bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased heart rate variability correlation between mother and child immediately pre‐operation
Authors: ARAI Y.‐C. P. , UEDA W. , USHIDA T. , KANDATSU N. , ITO H. , KOMATSU T.
Published: April 2009

Background: Maternal distress would correlate with the children's mental status, thereby influencing the activity of the autonomic nervous system (ANS) of the children and mothers. We hypothesized that pre‐anesthetic maternal ANS activity, when approaching close to their children's operation time, would correlate with children's ANS activity, and that the values of heart rate variability (HRV) would correlate.

Methods: We calculated maternal and children's HRVs and analyzed the relationship between the two. A total of 24 pairs of mother and child were analyzed. Maternal and children's HRVs were recorded from the night before the child's surgery to the arrival to the operation room.

Results: The ratios of low‐frequency components (LF) to high‐frequency components (HF) (LF/HF ratio) of children's and maternal HRVs obtained during the immediate pre‐operative period (06:00–08:00 hours) showed a significantly, positive correlation, but no correlation was found for the LF/HF ratios obtained during the pre‐operative night.

Conclusion: The LF/HF ratios of HRV immediately before surgery in children and mothers showed a significant positive correlation.
Association between central venous pressure and blood loss during hepatic resection in 984 living donors
Authors: KIM Y. K. , CHIN J. H. , KANG S. J. , JUN I. G. , SONG J. G. , JEONG S. M. , PARK J. Y. , HWANG G. S.
Published: April 2009

Background: Although low central venous pressure (CVP) anesthesia has been used to minimize blood loss during hepatectomy, the efficacy of this technique remains controversial. We therefore assessed the association between blood loss and CVP during hepatic resection, and examined significant determinants associated with intraoperative hemorrhage during hepatectomy in living donors.

Methods: Between April 2004 and April 2008, 984 living donors who underwent a hepatic resection were assessed retrospectively. Univariate and multivariate analyses were performed to explore the relationships between intraoperative blood loss and several variables including CVP.

Results: The mean intraoperative blood loss was 691.3 ± 365.5 ml. Only four donors required packed red blood cell transfusions (mean, 1.5 U). The mean duration of hepatic resection was 92.1 ± 26.3 min. The mean, maximum, and minimum values of CVP measured during hepatectomy were 4.6 ± 1.7, 5.3 ± 1.8, and 4.0 ± 1.8 mmHg, respectively, and were not significantly correlated with intraoperative blood loss. On multivariate analysis, predictors of hemorrhage were liver fatty change, gender, and body weight, but none of the mean CVP, surgeons, anesthesiologists, anesthesia duration, resected liver volume, hepatectomy type, systolic blood pressure, heart rate, or body temperature were significant.

Conclusions: CVP during hepatic resection was not associated with intraoperative blood loss in living liver donors, suggesting that CVP may not be an important factor in predicting blood loss during hepatectomy in healthy subjects.
Feasibility of infusion pumps for continuous spinal administration of local anesthetics in post‐operative pain therapy
Authors: WENK M. , PÖPPING D. M.
Published: April 2009

Background and Objectives: For completion of perioperative care and for general ethical considerations, any intraoperatively used catheter technique should be utilizable for post‐operative pain therapy. Continuous spinal anesthesia (CSA) is an established form of local anesthetic application. However, for its use in post‐operative therapy, infusion pumps are required that are technically able to deliver low rates and are distinctive in design to avoid possible pump or medication swaps. Because of a lack of devices specifically designed for CSA, we investigated the potential deployability of infusion pumps for post‐operative pain therapy via CSA microcatheters, which were originally designed and approved for different applications.

Methods: The accuracy of infusion rates of three different pumps was measured in a liquor model environment. Furthermore, we investigated safety and user‐friendliness by interviewing 30 anesthesiologists and 15 pain nurses.

Results: Except for the first hour of infusion, all pumps provided comparable and adequate flow profiles. However, interviews revealed significant risk factors for all pumps in terms of swapping devices, lines or medications and misprogramming the units.

Discussion: All pumps tested were technically able to deliver accurate flow rates; however, because the non‐CSA‐specific design involves the risk of medication overdosage and syringe swaps, none of the systems tested can be recommended for routine use in post‐operative CSA, irrespective of the fact that it was an off‐label application anyway. Therefore, to ensure patient safety, continuous spinal administration of local anesthetics via microcatheters is a questionable method of post‐operative pain therapy as long as non‐specific pumps are used.
Comparison of spinal anesthesia with general anesthesia on morphine requirement after abdominal hysterectomy
Authors: MASSICOTTE L. , CHALAOUI K. D. , BEAULIEU D. , ROY J.‐D. , BISSONNETTE F.
Published: April 2009

Purpose: The aim of this study was to compare morphine consumption with patient‐controlled analgesia (PCA) between spinal anesthesia (SA) (bupivacaine, morphine and fentanyl) and general anesthesia (GA) (sufentanil) after an abdominal hysterectomy.

Methods: Forty women were randomly assigned to receive SA with bupivacaine 15 mg, 0.15 mg of intrathecal morphine and 15 μg of fentanyl or GA with sufentanil, both combined with PCA. The primary outcome was morphine consumption with the PCA device. The secondary outcomes were post‐operative pain at rest and under stress on a visual analog scale, nausea, pruritus and respiratory depression on a standardized scale. Outcome measures were recorded at 6, 12, 18, 24 and 48 h post‐anesthesia. The duration of post‐anesthesia care unit (PACU) and hospital stay were recorded.

