bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improved cellular immune response elicited by a ubiquitin‐fused ESAT‐6 DNA vaccine against Mycobacterium tuberculosis
Authors: Wang Qing‐min , Kang Lin , Wang Xiao‐hua 
Published: April 2009

ABSTRACTThe present study evaluated the immune response elicited by a ubiquitin‐fused ESAT‐6 DNA vaccine against Mycobacterium tuberculosis. BALB/c mice were vaccinated with plasmid DNA encoding ESAT‐6 protein, ubiquitin‐fused ESAT‐6 DNA vaccine (UbGR‐ESAT‐6), pcDNA3‐ubiquitin and blank vector, respectively. ESAT‐6 DNA vaccine immunization induced a Thl‐polarized immune response. The production of Thl‐type cytokine (IFN‐γ) and proliferative T‐cell responses was enhanced significantly in mice immunized with UbGR‐ESAT‐6 fusion DNA vaccine, compared to non‐fusion DNA vaccine. This fusion DNA vaccine also resulted in an increased relative ratio of IgG2a to IgGl and the cytotoxicity of T cells. Thus, the present study demonstrated that the UbGR‐ESAT‐6 fusion DNA vaccine inoculation improved antigen‐specific cellular immune responses, which is helpful for protection against tuberculosis infection.
Ankylosing spondylitis: recent developments and anaesthetic implications
Authors: Woodward L. J. , Kam P. C. A. 
Published: April 2009

SummaryAnkylosing spondylitis can present significant challenges to the anaesthetist as a consequence of the potential difficult airway, cardiovascular and respiratory complications, and the medications used to reduce pain and control the disease. There is also an increased risk of neurological complications in the peri‐operative period. Awake fibreoptic intubation is the safest option in those patients with a potentially difficult airway as it allows continuous neurological monitoring while achieving a definitive airway. Neurophysiological monitoring (somatosensory and motor evoked potentials) should be considered in patients undergoing surgery for cervical spine deformity. The medical management of the disease has improved with the use of anti‐tumour necrosis factor‐α agents. There is potential for increased wound infection in patients taking these drugs. This article reviews the anaesthetic issues in patients with ankylosing spondylitis. The challenge to the anaesthetist is in the understanding of these issues so that appropriate management can be planned and undertaken.
Tracheal intubation and alternative airway management devices used by healthcare professionals with different level of pre‐existing skills: a manikin study*
Authors: Wahlen B. M. , Roewer N. , Lange M. , Kranke P. 
Published: April 2009

SummaryThe classic Laryngeal Mask Airway (cLMA™), ProSeal Laryngeal Mask Airway (PLMA™), Intubating Laryngeal Mask Airway™ (ILMA™), Combitube (CT™), Laryngeal Tube (LT™) and tracheal intubation (TI) were compared in a manikin study. Nurses, anaesthetic nurses, paramedics, physicians and anaesthetists inserted the devices three times in a randomised sequence. Time taken for successful insertion, success rates and ease of insertion were evaluated. Anaesthetists performed tracheal intubation significantly faster than other healthcare professionals (p < 0.05). Insertion times for the cLMA, PLMA, LT and CT were not significantly different between the groups. Insertion of the CT, ILMA and TI was associated with a significant learning effect in all groups. This was not observed with the cLMA, PLMA or LT. All non‐anaesthetists were able to insert the cLMA, PLMA and LT within two attempts with a > 90% success rate on the first attempt. The ILMA and TI were the only devices where more than one subject experienced some difficulty in insertion. The cLMA, PLMA and LT should be evaluated for use in situations where only limited airway training is possible.
Effect of nasal cannula oxygen administration on oxygen concentration at facial and adjacent landmarks
Authors: Orhan‐Sungur M. , Komatsu R. , Sherman A. , Jones L. , Walsh D. , Sessler D. I. 
Published: April 2009

SummaryAn oxygen‐enriched atmosphere enhances the potential for operating‐room fires. We thus determined oxygen concentrations at various facial landmarks during oxygen administration via nasal cannulae. Thirteen supine volunteers were draped similarly to patients undergoing a cervical‐node biopsy. Oxygen was delivered in random order through nasal cannulae at rates of 2, 4, and 6 l.min−1. Oxygen concentration was measured at pre‐determined facial landmarks and also distal to the drape at non‐facial sites. At a flow of 2 l.min−1, oxygen concentrations exceeded 23% only within a few centimetres of the nasal cannula. Concentration increased as a function of flow, but rarely exceeded 26%. At all flow rates, concentrations distal to the drape were < 24%. To reduce combustion risk, ignition sources should be kept at least 10 cm from the oxygen outlet when using nasal cannula at a flow rate ≥ 4 l.min−1.
Hypertension and intra‐operative incidents: a multicentre study of 125 000 surgical procedures in Swiss hospitals*
Authors: Beyer K. , Taffé P. , Halfon P. , Pittet V. , Pichard S. , Haller G. , Burnand B. ,   for the ADS study Group
Published: April 2009

