bluuebunny/crossref_metadata_2025 huggingface dataset:
Current management of inadvertent dural taps occurring during the siting of epidurals for pain relief in labour A survey of maternity units in the United Kingdom
Authors: Sajjad T. , Ryan T.D.R.
Published: September 2007

A postal survey of all maternity units in the UK was conducted to gain information regarding the management of inadvertent dural taps occurring during the siting of epidurals for pain relief in labour. Of the units surveyed only 58.5% had a written protocol for the management of dural taps. Following their occurrence, 99% of the units resiled the epidural and in 22%, the midwives continued to give the top‐ups. In only one‐third of this latter group was the dose of the top‐up reduced. In 46% of the units, patients who had a dural tap were allowed to push in the second stage of labour. As prophylaxis against the development of headache, 70% of the units infused crystalloids into the epidural space, whereas only 8.6% were in favour of an early prophylactic blood patch.
High frequency jet ventilation in the management of intra‐operative tracheal injury
Authors: Hodgson C. A. , Mostafa S. M.
Published: September 2007

A patient undergoing pharyngo‐oesphagectomy with gastric transposition sustained a large tracheal tear during the blind oesophageal dissection. High frequency jet ventilation was successfully employed in the acute airway management and continued postoperatively.
Validation of three paediatric pain scores for use by parents
Authors: WILSON G. A. M. , DOYLE E.
Published: September 2007

Twenty children undergoing general surgery and 20 children undergoing otorhinolaryngological surgery were simultaneously assessed on two occasions by a doctor and a parent using three pain scoring systems. The pain scoring systems used were the Objective Pain Score, a four point numerical score and a 100 mm visual analogue scale. There was a high correlation between the scores given by the doctor and by the parents for all three scoring systems with parents consistently giving slightly higher scores than the doctor. The correlation coefficients for parental and medical pain scores in recovery were 0.77 for the Objective Pain Score, 0.70 for the four point numerical score and 0.69 for the visual analogue scale (p < 0.01). At 1 h after leaving the recovery area the correlation coefficients were 0.81, 0.80 and 0.73 respectively (p < 0.01). These results suggest that parental scoring of pain in children will be useful in future audit and research of analgesic regimens, particularly in day‐case surgery.
A comparison of opioid solutions for patient‐controlled epidural analgesia
Authors: SMITH A. J. , HAYNES T. K. , ROBERTS D. E. , HARMER M.
Published: September 2007

Sixty patients took part in a randomised, double‐blind study to compare the analgesic and side effects of three opioid‐containing solutions for patient‐controlled epidural analgesia following abdominal surgery. Patients in group 1 received a solution containing bupivacaine 0.125% with fentanyl 10μg. ml−1, group 2 bupivacaine 0.125% with diamorphine 125μg. ml−1, group 3 pethidine 2.5 mg. ml−1. All groups received 4 ml.h−1 background infusion and 3 ml boluses every 20 min if necessary. There were no significant differences between the groups in visual analogue scale pain scores (p = 0.537) or volumes of solution used at 24 h (p = 0.351) or 48 h (p = 0.105). Motor block was significantly higher in group 2 (p < 0.004) and pruritis occurred significantly less in group 3 (p < 0.05). We conclude that these three solutions produce equivalent analgesia but that pethidine 2.5 mg. ml−1 may be associated with fewer side effects.
Central venous line sepsis in the intensive care unit A study comparing antibiotic coated catheters with plain catheters
Authors: THORNTON J. , TODD N. J. , WEBSTER N. R.
Published: September 2007

A randomised controlled clinical trial was undertaken to evaluate the efficacy of antibiotic bonded lines in the reduction of central venous catheter infection. One hundred and seventy‐six plain and bonded catheters were inserted into one hundred and ten patients in an intensive care unit, many of whom were admitted with evidence of sepsis. The catheters used in the study group, which had been pre‐treated by the manufacturers with the cationic surfactant tridodecylmethylammonium chloride, were bonded with vancomycin 1 g made up in 10 ml of water immediately prior to insertion. The catheters used in the control group were neither pre‐treated nor bonded with vancomycin. Eighty percent of control group catheters were infected compared with 62% of study catheters (p = 0.01). The most common organism isolated was coagulase negative staphylococcus. We conclude that antibiotic bonding can reduce central venous catheter infection even in a patient population with a high incidence of sepsis.
Evaluation of the contribution to postoperative analgesia by local cooling of the wound
Authors: BRANDNER B. , MUNRO B. , BROMLEY L. M. , HETREED M.
Published: September 2007

Thirty healthy patients undergoing lumbar spine surgery were randomly assigned to one of two groups for postoperative pain relief. Group 1 received morphine via patient controlled analgesia and local cooling of the wound by an externally applied cooling pad while group 2 received patient controlled analgesia alone. There was a significant reduction in morphine consumption when local cooling was applied (18.6 mg versus 30.2 mg at 12h, 29.0 mg versus 49.6 mg at 24 h, p < 0.05). Patients were also significantly more satisfied with their overall postoperative pain management when cooling therapy was used.
A double‐blind comparison of codeine and morphine for postoperative analgesia following intracranial surgery
Authors: GOLDSACK C. , SCUPLAK S. M. , SMITH M.
Published: September 2007

