bluuebunny/crossref_metadata_2025 huggingface dataset:
GaN nanowire lasers with low lasing thresholds
Authors: Gradečak Silvija , Qian Fang , Li Yat , Park Hong-Gyu , Lieber Charles M.
Published: October 2005

We report optically pumped room-temperature lasing in GaN nanowires grown by metalorganic chemical vapor deposition (MOCVD). Electron microscopy images reveal that the nanowires grow along a nonpolar ⟨11-20⟩ direction, have single-crystal structures and triangular cross sections. The nanowires function as free-standing Fabry–Pérot cavities with cavity mode spacings that depend inversely on length. Optical excitation studies demonstrate thresholds for stimulated emission of 22kW∕cm2 that are substantially lower than other previously reported GaN nanowires. Key contributions to low threshold lasing in these MOCVD GaN nanowire cavities and the development of electrically pumped GaN nanowire lasers are discussed.
Rapid assessment of maternal activity among rural Indian mothers (Pune Maternal Nutrition Study)
Authors: Kanade AN , Rao S , Yajnik CS , Margetts BM , Fall CHD
Published: October 2005

Objective

To develop an activity questionnaire for objective and rapid assessment of maternal habitual physical activity with the aim of describing its relationship with birth size.

Design

Prospective observational study.

Setting

Six villages near Pune, Maharashtra, India.

Subjects

Seven hundred and ninety-seven rural Indian mothers were studied after excluding abortions and termination of pregnancies, foetal anomalies, etc.

Method

Principal components analysis (PCA) was used to identify a few leading questions from an elaborate questionnaire involving 36 questions related to 14 typical maternal activities.

Results

On the basis of high loading (>0.8), PCA identified three activities, i.e. farming, fetching water and washing clothes. Questions and sub-questions related to these activities only were considered for defining an activity score for rapid assessment. Validation of this new activity score, with the score based on the elaborate questionnaire, showed 70% sensitivity as well as specificity. New activity scores showed strong inverse relationships similar to those observed using the elaborate questionnaire, at early as well as late gestation, with neonatal head circumference (P=0.001 and 0.055) and mid-arm circumference (P=0.02 and 0.03).

Conclusions

Simple questionnaires, based on leading activities identified by PCA, can be as informative as longer and detailed questionnaires. This method has potential for adaptation, especially in rural communities in developing countries.
Dietary Westernisation: conceptualisation and measurement in Mauritius
Authors: Uusitalo U , Sobal J , Moothoosamy L , Chitson P , Shaw J , Zimmet P , Tuomilehto J
Published: October 2005

Objectives

The aims of the study were to provide information that will contribute to conceptualising what is called ‘dietary Westernisation’, and to provide an example of measuring it on an individual level.

Design

Food consumption frequency and demographic data on adults in Mauritius were examined in 1988, 1992 and 1998. In 1992, a 24-hour recall was also included. The cross-sectional samples consisted of 1115 (age 25–74 years) Mauritians in 1987/88, 1917 (age 30–74 years) in 1992 and 2239 (age 20–74 years) in 1998. Principal components analysis was carried out on daily consumption frequencies of 10 indicator foods (white rice, white bakery bread, pulses, processed meat, poultry, fresh/frozen fish, butter, margarine, whole milk and skimmed/low-fat milk). Correlations between dietary patterns and selected food consumption frequencies were examined in each survey year.

Results

Four dietary patterns were identified as being related to dietary Westernisation. The Traditional dietary pattern was characterised by higher consumption frequencies of Indian breads, salted/smoked fish and sugar-sweetened tea. The Western dietary pattern was characterised by higher consumption frequencies of cakes/pastries, meat and many Western fast foods like burgers, but, surprisingly, also by brown bread, breakfast cereals and salad. The Bread/butter dietary pattern predominantly described more frequent consumption of bread compared with rice. The Margarine/milk dietary pattern was inconsistently related with staple foods. Younger, educated and wealthier Mauritians appeared to adopt Western dietary patterns earlier.

Conclusions

This study suggests that relatively few indicator foods are needed for measuring dietary Westernisation. Dietary Westernisation in a non-Western country may also include shifts towards voluntary consumption of healthier foods.
Is overweight and obesity in 9–10-year-old children in Liverpool related to deprivation and/or electoral ward when based on school attended?
Authors: Dummer Trevor JB , Gibbon Mark A , Hackett Allan F , Stratton Gareth , RTaylor Sue
Published: October 2005

Objectives

To determine whether weight problems in children (overweight, obesity and overweight or obesity) were related to deprivation indices when attributed only according to electoral ward of the school attended. To determine whether children with weight problems were more likely to be found in some wards rather than others, and to compare the distribution for boys and girls.

Design

Retrospective, cross-sectional, observational study.

Setting

One hundred and six primary schools from all parts of Liverpool city.

Subjects

Five cohorts of 9–10-year-old children between 1998 and 2003.

Main outcome measures

Body mass index (BMI) for each child to estimate proportions overweight, obese and overweight or obese according to international criteria.

Results

Between January 1998 and March 2003, the heights and weights of 7902 boys and 7514 girls were measured and BMI calculated. The prevalence of boys and girls categorised as overweight or obese was very high (1620, 20.6% and 1909, 25.7%, respectively). Prevalence was not related to deprivation and varied between wards only for the girls; some wards had very different prevalence rates for boys and girls (Picton: 59 boys, 23.4%; 106 girls, 36.6%). The most deprived ward did not have a remarkable prevalence of overweight or obesity (Speke: 32 boys, 15.3%; 40 girls, 19.8%).

