach Stephen , Lee Darlene , Mathewson Carrie A. , Olson Teika , O’Connor Katie , Prabhu Anna‐Liisa , Smailus Duane E. , Stott Jeffery M. , Tsai Miranda , Wye Natasja H. , Yang George S. , Zhuang Jun , Holt Robert A. , Putnam Nicholas H. , Vrebalov Julia , Giovannoni James J. , Grimwood Jane , Schmutz Jeremy , Rokhsar Daniel , Jones Steven J.M. , Marra Marco A. , Tuskan Gerald A. , Bohlmann Jörg , Ellis Brian E. , Ritland Kermit , Douglas Carl J. , Schein Jacqueline E.
Published: May 2007

As part of a larger project to sequence the Populus genome and generate genomic resources for this emerging model tree, we constructed a physical map of the Populus genome, representing one of the few such maps of an undomesticated, highly heterozygous plant species. The physical map, consisting of 2802 contigs, was constructed from fingerprinted bacterial artificial chromosome (BAC) clones. The map represents approximately 9.4‐fold coverage of the Populus genome, which has been estimated from the genome sequence assembly to be 485 ± 10 Mb in size. BAC ends were sequenced to assist long‐range assembly of whole‐genome shotgun sequence scaffolds and to anchor the physical map to the genome sequence. Simple sequence repeat‐based markers were derived from the end sequences and used to initiate integration of the BAC and genetic maps. A total of 2411 physical map contigs, representing 97% of all clones assigned to contigs, were aligned to the sequence assembly (JGI Populus trichocarpa, version 1.0). These alignments represent a total coverage of 384 Mb (79%) of the entire poplar sequence assembly and 295 Mb (96%) of linkage group sequence assemblies. A striking result of the physical map contig alignments to the sequence assembly was the co‐localization of multiple contigs across numerous regions of the 19 linkage groups. Targeted sequencing of BAC clones and genetic analysis in a small number of representative regions showed that these co‐aligning contigs represent distinct haplotypes in the heterozygous individual sequenced, and revealed the nature of these haplotype sequence differences.
The Huntington’s Disease quality of life battery for carers: reliability and validity
Authors: Aubeeluck A , Buchanan H
Published: May 2007

Research into the experience of the Huntington Disease (HD) spousal carer has established that carers experience several unique obstacles within their care‐giving role. However, there is still a need to establish methodically the factors that impact on the HD spousal carers’ situation and ultimately their quality of life. The aim of this pilot study, which was a result of three previous exploratory studies, was to validate a HD‐specific quality‐of‐life (QoL) measure, the Huntington disease quality‐of‐life battery for carers (HDQoL‐C) for use (initially) with spousal carers of HD patients. Eighty‐seven HD spousal carers took part in the piloting of the HDQoL‐C to assess its reliability and validity as a tool for use within QoL research. Results established the HDQoL‐C as a multidimensional and psychometrically sound disease‐specific and subjective QoL assessment tool that incorporates the individual’s physical health, psychological state, level of independence, social relationships and personal beliefs. The HDQoL‐C demonstrates good internal consistency, test–re‐test reliability and congruent validity.
An overview of isolated and syndromic oesophageal atresia
Authors: Geneviève D , De Pontual L , Amiel J , Sarnacki S , Lyonnet S
Published: May 2007

Oesophageal atresia (OA) and/or tracheo‐oesophageal fistula (TOF) are frequent malformations observed in approximately one in 3500 births. OA/TOF can be divided clinically into isolated OA (IOA) and syndromic OA (SOA) when associated with other features, the most frequent being cardiac, limb and vertebral malformations or anal atresia. SOA is observed in 50% of patients and can be subdivided into several causative groups comprising environmental agents, chromosomal disorders, malformative associations (CHARGE syndrome and VATER/VACTERL association), and other multiple congenital anomaly disorders. The observation of chromosomal disorders with SOA, as well as mouse models of OA provide support for the involvement of genetic factors in OA. Yet, epidemiological data (twin and family studies) do not support the major role of genetic factors in the majority of cases of IOA but rather a multifactorial model. However, several genes involved in SOA have been recently identified, namely N‐MYC, SOX2, and CHD7 involved in Feingold (MIM 164280), anophthalmia‐oesophageal‐genital (MIM 600992) and CHARGE syndromes respectively (MIM 214800), suggesting that OA/TOF, at least in their syndromic forms, may be a highly genetically heterogeneous group.
Symptom experience after lung transplantation: impact on quality of life and adherence
Authors: Kugler Christiane , Fischer Stefan , Gottlieb Jens , Tegtbur Uwe , Welte Tobias , Goerler Heidi , Simon Andre , Haverich Axel , Strueber Martin
Published: May 2007

Abstract: Background: Patients’ perceptions of immunosuppression‐ related symptom experience may impact on quality of life (QoL) and medication adherence.

Methods: A total of 308 lung transplant recipients were screened for study inclusion. Two hundred eighty‐seven patients (response rate 93%) completed a 91‐item questionnaire consisting of subscales focusing on symptom experiences (frequency and distress), and adherence. QoL was assessed by a 40‐item standardized instrument. Impact of symptom experiences on QoL and adherence were assessed. Potential determinants of immunosuppression induced symptom experiences were evaluated.