Codeine and morphine were compared in a double‐blind study of postoperative analgesia in 40 patients after intracranial neurosurgery. Eighteen patients received codeine phosphate 60 mg and 18 morphine sulphate 10 mg, both by intramuscular injection; 4 patients (10%) required no analgesia. Both drugs provided analgesia within 20 min of injection but morphine was more effective than codeine beyond 60 min (p = 0.01). Fewer doses of morphine than codeine were required (p = 0.003). Nine patients requested one dose of morphine and 9 two doses. Seven patients required three doses of codeine and 1 patient required four doses. Neither drug caused respiratory depression, sedation, pupillary constriction or unwanted cardiovascular effects. We conclude that, in the doses used, morphine is a safe alternative to codeine for analgesia after neurosurgery and has a more persistent action.
Carbon monoxide within circle systems
Authors: HARRISON N. , KNOWLES A. C. , WELCHEW E. A.
Published: September 2007

After reports of carbon monoxide toxicity from the United States, the Medicines Control Agency issued a warning which recommended that soda lime used in circle breathing systems should not be allowed to dry out. We have measured carbon monoxide levels within a circle system in vitro (under a variety of conditions) and in vivo. Carbon monoxide was detected only when a patient was connected to the circle system. As levels in the expiratory limb of the circle system were significantly higher than those in the inspiratory limb, we conclude that the patient acts as the source of carbon monoxide.
Awake fibreoptic intubation in the semi‐prone position following facial trauma
Authors: Neal M. R. , Groves J. , Gell I. R.
Published: September 2007

A fit 27‐year‐old man presented with severe facial trauma following an industrial accident. Initial assessment showed severe swelling around the lower jaw and haemorrhage from the mouth, nose, scalp and left ear. The patient was conscious with a Glasgow Coma Score of 13 but in respiratory distress. Following adoption of the prone position his airway improved. Relief of the patient's airway obstruction was a priority and the patient underwent awake fibreoptic intubation in the prone position prior to induction of anaesthesia. Computed tomography scans of his head and neck were unremarkable and after fixation of a bilateral mandibular fracture he made an uneventful recovery. Intubation in the semi‐prone position may be a useful technique in injuries of this type.
Total intravenous anaesthesia with propofol or inhalational anaesthesia with isoflurane for major abdominal surgery: Recovery characteristics and postoperative oxygenation—an international multicentre study
Authors: Phillips A. S. , Mirakhur R. K. , Glen J. B. , Hunter S. C.
Published: September 2007

Two hundred and ten adult patients undergoing open cholecystectomy, vagotomy or gastrectomy were included in a randomised multicentre study to compare postoperative nausea and vomiting, oxygen saturations for the first three postoperative nights, time to return of gastrointestinal function, mobilisation, and discharge from the hospital following induction and maintenance of anaesthesia with propofol and alfentanil or with thiopentone, nitrous oxide, isoflurane and alfentanil. Recovery from anaesthesia was significantly faster in the propofol group (mean (SD) times to eye opening and giving correct date of birth of 14.0 (SD 13.8) and 25.5 (SD 29.5) minutes, and 18.5 (SD 14.8) and 35.5 (SD 37.2) minutes in the propofol and isoflurane groups respectively). There was significantly less nausea in the propofol group (15.4%) than in the isoflurane group (33.7%) in the first two postoperative hours (p < 0.003) but not thereafter. There were no significant differences between the groups in any other recovery characteristics. The incidence of hypoxaemia (arterial oxygen saturation less than 93%) was close to 70% in both groups for the first three postoperative nights, indicating the need for oxygen therapy after major abdominal surgery.
The view of the glottis at laryngoscopy after unexpectedly difficult placement of the laryngeal mask
Authors: Asai T.
Published: September 2007

In 12 patients to whom a non‐depolarising neuromuscular relaxant had been given and in whom placement of the laryngeal mask had failed unexpectedly, the view of the larynx at laryngoscopy and the ease of tracheal intubation were examined. The glottis was only partially seen at laryngoscopy in three patients and was not seen at all in another three patients. Tracheal intubation was difficult in three of them. It would appear that in some patients both placement of the laryngeal mask and tracheal intubation are difficult. It is thus inadvisable to paralyse patients electively and rely on the laryngeal mask to secure a clear airway when tracheal intubation is predicted to be difficult.
Economics of low‐flow anaesthesia in children
Authors: PERKINS R. , MEAKIN G.
Published: September 2007

We have measured the consumption of isoflurane and fresh gas flows in 77 infants and children during 20 all‐day operating sessions using either the enclosed Mapleson A or the circle absorber mode of the Garden‘Ventmasta’ventilator. The average consumption (SD) of isoflurane in 37 patients anaesthetised using the A mode of the Garden system with a mean fresh gas flow of 2.6l.min−1 was 11.1 (4.2)g.h−1, while that in 40 patients anaesthetised using the circle absorber mode with a mean fresh gas flow of 1.21.min−1 was 4.7 (1.0)g.h−1. These figures represent an overall saving of 58% in the use of isoflurane (p < 0.0001) and a mean reduction in fresh gas flow of 54% (p < 0.0001) as a result of using low‐flow anaesthesia. With the addition of small bore breathing hoses the adult circle absorber system was practical to use in both infants and children. These findings should stimulate interest in the use of low‐flow techniques in children.
Pretreatment with controlled‐release morphine for pain after hysterectomy
Authors: CRUICKSHANK R. H. , SPENCER A. , ELLIS F. R.
Published: September 2007

