bluuebunny/crossref_metadata_2025 huggingface dataset:
Progression of oral snuff use among Finnish 13–16‐year‐old students and its relation to smoking behaviour
Authors: Haukkala Ari , Vartiainen Erkki , De Vries Hein
Published: February 2006

Aims  To examine the progression of oral moist snuff use among adolescents and its relation to smoking behaviour and nicotine addiction.

Design and setting  A 3‐year smoking prevention study in 27 schools of Helsinki, Finland, starting with the seventh grade to the ninth grade. 

Participants and measurements  Pupils (n = 2816) completed questionnaires four times, which included information on smoking behaviour, snuff experiments, nicotine addiction (Fagerström Tolerance Questionnaire) and other activities.

Findings  The prevalence of snuff experimentation rose among boys from 7% in the seventh grade to 43% 3 years later in the ninth grade, and among girls from 2% to 13% for the corresponding period. Among boys, smoking predicted later snuff use in all assessments and snuff experimentation predicted later weekly smoking. The impact of snuff experimentation upon later smoking experimentation was smaller than vice versa. Among boys active in sports, smoking was less common but snuff use was more common. Combined use was common; by the end of the follow‐up only 10% of weekly smokers had not tried oral snuff. Nicotine dependence scores increased linearly with snuff use among weekly smokers. 

Conclusions  Despite the European Union sales ban on oral snuff products since 1995, in Finland snuff use is common among boys. Although combined use of snuff and cigarettes is associated with higher levels of nicotine dependence among adolescent boys, the direction of causality is not known. Unlike cigarette smoking, oral snuff use was tried among boys who spent their free time with sports‐related activities.
Efficacy of maintenance treatment with naltrexone for opioid dependence: a meta‐analytical review
Authors: Johansson Björn Axel , Berglund Mats , Lindgren Anna
Published: February 2006

Aims  To determine the efficacy of naltrexone in reducing illicit opioid use and the potential moderating role of treatment retention.

 Design  First, randomized controlled trials (RCTs) comparing the regimens of treatment using the opioid antagonist, naltrexone, with controls were analysed by meta‐analysis for treatment effect with regard to a range of outcome criteria. The degree of heterogeneity was also determined. The moderating effect of other interventions during naltrexone maintenance was then estimated, particularly with regard to their effect on treatment retention.

Participants  Fifteen studies involving 1071 patients were found.

Measurements  All available outcomes were analysed in 10 studies of naltrexone versus control (seven placebo) and six studies of randomized psychosocial/psychopharmacological interventions.

Findings  Significant heterogeneity was found in the efficacy of naltrexone. Level of retention in treatment was found to be a moderator, explaining most of the heterogeneity found. Overall, naltrexone was significantly better than control conditions in reducing the number of opioid‐positive urines. This effect was only present in the high retention subgroup for differences in retention. Contingency management (CM) increased retention and naltrexone use, resulting in a reduced number of opioid‐positive urines.

Conclusion  Retention is important to the effect of naltrexone in treating opioid dependence. Contingency management is a promising method of increasing retention.
Some characteristics of early‐onset injection drug users prior to and at the time of their first injection
Authors: Abelson Jeanne , Treloar Carla , Crawford June , Kippax Susan , Van Beek Ingrid , Howard John
Published: February 2006

Aims  This paper examines differences between early‐ and late‐onset injection drug users (12–16 years versus 17–24 years) in terms of the antecedents and circumstances of first injection.

Design  Cross‐sectional retrospective design, using logistic regression.

Setting  Australia: Sydney, Brisbane, rural New South Wales.

Participants  A total of 336 injection drug users aged 16–25 years at the time of interview.

Measurements  Independent variables included family injection drug use, homelessness and other demographic variables, drugs used prior to the first injection, length of pre‐injection drug career, behaviours at time of first injection (e.g. drug injected, reasons/motives for the first injection, risk behaviours).

Findings  Early‐onset injection was associated independently with: having a family who injected drugs, having left school early, an unreliable source of income, a short pre‐injection drug career, planning of the first injection, reliance on others for administration of the first injection and denial that experimentation was the motive for the first injection. In bivariate analysis, early‐onset injection was associated further with: homelessness, being an Indigenous Australian, omission of use of certain pre‐injection drugs, group presence at first injection, reliance on others for acquisition of the first needle and syringe and having injected the first time because an injection was offered.

Conclusions  The research shows that early‐onset, compared with late‐onset injectors, are more likely to have an immediate family who inject drugs and other problematic beginnings in early life. They have an accelerated transition to injection, and differences in autonomy and motivation at first injection. These characteristics may make them more vulnerable to risk taking.
Fusarium wilt (Fusarium oxysporum f. sp. vasinfectum) genes expressed during infection of cotton (Gossypium hirsutum)†
Authors: MCFADDEN HELEN G. , WILSON IAIN W. , CHAPPLE ROBIN M. , DOWD CAITRIONA
Published: February 2006

We sought to identify Fusarium oxysporum f. sp. vasinfectum (Fov) genes that may be associated with pathogenicity. Initially we utilized microarray and Q‐PCR technology to identify Fov genes expressed in root and hypocotyl tissues during a compatible infection of cotton. We identified 218 fungal clones representing 174 Fov non‐redundant genes as expressed in planta. The majority of the expressed sequences were expressed in infected roots, with only six genes detected in hypocotyl tissue. The Fov genes identified were predominately of unknown function or associated with fungal growth and energy production. We then analysed the expression of the identified fungal genes in infected roots and in saprophytically grown mycelia and identified 11 genes preferentially expressed in plant tissue. A putative oxidoreductase gene (with homology to AtsC) was found to be highly preferentially expressed in planta. In Agrobacterium tumefaciens, AtsC is associated with virulence. Inoculation of a susceptible and a partially resistant cotton cultivar with either a pathogenic or a non‐pathogenic isolate of Fov revealed that the expression of the Fov AtsC homologue was associated with pathogenicity and disease symptom formation.
Use of tegaserod along with polyethylene glycol electrolyte solution for colonoscopy bowel preparation: a prospective, randomized, double‐blind, placebo‐controlled study
Authors: SANAKA M. R. , SUPER D. M. , MULLEN K. D. , FERGUSON D. R. , McCULLOUGH A. J.
Published: February 2006

Background  Polyethylene glycol electrolyte solution (PEG‐EL) used for colonoscopy preparation is not well tolerated by several patients. A significant number of patients have inadequate bowel preparation despite taking PEG‐EL.

