bluuebunny/crossref_metadata_2025 huggingface dataset:
ABC transporter‐mediated release of a haem chaperone allows cytochrome c biogenesis
Authors: Feissner Robert E. , Richard‐Fogal Cynthia L. , Frawley Elaine R. , Kranz Robert G.
Published: May 2006

Although organisms from all kingdoms have either the system I or II cytochrome c biogenesis pathway, it has remained a mystery as to why these two distinct pathways have developed. We have previously shown evidence that the system I pathway has a higher affinity for haem than system II for cytochrome c biogenesis. Here, we show the mechanism by which the system I pathway can utilize haem at low levels. The mechanism involves an ATP‐binding cassette (ABC) transporter that is required for release of the periplasmic haem chaperone CcmE to the last step of cytochrome c assembly. This ABC transporter is composed of the ABC subunit CcmA, and two membrane proteins, CcmB and CcmC. In the absence of CcmA or CcmB, holo(haem)CcmE binds to CcmC in a stable dead‐end complex, indicating high affinity binding of haem to CcmC. Expression of CcmA and CcmB facilitates formation of the CcmA2B1C1 complex and ATP‐dependent release of holoCcmE. We propose that the CcmA2B1C1 complex represents a new subgroup within the ABC transporter superfamily that functions to release a chaperone.
Validation of a semi‐automated scintigraphic technique for detecting episodic, real‐time colonic flow
Authors: Dinning P. G. , Mckay E. , Cook I. J.
Published: May 2006

Abstract  The relationships between the movement of colonic content and regional pressures have only been partially defined. During the analysis of a combined colonic scintigraphic and manometric study, a quantitative technique for determining discrete, episodic, real‐time colonic flow was developed. Our aim was to validate this technique through the construction of a computer‐generated phantom model of known antegrade and retrograde motility. The anthropoid phantom was rasterized into a 6‐mm voxel model to create a 3D voxel phantom of the colon with four distinct colonic segments. Associating a time/activity curve with each segment simulated dynamic behaviour. Activity in the model was based on data obtained from human colonic scintigraphic recordings using 30 MBq of 99mTc sulphur colloid. The flow was simulated by modifying the input time/activity functions to represent episodes of net flow of 2%, 5% or 10% of segmental content. Our quantitative technique was applied to the phantom model to measure the accuracy with which simulated flows were detected. Our quantitative technique proved to be a sensitive and specific means of detecting the presence and the magnitude of discrete episodes of colonic flow and therefore, should improve our ability to correlate colonic flow and motor patterns.
Advances in ontogeny of the enteric nervous system
Authors: Burns A. J. , Thapar N.
Published: May 2006

Abstract  The neurons and glia that comprise the enteric nervous system (ENS), the intrinsic innervation of the gastrointestinal tract, are derived from vagal and sacral regions of the neural crest. In order to form the ENS, neural crest‐derived precursors undergo a number of processes including survival, migration and proliferation, prior to differentiation into neuronal subtypes, some of which form functional connections with the gut smooth muscle. Investigation of the developmental processes that underlie ENS formation has progressed dramatically in recent years, in no small part due to the attention of scientists from a range of disciplines on the genesis of Hirschsprung's disease (aganglionic megacolon), the major congenital abnormality of the ENS. This review summarizes recent advances in the field of early ENS ontogeny and focuses on: (i) the spatiotemporal migratory pathways followed by vagal and sacral neural crest‐derived ENS precursors, including recent in vivo imaging of migrating crest cells within the gut, (ii) the roles of the RET and EDNRB signalling pathways and how these pathways interact to control ENS development, and (iii) how perpendicular migrations of neural crest cells within the gut lead to the formation of the myenteric and submucosal plexi located between the smooth muscle layers of the gut wall.
5‐HT4 receptor agonists enhance both cholinergic and nitrergic activities in human isolated colon circular muscle
Authors: Cellek S. , John A. K. , Thangiah R. , Dass N. B. , Bassil A. K. , Jarvie E. M. , Lalude O. , Vivekanandan S. , Sanger G. J.
Published: May 2006

Abstract  Previous studies have demonstrated mixed inhibitory and facilitatory effects of 5‐hydroxytryptamine‐4 (5‐HT4) receptor agonists on electrical field stimulation (EFS)‐induced responses in human isolated colon. Here we report three types of responses to EFS in human isolated colon circular muscle: monophasic cholinergic contraction during EFS, biphasic response (nitrergic relaxation during EFS followed by cholinergic contraction after termination of EFS) and triphasic response (cholinergic contraction followed by nitrergic relaxation during EFS and a tachykininergic contraction after EFS). The effects of two 5‐HT4 receptor agonists, prucalopride and tegaserod were then investigated on monophasic responses only. Each compound inhibited contractions during EFS in a concentration‐dependent manner. In the presence of Nω‐nitro‐l‐arginine methyl ester (l‐NAME) however, prucalopride and tegaserod enhanced the contractions in a concentration‐dependent manner. In strips where the tone was elevated with substance‐P and treated with scopolamine, EFS‐induced relaxations were enhanced by the two agonists. The above observed effects by the two agonists were abolished by 5‐HT4 receptor antagonist SB‐204070. The two agonists did not alter the tone raised by substance‐P in the presence of scopolamine and l‐NAME and did not affect carbachol‐induced contractions in the presence of tetrodotoxin. These results suggest that in the circular muscle of human colon, 5‐HT4 receptor agonists simultaneously facilitate the activity of neurones which release the inhibitory and excitatory neurotransmitters, nitric oxide and acetylcholine respectively.
Is there an influence of X‐chromosomal imprinting on the phenotype in Klinefelter syndrome? A clinical and molecular genetic study of 61 cases
Authors: Stemkens D , Roza T , Verrij L , Swaab H , Van Werkhoven MK , Alizadeh BZ , Sinke RJ , Giltay JC
Published: May 2006

