bluuebunny/crossref_metadata_2025 huggingface dataset:
The female partners' experiences of intimate relationship after a first myocardial infarction
Authors: Arenhall Eva , Kristofferzon Marja‐Leena , Fridlund Bengt , Nilsson Ulrica
Published: September 2010

Aim.  This study aimed to explore and describe women’s experience of intimate relationships in connection to and after their partner’s first myocardial infarction.

Background.  Support from partners is important for recovery, but little is known about partners’ experience of intimate relationships after myocardial infarction.

Design.  The study used an explorative, qualitative design.

Methods.  The first author interviewed 20 women having a partner who had suffered a first myocardial infarction during the preceding year. Qualitative content analysis was used to analyse the data.

Findings.  Three themes emerged: ‘limited life space’, ‘sense of life lost’ and ‘another dimension of life’. The women described how their self‐assumed responsibility led to a more stifling and limited life. Their sense of life lost was described in terms of deficits and feeling the loss. The women also described experiencing another dimension of life characterised by three subthemes: ‘uncertainty of life’, ‘certain of relationship’ and ‘share life more’.

Conclusions.  The partners’ myocardial infarction had an impact on the interviewees’ intimate relationships; they suffered a major loss and missed their ‘former’ partner, both emotionally and sexually. They struggled with the new asymmetry in their intimate relationship and felt compelled to adapt to their partners’ lack of sexual desire or function. Also, their partner controlled them, which lead towards a stifling, more limited life space.

Relevance to clinical practice.  Caregivers in hospital and primary care settings could apply the findings in their efforts to help couples recover or maintain intimate relationships following myocardial infarction.
Distinct glycan‐charged phosphodolichol carriers are required for the assembly of the pentasaccharide N‐linked to the Haloferax volcanii S‐layer glycoprotein
Authors: Guan Ziqiang , Naparstek Shai , Kaminski Lina , Konrad Zvia , Eichler Jerry
Published: September 2010

In Archaea, dolichol phosphates have been implicated as glycan carriers in the N‐glycosylation pathway, much like their eukaryal counterparts. To clarify this relation, highly sensitive liquid chromatography/mass spectrometry was employed to detect and characterize glycan‐charged phosphodolichols in the haloarchaeon Haloferax volcanii. It is reported that Hfx. volcanii contains a series of C55 and C60 dolichol phosphates presenting saturated isoprene subunits at the α and ω positions and sequentially modified with the first, second, third and methylated fourth sugar subunits comprising the first four subunits of the pentasaccharide N‐linked to the S‐layer glycoprotein, a reporter of N‐glycosylation. Moreover, when this glycan‐charged phosphodolichol pool was examined in cells deleted of agl genes encoding glycosyltransferases participating in N‐glycosylation and previously assigned roles in adding pentasaccharide residues one to four, the composition of the lipid‐linked glycans was perturbed in the identical manner as was S‐layer glycoprotein N‐glycosylation in these mutants. In contrast, the fifth sugar of the pentasaccharide, identified as mannose in this study, is added to a distinct dolichol phosphate carrier. This represents the first evidence that in Archaea, as in Eukarya, the oligosaccharides N‐linked to glycoproteins are sequentially assembled from glycans originating from distinct phosphodolichol carriers.
Heligmosomoides bakeri antigen rescues CD4‐positive T cells from glucocorticoid‐induced apoptosis by Bcl‐2 protein expression
Authors: DONSKOW K. , DRELA N. , DOLIGALSKA M.
Published: September 2010

Heligmosomoides bakeri infection in mice is associated with a dominant CD4+ T‐cell response and with the activity of natural Treg cells with CD4+CD25+ phenotype. The polarization of Th2 T‐cell phenotype and the increase in the CD4+CD25+ T cell population are regulated by glucocorticoids that induce apoptosis in CD4+CD25− T cells and inhibit apoptosis in CD4+CD25+ T cells. However, exposure of mice to H. bakeri antigen induces a high glucocorticoid concentration in serum and a reduction in the number of CD4‐positive; CD4+CD25− and CD4+CD25+ apoptotic T cells in mesenteric lymph node cells. In this study to evaluate the in vitro effect of the anti‐apoptotic property of H. bakeri antigen on T cells, apoptosis of these cells was induced by glucocorticoids‐dexamethasone (Dex). Excretory–secretory (ES) antigen of the nematode prevented Dex‐induced apoptosis in CD4‐positive T cells with CD4+CD25− and CD4+CD25High phenotype by Bcl‐2 protein expression. Contrary to the effect on CD4‐positive T cells, survival of CD8+ T cells was not connected with expression of Bcl‐2 protein. This suggest that H. bakeri antigen modulates CD4‐positive T cell sensitivity to glucocorticoid‐induced apoptosis by induction of Bcl‐2 protein.
A new, vapour‐phase mechanism for stomatal responses to humidity and temperature
Authors: PEAK DAVID , MOTT KEITH A.
Published: September 2010