In a double‐blind randomised study, two dosing regimens for controlled‐release morphine tablets were compared against placebo to ascertain the extent of prophylactic postoperative pain control in 51 women undergoing abdominal hysterectomy. One group of patients received controlled‐release morphine every 12 h for 2 days before surgery, a second group received a single dose of controlled‐release morphine 2h before surgery and a third group received placebo. Patient‐controlled analgesia system demands were compared for the first 38 h after surgery and 10‐point pain scores and McGill pain questionnaires were compared for the first 6 postoperative days and at 6 weeks after surgery. During the first 2 days after surgery, patients reported high levels of pain which were similar in all groups. Pain scores on the third and fourth postoperative days were significantly lower in those who had a single pre‐operative dose of controlled‐release morphine compared with placebo and those who had been treated with morphine every 12 hfor 2 days (p = 0.043 and 0.024 for third and fourth day respectively). Patient‐controlled analgesia demands were also fewer and less variable in those patients receiving the single dose of morphine 2h before surgery. The study shows a beneficial analgesic effect of a single pre‐operative dose of morphine, but shows no benefit for a more prolonged pre‐operative dosing regimen.
Effect of epidural block on the lag time of pulse oximeter response
Authors: XUE F. S. , LIAO X. , TONG S. Y. , LIU Q. H. , AN G. , LUO L. K.
Published: September 2007

Thirty‐six healthy patients, ASA 1, aged 16–41 years, scheduled for elective plastic surgery were studied to determine if thoracocervical or lumbar epidural blocks affected the lag time of the pulse oximeter response. Patients were allocated to receive thoracocervical epidural block (n = 20) (group 1) (lignocaine 1 %) or lumbar epidural block (n = 16) (group 2) (lignocaine 1.5%). Epidural block was performed with a 17‐gauge Tuohy needle inserted in the midline between C7‐T2 vertebrae in group 1 and between L3‐S1 in group 2 and an epidural catheter was introduced. Arterial oxygen saturation (Spo2) was measured continuously using a Datex pulse oximeter. The lag time of the pulse oximeter response was measured while breathing oxygen (100%) after breath‐holding. Values were obtained 10min before and 5, 10, 15, 20, 30, and 40 min after epidural injection of a test dose. There was a progressive decrease in the lag time of the pulse oximeter response so that by 30 min after epidural injection the mean (SD) value had decreased from 29 (6.1) to 14 (3.4) in Group 1 and 41 (12.8) to 23 (7.9) s in group 2 (p < 0.01).
Venous levels of lignocaine and bupivacaine after peribulbar block
Authors: GAO F. , BUDD A. J.
Published: September 2007

Twenty‐five patients undergoing elective cataract day surgery were studied after receiving a dual‐injection peribulbar block with a mixture consisting of equal volumes of 2% lignocaine and 0.75% bupivacaine with hyaluronidase. A maximum of 10ml of solution was used for the initial block; supplementary injections of up to 10 ml were given to five patients. Venous blood was taken prior to the block and then 1, 10, 20, 30, 60 and 90 min after the block. The peak mean concentrations of lignocaine (0.722 μg. ml−1) and bupivacaine (0.353 μg. ml−1)were found at 10–20 min after injection when no top‐up was given and at 10 min after the top‐up injection when required. All measured serum concentrations of lignocaine and bupivacaine were below the accepted toxic levels of the two drugs. However, the highest individual toxicity score after a top‐up was 0.915 which was very close to the toxicity threshold (= 1) when a scoring system was used to assess the combined levels.
Gas leakage and the laryngeal mask airway: A comparison with the tracheal tube and facemask during spontaneous ventilation using a circle breathing system
Authors: CAMERON A. E. , SIEVERT J. , ASBURY A. J. , JACKSON R.
Published: September 2007

The ability of the laryngeal mask airway, tracheal tube and facemask to provide a leak free seal in a clinical setting was assessed by measuring the minimal fresh gas flows needed in a closed circle system during spontaneous ventilation on 60 subjects. The fresh gas flow was reduced until no spillage occurred from the pop‐off valve. This fresh gas flow was taken to represent the sum of gas uptake by the subject and gas leakage from the circuit. The median fresh gas flow after 20 minutes was 350 ml. min−1 in the laryngeal mask airway group, 350 ml. min−1 in the tracheal tube group and 450 ml. min−1 in the facemask group. The fresh gas flow required for the facemask group was significantly higher than that for the laryngeal mask airway or tracheal tube groups (p < 0.01). There was no significant difference between the fresh gas flows required for the tracheal tube and laryngeal mask airway groups. We conclude that the laryngeal mask airway provides as good a gas tight seal as a tracheal tube in this context and would be of benefit in reducing anaesthetic gas pollution.
A laboratory assessment of oxygen delivery from a portable chemical generator
Authors: MURRAY W. B. , Bhimsan N. R. , Rout C. C.
Published: September 2007

A simple portable chemical oxygen generator was tested in the laboratory. The device is designed for use by the public as an oxygen supply until an emergency team arrives with appropriate oxygen cylinders. The generator was found to supply a mean (SD) flow of oxygen of 3.6 (0.01) 1.min−1 for 12.5 (range 12.4–12.6) min. The mean (SD) total volume of oxygen produced was 47 (0.17) 1. The supplied oxygen mask was a variable performance type with the problems and limitations inherent in this design; an oxygen flow of 8 l.min ‘is required to provide 40% oxygen and most of the oxygen is wasted and not available to the patient. This poses a serious limitation to any device which has a limited capability (inflow and/or total volume) for producing oxygen.
Use of a neonatal noninvasive blood pressure module on adult patients
Authors: GREEN D. W.
Published: September 2007

