bluuebunny/crossref_metadata_2025 huggingface dataset:
Resistance to sulphadrug‐based antifolate therapy in malaria: are we looking in the right place?
Authors: Platteeuw J. J.
Published: June 2006

Sulphadrug treatment failure in malaria therapy cannot solely be ascribed to the build‐up of genetic resistance within the parasitic genome. Although numerous in vitro studies have tried to determine the exact genetic markers that could predict treatment outcome in patients, this research has not been conclusive. Sulphadrugs work by competitive inhibition with pABA at one point of the pathway to de novo folate synthesis. However, evidence suggests that the malaria parasite is capable of overcoming this competitive inhibition by switching over to other metabolic pathways, like direct folate salvage from a person's bloodstream. In other words, increased folic acid administration, via diet or supplementation, may have reduced the effectiveness of sulphadrugs more than genetic mutations. Although in vitro studies are valuable for understanding disease mechanisms, we should not forget that the human being is infinitely more complex than any laboratory model.
De l’expérimentation À l’institutionnalisation positive: l’innovation sociale dans le logement communautaire au Québec
Authors: Bouchard Marie J.
Published: June 2006

Résumé**:  L’économie sociale est de plus en plus souvent associée explicitement à la notion d’innovation sociale. Comme un concept analogue à celui d’innovation technologique dans l’analyse de la dynamique économique, l’innovation sociale peut être vue comme un concept opératoire dans l’analyse de la dynamique sociale, de son évolution, de ses crises et de ses transformations. Nous présentons ici un cas d’économie sociale qui peut porter un éclairage sur les dynamiques de l’innovation sociale. Celle‐ci peut émerger pour combler les vides laissés par les transformations économiques, mais elle peut aussi mener à des transformations du système. Le cas du logement communautaire au Québec (organisations coopératives et sans but lucratif) permet d’illustrer les conditions qui mènent à l’émergence d’innovations sociales et les facteurs qui favorisent une trajectoire vers ce que nous appellerons une «institutionnalisation positive», qui intègre le changement dans les institutions plutôt que de subir les pressions isomorphiques du marché ou de l’État.
Assessment of metallothionein and antibodies to metallothionein in normal and autistic children having exposure to vaccine‐derived thimerosal
Authors: Singh Vijendra K. , Hanson Jeff
Published: June 2006

Allergic autoimmune reaction after exposure to heavy metals such as mercury may play a causal role in autism, a developmental disorder of the central nervous system. As metallothionein (MT) is the primary metal‐detoxifying protein in the body, we conducted a study of the MT protein and antibodies to metallothionein (anti‐MT) in normal and autistic children whose exposure to mercury was only from thimerosal‐containing vaccines. Laboratory analysis by immunoassays revealed that the serum level of MT did not significantly differ between normal and autistic children. Furthermore, autistic children harboured normal levels of anti‐MT, including antibodies to isoform MT‐I (anti‐MT‐I) and MT‐II (anti‐MT‐II), without any significant difference between normal and autistic children. Our findings indicate that because autistic children have a normal profile of MT and anti‐MT, the mercury‐induced autoimmunity to MT may not be implicated in the pathogenesis of autism.
The unity that does not exist – a review of A. Burt & R. Trivers 2006: Genes in Conflict
Authors: Helanterä H.
Published: June 2006

Organisms harbour several genetic elements with the potential to act selfishly, and thus undermine the fitness of the organism as a whole. In their book ‘Genes in conflict’, Austin Burt and Robert Trivers thoroughly review evolution and molecular biology of such selfish genetics elements, and set them in a kin selection framework. In this review I set their views in a larger multi-level selection framework, and consider potential problems in the study of selfish genetics elements.
Variation in Plant Substrates and its Consequences for Insect Vibrational Communication
Authors: Cocroft R. B. , Shugart H. J. , Konrad K. T. , Tibbs K.
Published: June 2006

Many insects and other arthropods communicate using plant‐borne vibrational signals. Vibration transmission along plant stems imposes a frequency filter on signals, and may cause signal degradation from reflected waves. Furthermore, different plant species and plant parts can differ in their transmission properties. This variability in the communication channel may constrain the reliability of signals, with important consequences for the evolution of vibrational communication systems, as well as for researchers studying signal variation at an individual, population, or species level. In this study we estimate the magnitude of substrate‐related variation in the mate advertisement signals of a treehopper (Hemiptera: Membracidae: Umbonia crassicornis). We used laser vibrometry to record the signals produced by 25 adult males on two different plant species, one host and one non‐host. We recorded male signals on two plants per species; within each plant, signals were recorded simultaneously at two distances. We measured three spectral characteristics (dominant frequency, relative amplitude of the signals’ high and low frequency components, frequency at the end of the signal) and two temporal characteristics (signal duration and click repetition rate). Spectral characteristics were influenced by the distance at which the signal was recorded, and this influence varied among plant species and individuals. Temporal characteristics were less influenced, although signal length was influenced by distance, an effect that varied among individual plants. Overall, the magnitude of the effects was small. Furthermore, there was significant within‐individual repeatability of almost all signal traits across different plant substrates. Signal characteristics were thus reliably associated with individuals, even when they signaled on different plants.
Looking for Food: Molecular Neuroethology of Invertebrate Feeding Behavior
Authors: Tan Eunice J. , Tang Bor L.
Published: June 2006