Aims  To determine the effect of prokinetic agent, tegaserod when given in addition to PEG‐EL on patient tolerance, quality of colonic preparation and adverse side effects experienced.

Methods  In this prospective, randomized, placebo‐controlled, double‐blind study, a total of 130 patients scheduled for colonoscopy were enrolled. They were instructed to take three pills of either tegaserod 6 mg each or placebo (one pill twice on the day prior to and third pill in the morning on the day of colonoscopy) in addition to standard 4L of PEG‐EL in the evening prior to the day of colonoscopy. Patient tolerance of preparation, quality of bowel preparation, overall satisfaction and adverse side effects were compared between the two groups.

Results  Fifty‐five patients in placebo group and 58 patients in tegaserod group completed the study. There was no difference between the two groups in the tolerance of preparation, quality of bowel preparation, overall satisfaction and the side effects.

Conclusion  Addition of tegaserod to polyethylene glycol electrolyte solution during colonoscopy preparation does not improve patient tolerance, quality of colonic preparation or the adverse side effects.
Changes of gastric mucosal architecture during long‐term omeprazole therapy: results of a randomized clinical trial
Authors: LUNDELL L. , HAVU N. , MIETTINEN P. , MYRVOLD H. E. , WALLIN L. , JULKUNEN R. , LEVANDER K. , HATLEBAKK J. G. , LIEDMAN B. , LAMM M. , MALM A. , WALAN A. ,   THE NORDIC GERD STUDY GROUP
Published: February 2006

Background  The impact of long‐term acid suppression on the gastric mucosa remains controversial.

Aim  To report further observations on an established cohort of patients with gastro‐oesophageal reflux disease, after 7 years of follow‐up.

Methods  Of the original cohort randomized to either antireflux surgery or omeprazole, 117 and 98 patients remained in the medical and surgical arms, respectively. Gastric biopsies were taken at baseline and throughout the study.

Results  Fifty‐three antireflux surgery and 39 omeprazole‐treated patients had Helicobacter pylori infection at randomization. Eighty‐three omeprazole‐treated and 60 antireflux surgery patients remained H. pylori negative over the 7 years, and no change was observed in mucosal morphology except for a change in endocrine cell population (linear and diffuse hyperplasia, P = 0.03). During the 7‐year study many patients, who were initially H. pylori infected, had the infection eradicated leaving only 13 omeprazole and 12 antireflux surgery patients still infected. In these patients, omeprazole induced a deterioration of the mucosal inflammation scores (P = 0.01) with a numerical increase of glandular atrophy.

Conclusions  Long‐term omeprazole therapy does not alter the exocrine oxyntic mucosal morphology in H. pylori‐negative patients, but mucosal endocrine cells appear to be under proliferative stimulation; in H. pylori‐positive patients there are changes in mucosal inflammation and atrophy.
Impact of spinal anaesthesia on peri‐operative lung volumes in obese and morbidly obese female patients*
Authors: Regli A. , von Ungern‐Sternberg B. S. , Reber A. , Schneider M. C.
Published: February 2006

Although obesity predisposes to postoperative pulmonary complications, data on the relationship between body mass index (BMI) and peri‐operative respiratory performance are limited. We prospectively studied the impact of spinal anaesthesia, obesity and vaginal surgery on lung volumes measured by spirometry in 28 patients with BMI 30–40 kg.m−2 and in 13 patients with BMI ≥ 40 kg.m−2. Vital capacity, forced vital capacity, forced expiratory volume in 1 s, mid‐expiratory and peak expiratory flows were measured during the pre‐operative visit (baseline), after effective spinal anaesthesia with premedication, and after the operation at 20 min, 1 h, 2 h, and 3 h (after mobilisation). Spinal anaesthesia and premedication were associated with a significant decrease in spirometric parameters. Spinal anaesthesia and premedication were associated with a significant decrease in spirometric parameters; mean (SD) vital capacities were − 19% (6.4) in patients with BMI 30–40 kg.m−2 and − 33% (9.0) in patients with BMI > 40 kg.m−2. The decrease of lung volumes remained constant for 2 h, whereas 3 h after the operation and after mobilisation, spirometric parameters significantly improved in all patients. This study showed that both spinal anaesthesia and obesity significantly impaired peri‐operative respiratory function.
A comparison of the insertion characteristics of the laryngeal tube and the laryngeal mask airway: a study of the ED50 propofol requirements
Authors: Burlacu C. L. , Gaskin P. , Fernandes A. , Carey M. , Briggs L.
Published: February 2006

