bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of mechanical ventilation on diaphragm function and biology
Authors: Gayan-Ramirez G. , Decramer M.
Published: January 2003

The pathophysiological mechanisms of weaning from mechanical ventilation are not fully known, but there is accumulating evidence that mechanical ventilation induces inspiratory muscle dysfunction.

Recently, several animal models have provided potential mechanisms for mechanical ventilation-induced effects on muscle function. In patients, weaning difficulties are associated with inspiratory muscle weakness and reduced endurance capacity. Animal studies demonstrated that diaphragm force was already decreased after 12 h of controlled mechanical ventilation and this worsened with time spent on the ventilator.

Diaphragmatic myofibril damage observed after 3-days controlled mechanical ventilation was inversely correlated with maximal diaphragmatic force. Downregulation of the diaphragm insulin-like growth factor-I and MyoD/myogenin messenger ribonucleic acid occurred after 24 h and diaphragmatic oxidative stress and increased protease activity after 18 h. In keeping with these findings, diaphragm fibre atrophy was shown after 12 h and reduced diaphragm mass was reported after 48 h of controlled mechanical ventilation.

These animal studies show that early alterations in diaphragm function develop after short-term mechanical ventilation. These alterations may contribute to the difficulties in weaning from mechanical ventilation seen in patients. Strategies to preserve respiratory muscle mass and function during mechanical ventilation should be developed. These may include: adaptation of medication, training of the diaphragm, stabilisation of the catabolic state and pharmacotherapy.
Children with mild asthma: do they benefit from inhaled corticosteroids?
Authors: Arets H.G.M. , Kamps A.W.A. , Brackel H.J.L. , Mulder P.G.H. , Vermue N.A. , van der Ent C.K.
Published: January 2003

In children with mild asthma, who show hardly any abnormalities in pulmonary function, objective measurement of the effect of inhaled corticosteroids is difficult.

The short term effect of fluticasone propionate (FP) in these children was evaluated, using both subjective and objective parameters. A total of 68 children (5–10 yrs old) were randomly assigned to either FP 250 µg or placebo twice daily as metered-dose inhalerviaspacer during 12 weeks. Symptom scores, use of rescue medication, wheezing, parent global evaluation and pulmonary function tests including forced expiratory volume in one second (FEV1), peak expiratory flow (PEF) and bronchial responsiveness (provocation dose of methacholine causing a 20% fall in FEV1(PD20)) were evaluated.

FP-treatedversusplacebo-treated children showed significant changes in percentage symptom-free days, use of β2-mimetics, morning and evening PEF, FEV1% pred and wheezing. No significant improvements were found in parent global evaluation, absolute values of FEV1nor PD20.

These findings show that inhaled corticosteroids are effective in children with mild asthma. This effect can be assessed by both objective and subjective parameters. Early start of inhaled corticosteroids should be considered even when pulmonary function is normal.
Comparison of a cardiorespiratory deviceversuspolysomnography for diagnosis of sleep apnoea
Authors: Calleja J.M. , Esnaola S. , Rubio R. , Durán J.
Published: January 2003

This study assessed the accuracy of a cardiorespiratory monitoring deviceversuspolysomnography for the diagnosis of suspected sleep apnoea/hypoponea syndrome (SAS).

A total of 86 patients (89% male, mean age 52 yrs) that had been referred to a sleep laboratory with a clinical diagnosis of SAS underwent cardiorespiratory polygraphy in an unattended mode using an ambulatory device (MERLIN). Analysis was carried out both automatically and manually. Conventional overnight full-channel polysomnography was performed simultaneously.

Valid polygraphical recordings were obtained from 79 patients. The mean±sd apnoea/hypopnoea index (AHI) was 34.4±29.2. The results obtained with manual scoring were superior to automatic scoring for all AHI thresholds. For an AHI of ≥5, which is diagnostic SAS, the optimum cut-off value for the manual respiratory event index was 6.7 and the cardiorespiratory monitoring device had 97.1% sensitivity and 90.9% specificity. Correct classification according to the different cut-off points obtainedviapolysomnography and the corresponding cut-off points in the MERLIN manual index were confirmed in 90–96% of patients.

The MERLIN device is a useful diagnostic approach for the initial assessment of adult patients with clinical suspicion of sleep apnoea/hypopnoea syndrome. Manual scoring is clearly better than automatic scoring in terms of agreement with the apnoea/hypopnoea index and to discern patients with sleep apnoea/hypopnoea syndrome.
Mortality in severe sleep apnoea/hypopnoea syndrome patients: impact of treatment
Authors: Marti S. , Sampol G. , Muñoz X. , Torres F. , Roca A. , Lloberes P. , Sagalés T. , Quesada P. , Morell F.
Published: January 2003

The aim of this study was to determine mortality in patients with sleep apnoea/hypopnoea syndrome (SAHS) according to the treatments employed and comorbidity.

An historical cohort of patients with SAHS diagnosed at a university hospital between 1982 and 1992 and followed until 1996 was studied. From a total of 475 SAHS patients, 444 (94%), with a mean±sd apnoea/hypopnoea index at diagnosis of 55±27, were located and included in the study. SAHS treatments employed were: surgery (88), weight loss (134), continuous positive airway pressure (124) and 98 patients were not treated.

