bluuebunny/crossref_metadata_2025 huggingface dataset:
Changing prevalence of gastroesophageal reflux with changing time: Longitudinal study in an Asian population
Authors: LIM SHEN L , GOH WEE TECK , LEE JEN‐MAI J , NG TZE PIN , HO KHEK‐YU ,   CONTRIBUTING MEMBERS OF THE COMMUNITY MEDICINE GI STUDY GROUP
Published: August 2010

Background:  The purpose of the present paper was to study previously obtained population‐based data on the prevalence of reflux symptoms in a random sample of community adults in Singapore. This sample was re‐investigated 5 years later to determine changes in the prevalence of reflux symptoms.

Methods:  In 1999, 237 (34%) of the original cohort of 696 persons who were interviewed in 1994, were re‐interviewed using a validated Gastrointestinal Symptoms Questionnaire. The original cohort was a race‐stratified random sample of residents in a Singaporean town. Reflux was defined as heartburn and/or acid regurgitation occurring at least once a month.

Results:  Among the 237 respondents (aged 25–89 years; male : female, 49:51; Chinese n = 106, 45%; Malay n = 69, 29%; Indian n = 60, 25%), reflux was reported by 25 respondents, giving a prevalence of 10.5 ± 2.0%. This compared with the prevalence of 5.5 ± 1.5% (odds ratio [OR], 2.2; 95% confidence interval [CI]: 1.0–5.2; P = 0.05) among the same 237 respondents in the 1994 survey. Of the 25 subjects who reported reflux in the current survey, 22 (88.0%) did not complain of reflux symptoms in the 1994 survey. The ethnic‐adjusted prevalence of reflux in 1999 was estimated to be 9.9 ± 1.9%. This was an increase above the prevalence in 1994 of 1.6 ± 1.0% (P = 0.051). The upward trend in the prevalence of reflux was not related to age, smoking, alcohol consumption, or increase in bodyweight.

Conclusions:  There is a rising trend of reflux symptoms frequency in the general population of Singapore over a 5‐year period.

© 2005 Blackwell Publishing Asia Pty Ltd
Enteral nutrition via percutaneous endoscopic gastrostomy and nutritional status of patients: Five‐year prospective study
Authors: ERDIL AHMET , SAKA MENDANE , ATES YUKSEL , TUZUN AHMET , BAGCI SAIT , UYGUN AHMET , YESILOVA ZEKI , GULSEN MUSTAFA , KARAEREN NECMETTIN , DAGALP KEMAL
Published: August 2010

Background:  Since it was described in 1980, percutaneous endoscopic gastrostomy (PEG) has been a widely used method for insertion of a gastrostomy tube in patients who are unable to swallow or maintain adequate nutrition. The aim of the present paper was to determine the complications of PEG insertion and to study pre‐ and post‐procedural nutritional status.

Methods:  During the period of March 1999–September 2004, placement of PEG tube was performed in 85 patients (22 women and 63 men). Patient nutritional status was assessed before and after PEG insertion via anthropometric measurements.

Results:  The most frequent indication for PEG insertion was neurological disorders (65.9%). Thirty patients died due to primary disease and two patients due to PEG‐related complications within 5 years. There were 14 early complications in 10 patients (15.2%; <30 days), and 18 late complications in 12 patients (19.6%). Total mortality was 37.6%. All complications other than four were minor. Before PEG insertion, patients were assessed with subjective global assessment and it was determined that 43.2% of them had severe, and 41.9% of them had mild malnutrition. After PEG insertion, significant improvements on patient nutrition levels was observed.

Conclusion:  Percutaneous endoscopic gastrostomy is a minimally invasive gastrostomy method with low morbidity and mortality rates, is easy to follow up and easy to replace when clogged.

© 2005 Blackwell Publishing Asia Pty Ltd
Brain natriuretic peptide and severity of disease in non‐alcoholic cirrhotic patients
Authors: YILDIZ RAMAZAN , YILDIRIM BULENT , KARINCAOGLU MELIH , HARPUTLUOGLU MURAT , HILMIOGLU FATIH
Published: August 2010

Background:  Cirrhotic patients have a hyperdynamic systemic circulation. They have insidious cardiac problems besides well‐known complications. Brain natriuretic peptide (BNP) relaxes vascular smooth muscle and has a portal hypotensive action. The relations between BNP levels and severity of disease, cardiac dysfunction and esophageal varices were studied in non‐alcoholic cirrhotic patients.

Methods:  Fifty‐two non‐alcoholic cirrhotic patients were evaluated for decompensation component of cirrhosis. The BNP concentration of echocardiographically examined patients was determined.

Results:  The BNP levels were significantly higher in ascites, spontaneous bacterial peritonitis and hepatic encephalopathy history group (P = 0.033, P < 0.001, P = 0.014, respectively), but no significant difference were observed for presence of esophageal varices and bleeding history (P = 0.267, P = 0.429). A significant correlation was observed between BNP concentration and Child score (r = 0.427, P = 0.012), interventricular septal thickness (r = 0.497, P < 0.001) and left ventricular posterior wall thickness (r = 0.526, P < 0.001). According to Child–Pugh classification there were no significant difference between groups for echocardiographic measurements and blood pressure (P > 0.05), but plasma BNP levels were significantly higher in Child class B and C patients compared with class A patients (P < 0.05).

Conclusion:  Increased levels of BNP are more likely related to the severity of disease in non‐alcoholic cirrhotic patients. The advanced cirrhosis is associated with more advanced cardiac dysfunction and BNP has prognostic value in progression of cirrhosis.

