bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased insulin resistance and risk of incident cerebrovascular events in patients with pre‐existing atherothrombotic disease
Authors: Tanne D. , Tenenbaum A. , Boyko V. , Benderly M. , Fisman E. Z. , Matas Z. , Adler Y. , Behar S.
Published: June 2009

Background and purpose:  Diabetes and the metabolic syndrome are known risk factors for ischaemic stroke. Our aim was to examine whether amongst patients with pre‐existing atherothrombotic disease, increased insulin resistance is associated with incident cerebrovascular events.

Methods:  Patients with stable coronary heart disease included in a secondary prevention trial were followed up for a mean of 6.2 years. Coronary heart disease was documented by a history of myocardial infarction ≥6 months and <5 years before enrollment and/or stable angina pectoris with evidence of ischaemia confirmed by ancillary diagnostic testing. Main exclusion criteria were insulin treated diabetes, hepatic or renal failure, and disabling stroke. Baseline insulin levels were measured in 2938 patients from stored frozen plasma samples and increased insulin resistance assessed using the homeostatic model assessment of insulin resistance (HOMA‐IR), categorized into tertiles or quartiles.

Results:  Crude rates of incident cerebrovascular events rose from 5.0% for HOMA‐IR at the bottom tertile to 5.7% at the middle tertile, and 7.0% at the top tertile (P = 0.07). HOMA‐IR at the top versus bottom tertile was associated with an unadjusted hazard ratio (HR) of 1.37 (95%CI, 0.94–1.98) and a 1‐unit increase in the ln HOMA‐IR was associated with a HR of 1.14 (95%CI, 0.97–1.35). In further analyses adjusting for potential confounders, or categorizing baseline HOMA‐IR into quartiles, or excluding diabetic patients, we did not identify an increased risk for incident cerebrovascular events conferred by the top category.

Conclusions:  Increased insulin resistance did not predict incident cerebrovascular events amongst patients with pre‐existing atherothrombotic disease.
Plasma levels of 15d‐PGJ2 are not altered in multiple sclerosis
Authors: Comabella M. , Pradillo J. M. , Fernández M. , Río J. , Lizasoain I. , Julià E. , Moro M. A. , Sastre‐Garriga J. , Montalban X.
Published: June 2009

Background:  The 15‐deoxi delta prostaglandin J2 (15d‐PGJ2) is a peroxisome proliferator‐activated receptor‐gamma agonist with potent anti‐inflammatory properties. It has been suggested that 15d‐PGJ2 may modulate multiple sclerosis (MS).

Methods:  Here, we investigated the plasma levels of 15d‐PGJ2 by enzyme‐linked immunoassay in 28 healthy controls and 140 MS patients [30 patients with primary‐progressive MS, 28 patients with secondary‐progressive MS, and 82 patients with relapsing‐remitting MS (28 patients during clinical remission, 25 patients during relapse, and 29 treated with interferon‐beta – IFN‐β)].

Results:  Levels of 15d‐PGJ2 were similar between healthy controls and untreated MS patients with different clinical courses of the disease. Treatment with IFN‐β had no effect on levels of 15d‐PGJ2.

Conclusions:  Although these findings suggest that 15d‐PGJ2 is not involved in the acute or chronic phases of the disease, further studies measuring 15d‐PGJ2 in cerebrospinal fluid samples are needed before excluding a role of 15d‐PGJ2 in MS.
Levodopa in the treatment of Parkinson’s disease
Authors: Schapira A. H. V. , Emre M. , Jenner P. , Poewe W.
Published: June 2009

The predominant motor features of Parkinson’s disease (PD) are caused by degeneration of dopaminergic neurones and can be reversed in part or whole by dopamine replacement or augmentation strategies. Physicians have most experience with the use of levodopa, which remains the most potent oral dopaminergic treatment for PD. There are reservations about the long‐term use of levodopa, most particularly in the context of its propensity to induce motor fluctuations and dyskinesias. Strategies exist to delay or diminish these complications, but the physician must lay the basis for these in the selection of drugs for early treatment and the sequence of drugs introduced subsequently. Levodopa efficacy and duration of effect may be enhanced by combination with a catechol‐O‐methyl transferase inhibitor. Maintaining good motor function and quality of life remain the primary goals of therapy and the principle that treatment must be tailored to the individual patient’s needs is paramount.
Relevance of the genetic polymorphism of NOD1 in Chlamydia pneumoniae seropositive stroke patients
Authors: Tiszlavicz Z. , Somogyvári F. , Kocsis Á. K. , Szolnoki Z. , Sztriha L. K. , Kis Z. , Vécsei L. , Mándi Y.
Published: June 2009

Background and purpose:  Chronic infections with certain pathogens, such as Chlamydia pneumoniae, and genetic parameters that influence inflammatory reactions have been suggested to contribute to ischaemic stroke. NOD1 is a potent cytosolic receptor for C. pneumoniae. The aim of this study was to investigate the genetic polymorphism of NOD1 from the aspect of the development of stroke.

Materials and methods:  A total of 280 patients with ischaemic stroke were enrolled in the study; 150 healthy blood donors served as controls. The G796A (E266K) NOD1 polymorphism was determined by restriction fragment length polymorphism. Chlamydia pneumoniae seropositivity was tested by ELISA.