Conclusions

Obesity is a major problem and requires urgent action but targeting intervention on the basis of administrative areas may be very wasteful. Different factors seem to lead to obesity in boys and girls, and attention should be paid to the role of the physical environment.
Deletion of DOCK2, a regulator of the actin cytoskeleton in lymphocytes, suppresses cardiac allograft rejection
Authors: Jiang Hongsi , Pan Fan , Erickson Laurie M. , Jang Mei-Shiang , Sanui Terukazu , Kunisaki Yuya , Sasazuki Takehiko , Kobayashi Masakazu , Fukui Yoshinori
Published: October 2005

Allograft rejection is induced by graft tissue infiltration of alloreactive T cells that are activated mainly in secondary lymphoid organs of the host. DOCK2 plays a critical role in lymphocyte homing and immunological synapse formation by regulating the actin cytoskeleton, yet its role in the in vivo immune response remains unknown. We show here that DOCK2 deficiency enables long-term survival of cardiac allografts across a complete mismatch of the major histocompatibility complex molecules. In DOCK2-deficient mice, alloreactivity and allocytotoxicity were suppressed significantly even after in vivo priming with alloantigens, which resulted in reduced intragraft expression of effector molecules, such as interferon-γ, granzyme B, and perforin. This is mediated, at least in part, by preventing potentially alloreactive T cells from recruiting into secondary lymphoid organs. In addition, we found that DOCK2 is critical for CD28-mediated Rac activation and is required for the full activation of alloreactive T cells. Although DOCK2-deficient, alloreactive T cells were activated in vitro in the presence of exogenous interleukin-2, these T cells, when transferred adoptively, failed to infiltrate into the allografts that were transplanted into RAG1-deficient mice. Thus, DOCK2 deficiency attenuates allograft rejection by simultaneously suppressing multiple and key processes. We propose that DOCK2 could be a novel molecular target for controlling transplant rejection.
Nucleic acids of mammalian origin can act as endogenous ligands for Toll-like receptors and may promote systemic lupus erythematosus
Authors: Barrat Franck J. , Meeker Thea , Gregorio Josh , Chan Jean H. , Uematsu Satoshi , Akira Shizuo , Chang Bonnie , Duramad Omar , Coffman Robert L.
Published: October 2005

Raised serum levels of interferon (IFN)-α have been observed in systemic lupus erythematosus (SLE) patients, and these levels are correlated with both disease activity and severity. The origin of this IFN-α is still unclear, but increasing evidence suggests the critical involvement of activated plasmacytoid predendritic cells (PDCs). In SLE patients, DNA and RNA viruses, as well as immune complexes (ICs), that consist of autoantibodies specific to self-DNA and RNA protein particles can stimulate production of IFN-α. We have developed three series of oligonucleotide (ODN)-based inhibitors of Toll-like receptor (TLR) signaling. These ODNs include inhibitors of TLR9, inhibitors of TLR7 but not TLR9, and sequences that inhibit both TLR7 and TLR9. Specificity of these inhibitors is confirmed by inhibition of IFN-α production by PDCs in response to DNA or RNA viruses. We show that mammalian DNA and RNA, in the form of ICs, are potent self-antigens for TLR9 and TLR7, respectively, and induce IFN-α production by PDCs. This work suggests that TLRs may have a critical role in the promotion of lupus through the induction of IFN-α by PDCs. These inhibitors of TLR signaling thus represent novel therapeutic agents with potential for the treatment of lupus.
Notch signaling is an important regulator of type 2 immunity
Authors: Tu LiLi , Fang Terry C. , Artis David , Shestova Olga , Pross Seth E. , Maillard Ivan , Pear Warren S.
Published: October 2005

Notch ligands and receptors have been implicated in helper T cell (Th cell) differentiation. Whether Notch signals are involved in differentiation of T helper type 1 (Th1) cells, Th2 cells, or both, however, remains unresolved. To clarify the role of Notch in Th cell differentiation, we generated mice that conditionally inactivate Notch signaling in mature T cells. Mice that lack Notch signaling in CD4+ T cells fail to develop a protective Th2 cell response against the gastrointestinal helminth Trichuris muris. In contrast, they exhibit effective Th1 cell responses and are able to control Leishmania major infection. These data demonstrate that Notch signaling is a regulator of type 2 immunity.
Investigation of Implicit Memory during Isoflurane Anesthesia for Elective Surgery Using the Process Dissociation Procedure
Authors: Iselin-Chaves Irène A. , Willems Sylvie J. , Jermann Françoise C. , Forster Alain , Adam Stéphane R. , Van der Linden Martial
Published: October 2005

Background

This prospective study evaluated memory function during general anesthesia for elective surgery and its relation to depth of hypnotic state. The authors also compared memory function in anesthetized and nonanesthetized subjects.

Methods

Words were played for 70 min via headphones to 48 patients (aged 18-70 yr) after induction of general anesthesia for elective surgery. Patients were unpremedicated, and the anesthetic regimen was free. The Bispectral Index (BIS) was recorded throughout the study. Within 36 h after the word presentation, memory was assessed using an auditory word stem completion test with inclusion and exclusion instructions. Memory performance and the contribution of explicit and implicit memory were calculated using the process dissociation procedure. The authors applied the same memory task to a control group of nonanesthetized subjects.

Results

Forty-seven patients received isoflurane, and one patient received propofol for anesthesia. The mean (+/- SD) BIS was 49 +/- 9. There was evidence of memory for words presented during light (BIS 61-80) and adequate anesthesia (BIS 41-60) but not during deep anesthesia (BIS 21-40). The process dissociation procedure showed a significant implicit memory contribution but not reliable explicit memory contribution (mean explicit memory scores 0.05 +/- 0.14, 0.04 +/- 0.09, and 0.05 +/- 0.14; mean automatic influence scores 0.14 +/- 0.12, 0.17 +/- 0.17, and 0.18 +/- 0.21 at BIS 21-40, 41-60, and 61-80, respectively). Compared with anesthetized patients, the memory performance of nonanesthetized subjects was better, with a higher contribution by explicit memory and a comparable contribution by implicit memory.

