bluuebunny/crossref_metadata_2025 huggingface dataset:
Protein C in renal allotransplantation during the perioperative period
Authors: SØRENSEN P. J. , NIELSEN A. H. , KNUDSEN F. , SCHMITZ O. , DYERBERG J.
Published: October 2011

Abstract Sørensen PJ. Nielsen AH. Knudsen F. Schmitz O. Dyerberg J (Department of Nephrology. and Department of Clinical Chemistry. Aalborg Hospital. Aalborg. and Department of Nephrology. University Hospital of Århus. Århus. Denmark). Protein C in renal allotransplantation during the perioperative period.

Protein C activity, both coagulant and amidolytic, as well as antigen level were studied during the perioperative period in 40 renal transplants recipients and 21 healthy controls. At transplantations the protein C coagulant activity was significantly lower in the patients than in the normal controls, and further decreased in the patients during the first week after transplantation, whereas the amidolytic activity of protein C was normal and the protein C antigen level was elevated. In the patients with established kidney function, protein C coagulant activity was higher than in patients with impaired graft function. Furthermore, it seems that the protein C coagulant activity was closely related to changes in graft function in the 11 patients with graft rejection episodes. The low protein C coagulant activity following renal transplantation could be a contributing factor to thromboembolic complications.
Primary ventricular fibrillation in acute myocardial infarction
Authors: MØLSTAD P.
Published: October 2011

Abstract Mølstad P (Medical Department. Hamar Hospital. Hamar. Norway). Primary ventricular fibrillation in acute myocardial infarction.

Primary ventricular fibrillation is an acute life‐threatening event if not treated promptly. The ability to predict this event during the course of an acute myocardial infarction could therefore have an important impact on the mode of treatment and monitoring. In the present study, clinical and laboratory information available at the initial evaluation of patients with an acute myocardial infarction was tested for its ability to predict subsequent primary ventricular fibrillation. Multiple logistic regression analysis was employed to select the predictors. Serum potassium, serum creatinine and no smoking were significant predictors of subsequent ventricular fibrillation. Although the prediction was statistically significant, the clinical value of the prediction is quite limited.
An evaluation of the accuracy of clinical diagnosis at admission in a population with epidemic meningococcal disease
Authors: MATHIASSEN B. , THOMSEN H. , LANDSFELDT U.
Published: October 2011

Abstract Mathiassen B, Thomsen H, Landsfeldt U (Department of Internal Medicine. Landssygehuset (Queen Alexandrina's Hospital). Torshavn. Faroe Islands). An evaluation of the accuracy of clinical diagnosis at admission in a population with epidemic meningococcal disease.

The accuracy (sensitivity and positive predictive value) of the clinical diagnosis given by the general practitioner before admission to hospital was evaluated retrospectively in a population with epidemic meningococcal disease. The study population consisted of approximately 32000 subjects.

In a 12‐year period, 344 patients were discharged from hospital with CNS infections, 274 of whom were admitted with a diagnosis suspecting a CNS infection. A further 401 patients were admitted with suspicion for, but discharged without a CNS infection.

Overall, the sensitivity was 79.7% and the positive predictive value was 40.6%. There were no significant changes in the accuracy during the study.

The sensitivity differed significantly between the age groups (P < 0.001) and was lowest among the adults (15 + years, 67.9%) and the 0–2‐year‐old children (72.7%). Also among the 0–2 year‐olds, the positive predictive value was low (34.1%) and not significant, indicating that it was more difficult to obtain the correct clinical diagnosis in this group.
Benzodiazepine poisoning: experience of 702 admissions to an intensive care unit during a 14‐year period
Authors: HÖJER J. , BAEHRENDTZ S. , GUSTAFSSON L.
Published: October 2011

Abstract Höjer J, Baehrendtz S, Gustafsson L (Department of Internal Medicine, Southern Hospital, and Department of Clinical Pharmacology, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden). Benzodiazepine poisoning: experience of 702 admissions to an intensive care unit during a 14‐year period.

A retrospective study covering a 14‐year period was carried out to estimate the incidence and assess the clinical features of benzodiazepine (BZD) poisoning. The annual contribution of BZDs to the total number of drug overdose cases admitted to an intensive care unit displayed an increasing trend over the period, and during the last years BZDs were involved in nearly one‐third of all cases. Among the 702 cases of BZD overdosage, 144 had ingested BZD alone, 200 had poisoned themselves with BZD combined with alcohol and 358 had taken BZD with other miscellaneous drugs. In 56% of all the cases the patients had severe central nervous system depression on admission. In 47% orotracheal intubation was performed and in 18% artificial ventilation was administered. Complications were recorded in 69 of the 702 cases (9.8%) and five cases were fatal. These clinical features were essentially the same in the group that had overdosed with just BZD. In conclusion, patients with drug overdosage involving BZD have a low hospital mortality, but the acute somatic risk is not negligible. Moreover, they consume a substantial proportion of the resources in the emergency room and the intensive care unit.
Global assessment of patients—a bedside study. I: the influence of physical findings on the global assessment
Authors: GJØRUP T. , HENDRIKSEN C. , BUGGE P. M. , JENSEN A. M.
Published: October 2011

Abstract Gjørup T, Hendriksen C, Bugge PM, Jensen AM (Department of Medicine C, Herlev Hospital and Statistical Research Unit, University of Copenhagen, Denmark). Global assessment of patients—a bedside study. I: the influence of physical findings on the global assessment.