© 2005 Blackwell Publishing Asia Pty Ltd
Genetic alterations of Wnt signaling pathway–associated genes in hepatocellular carcinoma
Authors: Kim Young‐Dae , Park Chang‐Hwan , Kim Hyun‐Soo , Choi Sung‐Kyu , Rew Jong‐Sun , Kim Dong‐Yi , Koh Yang‐Suk , Jeung Kyung‐Woon , Lee Kyung‐Hwa , Lee Ji‐Shin , Juhng Sang‐Woo , Lee Jae‐Hyuk
Published: August 2010

Background and Aim:  Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide. Recently, abnormal activation of the Wnt pathway has been found to be involved in the carcinogenesis of HCC. However, the relationship between genetic changes in the Wnt pathway–associated genes and its protein expression has not been studied in patients with HCC and cirrhotic nodules. The purpose of this study is to explore the contribution of inappropriate activation of the Wnt pathway in liver carcinogenesis.

Methods:  Somatic mutation in exons 3–5 of AXIN1 and exon 3 of β‐catenin were analyzed by direct sequencing and expression of axin and β‐catenin proteins by immunohistochemistry in a series of 36 patients with HCC and cirrhosis.

Results:  The AXIN1 and β‐catenin gene mutations were observed in 25% (9/36) and 2.8% (1/36) of HCCs, respectively. All mutations detected in AXIN1 and β‐catenin genes were missense point mutations. Abnormal nuclear expression of β‐catenin was observed in 11 of 36 cases of HCCs (30.6%), but not in cirrhotic nodules. Reduced or absent expression of axin was seen in 24 of 36 HCCs (66.7%). The abnormal expression of β‐catenin and axin proteins was closely correlated with mutations of AXIN1 and β‐catenin (P < 0.0001 and P = 0.008, respectively).

Conclusions:  These data suggest that mutation of AXIN1 gene is a frequent and late event for HCC associated with cirrhosis, and is correlated significantly with abnormal expression of axin and β‐catenin. Therefore, activation of Wnt signaling through AXIN1 rather than β‐catenin mutation might play an important role in liver carcinogenesis.
Community‐based screening for hepatocellular carcinoma in elderly residents in a hepatitis B‐ and C‐endemic area
Authors: Huang Yen‐Chieh , Huang Chih‐Fang , Chang Kuo‐Chin , Hung Shu‐Fen , Wang Jing‐Houng , Hung Chao‐Hung , Chen Chien‐Hung , Tseng Po‐Lin , Kee Kwong‐Ming , Yen Yi‐Hao , Tsai Pei‐Shan , Tsai Chin‐Chen , Lu Sheng‐Nan
Published: August 2010

Background and Aim:  The aim of the present study was to elucidate a reasonable model and the efficacy of hepatocellular carcinoma (HCC) screening on an elderly population.

Methods:  Two‐stage HCC screening was conducted in a hepatitis C virus (HCV)‐endemic area. First, participants underwent blood tests for hepatitis B surface antigen (HBsAg), anti‐HCV antibody, serum α‐fetoprotein (AFP), aspartate aminotransferase, alanine aminotransferase, and platelet count. Patients who were abnormal for any of the six markers were enrolled for second‐stage ultrasonography. Suspected cases were referred for confirmation. HCC cases were followed for 4 years. All patients were linked to national mortality and cancer register databases to identify newly‐developed HCC, 30 months after screening.

Results:  A total of 461 males and 541 females were screened for HCC, with 15.1% testing positive for HBsAg and 44.3% positive for anti‐HCV. Among them, 619 (61.8%) met the criteria of ultrasonographic screening; 527 (85.1%) responded, and 16 confirmed HCC (male/female = 8/8, 68.8 ± 8 years) cases were detected. All tumor diameters were less than 5 cm, and six were less than 2 cm. AFP and thrombocytopenia were two independent predictive factors of HCC. The overall survival rates of detected cases were 93.8% and 56.3% was 1 and 4 years, respectively. The only good prognostic predictor was “underwent curative treatment”. Another seven non‐HCC residents developed HCC after screening, and five of these were with either thrombocytopenia or AFP elevation.

Conclusion:  Under economical consideration, AFP and platelet count should be feasible screening markers of risk identification. Early detection and prompt treatment results in good prognosis in an aged population.
The long‐term neurodevelopmental outcome for very low birthweight (VLBW) infants with ‘dystonic’ signs at 4 months of age
Authors: KHADILKAR V. , TUDEHOPE D. , BURNS Y. , O'CALLAGHAN M. , MOHAY H.
Published: August 2010

Abstract  As very low birthweight (VLBW) infants are at a high risk of developmental handicap, it is important to establish predictors of long‐term adverse outcome at an early age so that early intervention can be instituted. Longitudinal neurodevelopmental assessments were performed in 107 VLBW infants at 1,4, 8 and 12 months corrected age. Eighteen were diagnosed as ‘dystonic’ at 4 months of age.

