bluuebunny/crossref_metadata_2025 huggingface dataset:
Thomas J. Watson and the Business-Government Relationship, 1933–1956
Authors: Stebenne David L.
Published: February 2005

The precise nature of the relationship between the American business community and the New Deal has been a lively topic of debate in recent years. This article looks at an important figure and firm in that relationship (Thomas J. Watson of IBM) to increase our understanding of it. This article focuses chronologically on the period from the early 1930s through the mid-1950s, when New-Deal-era public policy innovations were most influential. The overall picture that emerges from this study of the U.S. business-government relationship during those years is one of business accommodation of major changes in social conditions and public policies rather than a view of business as the primary leader of change.
An Early Global Business in a Colonial Context: The Strategies, Management, and Failure of John Palmer and Company of Calcutta, 1780–1830
Authors: Webster Tony
Published: February 2005

This article explores the business and managerial strategies of Palmer and Company, a Calcutta agency house, as it strove to develop its global business in an era of limited communications technology. The article considers the reasons for the eventual demise of the firm and the consequences for business in India. It examines the principles that governed the operations of the business and considers the extent to which these contributed to the demise of the firm. More generally, it considers the factors that contributed not only to the failure of Palmer and Company but also to the collapse of all the agency houses by 1833.
Increased Sensitivity to Thermal Pain and Reduced Subcutaneous Lidocaine Efficacy in Redheads
Authors: Liem Edwin B. , Joiner Teresa V. , Tsueda Kentaro , Sessler Daniel I.
Published: February 2005

Background

Anesthetic requirement in redheads is exaggerated, suggesting that redheads may be especially sensitive to pain. Therefore, the authors tested the hypotheses that women with natural red hair are more sensitive to pain and that redheads are resistant to topical and subcutaneous lidocaine.

Methods

The authors evaluated pain sensitivity in red-haired (n = 30) or dark-haired (n = 30) women by determining the electrical current perception threshold, pain perception, and maximum pain tolerance with a Neurometer CPT/C (Neurotron, Inc., Baltimore, MD). They evaluated the analogous warm and cold temperature thresholds with the TSA-II Neurosensory Analyzer (Medoc Ltd., Minneapolis, MN). Volunteers were tested with both devices at baseline and with the Neurometer after 1-h exposure to 4% liposomal lidocaine and after subcutaneous injection of 1% lidocaine. Data are presented as medians (interquartile ranges).

Results

Current perception, pain perception, and pain tolerance thresholds were similar in the red-haired and dark-haired women at 2,000, 250, and 5 Hz. In contrast, redheads were more sensitive to cold pain perception (22.6 [15.1-26.1] vs. 12.6 [0-20] degrees C; P = 0.004), cold pain tolerance (6.0 [0-9.7] vs. 0.0 [0.0-2.0] degrees C; P = 0.001), and heat pain (46.3 [45.7-47.5] vs. 47.7 [46.6-48.7] degrees C; P = 0.009). Subcutaneous lidocaine was significantly less effective in redheads (e.g., pain tolerance threshold at 2,000-Hz stimulation in redheads was 11.0 [8.5-16.5] vs. > 20.0 (14.5 to > 20) mA in others; P = 0.005).

Conclusion

Red hair is the phenotype for mutations of the melanocortin-1 receptor. Results indicate that redheads are more sensitive to thermal pain and are resistant to the analgesic effects of subcutaneous lidocaine. Mutations of the melanocortin-1 receptor, or a consequence thereof, thus modulate pain sensitivity.
The Impact of Pharmacogenomics on Postoperative Nausea and Vomiting
Authors: Candiotti Keith A. , Birnbach David J. , Lubarsky David A. , Nhuch Fani , Kamat Aimee , Koch Walter H. , Nikoloff Michele , Wu Lin , Andrews David
Published: February 2005

Background

Some patients treated with ondansetron for postoperative nausea and vomiting do not respond to therapy. One possible mechanism for this failure is ultrarapid drug metabolism via the cytochrome P-450 system, specifically the enzyme 2D6 (CYP2D6). Ultrarapid metabolism is seen in patients with multiple functional copies (>/= 3) of the CYP2D6 allele. This study was designed to determine whether patients who were given prophylactic ondansetron and had multiple CYP2D6 alleles had an increased rate of postoperative nausea and vomiting.

Methods

Two hundred fifty female patients undergoing standardized general anesthesia were given 4 mg ondansetron 30 min before extubation. Patients were observed for symptoms of nausea and vomiting. DNA was extracted from blood in all patients and was analyzed by using a gene-specific probe to determine the CYP2D6 gene copy number and genotyped by polymerase chain reaction amplification with a custom oligonucleotide microarray to determine the specific CYP2D6 genotypes.

Results

Eighty-eight patients experienced nausea, and 37 of those patients also had vomiting. In patients with one, two, or three CYP2D6 copies, the incidences of vomiting were 3 in 33 (27%), 27 in 198 (14%), and 7 in 23 (30%), respectively. The incidence of vomiting in subjects with three CYP2D6 copies was significantly different from those with two copies, but not from those with one copy. When analyzed by genotype, the incidences of vomiting in poor, intermediate, extensive, and ultrarapid metabolizers were 1 in 12 (8%), 5 in 30 (17%), 26 in 176 (15%), and 5 in 11 (45%), respectively (P < 0.01 vs. all other groups). There were no differences between groups in the incidence of nausea based on CYP2D6 copy number or genotype.

