bluuebunny/crossref_metadata_2025 huggingface dataset:
4‐Methylumbelliferone inhibits hyaluronate synthesis in human uterine cervical fibroblasts
Authors: Tanaka Kanji , Taniguchi Ryousuke , Higuchi Tsuyoshi , Ozaki Takashi , Mizunuma Hideki , Takagaki Keiichi
Published: November 2007

Aim:  Hyaluronate plays an important role in the regulation of cervical function during parturition. In our previous study we showed that 4‐methylumbelliferone (MU) suppresses hyaluronate synthesis by cultured human skin fibroblasts. The present study investigated the effects of MU on fibroblasts obtained from the human uterine cervix and assessed the possibility of controlling cervical ripening with MU.

Methods:  Human uterine cervical fibroblasts were collected from uterine cervices obtained from the uteri of three patients who had a total hysterectomy for uterine myoma at Hirosaki University Hospital. The fibroblasts were cultured in Dulbecco's modified Eagle's medium until confluence. They were then cultured in medium containing [3H]glucosamine (0.074 MBq/mL) with various MU doses. Hyaluronate synthesis was evaluated by assessing the incorporation of [3H]glucosamine into the soluble fraction of hyaluronate. Three independent studies were carried out on each specimen to clarify whether MU causes compositional changes or promotes hyaluronate degradation, whether the inhibitory effects of MU on hyaluronate synthesis are dose‐dependent, and whether the effects of MU are reversible.

Results:  MU added to the medium of the cultured cells reduced the synthesis of hyaluronate in a dose‐dependent manner. After MU was removed from the medium, hyaluronate synthesis recommenced, and the amount of [3H]hyaluronate synthesized was similar to the control level.

Conclusions:  MU inhibits the synthesis of hyaluronate in human uterine cervical fibroblasts.
Treatment options for bacterial vaginosis in patients at high risk of preterm labor and premature rupture of membranes
Authors: Darwish Atef , Elnshar Ehab M. , Hamadeh Suha M. , Makarem Mohammad H.
Published: November 2007

Aim:  To estimate the efficacy of different therapeutic modalities on proven cases of bacterial vaginosis (BV) in patients at high risk of preterm labor and premature rupture of membranes.

Methods:  This was a longitudinal prospective comparative study set in the antenatal outpatient clinic of the department of Obstetrics and Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt. Four hundred and sixty‐eight patients with a clinical picture of threatened preterm labor or at high risk of premature rupture of membranes in the third trimester were screened for BV. Positive BV was diagnosed in 156 patients. They were randomly classified into four equal groups according to the line of medical treatment. The treatments were: (i) oral metronidazole, (ii) clindamycin vaginal cream, (iii) oral clindamycin, or (iv) metronidazole vaginal suppositories. The effects of medical treatment on Amsel's criteria as well as maternal and fetal outcomes were measured.

Results:  Based on Amsel's criteria, 156 patients (33.3%) were diagnosed with BV. There was a significant disappearance of vaginal discharge, with decreased percentages of pH > 4.5, positive amine test, and clue cells after treatment of BV in the four groups without any statistically significant difference between them. There were variable effects of the different treatments on increasing birthweight values, admission to neonatal intensive care units, and prolongation of the gestational age. Some maternal adverse effects have been recorded. There were significant improvements of the outcomes for oral metronidazole and clindamycin compared with outcomes for intravaginal metronidazole and clindamycin.

Conclusions:  Metronidazole and clindamycin achieve nearly equivalent cure rates when administered orally or vaginally in patients at high risk of preterm labor and premature rupture of membranes. Oral metronidazole is considered the drug of choice in treating BV due its high cure rate, better outcomes, and low cost.
Three‐dimensional sonographic volume measurement of the fetal lung
Authors: Hata Toshiyuki , Kuno Atsushi , Dai Shu‐Yan , Inubashiri Eisuke , Hanaoka Uiko , Kanenishi Kenji , Yamashiro Chizu , Tanaka Hirokazu , Yanagihara Toshihiro
Published: November 2007

Aim:  The objective of this longitudinal study was to evaluate the growth of the fetal lung in normal pregnancies, using 3‐D ultrasound.

Methods:  3‐D sonographic examinations were performed on 14 appropriate‐for‐gestational‐age fetuses. Fetal lung volumes (left, right, and total lung volumes) were measured every 2–3 weeks from 20 weeks of gestational age until delivery. The common multiplanar technique was used to calculate fetal lung volume.

Results:  Curvilinear relationships were found between the gestational age and left (R2 = 86.9%, P < 0.0001), right (R2 = 83.9%, P < 0.0001) and total (R2 = 83.8%, P < 0.0001) lung volumes. The data described in this study were fairly comparable with previous data from autopsy series. However, there were big differences for predicted values of the fetal total lung volumes using 3‐D ultrasound among the present study and previous investigations.

Conclusion:  Our findings suggest that the standard curve for fetal lung volume using 3‐D ultrasound provides a role for evaluating the normal lung growth in the fetus. However, we do cast doubt on the reliability and reproducibility of fetal lung volume measurements using 3‐D ultrasound. Moreover, the data and its interpretation in our study should be taken with some degree of caution because of the small number of subjects studied. Further studies involving a larger sample size would be needed to confirm these findings.
Oral misoprostol for the prevention of primary post‐partum hemorrhage during third stage of labor
Authors: Enakpene Christopher A. , Morhason‐Bello Imran O. , Enakpene Evbu O. , Arowojolu Ayodele O. , Omigbodun Akinyinka O.
Published: November 2007

Aim:  To assess the effectiveness of oral misoprostol compared with methylergometrine in the prevention of primary post‐partum hemorrhage during the third stage of labor.

