bluuebunny/crossref_metadata_2025 huggingface dataset:
Progestin Receptor Subtypes in the Brain: The Known and the Unknown
Authors: Mani Shaila
Published: February 2008

Progesterone (P), the most biologically active progestin of ovarian origin, modulates numerous cellular functions in the central nervous system to coordinate physiology and reproduction. The neurobiological activity of P is mediated not by a single form of the progestin receptor (PR), but by two neural isoforms of PRs, PR-A and PR-B. Classical model of P action assumes that these neural effects are primarily mediated via their intracellular PRs, acting as transcriptional regulators, in steroid-sensitive neurons, modulating genes and genomic networks. Evidence has emerged, however, that activation of neural PRs is much more diverse; four distinct classes of molecules, neurotransmitters, peptide growth factors, cyclic nucleotides, and neurosteroids have been shown to activate the PRs via cross-talk and pathway convergence. In addition, rapid signaling events associated with membrane receptors and/or subpopulations of cytoplasmic PRs, via activation of protein kinase cascades, regulate PR gene expression in the cytoplasm independent of PR nuclear action. The increasing in vitro and in vivo evidence of differential transcriptional activities and coregulator interactions between PR-A and PR-B predict that these isoforms could have distinct roles in mediating additional and/or alternate signaling pathways within steroid-sensitive neurons. In this minireview, we evaluate the available data and discuss the possible roles of the isoforms in the regulation of neurobiological processes.
The effect of water deprivation on the tonicity responsive enhancer binding protein (TonEBP) and TonEBP-regulated genes in the kidney of the Spinifex hopping mouse,Notomys alexis
Authors: Bartolo Ray C. , Donald John A.
Published: February 2008

In desert rodents, the production of concentrated urine is essential for survival in xeric environments in order to conserve water. Reabsorption of water in the kidney is dependent on large osmotic gradients in the renal medulla. This causes the renal cells to be bathed in a hypertonic extracellular fluid that can compromise cellular function. In response to hypertonicity, kidney cells accumulate compatible, non-ionic osmolytes that lower the ionic strength within the cells to isotonic levels by replacing intracellular ionic electrolytes. The tonicity-responsive enhancer binding protein (TonEBP) is a transcription factor that regulates the expression of genes that encode proteins that catalyse the accumulation of compatible osmolytes. We investigated the expression of TonEBP mRNA and protein and compatible osmolyte genes in the Spinifex hopping mouse, Notomys alexis, an Australian desert rodent that produces a highly concentrated urine. TonEBP mRNA expression was unchanged after 3 days of water deprivation but was significantly increased after 7 and 14 days of water deprivation. Immunohistochemistry showed that during water deprivation TonEBP had translocated from the cytoplasm into the nucleus of cells in the renal medulla and papilla. In addition, 3, 7 and 14 days of water deprivation caused a significant increase in aldose reductase (AR), myo-inositol (SMIT),betaine/GABA (BGT-1) and taurine (TauT) transporter mRNA expression, which is indicative of an increase in TonEBP activity. In desert rodents, TonEBP regulation of gene transcription is probably an important mechanism to protect renal cells in the face of the large corticomedullary gradient that is required to concentrate urine and conserve water.
High-speed gallop locomotion in the Thoroughbred racehorse. I. The effect of incline on stride parameters
Authors: Parsons K. J. , Pfau T. , Wilson A. M.
Published: February 2008

During locomotion up an incline, power is required to elevate the centre of mass. This is provided when the animal's limbs are in contact with the ground. Measurements of stride timing variables from multiple limbs during high speed,over-ground locomotion would enhance our understanding of locomotor powering during changes in terrain. This study measured foot-on and foot-off times from galloping horses using a previously validated system of limb-mounted accelerometers and a global positioning system data logger. A detailed track survey provided incline information from all areas of the track. Measurements were made from six horses over a speed range of 9 to 13 m s–1. Foot-fall timings were used to calculate variables,which included stance duration, protraction duration, stride frequency and duty factor. The relationship between track incline and measured variables was assessed. Stride variables from horses galloping on level (0–2% incline)and incline (8–12% incline) sections of the track were compared. Fore-and hindlimb protraction durations were significantly reduced across the speed range during incline galloping (P=0.001). This resulted in a mean increase in stride frequency from 2.01 to 2.08 strides s–1 at 9.5 m s–1 and 2.10 to 2.17 strides s–1 at 12.5 m s–1 during incline galloping. Duty factor was significantly greater for the hindlimbs during incline galloping(P<0.001), increasing from 0.31 to 0.32 at 9.5 m s–1 and 0.28 to 0.29 at 12.5 m s–1. Peak limb force was calculated from duty factor and assumed fore- to hindlimb impulse distributions. Smaller peak vertical forces were calculated in the forelimbs and increased peak vertical forces were calculated in the hindlimbs when galloping on an incline. Measured changes in stride timing variables differ from those reported in trotting horses. We propose that horses increase their stride frequency at a given speed during incline galloping to provide power for moving the centre of mass up the slope.
Uptake of dissolved free amino acids by the scleractinian coral Stylophora pistillata
Authors: Grover Renaud , Maguer Jean-François , Allemand Denis , Ferrier-Pagès Christine
Published: February 2008

