bluuebunny/crossref_metadata_2025 huggingface dataset:
Defining an evidence‐based work environment for nursing in the USA
Authors: Kotzer Anne Marie , Arellana Kerry
Published: May 2008

Aims.  To describe and compare staff nurses’ perceptions of their real and ideal work environment in a tertiary paediatric facility; to provide administrators with research evidence for identifying areas for improvement.

Background.  The workforce shortage of hospital nurses is a global problem having an impact on the financial resources and efficient operations of an organisation and the quality of care delivered to patients. A direct relationship exists between job satisfaction, retention, turnover and elements of the nurses’ work environment. Research identifying specific elements of the current work setting that are in conflict with nurses’ views of their preferred practice milieu can help define an evidence‐based work environment for nursing.

Design and methods.  Using a descriptive survey design, a convenience sample of 385 nurses on five inpatient units and the float team completed two forms (real and ideal) of the work environment scale. The work environment scale consists of 10 subscales within three dimensions: relationship, personal growth and system maintenance and change.

Results.  A consistent pattern was seen across all units with reported high levels of involvement, peer cohesion, task orientation and managerial control. Scores for work pressure and autonomy were moderate‐high and physical comfort, supervisor support, clarity and innovation were moderate. Overall, highest scores were reported for involvement and lowest for physical comfort. Significant differences were found between real and ideal subscale scores suggesting that staff were able to identify areas for improvement.

Conclusions.  Despite moderate work pressure, staff affirmed a highly positive work environment on their units. Specific areas in their current work setting that were not congruent with their preferred work environment were identified and targeted for change.

Relevance to clinical practice.  Understanding dimensions of the nurses’ work environment needing improvement and involving staff in making and evaluating change supports an evidence‐based environment to attract and retain qualified staff.
Development of a 32‐item scale to assess postoperative dysfunction after upper gastrointestinal cancer resection
Authors: Nakamura Misuzu , Kido Yoshihiro , Egawa Takako
Published: May 2008

Aim.  The purpose of this study was to develop a 32‐item scale to assess postoperative dysfunction in patients who underwent surgery for gastric and oesophageal cancer and to evaluate its reliability and validity.

Background.  For the objective assessment of postoperative dysfunction in patients with upper gastointestinal cancer, we performed a preliminary survey by mail using a 34‐item questionnaire as a initial version. The results of the survey were assessed by item analysis of the scale. The scale items were further refined by researchers and specialists, and a 32‐item scale for the assessment of postoperative dysfunction (initial scale) was developed.

Methods.  Using this 32‐item scale (initial scale), a mail survey was performed of 379 subjects selected by random sampling.

Results.  The questionnaire was returned by 292 patients (77·1%) and 283 responses (74·7%) were valid. Of these, 221 respondents had gastric cancer and 62 oesophageal cancer. The mean age of respondents was 64·9 SD 9·8 (range 35–89) years. The mean total score of the 32‐items on the initial version for the assessment of postoperative dysfunction was 60·8 SD 16·7. The mean total score for gastric cancer patients and oesophageal cancer patients was 58·1 SD 15·8 and 70·1 SD 16·7 respectively. After the elimination of scale items regarded as irrelevant based on statistical considerations and the judgement of experts, factor analysis was performed. Seven factors were valid: ‘regurgitation reflux’, ‘limited activity because of decreased food consumption’, ‘passage dysfunction immediately after eating’, ‘dumping‐like symptoms’, ‘transfer dysfunction’, ‘hypoglycaemic symptoms’ and ‘diarrhoea‐like symptoms’. The cumulative proportion of variance by scale reliability was confirmed by a Cronbach's α‐coefficient of 0·926. The Cronbach's α‐coefficient for all 32 items on the initial version was 0.926, the Cronbach's α‐coefficient for sub‐items was 0·705–0·856, and Pearson's correlation coefficient of re‐test for the total score of the 32 items was 0·865, which confirmed a high degree of internal consistency. The construct validity of the scale was confirmed using the known‐group technique by operative procedures, and from the result of factorial validity. This scale was named ‘Postoperative Dysfunction for Upper Gastrointestinal Cancer 32; PODUGC‐32’.

Conclusion.  This scale is sufficiently reliable and valid and will be useful clinically.

Relevance to clinical practice.  We can use the new scale to assess postoperative dysfunction in patients with upper gastointestinal cancer for nursing practice.
Quality of life in patients with right‐ or left‐sided brain tumours: literature review
Authors: Palese Alvisa , Lamanna Francesca , Di Monte Carmen , Calligaris Sonia , Doretto Mara , Criveller Michela
Published: May 2008

Aims.  To determine if patients with left‐ or right‐sided hemisphere neoplasm perceive their quality of life (QoL) differently.

Background.  It is not clear whether patients with a lesion in the left hemisphere have a different QoL than those with a lesion in the right hemisphere. (1) In the pre‐operative period, patients with a left‐sided lesion may have different symptoms according to the position of the tumour. (2) Studies on patients with brain injury demonstrate an association between left frontal lesions and depression: depression can alter the patients’ perception of QoL. (3) In the postoperative period, right‐handed patients may be disadvantaged by surgical trauma to the motor cortex in the left hemisphere. (4) During the different phases of the disease, the various functions of the two hemispheres may influence the patient's capacity to control QoL; also, as suggested by authors, both the ego and the conscience are mostly located in the left hemisphere. This is the reason that patients with a left‐sided lesion may perceive a worse QoL.

