bluuebunny/crossref_metadata_2025 huggingface dataset:
The Young Person's CORE: Development of a brief outcome measure for young people
Authors: Twigg Elspeth , Barkham Michael , Bewick Bridgette M. , Mulhern Brendan , Connell Janice , Cooper Mick
Published: August 2009

Background: There is a need for a user‐friendly measure of change for use in school and youth counselling services which is easy for practitioners to administer and score, and which is appropriate for brief interventions. Aims: To develop such a measure and to present psychometric data on reliability, validity and sensitivity to change for the measure. Method: We employed a three‐stage approach: first, creating a pool of potential items; second, developing an 18‐item version; and third, refining to a final version comprising 10 items. We called the measure the Young Person's CORE (YP‐CORE). Results: The measure comprised eight negative and two positive items and included a single (negatively‐framed) risk‐to‐self item. Psychometric properties were all acceptable. Sensitivity to change was good and yielded an average improvement of 10 points on the YP‐CORE in a clinical group, broadly equivalent to changes in adult versions (e.g. Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE‐OM)). Conclusion: Initial validation work showed the measure to be well designed and sensitive to change. Analysis showed considerable variability as a function of age and gender suggesting the need for the collection of a large and diverse data set in order to produce gender and age‐specific norms.
School counsellors' and teachers' perceptions of their students' problems: Shared and divergent views
Authors: Tatar Moshe , Bekerman Zvi
Published: August 2009

Primary objective: This study investigates how school counsellors and teachers perceive their adolescent students’ problems and identifies the professional practices that allow them to understand and deal with these problems. Methods and procedures: An open‐ended questionnaire was administered to 38 Israeli senior‐high school counsellors and to 38 homeroom teachers working in educational institutions representing a variety of Jewish Israeli student populations. Results: Learning problems were identified by the counsellors and teachers as the main challenges for the students. The majority of the counsellors attribute students’ problems to the individuals themselves relying mainly on teachers’ reports. Teachers base their perceptions and assessments on direct observation of their students’ behaviours. Conversational techniques are the most preferred professional practices for tackling students’ problems. Conclusions: The importance of collaboration and team work between school counsellors and teachers and the parameters relevant for developing and promoting this collaboration more effectively are proposed and discussed.
Secondary school students’ preferences for school counsellors to be of the same ethnic origin as themselves
Authors: Chan Stephanie , Quinn Philip
Published: August 2009

Aims: This study looked at whether secondary school students would rather see a counsellor of the same ethnic origin as themselves, and whether this varied by ethnicity and gender. Method: A questionnaire survey was conducted with 761 students participating from two Glasgow secondary schools and four Belfast secondary/grammar schools. The study investigated participants’ responses to the question ‘Do you prefer speaking to a counsellor who is of the same ethnic origin as you?’ Results: Overall, the study found that 26.6% of students would rather see a counsellor of similar ethnic origin, 5.5% would rather not, 14.8% were not sure, and 53.1% did not mind. Students of white, Black and Minority Ethnic (BME) and non‐specific ethnic origins did not differ significantly in how much they would rather see a counsellor from their own ethnic background; but students of a BME background were approximately three times more likely to express a preference for a counsellor not of their ethnic origin as compared with white students. It was also found that twice as many male students would prefer not to see a counsellor of the same ethnic origin as themselves, as compared with female students. Implications of these findings are discussed in relation to other research and methodological limitations of this study are considered.
Secondary school students' preferences for location, format of counselling and gender of counsellor: A replication study based in Northern Ireland
Authors: Quinn Philip , Chan Stephanie
Published: August 2009

Aims: This study replicates a research investigation conducted by Cooper (2006), examining three factors that may affect students’ willingness to attend a school‐based counselling service: location of the service (school‐based or external); format (individual or group); and gender of counsellor. Method: The views of 589 students from four Northern Ireland secondary and grammar schools were surveyed and analysed using descriptive and inferential statistics. Results: As found by Cooper (2006), more than two thirds (68.2%) of students expressed a preference for seeing a counsellor in their school; over 80% of students expressed a preference for seeing a counsellor on their own; and a marked preference for female counsellors existed, particularly amongst female students.
‘Extra appendage’ or integrated service? School counsellors' reflections on their professional identity in an era of education reform
Authors: Harris Belinda
Published: August 2009

Aims: Since 2003, Government policies have located increasing responsibility for children's well‐being on schools working in partnership with other agencies. This study sought to investigate how these policies affect the working lives and professional identities of counsellors in schools in challenging circumstances in England. Method: In‐depth interviews with six school counsellors (4 primary and 2 secondary). Transcripts were analysed using Interpretive Phenomenological Analysis to reveal five master themes, one of which is the focus of this paper. Findings: School counsellors derive most reward from their therapeutic work with children. Their sense of professional identity however, is affected by their positioning within schools. Counsellors with dual roles perceive themselves as ‘insiders’ with the capacity to influence and contribute meaningfully to the school's well‐being agenda. Counsellors engaged on part‐time contracts either independently or via an agency feel like ‘outsiders’, situated on the margins of school life and vulnerable to neglectful and oppressive practices from school leadership. Some implications for practice are considered.
Practitioners’ views and experiences of participating in a school counselling evaluation study
Authors: Tracey Anne , McElearney Aisling , Adamson Gary , Shevlin Mark
Published: August 2009