The purpose of this prospective randomised double‐blind study was to determine the effective dose of propofol required for the successful first attempt insertion of the laryngeal tube compared with the laryngeal mask airway in patients co‐induced using alfentanil 5 μg.kg–1, undergoing short elective gynaecological procedures. The first patient in each group received propofol 2.5 mg.kg−1 for induction. In accordance with Dixon's up‐and‐down method, the dose of propofol for consecutive patients in each group was varied with increments or decrements of 0.5 mg.kg−1 based on the previous patient ‘all‐or‐none’ purposeful movement response to first attempt of insertion of the randomised device. The ED50 (SD) of propofol was 2.66 (0.86) mg.kg−1 and 2.33 (0.37) mg.kg−1 for the laryngeal tube and laryngeal mask patients, respectively, which did not reach statistical significance (p = 0.40). We conclude therefore that the insertion of the two airway devices requires similar bolus doses of propofol when alfentanil is used as the co‐induction drug.
Acute pain management for opioid dependent patients
Authors: Mehta V. , Langford R. M.
Published: February 2006

Patients requiring acute pain management may be opioid dependent as a result of either recreational or therapeutic opioid use, including those in opioid addiction programmes. Pain in these patients is often under‐estimated and under‐treated. In addiction, drug‐seeking behaviour differentiates it from simple dependence. With few randomised controlled trials, current evidence predominantly consists of guidelines based on case reports, retrospective studies and expert opinion. Consensus recommendations include maintaining regular provision of the patient's pre‐existing opioid requirement, with additional analgesia, ideally multimodal, in appropriate combinations of short‐acting opioid (as required), local anaesthesia, and adjuvant anti‐inflammatory analgesics and paracetamol. Patient controlled analgesia with higher bolus doses and shorter lock‐out intervals is a recommended strategy. Transdermal opioid patches and implantable pumps will continue to deliver opioid, to which non‐opioid and short‐acting opioids may be added. Re‐exposure to opioid is ideally avoided in previously addicted patients, but if not feasible, opioid therapy should be prescribed.
The impact of a consultant anaesthetist led pre‐operative assessment clinic on patients undergoing major vascular surgery*
Authors: Cantlay K. L. , Baker S. , Parry A. , Danjoux G.
Published: February 2006

Patients undergoing major vascular surgery are at high risk of peri‐operative morbidity and mortality owing to a combination of advanced age, significant co‐morbidity and the nature of the surgery. A consultant‐led pre‐operative assessment clinic provides an opportunity to stratify these patients on the basis of risk in advance of surgery, to make timely multidisciplinary referrals where appropriate, and to prescribe medical therapies according to the current best evidence. This results in fewer last‐minute cancellations for medical reasons and increased patient satisfaction, and may improve patient outcome. Such a clinic also provides an educational arena for nursing and trainee medical staff, and importantly allows those patients in whom the risks are felt to outweigh the potential benefits of surgery to be managed in a more fully informed manner.
Effect of perioperative steroids on renal function after liver transplantation*
Authors: Turner S. , Dhamarajah S. , Bosomworth M. , Bellamy M. C. ,   on behalf of the Leeds Liver Transplant Group
Published: February 2006

Subclinical renal dysfunction is thought to occur as a systemic manifestation of ischaemia‐reperfusion injury of other organs. Liver transplantation is associated with major ischaemia‐reperfusion injury. Thirty‐four patients undergoing elective liver transplantation were randomly allocated to receive either saline or 10 mg.kg−1 methylprednisolone on induction of anaesthesia. Urine was taken for N‐acetyl‐β‐D‐glucosaminidase, creatinine and other markers of tubular function. Serum chemistry was measured for 7 days. Creatinine concentration increased in the saline group but not in the methylprednisolone group (p < 0.0001), with the greatest difference on the third postoperative day (mean (SD) 164.8 (135.8) μmol.l−1vs 88.5 (39.4) μmol.l−1, respectively). Similar changes were seen in postoperative alanine transferase (865 (739) U.l−1vs 517 (608) U.l−1, respectively; p < 0.0001) on the second postoperative day. Both groups exhibited increases in markers of renal tubular dysfunction and of glomerular permeability. Patients in the saline group sustained more adverse events (8/17 (47%) vs 2/17 (12%); p = 0.02). The data confirm increased proximal tubular lysosomal turnover, consistent with an increased tubular protein load, following liver transplantation, and suggest that methylprednisolone protects against renal and hepatic dysfunction.
Pharmacokinetics of subcutaneously administered etanercept in subjects with psoriasis
Authors: Nestorov Ivan , Zitnik Ralph , DeVries Todd , Nakanishi Arline M. , Wang Andrea , Banfield Christopher
Published: February 2006

Aims

To present the results of the pharmacokinetic analysis of the concentration–time profiles of etanercept, a soluble receptor tumour necrosis factor (TNF) antagonist, in more than 1300 subjects with psoriasis.

Methods

Pharmacokinetic samples were collected in one phase‐2 and two phase‐3 placebo‐controlled, randomized clinical trials. Study 1 evaluated a 25‐mg twice weekly (BIW) etanercept dosing regimen administered by subcutaneous (s.c.) injection for 24 weeks. Study 2 evaluated 25‐mg BIW and 50‐mg BIW s.c. doses for 12 weeks. Study 3 evaluated 25 mg once weekly (QW), 25 mg BIW and 50 mg BIW s.c. doses for 24 weeks.

Results

The mean ± SD steady‐state predose serum concentrations of etanercept for the 25‐mg BIW arm at 12 weeks in study 1 were 1590 ± 885 ng ml−1. In study 2, mean ± SD etanercept steady‐state concentrations at 12 weeks were 1900 ± 1110 ng ml−1 in the 25‐mg BIW group and 3830 ± 1870 ng ml−1 in the 50‐mg BIW group. The mean ± SD steady‐state predose serum concentrations of etanercept at 12 weeks in study 3 were 768 ± 475 ng ml−1 for the 25‐mg QW regimen, 1990 ± 1030 ng ml−1 for the 25‐mg BIW regimen and 4020 ± 2100 ng ml−1 for the 50‐mg BIW regimen.