Methods:  This was a randomized controlled trial of 864 singleton low‐risk pregnant women. The outcomes were total blood loss, duration of the third stage of labor and peripartal change in hematocrit. Comparisons were by the χ2‐test and Student t‐test. Relative risks were calculated for side‐effects profile. A P‐value of less than 0.05 was statistically significant.

Results:  The biodata of all the participants were similar. The mean blood loss for the misoprostol and methylergometrine groups was 191.6 ± 134.5 mL and 246.0 ± 175.5 mL, respectively (95% CI: −79.3 to −39.5 mL). The mean duration of the third stage of labor was 19.6 ± 2.4 min and 9.4 ± 3.3 min in the misoprostol and methylergometrine groups, respectively (95% CI: 9.82–10.58 min). More subjects had blood loss >500 mL, 42 (9.7%) versus 6 (1.4%), and peripartal hematocrit change greater than 10%, 38 (8.8%) versus 5 (1.2%), in the methylergometrine group than in the misoprostol group, respectively. Also, more subjects received additional oxytocic in the methylergometrine group, compared to the misoprostol group (80 [18.5%] versus 33 [7.6%] patients, respectively).

Conclusions:  Orally administered misoprostol was more effective in reducing blood loss during the third stage of labor than intramuscular methylergometrine. However, there were more subjects in the misoprostol group in whom duration of the third stage of labor was greater than 15 min and who also had manual placental removal than in the methylergometrine group.
Subjective effect of magnetic resonance‐guided focused ultrasound surgery for uterine fibroids
Authors: Funaki Kaoru , Sawada Katsuhiro , Maeda Fumio , Nagai Syuji
Published: November 2007

Aim:  We treated 69 patients with symptomatic uterine fibroids using a magnetic resonance‐guided focused ultrasound surgery (MRgFUS) system. Our objective was to determine the clinical outcome of MRgFUS, focusing on symptom improvement, with emphasis on the time and extent of improvement.

Methods:  Patients who would have been otherwise offered conventional surgery were considered for eligibility. They were asked to report their symptom severities before and after treatment on the same query form. The questionnaire, given 6 months after treatment, included a question asking when the patients' symptoms started to improve. Their fibroids were classified into three types according to the signal intensity on T2‐weighted magnetic resonance images: type 1, low intensity as skeletal muscle, type 2, intermediate intensity, lower than myometrium but higher than skeletal muscle; and type 3, high intensity, the same as or higher than myometrium.

Results:  No severe adverse events occurred in any of the patients. Seven patients required alternative treatment after MRgFUS, with five of them having type 3 fibroids. Mean symptom scores were all reduced after MRgFUS, regardless of the symptom types. Frequent urination improved first, while heavy bleeding took longer to resolve than the other symptoms.

Conclusion:  MRgFUS is an effective and safe method for treating symptomatic uterine fibroids, especially for type 1 and type 2 fibroids. Type 3 fibroids, however, are difficult to treat using the current MRgFUS system.
Total salpingectomy during abdominal hysterectomy: Effects on ovarian reserve and ovarian stromal blood flow
Authors: Sezik Mekin , Ozkaya Okan , Demir Fuat , Sezik Hulya Toyran , Kaya Hakan
Published: November 2007

Aim:  To investigate the short‐ and medium‐term consequences of performing total salpingectomy during abdominal hysterectomy (without oophorectomy) on certain ovarian reserve parameters and blood flow velocity measurements through the ovarian stroma.

Methods:  Twenty‐four patients were recruited and randomized into two groups. Group 1 patients (n = 12) underwent total hysterectomy and complete excision of the fallopian tubes bilaterally. In group 2 (classical approach), fallopian tubes were removed partially leaving behind the neighboring paraovarian tissue. Pre‐ and postoperative (at 1 and 6 months) serum follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol values, ovarian volume estimation by transvaginal ultrasound, and ovarian stromal blood flow Doppler velocimetry were assessed during the early follicular phase. Mann–Whitney U‐test, Student's t‐test and Freidman's test were used for comparisons.

Results:  Baseline data were similar across the groups (P > 0.05). Mean FSH, LH, estradiol values, and ovarian volume were unchanged after both of the techniques. However, mean pulsatility index, resistance index, and systole/diastole (S/D) ratio were significantly decreased in both groups compared to baseline values (group 1, P = 0.027, P = 0.018, and P = 0.013, respectively; group 2, P = 0.01, P = 0.002, and P = 0.0001, respectively). Postoperative decline in the mean pulsatility index was more pronounced (P = 0.02) in group 2 (partial removal).