This study compared the outcomes at 4 and 6 years for 15 of the 18 dystonic with 75 of the 89 non‐dystonic VLBW infants, respectively. At 9 years of age, nine dystonic and 54 non‐dystonic infants were assessed on the Rutter Behaviour Questionnaire. Dystonic children had a lower mean General Cognitive Index (GCI; P= 0.001) and a higher incidence of disability as measured by the Burns Neuro‐Sensori‐Motor Developmental Assessment Scale (P = 0.0005) and Kitchen disability grading (P = 0.001). Even if the minor neurological aberrations of the premature dystonia syndrome in VLBW infants abate by one year of life, these infants still constitute a high‐risk group for subsequent neurodevelopmental disability and therefore require close observation and probably early intervention.
Short‐term outcome of mechanically ventilated infants weighing more than 2499 g at birth: A population based study*
Authors: SUTTON L. , BAJUK B. , DUFFY B. , ALEXANDER I. , ARNOLD J. , LESLIE G. , HENDERSON‐SMART D. , JOHN E. , ROBERTS V. , BERRY A. , GILL A. , GARVEY P. , CARTER G.
Published: August 2010

Abstract: Very little data exist describing the neonatal outcome of infants of birthweight 2500 g or more who require mechanical ventilation. Our aim was to collect population‐based data on such infants in New South Wales (NSW), and to monitor their neonatal morbidity, mortality to 1 year of age and the associated risk factors. The study group (NICUS infants) comprised all 341 infants weighing >2499 g who were admitted to the seven neonatal intensive care units in New South Wales and mechanically ventilated for 4 h or more between 1 January and 31 December, 1987.

Two groups of infants emerged: those who were preterm and mostly had hyaline membrane disease, and term and post‐term infants for whom the most common problem was ‘perinatal asphyxia’.

The most important factors associated with dying were a birthweight of over 3499 g (OR = 2.6; CI 1.03–6.6) and a 1 min Apgar score <4 (OR = 4.8; C11.4–16.9). Study group mothers were significantly more likely than all NSW mothers to have had a spontaneous abortion in the previous pregnancy (P<0.01), a pre‐existing medical condition or an obstetric complication in this pregnancy, or a Caesarean section for this delivery (P<0.001). This is the first population‐based study of high‐risk neonates without congenital anomalies to clearly document the worsening prognosis associated with a birthweight over 3499 g. Further research should be directed towards identifying prenatal and perinatal factors which might minimize the morbidity and mortality in this group of babies.
Trends in the health burden due to urinary tract infection in children in Australia
Authors: CRAIG JC , IRWIG LM , KNIGHT JF , ROY LP
Published: August 2010

Objective: To estimate the health burden of urinary tract infection in children less than 15 years of age in Australia and to ascertain whether any significant change has occurred during the past decade.

Methodology: The number of children less than 15 years of age who were admitted in New South Wales for urinary tract infection between 1981 and 1994 was ascertained from the Department of Health, and age and sex specific incidence rates were calculated using Australian Bureau of Statistics population data. Costs for inpatient care were calculated using the cost weights from Australia National Disease Related Groups Version 3 for urinary tract infection (DRG 577). The frequency of the four most commonly requested renal tract imaging procedures in children following urinary tract infection and which qualified for Medicare reimbursement were obtained from the Health Insurance Commission for 1984–1994: micturating cystourethrography, intravenous urography, renal ultrasonography, and nuclear medicine renal studies.

Results: There were 1203 children who were admitted with urinary tract infection in New South Wales in 1994, at an estimated cost of $A1.6 million. Since 1981, the age standardized annual incidence of urinary tract infection requiring hospitalization has increased from 0.5 to 0.9 per 1000 children, largely because of an increase in the number of young children admitted (from 0.6 to 2.0 per 1000 children less than 5 years of age). In 1994, 46 230 non‐inpatient renal imaging procedures were undertaken in children under 15 years of age at a cost of $A5.3 million.

Conclusions: Urinary tract infection is an important and increasing health problem for Australian children, particularly for preschool children. Whether this represents a true increase in the incidence of urinary tract infection or improved diagnosis and more intensive management is not possible to establish with this study design. Prospective population based studies are required to assess more completely the frequency with which urinary tract infection occurs in children and any changes that may be occurring.
Limitations of school entry immunization certificates
Authors: MIKSEVICIUS H , JOHNSON P , WATT PD
Published: August 2010

Objective: To compare the immunization certificate submission rate for kindergarten school children on the Central Coast of New South Wales for 1994 and 1995; to contact individual parents of children with incomplete or missing immunization certificates by issuing a personalised immunization reminder letter, and measuring their response.

Methodology: Seventy Central Coast schools were surveyed. Immunization documentation for 4177 kindergarten enrolments in 1995 were assessed. Children with incomplete or unknown immunization status were identified. Immunization reminder letters were sent by the schools to parents of the children that were identified. The school recorded any additional immunization certificates submitted.

Results: In 1995, 79% of kindergarten children submitted immunization certificates, unchanged from the previous year. Immunization reminder letters were sent to 856 families of children with no certificate and 215 families of children with an incomplete certificate. A further 263 immunization certificates were submitted, representing a 25% response rate. This intervention increased the percentage of kindergarten children with a certificate from 79% to 86%.