Results: The most frequent reported symptoms were tremor (70%) and hirsutism (68.1%), whereas Cushingoid appearance (38.6%) and muscle weakness (31.9%) appeared to be the most distressing symptoms. Women (p < 0.001) and younger patients (<40 yr; p < 0.0001) reported a significantly higher level of symptom experience compared with their counterparts respectively. Symptom experiences negatively influenced QoL in all dimensions (p < 0.006). Those who described experiencing adverse effects reported significantly more “drug holidays” (p ≤ 0.004) compared with those reporting minor frequent adverse effects. Patients’ self‐reported strategies to reduce adverse effects were to postpone medication intake (30%), to drop doses (8%), or to reduce doses (9%).

Conclusions: This study establishes a relationship between patients’ perceptions of immunosuppression‐related symptom experiences and the impact on QoL and adherence. Immunosuppression is accompanied by significant adverse effects in both symptom frequency and distress. Most frequently experienced symptoms do not necessarily have the greatest impact on perceived distress, and vice versa. High levels of adverse effects tend to negatively influence patients’ QoL and adherence. Future research is required to understand the relationship of these complex variables.
The use of sirolimus in ganciclovir‐resistant cytomegalovirus infections in renal transplant recipients
Authors: Ozaki Kikumi Suzete , Câmara Niels Olsen Saraiva , Nogueira Eliana , Pereira Mauricio Galvão , Granato Celso , Melaragno Cláudio , Camargo Luis Fernando Aranha , Pacheco‐Silva Alvaro
Published: May 2007

Abstract: Background: The widespread use of prophylactic ganciclovir and anti‐lymphocyte/thymocyte therapies are associated with increased induction of ganciclovir‐resistant cytomegalovirus (CMV) strains. The use of sirolimus has been associated with a lower incidence of CMV infection in transplant recipients. We questioned whether it could also be effective as a therapeutic treatment of resistant CMV infection.

Methods: Patients with ganciclovir‐resistant CMV infections determined clinically and by DNA sequencing analysis were enrolled. Antigenaemia and DNA sequencing were used to diagnosis and follow the mutations.

Results: Nine transplant patients were given sirolimus plus mycophenolate mofetil (n = 4) or a calcineurin inhibitor (n = 5). Seven out of nine recipients were CMV IgG negative before transplantation. We observed a rapid decrease in antigenaemia levels, reaching zero in eight out of nine (88.9%) patients within a median of 20.3 ± 10.1 d. Graft function remained stable and no patient presented acute rejection or recurrence of the CMV infection.

Conclusions: This suggests that the use of sirolimus plus ganciclovir therapy could be useful in ganciclovir‐resistant CMV infections.
Hemorrhagic cystitis: a retrospective single‐center survey
Authors: Hassan Zuzana , Remberger Mats , Svenberg Petter , Elbander Maria , Omazic Brigitta , Mattsson Jonas , Conrad Réka , Svahn Britt‐Marie , Ahlgren Anders , Sairafi Darius , Aschan Johan , Blanc Katarina Le , Barkholt Lisbeth , Ringdén Olle
Published: May 2007

Abstract:  Severe hemorrhagic cystitis (HC) may be a life‐threatening complication in allogeneic stem cell transplantation (SCT). In order to improve the strategies for prophylaxis and treatment, we retrospectively analyzed data on patients who underwent SCT at our center from 1990 through 2005. Patients with HC were identified through our database and their medical charts were reviewed. Grades 2–5 and 3–5 HC developed in 109/834 patients (13.1%) and 27/834 patients (3.2%), respectively. The frequency of HC decreased over the time from 18.0% in 1990–1992 to 9.5% in 2002–2005 (p = 0.005). HC started on a median of 35 (0–166) days post‐transplant and persisted for a median of 23 (2–270) days. Transplant‐related mortality was 21% in patients without HC, 15% in those with HC of grade 2, 55% in those with grade 3, and 71% in patients with HC of grades 4–5 (p < 0.001). In multivariate analysis, the risk factors for HC were myeloablative conditioning, busulphan, cytomegalovirus infection, hematological malignancy, and acute graft‐versus‐host disease (aGVHD). With four risk factors, the risk of HC development was 31%. Risk factors for severe HC of grades 3–5 were aGVHD and bacteremia.
HLA class II amino acid epitopes as susceptibility markers of sarcoidosis
Authors: Voorter C. E. M. , Amicosante M. , Berretta F. , Groeneveld L. , Drent M. , Van Den Berg‐Loonen E. M.
Published: May 2007

