bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preparing surgeons for rural Australia: the RACS Rural Surgical Training Program
Authors: Chong Aaron , Kiroff George 
Published: October 2014

AbstractBackgroundThe Royal Australasian College of Surgeons' Rural Surgical Training Program (RSTP) ran from 1996 to 2007. As a formal review of the RSTP had never occurred, it remained unknown whether the RSTP had achieved its objectives of training surgeons for and retaining them in practice in rural Australia.MethodsSixty‐six RSTP fellows and 67 general surgery fellows were asked to complete a survey evaluating factors influencing the decision to pursue a rural surgical career, the influence of the RSTP on subsequent career pathways and the adequacy of the RSTP in preparing its trainees for rural work.ResultsFifty‐one out of 66 RSTP fellows were noted to be in practice in metropolitan Australia, with only 15 in rural Australia. Responses obtained revealed rural surgical rotations during training as a major influence in the decision to perform rural work. Thirty out of 35 RSTP participants stated that the RSTP did not influence their subsequent careers. Six out of 15 RSTP respondents responded positively when asked about the adequacy of the RSTP in preparing its trainees for rural work.ConclusionThe RSTP largely succeeded in preparing its trainees for rural work, but did not succeed in retaining the majority of its trainees in practice in rural Australia. It appears that targeting doctors at the point of admission to surgical training, in the hope that this would translate into more rural surgeons, did not result in improved retention in rural areas.
Combined use of endometrial sample and magnetic resonance imaging in the preoperative risk‐stratification of endometrial carcinomas
Authors: Luomaranta Anna , Bützow Ralf , Pauna Arja‐Riitta , Leminen Arto , Loukovaara Mikko 
Published: October 2014

AbstractObjectiveTo compare two treatment strategies in women undergoing surgery for endometrial carcinoma.DesignRetrospective cohort study.SettingTertiary care center.Population1166 patients. Uterine biopsy/curettage was obtained in 1140 women, of whom 229 also had pelvic magnetic resonance imaging (MRI).MethodsWe compared two strategies: (i) routine pelvic lymphadenectomy and (ii) selective pelvic lymphadenectomy for women with high‐risk carcinomas as determined from preoperative histology and MRI. High‐risk carcinomas included grade 1–2 endometrioid carcinomas with ≥50% myometrial invasion, grade 3 endometrioid carcinomas, and nonendometrioid carcinomas. Others were considered low‐risk carcinomas.Main outcome measuresDiagnostic indices, treatment algorithms.ResultsOf the women who underwent lymphadenectomy, positive pelvic nodes were found in 2.3% of low‐risk carcinomas and 18.3% of high‐risk carcinomas. The combination of preoperative histology and MRI detected high‐risk carcinomas with a sensitivity of 85.7%, a specificity of 75.0%, a positive predictive value of 74.4%, and a negative predictive value of 86.1%. Area under curve was 0.804. In the routine lymphadenectomy algorithm, 54.1% of lymphadenectomies were performed for low‐risk carcinomas. In the selective lymphadenectomy algorithm, 14.3% of women with high‐risk carcinomas did not receive lymphadenectomy. Missed positive pelvic nodes were estimated to occur in 2.1% of patients in the selective strategy. Similarly, the estimated risk for isolated para‐aortic metastasis was 2.1%, regardless of treatment strategy.ConclusionsThe combination of preoperative histology and MRI is moderately sensitive and specific in detecting high‐risk endometrial carcinomas. The clinical utility of the method is hampered by the relatively high proportion of high‐risk cases that remain unrecognized preoperatively.
Anti‐Müllerian hormone reduction after ovarian cyst surgery is dependent on the histological cyst type and preoperative anti‐Müllerian hormone levels
Authors: Lind Tekla , Hammarström Margareta , Lampic Claudia , Rodriguez‐Wallberg Kenny 
Published: October 2014