By the end of follow-up, 49 patients had died. According to Cox regression analysis, mortality in treated patients was lower than in those not treated, but higher in those with a history of severe chronic obstructive pulmonary disease. Mortality in nontreated patients compared with that of the general population, adjusted for age and sex, showed excessive mortality, which decreased in treated patients. Stratification by age showed a greater mortality rate ratio in patients <50 yrs. These findings were maintained when mortality from cardiovascular causes was compared.

In conclusion, a rise in mortality was found in nontreated sleep apnoea/hypopnoea syndrome patients compared with the general population, whereas mortality in those treated for sleep apnoea/hypopnoea syndrome did not differ significantly from that of the general population.
Murine strain differences in airway inflammation caused by diesel exhaust particles
Authors: Miyabara Y , Yanagisawa R , Shimojo N , Takano H , Lim HB , Ichinose T , Sagai M
Published: January 2003

To elucidate whether immunoglobulin (Ig) E or IgG are involved in the murine asthma model, we compared the pathogenic features of mice that were high IgG responders (C3H/He) with mice that were high IgE responders (BALB/c) after intratracheal instillation of diesel exhaust particles (DEP) and ovalbumin sensitization. Both mouse strains received DEP intratracheally once a week for 5 weeks. After the second injection of DEP, ovalbumin and aluminium hydroxide were injected intraperitoneally. After the last DEP administration, the mice were challenged by exposure to an aerosol of ovalbumin. DEP caused increased IgG1 production and airway hyperresponsiveness after ovalbumin sensitization in C3H/He mice, although IgE production did not change in either strain. Furthermore, in C3H/He mice, the number of eosinophils and goblet cells in the bronchial epithelium, and the expression of interleukin-5 and interleukin-2 were increased by DEP and ovalbumin treatments. In contrast, the pathogenic changes in BALB/c mice were weak, even though the same protocol was used. In conclusion, murine strain differences in response to air pollutants and allergens seem to be related to antigen-specific immunoglobulin G1 production and cytokine expression in the lungs.
Attenuation of virus-induced airway dysfunction in rats treated with imiquimod
Authors: Stokes  , Sorkness RL , Kaplan MR , Castleman WL , Tomai MA , Miller RL , Lemanske RF
Published: January 2003

Viral respiratory infections cause acute airway abnormalities consisting of inflammation and physiological dysfunction in both animals and humans. It is likely that inflammatory cell products, such as cytokines, contribute substantially to viral-induced airway dysfunction. We hypothesized that imiquimod, an immune response enhancing agent that induces interferon-alpha, would attenuate the development of airway dysfunction during acute viral illness in rats. Adult Brown Norway rats were inoculated with parainfluenza type 1 (Sendai) virus or sterile vehicle, and treated with either imiquimod or water. Respiratory system resistance (Rrs), arterial oxygen tension (Pa,O2), lung viral titres and bronchoalveolar lavage (BAL) leucocyte counts were measured in anaesthetized, paralysed, ventilated rats. Virus-infected, water-treated rats had a significant decrease in Pa,O2 and had significant increases in leucocyte count and Rrs when compared to both the virus-infected, imiquimod-treated, (Pa,O2, p = 0.03; leucocyte count, p = 0.02; and Rrs, p = 0.009) and noninfected, water-treated rats (Pa,O2, p = 0.007; leucocyte count, p = 0.001; and Rrs, p = 0.01). In addition, imiquimod suppressed BAL eosinophils in both virus-infected (p = 0.02) and noninfected (p = 0.001) groups, and lowered overall virus titres (p = 0.03). Thus, both virus-induced airway inflammation and physiological dysfunction were attenuated significantly by imiquimod treatment in this animal model. By further delineating mechanisms by which infections induce airway dysfunction in animal models, more specific pharmacological interventions can be developed for the treatment of virus-induced asthma.
Action of moguisteine on the activity of tracheobronchial rapidly adapting receptors in the dog
Authors: Sant'Ambrogio G , Sant'Ambrogio FB
Published: January 2003

We have studied the effects of moguisteine, a new non-narcotic, peripherally acting antitussive compound, on tracheobronchial rapidly adapting irritant receptors (RARs). Experiments were carried out on dogs anaesthetized with a mixture of urethane and alpha-chloralose, paralysed with gallamine, vagotomized and artificially ventilated. Single unit action potentials identified as originating from tracheobronchial RARs were recorded from the peripheral cut end of the right vagus nerve. The activity of these receptors was recorded together with oesophageal pressure and arterial blood pressure. Fourteen RARs were challenged with moguisteine (200 microg x kg[-1] i.v.) in 0.4% dimethylsulphoxide (DMSO) or 0.4% DMSO alone (vehicle). Receptor activity was recorded before (control) and at 2, 5, 10, 15, 20, 30 and 45 min after administration of the challenging compounds. When the results at intervals of 2, 5, 10, 15 and 20 min were averaged for each dog, it was found that moguisteine decreased the mean activity of the 14 receptors to 75% of the control value (p<0.05); the greatest inhibition occurred 10-20 min after moguisteine administration. DMSO did not significantly affect the activity of these endings. Oesophageal pressure, arterial blood pressure and cardiac frequency were not altered during the experimental procedures. The overall results indicate the presence of an inhibitory effect of moguisteine on rapidly adapting irritant receptors that could account for the antitussigenic effect of this compound.
Chronic Chlamydia pneumoniae infection and asthma exacerbations in children
Authors: Cunningham AF , Johnston SL , Julious SA , Lampe FC , Ward ME
Published: January 2003