A clinical and statistical comparison of systolic, mean and diastolic arterial blood pressures was made between a non‐invasive technique using a neonatal oscillometric blood pressure monitor attached to the thumb versus an invasive technique using a catheter inserted into the ipsilateral radial artery in 18 patients undergoing general anaesthesia for major surgery. In 1258 readings, the mean differences between the pressures obtained (invasive versus non‐invasive) were + 9.1–7.9, and—0.7 mmHg for systolic, diastolic and mean pressures respectively. Oscillometric blood pressure measurement using the thumb appears to be an acceptable method for monitoring blood pressure during anaesthesia and has advantages over conventional cuff placement on the upper arm.
Hypotension, subarachnoid block and the elderly patient
Authors: CRITCHLEY L. A. H.
Published: September 2007

This article reviews the current literature on the management of hypotension during subarachnoid block in the elderly. Hypotension results from blockade of the sympathetic nervous system, which causes decreases in both systemic vascular resistance and cardiac output. Abolition of normal cardiovascular reflexes is also important and may explain unexpected cardiac arrests during subarachnoid block. Untreated block in the elderly results in decreases in systolic arterial pressure, systemic vascular resistance and central venous pressure. Cardiac output appears not to decrease as has been previously reported and heart rate is affected by several different factors. Preload to the heart should be maintained during block by giving adequate intravenous fluids and 8 ml. kg−1 is satisfactory in most cases. Adequate preloading prevents decreases in cardiac output and unexpected cardiac arrests. In this respect, mild head down tilt is also beneficial. Ideally, intravenous fluid should be given as the block is developing. Excessive fluid administration serves no useful purpose and can cause fluid overload and urinary retention. If systolic arterial pressure decreases by more than 25%, or to below 90 mmHg, treatment with a vasopressor is indicated. The efficacy of ephedrine has recently been questioned, as it is a poor vasoconstrictor and inotrope in the elderly. The α‐adrenoceptor agonists may prove a more logical choice, because they increase both peripheral resistance and preload. Metaraminol by infusion (< 10 ml.h−1 of 10 mg in 20ml) has been used successfully, though hypertension can occur.
Asystole from tetanic stimulation of the accessory nerve
Authors: Scott P. V.
Published: September 2007

An asystolic cardiac arrest is reported which occurred at the same time as supramaximal tetanic stimulation over the accessory nerve in order to evoke contractions in the trapezius and sternocleidomastoid muscles. The cause may have been the inadvertent stimulation of one or more of the cranial nerves of the carotid sheath at the base of the skull: the cranial root of the accessory nerve, the vagus, the sino‐carotid branch of the glossopharyngeal nerve or the hypoglossal nerve. The most likely culprit, if not the vagus itself, was the cranial root of the accessory nerve which both functionally and anatomically should be seen as an integral part of the vagus. It is suggested that stimulation of any nerve in the carotid sheath should be approached with caution and that a tetanic stimulus to this area might best be avoided.
Pain following craniotomy: a preliminary study comparing PCA morphine with intramuscular codeine phosphate
Authors: Stoneham M. D. , Cooper R. , Quiney N. F. , Walters F. J. M.
Published: September 2007

We have performed a prospective randomised trial of 30 patients undergoing craniotomy to compare intramuscular codeine phosphate with patient‐controlled analgesia using morphine 1 mg bolus with a 10‐min lockout and no background infusion. For 24 h postoperatively, pain, nausea, Glasgow coma score, respiratory rate and sedation score were assessed. There was a wide variation in the amounts of morphine requested by the patients in the patient‐controlled analgesia group in the first 24 h postoperatively (range 2–79 mg, median 17 mg). There was a small, but non‐significant, reduction in pain scores in the patient‐controlled analgesia group. There were no significant differences between the two groups in respect of nausea and vomiting, sedation score or respiratory rate. No major adverse effects were noted in either group. Patient‐controlled analgesia with morphine is an alternative to intramuscular codeine phosphate in neurosurgical patients which merits further investigation.
IgG‐mediated immunosuppression is not dependent on erythrocyte clearance or immunological evasion: implications for the mechanism of action of anti‐D in the prevention of haemolytic disease of the newborn?
Authors: Brinc Davor , Le‐Tien Hoang , Crow Andrew R. , Freedman John , Lazarus Alan H.
Published: September 2007

Haemolytic disease of the newborn (HDN) can be prevented by the passive administration of anti‐D to the mother. The most accepted theory to describe this activity of anti‐D is based upon its ability to clear opsonized erythrocytes before their recognition by the maternal immune system. We examined this hypothesis using a murine model of immunity to foreign erythrocytes. Whereas transfusion of foreign erythrocytes into mice induced immunoglobulin (Ig)M and IgG antibodies specific for the erythrocytes, these humoral immune responses were inhibited when the erythrocytes were opsonized with IgG. To specifically determine if immunological evasion occurs with these opsonized erythrocytes, we examined T‐cell responses from these mice. An erythrocyte‐specific T‐cell response was clearly detected. We then tested whether phagocytosis of opsonized erythrocytes is sufficient to prevent the antibody response. We exposed mononuclear phagocytic cells to sheep red blood cells (SRBC) in vitro and then adoptively transferred the phagocytic cells to recipient mice; opsonized SRBC unexpectedly increased, rather than decreased, the antibody response. These data indicate that removal of opsonized erythrocytes by phagocytic cells does not prevent their immunological recognition and suggest that antigen clearance may not be the predominant mechanism of anti‐erythrocyte action in downregulating the humoral immune response.
Systematic review of high dose chemotherapy and autologous haematopoietic stem cell transplantation for chronic lymphocytic leukaemia: what is the published evidence?
Authors: Kharfan‐Dabaja Mohamed A. , Kumar Ambuj , Behera Madhusmita , Djulbegovic Benjamin
Published: September 2007