Results: Patients in the SA group consumed at least two times less morphine at each time interval than the GA group: at 48 h, they used 19 ± 17 vs. 81 ± 31 mg (P<0.0001). Post‐operative pain at rest was lower in the SA group until the 18th hour and under stress until the 48th. There was more sedation in the GA group until the 18th hour. Little difference was observed in the incidence of pruritus. Nausea was more intense at the 6th hour in the GA group. There was no difference in the respiratory rate. The duration of PACU stay was shorter for the SA group (52 ± 9 vs. 73 ± 11 min, P<0.0001) as was the duration of hospital stay (2.2 ± 0.4 vs. 3.3 ± 0.7 days, P=0.01).

Conclusions: It is concluded that intrathecal morphine 0.15 mg with 15 μg of fentanyl decreases post‐operative pain and morphine consumption by PCA without increasing adverse reactions for women undergoing an abdominal hysterectomy.
Reactive oxygen species in rats with chronic post‐ischemia pain
Authors: KWAK K. H. , HAN C. G. , LEE S. H. , JEON Y. , PARK S. S. , KIM S. O. , BAEK W. Y. , HONG J. G. , LIM D. G.
Published: April 2009

Background: An emerging theme in the study of the pathophysiology of persistent pain is the role of reactive oxygen species (ROS). In the present study, we examined the hypothesis that the exogenous supply of antioxidant drugs during peri‐reperfusion would attenuate pain induced by ischemia/reperfusion (IR) injury. We investigated the analgesic effects of three antioxidants administered during peri‐reperfusion using an animal model of complex regional pain syndrome‐type I consisting of chronic post‐ischemia pain (CPIP) of the hind paw.

Methods: Application of a tight‐fitting tourniquet for a period of 3 h produced CPIP in male Sprague–Dawley rats. Low‐dose allopurinol (4 mg/kg), high‐dose allopurinol (40 mg/kg), superoxide dismutase (SOD, 4000 U/kg), N‐nitro‐l‐arginine methyl ester (l‐NAME, 10 mg/kg), or SOD (4000 U/kg)+l‐NAME (10 mg/kg) was administered intraperitoneally just after tourniquet application and at 1 and 2 days after reperfusion for 3 days. The effects of antioxidants in rats were investigated using mechanical and cold stimuli. Each group consisted of seven rats.

Results: Allopurinol caused significant alleviation in mechanical and cold allodynia for a period of 4 weeks in rats with CPIP. Both SOD and l‐NAME, which were used to investigate the roles of superoxide (O2 ˙−) and nitric oxide (NO) in pain, also attenuated neuropathic‐like pain symptoms in rats for 4 weeks.

Conclusions: Our findings suggest that O2 ˙− and NO mediate IR injury‐induced chronic pain, and that ROS scavengers administered during the peri‐reperfusion period have long‐term analgesic effects.
High thoracic epidural analgesia improves left ventricular function in patients with ischemic heart
Authors: JAKOBSEN C.‐J. , NYGAARD E. , NORRILD K. , KIRKEGAARD H. , NIELSEN J. , TORP P. , SLOTH E.
Published: April 2009

Background: In patients with ischemic heart disease, high thoracic epidural analgesia (HTEA) has been proposed to improve myocardial function. Tissue Doppler Imaging (TDI) is a tool for quantitative determination of myocardial systolic and diastolic velocities and a derivative of TDI is tissue tracking (TT), which allows quantitative assessment of myocardial systolic longitudinal displacement during systole. The purpose of this study was to evaluate the effect of thoracic epidural analgesia on left ventricular (LV) systolic and diastolic function by means of two‐dimensional (2D) echocardiography and TDI in patients with ischemic heart disease.

Methods: The effect of a high epidural block (at least Th1–Th5) on myocardial function in patients (N=15) with ischemic heart disease was evaluated. Simpson's 2D volumetric method was used to quantify LV volume and ejection fraction. Systolic longitudinal displacement was assessed by the TT score index and the diastolic function was evaluated from changes in early (E″) and atrial (A″) peak velocities during diastole.

Results: After HTEA, 2D measures of left ventricle function improved significantly together with the mean TT score index [from 5.87 ± 1.53 to 6.86 ± 1.38 (P<0.0003)], reflecting an increase in LV global systolic function and longitudinal systolic displacement. The E″/A″ ratio increased from 0.75 ± 0.27 to 1.09 ± 0.32 (P=0.0026), indicating improved relaxation.

Conclusion: A 2D‐echocardiography in combination with TDI indicates both improved systolic and diastolic function after HTEA in patients with ischemic heart disease.
Walking reduces the post‐void residual volume in parturients with epidural analgesia for labor: a randomized‐controlled study
Authors: WEINIGER C. F. , YAGHMOUR H. , NADJARI M. , EINAV S. , ELCHALAL U. , GINOSAR Y. , MATOT I.
Published: April 2009

Background: The post‐void residual volume is higher among parturients who received epidural analgesia than those who received no or alternative analgesia.

Methods: This prospective, randomized, controlled, non‐blinded study was performed in a tertiary referral center labor suite. The post‐void residual volume was measured by a transabdominal ultrasound following a voiding attempt. Healthy parturients with low‐dose epidural analgesia in active labor were randomized either to walk to the toilet or to use a bedpan for voiding. The primary outcome measure (post‐void residual volume in labor) was compared between the study groups.