The assignment of complex behavior of animals to the function of specific genes has seen significant advances in the past decade. The advent of modern tools of genetics and genomics permitted analyses that revealed a good number of neural system enriched genes whose products modulate, and whose polymorphism qualitatively or quantitatively influenced invertebrate feeding behavior. The most prominent of these genes are orthologues offoraging (for)and the neuropeptide Y (NPY)/NPY receptor. The former encodes a cyclic‐GMP‐dependent protein kinase, which functional genetics have been characterized inDrosophila melanogaster,Apis melliferaandCaenorhabditis elegans. Allelic variations and changes in the expression of the above genes could influence the initiation of particular feeding behaviors or related social phenotype. These genes have provided the first molecular insights towards feeding behavior in invertebrates. Besides detailed investigations into the neural pathways involved and mechanisms of function of the gene products, parallel studies in other animal models is imperative to understand ecological drivers of animal feeding behavior.
Cell cycle control by daf‐21/Hsp90 at the first meiotic prophase/metaphase boundary during oogenesis in Caenorhabditis elegans
Authors: Inoue Tadao , Hirata Kazumasa , Kuwana Yuichiro , Fujita Masahiro , Miwa Johji , Roy Richard , Yamaguchi Yasunori
Published: June 2006

DAF‐21, a Caenorhabditis elegans homologue of Hsp90, is expressed primarily in germline cells. Although mutations in the daf‐21 gene affect animal fertility, its cellular roles have remained elusive. To phenocopy daf‐21 mutations, we impaired the daf‐21 function by RNA interference (RNAi), and found that oocytes skipped the diakinesis arrest and displayed a defective diakinesis arrest, which led to the production of endomitotic oocytes with polyploid chromosomes (Emo phenotype). The same Emo phenotype was also observed with RNAi against wee‐1.3. To identify a cause for Emo, we examined the CDK‐1 (Cdc2) phosphorylation status in Emo animals, since CDK‐1 is a key regulator of the prophase/metaphase transition and is kept inactivated by WEE‐1.3 kinase during prophase. We immunostained both daf‐21(RNAi) and wee‐1.3(RNAi) animals with anti‐phosphorylated‐CDK‐1 antibody and observed no detectable phosphates on CDK‐1 in either of the animals. We also examined WEE‐1.3 expression in daf‐21(RNAi) and found a significant reduction of WEE‐1.3. These results indicate that CDK‐1 was not phosphorylated in either daf‐21(RNAi) or wee‐1.3(RNAi) animals, and suggest that daf‐21 was necessary for producing functional WEE‐1.3. Thus, all together, we propose that DAF‐21 indirectly regulates the meiotic prophase/metaphase transition during oocyte development by ensuring the normal function of WEE‐1.3.
Sperm–egg interaction is mediated by a sperm‐associated body in quail
Authors: Rabbani M. Golam , Sasanami Tomohiro , Mori Makoto , Yoshizaki Norio
Published: June 2006

The present study describes the holes in the inner vitelline membrane of fertile eggs of the quail Coturnix japonica, which remain after the spermatozoa pass through. It was shown that the light‐microscopically observable ‘holes’ correspond mostly to electron‐microscopically defined ‘disks’, and, to a lesser extent (about 5%), real holes. Immunofluorescent staining of the vitelline membranes with an antiquail ZPC antiserum was used to discriminate the holes from the disks light‐microscopically. Over 96% of holes were accompanied by calcium‐coated sperm‐associated bodies, indicating a close relationship between the two. There was no preferential localization of the disks, holes or sperm‐associated bodies in the vitelline membrane around the egg. The sperm‐associated bodies bound with the spermatozoa at the posterior end of sperm flagella. Incubation of the inner vitelline membranes, isolated from the largest follicles, with spermatozoa resulted in production only of the disks, whereas the holes (about 9%) were produced when the sperm‐associated bodies were added to the system. It was suggested that the sperm‐associated bodies assist fertile spermatozoa in binding to the inner vitelline membrane, making holes in the membrane and passing through them in fertile eggs.
Sex reversal in medaka treated in vitro with 17α‐methyldihydrotestosterone during oocyte maturation
Authors: Iwamatsu Takashi , Kobayashi Hirokuni , Yamashita Masakane
Published: June 2006

Using the S‐rR strain of the medaka Oryzias latipes, we examined the effect of a non‐aromatizable androgen on sex determination. Intrafollicular immature oocytes isolated before breakdown of the germinal vesicle were incubated in the presence of 17α‐methyldihydrotestosterone (MDHT) for about 10 h during their maturational period. At the end of incubation, mature oocytes were rinsed and then artificially inseminated in regular saline. The fertilized eggs were then allowed to develop in tap water, and the fry were reared on a regular powdered diet until adulthood. Sex reversal of female to male was observed in a manner dependent on the dose of MDHT. In the solvent control group in which intrafollicular oocytes were matured in medium containing no exogenous androgen, no sex reversal was observed. The present finding, that the sex of medakas can be reversed by a single in vitro exposure of immature oocytes to androgen during the preovulatory period, suggests the existence in the oocyte of a sex determinant sensitive to sex steroids. This method for controlling the sex of eggs before fertilization may establish sex‐determined eggs as potent material for investigating the mechanism of sex determination in the medaka.
Identification of Tgfβ1i4 as a downstream target of Foxc1
Authors: Sommer Paula , Napier Hugh R. , Hogan Brigid L. , Kidson Susan H.
Published: June 2006