Sarcoidosis is a multisystemic disorder of unknown etiology, affecting primarily the lung and characterized by epithelioid granulomas. Disease association studies showed human leukocyte antigen (HLA) class II to be related to sarcoidosis. Initially, we studied the association of sarcoidosis with DQB1, and in the present study, we evaluated all amino acid variants of the HLA‐DPB1, ‐DQB1, ‐DRB1, ‐DRB3, ‐DRB4 and ‐DRB5 genes to identify possible polymorphisms associated with the disease. Patients and controls were typed for class II genes to the allele level by sequence‐based typing. Multiple logistic regression models showed DRAla71 and DQPhe9 to be independently associated with the disease. Subdivision of patients according to their radiographic stage resulted in identification of DRArg74 as independent associated residue in the RS I group, whereas DRAla71 and DQTyr30 were associated with RS II–IV groups. Polymorphic residues specifically associated with sarcoidosis shed new light on the characteristics of sarcoidosis‐triggered peptides. Overall, pocket 9 of DQ and pocket 4 of DR seem to be the most important areas involved in the association with sarcoidosis.
A novel HLA‐B*35 (B*3570) allele of a Caucasian family differing with one amino acid mismatch from HLA‐B*3503 allele in exon 4
Authors: Schlaf G. , Erhuma M. E. , Seliger B. , Foell J. , Altermann W. W.
Published: May 2007

A novel human leucocyte antigen (HLA)‐B35 (HLA‐B*3570) allele has been identified in a Caucasian family from Middle Europe using single allele‐specific sequencing strategy. This allele is identical to the HLA‐B*3503 allele except for one point mutation in exon 4 at codon 188 (CAC→CGC), resulting in an amino acid change from histidine to arginine.
Play it in E or G: utilization of HLA‐E and ‐G in xenotransplantation
Authors: Crew Mark D.
Published: May 2007

Abstract Human NK cell‐mediated graft rejection is likely to be one of several biological obstacles to routine pig‐to‐human xenotransplantation. Abrogating NK cell activation by either elimination of activating ligands on porcine cells or expression of molecules serving as ligands for NK cell inhibitory receptors, or both, could overcome this hurdle. HLA‐E and ‐G exhibit very limited polymorphism and are ligands for NK cell inhibitory receptors. This review summarizes successes and limitations of their use in xenotransplantation as inferred from ex vivo analyses of NK cell activity, highlights potential effects they may have on T‐cell responses, and considers prospects of preclinical trials and potential outcomes.
Blockade of the PD‐1/PD‐1L pathway reverses the protective effect of anti‐CD40L therapy in a rat to mouse concordant islet xenotransplantation model
Authors: Mai Gang , Del Rio Maria‐Luisa , Tian Jiong , Ramirez Pablo , Buhler Leo , Rodriguez‐Barbosa Jose‐Ignacio
Published: May 2007

Abstract:  Background:  We have previously demonstrated that costimulatory blockade with anti‐CD40L monoclonal antibody (mAb) prolongs the survival of non‐vascularized concordant rat to mouse islet xenografts. Here, we examine whether signaling through the PD‐1/PD‐1L pathway is required for the anti‐CD40L therapy to prolong concordant islet graft survival using a novel anti‐murine PD‐1 mAb (clone 4F10).

Methods:  C57BL/6 mice received a cellular concordant islet xenograft under the left kidney capsule and four experimental groups were prepared. Group I: untreated control; group II: recipient mice were treated with three doses of 0.5 mg of anti‐CD40L mAb (clone MR1) on days 0, 2 and 4; group III: mice were treated with 0.5 mg of anti‐PD‐1 (CD279) mAb (clone 4F10) every other day for 8 days; and finally group IV: mice received the combined treatment that consisted of anti‐CD40L plus anti‐PD‐1 mAb.

Results:  Concordant islet xenografts transplanted in control untreated mice showed a median survival time (MST) of 17 ± 7.43 days, whereas anti‐CD40L treatment led to a significant prolongation of graft survival (MST: 154 ± 65.56, P < 0.0001). The administration of anti‐PD‐1 alone significantly accelerated graft rejection compared to non‐treated controls (MST: 10 ± 2.24 vs. MST: 17 ± 7.43, P < 0.0004). Remarkably, the combined administration of anti‐CD40L and anti‐PD‐1 reversed the protective effect obtained with anti‐CD40L alone (anti‐CD40L, MST: 154 ± 65.56 vs. anti‐CD40L plus anti‐PD‐1, MST: 10 ± 7.72, P < 0.0002).

Conclusion:  Overall, our data indicate that the PD‐1/PD‐1L pathway is required for the achievement of prolonged graft survival in anti‐CD40L‐treated mice in a setting of rat to mouse concordant islet xenotransplantation.
Acute gastric dilatation after porcine islet transplantation in a cynomolgus monkey – case history and review of the literature
Authors: Campanile Nathalie , Rood Pleunie P. P. M. , Yeh Peter , Casu Anna , Bottino Rita , Cooper David K. C.
Published: May 2007

Abstract:  We report a streptozotocin‐induced diabetic cynomolgus monkey that developed acute gastric dilatation within the first week after intraportal porcine islet transplantation. The monkey presented with increasing anorexia and somnolence, associated with persistent metabolic acidosis. On physical examination, a diffuse mass was palpable in the abdomen. Because of its deteriorating clinical condition, the monkey was euthanized. Necropsy revealed acute gastric dilatation. Potential etiological factors, possible methods of prevention, and guidelines for management are reviewed, with special emphasis on the incidence and management of acute gastric dilatation in non‐human primates.
An open non‐randomized study of recombinant activated factor VII in major postpartum haemorrhage
Authors: Ahonen J. , Jokela R. , Korttila K.
Published: May 2007

Background:  Empirical off‐label use of recombinant activated factor VII (rFVIIa) has been reported to be effective in some cases of severe postpartum haemorrhage (PPH). Successful management of these patients has lead to more wide‐spread use of rFVIIa in less severe cases without any evidence for the advantages of its administration.