Results: The toilet group (n=34) and the bedpan group (n=28) demonstrated similar post‐void residual volumes (212 ± 100 vs. 168 ± 93 ml, P=0.289). Twenty patients (59%) randomized to the toilet group were unable to walk and actually voided in a bedpan. A secondary analysis was performed analyzing the groups as treated. The post‐void residual volume was significantly lower in the actual toilet group (n=14, 63 ± 24 ml) vs. the bedpan group (n=48, 229 ± 200 ml), P=0.0052. Thirteen (93%) women who walked to the toilet managed to void before the ultrasound measurement vs. 20/48 (42%) using the bedpan, P=0.001. Fewer women who managed to walk to the toilet required urinary bladder catheterization during the labor than women who used the bedpan (6/14, 43% vs. 36/48, 75%) P=0.028.

Conclusion: Women who were randomized to walk to the bathroom with epidural analgesia and were able to do so during labor had a significantly reduced post‐void residual volume and a reduced requirement for urinary catheterization.
Post‐induction alfentanil reduces sevoflurane‐associated emergence agitation in children undergoing an adenotonsillectomy
Authors: KIM J. Y. , CHANG Y. J. , LEE J. Y. , PARK H. Y. , KWAK H. J.
Published: April 2009

Background: Emergence agitation is a common problem in paediatric anaesthesia, especially after volatile induction and maintenance anaesthesia (VIMA) with sevoflurane. The purpose of this study was to investigate the effect of alfentanil to prevent emergence agitation without delayed recovery after VIMA with sevoflurane in children undergoing an adenotonsillectomy.

Methods: One hundred and five children, aged 3–10 years, were randomly allocated to receive normal saline (control group), alfentanil 10 μg/kg (A10) or 20 μg/kg (A20) 1 min after loss of the eyelash reflex. Anaesthesia was induced and maintained with sevoflurane. Time to tracheal extubation, recovery time, Paediatric Anaesthesia Emergence Delirium (PAED) scale and emergence behaviour were assessed.

Results: The incidence of severe agitation was significantly lower in the A10 and A20 groups compared with those in the control group (11/32 and 12/34 vs. 24/34, respectively) (P=0.007, 0.006, respectively). PAED scales were significantly different between the three groups (P=0.008), and lower in the A10 and A20 groups than that in the control group (P=0.044, 0.013, respectively). However, the incidence of severe agitation and PAED scale was not different between the A10 and the A20 groups. Time to tracheal extubation and recovery time were similar in all three groups.

Conclusion: The administration of alfentanil 10 μg/kg after induction of anaesthesia for children undergoing an adenotonsillectomy under VIMA reduced the incidence of emergence agitation without delaying the recovery time or causing significant hypotension.
Inefficacy of simulator‐based training on anaesthesiologists' non‐technical skills*
Authors: ZAUSIG Y. A. , GRUBE C. , BOEKER‐BLUM T. , BUSCH C. J. , BAYER Y. , SINNER B. , ZINK W. , SCHAPER N. , GRAF B. M.
Published: April 2009

Background: Analysis of critical incidents in anaesthesia practice emphasizes the important role of non‐technical skills (NTS) in improving patient safety. Therefore, debriefing with regard to NTS has been added to medical management (MM) simulator training to improve acute crisis competencies of anaesthesiologists. The purpose of this study was to compare the NTS and MM performance of two groups of anaesthesiologists in a simulated anaesthesia crisis after undergoing different types of training.

Methods: Forty‐two anaesthesiologists were randomly assigned to two different training groups, with each group participating in two simulation training sessions. One group's (NTS+MMG) training included extensive debriefing of NTS (resource management, planning, leadership and communication) and MM, while the other group (MMG) received a simpler debriefing that focused solely on MM. The quality and quantity of NTS and quality of MM performance were rated by reviewing the videotapes of the scenarios.

Results: NTS+MMG did not prove superior to MMG with regard to behavioural and MM markers. The quality of NTS performances correlated significantly (P<0.01) with the quantity of NTS demonstration, and also correlated significantly with the MM actions (P<0.01) in both groups.

Conclusion: A single session of training including debriefing of NTS and MM did not improve the NTS performances of anaesthesiologists when compared with anaesthesiologists who only received MM training. This might indicate that a more frequent or individual training is needed to improve participants' NTS performance.
A comparison of SAPS II and SAPS 3 in a Norwegian intensive care unit population
Authors: STRAND K. , SØREIDE E. , AARDAL S. , FLAATTEN H.
Published: April 2009

Background: Simplified Acute Physiology Score (SAPS II) is the most widely used general severity scoring system in European intensive care medicine. Because its performance has been questioned in several external validation studies, SAPS 3 was recently released. To our knowledge, there are no published validation studies of SAPS II or SAPS 3 in the Scandinavian countries. We aimed to evaluate and compare the performance of SAPS II and SAPS 3 in a Norwegian intensive care unit (ICU) population.

Method: Prospectively collected data from adult patients admitted to two general ICUs at two different hospitals in Norway were used. Probability of mortality was calculated using the SAPS 3 global equation (SAPS 3 G), the SAPS 3 Northern European equation (SAPS 3 NE), and the original SAPS II equation. Performance was assessed by the standardized mortality ratio (SMR), area under receiving operating characteristic, and the Hosmer and Lemeshow goodness‐of‐fit Ĉ test.

