bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reduced exhaled breath condensate pH in asthmatic smokers using inhaled corticosteroids
Authors: KANE Binita , BORRILL Zoe , SOUTHWORTH Thomas , WOODCOCK Ashley , SINGH Dave 
Published: March 2009

ABSTRACTBackground and objectives:  Exhaled breath condensate (EBC) pH has been proposed as a biomarker of airway inflammation and oxidative stress in asthma. Cigarette smoking reduces EBC pH in mild asthma. The effects of smoking on EBC pH in more symptomatic asthmatic patients using inhaled corticosteroids (ICS) are unknown. We aimed to compare EBC pH in asthmatic smokers (AS) and non‐smokers (ANS) with moderate to severe disease, who were taking ICS. We also investigated the relationship between EBC pH and biomarkers of airway inflammation and oxidative stress.Methods:  AS (n = 18) and ANS (n = 17), who were using ICS, were recruited and EBC pH, sputum inflammatory cell counts and sputum supernatant 8‐isoprostane concentrations were measured. Full lung function testing was performed.Results:  EBC pH was significantly lower in AS than in ANS (6.91 vs 7.41). In AS there was a significant inverse correlation between EBC pH and 8‐isoprostane levels (r = −0.54, P = 0.03). There was no correlation between EBC pH and sputum neutrophil counts.Conclusions:  EBC pH appears to be a biomarker of the level of oxidative stress in smokers with moderate to severe asthma. EBC pH may have applications for the longitudinal monitoring of the effects of smoking on the airways of asthmatic patients.
Observations on environmental asbestos exposure in a high risk area
Authors: SAHIN Unal , OZTURK Onder , SONGUR Necla , BIRCAN Ahmet , AKKAYA Ahmet 
Published: March 2009

ABSTRACTBackground and objective:  Environmental asbestos exposure is causally associated with various pulmonary pathologies. In Turkey, one of the most important sources of asbestos exposure is dust originating from the walls of homes whitewashed with white stucco. The main asbestos types implicated are tremolite and, to a lesser extent, chrysotile. This study investigated the presence and effect of environmental asbestos exposure in a small village in Isparta, Turkey.Methods:  Samples of asbestos mine ore, whitewashed plaster from the interior walls of the houses and whitesoil from the outside walls of the houses were analysed. Chest radiographs of 132 villagers aged 30 years and over and living in the village during the study were obtained. Verbal histories from the relatives of people who had died from lung cancer or mesothelioma and hospital records contributed 13 cases to the study population, giving a total of 145 cases under study.Results:  Chrysotile fibres were found in the old asbestos mine sample, and zeolite in the whitesoil sample from the outside walls. Abnormal CXR were found in 19 subjects (14. 4%), the most common being pleural calcifications and/or pleural plaques (n = 14, 10.6%). A further five subjects with pleural calcifications and/or pleural plaques were identified from verbal autopsy and hospital records. Malignant pleural mesothelioma was present in one living subject and four of the deaths. A possible familial clustering of lung cancer and malignant mesothelioma was noted.Conclusion:  While tremolite asbestos is the asbestos found in most white soil in Turkey, in this village chrysotile asbestos was found in the white soil. Familial clustering may indicate genetic susceptibility or increased environmental exposure in some families.
Clinicopathological features and epidermal growth factor receptor mutations associated with epithelial–mesenchymal transition in non‐small cell lung cancer
Authors: DENG Qin‐Fang , ZHOU Cai‐Cun , SU Chun‐Xia 
Published: March 2009

