bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low‐dose bupivacaine spinal anaesthesia for percutaneous nephrolithotomy: the suitability and impact of adding intrathecal fentanyl
Authors: Atallah M. M. , Shorrab A. A. , Abdel Mageed Y. M. , Demian A. D. 
Published: July 2006

Background:  Unilateral spinal anaesthesia has been used for lower limb surgery with a stable cardiovascular state and a short recovery unit stay. We sought to test the suitability of low‐dose bupivacaine spinal anaesthesia for percutaneous nephrolithotomy, a procedure hitherto performed under general anaesthesia. Furthermore, we hypothesized that adding intrathecal fentanyl to bupivacaine may improve the quality of anaesthesia.Methods:  We randomly allocated, through computer‐generated randomization, 108 patients subjected to percutaneous nephrolithotomy to receive either 7.5 mg of hyperbaric bupivacaine 5 mg/ml alone or with the addition of 10 μg of fentanyl. Drugs were given at the L2–L3 interspace with the patient in the lateral decubitus position. The patients remained in this position for 10 min, after which the sensory and motor blocks were assessed. Intra‐operative analgesic supplementation, when deemed necessary, was achieved with intravenous fentanyl boluses (25 μg).Results:  The sensory and motor blocks after intrathecal bupivacaine and bupivacaine–fentanyl were similar. Sensory block, in both groups, reached the fifth and eighth thoracic dermatomes on the operative and non‐operative sides, respectively. Deep motor block occurred on the operative side in all patients and in nearly 50% of patients on the non‐operative side. The patients in the bupivacaine–fentanyl group required less intra‐operative and post‐operative analgesics, and both patients and endoscopists were better satisfied.Conclusion:  This study demonstrated, for the first time, that intrathecal low‐dose bupivacaine and fentanyl offers a reliable neuraxial block for patients subjected to percutaneous nephrolithotomy, with stable haemodynamics, good post‐operative analgesia and acceptable patient and endoscopist satisfaction.
Trendelenburg positioning does not prevent a decrease in cardiac output after induction of anaesthesia with propofol in children
Authors: Kardos A. , Földesi C. , Nagy A. , Sáringer A. , Kiss A. , Kiss G. , Marschalkó P. , Szabó M. 
Published: July 2006

Background and objective:  Induction of anaesthesia may cause decreased cardiac output and blood pressure. Head‐down tilt is often the first clinical step to treat hypotension. The objective of this randomized single centre study was to determine, with the use of impedance cardiography (ICG), whether Trendelenburg positioning modifies the haemodynamic response to propofol/fentanyl induction of anaesthesia in ASA I children.Methods:  Thirty ASA I children aged between 7 and 16 years scheduled for elective minor orthopaedic surgery were included. After intravenous induction with propofol and fentanyl in the head‐down group (HDG, n = 15), 5 min of 20° head‐down tilt was applied. In the supine group (SG, n = 15), no change in the supine position was made. Heart rate (HR), mean arterial blood pressure (MABP), end‐tidal carbon dioxide (ETCO2), stroke volume index (SVI), cardiac index (CI), systemic vascular resistance index (SVRI) and Heather index (HI) were recorded before (B), at 3 (A3), 5 (A5) and 8 (A8) minutes after induction in each group.Results:  After induction, a significant decrease in CI, MABP, HR and HI was recorded in both groups. In the study group, significantly lower values of HR (66 vs. 78 beat/min) and higher values of SVI (42.9 vs. 40.6 ml/min/m2) were measured at A3 compared with the control group. After induction, no difference in CI and SVRI was found between the two groups.Conclusion:  The present study shows that cardiac performance is not improved by Trendelenburg positioning after propofol/fentanyl induction of anaesthesia in children.
Positive end‐expiratory pressure optimization using electric impedance tomography in morbidly obese patients during laparoscopic gastric bypass surgery
Authors: Erlandsson K. , Odenstedt H. , Lundin S. , Stenqvist O. 
Published: July 2006