Conclusion

During general anesthesia for elective surgery, implicit memory persists even in adequate hypnotic states, to a comparable degree as in nonanesthetized subjects.
Does the Investing Layer of the Deep Cervical Fascia Exist?
Authors: Nash Lance , Nicholson Helen D. , Zhang Ming
Published: October 2005

Background

The placement of the superficial cervical plexus block has been the subject of controversy. Although the investing cervical fascia has been considered as an impenetrable barrier, clinically, the placement of the block deep or superficial to the fascia provides the same effective anesthesia. The underlying mechanism is unclear. The aim of this study was to investigate the three-dimensional organization of connective tissues in the anterior region of the neck.

Methods

Using a combination of dissection, E12 sheet plastination, and confocal microscopy, fascial structures in the anterior cervical triangle were examined in 10 adult human cadavers.

Results

In the upper cervical region, the fascia of strap muscles in the middle and the fasciae of the submandibular glands on both sides formed a dumbbell-like fascia sheet that had free lateral margins and did not continue with the sternocleidomastoid fascia. In the lower cervical region, no single connective tissue sheet extended directly between the sternocleidomastoid muscles. The fascial structure deep to platysma in the anterior cervical triangle comprised the strap fascia.

Conclusions

This study provides anatomical evidence to indicate that the so-called investing cervical fascia does not exist in the anterior triangle of the neck. Taking the previous reports together, the authors' findings strongly suggest that deep potential spaces in the neck are directly continuous with the subcutaneous tissue.
Effects of Dexmedetomidine on Hippocampal Focal Adhesion Kinase Tyrosine Phosphorylation in Physiologic and Ischemic Conditions
Authors: Dahmani Souhayl , Rouelle Danielle , Gressens Pierre , Mantz Jean
Published: October 2005

Background

Dexmedetomidine is a potent and selective alpha2-adrenoceptor agonist that exhibits a broad pattern of actions, including sedation, analgesia, and neuroprotection. Some of these actions (e.g., neuroprotection) may require targets involved in long-term cellular changes. The authors hypothesized that dexmedetomidine increases the expression of active (autophosphorylated) focal adhesion kinase (FAK), a nonreceptor tyrosine kinase playing a pivotal role in cellular plasticity and survival. Therefore, we examined the cellular mechanisms involved in this effect and its sensitivity to oxygen-glucose deprivation (OGD) in rat hippocampal slices.

Methods

The effects of dexmedetomidine on phospho-tyrosine FAK phosphorylation were studied first with or without various pharmacologic agents in normoxic conditions, and second in a model of pharmacologic preconditioning of slices subjected to 30 min of OGD followed by 1 h of reperfusion. FAK phosphorylation and caspase-3 activation were examined by immunoblotting. Neuronal death was assessed by propidium iodide fluorescence.

Results

Dexmedetomidine produced a dose-related increase in FAK phosphorylation (187 +/- 4%, mean +/- SD, from basal level, EC50 = 0.2 microm; 95% confidence interval, 0.09-0.5 microm). This effect was stereoselective and was completely blocked by yohimbine and the combination of the cyclic monophosphate permeant analog 8 bromo cyclic monophosphate and the phosphodiesterase inhibitor 3-isobutyl-1-methylxanthine. It was mimicked by the protein kinase A inhibitor H 89. In contrast, prazosin and the protein kinase C inhibitors chelerythrine and bisindolylmaleimide I were ineffective. OGD induced a significant increase in immunoreactivity of the cleaved caspase-3 17-kd fragment (417 +/- 22; P < 0.001), a decrease in FAK phosphorylation (78 +/- 12% of control; P < 0.05), and production of significant neuronal death. In OGD conditions, a preconditioning application of dexmedetomidine (0.2 microm, 20-min application, 3 h before anoxia) significantly reduced neuronal death and cleaved caspase-3 expression and significantly attenuated the decrease in phosphorylated FAK content. The dexmedetomidine-induced reduction in caspase-3 expression was significantly decreased by the Src tyrosine kinase inhibitor PP2.

Conclusion

Dexmedetomidine exhibits a preconditioning effect against ischemic injury in hippocampal slices subjected to OGD. Increase in phosphorylation of FAK via stimulation of alpha2 adrenoceptors and decrease in cleaved caspase-3 expression correlate with dexmedetomidine-induced cell survival.
Neutrophil Stimulation with Granulocyte Colony-stimulating Factor Worsens Ventilator-induced Lung Injury and Mortality in Rats
Authors: Karzai Waheedullah , Cui Xizhong , Heinicke Norbert , Niemann Christian , Gerstenberger Eric P. , Correa Rosaly , Banks Steven , Mehlhorn Bjoern , Bloos Frank , Reinhart Konrad , Eichacker Peter Q.
Published: October 2005

Background

Based on the association between the neutrophil and ventilator-induced lung injury, the authors hypothesized that neutrophil inhibition with fucoidin would be beneficial and stimulation with granulocyte colony-stimulating factor (G-CSF) would be harmful in a rat model of lethal ventilator-induced lung injury.

Methods

Animals (n = 111) were randomly assigned to be pretreated with fucoidin, G-CSF, or placebo (control) before 4 h of low-tidal-volume (10 ml/kg) or high-tidal-volume (40 ml/kg) mechanical ventilation.