ABSTRACTBackground and objective:  Small molecular inhibitors of the epidermal growth factor receptor (EGFR) have been extensively studied in non‐small cell lung cancer (NSCLC) patients. The discovery of molecular biomarkers that identify the subgroups of NSCLC patients benefiting from EGFR tyrosine kinase inhibitor (TKI) has become an important area of investigation. Recent studies have suggested that epithelial–mesenchymal transition (EMT) in tumours decreases the cellular requirements for EGFR signalling pathway, and this may provide a molecular signature to define those NSCLC patients most likely to respond to treatment with targeted EGFR TKI. This research explored the clinicopathological features and EGFR mutations associated with EMT in NSCLC.Methods:  The EMT status in surgically resected specimens from 62 patients with NSCLC was tested by immunohistochemical staining. The frequency of tumour epithelial phenotype was calculated and the strength of the association with clinicopathological features and EGFR genotype was determined by logistic regression.Results:  The overall frequency of the epithelial phenotype was 35.48% (22 of 62). Based on univariate analyses, the frequency of the epithelial phenotype (E‐cadherin‐positive) was greater for EGFR mutants versus wild types (77.78% vs 18.18%; P < 0.0001) and women versus men (54.55% vs 25%; P = 0.02). Multivariate logistic analysis showed that only the EGFR genotype (odds ratio, 0.063; 95% CI: 0.013–0.3; P = 0.0005) was significantly associated with the epithelial phenotype.Conclusion:  In patients with NSCLC, there is a higher frequency of epithelial markers in patients with EGFR mutation.
Natural stent in the management of post‐intubation tracheal stenosis
Authors: PARK Hye Yun , KIM Hojoong , KOH Won‐Jung , SUH Gee Young , CHUNG Man Pyo , KWON O Jung 
Published: March 2009

ABSTRACTBackground and objective:  The treatment choice for post‐intubation tracheal stenosis (PITS) in patients for whom surgery is not initially feasible is bronchoscopic silicone stenting. A new silicone stent, called the Natural stent (N stent), was investigated for its clinical efficacy and safety in patients with PITS.Methods:  A retrospective review was conducted of 32 patients with PITS who underwent N stenting between November 2001 and December 2006 and were followed for at least 12 months.Results:  Airway dilatation with combined modalities such as Nd : YAG laser, ballooning or bougienage was followed by N stent insertion. After intervention, all patients had symptomatic and spirometric improvement without immediate complications. Removal of the stent without re‐stenosis was successful in 38% of the patients at a median time of 7 months after insertion. The stent could not be removed or needed reinsertion in 31% of patients, and 16% of patients underwent surgery after initial stabilization by stenting. Late complications were stent migration (34%), mucostasis (31%), granulation tissue formation (38%) and re‐stenosis (40%). All patients tolerated the management of complications during a median follow up of 22 months.Conclusions:  Bronchoscopic N stenting is an effective treatment for patients with PITS in whom surgery is not feasible on initial presentation. Further stent development is necessary to reduce the late complication rate.
Acute effects of hyperoxia on resting pattern of ventilation and dyspnoea in COPD
Authors: MOORE Rosemary , BERLOWITZ David , PRETTO Jeffrey , BRAZZALE Danny , DENEHY Linda , JACKSON Bruce , MCDONALD Christine 
Published: March 2009

ABSTRACTBackground and objective:  Hyperoxia has been shown to reduce resting ventilation, hyperinflation and dyspnoea in patients with severely hypoxaemic COPD. This study assessed the effects of hyperoxia on these resting measures in patients with COPD of varying disease severity and characterized those patients who responded.Methods:  Measurements of dyspnoea (Borg score), oxyhaemoglobin saturation (SpO2), inspiratory capacity (IC), minute ventilation, tidal volume, breathing and cardiac frequency were performed at rest in 51 patients with COPD while they breathed air and 44% oxygen, in a randomized double‐blinded fashion.Results:  Hyperoxia induced significant reductions in cardiac frequency and dyspnoea and a significant increase in SpO2. No significant change was noted in IC for the group overall, and there was substantial inter‐subject variation in this measurement. No significant changes were found in ventilation, and there was no correlation between change in dyspnoea and change in IC. In patients with moderate to severe airflow obstruction (FEV1 < 70% predicted), a significant association was found between the degree of airflow obstruction and change in IC induced by hyperoxia.Conclusions:  Hyperoxia improved dyspnoea but did not significantly alter resting pulmonary hyperinflation in a group of patients with COPD of varying severity. However, in a subset patients with moderate to severe airflow obstruction a relationship existed between the severity of airflow obstruction and volume response to hyperoxia.
Cerebral blood flow monitoring using a novel laser Doppler flowmeter in asphyxiated infants
Authors: Ohashi Atsushi , Kuroyanagi Yuichi , Kitamura Naoyuki , Kinoshita Yo , Kaneko Kazunari , Yabuta Keijiro 
Published: March 2009