Conclusions

Pharmacokinetic results were highly consistent across clinical trials. The concentration–time profiles displayed dose proportionality. Etanercept concentrations in subjects with psoriasis are similar to the concentrations in subjects with rheumatoid arthritis.
Lack of sex‐related differences in saquinavir pharmacokinetics in an HIV‐seronegative cohort
Authors: Robertson Sarah M. , Formentini Elizabeth , Alfaro Raul M. , Natarajan Ven , Falloon Judith , Penzak Scott R.
Published: February 2006

Aims

To examine the influence of sex on steady‐state saquinavir pharmacokinetics in HIV‐seronegative volunteers administered saquinavir without a concomitant protease inhibitor.

Methods

Thirty‐eight healthy volunteers (14 female) received saquinavir soft‐gel capsules 1200 mg three times daily for 3 days to achieve steady‐state conditions. Following administration of the 10th dose, blood was collected serially over 8 h for measurement of saquinavir plasma concentrations. Saquinavir pharmacokinetic parameter values were determined using noncompartmental methods and compared between males and females. CYP3A phenotype (using oral midazolam) and MDR‐1 genotypes at positions 3435 and 2677 were determined for all subjects in order to characterize possible mechanisms for any observed sex‐related differences.

Results

There was no significant difference in saquinavir AUC0−8or any other pharmacokinetic parameter value between the sexes. These findings persisted after mathematically correcting for total body weight. The mean weight‐normalized AUC0−8was 29.9 (95% confidence interval 15.5, 44.3) and 29.8 (18.6, 40.9) ng h−1 ml−1 kg−1for males and females, respectively. No significant difference in CYP3A phenotype was observed between the groups; likewise, the distribution of MDR‐1 genotypes was similar for males and females.

Conclusion

In contrast to previous study findings, results from this investigation showed no difference in saquinavir pharmacokinetics between males and females. The discrepancy between our findings and those previously reported may be explained by the fact that we evaluated HIV‐seronegative volunteers and administered saquinavir in the absence of concomitant protease inhibitors such as ritonavir. Caution must be exercised when extrapolating pharmacokinetic data from healthy volunteer studies (including sex‐based pharmacokinetic differences) to HIV‐infected populations or to patients receiving additional concurrent medications.
Monitoring for adverse drug reactions
Authors: Coleman J. J. , Ferner R. E. , Evans S. J. W.
Published: February 2006

Monitoring describes the prospective supervision, observation, and testing of an ongoing process. The result of monitoring provides reassurance that the goal has been or will be achieved, or suggests changes that will allow it to be achieved. In therapeutics, most thought has been given to Therapeutic Drug Monitoring, that is, monitoring of drug concentrations to achieve benefit or avoid harm, or both. Patients and their clinicians can also monitor the progress of a disease, and adjust treatment accordingly, for example, to achieve optimum glycaemic control. Very little consideration has been given to the development of effective schemes for monitoring for the occurrence of adverse effects, such as biochemical or haematological disturbance. Significant harm may go undetected in controlled clinical trials. Even where harm is detected, published details of trials are usually insufficient to allow a practical monitoring scheme to be introduced. The result is that information available to prescribers, such as the Summary of Product Characteristics, frequently provides advice that is incomplete or impossible to follow. We discuss here the elements of logical schemes for monitoring for adverse drug reactions, and the possible contributions that computerized decision support can make. We should require evidence that if a monitoring scheme is proposed, it can be put into practice, will prove effective, and is affordable.
Retracted: Safety and efficacy of tramadol in the treatment of idiopathic detrusor overactivity: a double‐blind, placebo‐controlled, randomized study
Authors: Safarinejad M. R. , Hosseini S. Y.
Published: February 2006

Aim

To evaluate the efficacy and safety of tramadol in patients with idiopathic detrusor overactivity (IDO).

Methods

A total of 76 patients 18 years or older with IDO were randomly assigned to receive 100 mg tramadol sustained release (group 1, n = 38) or placebo (group 2, n = 38) every 12 h for 12 weeks. Clinical evaluation was performed at baseline and every 2 weeks during treatment. All patients underwent urodynamics and ice water test at baseline and 12‐week treatment. Main outcome measures were number of voids per 24 h, urine volume per void and episodes of urge incontinence per 24 h on a frequency volume chart and detailed recording of adverse effect.

Results

After 12 weeks of treatment mean number of voids per 24 h ± SD decreased from 9.3 ± 3.2 to 5.1 ± 2.1 (P < 0.001 vs. placebo) [95% confidence interval (CI) −5.1‐−0.4]. At that time mean urine volume per void increased from 158 ± 32 to 198 ± 76 ml (P < 0.001 vs. placebo) (95% CI 8‐22), while mean number of incontinence episodes per 24 h decreased from 3.2 ± 3.3 to 1.6 ± 2.8 (P < 0.001 vs. placebo) (95% CI −2‐0.3). Tramadol induced significant improvements in urodynamic parameters. More adverse effects were associated with tramadol treatment than with placebo (P < 0.05). The main adverse event with tramadol was nausea.

