bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of “Liberal”versus “Restrictive” Intraoperative Fluid Administration on Elimination of a Postoperative Fluid Load
Authors: Holte Kathrine , Hahn Robert G. , Ravn Lisbet , Bertelsen Kasper G. , Hansen Stinus , Kehlet Henrik
Published: March 2007

Background

Previously, the authors found "liberal" fluid administration (approximately 3 l Ringer's lactate [RL]) to improve early rehabilitation after laparoscopic cholecystectomy, suggesting functional hypovolemia to be present in patients receiving "restrictive" fluid administration (approximately 1 l RL). Because volume kinetic analysis after a volume load may distinguish between hypovolemic versus normovolemic states, the authors applied volume kinetic analysis after laparoscopic cholecystectomy to explain the difference in outcome between 3 and 1 l RL.

Methods

In a prospective, nonrandomized trial, the authors studied 20 patients undergoing laparoscopic cholecystectomy. Ten patients received 15 ml/kg RL (group 1) and 10 patients received 40 ml/kg RL (group 2) intraoperatively. All other aspects of perioperative management were standardized. A 12.5-ml/kg RL volume load was infused preoperatively and 4 h postoperatively. The distribution and elimination of the fluid load was estimated using volume kinetic analysis.

Results

Patient baseline demographics and intraoperative data did not differ between groups, except for intraoperative RL, having a median of 1,118 ml (range, 900-1,400 ml) in group 1 compared with a median of 2,960 ml (range, 2,000-3,960 ml) in group 2 (P<0.01). There were no significant preoperative versus postoperative differences in the size of the body fluid space expanded by infused fluid (V), whereas the clearance constant kr was higher postoperatively versus preoperatively (P=0.03). The preoperative versus postoperative changes in volume kinetics including V were not different between the two groups.

Conclusions

Elimination of an intravenous fluid load was increased after laparoscopic cholecystectomy per se but not influenced by the amount of intraoperative fluid administration.
Effect of a 0.5% Dilution of Propofol on Pain on Injection during Induction of Anesthesia in Children
Authors: Soltész Stefan , Silomon Malte , Gräf Gerhard , Mencke Thomas , Boulaadass Sabiha , Molter Gerd P.
Published: March 2007

Background

Pain on injection of propofol in children has been reported to be as high as 30-80%. The reason for the pain is assumed to be the aqueous phase of the propofol emulsion. Therefore, for the first time, this study tested the hypothesis that dilution of propofol to a 0.5% emulsion might reduce the incidence of pain during propofol injection.

Methods

The study design was prospective, monocenter, double-blind, and randomized. Sixty-four children aged 2-6 yr were scheduled to receive 0.5% or 1.0% propofol in a medium-chain-triglyceride/long-chain-triglyceride emulsion. Incidence and intensity of pain were assessed by spontaneous expressions of pain and withdrawal of the arm. In a subgroup of 21 children, serum triglyceride levels were measured before and 3 and 20 min after induction. Adverse events were recorded.

Results

Amounts of propofol required until loss of eyelash reflex were 4.40+/-1.01 mg/kg for 0.5% propofol and 4.31+/-0.86 mg/kg for 1.0% propofol. Percentages of children who showed at least one pain reaction were 23.3% in the 0.5% propofol group and 70.0% in the 1.0% propofol group (P<0.001). Serum triglycerides were higher in the 0.5% propofol group 3 and 20 min after injection (251.7 vs. 148.8 mg/dl; P=0.001 and 135.5 vs. 75.5 mg/dl; P=0.03). Adverse events or complications did not occur.

Conclusions

Dilution of propofol to a 0.5% medium-chain-triglyceride/long-chain-triglyceride emulsion reduced pain effectively during injection in children aged 2-6 yr. Cumulative doses until 4-5 mg/kg propofol led to moderate increases of triglyceride levels and did not result in significant adverse events.
Influence of Different Strategies of Volume Replacement on the Activity of Matrix Metalloproteinases
Authors: Volta Carlo A. , Alvisi Valentina , Campi Matilde , Marangoni Elisabetta , Alvisi Raffaele , Castellazzi Massimiliano , Fainardi Enrico , Manfrinato Maria C. , Dallocchio Franco , Bellini Tiziana
Published: March 2007

Background

Excessive production of matrix metalloproteinase 9 (MMP-9) is linked to tissue damage and anastomotic leakage after large bowel surgery. Hence, the aim of this study was to verify whether different strategies of fluids administration can reduce MMP-9 expression.

Methods

In the in vitro experiment, the authors tested the hypothesis of a direct inhibition of MMP-9 by the fluids used perioperatively, i.e., lactated Ringer's solution, 3.4% poligeline, and hydroxyethyl starch 130/0.4. In the in vivo experiment, 36 patients undergoing surgery for colon cancer were randomly assigned to three groups to receive lactated Ringer's solution, poligeline, or hydroxyethyl starch. MMP-9 and tissue inhibitor of metalloproteinases were measured from venous blood samples; the MMP-9/tissue inhibitor of metalloproteinases ratio was calculated as an index of equilibrium between the action of MMP-9 and its inhibition.