Methods.  A review of literature was carried out using the Medline database (1966–2007) and CINHAL (1982–2007), using the following Mesh Terms and key words: brain neoplasm, tumour or cancer, hemispheric dominance or laterality or right or left hemisphere, QoL.

Results.  Seven studies emerged that documented non‐homogeneous results and which included different populations. The association between QoL and the side of the lesion was evaluated.

Conclusions.  The lack of a substantial number of recent, robust follow‐up studies investigating the QoL in patients at different stages of disease and treatment indicates that more research is needed.

Relevance to clinical practice.  Understanding the QoL in patients with brain neoplasm and the differences between right and left hemisphere sites of the neoplasm can help nurses develop different interventions and offer more guidance for effective clinical intervention.
‘You don't talk about the voices’: voice hearers and community mental health nurses talk about responding to voice hearing experiences
Authors: Coffey Michael , Hewitt Jeanette
Published: May 2008

Aims and objectives.  To explore service user and community mental health nurses views on responses to voice hearing experiences.

Background.  People who hear distressing auditory hallucinations (voices) are often in contact with mental health services. Nursing responses to this experience have been limited, although emerging evidence suggests some utilitarian alternative interventions, such as discussing the content and meaning of the voices.

Design.  Using exploratory interviews, this study investigated the response to voice hearing, with a purposive sample of community mental health nurses (n = 20) and service users (n = 20). This paper reports on a thematic content analysis of transcribed interviews, which highlighted differences in perspectives of voice hearers and the nurses supporting them.

Results.  Voice hearers reported that interventions from community mental health nurses were limited to reviews of medication, access to the psychiatrist and non‐directive counselling. They identified alternative needs, which involved talking more about the content and meaning of their voices. Conversely, community mental health nurses regarded their responses to voice hearing as being considered, titrated and demonstrating an awareness of the personal contexts of service users. These responses were however restricted by their perception of skill limitations.

Conclusions.  The contrasting views of nurses and users of services demonstrated in this study, reveal multiple social realities that represent a challenge to accepted professional responses in the provision of mental health care.

Relevance to practice.  People who hear voices express an interest in more helpful responses from community mental health nurses. The findings of this study indicate that nurses must begin to orientate themselves towards a more critical practice stance that encompasses available knowledge on the voice hearing experience.
Exploring the relationship between personal control and the hospital environment
Authors: Williams Anne M , Dawson Sky , Kristjanson Linda J
Published: May 2008

Aims and objectives.  This paper describes the further development of the substantive theory Optimising Personal Control to Facilitate Emotional Comfort. In previous work, emotional comfort was identified as a therapeutic state that was influenced by several factors, one of which was the hospital environment. This paper focuses on aspects within the hospital environment that patients perceive to influence their feelings of personal control.

Background.  A relationship between control and health has been discussed in previous literature. There are indications that aspects of the hospital environment can impact on a patient's perception of control. This project explored personal control in relation to the hospital environment from the perspective of patients.

Method.  Grounded theory method was used. Data were collected from patients’ interviews and field observations and analysed using the constant comparative method. Interviews were tape‐recorded and transcribed verbatim. A qualitative data computer program was used to manage the data.

Results.  The results confirmed the findings of the original study where hospitalised patients were found to experience feelings of reduced personal control. The conditions of level of security, level of knowing and level of personal value were described in terms of their contribution to the patient's feelings of personal control.

Conclusions.  Specific directions for further research into the development and evaluation of therapeutic hospital environments that promote personal control and the associated emotional comfort are provided.

Relevance to clinical practice.  This research highlights the importance of considering patients’ feelings of personal control during their hospital stay. Several directions for establishment of therapeutic environments within hospitals are provided, but more research in this area is recommended.
Pain management: evaluating the effectiveness of an educational programme for surgical nursing staff
Authors: Lin Pi‐Chu , Chiang Hsiao‐Wen , Chiang Ting‐Ting , Chen Chyang‐Shiong
Published: May 2008

Aims and Objectives.  The purpose of this study was to assess the effectiveness of a pain management education programme in improving the nurses’ knowledge about, attitude towards and application of relaxation therapy.

Background.  Pain of surgical patients has long been an existing problem of health care. Nursing staff need to be educated continuously to develop the professional ability of pain management.

Methods.  A quasi‐study design with pre‐ and posttest and post‐ and posttest was used. Subjects were chosen from a medical centre in Taipei by convenience sampling. The total sample size of 81 was segregated into a study group of 42 and control group of 39 participants. The study group attended a seven‐session pain management programme totalling 15 hours. The control group received no pain management training. Scaled measurements were taken on pain management knowledge and attitude and relaxation therapy practice.

Results.  (1) Scores for pain management knowledge differed significantly between the two groups (F = 40·636, p = 0·001). (2) Attitudes towards pain management differed between the two groups (F = 8·328, p = 0·005) and remained stable over time (F = 1·603, p = 0·205). (3) Relaxation therapy practice differed significantly between the two groups, with the study group better than the control group (F = 4·006, p = 0·049). (4) Relaxation therapy was applied to nearly all (97·5%) of the patients cared for by study group nurses. All of the instructed patients performed this technique one to three times per day postsurgery.