Introduction: This study documents and describes practitioners’ views and experiences of the process of implementing an ‘impact evaluation’ of the independent school counselling service provided by the National Society for the Prevention of Cruelty to Children (NSPCC) in Northern Ireland. Method: Data was gathered from practitioners (n=18) across the duration of the evaluation process; at the pre, mid and post implementation stages of the evaluation process. Data‐gathering methods included consultation focus groups, records of training meetings, minutes of strategic advisory group meetings, a practitioner internet based discussion board and a structured questionnaire. A thematic analysis was carried out using Nvivo software. Results: Practitioner reflections confirmed the evaluation process as challenging yet with considerable benefits for recognition, self‐reflection and practice development. Discussion: Recommendations for integrating outcome evaluation within school counselling practice are presented.
School counselling in Wales: Recommendations for good practice
Authors: Pattison Sue , Rowland Nancy , Richards Kaye , Cromarty Karen , Jenkins Peter , Polat Filiz
Published: August 2009

Aims: This paper presents the context, methodologies and findings of a research project commissioned by the Welsh Assembly Government to evaluate school counselling and services available to children and young people in the UK and to make recommendations for future service development in Wales. Method: The study adopted three research methods: desk research (a literature review), a quantitative survey, and qualitative fieldwork. The survey included a sample of primary and secondary schools in Wales, as well as local authorities. Fieldwork included interviews with teachers, counsellors, parents, and children. Findings: Evidence‐based recommendations for counselling service provision in schools in Wales were developed, which now inform the Welsh Assembly Government's (WAG) National Strategy for counselling in schools in Wales (2008).
CEAS: cis-regulatory element annotation system
Authors: Shin Hyunjin , Liu Tao , Manrai Arjun K. , Liu X. Shirley
Published: August 2009

Summary: We present a tool designed to characterize genome-wide protein–DNA interaction patterns from ChIP-chip and ChIP-Seq data. This stand-alone extension of our web application CEAS (cis-regulatory element annotation system) provides summary statistics on ChIP enrichment in important genomic regions such as individual chromosomes, promoters, gene bodies or exons, and infers the genes most likely to be regulated by the binding factor under study. CEAS also enables biologists to visualize the average ChIP enrichment signals over specific genomic regions, particularly allowing observation of continuous and broad ChIP enrichment that might be too subtle to detect from ChIP peaks alone.

Availability: The CEAS Python package is publicly available at http://liulab.dfci.harvard.edu/CEAS.

Contact:  shin@jimmy.harvard.edu; xsliu@jimmy.harvard.edu

Supplementary information:  Supplementary data are available at Bioinformatics online.
Correlating multiple SNPs and multiple disease phenotypes: penalized non-linear canonical correlation analysis
Authors: Waaijenborg Sandra , Zwinderman Aeilko H.
Published: August 2009

Motivation: Canonical correlation analysis (CCA) can be used to capture the underlying genetic background of a complex disease, by associating two datasets containing information about a patient's phenotypical and genetic details. Often the genetic information is measured on a qualitative scale, consequently ordinary CCA cannot be applied to such data. Moreover, the size of the data in genetic studies can be enormous, thereby making the results difficult to interpret.

Results: We developed a penalized non-linear CCA approach that can deal with qualitative data by transforming each qualitative variable into a continuous variable through optimal scaling. Additionally, sparse results were obtained by adapting soft-thresholding to this non-linear version of the CCA. By means of simulation studies, we show that our method is capable of extracting relevant variables out of high-dimensional sets. We applied our method to a genetic dataset containing 144 patients with glial cancer.

Contact:  s.waaijenborg@amc.uva.nl
Mobyle: a new full web bioinformatics framework
Authors: Néron Bertrand , Ménager Hervé , Maufrais Corinne , Joly Nicolas , Maupetit Julien , Letort Sébastien , Carrere Sébastien , Tuffery Pierre , Letondal Catherine
Published: August 2009

Motivation: For the biologist, running bioinformatics analyses involves a time-consuming management of data and tools. Users need support to organize their work, retrieve parameters and reproduce their analyses. They also need to be able to combine their analytic tools using a safe data flow software mechanism. Finally, given that scientific tools can be difficult to install, it is particularly helpful for biologists to be able to use these tools through a web user interface. However, providing a web interface for a set of tools raises the problem that a single web portal cannot offer all the existing and possible services: it is the user, again, who has to cope with data copy among a number of different services. A framework enabling portal administrators to build a network of cooperating services would therefore clearly be beneficial.

Results: We have designed a system, Mobyle, to provide a flexible and usable Web environment for defining and running bioinformatics analyses. It embeds simple yet powerful data management features that allow the user to reproduce analyses and to combine tools using a hierarchical typing system. Mobyle offers invocation of services distributed over remote Mobyle servers, thus enabling a federated network of curated bioinformatics portals without the user having to learn complex concepts or to install sophisticated software. While being focused on the end user, the Mobyle system also addresses the need, for the bioinfomatician, to automate remote services execution: PlayMOBY is a companion tool that automates the publication of BioMOBY web services, using Mobyle program definitions.

Availability: The Mobyle system is distributed under the terms of the GNU GPLv2 on the project web site (http://bioweb2.pasteur.fr/projects/mobyle/). It is already deployed on three servers: http://mobyle.pasteur.fr, http://mobyle.rpbs.univ-paris-diderot.fr and http://lipm-bioinfo.toulouse.inra.fr/Mobyle. The PlayMOBY companion is distributed under the terms of the CeCILL license, and is available at http://lipm-bioinfo.toulouse.inra.fr/biomoby/PlayMOBY/.

