bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of disruptive behaviour displayed by older people in community and residential respite care settings
Authors: Neville Christine C. , Byrne Gerard J. A.
Published: March 2007

ABSTRACT: The aim of this study was to determine the prevalence of disruptive behaviour displayed by older people in community and residential respite care settings. The specific objectives were to (i) obtain an estimate of the frequency of disruptive behaviour displayed by older people in the community setting before residential respite care; (ii) characterize older people being admitted for residential respite care; and (iii) obtain an estimate of the frequency of disruptive behaviour displayed by older people in residential respite care. A quantitative approach using a cross‐sectional survey was employed in the community and in the residential aged care facilities. The older people (n = 100) had a mean age of 81.8 years (range 66–96 years). The older people were being admitted from their homes for booked respite care at residential aged care facilities in a regional Australian city. Home caregivers and nurses rated disruptive behaviour using the Dementia Behaviour Disturbance Scale (DBDS). Reliability data for the DBDS are provided. As expected, in both community and residential respite settings, older people with dementia (29%) scored significantly higher on the DBDS than people without dementia. In addition, DBDS scores were unexpectedly higher in the community setting than in the respite setting. These findings should be taken into consideration by primary health‐care professionals when offering treatment options to the home caregivers and by staff in the residential aged care facilities that offer respite.
Working with stories in nursing research: Procedures used in narrative analysis
Authors: Kelly Teresa , Howie Linsey
Published: March 2007

ABSTRACT:  This paper describes the procedures undertaken in a qualitative study that used nurses’ stories to examine the influence of Gestalt therapy training on the professional practice of psychiatric nurses. The paper places narrative research methodologies within a nursing context before introducing narrative inquiry, specifically narrative analysis methodology. Procedures used in the study are subsequently described in sufficient detail to serve as a guide for novice researchers interested in undertaking a narrative analysis study. An exemplar of a storied outcome is provided to evidence the product of the narrative analysis research process. The paper concludes with reflections on the importance of articulating the process of narrative analysis as a means of developing interest and competence in narrative research, and using nurses’ stories as a means of exploring, understanding, and communicating nursing practice.
Complete or partial hippocampal damage produces equivalent retrograde amnesia for remote contextual fear memories
Authors: Lehmann Hugo , Lacanilao Samuel , Sutherland Robert J.
Published: March 2007

We examined the effects of partial or complete damage to the hippocampus on long‐term retention of a Pavlovian conditioned fear response to context. Rats received a single contextual fear‐conditioning episode and 1 week, 3 months or 6 months later they received sham, partial (dorsal) or complete NMDA‐induced damage of the hippocampus. During a retention test conducted 2 weeks after surgery, the control rats exhibited high levels of freezing in the context, although their level of freezing was significantly lower with longer retention intervals. Rats with complete hippocampal damage displayed very little freezing in the context at each learning–surgery interval. Partial hippocampal damage caused a smaller but consistent deficit in conditioned responding, especially at longer learning–surgery intervals. Neither group of hippocampus‐damaged rats showed less retrograde amnesia for more remote memories. We found that the severity of retrograde amnesia for contextual fear conditioning following hippocampal damage is related to the extent of the damage and that there is consistent and severe retrograde amnesia for even remote contextual fear memories. These findings support the idea that the hippocampal formation has an essential and long‐lasting, possibly permanent, role in memory for contexts.
Neurotrophins modulate neuron–glia interactions at a vertebrate synapse
Authors: Todd Keith J. , Auld Daniel S. , Robitaille Richard
Published: March 2007

Neurotrophins are important modulators of synaptic function at both developing and mature synapses in the CNS and PNS. At the neuromuscular junction (NMJ), neurotrophins, as well as perisynaptic Schwann cells (PSCs) are critical for the long‐term maintenance and stability of the synapse. Considering this correlation and the acute interactions that occur at the synapse between PSCs and the nerve terminal, we wondered if neurotrophins could also be involved in neuron‐glia signalling. To test if neurotrophins were able to signal to PSCs we used brief applications of neurotrophin‐3 (NT‐3), brain‐derived neurotophic factor (BDNF) or nerve growth factor (NGF; 100 ng/mL). Soleus muscles of mice were incubated with the Ca2+ indicator Fluo‐4AM and Ca2+ responses in PSCs were elicited through nerve stimulation (50 Hz, 30 s). Our results indicate that acute application of both NT‐3 and BDNF, but not NGF, increased PSC Ca2+ responses. Investigation of the mechanisms involved in these increases revealed distinct pathways for BDNF and NT‐3. BDNF increased PSC responsiveness through potentiation of ATP responses while NT‐3 modulated muscarinic acetylcholine receptor signalling. Using local applications of the neurotrophins, we found that both neurotrophins were able to elicit Ca2+ responses in PSCs where BDNF used a phospholipase C–inositol 1,4,5‐triphosphate (PLC‐IP3) mechanism, while NT‐3 required extracellular Ca2+. Our results demonstrate a neurotrophin‐dependent modulation of neuron‐glia signalling through differential mechanisms employed by NT‐3 and BDNF. Hence, neurotrophins precisely and differentially regulate PSC functions through modulation of either purinergic or cholinergic signalling pathways.
Non‐oxidative glucose disposal is reduced in type 2 diabetes, but can be restored by aerobic exercise
Authors: Yokoyama H. , Mori K. , Emoto M. , Araki T. , Teramura M. , Mochizuki K. , Tashiro T. , Motozuka K. , Inoue Y. , Nishizawa Y.
Published: March 2007