Studies on Turner syndrome suggested the presence of X‐chromosomal‐imprinted genes involved in social and verbal cognition. Imprinted genes on autosomes were shown to affect growth. Could imprinting of such genes on the X chromosome also influence psychomotor development and growth in men with Klinefelter syndrome (KS), who have a supernumerary X? We recorded anthropometric and psychomotor development parameters for 61 males with KS (age range 2–56 years). In 54 cases, we were able to assess intelligence quotient (IQ) and found that impaired speech – and motor developmental problems were reported significantly more often in the paternal X – than in the maternal X group (P = 0.02). We found some significant (P < 0.05) increased body size parameters in the paternal X group, which concurs with data reporting a growth promoting influence of paternally derived genes. Our results suggest X‐chromosomal imprinting occurs in males with KS.
Clinical outcome of heart transplant recipients receiving tacrolimus with or without mycophenolate mofetil
Authors: Fuchs Uwe , Tenderich Gero , Zittermann Armin , Szabados Florian , Minami Kazutomo , Koerfer Reiner
Published: May 2006

Abstract:  Tacrolimus (TAC) is a calcineurin inhibitor that is used for cardiac allograft rejection. Efficacy and safety data of a combined TAC/mycophenolate mofetil (MMF) therapy in comparison with a TAC/cortisone therapy in heart recipients are lacking. We analysed the clinical outcome of 41 patients who received TAC in combination with MMF (TMF group) and of 41 patients who received TAC in combination with cortisone (TCO group). Outcomes were serum creatinine levels, cardiac rejections, cytomegalovirus infections, graft vasculopathy, malignancy rates and two‐yr survival. Baseline characteristics were comparable in the two study groups. During follow‐up, serum creatinine levels decreased slightly in the TMF group (p = 0.039) but not in the TCO group. Compared with the TMF group, more clinically proven cardiac rejections which needed a cortisone bolus and more severe rejections that needed lymphoablative therapy with OKT occurred in the TCO group (p = 0.001 and 0.04, respectively). In contrast, significantly more cytomegalovirus (CMV) infections occurred in the TMF group compared with the TCO group (p = 0.01). The number of patients with graft vasculopathy as well as malignancy rates and overall survival did not differ significantly between the two study groups. The introduction of MMF was associated with an improvement of renal function and a more efficient immunosuppressive therapy. However, this treatment strategy also had led to a higher CMV infection rate compared with cortisone. Consequently, no general recommendation can be given at present whether TAC should be combined with MMF or with cortisone in heart transplant recipients.
What delay should there be between primary infectious mononucleosis and renal transplantation?
Authors: Kerecuk L. , Amlot P. , Riad H. , Webb N. J. A.
Published: May 2006

Abstract: A 17‐yr‐old girl in end‐stage renal failure was due to undergo living‐related pre‐emptive renal transplantation when she developed acute infectious mononucleosis (AIM) from Epstein–Barr virus (EBV). In view of the risk of post‐transplant lymphoproliferative disorder (PTLD) we were unsure as to the optimal delay between AIM and renal transplantation. This report describes the process used to determine maturation of the immune response to EBV using a combination of serology, immunophenotyping and molecular viral load estimation. These tests showed that EBV had not been cleared and dialysis was instituted rather than proceed directly to transplantation. After EBV viral load became undetectable in the blood, living‐related donor was successfully performed 13 months after AIM. With 42‐month post‐transplant follow up there has been no evidence of PTLD.
Tacrolimus‐associated eosinophilic gastroenterocolitis in pediatric liver transplant recipients: Role of potential food allergies in pathogenesis
Authors: Saeed Shehzad A. , Integlia Mark J. , Pleskow Randi G. , Calenda Kathleen A. , Rohrer Richard J. , Dayal Yogeshwar , Grand Richard J.
Published: May 2006