Three physicians selected ten basic physical findings for a study of diagnostic decision making in the global assessment of patients. The physicians independently examined 201 hospital in‐patients for the presence of each of the findings and concluded their assessment with a global evaluation of whether the patient appeared ill. Each of the ten findings were used by at least one of the physicians in his overall assessment of the patient. All the observers considered ‘looking older than age’, ‘trouble with breathing’, ‘cyanosis’, and ‘anaemia’ important, but disagreed in their use of the remaining findings (P < 0.01). Agreement in the global clinical assessment is an essential prerequisite to uniformity in the approach to the patient.
Determinants of atrial natriuretic factor levels in coronary heart disease: significance of central pressures, heart chamber volumes and left ventricular mass
Authors: KELLER N. , MØGELVANG J. , SAUNAMÄKI K. , FRITZ‐HANSEN P. , SYKULSKI R. , HENRIKSEN O.
Published: October 2011

Abstract Keller N, Møgelvang J. Saunamäki K, Fritz‐Hansen P, Sykulski R, Henriksen O (Departments of Medicine, Division of Cardiology and Magnetic Resonance, Hvidovre Hospital, Hvidovre, and Cardiology, Copenhagen County Hospital in Gentofte, Hellerup. Denmark). Determinants of atrial natriuretic factor levels in coronary heart disease: significance of central pressures, heart chamber volumes and left ventricular mass.

Atrial natriuretic factor (ANF) was determined in pulmonary and systemic arterial plasma during diagnostic left and right heart catheterization in twenty‐three patients. In twenty of these patients ANF was subsequently measured in systemic arterial plasma during nuclear magnetic resonance (NMR) imaging of the heart with computation of left heart chamber volumes and left ventricular mass. Left ventricular end‐diastolic pressure was the strongest independent predictor of pulmonary arterial plasma ANF. whereas cardiac index best predicted aortic plasma ANF. Both pulmonary and aortic plasma ANF correlated with systolic and diastolic pulmonary arterial pressure, left ventricular end‐diastolic pressure and cardiac index. Left atrial volume index and left ventricular mass index did not correlate with systemic arterial plasma ANF whereas a positive linear correlation between left ventricular end‐diastolic volume index and ANF could be demonstrated (r = 0.61, P < 0.01). Left ventricular end‐diastolic volume index was the most important independent predictor of systemic arterial plasma ANF. Systemic arterial plasma ANF might be a simple marker of left ventricular dilatation in patients with heart disease.
The occurrence of malignant disease in adult nephrotic syndrome
Authors: LUND L. , JACOBSEN B. A. , SCHMIDT E. B.
Published: October 2011

Abstract Lund L, Jacobsen BA, Schmidt EB (Department of Medicine C, Aalborg Hospital, Aalborg, Denmark). The occurrence of malignant disease in adult nephrotic syndrome.

The aim of the present study was to determine the incidence of malignant disease (MD) in adult patients with nephrotic syndrome (NS). Eighty‐eight consecutive patients (38 females; 50 males; mean age 47 years; range 15–86) seen in a renal clinic in a 13‐year period with NS were studied. Eight of the patients had or developed MD. One patient had MD (medullary thyroid carcinoma) and NS diagnosed concomitantly and two patients had MD (both malignant lymphoma) diagnosed 19 and 21 months after the diagnosis of NS, respectively.

In conclusion, only few patients in a renal clinic at debut of NS do have a simultaneous MD. Furthermore, their risk of developing such a disease is at worst only slightly raised.
Serum sex hormone and gonadotropin concentrations in premenopausal women with multiple sclerosis
Authors: GRINSTED L. , HELTBERG A. , HAGEN C. , DJURSING H.
Published: October 2011

Abstract Grinsted L, Heltberg A, Hagen C, Djursing H (Department of Obstetrics and Gynecology, University Hospital of Copenhagen, Hvidovre, Department of Neurology Amtssygehuset, DK 4000 Roskilde and MS Rehabilitation Center. DK 4690 Haslev. and Department of Internal Medicine and Endocrinology, University Hospital of Odense, 5000 Odense, Denmark). Serum sex hormone and gonadotropin concentrations in premenopausal women with multiple sclerosis.

Dysfunctions within the hypothalamic‐pituitary‐gonadal axis occur frequently among women with multiple sclerosis (MS) and may induce menstrual disturbances and subsequent infertility. We have measured serum concentrations of prolactin, gonadotropins and sex hormone binding globulin (SHBG) as well as free and bound oestrogen and androgen levels in 14 women of fertile age with MS. These women all displayed regular cycles without having experienced fertility problems. As controls 14 normal women with regular periods and ideal body weight of 91 % (range 80–101) were included. Serum from both groups was sampled during the early follicular phase. The MS‐patients had significantly (P < 0.05) higher concentrations of prolactin, LH, FSH, total and free testosterone (P < 0.01) and a significantly lower serum concentration of oestrone sulphate (P < 0.01). The abnormal hormone concentrations were not related to clinical status of the disease. We propose that the increased androgen levels are of ovarian origin as adrenal androgens were normal.

The reason for the slight increase of prolactin and the marked increase of gonadotropins in women with MS is speculative. As oestradiol levels, however, were within normal range, we assume that a peripheral resistance to gonadotropins combined with an abnormal central regulation causes the increased pituitary secretion.
Serum β2‐microglobulin levels in thyroid diseases
Authors: LERVANG H.‐H. , MØLLER‐PETERSEN J. , DITZEL J.
Published: October 2011

Abstract Lervang H‐H, Møller‐Petersen J, Ditzel J (Section of Endocrinology, Department of Medicine and Department of Clinical Chemistry, Aalborg Hospital. Aalborg, Denmark). Serum β2‐microglobulin levels in thyroid diseases.