A new mechanism for stomatal responses to humidity and temperature is proposed. Unlike previously‐proposed mechanisms, which rely on liquid water transport to create water potential gradients within the leaf, the new mechanism assumes that water transport to the guard cells is primarily through the vapour phase. Under steady‐state conditions, guard cells are assumed to be in near‐equilibrium with the water vapour in the air near the bottom of the stomatal pore. As the water potential of this air varies with changing air humidity and leaf temperature, the resultant changes in guard cell water potential produce stomatal movements. A simple, closed‐form, mathematical model based on this idea is derived. The new model is parameterized for a previously published set of data and is shown to fit the data as well as or better than existing models. The model contains mathematical elements that are consistent with previously‐proposed mechanistic models based on liquid flow as well as empirical models based on relative humidity. As such, it provides a mechanistic explanation for the realm of validity for each of these approaches.
Factors required for the high CO2 specificity of the anaerobically induced maize GapC4 promoter in transgenic tobacco
Authors: NIEMEYER JULIA , MACHENS FABIAN , FORNEFELD EVA , KELLER‐HÜSCHEMENGER JENS , HEHL REINHARD
Published: September 2010

Flooding, a natural cause of anaerobiosis, is often accompanied by high CO2 concentrations in the flood water. Plants need to respond to these environmental conditions. Strong anaerobic reporter gene activity in tobacco (Nicotiana tabacum) controlled by the glycolytic glyceraldehyde‐3‐phosphate dehydrogenase (GapC4) promoter from maize (Zea mays) depends on the presence of CO2 and light. To identify factors required for CO2 regulated gene expression, promoter deletions fused to the β‐glucuronidase reporter gene were studied in transgenic tobacco. Deletion of a 40 bp fragment directly upstream of the TATA box leads to increased anaerobic reporter gene activity both, in the presence and absence of CO2. This deletion does not affect light specific anaerobic expression. A positive correlation between increasing CO2 concentrations and gene activity is observed. Electrophoretic mobility shift experiments indicate that tobacco nuclear extracts harbour proteins that bind to part of the 40 bp fragment. Database assisted as well as experimental analysis reveal a role for AP2/EREBP transcription factors for conferring the high CO2 specificity to the GapC4 promoter in tobacco leaves. This work highlights the importance for plants to respond to high environmental CO2 concentrations under anaerobic conditions.
The purinergic receptor P2Y2receptor mediates chemotaxis of dendritic cells and eosinophils in allergic lung inflammation
Authors: Müller T. , Robaye B. , Vieira R. P. , Ferrari D. , Grimm M. , Jakob T. , Martin S. F. , Di Virgilio F. , Boeynaems J.‐M. , Virchow J. C. , Idzko M.
Published: September 2010

To cite this article:Müller T, Robaye B, Vieira RP, Ferrari D, Grimm M, Jakob T, Martin SF, Di Virgilio F, Boeynaems J‐M, Virchow JC, Idzko M. The purinergic receptor P2Y2receptor mediates chemotaxis of dendritic cells and eosinophils in allergic lung inflammation.Allergy2010;65: 1545–1553.

Background: Extracellular ATP contributes to the pathogenesis of asthma via signalling at purinergic receptors. However, the precise purinergic receptors subtypes mediating the pro‐asthmatic effects of ATP have not been identified, yet.

Methods: In vivostudies were performed using the OVA‐alum model. Functional expression of the P2Y2purinergic receptor subtype on human monocyte‐derived dendritic cells and eosinophils was investigated using real‐time PCR, migration assays, and production of reactive oxygen species.

Results: Compared to wild‐type animals P2Y2−/− mice showed reduced allergic airway inflammation which can be explained by defective migration of blood myeloid DCs towards ATPin vitroandin vivo, whereas the influence of ATP on maturation and cytokine production was not changed. Additionally, ATP failed to induce migration of bone marrow–derived eosinophils from P2Y2R‐deficient animals. The relevance of our findings for humans was confirmed in functional studies with human monocyte‐derived DCs and eosinophils. Interestingly, stimulation of human DCs derived from allergic individuals with house dust mite allergen induced functional up‐regulation of the P2Y2R subtype. Furthermore, eosinophils isolated from asthmatic individuals expressed higher levels of P2Y2R compared to healthy controls. This was of functional relevance as these eosinophils were more sensitive to ATP‐induced migration and production of reactive oxygen metabolites.

Conclusions: In summary, P2Y2R appears to be involved in asthmatic airway inflammation by mediating ATP‐triggered migration of mDCs and eosinophils, as well as reactive oxygen species production. Together our data suggest that targeting P2Y2R might be a therapeutic option for the treatment of asthma.
Histological progression of chronic renal allograft injury comparing sirolimus and mycophenolate mofetil–based protocols. A single‐center, prospective, randomized, controlled study
Authors: Blydt‐Hansen Tom D. , Gibson Ian W. , Birk Patricia E.
Published: September 2010

Blydt‐Hansen TD, Gibson IW, Birk PE. Histological progression of chronic renal allograft injury comparing sirolimus and mycophenolate mofetil–based protocols. A single‐center, prospective, randomized, controlled study. Pediatr Transplantation 2010: 14:909–918. © 2010 John Wiley & Sons A/S.