Conclusions

In patients with non‐neurogenic IDO tramadol provided beneficial clinical and urodynamic results. Further studies are required to draw final conclusions on the efficacy of this drug in IDO.
Explicit use of the Biot coefficient in predicting shear‐wave velocity of water‐saturated sediments
Authors: Lee Myung W.
Published: February 2006

Predicting the shear‐wave (S‐wave) velocity is important in seismic modelling, amplitude analysis with offset, and other exploration and engineering applications. Under the low‐frequency approximation, the classical Biot–Gassmann theory relates the Biot coefficient to the bulk modulus of water‐saturated sediments. If the Biot coefficient under in situ conditions can be estimated, the shear modulus or the S‐wave velocity can be calculated. The Biot coefficient derived from the compressional‐wave (P‐wave) velocity of water‐saturated sediments often differs from and is less than that estimated from the S‐wave velocity, owing to the interactions between the pore fluid and the grain contacts. By correcting the Biot coefficients derived from P‐wave velocities of water‐saturated sediments measured at various differential pressures, an accurate method of predicting S‐wave velocities is proposed. Numerical results indicate that the predicted S‐wave velocities for consolidated and unconsolidated sediments agree well with measured velocities.
Deep resistivity structure of the Dikili‐Bergama region, west Anatolia, revealed by two‐ dimensional inversion of vertical electrical sounding data
Authors: Özürlan Gülçin , Candansayar M. Emin , Şahin M. Hüdavendigar
Published: February 2006

Within the framework of the National Marine Geological and Geophysical Program, we re‐examined deep vertical electrical sounding (VES) data. The data, measured in 1968 by the General Directorate of Mineral Research and Exploration (MTA) of Turkey with the aim of exploring the deep resistivity structure of the Dikili–Bergama region, focus on the geothermal potential. The geoelectrical resistivity survey was conducted using a Schlumberger array with a maximum electrode half‐spacing of 4.5 km. The two‐dimensional (2D) inversion was utilized to interpret the VES data that were collected along 15‐ to 30‐km profiles. The 2D resistivity–depth cross‐sections obtained show very low resistivity values near the Dikili and Kaynarca hot springs. The 2D inversion results also indicate the presence of fault zones striking nearly N–S and E–W, and fault‐bounded graben‐horst structures that show promising potential for geothermal field resources. The 2D gravity model, which is in good agreement with the density variation of the region, supports the resistivity structure revealed by 2D inversion. The lithology information obtained from the borehole near Kaynarca also confirms the results of the resistivity interpretation and the density model.
Inversion of elongated magnetic anomalies using magnitude transforms
Authors: Stavrev Petar
Published: February 2006

The calculable magnitudes of the anomalous magnetic field from simple 2D sources and their gradients and Laplacians appear as ratios that can be synthesized in functional forms, corresponding to the different source shapes. Field components and first‐order derivatives are involved in the inversion procedures presented. The structural index and source depth are estimated independently of each other. The applied functions allow magnetic profiles and magnetic maps to be shape‐ and depth‐converted with immediate imaging of the inversion results. The contours of these functions outline elongated loops around the 2.5D anomaly axis on magnetic maps. The width of the loops reflects the depth and structural index N of the source in the scale units of the inverted map. Model and field tests illustrate the effectiveness of this approach for fast automatic inversion of large sets of magnetic data for depth, shape, length and location of simple sources.
The Nontoxic CTA1‐DD Adjuvant Enhances Protective Immunity Against Helicobacter pylori Infection Following Mucosal Immunization
Authors: Akhiani A. A. , Stensson A. , Schön K. , Lycke N.
Published: February 2006

Safe and efficacious adjuvants are much needed to facilitate the development of mucosal vaccines. Here, we have asked whether our nontoxic vaccine adjuvant, CTA1‐DD, can enhance protective immunity against Helicobacter pylori infection. Intranasal immunizations with H. pylori lysate together with CTA1‐DD‐adjuvant induced significant protection in C57Bl/6 mice, almost as strong as similar immunizations using cholera toxin (CT)‐adjuvant. Protection remained strong even at 8 weeks postchallenge and the bacterial colonization was reduced by 20‐fold compared to lysate‐immunized controls. Although CTA1‐DD was designed to bind to B cells, µMT mice developed significant, but lower, level of protection following immunization. Intranasal immunizations with CT adjuvant in C57Bl/6 mice resulted in the development of severe postimmunization gastritis at 2 and 8 weeks postchallenge, whereas the degree of gastritis was substantially lower in the CTA1‐DD‐immunized mice. Protection induced by both CTA1‐DD‐ and CT adjuvant was associated with a strong local infiltration of CD4+ T cells in the gastric mucosa, and recall responses to specific Ag elicited substantial IFN‐γ production, indicating Th1‐dominance. These findings clearly demonstrate that CTA1‐DD adjuvant is a promising candidate to be further exploited in the development of a mucosal vaccine against H. pylori infection.
Serotonin Transporter mRNA Expression is Decreased by Lamivudine and Ribavirin and Increased by Interferon in Immune Cells
Authors: Tsao C.‐W. , Lin Y.‐S. , Cheng J.‐T. , Chang W.‐W. , Chen C.‐L. , Wu S.‐R. , Fan C.‐W. , Lo H.‐Y.
Published: February 2006

Clinical reports document that depression as a side effect is more prevalent in hepatic patients given interferon (IFN)‐α therapy than in those given lamivudine. The mechanisms, however, are poorly understood. Serotonin transporter (5‐HTT), via uptake of serotonin (5‐HT) into presynaptic serotoninergic neurons, is an initial action site for antidepressants. Real‐time polymerase chain reaction (PCR) was used to quantify 5‐HTT mRNA expression in immune cells in order to evaluate whether 5‐HTT acted as an indicator of depression. Results showed that the 5‐HTT mRNA expression was much higher in T‐cell and B‐cell lines than that in a monocytic cell line. Treatment with either lamivudine or ribavirin reduced the 5‐HTT mRNA expression, protein level and 5‐HT uptake in T‐cell line. Treatment with IFN‐α, however, increased those levels in the same group. A similar effect was observed in peripheral blood mononuclear cells (PBMC). Mimicking clinical use by treating PBMC with a combination of IFN‐α and ribavirin increased the 5‐HTT mRNA expression level. Our study indicates that these therapeutic drugs regulate 5‐HTT expression, which implies that 5‐HTT might be a trait marker in IFN‐α‐induced depression after hepatic therapy.
Interferon‐γ Gene (T874A and G2109A) Polymorphisms Are Associated With Microscopy‐positive Tuberculosis
Authors: Etokebe G. E. , Bulat‐Kardum L. , Johansen M. S. , Knezevic J. , Balen S. , Matakovic‐Mileusnic N. , Matanic D. , Flego V. , Pavelic J. , Beg‐Zec Z. , Dembic Z.
Published: February 2006