Conclusion:  It appears that complete removal of fallopian tubes during hysterectomy has no advantageous effect on ovarian blood supply. It might be important to protect the ovarian blood supply as much as possible while performing hysterectomy in the reproductive period.
First trimester ultrasound diagnosis of congenital diaphragmatic hernia
Authors: Daskalakis George , Anastasakis Eleftherios , Souka Athena , Manoli Asimina , Koumpis Chrisovalandis , Antsaklis Aris
Published: November 2007

Congenital diaphragmatic hernia is a rare structural defect, usually diagnosed in the second or third trimester of pregnancy. We present here a case of left‐sided diaphragmatic hernia diagnosed at 12 weeks of gestation and a short review of published reports on first trimester diagnosis of this defect. Ultrasound diagnosis of congenital diaphragmatic hernia cases, with early herniation of the viscera in the thorax, is feasible during the first trimester. The prerequisite is the systematic examination of the fetal anatomy. Hallmarks of the diagnosis, in the first trimester as well as later in pregnancy, are the presence of the stomach, bowel or liver in the chest, and the shift of the mediastinum. Early diagnosis of this defect is essential. This will allow timely intervention and appropriate management, following extensive parental counseling.
Retroperitoneal uterine leiomyoma occurring 5 years after hysterectomy for fibroids
Authors: Fukamachi Nobuyuki , Togami Shinichi , Iwamoto Ichiro , Tsuji Takahiro , Nomoto Mitsuharu , Goto Masamichi , Kamiyama Takuro , Fukukura Yoshihiko , Douchi Tsutomu
Published: November 2007

We encountered a 49‐year‐old, multiparous female with a very rare isolated retroperitoneal uterine leiomyoma measuring 72 × 43 mm in diameter occurring 5 years after hysterectomy for fibroids. The case was preliminarily diagnosed as right ovarian cancer or fibroma. An edematous, isolated solid tumor in the right retroperitoneal cavity was surgically resected. Pathological findings demonstrated uterine leiomyoma.
Diagnosis and therapy of pelvic actinomycosis
Authors: Taga Shigeki
Published: November 2007

Pelvic actinomycosis is difficult to diagnose. In most cases, it is not diagnosed until after surgery. If this condition is diagnosed preoperatively, it can be treated in many cases. Three cases of actinomycosis are reported here. Three women with intrauterine devices (IUD) each presented with lower abdominal pain and pelvic mass, and elevated white blood cell count and C‐reactive protein. Left salpingo‐oophorectomy was performed for one the women. The pathological diagnosis was actinomycosis. For the other two women, a Gram or Papanicolaou stain of the IUD sample showed actinomycetes. They were discharged after intravenous administration of penicillin without surgery.
Early awakening and extubation with remifentanil in ventilated premature neonates
Authors: E SILVA YERKES PEREIRA , GOMEZ RENATO SANTIAGO , MARCATTO JULIANA DE OLIVEIRA , MAXIMO THADEU ALVES , BARBOSA ROSILU FERREIRA , E SILVA ANA CRISTINA SIMÕES
Published: November 2007

Background:  Morphine is one of the most commonly used drugs for sedation and analgesia during mechanical ventilation, but its pharmacological profile has limitations, such as prolonged duration of action, especially in premature neonates. Because of its very short context‐sensitive half‐time, remifentanil has rapid onset and quickly decreases in plasma concentration after interrupting administration. The aim of the present study was to compare a continuous infusion of remifentanil and morphine during mechanical ventilation of premature neonates with respiratory distress syndrome (RDS).

Methods:  Twenty premature neonates (28–34 weeks) with RDS were randomized in a prospective double‐blinded study to receive either a continuous infusion of morphine (n = 10) or remifentanil (n = 10) for mechanical ventilation. The length of time to awaken and extubate the neonate after interrupting opioid administration was recorded. We also recorded stress (COMFORT scale), pain response [Neonatal Infant Pain Scale (NIPS)], hemodynamic and ventilatory variables as well as adverse effects secondary to infusion of the specific opioid.

Results:  After terminating infusion, the length of time required to awaken and extubate the neonates was 18.9‐ and 12.1‐fold longer, respectively, in the morphine group than in the remifentanil group. Both groups produced good quality sedation and analgesia as evaluated by the NIPS and COMFORT scores. No major side effects were observed.

Conclusions:  Our results show an interesting potential for the use of remifentanil in premature neonates. Remifentanil allowed an adequate level of sedation and analgesia as well as rapid recovery after discontinuation. However, further properly designed clinical trials are needed before it can be generally recommended.
Propofol–ketamine vs propofol–fentanyl combinations for deep sedation and analgesia in pediatric patients undergoing burn dressing changesa
Authors: TOSUN ZEYNEP , ESMAOGLU ALIYE , CORUH ATILLA
Published: November 2007

Background:  The aim of this study was to compare propofol–ketamine (PK) and propofol–fentanyl (PF) combinations for deep sedation and analgesia in pediatric burn wound dressing changes.

Methods:  Thirty‐two ASA physical status II and III inpatients with a second degree total burn surface area ranging from 5% to 25% were studied in a randomized, double blind fashion. Heart rate, systolic arterial pressure, peripheral oxygen saturation, respiratory rate and Ramsey sedation scores of all patients were recorded perioperatively. Patients were randomly assigned to receive either PK or PF: PK group (n = 17) received 1 mg·kg−1 ketamine + 1.2 mg·kg−1 propofol, and PF group (n = 15) received 1 μg·kg−1 fentanyl + 1.2 mg·kg−1 propofol for induction. Additional propofol (0.5–1 mg·kg−1) was administered when the patients showed discomfort in both groups. If the patient showed discomfort and/or increase in heart rate or systolic arterial pressure, despite additional propofol dose, additional bolus of 0.5–1 mg·kg−1 ketamine or 0.5–1 μg·kg−1 fentanyl was administered.

Results:  There were no significant differences in heart rate, systolic arterial pressure, peripheral oxygen saturation, respiratory rate and sedation scores during the procedure between the groups. Restlessness during the procedure was seen in seven (47%) patients in Group PF and one (5.9%) patient in Group PK (P = 0.013).