Results

In the in vitro experiment, the presence of hydroxyethyl starch 130/0.4 in the MMP-9 assay system showed a strong inhibition of the enzymatic activity compared with lactated Ringer's solution. In the in vivo experiment, MMP-9 and tissue inhibitor of metalloproteinases plasma levels did not differ among the three groups at baseline, whereas those levels increased significantly at the end of surgery. At that time, the MMP-9 plasma levels and the MMP-9/tissue inhibitor of metalloproteinases ratio were significantly higher in the lactated Ringer's solution and poligeline groups than in the hydroxyethyl starch group. These results were confirmed 72 h after surgery.

Conclusions

This study demonstrates that hydroxyethyl starch 130/04 decreases the circulating levels of MMP-9 in patients undergoing abdominal surgery.
Isoflurane Provides Long-term Protection against Focal Cerebral Ischemia in the Rat
Authors: Sakai Hiroaki , Sheng Huaxin , Yates Robert B. , Ishida Kazuyoshi , Pearlstein Robert D. , Warner David S.
Published: March 2007

Background

Long-term neuroprotection by isoflurane has been questioned. The authors examined factors in experimental models potentially critical to definition of enduring isoflurane neuroprotection.

Methods

Rats were prepared for temporary middle cerebral artery occlusion (MCAO). Pericranial normothermia was maintained. Neurologic deficits (range, 0-48; 0=no deficit) and cerebral infarct volumes were measured. In experiment 1, rats underwent 50 or 80 min MCAO while awake or anesthetized with 1.8% isoflurane. Blood pressure was controlled with phenylephrine. Outcome was evaluated 2 weeks later. In experiment 2, rats underwent 50 min MCAO while awake or anesthetized with isoflurane, with outcome evaluated 8 weeks later. In experiment 3, rats underwent 50 min MCAO while awake or anesthetized with isoflurane and 2 weeks recovery. Effects of phenylephrine and the mitochondrial adenosine triphosphate-sensitive K channel antagonist 5-hydroxydecanoate were studied. In experiment 4, isoflurane-anesthetized rats underwent 50 min MCAO with permanent or temporary common carotid artery occlusion, with outcome evaluated 2 weeks later.

Results

In experiment 1, isoflurane reduced neurologic deficit (median+/-interquartile range; awake vs. isoflurane: 11+/-12 vs. 8+/-6 for 80 min and 13+/-4 vs. 3+/-9 for 50 min; P=0.0006) and infarct size (160+/-97 vs. 84+/-62 mm for 80 min and 169+/-78 vs. 68+/-61 mm for 50 min; P<0.0001). In experiment 2, isoflurane protection persisted at 8 weeks after ischemia. In experiment 3, there was no effect of phenylephrine or 5-hydroxydecanoate. In experiment 4, permanent common carotid ligation increased infarct size threefold versus temporary occlusion.

Conclusions

Isoflurane repeatedly improved long-term neurologic and histologic outcome from focal ischemia independent of ischemia duration, perfusion pressure, or pretreatment with 5-hydroxydecanoate.
Milrinone Combined with Vasopressin Improves Cardiac Index after Cardiopulmonary Resuscitation in a Pig Model of Myocardial Infarction
Authors: Palmaers Thomas , Albrecht Sven , Heuser Fabian , Leuthold Christian , Schuettler Juergen , Schmitz Bernd
Published: March 2007

Background

Milrinone used for acute cardiac insufficiency could be of interest during cardiopulmonary resuscitation because of its positive inotropic effects. In this study, the combination of milrinone-vasopressin was compared with epinephrine and vasopressin, as well as with the combination of epinephrine-vasopressin, in reference to hemodynamics.

Methods

Thirty-two pigs underwent ligation of the circumflex coronary artery and induction of ventricular fibrillation lasting for 4 min. Cardiopulmonary resuscitation was performed after randomization to one of four groups: epinephrine (30-microg/kg bolus), vasopressin (0.4-U/kg bolus), epinephrine-vasopressin (15-microg/kg epinephrine bolus, 0.2-U/kg vasopressin bolus), or milrinone-vasopressin (0.4-U/kg vasopressin bolus, 50-microg/kg milrinone bolus over 5 min and a continuous infusion of 0.4 microg.kg.min). The hemodynamic variables were measured before cardiopulmonary resuscitation as well as 4, 8, 15, and 30 min after return of spontaneous circulation.

Results

All animals were resuscitated successfully. The animals of the milrinone-vasopressin group displayed significantly (P<0.05) higher cardiac index values (30 min after return of spontaneous circulation: epinephrine, 65.8+/-13.2; vasopressin, 70.7+/-18.3; epinephrine-vasopressin, 69.1+/-36.2; milrinone-vasopressin, 120.7+/-34.8 ml.min.kg) without a decrease in mean arterial pressure or coronary perfusion pressure.

Conclusions

The combination of vasopressin-milrinone as compared with epinephrine during cardiopulmonary resuscitation leads to an improved cardiac index without relevant decrease of mean arterial pressure or coronary perfusion pressure.
Effect of Isoflurane and Other Potent Inhaled Anesthetics on Minimum Alveolar Concentration, Learning, and the Righting Reflex in Mice Engineered to Express α1γ-Aminobutyric Acid Type A Receptors Unresponsive to Isoflurane
Authors: Sonner James M. , Werner David F. , Elsen Frank P. , Xing Yilei , Liao Mark , Harris R Adron , Harrison Neil L. , Fanselow Michael S. , Eger Edmond I. , Homanics Gregg E.
Published: March 2007

Background

Enhancement of the function of gamma-aminobutyric acid type A receptors containing the alpha1 subunit may underlie a portion of inhaled anesthetic action. To test this, the authors created gene knock-in mice harboring mutations that render the receptors insensitive to isoflurane while preserving sensitivity to halothane.