AbstractObjectiveTo investigate changes in serum anti‐Müllerian hormone (AMH) concentrations following ovarian cyst surgery, and predictors of these changes.DesignProspective cohort study with follow up at 3 and 6 months.SettingUniversity hospital.PopulationWomen of reproductive age scheduled for ovarian cyst surgery.MethodsWomen were recruited between March 2011 and March 2012 (n = 75). Serum AMH concentrations were measured preoperatively and at 3 and 6 months postoperatively.Main outcome measuresChanges in AMH after surgery and predictors for these changes.ResultsAfter surgery, median AMH levels decreased significantly from 2.7 μg/L (0.2–16.9) to 1.6 μg/L (0.2–9.9) at 3 months and were still low, 1.6 μg/L (0.2–8.3) at 6 months (both p < 0.001). In patients with unilateral cysts, a significant and more rapid AMH decrease was seen after enucleation of endometriomas (n = 19) vs. dermoid cysts (n = 22) (p = 0.010). The reduction was long‐lasting at 6 months. In a multivariate regression analysis, a higher baseline AMH concentration was predictive of AMH reduction at 3 [odds ratio (OR) 1.9, 95% CI 1.1–3.1] and 6 months postoperatively (OR 2.5, 95% CI 1.2–5.2). Women with normal or elevated baseline AMH presented with a significant reduction of −23% and −43% at 3 and 6 months, respectively, whereas women with low or very low AMH had minimal or no changes over time. Patient's age, cyst size, duration of surgery or intraoperative bleeding were not predictive of a postoperative AMH decrease.ConclusionsReduction of AMH was of greater magnitude and longer duration after enucleation of endometriomas and in women with normal and high preoperative AMH levels.
Adenosine receptors and renal ischaemia reperfusion injury
Authors: Rabadi M. M. , Lee H. T. 
Published: October 2014

AbstractOne of the frequent clinical complications that results in billions of dollars in healthcare costs annually in the United States is acute kidney injury (AKI). Ischaemia reperfusion (IR) injury is a major cause AKI. Unfortunately, no effective treatment or preventive measure for AKI exists. With increased surgical complexity coupled with increasing number of elderly, the incidence of AKI is becoming more frequent. Adenosine is a metabolic breakdown product of adenosine triphosphate (ATP) and contributes to the regulation of multiple physiological events. Extracellular adenosine activates four subtypes of adenosine receptors (AR) including A1AR, A2AAR, A2BAR and A3AR. In the kidney, adenosine regulates glomerular filtration rate, vascular tone, renin release and is an integrative part of tubular glomerular feedback signal to the afferent arterioles. In addition, each AR subtype powerfully modulates renal IR injury. The A1AR activation protects against ischaemic insult by reducing apoptosis, necrosis and inflammation. Activation of A2AAR protects against renal injury by modulating leucocyte‐mediated inflammation as well as directly reducing renal tubular inflammation. Activation of A2BAR acts via direct activation of renal parenchymal as well as renovascular receptors and is important in kidney preconditioning. Finally, activation of A3AR exacerbates renal damage following renal IR injury while A3AR antagonism attenuates renal damage following ischaemic insult. Latest body of research suggests that kidney AR modulation may be a promising approach to treat ischaemic AKI. This brief review focuses on the signalling pathways of adenosine in the kidney followed by the role for various AR modulations in protecting against ischaemic AKI.
Effects of dietary water‐soaked barley on amino acid digestibility, growth performance, pork quality and Longissimus dorsi muscle fatty acid profiles in pigs
Authors: Wang Jian Ping , Kim In Ho 
Published: October 2014

AbstractTwo experiments were conducted to assess the feeding value of water‐soaked barley (WB) as a replacement for dehulled barley (DB) in pigs. In experiment (Exp.) 1, eight barrows (body weight = 30.56 ± 0.78 kg) were fitted with a T‐cannula and allotted to a duplicated 4 × 4 Latin square design: WB10, 100g/kg WB; WB20, 200 g/kg WB; DB10, 100 g/kg DB; and DB20, 200 g/kg DB. In Exp. 2, 80 barrows (body weight = 70.56 ± 1.29 kg) were used in a 56‐day experiment: (i) WB15, 150 g/kg WB; (ii) WBD10, 100 g/kg WB and 50 g/kg DB; (iii) WBD5, 50 g/kg WB and 100 g/kg DB; and (iv) DB15, 150 g/kg DB. In Exp. 1, the apparent ileal digestibilities of total essential amino acids were higher (P < 0.05) in WB10 treatment than DB20. For Exp.2, the WB15 and WBD10 had higher pH and lower cooking loss (P < 0.05) than other two treatments. The WB15 treatment decreased (P < 0.05) the contents of palmitic acid (C16:0) in Longissimus dorsi muscle than WBD5 and DB15 treatments. In conclusion, it is suggested that water‐soaked barley improved some amino acid digestibility and the cooking loss and moderate fatty acid profiles in Longissimus dorsi muscle.
Hypothyroidism associated with acromegaly and insulin‐resistant diabetes mellitus in aSamoyed
Authors: Johnstone T , Terzo E , Mooney CT 
Published: October 2014