This study was designed to assess the importance of dissolved free amino acids (DFAA) as a nitrogen source for the scleractinian coral Stylophora pistillata. For this purpose, experiments were performed using 15N-enriched DFAAs, and %15N enrichment was measured both in animal tissue and zooxanthellae at different DFAA concentrations,incubation time and light levels. As previously observed for urea, which is another source of organic nitrogen, DFAA uptake exhibited a biphasic mode consisting of an active carrier-mediated transport for concentrations below 3μmol l–1 and a linear uptake for higher concentrations. The value of the carrier affinity (Km=1.23 μmol l–1 DFAA) indicated good adaptation of the corals to the low levels of DFAA concentrations measured in most oligotrophic waters. DFAA uptake was also correlated with light. The DFAA contribution to the nitrogen requirements for tissue growth was compared to the contribution of ammonia,nitrate and urea, for which uptake was also measured in S. pistillata. Inorganic sources (NH4+ and NO3–) contributed 75% of the daily nitrogen needs against 24% for organic sources. Taken altogether, dissolved organic and inorganic nitrogen can supply almost 100% of the nitrogen needs for tissue growth.
Homocysteine-induced extracellular superoxide dismutase and its epigenetic mechanisms in monocytes
Authors: Jiang Yideng , Jiang Jianzhong , Xiong Jiantuan , Cao Jun , Li Nan , Li Guizhong , Wang Shuren
Published: February 2008

Although a modest homocysteine (Hcy) elevation is associated with an increased cardiovascular risk, the underlying mechanisms whereby Hcy triggers the accumulation of cholesterol and the roles of the extracellular superoxide dismutase (EC-SOD) in the development of foam cells have not yet been elucidated. In this study, we found both increased numbers of foam cells and an accumulation of cholesterol, and the H2O2 and oxidized low-density lipoprotein content also increased. Levels of EC-SOD were significantly suppressed by Hcy, however, while 5-azacytidine (AZC), a potent DNA methyltransferase (DNMT) inhibitor, increased the expression of EC-SOD. A quantitative real-time PCR of EC-SOD revealed that Hcy (100 μmol l–1) accelerates DNA methylation of EC-SOD, but selectively increases the activity of DNA methyl transferase 1 (DNMT1). It showed that Hcy can reduce binding of methyl CpG and binding protein 2 (MeCP2) but has no effect on the activity of DNMT3. Moreover, chromatin immunoprecipitation assays demonstrated that Hcy increased the binding of acetylated histone H3 and H4 in monocytes. Based on the fact that the binding of MeCP2 with the EC-SOD was completely suppressed by AZC and trichostatin A [TSA, a histone deacetylase (HDAC) inhibitor], it is indicated that DNA methylation and HDAC mediate the binding of MeCP2 with EC-SOD gene. In conclusion, the study found that Hcy accelerates the development of foam cells by repressing EC-SOD transcription, and that Hcy exerts this function by upregulating DNA methylation via suppression of HDAC activity and increased DNMT1 activity.
Active sensing in a mormyrid fish: electric images and peripheral modifications of the signal carrier give evidence of dual foveation
Authors: Pusch Roland , von der Emde Gerhard , Hollmann Michael , Bacelo Joao , Nöbel Sabine , Grant Kirsty , Engelmann Jacob
Published: February 2008

Weakly electric fish generate electric fields with an electric organ and perceive them with cutaneous electroreceptors. During active electrolocation,nearby objects are detected by the distortions they cause in the electric field. The electrical properties of objects, their form and their distance,can be analysed and distinguished. Here we focus on Gnathonemus petersii (Günther 1862), an African fish of the family Mormyridae with a characteristic chin appendix, the Schnauzenorgan. Behavioural and anatomical results suggest that the mobile Schnauzenorgan and the nasal region serve special functions in electroreception, and can therefore be considered as electric foveae. We investigated passive pre-receptor mechanisms that shape and enhance the signal carrier. These mechanisms allow the fish to focus the electric field at the tip of its Schnauzenorgan where the density of electroreceptors is highest (tip-effect). Currents are funnelled by the open mouth (funnelling-effect), which leads to a homogenous voltage distribution in the nasal region. Field vectors at the trunk, the nasal region and the Schnauzenorgan are collimated but differ in the angle at which they are directed onto the sensory surface. To investigate the role of those pre-receptor effects on electrolocation, we recorded electric images of objects at the foveal regions. Furthermore, we used a behavioural response(novelty response) to assess the sensitivity of different skin areas to electrolocation stimuli and determined the receptor densities of these regions. Our results imply that both regions – the Schnauzenorgan and the nasal region – can be termed electric fovea but they serve separate functions during active electrolocation.
Quantitative analysis of neonatal skeletal muscle functional improvement in the mouse
Authors: Gokhin David S. , Ward Samuel R. , Bremner Shannon N. , Lieber Richard L.
Published: February 2008