Methods

The authors recorded miniature inhibitory synaptic currents in hippocampal neurons from hippocampal slices from knock-in and wild-type mice. They also determined the minimum alveolar concentration (MAC), and the concentration at which 50% of animals lost their righting reflexes and which suppressed pavlovian fear conditioning to tone and context in both genotypes.

Results

Miniature inhibitory postsynaptic currents decayed more rapidly in interneurons and CA1 pyramidal cells from the knock-in mice compared with wild-type animals. Isoflurane (0.5-1 MAC) prolonged the decay phase of miniature inhibitory postsynaptic currents in neurons of the wild-type mice, but this effect was significantly reduced in neurons from knock-in mice. Halothane (1 MAC) slowed the decay of miniature inhibitory postsynaptic current in both genotypes. The homozygous knock-in mice were more resistant than wild-type controls to loss of righting reflexes induced by isoflurane and enflurane, but not to halothane. The MAC for isoflurane, desflurane, and halothane did not differ between knock-in and wild-type mice. The knock-in mice and wild-type mice did not differ in their sensitivity to isoflurane for fear conditioning.

Conclusions

gamma-Aminobutyric acid type A receptors containing the alpha1 subunit participate in the inhibition of the righting reflexes by isoflurane and enflurane. They are not, however, involved in the amnestic effect of isoflurane or immobilizing actions of inhaled agents.
Determination of the EC50Amnesic Concentration of Etomidate and Its Diffusion Profile in Brain Tissue
Authors: Benkwitz Claudia , Liao Mark , Laster Michael J. , Sonner James M. , Eger Edmond I. , Pearce Robert A.
Published: March 2007

Background

Etomidate is a widely used general anesthetic that has become a useful tool to investigate mechanisms of anesthetic action in vivo and in brain slices. However, the free aqueous concentration of etomidate that corresponds to amnesia in vivo and the diffusion profile of etomidate in brain slices are not known.

Methods

The authors assessed the effect of intraperitoneally injected etomidate on contextual fear conditioning in mice. Etomidate concentrations in brain tissue were obtained by high-performance liquid chromatography. Uptake studies in 400-microm-thick brain slices were used to calculate the diffusion and partition coefficients of etomidate. A diffusion model was used to calculate the expected concentration profile within a brain slice as a function of time and depth. The predicted rate of drug equilibration was compared with the onset of electrophysiologic effects on inhibitory circuit function in recordings from hippocampal brain slices.

Results

Etomidate impaired contextual fear conditioning with an ED50 dose of 11.0+/-0.1 mg after intraperitoneal injection, which corresponded to an EC50 brain concentration of 208+/-9 ng/g. The brain:artificial cerebrospinal fluid partition coefficient was 3.35, yielding an EC50,amnesia aqueous concentration of 0.25 microm. The diffusion coefficient was approximately 0.2x10 cm/s. The development of etomidate action in hippocampal brain slices was compatible with the concentration profile predicted by this diffusion coefficient.

Conclusions

The free aqueous concentration of etomidate corresponding to amnesia, as defined by impaired contextual fear conditioning in mice, is 0.25 microM. Diffusion of etomidate into brain slices requires approximately an hour to reach 80% equilibration at a typical recording depth of 100 microm. This information will be useful in designing and interpreting in vitro studies using etomidate.
Inhalation of the Phosphodiesterase-3 Inhibitor Milrinone Attenuates Pulmonary Hypertension in a Rat Model of Congestive Heart Failure
Authors: Hentschel Thomas , Yin Ning , Riad Alexander , Habbazettl Helmut , Weimann Jörg , Koster Andreas , Tschope Carsten , Kuppe Hermann , Kuebler Wolfgang M.
Published: March 2007

Background

Most patients with congestive heart failure (CHF) develop pulmonary venous hypertension, but right ventricular afterload is frequently further elevated by increased pulmonary vascular resistance. To investigate whether inhalation of a vasodilatory phosphodiesterase-3 inhibitor may reverse this potentially detrimental process, the authors studied the effects of inhaled or intravenous milrinone on pulmonary and systemic hemodynamics in a rat model of CHF.

Methods

In male Sprague-Dawley rats, CHF was induced by supracoronary aortic banding, whereas sham-operated rats served as controls. Milrinone was administered as an intravenous infusion (0.2-1 microg.kg body weight.min) or by inhalation (0.2-5 mg/ml), and effects on pulmonary and systemic hemodynamics and lung water content were measured.

Results

In CHF rats, intravenous infusion of milrinone reduced both pulmonary and systemic arterial blood pressure. In contrast, inhalation of milrinone predominantly dilated pulmonary blood vessels, resulting in a reduced pulmonary-to-systemic vascular resistance ratio. Repeated milrinone inhalations in 20-min intervals caused a stable reduction of pulmonary artery pressure. No hemodynamic effects were detected when 0.9% NaCl was administered instead of milrinone or when milrinone was inhaled in sham-operated rats. No indications of potentially adverse effects of milrinone inhalation in CHF, such as left ventricular volume overload, were detected. Moreover, lung edema was significantly reduced by repeated milrinone inhalation.