Serum β2‐microglobulin was measured in 38 patients with thyroid diseases. Serum levels of β2‐microglobulin were significantly increased in patients with untreated Graves’ disease (median: 200 nmol l−1; P < 0.0002), and in patients with untreated toxic adenomas (222 nmol l−1; P< 0.0005) compared to 60 healthy control subjects (147 nmol l−1). Following antithyroid treatment of euthyroidism, serum β2‐microglobulin decreased significantly in both Graves’ disease (162 nmol 1−1) and toxic adenomas (175 nmol l−1); values which were not significantly different from that of the control group. The level of serum β2‐microglobulin in 12 patients with hypothyroidism was not different from that of the control group. However, in untreated hypothyroidism serum β2‐microglobulin was positively correlated with serum thyroxine (T4) (rho = 0.69: P < 0.05) and free thyroxine index (FT4I) (rho = 0.72; P< 0.02). It is concluded that elevated levels of serum β2‐microglobulin may reflect the increased metabolism in patients with thyrotoxicosis. Increased levels in active Graves’ disease may also partly be caused by immunological activation.
Ketosis, a complication of theophylline toxicity
Authors: RYAN T. , COUGHLAN G. , McGING P. , PHELAN D.
Published: October 2011

Abstract Ryan. T, Coughlan, G, McGing P, Phelan D (Department of Anaesthesia and Intensive Care, Mater Hospital, Eccles Street, Dublin 7, Ireland). Ketosis, a complication of theophylline toxicity.

A case of prolonged theophylline toxicity in a young non‐diabetic female is reported. Blood gas analysis revealed a mixed respiratory alkalosis and metabolic acidosis. The metabolic acidosis was due to ketoacids, which were detected in the patient's breath and urine.

The ketones cleared rapidly when theophylline elimination was increased with activated charcoal, i.v. metoprolol reduced excessive b‐adrenergic stimulation and a 10% dextrose infusion repleted hepatic glycogen.

Theophylline is known to increase free fatty acid levels. It is postulated that prolonged fasting led to depletion of hepatic glycogen and that ketones were generated by metabolism of elevated serum fatty acids.

In previous reviews of the metabolic abnormalities associated with theophylline toxicity ketosis has not been described.
Acetylsalicylic acid 100 mg and 1000 mg daily in acute myocardial infarction suspects: a placebo‐controlled trial
Authors: HUSTED S. E. , NIELSEN H. KRAEMMER , KRUSELL L. R. , FAERGEMAN O.
Published: October 2011

Abstract Husted SE, Kraemmer Nielsen H, Krusell LR, Faergeman O (Department of Internal Medicine and Cardiology, Åarhus Amtssygehus, University Hospital, Åarhus, Denmark). Acetylsalicylic acid 100 mg and 1000 mg daily in acute myocardial infarction suspects: a placebo‐controlled trial.

Of 1078 patients admitted to the coronary care unit with acute chest pain, 293 who had possible acute myocardial infarction and symptoms of median 4 h duration were randomized to treatment with acetylsalicylic acid (ASA) 100 mg daily, 1000 mg daily or placebo for 3 months. During hospitalization, the combined incidence of cardiac death and non‐fatal myocardial infarction on‐treatment (withdrawals not included) was significantly lower (P < 0.02) in the 100 mg group (7.1%) than in both the 1000 mg group (20.8%) and the placebo group (19.7%). During later time periods of treatment and at all time periods analysed according to the intention‐to‐treat principle (withdrawals included), data suggested the same trend, but differences were not statistically significant. Collagen‐induced platelet aggregation and serum thromboxane B2 were reduced to the same degree in the two ASA groups and were normal in the placebo group. The data suggest that low‐dose ASA could be cheap and safe as first‐aid therapy in myocardial infarction suspects.
Does fish oil protect renal function in cyclosporin‐treated psoriasis patients?
Authors: STOOF T. J. , KORSTANJE M. J. , BILO H. J. G. , STARINK TH. M. , HULSMANS R. F. H. J. , DONKER A. J. M.
Published: October 2011

Abstract Stoof TJ, Korstanje MJ, Bilo HJG, Starink THM, Hulsmans RFHJ, Donker AJM (Departments of Dermatology and Internal Medicine, Free University Hospital, Amsterdam, and Department of Dermatology, Academic Hospital, Maastricht, The Netherlands). Does fish oil protect renal function in cyclosporin‐treated psoriasis patients?

In order to study the influence of fish oil on CyA‐induced renal dysfunction, 13 patients with psoriasis (CyA group) received cyclosporin A (CyA) alone, and seven patients (CyA/EPA + DHA group) received a combination of cyclosporin A and fish oil (6 g eicosapentaenoic acid, C20:5 omega‐3, and docosahexaenoic acid, C22:6 omega‐3, daily) for 3 months. The glomerular filtration rate fell by 18.0 ± 9.6% in the CyA group compared with 8.7 ± 6.8% in the CyA/EPA + DHA group (mean ± SD, P < 0.05). The effective renal plasma flow fell by 10.6 ± 8.9% in the CyA group and did not change in the CyA/EPA + DHA group (P < 0.05). The calculated total renal vascular resistance increased by 19.8 ± 14.5% in the CyA group and did not change in the CyA/EPA + DHA group (P < 0.01). The results of this pilot study suggest that fish oil can reduce CyA‐associated renal dysfunction in psoriasis patients.
The clinical spectrum of hypocalcaemia associated with bone metastases
Authors: RIANCHO J. A. , ARJONA R. , VALLE R. , SANZ J. , GONZÁLEZ‐MACÍAS J.
Published: October 2011

Abstract Riancho JA, Arjona R, Valle R, Sanz J, González‐Macías I (Departamento de Medicina Interna, Hospital Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain). The clinical spectrum of hypocalcaemia associated with bone metastases.