Genetic susceptibility to tuberculosis includes several unknown yet different loci each contributing to a small extent. Intronic polymorphisms within the interferon‐γ (IFN‐γ) gene IFNG T+874A and IFNG G+2109A correlate with the IFN‐γ production in vitro, and the frequency of potential high IFN‐γ producers was previously reported by others to be lower in patients than in controls from Sicily. The aim of this study was to determine whether there is an association between polymorphisms in the IFN‐γ gene and predisposition to tuberculosis. We analysed two IFNG SNPs (T+874A and G+2109A) in patients (n = 253) hospitalized in Rijeka (Croatia) and controls (n = 519) from the same area. One‐fifth of the controls were healthy contacts of the diseased, and the rest were blood donors. IFNG alleles, their predicted haplotypes or genotypes were not associated with disease susceptibility. Thus, we could not reproduce results from Sicilian case‐control study. However, T/T+874 (possible high IFN‐γ producer) and +874A/A (putative low producer) genotypes were associated with microscopically positive–negative forms of disease. Haplotypes (T+874A and G+2109A) based on a prediction by software phase and subsequent genotype analysis corroborated these findings. Patients had significantly higher frequency of genotypes without T at +874 (AA/AA; AA/AG and AG/AG) in microscopy‐ or bacterial culture‐positive groups compared with their negative counterparts. These data suggest an association with disease severity rather than susceptibility to tuberculosis in Croatian Caucasian population.
Elimination of CD4+ CD25+ Regulatory T cells Breaks Down Reovirus Type 2‐Triggered and CpG ODN‐Induced Prolonged Mild Autoimmune Insulitis in DBA/1 Mice
Authors: Hayashi T. , Hasegawa K. , Sasaki Y. , Onodera T.
Published: February 2006

We have reported previously that subclinical prolonged mild T helper (Th) 1‐dependent autoimmune insulitis with impaired glucose tolerance in wealing DBA/1J mice, which is induced by the combined effects of reovirus type 2 (Reo‐2) and synthetic 20‐base oligodeoxynucleotides with CpG motifs (CpG ODN) (control mice). Compared with the control mice, newborn mice treated with monoclonal antibody (MoAb) against mouse CD25+ CD4+ T cells together with Reo‐2 and CpG ODN greatly reduced the absolute number of splenic CD25+ T cells and resulted in the development of severe insulitis, leading to an overt early diabetes. Moreover, the treatment of the MoAb increased production of interferon‐γ (IFN‐γ) and decreased that of interleukin‐4 (IL‐4) and transforming growth factor‐β1 (TGF‐β1) and developed high titre of autoantibodies against pancreatic islet cells. These evidences suggest that CD4+ CD25+ T cell may, at least in part, maintain tolerance to Reo‐2‐triggered and CpG ODN‐induced prolonged mild Th1‐dependent autoimmune insulitis, leading to the overt disease. This system may give a novel model to elucidate the mechanisms of the development of overt diabetes from borderline subclinical diabetes in virus‐triggered autoimmune type I diabetes in human.
Cerebrovascular accident with quadriplegia following postpartum eclampsia
Authors: Okafor U. V. , Efetie E. R. , Onwuekwe I. , Uwaezeoke T. C.
Published: February 2006

A 26‐year‐old woman (para 1 + 0) was managed at the National Hospital, Abuja, Nigeria for postpartum eclampsia with quadriplegia following referral from a peripheral hospital with a history of a solitary tonic/clonic seizure and unconsciousness. Her antenatal period had been uneventful until she presented with labour pains, where examination revealed an elevated blood pressure. She fitted once after delivery and remained unconscious for more than 12 h, hence the referral. The patient was managed in the intensive care unit (ICU), where she was found to be quadriplegic. She received mechanical ventilation for 21 days as part of her management in the ICU. Despite multidisciplinary care, she remained quadriplegic until a doctors' strike precluded further in‐patient management. This rare complication of eclampsia is discussed, together with the patient's management.
Identification of thoracic intervertebral spaces by means of surface anatomy: a magnetic resonance imaging study
Authors: Holmaas G. , Frederiksen D. , Ulvik A. , Vingsnes S. O. , Østgaard G. , Nordli H.
Published: February 2006

Background:  Successful thoracic epidural analgesia depends on the sensory blockage of specific dermatomes following appropriate placement of the epidural catheter. This study aimed to ascertain how accurately anaesthesiologists identify thoracic intervertebral spaces, and whether counting from the prominent vertebra is easier than using the iliac crest as an anatomical landmark.

Methods:  Five anaesthesiologists attempted to locate one out of five consecutive intervertebral spaces (Th7–Th8 to Th11–Th12) on patients referred for magnetic resonance imaging of the vertebral column. The intended thoracic interspace and the counting reference point (C7–Th1 or L3–L4) were marked with oil capsules. The body mass index, gender and position of the patient were recorded. The exact capsule positions were determined by a radiologist after the study.