SummaryIt is debated whether chronic hypertension increases the risk of cardiovascular incidents during anaesthesia. We studied all elective surgical operations performed in adults under general or regional anaesthesia between 2000 and 2004, in 24 hospitals collecting computerised clinical data on all anaesthetics since 1996. The focus was on cardiovascular incidents, though other anaesthesia‐related incidents were also evaluated. Among 124 939 interventions, 27 881 (22%) were performed in hypertensive patients. At least one cardiovascular incident occurred in 7549 interventions (6% (95% CI 5.9–6.2%)). The average adjusted odds ratio of cardiovascular risk for chronic hypertension was 1.38 (95% CI 1.27–1.49). However, across hospitals, adjusted odd ratios varied from 0.41 up to 2.25. Hypertension did not increase the risk of other incidents. Hypertensive patients are still at risk of intra‐operative cardiovascular incidents, while risk heterogeneity across hospitals, despite taking account of casemix and hospital characteristics, suggests variations in anaesthetic practices.
Evaluation of the LMA Supreme™ in 100 non‐paralysed patients*
Authors: Cook T. M. , Gatward J. J. , Handel J. , Hardy R. , Thompson C. , Srivastava R , Clarke P. A. 
Published: April 2009

SummaryWe studied the LMA Supreme™ in 100 elective, anaesthetised, healthy patients assessing: ease of use, airway quality, anatomical and functional positioning, airway leak and complications. Insertion was successful on first, second or third attempt in 90, nine and one patient respectively. Thirty manipulations were required in 22 patients to achieve a clear airway. Median [interquartile (range)] insertion time was 18 [10–25 (5–120)] s. During ventilation, an expired tidal volume of 7 ml.kg−1 was achieved in all patients. Median [interquartile (range)] airway leak pressure was 24 [20–28 (13–40)] cmH2O. On fibreoptic examination via the device, vocal cords were visible in 83 patients (85%). During maintenance, five patients (5%) required 13 airway manipulations. There was one episode of minor regurgitation, without aspiration. Other complications and patient side‐effects were mild and few. The LMA Supreme is easily and rapidly inserted, providing a reliable airway and good airway seal. Further studies are indicated to assess safety and performance compared to other supraglottic airway devices.
Myocardial infarction associated with the administration of intravenous ephedrine and metaraminol for spinal‐induced hypotension
Authors: Khavandi A. , Gatward J. J. , Whitaker J. , Walker P. 
Published: April 2009

SummaryA 31‐year‐old female with no risk factors for cardiac disease suffered a peri‐operative myocardial infarction during an elective gynaecological procedure under spinal anaesthesia. The timing and nature of cardiac symptoms suggest that the myocardial infarction was caused by coronary artery vasospasm secondary to ephedrine and/or metaraminol, which were administered to treat spinal‐induced hypotension. We review the recent literature and case reports on myocardial infarction attributed to sympathomimetic drugs, and recommend the use of sublingual or intravenous nitrates when signs or symptoms of coronary arterial vasospasm become evident during their use.
Risk index for peri‐operative atrial fibrillation in patients undergoing open intracranial neurosurgical procedures
Authors: Bilotta F. , Pizzichetta F. , Fiorani L. , Paoloni F. P. , Delfini R. , Rosa G. 
Published: April 2009

SummaryThe aim of this prospective study was to determine the prevalence of pre‐operative atrial fibrillation and the incidence of postoperative atrial fibrillation in patients undergoing elective or emergency intracranial neurosurgical procedures and the relation to survival and neurological outcome at 6‐months follow‐up compared to patients with sinus rhythm. A total of 2020 patients were enrolled; 1540 patients underwent elective procedures and 480 underwent emergency procedures. Prevalence of pre‐operative atrial fibrillation was 3.7% in elective and 7.2% in emergency procedures (p = 0.0012). In patients undergoing elective cerebral procedures with pre‐operative atrial fibrillation, compared to patients with sinus rhythm, 6‐month neurological outcome and survival rate are similar. In patients undergoing emergency neurosurgical cerebral procedures, the presence of pre‐operative atrial fibrillation is related to an increased risk of poor neurological outcome but with similar survival rate.
Anaesthesia in haemodynamically compromised emergency patients: does ketamine represent the best choice of induction agent?
Authors: Morris C. , Perris A. , Klein J. , Mahoney P. 
Published: April 2009