Abstract:  Tacrolimus is a macrolide agent that is now the primary immunosuppressant used in prevention of graft rejection in transplant recipients. It has been found to be superior to cyclosporine (CSA) for rescue therapy as well as for earlier weaning of steroids. Both tacrolimus and CSA share similar toxicity profiles; however, their gastrointestinal side effects have received little attention. We report three cases of eosinophilic colitis in liver transplant recipients, maintained on tacrolimus as immunosuppressive medication post‐liver transplantation. These patients also had high serum immunoglobulin (Ig)E levels, eosinophilia and IgE‐positive radioallergosorbent test for milk proteins. The colitis appeared to be mediated by food allergies. Each patient had symptomatic improvement following reduced immunosuppression and an appropriately restricted diet. We conclude that tacrolimus may play a role in the initiation of food allergies, leading to eosinophilic colitis. More studies are needed in a controlled setting to identify the prevalence of similar findings among other pediatric liver transplant recipients.
Polyomavirus‐associated nephropathy: update on antiviral strategies
Authors: Josephson M.A. , Williams J.W. , Chandraker A. , Randhawa P.S.
Published: May 2006

Abstract: Polyomavirus‐associated nephropathy (PVAN) is a major complication of kidney transplantation. Many centers respond to PVAN by reducing immunosuppression. Concern over precipitating rejection, as well as situations in which some PVAN‐afflicted individuals have multi‐organ transplants, can make reduction of immunosuppression undesirable. In these cases, effective antiviral strategies would be useful. This article describes clinical observations and experiences with 3 different antiviral protocols. Two protocols address antiviral treatment of nephropathy (cidofovir in one, and leflunomide in the other). The third protocol examines fluoroquinolone control of polyoma urinary excretion. Patients responded to all 3 strategies. These promising approaches deserve further evaluation with prospective controlled studies.
Polyomavirus‐associated nephropathy: update on BK virus‐specific immunity
Authors: Comoli P. , Binggeli S. , Ginevri F. , Hirsch H.H.
Published: May 2006

Abstract: The human polyomavirus type 1, also called BK virus (BKV), causes polyomavirus‐associated nephropathy (PVAN) in 1–10% of renal transplant recipients, with graft loss in over 50% of cases. The risk factors for PVAN are not conclusively defined and likely involve complementing determinants of recipient, graft, and virus. A central element seems to be the failing balance between BKV replication and BKV‐specific immune control, which can result from intense triple immunosuppression, HLA‐mismatches, prior rejection and anti‐rejection treatment, or BKV‐seropositive donor/seronegative recipient pairs. Consistent with this general hypothesis, the timely reduction of immunosuppression in kidney transplant recipients reduced graft loss to less than 10% of cases. However, the BKV‐specific humoral and cellular immune response is not well characterized. Recent work from several groups suggest that changes in antibody titers and BKV‐specific CD4+ and CD8+ T cells may help to better define the risk and the course of PVAN in renal transplant patients.
Validity and reliability of the MEDYN questionnaire for evaluation of functioning in mental health clients receiving occupational therapy
Authors: Odes Hodayah , Noter Ester , Nir Maya Bar , Marcus Dina , Shamir Yosefa , Nir Nira
Published: May 2006

Background:  A number of questionnaires are currently available for measuring functionality of mental health clients; however, they are complex, clumsy to use and impossible to compare to each other. There is a clear need for a simple and straightforward tool that uses quantitative measures. We formulated a questionnaire based on occupational, behavioural and cognitive theories to assess the functioning of psychiatric inpatients receiving occupational therapy.

Methods:  Thirty‐one patients hospitalised in a closed and an open ward and receiving occupational therapy were monitored during 4 weeks. Clinicians completed the questionnaire for each patient on a weekly basis.

Results:  Interrater reliability was found to be generally high with correlations among the raters in the closed ward being higher than among those in the open ward. Both cognitive and general/social functioning improved over time and the improvement was associated with type of illness and duration of treatment.

Conclusions:  The MEDYN questionnaire is a valid and reliable objective tool for functional assessment of this subgroup of patients.
The effects of specific educational preparation on emergency nurses’ clinical decisions regarding supplemental oxygen administration
Authors: Considine Julie , Botti Mari , Thomas Shane
Published: May 2006

Abstract  The use of supplemental oxygen by emergency nurses has important implications for patient outcomes, yet there is significant variability in oxygen administration practises. Specific education related to oxygen administration increases factual knowledge in this domain; however, the impact of knowledge acquisition on nurses’ clinical decisions is poorly understood. This study aimed to examine the effect of educational preparation on 20 emergency nurses’ decisions regarding the assessment of oxygenation and the use of supplemental oxygen. A pre‐test/post‐test, quasi‐experimental design was used. The intervention was a written, self‐directed learning package. The major effects of the completion of the learning package included no change in the number or types of parameters used by nurses to assess oxygenation, a significant decrease in the selection of simple masks, a significant increase in the selection of air entrainment masks, fewer hypothetical outcomes of unresolved respiratory distress and more hypothetical outcomes of decreased respiratory distress. As many nursing education programs are aimed at increasing factual knowledge, while experience remains relatively constant, a greater understanding of the relationship between factual knowledge and clinical decisions is needed if educational interventions are to improve patient outcomes.
An integrative science approach: Value added in stress research
Authors: King Shirley L. , Hegadoren Kathy M.
Published: May 2006