Methods:  Until November 2006, we had administered rFVIIa to 38 parturients. Based on our initial experience with the first 12 patients, we prepared guidelines for the use of rFVIIa. During the existence of these guidelines, we made a retrospective comparison of the 26 women who received rFVIIa with another 22 women who were treated during the same time period without using rFVIIa.

Results:  The total amount of blood loss was significantly higher (11.3 ± 4.5 vs. 8.0 ± 3.1 l), and the coagulation screen revealed significantly longer partial thromboplastin time (APTT) and prothrombin time (PT) values and significantly lower fibrinogen values in patients receiving rFVIIa. The need for red blood cells, platelets and fibrinogen concentrate was significantly higher in these women. Although the response was considered good in two‐thirds of the women, several patients received rFVIIa with a poor or no response as a result of arterial bleeding.

Conclusion:  The decision to use rFVIIa resulted from a more profound haemorrhage. We did not gain any evidence to extend the use of rFVIIa into less severe cases of PPH. Furthermore, this policy would result in a profound increase in the overall costs of the treatment. Randomized placebo‐controlled trials are urgently needed to optimize the use of rFVIIa in obstetric haemorrhage.
Risk factors for red cell transfusion in adults undergoing coronary artery bypass surgery: a systematic review
Authors: Shehata N. , Naglie G. , Alghamdi A. A. , Callum J. , Mazer C. D. , Hebert P. , Streiner D. , Wilson K.
Published: May 2007

Background and Objective  Identifying factors that can predict adults at high risk of receiving red blood cell transfusion during coronary artery bypass graft (CABG) surgery may aid in more efficient blood banking practices and may tailor blood conservation strategies for these adult patients. The objective was to identify clinical factors associated with increased red cell transfusion in adults undergoing CABG surgery.

Methods  A systematic review of the MEDLINE and HealthSTAR databases from 1966 to December 2005 was conducted. Citations containing the medical subject heading or textwords ‘coronary artery bypass graft’, ‘CABG’ and ‘cardiovascular surgery’ were combined with the medical subject headings or textwords ‘transfusion’ and ‘blood transfusion’.

Results  A total of 2461 abstracts were retrieved. Twenty‐one studies met the inclusion/exclusion criteria. Transfusion rates ranged from 7 to 97%. Several variables were identified that were associated with increased red cell transfusion rates including older age, female sex, low haemoglobin concentration or haematocrit value, renal insufficiency and urgent/emergent surgery. The strongest risk factor was the urgency of surgery (urgent or emergent surgery), which was associated with a 4× to 8× increase in transfusion rates compared to elective surgery. Increasing age and female sex increased the likelihood of transfusion by 1× to 3× and 2×, respectively.

Conclusions  Increasing patient age, female sex, lower preoperative haemoglobin levels, as well as the urgency of the CABG surgery were associated with higher transfusion rates. Identifying risk factors for transfusion may allow for targeted use of blood conservation strategies, improved efficiency in blood utilization and informing adults at risk of transfusion.
Interference with TRALI‐causing anti‐HLA DR alloantibody induction of human pulmonary microvascular endothelial cell injury by purified soluble HLA DR
Authors: Nishimura M. , Hashimoto S. , Satake M. , Okazaki H. , Tadokoro K.
Published: May 2007

Background and Objective  Antibodies to human leucocyte antigens (HLA) and human polymorphonuclear neutrophil (PMN) antigens are considered etiologic agents of transfusion‐related acute lung injury (TRALI). The aim of this study was to clarify the role of anti‐HLA DR antibodies in the pathophysiology of TRALI and the ability of purified soluble HLA DR (psHLA DR) to inhibit the release of cytokines in an in vitro model.

Materials and Methods  A coculture of human pulmonary microvascular endothelial cells (HMVEC) and monocytes in the presence of serum containing anti‐HLA DR alloantibodies previously associated with cases of TRALI was used as an in vitro TRALI model. The release of leukotriene B4 (LTB4) and tumour necrosis factor‐α (TNF‐α), the apoptosis of HMVECs were measured.

Results  The release of LTB4 and TNF‐α and apoptosis of HMVECs were observed in the model. The addition of psHLA DR markedly reduced the release of LTB4 and TNF‐α and inhibited apoptosis of HMVECs.