Conclusions.  Continuing education can improve nurses’ knowledge about, attitude towards and behaviour of pain management.

Relevance to clinical practice.  Results of this study could be used to guide the development and implementation of continuing education programmes for nursing staff to enhance patients’ care knowledge and skills.
Assessment of the nutritional status among residents in a Danish nursing home – health effects of a formulated food and meal policy
Authors: Kuosma Kirsi , Hjerrild Joan , Pedersen Preben Ulrich , Hundrup Yrsa Andersen
Published: May 2008

Aims and objectives.  To gain information about the effects of implementation of a written food and meal policy and to evaluate to what extent systematic nutritional assessment and intervention would result in weight stability among the residents.

Background.  Studies have shown that aged residents living in institutions suffer from malnutrition or are at risk of malnutrition. Health policies have pointed out that more attention should be given to individualised nutritional care. Several techniques are available to identify malnourished nursing home residents, but very few studies have reported findings of studies based on systematic nutritional assessment.

Design and methods.  A quasi‐experimental study based on a time series design used the residents as their own controls. The study included all 20 residents who resided at the nursing home at baseline in September 2004. Five residents died during the study period (mean age 84·4 years, range 62–91 years). Altogether 15 residents (75%) were assessed all five times during the study period.

Results.  The proportion of weight‐stable residents increased significantly over the study from 52·6% (CI 99%: 23·1–80·2) at baseline to 87·7% (p < 0·01) at the end of the study. The proportion of weight losers significantly decreased from 42% (CI 99%: 23·1–80·8) to 13·3% (p < 0·01). The weight ranges indicate substantial weight changes, but over time the weight ranges became narrower, indicating a tendency towards weight stability.

Conclusions.  Although the nursing home had a formulated food and meal policy, this study shows the importance of a regular nutritional assessment combined with an individualised care planning.

Relevance to clinical practice.  Regular weighing combined with individualised care planning results in weight stability in nursing home residents. Individualised approach for nutritional care led by a qualified nurse is just as important in nursing homes as it is in hospitals.
A review of developments in medical termination of pregnancy
Authors: Lipp Allyson
Published: May 2008

Aim.  This literature review aims to supplement guidelines by providing an overview of recent evidence relevant to medical termination of pregnancy.

Background.  Termination of pregnancy is available to women in the UK within legal parameters. Although guidelines form a strong body of evidence on which nurses and midwives can base their practice, there is a need to supplement them with up‐to‐date robust research findings.

Method.  A systematic search of the literature with high sensitivity and low specificity was undertaken on five databases using medical subject headings (MeSH) terms including (medical) induced abortion, therapeutic abortion and termination of pregnancy.

Results.  The literature search revealed articles under the following headings: The importance of choice for the women involved the need for the optimal medication type, dose, route and interval between stages one and two, and the optimum place for medical termination to take place.

Conclusion.  It was found that women attach a great deal of importance to the opportunity to choose their method of termination. The first stage of mifepristone is now a standard practice and an optimum dose has been determined. Several studies examined misoprostol used in the second stage of medical termination. There was some evidence for repeated doses of misoprostol, particularly in later gestation, with conflicting evidence on the optimal route. There were some grounds for reducing the interval between stages. Consideration should be given to home medical termination based on individual circumstances and choice. Gestation and previous obstetric history is an important factor to take into account when determining optimal regimen.

Relevance to clinical practice.  The number of medical termination of pregnancies performed has risen in recent years together with the nurses’ involvement. As new research is published, it is imperative that nurses adapt to base their involvement on the best available evidence.
Predictors of life situation among significant others of depressed or aphasic stroke patients
Authors: Franzén‐Dahlin Åsa , Laska Ann‐Charlotte , Larson Jenny , Wredling Regina , Billing Ewa , Murray Veronica
Published: May 2008

Aim.  The aim of this study was to examine predictors of the life situation of the significant other of depressed or aphasic stroke patients.

Background.  Depression and aphasia are common consequences of stroke, and both may put pressure on the significant other who have to deal not only with a possible physical handicap but also with communication and/or serious psychiatric difficulties.

Design.  Descriptive, cross‐sectional study.

Methods.  The participants were significant others of 71 depressed and 77 aphasic stroke patients. Depression was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorder, and degree of aphasia was diagnosed with the Amsterdam Nijmegen Everyday Language Test. Assessments of the life situation, state of depression and aggression, personality change and need of assistance were made through questionnaires issued to the significant others.

Results.  Perceived need of assistance was the only common predictor of life situation of the significant other in both groups (p < 0·001). With respect to the aphasic patients, perceived personality change (p < 0·001) and living with the patient (p = 0·004) were factors that had a negative effect on the life situation of the significant other.

Conclusions.  This study highlights that the perception of the patient’s need of assistance is an important factor in predicting the life situation among spouses of depressed as well as aphasic stroke patients. A comparison of the two groups to explain the life situation of the significant others revealed greater explanatory power for the aphasic group.