Whole‐body glucose utilization consists of mitochondrial glucose oxidation and non‐oxidative glycogen synthesis. We examined whether reduction of both non‐oxidative glucose disposal and glucose oxidation contributes to insulin resistance in type 2 diabetes. We also examined the effects of exercise on these two components. Whole‐body glucose disposal rate (GDR, mg/kg/min) was evaluated in 37 type 2 diabetic (T2DM) and 17 non‐diabetic (non‐DM) subjects as the mean of glucose infusion rate during steady state in the euglycaemic–hyperinsulinaemic clamp study. Glucose oxidation rates were assessed by indirect calorimetry, and non‐oxidative GDR was calculated by subtracting glucose oxidation rate from GDR. Intramyocellular lipid (IMCL) content of the soleus muscle was measured using 1H‐magnetic resonance spectroscopy. In 10 T2DM subjects, the changes in oxidative and non‐oxidative glucose disposal during clamp were examined after 3‐month exercise intervention. GDR (2.93 ± 1.55 vs. 4.55 ± 1.83, p = 0.001) and non‐oxidative GDR (1.45 ± 1.52 vs. 3.01 ± 1.87, p = 0.002) were significantly lower in T2DM than in non‐DM subjects. Glucose oxidation rate was comparable in the two groups, and inversely correlated with IMCL (n = 15, r =−0.565, p = 0.028). GDR (2.28 ± 1.67 to 4.63 ± 2.42, p = 0.021) and non‐oxidative GDR (0.72 ± 1.27 to 2.26 ± 1.91, p = 0.047) were increased after exercise intervention, although the change in glucose oxidation rate was not significant. In summary, reduction of non‐oxidative glucose disposal may contribute to decreased whole‐body glucose utilization. In addition, exercise improves insulin resistance mainly by increasing non‐oxidative glucose disposal in type 2 diabetes.
Night watchman, extractive, or developmental states? Some evidence from late colonial south‐east Asia1
Authors: BOOTH ANNE
Published: March 2007

The article examines aspects of government policy in different parts of colonial south‐east Asia, and in nominally independent Siam (Thailand) in the first four decades of the twentieth century. The emphasis is on taxation and expenditure policies, and their implications for the development of infrastructure and also for the welfare of indigenous populations. Attention is also given to the impact of government regulation of both factor and product markets. On the basis of the empirical evidence, the article argues that the traditional view of the colonial state as a ‘night watchman’ was not applicable to most parts of south‐east Asia after 1900. Governments were increasingly involved in implementing policies that today would be considered developmental, including building infrastructure and improving access to secular education and modern health care for the indigenous populations. But given the resources that they had, or had the potential to mobilize, more could have been achieved.
Intrapartum amnioinfusion for meconium‐stained amniotic fluid: a systematic review of randomised controlled trials
Authors: Xu H , Hofmeyr J , Roy C , Fraser WD
Published: March 2007

Background  Amnioinfusion (AI) is thought to dilute meconium when present in the amniotic fluid and so reduces the risk of meconium aspiration.

Objectives  To evaluate if AI reduces meconium aspiration syndrome (MAS) and other indicators of morbidity in babies born to women with meconium‐stained amniotic fluid (MSAF).

Search strategy  PubMed, Medline, EMBASE, and the Cochrane Controlled Trials Register from January 1980 to May 30, 2005, using the keywords ‘amnioinfusion’ and ‘meconium’.

Selection criteria  Randomised trials comparing AI with no AI for women in labour with MSAF. Trial quality was evaluated using pre‐established criteria.

Data collection and analysis  The following morbidity indicators were assessed: MAS, 5‐minute Apgar score < 7, arterial cord pH < 7.2, and caesarean section. Studies were stratified according to the level of peripartum surveillance (standard versus limited). Typical relative risks (RRs) with their 95% confidence intervals were calculated for each outcome using a random effects model.

Main results  In clinical settings with standard peripartum surveillance, we found no evidence that AI reduced the risk of MAS (RR 0.59, 95% CI 0.28–1.25), 5‐minute Apgar score < 7 (RR 0.90, 95% CI 0.58–1.41), or caesarean delivery (RR 0.89, 95% CI 0.73–1.10). In clinical settings with limited peripartum surveillance, AI appeared to reduce the risk of MAS (RR 0.25, 95% CI 0.13–0.47).

Conclusion  In clinical settings with standard peripartum surveillance, the evidence does not support the use of AI for MSAF. In settings with limited peripartum surveillance, where complications of MSAF are common, AI appears to reduce the risk of MAS. However, this finding requires confirmation by further studies.
Maternal serum screening for Down syndrome: are women’s perceptions changing?
Authors: Gidiri M , McFarlane J , Holding S , Lindow SW
Published: March 2007

Objectives  To document trends in serum screening for Down's syndrome.

Background  Trends in the uptake of serum screening for Down syndrome have not been documented in a UK population.

Design  A retrospective review of the rate of uptake in a unit that has offered serum screening for Down syndrome to all pregnant women.

Setting  A large north of England hospital that has offered universal Down syndrome screening using the ‘triple test’ since 1992.

Patients  A total of 47 998 women who booked for antenatal care.

Main outcome measures  Uptake of serum screening for Down syndrome.