Postnatal skeletal muscle growth is classically attributed to fiber hypertrophy and myogenic differentiation, but these processes do not account for the size-independent increase of muscle mechanical performance that occurs during postnatal growth. There is also little knowledge about the precise time-course of contractile function or the underlying factors that affect it. The present study investigated morphological factors (muscle fiber size and myofibrillar packing), biochemical factors (myosin heavy chain isoform and desmin intermediate filament protein expression), and muscle architecture during postnatal development in mice. Physiological testing of the mouse tibialis anterior revealed that maximum isometric stress increased from 27±3 kPa at postnatal day 1 to 169±10 kPa by postnatal day 28,roughly a sixfold increase. Morphological measurements revealed a robust increase in the size-independent packing of myofibrillar matrix material occurring with the functional improvement, with just 48.1±5.5% of the cross-sectional area filled with myofibrils at postnatal day 1 whereas 92.5±0.9% was filled by day 28. Expression of four myosin heavy chain isoforms (embryonic, neonatal, IIX and IIB), as well as desmin, correlated significantly with muscle mechanical function. Stepwise multiple regression showed that, of the variables measured, percentage content of neonatal myosin heavy chain was the best predictor of mechanical function during the postnatal time-course. These data provide the first specific structural basis for increases in muscle tension development during growth. Therefore, models of muscle growth must be modified to include an intrinsic quality enhancement component.
Ionoregulatory changes during metamorphosis and salinity exposure of juvenile sea lamprey (Petromyzon marinusL.)
Authors: Reis-Santos Patrick , McCormick Stephen D. , Wilson Jonathan M.
Published: February 2008

Ammocoetes of the anadromous sea lamprey Petromyzon marinus L. spend many years in freshwater before metamorphosing and migrating to sea. Metamorphosis involves the radical transformation from a substrate-dwelling,filter feeder into a free-swimming, parasitic feeder. In the present work we examined osmoregulatory differences between ammocoetes and transformers(metamorphic juveniles), and the effects of salinity acclimation. We measured the expression of key ion-transporting proteins[Na+/K+-ATPase, vacuolar (V)-type H+-ATPase and carbonic anhydrase (CA)] as well as a number of relevant blood parameters(hematocrit, [Na+] and [Cl–]). In addition,immunofluorescence microscopy was used to identify and characterize the distributions of Na+/K+-ATPase, V-type H+-ATPase and CA immunoreactive cells in the gill. Ammocoetes did not survive in the experiments with salinities greater than 10‰,whereas survival in high salinity (⩾25–35‰) increased with increased degree of metamorphosis in transformers. Plasma [Na+] and[Cl–] of ammocoetes in freshwater was lower than transformers and increased markedly at 10‰. In transformers, plasma ions increased only at high salinity (>25‰). Branchial Na+/K+-ATPase levels were ∼ tenfold higher in transformers compared to ammocoetes and salinity did not affect expression in either group. However, branchial H+-ATPase expression showed a negative correlation with salinity in both groups. Na+/K+-ATPase immunoreactivity was strongest in transformers and associated with clusters of cells in the interlamellar spaces. H+-ATPase (B subunit) immunoreactivity was localized to epithelial cells not expressing high Na+/K+-ATPase immunoreactivity and having a similar tissue distribution as carbonic anhydrase. The results indicate that branchial Na+/K+-ATPase and salinity tolerance increase in metamorphosing lampreys, and that branchial H+-ATPase is downregulated by salinity.
A new role for a classical gene: White transports cyclic GMP
Authors: Evans Jennifer M. , Day Jonathan P. , Cabrero Pablo , Dow Julian A. T. , Davies Shireen-Anne
Published: February 2008

Guanosine 3′-5′ cyclic monophosphate (cGMP) and adenosine 3′-5′ cyclic monophosphate (cAMP) are important regulators of cell and tissue function. However, cGMP and cAMP transport have received relatively limited attention, especially in model organisms where such studies can be conducted in vivo. The Drosophila Malpighian (renal) tubule transports cGMP and cAMP and utilises these as signalling molecules. We show here via substrate competition and drug inhibition studies that cAMP transport – but not cGMP transport – requires the presence of di-or tri-carboxylates; and that transport of both cyclic nucleotides occurs via ATP binding cassette sub-family G2 (ABCG2), but not viaABC sub-family C (ABCC), transporters. In Drosophila, the white (w) gene is known for the classic eye colour mutation. However, gene expression data show that of all adult tissues, w is most highly expressed in Malpighian tubules. Furthermore, as White is a member of the ABCG2 transporter class, it is a potential candidate for a tubule cGMP transporter. Assay of cGMP transport in w– (mutant) tubules shows that w is required for cGMP transport but not cAMP transport. Targeted over-expression of w in w– tubule principal cells significantly increases cGMP transport compared with that in w– controls. Conversely, treatment of wild-type tubules with cGMP increases w mRNA expression levels, implying that cGMP is a physiologically relevant substrate for White. Immunocytochemical localisation reveals that White is expressed in intracellular vesicles in tubule principal cells, suggesting that White participates in vesicular transepithelial transport of cGMP.
Is Routine Urine Cytology Useful in the Haematuria Clinic?
Authors: Viswanath S , Zelhof B , Ho E , Sethia K , Mills R
Published: February 2008

INTRODUCTION

The objective of this study was to determine the value of routine urine cytology in the initial evaluation of patients presenting to a one-stop haematuria clinic.

PATIENTS AND METHODS

A total of 1000 consecutive patients who attended the haematuria clinic between June 2003 and November 2004 were studied prospectively. A standard protocol was used to investigate these patients. This included urine cytology, upper tract imaging and flexible cystoscopy.

RESULTS

Overall, 986 samples of urine were sent for cytology. In 126 patients, the report was abnormal; of these, 71 patients were found to have bladder transitional cell carcinoma by flexible cystoscopy and a further 3 had upper tract transitional cell carcinoma diagnosed radiologically. The remaining 52 patients with abnormal cytology were not found to have cancer on further investigations. The total cost for urine cytology and additional investigations was £50,535.