Results:  There was a significant difference in NOD1 G796A genotype distribution between the controls and the stroke patients with C. pneumoniae seropositivity. The AA homozygote and GA heterozygote mutant variants were detected in 16% (25 of 152) and in 50% (77 of 152) of the C. pneumoniae‐positive stroke patients, as compared with 8% (6 of 84), and 28% (24 of 84), respectively, in the C. pneumoniae‐positive healthy controls. (OR = 2.559; 95% CI = 1.105–6.517, P = 0.04 and OR = 2.567; 95% CI = 1.451–4.540 P < 0.001, respectively). The stroke patients with the large vessel pathology exhibited the highest frequency of the mutant allele A (51%). In contrast, amongst the C. pneumoniae‐negative subjects, no difference in genotype frequency was observed between the stroke patients and the controls.

Conclusion:  Polymorphism in NOD1 G796A alone did not prove to be a risk factor for stroke in general, but in association with C. pneumoniae infection it appeared to be accompanied by an increased risk of the development of stroke.
BDNF Val66Met polymorphism is associated with cognitive impairment in Italian patients with Parkinson’s disease
Authors: Guerini F. R. , Beghi E. , Riboldazzi G. , Zangaglia R. , Pianezzola C. , Bono G. , Casali C. , Di Lorenzo C. , Agliardi C. , Nappi G. , Clerici M. , Martignoni E.
Published: June 2009

Background and purpose:  A possible association between Parkinson’s disease (PD) and the polymorphism of Brain Derived Neurotrophic Factor (BDNF) G196A (Val66Met) has been suggested by different studies that nevertheless yielded‐contrasting result. The purpose of this study was to analyze such possible association in a cohort of Italian PD patients.

Methods:  The BDNF polymorphisms were analyzed in 294 Italian patients with PD; results were compared to those obtained in 233 age‐ and sex‐matched healthy controls (HC) enrolled from two tertiary centres in Italy. Polymorphisms were determined by Restriction Fragment Length Polymorphism (RFLP) analysis; correlations between BDNF G196A polymorphism, and cognitive function were established by sub analyzing the results upon dividing PD patients based on their Mini Mental State Examination (MMSE) score.

Results:  Univariate analysis showed a highly significant correlation between the BDNF(AA) genotype and a MMSE score ≤24. Hence, the distribution of this genotype in PD individuals with a MMSE score ≤24 was significantly increased compared to PD patients with an MMSE score >24 and HC (P < 0.001 in both cases). Multivariate analyses showed that BDNF (AA) genotype was associated to a sixfold risk of cognitive impairment.

Conclusions:  The BDNF(AA) homozygote genotype is over‐represented in PD patients compared with normal individuals; this genotype was significantly correlated to cognitive impairment, age and disease severity. These results, although preliminary, could be important in establishing novel diagnostic and therapeutic approaches to PD.
Cognitive and cerebral hemodynamic impairment in scleroderma patients
Authors: Giuliodori G. , Fraticelli P. , Bartolini M. , Cagnetti C. , Baruffaldi R. , Rocchi M. B. L. , Provinciali L. , Gabrielli A. , Silvestrini M.
Published: June 2009

Background and purposes: Neurological involvement in systemic sclerosis is unusual despite the possible cerebral localization of vascular lesions. The aim of this study was to evaluate cognitive performances and cerebral vasoreactivity in young scleroderma patients without any signs or symptoms of nervous system involvement.

Methods: Sixteen scleroderma patients and 16 sex‐ and age‐matched healthy subjects without vascular risk factors were included. A neuropsychological assessment for the evaluation of different areas of cognition was performed. For an assessment of cerebrovascular reactivity (CVR), each subject was submitted to hypercapnia with transcranial Doppler ultrasonography using the Breath‐Holding Index (BHI).

Results: Patients had significantly lower adjusted mean levels of performance with respect to controls in the Modified Card Sorting Test (P < 0.001) and in the Trail Making Test Parts A and B (P < 0.001 andP < 0.05 respectively). Regarding CVR, BHI values were significantly lower in patients with respect to controls: 0.82 ± 0.44 vs. 1.34 ± 0.18,P < 0.0001.

Conclusions: These findings show the presence of reduced performances of executive functions in scleroderma patients. The associated alteration of CVR in the absence of other apparent causes of cerebrovascular impairment suggests that cognitive problems may be related to an alteration in cerebral perfusion regulation specifically linked to the disease. Further studies are needed to evaluate whether cognitive changes may be positively influenced by treatments aimed to improve vessels functionality in scleroderma patients.
Trends in Parkinson’s disease related mortality in England and Wales, 1993–2006
Authors: Mylne A. Q. N. , Griffiths C. , Rooney C. , Doyle P.
Published: June 2009

Background:  This paper describes changes in Parkinson’s disease (PD) mortality in England and Wales between 1993 and 2006 using all information on death certificates.

Methods:  Information on deaths was obtained from the Office for National Statistics. Mortality rates for any mention of PD on death certificates were directly age‐standardized using the European standard population. Average yearly changes in mortality rates were estimated using linear regression. The underlying cause of death on death certificates where PD was mentioned was examined by sex and calendar period.

Results:  Male PD age‐standardized mortality rates for any mention of PD decreased from 15.0 to 11.7 per 100 000 between 1993 and 2006. Female PD mortality rates fell from 6.3 to 4.9 per 100 000. Decreases were greater for older age‐groups. The proportion of deaths with PD recorded as the underlying cause increased by 50% in 2001 following implementation of the 10th revision of the International Classification of Diseases (ICD).