Abstract  Integrative approaches to understanding complex health issues can transcend disciplinary and knowledge boundaries and provide opportunities to view phenomena from diverse perspectives. These broad approaches to understanding phenomena of interest to nursing might provide new directions for nursing research and be a requisite for delivering safe, responsible, and holistic nursing care. The relationship between stress and illness is a strong example of a field of study that can be understood more fully from an integrative perspective. The potential of an integrative approach to contribute to improvements in human health and well‐being outweigh historical biases that have been associated with an integrative science approach.
Interdisciplinary researching: Exploring the opportunities and risks of working together
Authors: McCallin Antoinette M.
Published: May 2006

Abstract  The aim of this paper is to explore the issues that present both opportunities and risks when working in an interdisciplinary research project. As the research context changes in the social reform environment, some scientists suggest it is time to forge new scientific working relationships, to open up the boundaries between disciplines. Interdisciplinary research is an alternative approach for nurses who might develop different ways of working with health researchers from other disciplines. The ideas in this paper come from a larger, grounded theory study on interdisciplinary teamwork. The changing research context, the meaning of interdisciplinary working, collaboration, and competence, integrating different disciplinary perspectives, interprofessional learning opportunities, and the relevance for nurses are explored in relation to interdisciplinary researching. Interdisciplinary researching is complex and potentially risky; however, it does offer nurses the opportunities for professional growth, development, and research work satisfaction. Many nurses are already well‐trained researchers and might consider developing roles as interdisciplinary research project managers as well.
Opening our hearts and minds: The meaning of international clinical nursing electives in the personal and professional lives of nurses
Authors: Clark Callister Lynn , Harmer Cox Amy
Published: May 2006

Abstract Although international opportunities are the hallmark of nursing education at a large private university, the meaning of participating in such clinical nursing electives has not been described. The purpose of this phenomenological study of nurses was to examine the personal and professional meaning of participating in international clinical nursing electives during their undergraduate nursing studies. Audiotaped interviews were conducted with 20 former nursing students who had had this opportunity. “Opening our hearts and minds” was described by the study’s participants, with the following themes: increasing understanding of other cultures and peoples, increasing understanding of global sociopolitical and health issues, increasing the commitment to make a difference, experiencing personal and professional growth, contributing to professional development in the host country, making interpersonal connexions, and developing cultural competence. This study makes an important contribution to the documentation of the meaning of participating in international nursing clinical experiences. Data are being used for long‐term curricular planning in the development and refinement of future international clinical nursing electives and to provide outcomes data for professional accreditation. There are broader implications for the movement beyond individual cultural competence to increasing global consciousness and the improvement of global health care.
Intake of dietary soy isoflavones in relation to perimenstrual symptoms of Korean women living in the USA
Authors: Kim Hae Won , Kwon Mi Kyoung , Kim Nam Sun , Reame Nancy E.
Published: May 2006

Abstract  This study was conducted to identify the potential relationship between the dietary intake level of soy isoflavones and perimenstrual symptomatology. The research design was a cross‐sectional study. The sample was made up of 84 Korean women living in the USA, aged 28–40 years. The Moos Menstrual Distress Questionnaire (MDQ) and the Food Frequency Questionnaire were used as measurement tools. The soy isoflavone intake was significantly correlated with MDQ scores in the menstrual phase. In conclusion, the beneficial effect of dietary soy isoflavones on certain menstrual symptoms was established, suggesting that soy isoflavones could be one of the dietary factors related to the complexity of premenstrual syndrome (PMS). The positive effect of soy isoflavones on PMS warrants further study.
Concerns of Young Women Who are Positive for Brca1 and/or Brca2
Authors: Hamilton Rebekah
Published: May 2006

The purpose of the study was to examine the experience of predictive genetic testing for hereditary breast and ovarian cancer (HBOC) and to compare experiences of younger women (≤ 35 years old) to the older study cohort (36–60 years old).

Grounded theory was used to examine the phenomenon of adults choosing to have predictive genetic testing for HBOC. A sample of 19 women, ten ≤ 35 years old was recruited through community and internet support group announcements. Semi‐structured interviews were conducted in‐person, by telephone or E‐mail: according to participant preference.

Young women’s experiences were different particularly around concerns about: (i) career plans, (ii) reproduction, and (iii) intimate relationships. Other concerns not specific to young women but also described included: (i) family relationships, (ii) fears of personal mortality, (iii) life and health insurance, and (iv) health information needs.

A commonly voiced experience specific to the young adult age group was feeling ‘out‐of‐place’ in the oncology clinics and support groups which participants perceived as being focused on concerns of older women. Further study may clarify the extent and nature of informational, emotional, social and decision support needs that are unique to this young adult population.
Voices of Parents of Children with Neurofibromatosis 1(NF)
Authors: Dylis Ann M.
Published: May 2006

This presentation, phase I of an American Nurses’ Foundation funded study, is based on unanalyzed qualitative data from a prior study (Dylis, 2003) exploring family functioning in a large international sample of parents of children with Neurofibromatosis 1 (NF), the most common single gene disorder involving the nervous system. The purpose of this study was to identify themes from parental responses to two questions: ‘What do parents of children with NF want from health care providers?’ and ‘What were parental experiences at the initial time of their child’s NF diagnosis.’