Conclusion

If these results can be confirmed in humans, inhalation of nebulized milrinone may present a novel, effective, safe, and pulmonary selective strategy for the treatment of pulmonary venous hypertension in CHF.
Novel Starches
Authors: Madjdpour Caveh , Thyes Caroline , Buclin Thierry , Frascarolo Philippe , von Roten Inès , Fisch Andreas , Burmeister Marc , Bombeli Thomas , Spahn Donat R.
Published: March 2007

Background

Carboxymethyl starch (CMS) and carboxymethylated hydroxyethyl starch (CM-HES) might offer advantages over hydroxyethyl starch (HES) with regard to their volume expansion effect and their pharmacokinetic characteristics. The goal of the current study was to determine the pharmacokinetics of CMS and CM-HES and to investigate their influence on blood coagulation in comparison with the standard low-molecular, low-substituted HES (130/0.42) used in Europe.

Methods

The study was conducted as a randomized, blinded, parallel three-group study in 30 pigs. Twenty ml/kg of 6% HES (control), 6% CMS, or 6% CM-HES was infused as a single dose, and serial blood sampling was performed over 20 h to measure plasma concentration and molecular weight and to assess blood coagulation. Concentration-effect relations were assessed by pharmacokinetic-pharmacodynamic analysis.

Results

CMS and CM-HES showed significantly higher plasma concentrations and molecular weights over 20 h (P for both<0.001) with smaller volumes of distribution and longer elimination rates during the terminal phase (P for both<0.01) when compared with HES. CMS and CM-HES impaired whole blood coagulation more than HES as assessed by Thrombelastograph analysis (Haemoscope Corporation, Niles, IL). However, similar effects of all three starch preparations on blood coagulation were found when related to the plasma concentrations in mass units.

Conclusions

Carboxymethylation of starch results in an increased intravascular persistence and a slower fragmentation compared with HES. The greater impairment of blood coagulation by CMS and CM-HES seems to be caused by the higher plasma concentrations.
Sevoflurane Breakdown Produces Flammable Concentrations of Hydrogen
Authors: Dunning Marshall B. , Bretscher Lynn E. , Arain Shahbaz R. , Symkowski Yanina , Woehlck Harvey J.
Published: March 2007

Background

Fires, explosions, and extreme heat production may occur when sevoflurane reacts with desiccated barium hydroxide lime. The identity of the flammable gas has not previously been published, although carbon monoxide, methanol, formaldehyde, and methyl formate have been identified in low quantities.

Methods

The authors reacted sevoflurane with excess desiccated barium hydroxide lime or soda lime at 55 degrees, 100 degrees, 200 degrees, 300 degrees, and 400 degrees C. Formaldehyde, methanol, sodium formate, and hexafluoroisopropanol were reacted with barium hydroxide lime at 300 degrees or 400 degrees C. The authors measured hydrogen production by gas chromatography with a thermal conductivity detector and calculated the molar yield of hydrogen produced.

Results

Up to 3 moles of hydrogen were produced per mole of sevoflurane degraded. Each mole of formaldehyde produced up to 2 moles of hydrogen at 400 degrees C. Formate and hexafluoroisopropanol produced up to 1 mole of hydrogen each at 400 degrees C. More than 2 moles of hydrogen were produced by methanol at 400 degrees C. Soda lime and barium hydroxide lime produced similar amounts of hydrogen from sevoflurane above 200 degrees C, but barium hydroxide lime produced more than soda lime at lower temperatures. The temperature above which large amounts of hydrogen were produced seemed to be 300 degrees C.

Conclusions

Up to 3 moles of hydrogen are produced by the chemical reaction of sevoflurane with heated, desiccated absorbent. The high yield, ease of ignition, and low tissue solubility of hydrogen make it the most likely fuel in anesthesia machine fires due to the reaction of sevoflurane with desiccated absorbent.
Determination of the Full Dose–Response Relation of Intrathecal Bupivacaine, Levobupivacaine, and Ropivacaine, Combined with Sufentanil, for Labor Analgesia
Authors: Van de Velde Marc , Dreelinck Rebekka , Dubois Jasperina , Kumar Ariane , Deprest Jan , Lewi Liesbeth , Vandermeersch Eugene
Published: March 2007

Background

Ropivacaine and levobupivacaine are local anesthetics that produce less motor block and greater sensory-motor separation when compared with equal milligram doses of bupivacaine. Although minimum local analgesic concentration studies suggested that they are less potent than bupivacaine, full dose-response studies have not been performed. The current trial describes the dose-response relation of levobupivacaine, ropivacaine, and bupivacaine, combined with sufentanil, when used for intrathecal labor analgesia.

Methods

Four hundred fifty term parturients in active labor were included in this double-blind, randomized trial. Combined spinal-epidural anesthesia was performed, and ropivacaine, levobupivacaine, or bupivacaine was intrathecally administered in a dose of 1.0, 1.5, 2.0, 2.5, 3.0, or 3.5 mg, always combined with 1.5 microg sufentanil. Patients were considered responders to spinal analgesia if the visual analog scale score for pain was less than 25 mm within 15 min and the visual analog scale score remained less than 25 mm for 45 min. Patient demographics, obstetric data, maternal side effects, and fetal and neonatal well-being were noted. Group-specific dose-response curves were constructed using a probit regression model.