CONCLUSIONS

In this study of the initial evaluation of patients with haematuria, no case of urothelial malignancy was diagnosed on the basis of urine cytology alone. Therefore, urine cytology need not be used routinely in the initial diagnostic workup for haematuria.
Ureteric Stent Card Register – A 5-Year Retrospective Analysis
Authors: Tang Vincent CY , Gillooly John , Lee Elaine WY , Charig Clive R
Published: February 2008

INTRODUCTION

Ureteric stenting is a common urological procedure. Forgotten stents have a well-documented morbidity and mortality. Therefore, we asked the question, is a stent register an important factor in reducing the number of lost or overdue stents?

PATIENTS AND METHODS

We conducted a retrospective review of 203 patients who had ureteric stents inserted in the operating theatre, for the 5-year period 1 December 1998 to 1 December 2003. We analysed all stent cards, patient notes and theatre logs; where no record of stent removal was found, we contacted the patient, their GP or their local hospital.

RESULTS

A total of 191 patients were identified from the stent card register. An additional 12 patients were found from the theatre logs, but with no record in the stent card register. Of the 203 patients, 8 had bilateral stents. The most common indication for stenting was stone disease. Of the 203 patients, 11 had overdue stents and 51 had no record of the stents ever being removed. The 51 presumed ‘forgotten’ stents were traced, and it was found that 42 patients had had their stents removed by other hospitals, and 9 patients died with stents in situ, but before they were due for removal.

CONCLUSIONS

Our current stent card tracking system is ineffective, because it was infrequently reviewed. However, despite overdue and ‘forgotten’ stents which were removed by other hospitals, no patients came to any real harm and we had no lost stents. Our stent register system did not appear to play any role in terms of preventing stent loss, and it seems likely that there are other more effective safeguards in place to prevent this from happening. However, if a stent register was required at all, a computerised system would be preferable. Alternatively, patients could share some of the responsibility of stent tracking with their clinicians.
The Effectiveness of Physiotherapist-Led Arthroplasty Follow-Up Clinics
Authors: Walton MJ , Walton JC , Bell M , Scammell BE
Published: February 2008

INTRODUCTION

The conventional job descriptions of professionals within the NHS need to evolve in order to meet increasingly stringent targets and demands. One innovation is the introduction of a physiotherapist-led arthroplasty follow-up clinic. We present an audit of 1000 appointments to this clinic.

PATIENTS AND METHODS

A total of 865 patients were seen with 933 arthroplasties over an 8-month period; 135 appointments were not attended. Prospective data were collected at each attendance.

RESULTS

Less than 7.5% of patients required re-referral to an orthopaedic consultant, of which 36% were for consideration for further joint replacement. The cost of a physiotherapy appointment was £4.97 compared to £5.04 for a traditional orthopaedic assessment. By reducing the number of follow-up patients seen in orthopaedic clinics, we estimate that each consultant would be able to see two additional new patients per week.

CONCLUSIONS

Assessment of arthroplasty follow-up outside of the traditional orthopaedic clinic setting is a time-effective alternative; however, the cost-benefit and educational impact is less clear.
Short-Term Results of Musculotendinous Release for Paralytic Hip Subluxation in Children with Spastic Cerebral Palsy
Authors: Bishay Sherif NG
Published: February 2008

INTRODUCTION

Children with paralytic hip subluxation secondary to spastic cerebral palsy were treated with a standard protocol that depended on early detection of the subluxation using clinical examination detecting limited range of hip abduction of ≤ 30° and anteroposterior pelvis radiographs detecting subluxation ≥ 33% migration as indications.

PATIENTS AND METHODS

Patients underwent open adductor longus, proximal gracilis and proximal rectus femoris myotomy, and iliopsoas lengthening with immediate postoperative immobilisation in abduction bar for 3 weeks followed by physiotherapy. The protocol was applied to 50 children with a mean age of 3.6 years with 100 hips surgically corrected. Of these hips initially, 52% were mildly subluxated with ≤ 33% migration, 42% were moderately subluxated with > 33–66% migration, and 6% were severely subluxated with > 66% migration.

RESULTS

At a final postoperative follow-up of at least 24 months, 22% of these hips were classified as excellent with full containment and no migration, 54% were good with < 20% migration, and 24% were fair with 20–25% migration. No poor result with > 25% migration was obtained. No child developed an abduction contracture or wide-based gait that required treatment.

CONCLUSIONS

Early detection and application of this treatment algorithm for children with spastic hip disease should have satisfactory outcomes. Longer follow-up will be required to determine how many children will need bony reconstruction to maintain stable containment of hips at maturity.
Noise Pollution on an Acute Surgical Ward
Authors: McLaren Emma , Maxwell-Armstrong Charles
Published: February 2008

INTRODUCTION

This study was undertaken to measure and analyse noise levels over a 24-h period on five general surgical wards.

PATIENTS AND METHODS

Noise levels were measured on three wards with four bays of six beds each (wards A, B and C), one ward of side-rooms only (ward D) and a surgical high dependency unit (ward E) of eight beds. Noise levels were measured for 15 min at 4-hourly intervals over a period of 24 h midweek. The maximum sound pressure level, baseline sound pressure level and the equivalent continuous level (LEq) were recorded. Peak levels and LEq were compared with World Health Organization (WHO) guidelines for community noise. Control measurements were taken elsewhere in the hospital and at a variety of public places for comparison.