Results: One thousand eight hundred and sixty‐two patients were included after excluding readmissions, and patients who were admitted after coronary surgery or burns. The SMRs were SAPS 3 G 0.71 (0.65, 0.78), SAPS 3 NE 0.74 (0.68, 0.81), and SAPS II 0.82 (0.75, 0.91). Discrimination was good in all systems. Only the SAPS 3 equations displayed satisfactory calibration, as measured by the Hosmer–Lemeshow test.

Conclusion: The performance of SAPS 3 was satisfactory, but not markedly better than SAPS II. Both systems considerably overestimated mortality and exhibited good discrimination, but only the SAPS 3 equations showed satisfactory calibration. Customization of these equations based on a larger cohort is recommended.
Hyper osmolality does not modulate natriuretic peptide concentration in patients after coronary artery surgery
Authors: HONKONEN E. L. , JÄRVELÄ K. , HUHTALA H. , HOLM P. , LINDGREN L.
Published: April 2009

Background: The heart secretes natriuretic peptides (NPs) in response to myocardial stretch. Measuring NP concentrations is a helpful tool in guiding treatment. It has been suggested that sodium ion and hyperosmolality could affect NP excretion. If this is true, peri‐operative NP measurements could be inconsistent when hypertonic solutions are used. With different osmolalities but equal volumes of hydroxyethyl starch (HES) – and hypertonic saline (HS) – infusions, this double‐blinded study tested the hypothesis that osmolality modulates the excretion of NPs.

Methods: Fifty coronary surgery patients were randomized to receive within 30 min 4 ml/kg either HS or HES post‐operatively. Samples for analysis of atrial NP (ANP), brain NP (BNP), plasma and urine sodium and osmolality and urine oxygen tension were obtained before and 60 min after starting the infusions and on the first post‐operative morning. The haemodynamic parameters were measured at the same time points.

Results: Plasma osmolality and sodium increased only in the HS group. Changes in plasma BNP and ANP levels did not differ between the groups (P=0.212 and 0.356). There were no correlations between NP levels and osmolality or sodium at any time point. In the HS group, urine volume was higher (3295 vs. 2644 ml; P<0.05) and the need for furosemide treatment was less (0.4 vs. 3.8 mg; P<0.01) than in the HES group.

Conclusions: The absence of effects of plasma sodium content or hyperosmolality on NP release validates the value of NPs as a biomarker in peri‐operative patients.
Perineural meperidine blocks nerve conduction in a dose‐related manner: a randomized double‐blind study
Authors: ÖZTÜRK E. , BEYAZOVA M. , KAYA K. , MERAY J. , ZINNUROGLU M. , TARHAN B.
Published: April 2009

Background: Meperidine has been shown to exhibit a sensory block in peripheral nerves. However, its motor blockade ability is controversial. The aim of this study was to investigate, electroneurographically, the ability of meperidine to inhibit conduction in both sensory and motor fibres in the ulnar nerve.

Materials and methods: The study was conducted in a double‐blind, placebo‐controlled fashion. Eighteen healthy volunteers were randomized into three groups (Saline, meperidine 1% and meperidine 2%). Three millilitre of the study solution was administered to the ulnar nerve perineurally at the level of the wrist by the guidance of a nerve stimulator. Sensory nerve action potential (SNAP) and compound motor action potential (CMAP) amplitudes were recorded. At least a 20% decrease in the initial response amplitude was accepted as a block.

Results: The number of individuals with sensory and motor block with saline, meperidine 1% and meperidine 2% were 0/6, 6/6, 6/6 and 0/6, 5/6, 6/6, respectively (P<0.05). The maximum decrease in the median SNAP and CMAP amplitude values were 4.7% and 8.3% with saline; 38.5% and 46.4% with meperidine 1%; and 100% and 97.8% with meperidine 2%, respectively (P<0.05). Median values for the duration of sensory and motor block with meperidine 1% and meperidine 2% were 45, 52.5 and 30, 32.5 min, respectively.

Conclusion: Meperidine blocks sensory and motor nerve conduction in a dose‐related manner.
Isoflurane enhances spontaneous Ca2+oscillations in developing rat hippocampal neuronsin vitro
Authors: XIANG Q. , TAN L. , ZHAO Y.‐L. , WANG J.‐T. , JIN X.‐G. , LUO A.‐L.
Published: April 2009

Background:During the nervous system development, spontaneous synchronized Ca2+oscillations are thought to possess integrative properties because their amplitude and frequency can influence the patterning of neuronal connection, neuronal differentiation, axon outgrowth, and long‐distance wiring. Accumulating studies have confirmed that some drugs such as volatile anesthetic isoflurane produced histopathologic changes in the central nervous system in juvenile animal models. Because the hippocampus plays an important role in learning and memory, the present work was designed to characterize the Ca2+oscillations regulated by volatile anesthetic isoflurane in primary cultures of developing hippocampal neurons (5‐day‐cultured).

Methods:Primary cultures of rat hippocampal neurons (5‐day‐cultured) were loaded with the Ca2+indicator Fluo‐4AM (4 μM) and were studied with a confocal laser microscope.

Results:Approximately 22% of 5‐day‐cultured hippocampal neurons exhibited typical Ca2+oscillations. These oscillations were dose‐dependently enhanced by isoflurane (EC50 0.5 MAC, minimum alveolar concentration) and this effect could be reverted by bicuculline (50 μM), a specific γ‐aminobutyric acid (GABAA) receptor antagonist.