Conclusions

Patients with three copies of the CYP2D6 gene, a genotype consistent with ultrarapid metabolism, or both have an increased incidence of ondansetron failure for the prevention of postoperative vomiting but not nausea.
Awakening Concentration of Desflurane Is Decreased in Patients with Obstructive Jaundice
Authors: Song Jian-Gang , Cao Yun-Fei , Yang Li-Qun , Yu Wei-Feng , Li Quan , Song Jin-Chao , Fu Xiao-Yong , Fu Qiang
Published: February 2005

Background

Some studies suggest that behavioral complications of cholestasis, such as fatigue and pruritus, may be associated with altered neurotransmission in the brain. Because inhaled anesthetics primarily act on ion channels and receptors on the neuronal cell membrane and alter synaptic transmission in the central nervous system, it is possible that altered sensitivity to inhaled anesthetics may occur in cholestatic patients. Therefore, the authors compared the minimum alveolar concentration (MAC)-awake of desflurane in obstructive jaundiced patients with the MACawake in nonjaundiced patients.

Methods

Patients underwent inhalational induction of anesthesia with desflurane. MACawake was determined in each patient by observing the response to a verbal command (open eyes on request). An end-tidal anesthetic concentration was maintained at an initial target level of 1.4% for 15 min before a command. If a positive response was observed, the concentration of desflurane was increased by 0.1% and again kept constant for 15 min. The verbal command was then continued. This process was repeated until an end-tidal concentration was reached at which the patient did not respond to command. The anesthetic concentration midway between the value permitting the response and that just preventing the response was defined as MACawake for each patient.

Results

The MACawake of desflurane for patients with obstructive jaundice (1.78 +/- 0.19%) was significantly less than those observed for the control group (2.17 +/- 0.25%; P < 0.001) and correlated significantly with serum total bilirubin (r = -0.67, P = 0.0004).

Conclusions

The MACawake of desflurane is reduced in obstructive jaundiced patients compared with nonjaundiced controls.
Effects of Bispectral Index Monitoring on Recovery from Surgical Anesthesia in 1,580 Inpatients from an Academic Medical Center
Authors: Pavlin Janet D. , Souter Karen J. , Hong Jae Y. , Freund Peter R. , Bowdle T Andrew , Bower Jan O.
Published: February 2005

Background

The purpose of this study was to determine whether monitoring Bispectral Index (BIS) would affect recovery parameters in patients undergoing inpatient surgery.

Methods

Anesthesia providers (n = 69) were randomly assigned to one of two groups, a BIS or non-BIS control group. A randomized crossover design was used, with reassignment at monthly intervals for 7 months. Duration of time in the postanesthesia care unit, time from the end of surgery to leaving the operating room, and incidence of delayed recovery (> 50 min in recovery) were compared in patients treated intraoperatively with or without BIS monitoring. Data were analyzed by analysis of variance, unpaired t test, or chi-square test as appropriate.

Results

One thousand five hundred eighty patients in an academic medical center were studied. The mean BIS in the monitored group was 47. No differences were found in recovery parameters between the BIS-monitored group and the control group when comparisons were made using all subjects or when data were analyzed within anesthetic subgroups stratified by anesthetic agent or duration of anesthesia. There were some small reductions in the intraoperative concentration of sevoflurane (but not isoflurane).

Conclusions

The use of BIS monitoring for inpatients undergoing a wide variety of surgical procedures in an academic medical center had some minor effects on intraoperative anesthetic use but had no impact on recovery parameters.
Ketamine Attenuates Acetylcholine-induced Contraction by Decreasing Myofilament Ca2+Sensitivity in Pulmonary Veins
Authors: Ding Xueqin , Damron Derek S. , Murray Paul A.
Published: February 2005

Background

The authors investigated the extent and cellular mechanisms by which the intravenous anesthetic ketamine alters acetylcholine-induced contraction in pulmonary veins (PVs). They tested the hypothesis that ketamine inhibits acetylcholine contraction in PVs.

Methods

Canine PV rings with endothelium (E+) and without endothelium (E-) were isolated for measurement of isometric tension. The effects of ketamine (10(-5) m approximately 10(-3) m) on acetylcholine contraction were assessed in E+ and E- rings. The effects of inhibiting nitric oxide synthase on ketamine-induced changes in acetylcholine contraction were investigated in E+ rings, whereas the effects of Ca2+ influx and Ca2+ release were investigated in E- rings. In fura-2 loaded E- PV strips, the effects of ketamine (10(-4) m) on the intracellular Ca2+ concentration-tension relation (i.e., myofilament Ca sensitivity) were assessed in the presence or absence of acetylcholine. The roles of the protein kinase C and rho-kinase signaling pathways in ketamine-induced changes in myofilament Ca2+ sensitivity were also investigated.

Results

Ketamine caused dose-dependent (P < 0.001) inhibition of acetylcholine contraction in E+ and E- PV rings. The ketamine-induced attenuation of acetylcholine contraction was still observed after inhibition of nitric oxide synthase (P = 0.002), Ca2+ influx (P < 0.001), and Ca2+ release (P = 0.021). Ketamine alone had no effect on myofilament Ca2+ sensitivity (P = 0.892) but attenuated (P = 0.038) the acetylcholine-induced increase in myofilament Ca2+ sensitivity. This attenuation was still observed after rho-kinase inhibition (P = 0.039), whereas it was abolished by protein kinase C inhibition (P = 0.798).