Craniofacial development is severely affected by null mutations in Foxc1, indicating a multifunctional role for Foxc1 in ocular, maxilla and mandible, skull and facial gland development. To delineate signaling pathways in which Foxc1 is involved we compared the transcriptomes of whole heads of Foxc1+/+ and Foxc1−/– embryos using a candidate cDNA array comprising genes expressed in the head mesenchyme and ocular region, and a 7K oligo array. Absence of Foxc1 led to downregulation of Stat1 and Galnt4, and upregulation of Tgfβ1i4 at embryonic day 13.5 in the developing head mesenchyme. Comparative analyses revealed differences in the expression pattern of Tgfβ1i4 in the head mesenchyme of Foxc1−/– and Foxc1+/+ embryos. In the ocular regions of Foxc1−/– embryos, Tgfβ1i4 was expressed in higher levels in the conjunctival epithelium and in the condensing mesenchyme on the nasal aspect of the developing eye while in wild‐type embryos more intense expression was seen in the mesenchyme on the temporal aspect of the eye. Such data indicate that Foxc1 regulation of Tgfβ1i4 is complex and may be cell‐type dependent. Analysis of the regulation of Tgfβ1i4 by Foxc1 in a more homogenous cell population, mesenchymal cells isolated from the periocular region revealed that, in these cells, Foxc1 negatively regulated Tgfβ1i4 expression, presumably via secreted factors such as TGF‐β1. Since Foxc1 expression is essential for normal craniofacial development, it is possible that its downstream targets play a role in the development of the phenotypes associated with null mutations in Foxc1.
Germ cell‐less expression in zebrafish embryos
Authors: Li Wenyan , Deng Fengjiao , Wang Huannan , Zhen Yan , Xiang Fang , Sui Yang , Li Jianzhen
Published: June 2006

The gene of germ cell‐less (gcl) has been shown to be important in early differentiation of germ cells in Drosophila. Although the gcl homologue genes have been identified in some organisms, there is little data on the expression pattern and functional analysis of the gcl gene in zebrafish. In this research, real‐time quantitative reverse transcription–polymerase chain reaction showed that the level of gcl mRNA expression rapidly decreases from the 4‐cell stage to the sphere stage at which it reaches a minimum, gradually increases from the 50%‐epiboly stage, and then remains stable during the posterior stages. Results of in situ hybridization indicated that the transcripts of zebrafish gcl are evenly distributed in all blastomeres from the 2‐cell stage to the blastula period, different from that of vasa, nonas1 and dead end mRNA, and condense into some clusters of cells located along the blastoderm margin from the gastrulation period. During subsequent development, the transcripts are segregated as subcellular clumps to a small number of cells that would migrate to the position of the gonad in the dorsal side. In the adult, gcl mRNA was widely expressed in developing germ cells of both ovary and testis. These data suggest that zebrafish gcl have potentially important roles in the formation of primordial germ cells.
Development of the endoderm and gut in medaka, Oryzias latipes
Authors: Kobayashi Daisuke , Jindo Tomoko , Naruse Kiyoshi , Takeda Hiroyuki
Published: June 2006

We performed an extensive analysis of endodermal development and gut tube morphogenesis in the medaka embryo by histology and in situ hybridization. The markers used in these analyses included sox17, sox32, foxA2, gata‐4, ‐5, ‐6 and shh. sox17, sox32, foxA2, and gata‐5 and ‐6 are expressed in the early endoderm to the onset of gut tube formation. Sections of medaka embryos hybridized with foxA2, a pan‐endodermal marker during gut morphogenesis, demonstrated that gut tube formation is initiated in the anterior portion and that the anterior and mid/posterior gut undergo distinct morphogenetic processes. Tube formation in the anterior endoderm that is fated to the pharynx and esophagus is much delayed and appears to be independent of gut morphogenesis. The overall aspects of medaka gut development are similar to those of zebrafish, except that zebrafish tube formation initiates at both the anterior and posterior portions. Our results therefore describe both molecular and morphological aspects of medaka digestive system development that will be necessary for the characterization of medaka mutants.
Pre‐ and post‐treatment predictors of the early achievement of HBeAg loss in lamivudine‐resistant patients receiving adefovir therapy
Authors: Jang Jeong Won , Kim Min Soo , Lee So Yeon , Kim Chang Wook , Bae Si Hyun , Choi Jong Young , Cha Sang Bok , Yoon Seung Kew
Published: June 2006

Background and Aim:  This study investigated the clinical variables that predict hepatitis B e antigen (HBeAg) loss in lamivudine‐resistant patients receiving adefovir therapy.

Methods:  Fifty‐six consecutive HBeAg‐positive patients treated with adefovir for at least 12 months were enrolled in this study. All had serum alanine aminotransferase (ALT) levels over twice the upper limit of normal (ULN) as a result of lamivudine resistance. Predictors of HBeAg loss after switching from lamivudine to adefovir were examined.

Results:  During the follow‐up period, 18 (32.1%) of 56 patients showed a loss of HBeAg. The estimated rates of HBeAg loss at 6, 12, and 18 months were 11.5%, 26.8%, and 42.9%, respectively. Univariate analysis revealed that pretreatment ALT levels >10 × ULN (P = 0.029), a viral load at 3 months of therapy (P = 0.017), and viral decline by >3 log10 from baseline at 3 months (P < 0.001) were significantly associated with the loss of HBeAg within 12 months of therapy. With multivariate analysis using the stepwise logistic regression model, pretreatment ALT > 10 × ULN (odds ratio [OR], 4.22; 95% confidence interval [CI], 1.09–19.44; P = 0.044) and viral suppression >3 log10 at 3 months (OR, 10.39; 95% CI, 1.86–58.07; P = 0.008) were identified as the two independent predictors of HBeAg loss.