Contact:  mobyle-support@pasteur.fr; mobyle-support@rpbs.univ-paris-diderot.fr; letondal@pasteur.fr

Supplementary information:  Supplementary data are available at Bioinformatics online.
Simultaneous inference of biological networks of multiple species from genome-wide data and evolutionary information: a semi-supervised approach
Authors: Kashima Hisashi , Yamanishi Yoshihiro , Kato Tsuyoshi , Sugiyama Masashi , Tsuda Koji
Published: August 2009

Motivation: The existing supervised methods for biological network inference work on each of the networks individually based only on intra-species information such as gene expression data. We believe that it will be more effective to use genomic data and cross-species evolutionary information from different species simultaneously, rather than to use the genomic data alone.

Results: We created a new semi-supervised learning method called Link Propagation for inferring biological networks of multiple species based on genome-wide data and evolutionary information. The new method was applied to simultaneous reconstruction of three metabolic networks of Caenorhabditis elegans, Helicobacter pylori and Saccharomyces cerevisiae, based on gene expression similarities and amino acid sequence similarities. The experimental results proved that the new simultaneous network inference method consistently improves the predictive performance over the individual network inferences, and it also outperforms in accuracy and speed other established methods such as the pairwise support vector machine.

Availability: The software and data are available at http://cbio.ensmp.fr/∼yyamanishi/LinkPropagation/.

Contact:  kashima@mist.i.u-tokyo.ac.jp

Supplementary information:  Supplementary data are available at Bioinformatics online.
WEbcoli: an interactive and asynchronous web application for in silico design and analysis of genome-scale E.coli model
Authors: Jung Tae-Sung , Yeo Hock Chuan , Reddy Satty G. , Cho Wan-Sup , Lee Dong-Yup
Published: August 2009

Summary: WEbcoli is a WEb application for in silico designing, analyzing and engineering Escherichia coli metabolism. It is devised and implemented using advanced web technologies, thereby leading to enhanced usability and dynamic web accessibility. As a main feature, the WEbcoli system provides a user-friendly rich web interface, allowing users to virtually design and synthesize mutant strains derived from the genome-scale wild-type E.coli model and to customize pathways of interest through a graph editor. In addition, constraints-based flux analysis can be conducted for quantifying metabolic fluxes and charactering the physiological and metabolic states under various genetic and/or environmental conditions.

Availability: WEbcoli is freely accessible at http://webcoli.org.

Contact:  cheld@nus.edu.sg
Improving peptide identification with single-stage mass spectrum peaks
Authors: He Zengyou , Yu Weichuan
Published: August 2009

Motivation: Database searching is the major peptide identification method in shotgun proteomics. It searches tandem mass spectrometry (MS/MS) spectra against a protein database to identify target peptides. The success of such a database searching method relies on a scoring algorithm that can evaluate the quality of peptide-spectrum matches (PSMs) accurately. However, current scoring algorithms frequently generate inaccurate assignments due to variations and noises in the MS/MS spectra. To address this issue, we like to improve peptide identification by using additional information from other data sources.

Results: Single-stage MS data is complementary to MS/MS data in the sense that it provides broader mass coverage but less sequence information. In this article, we show that single-stage MS data can be used to re-rank PSMs. The proposed method explores a linear combination of scores between MS and MS/MS data to perform re-ranking. Experimental results on real data show that such a re-ranking strategy improves the identification performance significantly.

Availability:  http://bioinformatics.ust.hk/ReRankPSMwMS1.rar

Contact:  eezyhe@ust.hk

Supplementary information:  Supplementary data are available at Bioinformatics online.
Coherent trends in contiguous survey time-series of major ecological and commercial fish species in the Gulf of Maine ecosystem
Authors: Nye Janet A. , Bundy Alida , Shackell Nancy , Friedland Kevin D. , Link Jason S.
Published: August 2009

Nye, J. A., Bundy, A., Shackell, N., Friedland, K. D., and Link, J. S. 2010. Coherent trends in contiguous survey time-series of major ecological and commercial fish species in the Gulf of Maine ecosystem. – ICES Journal of Marine Science, 67: 26–40. Fish are often delineated into distinct population or stock units that reflect human institutional borders more than ecological factors. In the Northwest Atlantic, there are many species in the broader Gulf of Maine area (GOMA), yet the area is surveyed and managed for the most part in the south by the United States and in the north by Canada. Biomass time-series of 19 representative fish species and total biomass from 7 different surveys conducted by the United States and Canada in the GOMA are compared. All species showed coherent trends in relative biomass across at least two survey time-series, and in many species a single trend could describe all time-series trends accurately. For instance, Canadian and the US time-series of Atlantic cod, Atlantic herring, haddock, thorny skate, and goosefish had comparable trends. Conversely, species such as longhorn sculpin and spiny dogfish showed differing survey time-series trends and asynchronous event timing, suggesting that their population dynamics differ spatially. Collectively, the results demonstrate the value of comparing time-series for common species from contiguous ecosystems and elucidate the relative importance of environmental and fishing factors on each species.
Predictors of Postoperative Pain and Analgesic Consumption
Authors: Ip Hui Yun Vivian , Abrishami Amir , Peng Philip W. H. , Wong Jean , Chung Frances
Published: August 2009