Conclusions: Education of school staff during the 1994 immunization survey did not change the overall immunization certificate submission rate. Specifically targeting parents through schools can be an effective way of increasing immunization certificate submission.
Seed germination ecophysiology of two western North American species of Sambucus (Caprifoliaceae sensu lato), and comparisons with eastern North American and European congeners
Authors: HIDAYATI SITI N. , WALCK JEFFREY L. , TAYLOR JEANIE
Published: August 2010

Seeds of the western North American (wNA) species Sambucus caerulea in the Sambucus nigra species complex and Sambucus callicarpa in the Sambucus racemosa complex contain embryos that are 70–75% fully developed when freshly matured. These embryos must elongate approximately 15–25% before radicle emergence occurs. Embryos in seeds of both species grew better at 5°C than at 25/15°C. Dormancy was broken by cold stratification at 5°C, which was also the optimal temperature for germination. Gibberellic acid substituted for cold stratification in both species. Thus, seeds of both species have intermediate complex morphophysiological dormancy (MPD). The seed dormancy characteristics of both species differ from those of congeners in eastern North America (eNA). In contrast, dormancy break in S. callicarpa is similar to its European congeners, but is unclear in S. caerulea. Our study represents the first to compare seed dormancy among wNA, eNA and European congeners. In North America, the geographic pattern of dormancy break for Sambucus is similar to that of Osmorhiza (Apiaceae) and Erythronium (Liliaceae): cold stratification is required in wNA taxa and warm + cold stratification is required in eNA taxa. Moreover, the pattern in S. callicarpa is similar to that in some species of Sanicula (Apiaceae): cold stratification in Europe and warm + cold stratification in eNA. The evolution of seed dormancy in these groups might have occurred under similar environmental circumstances, resulting in the sharing of dormancy‐breaking mechanisms within geographical regions.
Introduction to the updated Australian and New Zealand consensus guidelines for the use of antifungal agents in the haematology/oncology setting, 2008
Authors: Slavin M. A.
Published: August 2010

The process for development of these consensus Australasian antifungal guidelines for use in adult patients with haematological malignancy is described. New features included, how the guidelines should be applied, the risk assessment tool used and the grading system for evidence and strength of recommendation are discussed.
EXCISION OF THE SUBMANDIBULAR GLAND: MINIMIZING THE RISK OF NERVE DAMAGE
Authors: Kennedy P. J. , Poole A. G.
Published: August 2010

Surgical texts do not clearly advise whether the ramus mandibularis should be identified in excision of the submandibular salivary gland for benign disease. An analysis of 74 patients was undertaken to assess the subsequent nerve function after submandibular salivary gland excision. Both glands were removed in two patients, making the total number of glands excised 76. In five cases the nerve was identified, in five patients the operative record did not clearly state whether the nerve was identified, and in the remaining 66 a non‐identification technique was used. The subsequent analysis was unable to follow‐up six patients fully. Seven patients had mild to moderate weakness in the early postoperative period, but all recovered, some taking up to 3 months to do so. Other complications were minor, except for two patients who had postoperative haemorrhage, one requiring a tracheostomy. As the majority of these patients had a non‐identification technique, and because searching for the nerve is tedious and time‐consuming, the former approach is recommended when operating for benign disease of the submandibular salivary gland.
Laryngoscopic techniques to assess vocal cord mobility following thyroid surgery
Authors: Kundra Pankaj , Kumar Vinoth , Srinivasan Krishnamachari , Gopalakrishnan Surianarayanan , Krishnappa Sudeep
Published: August 2010

Background:  Assessment of vocal cord mobility using Macintosh laryngoscope is frequently performed after extubation following thyroid surgery to rule out laryngeal nerve palsy. This study compared patient comfort and assessment accuracy of post‐operative vocal fold mobility with Macintosh laryngoscope and fibreoptic endoscope.

Methods:  One hundred four physically fit patients undergoing thyroid surgery were included for the study. Tele‐laryngoscopy was done to rule out pre‐existing vocal cord palsy. Direct laryngoscopy (DL) was performed to each patient after extubation, followed by nasal fibreoptic endoscopy (NFE) to assess the vocal cord mobility. Tele‐laryngoscopic assessment was repeated after 1 week to compare the DL and NFE findings. Patient reactivity score (PRS) and haemodynamic parameters were recorded with each technique.

Results:  Macintosh laryngoscope could pick up 4 (50% sensitivity and 88% specificity) and fibreoptic endoscope 7 (87.9% sensitivity and 98.9% specificity) out of the 8 vocal cord palsies identified by tele‐laryngoscopy. Patients had significant discomfort during DL (PRS median 3) when compared with NFE and tele‐laryngoscopy (PRS median 2), P < 0.05. Grade 1 view of larynx in 92.1% patients during intubation worsened to grade 2 (76.3%) and grade 3 (15.8%) during extubation with DL, and a significant rise in mean arterial pressure and heart rate was observed from the baseline value till 5 min and when compared with NFE (P < 0.05).

Conclusion:  NFE provides accurate assessment of vocal fold mobility with reasonable patient comfort in the immediate post‐operative period. Macintosh laryngoscope fails to give optimum visualization and predisposes the patient to significant discomfort and stress.
COMPARISON OF EXERCISE ELECTROCARDIOGRAPHY, THALLIUM‐201 MYOCARDIAL IMAGING and EXERCISE GATED BLOOD POOL SCAN IN PATIENTS WITH SUSPECTED CORONARY ARTERY DISEASE
Authors: O'KEEFE J. C. , EDWARDS A. C. , WISEMAN J. , COOPER R. A. , SHUTER B. , DONNELLY G. L.
Published: August 2010