Conclusions:  Pretreatment ALT levels and the initial pattern of post‐treatment viral decline are the strongest predictors of the early achievement of HBeAg loss following treatment with adefovir in lamivudine‐resistant patients. These results may provide useful information for the optimal timing of adefovir rescue as well as for better monitoring after treatment.
Mild zinc deficiency and dietary phytic acid accelerates the development of fulminant hepatitis in LEC rats
Authors: Saito Akiko , Nakayama Kenji , Hara Hiroshi
Published: June 2006

Background and Aim:  Restriction of copper intake delays hepatic copper accumulation in Long–Evans Cinnamon (LEC) rats, which are animal models of Wilson’s disease. Involvement of zinc is suggested to develop hepatitis in the disease; however, this has not been clarified. The aims of this study were to investigate the effects of mild zinc deficiency on the development of hepatitis and to determine the relationship between the absorption and hepatic levels of copper, zinc and iron.

Methods:  Male LEC and F344 (wild type atp7b) rats were fed a low zinc, phytate‐containing or control diet. The onset of hepatitis (Experiment 1), and absorptive rates of copper, zinc and iron and hepatitis indices in 4 weeks (Experiment 2) were observed.

Results:  The onset of fulminant hepatitis in LEC rats was much earlier in the low zinc and phytate groups (mean 94.6 ± 2.74 days and 82.8 ± 3.56 days old, respectively) than in the control group (136 ± 2.11 days old) with worse hepatitis indices. Hepatic copper levels were much higher in LEC rats than F344 rats, but were not largely different among the diet groups without prominent changes in copper absorption. Hepatic levels and intestinal absorption of zinc and iron were lower in the phytate group than in the control group.

Conclusion:  Mild zinc deficiencies caused by a low zinc or phytate‐containing diet accelerate the onset of hepatitis in LEC rats without increasing copper absorption, and zinc and iron metabolism may be involved in the earlier onset of jaundice of LEC rats.
PROVIDERS AND CONSUMERS SUPPORT THE WESTERN AUSTRALIAN AUDIT OF SURGICAL MORTALITY
Authors: Semmens James B. , Mountain Jenny A. , Sanfilippo Frank M. , Barraclough Jenny Y. , McKenzie Anne , Mukhtar S. Aqif , Haynes Natasha S. , Aitken R. James
Published: June 2006

Background:  The Western Australian Audit of Surgical Mortality (WAASM) was established in June 2001 to independently peer‐review all surgical deaths in Western Australia. The objectives of this study were (i) to evaluate whether participation in the WAASM has influenced clinical and hospital practice; and (ii) to ascertain the support and relevance of the WAASM to surgeons, hospitals and consumers.

Methods:  Three qualitative questionnaires were designed to evaluate the response of surgeons, hospital administrators and consumers to the WAASM. The outcomes measured included audit participation, value and use of feedback provided, changes to clinical and hospital practice and the future role of the WAASM.

Results:  The key findings were that 138 (73%) of 190 surgeons participating in the WAASM had changed their clinical practice in at least one way, 44 (24%) were aware of changes in hospital practice and 21 (11%) were aware of changes in a colleague’s practice. Particular areas where changes in surgical practice had occurred included attention to deep vein thrombosis prophylaxis (81, 44%), increased constructive discussion among peers (78, 42%) and quality of documentation in case notes (68, 37%). All groups supported the continuation of the WAASM. Hospital executives and consumers recommended that the WAASM be included in accreditation.

Conclusion:  Surgeons, hospitals and consumers supported the concept of independent peer review of surgical care. They confirmed the ability of audit to influence and change surgical and hospital practice. It strengthens the intention of the Royal Australasian College of Surgeons to extend the WAASM project throughout Australia and New Zealand.
PERITONEAL CARCINOMATOSIS FROM COLORECTAL CANCER AND SMALL BOWEL CANCER TREATED WITH PERITONECTOMY
Authors: Shehata Mena , Chu Frank , Saunders Vanessa , Kam Peter C. A. , Links Matthew , Morris David L
Published: June 2006

Background:  This study aims to assess the survival of patients who underwent peritonectomy, to assess the morbidity and mortality associated with the procedure and to review the published reports on the survival of patients with peritoneal spread of colorectal cancer (CRC).

Methods:  Peritonectomy involves resection of all visible peritoneal tumour and is followed by heated intraperitoneal chemotherapy. Peritonectomy with heated intraperitoneal chemotherapy is associated with a 3‐year survival of 30–50% in patients with low peritoneal cancer index (PCI) with peritoneal carcinomatosis from CRC. There are approximately 1000 patients in phase 2 studies and a large survival advantage was shown in a randomized control trial. We have carried out over 100 peritonectomy procedures. This study describes 22 patients with peritoneal spread of gastrointestinal cancer treated with peritonectomy between 1996 and March 2005. Twenty of these patients had primary colorectal cancer and two patients had primary small bowel cancer.

Results:  Of the 22 patients who underwent peritonectomy, 8 patients are now deceased. The median follow up is now 16.1 months. At 12 months, the survival was 61.5% and at 24 months the survival was 46.1%, which are creditable results comparable with the world published reports. We found that those patients with all macroscopic residual tumour removed at the end of the procedure (completeness of cancer resection, CCR O) had improved 24‐month survival compared with patients in whom there was incomplete tumour resection (53.3% survival vs 22.2%, respectively, P = 0.024). Patients with a PCI score less than 13 had better survival (P = 0.0003).