Background:  Morbidly obese patients have an increased risk for peri‐operative lung complications and develop a decrease in functional residual capacity (FRC). Electric impedance tomography (EIT) can be used for continuous, fast‐response measurement of lung volume changes. This method was used to optimize positive end‐expiratory pressure (PEEP) to maintain FRC.Methods:  Fifteen patients with a body mass index of 49 ± 8 kg/m2 were studied during anaesthesia for laparoscopic gastric bypass surgery. Before induction, 16 electrodes were placed around the thorax to monitor ventilation‐induced impedance changes. Calibration of the electric impedance tomograph against lung volume changes was made by increasing the tidal volume in steps of 200 ml. PEEP was titrated stepwise to maintain a horizontal baseline of the EIT curve, corresponding to a stable FRC. Absolute FRC was measured with a nitrogen wash‐out/wash‐in technique. Cardiac output was measured with an oesophageal Doppler method. Volume expanders, 1 ± 0.5 l, were given to prevent PEEP‐induced haemodynamic impairment.Results:  Impedance changes closely followed tidal volume changes (R2 > 0.95). The optimal PEEP level was 15 ± 1 cmH2O, and FRC at this PEEP level was 1706 ± 447 ml before and 2210 ± 540 ml after surgery (P < 0.01). The cardiac index increased significantly from 2.6 ± 0.5 before to 3.1 ± 0.8 l/min/m2 after surgery, and the alveolar dead space decreased. PaO2/FiO2, shunt and compliance remained unchanged.Conclusion:  EIT enables rapid assessment of lung volume changes in morbidly obese patients, and optimization of PEEP. High PEEP levels need to be used to maintain a normal FRC and to minimize shunt. Volume loading prevents circulatory depression in spite of a high PEEP level.
Development of renal failure during the initial 24 h of intensive care unit stay correlates with hospital mortality in trauma patients
Authors: Ala‐Kokko T. , Ohtonen P. , Laurila J. , Martikainen M. , Kaukoranta P. 
Published: July 2006

Background:  Although multiple organ failure is the leading late cause of death, there is controversy about the impact of acute organ dysfunction and failure on trauma survival.Methods:  Consecutive adult trauma admissions between January 2000 and June 2003, excluding isolated head traumas and burns, were analysed for parameters of organ function during the first 24 h following intensive care unit (ICU) admission using the Sequential Organ Failure Assessment (SOFA) scoring system. A national prospectively collected ICU data registry was used for analysis, including data from 22 ICUs in university and central hospitals in Finland.Results:  The study population consisted of 1044 eligible trauma admissions; 32% of the cases were treated at university hospital level, the rest being secondary referral central hospital admissions. The mean Acute Physiology and Chronic Health Evaluation (APACHE) II score was 15 (SD8), ICU mortality was 5.6% and a further 1.6% of patients died during their post‐ICU hospital stay. Forty‐five per cent of the patients were categorized as having multiple traumas. In univariate analysis, APACHE II ≥ 25 [odds ratio (OR), 35; 95% confidence interval (CI), 18–66] and renal failure (OR, 29.5; 95% CI, 14–63) produced the highest ORs for ICU mortality. In the APACHE II‐, sex‐ and age‐adjusted logistic regression model, renal failure was a significant risk factor for both ICU and hospital mortality (OR, 11.8; 95% CI, 3.9–35.4; OR, 8.2; 95% CI, 2.9–23.2, respectively).Conclusion:  The development of renal failure during the initial 24 h of ICU stay remained an independent risk factor for mortality in trauma patients requiring intensive care treatment even after adjusting for the APACHE II score, age and sex.
Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section*
Authors: Orbach‐Zinger S. , Friedman L. , Avramovich A. , Ilgiaeva N. , Orvieto R. , Sulkes J. , Eidelman L. A. 
Published: July 2006

Aim::  To identify parturients at risk of inability to extend labor epidural analgesia in whom alternative methods of anesthesia should be considered for Cesarean section (CS).Methods::  For 6 months, we prospectively studied women undergoing CS with a functioning epidural catheter in place from the delivery ward. All parturients received the same epidural protocol: bolus of bupivacaine 0.1% and fentanyl, followed by bupivacaine 0.1% and fentanyl (2 μg/ml) 10–15 ml/h and an additional 5 ml of bupivacaine 0.125% as top‐up according to patient request. Sixteen milliliters of lidocaine 2%, 1 ml of bicarbonate and 100 μg of fentanyl were given for CS. Failed epidural analgesia was defined as the need to convert to general anesthesia.Results::  Of the 101 parturients studied, 20 (19.8%) required conversion to general anesthesia. In univariate analysis, the likelihood of failed epidural anesthesia was inversely correlated with parturient age (P = 0.014) and directly correlated with pre‐pregnancy weight (P = 0.019), weight at the end of pregnancy (P = 0.003), body mass index at the end of pregnancy (P = 0.0004), gestational week (P = 0.008), number of top‐ups (P = 0.0004) and visual analog scale (VAS) score 2 h before CS (P = 0.03). In multivariate analysis, the number of top‐ups in the delivery ward was the best predictor of epidural anesthesia failure (odds ratio, 4.39; P = 0.005).Conclusion:  Younger, more obese parturients at a higher gestational week, requiring more top‐ups during labor and having a higher VAS score in the 2 h before CS are at risk for inability to extend labor epidural analgesia to epidural anesthesia for CS.
A broad-scale analysis of population differentiation for Zn tolerance in an emerging model species for tolerance study: Arabidopsis halleri (Brassicaceae)
Authors: Pauwels Maxime , Frérot Hélène , Bonnin Isabelle , Saumitou-laprade Pierre 
Published: July 2006