BackgroundThe aetiology of insulin resistance (IR) in naturally occurring canine hypothyroidism is poorly understood and likely multifactorial. Excess secretion of growth hormone (GH) by transdifferentiated pituitary cells may contribute toIRin some hypothyroid dogs, but although this has been demonstrated in experimental studies, it has not yet been documented in clinical cases.Case reportA 4‐year‐old male entireSamoyed presented with an 8‐month history of pedal hyperkeratosis and shifting lameness, which had been unresponsive to zinc supplementation, antibiotics and glucocorticoid therapy. The dog also exhibited exercise intolerance and polydipsia of 12 and 2 months duration, respectively. On physical examination, obesity, poor coat condition, widened interdental spaces and mild respiratory stridor were noted. Initial laboratory test results revealed concurrent hypothyroidism and diabetes mellitus (DM). Further investigations showedIR,GHexcess and a paradoxical increase ofGHfollowing stimulation with thyrotropin‐releasing hormone.ConclusionsTo the authors' knowledge, this is the first reported case that suggests thatGHalterations may have clinical significance in naturally occurring hypothyroidism. Among other factors, hypothyroidism‐inducedGHexcess should be considered as a possible cause ofIRin patients suffering from hypothyroidism and concurrentDM. In such cases,DMmay reverse with treatment of hypothyroidism, as was documented in this case.
Survival advantage of cyromazine‐resistant sheep blowfly larvae on dicyclanil‐ and cyromazine‐treated Merinos
Authors: Levot GW , Langfield BJ , Aiken DJ 
Published: October 2014

ObjectiveTo determine whether a cyromazine‐resistant strain of Lucilia cuprina was able to establish strikes sooner than a susceptible strain on cyromazine‐ or dicyclanil‐treated sheep.MethodsGroups of 7 sheep were treated with cyromazine or dicyclanil in accordance with label directions. Beginning 5 weeks after treatment, 5 sheep from each group were challenged by implantation of neonate larvae belonging to the cyromazine‐resistant strain ‘Nimmitabel‐selected’ and the susceptible blowfly strain ‘Field 2011’ according to standard larval implant technique. The implant sites were alternated between the shoulder, mid‐back and rump within the treatment zone. Similarly, implants of the resistant and susceptible strain larvae were alternated at each challenge such that the strain implanted on the left side of the sheep at one challenge was implanted on the right side at the next. Challenges were conducted at 3‐weekly intervals until the susceptible larvae formed strikes on at least 2 of the 5 sheep in a treatment group or until 29 weeks after treatment.ResultsSheep treated with cyromazine or dicyclanil were protected from flystrike by the cyromazine‐susceptible strain for periods consistent with, or longer than, the registered product label claims. The cyromazine‐resistant strain created strikes several weeks sooner after treatment than did the susceptible strain. Accordingly, the protection periods provided by cyromazine and dicyclanil against the resistant strain were reduced from 14 and 18–24 weeks to <8 weeks and <11 weeks, respectively.ConclusionResistance, even in the pure‐breeding resistant strain, was not so severe as to cause treatment failure with cyromazine or dicyclanil, but was sufficient to reduce the protection period provided. It is recommended that producers adopt management practices that minimise the development of resistance to these and other compounds.
Biomechanical evaluation of double Krackow sutures versus the three‐loop pulley suture in a canine gastrocnemius tendon avulsion model
Authors: Wilson L , Banks TA , Luckman P , Smith B 
Published: October 2014

ObjectiveTo compare two Krackow sutures with a three‐loop pulley suture for the reattachment of canine gastrocnemius tendons, using a tendon avulsion model.Study designIn vitro biomechanical study.MethodsTen paired gastrocnemius tendons were severed at their insertions on the calcaneal tuberosity and repaired with either two modified Krackow sutures or a modified three‐loop pulley suture. Sutures were placed in the tendon ends and through diverging bone tunnels in the medial and lateral processes of the calcaneal tuberosity. Tensile loads required to (a) create a 3‐mm gap and (b) induce construct failure were measured.ResultsThe mean load to achieve a 3‐mm gap was 77.22 ± 9.72 and 55.85 ± 9.91 N, and to result in construct failure was 106.88 ± 12.74 and 80.86 ± 12.23 N for the Krackow and three‐loop pulley suture patterns, respectively. These differences were statistically significant (P < 0.001 and P = 0.001, respectively).Conclusion and clinical relevanceTwo Krackow sutures were superior to the three‐loop pulley pattern in both resistance to 3‐mm gap formation and load to failure in a canine gastrocnemius avulsion model. The prevention of gap formation is critical for the success of tenorrhaphy. These results indicate that a suture pattern using two Krackow sutures may be clinically superior to the three‐loop pulley suture pattern in the repair of canine gastrocnemius avulsion. Further work is required to determine if this superiority is mirrored in the repair of other tendon avulsion or laceration scenarios.
Influence of gestational diabetes on the stereoselective pharmacokinetics and placental distribution of metoprolol and its metabolites in parturients
Authors: Antunes Natalícia de Jesus , Cavalli Ricardo Carvalho , Marques Maria Paula , Moisés Elaine Christine Dantas , Lanchote Vera Lucia 
Published: October 2014