Abstract: In an effort to mitigate progression of IF/TA associated with chronic renal allograft injury, we hypothesize that adjuvant immunosuppression with sirolimus (SRL) will delay progression compared with MMF. Subjects 5–17 yr old, >1‐yr post‐transplant with mild or moderate IF/TA (Banff criteria) and tacrolimus dose minimization were randomized to continue MMF or convert to SRL and followed for two yr. For the entire cohort (n = 20), there was significant progression of %GGS, ci, ct, cv, and ah scores over the follow‐up period (p < 0.05). There was no difference in rates of progression of Banff scores, %GGS, or % IF over two yr between the two groups, though power was low. Both groups exhibited similar rates of eGFR decline (MMF: −12.3 vs. SRL: −11.8 mL/min/1.73 m2/yr), which was correlated with ct score (p < 0.05). The SRL group had more episodes of acute allograft dysfunction and oral ulcers. Proteinuria at 24 months was significantly increased in the SRL group (6/9 subjects) but was not correlated with eGFR or %GGS. We conclude that neither MMF nor SRL, combined with low‐dose tacrolimus, was effective at mitigating progressive histological changes or functional decline associated with chronic renal allograft injury.
Mobile DNA can drive lineage extinction in prokaryotic populations
Authors: RANKIN D. J. , BICHSEL M. , WAGNER A.
Published: September 2010

Natural selection ultimately acts on genes and other DNA sequences. Adaptations that are good for the gene can have adverse effects at higher levels of organization, including the individual or the population. Mobile genetic elements illustrate this principle well, because they can self‐replicate within a genome at a cost to their host. As they are costly and can be transmitted horizontally, mobile elements can be seen as genomic parasites. It has been suggested that mobile elements may cause the extinction of their host populations. In organisms with very large populations, such as most bacteria, individual selection is highly effective in purging genomes of deleterious elements, suggesting that extinction is unlikely. Here we investigate the conditions under which mobile DNA can drive bacterial lineages to extinction. We use a range of epidemiological and ecological models to show that harmful mobile DNA can invade, and drive populations to extinction, provided their transmission rate is high and that mobile element‐induced mortality is not too high. Population extinction becomes more likely when there are more elements in the population. Even if elements are costly, extinction can still occur because of the combined effect of horizontal gene transfer, a mortality induced by mobile elements. Our study highlights the potential of mobile DNA to be selected at the population level, as well as at the individual level.
Chilled Storage of Ram Semen Improves with the Addition of Egg Yolk and Glycerol to Milk‐Based Extenders
Authors: Gil J , Fierro S , Bentancur O , Olivera‐Muzante J
Published: September 2010

Contents

This study aimed at comparing in vitro, ultra‐heat‐treated (UHT) skim milk and INRA‐96®‐based extenders supplemented or not with 5% egg yolk and/or 2% glycerol on sperm quality parameters along 72 h of preservation at 5°C, using a factorial design. Semen from six healthy mature Merino rams was pooled and extended in each medium using a split sample procedure (six replicates) and chilled. Subjective motility (SM) (%), membrane integrity (MI) (%) and uncapacitated spermatozoa (US) (×106 spermatozoa/AI dose) were used to assess the semen quality at 0, 12, 24, 48 and 72 h of preservation. UHT‐based extenders yielded better (p < 0.05) SM and MI than INRA‐96®‐based extenders (59.7% vs 57.9%; 60.2% vs 55.8%, respectively) but similar numbers of US (64.2% vs 62.3 × 106 sperm/AI dose, respectively) along the preservation time. Egg yolk–glycerol or just egg yolk as additives improved (p < 0.05) the results compared with the base extenders without additives or just with glycerol. The sperm parameters assessed decline slowly from 0 to 48 h, with a sharp decline (p < 0.05) at 72 h of preservation. In conclusion, UHT and INRA‐96® were similar as base extenders, and the addition of 5% egg yolk plus 2% glycerol or just 5% egg yolk improved the quality of ram semen preserved at 5°C, at least for 48 h. The combination of egg yolk–glycerol might provide extra protection in case of fluctuation of temperatures below 5°C, commonly seen under field conditions.
Cutaneous larva migrans in infants in the Adelaide Hills
Authors: Black Michael D , Grove David I , Butcher Andrew R , Warren Lachlan J
Published: September 2010

Four infants aged between 8 and 13 months presented between November 2002 and May 2006 with dermatitis of the lower abdomen, perineum or buttocks. All lived in semi‐rural properties in the Adelaide Hills and had not travelled outside South Australia. Wandering thread‐like serpiginous tracks were evident on examination, consistent with a diagnosis of cutaneous larva migrans. No abnormalities were detected on full blood examination, Strongyloides stercoralis serology or faecal analysis. Treatment with oral albendazole resulted in rapid resolution of symptoms. An epidemiological survey was undertaken which suggested possums or millipedes may have been the source of nematode larvae, the precise nature of which is unclear but could include Parastrongyloides trichosuri and Rhabditis necromena.
Alterations of muscarinic acetylcholine receptors‐2, 4 and α7‐nicotinic acetylcholine receptor expression after ischaemia / reperfusion in the rat isolated heart
Authors: Li Dong‐Ling , Liu Bing‐Hang , Sun Lei , Zhao Mei , He Xi , Yu Xiao‐Jiang , Zang Wei‐Jin
Published: September 2010

1. Cardiac acetylcholine receptors are involved in the negative inotropic effect of the vagus and the protection of the stimulated vagal nerve against myocardial ischaemic injury. Acetylcholine receptors consist of five types of muscarinic acetylcholine receptors (M AChR) and several nicotinic acetylcholine receptors (nAChR). Notably, ischaemic heart disease is accompanied by substantial withdrawal of vagal activity. However, it is not entirely clear what the changes of M2,4AChR and α7‐nAChR expression are after cardiac ischaemia/reperfusion (I/R) injury.

2. Cardiac functions were continuously recorded in Langendorff mode during 30 min of ischaemia and 60 min of reperfusion. Lactate dehydrogenase (LDH) leakage was measured. M2,4AChRs and α7‐nAChR expression were measured by reverse transcription polymerase chain reaction and western blot.