Conclusion  These results support the critical role of anti‐HLA DR alloantibodies in the pathogenesis of TRALI and suggest that the soluble HLA DR could inhibit TRALI development caused by anti‐HLA DR alloantibodies.
Peptidergic and Nitrergic Innervation of the Pineal Gland in the Domestic Pig: An Immunohistochemical Study
Authors: Nowicki M. , Wojtkiewicz J. , Lewczuk B. , Kosacka J. , Majewski M. , Przybylska‐Gornowicz Barbara
Published: May 2007

The presence and co‐localization of vasoactive intestinal polypeptide (VIP), peptide N‐terminal histidine C‐terminal isoleucine (PHI), pituitary adenylate cyclase‐activating peptide (PACAP), somatostatin (SOM), calcitonin gene‐related peptide (CGRP), substance P (SP) and the neuronal isoform of nitric oxide synthase (NOS) were studied in neuronal structures of the pig pineal gland. Paraformaldehyde‐fixed pineals of 3‐month‐old gilts were sliced into serial cryostat sections, which were subjected to a set of double immunofluorescence stainings. Based on the co‐existence patterns of neuropeptides, five populations of nerve fibres supplying the pig pineal were distinguished: (1) PHI‐positive, (2) PACAP‐positive, (3) SOM‐positive, (4) SP/CGRP‐positive and (5) SP‐positive/CGRP‐negative. Only a subpopulation of PHI‐positive fibres contained VIP at the level detectable by immunofluorescence. NOS was found in some intrapineal PHI‐ and VIP‐positive fibres. PHI‐, VIP‐ and NOS‐positive nerve fibres were more numerous in the peripheral than in the central part of the pineal. PACAP‐positive fibres were equally distributed within the gland. The density of SOM‐positive fibres was higher in the ventro‐proximal than in the dorso‐distal part of the pineal. SOM was also detected in some neuronal‐like cells or specialized pinealocytes situated in the central region of the gland. Two populations of fibres containing SP were found: CGRP‐positive, present in the distal and central parts of the pineal as well as CGRP‐negative, localized in the proximal compartment of the gland.
Gene therapy for disorders affecting children, progress and potential
Authors: Anson Donald S , Fletcher Janice M
Published: May 2007

Abstract:  For over two decades gene therapy has been actively pursued as a treatment modality for the inherited diseases that affect the paediatric population, however, it is still to make a real impact in the clinic. There are many reasons for this including inadequate technology and a lack of understanding of the biological complexities that impact on the efficiency of gene delivery and its outcomes, both positive and negative. However, recent progress is now addressing these issues and indicates that these problems can be overcome, and that gene therapy will play a significant role in the treatment of at least some of these disorders. This review will first give a short overview of relevant gene delivery technologies, what strategies can be used and which diseases are potential targets for gene therapy, and then illustrate several specific diseases for which gene therapy is actively being developed.
Idiopathic nephrotic syndrome in New Zealand children, demographic, clinical features, initial management and outcome after twelve‐month follow‐up: Results of a three‐year national surveillance study
Authors: Wong William
Published: May 2007

Aim:  To describe the demographic, clinical features, steroid response, histopathology and complications of all children diagnosed with idiopathic nephrotic syndrome (INS) in New Zealand over a 3‐year period.

Methods:  A questionnaire seeking relevant clinical information was sent to all paediatricians who reported a new case of nephrotic syndrome to the New Zealand Paediatric Surveillance Unit. A follow‐up questionnaire was sent to reporting paediatricians after the first 12 months of follow‐up.

Results:  The incidence was 1.9 children per 100 000 under age 15 years. There was no significant difference in INS between ethnic groups. Approximately 80.4% were steroid responsive with median time to response of 8.4 days and mean time to relapse was 15.1 ± 12.1 weeks (10.1–19.8 95% confidence interval). Follow‐up at 12 months after diagnosis showed that two‐thirds were either steroid dependent or frequent relapsers. Steroid resistance patients had a more variable course with some developing chronic renal failure and other remaining persistently nephrotic.

Conclusion:  The incidence and outcome of children with INS are similar to overseas studies. A large variety of steroid treatment regimens were noted. Current evidenced‐based guidelines to treat INS were used infrequently.
Evaluation of a paediatric asthma education package for health professionals
Authors: Drakeford Paul A , Davis Anne M , Van Asperen Peter P
Published: May 2007

Aim:  To evaluate an evidence‐based paediatric asthma management education package designed for health professionals with particular emphasis on formulation of written asthma action plans (AAPs) and inhalation device technique.

Methods:  A prospective cohort study was conducted involving graduate medical programme medical students and tertiary paediatric hospital junior house staff. Three case‐based Microsoft Powerpoint presentations were used to highlight important aspects of asthma management including the formulation of an AAP and inhalation device technique. This was delivered in small‐group sessions to medical students and as a self‐directed learning exercise to junior house staff. Outcome measures were ability to write an accurate AAP, confidence and competence in using and teaching asthma devices, and knowledge of asthma.

Results:  Forty medical students and 14 junior house staff were recruited. Mean scores for the written AAP improved from 4.2 (out of 19) to 16.2 for medical students (mean change 12.0; 95% confidence interval (CI) 11.0–13.0; P < 0.001) and from 11.5 to 16.8 for junior doctors (mean change 5.3; 95% CI 3.5–7.2; P < 0.001). Confidence in using and teaching asthma inhalation devices also improved (P < 0.001 for students and P < 0.05 for house staff), as did asthma knowledge and skills in using the devices in the students (P < 0.001).