Malignancy‐related hypocalcaemia has received less attention in the literature than the opposite perturbation, hypercalcaemia. Only, scarce and contradictory data exist about hypocalcaemia associated with bone metastases (BMH). We have reviewed the clinical records of 155 patients with bone metastases of solid tumours, 122 of which were followed during the whole course of the disease until death. The frequency of hypocalcaemia ranged from 5 to 13%, depending on the formula used to correct calcium values for protein concentration. BMH was almost exclusively limited to patients with osteoblastic metastases. The frequency of BMH among patients with prostate carcinoma was 13–27%, depending on the formula used. Only two of 60 patients with lytic bone lesions presented hypocalcaemia, and in both cases it was rather mild. The development of hypocalcaemia did not seem to imply a worse prognosis, at least in patients with carcinoma of the prostate. Thus, the prevalence of BMH appears to be higher than is usually considered. Adequate attention should be given to this disorder because of the potentially deleterious effects on several organ systems.
Critical review of the use of erythropoietin in the treatment of anaemia during therapy for chronic hepatitis C
Authors: Stickel F. , Helbling B. , Heim M. , Geier A. , Hirschi C. , Terziroli B. , Wehr K. , De Gottardi A. , Negro F. , Gerlach T.
Published: October 2011

Summary.  Combined pegylated interferon (PegIFN) and ribavirin represents the standard therapy for patients with chronic hepatitis C (CHC), which allows for sustained viral response (SVR) in up to 90% of patients depending on certain viral and host factors. Clinical studies have demonstrated the importance of adherence to therapy, that is, the ability of patients to tolerate and sustain a fully dosed therapy regimen. Adherence is markedly impaired by treatment‐related adverse effects. In particular, haemolytic anaemia often requires dose reduction or termination of ribavirin treatment, which compromises treatment efficacy. Recent evidence points to a beneficial role of recombinant erythropoietin (EPO) in alleviating ribavirin‐induced anaemia thereby improving quality of life, enabling higher ribavirin dosage and consequently improving SVR. However, no general consensus exists regarding the use of EPO for specific indications: its optimal dosing, treatment benefits and potential risks or cost efficiency. The Swiss Association for the Study of the Liver (SASL) has therefore organized an expert meeting to critically review and discuss the current evidence and to phrase recommendations for clinical practice. A consensus was reached recommending the use of EPO for patients infected with viral genotype 1 developing significant anaemia below 100 g/L haemoglobin and a haematocrit of <30% during standard therapy to improve quality of life and sustain optimal ribavirin dose. However, the evidence supporting its use in patients with pre‐existing anaemia, non‐1 viral genotypes, a former relapse or nonresponse, liver transplant recipients and cardiovascular or pulmonary disease is considered insufficient.
Occupational transmission of hepatitis C in healthcare workers and factors associated with seroconversion: UK surveillance data
Authors: Tomkins S. E. , Elford J. , Nichols T. , Aston J. , Cliffe S. J. , Roy K. , Grime P. , Ncube F. M.
Published: October 2011

Summary.  The study aims were to describe a case series of occupationally acquired hepatitis C (HCV) infections in UK healthcare workers and examine factors associated with transmission using exposure data reported to the Health Protection Agency between July 1997 and December 2007. Fifteen reported cases of documented HCV seroconversion occurred after percutaneous exposure, the majority from hollow‐bore needles used in the source patient’s vein or artery and contaminated with blood or blood‐stained fluid. The seroconversion rate was 2.2% (14/626). In multivariable analysis of healthcare workers with percutaneous exposure to blood or blood‐stained fluid, we demonstrate that blood sampling procedures (odds ratio [OR], 5.75; 95% CI, 1.33–24.91; P = 0.01) and depth of injury (OR for deep vs superficial injury, 21.99; 95% CI, 2.02–239.61; P = 0.02) are independently associated with a greater risk of HCV seroconversion. This is the first UK study of occupationally acquired HCV in healthcare workers. It has reinforced our knowledge of risk factors for HCV transmission. Most of these exposures and transmissions were preventable. Healthcare employers should provide regular education on the risks of occupational exposure and prevention through standard infection control procedures. They should ensure the availability of effective prevention measures and facilitate prompt reporting and adequate follow‐up of exposures.
Experimental infection of the tickAmblyomma cajennense, Cayenne tick, withRickettsia rickettsii, the agent of Rocky Mountain spotted fever
Authors: SOARES J. F. , SOARES H. S. , BARBIERI A. M. , LABRUNA M. B.
Published: October 2011