3. In hearts exposed to I/R injury, left ventricular development pressure, heart rate and ±dP/dtdecreased significantly compared with the controls. LDH leakage increased with respect to the controls during reperfusion.

4. In normal hearts, expression of M2,4AChR in the left ventricle were lower than in atria and the right ventricle, whereas expression of α7‐nAChR was dramatically higher in the left ventricle and right ventricle than the atria. After reperfusion, the mRNA and protein expression of M2AChR increased notably in the left and right ventricle, and α7‐nAChR was enhanced significantly in the left ventricle. M4AChR mRNA expression reduced notably after ischaemia and recovered to the control level after reperfusion in the atria, but the protein level did not change.

5. In conclusion, the increase in M2AChR and α7‐nAChR after reperfusion might be the compensatory response to myocardial I/R injury, providing new information for treatment of myocardial I/R injury.
Alternative management of anatomical right hemihepatectomy using ligation of inflow and outflow vessels without hilus dissection
Authors: Chen Xiao‐Ping , Zhang Zhi‐Wei , Huang Zhi‐Yong , Chen Yi‐Fa , Zhang Wan‐Guang , Qiu Fa‐Zu
Published: September 2010

Background and Aim:  The conventional method of anatomical right hemihepatectomy (ARHH) requires hilus dissection. We report a method without hilus dissection to minimize intraoperative bleeding.

Methods:  We retrospectively evaluated data of 107 patients who received ARHH involving ligation of corresponding inflow and outflow vessels (LCIOV) without hilus dissection between January 2000 and October 2008. Results were compared to those of patients who underwent non‐anatomical right hemihepatectomies (NARHH).

Results:  The two groups had similar gender and age (both, P > 0.05). The LCIOV group had a higher percentage of patients without intrahepatic metastases (94.6% vs 80.3%, P = 0.003). Hepatocellular carcinoma (HCC) lesion size (9.3 vs 10.2, P = 0.023), durations of inferior vena cava occlusion (4 vs 4.7, P < 0.001) and portal triad occlusion (7 vs 11, P < 0.001), blood loss (430 vs 580 mL, P = 0.001), transfusion volume (300 vs 520 mL, P < 0.001), and measures of postoperative liver function (e.g. maximum aspartate aminotransferase [AST]) of the LCIOV group were also significantly less than the NARHH group. Larger hepatic cavernous hemangiomas (HCH) lesion size (16.2 vs 13.0, P < 0.001), longer operative time (168 vs 154 min, P = 0.017), and a lower percentage of patients with inferior vena cava occulsion (17.8% vs 35.2%, P = 0.001), pleural effusions (19.3% vs 30.9%, P = 0.042), and blood transfusions (10.3% vs 75.0%, P < 0.001) were found in the LCIOV group.

Conclusion:  The reported method is a safe and bloodless technique for right hemihepatectomy in select patients.
Factors associated with unreliable liver stiffness measurement and its failure with transient elastography in the Chinese population
Authors: Wong Grace L‐H , Wong Vincent W‐S , Chim Angel M‐L , Yiu Karen K‐L , Chu Shirley H‐T , Li Mia K‐P , Chan Henry L‐Y
Published: September 2010

Background and Aim:  Liver stiffness measurement (LSM) with transient elastography is a non‐invasive and reliable test for liver fibrosis. However a small proportion of patients may have unreliable LSM or LSM failure. The aim of the present study was to investigate the factors associated with unreliable LSM or LSM failure in Chinese patients.

Methods:  We prospectively recruited liver patients for LSM. Unreliable LSM was defined as < 10 valid shots, an interquartile range (IQR)/LSM > 30%, or a success rate < 60%. LSM failure was defined as zero valid shots.

Results:  Among 3205 patients with LSM, 371 (11.6%) and 88 (2.7%) had unreliable LSM and LSM failure, respectively. The rates started to increase when body mass index (BMI) ≥ 28.0 kg/m2. Comparing patients with BMI ≥ 28.0–29.9 kg/m2 versus those with BMI ≥ 30.0 kg/m2, the rates of unreliable LSM (16.4% vs 18.9%; P = 0.62) and LSM failure (11.8% vs 17.8%; P = 0.16) were similar. BMI ≥ 28.0 kg/m2 was the most important factor associated with unreliable LSM (odds ratio [OR] = 2.9, 95% confidence interval [CI] = 2.1–3.9, P < 0.0001) and LSM failure (OR = 10.1, 95% CI = 6.4–14.2, P < 0.0001). Central obesity, defined as waist circumference > 80 cm in women and > 90 cm in men, was another independent risk factor of unreliable LSM (OR = 1.3, 95% CI = 1.0–1.6, P = 0.04) and LSM failure (OR = 5.8, 95% CI = 2.9–11.5, P < 0.0001).

Conclusion:  BMI ≥ 28.0 kg/m2 and central obesity were the independent risk factors of unreliable LSM and LSM failure in Chinese, and these rates were significantly higher in patients with extreme BMI.
Harmful gases including carcinogens produced during transurethral resection of the prostate and vaporization
Authors: Chung Yun Jo , Lee Sang Kyi , Han Suk Hee , Zhao Chen , Kim Myung Ki , Park Seung Chul , Park Jong Kwan
Published: September 2010

Objective:  To determine the chemical composition of surgical smoke produced during transurethral resection of the prostate (TURP) and vaporization.