Conclusion:Unlike its depressant effect on the Ca2+oscillations in adult neurons in previous researches, isoflurane dose‐dependently enhanced calcium oscillations in developing hippocampal neurons by activating GABAAreceptors, a major excitatory receptor in synergy withN‐methyl‐d‐aspartate receptors at the early stages of development. It may be involved in the mechanism of an isoflurane‐induced neurotoxic effect in the developing rodent brain.
Mortality in diabetic patients undergoing non‐cardiac surgery: a 7‐year follow‐up study
Authors: KROLIKOWSKA M. , KATAJA M. , PÖYHIÄ R. , DRZEWOSKI J. , HYNYNEN M.
Published: April 2009

Background: The prognosis of diabetic patients after non‐cardiac surgery remains controversial. This study was designed to compare the long‐term mortality between diabetic and non‐diabetic control patients undergoing non‐cardiac surgery and to evaluate the possible risk factors.

Methods: We investigated 274 consecutive diabetic patients and 282 non‐diabetic control patients who underwent non‐cardiac surgery within 1 year in a tertiary care hospital in Finland. The control group was matched for the same type of operations. Patients were followed for up to 7 years on average. The main outcome measure was mortality within 7 years.

Results: Mortality both in the short‐term postoperatively (≤21 days) and in the long‐term (up to 87 ½ months) was significantly higher in the diabetic patients compared with the non‐diabetic group: 3.5 vs. 0% (P<0.05) and 37.2 vs. 15% (P<0.00001), respectively. The major causes of death among diabetic subjects were diseases of the cardiovascular system (56.8%) compared with non‐diabetic patients (18.6%), P<0.0001. We found that diabetes mellitus per se is not a risk factor for post‐operative mortality but a combination of variables had a significant effect on both short‐ and long‐term mortality.

Conclusion: Diabetic patients undergoing non‐cardiac surgery had a significantly higher incidence of short‐term post‐operative and long‐term mortality compared with non‐diabetic subjects. We propose a model of predictors of death among diabetic individuals undergoing non‐cardiac surgery within a 7‐year follow‐up. The majority of deaths were associated with cardiovascular diseases.
Predictors of cardiac events in high‐risk patients undergoing emergency surgery
Authors: OSCARSSON A. , FREDRIKSON M. , SÖRLIDEN M. , ANSKÄR S. , GUPTA A. , SWAHN E. , EINTREI C.
Published: April 2009

Background: The aim of this study was to determine the incidence of myocardial damage and left ventricular myocardial dysfunction and their influence on outcome in high‐risk patients undergoing non‐elective surgery.

Methods: In this prospective observational study, 211 patients with American Society of Anesthesiologists classification III or IV undergoing emergent or urgent surgery were included.

Troponin I (TnI) was measured pre‐operatively, 12 and 48 h post‐operatively. Pre‐operative N‐terminal fragment of B‐type natriuretic peptide (NT‐proBNP), as a marker for left ventricular systolic dysfunction, was analyzed. The diagnostic thresholds were set to TnI >0.06 μg/l and NT‐proBNP >1800 pg/ml, respectively. Post‐operative major adverse cardiac events (MACE), 30‐day and 3‐months mortality were recorded.

Results: Elevated TnI levels were detected in 33% of the patients post‐operatively. A TnI elevation increased the risk of MACE (35% vs. 3% in patients with normal TnI levels, P<0.001) and 30‐day mortality (23% vs. 7%, P=0.003). Increased concentrations of NT‐proBNP were seen in 59% of the patients. Elevated NT‐proBNP was an independent predictor of myocardial damage post‐operatively, odds ratio, 6.2 [95% confidence interval (CI) 2.1–18.0] and resulted in an increased risk of MACE (21% vs. 2.5% in patients with NT‐proBNP ≤1800 pg/ml, P<0.001).

Conclusion: Myocardial damage is common in a high‐risk population undergoing unscheduled surgery. These results suggest a close correlation between myocardial damage in the post‐operative period and increased concentration of NT‐proBNP before surgery. The combinations of TnI and NT‐proBNP are reliable markers for monitoring patients at risk in the peri‐operative period as well as useful tools in our risk assessment pre‐operatively in emergency surgery.
Evaluation of esophageal varices on liver computed tomography: Receiver operating characteristic analyses of the performance of radiologists and endoscopists
Authors: Kim Hyojin , Choi Dongil , Gwak Geum‐Youn , Lee Joon Hyoek , Park Moon Kyung , Lee Hyang Ie , Kim Seong Hyun , Nam Sangyu , Yoo Eun Young , Do Young Soo
Published: April 2009

Background and Aim:  Recent liver multi‐detector row computed tomography (MDCT) always covers the distal esophagus with an excellent image quality. The aim of this study was to compare the performance of faculty abdominal radiologists with those of radiology residents and endoscopists for the detection of esophageal varices and high‐risk esophageal varices on liver MDCT.

Methods:  A total of 104 cirrhotic patients that had undergone liver MDCT 4 weeks or less before an upper endoscopy were evaluated. Two faculty abdominal radiologists, two radiology residents, and two endoscopists independently interpreted all of the CT images to detect the presence of esophageal varices and high‐risk (grade 2 or 3) esophageal varices. With endoscopic grading as the reference standard, their performances were compared by using receiver operating characteristic (ROC) curve analysis.

Results:  The areas under the ROC curves for the detection of esophageal varices indicated better performance of the abdominal radiologists (Az = 0.868), compared with the radiology residents (Az = 0.798) (P = 0.007) and endoscopists (Az = 0.784) (P = 0.006). For the detection of high‐risk esophageal varices, however, the performance of the abdominal radiologists (Az = 0.914) was similar to those of radiology residents (Az = 0.900) and endoscopists (Az = 0.907) (each P > 0.05).