Conclusion:  Parkinson’s disease mortality rates in England and Wales are decreasing, especially for men and for older age‐groups. Because of data limitations we are unable to ascertain whether the decrease of PD recorded on death certificates is because of a reduction in PD incidence, or to improved survival for PD patients resulting from advancements in PD treatments or to improvements in general medical care. The dramatic increase in PD as the underlying cause of death following ICD revision in 2001 demonstrates the dangers of using underlying cause of death to investigate mortality trends without being aware of the potential for artifacts.
Cell proliferation and death in the brain of active and hibernating frogs
Authors: Cerri Silvia , Bottiroli Giovanni , Bottone Maria Grazia , Barni Sergio , Bernocchi Graziella
Published: June 2009

‘Binomial’ cell proliferation and cell death have been studied in only a few non‐mammalian vertebrates, such as fish. We thought it of interest to map cell proliferation/apoptosis in the brain of the frog (Rana esculenta L.) as this animal species undergoes, during the annual cycle, physiological events that could be associated with central nervous system damage. Therefore, we compared the active period and the deep underground hibernation of the frog. Using western blot analysis for proliferating cell nuclear antigen (PCNA), we revealed a positive 36 kDa band in all samples and found higher optical density values in the hibernating frogs than in active frogs. In both active and hibernating frogs, we found regional differences in PCNA‐immunoreactive cells and terminal transferase dUTP nick‐end labelling apoptotic cells in the ventricular zones and parenchyma areas of the main encephalon subdivisions. During the active period of the frogs, the highest concentration of PCNA‐immunoreactive cells was found in the ventricle dorsal zone of the cerebral hemispheres but only some of the cells were apoptotic. By contrast, the tectal and cerebellar ventricular zones had a small or medium amount of PCNA‐immunoreactive cells, respectively, and a higher number of apoptotic cells. During hibernation, an increased PCNA‐immunoreactive cell number was observed in both the brain ventricles and parenchyma compared with active frogs. This increase was primarily evident in the lateral ventricles, a region known to be a proliferation ‘hot spot’. Although differences existed among the brain areas, a general increase of apoptotic cell death was found in hibernating frogs, with the highest number of apoptotic cells being detected in the parenchyma of the cerebral hemispheres and optic tectum. In particular, the increased number of apoptotic cells in the hibernating frogs compared with active frogs in the parenchyma of these brain areas occurred when cell proliferation was higher in the corresponding ventricular zones. We suggest that the high number of dying cells found in the parenchymal regions of hibernating frogs might provide the stimulus for the ventricular zones to proliferate. Hibernating frogs could utilize an increased cell proliferation in the brain areas as a neuroprotective strategy to face cell death and the onset of neurological damages. Therefore, the hibernator promises to be a valuable model for studying the mechanisms naturally carried out by the central nervous system in order to adapt itself or survive adverse conditions.
Development of the stapedius muscle and pyramidal eminence in humans
Authors: Rodríguez‐Vázquez J. F.
Published: June 2009

The aim of the study was to systematize the key developmental phases of the stapedius muscle and the pyramidal eminence to clarify their formation, as well as to understand the variations and anomalies that can affect these structures. Sixty human embryos and fetuses between 38 days and 17 weeks of development were studied. The stapedius muscle is formed by two anlagen, one for the tendon, which derives from the internal segment of the interhyale, and another for the belly, located in the second pharyngeal arch medial to the facial nerve and near the interhyale but forming a completely independent anlage. In the interhyale, two segments were differentiated, these forming an angle; at the vertex, the belly of the stapedius muscle is attached. The internal segment is located from the attachment of the belly of the stapedius muscle to the anlage of the stapes, forming the anlage of the tendon of the stapedius muscle. The external segment completely disappears at the beginning of the fetal period. The pyramidal eminence is formed by an anlage independent of Reichert’s cartilage, from the mesenchymal tissue of the tympanic cavity, which condenses around the belly of the stapedius muscle from 12 weeks of post‐conception development. The length of the tendon of the stapedius muscle in adults varies, depending on the attachment site of the belly of the stapedius muscle in the interhyale, which would determine the length of the internal segment (anlage of the tendon) and consequently the tendon length. This variation depends on the greater or lesser persistence of the angulation observed during development, between the tendon and the belly of the stapedius muscle.
The pattern of endocranial ontogenetic shape changes in humans
Authors: Neubauer Simon , Gunz Philipp , Hublin Jean‐Jacques
Published: June 2009