AimTo investigate the influence of gestational diabetes mellitus (GDM) on the kinetic disposition and transplacental and amniotic fluid distribution of metoprolol and its metabolites O‐desmethylmetoproloic acid and α‐hydroxymetoprolol stereoisomers in hypertensive parturients receiving a single dose of the racemic drug.MethodsThe study was conducted on hypertensive parturients with well‐controlled GDM (n = 11) and non‐diabetic hypertensive parturients (n = 24), all receiving a single 100 mg oral dose of racemic metoprolol tartrate before delivery. Serial maternal blood samples (0–24 h) and umbilical blood and amniotic fluid samples were collected for the quantitation of metoprolol and its metabolite stereoisomers using LC‐MS/MS or fluorescence detection.ResultsThe kinetic disposition of metoprolol and its metabolites was stereoselective in the diabetic and control groups. Well‐controlled GDM prolonged tmax for both enantiomers of metoprolol (1.5 vs. 2.5 h R‐(+)‐MET; 1.5 vs. 2.75 h S‐(−)‐MET) and O‐desmethylmetoproloic acid (2.0 vs. 3.5 h R‐(+)‐AOMD; 2.0 vs. 3.0 h S‐(−)‐OAMD), and for the four stereoisomers of α‐hydroxymetoprolol (2.0 vs. 3.0 h for 1′S,2R‐, 1′R,2R‐ and 1′R,2S‐OHM; 2.0 vs. 3.5 h for 1′S,2S‐OHM) and reduced the transplacental distribution of 1′S,2S‐, 1′R,2R‐, and 1′R,2S‐OHM by approximately 20%.ConclusionsThe kinetic disposition of metoprolol was enantioselective, with plasma accumulation of the S‐(−)‐MET eutomer. Well‐controlled GDM prolonged the tmax of metoprolol and O‐desmethylmetoproloic acid enantiomers and the α‐hydroxymetoprolol stereoisomers and reduced by about 20% the transplacental distribution of 1′S,2S‐, 1′R,2R‐, and 1′R,2S‐OHM. Thus, well‐controlled GDM did not change the activity of CYP2D6 and CYP3A involved in metoprolol metabolism.
Pharmacokinetics and safety of oseltamivir in patients with end‐stage renal disease treated with automated peritoneal dialysis
Authors: Patel Kashyap , Rayner Craig R. , Giraudon Mylène , Kamal Mohamed A. , Morcos Peter N. , Robson Richard , Kirkpatrick Carl M. 
Published: October 2014

AimsPatients with end‐stage renal disease (ESRD) are at increased risk of developing complications associated with influenza infection. Oseltamivir is indicated for influenza treatment in ESRD patients, but the disposition is poorly understood in this patient population. This study aimed to characterize the pharmacokinetics and tolerability of oseltamivir in automated peritoneal dialysis (APD) and construct a pharmacokinetic model to assist with optimized dosing.MethodsTen adults with ESRD were prescribed an aggressive APD regimen consisting of three continuous cycler‐assisted peritoneal dialysis (CCPD) sessions during the day and two continuous ambulatory (CAPD) sessions overnight. Oseltamivir was administered as a single 75 mg dose, immediately before APD treatment.ResultsOseltamivir was rapidly eliminated via first‐pass metabolism, with most of the dose (Fraction metabolized = 0.964) reaching the circulation as the active metabolite, oseltamivir carboxylate. This metabolite was cleared slowly and was quantifiable throughout the sampling interval. The disposition of oseltamivir and oseltamivir carboxylate was described by a two‐ and a one‐compartment model, respectively. Metabolite clearance by CCPD [0.32 l h−1 (70 kg)−1] was 1.9‐fold faster than via CAPD [0.17 l h−1 (70 kg)−1], with renal elimination being dominant in patients with residual urine production. Model simulations showed that a single 75 mg dose attained target exposures in patients with negligible or low urine clearance. However, higher doses are recommended for further investigation in patients with high residual renal function. In all patients, oseltamivir was well tolerated.ConclusionsIn APD patients with anuria or low residual renal elimination, a single 75 mg dose of oseltamivir produced exposures at the upper end of the safety margin.
Implementation of External Cephalic Version in the Netherlands: A Retrospective Cohort Study
Authors: Vlemmix Floortje , Rosman Ageeth N. , te Hoven Susan , van de Berg Suzanne , Fleuren Margot A.H. , Rijnders Marlies E. , Beuckens Antje , Opmeer Brent C. , Mol Ben Willem J. , Kok Marjolein 
Published: October 2014