Relevance to clinical practice.  Assessments of the spouses’ perception as well as of the patients’ factual situation may identify those significant others at risk. With this new approach, necessary steps may be taken to alleviate pressure on the significant other.
District nurses’ involvement in pain care: a theoretical model
Authors: Blomberg Anne‐Marie , Hylander Ingrid , Törnkvist Lena
Published: May 2008

Aim.  To explore district nurses care of chronic pain sufferers and to create a theoretical model that can explain the variation in district nurses experiences when caring for these patients.

Background.  Many people suffer from chronic pain, which greatly affects their wellbeing and causes physical suffering and psychosocial limitations. District nurses frequently meet patients who suffer from chronic pain and consequent problems. District nurses often feel powerless and ill‐equipped, and they experience difficulties during interactions with these patients.

Method.  This is a qualitative study with a theory‐generating approach. Data were collected from interviews with 20 district nurses in five focus groups. Interviews were taped, transcribed and then analysed as per the grounded theory method.

Results.  The result is a theoretical model of district nurses’ involvement in pain care. The model: (1) illustrates three main conditions in the care situation that influence district nurses’ involvement in pain care and (2) explains the connection between how district nurses actively or passively detect and actively or passively respond to patients with pain problems.

Conclusions.  The model explains why district nurses sometimes feel powerless or ill‐equipped in dealing with chronic pain problems. Insufficient conditions make it difficult for district nurses to become involved with pain problems and thus result in passive detection of and passive response to pain problems. Supporting patients to communicate their pain, collaboration with and involvement from other professionals regarding pain care, the organisation’s guidelines and support for pain care and training in pain care are interventions that will contribute to district nurses’ involvement in pain care.

Relevance to clinical practice.  Through the model, chronic pain care can be better explained and understood; consequently chronic pain care can be improved. The model can be used in each, unique, case‐study analysis. Nursing staff and students can also use the model as a basis for discussions about chronic pain sufferers.
Assessment of body image in obesity using a digital morphing technique
Authors: Johnstone A. M. , Stewart A. D. , Benson P. J. , Kalafati M. , Rectenwald L. , Horgan G.
Published: May 2008

Background  Historically, body image research has relied on generic, whole body outlines, which may not be suited to obese individuals. The development of computer generated, individualized digital images to represent body image may be more effective.

Methods  Sixty volunteers participated, with three categories of subject: lean, obese and lean regular exercisers. Body image was assessed using a digital morphing technique in comparison to two standard paper questionnaires.

Results  Using the novel digital morphing tool, obese subjects displayed poorer body awareness (perception) than their lean counterparts (P = 0.03), significantly over‐estimating their actual body size. Both genders overestimated body size to a similar degree. For body satisfaction, females wished to be smaller and males to be larger, identifying gender‐specific body regions (P < 0.001). Obese subjects showed greatest dissatisfaction (P < 0.001) with body image. There was significant correlation for body image dissatisfaction (P < 0.05) between the digital technique and the questionnaires, which was highest for the figural stimuli questionnaire (r = 0.80, P < 0.001).

Conclusions  This method represents a novel and alternative approach to rating body image perception (IP) and satisfaction in obese subjects, particularly providing data on specific regional areas. Body image dissatisfaction appears to be both due to poor body IP compounded with the desire to be smaller.
Body fat distribution, serum glucose, lipid and insulin response to meals in Alström syndrome
Authors: Paisey R. B. , Hodge D. , Williams K.
Published: May 2008

Background  Alström syndrome is an autosomal recessive condition characterized by obesity, insulin resistance and hypertriglyceridaemia. Responses to fat and carbohydrate ingestion are important in planning dietetic advice and may help to explain the mechanism of metabolic disorder in the syndrome.

Methods  After a 12‐h fast, five Alström subjects received a 3.1 MJ (742 kcal), 75.8% fat breakfast on day 1, and a 3.3 MJ (794 kcal), 77.5% carbohydrate breakfast on day 2. Serum glucose, triglyceride and insulin levels were measured at baseline, and 2 and 3.5 h post‐meal. Abdominal computerized tomography in three subjects and magnetic resonance imaging in one demonstrated distribution of abdominal fat.

Results  Body fat was distributed subcutaneously, as well as viscerally. There were no changes in serum glucose, insulin or triglycerides after the high fat meal. Triglycerides remained stable after the high carbohydrate meal but glucose and log insulin levels increased [8.4 ± 4.1 to 13.4 ± 6.9 mmol L−1 (P < 0.05) and 2.6 ± 0.27 to 3.15 ± 0.42 pmol L−1 (P < 0.05), respectively].

Conclusions  Dietetic advice in Alström syndrome must include calorie restriction to reduce obesity, which is predominantly subcutaneous. This study has shown that low carbohydrate advice may prove more effective than fat restriction in control of hyperglycaemia and hyperinsulinism. A single high energy meal does not exacerbate hypertriglyceridaemia.
A study of the attitudes and perceived barriers to undertaking clinical governance activities of dietitians in a Welsh National Health Service trust
Authors: Shakeshaft A. M.
Published: May 2008

Background  Previous studies of National Health Service (NHS) employees have identified barriers to undertaking clinical governance activities. Little of this research has investigated dietitians; however, where dietitians were included, generally positive attitudes towards research and evidence‐based practice were reported alongside the identified barriers.

Methods  A quantitative, whole population census was undertaken via a questionnaire distributed to 54 dietitians employed by Gwent Healthcare NHS Trust.