SummaryIn rapid sequence induction of anaesthesia in the emergency setting in shocked or hypotensive patients (e.g. ruptured abdominal aortic aneurysm, polytrauma or septic shock), prior resuscitation is often suboptimal and comorbidities (particularly cardiovascular) may be extensive. The induction agents with the most favourable pharmacological properties conferring haemodynamic stability appear to be ketamine and etomidate. However, etomidate has been withdrawn from use in some countries and impairs steroidogenesis. Ketamine has been traditionally contra‐indicated in the presence of brain injury, but we argue in this review that any adverse effects of the drug on intracranial pressure or cerebral blood flow are in fact attenuated or reversed by controlled ventilation, subsequent anaesthesia and the greater general haemodynamic stability conferred by the drug. Ketamine represents a very rational choice for rapid sequence induction in haemodynamically compromised patients.
Causes for cancellation of elective surgical procedures in a Spanish general hospital
Authors: González‐Arévalo A. , Gómez‐Arnau J. I. , DelaCruz F. J. , Marzal J. M. , Ramírez S. , Corral E. M. , García‐del‐Valle S. 
Published: April 2009

SummaryCancellation of scheduled surgery is undesirable for patients and an inefficient use of resources. We prospectively collected data for 52 consecutive months in a public general hospital to estimate the prevalence and causes. The overall cancellation rate was 6.5% (2559 of 39 115 scheduled operations). Cancellation by broad category was for ‘medical reasons’ in 50%, ‘patient‐related factors’ in 23%, and due to ‘administrative/logistic problems’ in 25%. The commonest specific causes within these categories were respectively: infections/fever (18%), patient did not attend (20%) and lack of theatre time (23%). This data will help direct resources to target prevention of cancellations as a result of these main problems.
Acquired hypernatraemia is an independent predictor of mortality in critically ill patients
Authors: O’Donoghue S. D. , Dulhunty J. M. , Bandeshe H. K. , Senthuran S. , Gowardman J. R. 
Published: April 2009

SummaryThis study reports the incidence and associated mortality of acquired hypernatraemia (Na > 150 mmol.l−1) in a general medical/surgical intensive care unit. Patients admitted over a 5‐year period with normal sodium values were eligible for inclusion; exclusions were made for burn/neurosurgical diagnoses and for hypertonic saline therapy. From 3475 admissions (3317 patients), 266 (7.7%) episodes of hypernatraemia were observed. Hospital mortality was 33.5% in the hypernatraemic group and 7.7% in the normonatraemic group (p < 0.001). Acquired hypernatraemia was an independent risk factor for in‐hospital mortality (OR 1.97, 95% CI 1.37–2.82, p < 0.001). Intermediate sodium levels (145–150 mmol.l−1) were associated with increased mortality (OR 1.42, 95% CI 1.02–1.98). Uncorrected sodium at discharge (p = 0.001) and peak sodium (p = 0.001) were better predictors of mortality than time to onset (p = 0.71) and duration of hypernatraemia (p = 1.0). Hypernatraemia avoidance is justified, but determinants of hypernatraemia and benefits of targeted treatment strategies require further elucidation.
Shear-wave splitting around the Eifel hotspot: evidence for a mantle upwelling
Authors: Walker K. T. , Bokelmann G. H. R. , Klemperer S. L. , Bock G. 
Published: April 2009