Humans show a unique pattern of brain growth that differentiates us from all other primates. In this study, we use virtual endocasts to provide a detailed description of shape changes during human postnatal ontogeny with geometric morphometric methods. Using CT scans of 108 dried human crania ranging in age from newborns to adults and several hundred landmarks and semi‐landmarks, we find that the endocranial ontogenetic trajectory is curvilinear with two bends, separating three distinct phases of shape change. We test to what extent endocranial shape change is driven by size increase and whether the curved ontogenetic trajectory can be explained by a simple model of modular development of the endocranial base and the endocranial vault. The hypothesis that endocranial shape change is driven exclusively by brain growth is not supported; we find changes in endocranial shape after adult size has been attained and that the transition from high rates to low rates of size increase does not correspond to one of the shape trajectory bends. The ontogenetic trajectory of the endocranial vault analyzed separately is nearly linear; the trajectory of the endocranial base, in contrast, is curved. The endocranial vault therefore acts as one developmental module during human postnatal ontogeny. Our data suggest that the cranial base comprises several submodules that follow their own temporally and/or spatially disjunct growth trajectories.
Bioactive TGF‐β can associate with lipoproteins and is enriched in those containing apolipoprotein E3
Authors: Tesseur Ina , Zhang Hui , Brecht Walter , Corn Jacob , Gong Jian‐Sheng , Yanagisawa Katsuhiko , Michikawa Makoto , Weisgraber Karl , Huang Yadong , Wyss‐Coray Tony
Published: June 2009

Transforming growth factor‐β1 (TGF‐β1) has central functions in development, tissue maintenance, and repair and has been implicated in major diseases. We discovered that TGF‐β1 contains several amphipathic helices and hydrophobic domains similar to apolipoprotein E (apoE), a protein involved in lipoprotein metabolism. Indeed, TGF‐β1 associates with lipoproteins isolated from human plasma, cultured liver cells, or astrocytes, and its bioactivity was highest in high‐density lipoprotein preparations. Importantly, lipoproteins containing the apoE3 isoform had higher TGF‐β levels and bioactivity than those containing apoE4, a major genetic risk factor for atherosclerosis and Alzheimer’s disease. Because TGF‐β1 can be protective in these diseases an association with apoE3 may be beneficial. Association of TGF‐β with different types of lipoproteins may facilitate its diffusion, regulate signaling, and offer additional specificity for this important growth factor.
Inhibition of tau fibrillization by oleocanthal via reaction with the amino groups of tau
Authors: Li Wenkai , Sperry Jeffrey B. , Crowe Alex , Trojanowski John Q. , Smith III Amos B , Lee Virginia M.‐Y.
Published: June 2009

Tau is a microtubule‐associated protein that promotes microtubule assembly and stability. In Alzheimer’s disease and related tauopathies, tau fibrillizes and aggregates into neurofibrillary tangles. Recently, oleocanthal isolated from extra virgin olive oil was found to display non‐steroidal anti‐inflammatory activity similar to ibuprofen. As our unpublished data indicates an inhibitory effect of oleocanthal on amyloid β peptide fibrillization, we reasoned that it might inhibit tau fibrillization as well. Herein, we demonstrate that oleocanthal abrogates fibrillization of tau by locking tau into the naturally unfolded state. Using PHF6 consisting of the amino acid residues VQIVYK, a hexapeptide within the third repeat of tau that is essential for fibrillization, we show that oleocanthal forms an adduct with the lysine via initial Schiff base formation. Structure and function studies demonstrate that the two aldehyde groups of oleocanthal are required for the inhibitory activity. These two aldehyde groups show certain specificity when titrated with free lysine and oleocanthal does not significantly affect the normal function of tau. These findings provide a potential scheme for the development of novel therapies for neurodegenerative tauopathies.
Immunotherapy for allergic rhinitis: clinical benefits and its working mechanisms
Authors: Nakai Y. , Ohashi Y.
Published: June 2009

Pollen immunotherapy exerts greater efficacy in the pollen season when the pollen count is not high than when it is high. Every pollen season, around half or more patients who have received pollen immunotherapy for >5 years are judged as good responders; those who have received immunotherapy for <5 years generally do less well. Therefore, the clinical response seems to depend on natural pollen counts and the duration of immunotherapy. In this study, peripheral blood mononuclear cells (PBMCs) were sampled before and during the pollen season to examine IL‐4, IL‐5, and IFN‐γ levels. It was revealed that pollen immunotherapy could decrease IL‐4 and ‐5 expression by pollen antigen‐stimulated PBMCs. When patients under immunotherapy were divided into good and poor response groups, clinical effectiveness was related to the depressed level of IL‐5 synthesis, but not to that of IL‐4 synthesis. Our study suggests that a decrease of IL‐5 expression during the pollen season is a key working mechanism of immunotherapy related to clinical effectiveness. In our patients, the incidence of systemic reactions was 5.8%/patient and <0.1%/injection. A higher incidence of systemic reactions was observed in patients with the presence or a past history of asthma, the presence but not a past history of atopic dermatitis, and higher levels of total IgE (>1000 U/mL). The incidence of systemic reactions in patients with 1 risk factor such as asthma, atopic dermatitis, and high IgE was 16.9%/patient and 0.1%/injection, whereas that in those without risk factors was 1.6%/patient and <0.1/injection.
Immunotherapy for cure and prophylaxis of allergic rhinitis
Authors: Ohashi Y. , Nakai Y.
Published: June 2009