In the laboratory,Amblyomma cajennense(Acari: Ixodidae) (Fabricius) larvae, nymphs and adults were exposed toRickettsia rickettsiiby feeding on needle‐inoculated animals, and thereafter reared on uninfected guinea pigs or rabbits. Regardless of the tick stage that acquired the infection, subsequent tick stages were shown to be infected (confirming transstadial and transovarial transmissions) and were able to transmitR. rickettsiito uninfected animals, as demonstrated by serological and molecular analyses. However, the larval, nymphal and adult stages ofA. cajennensewere shown to be partially refractory toR. rickettsiiinfection, as in all cases, only part of the ticks became infected by this agent, after being exposed to rickettsemic animals. In addition, less than 50% of the infected engorged females transmitted rickettsiae transovarially, and when they did so, only part of the offspring became infected, indicating that vertical transmission alone is not enough to maintainR. rickettsiiinA. cajennensefor multiple generations. Finally, theR. rickettsii‐infected tick groups had lower reproductive performance than the uninfected control group. Our results indicate thatA. cajennensehave a low efficiency to maintainR. rickettsiifor successive generations, asR. rickettsii‐infection rates should decline drastically throughout the successive tick generations.
Agaricus blazei Murrill and Inflammatory Mediators in Elderly Women: A Randomized Clinical Trial
Authors: Lima C. U. J. O. , Souza V. C. , Morita M. C. , Chiarello M. D. , de Oliveira Karnikowski M. G.
Published: October 2011

There is scientific evidence to suggest that the medicinal mushroom Agaricus blazei Murrill (AbM) has immunomodulatory effects on cytokine synthesis, both in vitro and in vivo. This study was the first randomized, double‐blind, placebo‐controlled trial designed to investigate these purported actions in elderly women. The objective of this study was to ascertain the effects of AbM intake on serum levels of interleukin‐6 (IL‐6), interferon‐gamma (IFN‐γ) and tumour necrosis factor‐alpha (TNF‐α) in community‐living seniors. The sample consisted of 57 elderly females who were carriers or homozygous for the majority allele of functional polymorphisms for the chosen cytokines. Subjects were randomly allocated to receive placebo (n = 29) or AbM dry extract (n = 28), 900 mg/day for 60 days. Body mass index, abdominal girth, body composition, blood pressure and cytokine (IL‐6, IFN‐γ, and TNF‐α) levels were measured, and food intake was assessed as a possible confounder. Analysis of these parameters showed the sample was characterized by overweight and excess adiposity. After the study period, no changes from baseline were detectable for any parameter in either group. In this study, AbM extract had no modulating effect on IL‐6, IFN‐γ or TNF‐α levels in elderly females.
Anesthesia and myasthenia gravis
Authors: BLICHFELDT‐LAURIDSEN L. , HANSEN B. D.
Published: October 2011

Myasthenia gravis (MG) is a disease affecting the nicotinic acetylcholine receptor of the post‐synaptic membrane of the neuromuscular junction, causing muscle fatigue and weakness. The myasthenic patient can be a challenge to anesthesiologists, and the post‐surgical risk of respiratory failure has always been a matter of concern. The incidence and prevalence of MG have been increasing for decades and the disease is underdiagnosed. This makes it important for the anesthesiologist to be aware of possible signs of the disease and to be properly updated on the optimal perioperative anesthesiological management of the myasthenic patient. The review is based on electronic searches on PubMed and a review of the references of the articles. The following keywords were used: myasthenia gravis AND neuromuscular blocking agents, myasthenia gravis AND sevoflurane, myasthenia gravis AND epidural, myasthenia gravis AND neuromuscular blockade reversal and myasthenia gravis AND pyridostigmine. The articles included were from reviews and clinical trials written in English. MG patients can easily be anesthetized without need for post‐surgery mechanical ventilation whether it is general anesthesia or peripheral nerve block. Volatile anesthesia or the use of an epidural for the patient makes it possible to avoid the use of neuromuscular blocking agents, and when used, it should be in smaller doses and the patient should be carefully monitored. This review shows that with thorough pre‐operative evaluation, continuing the daily pyridostigmine and careful monitoring the MG patient can be managed safely.
Regional cerebral blood flow and glucose metabolism during propofol anaesthesia in healthy subjects studied with positron emission tomography
Authors: SCHLÜNZEN L. , JUUL N. , HANSEN K. V. , COLD G. E.
Published: October 2011

Background

General anaesthetics can alter the relationship between regional cerebral glucose metabolism rate (rGMR) and regional cerebral blood flow (rCBF). With the present study, we wanted to assess quantitatively the effects of propofol on rCBF and rGMR in the same healthy volunteers measured with positron emission tomography (PET).

Methods

15O‐labelled water and 18F fluorodeoxyglucose were used as PET tracers to determine rCBF and rGMR, respectively, in eight healthy volunteers during the waking state (baseline) and during propofol anaesthesia. Propofol was titrated to keep a constant hypnotic depth (Bispectral Indes 35–40) throughout the anaesthesia. Changes in rGMR and rCBF were quantified using region‐of‐interest and voxel‐based analyses.

Results

The measured mean propofol concentration was 4.1 ± 0.8 μg/ml during anaesthesia. Compared with the conscious state, total CBF and GMR decreased during the anaesthetic state with 47% and 54%, respectively. In the white and grey matter, rCBF and rGMR were reduced by 37% and 49%, and by 45% and 57%, respectively. Propofol decreased rCBF in all brain structures by 46–55% (P ≤ 0.01) with highest significant decreases in the thalamus and parietal lobe. Regional GMR was reduced in all brain areas to 48–66% (P ≤ 0.01) with highest significant reductions in the occipital lobe, the lingual gyrus, parietal lobe, temporal lobe and thalamus. No increases in rCBF or rGMR happened anywhere.