AbstractBackgroundExternal cephalic version (ECV) reduces the rate of elective cesarean sections as a result of breech presentation. Several studies have shown that not all eligible women undergo an ECV attempt. The aim of this study was to evaluate the implementation of ECV in the Netherlands and to explain variation in implementation rates with hospital characteristics and individual factors.MethodsWe invited 40 hospitals to participate in this retrospective cohort study. We reviewed hospital charts for all singleton breech deliveries from 36 weeks' gestation and onwards between January 2008 and December 2009. We documented whether an ECV attempt was performed, reasons for not performing an attempt, mode of delivery, and hospital characteristics.ResultsWe included 4,770 women from 36 hospitals. ECV was performed in 2,443 women (62.2% of eligible women, range 8.2–83.6% in different hospitals). Implementation rates were higher in teaching hospitals, hospitals with special office hours for ECV, larger obstetric units, and hospitals located in larger cities. Suboptimal implementation was mainly caused by health care providers who did not offer ECV.ConclusionECV implementation rates vary widely among hospitals. Suboptimal implementation is mostly caused by the care provider not offering the treatment and secondly due to women not opting for the offered attempt. A prerequisite for designing a proper implementation strategy is a detailed understanding of the exact reasons for not offering and not opting for ECV.
Journeys of adjustment: the experiences of adolescents living with juvenile idiopathic arthritis
Authors: Cartwright T. , Fraser E. , Edmunds S. , Wilkinson N. , Jacobs K. 
Published: October 2014

AbstractBackgroundJuvenile idiopathic arthritis (JIA) is one of the most common diseases of childhood causing pain, swelling of joints and reduced mobility. Previous research has focused on the challenges and psychosocial impact of JIA, but there has been limited attention given to how young people adjust and adapt to living with a long‐term condition such as JIA. The aim of this qualitative study was therefore to explore adolescents' experiences of living with JIA, with particular focus on the process of adjustment.MethodsTen adolescents (7 female, 3 male) aged 13–17 years with good treatment adherence were recruited from an adolescent arthritis clinic. In‐depth interviews were conducted, and data were analysed by two researchers independently using interpretative phenomenological analysis.ResultsThese adolescents described the physical and psychosocial ‘burden of living with JIA’ and the challenges faced by an underlying preoccupation ‘to be a normal teenager’. However, their accounts also revealed ways in which they regained agency and developed ‘resilience through taking control’ over their lives. This resilience helped the adolescents re‐establish a sense of well‐being through an ongoing process of ‘acceptance and self‐growth’.ConclusionsAlthough much research has adopted a deficit model that focuses on adjustment problems, the current study highlights the resourcefulness of young people in managing the challenges of living with a long‐term condition. These experiences of successful adjustment can be used as the basis of positive, strength‐based intervention approaches for adolescents with arthritis to enhance resilience and well‐being.
False‐Belief Understanding and Social Preference Over the First 2 Years of School: A Longitudinal Study
Authors: Fink Elian , Begeer Sander , Hunt Caroline , de Rosnay Marc 
Published: October 2014

The role of false belief in establishing children's social relationships during the transition to school was examined and compared to other social cognitive constructs. One hundred and fourteen 5‐year‐olds were recruited during their 1st year of school (Time 1); 106 children were retained 1 year later. False belief, emotion expression recognition, empathy, verbal ability, and peer‐rated social preference were measured at both times. False belief at Time 1 had a direct influence on concurrent social preference, over and above the influence of emotion expression recognition and empathy. False belief made no independent contribution to later social preference accounting for stability in social preference. The role of social cognitive development is discussed with respect to how children establish and maintain their position in a peer group.