Despite improved responses, chronic lymphocytic leukaemia (CLL) remains incurable with conventional chemotherapy. Patients with poor‐risk factors or who fail conventional chemoimmunotherapy are offered autografts, preferably after achieving remission. This report presents the totality of evidence through a systematic review that assessed the efficacy of autografts in CLL. A search of MEDLINE databases from 1966–2006 and hand‐search of references identified 82 prospective‐randomized, non‐randomized comparisons or single‐arm trials, of which only nine met our inclusion criteria: two trials were funded by public/government, one by private foundations, one jointly by private/public, and was unclear in five. No randomized controlled trials comparing autografts versus conventional chemotherapy (or chemoimmunotherapy) were found. Six studies were single‐arm and three were non‐randomized with a control‐arm (autologous versus allogeneic). Overall, 361 patients were enrolled, but only 292 were transplanted. Transplant‐related mortality ranged from 0% to 9%. Complete responses ranged from 74% to 100% and molecular responses ranged from 57% to 88%. Overall survival ranged from 68% at 3 years to 58% at 6 years. It is uncertain whether autograft is superior to conventional therapy. The high incidence of myelodysplastic syndrome (9–12%) is particularly concerning in CLL, where median survival is 9 years.
The human leucocyte antigen‐G 14‐basepair polymorphism correlates with graft‐versus‐host disease in unrelated bone marrow transplantation for thalassaemia
Authors: La Nasa Giorgio , Littera Roberto , Locatelli Franco , Lai Sara , Alba Francesco , Caocci Giovanni , Lisini Daniela , Nesci Sonia , Vacca Adriana , Piras Eugenia , Bernardo Maria Ester , Cesare‐Merlone Alessandra Di , Orrù Sandro , Carcassi Carlo
Published: September 2007

The presence of the 14‐bp insertion polymorphism of the human leucocyte antigen (HLA)‐G gene (HLA‐G) promotes immune tolerance through increased synthesis of HLA‐G molecules. We investigated this polymorphism in a large cohort of 53 thalassaemia patients transplanted from an unrelated donor. Sixteen patients (30·2%) homozygous for the 14‐bp deletion had a higher risk of developing acute graft‐versus‐host disease (aGvHD) than patients homozygous for the 14‐bp insertion (−14‐bp/−14‐bp vs +14‐bp/+14‐bp: Relative Risk = 15·0; 95% confidence interval 1·59–141·24; P = 0·008). Therefore, the 14‐bp polymorphism could be an important predictive factor for aGvHD following bone marrow transplantation.
Risk of venous thrombosis: obesity and its joint effect with oral contraceptive use and prothrombotic mutations
Authors: Pomp Elisabeth R. , Le Cessie Saskia , Rosendaal Frits R. , Doggen Carine J. M.
Published: September 2007

In the Multiple Environmental and Genetic Assessment of risk factors for venous thrombosis (MEGA study), body weight, height and body mass index (BMI) were evaluated as risk factors. Additionally, the joint effect of obesity together with oral contraceptive use and prothrombotic mutations on the risk of venous thrombosis were analysed. Three‐thousand eight‐hundred and thirty‐four patients with a first venous thrombosis and 4683 control subjects were included, all non‐pregnant and without active malignancies. Relative to those with a normal BMI (<25 kg/m2), overweight (BMI ≥ 25 and BMI < 30 kg/m2) increased the risk of venous thrombosis 1·7‐fold [odds ratio (OR)adj(age and sex) 1·70, 95% confidence interval (CI) 1·55–1·87] and obesity (BMI ≥ 30 kg/m2) 2·4‐fold (ORadj 2·44, 95% CI 2·15–2·78). An increase in body weight and body height also individually increased thrombotic risk. Obese women who used oral contraceptives had a 24‐fold higher thrombotic risk (ORadj 23·78, 95% CI 13·35–42·34) than women with a normal BMI who did not use oral contraceptives. Relative to non‐carriers of normal BMI, the joint effect of factor V Leiden and obesity led to a 7·9‐fold increased risk (ORadj 7·86, 95% CI 4·70–13·15); for prothrombin 20210A this was a 6·6‐fold increased risk (ORadj 6·58, 95% CI 2·31–18·69). Body height, weight and obesity increase the risk of venous thrombosis, especially obesity in women using oral contraceptives.
Quality of life in chronic lymphocytic leukemia: an international survey of 1482 patients
Authors: Shanafelt Tait D. , Bowen Deborah , Venkat Chaya , Slager Susan L. , Zent Clive S. , Kay Neil E. , Reinalda Megan , Sloan Jeff A. , Call Timothy G.
Published: September 2007