Methods:  A total of 12 smoke samples were collected from a continuous irrigation suction drainage system to a Tenax absorber at a 0.05 L/min flow rate during TURP and vaporization. The gases were quantitatively and qualitatively analyzed by gas chromatography‐mass spectrometry (GC‐MS) equipped with a purge and trap sample injector.

Results:  The main chemical constituents of surgical smoke produced during TURP and vaporization include propylene, allene, isobutylene, 1,3‐butadiene, vinyl acetylene, mecaptomethane, ethyl acetylene, diacetylene, 1‐pentene, EtOH, piperylene, propenylacetylene, 1,4‐pentadiene, cyclopentadiene, acrylnitrile and butyrolactone. Three of the constituents are very toxic and carcinogenic (1,3‐butadiene, vinyl acetylene and acrylonitrile). The amount (mean ± standard deviation) of chemical components in the 45 L of gas and room air mixture produced during TURP and vaporization were as follows: propylene, 0.80 ± 0.52 mg; isobutylene, 212.85 ± 75.65 mg; 1,3‐butadiene, 0.93 ± 0.34 mg; ethyl acetylene, 0.09 ± 0.05 mg; 1‐pentene, 6.75 ± 1.62 mg; 1,4‐pentadiene, 0.06 ± 0.02 mg; and acrylonitrile, 1.62 ± 1.19 mg.

Conclusions:  Three of the toxic gases generated during TURP and vaporization are carcinogens (1,3‐butadiene, vinyl acetylene and acrylonitrile). Therefore, higher quality filter masks, smoke evacuation devices and/or smoke filters should be developed for the safety of the operating room personnel and patients during TURP and vaporization.
A survey of perioperative management of sickle cell disease in North America
Authors: Firth Paul G. , McMillan Kristen N. , Haberkern Charles M. , Yaster Myron , Bender Michael A. , Goodwin Salvatore R.
Published: September 2010

Background:  Children with sickle cell disease frequently undergo surgical procedures that are associated with acute exacerbations of the disease. Current perioperative management practices are unclear.

Objectives:  We aimed at describing the current management.

Methods:  We conducted an electronic survey of North American members of the Society for Pediatric Anesthesia, in which we asked about their perioperative management of sickle cell disease.

Results:  The response rate to valid addresses was 25% (n = 510/2006). In four scenarios, (a patient with mild disease undergoing a minor procedure; a patient with mild disease undergoing a more invasive procedure; a patient with severe disease undergoing a minor procedure; and a patient with severe disease undergoing a more invasive procedure) 80%, 38%, 27%, and 16% of respondents, respectively, would rely on oral fluids to hydrate patients during the preoperative fast, while 13%, 34%, 44%, and 59%, respectively, would use intravenous fluid. For the same four scenarios, 64%, 28%, 33%, and 10%, respectively, would not transfuse patients in an attempt to prevent sickle cell exacerbations, while 17%, 49%, 36%, and 51%, respectively, would transfuse to a hemoglobin concentration of 10 g·dl−1. The tendencies to administer preoperative intravenous fluid and to transfuse blood increased with disease severity and procedure invasiveness (P < 0.001). Although 89% felt comfortable managing patients with sickle cell disease, 73% thought an advisory statement on optimal perioperative management was needed.

Conclusions:  There is a wide variation in the management of children with sickle cell disease. Clinicians differentiate management based on disease severity and procedure type.
Approach to managing children with heart disease for noncardiac surgery
Authors: White Michelle C.
Published: September 2010

Congenital heart disease is the commonest birth defect, and advances in modern medicine mean 90% of these children now survive to adulthood. Therefore, many children present to their local hospital requiring general anesthesia for common childhood conditions. They pose a challenge for anesthesia because perioperative morbidity and mortality is greater compared with other children. It is impossible to prescribe a formula for anesthetizing children with heart disease because of the complexity of heart defects and the variety of noncardiac surgery. There is also a lack of high‐quality data of efficacy of one anesthetic technique over another. Much data come from case series or isolated case reports. In a rapidly advancing field such as cardiac surgery, studies of long‐term complications may be out of date by the time they are published, limiting applicability of the results. Because of these factors, claims of efficacy and safety of various approaches to managing children with heart disease for noncardiac surgery must be interpreted cautiously. This narrative review aims to present the evidence concerning a range of anesthetic techniques, the long‐term complications of congenital heart disease and suggest a physiological and evidence‐based approach to managing these children.
Is body mass index associated with pathological outcomes after radical prostatectomy in Korean men?
Authors: Lee Sang Eun , Lee Won Ki , Jeong Min Soo , Abdullajanov Murad , Kim Dae Sung , Park Hong Zoo , Jeong Sung Jin , Yoon Cheol Yong , Byun Seok‐Soo , Choe Gheeyoung , Hong Sung Kyu
Published: September 2010

Study Type – Therapy (case series) Level of Evidence 4

What’s known on the subject? and What does the study add?

Today, controversies continue with regards to the potential impact of obesity or increased body mass index (BMI) on actual pathological features of prostate cancer and/or clinical outcome after radical prostatectomy (RP). Moreover, a paucity of relevant data exist in the literature regarding Asian or Korean men.

For the first time to our knowledge, the study demonstrated that although higher BMI was significantly associated with extracapsular extension of tumour, BMI did not significantly enhance ability to preoperatively predict extracapsular extension of tumour and was not significantly associated with PSA outcome as well as other objective pathological outcomes in Korean men undergoing RP, who are generally leaner than Western counterparts.

OBJECTIVE

• To investigate the impact of increased body mass index (BMI) on pathological features after radical prostatectomy (RP) in Korean patients.