Methods  The results of the screening programme were contemporaneously recorded on a computer database, and the study team accessed the data.

Results  There was a significant reduction in the uptake of serum screening for Down syndrome from a maximum of 82.6% in 1993 to 41.4% in 2005. There was a significant but small trend upwards in the age of women accepting screening and also a significant trend in the increase in the screen‐positive rates.

Conclusions  The reduction in uptake of Down syndrome screening over the past 13 years must be taken into account when planning a screening programme. Other units should be encouraged to review their rate of uptake to determine if our data are representative of a wider trend.
Alternative isoforms of myelin/oligodendrocyte glycoprotein with variable cytoplasmic domains are expressed in human brain
Authors: Allamargot Chantal , Gardinier Minnetta V.
Published: March 2007

The human myelin/oligodendrocyte glycoprotein (MOG) gene is encoded by 10 exons that exhibit a complex pattern of alternative splicing. This report demonstrates that several MOG‐specific alternative splice variants are indeed expressed in human oligodendrocytes (OLs) and myelin during perinatal development and are retained through adulthood. While all forms possess the common extracellular Ig‐like domain, these alternative MOG structures differ significantly in their respective cytoplasmic domains. Peptide‐specific antibodies were generated to facilitate detection of these different MOG moieties. The fidelity of these antibodies is shown using N20 OLs expressing individual MOG variants. These antibodies also only co‐localize with another well‐characterized marker of OLs and myelin – PLP/DM20 proteins. Among the human tissue samples tested, very limited expression occurred by 36 weeks gestation for 2–3 MOG variants, and the remaining MOG isoforms were not evident until shortly after birth. This study represents the first evidence of alternative translation products from the MOG gene. To date, it is believed that alternative splicing of MOG is limited to primates. Recent completion of various genome projects has revealed that alternative splicing is much more prevalent than originally estimated, and species‐specific alternative splicing is now being shown to be highly relevant to expanding proteomic diversity.
Molecular identification and functional role of voltage‐gated sodium channels in rat carotid body chemoreceptor cells. Regulation of expression by chronic hypoxia in vivo
Authors: Caceres Ana I. , Obeso Ana , Gonzalez Constancio , Rocher Asuncion
Published: March 2007

We have assessed the expression, molecular identification and functional role of Na+ channels (Nav) in carotid bodies (CB) obtained from normoxic and chronically hypoxic adult rats. Veratridine evoked release of catecholamines (CA) from an in vitro preparation of intact CBs obtained from normoxic animals, the response being Ca2+ and Na+‐dependent and sensitive to tetrodotoxin (TTX). TTX inhibited by 25–50% the CA release response evoked by graded hypoxia. Immunoblot assays demonstrated the presence of Navα‐subunit (c. 220 kDa) in crude homogenates from rat CBs, being evident an up‐regulation (60%) of this protein in the CBs obtained from chronically hypoxic rats (10% O2; 7 days). This up‐regulation was accompanied by an enhanced TTX‐sensitive release response to veratridine, and by an enhanced ventilatory response to acute hypoxic stimuli. RT‐PCR studies demonstrated the expression of mRNA for Nav1.1, Nav1.2, Nav1.3, Nav1.6 and Nav1.7 isoforms. At least three isoforms, Nav1.1, Nav1.3 and Nav1.6 co‐localized with tyrosine hydroxylase in all chemoreceptor cells. RT‐PCR and immunocytochemistry indicated that Nav1.1 isoform was up‐regulated by chronic hypoxia in chemoreceptor cells. We conclude that Nav up‐regulation represents an adaptive mechanism to increase chemoreceptor sensitivity during acclimatization to sustained hypoxia as evidenced by enhanced ventilatory responses to acute hypoxic tests.
Pituitary adenylate cyclase‐activating polypeptide (PACAP) stimulates the oxygen sensing type I (glomus) cells of rat carotid bodies via reduction of a background TASK‐like K+current
Authors: Xu Fenglian , Tse Frederick W. , Tse Amy
Published: March 2007

Pituitary adenylate cyclase‐activating polypeptide (PACAP)‐deficient mice are prone to sudden neonatal death and have reduced respiratory response to hypoxia. Here we found that PACAP‐38 elevated cytosolic [Ca2+] ([Ca2+]i) in the oxygen sensing type I cells but not the glial‐like type II (sustentacular) cells of the rat carotid body. This action of PACAP could not be mimicked by vasoactive intestinal peptide but was abolished by PACAP 6‐38, implicating the involvement of PAC1receptors. H89, a protein kinase A (PKA) inhibitor attenuated the PACAP response. Simultaneous measurement of membrane potential and [Ca2+]ishowed that the PACAP‐mediated [Ca2+]irise was accompanied by depolarization and action potential firing. Ni2+, a blocker of voltage‐gated Ca2+channels (VGCC) or the removal of extracellular Ca2+reversibly inhibited the PACAP‐mediated [Ca2+]irise. In the presence of tetraethylammonium (TEA) and 4‐aminopyridine (4‐AP), PACAP reduced a background K+current. Anandamide, a blocker of TWIK‐related acid‐sensitive K+(TASK)‐like K+channel, occluded the inhibitory action of PACAP on K+current. We conclude that PACAP, acting via the PAC1receptors coupled PKA pathway inhibits a TASK‐like K+current and causes depolarization and VGCC activation. This stimulatory action of PACAP in carotid type I cells can partly account for the role of PACAP in respiratory disorders.
17β‐estradiol does not protect cerebellar granule cells from excitotoxicity or apoptosis
Authors: Miñano Alfredo , Cerbón Marco Antonio , Xifró Xavier , Malagelada Cristina , Aguilera José , Rodríguez‐Alvarez José
Published: March 2007