Conclusions

General anaesthesia with propofol is associated with a global metabolic and vascular depression in the human brain, with significant shifts in regional blood flow and metabolism indicating marked metabolic and vascular responsiveness in some cortical areas and thalamus.
Therapeutic hypothermia in adult cardiac arrest because of drowning
Authors: CHOI S. P. , YOUN C. S. , PARK K. N. , WEE J. H. , PARK J. H. , OH S. H. , KIM S. H. , KIM J. Y.
Published: October 2011

Background

Therapeutic hypothermia in adult victims who suffer cardiac arrest following drowning has been applied in only a small number of cases. In the last 4 years, we have employed therapeutic hypothermia to decrease hypoxia‐induced brain injury in these patients. The purpose of the present study was to report the results of the treatment of these patients.

Methods

This study investigated the utilisation of therapeutic hypothermia on consecutive patients with cardiac arrest because of drowning between 2005 and 2008. The study was conducted retrospectively, collecting data by reviewing medical records. Hypothermia, with a target temperature of 32–34°C, was induced for 24 h. Neurological outcomes were classified using the cerebral performance categories (CPCs). The primary outcome was neurological function at discharge.

Results

Twenty patients were treated with therapeutic hypothermia. Four patients (20%) exhibited a favourable neurological outcome (CPC 1–2). Two patients (10%) remained in a vegetative state at discharge (CPC 4), and 14 patients (70%) died (CPC 5). The most common complications during therapeutic hypothermia were pancreatitis and rhabdomyolysis. A longer duration of advanced cardiac life support (P = 0.035), an absence of motor response to pain after 3 days (P = 0.003), an abnormal brain imaging (P = 0.005) and a lack of cortical response to somatosensory evoked potential (P = 0.008) were related to an unfavourable outcome (CPC 3–5).

Conclusion

The present study did not demonstrate an advantage of therapeutic hypothermia in adult cardiac arrest after drowning compared with previous studies treated with conventional therapy. Further prospective studies are needed to evaluate the effects of therapeutic hypothermia.
A randomized trial on elderly laypersons' CPR performance in a realistic cardiac arrest simulation
Authors: NESET A. , BIRKENES T. S. , FURUNES T. , MYKLEBUST HE. , MYKLETUN R. J. , ODEGAARD S. , OLASVEENGEN T. M. , KRAMER‐JOHANSEN J.
Published: October 2011

Background

Bystander cardiopulmonary resuscitation (CPR) is important for survival after cardiac arrest. We hypothesized that elderly laypersons would perform CPR poorer in a realistic cardiac arrest simulation, compared to a traditional test.

Methods

Sixty‐four lay rescuers aged 50–75 were randomized to realistic or traditional test, both with ten minutes of telephone assisted CPR. Realistic simulation started suddenly without warning, leaving the test subject alone in a confined and noisy apartment. Traditional test was conducted in a spacious and calm classroom with a researcher present. CPR performance was recorded with a manikin with human like chest properties. Heart rate and self‐reported exhaustion were registered.

Results

CPR quality was not different in the two groups: compression depth, 43 mm ± 7 versus 43 ± 4, P = 0.72; compressions rate, 97 min−1 ± 11 versus 93 ± 15, P = 0.26; ventilation rate, 2.4 min−1 ± 1.7 versus 2.8 ± 1.1, P = 0.35; and hands‐off time 273 s ± 50 versus 270 ± 66, P = 0.82; in realistic (n = 31) and traditional (n = 33) groups, respectively. No fatigue was evident in the repeated measures analysis of variance. Work load was not different between the groups; attained percentage of age predicted maximum heart rate, 73% ± 9 and 76 ± 11, P = 0.37, reported exhaustion 43 ± 21 (scale: 0 to 100) and 37 ± 19, P = 0.24.

Conclusions

Elderly lay people are capable of performing chest compressions with acceptable quality for ten minutes in a realistic cardiac arrest simulation. Ventilation quality and hands‐off time were not adequate in either group.
First Report of Calonectria ilicicola Causing a New Disease on Laurus (Laurus nobilis) in Europe
Authors: Polizzi Giancarlo , Vitale Alessandro , Aiello Dalia , Guarnaccia Vladimiro , Crous Pedro , Lombard Lorenzo
Published: October 2011

Crown and root rot has been detected on potted Laurus nobilis plants in a nursery located in the Catania province (Italy). Perithecia referable to a Calonectria species were consistently detected on crowns and stems of symptomatic plants. Based on morphology, cultural features and molecular analysis, the species was identified as Calonectria ilicicola. Koch’s postulates were fulfilled by pathogenicity tests carried out on potted Laurus nobilis seedlings. To our knowledge, this is the first report of the occurrence of a disease caused by Ca. ilicicola on Laurus nobilis.
Latitudinal patterns and regionalization of plant diversity along a 4270‐km gradient in continental Chile
Authors: BANNISTER JAN R. , VIDAL OSVALDO J. , TENEB ERNESTO , SANDOVAL VICTOR
Published: October 2011