Preliminary content analysis themes included parental desires for provider sensitivity and for providers to provide holistic care, accurate information, appropriate communication, referrals, support, and respect. Diagnostic experience themes were symptom management based on the NF diagnostic criteria or specific system manifestations, expressed concern from others resulting in health care intervention, and stories of diagnostic delays, inaccuracies, and dismissal of parental knowledge.

The results from this phase might provide beginning qualitative evidence to assist in the future development of individualized nursing interventions aimed at improving the quality of life for families having a member(s) with NF. Knowledge of parental differences and similarities is essential in developing these interventions.
Comparing Psychological Adaptation to having a Disease Gene in Affected Individuals and Unaffected Carrier Parents
Authors: Read Catherine Y.
Published: May 2006

The Psychological Adaptation to Genetic Information Scale (PAGIS, Read et al.) has demonstrated that adaptation to genetic information is a multidimensional phenomenon comprised of five factors. The purpose of this web‐based survey was to compare PAGIS scores of individuals with a genetic disease (n = 137, 49%) with scores of parents who have transmitted a genetic disease to their child (n = 143, 51%). Each of 26 items is rated on a 1–6 Likert scale, where a higher score represents more positive adaptation. The biological parents had higher scores (P = 0.004) on the total PAGIS and four of the five subscales (non‐intrusiveness, support, self‐worth, and certainty). There was no significant difference between the two groups on the self‐efficacy subscale. Overall, parents who have transmitted a disease‐related gene to their child demonstrate more positive adaptation than affected individuals to the knowledge that they possess a disease‐related gene. This is not surprising, given the burden of having a genetic disease. However, parents do not score higher on the self‐efficacy subscale, a measure that reflects the client’s general perception of control over consequences of having the gene. The findings reinforce the multidimensional nature of psychological adaptation to genetic information, and suggest that these dimensions will vary among subgroups.
Prevalence and Burden of Disease in Hemochromatosis: Estimates Derived from Routine Data
Authors: Patch Christine , Roderick Paul , Rosenberg William
Published: May 2006

Since the discovery of the common mutation linked to hereditary hemochromatosis there has been a debate about the clinical morbidity associated with this condition. In the UK, Hospital Episode Statistics (HES) data provide information on patient care delivered by all NHS hospitals and trusts in England from 1989. Data were obtained for episodes with hemochromatosis as any diagnosis for six years (1997–2003).

Descriptive analyzes of the data were performed. Using estimates derived from the data and mortality statistics a life table approach estimated the probability by age of not having a first episode of care related to hemochromatosis in homozygotes (as a proxy for penetrance).

The number of patients with hemochromatosis increased with more males than females. The average age for males was 55, for females 57. Patients are still presenting with other diagnoses associated with hemochromatosis. The lifetime estimates from the life table were 9% of the male population of homozygotes and 4% of the female would have an episode of care related to hemochromatosis.

An increasing number of patients are being treated for hemochromatosis although the total numbers remains small. Patients are still presenting with preventable complications suggesting that there remains scope for improvements in case detection strategies.
Feasibility and Acceptability of Providing Nurse Counsellor Genetics Clinics in Primary Care
Authors: Westwood Greta
Published: May 2006

Increasing referrals to specialist genetics services have precipitated a review of models of service delivery in the United Kingdom. Little is known about whether a change in clinic location is feasible or acceptable for the patients seen. We consider the feasibility of genetics service development and delivery in primary care and develop a questionnaire to evaluate acceptability and cost to patients.

Between July 2003 and May 2004, 64 primary care appointments with a genetics nurse counsellor were offered to patients referred and registered with selected general practices. 45 (79%) patients attended their appointment and 34 (77%) returned their follow‐up questionnaire. Total mean satisfaction score was high and patients were most satisfied with the information and affective domains of the appointment. 48% of patients seen by the genetics nurse counselor remained in primary care. Patients were satisfied with the travel time and distance to clinic and patient clinic costs were limited. This study shows that patients do attend genetics nurse counselor clinics in primary care, and are satisfied with the new location. A large cluster randomized controlled trial is now being conducted to obtain a controlled comparison of acceptability to patients of attending clinics in primary vs. secondary care settings.
Demystifying Online Genetic Databases
Authors: Driscoll Carolyn , Cashion Anne , Conley Yvette , Homayouni Ramin , Xu Lijing
Published: May 2006

There has been an explosion of genetic information and keeping current can be difficult. Traditional methods for obtaining information may be obsolete. Many sources for genetic information are now found on the internet although they may be confusing to navigate and interpret. The purpose of this presentation is to outline commonly used genetic databases, and demonstrate how they may be accessed and used to interpret genetic data.