Pain is a subjective and multidimensional experience that is often inadequately managed in clinical practice. Effective control of postoperative pain is important after anesthesia and surgery. A systematic review was conducted to identify the independent predictive factors for postoperative pain and analgesic consumption. The authors identified 48 eligible studies with 23,037 patients included in the final analysis. Preoperative pain, anxiety, age, and type of surgery were four significant predictors for postoperative pain. Type of surgery, age, and psychological distress were the significant predictors for analgesic consumption. Gender was not found to be a consistent predictor as traditionally believed. Early identification of the predictors in patients at risk of postoperative pain will allow more effective intervention and better management. The coefficient of determination of the predictive models was less than 54%. More vigorous studies with robust statistics and validated designs are needed to investigate this field of interest.
Does Postoperative Delirium Limit the Use of Patient-controlled Analgesia in Older Surgical Patients?
Authors: Leung Jacqueline M. , Sands Laura P. , Paul Sudeshna , Joseph Tim , Kinjo Sakura , Tsai Tiffany
Published: August 2009

Unlabelled

BACKGROUNDPostoperative pain Is an independent predictor of postoperative delirium. Whether postoperative delirium limits patient-controlled analgesia (PCA) use has not been determined.

Methods

The authors conducted a nested cohort study in older patients undergoing noncardiac surgery and used PCA for postoperative analgesia. Delirium was measured by using the Confusion Assessment Method. The authors computed a structural equation model to determine the effects of pain and opioid consumption on delirium status and the effect of delirium on opioid use.

Results

Of 335 patients, 108 (32.2%) developed delirium on postoperative day (POD) 1, and 120 (35.8%) on POD 2. Postoperative delirium did not limit the use of PCA. Patients with postoperative delirium used more PCA in a 24-h period (POD 2) compared to those without delirium (mean dose of hydromorphone +/- SE adjusted for covariates was 2.24 +/- 0.71 mg vs. 1.25 +/- 0.67 mg, P = 0.02). Despite more opioid use, patients with delirium reported higher Visual Analogue Scale scores than those without delirium (POD 1: mean visual analog scale +/- SE at rest 4.2 +/- 0.23 vs. 3.3 +/- 0.22, P = 0.0051; POD 2: 3.3 +/- 0.23 vs. 2.5 +/- 0.19, P = 0.004). Path coefficients from structural equation model revealed that pain and opioid use affect delirium status, but delirium does not affect subsequent opioid dose.

Conclusions

Postoperative delirium did not limit PCA use. Despite more opioid use, visual analog scale scores were higher in patients with delirium. Future studies on delirium should consider the role of pain and pain management as potential etiologic factors.
Dreaming and Electroencephalographic Changes during Anesthesia Maintained with Propofol or Desflurane
Authors: Leslie Kate , Sleigh Jamie , Paech Michael J. , Voss Logan , Lim Chiew Woon , Sleigh Callum
Published: August 2009

Background

Dream recall is reportedly more common after propofol than after volatile anesthesia, but this may be due to delayed emergence or more amnesia after longer-acting volatiles. The electroencephalographic signs of dreaming during anesthesia and the differences between propofol and desflurane also are unknown. The authors therefore compared dream recall after propofol- or desflurane-maintained anesthesia and analyzed electroencephalographic patterns in dreamers and nondreamers and in propofol and desflurane patients for similarities to rapid eye movement and non-rapid eye movement sleep.

Methods

Three hundred patients presenting for noncardiac surgery were randomized to receive propofol- or desflurane-maintained anesthesia. The raw electroencephalogram was recorded from induction until patients were interviewed about dreaming when they became first oriented postoperatively. Using spectral and ordinal methods, the authors quantified the amount of sleep spindle-like activity and high-frequency power in the electroencephalogram.

Results

The incidence of dream recall was similar for propofol (27%) and desflurane (28%) patients. Times to interview were similar (median 20 [range 4-114] vs. 17 [7-86] min; P = 0.1029), but bispectral index values at interview were lower (85 [69-98] vs. 92 [40-98]; P < 0.0001) in propofol than in desflurane patients. During surgery, the raw electroencephalogram of propofol patients showed more and faster spindle activity than in desflurane patients (P < 0.001). The raw electroencephalogram of dreamers showed fewer spindles and more high-frequency power than in nondreamers in the 5 min before interview (P < 0.05).

Conclusions

Anesthetic-related dreaming seems to occur just before awakening and is associated with a rapid eye movement-like electroencephalographic pattern.
Role of Central and Mixed Venous Oxygen Saturation Measurement in Perioperative Care
Authors: Shepherd Stephen J. , Pearse Rupert M.
Published: August 2009

Complications after major surgery are a leading cause of morbidity and mortality. The etiology of postoperative complications is complex, but poor cardiorespiratory reserve appears to be a key factor. There is increasing interest in the use of central and mixed venous oxygen saturation to guide therapeutic interventions during the perioperative period. However, a detailed understanding of the physiologic principles of venous oximetry is essential for safe and effective use in clinical practice. Venous oxygen saturation reflects the balance between global oxygen delivery and oxygen consumption, which may be affected by a wide range of factors during the perioperative period. The purpose of this article is to describe the physiology and measurement of mixed and central venous oxygen saturation and to explore the findings of clinical investigations of their use in perioperative care.
Effects of Remifentanil on the Spectrum and Quantitative Parameters of Electroencephalogram in Propofol Anesthesia
Authors: Kortelainen Jukka , Koskinen Miika , Mustola Seppo , Seppänen Tapio
Published: August 2009

Background

A high dose of opioids associated with a low dose of propofol has become a popular anesthetic technique. However, the influence of opioids on the electroencephalographic phenomenon related to induction of anesthesia and, thereby, on the quantitative parameters used in the depth-of-anesthesia estimation is not well known.