The possible cure of Japanese cedar pollen‐induced allergic rhinitis (AR) by immunotherapy was investigated. The mechanism of cure was also studied from the viewpoint of the T cell response to allergen; it was documented that absence of IL‐5 production from allergen‐stimulated T cells was the major mechanism. The prophylactic aspect of immunotherapy was also investigated. Eighty‐eight asymptomatic subjects who were already sensitized to pollen were recruited. Of these subjects, 31 (prophylactic immunotherapy group) were treated with pollen immunotherapy for 3 years. The remaining 57 individuals (control group) were not treated with pollen immunotherapy. At the end of the 3‐year trial, only 28 of 57 individuals (49.1%) in the control group remained asymptomatic. On the other hand, 27 of 31 individuals (87.1%) in the prophylactic immunotherapy group remained asymptomatic. Prophylactic immunotherapy decreased IL‐4 synthesis from pollen allergen‐stimulated T cells, suggesting that this was the mechanism of prevention of symptoms' outbreak. We next examined whether mite immunotherapy for patients monosensitized to mite allergen could prevent new sensitization to pollens. A total of 132 patients monosensitized to house dust mites were included. Of these individuals, 52 (pharmacotherapy group) were treated with antihistamine tablets for 4 years, and the remaining 80 patients (mite immunotherapy group) were treated with mite immunotherapy for the same time period. Whereas 15 of 52 patients (28.8%) in the pharmacotherapy group attained new sensitization to some kinds of pollen allergens, only five of 80 patients (6.3%) in the mite immunotherapy group attained new sensitization. Our data suggest that mite immunotherapy can prevent new sensitization to pollen allergens. It is therefore concluded that pollen immunotherapy cannot only cure pollen‐induced AR but also prevent outbreaks of pollen‐induced AR, and that mite immunotherapy can prevent new sensitization to pollen allergens.
What has the relief of allergic conjunctivitis by intranasal steroids taught us about the pathophysiology of allergic rhinoconjunctivitis?
Authors: Naclerio R. , Baroody F.
Published: June 2009

Patients with allergic rhinitis (AR) report ocular symptoms 40–70% of the time. These symptoms can be burdensome and have a major impact on patients' quality of life. Most clinicians believe that ocular symptoms result from direct contact of allergen with the conjunctiva, although other explanations such as a nasal‐ocular reflex, blockage of the nasal lacrimal duct, and systemic effects of cytokines released from the nasal mucosa can explain the association. However, if direct contact by an allergen is the sole explanation, how do we explain the efficacy of intranasal steroids on the eye symptoms of AR, especially because most intranasal steroids have <0.5% systemic bioavailability? This paper highlights a potential mechanism for the development of ocular symptoms after nasal exposure to antigen, the nasal‐ocular reflex, and speculates how intranasal steroids can affect this reflex and eye symptoms. Two nasal‐challenge studies assessing the nasal‐ocular reflex are presented. The first shows the presence of a nasal‐ocular reflex in response to localized nasal‐antigen challenge, which is initiated by the release of histamine and blocked by a topical, intranasal antihistamine. The second study shows that the nasal‐ocular reflex is augmented with repeated nasal antigen challenge, a response that is inhibited by pretreatment with an intranasal steroid. These studies provide an explanation for the way in which treatment with intranasal steroids can work locally in the nose to reduce ocular symptoms in patients with AR. This explanation, however, would only be valid if the majority of eye symptoms in patients with AR were caused by the nasal‐ocular reflex and not by direct contact of antigen with the conjunctiva – an assumption supported by clinical studies.
Surgical treatment of the inferior turbinate for allergic rhinitis: clinical evaluation and therapeutic mechanisms of the different techniques
Authors: Takeno S. , Hirakawa K. , Ishino T. , Goh K.
Published: June 2009

Many different surgical procedures have been described to alleviate nasal obstruction due to turbinate hypertrophy in patients with allergic rhinitis (AR) who continuously have chronic nasal congestion. The goal of surgical procedures should be ‘optimal reduction of volume and secretion with preservation of function’. For a period of about 25 years, laser surgery of the inferior turbinate has been considered a simple and effective surgical treatment with a low complication rate that has been in widespread use by many ENT surgeons. Various trials have demonstrated the clinical effectiveness of a series of different laser systems including carbon dioxide, Nd:YAG, potassium‐titanyl‐phosphate, and diode laser. Laser surgery generally induces significant increases of the total volume of the nasal cavity. Several studies have provided evidence that the expression degree of local inflammatory cytokines and chemical mediators can be attenuated by the treatment. The mucociliary function of the inferior turbinate seems to be preserved after CO2 laser intervention. A breakthrough in the surgical procedures available for allergic patients who severely suffer from both intractable hypertrophic inferior turbinates and unregulated nasal secretion was introduced in Japan. Posterior nasal neurectomy is a novel alternative method in which neural bundles are selectively cut or cauterized from the sphenopalatine foramen. Resection of the posterior nasal nerve at this point enables surgeons to inhibit the parasympathetic nerve function of the nasal mucosa with no troublesome complications such as decrease of lacrimal secretion. The procedure simultaneously provides interruption of the somatic afferent innervation to the turbinate mucosa. Herein we assess the clinical effectiveness of this surgical procedure based on objective and measurable monitoring parameters and discuss the underlying therapeutic mechanisms.
Grasping the nutritional situation: a grounded theory study of patients’ experiences in intensive care
Authors: Persenius Mona W , Hall‐Lord Marie L , Wilde‐Larsson Bodil
Published: June 2009

Aim and objectives:  The aim of this study was to provide a theoretical understanding of nutritional experiences for patients with enteral nutrition (EN) during their stay in the intensive care unit (ICU).

Background:  It is well known that EN can result in underfeeding for patients in ICUs. How the patients experience their nutritional care during their stay in the ICU remains somewhat unclear.