According to the global latitudinal diversity gradient, a decrease in animal and plant species richness exists from the tropics towards higher latitudes. The aim of this study was to describe the latitudinal distribution patterns of Chilean continental flora and delineate biogeographic regions along a 4270‐km north–south gradient. We reviewed plant lists for each of the 39 parallels of continental Chile to build a database of the geographical distribution of vascular plant species comprising 184 families, 957 genera and 3787 species, which corresponded to 100%, 94.9% and 74.2% of the richness previously defined for Chile, respectively. Using this latitudinal presence–absence species matrix, we identified areas with high plant richness and endemism and performed a Cluster analysis using Jaccard index to delineate biogeographic regions. This study found that richness at family, genus and species levels follow a unimodal 4270‐km latitudinal distribution curve, with a concentration of richness in central Chile (31–42°S). The 37th parallel south (central Chile) presented the highest richness for all taxonomic levels and in specific zones the endemism (22–37°S) was especially high. This unimodal pattern contrasts the global latitudinal diversity gradient shown by other studies in the Northern hemisphere. Seven floristic regions were identified in this latitudinal gradient: tropical (18–22°S), north Mediterranean (23–28°S), central Mediterranean (29–32°S), south Mediterranean (33–37°S), north temperate (38–42°S), south temperate (43–52°S) and Austral (53–56°S). This regionalization coincides with previous bioclimatic classifications and illustrates the high heterogeneity of the biodiversity in Chile and the need for a reconsideration of governmental conservation strategies to protect this diversity throughout Chile.
Cost‐effectiveness of interventions for children with speech, language and communication needs (SLCN): a review using the Drummond and Jefferson (1996) ‘Referee's Checklist’
Authors: Law James , Zeng Biao , Lindsay Geoff , Beecham Jennifer
Published: October 2011

Background: Although economic evaluation has been widely recognized as a key feature of both health services and educational research, for many years there has been a paucity of such studies relevant to services for children with speech, language and communication needs (SLCN), making the application of economic arguments to the development of services difficult.

Aims: The study has two aims, namely to review systematically the cost‐effectiveness literature related to services for children with SLCN and to highlight key issues that need to be included in future economic effectiveness studies.

Methods & Procedures: A comprehensive search of the international literature for the last 30 years was completed and the studies were evaluated against the ‘gold standard’ criteria developed by Drummond and colleagues in 1996 and 2005.

Outcomes & Results: Five studies met the review inclusion criteria. All focused on young (2–11 years) children with SLCN and most compared clinic‐based and parent‐administered interventions. The studies provide variable levels of detail on the key elements needed, but few provided sufficient details of costs to draw comparisons across studies. Only two studies attempted to bring together costs and effectiveness data.

Conclusions & Implications: The studies point to the importance of home‐based and indirect intervention and, in many cases, emphasize the parental perspective. There is a need for intervention studies to include a cost dimension based on readily comparable methods of establishing unit costs and for greater use to be made of cost‐effectiveness analysis more generally.
Head and neck blocks in infants, children, and adolescents
Authors: Suresh Santhanam , Voronov Polina
Published: October 2011

This review will discuss the use of peripheral nerve blocks of the head and neck and its application to the practice of pediatric anesthesia using simple, landmark based approaches.
Operative experience of urological trainees in the UK
Authors: Gill Jonathan D. , Stewart Lianne F. , George Nicholas J.R. , Eardley Ian
Published: October 2011

What's known on the subject? and What does the study add?

One of the main components of surgical training is the development of operative skills which, in part, is related to the extent of the practical operative experience. The operative experience of urological trainees in the UK has not being previously published.

We examine trainees' current operative experience and analyse the changes over recent years. With a notable decrease in experience of certain procedures, we highlight the possible reasons and discuss the implications for future training.

We have examined the operative experience of urological trainees in the UK over a 6‐year period. Between 2004 and 2009, urological trainees submitting their operative logbooks to the Specialist Advisory Committee for the award of Certificate of Completion of Training were analysed. We recorded trainees' experience in eight operative procedures; transurethral resection of the prostate (TURP, including bipolar TURP), transurethral resection of bladder tumour (TURBT), radical nephrectomy (RN, open and laparoscopic), radical cystectomy (RC), radical prostatectomy (RP), percutaneous nephrolithotomy (PCNL) and ureteroscopy (flexible and rigid). In all, 251 logbooks were identified over the 6‐year period. In 2008/2009, the mean (range) number of cases ‘performed’ and ‘supervised’ were as follows; TURP 189 (41–516), TURBT 190 (50–432), open RN 21 (2–78), RC 10 (0–70), RP 13 (0–80), PCNL 19 (0–125), ureteroscopy 131 (14–465), laparoscopic RN 11 (0–97). Latterly there has been a significant reduction in the numbers of TURP, open RNs and RCs. There has been an increase in the use of trainees as assistants for RC, RP and open RN. There was a large variation in numbers of procedures performed between trainees. In summary there has been a recent decline in the numbers of TURP, open RNs and RCs performed. For all procedures, significant variability exists between trainees.
The Pacific Obesity Prevention in Communities project: project overview and methods
Authors: Swinburn B. A. , Millar L. , Utter J. , Kremer P. , Moodie M. , Mavoa H. , Snowdon W. , McCabe M. P. , Malakellis M. , de Courten M. , Waqa G. , Fotu K. F. , Roberts G. , Scragg R.
Published: October 2011

Obesity is increasing worldwide with the Pacific region having the highest prevalence among adults. The most common precursor of adult obesity is adolescent obesity making this a critical period for prevention. The Pacific Obesity Prevention in Communities project was a four‐country project (Fiji, Tonga, New Zealand and Australia) designed to prevent adolescent obesity. This paper overviews the project and the methods common to the four countries. Each country implemented a community‐based intervention programme promoting healthy eating, physical activity and healthy weight in adolescents. A community capacity‐building approach was used, with common processes employed but with contextualized interventions within each country. Changes in anthropometric, behavioural and perception outcomes were evaluated at the individual level and school environments and community capacity at the settings level. The evaluation tools common to each are described. Additional analytical studies included economic, socio‐cultural and policy studies. The project pioneered many areas of obesity prevention research: using multi‐country collaboration to build research capacity; testing a capacity‐building approach in ethnic groups with very high obesity prevalence; costing complex, long‐term community intervention programmes; systematically studying the powerful socio‐cultural influences on weight gain; and undertaking a participatory, national, priority‐setting process for policy interventions using simulation modelling of cost‐effectiveness of interventions.
Outcome results for the Ma'alahi Youth Project, a Tongan community‐based obesity prevention programme for adolescents
Authors: Fotu K. F. , Millar L. , Mavoa H. , Kremer P. , Moodie M. , Snowdon W. , Utter J. , Vivili P. , Schultz J. T. , Malakellis M. , McCabe M. P. , Roberts G. , Swinburn B. A.
Published: October 2011