Methods

Twenty-seven patients were divided into three groups to receive saline, low-dose remifentanil (7.5 microg x kg x h) or high-dose remifentanil (30 microg x kg x h) during induction of anesthesia with propofol (30 mg . kg . h). Electroencephalogram was recorded from Fz electrode, and its time-frequency properties in the patient groups were analyzed from the induction of anesthesia to the occurrence of burst suppression pattern. The group differences in 14 quantitative spectral parameters used in the depth-of-anesthesia estimation were examined as well.

Results

The time-frequency properties of electroencephalogram were different between groups. The high-frequency (greater than 14 Hz) activity during light anesthesia was decreased in remifentanil groups; whereas, increased activity in extended alpha band (7-14 Hz) and decreased activity in delta band (0.5-4 Hz) was observed during deep anesthesia. This resulted in statistically significant changes in all 14 quantitative parameters.

Conclusions

The effect of remifentanil on the spectrum and quantitative parameters of electroencephalogram is significant and strongly dependent on the level of anesthesia. Coadministration of opioids therefore challenges the reliability of the spectral properties of electroencephalogram in the depth-of-anesthesia estimation by using a frontal montage. Furthermore, the finding has implications for design of opioid coadministration studies.
Analgesic Efficacy of Peripheral κ-Opioid Receptor Agonist CR665 Compared to Oxycodone in a Multi-modal, Multi-tissue Experimental Human Pain Model
Authors: Arendt-Nielsen Lars , Olesen Anne E. , Staahl Camilla , Menzaghi Frédérique , Kell Sherron , Wong Gilbert Y. , Drewes Asbjørn M.
Published: August 2009

Background

Peripherally selective opioids may be beneficial in visceral pain management due to absence of centrally mediated side effects. The objectives of this study were: (1) to assess the effects of a peripherally selective tetrapeptide kappa-opioid receptor agonist, CR665, on experimental pain from multi-modal stimulation of skin, muscle, and viscera, and (2) contrast these effects with those of oxycodone (centrally acting opioid).

Methods

The study was designed as a single-center, single-dose, randomized, double-blind, placebo and active-controlled, double-dummy, three-way, crossover study in healthy males. Subjects received the following treatments in randomized order: (1) CR665 (0.36 mg/kg) administered intravenously over 1 h, (2) oxycodone (15 mg) administered orally, and (3) placebo administered intravenously and orally. The following pain tests were used: (1) cutaneous pinch pain tolerance threshold, (2) pressure pain detection and tolerance thresholds, (3) cuff pressure pain tolerance threshold, and (4) pain rating thresholds to distension and thermal stimulation of the esophagus. Measurements were performed before dosing and at 30, 60, and 90 min after dosing.

Results

Compared to placebo, oxycodone elevated cutaneous pinch pain tolerance (P < 0.001) and cuff pressure pain tolerance threshold (P < 0.001), as well as pain rating thresholds (visual analogue scale = 7) to esophageal distension (P < 0.001) and thermal stimulation (P < 0.002). Compared to placebo, CR665 significantly increased the pain rating threshold to esophageal distension (P < 0.005) but reduced the pain tolerance threshold to skin pinching (P = 0.007).

Conclusion

CR665 had a selective effect on visceral pain. Oxycodone exhibited a generalized effect, elevating thresholds for cutaneous, deep somatic, and visceral pain stimulation.
Bedside Prediction of Airway Length in Adults and Children
Authors: Lee Bong-Jae , Yi Jae-Woo , Chung Jun Young , Kim Dong-Ok , Kang Jong-Man
Published: August 2009

Background

Malpositioning of the endotracheal tube within the airway leads to serious complications such as endobronchial intubation. Prediction of the correct depth of an endotracheal tube is important and should be individualized. The manubriosternal joint (MSJ) is on the same horizontal plane with the tracheal carina. We compared the straight length from the upper incisor to the MSJ in the fully extended position (incisor-MSJ extension length) with the length from the upper incisor to the carina after intubation with a flexible fiberoptic bronchoscope through the endotracheal tube in the neutral position (incisor-carina neutral length).

Methods

One hundred adults and 50 children were studied. Induction of anesthesia was achieved with 1.5 mg/kg propofol and 0.6 mg/kg rocuronium IV. The incisor-MSJ extension length was measured after adequate mask ventilation. After intubation, the endotracheal tube was positioned properly at the upper incisor teeth, and the incisor-carina neutral length was measured with the fiberoptic bronchoscope at the carina.

Results

The correlation between the incisor-MSJ extension length and the incisor-carina neutral length is significant (P < 0.001) in both adults and children. A formula for the regression line in adults (children) can be obtained as the incisor-carina neutral length (cm) = 0.868 (1.009) x the incisor-MSJ extension length (cm) + 4.260 (0.468) with a high coefficient of determination; r(2) = 0.88 (0.98).