Results

All low-volume animals survived. With high volumes, compared with controls, fucoidin did not improve survival (3 of 20 control animals and 5 of 20 fucoidin animals died; P = 0.51) but G-CSF significantly worsened it (18 of 22 animals died; P < 0.001). Circulating neutrophils were increased early with G-CSF and late with fucoidin with low and high tidal volumes (P < 0.05 for each treatment and tidal volume). Fucoidin decreased lung neutrophils, but these were only significant with high tidal volumes, whereas G-CSF increased lung neutrophils but only significantly with low tidal volumes (P < or = 0.01 for each). Fucoidin did not alter any cardiopulmonary measure significantly. Compared with control, G-CSF increased airway pressures with high tidal volumes and worsened lung edema and arterial oxygen with both tidal volumes (P < 0.05 for each).

Conclusions

In this model, neutrophil stimulation by G-CSF increased lung dysfunction and with high tidal volumes worsened survival rates. Extrapolated clinically, neutrophil stimulation either by agents such as G-CSF or conditions such as sepsis may aggravate ventilator-induced lung injury.
Isoflurane Inhibits Cardiac Myocyte Apoptosis during Oxidative and Inflammatory Stress by Activating Akt and Enhancing Bcl-2 Expression
Authors: Jamnicki-Abegg Marina , Weihrauch Dorothee , Pagel Paul S. , Kersten Judy R. , Bosnjak Zeljko J. , Warltier David C. , Bienengraeber Martin W.
Published: October 2005

Background

Volatile anesthetics attenuate apoptosis. The underlying mechanisms remain undefined. The authors tested whether isoflurane reduces apoptosis in cardiomyocytes subjected to oxidative or inflammatory stress by enhancing Akt and B-cell lymphoma-2 (Bcl-2).

Methods

Adult and neonatal rat ventricular myocytes and atrial HL-1 myocytes were exposed to hypoxia, hydrogen peroxide, or neutrophils with or without isoflurane pretreatment. The authors assessed cell damage and investigated apoptosis using mitochondrial cytochrome c release, caspase activity, and TUNEL assay. They determined expression of phospho-Akt and Bcl-2 and tested their involvement by blocking phospho-Akt with wortmannin and Bcl-2 with HA14-1.

Results

Isoflurane significantly reduced the cell damage and apoptosis induced by hypoxia, H2O2, and neutrophils. Isoflurane reduced hypoxia-induced mitochondrial cytochrome c release in HL-1 cells by 45 +/- 12% and caspase activity by 28 +/- 4%; in neonatal cells, it reduced caspase activity by 43 +/- 5% and TUNEL-positive cells by 50 +/- 2%. Isoflurane attenuated H2O2-induced caspase activity in HL-1 cells by 48 +/- 16% and TUNEL-positive cells by 78 +/- 3%; in neonatal cells, it reduced caspase activity by 30 +/- 3% and TUNEL-positive cells by 32 +/- 7%. In adult cardiomyocytes exposed to neutrophils, isoflurane decreased both mitochondrial cytochrome c and caspase activity by 47 +/- 3% and TUNEL-positive cells by 25 +/- 4%. Isoflurane enhanced phospho-Akt and Bcl-2 expression. Wortmannin and HA14-1 prevented the action of isoflurane (53 +/- 8% and 54 +/- 7% apoptotic cells vs. 18 +/- 1% without blockers).

Conclusions

Isoflurane protects cardiomyocytes against apoptosis induced by hypoxia, H2O2, or activated neutrophils through Akt activation and increased Bcl-2 expression. This suggests that a reduction in apoptosis contributes to the cardioprotective effects of isoflurane.
Experimental Conditions Are Important Determinants of Cardiac Inotropic Effects of Propofol
Authors: Kanaya Noriaki , Gable Brad , Wickley Peter J. , Murray Paul A. , Damron Derek S.
Published: October 2005

Background

The rationale for this study is that the depressant effect of propofol on cardiac function in vitro is highly variable but may be explained by differences in the temperature and stimulation frequency used for the study. Both temperature and stimulation frequency are known to modulate cellular mechanisms that regulate intracellular free Ca2+ concentration ([Ca2+]i) and myofilament Ca2+ sensitivity in cardiac muscle. The authors hypothesized that temperature and stimulation frequency play a major role in determining propofol-induced alterations in [Ca2+]i and contraction in individual, electrically stimulated cardiomyocytes and the function of isolated perfused hearts.

Methods

Freshly isolated myocytes were obtained from adult rat hearts, loaded with fura-2, and placed on the stage of an inverted fluorescence microscope in a temperature-regulated bath. [Ca2+]i and myocyte shortening were simultaneously measured in individual cells at 28 degrees or 37 degrees C at various stimulation frequencies (0.3, 0.5, 1, 2, and 3 Hz) with and without propofol. Langendorff perfused hearts paced at 180 or 330 beats/min were used to assess the effects of propofol on overall cardiac function.

Results

At 28 degrees C (hypothermic) and, to a lesser extent, at 37 degrees C (normothermic), increasing stimulation frequency increased peak shortening and [Ca2+]i. Times to peak shortening and rate of relengthening were more prolonged at 28 degrees C compared with 37 degrees C at low stimulation frequencies (0.3 Hz), whereas the same conditions for [Ca2+]i were not altered by temperature. At 0.3 Hz and 28 degrees C, propofol caused a dose-dependent decrease in peak shortening and peak [Ca2+]i. These changes were greater at 28 degrees C compared with 37 degrees C and involved activation of protein kinase C. At a frequency of 2 Hz, there was a rightward shift in the dose-response relation for propofol on [Ca2+]i and shortening at both 37 degrees and 28 degrees C compared with that observed at 0.3 Hz. In Langendorff perfused hearts paced at 330 beats/min, clinically relevant concentrations of propofol decreased left ventricular developed pressure, with the effect being less at 28 degrees C compared with 37 degrees C. In contrast, only a supraclinical concentration of propofol decreased left ventricular developed pressure at 28 degrees C at either stimulation frequency.