Conclusions:  Both propofol–ketamine and propofol–fentanyl combinations provided effective sedation and analgesia during dressing changes in pediatric burn patients. But propofol–ketamine combination was superior to propofol–fentanyl combination because of more restlessness in patients given propofol–fentanyl.
Evaluation of cuffed tracheal tube size predicted using the Khine formula in children
Authors: DURACHER CAROLINE , SCHMAUTZ EMMANUELLE , MARTINON CLAIRE , FAIVRE JUDITH , CARLI PIERRE , ORLIAGUET GILLES
Published: November 2007

Background:  The correct size of cuffed endotracheal tube (CET) limits the risk of postintubation tracheal damage. The aim of this study was to compare the size of the CET used in children with the size predicted by the Khine formula [age (years)/4 + 3].

Methods:  After ethical committee approval, 204 children aged 1 day–15 years were included prospectively in the study. The choice of the size of the CET was made at the discretion of the attending anesthesiologist. The main criterion of judgment was the comparison of the leak before and after inflating the cuff at a pressure of 20 cm·H2O. Demographic data, tracheal tube size used and that predicted by Khine’s formulae and side‐effects were recorded.

Results:  Overall, 21% of the CET were in accordance with the size predicted by the Khine formula. In the remaining patients, 72% were oversized and 7% undersized. In 12 cases, the size of CET chosen initially was modified: for a larger size in eight children and for a smaller size in four others. Six children (2.9%) presented with minor postoperative complications.

Conclusions:  Our data suggest that Khine’s formula for predicting the appropriate tracheal tube size underestimates optimal size by 0.5 mm. We therefore recommend the use of the following formula: internal diameter of the CET = [age/4 + 3.5] in children >1 year of age which may be applied without increased risk of complications. The rate of tracheal reintubation as well as the detected leaks supports these recommendations.
Investigating the pharmacodynamics of ketamine in children
Authors: HERD DAVID W. , ANDERSON BRIAN J. , KEENE NATALIE A. , HOLFORD NICHOLAS H.G.
Published: November 2007

Background:  The aim of this study was to describe ketamine pharmacodynamics (PD) in children. Adult ketamine concentrations during recovery are reported as 0.74 mg·l−1 (sd 0.24 mg·l−1) with an EC50 for anesthesia of 2 mg·l−1 (sd 0.5 mg·l−1), but pediatric data are few.

Methods:  Children presenting for painful procedures in an Emergency Department were given ketamine 1–1.5 mg·kg−1 i.v. Blood was assayed for ketamine on three to six occasions (median 3) over the subsequent 14–152 min (median 28.5). Procedures were videotaped. Level of sedation (0–5; unresponsive – spontaneously awake without stimulus) and a test of memory were recorded. PD was investigated using a variable slope Emax model (sedation) or logistic regression (arousal time, memory) with nonlinear mixed effects models.

Results:  In total 60 children were enrolled. Pharmacokinetic data were collected in 54 of these children and there were 43 children available for PD study. The mean age was 8.15 years (sd 3.5 years) and weight was 34.9 kg (sd 15.8 kg). The half‐time describing equilibration between the effect compartment and central compartment was 11 s (95% CI 0.07–20 s). The EC50 for arousal was 0.52 (90% CI 0.22–1.17) mg·l−1. The Emax model with a baseline (E0) of five (spontaneously awake without stimulus) yielded a fractional Emax 0.939 [coefficient of variability (CV) 24%], an EC50 0.56 (CV 136%) mg·l−1 and a Hill coefficient 3.71. The EC50 for recall memory was 0.44 (90% CI 0.09–1.70) mg·l−1. The EC50 for remembering was 0.38 (90% CI 0.12–1.75) mg·l−1.

Conclusions:  Concentrations associated with arousal in children are analogous to adults. The ability to recall and remember occurs at similar concentrations to those associated with arousal. A concentration of 1 mg·l−1 was associated with a sedation level of three or less (arouses to consciousness with moderate tactile or loud verbal stimulus) in 95% of children while 1.5 mg·l−1 was associated with a sedation level of two or less (rouses slowly to consciousness with sustained painful stimulus) in 95% of children. These concentrations can be attained for 3–4 min after 1 mg·kg−1 and 1.5 mg·kg−1 ketamine IV bolus, respectively. The mean arousal time can be anticipated at approximately 10 min (1 mg·kg−1) and 15 min (1.5 mg·kg−1).
Scanning electron‐microscopic evaluation of cuff shoulders in pediatric tracheal tubes
Authors: MOEHRLEN UELI , ZIEGLER URS , WEISS MARKUS
Published: November 2007

Background:  Technical and conceptual shortcomings of cuffed pediatric tracheal tubes have been pointed out in the past, all representing a potential risk for mucosal damage of the pediatric airway. In this study, cuffed pediatric tracheal tubes from different manufacturers were investigated with regard to the cuff shoulder design using scanning electron microscopy (SEM).

Methods:  Cuffed pediatric tracheal tubes with the smallest internal diameter available were ordered from five manufacturers. SEM scans were performed from the tube shaft – cuff shoulder – tube cuff assembly and from the cuff shoulder alone. Each investigation was repeated in four samples of each tube brand. In addition, thickness of cuff membrane was measured.