Design and methods:  In this study, a grounded theory approach was chosen to conduct and analyse 14 interviews with patients and 21 observations of nutritional care during the patients’ stay in an ICU.

Findings:  The core category ‘grasping nutrition during the recovery process’ was reflected in, and related to, the categories ‘facing nutritional changes’, ‘making sense of the nutritional situation’ and ‘being involved with nutritional care’. While grasping the nutrition, the patients were emotionally shifting between worry, fear and failure, and relief and hope. Turning points were having the appetite back, getting rid of the feeding tube and regaining a functioning gut.

Conclusions:  The patients’ views of nutritional care during their stay in the ICU may contribute to understanding of how patients make sense of their nutritional changes and how they are involved in their nutritional care. This study shows that grasping the nutrition can be a way to regain some control in a situation where the patients are highly dependent on professional care. Further research is needed to develop this substantive theory in other intensive care settings to support patients’ nutritional journey in intensive care.

Relevance to clinical practice:  Nurses can promote patients’ abilities to grasp their nutritional situation during their recovery process. There is a need to focus not only on the patients’ physical needs but also on their emotional and social needs.
Communication, swallowing and feeding in the intensive care unit patient
Authors: Batty Sally
Published: June 2009

Background:  It is not uncommon for patients requiring a period of time in the intensive care unit (ICU) to experience difficulties with communication and/or swallowing, either as a result of their illness or as a result of the treatments they receive. These difficulties can be both short term and long term and require timely and appropriate intervention in order to improve the patient’s experience and expedite recovery/rehabilitation.

Aims:  The purpose of this article is to provide critical care nurses with an update on aspects of communication, swallowing and feeding in the ICU. The paper will focus on each area in relation to the current evidence base and factors of ‘best practice’ (as determined by expert opinion).

Implications for critical care nursing practice: 

Enabling communication can improve well‐being, increase compliance and reduce length of stay;

Simple modes of communication, e.g. writing/gesture/pictures can be very effective;

Coded eye blinking may be unreliable because of confusion with reflexive blinking;

Non‐oral nutrition will generally not meet the psychological and physical needs and benefits of oral intake;

Not all patients with a tracheostomy in situ will experience dysphagia; however, those considered ‘at risk’ should have their swallow assessed by an appropriately trained professional, e.g. speech and language therapist/dysphagia trained professional;

An inflated tracheostomy cuff will not prevent aspiration. The decision to commence oral intake in the presence of an inflated cuff should be made as a team and take into consideration the patient’s medical and psychological status;

The use of blue dye to assess the swallow carries a high false‐negative rate and cannot be relied on alone to predict either the presence or the absence of aspiration.

Conclusion:  There is still much more research to be performed and evidence to be gained regarding the input into communication, swallowing and feeding in the ICU; however, a full‐team approach to these areas can have very positive effects on the patient’s experience.
Quick change versus double pump while changing the infusion of inotropes: an experimental study
Authors: De Barbieri Ilaria , Frigo Anna C , Zampieron Alessandra
Published: June 2009

Background:  Quick change (QC) and double pumping (DP) are common methods of substituting the infusion of inotropes given through intravenous pump.

Aims:  The aim of the study was to compare two methods in respect with the variation in mean arterial pressure (MAP). The hypothesis was that the DP method could be the most effective in achieving haemodynamic stability.

Design:  The study is a randomized research in an open randomized clinical trial.

Methods:  The study took place at the Paediatric Intensive Care Unit of Padua Hospital. It considered patients of 0–36 months, not premature, treated with inotropic infusion with monitoring of blood pressure. The research obtained the approval of the Hospital Research Ethics committee and parents signed informed consent. Comparison of the two groups made use of the Wilcoxon test for the continuous variables and the Fisher’s exact test for the comparison of frequencies, at significance value of 5%. The data were registered in an Excel spreadsheet and analysed with SAS.

Results:  The sample comprised 30 patients of age between 1 and 27 months, of whom 13 (43%) were male. They were all affected by cardiac, respiratory or infective pathology, all of them intubated and on artificial respiratory support, sedated and infused with dopamine. The characteristics of the patients of the two groups did not differ significantly. The percentage variation of the baseline value of MAP after 30 min from starting the treatment between the two methods was not statistically significant (p = 0·85). The 95% confidence interval for the difference in the percentage variation of MAP between the two groups was (−3·1, +3·7). From a clinical perspective, the methods are to be considered equivalent.

Conclusions:  The study was conducted on a limited sample; no statistically significant differences were detected; QC is the quickest and more cost‐effective method.
Acute kidney injury and renal replacement therapy in the intensive care unit
Authors: Faber Peter , Klein Andrew A
Published: June 2009

Background:  Renal replacement therapy (RRT) is now offered as a routine treatment in most intensive care units (ICU) in the UK for patients suffering from acute kidney injury (AKI). It is important for all ICU staff to understand the underlying principles of the available therapeutic options and the possible complications thereof.

Aims and objectives:  The objective of this review was to provide an accessible theoretical and practical update on the management of RRT. In addition to a detailed discussion of the underlying principles and indications for the various modes of RRT, we will discuss the assessment of kidney function, possible complications and anticoagulation during RRT, following a review of the current literature.