PATIENTS AND METHODS

• We reviewed the records of 1000 Korean patients who underwent RP for prostate cancer and assessed the differences in pathological outcomes and biochemical recurrence‐free survival after RP according to BMI of subjects via univariate and multivariate analyses.

• A multivariate logistics regression model, the performance of which was analysed from a receiver operator characteristics curve, was applied to assess the predictive capacity of variables shown to be significant predictors of adverse pathological outcome.

RESULTS

• Among our subjects, only 17 (1.7%) men had BMI ≥30 kg/m2. After adjusting for various clinical variables, BMI (highest quartile vs others) was shown to be significantly associated with extracapsular extension of tumour (P= 0.014) and positive surgical margin (P= 0.019), but not with high pathological Gleason score (P= 0.912) and seminal vesicle invasion (P= 0.191).

• Meanwhile, the addition of BMI to a multivariate model devised for preoperatively predicting extracapsular extension of tumour did not significantly increase predictive accuracy of the model (P= 0.319). On multivariate analysis, BMI was not shown to be a significant predictor of biochemical recurrence‐free survival (P= 0.201).

CONCLUSION

• Although higher BMI was significantly associated with extracapsular extension of tumour, BMI did not significantly enhance the ability to preoperatively predict extracapsular extension of tumour and was not significantly associated with PSA outcome or with other objective pathological outcomes in Korean men undergoing RP, who are generally leaner than their western counterparts.
Longitudinal evaluation of the concordance and prognostic value of lymphovascular invasion in transurethral resection and radical cystectomy specimens
Authors: Resnick Matthew J. , Bergey Meredith , Magerfleisch Laurie , Tomaszewski John E. , Malkowicz S. Bruce , Guzzo Thomas J.
Published: September 2010

THIS IS A COMMENT MODERATED PAPER available at http://www.bjui.org/commentary

Study Type – Therapy (case series) Level of Evidence 4

What’s known on the subject? and What does the study add?

Lymphovascular invasion (LVI) is a prognostic marker for biologically aggressive disease in numerous tumour types. Indeed, numerous studies have documented the negative prognostic value of LVI in bladder cancer patients who have undergone radical cystectomy, however few studies have evaluated the prognostic value of LVI at TURBT. The current study examines both the concordance between the presence of LVI at TURBT and radical cystectomy specimens and furthermore examines the survival implications of the presence of LVI at both TURBT and radical cystectomy.

OBJECTIVE

To evaluate the concordance transurethral resection of bladder tumour (TURBT) and radical cystectomy (RC) specimens with regard to the presence of lymphovascular invasion (LVI). Additionally, to evaluate the prognostic value of LVI in the prediction of lymph node metastases, overall survival, disease‐specific survival and recurrence‐free survival following RC.

PATIENTS AND METHODS

The records of 487 patients who underwent RC at our institution between 1987 and 2008 were retrospectively reviewed and evaluated for the presence or absence of LVI as determined by pathological evaluation. The presence or absence of LVI was then evaluated on previous transrectal resection specimens of this cohort of patients undergoing RC. Cox regression and Kaplan–Meier analysis were undertaken to evaluate the contribution of LVI to various outcomes.

RESULTS

Of 474 patients with complete LVI data, 60 (12.3%) were found to have LVI at TURBT compared to 161 (33.1%) at RC. Although the presence of LVI at TURBT was more significantly associated with the presence of LVI at RC, only 42.9% of patients in whom LVI was documented at TURBT were found to harbour LVI at RC. The risk of nodal disease was higher in those patients with LVI at TURBT than in those with no evidence of LVI at TURBT (48.3% vs 25.0%, P < 0.001). Additionally, LVI at TURBT was associated with an increasing risk of pathological upstaging and the receipt of adjuvant chemotherapy. Survival analysis showed a significant decrement in overall and recurrence‐free survival among those with LVI at TURBT compared to those with no evidence of LVI.

CONCLUSIONS

Lymphovascular invasion at TURBT provides useful prognostic information that should be incorporated into clinical decision‐making, particularly with regard to cystectomy for nonmuscle‐invasive carcinoma and the administration of neoadjuvant chemotherapy.
Surgical management of lymph‐node‐positive prostate cancer: improves symptomatic control
Authors: Wiegand Lucas R. , Hernandez Mike , Pisters Louis L. , Spiess Philippe E.
Published: September 2010

Study Type – Therapy (case series) Level of Evidence 4

What’s known on the subject? and What does the study add?

There is a paucity of data regarding symptomatic local progression of patients treated with radical prostatectomy in the setting of lymph‐node‐positive prostate cancer. Our retrospective study shows that radical prostatectomy with adjuvant hormonal therapy improves local control of patients in this cohort.

OBJECTIVE

• To assess the impact of primary surgical therapy on local control for patients with lymph‐node‐positive prostate cancer.

METHODS

• A retrospective analysis from January 1982 to January 2001 identified 192 patients treated by radical retropubic prostatectomy (RRP, N= 87), hormonal ablative therapy (ADT, N= 74), or RRP plus adjuvant hormones (RRP + ADT, N= 31).

• Statistical analyses were conducted using the Kruskal–Wallis test, chi‐squared or Fisher’s exact test, log‐rank test and logistic regression with the statistical significance level set at P < 0.05.

RESULTS

• The incidence of local relapse in the three treatment groups (RRP, ADT and RRP + ADT) was 40.2%, 59.5% and 12.9%, respectively.