Results:  Major differences were found among the cuff shoulders investigated ranging from smooth transitions, softened borders to very sharp steps. There was also considerable difference in the thickness among the cuff membranes between the different tube brands ranging from 18 μm in polyurethane cuffs up to 90 μm in polyvinylchloride cuffs.

Conclusions:  Because the gap between the outer tracheal tube and the internal mucosal layer of the pediatric airway is often very narrow, some of the observed irregularities have the potential to injure the airway mucosa in pediatric patients, particularly during long‐term use and firm fit of the tracheal tube in the airway. As cuffed tubes are increasingly used in small children, the observed irregularities in some tracheal tube brands may need to be improved and their safety should be proved by the manufacturers.
Sedation with ketamine and low‐dose midazolam for short‐term procedures requiring pharyngeal manipulation in young children
Authors: NOVAK HELENA , ÅKESON PIA KARLSLAND , ÅKESON JONAS
Published: November 2007

Background: Pediatric intestinal biopsy procedures including considerable transpharyngeal manipulation of a wire‐guided metal capsule require adequate sedation or anesthesia. This retrospective cohort study was designed to evaluate intravenous sedation with ketamine and low‐dose midazolam in young children undergoing these procedures before and also after discharge from the hospital.

Methods: A total of 244 biopsy procedures in 217 children under the age of 16 years were evaluated. All anesthesia records were reviewed according to a defined study protocol and in 145 cases the parents were also interviewed by telephone to obtain further information on possible adverse effects before and after discharge.

Results: Ketamine and low‐dose midazolam were carefully titrated by an experienced anesthesia team at an approximate dose ratio of 40 : 1 (total doses 2.3 and 0.05 mg·kg−1) in continuously monitored spontaneously breathing children. Possibly associated problems before discharge were salivation (5.7%), vomiting (4.9%), oxygen desaturation (3.3%), laryngospasm (2.5%) and rash (1.2%) according to the patient records and blurred vision (27%), nausea and vomiting (19%), vertigo (13%) and hallucinations or nightmares (3.5%) according to telephone interviews. Few, mild and transient problems remained after discharge from the hospital.

Conclusions: Careful titration of ketamine and low‐dose midazolam provides adequate sedation for nonsurgical pediatric short‐term procedures also requiring considerable pharyngeal manipulation, particularly considering the low number of serious airway problems such as laryngospasm. The high incidence of late postoperative problems suggests that prospective studies should be designed for long‐term follow‐up of young children subjected to sedation or anesthesia.
Prevention of rocuronium‐induced withdrawal movement in children: a comparison of remifentanil with alfentanil
Authors: KIM JONG YEOP , KWAK HYUN JEONG , KIM JI YOUNG , PARK KWAN SIK , SONG JAE SEOK
Published: November 2007

Background: This study was designed to compare the efficacy of remifentanil and alfentanil without the venous occlusion technique in preventing the withdrawal response associated with rocuronium injection in children.

Methods: One hundred and twenty children aged between 3 and 10 years were randomly allocated into one of four groups to receive either i.v. remifentanil 0.5 μg·kg−1(remi 0.5 group), remifentanil 1 μg·kg−1(remi 1.0 group), alfentanil 15 μg·kg−1(alfentanil group) or saline 5 ml (saline group). Anesthesia was induced with 2.5% thiopental sodium 5 mg·kg−1and the test drug was injected over 30 s. One minute later, 1% rocuronium 0.6 mg·kg−1was injected over 5 s and the response was recorded. Mean arterial pressure (MAP) and heart rate (HR) were recorded on arrival in the operating room, before and 1 min after tracheal intubation.

Results: The incidence of withdrawal movement in the saline group (93%) was significantly higher than that in the remi 0.5, remi 1.0, and alfentanil groups (53%, 17%, and 20%, respectively) (P < 0.05). The incidence in the remi 1.0 and alfentanil groups was significantly less than that in the remi 0.5 group (P < 0.05). After intubation, MAP and HR were significantly higher in the saline group than that in remi 1.0 and alfentanil groups.

Conclusions: Both remifentanil 1 μg·kg−1and alfentanil 15 μg·kg−1can be used to prevent rocuronium‐associated withdrawal movement in children because they are equally effective and attenuate the increase in MAP and HR after intubation.
DNA barcoding reveals cryptic diversity in marine hydroids (Cnidaria, Hydrozoa) from coastal and deep‐sea environments
Authors: Moura Carlos J. , Harris David J. , Cunha Marina R. , Rogers Alex D.
Published: November 2007

Fifty‐six sequences of the mitochondrial 16S RNA gene were generated for hydroids, belonging to six nominal families — Eudendriidae, Lafoeidae, Haleciidae, Sertulariidae, Plumulariidae and Aglaopheniidae — collected from bathyal environments of the Gulf of Cadiz (22 haplotypes), Greenland (1 haplotype), Azores (1 haplotype), the shallow waters of the UK (17 haplotypes) and Portugal (2 haplotypes). When combined and analysed with 68 additional sequences published in GenBank, corresponding to 63 nominal species of these families (nine species in common between the GenBank sequences and those presented by the authors), cryptic species were detected (e.g. two species of Nemertesia and other of Lafoea), as well as apparent cases of conspecificity (e.g. Nemertesia antennina and N. perrieri and Aglaophenia octodonta, A. pluma and A. tubiformis). Other taxonomic inconsistencies were found in the data including cases where species from different genera clustered together (e.g. Sertularia cupressina, Thuiaria thuja, Abietinaria abietina and Ab. filicula). The mitochondrial 16S rRNA proved to be a useful DNA ‘barcode’ gene for hydroids, not only allowing discrimination of species, but also in some cases of populations, genera and families, and their intra‐ or interphylogenetic associations. Although still under‐represented in public data bases, the 16S rRNA gene is starting to be used frequently in the study of hydroids. These data provide powerful complementary evidence for advancing our understanding of hydrozoan systematics.
Expression of a harpin‐encoding gene in rice confers durable nonspecific resistance to Magnaporthe grisea
Authors: Shao Min , Wang Jinsheng , Dean Ralph A. , Lin Yongjun , Gao Xuewen , Hu Shuijin
Published: November 2007