RESULTS

The highest peak noise level recorded was 95.6 dB on ward E, a level comparable to a heavy truck. This exceeded all control peak readings except that recorded at the bus stop. Peak readings frequently exceeded 80 dB during the day on all wards. Each ward had at least one measurement which exceeded the peak sound level of 82.5 dB recorded in the supermarket. The highest peak measurements on wards A, B, C and E also exceeded peak readings at the hospital main entrance (83.4 dB) and coffee shop (83.4 dB). Ward E had the highest mean peak reading during the day and at night – 83.45 dB and 81.0 dB, respectively. Ward D, the ward of side-rooms, had the lowest day-time mean LEq (55.9 dB). Analysis of the LEq results showed that readings on ward E were significantly higher than readings on wards A, B and C as a group (P = 0.001). LEq readings on ward E were also significantly higher than readings on ward D (P < 0.001). Day and night levels differ significantly, but least so on the high dependency unit.

CONCLUSIONS

The WHO guidelines state that noise levels on wards should not exceed 30 dB LEq (day and night) and that peak noise levels at night should not exceed 40 dB. Our results exceed these guidelines at all times. It is likely that these findings will translate to other hospitals. Urgent measures are needed to rectify this.
D-Dimer in the Diagnosis of Deep Vein Thrombosis Following Total Hip and Knee Replacement: A Prospective Study
Authors: Rafee A , Herlikar D , Gilbert R , Stockwell RC , McLauchlan GJ
Published: February 2008

INTRODUCTION

The merit of using D-dimer estimations in patients following total hip and knee replacement has been previously questioned. A survey of radiology protocols in 70 hospitals ascertained that the test continues to be mandatory in 51 prior to formal radiological investigation of suspected deep vein thrombosis (DVT) in this patient population.

PATIENTS AND METHODS

In this study, D-dimer levels were measured pre-operatively and during the first 7 days following primary total hip and knee replacement to estimate the range of normal values in these patients.

RESULTS

All 78 patients were ultrasonographically shown to be clear of DVT. D-Dimer levels were significantly raised in all patients at all measurements during the first week. Levels after total knee replacement were higher than after total hip replacement. Comparison was made with an age-matched group who had a proven DVT. There was no difference in D-dimer levels between patients with or without a DVT.

CONCLUSIONS

The use of this test in this patient group is a waste of resource and merely delays appropriate radiological investigation and treatment.
Thorascopic Sympathectomy Performed Using Laser
Authors: Black SA , Taylor FGM , Russell MH , Ariga R , Thomas MH
Published: February 2008

INTRODUCTION

Thorascopic sympathectomy is accepted as an effective treatment for palmar hyperhidrosis, facial blushing and to a lesser extent for digital ischaemia and axillary hyperhidrosis.

PATIENTS AND METHODS

Data were collected retrospectively on patients undergoing thorascopic sympathectomy at St Peter's Hospital between 1987 and 2006. Patients were followed up by telephone interview.

RESULTS

A total of 233 thorascopic sympathectomy procedures were performed by a single operator in 123 patients. Ages ranged from 9–71 years and 75 were women. In patients, 105 had a bilateral and 13 a unilateral procedure, 5 patients had a bilateral procedure performed in two stages. In 6 upper limbs, the procedure could not be done. Overall, 110 patients (90%) had the procedure performed for palmar hyperhidrosis, 8 (6%) for facial blushing and in 5 (4%) patients the operation was performed for digital ischaemia with tissue loss. There were no deaths and all patients were discharged on day 1 following the procedure. Complications included bleeding (2), pulmonary oedema (1) and failed procedure (2); however, no incidences of Horner's syndrome occurred. Only 40 of 123 (32.5%) patients gave follow-up information. Of this small group, 33 of 40 (83%) were cured, 4 of 40 (10%) were better, 2 of 40 (5%) were unchanged and 1 patient was worse. Only 22 out of 40 (55%) of these patients were troubled by compensatory sweating, with only 4 of 40 (10%) reporting this as a major problem.

CONCLUSIONS

Thorascopic sympathectomy is safe and can be carried out as a single bilateral procedure in the majority of cases. The laser allows the use of a single port, requires less dissection than surgical or clipping techniques, is more precise than diathermy and may be less likely to cause a Horner's syndrome.
Future of Vascular Surgical Training: The Trainees' Views
Authors: Richards Toby , Jones Keith
Published: February 2008

INTRODUCTION

In the UK, surgical training includes all aspects of general surgery. Vascular surgery is not an independent specialty. We wished to assess the views of vascular trainees in UK on the future of vascular surgery and training.

MATERIALS AND METHODS

Trainees were surveyed in 2003, 2004 (after introduction of the European Working Time Directive) and 2005, concentrating on four areas – future practise of vascular surgery, role of endovascular training, vascular specialisation and future training.

RESULTS

The majority of trainees want to practise vascular surgery alone. In 2003, 80% thought training should include endovascular techniques. By 2005, all trainees regarded training as mandatory as endovascular techniques would represent a significant part of their future work. Opinion changed on training; from 4 years general then 2 years vascular surgery (qualification in general surgery) to 2 years general and 4 years vascular surgery (specialist qualification in vascular surgery; P < 0.0001). Opinion also changed, that vascular surgery should spilt from general surgery to form its own speciality (P < 0.0007).