Conclusions

Ketamine attenuates acetylcholine contraction by inhibiting the acetylcholine-induced increase in myofilament Ca2+ sensitivity, which is mediated by the protein kinase C signaling pathway.
Vaporized Perfluorohexane Attenuates Ventilator-induced Lung Injury in Isolated, Perfused Rabbit Lungs
Authors: Gama de Abreu Marcelo , Wilmink Beate , Hübler Matthias , Koch Thea
Published: February 2005

Background

The authors tested the hypothesis that administration of vaporized perfluorohexane may attenuate ventilator-induced lung injury.

Methods

In isolated, perfused rabbit lungs, airway pressure-versus-time curves were recorded. At baseline, peak inspiratory pressure and positive end-expiratory pressure of mechanically ventilated lungs were set to obtain straight pressure-versus-time curves in both the lower and upper ranges, which are associated with less collapse and overdistension, respectively. After that, peak inspiratory pressure and positive end-expiratory pressure were set at 30 cm H2O and 0, respectively, and animals were randomly assigned to one of two groups: (1) simultaneous administration of 14% perfluorohexane vapor in room air (n = 7) and (2) control group-ventilation with room air (n = 7). After 20 min of cycling collapse and overdistension, tidal volume and positive end-expiratory pressure were set back to baseline levels, administration of perfluorohexane in the therapy group was stopped, and mechanical ventilation was continued for up to 60 min. Lung weight, mean pulmonary artery pressure, and concentration of thromboxane B2 in the perfusate were measured. In addition, the distribution of pulmonary perfusate flow was assessed by using fluorescent-labeled microspheres.

Results

Significantly higher peak inspiratory values developed in control lungs than in lungs treated with perfluorohexane. In addition, upper ranges of pressure-versus-time curves were closer to straight lines in the perfluorohexane group. Lung weight, mean pulmonary arterial pressure, and release of thromboxane B2 were significantly higher in controls than in perfluorohexane-treated lungs. Also, redistribution of pulmonary perfusate flow from caudal to cranial zones was less important in the treatment group.

Conclusion

The authors conclude that the administration of perfluorohexane vapor attenuates the development of ventilator-induced lung injury in isolated, perfused rabbit lungs.
Drastic Decrease in Isoflurane Minimum Alveolar Concentration and Limb Movement Forces after Thoracic Spinal Cooling and Chronic Spinal Transection in Rats
Authors: Jinks Steven L. , Dominguez Carmen L. , Antognini Joseph F.
Published: February 2005

Background

Individuals with spinal cord injury may undergo multiple surgical procedures; however, it is not clear how spinal cord injury affects anesthetic requirements and movement force under anesthesia during both acute and chronic stages of the injury.

Methods

The authors determined the isoflurane minimum alveolar concentration (MAC) necessary to block movement in response to supramaximal noxious stimulation, as well as tail-flick and hind paw withdrawal latencies, before and up to 28 days after thoracic spinal transection. Tail-flick and hind paw withdrawal latencies were measured in the awake state to test for the presence of spinal shock or hyperreflexia. The authors measured limb forces elicited by noxious mechanical stimulation of a paw or the tail at 28 days after transection. Limb force experiments were also conducted in other animals that received a reversible spinal conduction block by cooling the spinal cord at the level of the eighth thoracic vertebra.

Results

A large decrease in MAC (to </= 40% of pretransection values) occurred after spinal transection, with partial recovery (to approximately 60% of control) at 14-28 days after transection. Awake tail-flick and hind paw withdrawal latencies were facilitated or unchanged, whereas reflex latencies under isoflurane were depressed or absent. However, at 80-90% of MAC, noxious stimulation of the hind paw elicited ipsilateral limb withdrawals in all animals. Hind limb forces were reduced (by >/= 90%) in both chronic and acute cold-block spinal animals.

Conclusions

The immobilizing potency of isoflurane increases substantially after spinal transection, despite the absence of a baseline motor depression, or "spinal shock." Therefore, isoflurane MAC is determined by a spinal depressant action, possibly counteracted by a supraspinal facilitatory action. The partial recovery in MAC at later time points suggests that neuronal plasticity after spinal cord injury influences anesthetic requirements.
Variability of Target-controlled Infusion Is Less Than the Variability after Bolus Injection
Authors: Hu Chuanpu , Horstman Damian J. , Shafer Steven L.
Published: February 2005

Background

Target-controlled infusion (TCI) drug delivery systems deliver intravenous drugs based on pharmacokinetic models. TCI devices administer a bolus, followed by exponentially declining infusions, to rapidly achieve and maintain pseudo-steady state drug concentrations in the plasma or at the site of drug effect. Many studies have documented the prediction accuracy of TCI devices. The authors' goal was to apply linear systems theory to characterize the relation between the variability in concentrations achieved with TCI devices and the variability in concentrations after intravenous bolus injection.

Methods

The authors developed a mathematical model of the variability of any arbitrary method of drug delivery, based on the variability with intravenous bolus injection or the variability with an arbitrary infusion regimen. They tested the model in a simulation of 1,000 patients receiving propofol by simple bolus injection, conventional infusion, or a TCI device. The authors then examined an experimental data set for the same behavior.