Mounting evidences have suggested that 17β‐estradiol (E2) could have a neuroprotective action in the CNS. In the present study, we wanted to study whether this estrogen was able to protect cerebellar granule cells (CGCs) from apoptosis or excitotoxicity. Our results suggest that E2 has no anti‐apoptotic effect in CGCs cultures. The lack of phosphoinositide 3‐kinase/Akt pathway activation in CGCs cultures could be on the basis of the failure of estradiol to protect CGCs from potassium‐deprivation and ceramide‐mediated apoptosis. Moreover, E2 does not protect CGCs from glutamate‐mediated death despite activating the extracellular signal regulated kinase kinase/extracellular signal regulated kinase pathway, which suggests that extracellular signal regulated kinase kinase/extracellular signal regulated kinase pathway activation is not sufficient to sustain an estrogen‐mediated neuroprotective effect in CGCs cultures. By contrast, we found that the estrogen had a significant neuroprotective effect against hydrogen peroxide‐mediated neuronal death. This effect was due to the antioxidant properties of the chemical structure of estradiol, as the biological inactive isomer 17α‐estradiol was also able to reduce hydrogen peroxide‐mediated neuronal death.
Apocynin alleviated hepatic oxidative burden and reduced liver injury in hypercholesterolaemia
Authors: Lu Long‐Sheng , Wu Chau‐Chung , Hung Li‐Man , Chiang Meng‐Tsan , Lin Ching‐Ting , Lin Chii‐Wann , Su Ming‐Jai
Published: March 2007

Background: This study addressed the effects of apocynin, a nicotinamide adenine dinucleotide phosphate (NADPH) oxidase inhibitor, on hepatic oxidative burden and liver injury during diet‐induced hypercholesterolaemia.

Methods and Results: Male Wistar rats were fed a 4% cholesterol‐enriched diet for 3 weeks. Apocynin was administered in drinking water concurrently. The high‐cholesterol diet (HC) significantly increased the serum level of cholesterol and hepatic cholesterol ester deposition, and these parameters were similar between the HC and high‐cholesterol diet plus apocynin (HCA) groups. The HC group showed abnormal liver function tests [alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase (Alk‐P)] as well as increased Evans blue extravasation and macrophages infiltration. Apocynin treatment could suppress these inflammation‐related parameters. In vivo measurement of NADPH‐derived cellular autofluorescence suggested that HC increased oxidative stress in hepatocytes. Biochemical analysis of redox status including thiobarbituric acid reactive substances, reduced glutathione, and oxidized glutathione also confirmed the phenomenon. Apocynin treatment was able to alleviate these indices of oxidative burden owing to HC. Furthermore, apocynin‐abrogated HC induced gp91phox expression, suggesting the involvement of NADPH oxidase in the pathogenesis.

Conclusions: We concluded that apocynin suppressed NADPH oxidase activation and subsequent liver injuries owing to high‐cholesterol intake in rats. The impacts of cholesterol metabolism disorders on pathogenesis and progression of steatohepatitis warrant further clinical investigation.
Hepatic stellate cell‐targeted delivery of M6P‐HSA‐glycyrrhetinic acid attenuates hepatic fibrogenesis in a bile duct ligation rat model
Authors: Luk John M. , Zhang Qi‐Sheng , Lee Nikki P. , Wo Jana Y. , Leung Pauline P. , Liu Ling‐Xiao , Hu Mei‐Yu , Cheung Kwok‐Fan , Hui Chee‐Kin , Lau George K. , Fan Sheung‐Tat
Published: March 2007

Background/Aims: Hepatic stellate cells (HSCs) play a key role in fibrogenesis. Here, we used mannose‐6‐phosphate‐modified human serum albumin (M6P26‐HSA) as a selective carrier to deliver antifibrotic drug 18β‐glycyrrhetinic acid (18β‐GA) in experimental fibrosis animals, and tested its effect in injured liver tissues.

Methods: Bile duct ligation (BDL) was performed to induce liver damage in rats. Masson's stain and immunocytochemistry were used to assess hepatic collagen deposits and uptakes of M6P26‐HSA‐GA in HSCs in rat livers. Gene expression profiles of procollagen type I α2, smooth muscle actin (SMA), and transforming growth factor‐β1 (TGF‐β1) were analysed by TaqMan and quantitative polymerase chain reaction assays. The depositions of M6P26‐HSA‐GA in the HSC‐T6 cell line and primary HSCs were assessed by immunofluorescent staining.

Results: Treatment with M6P26‐HSA‐GA at 10 mg/kg (three times/week for 2 weeks), but not the equivalent doses of free 18β‐GA and M6P26‐HSA carrier alone, could significantly attenuate collagen deposits in BDL rat liver. Masson's stain and TaqMan assay revealed significant modulation of procollagen type I α2 in the BDL‐injured liver. The depositions of M6P26‐HSA‐GA in HSCs were revealed by immunostaining with HSA and SMA markers. M6P26‐HSA bound activated HSCs in vitro and the immunoreactivity of M6P26‐HSA‐GA was detected in the cytoplasm and cell surface of HSCs and HSC‐T6 cells. The gene transcript levels of SMA and TGF‐β1 were modulated in HSC‐T6 cells treated with M6P26‐HSA‐GA.