Results  Dietitians reported positive attitudes towards clinical governance; however, barriers to undertaking clinical governance activities were identified. The main barriers included lack of time, inadequate funding, the view that direct patient care should always be prioritised over clinical governance activities and inadequate research and critical evaluation skills.

Conclusions  Findings were similar to those reported in previous studies of NHS staff. Where comparison was possible, all of the barriers identified were reported at lower levels than in previous studies. As the study was purely quantitative in nature, no understanding was gained regarding the nature of identified barriers or what factors influenced the dietitians’ attitudes and perceptions. For further in‐depth analysis of these factors, a qualitative study is recommended. As the study comprised a whole population census, the findings cannot be generalized to the dietetic profession as a whole, or to other staff groups within or outside of the study Trust.
Gastrointestinal inflammation: lessons from metabolic modulators
Authors: Arulampalam V.
Published: May 2008

The link between inflammation and metabolism was apparent already early last century, but has recently been revitalized following molecular studies of artherosclerosis, obesity and insulin resistance. A growing list of nuclear receptors, pivotal players in lipid, xenobiotic and energy metabolism has been identified as having immunomodulatory functions. These receptors might hold the key to some of the questions pertinent to chronic inflammation, and can lend themselves to be manipulated as therapeutic agents. This review will attempt to appraise the importance of such mediators in the pathophysiology of chronic inflammation in the colon.
Hepatitis C in ethnic minority populations in England
Authors: Mann A. G. , Trotter C. L. , Adekoyejo Balogun M. , Ramsay M. E.
Published: May 2008

Summary.  The aim of the study was to investigate the differing epidemiology of hepatitis C‐related end‐stage liver disease in ethnic minorities in England. We used Hospital Episode Statistics from 1997/98 to 2004/05 to directly age‐standardize numbers of episodes and deaths from hepatitis C‐related end‐stage liver disease in ethnic groups using the white English population as standard and the age‐structured population by ethnic group from the 2001 Census. We estimated the odds of having a diagnosis of end‐stage liver disease amongst hepatitis C‐infected individuals in each ethnic group compared with whites using logistic regression. The main outcome measures were age‐standardized morbidity and mortality ratios and morbidity and mortality odds ratios. Standardized ratios (95% confidence interval) for hepatitis C‐related end‐stage liver disease ranged from 73 (38–140) in Chinese people to 1063 (952–1186) for those from an ‘Other’ ethnic group. Amongst individuals with a diagnosis of hepatitis C infection, the odds ratios (95% CI) of severe liver disease were 1.42 (1.13–1.79), 1.57 (1.36–1.81), 2.44 (1.85–3.22), 1.73 (1.36–2.19) and 1.83 (1.08–3.10) comparing individuals of Black African, Pakistani, Bangladeshi, Indian and Chinese origin with whites, respectively. Ethnic minority populations in England are more likely than whites to experience an admission or to die from severe liver disease as a result of hepatitis C infection. Ethnic minority populations may have a higher prevalence of hepatitis C or they may experience a poorer prognosis because of differential access to health services, longer duration of infection or the prevalence of co‐morbidities.
In vitro effect of thymosin‐alpha1 and interferon‐alpha on Th1 and Th2 cytokine synthesis in patients with eAg‐negative chronic hepatitis B
Authors: Loggi E. , Gramenzi A. , Margotti M. , Cursaro C. , Galli S. , Vitale G. , Grandini E. , Scuteri A. , Vukotic R. , Andreone P. , Bernardi M.
Published: May 2008

Summary.  Thymosin alpha‐1 (Tα1) has been shown to be effective in chronic hepatitis B treatment. This study investigated the effect of Tα1 and interferon‐alpha (IFNα) on cytokine production by peripheral blood mononuclear cells (PBMCs) of 12 patients with eAg‐negative chronic hepatitis B (HBV). We evaluated the effect of incubation with Tα1, IFNα or both on the synthesis of T‐helper 1 (Th1) cytokines [interleukin‐2 (IL‐2), IFNγ] and Th2 cytokines (IL‐4, IL‐10) and of antiviral protein 2′,5′‐oligoadenylate synthetase (2′,5′‐OAS) in patients and in a group of 10 healthy controls. Concerning Th1 profile, controls showed lower IL‐2 synthesis than HBV patients. In HBV setting, IFNα/Tα1 combination was able to increase IL‐2 production significantly, when compared with baseline condition. About the Th2‐cytokines, controls showed statistically lower synthesis of IL‐4 and higher production of IL‐10, than HBV patients. In these latter, IFNα increased the synthesis of IL‐10 compared with baseline. Interestingly, both Tα1 alone and the IFNα/Tα1 combination reversed this effect. Finally, compared with baseline, the synthesis of 2′,5′‐OAS was significantly higher in the presence of Tα1 and IFNα alone, and in the presence of IFNα/Tα1 association, while no differences were found between controls and HBV patients. In conclusion, in PBMCs from eAg‐negative HBV patients, Tα1 alone was able to increase the antiviral protein synthesis, while in association with IFNα, it stimulated the IL‐2 synthesis and inhibited the IFN‐induced IL‐10 production. These results need further investigations, but reinforce the idea of an immunotherapeutic approach for chronic hepatitis B.
Liver fibrosis on account of chronic hepatitis C is more severe in HIV‐positive than HIV‐negative patients despite antiretroviral therapy
Authors: De Lédinghen V. , Barreiro P. , Foucher J. , Labarga P. , Castéra L. , Vispo M. E. , Bernard P.‐H. , Martin‐Carbonero L. , Neau D. , García‐Gascó P. , Merrouche W. , Soriano V.
Published: May 2008