This study was undertaken to investigate the reported association between Chlamydia pneumoniae and Mycoplasma pneumoniae infection and the expression of asthma-related symptoms. One hundred and eight children with asthma symptoms, aged 9-11 yrs, completed a 13 month longitudinal study. The children maintained a daily diary of respiratory symptoms and peak flow rates. When respiratory symptoms were reported an investigator was called and a nasal aspirate obtained. In total 292 episodes were reported. After the study 65 children provided samples when asymptomatic. The presence of infection was investigated by the polymerase chain reaction for C. pneumoniae and M. pneumoniae and C. pneumoniae secretory immunoglobulin A (IgA) was detected by amplified enzyme immunoassay. C. pneumoniae detections were similar between the symptomatic and asymptomatic episodes (23 versus 28%, respectively). Children who reported multiple episodes also tended to remain PCR positive for C. pneumoniae suggesting chronic infection (p< 0.02). C. pneumoniae-specific secretory-IgA antibodies were more than seven times greater in subjects who reported four or more exacerbations in the study compared to those who reported just one (p<0.02). M. pneumoniae was found in two of 292 reports and in two of 65 asymptomatic samples. In conclusion, chronic Chlamydia pneumoniae infection is common in schoolage children and immune responses to C. pneumoniae are positively associated with frequency of asthma exacerbations. We suggest that the immune response to chronic C. pneumoniae infection may interact with allergic inflammation to increase asthma symptoms. In contrast Mycoplasma pneumoniae was not found to be important in this study.
Hospitalization for lower respiratory disease during 20 yrs among under 5 yr old children in Stockholm County: a population based survey
Authors: Wickman M , Farahmand BY , Persson PG , Pershagen G
Published: January 2003

Lower respiratory disease (LRD) is a common cause of hospitalization in infants, and episodes of obstructive LRD increase the risk for asthma later in life. The purpose of this study was to assess time trends and geographical variation of first time hospitalization for LRD among children in Stockholm County, Sweden. Data on first time admittance for LRD among children aged up to 5 yrs from 1973 through 1992 were obtained from the Stockholm County Council hospital discharge register, and population register data were used for estimation of the population at risk. Municipal data were available for 1982-1992 on outbreaks of respiratory syncytial virus (RSV) infections and socio-economic factors. A total of 12,450 children had been hospitalized for the first time with LRD. For children aged <2 yrs a 100% increase in the rate of first time hospitalization for LRD was observed during the study period and children aged up to 1 yr predominated (50%). The average yearly increase in the population based first time hospital admission rate for LRD was 1.82%. Males constituted 65% of the cases. Of the diagnoses, 89.6% were consistent with obstructive LRD, e.g. asthma and obstructive bronchitis. In children aged up to 1 yr, peaks in the rate of hospitalization tended to coincide with outbreaks of RSV infections. Differences in hospitalization between municipalities seemed to be partly explained by differences in the admission practices of the four paediatric hospitals in the area. We conclude that the increased rate of hospitalization for lower respiratory disease in infants of Stockholm County may reflect a true increase in the incidence of obstructive respiratory disease. However, several factors determine admittance to hospital and the results need to be interpreted with caution.
Acute effects of deep diaphragmatic breathing in COPD patients with chronic respiratory insufficiency
Authors: Vitacca M , Clini E , Bianchi L , Ambrosino N
Published: January 2003

This study investigated the impact of deep diaphragmatic breathing (DB) on blood gases, breathing pattern, pulmonary mechanics and dyspnoea in severe hypercapnic chronic obstructive pulmonary disease (COPD) patients recovering from an acute exacerbation. Transcutaneous partial pressure of carbon dioxide (Ptc,CO2) and oxygen (Ptc,O2) and arterial oxygen saturation (Sa,O2), were continuously monitored in 25 COPD patients with chronic hypercapnia, during natural breathing and DB. In eight of these patients, breathing pattern and minute ventilation (V'E) were also assessed by means of a respiratory inductance plethysmography. In five tracheostomized patients, breathing pattern and mechanics were assessed by means of a pneumotachograph/pressure transducer connected to an oesophageal balloon. Subjective rating of dyspnoea was performed by means of a visual analogue scale. In comparison to natural breathing deep DB was associated with a significant increase in Ptc,O2 and a significant decrease in Ptc,CO2, with a significant increase in tidal volume and a significant reduction in respiratory rate resulting in increased V'E. During DB, dyspnoea worsened significantly and inspiratory muscle effort increased, as demonstrated by an increase in oesophageal pressure swings, pressure-time product and work of breathing. We conclude that in severe chronic obstructive pulmonary disease patients with chronic hypercapnia, deep diaphragmatic breathing is associated with improvement of blood gases at the expense of a greater inspiratory muscle loading.
Heart block in patients with obstructive sleep apnoea: pathogenetic factors and effects of treatment
Authors: Koehler U , Fus E , Grimm W , Pankow W , Schafer H , Stammnitz A , Peter JH
Published: January 2003