The mission of the National Center for Biotechnology Information (NCBI), a resource for molecular biology information, is to develop new information technologies to support understanding of molecular and genetic processes related to health and disease. NCBI services include PubMed, Nucleotide, and the BLAST algorithm for sequence comparison. In this presentation, several genetic databases will be explored. Each database will be defined, the available genetic information described, database access demonstrated, and website information displayed. This presentation will provide education related to several genetic databases as a means of facilitating and promoting access to this information by a larger audience of nurses and health care providers involved with genetic health care.
Genetics and Genomics Nursing: Scope and Standards of Practice
Authors: Greco Karen E.
Published: May 2006

Genetics and genomics nursing is a new and expanding specialty practice. The International Society of Nurses in Genetics (ISONG) is the leader in defining genetics nursing and establishing scope and standards of practice for genetics nurses. Through ISONGs efforts, in 1997 The American Nurses Association (ANA) established genetics nursing as an official nursing specialty. This was followed by publication of The Scope And Standards Of Clinical Genetics Nursing Practice by ISONG and ANA in 1998. The roles of nurses in genetics and genomics have evolved and expanded since publication of this landmark document. A committee within ISONG representing genetics nurses in diverse specialties and practice settings has drafted a new scope and standards document in collaboration with ANA entitled Genetics Nursing: Scope and Standards of Practice, which is expected to be published by American Nurses Publishing in 2006. The purpose of the new scope and standards document is to define the parameters of genetics and genomics nursing practice at the basic and advanced practice level, include‐non‐clinical roles such as education, research, and administration, address the broader focus of genomics, and be applicable to genetics nurses within and outside of the United States since ISONG as an international organization.
Images of Cloning and Stem Cell Research in Mass Media: Cartoon Semiotics
Authors: Giarelli Ellen
Published: May 2006

Public understanding, and ultimately, the acceptance of the use of genetic science for public good, is affected by what the public already believes and how these beliefs may be altered by various claims. This presentation describes how editorial cartoons portray social characteristics of sex, culture, and the social role of the users of the science and how the cartoons present the consequences and value of cloning and stem cell research. Images were analyzed for manifest (denotation) and latent (connotation) meanings found in editorial cartoons published from 2001 to 2004. Semiotics was applied for the visual analyzes. Data were collected form 106 editorial cartoons that appeared in 51 different syndicated sources in that appear nationally (48%)m locally or regionally (40%), and on six World Wide web sites (12%) from 2001 to 2004 in 27 states. The cartoons appeared in 2001 (30%) and 2002 (47%). Eighty‐six cartoons referenced cloning and 20 cartoons referenced stem cell research. Males were portrayed 64% of the time (n = 187) and were the only constituents of the four large groups. There were only 37 female characters in the editorial cartoons. Regardless of year of publication, stem cell research was depicted as having a positive value, and cloning was portrayed negatively. Some major themes are: politics is intruding on science, embryonic stem cell researchers value one kind of life over another, cloning will lead to the mass production of evil, cloning creates monsters, politics will influence who or what will be cloned.
Long‐term, health‐related, quality of life comparison in patients undergoing single stage vs staged resection for complicated diverticular disease
Authors: Constantinides V. A. , Aydin H. N. , Tekkis P. P. , Fazio V. W. , Heriot A. G. , Remzi F. H.
Published: May 2006

Objective  To evaluate long‐term health‐related quality of life, for single‐staged and staged resections following reversal, for complicated diverticular disease.

Patients and methods  Between 1981 and 2003, 188 patients undergoing single stage (n = 158) or staged resection (n = 30) completed the SF‐36 questionnaire. Health‐related quality of life (HRQL) was compared between the two groups and the US normal population based on the eight domains of the SF‐36. HRQL analysis was also performed at various time intervals. The effect of age and postoperative complications on HRQL was also determined. Functional and postoperative outcomes were also assessed.

Results  The single and staged resection groups differed in the presence of comorbidity, degree of peritoneal contamination and operative urgency. No difference in functional outcomes or HRQL was found, even after analysing time‐interval subgroups. Social functioning and general health was substantially worse in both groups when compared to US norms. Ageing was found to significantly reduce physical functioning (P < 0.001) and physical and emotional role limitations (P < 0.001 for both). Post‐operative complications significantly reduced scores when compared to patients without complications, for physical functioning (63.57 vs 78.7, respectively; P < 0.001), physical role limitation (80.65 vs 86.9, respectively; P < 0.001) and bodily pain (66.67 vs 74.81, respectively; P < 0.01).

Conclusions  No significant difference in long‐term HRQL was found in patients undergoing single staged or staged resection for complicated diverticular disease. There was significant impact of ageing and postoperative complications on physical health. Prospective studies that include pre‐operative data on HRQL are required to compare the two operative techniques, with emphasis on quality of life of patients left with a permanent stoma.
Low anterior resection with total mesorectal excision for rectal cancer: functional assessment and factors affecting outcome
Authors: Kakodkar R. , Gupta S. , Nundy S.
Published: May 2006

Objective  Many patients experience disordered defaecation after low anterior resection of the rectum (LARR). We analysed the anorectal function of these patients to determine which factors might contribute to this problem.

Patients and methods  Between November 2002 and January 2004, 18 consecutive patients (11 males and 7 females) who underwent LARR with total mesorectal excision (TME) for rectal cancer were assessed by anorectal manometry, balloon proctometry and the Wexner continence questionnaire before operation and at 6 months and 1 year following stoma closure. Sixteen volunteers (11 males and 5 females) were evaluated for comparison. Stepwise logistic regression was performed for variables that were highly significant at univariate analysis.