Conclusions:  Peritonectomy for peritoneal carcinomatosis from CRC offers patients improved survival. Our results are consistent with the published data with respect to improved survival in patients with low PCI and complete cytoreduction.
FACTORS AFFECTING EARLY MORTALITY IN SPONTANEOUS RUPTURE OF HEPATOCELLULAR CARCINOMA
Authors: Tan Felicia L.‐S. , Tan Yu‐Meng , Chung Alexander Y.‐F. , Cheow Peng C. , Chow Pierce K.‐H. , Ooi London L.
Published: June 2006

Background:  Spontaneous rupture of hepatocellular carcinoma (HCC) is a catastrophic surgical emergency with high mortality rates. The aim of this study is to determine the factors associated with the prognosis and to assess the outcome of different management strategies.

Methods:  A retrospective study of 34 consecutive patients with spontaneous rupture of HCC was conducted from January 1996 to January 2004. Clinical, biochemical and operative factors influencing 30‐day mortality were analysed.

Results:  In our study, 30‐day mortality rate was 32% (n = 11). Presence of cirrhosis, Child’s C status, shock on admission, higher blood transfusion requirement, raised α‐fetoprotein, raised alkaline phosphatase, raised aspartate transaminase, and raised indocyanine green at 15 min were all associated with increased risk of 30‐day mortality on univariate analysis (P < 0.05). On multivariate analysis, only shock on admission (P = 0.001) and higher blood transfusion requirement (P = 0.01) were significant independent factors affecting early mortality. Surgical intervention was associated with a better 30‐day survival as compared with medical therapy or transarterial embolization. The median survival time of patients undergoing curative resection was significantly longer than that of patients who had surgery for haemostasis only (420 vs 205 days). The overall median survival was 161 days.

Conclusions:  Spontaneous rupture of HCC is a potentially salvageable complication of HCC. Poor prognosis is associated with poor liver reserve, advanced disease and severity of haemorrhage. Shock and blood transfusion requirement are the only independent factors affecting early mortality.
OPTIMAL NUMBER OF SENTINEL NODES AFTER INTRADERMAL INJECTION ISOTOPE AND BLUE DYE
Authors: Low Kenny S.‐S. , Littlejohn David R. G.
Published: June 2006

Background:  Sentinel node (SN) biopsy for breast cancer is becoming more common owing to its lower morbidity when compared with full axillary dissection. However, the optimal method of finding and the number of SN to be dissected are still subject to conjecture. The aim of this study was to determine the optimal number of SN required to accurately stage an axilla after the i.d. injection of isotope and blue dye.

Method:  Prospective data from all patients undergoing SN biopsy from April 2000 to September 2004 were analysed. For positive SN, the order in which they became positive was then tabulated.

Results:  During the 4 years, 113 patients who fulfilled the selection criteria had undergone SN biopsy with 216 SN harvested. Of these, 33 patients had positive SN results. If only the first SN was analysed, 87.9% of those positive biopsies would have been discovered. Two SN raised the predictive value to 97.0%.

Conclusion:  Two SN would seem to be the optimal number to harvest after i.d. injection of both isotope and blue dye.
EARLY PROSTHETIC COMPLICATIONS AFTER UNIPOLAR HEMIARTHROPLASTY
Authors: Weinrauch Patrick C. L. , Moore William R. , Shooter David R. , Wilkinson Matthew P. R. , Bonrath Esther M. , Dedy Nicolas J. , McMeniman Timothy J. , Jabur Majid K. A. , Whitehouse Sarah L. , Crawford Ross W.
Published: June 2006

Background:  In Australia, the most frequently used hemiarthroplasty prosthesis for the management of displaced intracapsular femoral neck fractures is the Uncemented Austin Moore (UAM). Despite concerns regarding poor functional outcomes and increased early revision rates associated with the UAM prosthesis, apprehension regarding the systemic side‐effects of polymethylmethacrylate cement implantation in the elderly patient continues to influence prosthesis selection. This study examines the incidence of early prosthesis related complications after UAM and Cemented Thompson (CT) hemiarthroplasty procedures for the management of femoral neck fractures.

Methods:  A multicentre retrospective review of charts and radiographs was conducted in 1118 unipolar hemiarthroplasty implantations to determine early complications associated with the CT and UAM prostheses over a 6‐year period in five Queensland public hospitals.

Results:  Intraoperative periprosthetic fractures were sustained in 11.8% of UAM and 1.8% of CT implantations (P < 0.0001). Intraoperative periprosthetic fractures were associated with an increased requirement for reoperation within 1 month of the index procedure (P = 0.05). No statistical difference in the incidence of intraoperative periprosthetic fractures could be observed between the hospitals participating, regardless of the proportional use of each prosthesis. Early dislocation rates were similar for the UAM and CT prostheses. The intraoperative mortality rate attributable to the use of polymethylmethacrylate cement during hip hemiarthroplasty was 1/738 (0.14%).