Conclusions: The M6P26‐HSA holds promise as a targeting carrier for the liver or HSCs, which may be used to deliver 18β‐GA as a therapeutic agent to treat liver fibrosis.
Cerebrospinal fluid and serum prolactin in systemic lupus erythematosus with and without central nervous system involvement
Authors: DAI Lie , WU Yimei , ZHENG Donghui , HAN Zhijuan , CHEN Lan X. , SCHUMACHER H. Ralph
Published: March 2007

Aim: Recent research has shown that prolactin (PRL) may participate in the pathogenesis of systemic lupus erythematosus (SLE) and hyperprolactinemia may be related to disease activity. The current study investigated both serum and cerebrospinal fluid (CSF) PRL in SLE patients and their possible relationship to central nervous system (CNS) involvement.

Methods: Prolactin levels were determined by immunoradiometric assay. Serum PRL levels were detected in 80 patients with SLE and 25 matched healthy controls. Disease activity was scored by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI). CSF PRL levels were detected in seven cases of CNS involving SLE, eight cases of non‐CNS involved inactive SLE and eight cases of non‐SLE CNS disorders.

Results: Hyperprolactinemia was present in 40% of SLE patients. Serum PRL levels were significantly correlated with SLEDAI scores. There was no significant difference in serum PRL levels between SLE patients with or without CNS involvement, but the mean CSF PRL levels were higher in CNS‐involved SLE patients than in non‐CNS‐involved SLE and non‐SLE patients. There was no significant correlation between serum and CSF PRL levels.

Conclusions: Our results suggest that high serum PRL levels correlate with active disease in SLE, but not with CNS involvement. CSF PRL levels in SLE patients correlate with CNS involvement, which indicates that CSF PRL may be involved in the pathogenesis of CNS‐SLE.
Renal angiographic findings in systemic sclerosis: ‘the Egyptian experience’
Authors: EMAD Yasser , EL‐GOHARY Tarek , MUSTAFA Hisham , BASSYOUNI Iman H. , AZAB Noha A.
Published: March 2007

Objective:  This study was designed to search for a possible pathological involvement of renal arteries among patients with systemic sclerosis (SSc) and to correlate the findings with renal functions.

Patients and methods:  Fourteen female patients with SSc were recruited for this study. The diagnosis and classification of SSc was based on the 1980 American College of Rheumatology criteria for classification of SSc. Nine patients had diffuse‐type SSc, and the remaining five belonged to the limited type of the disease. All patients were evaluated by history‐taking, clinical examination, laboratory investigations and renal angiography.

Results:  Three out of the nine patients (33.3%) with diffuse SSc had tortuous renal arteries, but there were none in the limited type. Two patients (22.2%) with diffuse SSc had ectatic renal arteries and three (33.3%) had osteal renal artery stenosis. Tortuous abdominal aorta was detected in one patient (11.1%) with diffuse SSc and congenital double renal artery in another (11.1%). Two out of the five patients with limited‐type disease (40%) had osteal renal artery stenosis that was bilateral in one case. Bilateral renal artery affection was observed in 3/14 studied patients (21.42%), and two of these had diffuse disease and one had limited disease. Three patients had hypertension (two had diffuse pattern and one had limited pattern).

Conclusion:  We consider that renal artery stenosis is the most important among all the findings detected and should be considered in SSc patients presenting with renal crisis because use of angiotensin converting enzyme (ACE) inhibitors in this situation may be deleterious rather than beneficial.
Supraorbital nodule biopsy leading to the diagnosis of giant cell arteritis
Authors: TESHA Paul , RAJENDRAM Ranjan , LAGNADO Ruby , BROWN Lawrence , SAMPATH Raghavan
Published: March 2007

Giant cell arteritis is a systemic vasculitis which usually involves the cranial arteries. We report the case of a 57‐year‐old patient presenting with headache and painful subcutaneous supraorbital nodule. A subsequent biopsy of a supraorbital nodule led to the diagnosis of giant cell arteritis.
Childbirth in ancient Rome: From traditional folklore to obstetrics
Authors: TODMAN Donald
Published: March 2007

In ancient Rome, childbirth was a hazardous event for both mother and child with high rates of infant and maternal mortality. Traditional Roman medicine centred on folklore and religious practices, but with the development of Hippocratic medicine came significant advances in the care of women during pregnancy and confinement. Midwives or obstetrices played an important role and applied rational scientific practices to improve outcomes. This evolution from folklore to obstetrics was a pivotal point in the history of childbirth.
Maternal morbidity and mortality associated with elective Caesarean delivery at a university hospital in Nigeria
Authors: OLADAPO Olufemi T. , LAMINA Mustafa A. , SULE‐ODU Adewale O.
Published: March 2007

Background:  Data about maternal outcomes of elective Caesarean section in low‐income countries are limited.

Aims:  To estimate the maternal morbidity and mortality associated with elective Caesarean delivery at a Nigerian University hospital.

Methods:  Retrospective analysis of all elective Caesarean deliveries at the Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria (1990–2005). For each case of elective Caesarean delivery, four parturients who achieved non‐operative vaginal delivery following spontaneous onset of labour were selected to serve as a referent group. Morbidity outcomes and mortality among women who had elective Caesarean delivery were compared with those of the referent group to estimate their comparative risks. Level of significance was put at P < 0.05.