Results

The variability of any arbitrary infusion regimen, including TCI, is bounded by the variability after bolus injection. This is observed in the simulation and experimental data sets as well.

Conclusion

TCI devices neither create nor eliminate biologic variability. For any drug described by linear pharmacokinetic models, no infusion regimen, including TCI, can have higher variability than that observed after bolus injection. The median performance of TCI devices should be reasonably close to the prediction of the device. However, the overall spread of the observations is an intrinsic property of the drug, not the TCI delivery system.
Minimum Local Analgesic Doses of Ropivacaine, Levobupivacaine, and Bupivacaine for Intrathecal Labor Analgesia
Authors: Camorcia Michela , Capogna Giorgio , Columb Malachy O.
Published: February 2005

Background

Doses for intrathecal opioid-local anesthetic mixtures have been arbitrarily chosen. The aim of this study was to compare the analgesic efficacies of intrathecal ropivacaine, levobupivacaine, and bupivacaine for labor analgesia and to determine the analgesic potency ratios for these three drugs. For this purpose, the authors used the up-down sequential allocation model, which estimates the minimum local analgesic dose for intrathecal local anesthetic.

Methods

Ninety-seven nulliparous term parturients in spontaneous labor, requesting combined spinal-epidural analgesia, were randomly allocated to one of three groups to receive 0.25% spinal ropivacaine, levobupivacaine, or bupivacaine. The initial dose of the local anesthetic drug was chosen to be 2.5 mg, and the testing interval was set at 0.25 mg. The subsequent doses were determined by the response of the previous parturient. Efficacy was accepted if the visual analog pain score decreased to 10 mm or less on a 100-mm scale within 30 min. The minimum local analgesic dose was calculated using the method of Dixon and Massey.

Results

The intrathecal minimum local analgesic dose was 3.64 mg (95% confidence interval, 3.33-3.96 mg) for ropivacaine, 2.94 (2.73-3.16) mg for levobupivacaine, and 2.37 (2.17-2.58) mg for bupivacaine. The relative analgesic potency ratios were 0.65 (0.56-0.76) for ropivacaine:bupivacaine, 0.80 (0.70-0.92) for ropivacaine:levobupivacaine, and 0.81 (0.69-0.94) for levobupivacaine:bupivacaine. There were significant trends (P </= 0.021) for greater motor block with bupivacaine and levobupivacaine.

Conclusions

This study suggests a potency hierarchy of spinal bupivacaine > levobupivacaine > ropivacaine.
Drug-sensitivity profile of clinical Mycobacterium tuberculosis isolates – a retrospective study from a chest-disease institute in India
Authors: Dam T , Isa M , Bose M
Published: February 2005

Multi-drug-resistant tuberculosis (MDR-TB) is a major public-health problem, because treatment is complicated and patients remain infectious for months or years, despite receiving the best available therapy. To gain better understanding of MDR-TB, a retrospective study was initiated to determine the level of drug resistance among patients in a chest-disease institute in India. Two hundred and sixty-three isolates from treatment-failure pulmonary tuberculosis patients (20–70 years) were studied. Drug-sensitivity testing was performed by the modified-proportion method. First- and second-line drugs, along with two quinolone drugs (ofloxacin and ciprofloxacin), were tested. Patients included in this study did not improve with therapy; however, 151 isolates (57.5 %) were susceptible to all four first-line antituberculosis drugs. This study reports low resistance to fluoroquinolones among the strains present in these patients.
Application of a viability-staining method for Mycobacterium leprae derived from the athymic (nu/nu) mouse foot pad
Authors: Lahiri Ramanuj , Randhawa Baljit , Krahenbuhl James
Published: February 2005

Mycobacterium lepraecannot be cultured, so ascertaining viability of the organism remains a major obstacle, impeding many avenues of investigation. This study tested a two-colour, Syto9 and propidium iodide, fluorescence assay, which scores for membrane damage in individual bacilli, to determine if a rapid direct-count viability-staining technique can be reliably applied toM. leprae. A variety of experimental conditions were employed to validate this technique. This technique was also used to correlate the viability ofM. lepraewith the course of athymic mouse foot pad infection to optimize the provision of viableM. lepraeas a research reagent. The data show that in untreated suspensions ofM. lepraethere is a good correlation between the metabolic activity of leprosy bacilli and their membrane damage. Fixation ofM. lepraewith ethanol, paraformaldehyde and gluteraldehyde completely suppressed their metabolic activity but showed little effect on their membrane integrity. The present study also showed that the metabolic activity ofM. lepraedeclines more than the extent of membrane damage at 37 °C within 72 h, but that they are not significantly affected at 33 °C. Irradiation at 104Gy showed high numbers of dead bacilli by the staining method. The results show that the reliability of metabolic-activity data as well as viability-staining data is dependent on the method by whichM. lepraeis killed. This staining method helped us predict reliably that the smallerM. leprae-infected athymic mouse foot pad seen early in infection, between 4 and 5 months, yields markedly better quality leprosy bacilli than older, larger foot pad infections, as defined by their metabolic activity and membrane integrity.
A novel species-specific PCR assay for identifying Lactobacillus fermentum
Authors: Dickson E M , Riggio M P , Macpherson L
Published: February 2005