:We compared three non invasive tests, 12 lead exercise electrocardiography (ECG), thallium 201 myocardial imaging (T1), and rest and exercise equilibrium gated blood pool scanning (GBPS) for the detection of coronary disease, in 50 patients undergoing coronary angiography for evaluation of chest pain. Twenty eight patients had significant coronary disease, while 22 patients had insignificant coronary disease. The sensitivity of exercise ECG for detecting coronary disease was 64%. By comparison the sensitivities for the other tests were: T1 imaging 79% (NS); exercise GBPS 86% (p<0.05); T1 imaging combined with exercise ECG 89% (p<0.01) and the combination of all tests 96% (p<0.005). The specificity for exercise ECG was 82%, and was similar to T1 imaging 86%, GBPS 82% and the combination of all tests 64% (borderline significance, p<0.1). Thus GBPS and T1 imaging combined with exercise ECG, are more sensitive indicators of coronary disease than exercise ECG alone. Combined testing is highly sensitive for coronary disease but with a reduction in specificity.
LORAZEPAM AS AN ADJUNCT TO ANTIEMETIC THERAPY WITH HALOPERIDOL IN PATIENTS RECEIVING CYTOTOXIC CHEMOTHERAPY
Authors: FRIEDLANDER M. L. , KEARSLEY J. H. , SIMS K. , COATES A. , HEDLEY D. , RAGHAVAN D. , FOX R. M. , TATTERSALL M. H. N.
Published: August 2010

Twenty‐seven consecutive patients were treated with 3 mg oral lorazepam and 2.5 mg intravenous haloperidol in an effort to improve patient tolerance of cytotoxic chemotherapy and decrease nausea and vomiting. Antiemetic efficacy and side‐effects were assessed using a patient questionnaire. Vomiting either did not occur, or was considered to be of only moderate intensity in 22 patients (81%) and usually ceased within 24 hours of commencing chemotherapy. Similarly, nausea was either absent or of only moderate severity, lasting less than 48 hours in the majority of patients. Eight of 11 patients who had received similar previous cytotoxic treatment with antiemetic agents but not lorazepam considered that lorazepam and haloperidol had considerably improved their tolerance of chemotherapy. The side‐effects of haloperidol and lorazepam were mild and well tolerated.
TOTAL LIPODYSTROPHY — A REPORT OF A CASE WITH PERIPHERAL NEUROPATHY and GLOMERULONEPHRITIS
Authors: TUCK R. R. , ELLIS D. , McLEOD J. G. , KIRWAN P. D. , BASTEN A.
Published: August 2010

The clinical, neurophysiology, and pathological findings are reported in a man who had total lipodystrophy associated with glomerulonephritis and a painful sensory peripheral neuropathy. It is suggested that the three conditions may be related and that they have an immunological basis.
NEUROLEPTIC MALIGNANT SYNDROME
Authors: SCARLETT J. D. , ZIMMERMAN R. , BERKOVIC S. F.
Published: August 2010

Two cases of neuroleptic malignant syndrome (NMS) are presented. This rare pattern of neuroleptic drug toxicity is characterised by fever, muscular rigidity, akinesia and elevated plasma creatine kinase. The condition may be fatal and early recognition is essential. Evidence is presented that NMS is unrelated to malignant hyperpyrexia.
Experience of once‐daily aminoglycoside dosing using a target area under the concentration‐time curve
Authors: Barclay M. L. , Duffully1 S. B. , Begg E. J. , Buttimore R. C.
Published: August 2010

Background: Many centres are changing to once‐daily aminoglycoside administration. However, proposed methods for this practice often have theoretical and practical difficulties. We have developed a method in which a target area under the concentration‐time curve (AUC) is used instead of traditional peak and trough serum concentrations.

Methods: Following a starting dose of 5–7 mg/kg, administered by 30‐minute infusion, the AUC was calculated using two serum aminoglycoside concentrations taken at one and six‐14 hours after the start of the infusion. Dose adjustment was made to correct for any difference between the calculated AUC and a target AUC (72–101 mg.1‐1.h). The method was assessed for practicality and precision in 100 courses of treatment. The incidence of aminoglycoside toxicity was documented.

Aims: To analyse our experience with the target AUC method in the first 100 courses of once‐daily aminoglycoside administration in the Christchurch, New Zealand hospitals.

Results: The mean final dose of 6.68 mg/kg, and AUC of 92.8 mg. 1 ‐1.h, were significantly different from the mean starting dose and AUC of 5.67 mg/kg and 74.0 mg.1‐1.h, respectively. The method appeared to be more precise than empirical dosing at achieving the target AUC even though the final recommended dose had more variability than the starting dose. Although the study was uncontrolled, observed nephrotoxicity (2%) and ototoxicity (up to 6.9%) were no greater than expected from the results of other studies. There were no deaths related to antibiotic failure.

Conclusions: The AUC method was practical, and more appropriate for once‐daily dosing than the conventional method of aiming for target peak and trough concentrations. Dose adjustment can be made before the next dose.
Low yield in screening patients with sporadic motor neuron disease for Kennedy disease
Authors: Saunderson R. B. , Yu B. , Trent R. J. A. , Pamphlett R.
Published: August 2010

The diagnostic yield of testing for Kennedy disease in patients diagnosed with sporadic motor neuron disease (MND) is unclear. We measured the CAG repeat lengths in the androgen receptor gene of patients with progressive limb weakness who had either upper and lower motor signs (n = 130), or lower motor neuron signs alone (n = 30). Only one patient with a long history of lower motor weakness had a repeat length in the Kennedy disease range. Testing for Kennedy disease is unlikely to benefit MND patients with upper motor neuron signs or those with a short history of lower motor signs.
Fracture prevention strategies in patients presenting to Australian hospitals with minimal‐trauma fractures: a major treatment gap
Authors: Teede H. J. , Jayasuriya I. A. , Gilfillan C. P.
Published: August 2010

Background: The aim of this study was to examine current fracture prevention strategies through the recognition, investigation and treatment of osteoporosis in patients presenting to acute hospitals with minimal‐trauma fracture.