Conclusions:  Experienced readers have a better ability to detect esophageal varices on liver MDCT, but had no higher performance to evaluate high‐risk esophageal varices. As the accuracy of detecting high‐risk esophageal varices with clinical relevance on liver MDCT is excellent, even by endoscopists, the evaluation of esophageal varices from a recent liver MDCT may be useful to avoid the use of low‐yield endoscopy.
Psychometric properties of the Japanese version of the Beck Cognitive Insight Scale: Relation of cognitive insight to clinical insight
Authors: Uchida Tomohiro , Matsumoto Kazunori , Kikuchi Akiko , Miyakoshi Tetsuo , Ito Fumiaki , Ueno Takashi , Matsuoka Hiroo
Published: April 2009

Aim:  Insight in schizophrenia is considered to have a multidimensional construct, and cognitive insight is thought to be an important dimension of insight: an ability to evaluate and correct one's own distorted beliefs and misinterpretations. The Beck Cognitive Insight Scale (BCIS) was developed to measure cognitive insight, and studies have shown that cognitive insight is associated with several clinical features in schizophrenia. The aim of the present study was to develop a Japanese version of the BCIS (BCIS‐J) and assess the psychometric properties of this instrument.

Methods:  The BCIS‐J was completed by university students (n = 183) and patients with schizophrenia (n = 30). The Japanese version of the Schedule for the Assessment of Insight was used to measure clinical insight in patients with schizophrenia, and its association with the BCIS‐J was investigated.

Results:  Factor analysis in the university students indicated that the BCIS‐J was composed of two factors, self‐reflectiveness and self‐certainty, as was seen in the original BCIS. The relation between the specific dimensions of clinical insight and each component of the BCIS‐J in patients with schizophrenia indicated that overconfidence in their belief or judgment may be involved in their attitude to treatment and openness to feedback, and objectivity might be essential to attribute one's symptoms as part of mental illness.

Conclusions:  The BCIS‐J is a reliable and valid instrument to measure cognitive aspects of insight and appears to complement clinical insight scales.
Randomized clinical comparison of perospirone and risperidone in patients with schizophrenia: Kansai Psychiatric Multicenter Study
Authors: Okugawa Gaku , Kato Masaki , Wakeno Masataka , Koh Jun , Morikawa Masayuki , Matsumoto Naoki , Shinosaki Kazuhiro , Yoneda Hiroshi , Kishimoto Toshifumi , Kinoshita Toshihiko
Published: April 2009

Aim:  Perospirone is classified as a second‐generation antipsychotic agent for the treatment of schizophrenia. Perospirone binds with high affinity to serotonin 5‐HT2A receptors and dopamine D2 receptors. There are no reports of clinical comparisons of perospirone and risperidone in multicenter studies. To clarify the clinical traits of perospirone in the treatment of schizophrenia, the clinical efficacies and side‐effects of perospirone and risperidone were compared in a randomized clinical multicenter trial.

Methods:  Sixty‐six schizophrenia patients were enrolled in the trial. The Positive and Negative Syndrome Scale (PANSS) total, positive, negative and general symptoms scores and Drug‐Induced Extra‐Pyramidal Symptoms Scale (DIEPSS) scores were investigated at 0, 4, 8 and 12 weeks.

Results:  Significant reductions in the PANSS total and subscale scores were observed in both the perospirone and risperidone groups, with no significant between‐group differences at 4 and 12 weeks. Risperidone improved the total scores and overall psychopathologic symptom total scores more effectively than perospirone at week 8. There were no significant differences in the DIEPSS scores at 0, 4, 8 and 12 weeks between the perospirone and risperidone groups. The numbers of patients who dropped out did not differ between the perospirone and risperidone groups.

Conclusions:  Perospirone was as effective as risperidone against positive and negative symptoms in patients with schizophrenia. Both antipsychotic agents were equally well‐tolerated.
Differentiation between attention‐deficit/hyperactivity disorder and pervasive developmental disorders with hyperactivity on objective activity levels using actigraphs
Authors: Tsujii Noa , Okada Akira , Kaku Reigetsu , Kuriki Noriko , Hanada Kazushi , Shirakawa Osamu
Published: April 2009

Aims:  To clarify differences in objective activity levels between children with attention‐deficit/hyperactivity disorder (ADHD) and those with pervasive developmental disorders (PDD) and hyperactivity.

Method:  Eighteen boys with combined type ADHD, 10 boys with PDD with hyperactivity, and 18 control boys wore actigraphs for 1 week while attending elementary school. In addition to the average activity level, the standard deviation in the activity levels were compared for two continuous situations: (i) in‐seat classes, in which the participants were expected to sit in their own seats and learn quietly; and (ii) free recess periods following the in‐seat classes.

Results:  All the groups were affected by the situational shift, the average activity level of each the groups was higher and the standard deviation was smaller than those during the in‐seat classes. The boys with ADHD exhibited a still smaller standard deviation than the controls and the boys with PDD and hyperactivity during the free recess period; no difference between the controls and the boys with PDD was seen. The boys with PDD exhibited a significantly lower average activity level than the other groups. No differences among the groups in the average activity levels and standard deviation were seen during the in‐seat classes.