Lactobacillus fermentum is a Gram-positive bacterium that is associated with active caries lesions. Methods for identifying Lactobacillus species traditionally have been based upon culture methods coupled with biochemical tests, which are generally unreliable. The aim of this study was to develop a species-specific PCR assay for the direct detection of L. fermentum in oral clinical samples. PCR primers specific for L. fermentum were identified by alignment of bacterial 16S rRNA genes and selection of sequences specific for L. fermentum at their 3′ ends. PCR positivity for L. fermentum DNA was indicated by amplification of a 337 bp product. The primers were shown to be specific for L. fermentum DNA, since no PCR product was obtained when genomic DNA from a wide range of other oral bacteria, including closely related Lactobacillus species, were used as test species. The PCR assay was then used in an attempt to identify L. fermentum DNA in supragingival plaque samples and in pus aspirates from subjects with acute dento-alveolar abscesses. Four out of 70 (5.7 %) supragingival plaque samples analysed were positive for the presence of L. fermentum DNA while none of the 19 pus samples analysed was positive for L. fermentum DNA. This PCR assay provides a more rapid, specific and sensitive alternative to conventional culture methods for the identification of L. fermentum in clinical specimens.
Influence of antimicrobial treatment for Helicobacter pylori infection on the intestinal microflora in Japanese macaques
Authors: Tanaka Junji , Fukuda Yoshihiro , Shintani Shigeyuki , Hori Kazutoshi , Tomita Toshihiko , Ohkusa Toshifumi , Matsumoto Takayuki , Miwa Hiroto
Published: February 2005

Eradication treatment for Helicobacter pylori is known to cause mild but relatively frequent adverse effects. Some adverse effects such as diarrhoea and soft stools are related to disruption of the composition of the intestinal microflora. This study investigated the microfloral changes resulting from administration of an eradication regimen using proton pump inhibitor (PPI), amoxycillin and clarithromycin. Twenty-eight laboratory-bred Japanese macaques either were administered eradication treatment by this regimen for 7 days or received no medication. Faecal samples were collected for analysis on days 0, 8 and 15, and both aerobic and anaerobic cultures were performed. Among aerobic bacteria, Streptococcus had significantly decreased by day 8, while Enterococcus and Enterobacteriaceae had significantly increased. However, the total number of aerobic bacteria was not significantly decreased from pretreatment levels 1 day after completion of treatment. The number of anaerobic bacteria did not change significantly by day 8. However, the number of Lactobacillus and the detection rate of Bifidobacterium, Peptostreptococcus and Veillonella significantly decreased by day 8, although the number of Bifidobacterium, Peptostreptococcus and Veillonella had almost recovered up to the pretreatment levels 1 week after completion of treatment (day 15). These results suggest that the alterations in the composition of the intestinal microflora caused by the antimicrobial regimen that excludes metronidazole are different from those caused by the regimen including this drug. However, the alterations in bacterial microflora had almost reversed 7 days after completion of treatment in these macaques, which supports clinical findings that diarrhoea or soft stools in humans resolve relatively quickly after a similar treatment.
Attitudes and practices of private medical providers towards family planning and abortion services in Nigeria
Authors: Okonofua F. E. , Shittu S. O. , Oronsaye F. , Ogunsakin D. , Ogbomwan S. , Zayyan M.
Published: February 2005

Context.  The study was designed to investigate the attitudes and practices of private medical practitioners towards abortion, postabortion care and postabortion family planning in Nigeria.

Methods.  Three hundred and twenty‐three private practitioners who were proprietors of private clinics in three states of the country were interviewed with a structured questionnaire that elicited information on their knowledge and experiences of abortion and postabortion care in the cities.

Results.  Twenty‐four percent of the doctors reported that they routinely terminate unwanted pregnancies when requested to do so by women, while 82% reported that they frequently treat women who experience complications of unsafe abortion. Over 45% reported that they use manual vacuum aspiration (MVA) for the management of abortion in the first trimester, while 25% use dilatation and curettage (D&C). Nearly 28% reported the use of MVA followed by D&C in the first trimester. Fifty‐seven percent reported their lack of expertise in managing second‐trimester abortions, while those admitting that they manage second‐trimester abortions reported nonstandard methods and procedures. In addition, there was evidence of inadequate counseling of women, lack of institutional protocols and poor use of postabortion family planning by the doctors.

Conclusions.  These results suggest the need for a program of retraining of private practitioners on the principles and practices of safe abortion, postabortion care and family planning in Nigeria and the integration of these topics into medical training curricula in the country.
Inhibin A and B as markers of menopause: a five‐year prospective longitudinal study of hormonal changes during the menopausal transition
Authors: Øverlie Inger , MØrkrid Lars , Andersson Anna‐Maria , SkakkebÆk Niels E. , Moen Mette H. , Holte Arne
Published: February 2005

Objectives.  A more direct and precise hormonal marker of the menopause has been required for some time. The aim of this study was to identify the most accurate marker of the menopause, based on analyses of inhibin A and B, FSH, LH and estradiol (E2), among 59 healthy women without hormonal treatment during the perimenopause and early postmenopause.

Methods.  Fifty‐nine women, aged 46–56 years (mean age 51.2 years), were examined annually for 5 years during the menopausal transition and had venous blood drawn simultaneously for later analyses of the above‐mentioned hormones.

Results.  Inhibin A showed a steady decline from at least 4 years before the final menstrual period (FMP) until 1 year before menopause, whereas inhibin B had a shorter lasting decline from year 3 to year 2 before menopause, concomitant with a rise in FSH and LH.