Heart block during sleep has been described in up to 10% of patients with obstructive sleep apnoea. The aim of this study was to determine the relationship between sleep stage, oxygen desaturation and apnoea-associated bradyarrhythmias as well as the effect of nasal continuous positive airway pressure (nCPAP)/nasal bi-level positive airway pressure (nBiPAP) therapy on these arrhythmias in patients without electrophysiological abnormalities. Sixteen patients (14 males and two females, mean age 49.6+/-10.4 yrs) with sleep apnoea and nocturnal heart block underwent polysomnography after exclusion of electrophysiological abnormalities of the sinus node function and atrioventricular (AV) conduction system by invasive electrophysiological evaluation. During sleep, 651 episodes of heart block were recorded, 572 (87.9%) occurred during rapid eye movement (REM) sleep and 79 (12.1%) during nonrapid eye movement (NREM) sleep stages 1 and 2. During REM sleep, the frequency of heart block was significantly higher than during NREM sleep: 0.69+/-0.99 versus 0.02+/-0.04 episodes of heart block x min(-1) of the respective sleep stage (p<0.001). During apnoeas or hypopnoeas, 609 bradyarrhythmias (93.5%) occurred with a desaturation of at least 4%. With nCPAP/ nBiPAP therapy, apnoea/hypopnoea index (AHI) decreased from 75.5+/-39.6 x h(-1) to 3.0+/-6.6 x h(-1) (p<0.01) and the number of arrhythmias from 651 to 72 (p<0.01). We conclude that: 1) 87.9% of apnoea-associated bradyarrhythmias occur during rapid eye movement sleep; 2) the vast majority of heart block episodes occur during a desaturation of at least 4% without a previously described threshold value of 72%; and 3) nasal continuous positive airway pressure or nasal bi-level positive airway pressure is the therapy of choice in patients with apnoea-associated bradyarrhythmias.
Validation of automated sleep analysis in normal children
Authors: Villa MP , Piro S , Dotta A , Bonci E , Scola P , Paggi B , Paglietti MG , Midulla F , Ronchetti R
Published: January 2003

With the aim of determining normal reference values for our sleep laboratory and evaluating the reliability of automated analysis for scoring polysomnographic studies in children, we recorded polysomnograms in 16 healthy boarding-school children. Sleep recordings were obtained with a computer system (Medilog SAC, Oxford Instruments). Polysomnographic variables were monitored continuously on a 16-channel recorder equipped with a video. Data were acquired on optical disk for computer-assisted data interpretation. Sleep stages and respiratory events were also scored visually by operator. Comparison with visual scores showed that the computer system significantly overscored wakefulness (W) (p<0.02) and stage IV (p<0.001) and underscored stage II (p<0.001) and rapid eye movement (REM) sleep (p<0.001). It also assigned respiratory events a higher score than did visual scoring, as shown by the higher apnoea index (AI) and hypopnoea index (HI) (AI p<0.03; HI p<0.001). Regression analysis showed a significant correlation between visual and automated scores for central (r=0.679; p<0.004) and obstructive apnoea (r=0.631; p<0.008). Computer apnoea scores did not correlate with visual scores. Much remains to be done before computer-based scoring systems can be relied upon, without visual scoring, for polysomnographic sleep studies in children. Their main advantage at present is that they offer a convenient means of saving paper, space and time.
Subjective scoring of cough in children: parent-completed vs child-completed diary cards vs an objective method
Authors: Chang AB , Newman RG , Carlin JB , Phelan PD , Robertson CF
Published: January 2003

Cough is often used as an outcome measure, although the reporting of cough is unreliable. Using a 24 h ambulatory cough meter to measure cough frequency, the aim of this study was to compare: 1) the correlation of child-completed diary cards to the objective measurement, with that of parent-completed diary cards; and 2) the visual analogue scale (VAS) to the verbal category descriptive (VCD) score. The cough meter consisted of a previously validated Holter monitor and a cough processor. Eighty four children (39 with recurrent cough and 45 controls, aged 6-17 yrs) used a cough meter at least once. Thirty three subjects used the cough meter twice. Parents and children completed separate diary cards using the VAS and VCD scores. The strength of the relationship between the subjective scores and the objective recordings was analysed by spearman's rank correlation coefficient. For daytime cough, child-completed diary cards and the VCD correlated better to the objective measurement than parent-completed diary cards and the VAS, respectively. In subjects that used the cough meter twice, the difference between the cough frequency correlated to the difference in the subjective scores. The confidence intervals for the correlation coefficients were wide. The agreement between the objective and subjective presence of daytime cough was good but that for night-time cough was poor. We conclude that the severity of cough defined on diary cards may not represent cough frequency. Objective readings are first choice but currently not yet practical. The verbal category descriptive diary card completed by children and assisted by parents has the highest correlation to cough frequency measured objectively.
Nicotine replacement: a new approach to reducing tobacco-related harm
Authors: Jimenez-Ruiz C , Kunze M , Fagerstrom KO
Published: January 2003