AbstractBackground:  The aim of the present study was to investigate the role of early changes in cerebral blood flow (CBF) predicting the severity of neurological outcome in asphyxiated infants.Method:  Serial monitoring of CBF was performed using a newly developed laser Doppler flowmeter (LDF) in parallel with conventional hemodynamic monitoring, such as mean arterial blood pressure (mABP) or heart rate (HR) in 11 asphyxiated infants (five infants with neurological sequelae and six infants without sequelae) during the first 4 days of life. Psychomotor development was followed up to 20 months.Results:  No differences in average CBF, mABP, average HR, or Apgar scores were found between infants with neurological sequelae and those without (P > 0.1). Significant difference was found only in average stability index during the first 48 h of life (SI48), defined as a coefficient of variation of CBF during the corresponding period (P= 0.04). An SI48 ≥ 0.24 had positive predictive value of 100% for neurological sequelae while that <0.24 had a negative predictive value of 66.7%.Conclusion:  SI48, an average stability index of CBF during the first 48 h of life, can be a useful index to predict neurological outcome in asphyxiated infants.
Polymorphism of cytochrome P450 2B6 and prostate cancer risk: A significant association in a Japanese population
Authors: Kurosaki Takayuki , Suzuki Motofumi , Enomoto Yutaka , Arai Tomio , Sawabe Motoji , Hosoi Takayuki , Homma Yukio , Kitamura Tadaichi 
Published: March 2009

Objectives:  To explore whether Lys262Arg polymorphism of the Cytochrome P450 2B6 (CYP2B6) gene could act as a genetic marker for prostate cancer risk among Japanese men.Methods:  A total of 350 patients with sporadic prostate cancer and 328 controls were examined. A single nucleotide polymorphism with non‐synonymous amino acid change located at Lys262Arg of the CYP2B6 gene was genotyped using a TaqMan assay.Results:  The frequency of the Arg/Arg genotype among prostate cancer patients was significantly higher than that among the controls (P = 0.027). The frequency of the G allele of the Lys262Arg polymorphism was also significantly higher in prostate cancer patients than in the controls (30.4% vs 24.8%, P = 0.025). Patients with the Lys/Arg plus Arg/Arg genotypes carried a low Gleason score more frequently than those with the Lys/Lys genotype (P = 0.042). The frequency of the G allele of the Lys262Arg polymorphism was significantly higher in the low Gleason score group than that in the high Gleason score group (34.3% vs 26.8%, P = 0.038).Conclusions:  Lys262Arg polymorphism of the CYP2B6 gene may be a genetic marker for evaluating the risk of sporadic prostate cancer in native Japanese men.
Laparoscopic versus open radical prostatectomy: Urodynamic evaluation of vesicourethral function
Authors: Matsukawa Yoshihisa , Hattori Ryohei , Yoshikawa Yoko , Ono Yoshinari , Gotoh Momokazu 
Published: March 2009

Objectives:  To assess the impact of laparoscopic radical prostatectomy on vesicourethral function and compare it to that of open radical prostatectomy.Methods:  Sixty‐three patients undergoing laparoscopic radical prostatectomy for localized prostate cancer were included in this retrospective analysis. Urodynamic parameters, including maximum urethral closing pressure (MUCP), functional profile length (FPL), bladder compliance, maximum cystometric capacity (MCC) and detrusor overactivity, were considered. Continence status and changes in urodynamic findings before and after surgery were evaluated. In addition, postoperative urodynamic findings were compared with those in 58 patients undergoing open radical prostatectomy.Results:  After laparoscopic radical prostatectomy, MUCP and FPL showed a significant postoperative decrease. Continence rates after surgery were 82% in the laparoscopic and 78% in the open group. Comparison of postoperative data between continent and incontinent patients in both surgical groups showed significantly lower MUCP, shorter FPL, lower bladder compliance and higher incidence of detrusor overactivity in incontinent patients. Although there was no significant difference in postoperative MUCP and FPL between the two groups, bladder compliance was significantly lower and incidence of detrusor overactivity was significantly higher in the open prostatectomy group.Conclusions:  Laparoscopic radical prostatectomy has a negative impact on storage function by impairing function of the urethral sphincter and decreasing bladder compliance. There is no difference in postoperative urethral function between open and laparoscopic radical prostatectomy. Laparoscopic surgery might be associated with less impairment of bladder function than open surgery.
Training tomorrow’s surgeons: what are we looking for and how can we achieve it?
Authors: Grantcharov Teodor P. , Reznick Richard K. 
Published: March 2009