Conclusions

The airway length from the upper incisor to the carina in the neutral position can be predicted by the straight length from the upper incisor to the MSJ in the fully extended position.
Precision of Traditional Approaches for Lumbar Plexus Block
Authors: Heller Axel R. , Fuchs Alexander , Rössel Thomas , Vicent Oliver , Wiessner Diana , Funk Richard H. W. , Koch Thea , Litz Rainer J.
Published: August 2009

Background

Traditional methods for approaching the lumbar plexus from the posterior rely on finding the intersection of lines that are drawn based on surface landmarks. These methods may be inaccurate in many cases. The aim of this study was to determine the accuracy of these traditional approaches and determine if modifications could increase their accuracy.

Methods

The lumbar plexus region of 48 cadavers (78 +/- 7 yr; 167 +/- 6 cm; 60 +/- 13 kg; men/women: 29/19) was dissected, and relevant anatomic structures were marked. Needle proximity curves were obtained by triangulation for the five traditional approaches and for vectors from the posterior superior iliac spine directed towards the lumbar spinous processes of L3 and towards L4.

Results

Proximity curves (mean +/- SD) showed that except Pandin's approach (13 +/- 5 mm too medial), all others were too lateral: Winnie (17 +/- 8 mm), Chayen (8 +/- 5 mm), Capdevila (6 +/- 4 mm), and Dekrey (17 +/- 6 mm). Further, the curves had a narrow parabolic shape and thus a narrow margin of error. Both diagonal vectors had a significantly higher proximity to the lumbar plexus as compared with traditional approaches with a wide parabola, indicating more error tolerance. Using the vector posterior superior iliac spine-L3 with a length between 1/6-1/3 (= 16-22 mm) of the distance posterior superior iliac spine-L3, a proximity to the lumbar plexus < 5.0 +/- 0.3 mm was reached.

Conclusion

Improvement of both the proximity and the margin of error is possible by using diagonal landmark vectors. Relying on the position of the posterior superior iliac spine eliminates the sex and sided differences and individual body size, which can be problematic if firm metric distances are used in determining the entry point.
Isoflurane Inhibits the Tetrodotoxin-resistant Voltage-gated Sodium Channel Nav1.8
Authors: Herold Karl F. , Nau Carla , Ouyang Wei , Hemmings Hugh C.
Published: August 2009

Background

Voltage-gated sodium channels (Nav) mediate neuronal action potentials. Tetrodotoxin inhibits all Nav isoforms, but Nav1.8 and Nav1.9 are relatively tetrodotoxin-resistant (TTX-r) compared to other isoforms. Nav1.8 is highly expressed in dorsal root ganglion neurons and is functionally linked to nociception, but the sensitivity of TTX-r isoforms to inhaled anesthetics is unclear.

Methods

The sensitivities of heterologously expressed rat TTX-r Nav1.8 and endogenous tetrodotoxin-sensitive (TTX-s) Nav to the prototypic inhaled anesthetic isoflurane were tested in mammalian ND7/23 cells using patch-clamp electrophysiology.

Results

From a holding potential of -70 mV, isoflurane (0.53 +/- 0.06 mM, 1.8 minimum alveolar concentration at 24 degrees C) reduced normalized peak Na current (INa) of Nav1.8 to 0.55 +/- 0.03 and of endogenous TTX-s Nav to 0.56 +/- 0.06. Isoflurane minimally inhibited INa from a holding potential of -140 mV. Isoflurane did not affect voltage-dependence of activation, but it significantly shifted voltage-dependence of steady-state inactivation by -6 mV for Nav1.8 and by -7 mV for TTX-s Nav. IC50 values for inhibition of peak INa were 0.67 +/- 0.06 mM for Nav1.8 and 0.66 +/- 0.09 mM for TTX-s Nav; significant inhibition occurred at clinically relevant concentrations as low as 0.58 minimum alveolar concentration. Isoflurane produced use-dependent block of Nav1.8; at a stimulation frequency of 10 Hz, 0.56 +/- 0.08 mM isoflurane reduced INa to 0.64 +/- 0.01 versus 0.78 +/- 0.01 for control.

Conclusion

Isoflurane inhibited the tetrodotoxin-resistant isoform Nav1.8 with potency comparable to that for endogenous tetrodotoxin-sensitive Nav isoforms, indicating that sensitivity to inhaled anesthetics is conserved across diverse Nav family members. Block of Nav1.8 in dorsal root ganglion neurons could contribute to the effects of inhaled anesthetics on peripheral nociceptive mechanisms.
Epinephrine Impairs Lipid Resuscitation from Bupivacaine Overdose
Authors: Hiller David B. , Gregorio Guido Di , Ripper Richard , Kelly Kemba , Massad Malek , Edelman Lucas , Edelman Guy , Feinstein Douglas L. , Weinberg Guy L.
Published: August 2009

Background

Lipid emulsion infusion reverses local anesthetic-induced cardiac toxicity, but the effect of adding epinephrine has not been studied. We compared escalating doses of epinephrine on recovery with lipid infusion in a rat model of bupivacaine overdose.

Methods

Rats anesthetized with isoflurane received an IV bolus of 20 mg/kg bupivacaine, producing asystole (zero time) in all animals. Ventilation (100% oxygen) and chest compressions were started immediately, and at 3 min the rats received one of six IV treatments (n = 5 for all groups): 5 ml/kg saline followed by infusion for 2 min at 1.0 ml x kg x min, and a second 5 ml/kg bolus at 5 min; or the same bolus and infusion treatment using 30% lipid emulsion plus a single injection of epinephrine at one of five doses: 0 (lipid control), 1, 2.5, 10, or 25 mcg/kg. An electrocardiogram and arterial pressure were monitored continuously, and arterial blood gas was measured at 7.5 and 15 min.