Engineering durable nonspecific resistance to phytopathogens is one of the ultimate goals of plant breeding. However, most attempts to reach this goal fail as a result of rapid changes in pathogen populations and the sheer diversity of pathogen infection mechanisms. In this study, we show that the expression of a harpin‐encoding gene (hrf1), derived from Xanthomonas oryzae pv. oryzae, confers nonspecific resistance in rice to the blast fungus Magnaporthe grisea. Transgenic plants and their T1–T7 progenies were highly resistant to all major M. grisea races in rice‐growing areas along the Yangtze River, China. The expression of defence‐related genes was activated in resistant transgenic plants, and the formation of melanized appressoria, which is essential for foliar infection, was inhibited on plant leaves. These results suggest that harpins may offer new opportunities for generating broad‐spectrum disease resistance in other crops.
THE EAR OF THE BEHOLDER: SPECTATOR FIGURES AND NARRATIVE STRUCTURE IN POMPEIAN PAINTING
Authors: LORENZ KATHARINA
Published: November 2007

The debate on spectator figures in Roman painting has traditionally concentrated on their function as virtually meaning‐free space‐fillers, or on their potential to make external viewers aware of the fact that they are looking at a picture. This article takes a different approach and uses the spectator figures of two frescoes from a house within the Scavo del Principe di Montenegro in Pompeii as a means of exploring the narrative strategies of Pompeian mythological painting. The satyr ear of one of the spectators, which in previous research has gone unnoticed, and the elements of gender masquerading which come with it, form the ground for reconsidering the spectators' contribution to the reception aesthetics of an image, its mythological and its emotive content. The result is a fresh assessment of Pompeian painting as a laboratory for the exploration of visual story‐telling and of the shifts in the engagement of Roman audiences with mythological stories throughout the first century ce.
HAPPINESS WITH A LONG PIECE OF BLACK LEADER: CHRIS MARKER'S SANS SOLEIL
Authors: MAVOR CAROL
Published: November 2007

Chris Marker, best known for his 1962 film, La Jetée, released Sans Soleil in 1982. Sans Soleil migrates quickly between places, time spans and a continual collectomania of images by Marker and other cameramen. Sans Soleil's image repertoire is as fleeting as Marcel Proust's famous, evasive nibble of the scallop‐shell shaped madeleine cake. This essay explores Marker's interest in the profoundness of Proustian memory. As Marker claims in his ‘sunless’ film: ‘I will have spent my life trying to understand the function of remembering, which is not the opposite of forgetting, but rather its lining. We do not remember, we rewrite memory much as history is rewritten.’
The energetic leader
Authors: Balfour Fergie , Landale Anthony
Published: November 2007

Fergie Balfour has an enviable track record for leading company turnarounds, such as at Calvin Klein and Birds Eye. Now he is taking on Unilever's Food Solutions business in Asia, Africa and the Middle East. Anthony Landale spoke to him about how he unlocks energy in people and organizations.
Great decision!
Authors: Crainer Stuart
Published: November 2007

The majority of management decisions go unnoticed. Stuart Crainer reminds us of some that have changed our world.
Globalization and poverty
Authors: Blowfield Michael
Published: November 2007

Can business eliminate poverty? And, if yes, should it? As business becomes more global in scope, companies need to think about how they will address the poorest sectors of the planet. Michael Blowfield talks about the four dimensions of the business‐poverty relationship.
Creative financing
Authors: Higson Chris , Rivers Oliver , Deboo Martin
Published: November 2007

Those who manage the arts enhance our culture ‐ but how are they at enhancing the bottom line?Chris Higson, Oliver Rivers and Martin Deboo propose a value narrative to analyze how creative industries can become better businesses and alluring investments.
Where business and politics meet
Authors: Bach David , Brown Tom
Published: November 2007

Strategy is an essential ingredient of business success. In this interview, David Bach tells Tom Brown how he came to believe that nonmarket strategy is just as important for future corporate success.
Turning the back office into an accelerator
Authors: Rogers Paul , Saenz Hernan , Greenspan Nick
Published: November 2007

Paul Rogers, Herman Saenz and Nick Greenspan are convinced that support services have a critical impact on the success of an organization.
Curing healthcare
Authors: Crainer Stuart
Published: November 2007

No one running a company, large or small, can ignore the rising costs of healthcare. Yet, for all the attention paid to it, few companies feel that they have a state‐of‐the‐art healthcare system. One company that has made great strides in this direction is Pitney Bowes, whose Executive Chairman Mike Critelli has been a leader on new ways to think about healthcare. Here, he talks with Stuart Crainer about the progress his company has made as well as the fact that healthcare is an important issue that communities and nations must also address.
Addicted to technology
Authors: Kakabadse Nada , Porter Gayle , Vance David
Published: November 2007