Conclusion

These results demonstrate that temperature and stimulation frequency alter the inhibitory effect of propofol on cardiomyocyte [Ca2+]i and contraction. In isolated cardiomyocytes, the inhibitory effects of propofol are more pronounced during hypothermia and at higher stimulation frequencies and involve activation of protein kinase C. In Langendorff perfused hearts at constant heart rate, the inhibitory effects of propofol at clinically relevant concentrations are more pronounced during normothermic conditions.
Continuous Peripheral Nerve Blocks in Hospital Wards after Orthopedic Surgery
Authors: Capdevila Xavier , Pirat Philippe , Bringuier Sophie , Gaertner Elisabeth , Singelyn François , Bernard Nathalie , Choquet Olivier , Bouaziz Hervé , Bonnet Francis
Published: October 2005

Background

Continuous peripheral nerve block (CPNB) is the technique of choice for postoperative analgesia after painful orthopedic surgery. However, the incidence of neurologic and infectious adverse events in the postoperative period are not well established. This issue was the aim of the study.

Methods

Patients scheduled to undergo orthopedic surgery performed with a CPNB were prospectively included during 1 yr in a multicenter study. Efficacy of postoperative analgesia, bacteriologic cultures of the catheter, and acute neurologic and infectious adverse events were evaluated after surgery in 1,416 patients at arrival in the postanesthesia care unit, at hour 1, and every 24 h up to day 5. Risk factors for adverse events were determined using logistic regression.

Results

The median duration of CPNB was 56 h. Both general anesthesia and CPNB were performed in 73.6% of the patients. Postoperative analgesia was effective in 96.3%, but an increase in pain scores was noted at hour 24 (P = 0.01). Hypoesthesia or numbness occurred in 3% and 2.2%, respectively, and paresthesia occurred in 1.5%. Three neural lesions (0.21%) were noted after continuous femoral nerve block. Two of these patients were anesthetized during block procedure. Nerve damage completely resolved 36 h to 10 weeks later. Cultures from 28.7% of the catheters were positive. Three percent of patients had local inflammatory signs. The bacterial species most frequently found were coagulase-negative staphylococcus (61%) and gram-negative bacillus (21.6%). A Staphylococcus aureus psoas abscess (0.07%) was reported in one diabetic woman. Independent risk factors for paresthesia/dysesthesia were postoperative monitoring in intensive care, age less than 40 yr, and use of bupivacaine. Risk factors for local inflammation/infection were postoperative monitoring in intensive care, catheter duration greater than 48 h, male sex, and absence of antibiotic prophylaxis.

Conclusion

CPNB is an effective technique for postoperative analgesia. Minor incidents and bacterial colonization of catheters are frequent, with no adverse clinical consequences in the large majority of cases. Major neurologic and infectious adverse events are rare.
Receptors, G Proteins, and Their Interactions
Authors: Hollmann Markus W. , Strumper Danja , Herroeder Susanne , Durieux Marcel E. , Warltier David C.
Published: October 2005

Membrane receptors coupling to intracellular G proteins (G protein-coupled receptors) form one of the major classes of membrane signaling proteins. They are of great importance to the practice of anesthesiology because they are involved in many systems of relevance to the specialty (cardiovascular and respiratory control, pain transmission, and others) and many drugs target these systems. In recent years, understanding of these signaling systems has grown. The structure of receptors and G proteins has been elucidated in more detail, their regulation is better understood, and the complexity of interactions between the various parts of the system (receptors, G proteins, effectors, and regulatory molecules) has become clear. These findings may help explain both actions and side effects of drugs. In addition, these newly discovered targets are likely to play important roles in disease states of relevance to anesthesiologists.
Gfi1 functions downstream of Math1 to control intestinal secretory cell subtype allocation and differentiation
Authors: Shroyer Noah F. , Wallis Deeann , Venken Koen J.T. , Bellen Hugo J. , Zoghbi Huda Y.
Published: October 2005

Gfi1 is a transcriptional repressor implicated in lymphomagenesis, neutropenia, and hematopoietic development, as well as ear and lung development. Here, we demonstrate that Gfi1 functions downstream of Math1 in intestinal secretory lineage differentiation. Gfi1-/- mice lack Paneth cells, have fewer goblet cells, and supernumerary enteroendocrine cells. Gfi1-/- mice show gene expression changes consistent with this altered cell allocation. These data suggest that Gfi1 functions to select goblet/Paneth versus enteroendocrine progenitors. We propose a model of intestinal cell fate choice in which β-catenin and Cdx function upstream of Math1, and lineage-specific genes such as Ngn3 act downstream of Gfi1.
Multiple Type-B Response Regulators Mediate Cytokinin Signal Transduction in Arabidopsis
Authors: Mason Michael G. , Mathews Dennis E. , Argyros D. Aaron , Maxwell Bridey B. , Kieber Joseph J. , Alonso Jose M. , Ecker Joseph R. , Schaller G. Eric
Published: October 2005