CONCLUSIONS

Trainees now regard training in endovascular techniques and endovascular aneurysm repair as mandatory. The majority wish to specialise from general surgery and achieve a separate qualification in vascular surgery.
EDTA in Dried Blood Spots Leads to False Results in Neonatal Endocrinologic Screening
Authors: Holtkamp Ute , Klein Jeanette , Sander Johannes , Peter Michael , Janzen Nils , Steuerwald Ulrike , Blankenstein Oliver
Published: February 2008

Background: Blood samples for neonatal screening for inborn errors of metabolism are collected and shipped on standardized filter paper cards. Occasionally these samples are contaminated with EDTA, which is often used for anticoagulation. EDTA may interfere with newborn screening tests based on lanthanide fluorescence and thus lead to false-negative or false-positive results.

Methods: We used tandem mass spectrometry (MS/MS) to detect EDTA in dried blood spots by use of an extra experiment that was integrated into the standard MS/MS neonatal screening and did not require an additional sample spot, nor extra time or work. We analyzed the influence of different blood sampling procedures on lanthanide fluorescence tests for thyroid-stimulating hormone (TSH) and 17-hydroxyprogesterone (17-OHP).

Results: EDTA was increased in 138 of 190 000 newborn screening samples, 27 of which caused false- positive results in the immunoassay for 17-OHP. No false-negative TSH results were found. False-positive results in the 17-OHP test occurred when EDTA concentrations were >2.0 g/L; the TSH test, however, produced false negatives only when EDTA concentrations were >3.0 g/L. Using EDTA-containing devices the procedure of blood collection significantly influenced the concentration of the anticoagulant.

Conclusion: Addition of EDTA quantification into standard MS/MS tests is a simple and useful method to avoid false-positive or false-negative neonatal screening results in lanthanide fluorescence–based tests.
Research-Based Guidelines for Designing Blended Learning
Authors: Sims Dana E. , Burke C. Shawn , Metcalf David S. , Salas Eduardo
Published: February 2008

FEATURE AT A GLANCE: Today's organizations exist in an ever-changing, global, knowledge-based environment. As such, they expect employees to rapidly gain new knowledge, skills, and abilities (KSAs) to ensure the organization's viability. Blended learning, which evolved from e-learning, has been offered as one means to support employee development and organizational viability. A review of the literature makes it clear that most guidance offered to practitioners has focused on the “bells and whistles” of the technology rather than the pedagogical value of blended learning. We offer 10 research-based guidelines to aid in the development of blended learning courses that are theoretically sound, engage trainees, and lead to effective learning outcomes.
Effect of Skin Barrier Therapy on Neonatal Mortality Rates in Preterm Infants in Bangladesh: A Randomized, Controlled, Clinical Trial
Authors: Darmstadt Gary L. , Saha Samir K. , Ahmed A.S.M. Nawshad Uddin , Ahmed Saifuddin , Chowdhury M.A.K. Azad , Law Paul A. , Rosenberg Rebecca E. , Black Robert E. , Santosham Mathuram
Published: February 2008

OBJECTIVE. Skin barrier therapy during the neonatal period, when the skin barrier is most highly compromised and the risk of death is greatest, has been shown to have a number of potential benefits, including reduced risk of nosocomial sepsis. Topical application of emollients that augment skin barrier function was evaluated as a strategy for improving survival rates among hospitalized preterm infants in Bangladesh.

METHODS. A prospective, randomized, controlled, clinical trial was conducted in the special care nursery at Dhaka Shishu (Children) Hospital, the largest tertiary care children's hospital in Bangladesh. Preterm infants (gestational age: ≤33 weeks; N = 497) received daily topical applications of sunflower seed oil or Aquaphor ointment. Neonatal mortality rates were compared in an intent-to-treat analysis with a control group that did not receive emollient therapy.

RESULTS. Treatment with sunflower seed oil resulted in a statistically significant 26% reduction in mortality rates, compared with infants not receiving topical emollient therapy. Aquaphor therapy also significantly reduced mortality rates, by 32%.

CONCLUSIONS. Topical therapy with skin barrier-enhancing emollients improved survival rates among preterm hospitalized infants in Bangladesh. This study provides strong evidence for the implementation of topical therapy for high-risk preterm neonates in developing countries.
Association of Hypoalbuminemia With the Presence and Size of Pleural Effusion in Children With Pneumonia
Authors: Prais Dario , Kuzmenko Elena , Amir Jacob , Harel Liora
Published: February 2008

OBJECTIVE. Hypoalbuminemia is a common finding in children with massive parapneumonic pleural effusion; however, its incidence and pathogenesis are unclear. The objective of this study was to assess the presence and severity of hypoalbuminemia in children with parapneumonic pleural effusion and to propose a possible pathophysiologic mechanism.

METHODS. The clinical charts of patients who were hospitalized in a tertiary pediatric center with bacterial pneumonia complicated by pleural effusion were reviewed. The volume of pleural fluid was assessed semiquantitatively and categorized as small, moderate, or large. The lowest serum albumin level was recorded, and caloric intake and protein loss were evaluated. Findings were compared with age- and gender-matched children who had bacterial pneumonia without pleural effusion and with children who had acute illnesses other than pneumonia.