Although a diagnosis of chronic lymphocytic leukemia (CLL) can have a profound effect on the quality of life (QOL), few studies have objectively measured the QOL of CLL patients or compared it to the general population. We conducted an international, web‐based survey of patients with CLL using standardized instruments with published population norms to evaluate fatigue and QOL. Co‐morbid health conditions were assessed using the Charlson Co‐Morbidity Index. Between June and October 2006, 1482 patients with CLL responded to the survey. The physical, social/family, functional, and overall QOL scores of CLL patients were similar to or better than published population norms. In contrast, the emotional well‐being scores of CLL patients were dramatically lower than that of both the general population (P < 0·001) and patients with other types of cancer (P < 0·001). QOL scores were lower among individuals with advanced stage disease (all P < 0·05). Factors associated with lower overall QOL on multivariate analysis included older age, greater fatigue, severity of co‐morbid health conditions, and current treatment. CLL has a profound impact on QOL at all disease stages. The effects of CLL on QOL appear to differ from that of other malignancies with a more marked impact on emotional QOL. Research identifying efficacious psycho‐oncologic support interventions for patients with CLL is needed.
Bone morphogenetic protein 4 modulates c‐Kit expression and differentiation potential in murine embryonic aorta‐gonad‐mesonephros haematopoiesis in vitro
Authors: Marshall Caroline J. , Sinclair Joanna C. , Thrasher Adrian J. , Kinnon Christine
Published: September 2007

The transforming growth factor‐β‐related factor bone morphogenetic protein 4 (BMP4) is expressed in the human embryonic aorta‐gonad‐mesonephros (AGM) coincident with the emergence of haematopoietic cells and influences postnatal mammalian haematopoietic stem cells in vitro. To investigate the role of BMP4 in mammalian embryonic haematopoiesis, cells were isolated from murine AGM and two populations of CD34+ cells with different levels of c‐Kit expression and multipotency were identified. CD34+/c‐Kithigh cells express CD45 and are haematopoietic‐restricted progenitors. In contrast, CD34+/c‐Kitlow cells are Flk1+/CD45neg and generate adherent colonies in ex vivo culture that resemble haemangioblast colonies identified in other systems. The addition of BMP4 to AGM cells resulted in expansion of the CD34+/c‐Kitlow cell pool within 48 h, via a combination of down modulation of the c‐Kit receptor in CD34+/c‐Kithigh cells and proliferation. In long‐term culture, BMP4 increased the growth/survival of CD34+/c‐Kithigh haematopoietic progenitors, effects that were blocked by BMP inhibitors. CD34+/c‐Kithigh progenitors cultured with BMP4 also generated adherent colonies typical of c‐Kitlow cells. These results suggest that BMP4 regulates c‐Kit expression and differentiation potential in CD34+ AGM cells and supports a role for BMP signalling in the maintenance of multipotency during embryonic haematopoiesis, providing an insight into stem cell homeostasis within the mammalian haematopoietic niche.
Molecular identification of a begomovirus causing yellow vein disease on Calendula officinalis in India
Authors: Khan A. A. , Khan M. S. , Raj S. K. , Naqvi Q. A.
Published: September 2007

A whitefly transmitted begomovirus was detected by PCR using begomovirus‐specific primers from naturally infected Calendula officinalis plants showing yellow vein disease symptoms. An approximately 800 bp PCR amplicon was cloned and sequenced to identify the species of the virus isolate. Analysis of nucleotide sequence data resulted in its identification as the complete coat protein gene open reading frame (CP ORF) of 771 bp, which encoded 256 amino acid residues. The coat protein of the virus isolate shared maximum identities of 96–97% with four strains of Tobacco curly shoot virus (ToCSV) and an Ageratum enation virus (AgEV) during BLAST analysis of sequence data. Nucleotide‐ and amino acid‐based phylogenetic analysis revealed the close relationship of the isolate with ToCSV strains, therefore it has been identified as an isolate of ToCSV and C. officinalis is considered to be a new host of ToCSV begomovirus. Association of a DNA‐β molecule with the virus isolate was also detected by PCR and Southern hybridization tests using DNA‐β specific primers and probe.
Phenology modelling of major insect pests in fruit orchards from biological basics to decision support: the forecasting tool SOPRA*
Authors: Samietz J. , Graf B. , Höhn H. , Schaub L. , Höpli H. U.
Published: September 2007

The forecasting tool SOPRA has been developed with the objective of optimizing timing of monitoring, management and control measures of insect pests in fruit orchards in Switzerland. Applying time‐varying distributed delay approaches, phenology‐models were developed driven by solar radiation, air temperature and soil temperature on hourly basis. Relationships between temperature and stage‐specific development rates for relevant stages of the life cycles were established under controlled laboratory conditions for Dysaphis plantaginea, Hoplocampa testudinea, Cydia pomonella, Grapholita lobarzewskii, Cacopsylla pyri, Rhagoletis cerasi, Anthonomus pomorum and Adoxophyes orana. The implementation of body temperatures in the models is based on habitat selection and biophysical modelling of habitat conditions. In order to validate modelling, phenology predictions were compared with several years of independent field observations. On the basis of local weather data, the age structure of the pest populations is simulated and crucial events for management activities are announced. Through a web interface, the simulation results are made available to consultants and growers (http://www.sopra.info) and the latter can be applied as a decision support system for the eight major insect pests of fruit orchards in the alpine valleys and north of the Alps on local and regional scale.
Forecasting of Fusarium head blight and deoxynivalenol content in winter wheat with FusaProg*
Authors: Musa T. , Hecker A. , Vogelgsang S. , Forrer H. R.
Published: September 2007