Primary prevention is usually regarded as the most desirable goal in efforts to control tobacco-related diseases. However, this has not been very effective so far; moreover, it would take 30-40 yrs for primary prevention to translate into major health benefits. Modification of tobacco products and/or reduction of tobacco use may also have some impact on tobacco-related diseases. A tobacco dose-dependent risk has been observed in these diseases, including cancer, cardiovascular diseases, chronic nonspecific respiratory disorders, and problems during pregnancy. Reduced smoking (smoking fewer cigarettes, leading to a reduced intake of toxic substances) may be indicated in individuals who: 1) are failing in cessation attempts; 2) want to quit but are unable to do so; and 3) do not want to quit but want to reduce smoking. Studies have shown that nicotine replacement medications may be an untapped source in efforts to reduce smoking. Based on Austrian data, it is estimated that, approximately 10 yrs after implementation, a 1% reduction in smoking could save 14 male lung cancer deaths each year, and a 50% reduction would save 700 male lives. Inclusion of females and other tobacco-related diseases suggest that thousands of lives could be saved if smoking could be reduced by 50%. In the European Union, such a reduction in smoking could save > or = 100,000 lives annually. Even a 1% reduction would save 1,000 lives. In conclusion, reduced smoking should be explored as a valid method of reducing tobacco-related harm in those unwilling or unable to quit smoking.
Massive haemoptysis complicating exogenous lipid pneumonia
Authors: Haro M , Murcia I , Nunez A , Julia E , Valer J
Published: January 2003

Exogenous lipid pneumonia is an uncommon condition resulting from the aspiration or inhalation of fat or oil material. The prognosis in this entity is usually good and complications are rare. We report an unusual case of chronic lipid pneumonia complicated with massive haemoptysis who responded to steroid therapy after arterial embolization.
Climate change impacts on the thermal performance of Portuguese buildings. Results of the SIAM study
Authors: Aguiar R , Oliveira M , Gonccedilalves H
Published: January 2003

Results of the ” rst studies speci” cally dedicated to the impact of climate change on the thermal behaviour of buildings in Portugal are discussed within this paper. A top-down econometric/statistical analysis was attempted in order to correlate ‘ uctuations of temperature and energy consumption in the residential and services sectors, but the results were not conclusive. A bottom-up numerical thermal simulation of representative buildings for various regions of Portugal was more successful. Unlike most studies for northern countries, it is predicted that the energy demand for space conditioning in Portugal would greatly increase by the end of the twenty-” rst century, assuming ” xed characteristics of the building sectors. The heating season is shorter and the heating thermal load reduced (with HadCM3 model scenarios, less 250–410 kWh for residences, less 5–7 kWh/m2 for offices), but these economies are offset by an extended cooling season and large increases of the cooling thermal loads (additional 500–880 kWh for residences, 19–24 kWh/m2 for offices). Higher resolution studies using HadRM data resulted in yet more serious climate change impacts.
Is the test constructor a facet?
Authors: Jafarpur Abdoljavad
Published: January 2003

Most modern language testers believe that the writing of a successful instrument begins with specifications, and that instruments constructed devoid of specifications are likely to go astray. The purpose of this study was to explore the relative impact of the test-developer on the performance of test-takers using multiple-choice reading comprehension tests that had no specifications. Traditional reading comprehension tests often consist of short prose passages followed by sets of multiple-choicecomprehension questions. The test constructor formulates the stem and the choices on the basis of his or her own renditions of the passage. The test-takers provide evidence of their comprehension in terms of their written responses to the items designed by the test constructor. Since the characteristics of the test method limit the responses the testees can provide, the expected response becomes part of the test method. Accordingly, it seems reasonable to suggest that there may be a facet associated with the test-developer.Six passages each with 3 different sets of multiple-choice items constructed by 3 (groups of) individuals were trialled on 335 Iranian EFL (English as a foreign language) learners. The results revealed differential performance on almost all sets, suggesting a test constructor effect.
Parallel replacement of the oxygenator that is not transferring oxygen: the PRONTO procedure
Authors: Groom R C , Forest R J , Cormack J E , Niimi K S , Morton J
Published: January 2003

We present here a technique to replace a failed oxygenator by inserting a second oxygenator in parallel (PRONTO) within the cardiopulmonary bypass (CPB) circuit. Oxygenator failure is a potential hazard that may result in patient injury or death. Although failures are rare, safety surveys conducted over the last 25 years suggest that the incidence of oxygenator failures is on the rise. This emergency procedure may be easily applied to any standard CPB circuit with a few minor alterations. The technique is simple; it can be carried out rapidly. An important advantage of this technique is that it may be executed without interrupting blood flow to the patient, which may reduce the incidence of patient injury or death.
Intraoperative modality of treatment for peritoneal carcinomatosis: use of hyperthermic interperitoneal chemoperfusion
Authors: Sutton S W , Yancey L W , Chase V A , Hunley E K , McCarty T M , Kuhn J A , Loggie B W
Published: January 2003

The use of hyperthermia as an adjunct to chemotherapy in the treatment of peritoneal carcinomatosis is a promising technique for patients who otherwise have a poor prognosis for survival. We, herein, report an overview and description of our technique for the safe conduct of this treatment. Included in these data are a total of 71 patients who underwent an intraoperative treatment with Mitomycin C at temperatures of 41-42°C for a 90- to 120-min time period. The treatment protocol, perfusion system description, technical considerations, and potential complications are also included. The prognosis for intraabdominal carcinomatosis is poor with conventional treatments and modalities. We believe that the use of this technique offers a very positive clinical alternative for patients undergoing treatment for laparoscopic palliation of malignant ascites and/or surgical debulking for intraoperative treatment and prevention of metastasis.
The immediate haemodynamic response to the initiation of extracorporeal membrane oxygenation in a piglet model of infant hypoxic respiratory failure
Authors: Golej J , Kahlbacher H , Schöffmann G , Winter P , Burda G , Boigner H , Trittenwein G
Published: January 2003