Methods: A retrospective audit using a standardized database was conducted in 16 Australian hospitals. This involved 1829 cases of minimal‐trauma fracture initially presenting to hospital emergency departments during 2003–2005. Cases of minimal‐trauma fracture were retrospectively identified using diagnosis‐related group fracture codes and case record review at each site. Relevant data were entered into a standardized database and analysed centrally and independently. Risk factors for osteoporosis, investigations, interventions and discharge follow up were recorded.

Results: The percentage of minimal‐trauma fracture patients who underwent investigation or initiated therapy designed to prevent subsequent minimal‐trauma fracture was obtained. Less than 13% of patients presenting to hospital with minimal‐trauma fractures had risk factors for fracture identified. Ten per cent were appropriately investigated, 12% were commenced on calcium and 12% on vitamin D. Eight per cent started bisphosphonates and 1% selective oestrogens receptor modulators in the acute setting.

Conclusion: Most patients presenting to Australian hospitals with minimal‐trauma fracture are neither investigated nor treated for osteoporosis. As this group is at high risk of subsequent fracture, this is a missed opportunity to reduce fracture burden.
Death of the first white resident of North Queensland
Authors: Bossingham D.
Published: August 2010

The first white resident of North Queensland’s death certificate gives the final illness as ‘arthritis’. This examination of contemporary records and more recent reports, together with the results of discussion with colleagues interested in medicine and history, attempts to suggest the reasons for his various symptoms and his final demise. This life story is reminiscent of a ‘Boy’s own’ adventure with shipwrecks, survival at sea, coexistence with Aboriginal tribesmen before returning to ‘white society’, marriage and the start of a family.

Are there lessons here for the twenty‐first century physician and rheumatologist? Would the commonplace illnesses of mid nineteenth‐century Queensland be very different to the problems seen in our outpatient clinics today?
Nitric oxide and the clinical manifestations of acute porphyria
Authors: Thachil J.
Published: August 2010

The porphyrias comprise a clinically and genetically heterogenous group of diseases mostly arising from a genetically determined dysfunction of specific enzymes along the pathway of haeme biosynthesis. This leads to a pathological accumulation and measurable excretion of porphyrins and/or porphyrin precursors, which is considered the cause of the clinical features related to this group of diseases. However, acute porphyria can present with varied symptoms, which have some features in common with other diseases where nitric oxide has been shown to play a role. The article describes the possibility of nitric oxide depletion in porphyria contributing to its clinical manifestations.
Prenatal diagnosis and postnatal follow‐up of a child with mosaic trisomy 22 with several levels of mosaicism in different tissues
Authors: Mazza Vincenzo , Latella Silvia , Fenu Valentina , Ferrari Paola , Bonilauri Carlotta , Santucci Sandra , Percesepe Antonio
Published: August 2010

We report on the case of a patient with mosaic trisomy 22, who was diagnosed prenatally by amniocentesis during the 16th week of pregnancy. In the foetus, three trisomic clones were found out of the nine that were analyzed (the other six clones had a 46,XY karyotype). Cytogenetic analysis of cord blood during the 20th week of pregnancy showed a normal male karyotype; however, a placental biopsy that was performed at the same time showed 100% and 95% trisomic cells in the chromosomal analysis of direct and long‐term cultures, respectively. A follow‐up ultrasonographic examination excluded major congenital malformations and the abdominal and cranial circumferences were normal until the 24th week of pregnancy. At this point, a deflection of the growth curve occurred and the values were persistently below the 3rd centile until birth. After birth, karyotypic and fluorescent in situ hybridisation analyses performed on the fibroblasts of the neonate showed that 3–4% of the cell lines were trisomic, and studies using microsatellite markers showed normal allelic segregation, which excluded uniparental disomy. The period of postnatal follow‐up was characterised by a significant growth deficit (height and head circumference were less than the 3rd centile) and by mental retardation. The present case is compatible with other earlier reports that showed that the levels of trisomy 22 are tissue‐specific and are of little help in establishing the prognosis of the chromosomal abnormality.
THE PLASTICITY AND FRACTURE OF IN‐SITU COMPOSITES
Authors: Wood J. T. , Embury J. D.
Published: August 2010

Abstract Heavily deformed two‐phase materials, often referred to as in‐situ composites, have been shown to exhibit strengths which approach the theoretical limit. This paper considers the mechanical response of these materials from both a macroscopic and microscopic point of view in terms of the competing processes of continued plastic Bow and fracture. The results from a wide variety of composite systems and experimental techniques are examined to suggest a number of areas requiring further study in the fields of plasticity and fracture of engineering materials.
MEAN STRESS EFFECTS IN MULTIAXIAL FATIGUE
Authors: Glinka G. , Wang G. , Plumtree A.
Published: August 2010

Abstract A multiaxial fatigue strain energy density parameter has been formulated which normalizes fatigue data obtained under a variety of mean stress levels and loading combinations. This parameter represents that proportion of the overall strain energy contributed by the stresses and strains on the critical or fracture plane. It is shown that multiaxial fatigue life data may be accurately correlated by applying this parameter to the experimental results of Inconel 718 alloy subjected to a variety of mean normal and shear stress levels, as well as to SAE 1045 steel tested under tension, torsion and simultaneous tension and torsion.
LIGAMENT‐YIELD LOAD OF PLATES AND CYLINDERS WITH AN AXIAL SEMI‐ELLIPTICAL FLAW
Authors: Shen G. , Tyson W. R.
Published: August 2010