Results  The mean daily preoperative stool frequency was 2, mean basal pressure (MBP) 43.12 cm H2O, maximum threshold volume (MTV) 181.8 ml, length of high‐pressure zone (HPZ) 3.11 cm and the rectoanal inhibitory reflex (RAIR) was present in all the patients. Twelve months after stoma closure, the stool frequency was 3.3, MBP 37.7 cm H2O, MTV 146.3 ml, length of HPZ 2.88 cm and Wexner score 4.37. Comparing patients having a good anorectal function (Wexner score ≥ 5) with those having an unsatisfactory function, we found that, on multivariate analysis, the factors that independently contributed to a poor outcome at 12 months after operation were the absence of RAIR as well as an MTV and HPZ below the fifth percentile of normal individuals.

Conclusions  Many patients undergoing LARR with TME for rectal cancer experience an anterior resection syndrome that persists for at least 1 year. Those with no RAIR and subnormal MTV and HPZ lengths can be predicted to have an unsatisfactory outcome.
Safety of bowel resection for colorectal surgical emergency in the elderly
Authors: Pavlidis T. E. , Marakis G. , Ballas K. , Rafailidis S. , Psarras K. , Pissas D. , Papanicolaou K. , Sakantamis A.
Published: May 2006

Objective  Colorectal emergency requiring radical surgery is becoming increasingly frequent in the elderly and problems remain as regards the best management policy. Our long‐time experience is presented in this study.

Patients and methods  In the last 23 years, 105 elderly patients, aged ≥ 65 years, with colorectal disease underwent an emergency operation in our Surgical Department. Forty‐five patients (mean age 72 years) had benign disease and 60 patients (mean age 76.5 years) colorectal carcinoma.

Results  The carcinoma was located in the left colon (68%), right colon (18%) and rectum (14%). Mostly, patients with malignant cancer presented with obstructive ileus, and patients with benign tumours with perforation and peritonitis, with a predominance of diverticulitis. A resection operation either with primary anastomosis or Hartmann's procedure was performed in 75% of cases; in the rest, only palliation was resorted to. Forty‐three per cent of the patients with colorectal cancer emergency were ≥80 years of age. The mean morbidity was 25% and mortality 17%, which make up to 33% and 26.6% for benign disease, and 20% and 10% for malignant cancer, respectively. The mortality rate was higher in patients with perforation than those with obstruction.

Conclusion  Advanced age is not a contraindication to radical surgery in case of colorectal emergency in the elderly. In the majority, a resection operation is feasible. In high‐risk patients, colostomy is a life‐saving alternative.
Surgery for neoplastic changes in ulcerative colitis – can limited resection be justified? Outcome for patients who underwent limited surgery
Authors: Lindberg J. , Stenling R. , Palmqvist R. , Rutegård J.
Published: May 2006

Background  Patients with ulcerative colitis (UC) are at an increased risk of developing colorectal cancer (CRC). The aim of this study was to investigate the outcome for the patients who underwent limited resection of the colon and/or rectum instead of panproctocolectomy (PPC), with special attention to those with neoplastic changes.

Methods  Since 1977, all known patients with UC from our catchment area have been included in our surveillance programme. A total of 210 patients with UC have been followed up with regular colonoscopies and biopsies. Indications for surgery were severe therapy‐resistant disease (TRD), high‐grade dysplasia (HGD), CRC or repeated findings of low‐grade dysplasia (LGD). Patient compliance was excellent.

Results  Fifty‐one patients were operated on. In 29 of these patients, PPC was performed initially. At the end‐point of the study, additionally seven patients had been radically operated on and three more patients planned to undergo such an operation. Accordingly, 22 patients had their first operation performed as a resection of either a part of or the whole colon or rectum. In this group, there were four patients diagnosed with CRC and three with dysplasia‐associated lesion or mass (DALM). One of them died 6 months after surgery because of disseminated CRC, whereas the other patients were alive at the end‐point of the study. One of these seven patients with CRC or DALM had at end‐point been radically operated on and two patients were awaiting such a procedure (in two patients because of LGD and in one patient because of TRD). Six of the patients who had a colorectal resection performed on the indication of TRD were radically operated later on, five of them because of relapsed TRD and one patient because of LGD in the remaining rectal mucosa. Twenty‐one patients gained a mean of 9.4 years with presumably better bowel function, from undergoing a limited resection instead of PPC. None of the patients who underwent a colonic and/or rectal resection died because of CRC or metachronous cancer in their remaining colon or rectum.

Conclusion  The results of this study indicate that a limited resection of the colon and/or rectum in patients with UC, which requires surgical intervention increases the time with presumably better bowel function and may therefore be an alternative to PPC without increased risk of dying from CRC. This is dependent on the flexibility of the medical service and patient compliance.
The incidence of anastomotic leaks in patients undergoing colorectal surgery
Authors: Platell C. , Barwood N. , Dorfmann G. , Makin G.
Published: May 2006

Background  There is evolving interest in auditing and credentialling the performance of surgeons. The incidence of anastomotic leakage has been proposed as a measure of performance following colorectal surgery. The aim of this study was to evaluate the incidence and risk factors associated with anastomotic leakage in patients undergoing resections of the colon and rectum.