Conclusion:  The education package was effective in teaching participants how to write an accurate AAP and improved their confidence and ability in demonstrating proper inhalation device technique. We believe that the package has the potential to be used more widely for either small‐group or self‐directed learning.
CPAP use in babies with respiratory distress in Australian special care nurseries
Authors: Buckmaster Adam G , Arnolda Gaston RB , Wright Ian MR , Henderson‐Smart David J
Published: May 2007

Aim:  This study sought to identify the number of special care nurseries (SCNs) already using CPAP in 2004, and the number considering its use in the following 2 years, and to describe the characteristics of those hospitals.

Methods:  All Australian hospitals with >200 registered deliveries in the year 2002, a SCN and at least one paediatrician were eligible (n = 157). Separate questionnaires were sent to the nurse unit manager (NUM) and the paediatrician responsible for the SCN in late 2004.

Results:  Of 157 eligible SCNs, 143 (91%) responded. CPAP was being used in 24/143 (17%). Of those nurseries not already using CPAP a further 45/119 (38%) were considering doing so in 2005/2006. State/Territory, greater availability of junior medical staff, use of a helicopter/airplane for transferring infants to tertiary centres and number of paediatricians were significantly associated with use of CPAP (all P < 0.05). Consideration of use was significantly associated with greater availability of junior medical staff, larger numbers of births and time to nearest (tertiary) centre (all P < 0.05).

Conclusion:  There is a strong predisposition for the use of CPAP in SCNs despite the lack of evidence for its benefits or risks there. Studies are urgently required on the clinical benefits and risks of CPAP in a non‐tertiary centre before the widespread introduction of CPAP takes place.
Epidemiology of severe hepatitis A in Indigenous Australian children
Authors: MacIntyre C Raina , Burgess Margaret , Isaacs David , McIntyre Peter B , Menzies Robert , Hull Brynley
Published: May 2007

Aims:  To describe the epidemiology of hepatitis A in Indigenous Australian children.

Methods:  Analysis and mapping of national notification and hospitalisation data.

Results:  Indigenous Australian children are at far higher risk of clinical hepatitis A than their non‐Indigenous counterparts, particularly in the age group 0–4 years. Rates of hospitalisation (15.5 vs. 0.3 per 100 000) and notification (24.4 vs. 1.8 per 100 000) were higher in Indigenous children aged 0–4 years compared with other children in the same age group. In the age group 5–14 years, the rates were 4.4 per 100 000 (Indigenous) versus 0.6 per 100 000 (non‐Indigenous) hospitalisations. This excess morbidity falls sharply with age. Rates were the highest in the Northern Territory, South Australia, Western Australia and North Queensland.

Conclusions:  Indigenous children are at risk of hepatitis A, particularly early in life. Mapping shows that rates were the highest in jurisdictions with the largest Indigenous populations. This study presents baseline data against which to measure the success of new hepatitis A vaccination programme for Indigenous Australian children which commenced in 2005.
Pain relief for simple procedures in New Zealand neonatal units: Practice change over six years
Authors: Heaton Paul , Herd David , Fernando Andrew
Published: May 2007

Aim:  Newborn infants are routinely exposed to pain. We wanted to see how practice regarding pain relief changed over a 6‐year period.

Methods:  Serial audits were carried out of existing practice and attitudes at three points, over a 6‐year span, in New Zealand neonatal units.

Results:  Almost all units agreed that many commonly performed procedures were painful over the 6‐year study period. The number of units using analgesia rose markedly over the same period.

Conclusions:  The fact that a simple, cheap and effective intervention (oral sucrose) has taken more than 6 years to be used routinely in New Zealand highlights the problem of turning evidence into practice.
CANCER RISKS FOR AUSTRALIAN WOMEN WITH A BRCA1 OR A BRCA2 MUTATION
Authors: Suthers Graeme K.
Published: May 2007

One of the primary purposes of genetic testing for mutations in the BRCA1 and BRCA2 genes in patients with familial breast/ovarian cancer has been to provide accurate advice to at‐risk relatives. The provision of such advice has been hampered by a lack of appropriate data regarding the cancer risks. Chen and colleagues recently provided precise estimates of the relative risks of breast and ovarian cancer in almost 2000 kindreds with such mutations ascertained through familial cancer clinics across USA. The baseline incidence of breast cancer is lower in Australia than in North America. The relative risks derived from the study have been combined with Australian baseline incidence data to estimate the absolute short‐term and long‐term risks of breast and ovarian cancers for Australian carriers of different ages. The results are presented as a series of graphs that may be useful in counselling an unaffected carrier of a specified age. It is of note that the incidence of breast cancer in carriers is high in premenopausal women, but approaches the population incidence in postmenopausal women. Conversely, the incidence of ovarian cancer continues to increase from the age of 40 years. Among carriers of BRCA1 or BRCA2 mutations, the cumulative lifetime risk of developing breast cancer is 50–60% and the equivalent risk of ovarian cancer is 20–40%. An unaffected carrier aged 60 years is at greater risk of developing ovarian cancer than breast cancer. These observations have important implications for genetic counselling and decisions regarding prophylactic surgery.
DRAIN CLAMPING IN KNEE ARTHROPLASTY, A RANDOMIZED CONTROLLED TRIAL
Authors: Raleigh Eden , Hing Caroline B. , Hanusiewicz Andrew S. , Fletcher Scott A. , Price Rohan
Published: May 2007

Background:  The purpose of this study was to determine whether repeated clamping of a suction drainage system will result in less external blood loss, blood transfusion and no increase in complications compared to a routine continuous suction drainage system. This was a randomized prospective study on patients undergoing total knee arthroplasty.