SummaryWe present the results of a shear-wave splitting analysis across the Eifel hotspot in west-central Europe. Our data set includes 18 permanent European broadband stations and 102 temporary Eifel broadband and short-period stations. We observe variations in splitting at most permanent stations, but are not able to model them reliably with unique dipping-axis or two-layer anisotropy models. We prefer instead a single-layer model with a horizontal fast axis to approximate the first-order anisotropy, which varies smoothly between stations. We observe a first-order parabolic pattern in fast polarization azimuth around the hotspot, which suggests that a lattice preferred orientation (LPO) of olivine fast axes exists in the asthenosphere as a result of the interaction between the slowly WSW-moving Eurasian plate and a mantle upwelling beneath the Eifel volcanic fields. The minority of the variation not explained by this model correlates with rapid lateral changes in splitting, and is interpreted as a result of additional anisotropy and/or the effects of dynamic recrystallization associated with LPO development in the region of corner flow near the conduit. Our parabolic asthenospheric flow (PAF) interpretation is consistent with Eifel geological, tomographic, receiver function, global absolute plate motion, electrical conductivity anisotropy, and geochemical studies, as well as with splitting studies in the Great Basin and around Hawaii.We suggest that the Eifel upwelling is sporadic, and a result of a low excess upwelling temperature and/or varying crustal stresses that periodically shift and facilitate eruption. The PAF pattern we observe neither suggests nor rules out anisotropy in the conduit associated with a wet Eifel upwelling.We use our optimum PAF model parameters to calculate a Eurasian plate speed of 12 km Ma−1, which is consistent with the recent HS3-NUVEL1A speed of 19 ± 14 km Ma−1.
Seismic tomography of the Tongariro Volcanic Centre, New Zealand
Authors: Rowlands D. P. , White R. S. , Haines A. J. 
Published: April 2009

SummaryTomographic inversion of local earthquake P- and S-wave traveltime data is used to investigate 3-D P-wave velocity (Vp) and P-wave/S-wave velocity ratio (Vp/Vs) variations at the Tongariro Volcanic Centre (TgVC), New Zealand. P-wave model resolution is generally high throughout the TgVC at depths of around 3–9 km below sea level. Near-surface resolution is lower since rays at shallow depths are predominantly subparallel. Resolution decreases below 12 km depth due to clustering of seismicity at greater depths. The final 3-D Vp model shows low-velocity volumes from 3 to 7 and 8 km depth, respectively beneath the active volcanoes Ruapehu and Ngauruhoe. Smaller low-velocity volumes are observed beneath the active Tongariro volcano and the extinct Tama Lakes vents. Synthetic tests indicate that the resolution of the 3-D Vp/Vs model is insufficient to permit any reliable interpretation.Accurate earthquake depths are determined for the first time within the TgVC. Seismicity is largely restricted to two clusters west of Ruapehu, possibly with origins on eastward striking branches of the normal Raurimu Fault, two lineations near Waiouru in the south-east of the study area and a fault belt between Tongariro and Lake Taupo in the north of the study area.Earthquake depths indicate possible shallowing of the brittle-ductile transition beneath Ruapehu and Ngauruhoe.
Space maintenance
Authors: LAING EMMA , ASHLEY PAUL , NAINI FARHAD B. , GILL DALJIT S. 
Published: April 2009

Objective.  The use of a space maintainer appliance, or restoration of a carious primary tooth that can then act as a natural space maintainer, may potentially obviate the consequences of loss of arch length and the need for complex orthodontic treatment at a later stage. Nevertheless, all space maintainer appliances are plaque retentive and may predispose to dental caries and gingival inflammation. Space maintainer appliances may also impinge on the soft tissues, interfere with eruption of adjacent teeth, fracture, and become dislodged or lost. This review article provides a summary of the available evidence, and considers the indications for space maintenance.Methods.  Medline and Ovid Medline were scanned, and additionally a hand‐search of non‐listed peer‐reviewed papers written in English was performed. A total of 16 pertinent papers published between 1987 and 2007 that satisfied the inclusion criteria were selected for discussion.Conclusions.  There is limited evidence to recommend either for or against the use of space maintainers to prevent or reduce the severity of malocclusion in the permanent dentition. Decisions regarding the use of space maintainers should be guided by balancing the occlusal disturbance that may result if one is not used against the potential plaque accumulation and caries that the appliance may cause.
Has urbanization become a risk factor for dental caries in Kerala, India: a cross‐sectional study of children aged 6 and 12 years
Authors: CHRISTIAN BRADLEY , EVANS R. WENDELL 
Published: April 2009