Search strategies:  Pubmed, Medline and the Cumulative Index to Nursing and Allied Health Literature were searched using the keywords renal function, RRT, dialysis, renal failure kidney injury, together with intensive care, intensive therapy and critical care. We included only studies published in English from 1998 to 2008 and from these identified and included additional publications. The 12 most relevant publications are referenced in this review.

Conclusion:  AKI is associated with increased mortality in ICU, and RRT should be considered early in the disease process. Continuous haemofiltration is the most common modality of treatment in this group of patients, and a detailed knowledge of the management of such patients is required.
Earplugs improve patients’ subjective experience of sleep in critical care
Authors: Scotto Carrie J , McClusky Carol , Spillan Scott , Kimmel Justin
Published: June 2009

Aims:  This study aimed to determine the effects of earplug use on the subjective experience of sleep for patients in critical care.

Background:  The negative effects of noise in critical care include sleep disturbances, increased stress response, and reduced patient satisfaction. The nature of critical care often precludes quiet time protocols. Previous studies indicated that earplugs can improve REM sleep and sleep efficiency. This study examined the effects of earplugs as a non‐invasive method for improving the subjective sleep experience and increasing patient satisfaction.

Design:  Quasi‐experimental intervention study with random assignment of subjects.

Method:  Subjects were non‐ventilated, non‐sedated adults admitted to critical care. The intervention group used earplugs during nighttime sleep hours allowing short term removal during patient care. Participants completed the Verran‐Snyder‐Halpern Sleep Scale, an 8‐question visual analogue scale, to describe their subjective response to sleep. Two sample T‐tests were used to detect differences between the group scores.

Results:  88 participants (49 intervention/39 control) completed the study. Mean age 63, 56% males, 93% Caucasian. Total sleep satisfaction scores were significantly better for the intervention group (p = .002). Seven of the subjective categories were independently significant (p = .005‐.044). One category, satisfaction with the amount of time needed to fall asleep, was not significant (p = .111).

Conclusions:  Earplug use improved the subjective experience of sleep for un‐medicated critical care patients without interfering with care delivery.

Relevance to Practice:  The negligible cost and low level of invasiveness of earplugs makes this preferable as a primary intervention to promote sleep while avoiding unnecessary sedating medications.
Evaluation of chronic hypertension in pregnant young women
Authors: DE SOUSA Joana , EAGLETON Carl , LO Chern
Published: June 2009

Women with chronic hypertension are at higher risk of adverse obstetric outcomes. It is essential that the condition is identified and evaluated appropriately in early pregnancy. Therefore, an audit has been carried out to assess how well young pregnant women with chronic hypertension were investigated for secondary cause in South Auckland, compared with the recommendations of the Australasian Society for the Study of Hypertension in Pregnancy.

The evaluation of chronic hypertension by history taking, physical examination, laboratory assessment and radiology tests was highly variable. Only 76% of women had appropriate follow‐up for their hypertension. Screening for secondary causes was not consistent, and the majority had incomplete investigation.
The effect of the levonorgestrel releasing intrauterine system on endometrial hyperplasia: An Australian study and systematic review
Authors: BUTTINI Melissa J. , JORDAN Susan J. , WEBB Penelope M.
Published: June 2009

Background: The levonorgestrel intrauterine system (LNG‐IUS) provides effective contraception and treatment for menorrhagia and is used to prevent endometrial hyperplasia (EH) in women taking unopposed oestrogens.

Aims: The aim of this study was to assess whether the LNG‐IUS was also a safe and effective treatment for EH and to conduct a systematic review of the literature.

Methods: A retrospective record review was undertaken in a private gynaecology practice in Brisbane, Australia, and included all women with EH treated with hysterectomy, oral progestins or LNG‐IUS between January 2004 and April 2007. Histopathological findings from hysterectomy specimens or endometrial biopsies were used to calculate rates of regression of the EH.

Results: Twenty‐one women elected to have a hysterectomy and seven of those (33%) had no persisting hyperplasia at surgery. Twenty‐six women had a LNG‐IUS inserted at initial hysteroscopy dilatation and curettage or shortly afterwards; seven of those elected to proceed to hysterectomy when their diagnosis was known. Among ten women who used oral progestin treatment, 90% showed initial regression; two with recurrent EH were subsequently treated successfully with LNG‐IUS. All 21 women (100%), including one with atypia, treated with LNG‐IUS for more than seven weeks had normal endometrial histology on subsequent assessment. No women developed endometrial cancer. Pooled analysis of the published literature gave a 96% regression rate for non‐atypical EH treated with LNG‐IUS.

Conclusions: These data contribute further evidence that LNG‐IUS is a safe and effective method for treating non‐atypical EH. Whether LNG‐IUS could provide a safe and cost‐effective alternative to hysterectomy for atypical EH warrants further examination.
Population rates of haemorrhage and transfusions among obstetric patients in NSW: A short communication
Authors: ROBERTS Christine L. , FORD Jane B. , THOMPSON Jane F. , MORRIS Jonathan M.
Published: June 2009

We estimated the population rates of obstetric haemorrhage and transfusion among women giving birth, utilising data collected in a review of the delivery admissions of 1200 randomly selected women in New South Wales in 2002. The estimated population obstetric haemorrhage rate was 13.1% (11.4% post‐partum haemorrhage (PPH), 2.2% antepartum haemorrhage) and the transfusion rate was 1.06% (0.9% vaginal births, 1.6% of caesarean sections). When variations in definitions and denominators were accounted for, the difference in PPH rates among vaginal births (13.1%) and caesarean sections (6.3%) disappeared, suggesting PPH is under‐ascertained for women delivered by caesarean section.
Reclassification of unexplained stillbirths using clinical practice guidelines
Authors: HEADLEY Elizabeth , GORDON Adrienne , JEFFERY Heather
Published: June 2009

Background: Twenty‐eight per cent of stillbirths in Australia remain unexplained. A clinical practice guideline (CPG) produced by the Perinatal Society of Australia and New Zealand (PSANZ) Perinatal Mortality Special Interest Group is in use to assist clinicians in the investigation and audit of perinatal deaths.