There is evidence that haemodynamic fluctuations on extracorporeal membrane oxygenation (ECMO) increase the risk of cerebral damage. We hypothesized that initiation of venovenous (VV) or venoarterial (VA) ECMO itself causes haemodynamic fluctuations and, thus, established an infant animal ECMO model in order to discuss this hypothesis. Five piglets were cannulated using the jugular and femoral veins (VV group) and five using the jugular vein and carotid artery (VA group). All animals were subjected to hypoxic ventilation (FiO2 8%) for 10 min, leading to a paO2 of < 40 mmHg, and subsequently rescued by ECMO. The heart rate (HR) and mean arterial blood pressure (MAP) were recorded at 5-min intervals; the arterial blood lactate was measured prior to and after 5 and 10 min of hypoxia, as well as 30, 60 and 120 min after initiation of ECMO. The response to initiation of ECMO was similar in the VV and VA groups with regard to HR and lactate, but differed significantly in MAP. HR decreased significantly from 135± 7 to 103± 6 beats/min ( p < 0.05) and from 132± 8 to 84± 9 beats/min ( p < 0.01) at 5 min ( p= NS) after installation; lactate increased from 1.4± 0.1 to 1.8± 0.2 mmol/l ( p= NS) and from 1.4± 0.2 to 1.6± 0.5 mmol/l ( p= NS) after 30 min ( p= NS); MAP decreased from 80± 5 to 63± 3 mmHg ( p= NS) and increased from 75± 4 to 84± 3 mmHg ( p= NS) at 5 min ( p= 0.001), respectively. The initiation of ECMO is associated with haemodynamic fluctuations in both modalities, which differ with regard to blood pressure reaction.
Extracorporeal membrane oxygenation for pneumonitis after a Glenn palliation
Authors: Nielsen James C , Seiden Howard S , Nguyen Khanh , Vlahakis Susan A , Ravishankar Chitra
Published: January 2003

A five-month old male with a single ventricle palliated with a bidirectional cavopulmonary anastomosis developed severe respiratory insufficiency from respiratory syncytial virus (RSV) pneumonitis. He was successfully rescued with extra-corporeal membrane oxygenation (ECMO) therapy and recovered with minimal morbidity.
Are we underestimating the clinical efficacy of botulinum toxin (type A)? Quantifying changes in spasticity, strength and upper limb function after injections of Botox® to the elbow flexors in a unilateral stroke population
Authors: Pandyan Anand D , Vuadens Philippe , van Wijck Frederike MJ , Stark Sandra , Johnson Garth R , Barnes Michael P
Published: January 2003

Objective: To quantify the clinical efficacy of botulinum toxin type A in treating elbow flexor spasticity in a unilateral stroke population. Location: A spasticity clinic at a regional neurological rehabilitation centre.

Study design: A convenience sample longitudinal study. Fourteen subjects with elbow flexor spasticity secondary to a stroke were recruited. Two repeated measures, one before and another four weeks after treatment, were taken to quantify clinical efficacy.

Outcome measures: Elbow flexor spasticity was simultaneously rated with the modified Ashworth scale (MAS) and quantified by measuring the surface EMG from the flexors using a custom-built device. Strength at the elbow (isometric), grip strength and upper limb function (Action Research Arm test) were also assessed.

Treatment: Injections of botulinum toxin type A (Botox®) to the m.biceps brachii (mean dose 70 U), m.brachioradialis (mean dose 56.5 U) and m.flexor digitorum longus (mean dose 83.3 U).

Results: Following treatment, spasticity (as measured by flexor EMG activity) reduced but the MAS was unable to detect this improvement. In some subjects, isometric flexor strength at the elbow as well as grip strength increased. This was contrary to the expected weakening following treatment with botulinum toxin type A and suggests an optimization of motor control.

Conclusion: Treatment with Botox® reduces spasticity but does not necessarily cause a reduction in the force generating capabilities at the joint. The improvement in strength may have contributed to the improvements in upper limb function. The MAS is an inappropriate measure of spasticity.
How well do general practitioners deliver palliative care? A systematic review
Authors: Mitchell Geoffrey K
Published: January 2003

General practitioners (GPs) deliver the majority of palliative care to patients in the last year of life. This article seeks to examine the nature of GP care, perceptions of the GPs themselves and others of that care, the adequacy of palliative care training, issues relating to accessibility of GPs to palliative care patients, and strategies that may be of use in encouraging more effective delivery of palliative care by GPs. Medline and PubMed databases from 1966 to 2000 were searched, and 135 references identified. Sixty-six of these described studies relevant to GP palliative care. GPs value this part of their work. Most of the time, patients appreciate the contribution the GP makes to palliative care particularly if the GP is accessible, takes time to listen, allows patient and carer to ventilate their feelings, and is seen to be making efforts made regarding symptom relief. However, reports from bereaved relatives suggest that palliative care is performed less well in the community than in other settings. GPs express discomfort about their competence to perform palliative care adequately. They tend to miss symptoms which are not treatable by them, or which are less common. However, with appropriate specialist support and facilities, GPs have been shown to deliver sound and effective care. GP comfort working with specialist teams increases with exposure to this form of patient management, as does the understanding of the potential other team members have in contributing to the care of the patient. Formal arrangements engaging GPs to work with specialist teams have been shown to improve functional outcomes, patient satisfaction, improve effective use of resources and improve effective physician behaviour in other areas of medicine. Efforts by specialist services to develop formal involvement of GPs in the care of individual patients, may be an effective method of improving GP palliative care skills and appreciation of the roles specialist services can play.
Anima urbis
Authors: Wolch Jennifer
Published: January 2003