Can new technology provided by a company to boost productivity cause workers to become addicted? If yes, who's responsible: workers or management?Nada Kakabadse, Gayle Porter and David Vance see an uncharted legal frontier emerging. Is any company prepared?
Success and beyond
Authors: Jelman Reynold
Published: November 2007

Business psychologist Reynold Jelman believes that leaders who focus only on visible measures of success can be a liability to their organizations.
Financial Globalisation and Emerging Markets Volatility
Authors: Leijonhufvud Christina
Published: November 2007

The volatility of capital flows to emerging market (EM) countries and frequency of financial crises have imposed high welfare costs on the countries involved. The empirical literature provides, at best, a mixed picture on the relationship between long‐run EM country growth and financial integration. Meanwhile, the prevailing policy discourse regarding reform of the international financial system remains incomplete: the focus has largely been on either institutional and policy measures required of EM countries or international crisis‐resolution procedures. The role played by private financial markets and institutions in the developed world has not received adequate attention. This paper describes some of the structural features inherent in today's financial markets that directly contribute to the instability in EM capital flows.
Enterprise‐level training in developing countries: do international standards matter?*
Authors: Blunch Niels‐Hugo , Castro Paula
Published: November 2007

Several studies have examined the determinants of training in developing countries but few have paid attention to the potential importance of international standards such as ISO 9000 or ISO 14000 on the firm's training decision. This article examines training determinants using recent employer surveys for five developing countries: Ethiopia, Honduras, Indonesia, Morocco and Nicaragua. It finds that ISO certification status is an important determinant of training, even after controlling for other characteristics such as workers’ formal schooling, firm size, industry and foreign ownership. This points toward the importance of international standards, including product quality and production standards, for firm training. The article also discusses policy implications related to the findings and provides directions for further research.
The effects of training design, individual characteristics and work environment on transfer of training
Authors: Velada Raquel , Caetano António , Michel John W. , Lyons Brian D. , Kavanagh Michael J.
Published: November 2007

This study aims to gain insight into some of the factors that determine the transfer of training to the work context. The present research examined the relationship between three types of predictors on transfer of training, including training design, individual characteristics and work environment. Data was collected at two points in time from 182 employees in a large grocery organization. The results indicated that transfer design, performance self‐efficacy, training retention and performance feedback were significantly related to transfer of training. Contrary to expectation, supervisory support was not significantly related to transfer of training. These results suggest that in order to enhance transfer of training, organizations should design training that gives trainees the ability to transfer learning, reinforces the trainee's beliefs in their ability to transfer, ensures the training content is retained over time and provides appropriate feedback regarding employee job performance following training activities.
Identifying trainers' knowledge of training transfer research findings – closing the gap between research and practice
Authors: Hutchins Holly M. , Burke Lisa A.
Published: November 2007

Training professionals were surveyed concerning their knowledge of transfer of training research. Survey items were developed from an integrative literature review based on empirical findings of factors that directly or indirectly (through learning) influence training transfer. Survey results suggest that training professionals are in agreement with empirical transfer findings in the areas of training design and the work environment, but differ in their agreement of how individual differences impact transfer success and of relevant transfer evaluation findings. Training professionals were more familiar with academic transfer research when they occupied higher job positions within their organization, held a training certification and had a college degree. The results of our study and the implications for addressing the research‐to‐practice gap among training professionals are also discussed.
Refractory Chronic Headache Associated with Obstructive Sleep Apnoea Syndrome
Authors: Mitsikostas DD , Vikelis M , Viskos A
Published: November 2007

The aim was to investigate the comorbidity of chronic refractory headache with obstructive sleep apnoea syndrome (OSAs). Seventy-two patients (51 women and 21 men) with chronic and refractory headaches, whose headache occurred during sleep or whose sleep was accompanied by snoring, were submitted to polysomnography. Patients diagnosed with OSAs (respiratory disturbance index > 10) began continuous positive airway pressure (C-PAP) treatment and were followed up for ≥ 6 months. Twenty-one cases of OSAs were identified (29.2% of the total investigated, 13.7% of the women and 66.6% of the men). Headaches were classified into several headache disorders, medication overuse headache and cluster headache being the most prevalent (nine and six of the 21 cases, respectively). In one case (1.4% of the total sample, 4.7% of all the men), the criteria for hypnic headache were fulfilled. Multivariate regression analysis revealed that age, male gender and body mass index were associated with OSAs. C-PAP treatment improved both sleep apnoea and headache in only a third of the cases. Patients suffering from chronic refractory headache associated with sleep or snoring, in particular those who are also middle-aged, overweight men, should be considered for polysomnography. C-PAP treatment alone does not seem to improve headache, but further investigation is needed.
Migrainous Vertigo: Clinical, Oculographic and Posturographic Findings
Authors: Çelebisoy N , Gökçay F , Şirin H , Biçak N
Published: November 2007

Migrainous vertigo (MV) is accepted as a common cause of episodic vertigo. The peripheral or central vestibular localization of the deficit as well as the pathophysiology is unclear. This prospective study was designed to assess the clinical features of MV and to search for the localization of the vestibular pathology. Thirty-five patients with MV, 20 patients with migraine and 20 healthy volunteers were studied. Comprehensive neurotological tests were performed between attacks. None of the normal controls or the patients with migraine had ocular motor deficits or caloric test abnormalities. Three patients in the MV group showed saccadic pursuit (8.6±), in one of whom saccadic hypometria was also present. Caloric test results revealed unilateral caloric hypofunction in seven patients (20±). Static posturography results revealed increased sway velocity when the eyes were closed or the platform was distorted in patients with MV. These findings during the symptom-free period revealed that peripheral vestibular dysfunction was more common than a central deficit.
Alopecia areata: topical immunotherapy treatment with diphencyprone
Authors: Avgerinou G , Gregoriou S , Rigopoulos D , Stratigos A , Kalogeromitros D , Katsambas A
Published: November 2007

Background  Topical immunotherapy with diphencyprone (DPCP) is considered the most effective treatment of alopecia areata (AA).