Abstract
Although current knowledge about the overall distribution of zinc (Zn) tolerance in Arabidopsis halleri populations is scarce, the species is an emerging model for the study of heavy metal tolerance in plants. We attempted to improve this knowledge by testing the Zn tolerance of scattered European metallicolous (M) and nonmetallicolous (NM) populations of A. h. subsp. halleri and A. h. subsp. ovirensis in hydroponic culture. The occurrence of constitutive tolerance was unconditionally established in A. h. halleri and tolerance was extended to the subspecies ovirensis. M populations were the most tolerant but there was a continuous range of variation in tolerance from NM to M populations. Finally, relatively high levels of tolerance were detected in some NM populations, suggesting that enhanced tolerance could be present at high frequency in populations that have not experienced metal exposure. We used our results to argue the evolutionary dynamics and origin of Zn tolerance in A. halleri.
Anti‐HBc screening of blood donors: a comparison of nine anti‐HBc tests
Authors: Schmidt M. , Nübling C. M. , Scheiblauer H. , Chudy M. , Walch L. A. , Seifried E. , Roth W. K. , Hourfar M. K. 
Published: July 2006

Background and Objectives Since voluntary introduction of hepatitis B virus (HBV) minipool nucleic acid amplification technology (NAT) at the German Red Cross, the expected residual risk of a transfusion‐associated HBV infection has been estimated to be 1 : 500 000 – about 10 times higher than for human immunodeficiency virus (HIV) or hepatitis C virus (HCV) infection. Donors demonstrating chronic positivity for antibody to hepatitis B core antigen (anti‐HBc), negativity for hepatitis B surface antigen (HBsAg) and polymerase chain reaction (PCR)‐negative with a low virus load are a major cause of this increased risk.Materials and Methods Ten‐thousand blood donors from our blood‐donation centre were screened for anti‐HBc using the current PRISM® HBc and the new PRISM® HBcore assay to evaluate the diagnostic sensitivity and specificity of these tests. PRISM® HBc‐ or PRISM® HBcore‐reactive samples were further analysed using seven additional tests for anti‐HBc, two tests for antibody to hepatitis B surface antigen (anti‐HBs), one test for antibody to hepatitis B envelope antigen (anti‐HBe) and three HBV NAT assays.Results From a total of 10 000 donors, nine and 14 samples were reactive only in the PRISM® HBc and the PRISM® HBcore, respectively, whereas 165 samples were reactive in both anti‐HBc assays. Further analysis of these 188 anti‐HBc‐reactive specimens in a total of nine different anti‐HBc assays revealed concordant results for 162 (86·2%) specimens. Sample cut‐off values for anti‐HBc were significantly (P < 0·01) lower for anti‐HBc‐only reactive samples compared with specimens that were also reactive for anti‐HBs or anti‐HBe.Conclusions Both PRISM anti‐HBc assays revealed that ≈ 1·8% of non‐prescreened blood donors from Germany were reactive for anti‐HBc. Although sensitivity was comparable between both assays, specificity was increased significantly with the PRISM® HBcore. High anti‐HBc sample cut‐off values were indicative for reactivity in other HBV parameters and for concordant results in the nine different anti‐HBc assays. Look‐back investigations are necessary to estimate the infection risk both of anti‐HBc‐only positive and of anti‐HBc/anti‐HBs‐positive blood transfusions.
Low‐molecular‐weight protein (LMP)2/LMP7 abnormality underlies the downregulation of human leukocyte antigen class I antigen in a hepatocellular carcinoma cell line
Authors: Shen Yu‐Qing , Zhang Jian‐Qiong , Xia Mei , Miao Feng‐Qing , Shan Xiang‐Nian , Xie Wei 
Published: July 2006