Type-B Arabidopsis thaliana response regulators (ARRs) are transcription factors that function in the final step of two-component signaling systems. To characterize their role in plant growth and development, we isolated T-DNA insertions within six of the genes (ARR1, ARR2, ARR10, ARR11, ARR12, and ARR18) from the largest subfamily of type-B ARRs and also constructed various double and triple combinations of these mutations. Higher order mutants revealed progressively decreased sensitivity to cytokinin, including effects on root elongation, lateral root formation, callus induction and greening, and induction of cytokinin primary response genes. The triple mutant arr1,10,12 showed almost complete insensitivity to cytokinin under many of the assay conditions used. By contrast, no significant change in the sensitivity to ethylene was found among the mutants examined. These results indicate that there is functional overlap among the type-B ARRs and that they act as positive regulators of cytokinin signal transduction.
Arterial embolization and prophylactic catheterization for the treatment for severe obstetric hemorrhage*
Authors: Ojala Kati , Perälä Jukka , Kariniemi Juho , Ranta Pirjo , Raudaskoski Tytti , Tekay Aydin
Published: October 2005

Background.  To evaluate indications, efficacy, and complications associated with arterial embolization and prophylactic balloon catheterization in the management of obstetric hemorrhage at a university hospital.

Methods.  Twenty‐two women underwent arterial embolization between February 2001 and November 2003 for the treatment for primary postpartum hemorrhage resulting from abnormal placentation (n = 11), uterine atony (n = 7), paravaginal laceration (n = 3), and disseminated intravascular coagulopathy (n = 1). Blood loss was between 3.2 and 15 l. In seven patients, abnormal placentation was diagnosed prenatally and in these patients balloon catheterization was performed prophylactically before elective cesarean section.

Results.  Of the seven patients, who underwent prophylactic catheterization, embolization was successful in five resulting in adequate hemostasis. Hysterectomy was performed in three, in two patients for uncontrolled hemorrhage and in one patient for placental invasion to bladder. There were no complications associated with prophylactic catheterization and embolization. The other 15 patients were treated in an emergency setting. In eight patients, embolization was performed as a primary surgery, and it was successful in six. In the other seven patients, hysterectomy was performed as an emergency surgery, but bleeding continued. Of these, in six patients, hemostasis was achieved with embolization. Complications associated with emergency embolization were observed in three patients. These were thrombosis of left popliteal artery, vaginal necrosis, and paresthesia of the right leg.

Conclusions.  Arterial embolization is of significant value in treating obstetric hemorrhage. Prophylactic insertion of balloon catheters before cesarean section seems to be a safe and effective method in controlling anticipated bleeding. In patients with persistent bleeding following cesarean section and hysterectomy, embolization could be a primary procedure before resurgery.
Routine ultrasound screening and detection of congenital anomalies outside a university setting
Authors: Nakling Jakob , Backe Bjørn
Published: October 2005

Background.  To assess the sensitivity for detecting fetal congenital anomalies by a routine ultrasound examination program at midtrimester performed in an unselected population by midwives and specialists in obstetrics and gynecology.

Methods.  Six hundred seventy‐six of the pregnancies had the midtrimester ultrasound examinations performed outside the county. Three hundred seventeen of the women had midtrimester ultrasound examinations performed in the county, but delivered outside the county. A total of 18 181 pregnancies were eligible for the study.

Results.  Altogether there were 267 fetuses and newborns with anomalies, which gives a prevalence of 1.5%. One hundred three of the 267 anomalies were detected at the midtrimester ultrasound examination, yielding a sensitivity of 39.0%. There were 11 false positives and 163 remained undiagnosed (false negatives), which gives a specificity of 99.9% and a positive predictive value of 90.4%. The sensitivity for detecting anomalies ranged from 74.4 to 8.3% according to the organ system of the fetus.

Conclusions.  Our study shows that midtrimester routine ultrasound examination in district hospitals can achieve a detection rate of congenital anomalies comparable with tertiary centers. One‐stage ultrasound examination at midtrimester gives acceptable results concerning congenital anomalies with few false‐positive results.
Nitric oxide induces endometrial secretion at implantation time
Authors: Mörlin B. , Andersson E. , Byström B. , Hammarström M.
Published: October 2005

Background.  Uterine cervical secretory cells receive a sympathetic cholinergic secretomotor innervation. Glandular nitric oxide (NO) production has been proposed to be a prerequisite for muscarine‐induced carbohydrate secretion from endometrial glands and cervical glands at ovulation time and from the seminal vesicle glands. Nitric oxide has also been suggested to have a significant role in the process of implantation and early pregnancy in the mouse, a process, which has also been compared with an inflammatory response.

Methods.  The carbohydrate secretion from everted guinea pig uterine horns placed in organ baths was estimated. Polymerase chain reaction was performed in order to identify the isoforms of nitric oxide synthase (NOS).

Results.  Carbamylcholine chloride (Carbachol) induced carbohydrate secretion of the endometrium, whereas L‐NNA and L‐NAME inhibited the Carbachol‐induced secretion. The isomer D‐NAME had no effect on Carbachol‐induced secretion. The NO donor GTN induced carbohydrate secretion of the endometrium. The addition of the nitrergic inhibitor of soluble guanylyl cyclase (sGC) ODQ to Carbachol and to the NO donor GTN gave a reduced response. No synergism was seen when the sGC stimulator YC‐1 was applied together with Carbachol. Three isoforms of NOS – endothelial NOS (eNOS), cytokine‐inducible NOS (iNOS), and neuronal (nNOS) – were identified at implantation time and may take place in the endometrial cell.

Conclusions.  The results of this study suggest that glandular NO production is a prerequisite for the autonomic nervous modulation of endometrial secretion in the guinea pig and that NO may play a role in the implantation time.
In pregnant women who smoke, caffeine consumption is associated with an increased level of homocysteine
Authors: Carlsen Sven M. , Jacobsen Geir , Vatten Lars , Romundstad Pål
Published: October 2005

Aim.  To investigate whether maternal caffeine consumption is associated with increased maternal homocysteine (Hcy) levels in uncomplicated pregnancies.