Objective  To assess the efficacy of DPCP in the treatment of extensive or long‐lasting AA in Greek patients.

Methods  Sixty‐four patients with extensive and/or long‐lasting AA were sensitized with 2% diphencyprone. During each weekly subsequent visit, patients were treated with gradually denser concentrations adjusted in order to maintain erythema and itch on the patient's scalp for 48 h. Patients’ hair re‐growth was evaluated every 3 months for 2 years.

Results  Forty‐five patients responded among the 54 completing therapy (83.3%). Initial response was observed 3.48 ± 1.05 months after the initial treatment. Twenty patients among the responders achieved a grade 4 response, 15 patients achieved grade 3, 9 patients achieved grade 2, and 1 patient achieved a grade 1 response. The mean duration of treatment until maximum response was 6.14 ± 1.48 months. Thirty‐one patients (68.9%) had a relapse during follow‐up and were treated again. The only adverse event among patients completing therapy was contact dermatitis of the face or neck (9 of 54) that resolved after topical corticosteroid application within 7 days. Statistical analysis did not establish any association among duration of AA, age, gender, atopic diathesis, nail involvement and presence of thyroid antibodies with response to treatment.

Conclusion  Treatment of Greek patients with AA with diphencyprone presents high response rates similar to those reported by previous studies. The treatment is adequately tolerated by most of the patients, and they are willing to repeat it in cases of relapse.
Keratin and filaggrin expression in keratoacanthoma
Authors: Ito Yoshiyuki , Kurokawa Ichiro , Nishimura Keisuke , Hakamada Arata , Isoda Ken‐ichi , Yamanaka Kei‐ichi , Tsubura Airo , Mizutani Hitoshi
Published: November 2007

To clarify the histogenesis of keratoacanthoma, we studied keratin (K) expression in keratoacanthoma (KA) using 10 different anti‐keratin antibodies against K1, K7, K8, K10, K14, K15, K16, K17, K18 and K19 and anti‐filaggrin (filament aggregating protein) antibody. In the centre of KA, K1 and K10 expressions were declined, and K14 and K16 were detected in the tumour cells, suggesting differentiation towards the outer root sheath beneath the orifice of the sebaceous duct. These results suggest that KA differentiates towards the outer root sheath beneath the opening of the sebaceous duct.
United We Stand? The European Union's International Actorness in the Cases of the International Criminal Court and the Kyoto Protocol*
Authors: GROENLEER MARTIJN L.P. , VAN SCHAIK LOUISE G.
Published: November 2007

In this article we examine the relationship between the institutional set‐up of the EU foreign policy‐making process and the international actorness of the EU in two particular cases: the International Criminal Court and the Kyoto Protocol. Whereas in both cases policy‐making is organized along intergovernmental lines, the EU has shown a relatively high degree of international actorness. We argue that this is the combined result of the considerable congruence of EU Member States' initial preferences and the social interactions between EU Member States, third countries and non‐state actors, through which preferences converged even further over time.
How to Cut the Seigniorage Cake into Fair Shares in an Enlarged EMU
Authors: HANSEN JØRGEN DRUD , KING ROSWITHA M.
Published: November 2007

The European Central Bank redistributes each year seigniorage from issuing euro notes to the National Central Banks of the euro countries. The key for this redistribution is, from 2008, based on the respective GDP and population proportions of the euro countries. Applying the distribution formula to the new EU countries from central and eastern Europe seems to give these countries a large net benefit compared with the seigniorage they bring in, i.e. their share of currency in circulation. However, as argued in this article, currency demand in the new EU member countries is expected to increase relative to the present group of euro countries – especially after gaining membership in the EMU because of integration of the financial markets and, in the longer term, catching‐up growth. Hence, it is doubtful whether a large unintended redistribution of seigniorage to the benefit of acceding EMU countries will materialize in the future.
The Construction of EU Normative Power*
Authors: PACE MICHELLE
Published: November 2007

This article focuses on the constructed nature of the EU's so‐called ‘normative power’ (NPEU). It proposes that, while a successful construction of NPEU would secure a role for the EU globally, challenges to NPEU constructions would disempower any EU attempts at its global reach based on such projections. The Middle East conflict is taken as a case in point.
Accommodating Normative Divergence in European Foreign Policy Co‐ordination: The Example of the Iraq Crisis
Authors: PUETTER UWE , WIENER ANTJE
Published: November 2007

In situations of international crises normative divergence regarding policy responses is a recurrent phenomenon. It is a problem which remains to be addressed despite assumptions about internationally established communities such as the liberal community of Western states. The case of the European Union's failure to co‐ordinate a common policy response in connection with the war on Iraq demonstrates that conflict between Member States about appropriate common policy responses is enhanced by external crises. Common commitment to shared community norms is hence considered as an insufficient basis for policy consensus or, for that matter, sustainable compromise. The article discusses how and why these divergences emerge and suggests institutionalizing collective processes of norm contestation at the European level.