Objectives.  The objectives of this study were to: (i) test the hypothesis that urbanization is a risk factor for dental caries in children aged 6 and 12 years in Kollam, Kerala; and (ii) identify other possible risk factors for dental caries.Methods.  A cross‐sectional study design was followed. The subjects were stratified by socio‐demographic status into urban middle class, urban poor, and rural poor. Caries experience was measured by visual examination of teeth according to the World Health Organization criteria. Data on potential risk factors were collected using a close‐ended, structured, and interviewer‐administered questionnaire. Data modelling was conducted using logistic regression analyses.Results.  Eight hundred seventy‐six children were examined; 53% of 6‐year‐olds and 90% of 12‐year‐olds examined were caries free. The caries experience rates were 1.40 decayed, missing, or filled primary teeth and 0.15 Decayed, Missing, and Filled Teeth (DMFT) for the 6‐ and 12‐year‐olds, respectively. Urban children did not have a higher caries experience compared with rural children. The only risk factor associated with a significant difference in DMFT scores was the dental visiting pattern. Children who visited the dentist had a significantly higher mean DMFT score (P = 0.009).Conclusion.  There was no evidence that urbanization is a risk factor for dental caries in Kerala. Dental caries experience was low, against any standard, in Kollam. Risk factors for caries were not identified.
Evidence‐based practice‐focused interactive teaching strategy: a controlled study
Authors: Kim Son C. , Brown Caroline E. , Fields Willa , Stichler Jaynelle F. 
Published: April 2009

AbstractTitle.  Evidence‐based practice‐focused interactive teaching strategy: a controlled study. Aim.  This paper is a report of a study to evaluate the effectiveness of the evidence‐based practice (EBP)‐focused interactive teaching (E‐FIT) strategy.Background.  Although EBP is a mandatory competency for all healthcare professionals, little is known about the effectiveness of E‐FIT in nursing.Methods.  A quasi‐experimental, controlled, pre‐ and post‐test study involving senior, 4th‐year nursing students (N = 208) at two nursing schools in the USA was carried out from August 2007 to May 2008. The experimental group (n = 88) received the E‐FIT strategy intervention and the control group (n = 120) received standard teaching. A Knowledge, Attitudes and Behaviors Questionnaire for Evidence‐Based Practice was used to assess the effectiveness of the E‐FIT strategy.Results.  Independent t‐tests showed that the experimental group had statistically significant higher post‐test Evidence‐Based Practice Knowledge (mean difference = 0·25; P = 0·001) and Evidence‐Based Practice Use (mean difference = 0·26; P = 0·015) subscale scores compared to the control group, but showed no statistically significant differences in Attitudes toward Evidence‐Based Practice and Future Use of Evidence‐Based Practice (mean difference = −0·12; P = 0·398 and mean difference = 0·13; P = 0·255 respectively). Hierarchical multiple regression analyses of the post‐test data indicated that the intervention explained 7·6% and 5·1% of variance in Evidence‐Based Practice Knowledge and Evidence‐Based Practice Use respectively.Conclusion.  The EBP‐focused interactive teaching strategy was effective in improving the knowledge and use of EBP among nursing students but not attitudes toward or future use of EBP.
Smoking‐cessation therapy using varenicline: the cost‐utility of an additional 12‐week course of varenicline for the maintenance of smoking abstinence
Authors: Bolin Kristian , Mörk Ann‐Christin , Wilson Koo 
Published: April 2009

AbstractStudy objectives  To evaluate the cost‐effectiveness of an additional 12‐week treatment with varenicline for abstainers who had successfully completed an initial 12‐week treatment.Design  The Benefits of Smoking Cessation on Outcomes simulation model was used to simulate both direct and indirect effects of smoking cessation. All calculations were performed in 2003 Swedish prices.Setting  Sweden in 2003.Patients or participants  The modelled cohort consisted of 25% of adult smokers motivated to quit smoking (168 844 males and 208 737 females). The age and sex distributions of the cohort reflect that of the Swedish population in 2003.Interventions  Smokers who had achieved abstinence for at least 7 days following 12‐week open‐label treatment with varenicline were randomized to receive an additional 12‐week treatment with either varenicline or placebo.Measurements and results  The incremental costs per quality‐adjusted life‐year (QALY) gained, for abstainers who received an additional 12‐week varenicline treatment compared with only 12 weeks, were €7066 for men and €7108 for women, over a 50‐year time horizon. (1€ ≈ SEK 9.12). These estimates excluded indirect effects on production and consumption of increased survival. The corresponding incremental costs per QALY including indirect effects were €24 149 and €24 436, respectively. Sensitivity analysis indicated that the estimated cost‐utility ratios are robust, but relatively sensitive to treatment efficiency and intervention costs.Conclusions  An additional 12‐week course of varenicline treatment, provided to abstainers after an initial 12‐week treatment, produces relatively low incremental cost‐utility ratios in the spectrum of life‐saving medical treatments.