Conclusion.  The present study confirmed previous observations that inhibin A had a continuous decline starting before the decline of inhibin B, suggesting that an increasing part of the cycle was anovulatory. The fall in inhibin B and the increase in FSH constitute markers of ovarian aging. One year prior to menopause neither inhibin A nor inhibin B could be detected. The disappearance of these peptide hormones is an important predictor of the approaching menopause.
Normative values of Doppler velocimetry of five major fetal arteries as determined by color power angiography
Authors: Konje Justin C. , Abrams Keith R. , Taylor David J.
Published: February 2005

Objective.  To produce normograms of Doppler indices of major fetal arteries and their ratios relative to the ascending aorta in a cohort of appropriately grown for gestational age fetuses.

Methods.  Prospective longitudinal study of 70 women with appropriately grown for gestational age fetuses between 24 and 38 weeks' gestation attending the Fetal Growth Clinic of a large UK teaching hospital. Doppler velocimetry of the middle cerebral (MCA), umbilical (UmA) and renal arteries (RA) and the ascending (AAO) and descending (DAO) aortas were studied using color power angiography. Ratios of the Doppler indices [pulsatility index (PI), resistance index (RI), systolic/diastolic (S/D) ratio] were then calculated using the ascending aorta as the reference numerator for the other four vessels to produce normograms. Regression analysis was performed to determined the significance, if any, of the changes in these ratios with gestation.

Results.  The normograms of the various Doppler indices were similar for the middle cerebral artery, ascending and descending aortas. There was an initial rise to a peak between 30 and 32 weeks and then a gradual return to values at 38 weeks similar to those at 24 weeks' gestation. In the renal artery, the indices showed very little variation with gestation. However, there was a gradual fall in the indices with gestation in the umbilical artery. The ratios of the various indices relative to that of the ascending aorta demonstrated an increase with gestation. The changes with gestation were statistically significant for the ratios of the indices from the ascending aorta to those of the middle cerebral, renal and umbilical arteries but not for those of the descending aorta.

Conclusions.  The vascular resistance in the five fetal arteries decreased towards the end of pregnancy and the ratios of their indices relative to those of the ascending aorta decreased from 24 to 38 weeks' gestation. Early subtle changes in circulation in compromised fetuses may be identified early from deviations in these normograms.
The effect of placental removal method and site of uterine repair on postcesarean endometritis and operative blood loss
Authors: Baksu Alparslan , Kalan Aysel , Ozkan ArzU , Baksu Başak , Tekelioğlu Meltem , Goker Nimet
Published: February 2005

Background.  Our purpose was to determine whether blood loss during cesarean section and postoperative endometritis rate were associated with the method of placental removal and site of uterine repair.

Methods.  This prospective randomized study involved 840 women who underwent cesarean section. The patients were grouped into four: (1) manual placental delivery + exteriorized uterine repair; (2) spontaneous placental delivery + exteriorized uterine repair; (3) manual placental delivery + in situ uterine repair; (4) spontaneous placental delivery + in situ uterine repair. Patients were excluded if they had received intrapartum antibiotics, had chorioamnionitis, required an emergency cesarean hysterectomy, had rupture of membranes for more than 12 hr, had bleeding diathesis, and had abnormal placentation or prior postpartum hemorrhage. The main outcome measures were postoperative hemoglobin and hematocrit values, and postcesarean endometritis.

Results.  There were no statistically significant differences in mean maternal age, parity, gestational age, presence and duration of membrane rupture and number of vaginal examinations between the four groups. The decrease in postoperative hemoglobin (P < 0.05) and hematocrit (P < 0.001) was significantly greater in the manual removal groups (groups 1 and 3) than in the spontaneous expulsion groups (groups 2 and 4) at 48 hr postoperatively. The incidence of postoperative endometritis was significantly higher in manual removal groups (15.2%) (groups 1 and 3) than in spontaneous groups (5.7%) (groups 2 and 4) (P < 0.05).

Conclusions.  Manual removal of the placenta at cesarean delivery results in more operative blood loss and a higher incidence of postcesarean endometritis.
Dreaming during anaesthesia in patients at high risk of awareness
Authors: Leslie K. , Myles P. S. , Forbes A. , Chan M. T. V. , Swallow S. K. , Short T. G.
Published: February 2005

Dreaming during anaesthesia is commonly reported but remains poorly understood. In this study, adult surgical patients at high risk of awareness were randomly assigned to receive bispectral index (BIS)‐guided anaesthesia or routine care, and were interviewed about dreaming three times postoperatively. Dreaming patients (n = 134) were compared with all other patients who were interviewed at least once (n = 2251). Intraoperative dreaming was reported by 4.2%, 3.9% and 3.4% of patients at 2–4 h, 24–36 h and 30 days after surgery, respectively. Fewer BIS‐monitored patients reported intra‐operative dreaming at 2–4 h than control patients (2.7% vs. 5.7%; p = 0.004). Reports of dreaming were similar in the two groups at 24–36 h and 30 days. Dreaming patients were younger (p = 0.001); healthier (p < 0.001) and more likely to be women (p < 0.001), and were less satisfied with anaesthetic care (p = 0.004) than other patients.
Overweight children in Beirut: prevalence estimates and characteristics
Authors: Jabre P. , Sikias P. , Khater‐Menassa B. , Baddoura R. , Awada H.
Published: February 2005

Objective  To estimate, for the first time, overweight prevalence and associated characteristics in a representative sample of prepubertal children in Beirut, Lebanon's capital.