Results:  A total of 164 elective Caesarean sections were performed out of 6882 deliveries (2.4%). All morbidities were more frequent among women who had elective Caesarean section compared to those who had vaginal delivery but only peripartum blood transfusion (11.6 vs 5.6%), puerperal febrile morbidity (11.0 vs 4.7%), unplanned readmission (4.3 vs 1.4%), mean fall in haemoglobin concentration (1.5 ± 0.6 vs 0.5 ± 0.7 g/dL) and mean hospital stay (13.3 ± 8.8 vs 6.2 ± 5.4 days) showed statistically significant differences. There was one maternal death among the elective Caesarean section group, giving a maternal mortality ratio of 6.1:1000 deliveries, which was not significantly different from 3.0:1000 deliveries in the referent group.

Conclusion:  Elective Caesarean delivery in this hospital is certainly accompanied by considerable maternal risks and should be offered to pregnant women with extreme caution. Efforts should be made to improve its safety by investigating and rectifying the factors responsible for the associated severe maternal complications.
The Vabra aspirator versus the Pipelle device for outpatient endometrial sampling
Authors: NAIM Norzilawati M. , MAHDY Zaleha A. , AHMAD Shuhaila , RAZI Zainul Rashid M.
Published: March 2007

Objective:  To compare the effectiveness of the Vabra aspirator and the Pipelle device as an outpatient endometrial assessment tool.

Method:  This was a randomised, prospective trial conducted for a period of one year.

Results:  A total of 147 patients were recruited, of which 71 were in the Vabra group and 76 were in the Pipelle arm. The procedure success rate in the Pipelle group was significantly higher than the Vabra arm (98.7 vs 88.7%, P = 0.02). Adequate tissue yield was also significantly more in the Pipelle arm (73.3 vs 52.4%, P = 0.02). Cost–benefit analysis revealed a higher average cost per patient in the Vabra group compared to the Pipelle arm.

Conclusion:  This study proved that the Vabra aspirator was not as effective as the Pipelle device in obtaining endometrial tissue for histological diagnosis. Despite its higher price per unit, the Pipelle device was a more cost‐effective tool for outpatient endometrial assessment.
The simple outpatient management of Bartholin's abscess using the Word catheter: A preliminary study
Authors: HAIDER Zara , CONDOUS George , KIRK Emma , MUKRI Faizah , BOURNE Tom
Published: March 2007

Introduction:  Bartholin's cysts/abscess affects 2% of women. Conventional treatment is marsupialisation under general anaesthetic. We evaluated a conservative approach in a non‐randomised prospective interventional study over 12 months.

Method:  Women with a Bartholin's abscess were counselled and those who opted for the Word catheter (WC) had it inserted under local anaesthetic (follow up at one week and four weeks, when catheter was removed). Women recorded pain scores and completed a qualitative questionnaire and had telephone follow up at six months. Outcome measures were abscess resolution and acceptability of treatment.

Results:  Fifty‐eight women attended with a Bartholin's abscess requiring drainage. Twenty‐three of 58 (40%) elected for marsupialisation. Thirty‐five of 58 (60%) women had a WC inserted. Twenty‐seven of 35 (77%) women retained their catheter for four weeks (three catheters fell out within 24 h of insertion, three catheters fell out within one week, one fell out after 11 days and there was one failed insertion). One woman had a recurrence six months after treatment. Abscess resolution occurred in 34 of 35 (97%). No woman reported significant discomfort at one week. Twenty‐four of 27 women (89%) said that if they suffered a recurrence, they would have another WC inserted. Three of 27 (11%) women had intercourse within the second week of catheter insertion and reported that it was not uncomfortable. Fourteen women who had marsupialisation were traced and none had suffered a recurrence six months after treatment.

Conclusions:  The WC is a safe and effective treatment for a Bartholin's abscess. It may be considered as an alternative to marsupialisation.
The use of complementary medicine and therapies by patients attending a reproductive medicine unit in South Australia: A prospective survey
Authors: STANKIEWICZ Marcin , SMITH Caroline , ALVINO Helen , NORMAN Robert
Published: March 2007

Background:  There is limited research describing the use of complementary medicines (CM) and therapies among patients with infertility.

Objective:  (i) To examine the use of CM by subjects attending an infertility clinic at their first consultation and six months later; (ii) to examine men's and women's views on the effectiveness and safety of these practices; and (iii) to examine the documentation of the use of CMs and therapies in clinical notes.

Design:  A prospective survey of 100 consecutive new patients presenting to an infertility clinic. Subjects were requested to complete a self‐administered questionnaire at their first visit and six months later. A retrospective audit of 200 patient records.

Results:  A response rate of 72% was obtained. Sixty‐six percent of patients attending the infertility clinic in South Australia used CMs. Six months following the initial consultation the use of CMs had declined. The most commonly used CMs included multivitamins, herbs, and mineral supplements, and subjects consulted most frequently with naturopaths, chiropractors and acupuncturists. The use of CMs and therapies was poorly documented by clinical staff.