Results

Epinephrine improved initial return of spontaneous circulation (rate-pressure product > 30% baseline) but only 3 of 5 rats at 10 mcg/kg and 1 of 5 rats at 25 mcg/kg sustained return of spontaneous circulation by 15 min. Lipid alone resulted in slower but more sustained recovery. Epinephrine doses above a threshold near 10 mcg/kg increased lactate, worsened acidosis, and resulted in poor recovery at 15 min, as compared with lipid controls. There was tight correlation of epinephrine dose to serum lactate at 15 min.

Conclusions

Epinephrine over a threshold dose near 10 mcg/kg impairs lipid resuscitation from bupivacaine overdose, possibly by inducing hyperlactatemia.
In Vitro Effects of Propofol and Volatile Agents on Pharmacologically Induced Chloride Channel Myotonia
Authors: Bandschapp Oliver , Ginz Hans F. , Soule Charles L. , Girard Thierry , Urwyler Albert , Iaizzo Paul A.
Published: August 2009

Background

Anesthetic choice for patients with chloride channel myotonia remains under debate. The authors have, therefore, investigated the in vitro effects of various anesthetic agents on pharmacologically induced chloride channel myotonia.

Methods

Functionally viable (> 10 mN force generation) rectus abdominis muscle preparations obtained from normal swine were investigated using in vitro muscle contracture test baths. During continuous 0.1-Hz supramaximal electrical stimulation, the chloride channel blocker 9-anthracenecarboxylic acid (64 microM) was added before the addition of propofol or one of three volatile anesthetics. The concentration of propofol in either Intralipid (n = 11) or dimethyl sulfoxide (n = 10) was doubled every 10 min (from 4-512 microM). The concentration of halothane (n = 8), isoflurane (n = 8), and sevoflurane (n = 8) was doubled from 0.25 vol% up to the maximum dose according to calibrated vaporizers. Control muscle bundles were either untreated (n = 30) or exposed to 9-anthracenecarboxylic acid (n = 19).

Results

The myotonic reactions induced by 9-anthracenecarboxylic acid were reversed by high-dose (> 64 microM) propofol (P < 0.01). Halothane, isoflurane, or sevoflurane each enhanced the myotonic reactions at 5.4 (P < 0.001), 0.21 (P < 0.01), and 0.5 minimum alveolar concentrations (P < 0.05), respectively.

Conclusions

The authors' in vitro data imply that propofol administration for general anesthesia may be better suited for patients with chloride channel myotonia versus volatile anesthetics. In isolated swine skeletal muscle bundles, propofol elicited a reversal of 9-anthracenecarboxylic acid-induced chloride channel myotonia, whereas volatile anesthetics further increased the associated myotonic reactions.
Spinal Microglial Expression and Mechanical Hypersensitivity in a Postoperative Pain Model: Comparison with a Neuropathic Pain Model
Authors: Ito Naomi , Obata Hideaki , Saito Shigeru
Published: August 2009

Background

Postoperative pain control contributes to quality of life. Activation of spinal cord microglia after peripheral nerve injury contributes to mechanical hypersensitivity. The contribution of spinal cord microglia to hypersensitivity after surgery, however, is not well understood. Here, the authors evaluated whether inhibition of spinal microglia reduced postoperative mechanical hypersensitivity, and if so, whether the effect differed from that in a rat neuropathic pain model.

Methods

Male Sprague-Dawley rats underwent either unilateral plantar hind paw incision (postoperative pain model) or L5 spinal nerve transection (neuropathic pain model), and the development of mechanical hypersensitivity was assessed using von Frey filaments. The microglial inhibitor minocycline was intraperitoneally administered daily for either 3 or 7 days. Spinal microglial activation was evaluated by OX42 immunohistochemistry. We also tested the effect of intrathecal administration of a p38 mitogen-activated protein kinase inhibitor, SB203580.

Results

In the postoperative pain model, minocycline did not suppress mechanical hypersensitivity, but did inhibit an increase in spinal OX42 expression. In contrast, in the neuropathic pain model, minocycline reduced mechanical hypersensitivity in a dose-related manner and inhibited spinal OX42 expression. SB203580 attenuated hypersensitivity in the neuropathic pain model, but not in the postoperative pain model.

Conclusions

The results of the present study suggest that spinal OX42 expression has a more important role in the development of neuropathic pain than in postoperative pain, and that an increase in spinal OX42 expression does not contribute to postoperative mechanical hypersensitivity.
Accuracy of Postoperative End-tidal Pco2Measurements with Mainstream and Sidestream Capnography in Non-obese Patients and in Obese Patients with and without Obstructive Sleep Apnea
Authors: Kasuya Yusuke , Akça Ozan , Sessler Daniel I. , Ozaki Makoto , Komatsu Ryu
Published: August 2009

Background

Obtaining accurate end-tidal carbon dioxide pressure measurements via nasal cannula poses difficulties in postanesthesia patients who are mouth breathers, including those who are obese and those with obstructive sleep apnea (OSA); a nasal cannula with an oral guide may improve measurement accuracy in these patients. The authors evaluated the accuracy of a mainstream capnometer with an oral guide nasal cannula and a sidestream capnometer with a nasal cannula that did or did not incorporate an oral guide in spontaneously breathing non-obese patients and obese patients with and without OSA during recovery from general anesthesia.