Geographers have long neglected the role of nature in shaping the urban experience. Yet the anima urbis – the breath, life, soul and spirit of the city – is embodied in its animal as well as human life forms. Recent work focused on human-animal relations has begun to re-animate analyses of the city. Such studies range widely, exploring, for example: historical and literary perspectives on the place of animals in the city; links between urban institutions such as zoos and colonialism, nationalism and racial identity formation; negotiations around human-wildlife interactions at the urban fringe; and gender and cultural diversity in attitudes toward animals in world cities. In addition, geographers have begun to consider animals and the urban moral landscape, and assess competing rubrics of planning practice as they relate to animals in the city. Together, these efforts suggest a research agenda for urban geographers interested in human-animal relations, that may help bridge gaps between human and physical geography, and propel the study of nature-society relations to the fore in urban geography.
Holocene reworking of drift-mantled hillslopes in Glen Docherty, Northwest Highlands, Scotland
Authors: Curry Alastair M.
Published: January 2003

Sections exposed within a colluvial debris cone in Glen Docherty, Scotland, reveal in-situ palaeosols intercalated with debrisflow diamictons and horizons of slopewash deposits. Radiocarbon dating of the palaeo sols suggests that drift reworking at this site involved brief, intermittent episodes of debrisflow and slopewash activity since c. 6.5 cal. ka BP. At least four such phases can be recognized: c. 6.5–6.2, 5.6–5.3, 4.9–4.6 cal. ka BP and after c. 450 cal. BP. The palaeosols examined show no evidence of local burning of vegetation. A calibrated radiocarbon age for the onset of the most recent phase of reworking may be interpreted as reflecting woodland clearance and/or the influence of extreme rainfall events during the ‘Little Ice Age’ period of regional climatic deterioration. The combined chronostratigraphic and palaeoecological evidence points to discrete, local rainstorms that are seemingly unrelated to long-term climatic change as the most likely cause of enhanced slope reworking, at least prior to c. 450 cal. BP. If this interpretation is valid, it implies that the formation of Holocene debris cones elsewhere in upland Britain may have been due primarily to a small number of localized, extreme rainstorm events. Consequently, caution is necessary in using debrisflow chronostratigraphy alone as a means of reconstructing long-term climate patterns.
A 963-year reconstruction of summer (JJA) stream flow in the White River, Arkansas, USA, from tree-rings
Authors: Cleaveland M. K.
Published: January 2003

An average of three baldcypress ( Taxodium distichum) ring-width chronologies was used to recon struct total summer (JJA) mean daily flow of the White River at Clarendon, Arkansas, for years 1023–1985. A quadratic transformation of the tree-ring data accounted for 68% (R2 adjusted for degrees of freedom lost) when regressed against total summer flow 1931–1985. The distribution of the quadratic reconstruction matched the gauged distribution much better than a simple linear model which only accounted for 62% of the variance. The model was validated by comparing regression estimates against independent data. Years with summer flow below the 25th percentile occur nonrandomly, i.e., they tend to cluster, in both the reconstructed and gauged data. Hydrologic regimes have apparently varied considerably in the past on annual to century time-scales, with extended dry and wet periods that exceeded anything in the modern record. The frequency of both wet and dry extremes has varied considerably over the last millennium. The eleventh through thirteenth cen turies were not analysed due to reduced replication, but the well-replicated fourteenth and twentieth centuries both have large numbers of extremes. The twentieth century appears to have more extreme low flows than the previous centuries and also to have a large number of high flows. The practical consequences for society of variation in extremes and persistence of low flows may be considerable. Climatic change or anthropogenic changes to the watershed (e.g., widespread upland clearing for agriculture and logging of bottomland forests) may be responsible for the change in hydrologic regime during the twentieth century.
Diatom indicators of peatland development at Pogonia Bog Pond, Minnesota, USA
Authors: Brugam Richard B. , Swain Patricia
Published: January 2003

Sediment cores were taken from the central pond and fringing mat of a Sphagnum peatland located in the Big Woods vegetation type. Pollen analysis of the pond core spanning 12 000 cal. BP to the present indicated a mid-postglacial warm period (10 000 to 3900 cal. BP at this site), when the area was covered by open oak woodland and prairie. From 3900 to 300 cal. BP oak forest expanded. At 300 cal. BP (ad 1650) Big Woods species (e.g., Tilia, Ostrya, Ulmus and Acer) increased as a result of ‘Little Ice Age’ cooling. Diatoms indicating water of high acid-neutralizing capacity (e.g., Stephanodiscus hantzschii) dominated the lake during the mid-Holocene. At 2100 cal. BP these species were succeeded by Aulacoseira distans and A. perglabra, indicating water of low acid-neutralizing capacity and marking peatland initiation. Transfer functions derived from diatoms in surface-sediment samples from Minnesota and the Upper Peninsula of Michigan suggest that this change was associated with reduced acid-neutralizing capacity in Pogonia Bog Pond. This decline was probably caused by peat accumulation around the Pond. The development of peatland at Pogonia Bog is late relative to sites farther north and east, indicating that the climate of the site has become conducive to peat accumulation in the last 2200 years and that the initiation of peatland development represents a time-transgressive boundary that has moved across central North America.
Century scale climate forcing of fire regimes in the American Southwest
Authors: Grissino Mayer Henri D. , Swetnam Thomas W.
Published: January 2003