Abstract The loads for yield of plates and cylinders with semi‐elliptical surface flaws have been evaluated by a weight‐function method incorporating stress intensity factors using results from finite element calculation. A new weight function for loads partially distributed along a chord is proposed. The yield load is defined as that at which the plastic zone first reaches the back surface. The results show that the effects of the cylinder geometry parameter t/R on yield load is small, and it is proposed that the plate results be used also for cylinders over the range of geometries 0 ≤t/R≤ 0.1.
DISLOCATION STRUCTURES NEAR THE FATIGUE CRACK TIP IN COPPER
Authors: Tong Z.‐X. , Baíulon J.‐P.
Published: August 2010

AbstractThe dislocation structures formed in the plastic wake of a long fatigue crack have been characterized by TEM for polycrystalline copper tested in air and in vacuum. In order of increasing distanceDfrom the fracture surface, typical structures are cells, walls, PSBs and veins, and finally loop patches and dislocation tangles. The outer boundaries of these different regions depend on the stress intensity factor range ΔK.By comparison with the dislocation structures developed in LCF specimens fatigued at a constant strain amplitude, the structures in the plastic wake appear much distorted and more than one set of slip systems are often found to be activated. This feature is the consequence of the complex stress history occuring in a unit volume of material located at a distanceDfrom the fracture surface. Due to this fact, the plastic strain gradient deduced from the size of dislocation cells can only be approximated. The dislocation structures formed near the fatigue crack tip in vacuum appear to be somewhat different from those formed in air; the cell boundaries are much denser, sharper and straighter, the misorientations between them are more marked and, at a given distanceDand for a given applied ΔK, the cell size is also smaller than that formed in air. These effects are the consequence of the larger number of cycles that a unit volume of material located at a given distanceDcan sustain during fatigue cracking in vacuum.
THE BEHAVIOUR OF SMALL CORNER CRACKS IN A FERRITIC/PEARLITIC STEEL: EXPERIMENTS AND ANALYIS
Authors: Craig D. , Ellyin F. , Kujawski D.
Published: August 2010

Abstract An experimental investigation into the growth and closure behaviour of small corner cracks has been conducted on a low carbon steel (ASTM A516 Grade 70). This ferritic/pearlitic steel has been chosen to investigate the complexities of small crack behaviour in the dual phase material. Innovative procedures are used for compliance measurement and opening load determination. The closure and growth behaviour of the small corner cracks are presented in terms of shape and size. The results are divided into two stages, the first pertaining to the “stationary crack”, and the second dealing with the crack as it grows. The cracks are shown to exhibit an irregular growth rate, which is in part, shown to correspond with microstructural features of the material. In the short crack regime, the linear fracture mechanics parameter, ΔK does not correlate with the data and the use of a ΔKeff based on the effective applied load provided little improvement.
FATIGUE CRACK CLOSURE MEASUREMENTS ON 2024‐T3 SHEET SPECIMENS
Authors: Yisheng W. , Schijve J.
Published: August 2010

Abstract A computer‐controlled procedure has been developed for automatic measurement of the crack opening stress Sop during fatigue tests. A crack opening displacement gauge (COD meter) is used to obtain digital data on the load versus COD curves. Three methods for deriving Sop from the data sets are compared (1) a slope method, (2) a tangent lines intersecting method, and (3) a tangent point method. The effect of the position of the COD meter with respect to the crack tip on Sop is studied in tests of 2024‐T3 specimens. Results of crack growth and Sop are presented for CA loading with an overload, and with an overload followed by an underload.
On the use of nominal stresses to predict the fatigue strength of welded joints under biaxial cyclic loading
Authors: SUSMEL L. , TOVO R.
Published: August 2010

In this paper, the modified Wöhler curve method proposed by Susmel and Lazzarin is employed to predict the fatigue life of welded connections subjected to biaxial cyclic loading. This criterion is reformulated here in order not to take into account the mean stress effect, as suggested by several design codes (at least when welded connections are not completely stress relieved). The accuracy of the proposed method in fatigue lifetime estimation was evaluated by using a number of data sets taken from the literature. The modified Wöhler curve method was applied in terms of nominal stresses and was calibrated using the uniaxial and torsional fatigue curve determined by reanalysing the experimental data, as well as using the standard fatigue curves of the Eurocode 3. The proposed approach was seen to be successful, giving multiaxial fatigue life predictions located within the widest scatter band related either to uniaxial or to torsional data, independently of both out‐of‐phase angle and load ratio value. Finally, the accuracy of the modified Wöhler curve method was compared to the one obtained by applying the procedure suggested by the Eurocode 3: the proposed criterion is demonstrated to be much more accurate and reliable than the standard one.
Quantitative assessment of preferential fatigue initiation sites in a multi‐phase aluminium alloy
Authors: JOYCE M. R. , LEE K. K. , SYNGELLAKIS S. , REED P. A. S.
Published: August 2010

Complex multi‐phase Al–Sn–Si alloys are commonly employed in the manufacture of small automotive plain bearings. The fundamental fatigue initiation behaviour of this class of alloys is currently not well understood. A range of analytical techniques were applied to investigate preferential initiation site location and to attempt to identify critical microstructural features. It was apparent from experimental studies that points of fatigue crack initiation are associated with the Si secondary phase. Using tessellation approaches and subsequently both adaptive numerical modelling and micro‐scale finite element modelling allowed the identification of features affecting the probability that a given Si phase would initiate a fatigue crack.
Material fatigue properties for assessing mechanical components weakened by notches and defects
Authors: ATZORI B. , MENEGHETTI G. , SUSMEL L.
Published: August 2010