AbstractThe aim of a surgical residency program is to produce competent professionals in a safe and pedagogically efficient environment. For many years, there has been an overemphasis on technical attributes as the fundamental competencies of a trained surgeon. With the advent of new frameworks for defining the outcomes of surgical training, such as CanMeds from the Royal College of Physicians and Surgeons of Canada and the six competencies outlined by the Accreditation Council for Graduate Medical Education in USA, there has been a broadening of the focus of surgical training. Although technical proficiency is definitely an important prerequisite for a successful outcome, other qualities such as intellectual abilities, personality and communication skills, and a commitment to practice are important elements in the profile of a competent surgeon. Recently, there is a growing appreciation for the heterogeneity in achievement of technical competence among our trainees, with some residents able to quickly master technical skill in contrast to others who may never achieve mastery in the technical domain. The questions of how to select, teach and grant privileges for independent practice requires an understanding of the components of surgical competence and implementation of evidence based tools for training and assessment of these competencies.
Training in the private sector: what works and how do we increase opportunities?
Authors: Watters David A. K. , D’Souza B. , Guest G. , Wardill D. , Levy S. , O’Keefe M. , Crowley S. 
Published: March 2009

AbstractIn Australia 61% of elective surgery takes place in private hospitals where current opportunities for surgical education and training (SET) are limited. The situation will shortly be compounded because of the large increase in local medical graduates, many of whom will aspire to be surgeons. How and where to train these extra surgeons to meet the expanding needs of the community must be addressed. Two models of private sector training are reviewed both of which involved combined training in both private and public sectors. Two second‐year (SET 2) positions were created from one public hospital SET position by using the private sector for 3.5 days per week for 3 months of a 6‐month rotation. The second model was applicable to post‐fellowship training with a fairly even split between public and private sector responsibilities. In the first year, four registrars shared the two 6‐month rotations for the SET 2 position. Trainees did the required minimum procedures (range 109–139) with primary operating targets of 20–25% (range 21–32%). The post‐fellowship position in colorectal surgery was greatly enhanced by the private sector involvement with regard to operating experience as well as meeting part of the remuneration of the trainee. Successful models for training within the private sector in Australia can be found. To expand training in the private sector there will need to be a cultural shift in the perceptions of surgeons, patients, administrators, and trainees. Funding for posts may be available to those private hospitals that can meet the Royal Australasian College of Surgeons’ accreditation standards for posts and hospitals.
Experience matters: comparing novice and expert ratings of non‐technical skills using the NOTSS system
Authors: Yule Steven , Rowley David , Flin Rhona , Maran Nikki , Youngson George , Duncan John , Paterson‐Brown Simon 
Published: March 2009

AbstractThere is growing evidence that non‐technical skills (NTS) are related to surgical outcomes and patient safety. The aim of this study was to further evaluate a behaviour rating system (NOTSS: Non‐Technical Skills for Surgeons) which can be used for workplace assessment of the cognitive and social skills which are essential components of NTS. A novice group composed of consultant surgeons (n = 44) from five Scottish hospitals attended one of six experimental sessions and were trained to use the NOTSS system. They then used NOTSS to rate surgeons’ behaviors in six simulated scenarios filmed in the operating room. The behaviours demonstrated in each scenario were compared to expert ratings to determine accuracy. The mode rating from the novice group (who received a short training session in behaviour assessment) was the same as the expert group in 50% of ratings. Where there was disagreement, novice raters tended to provide lower ratings than the experts. Novice raters require significant training in this emerging area of competence in order to accurately rate non‐technical skills.
Evolution of the OSCA–OSCE–Clinical Examination of the Royal Australasian College of Surgeons
Authors: Serpell Jonathan W. 
Published: March 2009