Results

The ED95 of bupivacaine was 3.3 mg (95% confidence interval, 2.9-4.1). The ED95s of ropivacaine and levobupivacaine were 4.8 mg (95% confidence interval, 4.0-6.7) and 5.0 mg (95% confidence interval, 4.1-7.0), respectively. Racemic bupivacaine was significantly more potent than ropivacaine (P=0.0027) and levobupivacaine (P=0.0006). Ropivacaine and levobupivacaine were of similar potency (P=0.91).

Conclusions

This full dose-response study suggests that ropivacaine and levobupivacaine are of similar potency, whereas bupivacaine is more potent than both other drugs.
Automated Documentation Error Detection and Notification Improves Anesthesia Billing Performance
Authors: Spring Stephen F. , Sandberg Warren S. , Anupama Shaji , Walsh John L. , Driscoll William D. , Raines Douglas E.
Published: March 2007

Background

Documentation of key times and events is required to obtain reimbursement for anesthesia services. The authors installed an information management system to improve record keeping and billing performance but found that a significant number of their records still could not be billed in a timely manner, and some records were never billed at all because they contained documentation errors.

Methods

Computer software was developed that automatically examines electronic anesthetic records and alerts clinicians to documentation errors by alphanumeric page and e-mail. The software's efficacy was determined retrospectively by comparing billing performance before and after its implementation. Staff satisfaction with the software was assessed by survey.

Results

After implementation of this software, the percentage of anesthetic records that could never be billed declined from 1.31% to 0.04%, and the median time to correct documentation errors decreased from 33 days to 3 days. The average time to release an anesthetic record to the billing service decreased from 3.0+/-0.1 days to 1.1+/-0.2 days. More than 90% of staff found the system to be helpful and easier to use than the previous manual process for error detection and notification.

Conclusion

This system allowed the authors to reduce the median time to correct documentation errors and the number of anesthetic records that were never billed by at least an order of magnitude. The authors estimate that these improvements increased their department's revenue by approximately $400,000 per year.
Diagnosis and Treatment of Vascular Air Embolism
Authors: Mirski Marek A. , Lele Abhijit Vijay , Fitzsimmons Lunei , Toung Thomas J. K. , Warltier David C.
Published: March 2007

Vascular air embolism is a potentially life-threatening event that is now encountered routinely in the operating room and other patient care areas. The circumstances under which physicians and nurses may encounter air embolism are no longer limited to neurosurgical procedures conducted in the "sitting position" and occur in such diverse areas as the interventional radiology suite or laparoscopic surgical center. Advances in monitoring devices coupled with an understanding of the pathophysiology of vascular air embolism will enable the physician to successfully manage these potentially challenging clinical scenarios. A comprehensive review of the etiology and diagnosis of vascular air embolism, including approaches to prevention and management based on experimental and clinical data, is presented. This compendium of information will permit the healthcare professional to rapidly assess the relative risk of vascular air embolism and implement monitoring and treatment strategies appropriate for the planned invasive procedure.
An Early Example of Evidence-based Medicine
Authors: Cheney Frederick W. , Warner David S.
Published: March 2007

Diffusion anoxia. By Bernard Raymond Fink. Anesthesiology 1955; 16:511-14. In 1955, Dr. Bernard Raymond Fink published his findings that described the mechanism by which hypoxemia occurred when nitrous oxide-oxygen anesthesia was discontinued and room air breathing commenced. Using an ear oximeter and brachial artery blood gases, he measured oxygen saturation in eight healthy patients who had received 75% nitrous oxide-25% oxygen for gynecologic surgery. He showed that oxygen saturation decreased from 5% to 10% and often reached a value below 90% when the patient began room air breathing after the nitrous oxide-oxygen was discontinued. The effect was seen over a 10-min period. He concluded that "anoxia arises because the outward diffusion of nitrous oxide lowers the alveolar partial pressure of oxygen." This phenomenon can become a causative factor of cardiac arrest in patients with impaired pulmonary or cardiac reserves.
Freshwater shrimp–sponge association from an ancient lake
Authors: Rintelen Kristina von , Rintelen Thomas von , Meixner Martin , Lüter Carsten , Cai Yixiong , Glaubrecht Matthias
Published: March 2007

Shrimp–sponge associations occur frequently in marine ecosystems, serving as model systems for the evolution of eusociality. Here, we describe the first known instance of such association in freshwater from an ancient lake in Indonesia. The shrimp
Caridina spongicola
forms an exclusive and probably commensal association with a yet undescribed spongillinid sponge. Phylogenetic and ecological data suggest a comparatively recent origin of both taxa. Climatic fluctuations may have facilitated speciation and occasional hybridization of the shrimp species, which is derived from a rock-dwelling ancestor. Their extremely localized occurrence in an increasingly disturbed area makes both taxa a conservation priority.
Water waves and integrability
Authors: Ivanov Rossen I
Published: March 2007