Aims: To describe in a tertiary hospital using the PSANZ stillbirth investigation guidelines: (i) the distribution and classification of stillbirths, and (ii) the compliance with suggested stillbirth core investigations.

Methods: Retrospective cohort of all stillbirths delivered between November 2005 and March 2008. Stillbirths were defined as no sign of life on delivery at ≥ 20 weeks gestation or 400 g birthweight if gestation is unknown. Data were collected via the hospital Perinatal Mortality Audit Committee (PMAC). Cause of death was classified by the PSANZ Perinatal Death Classification.

Results: There were 86 stillbirths (rate 7.2 per 1000 births). The percentage of unexplained stillbirths was 34% and 13% before and after CPG investigations, respectively. Unexplained stillbirths had the highest compliance with the recommended investigations. The initial cause of death documented on the death certificate was changed by the PMAC in 19 cases. The investigations most likely to prompt a change in the cause of death classification were autopsy and placental pathology.

Conclusions: The percentage of unexplained stillbirths is lower than the national average in a hospital using the Perinatal Mortality Audit Guidelines. However, overall compliance is low, suggesting a targeted approach to investigation is used by clinicians despite a policy that aims to be non‐selective. Autopsy and placental examination are the most useful investigations in assisting formal classification of cause of death.
The value of laparoscopic skills courses
Authors: CONDOUS George , ALHAMDAN Dalya , BIGNARDI Tommaso , VAN CALSTER Ben , VAN HUFFEL Sabine , TIMMERMAN Dirk , LAM Alan
Published: June 2009

Objectives: To evaluate the effectiveness of ‘hands‐on’ laparoscopic skills course.

Methods: A prospective observational study conducted between May 2005 and June 2006. All gynaecologists who attended ‘hands‐on’ laparoscopic skills course held over a five‐day period were assessed initially and at the end of the intensive course. Subjective assessment involved each attendee self‐scoring their own knowledge in laparoscopy in different fields; this was done using visual analog scoring (VAS). Objective assessment was done through multiple choice questions (MCQs) and motor skill tasks. The difference between the performances of each of the candidates at pre‐ and post‐course periods was evaluated using the Wilcoxon signed rank test. P‐values < 0.05 represented statistical significance.

Setting: Centre for Advanced Reproductive Endosurgery (CARE), Royal North Shore Hospital, University of Sydney, Sydney, Australia.

Results:  Twenty‐four consecutive gynaecologists have been enrolled in the study – 14 were specialists and ten were obstetrics and gynaecology trainees. Mean age was 44.4 years (range 35–58 years). Pre‐ and post‐course subjective assessment measuring VAS improved significantly for all variables. Objective measurements of pre‐ and post‐course mean MCQ results also improved significantly from 71% to 84.5%, respectively (P‐value < 0.0001). There was dramatic improvement in the performing of motor skills in the dry laboratory.

Conclusions: Laparoscopic skills workshops can improve both knowledge base and motor skills. Such courses result in a short‐term measurable improvement. Future studies should focus on assessing the impact of such ‘hands‐on’ courses to see if these skills are transferred to the operating room.
Cervical parakeratosis/hyperkeratosis as an important cause for false negative results of Pap smear and human papillomavirus test
Authors: XIAO Guang‐Qian , EMANUEL Patrick O. M.
Published: June 2009

Like any screening method, Pap and HPV tests are subject to false negative results.

Aim: We investigated the possible relationship between cervical parakeratosis/hyperkeratosis and a false negative result for both Pap and human papillomavirus (HPV) testing.

Methods: A total of 551 cases with diagnostically adequate cervical biopsies and Pap tests performed concurrently were examined.

Results: The vast majority of the cases (75.5%) were of concordance in diagnosis. Among the 135 discordant diagnoses were 98 with low‐grade squamous intraepithelial lesion (LSIL) biopsy and negative Pap test and 34 with negative biopsy and LSIL Pap test. With rare exceptions, no significant discordance between concurrent biopsy and Pap test was found in the cases of high‐grade squamous intraepithelial lesion (HSIL). Cervical parakeratosis/hyperkeratosis was noted in 87.8% of the LSIL biopsies with concurrent negative Pap tests. An 83.3% HPV‐negative rate was also observed in this group. By comparison, parakeratosis/hyperkeratosis was less frequent (62.6%) in the SIL biopsies with concordant concurrent SIL Pap tests and usually seen focally when present. The negative HPV rates for these concordant LSIL and HSIL groups were 12.7% and 0.0%, respectively.

Conclusion: Cervical parakeratosis/hyperkeratosis is an important cause for the negative results of Pap and HPV tests in LSIL, and practising gynaecologist and pathologist should be aware of this possible diagnostic dilemma.