Conclusion:  Complementary medicines and therapies are widely used by patients with infertility. Health‐care practitioners and fertility specialists need to be proactive in acquiring and documenting the use of these practices. There is a need to provide further information to patients on the use of CMs and therapies. Further research examining the reasons for use of CMs and therapies is needed.
Persistence of Forest Birds in the Costa Rican Agricultural Countryside
Authors: SEKERCIOGLU CAGAN H. , LOARIE SCOTT R. , OVIEDO BRENES FEDERICO , EHRLICH PAUL R. , DAILY GRETCHEN C.
Published: March 2007

Abstract:  Understanding the persistence mechanisms of tropical forest species in human‐dominated landscapes is a fundamental challenge of tropical ecology and conservation. Many species, including more than half of Costa Rica's native land birds, use mostly deforested agricultural countryside, but how they do so is poorly known. Do they commute regularly to forest or can some species survive in this human‐dominated landscape year‐round? Using radiotelemetry, we detailed the habitat use, movement, foraging, and nesting patterns of three bird species, Catharus aurantiirostris, Tangara icterocephala, and Turdus assimilis, by obtaining 8101 locations from 156 individuals. We chose forest birds that varied in their vulnerability to deforestation and were representative of the species found both in forest and human‐dominated landscapes. Our study species did not commute from extensive forest; rather, they fed and bred in the agricultural countryside. Nevertheless, T. icterocephala and T. assimilis, which are more habitat sensitive, were highly dependent on the remaining trees. Although trees constituted only 11% of land cover, these birds spent 69% to 85% of their time in them. Breeding success of C. aurantiirostris and T. icterocephala in deforested habitats was not different than in forest remnants, where T. assimilis experienced reduced breeding success. Although this suggests an ecological trap for T. assimilis, higher fledgling survival in forest remnants may make up for lower productivity. Tropical countryside has high potential conservation value, which can be enhanced with even modest increases in tree cover. Our findings have applicability to many human‐dominated tropical areas that have the potential to conserve substantial biodiversity if appropriate restoration measures are taken.
National Threatened Species Listing Based on IUCN Criteria and Regional Guidelines: Current Status and Future Perspectives
Authors: MILLER REBECCA M. , RODRÍGUEZ JON PAUL , ANISKOWICZ‐FOWLER THERESA , BAMBARADENIYA CHANNA , BOLES RUBEN , EATON MARK A. , GÄRDENFORS ULF , KELLER VERENA , MOLUR SANJAY , WALKER SALLY , POLLOCK CAROLINE
Published: March 2007

Abstract:  As countries worldwide become increasingly interested in conserving biodiversity, the profile of national threatened species lists expands and these lists become more influential in determining conservation priorities. The World Conservation Union (IUCN) Categories and Criteria for evaluating extinction risk, originally intended for use at the global level, are increasingly being used at the national level. To facilitate this process, the IUCN recently published guidelines for the application of the criteria at subglobal levels. We evaluated the application of these guidelines, focusing on the opinions and experience of the global community of national assessors. To assess the extent to which IUCN criteria have been used in official national listing efforts, we sent a survey to 180 Convention on Biological Diversity national focal points designated by governments. Of the respondents, 77% had developed national threatened species lists. Of these, 78% applied a version of the IUCN criteria, and 88% plan to produce future threatened species lists. The majority of this last group (83%) will use IUCN criteria. Of the countries that have or will develop a threatened species list, 82% incorporated their list or the IUCN criteria into national conservation strategies. We further explored the issues highlighted by the survey results by integrating the experience of assessors that have produced national lists. Most of the problems national assessors faced when applying the IUCN criteria arose when the criteria were applied at the regional level without the IUCN Regional Guidelines and when assessors were confused about the purpose of the IUCN criteria and lacked training in their proper use. To improve their clarity and increase their repeatability, we recommend that the IUCN increase communication and information exchange among countries and between regional and global assessors, potentially through an interactive Web site, to facilitate the development of national red lists and to improve their conservation value within and between countries.
Potential of Marine Reserves to Cause Community‐Wide Changes beyond Their Boundaries
Authors: GUIDETTI PAOLO
Published: March 2007

Abstract:  Fishing and other human activities can alter the abundances, size structure, and behavior of species playing key roles in shaping marine communities (e.g., keystone predators), which may in turn cause ecosystem shifts. Despite extensive evidence that cascading trophic interactions can underlie community‐wide recovery inside no‐take marine reserves by protecting high‐level predators, the spatial extent of these effects into adjacent fished areas is unknown. I examined the potential for community‐wide changes (i.e., the transition from overgrazed coralline barrens to macroalgal beds) in temperate rocky reefs within and around a no‐take marine reserve. For this purpose I assessed distribution patterns of predatory fishes, sea urchins, and barrens across the reserve boundaries. Predatory fishes were significantly more abundant within the reserve than in adjacent locations, with moderate spillover across the reserve edges. In contrast, community‐wide changes of benthic assemblages were apparent well beyond the reserve boundaries, which is consistent with temporary movements of predatory fishes (e.g., foraging migration) from the reserve to surrounding areas. My results suggest that no‐take marine reserves can promote community‐wide changes beyond their boundaries.
Conservation Easements: Biodiversity Protection and Private Use
Authors: RISSMAN ADENA R. , LOZIER LYNN , COMENDANT TOSHA , KAREIVA PETER , KIESECKER JOSEPH M. , SHAW M. REBECCA , MERENLENDER ADINA M.
Published: March 2007