Tonga has a very high prevalence of obesity with steep increases during youth, making adolescence a critical time for obesity prevention. The Ma'alahi Youth Project, the Tongan arm of the Pacific Obesity Prevention in Communities project, was a 3‐year, quasi‐experimental study of community‐based interventions among adolescents in three districts on Tonga's main island (Tongatapu) compared to the island of Vava'u. Interventions focused mainly on capacity building, social marketing, education and activities promoting physical activity and local fruit and vegetables. The evaluation used a longitudinal design (mean follow‐up duration 2.4 years). Both intervention and comparison groups showed similar large increases in overweight and obesity prevalence (10.1% points, n = 815; 12.6% points, n = 897 respectively). Apart from a small relative decrease in percentage body fat in the intervention group (−1.5%, P < 0.0001), there were no differences in outcomes for any anthropometric variables between groups and behavioural changes did not follow a clear positive pattern. In conclusion, the Ma'alahi Youth Project had no impact on the large increase in prevalence of overweight and obesity among Tongan adolescents. Community‐based interventions in such populations with high obesity prevalence may require more intensive or longer interventions, as well as specific strategies targeting the substantial socio‐cultural barriers to achieving a healthy weight.
Maximum likelihood estimation for nearly non‐stationary stable autoregressive processes
Authors: Zhang Rong‐Mao , Chan Ngai Hang
Published: October 2011

The maximum likelihood estimate (MLE) of the autoregressive coefficient of a near‐unit root autoregressive process Yt = ρnYt−1 + ɛt with α‐stable noise {ɛt} is studied in this paper. Herein ρn = 1 − γ/n, γ ≥ 0 is a constant, Y0 is a fixed random variable and εt is an α‐stable random variable with characteristic function φ(t,θ) for some parameter θ. It is shown that when 0 < α < 1 or α > 1 and Eɛ1 = 0, the limit distribution of the MLE of ρn and θ are mixtures of a stable process and Gaussian processes. On the other hand, when α > 1 and Eɛ1 ≠ 0, the limit distribution of the MLE of ρn and θ are normal. A Monte Carlo simulation reveals that the MLE performs better than the usual least squares procedures, particularly for the case when the tail index α is less than 1.
Estimating the Return to College in Britain Using Regression and Propensity Score Matching
Authors: Fan Wen
Published: October 2011

College graduates tend to earn more than non‐graduates but it is difficult to ascertain how much of this empirical association between wages and college degree is due to the causal effect of a college degree and how much is due to unobserved factors that influence both wages and education (e.g. ability). In this paper, I use the 1970 British Cohort Study to examine the college premium for people who have a similar ability level by using a restricted sample of people who are all college eligible but some never attend. Compared with using the full sample, restricting the sample to college‐eligible reduces the return to college significantly using both regression and propensity score matching estimates. The finding suggests the importance of comparing individuals of similar ability levels when estimating the return to college.
The impact of microcredit on self‐employment profits in Vietnam
Authors: Lensink Robert , Pham Thi Thu Tra
Published: October 2011

This study examines the impact of microcredit on household self‐employment profits in Vietnam. For two indicators of credit participation – a dichotomous participation dummy and the accumulated amount of microcredit received per household – the analysis reveals a positive effect on household profits. The analysis also reveals that an instrumental variable method within a fixed‐effects framework can control for the possible endogeneity of credit and thereby identify the true effect of credit.
Credit risk assessment in the microfinance industry
Authors: Ayayi Ayi Gavriel
Published: October 2011

This paper discusses credit risk assessment through conventional and specialized credit evaluation metrics. I find that low credit risk is a direct consequence of sound implementation of good governance practices and sustainable financial performance through sound qualitative and quantitative risk management tools. Furthermore, I find that the depth and breadth of outreach and write‐off are by some margin the two most important determinant indicators of a microfinance institutions’ (MFI’s) credit risk control. In addition, I demonstrate that there is no significant statistical difference in terms of risk management among the different types of MFIs. Results also suggest that constructive regulation to promote MFIs has a non‐negligible impact on the risk assessment of MFIs.
Pusey's ‘Lectures on Types and Prophecies of the Old Testament’: Implications for Eucharistic Theology
Authors: DOUGLAS BRIAN
Published: October 2011

Edward Pusey's ‘Lectures on Types and Prophecies of the Old Testament’ remain unpublished and little known. Despite this they contain important insights exploring prophecy and sacramental theology based on the philosophical assumptions of moderate realism expressed through the notions of ‘type’ and ‘archetype’. This article explores Pusey's ‘Lectures’ with particular emphasis on sacramental realism. Pusey's philosophical insights concerning a moderate realist view of the Eucharist are discussed and links with eucharistic theology in the wider Anglican and other traditions are made. Links with the reflections of theologians and philosophers are also drawn out in an effort to establish that the ‘Lectures’ continue to be of value in the present and so deserving of wider appreciation and use.