Results:  In 92 patients, 26.7% of the thoracic interspaces were correctly identified. The counting reference point was the only variable studied with a significant influence on error. The accuracy increased when the iliac crest was used as an anatomical landmark rather than the prominent vertebra (odds ratio, 0.29). The majority (76.4%) of all the incorrectly placed capsules were found cephalad to the intended level.

Conclusion:  We recommend that the caudal of two to three possible interspaces should be used when placing an epidural catheter in the thoracic spine. Because of the inaccurate localization of the thoracic intervertebral spaces, documentation should state the site of puncture as being in the upper or lower thoracic spine instead of claiming to be in an exact interspace.
Similar onset time of 2‐chloroprocaine and lidocaine + epinephrine for epidural anesthesia for elective Cesarean section
Authors: Bjørnestad E. , Iversen O. L. E. E. , Raeder J.
Published: February 2006

Background:  The use of regional anesthesia for elective Cesarean section has been demonstrated to be safe for both the mother and new‐born. In parturients with an epidural catheter placed previously for labor analgesia, extension of the epidural block may be the preferred option, provided that adequate speed of onset and adequate surgical anesthesia are obtained. We therefore performed a prospective, randomized, double‐blind trial to examine the speed of onset and anesthetic quality of 2‐chloroprocaine vs. a solution of lidocaine with one additive, epinephrine 5 µg/ml.

Methods:  Forty ASA I patients, scheduled for elective Cesarean section, were randomly assigned to two groups: the 2‐chloroprocaine group received 2‐chloroprocaine 30 mg/ml and the lidocaine group received the same amount (ml) of lidocaine 20 mg/ml with 5 µg/ml epinephrine. The speed of onset was defined as the time taken to loss of cold sensation from 70% ethanol application at thoracic dermatome level 5 (Th5).

Results:  The time to achieve loss of cold sensation at Th5 was similar in both groups: median of 8 min (range, 4–13 min) in the 2‐chloroprocaine group vs. 5 min (range, 2–22 min) in the lidocaine group (NS). Epidural anesthesia was successful for surgery in all but one patient (lidocaine group). There was no significant difference in the need for supplemental intravenous alfentanil between the two groups: 30% vs. 20% of patients in the 2‐chloroprocaine and lidocaine groups, respectively; the pain scores (visual analog scale) were also similar. Intra‐operative complications occurred with similar frequency, and none was serious. In the patients in the 2‐chloroprocaine group, 11 (55%) had episodes of systolic blood pressure less than 90 mmHg vs. 15 (75%) in the lidocaine group (NS).

Conclusion:  Both 2‐chloroprocaine and lidocaine have a rapid onset of effect and are suitable local anesthetic agents for Cesarean section. In view of the time taken for preparation and the potential for logistic problems when an additive is used, a pre‐prepared solution, such as 2‐chloroprocaine, may be preferred.
Anesthesia for Indian Ocean tsunami‐affected patients at a southern Thailand provincial hospital
Authors: Charuluxananan S. , Bunburaphong P. , Tuchinda L. , Vorapaluk P. , Kyokong O.
Published: February 2006

Background:  On 26 December 2004, a giant earthquake shook South‐East Asia, triggering deadly flood waves (tsunami) across the Indian Ocean. The Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand joined the Thai Red Cross Society to provide relief in southern Thailand. The objective of this article is to characterize the emergency surgical patients and anesthesia profiles of tsunami victims at Phang‐Nga Provincial Hospital.

Methods:  Available records from the operating room and anesthesia unit of Phang‐Nga Provincial Hospital, together with laboratory and administrative data, during the period 26–31 December 2004 were collected and analyzed using descriptive statistics.

Results:  Thai Red Cross teams provided surgical emergency services for 107 cases during 28–30 December 2004. Ninety‐three cases (86%) were Caucasian, one (0.9%) was Japanese and nine (8.4%) were Thai. ASA physical status classifications of 1, 2 and 3 were present in 87.8%, 8.4% and 0.4%, respectively. The majority of injuries comprised multiple soft tissue wounds with severe infection. Eighty‐five per cent of cases received debridement and 14.0% tendon or nerve repair or fixation of bone. The anesthesia choices were general endotracheal with rapid sequence induction and intubation (69.2%), general under mask (19.6%), total intravenous anesthesia (4.7%), spinal anesthesia (3.7%) and local anesthesia (2.8%). Anesthesia‐related problems included a lack of pre‐operative laboratory investigation, hypovolemia, severe wound infection with early sepsis and aspiration pneumonia. Common intra‐operative complications included hypotension and oxygen desaturation from pulmonary aspiration or lung contusion. There was one case of post‐operative reintubation and no peri‐operative mortality.

Conclusion:  Anesthesia‐related problems in tsunami victims included pulmonary aspiration, hypovolemia, sepsis and lack of pre‐operative laboratory investigation. General anesthesia was the most common anesthetic technique. Common intra‐operative complications included hypotension and oxygen desaturation.
Depth of a central venous catheter tip: length of insertion guideline for pediatric patients
Authors: Yoon S. Z. , Shin T. J. , Kim H. S. , Lee J. , Kim C. S. , Kim S. D. , Park C. D.
Published: February 2006

Background:  In pediatric patients, several studies have been undertaken to establish central venous catheter (CVC) tip optimal depth. Assessments of catheter tip position using chest radiographs may be misleading, whereas transesophageal echocardiography (TEE) has been shown to accurately monitor catheter tip placement at the superior vena cava–right atrial (SVC–RA) junction. The aim of this study was to issue a guideline for ideal catheter insertion depth, from the right internal jugular vein (IJV) using TEE to confirm the position of the catheter tip at the SVC–RA junction.