Design  A cross‐sectional study with a home interview including measurements of weight and height and a structured questionnaire.

Subjects  A total of 234 children aged 6–8 years in Beirut: 131 boys, 103 girls.

Methods  Prevalence of overweight and obesity was based on the international cut‐off points for body mass index (BMI) by age and gender proposed by the International Obesity Task Force. The characteristics of overweight examined were: age, gender, household and family size, single‐ vs. two‐parent family, parents’ level of education and profession, physical activity and dietary intake of children.

Results  Prevalence of overweight and obesity was 26% and 7% respectively in boys, 25% and 6% in girls. Overweight was significantly associated with low physical activity (P < 0.05) and mother's BMI (P < 0.05).

Conclusions  This study identified a high proportion of overweight in 6‐ to 8‐year‐old children in Beirut. Reduced physical activity was the most significant factor associated with childhood overweight. Further studies in different regions in Lebanon are necessary to identify national characteristics; prevention efforts will be designed accordingly.
Do ‘clumsy’ children have visual recognition problems?
Authors: Sigmundsson H. , Hopkins B.
Published: February 2005

ObjectiveVisual recognition by 8‐year‐old children with hand–eye co‐ordination problems (HECP), and by a control group of children without such problems was tested using a task of visual closure.

DesignThe task required the children to identify common objects from an incomplete visual presentation.

ResultAs predicted, it was found that the HECP children, who were designated as such solely on the basis of their motor difficulties, identified significantly fewer correct objects than their control counterparts.

ConclusionsThis finding raises the possibility that the visual processing problems of clumsy children contribute to, or even strongly determine, not only their movement problems but also their learning difficulties.
Mothers’ perceptions of children's quality of life following early diagnosis and treatment for retinoblastoma (Rb)
Authors: Sheppard Linda , Eiser Christine , Kingston Judith
Published: February 2005

We describe the Quality of Life (QoL) and IQ of survivors of retinoblastoma (Rb), both in relation to the normal population and between subgroups of Rb patients differing in relative risk (i.e. unilateral vs. bilateral disease). The sample included 54 children (28 males, age‐range 8–16 years) and their mothers. Mothers completed standardized questionnaires to report their own QoL and that of their child. Children completed a brief IQ test. Compared with population norms, mothers reported lower levels of QoL for their child on total QoL and for sub‐scales measuring Physical and Psychosocial function. Mothers reported their own QoL to be comparable or higher than norms on all but one of eight sub‐scales (energy/vitality). Compared with population norms, children with no visual impairment scored in the normal range for tasks measuring Verbal IQ, but below the mean on tasks measuring Performance IQ. According to their mothers, survivors of Rb have excellent school attendance and take part in most school activities. However, based on standardized questionnaire, they show compromised QoL. We consider that excellent survival rates in Rb are matched with good QoL according to mothers’ report.
Can we detect cervical human papillomavirus (HPV) infection by cytomorphology alone? Diagnostic value of non‐classic cytological signs of HPV effect in minimally abnormal Pap tests
Authors: Bollmann M. , Bánkfalvi A. , Trosic A. , Speich N. , Schmitt C. , Bollmann R.
Published: February 2005

Objective:  Our aim was to assess the validity of non‐classical cytological signs in minimally abnormal cervical smears for the prediction of HPV infection.

Methods:  164 ThinPrep monolayers were re‐screened for mild nuclear changes, disorders of keratinisation, abortive koilocytes and ‘measles cells’, as well as degenerative changes. HPV DNA was detected by GP5+/6+ and MY09/MY11 consensus primer PCR assays.

Results:  Seventy six of 164 cases (46.3%) had HPV positivity by PCR. All cytomorphological features studied were significantly associated with the presence of HPV. Mild nuclear changes had 100% sensitivity and 100% negative predictive value for HPV infection.

Conclusions:  Our results indicate that non‐classic cytomorphological signs can improve the sensitivity of cytology for detecting HPV. Minimally abnormal Pap smears lacking mild nuclear changes (16%) in the present study – do not require further molecular HPV testing.
HPV triage of women with atypical squamous cells of undetermined significance: a 3‐year experience in an Italian organized programme
Authors: Dalla Palma P. , Pojer A. , Girlando S.
Published: February 2005

Objective:  The purpose of our study was to determine if Hybrid Capture II assay(HCII) on Liquid Based Cytology (LCB) improves the accuracy (higher sensitivity, similar specificity) than the repeat conventional Pap smear in smears with Atypical Squamous Cell (ASC) of Undetermined Significance diagnosis.

Methods:  HPV testing was used to manage women, especially the older ones, with cervical abnormalities detected through our triennial organized screening in order to avoid unnecessary colposcopy and excessive follow‐up if the woman is HPV negative. The HPV DNA Triage was offered without any charge to 909 women with ASC. The Bethesda System was used for the classification of these equivocal cytological findings and more precisely the 1991 version (ASCUS) until the summer 2001 (315 cases) and the new one 2001 classification (ASC‐US and ASC‐H) after this date (594 cases). The presence or absence of a cervical intraepithelial neoplasia of grade I or worse [CIN1+], and of grade II or worse [CIN2+], was confirmed by biopsy.