Conclusions:  The observed objective activity levels in each group reflect the degree to which the boys are able to tolerate changes in situations. Objective measurement of activity levels may be useful to differentiate hyperactivity in children with ADHD from that in children without ADHD.
Association between feasibility of discharge, clinical state, and patient attitude among inpatients with schizophrenia in Japan
Authors: Mino Yoshio , Oshima Iwao , Shimodera Shinji
Published: April 2009

Aim:  There have been some studies on the feasibility of discharging mentally ill inpatients from mental hospitals. The purpose of the present study was to investigate how a psychiatrist judges whether an inpatient can be discharged.

Methods:  A survey regarding such judgments on discharge was conducted involving 549 inpatients with schizophrenia with a hospital stay of ≥1 year. Relationships between psychiatrist judgments on discharge and the Brief Psychiatric Rating Scale (BPRS), Scales for the Assessment of Negative Symptoms (SANS), Global Assessment Scale (GAS), patient attitude to discharge, and other variables were investigated. A similar analysis was conducted regarding patient attitudes toward discharge.

Results:  After controlling for potential confounding factors using multiple logistic regression, the judgments showed significant relationships with BPRS‐P, SANS, GAS, and age. Patient attitudes showed significant relationships with the length of the current hospital stay, SANS, and psychiatrists' judgments.

Conclusion:  A psychiatrist's judgment regarding discharge is a comprehensive decision that takes into account psychiatric symptoms, social functioning, and age. Such a judgment could also affect a patient's own attitude toward discharge.
Attenuated prefrontal activation during a verbal fluency task in remitted major depression
Authors: Okada Go , Okamoto Yasumasa , Yamashita Hidehisa , Ueda Kazutaka , Takami Hiroshi , Yamawaki Shigeto
Published: April 2009

The aim of the present study was to investigate whether a functional abnormality in the left prefrontal cortex observed in patients with major depression performing a verbal fluency task is present after remission of depression. Functional magnetic resonance imaging was used to study changes in cerebral blood oxygenation in eight remitted patients with major depression and 10 healthy control subjects during a verbal fluency task. Compared to the control subjects, the patients had a reduced response in the left prefrontal cortex (middle frontal gyrus, Brodmann area 10). These findings suggest the presence of dysfunction in the left prefrontal cortex during remission in major depression.
Neuropsychiatric symptoms predict change in quality of life of Alzheimer disease patients: A two‐year follow‐up study
Authors: Tatsumi Hiroshi , Nakaaki Shutaro , Torii Katsuyoshi , Shinagawa Yoshihiro , Watanabe Norio , Murata Yoshie , Sato Junko , Mimura Masaru , Furukawa Toshiaki A.
Published: April 2009

Aim:  To examine the effect of neuropsychiatric symptoms on longitudinal changes in the quality of life (QOL) of patients with Alzheimer disease (AD).

Methods:  First, we investigated whether neuropsychiatric symptoms at baseline predict changes in the QOL of AD patients over time. Then we examined the associations between changes in neuropsychiatric symptoms and changes in QOL. QOL was assessed using the Japanese version of the Quality of Life–Alzheimer Disease (QOL–AD) scale and other clinical instruments [the Mini‐Mental State Examination, The Neuropsychiatry Inventory (NPI)] at baseline and again two years later in 96 AD patients among 140 AD patients at baseline. We performed a multiple regression analysis of the baseline QOL–AD score, NPI score (mood, psychosis, and euphoria factor), Mini‐Mental State Examination score, and other clinical instrument variables (e.g. Activities‐of‐Daily‐Living scores) to determine their contribution to the change in QOL–AD score.

Results:  While the total QOL–AD score based on the patients' responses did not change significantly, the total QOL–AD score derived from the caregivers' responses declined. Both the Activities‐of‐Daily‐Living score and the mood factor of the NPI score predicted the change in the QOL–AD score as assessed by the caregivers' responses. In addition, there was a significant correlation between the changes in two factors of the NPI, i.e. the mood and psychosis factor, and the changes in the QOL–AD score based on the caregivers' responses.

Conclusions:  The presence of specific neuropsychiatric symptoms (mood and psychosis symptoms) was associated with changes in the QOL of AD patients during the follow‐up period.
Risk factors for obstructive sleep apnea syndrome screening in mood disorder patients
Authors: Hattori Miho , Kitajima Tsuyoshi , Mekata Takahiro , Kanamori Aya , Imamura Mototaka , Sakakibara Hiroki , Kayukawa Yuhei , Okada Tamotsu , Iwata Nakao
Published: April 2009

Aims:  Previous studies have reported that the incidence of obstructive sleep apnea syndrome (OSAS) in patients with depression is higher than in the general population. We examined the risk factors to predict OSAS in mood disorder patients with depressive symptoms.

Method:  We conducted polysomnography for patients who satisfied the following criteria: (i) diagnosis of major depressive disorder or bipolar disorder according to the Mini‐International Neuropsychiatric Interview (MINI); (ii) a score of ≥10 on the Hamilton Rating Scale for Depression (HAM‐D); (iii) fulfillment of either (a) or (b) below: (a) at least one of the following: severe snoring, witnessed apnea during sleep, excessive daytime sleepiness; (b) at least one of the following plus an oxygen desaturation index of 4% ≥5 times/h by pulse oximeter: mild snoring, sleep disturbance, headache, high blood pressure. The patients with apnea hypopnea index ≥5 were diagnosed with OSAS.