Abstract:  Conservation easements are one of the primary tools for conserving biodiversity on private land. Despite their increasing use, little quantitative data are available on what species and habitats conservation easements aim to protect, how much structural development they allow, or what types of land use they commonly permit. To address these knowledge gaps, we surveyed staff responsible for 119 conservation easements established by the largest nonprofit easement holder, The Nature Conservancy, between 1985 and 2004. Most easements (80%) aimed to provide core habitat to protect species or communities on‐site, and nearly all were designed to reduce development. Conservation easements also allowed for a wide range of private uses, which may result in additional fragmentation and habitat disturbance. Some residential or commercial use, new structures, or subdivision of the property were permitted on 85% of sampled conservation easements. Over half (56%) allowed some additional buildings, of which 60% restricted structure size or building area. Working landscape easements with ranching, forestry, or farming made up nearly half (46%) of the easement properties sampled and were more likely than easements without these uses to be designated as buffers to enhance biodiversity in the surrounding area. Our results demonstrate the need for clear restrictions on building and subdivision in easements, research on the compatibility of private uses on easement land, and greater public understanding of the trade‐offs implicit in the use of conservation easements for biodiversity conservation.
Randomized clinical trial comparing two options for postoperative incisional care to prevent poststernotomy surgical site infections
Authors: Segers Patrique , De Jong Antonius P. , Spanjaard Lodewijk , Ubbink Dirk T. , De Mol Bas A.J.M.
Published: March 2007

Surgical site infection (SSI) remains an important complication of cardiac surgery. Prevention is important, as SSI is associated with high mortality and morbidity rates. Incisional care is an important daily issue for surgeons. However, there is still scant scientific evidence on which guidelines can be based. A randomized clinical trial was performed to compare two options for postoperative incisional care. Patients undergoing sternotomy for cardiothoracic surgery were eligible. To protect an incision from exogenous contamination or direct inoculation by endogenous pathogens, the study group received an adhesive drape, impermeable to water and air. The control group was treated with a water‐ and air‐permeable absorbent dressing. Primary outcome measure was SSI. Between March 2003 and January 2005, 1,185 patients were included. Both groups were comparable for base‐line characteristics. No significant difference was found in the incidence of sternal SSI between groups (2.6 vs. 3.3%). In our study, an incisional‐care program using a sterile, impermeable adhesive drape did not perform better than an absorbent dressing in reducing SSI after cardiothoracic surgery. In our view, future studies in the field of prevention of SSI should concentrate on other areas of interest.
Randomized trial of two foam dressings in the management of chronic venous ulceration
Authors: Franks Peter J. , Moody Marion , Moffatt Christine J. , Hiskett Gill , Gatto Pauline , Davies Claire , Furlong Winnie T. , Barrow Erica , Thomas Hazel ,   On behalf of the Wound Healing Nursing Research Group
Published: March 2007

A multicenter prospective randomized clinical trial was undertaken to compare two foam dressings (Allevyn Hydrocellular, Smith & Nephew and Mepilex, Molnlycke Health Care AB) in the management of chronic venous leg ulceration. Patients were also randomized to two compression bandage systems (4‐layer vs. cohesive short stretch) as a factorial design. Those with causes of ulceration other than venous disease were excluded. In all, 156 patients met the entry criteria and were randomized from the 12 clinical centers with a median (range) ulcer size of 4.33 (0.33–123.10) cm2. After 24 weeks a total of 100 (64.1%) patients had complete ulcer closure, 46 (29.5%) had withdrawn from the trial, nine (5.8%) remained unhealed and one patient died. Of the patients randomized to Mepilex, 50/75 (66.7%) had complete ulcer healing compared with 50/81 (61.7%) on Allevyn. The hazard ratio for healing after adjustment for bandage type and trial center was 1.48 (95% C.I. 0.87–2.54,p=0.15), which only marginally changed following adjustment for baseline variables, neither of which achieved statistical significance (p=0.16). Withdrawal rates were similar between groups (23, 30.7% Mepilex vs. 23, 28.4% Allevyn). Pain improved following treatment with both dressings (p<0.001), but with no difference between dressings.
Trehalose lyophilized platelets for wound healing
Authors: Pietramaggiori Giorgio , Kaipainen Arja , Ho David , Orser Cindy , Pebley Walter , Rudolph Alan , Orgill Dennis P.
Published: March 2007

Fresh platelet preparations are utilized to treat a wide variety of wounds, although storage limitations and mixed results have hampered their clinical use. We hypothesized that concentrated lyophilized and reconstituted platelet preparations, preserved with trehalose, maintain and possibly enhance fresh platelets' ability to improve wound healing. We studied the ability of a single dose of trehalose lyophilized and reconstituted platelets to enhance wound healing when topically applied on full‐thickness wounds in the genetically diabetic mouse. We compared these results with the application of multiple doses of fresh platelet preparations and trehalose lyophilized and reconstituted platelets as well as multiple doses of vascular endothelial growth factor (VEGF) and wounds left untreated. Trehalose lyophilized and reconstituted platelets, in single and multiple applications, multiple applications of fresh platelets and multiple applications of VEGF increased granulation tissue deposition, vascularity, and proliferation when compared with untreated wounds, as assessed by histology and immunohistochemistry. Wounds treated with multiple doses of VEGF and a single dose of freeze‐dried platelets reached 90% closure faster than wounds left untreated. A single administration of trehalose lyophilized and reconstituted platelet preparations enhanced diabetic wound healing, therefore representing a promising strategy for the treatment of nonhealing wounds.