Methods  A prospective database was developed for all patients undergoing colorectal surgery. Anastomotic leakage was defined prior to the commencement of the study. A logistic regression analysis was performed to determine independent predictors of leakage. The variables analysed included age, sex, American Society of Anesthesiology (ASA) score, anatomical location, pathology, emergency surgery, type of anastomosis, a covering stoma and radiotherapy. Significance was defined as the probability of a type 1 error of < 5%. The results are presented as odds ratios (ORs) and 95% confidence intervals (95% CIs).

Results  There were 1598 patients who underwent 1639 anastomoses. Their mean age was 63 years, 34% of patients were ASA 3 or 4, and 16% of the operations were emergencies. Anastomotic leaks occurred in 2.4% (40/1639) of anastomoses. The leak rate for intraperitoneal anastomoses was 1.5% (19/1283) vs 6.6% for extraperitoneal anastomoses (21/316). Half of these leaks (20/40) were managed with re‐operation or percutaneous drainage procedures. Ultra‐low anterior resections were associated with the highest leak rate (8%, 18/225). A logistic regression analysis identified a covering stoma (P = 0.0001, OR 5.078, 95% CI 2.527–10.23) and diverticular disease (P = 0.037, OR 2.304, 95% CI 1.053–5.042) as independent predictors of a leak.

Conclusions  Within this surgical unit, the incidence of leaks from intraabdominal anastomoses was relatively low. However, leaks in patients undergoing extraperitoneal anastomoses continue to be a major cause of morbidity and mortality.
IDF and ATP‐III definitions of metabolic syndrome in the prediction of all‐cause mortality in type 2 diabetic patients
Authors: Monami M. , Marchionni N. , Masotti G. , Mannucci E.
Published: May 2006

Aim:  The metabolic syndrome (MS) is associated with increased cardiovascular morbidity and mortality. Recently, the International Diabetes Federation (IDF) proposed to lower diagnostic thresholds for fasting glucose and waist circumference and to limit the diagnosis of MS only to subjects with abdominal adiposity. The aim of the present study was to assess the prognostic value of IDF criteria in diabetic patients, in comparison with previous ATP‐III criteria.

Methods:  An observational cohort study was performed on a consecutive series of 882 Caucasian type 2 diabetic outpatients, aged 65.3 ± 10.9 years, with a duration of diabetes of 13.1 ± 10.6 years. Information on 3‐year all‐cause mortality was obtained by the City of Florence Registry Office.

Results:  The prevalence of MS was 68.4 and 73.7% using ATP‐III and IDF criteria, respectively. Over the follow‐up period, 115 (13.6%) deaths were recorded. Patients with ATP‐III‐defined MS showed a significantly higher mortality rate when compared with the rest of the sample (16.1% vs. 8.2%; p = 0.002), whereas a non‐significant trend was observed using IDF classification (14.9% vs. 10.0%, p = 0.064). At Cox regression analysis, after adjustment for sex, age, and its individual components, diagnosis of MS with ATP‐III criteria, but not with IDF criteria [OR (95% CI) 1.65 (0.99–2.72), p = 0.053], was significantly associated with higher mortality [OR (95%,CI) 2.38 [1.18–4.76]).

Conclusion:  In conclusion, in Caucasian type 2 diabetic patients the application of IDF criteria determines an increase of estimated prevalence of MS, without improving its prognostic value. Further studies are needed before the newer IDF criteria for MS are adopted on a larger scale.
Circulating adipocytokines in non‐diabetic and Type 1 diabetic children: relationship to insulin therapy, glycaemic control and pubertal development
Authors: Celi F. , Bini V. , Papi F. , Santilli E. , Castellani M. S. , Ferretti A. , Mencacci M. , Berioli M. G. , De Giorgi G. , Falorni A.
Published: May 2006

Aim  To determine the influence of Type 1 diabetes mellitus on circulating adipocytokines in children.

Methods  The circulating concentrations of leptin, adiponectin, resistin and tumour necrosis factor (TNF)‐α were measured in 91 children, aged 11.1 ± 2.7 years, with Type 1 diabetes mellitus (T1DM). Ninety‐one healthy children were selected as control subjects.

Results  Body mass index‐adjusted leptin concentrations were higher in the pubertal diabetic children compared with the control children. There was a significant positive correlation between leptin and daily insulin dose in the diabetic group. Circulating adiponectin concentrations were higher in the prepubertal diabetic children and were positively associated with HbA1c. Resistin concentrations were lower in the prepubertal non‐diabetic subjects compared with the pubertal non‐diabetic children, whose values were higher than those of the diabetic children. TNF‐α concentrations were similar in non‐diabetic and diabetic children.

Conclusions  Circulating concentrations of adipocytokines are abnormal in Type 1 diabetic children, although the direction of change differs by cytokine. Pubertal development, in addition to insulin treatment and glycaemic control, also influences the concentrations.