Methods:  Group A patients’ drains were left clamped for all but 5 min (or 100 mL drainage) every 2 h for the first 6 h, then at 12‐h and 24‐h periods, when the drains were removed. Group B patients had continuous suction drainage. The amount of external blood loss, transfusion requirements and complications were compared between the two groups. The study group comprised 66 patients.

Results:  The mean external blood loss in the clamped drain group was 296.67 mL (standard deviation 160.28 mL) with a mean drain in situ time of 32 h, significantly less (P < 0.05) than the continuous drain group that had a mean external blood loss of 796 mL (standard deviation 250.34 mL) with a mean drain in situ time of 34 h. There was no difference in the requirements for transfusion between the two groups.

Conclusion:  We conclude that clamping drains intermittently in hybrid total knee arthroplasty results in significantly less external blood loss with no change in morbidity or mortality. This study was a level 1 therapeutic study (i.e. with level of evidence randomized control trial with a significant difference).
USEFULNESS OF INFRARED SPECTROSCOPY IN DIAGNOSIS OF ACUTE PANCREATITIS
Authors: Petrov Maxim S. , Gordetzov Alexander S. , Emelyanov Nikolay V.
Published: May 2007

Background:  The lack of a gold standard for the diagnosis of acute pancreatitis remains a problem. Our aim was to evaluate whether infrared spectroscopy of serum can establish the diagnosis of acute pancreatitis.

Methods:  Sixty‐four patients with acute pancreatitis, 112 patients with non‐pancreatic acute abdomen and 40 healthy subjects were studied. In addition to serum infrared spectral analysis, serum concentrations of amylase and lipase were measured on admission.

Results:  Infrared spectroscopy based on serum absorption patterns in the range 800–1000 nm successfully distinguished acute pancreatitis from acute abdominal disorders of extrapancreatic origin and from control specimens. The sensitivity, specificity and positive and negative predictive values of infrared spectroscopy on admission were 91, 91, 85, and 94%, respectively. Within 24 h of onset of symptoms, infrared spectroscopy, lipase and amylase showed similar areas under the ROC curves for infrared spectra of serum (0.93), lipase (0.96) and amylase (0.91).

Conclusions:  The successful classification of infrared spectra in patients with acute pancreatitis implies that the pathophysiology of disease alters the composition of the specimen in a characteristic fashion – in this case the serum make‐up reflects the presence of acute pancreatitis.
INCREASING NUMBERS OF ADMISSIONS TO THE ADULT BURNS SERVICE AT THE ROYAL ADELAIDE HOSPITAL 2001–2004
Authors: Greenwood John E. , Tee Richard , Jackson Wendy L.
Published: May 2007

Background:  The purpose of the study was to illustrate the increasing trend in the number of adult burns patients admitted to the Royal Adelaide Hospital and attempt to explain it and to describe the burn patients admitted to the Royal Adelaide Hospital in terms of age, sex, origin, cause and burn size, particularly since the increasing trend began, in an effort to identify a particular group or burn cause, which may make up a large proportion of the increasing numbers.

Methods:  A retrospective review of 1548 acute burn‐injured patients using information from the burns unit database between 1996 and 2004 was carried out.

Results:  Of 1841 total admissions, 1548 were admitted for acute burn injury. There has been an increase in the number of admissions since 2001 amounting to ∼20% per annum. The cumulative rise in total admissions 2000–2004 is 107% where the increase in acute burn admission in the same period is 82%. There appears to be no difference whether the patient is from a rural or a metropolitan area. Burns of <10% total body surface area constitute most of the increase and are mainly flame and scald injuries. Chemical and contact burns are proportionately increasing.

Conclusion:  The increase in acute admissions is mainly due to the increasing presentation of smaller burns to the unit. The statewide rural burn education programme and media exposure following the 2002 Bali bombings may have contributed to the increase in acute admissions.
BENIGN NODULAR GOITRE PRESENTING AS ACUTE AIRWAY OBSTRUCTION
Authors: Abraham Deepak , Singh Nikhil , Lang Brian , Chan Wai‐Fan , Lo Chung‐Yau
Published: May 2007

Background:  Although rare in non‐endemic areas, benign nodular goitre may cause acute airway obstruction and the clinical management of this condition remains a challenge.

Methods:  From 1996 to 2005, a total of 1115 patients underwent thyroid surgery at our institution and of these, 7 patients were identified to have a benign nodular goitre leading to acute airway obstruction. They were retrospectively reviewed with reference to the aetiology, presentation, perioperative management and postoperative outcome.