Results:  The HPV DNA Triage showed a good accuracy (specificity over 94%, sensitivity of 37% and PPV for CIN2+ lesions around 30%). The higher values of ASC‐H lesions (.462) for the sensitivity for CIN 2+ probably signify that this lesion is already a SIL.

Conclusions:  Our data were comparable with those recently published on the meta‐analysis by Arbyn et al., confirming the promising approach of our guidelines for the treatment of these patients even in terms of Health Technology Assessment (HTA).
Searching for RET/PTC rearrangements and BRAF V599E mutation in thyroid aspirates might contribute to establish a preoperative diagnosis of papillary thyroid carcinoma
Authors: Domingues R. , Mendonça E. , Sobrinho L. , Bugalho M. J.
Published: February 2005

Objective:  Searching for multiple molecular markers in thyroid aspirates appears to be a promising approach for establishing a preoperative diagnosis of papillary thyroid carcinoma (PTC).

Methods:  Based on this hypothesis, a total of 63 samples from 55 patients, were collected at random. RNA was extracted from the residue cells inside the needle used for fine needle aspiration cytology (FNAC) and thereafter molecular analysis was carried out both for RET rearrangements (type 1, 2, 3) and BRAF codon 599 mutation molecule. Results were compared with the cytological and histopathological diagnoses in 24 patients submitted to surgery.

Results:  58% PTCs presented a genetic alteration either RET/PTC rearrangement, BRAF V599E mutation or both: three cases of PTCs (25%) presented a RET/PTC rearrangement; three cases of PTCs (25%) presented a BRAF V599E mutation and in one case (8%) both alterations were identified.

Conclusions:  The present results suggest that searching for multiple molecular markers in thyroid aspirates may enhance the accuracy of FNAC and refine preoperative diagnosis of PTC.
The role of liquid‐based cytology associated with curettage in the investigation of endometrial lesions from postmenopausal women
Authors: Papaefthimiou M. , Symiakaki H. , Mentzelopoulou P. , Giahnaki A. E. , Voulgaris Z. , Diakomanolis E. , Kyroudes A. , Karakitsos P.
Published: February 2005

Objective:  This study investigates the role of liquid‐based cytology with ThinPrep® technique, in the detection of endometrial lesions, using direct endometrial sampling from postmenopausal women with the Endogyn endometrial device.

Methods:  It was performed on 491 postmenopausal women referred to our clinic for abnormal bleeding or other symptoms and/or a thickness of endometrium >5 mm on ultrasound. Endometrial sampling, dilatation and curettage (D&C) and hysterectomy were performed on all patients. For the diagnosis, the WHO classification scheme was used.

Results:  According to our findings a sensitivity of 98.08%, specificity of 100%, positive predictive value of 100%, negative predictive value of 100% and overall accuracy of 98.98% were observed in both endometrial sampling and in D&C.

Conclusions:  Endometrial sampling is complementary to D&C for the diagnosis of endometrial lesions and it is necessary for it to be performed before D&C and/or hysterectomy.
Clinical relevance of human papillomavirus testing in cytopathology
Authors: Brink A. A. T. P. , Zielinski G. D. , Steenbergen R. D. M. , Snijders P. J. F. , Meijer C. J. L. M.
Published: February 2005

Cancer of the uterine cervix is the second most common cancer in women worldwide. Currently, cervical screening is based on cytology alone. Because infection with high‐risk human papillomavirus types (hrHPVs) is a necessary cause of cervical cancer, it has been postulated that screening might become more efficient when it is based on combined cytology and hrHPV testing. In this review we will discuss the advantages of added HPV tests in cervical cancer screening, as a quality control for false‐negative smears, in triage of women with equivocal smears, in follow‐up of women treated for CIN3 or cervical cancer and for the detection of cervical adenocarcinoma.
Distribution of aquatic vascular plants in lowland rivers: separating the effects of local environmental conditions, longitudinal connectivity and river basin isolation
Authors: DEMARS BENOÎT O. L. , HARPER DAVID M.
Published: February 2005

1. Changes in species distributions along rivers have rarely been observed independently of changes in environmental conditions and meaningful comparison between different catchments is made difficult by the limited geographical distribution of species. This study presents a new approach to quantify the effect of the spatial structure of lowland river networks on aquatic plant distribution and to explore the potential underlying processes using species life‐history characteristics.

2. Twenty‐five species of aquatic vascular plants recorded in 62 sites across five calcareous river basins were used to investigate (i) the temporal turnover of plant species, (ii) the habitat utilisation of species, (iii) the trade‐offs between different plant life‐history characteristics and (iv) the relationship between species life‐history characteristics and habitat utilisation.

3. The annual plant turnover within a 3‐year period was, although significant, extremely low. It suggests that results from spatial surveys conducted over 3 years should not be undermined by temporal changes.

4. Spatial connectivity along and between rivers was more important than in‐channel physical characteristics in shaping species assemblages. Neither chemical factors (ammonium, phosphate) nor extrinsic biotic competitors (filamentous green algae) significantly influenced plant distribution.

5. The most common combinations of life‐history characteristics were neither related to environmental conditions nor to spatial isolation. Instead, they could reflect natural selection processes associated with larger scales than those considered in this study.

6. Plant distribution was most strongly related to the dispersal and regeneration abilities of the plants, supporting the hypotheses relating to longitudinal connectivity. The hypothesis that different growth forms would be associated with different in‐channel physical features was not verified. As expected, there were no substantial differences in plant life‐history characteristics between river basins.