Conclusions:  The results of this study support the use of the CT prosthesis for the management of femoral neck fractures to reduce the high incidence of intraoperative periprosthetic fractures and associated requirements for early reoperation experienced with the UAM.
CRITICAL COURSE OF THE ANTERIOR LARYNGEAL BRANCH OF THE INFERIOR LARYNGEAL NERVE
Authors: Yalçin Bülent , Tuğcu Harun , Cantürk Nergis , Kurt Bülent , Ozan Hasan
Published: June 2006

Background:  Although in the past few authors stated that the nerve penetrated the ligament of Berry, many new authors have not confirmed this assertion. Because of the clinical importance and indefiniteness of this subject, we aimed to present an anatomical study concerning the course of the inferior laryngeal nerve.

Method:  In 60 specimens, 102 sides were examined for this project, including 41 male and 19 female cadavers between the ages of 40 and 89 years at death.

Results:  In two sides (one on the right and the other on the left), we found that the anterior (motor) laryngeal branch of the inferior laryngeal nerve penetrated the ligament unilaterally. The branch entered the ligament 5.6, 7.2 mm above its lower border and 3.3, 1.9 mm below its upper border. Distances from the entrance point of the branch to the trachea and thyroid were 9.5, 8.2 mm and 3.1, 2.2 mm, respectively.

Conclusion:  We found two anterior laryngeal branches penetrating the ligament of Berry. This subject is very important during the thyroid surgery, particularly during the division of the ligament for total lobectomy.
DRIVING PLASTERED: WHO DOES IT, IS IT SAFE AND WHAT TO TELL PATIENTS
Authors: Kalamaras Michael A. , Rando Angelo , Pitchford Donald G. K.
Published: June 2006

Background:  The number and safety of patients who drive in an upper limb fracture cast has been largely untested. This study investigates the proportion of persons who drive in their casts and the capability of a casted persons driving is also assessed. The stance of government and insurance bodies is reviewed. The aim is to provide a guide for when a doctor should advise a patient not to drive while wearing an upper limb fracture cast.

Methods:  Patients attending fracture clinic in upper limb casts were anonymously surveyed and asked (along with demographics) if they drove while in a cast and if they believed it illegal or covered by insurance to drive. Driving tests of the author wearing upper limb fracture casts were undertaken. The Queensland police traffic branch, the Queensland Department of Transport and the RACQ insurance company were contacted to review the legal and insurance issues involved.

Results:  Two‐thirds of male and one‐third of female patients (half overall) were found to drive while in an upper limb cast. The author failed driving instructor tests in all casts and occupational therapist driving assessments while wearing long arm casts. The author passed occupational therapy driving assessments in left and right short arm casts.

Conclusions:  According to these results, a doctor’s advice should be to patients not to drive in a long arm upper limb fracture cast and to consider concomitant patient factors when advising patients in short arm casts. Although we do not suggest that patients drive while wearing any cast, we have found a large proportion do. Our limited study has found that a young, fit and pain‐free person may be able to drive well enough to pass a driving test while wearing a short arm cast.
DOES PRESENTATION AT THE REGISTRARS’ PAPERS DAY PREDICT FUTURE PUBLICATION?
Authors: Wong Shing W. , Crowe Philip J.
Published: June 2006

There are research requirements for trainees to be eligible to present for their final examinations (Fellowship of Royal Australasian College of Surgeons, FRACS). One option is the presentation of a paper or poster at a meeting of which abstracts are subject to review and selection. This includes presentation at the annual Registrars’ Papers Day (RPD) in New South Wales. There has been some debate surrounding whether research requirements are fulfilled by presentation at such meetings. Publication in a peer‐reviewed journal should be the ultimate aim. A high publication rate will validate the quality of the meeting. All abstracts submitted to the RPD in 1998 and 1999 were analysed. A Medline search was performed in 2005 to identify publication of these presentations in a peer‐reviewed journal. Variables of the study that were potentially predictive of subsequent publication were analysed. This included type of presentation, surgical specialty, clinical or laboratory‐based study, study design (prospective or retrospective) and sample size. Chi‐squared test with Yates’ continuity correction was used to compare two independent proportions and significance was set at P < 0.05. The publication rates were: oral presentations 50% (17/34), poster presentations 39% (9/23) and rejected presentations 20% (2/10). The mean and median time to publication was 23.8 and 21.0 months. Prospective design was the only variable identified to have a statistically significant effect on the publication rate (P < 0.002). The most common publishing journal was the Australian and New Zealand Journal of Surgery (12 of 26). Overall consistency (author and study sample consistency) from presentation to publication was 32%. The overall 46% publication rate of this state‐based trainees‐organized meeting compares favourably with international meetings. The research requirement of the Royal Australasian College of Surgeons (RACS), which includes presentation at the RPD in New South Wales, produces good quality papers for publication.
BRONCHOSCOPIC DIAGNOSIS OF AN EXTENSIVE TRACHEAL LACERATION
Authors: Chen Derek , Edwards Mark
Published: June 2006

Tracheal lacerations resulting from endotracheal intubation are extremely rare. We report a case where the initial diagnosis was misled by the radiological findings. Our case uniquely emphasizes several issues pertinent to the management of tracheal lacerations. We review the published works on this topic and emphasize the role of fibre‐optic bronchoscopy in the assessment of airway injuries before operative management.
Association of beta‐2‐adrenoceptor polymorphisms and pulmonary function in patients with chronic obstructive pulmonary disease
Authors: Ruse Charlotte E , Hill Maureen C , Wheatley Amanda P , Burton Paul B , Connolly Martin J , Parker Stuart G , Wardlaw Andrew J
Published: June 2006

Aims:  The Dutch Hypothesis suggests that asthma and chronic obstructive pulmonary disease may share some pathogenic mechanisms. There is considerable evidence that polymorphisms of the β2 adrenoceptor have disease‐modifying roles in juvenile onset asthma, determining severity and response to β agonists, but not determining disease susceptibility. There is evidence from family and twin studies to suggest that chronic obstructive pulmonary disease (COPD) also has a significant genetic component. We therefore hypothesized that β2 adrenoceptor polymorphisms would have similar disease modifying roles in patients with COPD.