Methods

The study enrolled 20 non-obese patients (body mass index less than 30 kg/m) without OSA, 20 obese patients (body mass index greater than 35 kg/m) without OSA, and 20 obese patients with OSA. End-tidal carbon dioxide pressure was measured by using three capnometer/cannula combinations (oxygen at 4 l/min): (1) a mainstream capnometer with oral guide nasal cannula, (2) a sidestream capnometer with a nasal cannula that included an oral guide, and (3) a sidestream capnometer with a standard nasal cannula. Arterial carbon dioxide partial pressure was determined simultaneously. The major outcome was the arterial-to-end-tidal partial pressure difference with each combination.

Results

In non-obese patients, arterial-to-end-tidal pressure difference was 3.0 +/- 2.6 (mean +/- SD) mmHg with the mainstream capnometer, 4.9 +/- 2.3 mmHg with the sidestream capnometer and oral guide cannula, and 7.1 +/- 3.5 mmHg with the sidestream capnometer and a standard cannula (P < 0.05). In obese non-OSA patients, it was 3.9 +/- 2.6 mmHg, 6.4 +/- 3.1 mmHg, and 8.1 +/- 5.0 mmHg, respectively (P < 0.05). In obese OSA patients, it was 4.0 +/- 3.1 mmHg, 6.3 +/- 3.2 mmHg, and 8.3 +/- 4.6 mmHg, respectively (P < 0.05).

Conclusions

Mainstream capnometry performed best, and an oral guide improved the performance of sidestream capnometry. Accuracy in non-obese and obese patients, with and without OSA, was similar.
Desflurane, Isoflurane, and Sevoflurane Provide Limited Neuroprotection against Neonatal Hypoxia-Ischemia in a Delayed Preconditioning Paradigm
Authors: McAuliffe John J. , Loepke Andreas W. , Miles Lili , Joseph Bernadin , Hughes Elizabeth , Vorhees Charles V.
Published: August 2009

Background

The volatile anesthetics desflurane, isoflurane, and sevoflurane have been found to produce neuroprotection in various paradigms. The authors used these agents in a delayed preconditioning model to test the hypothesis that they could provide neuroprotection against neonatal hypoxia-ischemia as assessed by a battery of behavioral tests.

Methods

Institutional Animal Care and Use Committee approval was obtained. A total of 140, C57-129T2 F1 hybrid 9-day-old mice were randomized to 3 h of preconditioning with room air (Group Sham and Group HI), 8.4% desflurane in 40% oxygen (Group D), 1.8% isoflurane (Group I), or 3.1% sevoflurane (Group S). Twenty-four hours later, the Group HI, D, I, and S mice had 60 min of hypoxia-ischemia, and Group Sham had 60 min of sham HI. Surviving animals had behavioral testing, including open field activity, acoustic startle, prepulse inhibition, rotorod, novel object recognition, water mazes, and apomorphine challenge. Histologic analysis was also performed.

Results

Mice in Groups D, I, and S performed better than Group HI and similarly to Group Sham on novel object recognition and apomorphine challenge and better than Group HI but not as well as Group Sham on cued maze testing. All mice exposed to hypoxia-ischemia performed worse than Group Sham on the spatially oriented water mazes with no difference among groups. Histologic sections did not show any significant effect of preconditioning on injury scores.

Conclusions

Volatile agent preconditioning partially protects perirhinal cortex and striatal dependent functions against moderate to severe neonatal hypoxia-ischemia.
Placental Transfer and Fetal Metabolic Effects of Phenylephrine and Ephedrine during Spinal Anesthesia for Cesarean Delivery
Authors: Ngan Kee Warwick D. , Khaw Kim S. , Tan Perpetua E. , Ng Floria F. , Karmakar Manoj K.
Published: August 2009

Background

Use of ephedrine in obstetric patients is associated with depression of fetal acid-base status. The authors hypothesized that the mechanism underlying this is transfer of ephedrine across the placenta and stimulation of metabolism in the fetus.

Methods

A total of 104 women having elective Cesarean delivery under spinal anesthesia randomly received infusion of phenylephrine (100 microg/ml) or ephedrine (8 mg/ml) titrated to maintain systolic blood pressure near baseline. At delivery, maternal arterial, umbilical arterial, and umbilical venous blood samples were taken for measurement of blood gases and plasma concentrations of phenylephrine, ephedrine, lactate, glucose, epinephrine, and norepinephrine.

Results

In the ephedrine group, umbilical arterial and umbilical venous pH and base excess were lower, whereas umbilical arterial and umbilical venous plasma concentrations of lactate, glucose, epinephrine, and norepinephrine were greater. Umbilical arterial Pco2 and umbilical venous Po2 were greater in the ephedrine group. Placental transfer was greater for ephedrine (median umbilical venous/maternal arterial plasma concentration ratio 1.13 vs. 0.17). The umbilical arterial/umbilical venous plasma concentration ratio was greater for ephedrine (median 0.83 vs. 0.71).

Conclusions

Ephedrine crosses the placenta to a greater extent and undergoes less early metabolism and/or redistribution in the fetus compared with phenylephrine. The associated increased fetal concentrations of lactate, glucose, and catecholamines support the hypothesis that depression of fetal pH and base excess with ephedrine is related to metabolic effects secondary to stimulation of fetal beta-adrenergic receptors. Despite historical evidence suggesting uteroplacental blood flow may be better maintained with ephedrine, the overall effect of the vasopressors on fetal oxygen supply and demand balance may favor phenylephrine.