Fusarium head blight is one of the most serious cereal diseases of the world. Epidemics of Fusarium head blight can lead to a decline in grain quality and yield. In addition, grains often become contaminated with mycotoxins, which are harmful to humans and animals. In a field survey of winter wheat in Switzerland, Fusarium graminearum proved to be the most prevalent species responsible for head blight and deoxynivalenol the most common mycotoxin. To elucidate and quantify single or combined effects of cropping factors on F. graminearum infestation and to reduce the risk of mycotoxin contamination of wheat under conservation tillage, we developed the decision support system FusaProg. Our model takes into account the effects of cropping factors, previous crops, soil and straw management, as well as the F. graminearum susceptibility of the planted variety. These factors are used as driving variables and are combined with the prevailing weather conditions and growth stage in order to predict the deoxynivalenol content of a specific wheat plot before harvest. To use FusaProg as a threshold‐based tool to control F. graminearum with optimized timing of fungicide applications, forecasts of deoxynivalenol contents are conducted during the flowering period. FusaProg is an Internet‐based decision support system which not only provides information about the local and regional F. graminearum infection risks; it also forecasts plot‐specific deoxynivalenol contamination of winter wheat. In 2006, the system was evaluated by Swiss cantonal plant protection officers, and in 2007, the system will be made available to Swiss wheat producers.
IT applications in Hungarian plant protection and soil conservation, focusing on GIS*
Authors: Szabó L. , Dancsházy Z.
Published: September 2007

In Hungary, plant protection and soil conservation are not only believed to be closely related, but are managed in a single, nationwide Service. GIS is used to assist the Service in organising this joint activity by:

establishing the infrastructure suitable for coordinating different kinds of data collection, GIS processing, transfer and publication of such data

improving the staff capacity by providing training and technical assistance in using GIS, capturing field data, navigating and using thematic maps

creating a simple and interactive interface for accessing geographic data produced from activities of controlling use of plant protection products, in plant health, in controlling weeds and in soil conservation

providing guidance for designing, monitoring and assessing the impact of particular programmes (e.g. implementing nitrate and sewage sludge directives, ragweed eradication, survey and monitoring for quarantine and other economically important pests)

establishing an Agro‐environmental Information and Monitoring System to support environmentally friendly farming.

The Service operates one nationwide and six regional GIS centres. Databases are now tested and operated for the Intranet. Interactive maps are planned to be publicly accessible through a map server from 2007.
Downy mildew outbreaks on grapevine under climate change: elaboration and application of an empirical‐statistical model*
Authors: Salinari F. , Giosuè S. , Rossi V. , Tubiello F. N. , Rosenzweig C. , Gullino M. L.
Published: September 2007

The global climate is changing. Much research has already been carried out to assess the potential impacts of climate change on plant physiology. However, effects on plant disease have not yet been deeply studied. In this paper, an empirical disease model for primary infection of downy mildew on grapevine was elaborated and used to project future disease dynamics under climate change. The disease model was run under the outputs of the General Circulation Model (GCM) and future scenarios of downy mildew primary outbreaks were generated at several sites all over the word for three future dates: 2030, 2050, 2080. Results suggested a potential general advance of first disease outbreaks, both in the Northern and Southern Hemispheres, for all three future decades considered. The advance is predicted to be from about a minimum of one day in South Africa in 2030 to a maximum of 28 days in Chile and China in 2080. The advance in the outbreak time could lead to more severe infections, due to the polycyclic nature of the pathogen. Therefore, changes in the timing and frequency of fungicide treatments could be expected in the future, with a possible increase in the costs of disease management.
Pumpkin yellow vein mosaic disease is caused by two distinct begomoviruses: complete viral sequences and comparative transmission by an indigenous Bemisia tabaci and the introduced B‐biotype
Authors: Maruthi M. N. , Rekha A. R. , Muniyappa V.
Published: September 2007

Pumpkin yellow vein mosaic disease (PYVMD) causes significant damage to pumpkin production throughout India. A begomovirus causing PYVMD in South India was characterized recently but the nature of virus causing the disease in North India was not known. Samples of PYVMD were obtained from North India and two putative begomoviruses were PCR‐amplified and sequenced. Comparison of complete DNA‐A sequences indicated that PYVMD in North and South India were caused by two distinct begomoviruses and shared only approximately 88% DNA‐A nucleotide identity. The South Indian isolate was most closely related to Squash leaf curl China virus between 91 and 96% identities, and the two North Indian isolates to Tomato leaf curl New Delhi virus between 94 and 96% identities. The South Indian isolate was previously shown to be transmitted by the indigenous biotype of Bemisia tabaci, however, the situation has since changed with the introduction of the B‐biotype to South India in 1999. Comparative transmission experiments between the indigenous biotype v/s the introduced B‐biotype for the time required for virus acquisition (30 min v/s 15 min), inoculation (15 min v/s 10 min) and incubation (30 min v/s 4 h) have indicated that the B‐biotype transmits the virus quickly and more efficiently than the indigenous biotype. An epidemic of PYVMD was recorded for the first time in South India in 2004 with disease incidences of up to 100% and significant yield losses. This may be due to a combination of several factors including the large numbers of B‐biotype populations, the ability of the B‐biotype to transmit the virus efficiently and the cultivation of susceptible varieties. These possibilities and the threat to pumpkin cultivation associated with the spread of the B‐biotype in India are discussed.
SIMBLIGHT1 – a new model to predict first occurrence of potato late blight*
Authors: Kleinhenz Benno , Falke Kristina , Kakau Joachim , Rossberg Dietmar
Published: September 2007