Methods.  Ninety‐two pregnant women were randomly selected, and maternal serum levels of folate, vitamin B12, and Hcy at gestational weeks 17 and 33 were measured. Caffeine consumption was estimated from dietary records collected at the same gestational ages.

Results.  In women who smoked, Hcy levels were associated with caffeine consumption both in gestational weeks 17 and 33 and with folate at week 33. Consumption of one cup of coffee was associated with an increase in maternal Hcy of 0.26 µmol/l at week 17 and 0.69 µmol/l at week 33, indicating that one extra cup (150 ml) of coffee per day may increase Hcy by 5–10% in pregnant smokers. In non‐smokers, caffeine consumption was not associated with Hcy levels.

Conclusions.  In uncomplicated pregnancies, maternal caffeine consumption early in the second and in the third trimester is associated with increased maternal Hcy levels in women who smoked, but not in non‐smokers.
Urinary cyclic guanosine 3′,5′‐monophosphate and cyclic adenosine 3′,5′‐monophosphate changes in spontaneous and induced onset active labor
Authors: Chen Da‐Chung , Yuan Shyng‐Shiou F. , Su Her‐Young , Lo Shin‐Chieh , Ren Shin‐Sia , Wu Gwo‐Jang
Published: October 2005

Background.  The aim of this prospective, randomized study was to investigate the changes in urinary cyclic guanosine 3′,5′‐monophosphate (cGMP) and cyclic adenosine 3′,5′‐monophosphate (cAMP) between the latent and the active phases of spontaneous and prostaglandin E1 (PGE1)‐induced labor.

Methods.  Seventy singleton pregnant women at 36–41+ weeks' gestation without signs of fetal distress were enrolled. The first group consisted of 35 pregnant women in whom labor was induced by PGE1 applied intravaginally. The second group consisted of 35 women who had spontaneous active labor. Clinical data of the two groups were assessed as labor progressed.

Results.  After the onset of active labor, urinary cGMP/creatinine (U cGMP/Cr) decreased in both groups with the percentage decline of 35.2 and 9.7, respectively, but this difference was only significant in the PGE1‐induced group (P = 0.033). After the onset of active labor, urinary cAMP/creatinine (U cAMP/Cr) decreased in both groups with the percentage decline of 36.5 and 15.6, respectively, but this difference was only significant in the PGE1‐induced group (P = 0.001). The duration of the latent phase was significantly shortened in the PGE1‐induced group compared with the spontaneous labor group (P < 0.05).

Conclusions.  Decreased U cGMP/Cr and U cAMP/Cr may be a transition from the latent to the active phase in PGE1‐induced labor. Our results suggest that U cGMP/Cr and U cAMP/Cr can serve as easily obtained secondary messenger markers of myometrial contractility and cervical ripening at the onset of active labor. The NO‐cGMP system and the G‐protein α‐cAMP system in the human uterus may concomitantly contribute to uterine quiescence during pregnancy and show downregulation in U cGMP/Cr and U cAMP/Cr at the initiation of active labor.
Improved survival with clinical guidelines? Evaluation of a quality register linked to clinical guidelines for ovarian cancer in the western health care region in Sweden between 1 September 1993 and 1 June 1998
Authors: Åkeson Margaretha , Zetterqvist Britt‐Marie , Holmberg Erik , Horvath György
Published: October 2005

Background.  New clinical guidelines (CGs) for ovarian cancer in the western health care region in Sweden were established, beginning in September 1993 and still in effect.

Methods.  A retrospective evaluation of 5 years of quality registration linked to CGs for ovarian cancer in this region was undertaken. The study material comprised 718 patients. Relative survival rates for the studied patients were compared with National Cancer Register data for the western health care region during the same period. The National Cancer Register data were also used to compare survival rate during the studied period and the preceding 5‐year period.

Results.  Relative 5‐year survival rate in our material was 46.1%. Relative survival in western Sweden during the studied period was found to be improved compared with that during the preceding period (P < 0.02).

Conclusions.  The CGs have led to an improved, tighter organization, with fewer clinicians in special ‘tumor teams’ performing more aggressive tumor reduction surgery. Chemotherapy prescription is centralized, while the actual administration is decentralized. This has probably been important for the good 5‐year survival results.
Folate, vitamin B12, and homocysteine levels in South Asian women with growth‐retarded fetuses
Authors: Lindblad Bo , Zaman Shakila , Malik Aisha , Martin Helena , Ekström Anna Mia , Amu Sylvie , Holmgren Arne , Norman Mikael
Published: October 2005

Objective.  To investigate whether intrauterine growth retardation (IUGR) and preterm delivery in a poor population of South Asia was associated with altered maternal and fetal levels of folate, vitamin B12, and homocysteine.

Subjects and methods.  Hundred and twenty‐eight pregnant women from a low socio‐economic strata in the city of Lahore, Pakistan were followed with ultrasound of fetal growth from the 12th week of pregnancy. Blood samples were drawn from the woman and the cord at delivery. Serum was analyzed by a chemiluminescent immunoassay for folate and vitamin B12 and by fluorescence polarization immunoassay for total homocysteine (tHcy).