AbstractBackground:  Tumor cells may alter the expression of numerous components involved in antigen‐processing machinery to decrease human leukocyte antigen (HLA) class I expression, allowing the tumor cells to escape immune surveillance. The purpose of the present study was to investigate the involvement of these components in the downregulation of HLA class I expression in human hepatocellular carcinoma cell line BEL7404.Methods:  Expression of HLA‐I and antigen presentation‐related genes were analyzed by flow cytometry and polymerase chain reaction. The HLA class I‐deficient BEL7404 cell was transfected with the low‐molecular‐weight protein (LMP) 2 and LMP7 gene and were analyzed by flow cytometry for restoration of surface HLA class I expression.Results:  The BEL7404 cells downregulated the expression of HLA class I antigen and lacked expression of LMP2 and LMP7. Interferon (IFN)‐γ treatment increased the expression of LMP2 but not LMP7. The LMP2‐transfected BEL7404 cells or LMP2 and LMP7‐cotransfected cells restored surface HLA class I expression while LMP7‐transfected cells did not. However, in IFN‐γ‐treated BEL7404 cells, transfection with the LMP7 gene induced more HLA class I expression than mock transfection.Conclusions:  The LMP2 gene was required for the expression of HLA class I molecules in BEL7404. The LMP7 was not the major reason for loss of HLA class I in BEL7404 cells, although the supply of exogenous LMP7 could increase surface expression of HLA class I antigen.
Clinical outcomes and learning curve of a laparoscopic adrenalectomy in 103 consecutive cases at a single institute
Authors: ETO MASATOSHI , HARANO MASAHIKO , KOGA HIROFUMI , TANAKA MASATOSHI , NAITO SEIJI 
Published: July 2006

Objective:  We examined the clinical outcomes and the learning curve for a laparoscopic adrenalectomy (LA) in 103 consecutive cases performed by three surgeons at our institute, according to the type of adrenal disorder.Patients and Methods:  One hundred and three patients with adrenal tumors, including 38 cases of primary aldosteronism, 33 cases of Cushing syndrome (including preclinical Cushing syndrome), 15 cases of pheochromocytoma, and nine cases of non‐functioning adenoma were evaluated, while focusing on the approaches, intraoperative and postoperative data, and the learning curve of LA, according the type of adrenal disorder.Results:  There was no significant difference in the operation time, estimated blood loss, incidence of conversion to open surgery and blood transfusion, or postoperative recovery among the patients treated by LA for aldosteronoma, Cushing adenoma, pheochromocytoma, and non‐functioning adenoma. In the cases of aldosteronoma and Cushing adenoma, the learning curve for the operation time and blood loss in each operator tended to decrease as the number of operations increased. On the other hand, in the cases treated by LA for pheochromocytoma, no trends in either the operation time or blood loss were observed. However, there has been neither any conversion to open surgery nor blood transfusion in cases treated by LA since 1998 (our 42nd case), even after the changes in the operators.Conclusions:  Our results clearly indicate that LA is becoming safer than before, probably due to improvements in the technique, education, and training of surgeons, in addition to the increased number of cases now treated by LA.
Effectiveness of local anaesthesia techniques in patients undergoing transrectal ultrasound‐guided prostate biopsy: A prospective randomized study
Authors: SONG SEUNG‐HUN , KIM JEONG KON , SONG KANGHYON , AHN HANJONG , KIM CHOUNG‐SOO 
Published: July 2006

Aim:  This study was designed to compare the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during transrectal ultrasound (TRUS)‐guided prostate biopsy.Methods:  Ninety men undergoing transrectal prostate biopsy from July through December 2004 were randomized into three groups of 30 patients each. Before the biopsy, patients in Group 1 received 20 mL of 2% lidocaine gel intrarectally; patients in Group 2 received 5 mL (2.5 mL per side) of 2% lidocaine solution injected near the junction of the seminal vesicle with the base of the prostate (along the neurovascular bundles), and patients in Group 3 (control group) received 5 mL (2.5 mL per side) of normal saline injected along the neurovascular bundles. Pain level after the biopsy was assessed using a 10‐point linear visual analog scale (VAS). Results were statistically compared by the Wilcoxon Rank Sum test.Results:  Patients in Group 2 had significantly lower VAS scores than those in Group 3 (3.6 ± 2.1 vs 5.8 ± 1.9, P < 0.0001), but those in Group 1 did not (5.5 ± 2.7 vs 5.8 ± 1.9, P = 0.67). Gross hematuria, rectal bleeding, and hemospermia occurred in 36 (40.0%), 6 (7%) and 5 (6%) patients. One patient had temporary vasovagal syncope. No patient reported febrile urinary tract infection or urinary retention.Conclusions:  Periprostatic injection of local anaesthetic is a safe technique that significantly reduces pain during prostate biopsy, whereas intrarectal lidocaine injection did not reduce pain. This safe, simple technique should be applied in men undergoing TRUS‐guided prostate biopsy to limit patient discomfort.
Clinical outcome of 36 male patients with primary urethral carcinoma: A single center experience
Authors: THYAVIHALLY YUVARAJA B , TONGAONKAR HEMANT B , SRIVASTAVA SHYAM K , MAHANTSHETTY UMESH , KUMAR PRABHASH , RAIBHATTANAVAR SRINIVAS G 
Published: July 2006