Summary.  The recent availability of non‐invasive tools to measure liver fibrosis has allowed examination of its extent and determination of predictors in all patients with chronic hepatitis C virus (HCV) infection. On the other hand, most information on hepatic fibrosis in HCV/human immunodeficiency virus (HIV)‐coinfected patients has been derived from liver biopsies taken before highly active antiretroviral therapy (HAART) was widely available. All consecutive HCV patients with elevated aminotransferases seen during the last 3 years were evaluated and liver fibrosis measured using transient elastography (FibroScan®) and biochemical indexes. Patients were split according to their HIV serostatus. A total of 656 (69.6%) HCV‐monoinfected and 287 (30.4%) HIV/HCV‐coinfected patients were assessed. Mean CD4 count of coinfected patients was 493 cells/μL and 88% were under HAART (mean time, 4.2 ± 2.4 years). Advanced liver fibrosis or cirrhosis was recognized in 39% of the coinfected and 18% of the monoinfected patients (P < 0.005). A good correlation was found between FibroScan® and biochemical indexes [AST to platelet ratio index (r = 0.405, P < 0.0001), FIB‐4 (r = 0.393, P < 0.0001) and Forns (r = 0.407, P < 0.0001)], regardless of the HIV status. In the multivariate analysis, age >45 years, body mass index (BMI) >25 kg/m2, and HIV infection were independently associated with advanced liver fibrosis or cirrhosis. HIV/HCV‐coinfected patients have more advanced liver fibrosis than HCV‐monoinfected patients despite the immunologic benefit of HAART.
Indomethacin improves locomotor deficit and reduces brain concentrations of neuroinhibitory steroids in rats following portacaval anastomosis
Authors: Ahboucha S. , Jiang W. , Chatauret N. , Mamer O. , Baker G. B. , Butterworth R. F.
Published: May 2008

Abstract  Hepatic encephalopathy (HE) is a neuropsychiatric complication of both acute and chronic liver failure characterized by progressive neuronal inhibition. Some neurosteroids are potent positive allosteric modulators of the gamma‐aminobutyric acid (GABA)‐A receptor complex, and ‘increased GABAergic tone’ has been proposed to explain the neuroinhibition characteristics of HE. Brain levels of the neurosteroids pregnenolone, allopregnanolone and tetrahydrodesoxycorticosterone (THDOC) and the functional status of the GABA‐A receptor complex were assessed in rats following portacaval anastomosis (PCA). Effects of indomethacin, an inhibitor of the 3α‐hydroxysteroid dehydrogenase enzyme involved in neurosteroid synthesis, on PCA rat locomotor activity and brain neurosteroid levels were also assessed. Significant increases of the neurosteroid pregnenolone (2.6‐fold), allopregnanolone (1.7‐fold) and THDOC (4.7‐fold) were observed in brains of PCA rats. Brain levels of these neurosteroids were in the nanomolar range, sufficient to exert positive allosteric modulatory effects at the GABA‐A receptor. Indomethacin (0.1–5 mg kg−1) ameliorated dose‐dependently the locomotor deficit of PCA rats and concomitantly normalized brain levels of allopregnanolone and THDOC. Increased brain levels of neurosteroids with positive allosteric modulatory actions at the neuronal GABA‐A receptor offer a cogent explanation for the notion of ‘increased GABAergic tone’ in HE. Pharmacological approaches using agents that either reduce neurosteroid synthesis or modulate the neurosteroid site on GABA‐A receptor could offer new therapeutic tools for the management and treatment of HE.
Acotiamide hydrochloride (Z‐338), a novel prokinetic agent, restores delayed gastric emptying and feeding inhibition induced by restraint stress in rats
Authors: Seto K. , Sasaki T. , Katsunuma K. , Kobayashi N. , Tanaka K. , Tack J.
Published: May 2008

Abstract Acotiamide hydrochloride (Z‐338) is a member of new class prokinetic agents currently being developed for the treatment of functional dyspepsia (FD). DNA microarray analysis showed that acotiamide altered the expressions of stress‐related genes such asγ‐aminobutyric acid (GABA) receptors, GABA transporters and neuromedin U (NmU) in the medulla oblongata or hypothalamus after administration of acotiamide. Therefore, effects of acotiamide on stress‐related symptoms, delayed gastric emptying and feeding inhibition, in rats were examined. Acotiamide significantly improved both delayed gastric emptying and feeding inhibition in restraint stress‐induced model, but did not affect both basal gastric emptying and feeding in intact rats, indicating that acotiamide exerted effects only on gastric emptying and feeding impaired by the stress. On the other hand, mosapride showed significant acceleration of gastric emptying in intact and restraint stress‐induced model, and itopride showed no effect on restraint stress‐induced delayed gastric emptying. In addition, gene expression of NmU increased by restraint stress was suppressed by administration of acotiamide, while acotiamide had no effect on delayed gastric emptying induced by an intracerebroventricular administration of NmU, suggesting that the suppressive effect of acotiamide on gene expression of NmU might be important to restore delayed gastric emptying or feeding inhibition induced by restraint stress. These findings suggest that acotiamide might play an important role in regulation of stress response. As stress is considered to be a major contributing factor in the development of FD, the observed effects may be relevant for symptom improvement in FD.
‘SPRAWLING’: A NEW MUTANT MOUSE WITH FAILURE OF MYELINATION OF SENSORY AXONS AND A DEFICIENCY OF MUSCLE SPINDLES
Authors: DUCHEN L. W.
Published: May 2008