Results.  Fourty‐six infants showed IUGR. In term, but not preterm, deliveries with IUGR, maternal and cord blood folate levels were half of those in deliveries of normal birth weight infants (P = 0.004 and P = 0.005). The risk of IUGR was reduced among women with folate levels in the highest quartile (OR 0.31, 95% CI 0.10–0.84). There was no association between vitamin B12 and IUGR. Total homocysteine levels were higher in women delivering IUGR infants (P = 0.02). There was an inverse correlation between cord blood folate and tHcy levels (r = −0.26, P = 0.006). We also found increased risks for hypertensive illness (OR 3.5, 95% CI 1.4–8.6) and premature delivery (OR 2.5, 95% CI 1.1–6.2) in women in the highest quartile of tHcy.

Conclusions.  The occurrence of IUGR increased with low maternal and cord concentrations of folate and high maternal levels of tHcy. Further studies on the effects of vitamin B supplementation through pregnancy are warranted.
Perinatal results following the prenatal ultrasound diagnosis of single umbilical artery
Authors: Cristina Martínez‐Payo , Ana Gaitero , Inés Tamarit , Manuel García‐Espantaleón , Enrique Iglesias Goy
Published: October 2005

Objective.  To study the perinatal results in our population, following the prenatal ultrasound diagnosis of a single umbilical artery (SUA), as this alteration is associated with fetal malformations, chromosomal abnormality, and poor perinatal results.

Materials and methods.  A retrospective review of all obstetric ultrasounds carried out between October 2000 and December 2003 in our service, obtaining the postnatal results of the fetuses diagnosed with an SUA.

Results.  From a total of 5987 pregnant patients examined by ultrasound scan at 20th week, an SUA was found in 40 cases, representing an incidence of 0.7%. Of these, 84.6% were normal pregnancies at birth and 15.4% presented other malformations and/or chromosomal abnormalities. No aneuploidy was found in pregnancies where there were no other associated findings in the ultrasound scan at 20 weeks. All cases with serious congenital malformations accompanying the SUA were diagnosed prenatally. There was a 5% of perinatal mortality rate among our fetuses with SUA, which represents a mortality rate 10 times greater than the overall rate among our patients.

Conclusions.  The ultrasound discovery of an SUA implies the meticulous search for other associated malformations, and in the absence of these, the risk of a chromosomal abnormality is very low, unless it is a high‐risk patient. However, the growth and wellbeing of the fetus must be carefully monitored in the last 3 months, although the ultrasound scan does not show any other associated alterations.
Bilateral notching of uterine arteries at 12–14 weeks of gestation for prediction of hypertensive disorders of pregnancy
Authors: Vainio Merja , Kujansuu Erkki , Koivisto Anna‐Maija , Mäenpää Johanna
Published: October 2005

Objective.  To assess the value of transvaginal uterine artery Doppler ultrasound at 12–14 weeks of gestation in predicting hypertensive disorders of pregnancy in high‐risk women.

Methods.  One hundred and twenty high‐risk women were evaluated prospectively by Doppler ultrasound of uterine and umbilical arteries at 12–14 weeks of gestation. The presence of bilateral notches, resistance and pulsatility index (PI), mean and maximum flow velocities of uterine arteries, and resistance and PI of umbilical arteries were investigated. Those with bilateral notching were randomized to acetylsalicylic acid (n = 43) or placebo groups (n = 43) and were followed up twice during pregnancy with the same ultrasound measurements. The women without bilateral notches (n = 29) served as controls. In this study, we compared 43 women in the placebo group to 29 controls without bilateral notches. The outcome measures were pregnancy‐induced hypertension, pre‐eclampsia and intrauterine growth restriction.

Results.  The sensitivity of bilateral notching in predicting hypertensive disorders of pregnancy decreased with advancing pregnancy from 91 to 35%, and the specificity and the positive predictive values increased from 41 to 94% and from 7 to 70%, respectively. The negative predictive values ranged from 86 to 97%.

Conclusion.  Bilateral notching of uterine arteries at 12–14 weeks is a useful tool in predicting the development of hypertensive disorders in high‐risk pregnancies. It is also a suitable test for surveillance of high‐risk pregnancies.
Global Environmental Governance and the Challenge of Shadow States: The Impact of Illicit Sapphire Mining in Madagascar
Authors: Duffy Rosaleen
Published: October 2005

The environment has become a key site of global governance because of its transboundary nature: forests, wildlife and oceans have all become central foci for networks of global governance which link international organizations, international financial institutions, states and non‐governmental organizations. This article examines how contemporary forms of global governance can be challenged and even subverted. It uses the concept of shadow states introduced by William Reno to explore how invisible global networks flow through developing states, to show how they constitute important political and economic interest groups, and to assess what kinds of environmental impact they have. It explores how powerful these networks are, and whether they are able to challenge or subvert attempts to manage, control or govern the environment. The author provides an analysis of the ways in which the clandestine networks of shadow states impact on conservation initiatives in the developing world, focusing on the features of global environmental governance and the problems posed by illicit gem mining and trafficking in Madagascar.
Donor‐Driven Justice and its Discontents: The Case of Rwanda
Authors: Oomen Barbara
Published: October 2005

Never before was a process of doing justice driven so strongly from the outside as in post‐genocide Rwanda. Not only did the 1994 genocide lead to the founding of the International Tribunal, but it also induced intensive donor involvement in domestic attempts to ‘break the cycle of hatred’— from the work done by the national courts and the Unity Commission to the gacaca. In this sense, Rwanda became the forerunner of a much wider trend, towards a judicialization of international relations, for instance through an emphasis on international criminal law. However, the past decade of donor involvement in Rwanda in general, and the case of the gacaca in particular, show us how this specific — technocratic, de‐contextualized — emphasis on justice might seem innocuous at first glance, but carries dangers within it, particularly if it takes place in an increasingly autocratic and oppressive political environment like that of contemporary Rwanda.