Results:  Of the 32 mood disorder patients who met the subject conditions, 59.4% had OSAS. The diagnosis rate with our criteria was significantly higher than the previously reported incidence of OSAS in patients with depression. There was no significant difference among diagnosis rates as to individual risk factors or the number of risk factors. A multiple regression test showed no significant association between apnea–hypopnea index and other clinical factors including depression severity.

Conclusion:  The present results showed that OSAS can be detected at a remarkably higher rate by considering appropriate OSAS risk factors in mood disorder patients, and suggested that there is a high rate of undetected and therefore untreated OSAS among mood disorder patients.
The role of species traits and taxonomic patterns in alien bird impacts
Authors: Shirley Susan M. , Kark Salit
Published: April 2009

Aim  To test whether the distribution of alien bird impacts varies across bird families and regions of origin, and to investigate whether species traits associated with successful introductions can predict which species will have negative impacts in the new area of introduction.

Location  Europe and the Mediterranean Basin.

Methods  Combining historical information and published literature about negative economic, biological and human health impacts, we compared the distribution of impacts among bird families and native origins of bird species for three major types of impact (economic, biodiversity and human health). We examined the relationships between ecological, biological and reproductive characteristics of species and the severity of the impacts.

Results  The majority of alien species with reported impacts originated from the Afrotropical, Indo‐Malayan and Palaearctic biogeographical regions. The distribution of alien bird species in Europe with reported impacts shows a taxonomic bias and largely mirrors patterns of establishment. While most species had primarily either economic or biodiversity impacts, several species in the Anatidae, Corvidae, Passeridae, Phasianidae and Sturnidae families were associated with moderate to serious negative impacts on both economic resources and native biodiversity. After controlling for taxonomic effects, species with the greatest overall impacts were habitat generalists and multi‐brooded, while species with smaller bodies and the tendency to form large feeding or roosting flocks were linked with greater impacts on native biodiversity.

Main conclusions  This study presents the first synthesis of published impact data for alien birds and provides a broad‐scale perspective on factors that contribute to their impacts. The results show that accounting for both species traits and taxonomy improves our ability to predict the impacts of alien bird species. Because several species are currently in the early stages of establishment in Europe, there may be an opportunity to limit negative impacts with efforts that promote proactive strategies against species and families possessing the above characteristics.
New mitigation measures reducing seabird by‐catch in trawl fisheries
Authors: Bull Leigh S
Published: April 2009

This paper provides an update on an earlier review [Fish & Fisheries 8 (2007) 31] of mitigation methods used to reduce seabird by‐catch in trawl fisheries. Interactions of seabirds with trawl vessels fall into two broad categories: those focused on the trawl warps and those focused around trawl nets. For reducing seabird strikes on trawl warps, the use of bird‐scaring lines has been proved to be the most effective mitigation device in the trawl fisheries in which comparative studies have been undertaken. However, the retention or strategic management of fish waste (offal and discards) is recommended as the most effective primary measure for by‐catch reduction, and as such should be viewed as the best long‐term solution to reducing seabird by‐catch in trawl fisheries. Coincident with effective fish waste management, measures such as cleaning the net prior to shooting and reducing the time the net is on the surface should be viewed as best practice measures and incorporated into normal fishing activities. While a number of methods have been trialled to reduce the incidence of warp strikes, there continues to be the need for more work on effective measures for reducing interactions of seabirds with the trawl net.
Editorial Ruminations: Publishing Kyklos
Authors: Frey Bruno S. , Eichenberger Reiner , Frey René L.
Published: April 2009

Scholars today are under increasing pressure to publish in A journals, the main role of which consists in certifying that a paper meets traditional academic standards. Consequences of this pressure are multiple authorship, the slicing of ideas, and incentives to deviate from the truth. The overburdened reviewers' evaluations are characterized by selfish efforts to protect their intellectual capital and to avoid risk. The behaviour of editors depends much on whether there are a large or small number of editors.

The editors of Kyklos respond to these developments by welcoming innovative papers that go beyond standardized orthodoxy.
Obesity as Market Failure: Could a ‘Deliberative Economy’ Overcome the Problems of Paternalism?
Authors: Anand Paul , Gray Alastair
Published: April 2009

The paper argues that the problem of obesity can usefully be seen as illustrating a new kind of market failure. At the heart of such failures is the emergence of a sub‐optimal choice environment which, though derived from a large number of small individual optimising decisions, is not the choice environment that people would choose if they were able to choose the environment itself. This idea is claimed to be consistent with modern economic theories of freedom of choice and applicable particularly to choice environments that emerge in highly competitive market situations. The retail supply of food and consumer credit is discussed by way of example. Concluding, the paper develops the concept of a ‘deliberative economy’ as an alternative to liberal paternalism and explores conditions under which such an approach to social choice might deliver desirable outcomes.
Bureaucracy and Financial Markets
Authors: Nee Victor , Opper Sonja
Published: April 2009

Recent research on financial market development has focused on the nature of the legal system. The law and finance literature, however, exclusively focuses on the abuse of management power as a major cause of shareholder expropriation. We examine the role of the administrative capability of the state in providing and guaranteeing the institutional foundations for financial market development. The characteristic feature of bureaucracy is predictable, calculable and methodical performance. Our analysis of the linkage between bureaucratic quality and financial market development confirms our hypothesis that arm's length finance not only needs a reliable legal environment, but also bureaucratic effectiveness (1) We provide evidence that state bureaucratic performance plays a crucial role in determining financial market development; (2) We find that legal origin plays an indirect role, as it affects the financial market development through the channel of the quality of state bureaucratic performance, but it does not exert a direct and independent effect.