A new neurological mutant mouse ‘Sprawling’ was studied and this paper presents some of its clinical and pathological features. The disorder is transmitted by a dominant gene (symbol Swl) and when fully developed is characterized by an ataxia and defective position sense chiefly affecting the hind limbs. The main pathological abnormalities were found in both central and peripheral branches of the axons of sensory ganglion cells. The sensory roots, dorsal columns of the spinal cord and the peripheral nerves showed a deficiency of myelinated axons. This abnormality was more severe caudally than rostrally. No evidence for axonal degeneration or regeneration was present yet sensory ganglion cells showed marked chromatolysis which persisted throughout the life of the animal. There was a severe deficiency of sensory receptors and spindles were virtually absent from the hind limb and paw muscles. It seems likely that this inherited disorder of the nervous system is due to a failure in the maturation and myelination of sensory axons with a secondary failure in the development of muscle spindles and other receptors which are dependent on their sensory innervation for normal differentiation.
MUSCLE TRANSPLANTATION BETWEEN NORMAL AND DYSTROPHIC MICE. 1. HISTOLOGICAL STUDIES
Authors: NEERUNJUN J. S. , DUBOWITZ V.
Published: May 2008

Minced normal and dystrophic tibialis anterior muscles were transplanted into normal and dystrophic mice in the presence or absence of the peroneal nerve. Transplants were examined at intervals ranging from 0 to over 300 days in normal hosts and 0 to 200 days in dystrophic hosts. In the first 10 days after tranriplantation all muscle minces underwent degeneration followed by proliferation of precursor cells of connective tissue and muscle. By 8 days, myotubes with internal nuclei were abundant. Further differentiation of myotubes into muscle fibres occurred only in normal hosts with an intact peroneal nerve. Transplants in dystrophic mice, and in normal mice in which the peroneal nerves were capped with polydimethyl silicone rubber, underwent progressive degeneration, and by 100 days consisted mainly of connective tissue and fat. In normal hosts innervated dystrophic transplants were histologically similar to auto‐ and homotransplants of normal muscle. A significant population of regenerated fibres in normal and dystrophic transplants showed internal nuclei, variation in size and splitting, and were smaller in diameter than those from intact normal muscles. Since normal and dystrophic transplants failed to survive in the dystrophic hosts and in the denervated state in normal mice, it is suggested that the failure of dystrophic mice to maintain minced muscle transplants may be due to an inherent inability of dystrophic nerves to establish functional neuromuscular contact with these transplants.
SOME DYNAMIC ASPECTS OF BRAIN METABOLISM IN RATS GIVEN A PORTOCAVAL ANASTOMOSIS
Authors: CREMER JILL E. , HEATH D. F. , TEAL HAZEL M. , WOODS MARGARET S. , CAVANAGH J. B.
Published: May 2008

Some dynamic aspects of brain metabolism in rats given a portocaval anastomosis

Three weeks after portocaval shunt, when the only ultrastructural change in the CNS is watery swelling of astrocytes, the chronic hyperammonaemia so induced is associated with an increase of brain glutamine (330%), and a decrease of glutamate (90%) and glucose (63%). The metabolic fate of [2–14C] glucose was followed over a time course of 40 min after an intravenous injection. Details are given of a compartmental analysis of metabolic kinetic relationships, particularly of brain glutamate and glutamine. When applied to [2–14C]glucose data there was no evidence of an increased rate of glutamine synthesis in the operated rats. The increased labelling of glutamine could be accounted for by a larger pool size with a slower fractional turnover coefficient. In control rats [l‐14C]butyrate conferred label very rapidly on a small fraction of brain glutamine. Analysis showed there was little or no overlap between pools of amino acids labelled by [1–14C]butyrate and those labelled by [2–14C]glu‐cose. In operated animals there was a marked decrease in the total amount of labelled [l‐14C]butyrate entering the brain. Analysis showed some overlap between labelling of amino acids by [14C]butyrate and [14C]glucose, as well as several other changes. The biochemical differences found are likely to be causally related to the ultrastructural changes in astrocytes and lend support to previous concepts of morphological assignments to metabolic compartments.
PRIMARY RETICULUM CELL SARCOMA OF THE BRAIN
Authors: VUIA O.
Published: May 2008