• Among those with local relapse, the incidence of symptomatic local relapse (defined as local symptoms secondary to locally recurrent prostate cancer) was 25.7%, 75.0% and 50.0%, respectively.

• Logistic regression analysis used to identify predictors of local relapse indicated that patients treated with ADT (OR = 1.96; P= 0.270) had higher odds of having a local relapse whereas patients treated with RRP + ADT (OR = 0.20; P= 0.032) had significantly lower odds of having a local relapse compared with patients treated with RRP (reference group) after adjusting for other significant predictors such as increases in serum PSA at diagnosis (OR = 1.09; P= 0.018) and biochemical failure after primary therapy (OR = 48.3; P < 0.001).

• Logistic regression analysis used to identify predictors of symptomatic local relapse, among patients having had a relapse, indicated that patients treated with RRP + ADT (OR = 2.90; P= 0.322) had higher odds of having a symptomatic local relapse whereas patients treated with ADT alone (OR = 8.67; P < 0.001) had significantly higher odds of having a symptomatic local relapse compared with patients treated with RRP (reference group).

CONCLUSIONS

• Radical prostatectomy (with adjuvant hormonal therapy) provides improved local control in patients with lymph‐node‐positive prostate cancer.

• This important endpoint must be considered when determining the optimal treatment of patients with node‐positive disease.
The effects of metabolic conditions on prostate cancer incidence over 15 years of follow‐up: results from the Olmsted County Study
Authors: Wallner Lauren P. , Morgenstern Hal , McGree Michaela E. , Jacobson Debra J. , St. Sauver Jennifer L. , Jacobsen Steven J. , Sarma Aruna V.
Published: September 2010

Study Type – Prognosis (population‐based cohort) Level of Evidence 2a

What’s known on the subject? and What does the study add?

Previous research focusing on the role of metabolic conditions and the risk of prostate cancer is inconsistent in that it focuses on various definitions of the metabolic syndrome, a cluster of metabolic conditions that included obesity and diabetes and hypertension and does not look at the conditions alone or in combination with each other. While studies have shown an increased risk of prostate cancer in the presence of the metabolic syndrome, it is unknown whether various clusters of the conditions or the conditions themselves are differentially associated with prostate cancer risk.

This study contributes to this field by investigating how these conditions are individually and in combination associated with the development of prostate cancer. Rather than just combining the conditions in to the metabolic syndrome and looking at the associated risk, we sought to identify whether the individual components were associated with prostate cancer and whether the varying combinations of them (the interactions) were differentially associated with the development of prostate cancer.

OBJECTIVE

• To determine if combinations of obesity, hypertension and diabetes influence the development of prostate cancer over 15 years of follow‐up.

PATIENTS AND METHODS

• In 1990, a randomly selected cohort of Caucasian men from Olmsted County, MN, USA, aged 40–79 years, was recruited; 2445 completed a questionnaire that included physician‐diagnosed diabetes and hypertension.

• Anthropometric measures were collected during clinical examination. Biopsy‐confirmed prostate cancer was identified from medical records.

• Proportional hazards regression was used to estimate the effects of these metabolic conditions, both individually and in combination, on the incidence rate of prostate cancer.

RESULTS

• Men with hypertension alone or in combination with diabetes were more likely to develop prostate cancer than were men without any of the metabolic conditions.

• The metabolic syndrome – the presence of all three conditions compared with men with no metabolic components – was only minimally and inversely associated with prostate cancer [hazard ratio (HR): 0.81; 95% confidence interval (CI): 0.20, 3.3] and no monotonic association between the number of metabolic components and prostate cancer was observed.

CONCLUSIONS

• Our results suggest that it may not be sufficient to treat metabolic conditions as one variable when investigating the aetiology of prostate cancer in Caucasian men.

• Further research should focus on the separate and combined effects of these metabolic conditions in large

samples.
Rude Accountability: Informal Pressures on Frontline Bureaucrats in Bangladesh
Authors: Hossain Naomi
Published: September 2010

This article is about ‘rude’ forms of accountability — the informal pressures used by citizens to claim public services and to sanction service failures. Rude accountability is characterized by a lack of official rules or formal basis and a reliance on the power of social norms and rules to influence and sanction official performance. The article draws on evidence from Bangladesh, a state which has not reformed its social sector governance, to explore when and why poor citizens resort to ‘rude’ accountability, whether they have a comparative advantage in the use of informal mechanisms, and whether these work, in terms of gaining better service. It asks what informal accountability mechanisms imply for governance reform in social services, and discusses lessons for other ‘unreformed’ states like Bangladesh.
Subverting Regulatory Protection of ‘Natural Commodities’: The Prunus Africana in Madagascar
Authors: Neimark Benjamin
Published: September 2010

This article explores the contradictions that have emerged along the commodity chain of the endangered medicinal tree Prunus africana in Madagascar. The study provides a unique opportunity to build on theories of access, highlighting in particular the themes of social relations, culture and power in mediating access to natural resources and benefits that derive from commercialization. Commodity chain analysis is employed to illustrate that property rights, based solely on formal rights, legal claims or customary rights to ‘natural commodities’ are insufficient to measure who is able to gain and maintain access to the species. The results show that power, regulation and exclusion have a much greater impact on who is able to tap into the benefits of P. africana commercialization. This article illustrates how extraction firms in Madagascar have over the years finessed their way, through ‘green conditionalities’ or conservation concessions, into continued extraction of P. africana — all in the face of widespread regulation.
Attrition in paediatric weight management: a review of the literature and new directions
Authors: Skelton J. A. , Beech B. M.
Published: September 2010