Euler's equations describe the motion of inviscid fluid. In the case of shallow water, when a perturbative asymptotic expansion of Euler's equations is considered (to a certain order of smallness of the scale parameters), relations to certain integrable equations emerge. Some recent results concerning the use of integrable equation in modelling the motion of shallow water waves are reviewed in this contribution.
Superposed deformation in turbidites and syn‐sedimentary slides of the tectonically active Miocene Waitemata Basin, northern New Zealand
Authors: Spörli K. B. , Rowland J. V.
Published: March 2007

The Miocene Waitemata Basin was deposited on a moving base provided by the Northland Allochthon, which was emplaced in the Late Oligocene, as a new convergent plate boundary was established in northern New Zealand. The basin experienced complex interaction between tectonic and gravity‐driven shallow deformation. Spectacular examples of the resulting structures exposed on eastern Whangaparaoa Peninsula 50 km north of Auckland provide a world‐class example of weak rock deformation, the neglected domain between soft‐sediment and hard rock deformation. Quartz‐poor turbidite sequences display a protracted sequence of deformations: D1, synsedimentary slumping; D2, large scale deeper‐seated sliding and extensional low‐angle shearing, associated with generation of boudinage and broken formation; D3, thrusting and folding, indicating transport mostly to the SE; D4, thrusting and folding in the opposite direction; D5, further folding, including sinistral shear; D6, steep faults. The deformation sequence suggests continuous or intermittent southeastward transport of units with increasing sedimentary and structural burial. By phase D3, the rocks had passed from the soft‐sediment state to low levels of consolidation. However, with a compressive strength of ∼5 MPa they are weak rocks even today. Such weak‐rock deformation must be important in other sedimentary basins, especially those associated with active convergent plate boundaries and with immature source areas for their sediments.
Dipyridamole enhances ischemia‐induced reactive hyperemia by increased adenosine receptor stimulation
Authors: Meijer P. , Riksen N. , Scheffer G.‐J. , Smits P. , Rongen G. A.
Published: March 2007

Introduction:  Dipyridamole enhances post‐occlusive reactive hyperemia (PORH) in the human forearm. The mechanism of this potentiation remains to be elucidated. We hypothesize that dipyridamole augments PORH by increasing interstitial adenosine and subsequent stimulation of adenosine receptors. To test this hypothesis, the effect of caffeine (an adenosine A1 and A2 receptor antagonist) on dipyridamole‐induced augmentation of PORH was explored.

Methods:  Eight healthy volunteers (6 female; age 19–24 year) abstained from caffeine intake for at least 24 hours. The brachial artery was cannulated for drug infusion. After forearm circulation had been occluded for 5 minutes and starting immediately upon reperfusion, forearm blood flow was measured for 5 minutes using venous occlusion mercury‐in‐silastic strain gauge plethysmography. At least one hour after reperfusion, this procedure was repeated during intra‐arterial infusion of dipyridamole (7.4 nmol/min/dl forearm). At least two weeks later, this whole procedure was repeated, but now in the presence of caffeine (0.46 μmol/min/dl forearm).

Statistics:  For each subsequent minute, forearm blood flow was averaged to one value. An ANOVA for repeated measures was performed with caffeine, dipyridamole and reperfusion time as within‐subject factors. Results are expressed as mean ± SEM.

Results:

FBF: forearm blood flow

P < 0.05 for the effect of dipyridamole on PORH

P > 0.5 for the effect of caffeine on PORH

P < 0.01 for the interaction between caffeine and dipyridamole.

Conclusions:  Caffeine abolishes the augmenting effect of dipyridamole on PORH. This indicates that adenosine receptors are involved in the dipyridamole‐induced augmentation of PORH.
Child adjustment in high conflict families
Authors: Smith J , Berthelsen D , O'Connor I
Published: March 2007

Children exposed to spousal violence are at risk for social‐emotional problems. This research investigated a number of family and child factors which might influence the effects of witnessing spousal violence on young children. Fifty‐four mothers who had at least one child in the age range of 3 to 6 years participated in the study. These women had left a violent relationship 12 to 24 months prior to their participation in the study and were not in a new relationship. Information was collected through a structured interview which included the administration of a standardized family violence measure (conflict tactics scale) and child adjustment profile (child behaviour checklist). Forty‐two per cent of the children exhibited a level of behavioural problems which would warrant clinical intervention. The amount of violence that the children witnessed, the children's responses when the violence occurred and whether the child copied the violent partner's behaviour, were associated with the children's behavioural adjustment scores. Maternal parenting style was not found to have a significant effect on behavioural adjustment. The study provided important quantitative and qualitative data on the nature of parent‐child relationships and children's adjustment in families where there is spousal violence.
Depiction of pain in the self‐drawings of children with sickle cell disease
Authors: Stefanatou Athena , Bowler Dermot
Published: March 2007

In an attempt to explore the perception of pain in children, 30 children with sickle cell disease were asked to make two drawings; one of themselves and one of themselves in pain. It was hypothesized that the cognitive ability and the emotional state of the child would be affected by the pain experience. Children and their parents were interviewed on the incidence of pain and on the child's control over it. The cognitive ability of the child was related to the kind of control he/she exercised over the pain. An analysis of the drawings concerning their thematic representations, colour and size is also presented. The mental age of the child dropped in the drawing of pain as compared to the non‐pain drawing but it was found to be irrelevant to the kind of control the child exercised on the pain.
Variations in take‐up off the Family Fund
Authors: Hirst M A
Published: March 2007