Prediction of the first occurrence of potato late blight (Phytophthora infestans) given by the SIMPHYT1 model, which has been used for about 20 years, has not been found satisfactory in years with high soil moisture. Consequently, a new model, SIMBLIGHT1, has been developed. As input parameters SIMBLIGHT1 requires temperature, relative humidity and information on soil moisture, crop prevalence and cultivar susceptibility. SIMBLIGHT1 calculates a cumulative risk index for several groups of emergence dates and signals the start of the epidemic once a given threshold is overridden. Model validation and comparison of SIMBLIGHT1 with SIMPHYT1 were performed with field data from 11 years. Results were promising and SIMBLIGHT1 gave better results than SIMPHYT1 when soils of potato fields were waterlogged. Efforts are currently being made to improve SIMBLIGHT1 and in the long term this model will replace SIMPHYT1.
Decision support systems: barriers and farmers’ need for support*
Authors: Jørgensen L. N. , Noe E. , Langvad A. M. , Jensen J. E. , Ørum J. E. , Rydahl P.
Published: September 2007

The highly complex knowledge of scientific disciplines makes nuanced analysis and modelling possible. However, the information produced often does not reach farmers because it is presented in a way that does not correspond to the way their work is carried out in practice. The decision support system Crop Protection Online is widely used by advisors and as a learning tool for students. Although the system has been validated in many field trials over the years and has shown reliable results, the number of end‐users among farmers has been relatively low during the last 10 years (approximately 1000 farmers). A sociological investigation of farmers’ decision‐making styles in the area of crop protection has shown that arable farmers can be divided into three major groups: (a) system‐orientated farmers, (b) experience‐based farmers and (c) advisory‐orientated farmers. The information required by these three groups to make their decisions varies and therefore different ways of using decision support systems need to be provided. Decision support systems need to be developed in close dialogue and collaboration with user groups.
The Antiseptic Properties of Povidone‐lodine and Tincture of Metaphen used Topically on the Tooth Surface
Authors: DEEDS KENNETH M. , MARSHALL F. JAMES , ROSEN SAMUEL
Published: September 2007

This article is abstracted from a thesis submitted by the senior author in partial fulfilment of the requirements for the degree of Master of Science in the Graduate School, Ohio State University.
Reduction in pulpal inflammation beneath surface‐sealed silicates
Authors: TOBIAS R. S. , PLANT C. G. , BROWNE R. M.
Published: September 2007

The authors acknowledge the financial support of Amalgamated Dental International, and the technical help from the staff within he Department of Oral Pathology.
Factors promoting the tissue dissolving capability of sodium hypochlorite
Authors: MOORER W. R. , WESSELINK P. R.
Published: September 2007

The authors thank Mr A. J. Lammens for his technical assistance and Dr S. R. Fox for his assistance in preparing the manuscript.
A modification of the Millipore method for screening restorative materials
Authors: MERYON SYLVIA D. , STEPHENS P. G. , BROWNE R. M.
Published: September 2007

The cytotoxic effects of Concise composite, zinc phosphate and silicate cements, and zinc oxide/eugenol were evaluated in an in vitro system which ensured good cell/material contact. The material contact. The materials were incubated for increasing lengths of time, and their toxicity as assessed by their effect on SDH staining ranked them in order of increasing severity Concise < Silicap < zinc phosphate < zinc oxide/eugenol. On the basis of cellular morphology Silicap was more toxic than zinc phosphate. Overall there was poor correlation between these two methods of assessment. A layer of compacted dentine powder between the test material and cell monolayer reduced the cytotoxic effects of all materials.

This study was supported by a grant from D.H.S.S., No. R/E 1050/105. The authors are grateful to Dr Buchan, Department of Medical Microbiology for the initial supply of cells, to the photography unit in preparing figures and to Miss H. Rupp for typing the manuscript.
The pulpal effects of medicaments containing formaldehyde following pulpotomy in monkeys
Authors: MULLEM P. J. VAN , WEELDEREN M. WIJNBERGEN‐BUIJEN VAN
Published: September 2007

The authors are grateful to Miss W. Go, dental practitioner, for performing the pulpotomies and for taking part in examining the histological slides, to Mr P. B. Spaan and his staff at the Central Animal Laboratory, University of Nijmegen, for their help and to Mr S. J. A. M. Nottet and Miss Pia Helmich for technical preparation of the histological specimens.
Fluoride as the possible cytotoxic component of Silicap. 2. Effect on cellular enzymes in different cell types
Authors: MERYON SYLVIA D. , STEPHENS P. G.
Published: September 2007

This study was supported by a grant from the DHSS, No. R/E 1050/105. The authors are grateful to Mrs J. Edwards who maintained the mouse colony, to Dr Buchan, Department of Medical Microbiology, for the initial supply of cells, and to Dr Riches, Department of Immunology, for use of the automated continuous flow apparatus for enzyme analysis. In addition, the help of the Photographic Unit in preparing figures is acknowledged, and grateful thanks are extended to Professor R. M. Browne for all his help and advice.
Effect of high‐ and low‐speed burs used for partial pulpotomy in monkey teeth
Authors: HEIDE S.
Published: September 2007

Abstract. This study investigated the immediate effect of partial pulpotomy in monkey teeth using different rotary instruments. The rotary instruments used were a diamond bur at 300,000 rpm, a tungsten carbide bur at 300,000 rpm and a steel round bur at 6,000 rpm. The pulps were examined half‐an‐hour after the operative procedure. Both high speed techniques were shown to cause minimal damage to the pulp. The results also suggested that steel round burs produced a satisfactory alternative where the bur could be supported on dentine.