This paper addresses the problem of estimating the material fatigue properties for assessing real mechanical components. Initially, some practical rules are proposed to estimate the fully reversed plain fatigue limit, Δσ0, using the material tensile stress. These rules are obtained by subdividing materials into five different groups: carbon steels, low‐alloy steels, high‐alloy steels, aluminium alloys and cast irons. Subsequently, using a large database of fatigue data found in the literature, it is demonstrated that the fully reversed torsional plain fatigue limit can be directly estimated from the fully reversed uniaxial plain fatigue limit by simply using Von Mises' formula. Finally, some empirical equations are proposed to estimate El Haddad's short crack constant, a0. These equations are based on the assumption that this material property can be derived from the plain fatigue limit determined at a given load ratio, R. Since the a0 values depend on the load ratio, so a0 versus Δσ0 relationships can directly account for the R influence. The aim of this paper is to provide engineers engaged in assessing real structural components with empirical rules to estimate the material fatigue properties. All these pieces of information are needed to apply the most modern methods suitable for assessing components weakened by any kind of geometrical feature and subjected to any kind of fatigue loading.
Fracture behaviour of an Al2O3–ZrO2 multi‐layered ceramic with residual stresses due to phase transformations*
Authors: BERMEJO R. , TORRES Y. , SÁNCHEZ‐HERENCIA A. J. , BAUDÍN C. , ANGLADA M. , LLANES L.
Published: August 2010

The fracture behaviour of a ceramic multi‐layer designed with thin internal compressive layers and obtained by slip casting is studied. It consists of nine alternated Al2O3–5vol%tZrO2 and Al2O3–30vol%mZrO2 layers of 530 μm and 100 μm thickness, respectively. Mechanical characterization includes evaluation of Vickers Hardness, Young's modulus and fracture strength under four‐point bending. In addition, the residual stress magnitude and distribution in the laminate is determined both analytically, from calculations using the differential strain between layers and the elastic properties, and experimentally, using indentation techniques. The experimental findings in terms of mechanical strength and fractography show a subcritical growth of the natural flaws in the laminate before catastrophic failure occurs, owing to the relevant role of the thin Al2O3–30vol%mZrO2 layers with compressive stresses inherent to the zirconia phase transformation. These layers are also responsible for the increase in toughness to levels of at least three times that of the reference Al2O3–5vol%tZrO2 monolith.
Fatigue life prediction of vulcanized natural rubber under proportional and non‐proportional loading
Authors: WANG Y. , YU W. , CHEN X. , YAN L.
Published: August 2010

To investigate the multiaxial fatigue properties of vulcanized natural rubber (NR), a series of tests including both proportional and non‐proportional loading paths on small specimens were performed. The existing fatigue life prediction approaches are evaluated with life data obtained in the tests. It is shown that the equivalent strain approach presents a good prediction of the fatigue life although it has a certain shortcoming. Compared with the strain energy density (SED) model, the cracking energy density (CED) model represents the portion of SED that is available to be released by virtue of crack growth on a given material plane, so it gives better results in the life prediction. Some of the approaches based on critical plane which are widely used for metal fatigue are also tested in this paper, and the results show that the Chen‐Xu‐Huang (CXH) model gives a better prediction, compared with the Smith‐Watson‐Topper (SWT) and Wang–Brown (WB) model. A modified Fatemi–Socie's model has also been introduced, and the results show that the modified model can be used to predict the fatigue life of rubber material well.
Calculation of stress intensity factors for a longitudinal semi‐elliptical crack in a finite‐length thick‐walled cylinder
Authors: NABAVI S. M. , SHAHANI A. R.
Published: August 2010

The purpose of this paper is to present the effect of finite boundary on the stress intensity factor of an internal semi‐elliptical crack in a pressurized finite‐length thick‐walled cylinder (Ri/t= 4). The three‐dimensional finite element method, in conjunction with the weight function method, is used for computing the stress intensity factor at the deepest and surface points of an axial semi‐elliptical crack in a cylinder. The transition aspect ratios, the aspect ratios in which the maximum stress intensity factor translates from the deepest to the surface points of the crack, are calculated for different relative depths and cylinder lengths. The results show that the stress intensity factor increases as the cylinder length decreases, especially at the corner point of the crack compared with the deepest point. The major advantage of this paper is that a closed‐form expression is extracted for the stress intensity factor at the surface point of a semi‐elliptical crack, which experiences higher changes due to the effect of the finite boundary of the cylinder.
Micromechanical interactions in a superduplex stainless steel subjected to low cycle fatigue loading
Authors: PENG R. LIN , CHAI G. , JIA N. , WANG Y. D. , JOHANSSON S.
Published: August 2010

Micromechanical interactions in an austenitic‐ferritic SAF 2507 steel under lowcycle fatigue loading was studied by experiment and simulation. Neutron diffraction measurements of residual lattice strains were made on specimens unloaded from different cyclic deformation stages, namely cyclic hardening, softening and saturation. With self‐consistent modelling, the micromechanical behaviour of the constituent phases was studied for the first loading cycle. The evolution of the residual lattice strain distributions with cyclic loading and the development of phase stresses have been analysed with respect to the initial residual stress field and the different mechanical properties of the constituent phases.