Methods:  One hundred and ninety‐five COPD subjects and 142 matched controls were recruited. All had detailed clinical phenotyping. Subjects were genotyped for the Agr → Gly polymorphism at codon 16, the Gln → Glu polymorphism at codon 27, and the SNPC/T‐47 promoter polymorphism.

Results:  In patients with COPD (mean age 67, 57% male), individuals with the homozygous Gly16/homozygous Glu27/homozygous SNP −47*C genotype had significantly worse lung function as measured by forced expiratory volume 1, expressed as a percentage of its predicted value (39.2 compared with 45.8, P = 0.004), and for forced vital capacity (FVC) percent predicted (77.2 compared with 70.4, P = 0.02). The polymorphisms had no effect on disease susceptibility.

Conclusion:  The Arg16, Gln27, SNPC/T‐47 β2 adrenoceptor polymorphisms may have disease modifying roles in patients with COPD.
Dental status and mortality in institutionalized elderly people
Authors: Ohrui Takahashi , Matsui Toshifumi , Yoshida Mitsuyoshi , Yoneyama Takeyoshi , Adachi Mieko , Akagawa Yasumasa , He Mei , Yamaya Mutsuo , Arai Hiroyuki , Sasaki Hidetada ,   Members of the Oral Care Working Group
Published: June 2006

Background: Inadequate dentition for mastication is one of the major issues associated with systemic health for institutionalized elderly people, but its prognostic value and related deaths have not been fully examined.

Methods: Four hundred and three patients aged 65 and older were recruited from nine nursing homes and were prospectively followed up for morbidity and mortality for 5 years in Japan. These patients were classified into three groups according to dental status: patients who had adequate dentition with natural teeth only or natural teeth with partial dentures (Group A); those who were edentulous but wearing full dentures (Group B); and those who had inadequate dentition without dentures (Group C).

Results: Dental status was strongly related to age, cognitive function and activities of daily living. After allowing for confounding effects, the 2‐year risk of mortality among those in Group C was 1.84 times that of Group A (95% confidence interval 1.01–3.36,P = 0.047). Furthermore, the 5‐year mortality rate in Group C was higher than that in Group A, whereas that was not significant with a hazard ratio of 1.30 (0.90–1.88,P = 0.168). The main causes of death were respiratory infections, which explained 14.1% of all causes of death in Group A, 14.3% in Group B and 18.3% in Group C. Any associations between a specific cause of death and the different dental status did not reach a significant level.

Conclusion: Inadequate dental status is associated with high overall mortality. Our findings suggest that systemic attention to dental status should be recommended in institutionalized elderly people.
Treatment with HMG‐CoA reductase inhibitors (statins) attenuates the progression of aortic valve stenosis in the elderly
Authors: Kuwabara Masanori , Kitaoka Hiroaki , Okawa Makoto , Furuno Takashi , Nishinaga Masanori , Doi Yoshinori
Published: June 2006

Aim:  Recent studies have shown that degenerative aortic stenosis (AS) relates to the process of atherosclerosis. The purpose of this study was to determine whether the use of 3‐hydroxy‐3‐methygulutaryl coenzyme A (HMG‐CoA) reductase inhibitor (statin) delays progression of AS in the elderly.

Methods:  Thirty‐three elderly patients (> 65 years; mean age, 75 ± 6 years) with mild to moderate degenerative AS underwent two consecutive echocardiograms at least 6 months apart.

Results:  Thirteen patients were treated with statin and the remaining 20 were not treated with statin. The two groups were similar in age (74 ± 5 vs 75 ± 6 years) and initial peak pressure gradient (45 ± 27 vs 40 ± 31 mmHg). The annual increase in peak pressure gradient in statin group was smaller than that in the non‐statin group (1.25 ± 5.3 mmHg/year vs 6.04 ± 6.12 mmHg/year, P < 0.05). In multiple regression analysis, statin usage was an independent predictor of a smaller increase in peak gradient after adjusting for age, initial peak gradient, diabetes mellitus and hypertension.

Conclusions:  Statin‐treated patients had delayed AS progression compared with those not treated with statin. In the elderly, statin treatment may delay the rate of progression of degenerative AS.
Predictors of functional status in Japanese community‐dwelling older persons during a 2‐year follow up
Authors: Kawamoto Ryuichi , Tomita Hitomi , Oka Yuichiro , Ohtsuka Nobuyuki
Published: June 2006

Aims:  To clarify baseline sociodemographic and health characteristics that predict subsequent functional outcome in community‐dwelling Japanese older persons.

Methods:  All subjects were enrolled from the April 2001 resident registry of Nomura‐cho, Seiyo‐city in Ehime prefecture. Of 1392 community‐dwelling persons aged 65 and older who could provide complete responses to questionnaires including functional status in the first survey, 1105 subjects were also able to provide complete answers in the second survey. Functional status was categorized according to a hierarchical scale as: completely functional; with functional limitations; and with disabilities in instrumental activities of daily living (IADL). A multivariate logistic regression model was used to estimate the ability of selected 2001 sociodemographic and health status variables to predict 2003 functional status.