Interannual time-scale associations between fire occurrence anddrought indices, the Southern Oscillation, and other synopticpatterns demonstrate that large-scale, long term atmospheric featuresare precursors to regional fire activity. However, our knowledge offire-climate relations over longer (century) timescales is fragmentary because of the rarity of comparable climate and fire time-series with sufficient resolution, length and regional extent. In this study, we develop reconstructions of wildfire occurrence from tree-ring data collected from northwestern New Mexico to compare with a millennium-length dendroclimatic reconstruction of precipitation. Reconstructions of both wildfires and climate show simultaneous changes since AD 1700 that indicate climate forcing of wildfire regimes on interannual to century timescales. Following a centuries-long dry period with high fire frequency ( c. AD 1400-1790), annual precipitation increased, fire frequency decreased, and the season of fire shifted from predominantly midsummer to late spring. We hypothesize that these shifts in fire regimes reflect long-term changes in rainfall patternsassociated with changes in synoptic-scale atmospheric circulation patterns and the Southern Oscillation. Our evidence supports century-scale climate forcing of fire regimes in the American Southwest, providing a useful analogue of future wildfire regimes expected uinder changing global climate conditions.
Late-Holocene human impact and peat development in the Černá Hora bog, Krkonoše Mountains, Czech Republic
Authors: Speranza Alessandra , Hanke Juliane , van Geel Bas , Fanta Josef
Published: January 2003

Pollen analysis of a small peat bog at Černá Hora, Czech Republic, shows late-Holocene human impact on the vegetation. The palynological results are compared with historical documentation. Macrofossil analysis and changing pollen concentrations provide evidence that human impact on the regional vegetation determined changes in the hydrological conditions of the bog, and in the peat accumulation rate. From approxi mately 2100 BP (start of peat growth) to approximately 1400 BP no human impact has been identified from the pollen record and the decomposition of the peat deposit indicates moderately moist conditions within the catchment. Subsequent changes corresponded with two phases of inferred human impact on the vegetation. From approximately 1400 BP (seventh to eighth centuries AD) and especially after 900 BP (eleventh to twelfth centuries AD), human impact (deforestation) became evident and the less decomposed peat was formed under locally wet conditions.
AMS 14C dating of Holocene estuarine deposits: consequences of high-energy and reworked foraminifera
Authors: Cearreta Alejandro , Murray John W.
Published: January 2003

Benthic foraminiferal species were used to AMS date Holocene sediments adjacent to trangressive overlap boundaries (TOB) in two high-energy estuaries in northern Spain. It had previously been recognized that the foraminifera could be divided into indigenous and exotic components. Whereas it was known that the exotic forms had been transported into the estuaries from the adjacent inner shelf, it was assumed that the indigenous forms were in situ. The AMS dates based on indigenous forms obtained from pairs of samples adjacent to the TOB showed an inverse relationship in three out of four boreholes (i.e., the age of the higher sample was older than that of the lower). The most probable explanation of this unexpected result is that there had been significant reworking of indigenous foraminifera especially associated with the transgressive episode. It is concluded that, in high energy estuaries, AMS dating on foraminiferal shells is influenced by transport and reworking even of the indigenous component. Therefore, if only foraminifera are available for dating, we recommend that closely spaced pairs of samples should be dated in order to assess the reliability of the results.
Response of climate to solar forcing recorded in a 6000-yearδ18O time-series of Chinese peat cellulose
Authors: Hong Y. T. , Jiang H. B. , Liu T. S. , Zhou L. P. , Beer J. , Li H. D. , Leng X. T. , Hong B. , Qin X. G.
Published: January 2003

Previous studies have shown that the oxygen isotope ratio (δ18O) of plant cellulose can serve as a sensitive proxy indicator of past climate, but its application has mainly been restricted to tree-rings. Here we present a 6000-year high-resolutionδ18O record of peat plant cellulose from northeastern China. Theδ18O variation is interpreted as reflecting changes in regional surface air temperature. The climate events inferred from the isotope data agree well with archaeological and historic evidence. The record shows a striking corre spondence of climate events to nearly all of the apparent solar activity changes characterized by the atmospheric radiocarbon in tree-rings over the past 6000 years. Spectral analysis of theδ18O record reveals the periodicities of around 86, 93, 101, 110, 127, 132, 140, 155, 207, 245, 311, 590, 820 and 1046 years, which are similar to those detected in the solar excursions. We consider these observations as further evidence for a close relationship between solar activity and climate variations on timescales of decades to centuries. Our results also have implications for distinguishing between natural and anthropogenic contributions to future climate change.