Results:  All seven patients were elderly women with a history of symptomatic goitre and concomitant medical problems. Five patients required emergency tracheal intubation, whereas two patients underwent urgent tracheostomy. Total thyroidectomy was successfully carried out for all patients and there was no hospital death. Perioperative complications included three patients with pneumonia, two with renal failure and one with perforated duodenal ulcer. Surgically related complications included transient recurrent nerve palsy in one patient and transient hypocalcaemia in four. After a median follow up of 22 months (range, 4–53 months), two patients died of cerebrovascular accident.

Conclusion:  Prompt airway protection followed by total thyroidectomy within the same hospital admission should be recommended and can be associated with favourable outcome.
MYCOBACTERIAL SOFT TISSUE INFECTIONS IN NORTH QUEENSLAND
Authors: Jackson Elizabeth , Stewart Adam , Maguire Errol J , Norton Robert E
Published: May 2007

Background:  Mycobacterial soft tissue infections are a heterogeneous group of infections that usually require a variety of therapeutic methods for cure. North Queensland has an environment, which predisposes to several such infections. The aim of this study was to assess the incidence and epidemiology of mycobacterial soft tissue infections in North Queensland and to review surgical and non‐surgical interventions in these conditions.

Methods:  This study was a retrospective review of all patients with a proven mycobacterial soft tissue infection, seen between 1997 and 2005 in a tertiary referral centre in North Queensland.

Results:  In total, 34 patients were identified. The most common causative organisms were Mycobacterium fortuitum (44%), M. ulcerans (17.6%) and M. abscessus (11.8%). The risk factors identified were the male sex, lower‐limb involvement and preceding trauma including surgery. Twenty‐four (70.6%) patients had surgical excision or debridement with a variety of adjuvant antimicrobial therapies. There were eight (23.5%) local recurrences.

Conclusion:  The optimal management of soft tissue mycobacterial infections includes early microbiological identification based on tissue biopsy, appropriate combination antimicrobial therapy and early wide surgical excision where appropriate. North Queensland has a unique environment, which may predispose to these infections. An awareness of this is essential to surgical practice in the region.
SENSATION RECOVERY IMPROVED BY GREAT AURICULAR NERVE PRESERVATION IN PAROTIDECTOMY: A PROSPECTIVE DOUBLE‐BLIND STUDY
Authors: Suen Dacita T. K. , Chow Tam‐Lin , Lam Clement Y. W. , Wong Eric S. W. , Lam Siu‐Ho
Published: May 2007

Background:  The great auricular nerve (GAN) is frequently sacrificed during parotidectomy and causes sensory disturbance of the auricle. Our study is to investigate whether GAN preservation can improve the sensory recovery.

Methods:  Patients undergoing superficial or total conservative parotidectomy for benign tumours were recruited consecutively from November 1998 to September 2001. Different sensory methods (light touch, two‐point discrimination and sharp pain) of the auricle were evaluated by a designated physiotherapist preoperatively as well as at 1, 3, 6 and 12 months postoperatively. The patients and the physiotherapist were blinded to the integrity of the GAN. Long‐term subjective assessment was also carried out beyond 2 years postoperatively.

Results:  A total of 21 patients were recruited for the study. GAN were preserved in 10 patients. The mean follow up was 16 months (12–42 months). There was no difference in sex distribution, type of operation and pathology of parotid tumour between the two groups. No postoperative mortality occurred and postoperative morbidity did not differ between the two groups. Patients with GAN preserved had significantly better light touch and sharp pain recovery at 1 year postoperatively. Subjective assessment of sensory dysfunction also favoured GAN preservation.

Conclusion:  Great auricular nerve preservation minimizes the postoperative sensory disturbance and should be considered whenever tumour clearance is not compromised.
SPHINCTER‐PRESERVING OPERATIONS WITHOUT DEFUNCTIONING STOMA
Authors: Lee Sun‐Il , Sohn Seung‐Kook , Park Yoon‐Ah
Published: May 2007

Sphincter‐preserving operations have increasingly been carried out during the last few decades; nevertheless, temporary defunctioning stoma is still being frequently used for low colorectal anastomosis (LCRA) with staplers and hand‐sewn coloanal anastomosis (CAA). From 1994 to 2003, 131 consecutive patients with rectal cancer with tumours within 7 cm from the anal verge underwent LCRA or CAA without defunctioning stoma. Anastomotic complications and treatment were compared between the groups. The median follow up was 31.4 months. Complications related to anastomosis were 10.7% for LCRA with 7.1% of anastomotic leakage (two men and two women) and 13.3% for CAA with 4.0% of anastomotic leakage (three men). Treatments for leakage included colostomy (three LCRA), CAA construction (one LCRA) and conservative treatment (three CAA). Twenty eight percent of CAA received preoperative radiation therapy, and the anastomic leakage developed in 14% of them. Anastomotic leakage and its treatment with CAA are different from those in LCRA, and CAA can safely be used without defunctioning stoma during sphincter‐preserving operation for low‐lying rectal cancer.