Results:  Subjects consisted of 470 men (mean age ± standard deviation, 72 ± 5.9 years) and 635 women (73 ± 7.1 years). During the 2‐year follow up, significant independent predictors of future functional status by multiple logistic regression analysis included: (i) age (odds ratio: 0.511, 95% confidence interval [CI]: 0.329–0.791); (ii) spouse (1.655, 1.044–2.621); (iii) activities of daily living (3.231, 2.008–5.199); (iv) baseline instrumental self‐maintenance (14.62, 9.065–23.57); and (v) social role (2.176, 1.419–3.337) after controlling for baseline functional status.

Conclusion:  These results indicate that many background factors are predictive of subsequent physical function in community‐dwelling older persons. Thus, early prevention and intervention regarding these background factors might be critical to promote and maintain functional status.
Klotho gene promoter polymorphism and cognitive impairment
Authors: Shimokata Hiroshi , Ando Fujiko , Fukukawa Yasuyuki , Nishita Yukiko
Published: June 2006

Aim:  To study the association between the klotho gene polymorphism and cognitive impairment in community‐living men and women.

Methods:  The subjects consisted of 2234 community‐living Japanese men and women aged 40–79 years. The klotho gene promoter polymorphism G‐395A was identified and cognitive function was assessed using the Japanese Wechsler Adult Intelligence Scales – Revised Short Forms ( JWAIS‐R SF) and Mini‐Mental State Examination (MMSE). Brain infarction and atrophy were assessed by brain magnetic resonance imaging (MRI). The differences in cognitive function, infarction and atrophy were compared between the GG type and GA/AA type of the klotho gene G‐395A polymorphism.

Results:  The distribution of the klotho gene G‐395A polymorphism was GG 1639 (73.4%), GA 539 (24.1%), and AA 56 (2.5%). There was no significant difference in intelligence quotient (IQ) between the GG type and GA/AA type in the subjects aged 40–59 years. However, the IQ level was significantly different in terms of the klotho genotype for subjects aged 60–79 years (P = 0.004). The mean and SE of IQ levels of the subjects with the GG type and the GA/AA type at nucleotide −395 were 99.8 ± 0.5 and 102.6 ± 0.8, respectively. There were also significant differences in three subtests of JWAIS‐R SF – Information, Similarities, and Picture Completion – for subjects aged 60–79 years. Also, the MMSE score was slightly lower for the GG type than for the GA/AA type (P = 0.099). However, there were no differences in the findings of brain MRI.

Conclusion:  There were statistically significant differences in cognitive function for klotho gene promoter polymorphism G‐395A only in subjects aged 60 or over. This polymorphism may be associated with age‐related cognitive impairment.
Safe removal of LMA in children – at what BIS?
Authors: SINHA APARNA , SOOD JAYASHREE
Published: June 2006

Background:  Removal of an LMA without producing untoward complications has remained a matter of concern to all anesthesiologists; more so in pediatric practice where the margin of safety is narrow. Most work on LMA in adults supports its removal following return of airway reflexes. The situation regarding its removal in children is, however, less clear.

Methods:  We conducted a randomized, prospective study to compare incidence of airway complications after removal of the LMA at deep or awake planes in 120 children, ASA I or II, aged 1–8 years and to objectively determine the most appropriate Bispectral index (BIS) to allow safe removal of an LMA in children. They were studied in two groups of 60 and depth of anesthesia (whether awake‐Gp A or deep‐Gp D) for LMA removal was decided by random distribution from sealed envelopes. BIS was recorded continuously for all the patients until 2 min after removal of LMA.

Results:  Mean SpO2 after removal of LMA was 93% Gp A and 98% in Gp D. The mean duration of surgery in Gp A was 53.9 ± 10 and in Gp D 46.7 ± 4 min. PESev at removal in Gp A was 0.20 ± 0.16 and in Gp D was 0.59 ± 0.1. BIS median in Gp A was 79 with a maximum of 86 and minimum of 66. In Gp D BIS, median was 60 with maximum of 76 and minimum of 58. The number of patients with airway complications in awake removal group was 21 (35%) and in deep removal group was 4 (6.6%).

Conclusions:  Bispectral index scoring should prove a useful adjunct to the present monitoring and can be used to achieve smoother emergence conditions. We suggest that LMA removal should be attempted in children when a BIS value of approximately 60 is reached.
Anesthesia management with short acting agents for bilateral pheochromocytoma removal in a 12‐year‐old boy
Authors: BAKAN MEFKUR , KAYA GUNER , CAKMAKKAYA SERPIL , TUFANOGULLARI BURCU
Published: June 2006

A 12‐year‐old boy with bilateral adrenal pheochromocytoma pretreated with furosemide, nifedipine, prazosin, and propranolol underwent surgical removal of the tumors. General anesthesia with desflurane, remifentanil infusion and thoracic epidural analgesia was performed. To control the blood pressure (BP), remifentanil up to 1 μg·kg−1·min−1infusion rate, sodium nitroprusside, and esmolol infusions were administered successfully. Following the ligation of the adrenal veins, hemodynamic parameters were stable and neither inotropic support nor corticosteroid replacement was required. We concluded that remifentanil‐based anesthesia combined with low‐dose desflurane and thoracic epidural analgesia may reduce the need for vasoactive drugs in the anesthesia management of pheochromocytoma. This combination may not prevent the hemodynamic fluctuations during tumor manipulation, but appears to facilitate a rapid and stable postoperative recovery.