This is a report of five cases of primary intracerebral reticulum cell sarcoma, three with cerebral and two with cerebellar localization. The one case studied anatomically (the other four were diagnosed by biopsy) was a frontal recurrence after an interval of seven years quiescence following surgery for a temporal tumour, treated post‐operatively by radiotherapy. Postmortem examination of the viscera revealed no pathological changes. In all five cases the microscopic examination showed the tumour to be formed of a perivascular proliferation of cells having clear nuclei and one or more nucleoli, and associated with the formation of reticulin fibres. Electron microscopical examination revealed the multiplication of undifferentiated cells apparently starting the neoplastic transformation of the periadventitial elements. Both the microscopic and ultrastructural features corresponded to those of primary reticulum cell sarcoma of the brain.
OBSERVATIONS ON THE PATHOGENESIS OF SPINA BIFIDA IN CHICK EMBRYOS: FORKING OF THE NEURAL TUBE
Authors: ROKOS J.
Published: May 2008

Observations on the pathogenesis of spina bifida in chick embryos: forking of the neural tube

Forking is an early malformation in which the neural tube is split into 2–6 tubules, walled off by neuroepithelium. Occasionally the undivided tube proximal to forking of the neural tube (FNT) or some of the secondary tubules, may show marked cystic dilatation. FNT may occur at any level of the cord and hence its development is not related to the caudal cell mass (‘tail node’). It is important that FNT may be covered by intact ectoderm or may occur simultaneously with myeloschisis. Spina bifida (SB) probably develops in those cases of FNT in which marked increase in volume of the malformed tube, due either to cystic dilatation or to presence of multiple tubules, prevents the mesoderm from growing between the ectoderm and the neural tissue. FNT seems to result from primary damage to the neural tissue around the posterior neuropore, followed by formation of supernumerary tubules from fragmented neuroepithelium. This process does not interfere with normal growth of the ectoderm. The likely consequences of FNT are deduced tentatively from a comparison with cases of fully developed spontaneous human SB associated with diastematomyelia (DM). FNT is related to variable degree of myelodysplasia, diplomyelia, myelocystocele and meningocele. The hypothesis (Rokos, 1975) that meningocele is a manifestation of anteroposterior FNT (anteroposterior DM) is supported by the present findings.
NEUROFIBILARY DEGENERATION INDUCED IN THE RABBIT BY ALUMINUM CHLORIDE: ALUMINIUM NEUROFIBRILLARY TANGLES
Authors: YATES CELIA. M. , GORDON A. , WILSON HELEN
Published: May 2008

Neurofibrillary degeneration induced in the rabbit by aluminium chloride aluminium neurofibrillary tangles

Neurofibrillary tangles were produced in the brain and spinal cord of rabbits by the intraventricular administration of aluminium chloride. The development of the tangles and of the accompanying behavioural effects was followed. The presence of tangles consistently preceded the onset of behavioural effects which comprised impairment of motor activity, terminal convulsions and opisthotonos. Limited electroencephalographic studies suggested that the convulsions were not of cortical origin. The lesion consisted of massed intraneuronal argyrophilic tangles which appeared as cytoplasmic clearings in sections stained with haematoxylin and eosin. The size of the tangle and the number of affected neurons increased with time and the tangles themselves were rather larger and differed in their distribution from those found in senile dementia and Alzheimer's disease. Of note was the sparing of the vagal nuclei and contrasting sensitivity of the hypoglossal nuclei to aluminium. It is suggested that aluminium‐induced tangles in the rabbit could serve as a model for the study of tangle formation.
EOSINOPHILIC ROD‐LIKE STRUCTURES IN MYELINATED FIBERS OF HAMSTER SPINAL ROOTS
Authors: HIRANO A. , DEMBITZER H. M.
Published: May 2008

Eosinophilic rod‐like structures in myelinated fibers of hamster spinal roots

The spinal roots of homozygous mutant hamsters carrying the recessive gene for hind leg paralysis as well as normal controls were studied at both the light and electron microscopic levels. Eosinophilic rod‐like inclusions essentially identical to those seen in human brains were observed in the inner loops of Schwann cells of myelinated fibers of the spinal roots. The electron microscope revealed inclusions with the characteristic ‘lattice‐like’ structure as well as other purely filamentous bodies. Both mutant and normal hamsters displayed these changes but they were more frequent in mutant animals.
APPLICATION OF AN IMMUNOPEROXIDASE METHOD TO A STUDY OF THE CENTRAL NERVOUS SYSTEM: PRELIMINARY FINDINGS IN A STUDY OF HUMAN FORMALIN‐FIXED MATERIAL
Authors: ESIRI M. M. , TAYLOR C. R. , MASON D. Y.
Published: May 2008

Application of an immunoperoxidase method to a study of the central nervous system: preliminary findings in a study of human formalin‐fixed material

Central nervous system matcrial from 40 patients has been studied using the immunoperoxidase technique on formalin‐fixed paraffin‐embedded tissues, to examine the distribution of immunoglobulins, transferrin, and lysozyme. In various pathological conditions there was evidence of deposition of immunoglobulins and other serum proteins on or in myelin sheaths, and neurons. In patients dying without evidence of neurological disease there was similar faint staining which was limited to perivascular zones and was probably due to postmortem diffusion of serum proteins out of vessels. Where present, reactive astrocytes stained for the presence of a number of serum proteins, including immunoglobulin and transferrin. In various inflammatory conditions immunoglobulin was demonstrated in mononuclear inflammatory cells in the perivascular spaces and in the neuropil of the brain. In recent plaques of multiple sclerosis there was positive specific staining of mononuclear inflammatory cells and myelin sheaths for immunoglobulin. The significance of these observations is briefly discussed.