Aim:  Retrospective analysis of male urethral carcinoma to assess the best therapeutic approach to the management of this tumor.Methods:  A review of 36 cases of male urethral carcinoma diagnosed and treated at our center was performed. Clinical features, treatment modality and outcomes were analysed.Results:  The overall median survival time was 55.16 months. The 5‐year overall and disease‐free survival rate for the cohort was 49% and 23%, respectively. The 5‐year survival is 67% for low‐stage versus 33% for high‐stage tumors and is significantly different (P = 0.001). The survival was 72% for tumors of the distal urethra versus 36% for tumors of the proximal, with a P‐value of 0.02.Conclusion:  The tumor location and clinicopathological stage were the most important predictors of the disease‐free and overall survival. Multimodal approach is necessary for achieving local control especially for proximal and higher stage tumors.
Efficacy and safety of on‐demand tadalafil for the treatment of erectile dysfunction in South‐East Asian men
Authors: GUO YING LU , ZHU JI CHUAN , PAN TIAN MING , DING QIANG , WANG YI XIN , CHEONG NG FOO , LIM EDWIN , SHEN WEI , VENUGOPALAN MURALI , CHAN MELANIE 
Published: July 2006

Aim:  Tadalafil is an inhibitor of phosphodiesterase type 5 used for the treatment of erectile dysfunction (ED). The efficacy and safety of tadalafil have been evaluated extensively in Western populations. Our aim was to assess the efficacy and safety of on‐demand tadalafil for the treatment of ED in South‐East Asian men.Methods:  This was a randomized, double‐blind, placebo‐controlled study of men with mild to severe ED of various etiologies randomized to receive placebo (n = 122), tadalafil 10 mg (n = 120), or tadalafil 20 mg (n = 125), taken as needed (maximum once daily) for 12 weeks. Efficacy assessments included the International Index of Erectile Function (IIEF), the Sexual Encounter Profile (SEP) diary, and a Global Assessment Question (GAQ).Results:  Men from China, Singapore, and the Philippines participated in this trial (n = 367). Compared with placebo, tadalafil significantly improved erectile dysfunction on all efficacy outcomes (P < 0.001). Patients receiving tadalafil 10 mg and 20 mg experienced a significant mean improvement of 8.1 and 8.7, respectively, in the IIEF Erectile Function (IIEF‐EF) domain score from baseline (vs placebo 2.4, P < 0.001). In patients receiving tadalafil 10 mg and 20 mg, the mean per‐patient success rate for intercourse attempts (SEP3) was 62% and 70%, respectively, compared with 32% for the placebo group (P < 0.001). Of patients who received tadalafil 10 mg and 20 mg, 81% and 86% reported improved erections at endpoint (GAQ) compared with 44% in the placebo group (P < 0.001). The most common adverse events reported by patients were headache, back pain, dyspepsia, and dizziness.Conclusions:  Tadalafil was an effective and well‐tolerated treatment for South‐East Asian men with ED.
Fibronectin inhibits endocytosis of calcium oxalate crystals by renal tubular cells
Authors: TSUJIHATA MASAO , YOSHIMURA KAZUHIRO , TSUJIKAWA KOZO , TEI NORIHIDE , OKUYAMA AKIHIKO 
Published: July 2006

Background:  Fibronectin (FN; 230 kDa) is a multifunctional α2‐glycoprotein distributed throughout the extracellular matrix and body fluids. We recently reported that FN has a protective effect against injury of renal tubular cells by exposure to oxalate and calcium oxalate (CaOX) crystals and inhibits the adhesion of CaOX crystals to renal tubular cells. In the study presented here, we investigated whether FN has inhibitory effect on crystal endocytosis by renal tubular cells.Methods:  The inhibitory effect of FN on endocytosis of CaOX crystals by MDCK cells was examined by using a radioactivity uptake assay. Also, crystal endocytosis by cells was morphologically assessed by means of transmission electron microscopy (TEM).Results:  FN had inhibitory effects on CaOX crystal endocytosis by MDCK cells. The morphological TEM study showed that few crystals were taken into cells when FN was added compared to the number of crystals when FN was not added.Conclusion:  We found that FN had the inhibitory effects on the interaction between crystals and renal tubular cells, including the adhesion or endocytosis of crystals by cells.