This paper investigates geographical variations in successful and unsuccessful applications to the Family Fund Trust which provides grants to families with severely disabled children. A new measure of take‐up is developed which takes account of demographic differences between local social services authorities and relates local take‐up levels to national rates. The take‐up of grants varies more than twofold across local authorities but is generally higher in deprived areas, suggesting that the help available from the fund is targeting those most in need. Nonetheless use of the fund is less than expected in metropolitan areas characterized by rented accommodation, high rise dwellings and minority ethnic groups. Ethnic monitoring and other measures to promote equal opportunities have recently been introduced. If take‐up were uniformly high across England and Wales the current caseload and budget would increase by more than half. Local authorities where renewed efforts might be most effectively targeted to encourage families to apply for a grant can be identified but any publicity would need to ensure that inappropriate applications are kept to a minimum.
Preventing suicide in young people: what is known and what is needed
Authors: Williams K.
Published: March 2007

In the UK the suicide rate for male adolescents has nearly doubled since 1975. With a similar increase reported from other countries it is not surprising that preventing suicide in young people has become a priority for many health professionals and policy makers. Unfortunately despite advances in our understanding of suicide in young people there are still deficiencies and inconsistencies in our knowledge. There are also problems in transforming our knowledge of suicide and suicidal behaviour in young people and our understanding of theoretically possible approaches to prevention into effective suicide prevention strategies. To increase the chance of preventing suicide in young people we need to be aware of the problems of putting theory into practice and evaluate all interventions that are undertaken to determine their appropriateness and effectiveness.
Ten steps for successful breast‐feeding: assessment of hospital performance, its determinants and planning for improvement
Authors: Gökçay G , Uzel N , Kayatürk F , Neyzi O
Published: March 2007

This paper discusses results from a project which aims to document the maternity hospital practices in Istanbul within the context of Ten Steps for Successful Breastfeeding. Instruments developed for use in hospital level implementation of the WHO/UNICEF baby friendly hospital initiative were used in five hospitals (two public and three private). No hospital was implementing all Ten Steps. A core hospital team on lactation management and a sufficient number of health personnel skillful in breastfeeding counselling and adequate delivery room conditions are required to implement the Ten Steps. It is very difficult to provide these conditions in public hospitals with an excessive patient load. On the other hand, the fee for service system and the policy of changing practices according to the wishes of the clients can also become barriers to successful breastfeeding, as may occur in some private hospitals.
Parental separation: effects on children; implications for services
Authors: Holroyd R , Sheppard A.
Published: March 2007

It Is commonly assumed that the children of separated or divorced parents are disadvantaged financially and In terms of social development. A small‐scale study was designed involving 14 volunteer parents who were separated from their spouses/partners and their 28 children, ranging in age from 5 to 12 years. Structured interviews examined the families’attitudes and feelings about the separation, the mental health of the parents, the emotional and behavioural reactions of the children, and the families’use of services. The results suggested that over 60% of the girls showed internalizing, and over 60% of the boys displayed externalizing behavioural difficulties. About 40% of the children suffered psychosomatic disorders. Nearly 75% of the parents suffered depression before and after separation. Depression, itself, may act to exacerbate children's emotional and behavioural difficulties. Although all the parents had received medication for their depression, few of the children had received any help for their difficulties. The urgent need for services to help such children Is discussed.
Peer relations and friendship in physically disabled children
Authors: Mulderij K J.
Published: March 2007

This article presents the results of a literature study and qualitative fieldwork Into the way physically disabled children experience friendship. We discuss literature on how children make contact with peers, on the nature of their friendship and on what It is like to be excluded. Some aspects are complemented with information from the children themselves. Peer relations and friendship are the very essence of a happy childhood. This article therefore closes with a number of recommendations to improve peer relationships.
A re‐appraisal of screening for colour vision impairments
Authors: Holroyd E , Hall D M B
Published: March 2007

Screening for colour vision Impairments (CVI) has been carried out In schools in the UK since 1934, but little is known about Its yield or value. A survey was conducted among Sheffield schoolboys, school nurses and optometrists to determine the benefits of CVI screening. The results Indicated that between 4.2 and 5.2% of boys had been identified as having a CVI, compared with the expected prevalence of 8% Boys were ill‐informed about the significance of CVI for careers planning but recognized the potential importance of having this information before making decisions about choice of subjects and examinations. Possible reasons for the low yield of screening are reviewed and alternative strategies are discussed.
Evaluation of a cancer‐based coping and caring course used in three different settings
Authors: Cleave H , Charlton A
Published: March 2007

Cancer in the family may affect the psycho‐social adjustment of the children involved. Children who have survived childhood cancer or with a parent or sibling with cancer, may find protection from the risk of emotional and behavioural difficulties from effective external support systems. A training course was developed by the Cancer Research Campaign to help professionals who make up potential external support systems, cope with children experiencing cancer‐related life crises. The course was offered to, and evaluated with, practising teachers, student teachers and Cancer Aid and Listening Line workers. Results from interviews and pre and post course questionnaires indicated that after the course all three groups felt more confident in dealing with children under stress. Participants felt that specific skills such as‘attentive listening’had increased as a result of the course. Of the three groups the practising teachers have found the course the most useful in their work and have been able to disseminate their newly acquired skills throughout their schools. Teachers are expected to cope with students’various life crises as they arise in schools. Basic counselling skills training for teachers could help them cope with these in a more confident manner, thereby reducing the risk of emotional and behavioural difficulties and contributing towards a Health Promoting School ethos.
Perceptions of the risk of child abduction or loss and the utility of child electronic security devices
Authors: Dixon R M , Pasnak R.
Published: March 2007