RESULTS. Of the 50 patients in the study group, 15 (30%) had small effusions, 16 (32%) had moderate effusions, and 19 (38%) had large effusions. Moderate-to-severe hypoalbuminemia was found in 52% of the study group, 6% of the patients with pneumonia without pleural effusion, and none of the patients with other illnesses. Mean serum albumin level was lower in patients with large pleural effusions than in patients with small effusions (2.66 ± 0.37 vs 3.66 ± 0.47 g/dL). There was no evidence of albumin loss or significant malnutrition. Estimation of the amount of albumin in the drained pleural fluid suggested an albumin shift from blood to pleural fluid.

CONCLUSIONS. Significant hypoalbuminemia is common in children with parapneumonic pleural effusion. Large effusions are associated with low serum albumin levels, which might be explained in part by a shift from blood to pleural fluid.
High-Concentration Nitrous Oxide for Procedural Sedation in Children: Adverse Events and Depth of Sedation
Authors: Babl Franz E. , Oakley Ed , Seaman Cameron , Barnett Peter , Sharwood Lisa N.
Published: February 2008

OBJECTIVE. Nitrous oxide is an attractive agent for procedural sedation and analgesia in the emergency department; however, there are limited safety data for high-concentration continuous-flow nitrous oxide (50%–70%) and its use in young children. We set out to characterize the depth of sedation and incidence of adverse events associated with various concentrations of nitrous oxide used in a pediatric emergency department.

METHODS. This was a prospective observational study of nitrous oxide use for procedural sedation and analgesia in a tertiary children's hospital emergency department. Nitrous oxide concentration, adverse events, and sedation depth were recorded. Adverse events were categorized as mild or serious. Sedation depth was recorded on a sedation scale from 0 to 6.

RESULTS. A total of 762 patients who were aged 1 to 17 years received nitrous oxide during the 2-year study period. A total of 548 (72%) received nitrous oxide 70%, and 101 (13%) received nitrous oxide 50%. Moderate or deep sedation with scores of ≤2 occurred in 3% of patients who had received nitrous oxide 70% and no patients who had received nitrous oxide 50%. Mean sedation scores were 4.4 at nitrous oxide 70% and 4.6 at nitrous oxide 50%. Sixty-three (8.3%) patients sustained 70 mild and self-resolving adverse events, most of which were vomiting (5.7%); 2 (0.2%) patients had serious adverse events. There was no significant difference in adverse events rates between nitrous oxide 70% (8.4%) and nitrous oxide 50% (9.9%). There was no significant difference in the percentage of deep sedation when children who were ≤3 years of age (2.9%) were compared with older children (2.8%).

CONCLUSIONS. In this largest prospective emergency department series, high-concentration continuous-flow nitrous oxide (70%) was found to be a safe agent for procedural sedation and analgesia when embedded in a comprehensive sedation program. Nitrous oxide also seems safe in children aged 1 to 3 years.
Prevalence of Hepatopulmonary Syndrome in Children
Authors: Noli Khalid , Solomon Melinda , Golding Fraser , Charron Martin , Ling Simon C.
Published: February 2008

OBJECTIVE. The hepatopulmonary syndrome is defined as a triad of liver disease, hypoxemia, and intrapulmonary vascular dilation. The reported prevalence of hepatopulmonary syndrome in adults with cirrhosis ranges from 4% to 29%; however, the prevalence of hepatopulmonary syndrome and its outcome in children is unknown. The objective of this study was to describe prospectively the prevalence of intrapulmonary vascular dilation and hepatopulmonary syndrome in children with liver disease.

METHODS. Pulse oximetry was undertaken in children with liver disease, and those with oxygen saturation ≤97%, those with cirrhosis, and those with clinically severe portal hypertension from other causes underwent contrast-enhanced echocardiography for detection of intrapulmonary vascular dilations. Patients with intrapulmonary vascular dilation underwent arterial blood gas analysis and technetium-99m–labeled macroaggregated albumin scan.

RESULTS. Oxygen saturation was measured in 301 children and was ≤97% in 8. These 8 and an additional 18 patients with cirrhosis or portal hypertension underwent contrast-enhanced echocardiography. Seven (27%) patients had intrapulmonary vascular dilation detected by contrast-enhanced echocardiography; 2 of these patients had abnormal arterial blood gas analysis and thus met diagnostic criteria for hepatopulmonary syndrome (representing 8% of patients with cirrhosis or severe portal hypertension). Both patients with hepatopulmonary syndrome had abnormal pulse oximetry. Technetium-99m–labeled macroaggregated albumin scans for 6 patients showed a median 6.5% (range: 4%–12%) tracer uptake outside the lungs.

CONCLUSIONS. Hepatopulmonary syndrome occurs in an important minority of children with cirrhosis or severe portal hypertension. Additional studies should be undertaken to determine the importance of intrapulmonary vascular dilation without hepatopulmonary syndrome and the impact of hepatopulmonary syndrome on the outcomes of affected children.
Clinical Outcomes After an Unstructured Treatment Interruption in Children and Adolescents With Perinatally Acquired HIV Infection
Authors: Saitoh Akihiko , Foca Marc , Viani Rolando M. , Heffernan-Vacca Susan , Vaida Florin , Lujan-Zilbermann Jorge , Emmanuel Patricia J. , Deville Jaime G. , Spector Stephen A.
Published: February 2008

OBJECTIVE. An unstructured treatment interruption in children with perinatally acquired HIV infection is an issue with unresolved significance. The objective of this study was to investigate the actual prevalence and clinical outcomes of a treatment interruption in children and adolescents with perinatally acquired HIV-1 infection.