AbstractThe Objective Structured Clinical Assessment (OSCA) was introduced by the Royal Australasian College of Surgeons in 1990. Over the last 5 years important changes have been made to the format of the examination to improve the processes of the examination overall and its reliability and validity. Competency scores have been introduced to comprise 25% of the score for each station to allow an additional judgement by the examiner of clinical competence beyond the structure objective marking scale. The examination has changed to a purely clinical examination with an increase in stations from 12 to 16 and deletion of the written component. The name has progressively changed from OSCA to Objective Structured Clinical Examination to Clinical Examination. The roles of the clinical committee have been refined and a database of station questions has been developed. This enables a blueprint matrix of clinical skills and specialty classifications to ensure a broad representation of stations on each examination. The database also allows information to be collected about the performance of stations and statistical analysis has shown the current clinical exam to have an overall reliability of approximately 0.7, which is a good level of reliability. Progressively stations with low correlation are being reduced and reproducibility across multiple centres is being assessed. In the 18 years since this examination was introduced multiple changes have refined the processes, reliability and validity of the examination.
Evolution of the final fellowship examination
Authors: Panting Allan , Black Robert 
Published: March 2009

AbstractThe Royal Australasian College of Surgeons Final Fellowship or exit examination, common to nine surgical specialties, has undergone substantial change since the beginning of formal assessment in 1934. These changes reflect the altered requirements of the different specialties and developments in examination techniques and technology. Although there is now some variation between specialties in the format of each segment of the examination, consistency remains with seven segments of the examination being common to all specialties – two written papers, two clinical segments and three vivas. Approval for Fellowship, indicating success in the examination, is the responsibility of the full Court of Examiners although guided by each Specialty Court. During the past decade the examination has become more structured and objective and all candidates experience similar assessment. Considerable work has been undertaken to ensure that the examination process is appropriate and fair. A review of examination outcomes 2001–2007 shows some variation between specialties. Although the basis for this is multifactorial, some differences between Specialty Courts of Examiners in the structure of the examination and the assessment process may be small contributory factors. With an increased emphasis on competence‐based assessment during training the form of this exit examination will continue to evolve.
Guide to the Assessment of Competence and Performance in Practising Surgeons
Authors: Dickinson Ian , Watters David , Graham Ian , Montgomery Pam , Collins John 
Published: March 2009

AbstractSurgical performance is increasingly under public scrutiny and non‐technical behavioural issues are more frequently the focus of complaints. Currently, there is a lack of a suitable framework or template to assist surgeons in the assessment of their own performance or that of their colleagues. A Royal Australasian College of Surgeons (RACS) Working Party considered the methods currently available to define and assess surgical performance. The scope included assessment tools, resources available, and support for surgeons. The Non‐Technical Skills for Surgeons (NOTSS) programme developed by the Royal College of Surgeons, Edinburgh and the School of Psychology, University of Aberdeen was of particular interest. This programme was reviewed, adapted and expanded. The nine RACS competencies were used as the foundation for developing a set of three behavioural patterns within each competency domain. Each behavioural pattern was then described by a set of eight behavioural markers – describing four good and four poor behaviours. A variety of resources were identified to assist surgeons, including College and other similar courses and guidelines, publications covering professionalism‐and health issues and support through various agencies. It was recognized that the College has a role to support its Fellows and to ensure any review of performance is conducted impartially, competently and confidentially. The resulting guide was approved by College Council in June 2008 and later distributed to Fellows and hospitals throughout Australia and New Zealand. It is intended to be used for self‐reflection and self‐assessment, although it could equally be used as a template for the review of an individual surgeon’s performance by a clinical director of surgery or other agency. Considerable progress has been made in the assessment of performance of practising surgeons. This guide has been published to address performance issues across all RACS competencies. It also outlines a variety of assessment methods and strategies to support surgeons.