Perceptions of the susceptibility of young children to becoming lost or being abducted, and of the potential usefulness of child electronic security devices, were examined via a questionnaire. Data were provided by 41 volunteers, most of them from a local government office centre. The questionnaire asked for demographic data, and then for the risk of a child being abducted or lost when under the supervision of different caregivers and in different situations. The probable effectiveness of three common abductor ploys was also addressed. The questionnaire concluded with 10 questions about child electronic security devices. Respondents viewed mothers, fathers, and grandparents as equally responsible caregivers and young adults/babysitters as the least responsible. These effects diminished as the age of the children increased. The garden at home was Judged to be the most secure environment for children of all ages, while an amusement park was judged the least secure environment. Children were perceived to be more at risk of an abduction when a stranger asked for physical assistance or to take them to the hospital because their parents were hurt, than when asked for directions. Furthermore, the respondents expressed a moderately strong need for child electronic security devices, and viewed parents who use them as more responsible than those who do not.
The parent between the child and the professional — some ethical implications
Authors: Kristensson‐Hallström I , Nilstun T
Published: March 2007

In this paper ethical implications of parental participation in paediatric care are discussed. The paper is based on interviews with 20 parents, whose children were admitted and operated on at a paediatric surgery department In Sweden. In one part of the interview the parent was invited to speak about situations experienced as problematic during the hospitalization. Three different types of situations were described by the parents as especially problematic. In the first situation the parents’ability to influence their own situation was limited. Parents got upset when staff did not treat them as autonomous persons. In the second type of situation things‘had to be done’to the child, for example the surgery, the anaesthesia, removing an indwelling catheter and giving an enema. The parents understood and accepted this, but the child was sometimes unable to agree usually because of anxiety and fear. In the third type of situation parents felt that professionals did not take them or their child seriously. In order to avoid or alleviate such situations, the professionals ought to mediate a permissive attitude to the expressions of concern. Thus, when the parents worry, the professionals ought to listen more attentively and, whenever possible and adequate, respect their concerns.
Speech perception and speech comprehension investigations of pre‐term newborns and high‐risk neonates of pre‐school age
Authors: Beke A. , Gósy M
Published: March 2007

The purpose of this study is to establish whether there is any connection between neonatal morbidity and speech perception and comprehension In children of pre‐school age who have previously been treated as newborn infants In an intensive care unit. The test applied is a method invented in Hungary for the analysis of global hearing, speech perception and comprehension. The authors summarize the results of their follow‐up studies of 52 children with respiratory disorders as newborns, some of whom were born as pre‐term and some as full‐term newborns with asphyxia. The children have been put into three groups according to their maturity and their birthweight. Newborns with hearing loss and mental retardation were excluded from this study. Of the various neonatal factors the results show: complications of delivery, birthweight, hypoxia, persistent ductus arteriosus, duration of ventilation and complications of respiratory treatment are found to be correlated to perception and comprehension. Incidences of poor achievement obtained in the most characteristic subtests have been compared among the different groups of newborns. The intelligence level of pre‐school children is found to be closely correlated to speech perception and comprehension.
Infant feeding and maternal concerns about stool hardness
Authors: Morley R , Abbott R A , Lucas A
Published: March 2007

From a questionnaire completed by 195 mothers of infants aged 3‐12 weeks we found that significantly more formula than breast‐feeding mothers had concerns about stool hardness and had sought professional advice, resulting in both increased use of health care resources and more dietary interventions.
Choice of medical investigations for developmental delay: a questionnaire survey
Authors: Gringras P
Published: March 2007

The aim of this study was to describe the range and cost of investigations ordered by paediatricians for children with mild to moderate developmental delay. A total of 79 consultants on the Thames Regions Consultant Community Paediatricians database were sent a faxed questionnaire and 86% of the paediatricians responded. The number of tests ordered by each paediatrician ranged from none to 15; 26 different medical investigations were selected. The four most common tests were chromosomes for karyotyping, fragile X testing, thyroid function testing and metabolic studies which each appeared in over half of the responses. The median cost of the investigations chosen was 386 with a range from 0‐E1181. This study revealed marked variations in clinical practice when paediatricians investigate a developmentally delayed child. This was found to reflect both personal bias and a lack of consensus in the medical literature. There is a need for accurate community based prevalence data on causes of developmental delay, and critical appraisal of the available diagnostic tests.
The piloting of a group for the fathers of children with Down syndrome
Authors: West A
Published: March 2007

The health services often struggle in their attempts to engage and support fathers. This paper describes the piloting of a small group for the fathers of children with a disability, in this case Down Syndrome. The group is described from conception to conclusion and limitations of the study are discussed. The group approach meets a need for a proportion of fathers who prove able to explore their experiences and feelings.