METHODS. Clinical data were analyzed for 72 children and adolescents who had HIV-1 infection and stopped their medications at 4 academic centers in the United States between January 2000 and September 2004.

RESULTS. Among 405 patients with perinatal HIV-1 infection, 72 (17.8%) experienced a treatment interruption during the observation period. The mean age of patients at the time of the treatment interruption was 12.8 years, and the mean length of the treatment interruption was 14 months. Medication fatigue was the most common reason for a treatment interruption. The CD4+ T-cell percentage nadir before the treatment interruption did not predict CD4+ T-cell percentage declines during the treatment interruption; however, the CD4+ T-cell percentage gain from nadir to the time of the treatment interruption predicted CD4+ T-cell percentage declines during the treatment interruption. During the median follow-up of 19 months (range: 6–48 months), 48 (67%) patients resumed antiretroviral medications. As expected, there was a continuous CD4+ T-cell percentage decrease and plasma HIV-1 RNA increase during the observation period. Overall, 7 (10%) patients were admitted to the hospital; 2 (3%) patients experienced an AIDS-defining illness.

CONCLUSIONS. An unstructured treatment interruption seems to be a major issue for youth with perinatally acquired HIV-1 infection. Patients who experienced the greatest rise in CD4+ T-cell percentage on treatment had the largest CD4+ T-cell percentage decline after the treatment interruption. Close monitoring is required when a treatment interruption occurs in children and adolescents with HIV infection.
Randomized, Controlled Trial of an Internet-Facilitated Intervention for Reducing Binge Eating and Overweight in Adolescents
Authors: Jones Megan , Luce Kristine H. , Osborne Megan I. , Taylor Katherine , Cunning Darby , Doyle Angela Celio , Wilfley Denise E. , Taylor C. Barr
Published: February 2008

OBJECTIVE. This study examined the efficacy of an Internet-facilitated intervention for weight maintenance and binge eating in adolescents.

METHODS. A total of 105 adolescent male and female high school students at risk for overweight (mean age: 15.1 ± 1.0 years) were randomly assigned to a 16-week online intervention, StudentBodies2-BED (n = 52), or the wait-list control group (n = 53).

RESULTS. Participants in the StudentBodies2-BED group had significantly lower BMI z scores and BMI from baseline assessment to follow-up assessment, compared with the wait-list control group. In addition, significant reductions in objective binge episodes and subjective binge episodes from baseline assessment to posttreatment assessment and from baseline assessment to follow-up assessment were observed among StudentBodies2-BED participants. The StudentBodies2-BED group also reported significantly reduced weight and shape concerns from posttreatment assessment to follow-up assessment and from baseline assessment to follow-up assessment. Participants in the StudentBodies2-BED group who engaged in objective overeating or binge eating episodes at baseline assessment experienced a significantly greater reduction in BMI at follow-up assessment, compared with the wait-list control group.

CONCLUSIONS. Results suggest that an Internet-facilitated intervention is moderately effective in short-term weight loss and weight maintenance and yields a large reduction in binge eating. This study also demonstrates that weight management and reduction of eating disorder psychopathological features can be achieved simultaneously by using an easily disseminated, Internet-facilitated program.
Asthmatic Symptoms, Physical Activity, and Overweight in Young Children: A Cohort Study
Authors: Eijkemans Marianne , Mommers Monique , de Vries Sanne I. , van Buuren Stef , Stafleu Annette , Bakker Ingrid , Thijs Carel
Published: February 2008

OBJECTIVE. Prevalence of asthma and overweight has increased simultaneously during the past decades. Several studies have reported an association between these two health problems, but it is unclear whether this relation is causal. We hypothesize that children with asthmatic symptoms are less physically active, which may contribute to the development of overweight.

PATIENTS AND METHODS. The study included children from the KOALA Birth Cohort Study who were invited at 4 to 5 years of age to wear an Actigraph accelerometer for 5 days (n = 305; 152 boys). Information on wheezing was gathered by repeated questionnaires completed by parents at child ages 7 months and 1, 2, and 4 to 5 years. Questionnaires on physical activity were completed at child age 4 to 5 years, and height, weight, and abdominal circumference were measured. Accelerometer data were expressed as mean counts per minute, minutes per day performing vigorous activity, and moderate-to-vigorous physical activity during ≥1 minute.

RESULTS. Children who had wheezed in the last 12 months showed very similar activity levels compared with children who had never wheezed. By contrast, boys who had wheezed at least once but not in the last 12 months were more physically active than boys who had never wheezed (geometric mean: 694 vs 625 cpm; adjusted geometric mean ratio: 1.11). This was not found for girls. Similar results were found in parent-reported physical activity data. No association was found between wheezing at any age and overweight at the age of 4 to 5 years.

CONCLUSIONS. These results do not support our hypothesis and previous studies that showed that wheezing children are less physically active. Our data provide no evidence that asthmatic symptoms induce a lower physical activity level and more overweight. Additional research could concentrate on the effect of physical activity and overweight on the development of asthmatic symptoms.