Methods:  Over a 6‐month period, we studied 60 right internal jugular vein catheterizations in infants and children undergoing surgery for congenital heart disease. Positions of CVC tips were confirmed to be at the SVC–RA junction by TEE. Distance from the skin puncture site to the SVC–RA junction, height, weight, and age were recorded.

Results:  Distances measured were found to be highly correlated with patient height. The following guideline allows the CVC tip to be positioned above the RA in 97.5% of patients with an accuracy of 95%: optimal depth of insertion (cm) = 1.7 + (0.07 × height) in patients whose height is between 40 and 140 cm.

Conclusion:  The model proposed for the insertion of the CVC tip in pediatric patients could be used to prevent inadvertent catheter tip placement into the atrium.
The influence of propofol on P‐selectin expression and nitric oxide production in re‐oxygenated human umbilical vein endothelial cells
Authors: Corcoran T. B. , O'Shea A. , Engel A. , Shorten G. D.
Published: February 2006

Background:  Reperfusion injury is characterized by free radical production and endothelial inflammation. Neutrophils mediate much of the end‐organ injury that occurs, requiring P‐selectin‐mediated neutrophil–endothelial adhesion, and this is associated with decreased endothelial nitric oxide production. Propofol has antioxidant properties in vitro which might abrogate this inflammation.

Methods:  Cultured human umbilical vein endothelial cells were exposed to 20 h of hypoxia and then returned to normoxic conditions. Cells were treated with saline, Diprivan 5 µg/l or propofol 5 µg/l for 4 h after re‐oxygenation and were then examined for P‐selectin expression and supernatant nitric oxide concentrations for 24 h. P‐selectin was determined by flow cytometry, and culture supernatant nitric oxide was measured as nitrite.

Results:  In saline‐treated cells, a biphasic increase in P‐selectin expression was demonstrated at 30 min (P = 0.01) and 4 h (P = 0.023) after re‐oxygenation. Propofol and Diprivan prevented these increases in P‐selectin expression (P < 0.05). Four hours after re‐oxygenation, propofol decreased endothelial nitric oxide production (P = 0.035).

Conclusion:  This is the first study to demonstrate an effect of propofol upon endothelial P‐selectin expression. Such an effect may be important in situations of reperfusion injury such as cardiac transplantation and coronary artery bypass surgery. We conclude that propofol attenuates re‐oxygenation‐induced endothelial inflammation in vitro.
The effect of intrathecal fentanyl added to hyperbaric bupivacaine on maternal respiratory function during Cesarean section
Authors: Arai Y‐C. P. , Ogata J. , Fukunaga K. , Shimazu A. , Fujioka A. , Uchida T.
Published: February 2006

Background:  Subarachnoid blockade with local anesthetics induces respiratory depression. Although the addition of fentanyl to bupivacaine has become popular in subarachnoid blockade for Cesarean section, there is no information on the effect of intrathecal fentanyl on maternal spirometric respiratory function in parturients undergoing Cesarean section.

Methods:  We tested the effect of the addition of intrathecal fentanyl to hyperbaric bupivacaine on maternal spirometric performance in 40 consenting parturients undergoing Cesarean section. The parturients were randomized into two groups: those receiving 2.0 ml of hyperbaric bupivacaine 0.5% and 0.4 ml of saline intrathecally and those receiving 2.0 ml of hyperbaric bupivacaine and 0.4 ml of fentanyl (20 µg) intrathecally. We performed spirometry on arriving at the operation room and 15 min after subarachnoid blockade.

Results:  Subarachnoid blockade with bupivacaine significantly decreased the peak expiratory flow rate, but did not induce significant changes in vital capacity and forced vital capacity. The addition of intrathecal fentanyl to bupivacaine improved the quality of subarachnoid blockade, but did not lead to a deterioration in respiratory function compared with intrathecal bupivacaine alone.

Conclusions:  The addition of intrathecal fentanyl to hyperbaric bupivacaine did not lead to a deterioration in maternal spirometric respiratory function in parturients undergoing Cesarean section.
Cardiopulmonary distress during obstetrical anaesthesia: attempts to diagnose amniotic fluid embolism in a case series of suspected allergic anaphylaxis
Authors: Harboe T. , Benson M. D. , Oi H. , Softeland E. , Bjorge L. , Guttormsen A. B.
Published: February 2006

Background:  Cardiopulmonary distress during obstetrical anaesthesia may result from a drug‐induced allergic reaction, but, in the obstetrical setting, allergic anaphylaxis may be inseparable from amniotic fluid embolism in terms of the clinical presentation. Further investigations, using allergy tests and other laboratory analyses, are then needed to pursue a diagnostic clarification.

Methods:  Twelve women suspected of having developed anaphylaxis during obstetrical anaesthesia underwent allergy follow‐up investigations and further serological tests with the amniotic fluid embolism marker sialyl Tn and complement factors (C3 and C4) in an attempt to differentiate amniotic fluid embolism from drug‐induced allergic anaphylaxis.

Results:  The diagnostic programme revealed one case of probable amniotic fluid embolism and four cases of probable drug‐induced allergic anaphylaxis. Of the remaining seven cases, there were two cases that, by diagnostic exclusion, could be classified as possible cases of amniotic fluid embolism. The cause of the reactions remained unresolved in five cases.

Conclusions:  It can be difficult to differentiate between anaphylaxis and amniotic fluid embolism, especially amongst survivors. Diagnostic markers that can be applied on peripheral blood samples are promising, but larger studies are needed to validate their use in the diagnosis of causes of cardiopulmonary distress during obstetrical anaesthesia.