Paediatric obesity continues to be one of the most important health issues facing children and families today, and there remains a need for effective treatment options. There are a few reports in the literature demonstrating high rates of attrition from paediatric weight management programmes, ranging from 27% to 73%. While some studies show that racial/ethnic minorities, the economically disadvantaged and those with higher levels of obesity are at risk, other studies do not. There is some consistency in reasons given by families for attrition from treatment, most often scheduling issues and programmes not meeting family needs or expectations. This review highlights identified contributors to attrition from paediatric weight management and provides a framework to study this problem, based on models of adherence to paediatric medical regimens.
Weight gain in breast cancer survivors: prevalence, pattern and health consequences
Authors: Vance V. , Mourtzakis M. , McCargar L. , Hanning R.
Published: September 2010

Weight gain is a common and persistent problem for many breast cancer survivors and is associated with adverse health consequences. A comprehensive review of the English language literature was conducted to investigate the frequency, magnitude and pattern of weight gain among breast cancer survivors, to identify factors that are associated with these changes and to review the clinical significance of weight gain on disease free survival and overall health. While there appears to be a general trend toward a reduction in the magnitude of weight gain in recent years, as many as 50–96% of women experience weight gain during treatment and many, including some women who remain weight stable during treatment, report progressive weight gain in the months and years after diagnosis. Weight gain is more common in women receiving adjuvant chemotherapy, especially for women receiving longer duration treatments and seems to be especially pronounced in premenopausal women. With or without weight gain, unfavourable changes in body composition including fat gain and loss of lean tissue are prevalent. This unique pattern of weight gain and change in body composition is distressing for most women, poses significant risk for the development of co‐morbid conditions and may impact on long term disease‐free survival.
Preventing excessive gestational weight gain: a systematic review of interventions
Authors: Skouteris H. , Hartley‐Clark L. , McCabe M. , Milgrom J. , Kent B. , Herring S. J. , Gale J.
Published: September 2010

Women who gain excessive weight during pregnancy have an increased risk of post‐partum obesity, and retention of gestational weight gain (GWG) post birth is a strong predictor of maternal overweight/obesity a decade or more after the birth. The aim of the current review was to identify, and evaluate the effect of key variables designed to modify risk factors for excessive weight gain in pregnant women that have been targeted in interventions over the last decade. The 10 interventions focused primarily on behavioural changes in relation to physical activity and/or to eating. While six studies reported significantly less weight gain in the intervention women, only three showed that women in the intervention were significantly more likely to gain within recommended guidelines. GWG was reduced in only normal‐weight, low‐income, obese, or overweight women, or not at all. Only one study reported a reduction in GWG in women with body mass indexes spanning the normal, overweight and obese categories. The findings were inconsistent in relation to what factors need to be targeted in intervention programmes to reduce GWG. Consideration of psychological factors relevant to pregnancy, in addition to behavioural changes in relation to eating and physical activity, is suggested for future intervention studies.
Australia’s National Action Plan for Salinity and Water Quality: a retrospective assessment*
Authors: Pannell David J. , Roberts Anna M.
Published: September 2010

Perceptions of a salinity ‘crisis’ in Australia around 2000 resulted in the establishment of a major national program that aimed to prevent, stabilize, and reverse trends in salinity. The National Action Plan for Salinity and Water Quality allocated A$1.4 billion of public funds to 1700 projects over 7 years. Here, we assess the performance of the program in relation to 12 features that we propose as being essential for programs that aim to address complex environmental problems. The features include use of technical information to guide investment prioritization, use of socio‐economic information, effective integration of information for prioritization, selection of appropriate targets, choice of appropriate policy mechanisms, and provision of incentives and support to environmental managers to pursue environmental outcomes cost effectively. Our assessment reinforces findings from a number of public reviews that found serious weaknesses in the program. Overall, with a few exceptions, projects under the National Action Plan generated few worthwhile salinity mitigation benefits and will have little enduring benefit. This was readily foreseeable given attention to the scientific and economic knowledge of salinity available at the time the program was developed.
The income elasticity of meat: a meta‐analysis
Authors: Gallet Craig A.
Published: September 2010

The demand for meat has been estimated by many studies utilizing various data and estimation methods. In this study, we perform a meta‐analysis of the income elasticity of meat that involves regressing 3357 estimated income elasticities, collected from 393 studies, on variables that control for study characteristics. Across several meta‐regression specifications, we find significant differences in income elasticities tied to the type of meat being studied, as well as a few functional forms, data aggregations, publication characteristics, and locations of demand. However, many study characteristics do not significantly influence reported income elasticities. Less concern should be given to such characteristics when choosing an income elasticity from the literature.
Dairy disaggregation and joint production in an economy‐wide model*‡
Authors: Charteris Angus , Winchester Niven
Published: September 2010

We examine the impact of dairy disaggregation and joint production on trade liberalisation outcomes in an economy‐wide model. Depending on parameterisation, our model includes either (i) a single dairy commodity, (ii) several dairy commodities without joint production or (iii) several dairy commodities with joint production. In a numerical application, we consider the removal of US tariffs on dairy exports from New Zealand (the world’s largest dairy exporter). We show that failing to account for joint production when dairy commodities are disaggregated leads to misleading results. Our preferred dairy production function differs from those used in other applied trade models. Our analysis can be used to determine when accounting for joint production in other sectors is important.